Health determinants and democratic society

Health is a complex term to define and evaluate, which has changed over time.

From the classic concept of health as the absence of disease or infirmity, in 1946 the World Health Organization defined it as the state of complete physical, mental and social well-being. As can be seen, the concept is as broad as it is complex to achieve, similar to what we consider happiness or well-being.

In 1978, at the Alma-Ata conference, a new, more dynamic and measurable concept was established, understanding health as the achievement of the highest possible level of physical, mental, social and functional wellbeing that is permitted by the social factors in which the individual and the community live. Emphasizing individual and collective responsibility in reaching the desired goal.

The current changes in life expectancy are not only due to the great medical advances, both in diagnostic and therapeutic capacity (antibiotics, insulin, vaccinations, surgical advances), but mainly to the socio-economic changes that have taken place in the western world from the hygienic point of view in the availability of clean water, dietary changes, and changes in work.

Already in 1974 M. Lalonde, Canada's Minister of Health, established the following health determinants, which were later analysed in terms of their influence on mortality and health expenditure:

Therefore, personal conduct or behaviour together with the environment is one of the main determinants of health and paradoxically, the one in which the least investment is made.

However, the influence of psychosocial factors is very variable, on the one hand it depends on the way of adapting to the different adverse external circumstances and the degree of one's control, achieving a framework of trust and personal determination. This is what the American sociologist A. Antonovsky calls "sense of coherence" when analysing the influence of chronic stress on health and coping capacity, which determines that when faced with the same conditions of poverty or bad habits, the individual response is fundamental.

In our country, as in the whole of southern Europe, social cuts have a great impact on health indicators in the medium term. The Bertelsmann Stiftung Foundation has established a Social Justice Index which takes into account poverty prevention, equity of access to education, access to the labour market, social cohesion and intergenerational justice.

Spain ranks 21st out of 28, only ahead of Croatia, Latvia, Italy, Greece, falling in only 6 years by 8 places. The European fracture is generating a rich and cohesive north, in contrast to a poor and unequal south, derived from austerity policies (education, labour, health) and which will have medium- to long-term consequences on the health of the populations.

In this context it is not difficult to guess that those groups of people who are more vulnerable, such as the elderly with high rates of poverty, isolation, loneliness will be among the most affected.