Health

The World Health Organization (WHO) defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” This definition is perhaps the most well known and also the most criticized, mainly because it is difficult to operationalize for achieving (and measuring) health. Despite its lack of specificity, however, the definition introduces the social dimension of health. For the WHO definition to be useful in health research and practice, physical, mental, and social well-being must be interpreted in specific social, political, and cultural contexts.

Different conceptualizations of health indicate different determinants of health. These determinants of health, in turn, prompt specific public policies and individual behaviors for achieving health. For example, suppose health is considered as the normal physiological functioning of the bodily organs. If contaminated water is believed to disturb the normal functioning of the organs, then social policies would regulate water quality, while individuals might choose not to drink tap water. In another example, if a society considers health as active social participation, then social policies would be in place to remove barriers to social participation, and individuals would seek out opportunities for social activities.

The various ways of conceptualizing health are reflected in social policies and individual behaviors. These conceptualizations also hold different parties accountable. If a society conceives that good or ill health is a consequence of an individual's discretionary behaviors (e.g., washing hands before handling food to avoid food poisoning), then individuals would be responsible for their own health. Conversely, if a society regards health as a reflection of social and political systems (e.g., increased infant mortality after community health center funding is cut), then policymakers would be held accountable. Societies and individuals have different and complex matrices of causality and accountability for various health outcomes. Some health conditions are attributed to individuals, while others to social policy or even to uncontrollable forces (e.g., fate, nature). Health services researchers and policymakers must recognize the strengths and limitations of the various conceptualizations of health that they use in studying health-related issues, shaping public policy, and providing services.

In the following sections, the philosophical underpinnings for the definition of health will be discussed, and the ways in which different views of health are reflected in various measures of health will be examined. Next, various determinants of health from a social-ecological perspective will be reviewed. Finally, the question of who is responsible for health is addressed.