SHE defines health broadly and positively but also includes a 'settings approach'.
A 'settings approach' orginates from the idea that 'Health is created in places where people ‘live, love, learn, work and play (Ottawa charter).1’
Consequently, actions to improve and sustain health should consider these settings e.g. the school environment and therefore the importance of creating Health Promoting Schools (HPS).
To understand SHE’s definition of health the following historical facts can be useful.
- In 1946, the World Health Organisation2 defined health as a combination of physical, mental, and social wellbeing and a fundamental human right in a democratic and just society. This was the start of recognizing that a broader definition of health was important.
- The more traditional, older medical definition of health focused on why people became ill, what the risk factors were, and how these factors can be avoided. This definition resulted in what Crawford in 19773 called “blaming the victim” which attributes illness primarily to an individual’s lifestyle (choice in relation to nutrition, exercise, alcohol, and smoking) while neglecting other factors such as inequality and a person’s living conditions.
- In 1979, health was defined particularly positively by Aaron Antonovsky4. This definition of health focused on what kept people healthy. Comprehensibility, manageability, and meaningfulness were the 3 essential components in his understanding of health. The combination of these factors provides people with a “sense of coherence” essential to maintaining health.
- Health can also be defined as an individual’s sense of being (physical, psychological, and spiritual), becoming (work, learning, leisure) and belonging (social, relational, and working environment). This model5 can be helpful for teachers for example working with social relations (belonging), school achievement, and feeling of success of each student (becoming), or with guiding students to initiate positive changes in the school environment (being).
1. Ottawa Charter for Health Promotion, Department of Health Promotion, NCD Prevention and Surveillance (HPS), World Health Organization, Geneva
2. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.
3. Crawford, R. (1977). You are Dangerous to Your Health: The Ideology and Politics of Victim Blaming. International Journal of Health Services, 7(4), 663–680. https://doi.org/10.2190/YU77-T7B1-EN9X-G0PN
4. Antonovsky, A. (1979). Health, stress, and coping. San Francisco: Jossey-Bass.
5. Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard University Press.