Health is always and everywhere

1. Health is Always

Find a window and look out at the scene.

That’s where health happens.

It’s not just when an individual works out at the gym. Or sits down for lunch. And especially not just under the care of a physician.

It happens in those places. And every moment between.

It happens at happy hour with friends. It happens smoking a cigarette. It happens in a place of worship. It happens in the day-to-day mundane or the exceptionally engaging 9–5 of a workday.

Health is always. It’s the outcome of existence.

University of Nebraska Lincoln Wellness Model
University of Nebraska Lincoln Wellness Model

The University of Nebraska’s Wellness Model represents the scope and scale of Health is Always recognition: it’s elements of emotional, physical, social, environmental, occupational, spiritual, and intellectual wellness represent the totality of life.


2. Health is Personal

It’s almost too logical to state. But in a population health world, it’s too important to forget.

No situation better illustrates this reality than that of a 2009 U.S. Preventive Services Task Force recommendation for mammograms, a recommendation made on the basis of population health science. Mammograms for patients under 50 with average breast cancer risk, the USPSTF essentially said, were causing more harm than the potential good that can come from earlier screening.

Whether the science underlying the USPSTF’s 2009 recommendations supported the position mattered little when the news was met by public perception. And this is where the dichotomy of population health meets that of an individual: individuals framed breast cancer screening as a personal issue, not one of a population. Individuals care very little, if at all, about population health.

“What about me?”

That’s the pivot question, asked in a variety of ways and in differing circumstances. It’s the expression of health viewed through the perspective of an individual: Health is Personal.

Determinants of Health: Dahlgren and Whitehead
Determinants of Health: Dahlgren and Whitehead

Health status is determined by contextual factors such as genetics, lifestyle choices, and living conditions as in Dahlgren and Whitehead’s “Determinants of Health” model.


3. Health is Local

Health is Always and Health is Personal lie at the intersection and in the interaction of a long accepted truth: Health is Local. Health is not created by a single healthcare provider, nor the local recreation department, or a community garden in the middle of the city. It’s all of these and everything else.

For those elements of health within the realm of reasonable control (namely everything except age, sex, hereditary factors), the context of local is immensely important to the opportunities (good and bad) available. Those opportunities like where to work, where to attend school, and where to worship. Such as where to meet, where to shop, and where to spend free time. Or the air we breathe, water we drink, and food we eat. Our friends, family, and connections.

Choosing to engage in health-creating behaviors is contingent upon availability; often the most available lies within the communities where we work, live, and play.

In their book Healthy Cities: Promoting Health in the Urban Context Trevor Hancock and Leonard Duhl describe elements of a healthy community:

  • A clean, safe, high-quality environment
  • An ecosystem that is stable now and sustainable in the long term
  • A strong, mutually supportive, and nonexploitative community
  • A high degree of public participation in and control over the decisions affecting one’s life, health, and well-being
  • The meeting of basic needs (food, water, shelter, income, safety, work) for all the city’s people
  • Access to a wide variety of experiences and resources, with the possibility of multiple contacts, interaction, and communication
  • A diverse, vital, and innovative city economy
  • Encouragement of connection with the past, cultural and biological heritage, and other groups and individuals
  • A city form that is compatible with and enhances the preceding parameters and behaviors
  • An optimum level of appropriate public health and sick care services available to all
  • High health status (both high positive health status and low disease status)

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