PUBLIC HEALTH ASSIGNMENT

[Document subtitle]

NAME: NG’ANDWE MUSONDA

ID 2681000MO
QUESTION; DISCRIBE THE DIFFERENT CONCEPTS AND PESPECTIVES OF HEALTH, HOW DO YOU PERCEIVE HEALTH.

LIST TH VARIANT DETERMINANTS OF HEALTH

[DATE]
[COMPANY NAME]
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 TABLE OF CONTENTS

1. INTRODUCTION
2. MAIN BODY
3. CONCLUSION
4. BIBIOGRAPHY
 INTRODUCTION

Health is a state of physical, mental and social well being and not merely the absence of disease and infirmity.

The meaning of health has evolved over time. In keeping with the biomedical perspective, early definitions of
health focused on the theme of the body's ability to function; health was seen as a state of normal function that
could be disrupted from time to time by disease. An example of such a definition of health is: "a state
characterized by anatomic, physiologic, and psychological integrity; ability to perform personally valued
family, work, and community roles; ability to deal with physical, biological, psychological, and social stress".
Then in 1948, in a radical departure from previous definitions, the World Health Organization (WHO) proposed
a definition that aimed higher: linking health to well-being, in terms of "physical, mental, and social well-being,
and not merely the absence of disease and infirmity". Although this definition was welcomed by some as being
innovative, it was also criticized as being vague, excessively broad and was not construed as measurable. For a
long time, it was set aside as an impractical ideal and most discussions of health returned to the practicality of
the biomedical model.

Just as there was a shift from viewing disease as a state to thinking of it as a process, the same shift happened in
definitions of health. Again, the WHO played a leading role when it fostered the development of the health
promotion movement in the 1980s. This brought in a new conception of health, not as a state, but in dynamic
terms of resiliency, in other words, as "a resource for living". 1984 WHO revised the definition of health
defined it as "the extent to which an individual or group is able to realize aspirations and satisfy needs and to
change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a
positive concept, emphasizing social and personal resources, as well as physical capacities". Thus, health
referred to the ability to maintain homeostasis and recover from insults. Mental, intellectual, emotional and
social health referred to a person's ability to handle stress, to acquire skills, to maintain relationships, all of
which form resources for resiliency and independent living. This opens up many possibilities for health to be
taught, strengthened and learned.

Since the late 1970s, the federal Healthy People Initiative has been a visible component of the United States’
approach to improving population health. In each decade, a new version of Healthy People is issued, featuring
updated goals and identifying topic areas and quantifiable objectives for health improvement during the
succeeding ten years, with assessment at that point of progress or lack thereof. Progress has been limited to
many objectives, leading to concerns about the effectiveness of Healthy People in shaping outcomes in the
context of a decentralized and uncoordinated US health system. Healthy People 2020 gives more prominence to
health promotion and preventive approaches and adds a substantive focus on the importance of addressing
social determinants of health. A new expanded digital interface facilitates use and dissemination rather than
bulky printed books as produced in the past. The impact of these changes to Healthy People will be determined
in the coming years.

Systematic activities to prevent or cure health problems and promote good health in humans are undertaken by
health care providers. Applications with regard to animal health are covered by the veterinary sciences. The
term "healthy" is also widely used in the context of many types of non-living organizations and their impacts for
the benefit of humans, such as in the sense of healthy communities, healthy cities or healthy environments. In
addition to health care interventions and a person's surroundings, a number of other factors are known to
influence the health status of individuals, including their background, lifestyle, and economic, social conditions
and spirituality; these are referred to as "determinants of health." Studies have shown that high levels of stress
can affect human health.

In the first decade of the 21st century, the conceptualization of health as an ability opened the door for self-
assessments to become the main indicators to judge the performance of efforts aimed at improving human
health. It also created the opportunity for every person to feel healthy, even in the presence of multiple chronic
diseases, or a terminal condition, and for the re-examination of determinants of health, away from the traditional
approach that focuses on the reduction of the prevalence of diseases

CONCEPTS OF HEALTH

The World Health Organization (WHO) defines health as ‘a state of complete physical, mental and social
wellbeing and not merely the absence of disease or infirmity’ (WHO, 1948). This is consistent with the
biopsychosocial model of health, which considers physiological, psychological and social factors in health and
illness, and interactions between these factors. It differs from the traditional medical model, which defines
health as the absence of illness or disease and emphasizes the role of clinical diagnosis and intervention. The
WHO definition links health explicitly with wellbeing, and conceptualizes health as a human right requiring
physical and social resources to achieve and maintain. ‘Wellbeing’ refers to a positive rather than neutral state,
framing health as a positive aspiration. This definition was adapted by the 1986 Ottawa charter, which describes
health as ‘a resource for everyday life, not the object of living’. From this perspective health is a means to living
well, which highlights the link between health and participation in society.

A major criticism of this view of health is that it is unrealistic, because it ‘leaves most of us unhealthy most of
the time’ (Smith, 2008); few, if any people will have complete physical, mental and social wellbeing all the
time, which can make this approach unhelpful and counterproductive . It fails to take into account not just
temporary spells of ill health, but also the growing number of people living with chronic illnesses and
disabilities. Furthermore, it might be argued that focusing on ‘complete’ health as a goal contributes to the
overmedicalization of society by pathologizing suboptimal health states .

Huber et al. (2011) proposed a new definition of health as ‘the ability to adapt and to self-manage’, which
includes the ability of people to adapt to their situation as key to health. It also acknowledges the subjective
element of health; what health and wellbeing mean will differ from one person to the next, depending on the
context and their needs. This is considered by many to be a limitation of broader definitions of health, on the
grounds that wellbeing is neither objective nor measurable. A further limitation of this approach is that it is very
individualistic and takes little account of the wider determinants of health . Responsibility for health is seen as
individual rather than collective, with little scope to promote it as a human right.

2. Mental health and wellbeing

Defining wellbeing is key to discussing and conceptualizing mental health and public mental health, with much
debate and some controversy over recent years. Wellbeing sits outside the medical model of health as its
presence or absence is not a diagnosis. It is widely accepted that subjective wellbeing varies greatly between
individuals, as do the factors that contribute to it. This does not mean to say however that it cannot be defined or
measured, and there has been considerable progress in this area.

The FPH’s definition of mental wellbeing is synonymous with the WHO’s holistic and positive definition of
health, and with the positive psychology approach advocated by Seligman (2000). Positive psychology reflects
the core public health principle of protecting and improving health, focusing on keeping people well rather than
treating illness. More recently Seligman (2011) introduced the PERMA model of flourishing, which has five
core elements of psychological well-being: positive emotions, engagement, relationships, meaning, and
accomplishment. Consistent with these definitions is the approach taken by the Wellbeing Institute at the
University of Cambridge, which defines wellbeing as ‘positive and sustainable characteristics which enable
individuals and organizations to thrive and flourish’. Others nevertheless argue that wellbeing is a social and
cultural construct, questioning the value of approaches that attempt to quantify and categories it.
However, a common theme that has emerged from the various definitions of wellbeing is that of ‘feeling good
and functioning well’. This broad definition encompasses an individual’s own experience of their life, and a
comparison of their life circumstances with social norms and values. Wellbeing may therefore be viewed as
having two dimensions: objective and subjective wellbeing. Objective wellbeing is more of a proxy measure
based on assumptions about basic human needs and rights, including aspects such as adequate food, physical
health, education, and safety. Objective wellbeing can be measured through self-report (e.g. asking people
whether they have a specific health condition), or through more objective measures (e.g. mortality rates and life
expectancy). Subjective wellbeing (or personal wellbeing) is measured by asking people directly how they
think and feel about their own wellbeing, and includes aspects such as life satisfaction (evaluation), positive
emotions (hedonic), and whether their life is meaningful (eudemonic). The Warwick-Edinburgh Mental
Wellbeing Scale (WEMWBS) is a validated tool for monitoring subjective mental wellbeing in the general
population and the evaluation of projects, programmes and policies which aim to improve mental wellbeing
(Tennant et al., 2007).

In 2008 the New Economics Foundation identified five evidence-based actions people can take in their daily
lives to improve their wellbeing, known as the 5 Ways to Wellbeing: connect, be active, take notice, keep
learning, and give. These actions have been promoted and applied in a range of public health settings. Although
it is recognized that these are very broad concepts that are open to subjective interpretation and cover any
number of activities, the 5 Ways to Wellbeing is a useful tool for stimulating discussions about wellbeing and
public mental health, and enabling individuals to think about ways in which to improve their own wellbeing.

The relationship between mental and physical health

Mental health and physical health are inextricably linked, with evidence for a strong relationship between the
two accumulating over recent decades and challenging the historical notion of mind-body duality. Mechanisms
for this association can be physiological, behavioral and social, as identified by the biopsychosocial model of
health. The nature of this relationship is two-way, with mental health influencing physical health and vice versa.

Mammalian stress responses (i.e. fight, flight or freeze) are known to affect physiological processes regulated
by the autonomic nervous system, including cardiovascular, respiratory, digestive, repair and defense functions.
A number of medical conditions have been linked to stress, such as irritable bowel syndrome (Blanchard, 2001),
asthma (e.g. Lehrer et al., 2002) and migraine headaches (e.g. Robbins, 1994). Likewise, stronger immune
function has been associated with high levels of social support (e.g. Esterling et al., 1996) and hardiness
(Dolbier et al., 2001), both of which may modify experiences of stress (e.g. Cottington & House, 1987) and its
physiological manifestations (Karlin, Brondolo & Schwartz, 2003). Whilst it is clear that physical ill-health can
be accompanied by mental health problems such as anxiety and depression, the resulting psychological state
may in turn impede the recovery or stabilization of medical conditions, thus producing a vicious circle in which
wellbeing is difficult to attain (Evans et al. 2000).

Behavioral and social risk factors for physical and mental health problems tend to overlap, which can make it
difficult to determine whether mental illness precedes physical illness, or vice versa. The Kings Fund estimates
that more than four million people in England with a long-term physical health problem also have a mental
health problem (Naylor et al., 2012), and the physical health of people with severe and enduring mental illness
is often poor (Barry et al., 2015). Unhealthy lifestyles as responses to stress often contribute to this association;
for example, people with mental health problems consume almost half of all tobacco, and are more likely to
develop a substance use disorder than the reverse (Frisher et al., 2003). People with mental health problems may
also have more difficulty accessing services, which exacerbates both mental and physical illness.

The relationship between mental health and wellbeing

The relationship between mental health and wellbeing is described from two main perspectives: the dual continuum
model, and the single continuum model. The dual continuum model views mental health as strongly related to
but separate from mental wellbeing, whereby an individual is either mentally well or ill (mental health), and
either flourishing or not flourishing (mental wellbeing). This model may apply to situations where it is possible
to have a mental illness diagnosis and still have a high level of wellbeing; for example, someone with bipolar
disorder may have high wellbeing if their condition is being managed, e.g. with medication, or if they are not
currently experiencing an episode of symptoms. It is consistent with definitions of health that emphasize the
importance of adaptation, as described above (Defining health and wellbeing). However, it is based on the view
that people never fully recover from mental illness, which has been debated as ‘recovery’ can be defined in a
number of ways depending on the perspective and context. One framework applies the same concepts as with
chronic physical illness, with three forms of recovery: clinical recovery, in which the person is cured or in
remission; illness management, in which symptoms are controlled, monitored and managed by clinicians; and
personal recovery, in which individuals who are still experiencing symptoms function as best as they can within
the limitations of their illness .

The single continuum model views mental wellbeing as integral to mental health. It places mental health and
wellbeing on a single spectrum, with mental illness/low wellbeing at one extreme and mental wellness/high
wellbeing at the other. According to this model, mental health and wellbeing are distributed continuously in
populations, and it is also possible to move in and out of those states. Professor Geoffrey Rose proposed that
where a health issue is continuously distributed in the population, the mean predicts the proportion of the
population with a diagnosable illness. It should therefore be possible to reduce levels of mental illness in a
population by improving overall levels of population wellbeing, i.e. ‘shifting the curve’. This has been
demonstrated for common mental health disorders in both children (Goodman & Goodman, 2011) and adults
(Veerman et al., 2009), but there is currently insufficient evidence in relation to severe and enduring mental
illness. There has recently been some controversy over this approach in mental health promotion and the
measurement of population wellbeing (see Annual Report of the Chief Medical Officer, 2013 and FPH Mental
Health Committee response.

PESPECTIVE OF HEALTH

Theoretical Perspectives on Health and Medicine

Each of the three major theoretical perspectives approaches the topics of health, illness, and medicine
differently. You may prefer just one of the theories that follow, or you may find that combining theories and
perspectives provides a fuller picture of how we experience health and wellness.

Functionalism
According to the functionalist perspective, health is vital to the stability of the society, and therefore sickness is
a sanctioned form of deviance. Talcott Parsons (1951) was the first to discuss this in terms of the sick role:
patterns of expectations that define appropriate behavior for the sick and for those who take care of them.

According to Parsons, the sick person has a specific role with both rights and responsibilities. To start with, she
has not chosen to be sick and should not be treated as responsible for her condition. The sick person also has the
right of being exempt from normal social roles; she is not required to fulfill the obligation of a well person and
can avoid her normal responsibilities without censure. However, this exemption is temporary and relative to the
severity of the illness. The exemption also requires legitimation by a physician; that is, a physician must certify
that the illness is genuine.

The responsibility of the sick person is twofold: to try to get well and to seek technically competent help from a
physician. If the sick person stays ill longer than is appropriate (malingers), she may be stigmatized.
Parsons argues that since the sick are unable to fulfill their normal societal roles, their sickness weakens the
society. Therefore, it is sometimes necessary for various forms of social control to bring the behavior of a sick
person back in line with normal expectations. In this model of health, doctors serve as gatekeepers, deciding
who is healthy and who is sick—a relationship in which the doctor has all the power. But is it appropriate to
allow doctors so much power over deciding who is sick? And what about people who are sick, but are unwilling
to leave their positions for any number of reasons (personal/social obligations, financial need, or lack of
insurance, for instance).

Conflict Perspective
Theorists using the conflict perspective suggest that issues with the healthcare system, as with most other social
problems, are rooted in capitalist society. According to conflict theorists, capitalism and the pursuit of profit
lead to the commodification of health: the changing of something not generally thought of as a commodity into
something that can be bought and sold in a marketplace. In this view, people with money and power—the
dominant group—are the ones who make decisions about how the healthcare system will be run. They therefore
ensure that they will have healthcare coverage, while simultaneously ensuring that subordinate groups stay
subordinate through lack of access. This creates significant healthcare—and health—disparities between the
dominant and subordinate groups.

Alongside the health disparities created by class inequalities, there are a number of health disparities created by
racism, sexism, ageism, and heterosexism. When health is a commodity, the poor are more likely to experience
illness caused by poor diet, to live and work in unhealthy environments, and are less likely to challenge the
system. In the United States, a disproportionate number of racial minorities also have less economic power, so
they bear a great deal of the burden of poor health. It is not only the poor who suffer from the conflict between
dominant and subordinate groups. For many years now, homosexual couples have been denied spousal benefits,
either in the form of health insurance or in terms of medical responsibility. Further adding to the issue, doctors
hold a disproportionate amount of power in the doctor/patient relationship, which provides them with extensive
social and economic benefits.

While conflict theorists are accurate in pointing out certain inequalities in the healthcare system, they do not
give enough credit to medical advances that would not have been made without an economic structure to
support and reward researchers: a structure dependent on profitability. Additionally, in their criticism of the
power differential between doctor and patient, they are perhaps dismissive of the hard-won medical expertise
possessed by doctors and not patients, which renders a truly egalitarian relationship more elusive.

Symbolic Interactionism
According to theorists working in this perspective, health and illness are both socially constructed. As we
discussed in the beginning of the chapter, interactionists focus on the specific meanings and causes people
attribute to illness. The term medicalization of deviance refers to the process that changes “bad” behavior into
“sick” behavior. A related process is DE medicalization, in which “sick” behavior is normalized again.
Medicalization and DE medicalization affect who responds to the patient, how people respond to the patient,
and how people view the personal responsibility of the patient (Conrad and Schneider 1992).

In this engraving from the nineteenth century, “King Alcohol” is shown with a skeleton on a barrel of alcohol.
The words “poverty,” “misery,” “crime,” and “death” hang in the air behind him. (Photo courtesy of the Library
of Congress/Wikimedia Commons)

An example of medicalization is illustrated by the history of how our society views alcohol and alcoholism.
During the nineteenth century, people who drank too much were considered bad, lazy people. They were called
drunks, and it was not uncommon for them to be arrested or run out of a town. Drunks were not treated in a
sympathetic way because, at that time, it was thought that it was their own fault that they could not stop
drinking. During the latter half of the twentieth century, however, people who drank too much were
increasingly defined as alcoholics: people with a disease or a genetic predisposition to addiction who were not
responsible for their drinking. With alcoholism defined as a disease and not a personal choice, alcoholics came
to be viewed with more compassion and understanding. Thus, “badness” was transformed into “sickness.”

There are numerous examples of DE medicalization in history as well. During the Civil War era, slaves who
frequently ran away from their owners were diagnosed with a mental disorder called drapetomania. This has
since been reinterpreted as a completely appropriate response to being enslaved. A more recent example is
homosexuality, which was labeled a mental disorder or a sexual orientation disturbance by the American
Psychological Association until 1973.

While interactionism does acknowledge the subjective nature of diagnosis, it is important to remember who
most benefits when a behavior becomes defined as illness. Pharmaceutical companies make billions treating
illnesses such as fatigue, insomnia, and hyperactivity that may not actually be illnesses in need of treatment, but
opportunities for companies to make more money.

PERCEPTION OF HEALTH

A Mayo Clinic study published in the American Journal of Health Behavior investigates differences in how
men and women perceive their own health. The study finds that confidence in maintaining good health habits
can be influenced by gender.

Men reported higher levels of physical activity and greater confidence in their ability to remain physically
active, according to the study, which surveyed 2,784 users at the Mayo Clinic Dan Abraham Healthy Living
Center, an employee wellness center. Men and women had comparable levels of confidence that they would
maintain a healthy diet.

"Our findings suggest that confidence in maintaining health habits can be influenced by gender and also
depends on which specific habit is being assessed -- physical activity, for example, versus diet," says Richa
Sood, M.D., a Mayo Clinic internist, and a co-author and designer of the study. "This is important information
to keep in mind when designing wellness programs, to maximize their utilization and impact on employee
health and wellness."

To learn more about possible gender-specific factors for underutilization of employee wellness centers,
researchers distributed surveys to 11,427 wellness center users, 2,784 of whom responded with complete data.
Of the respondents, 68% were women, and the mean age was 49.

The survey asked questions about users' health status and select health conditions, confidence in maintaining
healthy habits, and stress level and social interactions. Men and women reported comparable levels of stress and
support for healthy living, according to the study. More men reported having hypertension, diabetes, high
cholesterol and tobacco use than women. Nonetheless, there was no significant gender difference in perception
of personal health.

"We were surprised by the finding that men felt they were as healthy as women despite having more medical
problems," Dr. Sood says.

Women had lower self-reported levels of physical activity and lower confidence that they would maintain that
activity.
"This difference may have cultural roots because gender has been shown to influence self-efficacy, particularly
for physical activity," says Dr. Sood. "Our study shows that self-efficacy is domain-dependent and can't be
generalized as a gender-specific trait. But understanding gender differences among working adults can help
optimize employee wellness services."

Despite the availability of employee wellness centers across the country, the services typically are underused,
according to the study. Incorporating gender-specific elements in the design and programming of wellness
centers can improve their use, enhance wellness and indirectly reduce health care costs.
 Determinants of health may be
biological,behavioral,socialculture,economic and ecological. Broadly ,these
can be divided in to four categories; nutrition,lifestyle,environment and
genetics. When any one of the pillars of health determinants becomes weak, a support system is needed. The
considered 5th determinants of health and involves medical care. Interestingly two determinants ,nutrition and life style
are in our hands, hence called modifiable factors. Many diseases are caused by bad practices of these. The degraded
ecosystem and environmental pollution are the causes of several disorders and diseases, with the help of powerful
technology and screening methods many disorders of genetic origin can be prevented.

Over 75% or more of resources are allocated to health care budgets especially rich countries, people should be
empowered to take their health in there own hands through lifestyle modification.

Physical determinants of health examples, natural environment such as trees, grass or weather, built environment such
as buildings, side walks and roads, worksites, housing, exposure to toxic substances, physical barriers e.g. people with
disability.

Social determinants….Economic stability; employment, food security, housing instability, poverty., education, social and
community context, health and health care, neighborhood and built environment

Biological and genetics; age,sex,hiv status, inherited conditions eg sickle cell anemia.

Individual behaviour;diet,physical activity, alcohol, cigarette and other drug use and hand washing.
 CONCLUSION

Health is a state of physical, mental and social well being and not merely the absence of disease and
infirmity.health as ‘a resource for everyday life, not the object of living’. From this perspective health is a
means to living well, which highlights the link between health and participation in society.Determinants of
health may be biological,behavioral,socialculture,economic and ecologiocal.
 BIBIOGRAPHY

1. Encyclopedia of health communication by Teresa .l. Thompson 2014

2. Evidence based public health, ross .c .Brownson 2018
3. Abraham S C S, SHEEN, HEALTH BELIEFS, 1996
4. BLAXTER M ,1990 Health and lifestyle London
5. Department of health 2003 health survey for England 2001, london