Green, J., Cross, R., Woodall, J. and Tones, K. (2019) Health Promotion: Planning and Strategies. 4th edn. London, Sage. Chapter 1: Health and Health Promotion. This book chapter provides a more in-depth, critical overview of the nature of health, drawing on a number of different perspectives and highlighting the importance of understanding health in order to inform health-promotion programmes.
Duncan, P. (2007) Critical Perspectives on Health. Basingstoke, Palgrave Macmillan. This book addresses the question ‘what is health?’ and critically examines a range of diverse perspectives. It is a useful follow-up to this chapter and explores a number of issues in greater analytical depth than can be achieved here. See part III, Critical Perspectives on Health, for a more in-depth critical discussion about the nature of health.
2 Contemporary Threats to Health
Key learning outcomes
By the end of this chapter you should be able to:
understand how health threats can be conceptualized
analyse how changing patterns of health relate to key societal events
identify contemporary public-health issues within society
Overview
This chapter aims to give an overview of the main issues and challenges in relation to public health in the twenty-first century and to explore the key health ‘issues’ focused upon in the current public-health agenda across the UK and beyond. The importance of these issues is fully discussed at the end of this chapter, but to really understand health within contemporary society, it is essential to be able to identify what the key health issues and challenges are. Therefore, this chapter starts with an exploration of the nature of threats and factors that influence societal decisions about their magnitude. Secondly, changing patterns of health threats are outlined and epidemiological transitions are discussed. Thirdly, current key threats to public health, including both communicable and non-communicable diseases, are examined. Finally, the chapter discusses critically current threats to health such as lifestyle diseases that are inherently socially influenced. For example, illnesses associated with the over-consumption of food and alcohol, the problems of inactivity and sedentary lifestyles and risky behaviours such as unprotected sexual encounters. These issues are also discussed in more depth in chapters 6 and 8. Complete the following learning task, which will help you to think about how you personally perceive and rate health threats.
Learning task 2.1
The significance of health threats
Place in rank order which you think are the most significant threats to health at the current time, where 1 is the most significant and 14 the least significant.
Obesity
Poverty
Climate change
Extreme weather (flash flooding, wildfires)
HIV
Malaria
Unequal societies
Mental illness
Social policy changes – austerity and health-care expenditure cuts
New infectious diseases
Road traffic collisions
Loneliness/social isolation
Depression
Crime
What kind of things influenced your ranking order and decision-making?
You should have seen from the above learning task that deciding what are the most important threats to health is not easy and there are a numbers of factors that can and do influence our decisions. You may have decided to rank topics higher up the scale that affected most people, or based your decisions upon the perceived seriousness or importance of the threats from the list. You could have been influenced by what you read and see in the media on a daily basis when making your decision. A number of factors that can influence both our perceptions and conceptualization of contemporary health threats are outlined in the next section.
Conceptualizing the identifying of threats
Nature and determinants of health
As we have seen in chapter 1, defining what we may see as a threat to health will be intrinsically linked to how we define health. Even the word ‘threat’ is linked to negative, commodity, pathogenic and biomedical concepts of health. Implicit in this discussion is that full health is compromised by a threat and that it can be restored by preventive treatment and curative interventions. If, however, we consider health under more positive and salutogenic (what generates health and well-being, as discussed in chapter 1) conceptual frameworks, then the word ‘threat’ is not as appropriate, as we are concerned with the creation of health not the avoidance of disease, illness and disability (Antonovsky, 1996). Often an understanding of the word health in the popular sense is limited to notions of physical health, with increasing recognition of mental illness, although social and community health is relatively neglected in popular discourses of health (see chapter 9 for a discussion of community as a determinant of health). This can shape what are defined as threats to health.
The COVID-19 pandemic was quickly perceived as a threat to biological health. However, it also uncovered related health threats – such as those relating to mental health – and soon demonstrated the social determinants of health as different groups were affected to varying degrees.
Similarly, if we define the influences on our health as ultimately biological in nature, leading to ill-health and malfunctioning of the healthy physiological state of the body, then the threats will be conceived as factors influencing our biological states. For example, eating too much saturated fat in our diet leads to increased plasma cholesterol, resulting in atherosclerosis and an increased risk of coronary heart disease (Hu, Manson and Willett 2001; NHS, 2017).
However, if we subscribe to the social model of health and acknowledge the importance of socio-economic factors in determining well-being and disease, then we will view threats more broadly and shaped by the social world in which we live (see chapter 4 for a more detailed discussion of how society influences health). Continuing with the previous example and applying the social model of health, we should recognize that the influences on eating high levels of saturated fats are shaped by societal demands for inexpensive, tasty