1.1 Defining Health and Wellness

Some of these factors are outside of your control: genetics, family history, age, gender, race, and sexual orientation. You have the power to modify other factors: beliefs and values, resiliency, coping skills, financial resources, education, health literacy, and health-related behaviors (diet, physical activity, sleep, substance use, sexual behaviors).

Relationships include formal and informal social networks: family members, friends, roommates, classmates, coworkers, clubs, and support groups. Social support benefits health, particularly when friends and peers model and encourage health-promoting behaviors. In contrast, discord and violence undermine health; so does associating closely with people who abuse substances, engage in risky sexual behaviors, have consistently unhealthy diets, and disdain physical exercise.

Resources include the quality of neighborhoods, schools, religious institutions, housing, clinics and hospitals, parks and recreation centers, workplaces, air and water, and transportation. The cohesiveness of community members also figures in. In a pivotal examination of the health determinants, J. Michael McGinnis and colleagues wrote, “Our genetic predispositions affect the health care we need, and our social circumstances affect the health care we receive.”

Society and culture establish norms and attitudes about health-related issues such as diet, physical activity levels, body weight, smoking, substance abuse, sexuality, and violence. Intolerance and inequality based on gender, age, race/ethnicity, and sexual preference socially and economically marginalize those groups. The country’s overall economic health influences employment rates as well as the funding of social services, education, and health care. Environmental conditions directly impact health. Public health policies (public smoking bans, gun-control laws, seatbelt laws, universal vaccination, health insurance mandates) affect whole populations.

You inherit your genes from your biological parents. Your family also powerfully shapes your attitudes, values, eating habits, physical activity patterns, methods of managing stress, and social skills. Healthy families support and love one another, share responsibilities, eat together, enjoy leisure activities together, and don’t abuse substances. Well-nurtured children have better health and survival rates than those who face adversity.

Educational level predicts health and longevity. Surveys show that college graduates are twice as likely as those who hadn’t graduated from high school to be in excellent health. Among people aged 45 to 64, the death rate for those with the highest level of education is 2.5 times lower than for people with the lowest education.

Education helps to close the racial-disparity gap between whites and nonwhites. One study found that, compared with whites with less than 12 years of education, blacks and Hispanics with 16 years of education lived an additional 7.5 and 13.6 years, respectively. Persistent racial discrimination and a two-tiered education system probably explain why most educated white men outlived the least educated black men by 14.2 years. The gap was 10.3 years for highly educated white women versus less educated black women. Death rates for those with higher levels of education are decreasing, whereas death rates for those with lower levels of education have remained steady or have increased.

Nevertheless, education promotes health for multiple reasons. Higher educational attainment correlates with better jobs, higher income, higher social status, health insurance coverage, less smoking, more physical activity, and less obesity. Taking a class in personal health gives you many tools and increases your health literacy, your ability to locate and understand health information, to obtain health services and to make informed health care decisions. Greater health literacy is linked to a reduced risk of hospitalizations, emergency room visits, and deaths.

Poverty contributes to an estimated 6 percent of mortalityDeath. (death). Income inequality (the difference in income between the richest and the poorest citizens) has widened over recent decades. For every 1 percent increase in income inequality, mortality rates rise 0.4 for those at the bottom. Possibly more important than absolute income level is how poor you feel. Feeling poor is stressful, which is bad for your health. Relative to more affluent neighborhoods, poor neighborhoods tend to have higher crime, worse pollution, suboptimal schools, scarcer grocery stores, and fewer parks and other green spaces—all of which undermine health and well-being.

RaceCategories of humans based largely upon physical characteristics. refers to categories of people based largely upon physical appearance: the color of skin, hair, and eyes and the shape of the nose, eyes, and jaw. Ancestry influences these appearances. Ancestry also shapes ethnicityRefers to groups of people defined by their culture, traditions, nationality, or ancestry., as do culture, nationality, language, traditions, and beliefs. While race is inherited, ethnicity is acquired. Any given race contains a host of ethnic groups. People who look white may identify with entirely different ethnic groups: Scandinavian, Australian, New Englanders, and so on. People with brown skin might fit into the pigeonhole for Hispanic yet be Dominican, Puerto Rican, Cuban, Spanish, or Brazilian.

The racial divisions used by the U.S. Census Bureau are white, black (African American), American Indian or Alaskan Native (also called Native Americans), and Asian (also called Asian American), Native Hawaiian, or Other Pacific Islander. Multiracial refers to a blend of two or more races.

Ethnicity affects health by influencing dietary patterns and attitudes toward education, substance use, physical activity, and health care. Only a few diseases fall along racial lines. For example, sickle cell disease mainly affects people of African and Mediterranean descent; cystic fibrosis tends to affect people of Northern European ancestry. Note that race is largely based on superficial biological characteristics. Of the genetic variation among humans, there’s far more variation within a continental group (e.g., Africans, Asians, Europeans) than between one race and another.

Nevertheless race contributes significantly to health disparities. Life expectancy at birth is 86.5 years for Asian-Americans, 82.8 years for Hispanics, 78.9 years for whites, 76.9 years for Native Americans, and 74.6 years for blacks (African-Americans). To survive into ripe old age, you need to make it out of childhood. In 2011, the infant mortality rate was more than twice as high for blacks as for whites, primarily due to premature birth. 

Causes of death and disease prevalence vary by race. For instance, in 2015 the number one cause of death in whites, blacks, and American Indians was heart disease. For Hispanics and Asian/Pacific Islanders, cancer is the top killer. Hispanics are more vulnerable to diabetes, blacks to stroke, and whites to Alzheimer’s disease. Relatively more deaths from accidents, liver disease, and diabetes affect American Indians and Alaska Natives.

A number of factors contribute to race-related health disparities. At the top of the list is racism, a bias toward or against members of a particular race. The presumption is that one race is somehow better or worse than another. Ungrounded stereotypes take root. Discrimination based on race hinders upward mobility among social classes and undermines health. Marginalization is stressful. Language barriers can further hamper the success of immigrants.

Underprivileged racial minorities more often live in poor neighborhoods marred by substance use, violence, substandard housing, and suboptimal schools. Green spaces, parks, recreation centers, and grocery stores (stocked with fresh produce) are often in short supply. Access to health care may be limited. Some experts believe that social conditions are the main causes of racial health disparities and far outweigh biological risk factors and access to medical technology.

Sex is biologically based. The World Health Organization defines gender as “the socially constructed roles, behaviors, activities, and attributes that a given society considers appropriate for men and women.” American women outlive men by five years. Life expectancy for a girl born in 2015 was 81.2 years versus 76.3 years for a boy. A complex interplay of biological and cultural differences contributes to this difference. Hormonal differences affect vulnerabilities to certain illnesses. Women are more likely to suffer from depression and osteoporosis (brittle bones). Men are more likely to die from accidents and violence. Women more often consult with health professionals for preventive care and sick care. Chapter 6 “Social and Gender Health” will discuss theories about gender-based health disparities in more detail.

Conventional medical care has a limited effect on people’s health. Insufficient medical care accounts for an estimated 10 percent of deaths. Researchers and scientists predict that, as the population continues to age (and requires more medical care), that number will rise. Older people tend to have more diseases, many of which can be managed by medical treatment. No matter one’s age, medical treatment can be lifesaving, particularly in the face of overwhelming infection or traumatic injury. Vaccinations prevent many infections that once cut life short. Medical technology helps diagnose and promptly treat many diseases.

On the other hand, medical care sometimes causes harm. A landmark 1999 study from the Institute of Medicine reported that as many as 98,000 people die each year from medical errors—more than deaths from car crashes, AIDS, and breast cancer. A 2016 study revealed that the problem was perhaps even worse. One out of three hospital patients in the United States experienced a medical error. Examples include hospital-acquired infections, adverse drug reactions, surgical injuries, and surgeries on the wrong site.

Modifiable lifestyle patterns contribute to an estimated 20-40 percent of deaths. Each day, you make important decisions about diet, physical activity, substance use, and sex. You decide how you’ll handle life’s curveballs, whether you stress out or view them as challenges to master. You budget how much time you make for sleep and socializing.

Four unhealthy behaviors—lack of physical activity, poor diet, tobacco use, and excessive alcohol consumption—cause most of the illness and death related to chronic diseases. A British study tracked the impact on longevity of those four health behaviors over a span of eleven years. People with the lowest scores (smoked, didn’t exercise, drank too much, and didn’t consume at least five servings of fruit and vegetables a day) had four times the risk of dying relative to their peers who made the healthiest choices.