Features, What The Health

Health, Wealth and Wellness — What’s The Story?

By Elizabeth Serieux PhD, MPH

IN the previous article, published in last Saturday’s issue, we described public health and looked at a very detailed definition of what it is; in a nutshell, the science of promoting, protecting and improving population health. We also briefly mentioned the relationship between health and wealth and, as promised, this week’s article is dedicated to deeper exploration of the relationship among health, wealth and wellness.

I already hear some of you asking, “What’s the difference between health and wellness — aren’t they the same thing?” The answer is that while these words are sometimes used interchangeably, they, in fact, do not mean the same thing. Therefore, before we go any further, let’s address this question.

Health refers to “a state of physical, mental and social wellbeing and not just the absence of disease” whereas wellness, according to the National Wellness Institute, refers to “a conscious, self- directed and evolving process of achieving full potential.” In other words, it is the active process of making choices that will lead us to a better state of health.

Further, there are different dimensions of wellness, the number of which can range anywhere from 5 to 10, depending on the amount of detail required. For our purposes, we will consider wellness as having the following seven dimensions: physical, emotional, social, spiritual, intellectual, occupational, and environmental. Therefore, wellness, overall, refers to the active process of making good decisions/choices in all of those seven dimensions, the end result of which will be good health.

At first glance, the link between health and wealth seems clear; we know that healthy adults are able to work more productively than unhealthy ones and healthier children learn better, stay in school longer and typically earn more when they do enter the workforce. People with more disposable income are typically able to afford more visits to the doctor, which means they are able to catch early warning signs and symptoms of disease and take action.

Part of that action is usually a healthier diet, physical activity and in some cases medication; well, healthier foods usually cost more, physical activity requires a safe environment for outdoor exercise or a gym membership and medication is generally costly. So, those with more income are better able to actively engage in the processes that lead to better health (wellness).

Likewise, children who are well-fed and healthy perform better at school and thus have more opportunities available to them upon leaving while those who go hungry or miss school regularly because of regular illness, perform poorly and have fewer options available to them after graduation (if they even make it that far).

These are only a few examples but the net result is a self-reinforcing paradigm where health is skewed in favour of the wealthy and wealth is skewed in favour of the healthy. Therefore, there is a cycle of cumulative advantage and disadvantage which occurs and one of the most efficient ways to interrupt this cycle is to promote health on a population level.

Research has shown that poor economic and social conditions negatively affect health throughout life. Specifically, people who live in poorer economic and social circumstances have a shorter life expectancy and they experience more disease than people who live in better circumstances. This phenomenon is referred to as the social gradient in health and it exists in the richest of countries, in the poorest of countries and in all those in between.

The undisputed existence of this gradient means that health is not simply a matter of biology or “good genes” but that it is also greatly affected by the everyday conditions in which we live, work and – yes — play. These are collectively referred to as the social determinants of health and they are very important because they identify the causes of ill-health at a population level and provide an excellent starting-point for addressing the social injustice caused by the health gradient.

So, what are these social determinants of health? The following ten areas are usually considered as having the biggest “bang for the buck”: socio-economic status (measured as education level, income, etc.), food, stress, early life conditions, unemployment, conditions of work, social support (or lack thereof), social exclusion, addiction, and transport.

So, while we typically may not associate these areas with our health, they are, in fact, the factors that promote or prevent good health. A close look at these factors reveals that they are related to the dimensions of wellness identified earlier. While we as individuals need to make the best choices we can in our various contexts, it is also clear that our current concept of health systems/healthcare must be expanded and that a cross-sectoral approach must be taken if we are ever to create any lasting improvements in our health and economic status as a nation.

Next week, we will explore the social determinants of health in greater detail.

Thank you for reading. Here’s your homework this week: Think about ways in which you can promote wellness in your family and/or your community and do at least one of the things you thought about. If you want to tell us about it, you can do so at [email protected]

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