Section A
The concept of health holds different meanings for different
people and groups. These meaning of health have also changed over time.
This change is no more evident than in western society today, when notions of
health and health promotion are being challenged and expanded in new
ways. For much of recent western history, health has been viewed
in the physical sense only. That is, good health has been connected to the
smooth mechanical operation of the body, while ill health has been attributed to
a breakdown in this machine. Health in this sense has been defined as the
absence of disease or illness and is seen in medical terms. According to this
view, creating health for people means providing medical care to treat or
prevent disease and illness. During this period, there was an emphasis on
providing clean water, improved sanitation and housing. In the
late 1940s the World Health Organization challenged this physically and
medically oriented view of health. They stated that "health is a complete state
of physical, mental and social well-being and is not merely the absence of
disease" (WHO, 1946). Health and the person were seen more holistically and not
just in physical terms. The 1970s was a time of focusing on the
prevention of disease and illness by emphasizing the importance of the
lifestyles and behavior of the individual. Specific behaviors which were seen to
increase risk of disease, such as smoking, lack of fitness and unhealthy eating
habits, were targeted. Creating health meant providing not only medical health
care, but health promotion programs and policies which would help people
maintain healthy behaviors and lifestyles. While this individualistic healthy
lifestyles approach to health worked for some (the wealthy members of society),
people experiencing poverty, unemployment, underemployment or little control
over the conditions of their daily lives benefited little from it. This was
largely because both the healthy lifestyles approach and the medical approach to
health ignored the social and environmental conditions affecting the health of
people. During the 1980s and 1990s there has been a growing
swing away from seeing lifestyle risks as the root cause of poor health. While
lifestyles factors still remain important, health is being viewed also in terms
of the social, economic and environmental contexts in which people live. This
broad approach to health is called the socio-ecological view of health. It was
endorsed at the first International Conference of Health Promotion held in 1986,
Ottawa. People from 38 countries attended the meeting and reached an agreement
about the creation of health. It is clear from their agreement that the creation
of health is about much more than encouraging healthy individual behaviors and
lifestyles and providing appropriate medical care. It must include addressing
issues as poverty, pollution, urbanization, natural resource depletion, social
alienation and poor working conditions. The social, economical and environmental
contexts which contribute to the creation of health do not operate separately or
independently of each other. Rather, they are interacting and interdependent,
and it is the complex interrelationships between them which determine the
conditions that promote them. According to the agreement reached at the first International Conference of Health Promotion, the ______ between social, economical and environmental contexts determine the conditions that promote health.