Community Health Systems

Defining Health

The following definition of health from the preamble to the constitution of the World Health Organization (WHO) has guided the development of the WHO's policies and programs since 1948, when it became operational:

• Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. (World Health Organization 1948)

The definition is broad and multidimensional, making the point that health is not just about physical status, but mental and social condition as well. Health is equated with well-being, not with the mere absence of sickness.

Treating Illness

Trying to make this notion of health a reality has been challenging in part because many of the world's health care systems might in fact be more accurately termed illness care systems. That is, they concern themselves more with treating or preventing illness than with [Page 267]establishing well-being. This model of health, sometimes referred to as the medical model, aims to get patients to the point where they are not manifesting symptoms of illness, that is, they are not sick. In this view, then, one who is not sick is well. But people who are not sick may not be particularly well, either. They are simply asymptomatic—of either illness or wellness.

Medicine and the allied professions assume responsibility for treating illness. Public health has traditionally made its purview the prevention of illness, although this delimitation is changing as the profession embraces the development of what has been called the “new public health”—helping people move toward wellness. Health education as a field fully embraces the promotion of wellness, although it too has struggled in the past with self-imposed limitations, overemphasizing the role of cognition as opposed to the role of beliefs in determining—and changing—behavior.

Promoting Wellness: The Health Field Concept

In 1974, Marc Lalonde, Canada's minister of health at the time, released a report entitled A New Perspective on the Health of Canadians. That report set forth the idea of health as the result of four determinants—human biology, the environment, health care, and lifestyle—that constantly interact in a person's life and within community to produce health status. This concept of health has helped people move from the medical view of health to a more systemic and ecological view and has led to the development of concepts of health promotion. Understanding the conditions producing illness and the resulting need for health care requires assessment of root causes—going upstream, as it were—to identify the factors producing the illness for which the medical care system was designed in the first place.

Health as Process

Another current understanding of health views it as the process of becoming all that one can be. If one accepts this view, then the role of the health care system, in concert with other segments of the community, is to help people become as healthy as possible. That means helping them to explore and express their potential in all the multiple dimensions of health: physical, mental, emotional, social, cultural, spiritual, intellectual, economic, and so forth. In this health-as-process model, individuals assume ultimate responsibility for their own health status and look to their communities, including their families, schools, business and industry, institutions of faith, government, and the health care system, to facilitate their process of self-actualization.

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