Survival has always been a human preoccupation – what plants are poisonous? What do we do if a snake bites us? What water is safe to drink?
But survival is not the same as health.
Existing is not the same as thriving, flourishing, and feeling alive.
So what makes us healthy? Sometimes it seems like there could be an entire internet dedicated to this topic.At its core, we can say that being healthy is about more than metrics of blood cholesterol and resting heart rate. Of course, health is deeply connected to our physical bodies. But if the COVID-19 pandemic has shown us anything, its that health is also deeply intertwined with our social lives, our mental and emotional selves, and even our wallets.
This is not to say that we shouldn’t care about the numbers. The thermodynamics of weight loss are not a made up thing. Time under tension creates measurable effects in muscle. And the hours of sleep we get matter for our recovery and performance.
But we also need to understand that these numbers don’t just exist within bodies. They exist within people – whose bodies also contain their curious and inventive minds, emotional hearts, and complicated backstories. And these people live within the larger systems of their communities, workplaces and nations.
In this post, we look at human health from this “systems” perspective, often referred to as the Determinants of Health, and introduce IoM’s applied approach to making meaningful changes in this system.
What are the Determinants of Health?
The Determinants of Health categorizes all the factors that influence an individual’s health. These include both physical and social factors, and most of them are related to an individual’s context or circumstances. Essentially, the determinants of health explains how the conditions of life affect the conditions of health.
To quote from the World Health Organization,
“Many factors combine together to affect the health of individuals and communities. Whether people are healthy or not, is determined by their circumstances and environment. To a large extent, factors such as where we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family all have considerable impacts on health, whereas the more commonly considered factors such as access and use of health care services often have less of an impact.”
The list of factors, as you can imagine, is lengthy. And the system they describe, as with any system, seems so complex it’s hard to know where we can start if we want to help make an impact.
Which is why we’ve written this article. As with most things in health, fitness, and performance – it doesn’t have to be so complicated 🙂
Determinants of Health – Simplified
At the Institute of Motion, we simplify this down to two main categories: the individual and the social.
Individual determinants of Health are the things that reside within each of us as individuals. Our genetics and physiology, sure, but also our behaviours, feelings and social life. We divide these into three “buckets”:
- The optimal functioning, adaptation and resilience within the systems and structures of the body.
- Includes physical activity, eating, and recovery.
- Feeling capable of managing life’s ups and downs, and generally having a positive outlook.
- Includes a person’s thoughts, feelings and actions.
- This is the health and well-being created by feeling connected to other people, our sense of capability in our roles (socially, or occupationally), our sense of contributing (whether in our families, communities or jobs).
- Includes social connection, self-efficacy, and financial stability.
This isn’t an exhaustive description of the three buckets, but a general overview. And you can already see that it would be impossible to perfectly separate any of these “buckets” – if you have a job that involves physical work, you already know how tightly these are all connected.
The Social Determinants of Health are the surrounding elements that affect health access, behaviours and outcomes. We like to think of this as the health “environment,” and it is shaping our choices and behaviours all the time. The CDC has identified 5 main categories for these factors, which we use in our model:
- Healthcare access and quality
- Access to Education
- Neighbourhood and built environment
- Community and social context
- Economic Stability
Social determinants of health affect access and options. They affect our skills and abilities, as knowledge of health behaviours is not something we’re born with. And they affect our health from beyond the sphere of behaviour; the racism, sexism, and economic factors that affect society at large also affect our health individually.
A really simple example is how people tend to drive faster on wider streets – if we see four lanes of traffic, we get moving. Of course, we can choose to respect the speed limit, but it means overriding the suggestion provided by the environment.
But perhaps a more important example is this: In a wealthy neighbourhood with a weekly farmer’s market, it is easy to opt for fresh fruits and vegetables on a regular basis. But in a “food desert” neighbourhood, where the only shop is a mini-mart or bodega and the healthy foods are either not available or too expensive, eating well is not so straightforward.
So, when it comes to our health, we are all individuals with the ability to make choices about our behaviours. But the social aspects are always riding shotgun – shaping our environment and affecting our health outcomes.
Applied approach to Determinants of Health
At IoM, we have long been interested in how big ideas could translate into practical reality. For nearly two decades, we’ve been studying human health and performance as both an individual practice and a perspective from which to shape environments.
Taking an applied approach to the determinants of health means considering this “system” of health, and looking for points at which we can impact the system in positive ways.
This also means evaluating the promoters and disruptors of health that are present, and working towards minimizing disruptors while dialing up promoters.