The concept of health has changed over time, since the World Health Organization (WHO) defined it in 1948 as the state of complete physical mental and social well-being and not only the absence of diseases or conditions 1 . Subsequently Milton Terri defined it as a state of physical, mental and social well-being with the ability to function and not only the absence of disease or disability.
The WHO with the strategy of “Health for all in the year 2000” established that all people have a sufficient level of health so that they can work productively and participate actively in the social life of the community where they live 2 .
Participate Actively in The Social Life of The Community Where They live
Health encompasses subjective aspects (physical, mental and social well-being), objectives (ability to function) and social aspects (adaptation and socially productive work), therefore, it is a resource for daily life, not the objective of life. It is a positive concept that emphasizes social and personal resources, as well as physical abilities.
Health is a fundamental human right, the Ottawa Charter highlights certain prerequisites for health, which include peace, adequate financial and nutritional resources, housing, a stable ecosystem and a sustainable use of resources.
The recognition of these prerequisites reveals the close relationship that exists between social and economic conditions, the physical environment, individual lifestyles and health
Determinants of Health
The determinants of the health status of the population have been subject to the historical contingencies of the human species, ranging from environmental, biological, behavioral, social, economic, labor, cultural factors and, of course, health services as an organized and specialized response to society to prevent disease and restore health.
Marc Blondel, Canadian Minister of Health, in the document New Perspectives on the Health of Canadians (1974), enunciated a model that has had great influence in recent years and that establishes that the health of a community is conditioned by the interaction of four groups of factors.
1. The Environment: which includes factors that affect man’s environment and decisively influence his health, are those related not only to the natural environment, but also and especially to the social environment.
2. Life styles and habits: in which the behaviors and life habits that negatively affect health are considered. These behaviors are formed by personal decisions and by influences from our environment and social group.
3. The health system: understanding as such the set of centers, human resources, economic means, materials and technologies, etc., conditioned by variables such as accessibility, efficiency and effectiveness, centers and resources, as well as good practice and coverage, among others.
4. Human biology: refers to the genetic load and hereditary factors, they acquire great relevance from the advances in genetic engineering achieved in recent years that open other possibilities and that in their positive aspect may prevent genetically known diseases, but that raise questions in the field of bioethics and potential health inequalities given the costs that these practices require.
Social Determinants of Health
In more recent years it has been argued with greater force that social conditions strongly influence the possibility of having good health.
The Commission on Social Determinants of Health (CDSS) of the WHO, in 2008 defined Social Determinants of Health as “the circumstances in which people are born grow live work and age including the health system ”
4 . These circumstances are the result of the distribution of money, power and resources at the global, national and local levels which in turn depends on the policies adopted uneven distribution translates into large differences in health between developed and developing countries.
At the same time within nations there may be marked inequalities between states, regions and localities and even between different population groups.
These differences shape the health status of each individual through their impact on intermediate determinants such as living conditions lifestyles psycho social circumstances behavioral or biological factors and the health system itself.