Week 8: Global and planetary health

WHO definition of health 

  • “ A state of complete, mental and social well-being rather than a mere absence of disease or infirmity” 

  • 1984 world health organization expanded and updated the definition to:

  • The extent to which an individual or group is able to realise aspirations and satisfy needs, and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept emphasizing social and personal resources as well as physical capabilities


Canadian timeline 

  • 1971: Health canada long-range planning branch established 

  • 1974: new perspective on the health of canadians (the lalonde report) published 

  • 1978: Health promotion directorate formed within health canada, which initiates a series of government policies to apply the recommendations of the lalonde report

  • 1982: Cabinet approves a permanent health promotion policy and program, resulting in specific initiative dealing with, for ex, tobacco, alcohol, drugs, and nutrition; developmental work in core programs, including school and workplace health, heart health, and child health; and establishment of a national health promotion survey 

  • 1984: “Beyond Health Care” conference sponsored by the toronto board of health, the canadian public health association, and national health and welfare; 2 key health promotion concepts initiated: healthy public policy and the healthy city 

  • 1986: The Epp report, Achieving Health for All: A framework for the health of canadians, is published 

  • 1986: the first international conference on health promotion is held in ottawa in collaboration with the world health organization and the canadian public health association; the ottawa charter for health promotion is issued



 Lalonde Report 

  • 1974

  • Was the first significant government report to suggest that health care services were not the most important determinant of health 

  • After reviewing the evidence the report suggested that there were four “health fields” 

  1. Lifestyle 

  2. Environment

  3. Health care organization 

  4. Human biology 

  • That major improvements in health would result primarily from improvements in lifestyle, environment and our knowledge of human biology 

  • Leads away from the “victim blaming” lifestyle approach to the multi facet community approach 


  • 1986 

  • 200 participants from 38 countries 

  • This conference was primarily a response to growing expectations for a new public health movement around the world 

  • The conference stimulated an open dialogue among health workers. Politicians, academics and representatives of the government. Voluntary and community organizations. 

  • The charter they drew up reflected their individual and collective commitment to the common goal of health for all by year 2000 

  • Became canada's blueprint for achieving the WHO goal of “health for all 2000” 


Ottawa charter: Health promotion 

  • The ottawa charter supported the socio-environmental approach to health 

  • Prerequisites for health 

  • Peace, shelter, education, food, income a stable ecosystem, sustainable resources, social justice and equity 

  • Advocate 

  • Political, economic, social, cultural, environmental, behavioural and biological factors cna all favour health or be harmful to it 

  • Aims at making these conditions favourable through advocacy for health 

  • Enable 

  • Achieving equity in health 

  • Mediate 

  • Coordinated action by all concerned 


The article lists three phases: 

  1. 1960-1970: social awareness (participants were educated on social and health inequities 

  2. 1970-1990: empirical concepts (when evidence base on health inequities and the mechanisms behind then began to solidify) 

  3. 2000-present: distinct research approach ( researching specific area to see how they have changed and are still applicable to the social inequity) 


Major models of health 

  • These approaches lead to different definitions of problems, different strategies, different target groups, and different people responsible for the activities of promoting health 

  • Medical model (traditional) 

  • Represents a stability orientation to health, dominated western thinking for most of the twentieth century. It emphasizes that medical intervention restores health. Health problems are defined primarily as physiological risk factors- physiologically defined characteristics that are precursors to or risk factors for disease. 

  • Ex: CVD, Cancer, HIV/AIDs, CVA, Diabetes. Obesity 

  • Behavioural model (lifestyle) 

  • 1970’s progressing from medical focus to understand what contributed to health and illness 

  • 1974 Lalonde report- shifted emphasis from medical-> behavioural 

  • Defined health determinants (4 health fields) as lifestyle, environment, human biology and organization of health care 

  • Focus on lifestyle behaviours that contribute to chronic disease 

  • Aim to decrease the behavioural risk factors (smoking, lack or exercise, diet) 

  • Responsibility is on the individual to adapt to health- enhancing behaviours 

  • Ex: smoking, poor eating habits, lack of activity , substance abuse, lack of life skills 

  • Socio-environmental (structural) 

  • 1980’s- Health and social structures are linked 

  • Strong relationship between personal health behaviours and social and physical environments

  • Responsibility shifted towards society rather than individual (social justice and equity) 

  • Aligned with upstream thinking 

  • Ex: living and working conditions were perceived as barriers to engaging in healthy behaviours 

  • The ottawa charter for health promotion supported this approach to health  

  • Ex: poverty, unemployment, isolation, pollution, stressors, Hazardous living/working conditions


Health promotion 

  • The process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental, and social wellbeing, an individual or group must be able to identify and to realize aspirations to satisfy needs, and to change or cope with the environment 


Primary, secondary, tertiary prevention

  • Primary prevention 

  • Activities protect against a disease before signs and symptoms occur (pre-pathogenesis stage of disease) 

  • Intent: reduce of eliminate causative risk factors (risk reduction)

  • Ex: encourage exercise and healthy eating to prevent individuals from becoming overweight

  • Secondary prevention

  • Activities promote early detection of disease once pathogenesis has occurred, so that prompt treatment can be initiated to halt disease and limit disability 

  • Intent: early identification (through screening and treatment) 

  • Ex: check body mass index (BMI) at every well checkup to identify individuals who are overweight or obese 

  • Tertiary prevention 

  • Activities are initiated in convalescence stage of disease and are directed toward minimizing residual disability and helping people to productively with limitations 

  • Intent: prevent sequelae (stop bad things from getting worse) 

  • Ex: help obese individuals lose weight to prevent progression to more severe consequences 


What is a population health approach? 

  • Goal: to maintain the health status of groups or communities, and to reduce inequalities between group or within groups 

  • Determinants of health are factors affecting, influencing and having an impact upon population health. 

  • Assessing  a group or community’s health status, data are collected to evaluate the effect of these determinants

  1. A strategy for taking action on health issues and addressing health needs and inequalities, through implementing policies, programs and services 

  2. A conceptual framework for thinking about the health of groups and communities 

  3. An action directed at community, societal or systems levels, to have an impact on population health 

  4. As a collaborative strategy between different sectors and groups with a common goal of maintenance and improvement of health status. 


Assumptions of a population health approach 

  1. Health is a resource for everyday living the determinants of health are key, complex and interrelated 

  2. The focus is upstream 

  3. Health is the business of all 

  4. Evidence guides decision making 

  5. Accountability is increased 

  6. Management of health issues is horizontal 

  7. Involves multiple strategies, settings, systems and sectors 



Achieving health for all: A Framework for health promotion (1986)

  • Commonly called the Epp report (1986) 

  • Concepts from the Ottawa Charter were incorporated 

  • Become Canada’s blueprint for WHO’s “health for all 2000)

  • Identified three major challenges: 

  1. Reducing inequities 

  2. Increasing prevention 

  3. Enhancing coping mechanisms

  • The report acknowledged disparities in health: between low/high income, and that living and working conditions were “social determinants of health” 


Social determinants of health

  • Refers to a specific group of social and economic factors within the broader determinants of health. These relate to an individual’s place in society, such as income, education or employment. Experiences of discrimination, racism and historical trauma are important social determinants of health for certain groups such as indigenous peoples, LGBTQ and black canadians. 

  • These circumstances are shaped by the distribution of money, power and resources at global, national and local levels 

  • The social determinants of health are mostly responsible for health inequalities- the unfair and avoidable differences in health status seen within and between countries (WHO) 



Determinants of health and their relationship to today’s nursing practice

  • Sparks (2010) reported that differential health outcomes are due to social inequalities and actions to improve health outcomes must include actions to reduce those inequities. 

  • WHO commission on social determinants of health, 2007. Identified 3 overarching recommendations to reduce health inequities nationally and globally: 

  1. Improve daily living conditions 

  2. Tackle the unequal distribution of power, money and resources 

  3. Measure and understand the problem and assess the results of action 


Most urgent health challenges from 202- world health organization 

  1. Elevating health in the climate debate 

  2. Delivering health in conflict and crisis 

  3. Making healthcare fairer 

  4. Expanding access to medicines 

  5. Stopping infectious diseases 

  6. Preparing for epidemics 

  7. Protecting people from dangerous products 

  8. Investing in the people who defend out health 

  9. Keeping adolescents safe

  10. Earning public trust


Global health, international, public health 

  • Koplan et al (2009) suggest that global health overlaps with concepts derived from the disciplines of public health, global health, and international health 

  • Each of these domains shares several common characteristics: 

  • A population-based and preventative focus

  • Work with marginalized populations 

  • A focus on multidisciplinary and interdisciplinary approaches 

  • Acknowledgement that health is a public good 

  • An emphasis on systems and structures, and participation with key stakeholders 



Grootijan & Newman (2012): relevance of globalization to nurses 

  • Tw broad characteristics of nursing prac in globalized world

  1. Sustainability for nurses 

  2. social justice and equity and nursing 

  • Three essential attributes of what nurses need to know to practice in globalized world: 

  1. Understand the environment 

  2. Prioritize health promotion 

  3. Response to the globalization of health by including global considerations in their actions locally