Wednesday, 27 April 2011

Health as a social dynamic

Richard Eckersley

A neglected attribute of population health is that it is an important dynamic in the functioning of societies. Typically, public-health reports express this role in terms of the direct and indirect economic costs of poor health (that is, the costs of health care and lost productivity), with some acknowledgement of the social costs to individuals, families and communities. But these effects are just one part of a bigger, more complex, picture.

Poor health, both physical and mental, affects people in many life roles – as students, workers, parents and citizens. These impacts are not only the result of clinically significant health problems (which, nonetheless, affect substantial segments of the population). High rates of illness, especially mental illness, also reflect public mood, morale and vitality. Poor population health weakens a society's confidence and resilience, and so its capacity to deal with the challenges of the modern world. And this, in turn, further impacts on population health.

This is not widely appreciated. A false dichotomy often characterises debate and discussion about national and international affairs. On the one hand, these matters are seen as shaped by large, external forces such as economic development, technological change, environmental degradation and resource depletion, and war and conflict. Population health may be affected by these forces, but health itself is not usually seen as a contributor to larger-scale social developments. The perspectives of economics, politics and the environment dominate the discourse. On the other hand, considerations of health focus on internal, psychological and physiological processes and personal attributes, circumstances, behaviours and experiences. The dominant frame of reference is the biomedical model of health as an attribute or property of individuals, as discussed above.

This separation is misleading. The reality is that change in both social and personal, external and internal, worlds is shaped by a complex interplay between them. Understanding this interplay is important to comprehending what is happening in both realms. In other words, human ‘subjectivity’ plays an important part in the functioning of social systems; it is what most distinguishes them from other, biophysical systems. Health is not just an individual illness that requires treatment, but also an issue having national, even global, causes and consequences.

Health is a way of better understanding humanity and how people should live. Just as someone who is unwell will be less able to function effectively and withstand adversity, so too will a less healthy population make a less resilient society. Population health may be an important factor in determining whether societies respond effectively to adversity – or in ways that make the situation worse. In particular, mental health and morale could have a critical bearing on how societies cope with climate change and other 21st Century global threats.

Population health perspectives can make an important contribution to sustainable development and the quest for a high, equitable and enduring quality of life: they provide a means of integrating, balancing and reconciling different social priorities by allowing them to be measured against a common goal or benchmark: improving human health and wellbeing. Population health is, then, a key element of achieving a socially, economically and environmentally sustainable way of living - humanity’s greatest challenge.

This is an edited extract from:
Eckersley R. 2011. The science and politics of population health: giving health a greater role in public policy. WebmedCentral PUBLIC HEALTH 2011; 2(3):WMC001697

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