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The Definition of Health and Why It Matters for Health Equity

Why It Matters

When you work in health care, it can be easy to believe that health happens when a person comes into a clinic or a hospital.
The Definition of Health and Why It Matters for Health Equity

Photo by Markus Spiske | Unsplash

When it comes to forming our deepest beliefs about health, context matters. This became clear to me at the start one of the first courses I ever taught on US health policy. The class was full of graduate students who were already health care professionals.

I had been welcoming the class and introducing myself. I was maybe 30 seconds in when a student put their hand up. When I called on them, they said, “What you said was pretty radical.”

I did a quick review in my mind. Was I too enthusiastic? Was I unclear? I could not understand the remark. “Could you tell me what I said that was radical?” I asked.

“You said that health care was a right.”

I was completely astounded. I paused. I then addressed the rest of the class of about 40 or so students. “Is there anybody else who feels that saying that health is a right is radical?” There were about 10 to 15 students who raised their hands.

Two things happened in that moment. First, I realized that I had incorrectly believed that a class full of health care professionals would agree with my statement. Second, I was heartbroken to be having such a conversation. Coming from Canada — where I grew up, was educated, practiced, and taught — I had never encountered such a striking ideological difference among a group of health care professionals. Was it because the system of care in which I had been so deeply immersed was guaranteed through the Canada Health Act? Did my privilege of being socialized to believe in a right to health keep me from recognizing that this belief is not as widely held as I assumed?

I took a deep breath and said, “I have some assumptions that we are going to unpack.” I closed my lesson plan, and we spent the next several hours in deep conversation to learn from each other and explore this whole notion of health as a right.

Defining Health

As the experience in my class demonstrates, we can often use a word that seems so simple — like health — and not realize we do not have a shared understanding of what it means. For me, health is a state that is dynamic. It transcends location. It is more than just the absence of disease. It is interconnected with everything that we are, everything that we do, and everything that we would like to be. It is an act of human liberation and justice-making centered on what it means to the individual and their community.

Health is social and environmental. It is strengths- and asset-based. It is also determined by context, conditions, culture, and so many other factors. If you pay close enough attention, you can see the pulse of health in almost everything. If you look even closer, you can also see the absence of health in many disparities and inequities. You see equity gaps in housing, access to food, and income. They permeate systems ranging from education to criminal justice. When you see enough of them, in so many places and in so many populations, you cannot unsee what you saw, and you cannot unknow what you know.

Living within the context of the United States has increased my passion and sense of urgency to achieve structural and system change. While there are many system flaws in Canada and elsewhere, seeing a system where the most basic of health is not afforded to everyone regardless of their ability to pay has deepened my convictions.

I believe that health is a right because how can you fully enjoy other rights without health? Health is also about justice. Without justice in health, efforts to achieve health and health equity are stifled.

The Power of Getting Proximate

To help my students understand the links between health, equity, and justice, I had to help them understand our context. I invited someone from the Office of Human Rights to come in and talk about the national and state landscape, including the history of our city and of our institution within the community.

I then took the students out of the classroom to immerse them within the community. I wanted them to experience school without walls, and let community expertise guide their approaches, priorities, and programs. I wanted them to have bi-directional learning and relational experiences.

When you work in health care — as these students did — it can be easy to believe that health happens when a person comes into a health space, like a clinic or a hospital. So, I took them from those settings so they could start to connect the dots between health and where people live their lives because that is where health happens. Health happens at home. Health happens in the community. Health happens in schools. It happens everywhere.

The people we met in the community talked about why they could not (or would not) access traditional health care. They spoke of their distrust of the health care system and the history that created that distrust. The students learned things that I could never teach from a textbook. It made what we were talking about in class real. It humanized the lived experience and recentered the expertise of the community in their health. It brought the students proximal to the issues and closer to understanding health and reimagining what it could be.

In class, I taught them about aspirational health resolutions, policies, and commitments that support a reoriented understanding of health. I went back to foundational documents, such as the 1948 United Nations Declaration of Human Rights, to expand their understanding of health. I read them Article 25:

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

I talked about how member countries (including the United States) drafted and voted to adopt the Declaration. Many of the students had never heard of it. After spending time in the community, they started to ask, “So, this right has been codified. What are we doing about it?” It is a good question. It is the question.

I believe more of us working in health care need to better understand the structures and systems that are important in creating health. These include where people live, work, and learn and not only where they get their health care. I believe we must create new structures to intentionally deliver equity and just care instead of only trying to work in obdurate structures that were never designed for equity and justice.

I love working in health care, and I am unreasonably convinced that — despite all evidence to the contrary — that we can do better and be better in this country regarding health. Horace Mann said you should “be ashamed to die until you have won some victory for humanity.” What better victory could there be for humanity than affording every individual the right to health in ways that honor culture, co-creation, and liberation?

Camille Burnett, PhD, MPA, APHN-BC, BScN, RN, DSW, FAAN, CGNC, is the Institute for Healthcare Improvement (IHI) Vice President, Health Equity and faculty for the IHI Leadership for Health Equity Professional Development Program.

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