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Healthy Choices

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"The key to National Health Improvement is more people making healthier choices more of the time." Discuss

This essay aims to discuss making healthier choices in the socio-economic context of health. Health and public health will also be defined.

Health has diverse meanings to various people; The World Health Organisation (WHO) defines health as a state of complete physical, mental and social wellbeing, and not only the absence of disease and infirmity. (WHO, 1948) However, this definition has been criticized by many authors (Aggleton 1990, Ewles and Simnet 1999,) for viewing health in static terms, being idealistic and failing to address the concept that health is not just determined by the individual. In addition, Blaxter (1990) defines health negatively, as the absence of illness, functionally as the ability to cope with everyday activities, or positively, as fitness and well-being.

"Public health is the science and art of preventing disease, prolonging life and promoting physical health and efficiency through organized community efforts for the sanitation of the environment, the control of community infections, the education of the individual in principles of personal hygiene, the organization of medical and nursing service for the early diagnosis and preventive treatment of disease, and the development of social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health"(Baggott, 2000a).

Ottawa Charter (1986), states that for people to reach a state of complete physical, mental and social wellbeing, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. The fundamental conditions for health are peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and equity. Similarly various commentators have identified various prerequisites for health to achieve a state of "complete physical, mental and social well-being" such as, adequate shelter, nourishing food, good hygiene practices, clean and abundant water and fuel are essential. (Centres for Disease Control and Prevention, 2002)

Evidence suggests that in many countries, current investment in health is inadequate and often ineffective. Increasing investment for health development requires a truly multi-sectoral approach, including additional resources to education, housing as well as the health sector. Greater investment for health, and re-orientation of existing investments- both within and between countries- has the potential to significantly advance human development, health and quality of life. Investments in health should reflect the needs of certain groups such as women, children, older people, indigenous, poor and marginalized. Jakarta Declaration (WHO, 1997)

Equally important Baggott (2000b) argues that health is a fundamental human right and a social goal. And he further defines Health in appositive sense, in line with the classic WHO definition which includes mental, physical and social wellbeing, not just the absence of illness or disease and suggests that policies should be reoriented to focus on the maintaining and improving health.

There should be consideration of the complex set of cultural, economic, social political and environmental factors, as well as biological and genetic components influences the health and well-being of populations (Annendale, 1998) In addition to that, Wardle et al, (2003a) argues that since healthy lifestyles are likely to benefit health over the long term, then socioeconomic differences in thinking about the future and expectations about the lifespan might affect motivation to maintain healthy lifestyles and awareness of the importance of lifestyle to people would rethink more often about things they could do to stay healthy than would less privileged groups.

Wilkinson (1996a) argues that poverty is bad for health. The lower material standard of living is, as measured by indicators like income the worse the level of health, whether measured by mortality, or quality of life. Socioeconomic differences in health behaviours are associated with a number of factors as a childhood background and education, material hardship, and social integration. Some of these factors are likely to exert to their effects through more proximal determinants of behaviour such as attitudes, motivation, beliefs in health benefits, self efficacy and perceived barriers to healthy choices, all of which are associated with individual differences in health behaviours. (Wardle et al, 2003b)

It is argued that individual lifestyles affect health but social, economic and environ mental factors greatly determine increased risk of disease and adverse outcomes of disease. (Townsend et al, 1988; Harris et al, 1999). Health status is influenced by individual characteristics and behavioural patterns) but continues to be significantly determined by the different social, economic and environmental circumstances of individuals and populations. The relationships between these social factors and health, although easy to observe, are less well understood and much more difficult to act upon. Consequently they have been given much less attention as a basis for Public Health intervention than have individual behaviours in the recent past. (Nutbeam, 2000a)

Anderson (2003a), states that Social determinants of health are societal conditions that affect health and can potentially be altered by social and health policies and programs Such as Social institutions- including cultural and religious institutions, economic systems, and political structures; surroundings- include neighbourhoods, workplaces, towns, cities, and built environments; and social relationships- including position in social hierarchy, differential treatment of social groups, and social networks. Affordable and safe housing, access to culturally competent health care systems, are examples of using social resources to improve health. (Anderson et al, 2002)

According to Hahn et al (1996), apart from the evidence on absolute deprivation, there is growing evidence that the relative distribution of income in a society matters in its own right for the population health and the choices they may make. Rich people might not be able to buy health, but research documenting class inequalities in health demonstrates that they do live longer, and the poor do die, in greater numbers at all ages; and the poor are sicker, too (Wilkinson 1996, Kaplan and Lynch 1997). Socioeconomic inequalities in health persist even in the wealthiest



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