Concepts of health and its determinants

Rationale

Concepts of health, illness, disease, and the socially defined sick role are fundamental to understanding the health of a community and to applying that knowledge to the patients that a physician serves. With advances in care, the aspirations of patients for good health have expanded, and this has placed new demands on physicians to address issues that are not strictly biomedical in nature. These concepts are also important if the physician is to understand health and illness behavior.

Key Objectives

1. Define and discuss the concepts of health, wellness, illness, disease, and sickness
2. Describe the determinants of health and how they affect the health of a population and the individuals it comprises

Enabling Objectives

As defined by Health Canada and the World Health Organization, the candidate will

1. discuss alternative definitions of health;
2. describe the determinants of health, including
   1. income and social status;
   2. social supports and coping skills;
   3. education and literacy;
   4. employment and working conditions;
   5. social and work environments;
   6. physical environments;
   7. healthy behaviours;
   8. childhood experiences;
   9. biology and genetic endowment;
   10. access to health services;
   11. gender;
   12. culture; and
   13. race/racism; and
3. explain how the differential distribution of health determinants influences health status;
4. explain the possible mechanisms by which determinants influence health status;
5. discuss the concept of life course, natural history of disease, particularly with respect to possible public health and clinical interventions;
6. describe the concept of illness behavior and the way this affects access to health care and adherence to therapeutic recommendations; and
7. discuss how race, culture, and spirituality influence health and health practices, and how they are related to other determinants of health.