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.’1
Health is a cumulative state that involves the capacity, perceived or actual, of individuals to thrive in their social and physical environment and to function and cope with specific illnesses and life in general.2
Health is therefore influenced by a wide range of factors. Dahlgren and Whitehead’s model (see below)3proposes that genetic predisposition interacts with environmental influences and individual lifestyle behaviours to produce health or ill health, which is then mediated by health care services to restore health where required.
Source: Dahlgren and Whitehead 1991
Worldwide evidence has shown that living standards and levels of education have the greatest influence on health. While current work in the NHS focuses on curative healthcare – fixing people once they become unwell – the local authority delivers services that influence health promotion and prevent people from getting ill in the first place. Working in partnership thus increases our chances of reducing inequalities in health. In addition, both Merton clinical commissioning group (CCG) and London Borough of Merton (LBM) provide services to the same populations that would be more effective if coordinated.
The influences on health – social determinants of health – are the conditions in which people are born, grow, live, work and age. These conditions combine to create health and ill health and are dependent on the quality of education, employment and economic wellbeing, the built environment, housing and a nurturing environment in childhood, for example. They are shaped by policy decisions, which are mostly responsible for inequities in health – the unfair and avoidable differences in health status seen within and between groups of people. The negative influences associated with poverty are two-fold:
- People living in poverty are more likely to be exposed to conditions that are adverse to their health (crowded or slum living conditions, unsafe neighbourhoods).
- People living in poor circumstances are more likely to be negatively affected by these adverse conditions.
The rest of this section focuses on the following determinants of health and wellbeing:
1. ^ World Health Organization (WHO). Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19 June-22 July 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.
2. ^ World Health Organization (WHO) (1999).
Men, Ageing and Health. Achieving Health Across the Lifespan.
3. ^ Dahlgren, G. and Whitehead, M. (1991).
Policies and strategies to promote social equity in health. Stockholm: Stockholm Institute for Future Studies