What is Health?

What is Health?  

How do you define health? If you ask 100 people to define what health means to them, you might get 100 different answers.  Some might define health as the absence of disease.  Traditional medical training often focuses on specific disease pathways and treatment.  There is a tendency to think about health as the result of individual genetic factors, access to health care, and individual behaviors.  However, there is a great deal of research which shows that health outcomes are much more complex.  Health outcomes are much more a result of our social, environmental and political context.

Life Expectancy by county in the US (White males and females)

In the paper “Eight Americas: Investigating Mortality Disparities across Races, Counties, and Race- Counties in the United States” Murray et al examined eight subgroups of the US population. They defined the “Eight America” based on race, location of the county, income and homicide rates. 

Here is one of their graphs of the life expectancy in different counties in the US for white men and women. For men, the life expectancy ranges from 65.7 to 80.4, a difference of nearly 15 years between various counties.  Researchers have looked at variables such as education, income, employment opportunities, social environments and many other variables to see why such a difference exists.

The authors looked at the mortality of the subgroups for diseases such as HIV, injuries, communicable diseases, chronic disease, and cancer.  What they found was that there were significant mortality disparities that could not be controlled for based on race, income or access to health care.  

Some people say that Americans have the best health.  For a certain subpopulation that statement is correct. When one looks at the different life expectancy based on the “Eight Americas”, Asian Americans tend to have one of the highest life expectancy in the world.  However, when one looks at the other “Eight Americas” you can see that different groups have life expectancy closer to developing countries such as Honduras, Vietnam or Kyrgyzstan. 

Eight Americas and World Life Expectancy

As you can see by looking at the graph above, Asian Americans have the highest life expectancy in the US.  They actually fall just above Japan, the country that ranks third in life expectancy for all countries!  As you move across the “Eight Americas” you can see that most middle Americans have a life expectancy which is about the same as Cuba. High Risk Urban Black Americans have a life expectancy similar to Kyrgyzstan that ranks 146^th out of all the countries. 

Social Determinants of Health

The graphs above highlight health disparities in life expectancy for different populations in the US.  In addition to life expectancy, health disparities exist for health outcomes including diabetes, asthma, anemia, dental cavities, and childhood obesity.  Significant research has looked at different modifiable factors that cause such different outcomes.  These factors are called the “Social Determinants of Health.”

One of the leading researchers examining these differences in health outcomes is Dr. Michael Marmot. His groundbreaking research, The Whitehall Study, showed that there was a social gradient of life expectancy.  There were not just differences between poor and wealthy, but there was a predictable difference of life expectancy based on your social class.  This work has been replicated in other countries such as Canada and the United States. It has profound implications for how we think about health, health inequalities, and how we can improve health outcomes. 

Listen to what Dr. Marmot has to say about the Social Determinants of Health: