Learning Objectives
By the end of this section, you will be able to:
- Define the terms health and wellness
- Describe the Healthy People 2030 initiative
- Analyze the five social determinants of health
Health and wellness are important concepts related to individuals’ physical, mental, and social well-being. Maintaining good health and wellness requires a holistic approach, which means addressing the whole patient to assess and treat all facets of the person. This includes regular exercise, a balanced diet, adequate rest, and stress management. In addition to these physical factors, mental and emotional health is also critical to overall well-being. This includes developing healthy coping mechanisms, practicing mindfulness, and seeking help when needed. Prioritizing health and wellness can lead to numerous benefits, including increased energy, improved cognitive function, reduced risk of chronic diseases, and a more optimistic attitude toward life. By adopting healthy habits and focusing on holistic well-being, individuals can improve their quality of life and increase their resilience when faced with challenges. Health and wellness should be viewed as an ongoing journey that requires a long-term commitment to self-care and personal growth.
Definitions of Health and Wellness
Health and wellness are two different concepts, but they are interrelated. While health is mainly focused on the state of the physical, mental, and social aspects of an individual’s life, wellness takes a more holistic approach, which views the person as a whole, considering individual activities, choices, and lifestyle in order to achieve a balanced and fulfilling life.
Health
The term health refers to the comprehensive view of physical, mental, emotional, and social well-being. Similarly, health is not simply the absence of disease or illness but a multifaceted concept that encompasses various aspects of a person’s life. These aspects should be assessed not only individually but interconnectedly as well.
Human Dimensions
The human dimensions of health are facets of wellness that interrelate to demonstrate a comprehensive view of health (Table 4.1). The five dimensions include emotional health, physical health, social health, intellectual health, and spiritual health (PDHPE.NET, 2023). All these human dimensions are interrelated and influence one another. Neglecting any aspect of them can have a negative impact on a person’s health. For example, if a person’s emotional health is neglected, it can impact their physical health. People with depression or anxiety commonly have decreased appetite and decreased physical activity and/or social interactions with others. With deteriorated emotional health and impacted physical/social health, the person’s overall health will be affected eventually. Therefore, it is important to take a holistic approach that addresses all aspects of health to achieve overall well-being.
| Term | Definition | Example Activities |
|---|---|---|
| Physical health | Individual’s ability to perform daily activities, maintain healthy body weight, and prevent illness and disease | Exercise, healthy diet, medication compliance (e.g., running, swimming) |
| Emotional health | Individual’s ability to manage and express their emotions, cope with stress, and experience positive emotions | Meditation, mindfulness (e.g., going to yoga class) |
| Social health | Individual’s ability to participate in social activities, interact with others, and experience a sense of belonging and connection | Social networking (e.g., going to the movies with friends) |
| Intellectual health | Individual’s ability to acquire new skills, think critically, and engage in creative activities | Learning new activities (e.g., taking a painting class or learning a new language) |
| Spiritual health | Individual’s ability to achieve a purposeful and meaningful life | Religious activities or activities that bring peace to the individual (e.g., going to church or a religious celebration, visiting the ocean or mountains, connecting to nature) |
Wellness
The Global Wellness Institute (2023) defines wellness as “the active pursuit of activities, choices, and lifestyles that lead to a state of holistic health” (para. 4). It includes eight mutually codependent dimensions: physical dimension of wellness, emotional dimension of wellness, social dimension of wellness, occupational dimension of wellness, spiritual dimension of wellness, intellectual dimension of wellness, environmental dimension of wellness, and financial dimension of wellness (Table 4.2) (Compass Health, 2022). The dimensions of wellness are interrelated and affect each other in various ways. If any one of these dimensions is neglected over time, it will adversely affect one’s health, well-being, and quality of life (QoL). For example, if sleep is neglected, over time this will impact one’s ability to navigate stress and cope with challenging situations. This demonstrates how neglect of the physical dimension can negatively impact the emotional dimension. Similarly, if a patient is unable to access clean air over time, this will negatively impact their respiratory system, thus demonstrating how the environmental dimension can impact the physical dimension. By working to improve each dimension of wellness, individuals can achieve a state of optimal health and well-being.
| Term | Definition | Example Activities |
|---|---|---|
| Physical dimension of wellness | The actions to maintain an individual’s physical health | Nutrition, exercise, sleep, and regular medical checkups |
| Emotional dimension of wellness | The actions to increase self-awareness and self-regulation to manage emotions in a healthy and constructive way | Activities to cope with stress and adversity and promote positive emotions |
| Social dimension of wellness | The actions to maintain healthy and positive relationships with others | Activities including utilization of communication skills and social support to achieve a sense of belonging |
| Occupational dimension of wellness | The actions to achieve job satisfaction, work–life balance, and personal growth and development | Activities to develop personal career goals |
| Spiritual dimension of wellness | The actions to achieve personal values | Activities including reinforcement of beliefs and practices that promote inner peace, happiness, and fulfillment |
| Intellectual dimension of wellness | The actions to acquire new skills and generate new knowledge | Activities to obtain knowledge, such as pursuing certifications, courses, and self-guided learning |
| Environmental dimension of wellness | The actions to achieve a good relationship with the surrounding environment | Activities including access to clean air and water and a safe and healthy living and working environment |
| Financial dimension of wellness | The actions to achieve financial stability to meet basic needs and experience a sense of financial security | Income, expenses, debt, savings, and investments |
The most well-known model for wellness is Dunn’s Theory of Wellness. Dunn’s Theory of Wellness, also known as the High-Level Wellness Model, defines wellness as an ongoing process of growth and development that encompasses all aspects of an individual’s life. It emphasizes the importance of taking a holistic approach to health and wellness and recognizes that all dimensions of wellness are interrelated and contribute to overall well-being. According to this theory, there are four processes to achieve wellness: being, belonging, becoming, and befitting.
Being
In Dunn’s Theory of Wellness, being is defined as recognizing oneself as an individual and actively working to achieve a state of high-level wellness in all eight dimensions. This includes engaging in regular physical activity, managing stress, developing healthy relationships, pursuing intellectual interests, nurturing spirituality, and finding meaning and purpose in one’s work. Individuals who are in a state of high-level wellness are thought to have a strong sense of self-awareness and can make choices that support their overall well-being.
Belonging
The word belonging is defined as the feeling of being accepted, valued, and supported by others, as well as the sense of being part of a larger community or group. Belonging is a key dimension of wellness in Dunn’s Theory of Wellness. This dimension focuses on an individual’s sense of connectedness to their communities and social networks. The dimension recognizes the importance of social relationships and the impact they can have on an individual’s mental and emotional well-being. Individuals who have a strong sense of belonging tend to have higher levels of self-esteem, improved coping skills, and a greater sense of purpose and meaning in life. However, the absence of belonging or social isolation can have negative impacts on an individual’s health and well-being, including increased stress, depression, and a higher risk of chronic diseases. Therefore, promoting a sense of belonging and social connection is essential to achieve a state of high-level wellness in Dunn’s Theory of Wellness.
Becoming
The word becoming is defined as an individual’s pursuit of personal growth and self-improvement, as well as their openness to new experiences and perspectives. Becoming emphasizes the importance of ongoing growth and development. It recognizes that personal growth and development are ongoing processes that require a commitment to lifelong learning and self-reflection. Individuals who prioritize the dimension of becoming are often interested in expanding their knowledge, pursuing new hobbies, and exploring new opportunities for personal and professional growth. This dimension also acknowledges that personal growth can occur through challenges and setbacks, as these experiences can provide opportunities for learning and personal development. In Dunn’s Theory of Wellness, becoming is seen as an essential component of overall well-being, as it contributes to a sense of purpose, meaning, and fulfillment in life. By actively pursuing personal growth and development, such as by going back to school to enhance one’s education, individuals can enhance their overall well-being and improve their quality of life (QoL).
Befitting
Taking proactive self-care strategies and personal responsibility to make personal choices to benefit one’s well-being is known as befitting. It includes taking steps to prevent illness and promote overall health and well-being, such as adopting healthy habits, managing stress, getting regular checkups, and taking care of one’s mental and emotional health. By making choices that prioritize long-term well-being, individuals can improve their quality of life and reduce the risk of chronic diseases and other health problems.
Patient Conversations
What Does Your Patient Know About Health and Wellness?
Scenario: The patient was admitted to the medical-surgical floor for chest pain. In the morning, the nurse walks into the patient’s room.
Nurse: Good morning, how are you feeling today?
Patient: Hi, I’m feeling much better today. I am trying to stay healthy, and I expect to be discharged soon.
Nurse: That’s great to hear. Can you tell me what you are doing to try to keep healthy?
Patient: Well, I try to eat healthy and exercise regularly.
Nurse: Those are definitely important aspects of overall health and wellness. But did you know that being healthy isn’t just about physical health?
Patient: Really? What else is there?
Nurse: Health and wellness encompasses much more than just physical health. It also includes psychological health, a balanced lifestyle, and social well-being. These different aspects work together to make up your overall well-being.
Patient: I see. I never really thought about it that way.
Nurse: It’s a common misconception, but think about it. If you’re physically healthy, but you’re constantly stressed or not getting enough sleep, it can still take a toll on your overall well-being. That’s why it’s important to strive for balance in all aspects of your life.
Patient: That makes sense. So, how can I work on these other aspects of wellness?
Nurse: Well, for psychological health, it’s important to take care of your mental and emotional well-being. This can include things like practicing mindfulness, seeking therapy or counseling if needed, and finding ways to manage stress. For a balanced lifestyle, it’s important to make time for activities you enjoy, connect with others, and have a good work–life balance. And for social well-being, it’s important to build and maintain healthy relationships with friends and family.
Patient: I never realized there were so many different aspects of wellness. Thank you for explaining it to me.
Nurse: You’re welcome. Remember, taking care of your overall well-being can have a positive impact on all areas of your life. Let me know if you have any other questions or concerns.
Healthy People 2030
To improve people’s health and well-being over the next decade, the Healthy People 2030 initiative sets a variety of data-driven national objectives. Included in the Healthy People 2030 initiative are 358 core, measurable, and developmental objectives (U.S. Department of Health and Human Services, 2023). These objectives provide a clear and concrete guide to improving the health of the nation, focusing on the most critical challenges and priorities for the public.
Link to Learning
The Healthy People 2030 website is coordinated by the Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, Office of the Secretary, and U.S. Department of Health and Human Services. This Five Social Determinants of Health in Healthy People 2030 video gives additional information.
Objectives and Data
The Healthy People 2030 initiative has three types of objectives: core, developmental, and research objectives (Table 4.3). Five intuitive topics are covered in the Healthy People 2030 objectives: health conditions, health behaviors, populations, settings and systems, and social determinants (Office of Disease Prevention and Health Promotion, 2023a).
More than eighty data systems are used as part of the Healthy People 2030 initiative to track progress toward the achievement of objectives over the course of the decade. These include national censuses of events (e.g., the National Vital Statistics System), nationally representative sample surveys (e.g., the National Health Interview Survey), and other valid and reliable data sources (e.g., the State Tobacco Activities Tracking and Evaluation System).
| Objective | Description |
|---|---|
| Core objectives | Address high-priority public health issues, including evidence-based interventions. The core objectives were developed using valid and reliable data obtained from the nationally representative population. The baseline data for the core objectives were from 2015. |
| Development objectives | Represent high-priority public health issues that can be addressed with evidence-based interventions but which do not yet have reliable baseline data. |
| Research objectives | Represent issues of public health with high health and economic burdens or significant disparities between groups of people, but which lack evidence-based interventions. |
Leading Health Indicators
The Healthy People 2030 initiative has twenty-three leading health indicators selected from high-priority Healthy People 2030 objectives to inspire action to improve health and well-being and provide a point of measure for success. As a set, leading health indicators encompass all aspects of health. Most leading health indicators focus on factors that contribute to the leading causes of death and disease in the United States, such as cigarette smoking, suicide, exposure to unhealthy air, and so on. These indicators help community and state organizations focus efforts and resources on improving health and well-being. The leading health indicators cover the life span and include objectives across topic areas, such as improved oral health interventions and increasing the proportion of people with health insurance.
Link to Learning
The leading health indicators provide multiple data on the high-priority objectives in the Healthy People 2023 initiative. The data provide information on the trend and progress of fulfilling the objectives, which could help policymakers, researchers, and healthcare providers initiate actions to improve the public’s well-being.
Health Equity
According to the Healthy People 2030 initiative, health equity is the attainment of the highest level of health for every person. Achieving health equity means valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities and historical and contemporary injustices and eliminate health and healthcare disparities (Office of Disease Prevention and Health Promotion, 2023b). It aligns with the overarching goal of the Healthy People 2030 initiative to eliminate health disparities, achieve health equity, and improve health literacy for everyone. Examples of aiming to achieve health equity include providing accessible healthcare services, making medications affordable, promoting health education, addressing language and cultural barriers, expanding health insurance coverage, addressing social determinants of health, conducting research on health disparities, and engaging communities in decision-making processes.
Health Literacy
The ability to obtain, understand, and use information to make medical decisions is known as health literacy. One of the Healthy People 2030 initiative’s overarching goals is to “eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all,” which demonstrates the importance of this concept (Office of Disease Prevention and Health Promotion, 2023c).
The Healthy People 2030 initiative addresses both personal health literacy and organizational health literacy. While personal health literacy focuses on the ability of a single person to comprehend and use health information, organizational health literacy focuses on how an organization can help individuals find and use this information for themselves to make decisions about their health and wellness. The Healthy People 2030 initiative recognizes that personal health literacy is context specific, and that health information and service providers have the responsibility to improve personal health literacy. Examples of aiming to improve individuals’ health literacy include clearly communicating, implementing health education programs, providing multimedia tools, and promoting digital literacy.
Patient Conversations
Importance of Assessing Health Literacy Levels to Provide Effective Education
Scenario: The nurse is educating a newly diagnosed patient with diabetes about making healthy choices. In this scenario, the nurse, Silvia, realizes that her previous teaching efforts were completely misunderstood. Mrs. Harvey has a lower healthcare literacy level than what was assumed.
Nurse: Hello, Mrs. Harvey. How are you?
Patient: Hello there, Silvia. I am ready to go home.
Nurse: Yes ma’am, I hear you. Let’s sit, and I’ll go over your discharge paperwork with you.
Patient: Alright (nodding).
Nurse: So, I know you know about your diabetes and how to check your blood sugar. Today I want to talk about your feet.
Patient: My feet? What about my feet?
Nurse: Well, now that you have diabetes, you will have to have really good foot care. You will have to check your feet every day.
Patient: I can do that. I’ll do it when I get home.
Nurse: Yes, make sure you wear shoes that fit well and aren’t tight on your feet.
Patient: Okay. I can do that. I will definitely do like you said and check my foot for diabetes every day and see if there is diabetes in my shoes too. Do you think it’s in my clothes? I don’t want to have to throw my clothes out. That’s expensive.
Nurse: Oh no, Mrs. Harvey. You are checking your feet for injuries and wounds. Remember, we watched the video on checking to make sure you don’t have any injuries that you can’t feel on your feet.
Patient: Yes, we did watch the video, but if I don’t have anything wrong with my feet, why am I checking them? I thought you said to check my blood sugar. Now you want me to check my feet? Just tell the truth, is the diabetes moving down to my feet now?
Nurse: You know what, Mrs. Harvey? Why don’t I start over and take this step by step with you? I will go over what diabetes is first. Then we can go over what it does to the body, and then I’ll explain what we check for and why.
Patient: Okay, thank you. And can you teach my granddaughter too? She’s coming to see me after lunch today. She’s in that fancy college and is very smart. She’s studying to be a nurse, you know.
Nurse: Yes, I can. I can get everything ready and come back to teach both of you this afternoon.
Social Determinants of Health
The conditions associated with birth, childhood, education, work, play, worship, and aging that impact health, functioning, and quality-of-life outcomes are termed social determinants of health (SDOH). Social determinants of health align with one of the Healthy People 2030’s five overarching goals: “Create social, physical, and economic environments that promote attaining the full potential for health and well-being for all” (Office of Disease Prevention and Health Promotion, 2023d). Social determinants of health have a major impact on people’s health, well-being, and quality of life. They include five domains: economic stability, healthcare access and quality, education access and quality, neighborhood and built environment, and social and community context. Figure 4.2 outlines the five social determinants of health identified by the HHS.
Economic Stability
In the United States, one out of ten people live in poverty, and many cannot afford basic necessities like food, health care, and housing (Semega et al., 2019). As economic stability is a large concern in the United States, one of the Healthy People 2030 goals is to help people earn steady incomes that allow them to meet their health needs. Those who have lower levels of income are less likely to comfortably afford reliable health insurance coverage, preventive care, and resources to support overall health, such as fresh produce. Further, those with lower incomes are more likely to have difficulties paying for expensive treatments or procedures that may be needed.
Steady employment, and thus steady income, can help provide families with financial support for their healthcare needs. A disability, injury, or chronic health condition may make finding or keeping a job difficult for some people, impacting their overall economic stability. To offset these challenges, a variety of employment programs, career counseling, and high-quality childcare services can assist people with finding and keeping jobs. For example, the U.S. Department of Labor supports Job Corps, which provides skills training for those looking for employment. Additionally, programs such as welfare and Head Start help children and families obtain nutrition and medical supplies. Additionally, health, well-being, and poverty can be reduced and improved by policies that help people pay for food, housing, health care, and education.
Healthcare Access and Quality
Approximately 8 percent of Americans lack health insurance coverage, and many people are unable to receive health care (HHS, 2022). One of the Healthy People 2030 goals is to increase access to comprehensive, high-quality healthcare services.
Patients without insurance may have difficulty accessing health care, and they may be unable to afford medications and healthcare services. Strategies to increase rates of insurance coverage of preventive care and treatment for chronic illnesses are important to help more people to get necessary healthcare services. Other factors, such as lacking a primary care provider and transportation to and from healthcare facilities, may hinder people from getting recommended healthcare services. Interventions to increase access to healthcare services and improve in-person or remote communication can help more people obtain the healthcare services they need. Example initiatives aiming to increase healthcare access and quality include offering universal health coverage (e.g., the Affordable Care Act), expanding primary care services, utilizing telehealth, reducing wait times, facilitating health information exchange, fostering cultural competence, and addressing health disparities.
Education Access and Quality
People who have higher education levels are more likely to be healthier and live longer (Raghupathi & Raghupathi, 2020). Adult education, especially post-secondary education, is the most important factor influencing life expectancy and infant mortality (Raghupathi & Raghupathi, 2020). One of the Healthy People 2030 goals is to increase educational opportunities and help children and adolescents do well in school. This foundation for learning will then help those children and adolescents as they move into adulthood.
Numerous families are unable to finance the expense of their children’s college education. Some children reside in areas with underperforming schools. The stress of living in poverty can impact children’s brain development and make it hard for them to do well in school. Interventions that can help children and adolescents do well in school can have long-term health benefits.
Neighborhood and Built Environment
The neighborhoods people live in have a huge impact on their health and well-being. One of the Healthy People 2030 goals is to create neighborhoods and environments that promote health and safety. Example initiatives to create healthy neighborhoods and built environments include creating multiple green spaces (open spaces designated for grass or trees) or parks for residents, allocating food markets and fresh produce markets near residential areas, and providing accessible resources to the community. With healthy neighborhoods and environments, residents can overcome barriers such as transportation or lack of resources. The initiatives can help to promote residents’ health and quality of life (QoL).
Many individuals in the United States reside in neighborhoods with elevated levels of danger, such as high rates of violence or poor-quality air and water. Racial/ethnic minorities and people with low incomes are particularly prone to living in such areas. Moreover, certain individuals are exposed to environmental risk factors that could negatively impact their well-being, including exposure to secondhand smoke or loud noises. To address these issues and promote good health, interventions at the local, state, and national levels are crucial. For example, incorporating bike lanes and sidewalks in community designs can improve safety, promote physical activity, and boost the overall quality of life.
Social and Community Context
Individuals’ relationships and interactions with family, friends, coworkers, and community members can have a major impact on their health and well-being. One of the Healthy People 2030 goals is to increase social and community support.
Individuals sometimes encounter challenges, such as discrimination, financial instability, and living in unsafe areas, which can adversely affect their health and safety. Having positive relationships within one’s family, workplace, and community can help alleviate these negative impacts. However, there are certain groups, such as children with incarcerated parents and bullied adolescents, who lack such support. Bullying can lead to profound psychological distress, social isolation, and compromised physical and mental health outcomes for affected adolescents. Interventions aimed at providing social and community support are essential to improve the overall health and well-being of individuals. Targeted interventions, such as counseling services, mentorship programs, community support groups, and educational initiatives, are needed to provide support and resources for these at-risk populations. Examples of such support and resource services include the Centers for Disease Control and Prevention, the American Psychiatric Association, the Crisis Text Line, and local health departments.