Personal care medicine: Social health

“Health is not just the absence of disease, but a state of complete physical, mental and social well-being” is a well-recognized definition of health as given by the World Health Organization (WHO).

As this definition clearly states, the social contexts of health and disease or “social health” are the conditions in which we live, learn, work and age – the conditions of day-to-day life. These in turn are influenced by the political, social and economic systems of the country. How a person gets along with other people and how do people talk about a person behind his back is also social health.

These social determinants of health are equally important or perhaps even more important in influencing the health and well-being of an individual. For this reason, they have also been called “the causes of the causes”.

The WHO has identified 10 social determinants of health:

1. Social gradient
2. Stress
3. Early life
4. Social exclusion
5. Work
6. Unemployment
7. Social support
8. Addiction
9. Food
10. Transport

Social gradient is measured by variables such as income, education, housing or occupation. 

Education inculcates healthy behaviors. Housing determines better access to healthy foods and health services. Conflicts, gender inequality are also important social determinant of health as they may also influence availability and access to health services.  

Food- and water-borne diseases are due to lack of access to safe food and clean drinking water and poor sanitation. These are more often than not the consequence of poverty or low income, which is associated with poor housing, overcrowding and poor sanitation. So, you may treat that one episode of diarrhea but, the patient who lives in areas of poor housing and sanitation may come back to you with recurrent episodes of diarrheal diseases.

Air pollution is a major environmental risk to health. NCDs, such as cardiovascular diseases including stroke, chronic respiratory diseases and cancers have been linked to outdoor air pollution. Exposure to biomass smoke, or indoor air pollution, is a major risk factor for COPD.

A patient who is struggling to meet his daily needs may not be amenable to advice about lifestyle modifications – quitting smoking, physical activity/exercise, healthy food. These will not be a priority for him. 

Social isolation will only further the condition in a patient of depression.

Persons whom we come in contact with daily, be it family or friends, also influence healthy behaviors. For example, if your family and friends exercise regularly, it is more than likely that you will also pick up this healthy habit. But remember, bad habits are also catching, for example, alcoholism, substance abuse, smoking, etc.

A research published in the May 22, 2008 issue of the New England Journal of Medicine had shown that when one person quits smoking, than others are likely to follow. One person quitting can cause a ripple effect, making others more likely to kick the habit.

• If your spouse stops smoking, you’re 67% less likely to continue smoking.
• If your friend kicks the habit, it’s about 36% less likely that you’ll be smoking.
• When a sibling gives up cigarettes, your risk of smoking decreases by 25%.
• Risk of smoking drops by 34% if a coworker in a small office quits smoking.

So, have positive influences around you. Keep the company or “sangat” of good people to spend time with. Adi Shankaracharya has described Sangat as the main force for living a spiritual life.

India has the double burden of infectious diseases and non communicable diseases, undernutrition and overnutrition (overweight and obesity). This is a reflection of the health inequities in the country.

Therefore, achieving the desired health outcomes is not just dependent on treating the disease alone. Addressing the social determinants of health is equally important, first to achieve the desired results and then to sustain them. A healthy person is more productive and contributes to the growth and development of society.

The concept of “One Health” recognizes that the health of people, animals and the environment are connected. Many diseases in humans or zoonoses are spread from animals.

Treat the person in totality and not just the disease.

As Sir William Osler said, “The good physician treats the disease; the great physician treats the patient who has the disease.”

Dr KK Aggarwal

National President IMA & HCFI