What is health?

So far we have discussed how public health progressed through the centuries and predominantly aimed to tackle unhealthy conditions resulting in ill health or death. As public health advanced, its focus and aims extended and the concept of public health was expanded. No longer was, and is, the sole aim to tackle illness and death, but ‘the new public health’ aimed to promote a broader sense of health. In 1948 the World Health Organization was founded, which defines health “as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.

It was a bold definition that allowed focus beyond the physical aspects of health, but offered a more holistic view of health, including the mental and social aspects of health. Underpinning this definition is a view on the societies we live in with all its wider factors that influence health. A healthy society is not one that waits for people to become ill and to then treat them, but a healthy society is one that encourages good wellbeing for all individuals and communities as a whole, and enables and empowers their populations, individuals and communities, to lead healthy and fulfilling lives. This new and much more comprehensive understanding of health, allowed a new direction for public health.

This new direction for public heath led to a historical moment, the Alma-Ata Declaration in 1978 (Declaration of Alma-Ata, 1978), which begins with that definition of health. The Alma Ata Declaration could be perceived as a recognition that health is a fundamental human right and that the ‘attainment of the highest possible level of health is a most important world-wide social goal whose social realisation requires the action of many other social and economic sectors in addition to the health sector’ (WHO, 1978).

The Alma Ata Declaration continued by stating that the gross inequality in health, between low and high income countries but also within countries, is unacceptable and that governments have a responsibility for the health of their people by providing adequate provision of health and social measures. The journey for public health continued and was followed by the Ottawa Charter (First International Conference on Health Promotion, 1986), which was the first International Conference on Health Promotion held in Ottawa, Canada in 1986.

This conference was a response to the growing public health movement with this new direction and a focus on this holistic view of health, and aimed to set out specific actions and commitment to health promotion, underpinned by a social justice and equity principle of ‘health for all’. All these changes led to a new focus in public health and a new understanding of what public health is, and what it should be. Public health has been defined in many differed ways.

One definition is: ‘Public health is the art and science of preventing disease, prolonging life, and promoting health through the organized efforts of society’ (Acheson, 1988; WHO). The Institute of Medicine states that the mission of public health is ‘fulfilling society’s interest in assuring conditions in which people can be healthy’ (Institute of Medicine, 1988). Similarly, the World Health Organization stresses that ‘public health aims to provide maximum benefit for the largest number of people’ (Krug, 2002; WHO). The concerns of society as a whole are always in the forefront of public health, which you can all see now clearly with the public health crisis we are currently in.

Concerns will always keep changing and the methods for addressing the concerns keep expanding, new technologies are developed and global, local and national interventions are becoming a necessary part of public health. Public health is about helping people to stay healthy and protecting them from threats to their health. But not only that. The goal of public health is the biological, physical, and mental well-being of all members of society. Thus, public health must address the challenge of confronting health problems and political, social, cultural and economic factors affecting health, not only at the community, state, and national levels, but at the global level as well (Detels, 2009).