New definition of health, or an updated health care system

In 1948 the World Health Organization (WHO) defined health as “a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity” (Callahan, 2012) This definition remained unchanged for over sixty years and now, there is an increased demand for a new definition of health.

A potential new health definition was presented by Fabio Leonardi in his 2018 article, “The definition of health: towards new prospective” has proposed a new definition of health as being “the capability to cope with and to manage one’s own malaise and well-being conditions. In more operative terms, health may be conceptualized as the capability to react to all kinds of environmental events having the desired emotional, cognitive and behavioral responses and avoiding those undesirable ones.” (Leonardi, 2018) In this new proposed definition of health, the author suggests that health should not be a state to achieve, rather, health should be an ongoing dynamic and complex process which any individual should be able to achieve regardless of their age, race, ethnicity, and social economical state and should be based on personal priorities, needs and expectations.

The sixty year old health definition should be updated to match current healthcare needs and individual expectations. While it is progressive to update this definition, healthcare systems and their delivery must follow en suite.

After the 1960s, the life expectancy of people increased due to availability of medication, more hospital services, and improved technology. (Gerad F Anderson, 2000) The increased life expectancy after age 65 contributes to the increased demand for continued care. In the United States and in Canada, one in six elderly people needed home care due to various illnesses (Gerad F Anderson, 2000). As the population ages, the proportion of people living with chronic illnesses increases. Christine Walker explains in her article, “Recognizing the changing boundaries of illness in defining terms of chronic illness” that the World Health Organization acknowledges that there is a relationship between the aging population and increased prevalence of chronic illness. (Walker, 2001) Chronic diseases are not only affecting the ageing population, there are chronic illnesses such obesity which affect all age groups and socioeconomic classes. Nearly one third of the world population are overweight or obese and chronic conditions caused by excess weight has more than doubled since 1980 (Ulijaszek, 2000). Even though obesity itself is considered a chronic condition, it can lead to other chronic diseases such as diabetes and heart disease. The result of the increased prevalence of these diseases can overburden healthcare systems and societies. (Ulijaszek, 2000)

In a Statistics Canada report in 2004, 59.1% of Canadian adults were overweight or obese and 23.1% of adults were obese. (Health Reports, 2006) The current research identified that increasing obesity rates and rising complications associated with obesity could lead to an unhealthy and unproductive population, as well as put unnecessary pressure on healthcare systems. (Huang, 2008)

In Canada, groups most affected by chronic illnesses are marginalized populations, in particular, Aboriginal women. Aboriginal women experience more health issues than rest of the Canadians (Akee, 2018) For example, a woman registered in the country’s [First Nation] registry is more likely to face untimely death than rest of the Canadian women. (Akee, 2018)

According to a 2004 article from Prairie Women’s Health Centre of Excellence, Aboriginal women in Canada experience decreased life expectancy, elevated morbidity rates as well as elevated suicide rates in comparison to non-Aboriginal women. (Carrie Bourassa, 2008) Aboriginal women on or off the reserves, experience poorer health than non-aboriginal Canadian women. Furthermore, they experience significantly higher rates of coronary heart diseases, cancer, cardiovascular diseases and other chronic illnesses. 41% of Aboriginal women age 55-64 reported fair or poor health compared to 19% of Canadians in the same age group. (Carrie Bourassa, 2008) Today, chronic conditions due to ageing, obesity, and Aboriginal issues are being discussed and identified by multiple levels of government. The question still stands: have we done enough to address the health determinants?

As the delivery of healthcare is under provincial authority, understanding of the health determinants by provincial health officials are vital in addressing current healthcare issues. However, the current state is far from it. Julia Brassolotto and Dennis Raohael in their journal article “Epistemological barriers to addressing the social determinants of health among public health professionals in Ontario, Canada: a qualitative inquiry” interviewed lead medical officers and healthcare professionals from nine public health units and concluded that “Ontario public health units generally neglected the social determents of health and act on risk aversions and behaviorally oriented health promotion approaches” (Julia Brassolotto, 2013) Their conclusion were based on the interviews they conducted with the medical professionals of Ontario public health units. They evaluated the public health units’ websites and then sent these public health units a questionnaire and evaluated the answers. After analyzing all the data, they concluded that various public health units understood and interpreted the social determinants of health differently and therefore executed their dominant research and practice paradigms according to their understanding.

Even though all the public health units addressed and understood the health determents according to their own views and beliefs, the authors recognized that in order to address the health determinants in Ontario, the province should centralize the social determinants of healthcare leadership, invest in meaningful research and involve all levels of health authorities. (Julia Brassolotto, 2013)

Julia Brassolotto’s conclusions of Ontario health determinants is that Ontario is lacking a centralized approach. The benefits of a centralized approach was analyzed by Sholom Glouberman and John Millar’s conclusion in their “Evolution of the Determinants of Health, Health Policy, and Health Information Systems in Canada”. They found that as a result of health education messages and restrictions on advertising, the national smoking rate dropped from approximately 50% to approximately 25.8%. (Sholom Glouberman, 2003) However Sholom further explains that over the past decade more attention was given to the cost of healthcare.

As a result, the public health dialog has taken a cost saving route, rather than addressing the health determinants and emerging health issues. He raised concerns over that emerging unsolved health issues like poverty, the obesity epidemic, and Aboriginal health issues. Compared to European countries like Sweden and the UK, Glouberman believes that Canada is far behind in addressing pressing health issues.

The delivery of healthcare should be adjusted to meet the current healthcare issues. Federal government should prioritize the major health issues in Canada such as poverty, obesity, chronic diseases and the Aboriginal health issues, which are common to all the provinces and territories and the allocation of funds to the provincial governments should be directed towards addressing those issues. Health policies should be adjusted and changed from the Federal government level to address the identified health determinants and to implement preventative strategies. The focus from all levels of governments should be to build a timely healthcare system instead of the current disease care system.

References

Akee, R. (2018, February Wednesday). Why are Canada's first nation women dying at such an alarming rate? https://www.brookings.edu/blog/up-front/2018/02/28/why-are-canadas-first-nations-women-dying-at-such-an-alarming-rate/.

Brassolotto, J., Raphael, D., & Baldeo, N. (2013). Epistemological barriers to addressing the social determinants of health among public health professionals in Ontario, Canada: A qualitative inquiry. Critical Public Health,24(3), 321-336. doi:10.1080/09581596.2013.820256

Callahan, D. (2012). The WHO Definition of “Health”. The Roots of Bioethics, 62-74. doi:10.1093/acprof:oso/9780199931378.003.0005

Carrie Bourassa, K. m. (2008). Racism, sexism, and colonialism The impact on the Health of Aboriginal Women in Canada. Canadian Woman studies, 23-28.

Glouberman, S., & Millar, J. (2003). Evolution of the Determinants of Health, Health Policy, and Health Information Systems in Canada. American Journal of Public Health,93(3), 388-392. doi:10.2105/ajph.93.3.388

Huang, T. T. (2008). Transforming Research Strategies for Understanding and Preventing Obesity. Jama,300(15), 1811. doi:10.1001/jama.300.15.1811

Leonardi, F. (2018). The Definition of Health: Towards New Perspectives. International Journal of Health Services,48(4), 735-748. doi:10.1177/0020731418782653

Population aging: A comparison among industrialized countries. (2000). The Aging Male,3(3), 158-158. doi:10.1080/13685530008500328

Ulijaszek, S. J. (2003). Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation. WHO Technical Report Series 894. Pp. 252. (World Health Organization, Geneva, 2000.) SFr 56.00, ISBN 92-4-120894-5, paperback. Journal of Biosocial Science,35(4), 624-625. doi:10.1017/s0021932003245508

Walker, C. (2001). Recognising the changing boundaries of illness in defining terms of chronic illness. Australian Health Review,24(2), 207. doi:10.1071/ah010207