What is Health?

Health is a critical aspect of our existence as human beings.  Focusing on the health of children, in particular, is very beneficial.  Early behaviors and habits are predictive of quality and quantity of lives as well as the wellness of our society.

Health and Wellness involves much more than just the physical body.  There are various aspects of health that allow individuals to address their wellness in a number of areas. For example, how we feel mentally and respond emotionally, are just as important as the wellness of our physical body.  These different domains or dimensions of health, as noted in the Wellness Wheel, impact one another in various ways.

If you have taken any other health courses or done some health-related research, you may have noticed that different sources will categorize the domains or dimensions of health differently.  You might see one model with three dimensions and another with eight. In this text, we will categorize health and wellness into six dimensions or domains.

Identifying Health

Who Is Healthy?

*Critical Question – Which of the children pictured below would you say are the healthiest?  Which are the least healthy? Why? 

Which children did you choose as the healthiest, the least healthy?

Many people would have chosen the dancer or the baseball player as the healthiest. Why?  They appear to be maintaining a healthy weight and aren’t participating in unhealthy behavior (that we can see). Many would have chosen the overweight boy or child with the remote control as the least healthy.  Would that be correct?  Not necessarily.

Many people judge people’s health on only one dimension or domain of health – the physical. There are multiple dimensions to health as noted in the Wellness Wheel.   Physical health is the easiest to “see”, so we tend to judge a person’s health by this one dimension.

Now look at the pictures again and review the dimensions of health in the Wellness Wheel.  What “unseen” aspects of health might affect the people who “appear” healthy?  Is it possible that people who appear to be very fit are actually suffering in other dimensions of health?  Is it possible that the people who appear unhealthy are actually doing well in other health dimensions?  Even if someone appears physically healthy, they may be unhealthy in ways that we cannot see. The person’s blood vessels may be in an unhealthy state, or they may be suffering from emotional health issues.  Our health and wellness status is made up of various dimensions of health.  The dimensions have a significant influence on one another.

Leading Causes of Death in the United States

Most people living in the US will die from a chronic disease.  Chronic disease is disease that typically begins slowly, progresses and persists, with a variety of signs and symptoms that can be treated, but not cured by medication.  The top two causes of death in the US for all ages are “diseases of the heart” and “malignant neoplasms” (cancer). This is a change from historical causes of death. A century ago, most people died from infectious diseases, not chronic diseases such as heart disease and cancer.

Heart Disease

Over time, plaque can thicken and stiffen artery walls, which can block blood flow through your blood vessels. This can be caused by preventable issues, such as an unhealthy diet, lack of exercise, unmanaged stress, being overweight and smoking.

Cancer

Cancer cells develop within normal cells.  Damage to the DNA of healthy cells disrupts their orderly growth over time, leading to the formation of cancer.

Carcinogens are things that contribute to cancer. A poor diet, chemicals such as those in smoke, UV radiation, sunburn, as well as some infections can contribute to the damage described above and the formation of cancer.

How are chronic diseases different from infectious diseases and why does it matter?

In contrast with chronic diseases, which are acquired over time, infectious diseases such as tuberculosis and influenza are acquired quickly.  Behaviors such as hand washing, sanitation, and immunization are important prevention measures for infectious diseases and are more easily defined and contained than chronic disease.  Is there an immunization for heart disease or cancer?  No.  Can you imagine being able to prevent heart disease and cancer with handwashing and proper sanitation?  So although we have been able to significantly reduce death and disability related to infectious disease, the prevention for chronic disease mostly lies in the hands of individuals and the behaviors they choose over time, which is much more challenging. When young people begin with healthy habits, those behaviors can contribute to protection against chronic disease.

Leading Cause of Death for Youth in the United States

The leading cause of death for infants, children, and adolescents is accidents or unintentional injuries.  Most childhood injuries can be prevented. Parents and caregivers can play a life-saving role in protecting children from injuries. Unintentional injuries are largely a result of motor vehicle crashes.  However, the number dying from accidents pales in comparison to the number that will die of chronic disease at a later time. Once individuals reach middle age and beyond, their top risks are heart disease and cancer.

Prevention

In order to move toward a high level of well-being and away from illness, prevention is a key factor.  Prevention is particularly relevant when it comes to young people.  Early habits and behaviors can either contribute to disease or help to prevent disease.  More healthy behaviors over time will result in healthier outcomes.

Types of Prevention

There are three different types of prevention when it comes to health; Primary, Secondary, and Tertiary.

1. Primary prevention involves measures taken to prevent a health problem before it happens. These are things individuals can do themselves such as exercising, eating a healthy diet, not smoking, and reducing stress. Vaccinations are also an example of primary prevention. Primary prevention is very beneficial for both health and cost savings. Primary prevention is naturally a main focus when we are working with young people, as typically they are starting out healthy and we can help them to prevent health issues from occurring
2. Secondary prevention involves measures taken to stop progression or reverse a health risk once it has been identified. Secondary prevention includes going to healthcare providers for screenings. Some people mistakenly think that going to a healthcare provider is primary prevention. Your practitioner may be called a “Primary” Care Physician, but that is different than primary prevention.  Think about it this way.  If you go to your physician for a test or an examination and something is discovered, does that prevent the problem from occurring?  No, it has already occurred!  Screenings and examinations, therefore, are secondary prevention.  If you have a healthcare provider who is working with you to encourage healthy behaviors when you are completely healthy, then yes, they could be promoting primary prevention.  However, the majority of healthcare visits are not for this purpose.
3. Tertiary prevention consists of measures taken to treat a full blown health problem that may not be able to be stopped or reversed. Individuals may be able to do things that will help their quality of life without curing the problem. People who already have health issues may do a range of things, from changing their dietary intake to having a surgical procedure to increase comfort.

Prevention vs. Treatment

Is Primary Prevention a Top Priority in Our Society? 

We have talked a lot about prevention.  Is it a top priority in our society?  When you compare prevention and treatment, which one wins?  Currently, in our society, we have seen some increase in focus on prevention, but treatment dominates the scene.  In our healthcare system, many people “get paid” when we get sick, therefore, there isn’t much incentive for prevention.  Many people “get paid” when we need to visit a health care practitioner, when we need medication, when we need surgery or other care.  

Primary prevention would save money in the long run and would allow individuals to have more healthy and well days during their lives. Focusing on children with primary prevention is extremely important since they are less likely to have any health issues to begin with. 

When we are successful in preventing, we are really the ones who get paid!  We save a fee or co-pay that we would have paid for the visit or the prescription.  You may not think of it as “getting paid”, but if you prevent five doctor visits over a year at $20 per visit, you’ve saved yourself from paying $100 in a year.  This doesn’t include the time, travel, pain, or prescription costs that you’ve saved.  It pays for us to take charge of our health. Feeling good about healthy behaviors and doing things that make us feel good in the shorter term are helpful in getting us to the long term benefits.

There has been a movement toward increasing primary prevention.  Due to continued rising healthcare costs, our healthcare system is shifting in a direction that moves funding to healthcare providers that work toward prevention and reduce hospitalizations.  We should continue to see more focus on prevention across the board in healthcare and healthcare-related careers.

It would seem that high health expenditures in the US would result in better health outcomes such as higher life expectancy at birth and lower infant mortality and death rates.  Although the US spends an extraordinary amount on healthcare, the US does not rank well for infant mortality or life expectancy in comparison with countries spending significantly less on healthcare.  Why would this be the case? Some of the differences that have been cited as explanations are health behavior choices and pharmaceutical spending. Also, unlike other countries with higher life expectancies and lower costs, the U.S. mostly relies on voluntary health insurance to fund health-care costs. By contrast, the 10 countries with the highest life expectancy depend on voluntary insurance for a low percentage of their costs, and government spending for nearly half.

What are “Healthy People” Goals?

Healthy People goals for the United States are created by the US Department of Health and Human Services every ten years with the intent of helping the people of the nation live healthier lives. Healthy People provides a comprehensive set of national goals and objectives for improving the health and reducing health disparities for all Americans. Healthy People contains more than 40 topic areas with over 1,200 objectives. A smaller set of Healthy People objectives, called Leading Health Indicators (LHIs), have been selected to communicate high-priority health issues and actions that can be taken to address them.

The “Ten Great Public Health Achievements of the 20th Century” have been instrumental in moving health in a positive direction overall.

1. Immunizations
2. Motor vehicle safety
3. Workplace safety
4. Control of infectious diseases (which includes immunizations)
5. Declines in deaths from heart disease and stroke
6. Safer and healthier foods
7. Healthier mothers and babies
8. Family planning
9. Fluoridation of drinking water to prevent dental caries (cavities)
10. Reduction of tobacco use