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Population Health for Nurses

4.1 Defining Health

Population Health for Nurses4.1 Defining Health

Learning Outcomes

By the end of this section, you should will be able to:

  • 4.1.1 Discuss the different meanings of health.
  • 4.1.2 Formulate a definition of health.
  • 4.1.3 Explain the purpose of measuring health outcomes in a population.

What first comes to mind when you think about health? Many people would describe a healthy person as someone who eats nutritious food, exercises regularly, manages stress, spends time outdoors, and receives adequate rest. 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” (n.d.-a). This holistic perspective considers how many factors are key components of an individual’s well-being. These factors, or determinants of health, include genetics, behavior, environment, physical influences, medical care, and social factors. Modifying one of these factors can have a positive or negative effect on a person’s health. For example, reducing sodium intake may have a positive effect, such as lowering high blood pressure. Conversely, smoking cigarettes may result in a negative consequence, such as increasing the risk of emphysema or lung cancer.

As Social Determinants Affecting Health Outcomes discusses in more depth, additional factors called social determinants of health (SDOH) affect an individual’s health and well-being. SDOH are “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks” (ODPHP, n.d.-j). They include economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context. For example, someone without a social support network or close family connections may feel disconnected from their community, leading to poor mental health.

Social Determinants of Health

This brief video explores some of the practical effects of the social determinants of health. The scenario in the video depicts the ramifications of social differences from a child’s perspective.

Watch the video, and then respond to the following questions.

  1. What characteristics of his community did A. J. identify that could affect his family’s health?
  2. Consider your own community. What social factors are present that you think support the health of your community?
  3. Again, considering your own community, what social determinants exist that negatively affect the community’s health?
  4. What is something you can do to positively influence social conditions in your community?

What Does It Mean to Be Healthy?

How individuals view what it means to be healthy varies depending on how they define health. For example, those who perceive health as complete physical well-being may consider themselves unhealthy if they are diagnosed with a chronic illness like asthma. In contrast, someone with a holistic view of health may consider themselves healthy despite having a chronic condition if the illness does not significantly affect other aspects of their life. Well-being, or the subjective perception that life is going well, is important from a public health perspective, as it is an outcome that can be measured to determine the benefits of disease prevention and health promotion initiatives within a population. Well-being relates to overall life satisfaction and encompasses a range of factors, including physical, social, economic, emotional, and psychological, to name a few (CDC, 2018).

The term health-related quality of life (HRQL), sometimes abbreviated HRQOL, refers to the perceived physical and mental well-being of an individual or population. HRQL, although subjective, can be measured using a variety of surveys and scales (CDC, 2018). A healthy population can satisfy its needs and cope with a range of environments. The health of a population also often depends on the extent to which there is inequality in health outcomes within that population. Populations with the greatest lifespan variation also have the highest mean mortality rates (CDC, 2018; McCartney et al., 2019).

The attainment of health requires access to various resources and is also affected by the SDOH. The WHO and organizations such as the American Heart Association (AHA) and American Diabetes Association (ADA) provide health education designed to address the critical components of health, including access to health care, safe environment and transportation, healthy food and healthy habits, and mental health and social supports (ADA, n.d.; AHA, n.d.; WHO, 2019).

Factors necessary to attain health include the following:

  • Access to health care: Factors such as health insurance and the availability and geographical location of health care facilities affect the health of individuals and communities (Office of Disease Prevention and Health Promotion [ODPHP], n.d.-a). Other factors include health literacy, or the ability to comprehend health information, and trust in the health care system, particularly if there are barriers such as socioeconomic or cultural disparities (CDC, 2023f; WHO, n.d.-c).
  • Safe environment and transportation: The environment has a significant role in the health of individuals and communities. Physical safety; environmental safety, such as safe water; and the accessibility of employment, schools, and recreation all affect the health of community members (WHO, n.d.-c).
  • Healthy food and healthy habits: The availability of healthy food, the ability to properly store food, and the development of healthy food habits all promote health. Other healthy habits, such as refraining from smoking or the harmful use of alcohol and engaging in physical activity, provide additional health benefits. Failure to engage in these healthy habits is a risk factor for many chronic diseases, such as cardiovascular disease and diabetes (ADA, n.d.; AHA, n.d.; WHO, 2019).
  • Mental health and social supports: Mental health issues, such as depression, anxiety, and stress, have a negative effect on health. Individuals with chronic illnesses, such as diabetes, face additional stressors. The presence of social supports, such as family and friends, has positive health benefits. Individuals with chronic diseases, such as diabetes or cardiovascular disease, often benefit from support groups, which promote mental health (ADA, n.d.; AHA, n.d.; WHO, 2019).

What Does Health Mean to You?

In this video from the World Health Organization (WHO), individuals from diverse cultures describe their personal definitions of health.

Watch the video, and then respond to the following questions.

  1. What is your definition of health?
  2. Which characteristics of health do the individuals interviewed mention consistently, if any?
  3. How do their definitions compare to yours?

Health Outcomes

As discussed in What Is Population Health?, population health looks beyond the individual client to consider the health of a group or larger community, as well as environmental, economic, social, behavioral, and other factors that influence health. One way to assess the health of a population is by measuring health outcomes. A health outcome is “a change in the health status of an individual, group or population that is attributable to a planned intervention or series of interventions, regardless of whether such an intervention was intended to change health status” (WHO, 2021a, p. 20). A health outcome related to an individual client would focus on the effectiveness of an intervention for that client. Population health outcomes consider broad topics related to a larger group or target population, such as mortality rates, life expectancy rates, quality of life, the prevalence of chronic conditions, or measures of the frequency of death in a defined population during a specific time interval. Positive health outcomes include being alive with a sense of well-being and an ability to function well mentally, physically, and socially. Negative health outcomes include death, an inability to function, and a lack of well-being. Recall that numerous factors can affect both an individual’s and a population’s health.

Theory in Action

A Grassroots Population Health Initiative

Efforts to improve a community’s health can take all forms and can be driven by everyday citizens, not just by the community’s leaders. Watch the video “Palm Beach County: Co-powering Solutions” to learn more about how a county in Florida “co-powered” its citizens to improve the county’s “culture of health.”

Watch the video, and then respond to the following questions.

  1. How is the West Palm Beach community health initiative addressing mental health issues from a holistic perspective?
  2. What factors did the initiative identify that negatively impact the community’s health?
  3. How did community members participate in identifying desired outcomes?
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