What is the definition of health? Canguilhem argued that “health” should encompass the animate and inanimate environments and the mental, social, and physical dimensions of life. He also stressed the need for a comprehensive definition of health, one that takes the patient into account. This approach places the patient in a position of self-determination. In other words, health is not just the absence of disease, but the management of disease, and not the absence of illness.
In 1948, when the World Health Organization drafted its constitution, life expectancy was only 48 years for men and 53 years for women. Diphtheria and polio were rampant and contributed to low life expectancies. Since then, the world’s health has evolved enormously. In the 1950s, cancer, heart disease, and stroke ranked among the leading causes of death in the developed world. In 2011, these three causes of death had dropped to the bottom three.
Social determinants of health are conditions in one’s environment that contribute to health and disease outcomes. These factors include access to health care, educational attainment, and health behaviors. While health outcomes are influenced by many factors, interaction between individuals and their environment contributes to poor health outcomes. Furthermore, access to health care services and quality of care are also key determinants of health. Healthy People 2020 explicitly addresses these factors in its policy agenda. It also integrates them throughout its topic areas.
The National Bureau of Economic Research defines health systems as organizations with multiple providers. Health systems can be categorized as hospital systems, private nonprofit organizations, or multihospital systems. Regardless of the definition, health care organizations share a common mission in providing health care. They must be patient-centered and integrated, and have a patient-majority governing board. Ultimately, these organizations are responsible for improving the quality of health care in their communities. The definition of a health system is not static; it is continually evolving.
Socioeconomic status affects health outcomes, and individuals with lower SES are more likely to experience stress from daily living, financial challenges, and marriage disruption. This is not to say that poor health outcomes are inevitable. But studies suggest that people of color and lower-income individuals are at greater risk of poor health and suffering from fewer health care services. In addition, a study by KFF/The Undefeated found that people of color reported less favorable experiences in the health care system.