229. CCA Study Notes: Health, Wellness, and Factors That Influence Health

The Big Picture

Health means more than being free from disease. A person’s well-being involves the body, emotions, relationships, thinking, and sense of meaning or purpose.

These parts of health affect one another. A person might have a disease or disability and still experience a high level of wellness. Someone in excellent physical condition might struggle in other areas of life.

Health also depends on factors outside personal choice. Income, work, education, social support, environment, access to health services, biology, culture, and other conditions all influence health.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

How the Meaning of Health Changed

In the late 1800s, people often viewed health as simply not being sick. Infectious diseases ⓘ such as pneumonia, tuberculosis, and influenza caused many deaths.

During the first half of the twentieth century, vaccinations, antibiotics, health education, and cleaner living conditions reduced the spread of disease. People lived longer and experienced illness less often.

Later views of health became broader. Health began to focus on the whole person and the many factors that affect well-being.

A widely accepted view of health includes physical, mental, and social well-being. It goes beyond simply having no disease or infirmity ⓘ.

The WHO also recognizes health as including the ability to lead a socially and economically productive life.

Holistic Health Looks at the Whole Person

Holism means looking at the whole person rather than focusing on one part of health.

The five dimensions are:

1. Physical
2. Emotional
3. Social
4. Spiritual
5. Cognitive

Each dimension connects with the others.

Psychosocial health refers to well-being in the social, emotional, intellectual, and spiritual parts of life.

Holistic health care considers psychosocial well-being together with physical health.

Physical Health

Physical health means well-being in the physical dimension. The body is strong, fit, and free from disease.

Genetics and lifestyle both influence physical health.

Factors that support physical health include:

• eating nutritious foods
• exercising regularly
• living in a smoke-free environment
• drinking alcohol moderately or not at all
• getting a good night’s sleep
• maintaining optimal body weight according to body mass index
• following safety practices
• seeking medical attention when needed

For example, support workers help ensure a clean, safe, and comfortable environment, may prepare nutritious meals, and may assist clients with physical activity.

Emotional Health

Emotional health involves functioning well and adapting to life circumstances. It does not mean never having negative emotions.

Emotionally healthy people tend to feel good about themselves. They show self-esteem, self-control, and self-awareness. They also give and receive from others without constant fear of rejection or hurt.

Emotional health changes throughout life. Loss, illness, suffering, and other difficult events affect emotional well-being, even in people who previously had strong emotional health.

Some people with poor emotional health experience depression, insecurity, or feelings that overwhelm them. Upset feelings sometimes appear as aggression.

CCA action: Pay attention to a client’s emotions and respond with care.

Avoid: Do not judge a client because their mood or behaviour changes. A person who usually seems cheerful might sometimes become irritable.

Social Health

Social health means well-being through stable and satisfying relationships.

Strong social health includes respectful, warm, and open relationships. Social health often changes throughout life.

Isolation and loneliness affect many people, including:

• older people
• people who lose partners, friends, or other relationships
• newcomers living in unfamiliar surroundings
• people facing language barriers

People often rely on others for practical and emotional needs. These needs include companionship, belonging, comfort, encouragement, reassurance, guidance, advice, and practical help.

Social Support Systems

A social support system is an informal group of people who help one another or help others outside the group.

Social support contributes to overall health.

Social support may be as important to wellness as a nutritious diet, a smoke-free environment, and regular exercise.

Support systems provide different forms of help, including food, housing, financial assistance, and emotional support during crises.

Strong support sometimes helps people who are ill or frail remain at home instead of moving into a live-in facility ⓘ. Social support also supports some people living with dementia who remain at home longer.

Support workers sometimes form an important part of a client’s social support system. Their support includes help with activities of daily living, home management, and compassionate emotional support.

Spiritual Health

Spiritual health involves belief in a purpose greater than oneself.

Spirituality does not require membership in an organized religion or belief in a higher being. For some people, religion plays a central role in spiritual health.

Spiritual health often includes:

• a sense that life has meaning
• beliefs about right and wrong
• behaviour that reflects those beliefs
• concern with personal fulfillment
• compassion
• honesty
• humility
• forgiveness
• charity

People express spirituality in different ways. Culture also influences spiritual expression.

CCA action: Respect each client’s expression of spirituality.

In a live-in facility, a support worker might have responsibility for transporting a client to a religious service within the building. When assigned this responsibility, the worker should arrive on time.

In a private home, religious or spiritual symbols might appear throughout the home.

Always: Treat those items with respect.

Indigenous Perspectives on Health and Spirituality

Traditional Indigenous perspectives described in this topic connect health closely with spirituality. Harmony among mind, body, and spirit holds an important place in these traditions.

Many Indigenous people combine traditional knowledge with modern health practices.

First Nations ⓘ perspectives described here also emphasize balance, interconnectedness, nature, spirituality, family, community, culture, and relationships with creation.

Cognitive Health

Cognitive health means well-being in the intellectual dimension through an active and creative mind.

Cognitively healthy people often:

• stay curious
• take an interest in events around them
• analyze information
• reason
• solve problems
• remain open-minded
• keep learning

People facing cognitive health challenges sometimes withdraw from events or relationships. Some feel embarrassed about changes in thinking, reasoning, or communication. Others experience confusion about events around them.

The source of cognitive challenges matters. Most people with cognitive health challenges experience these changes because of declining overall health, not because of their lifestyle.

Live-in facilities often offer recreational programs that support cognitive and social health. Activities that keep the mind active include reading, crossword puzzles, indoor plants, crafts, knitting, games, and outings.

CCA action: Encourage clients to take part in suitable activities and talk with them about community and world events.

Health Is Influenced by More Than Personal Choice

Some factors affecting health sit outside a person’s immediate control.

A person might follow healthy practices and still experience serious illness because of an inherited condition. A person or community also faces health effects from living near environmental hazards or far from needed health services.

Differences in health status between individuals or groups are called health inequalities.

Health depends on both individual health practices and broader living conditions.

Determinants of Health

Determinants of health are major factors that influence health status in individuals and communities.

They include personal, social, economic, biological, and environmental influences. These factors interact with one another.

Canada identifies these 12 determinants of health:

1. Income and social status
2. Employment and working conditions
3. Education and literacy
4. Childhood experiences
5. Physical environments
6. Social supports and coping skills ⓘ
7. Healthy behaviours
8. Access to health services
9. Biology and genetic endowment
10. Gender
11. Culture
12. Race/Racism

How Determinants Affect Health

Income and social status influence living conditions. Higher income supports access to needs such as safe housing and sufficient nutritious food.

Education supports knowledge and problem-solving skills. It also connects with job opportunities, income security, job satisfaction, and the ability to find and understand health information.

Employment conditions affect health too. Unemployment, underemployment ⓘ, stressful work, and unsafe work are associated with poorer health.

Social support from family, friends, communities, and broader social networks contributes to well-being. These relationships help people solve problems, cope with challenges, and maintain a sense of control.

Physical Environments and Environmental Health

Physical environments include both natural and human-made surroundings.

Environmental health deals with physical, chemical, and biological factors outside the person, along with related factors that influence behaviour.

Examples of environmental influences include:

• air quality
• noise
• soil conditions
• water conditions
• climate
• safety hazards
• pests

Reducing harmful environmental influences gives people and communities a better opportunity for good health.

Childhood, Biology, and Health Services

A young person’s development is influenced by several conditions, including housing, neighbourhood, family income, parents’ education, nutritious food, physical recreation, genetics, and access to dental and medical care.

Biology and genetic endowment also affect health. Genetic factors influence individual responses and sometimes increase a person’s tendency toward particular diseases or health problems.

Health services contribute to population health through efforts that maintain and promote health, prevent disease, and restore health and function.

Gender and Culture

Gender refers to socially assigned roles, traits, attitudes, behaviours, values, power, and influence associated with the sexes. Gender-related social roles and status influence health issues and health-system practices.

Culture also influences health. People whose cultural practices differ from dominant practices sometimes experience marginalization ⓘ, devaluation of their language and culture, and reduced access to culturally appropriate health services.

Canada and the WHO Use Different Lists

The World Health Organization identifies a different set of 10 global social determinants:

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

Difference: Canada’s list and the World Health Organization’s list are not identical.

Optimal Health and Wellness

Optimal health means reaching the highest achievable level of well-being in all five dimensions.

Wellness means achieving the best health possible across all dimensions of life.

Wellness does not require perfect health in every area at all times. Everyone experiences periods of illness, stress, or difficulty.

Seeking wellness lasts throughout life. It involves choices that improve quality of life and support growth across different areas of well-being.

A disease or disability does not automatically prevent a person from experiencing high wellness. A person might manage an illness, feel good about themselves, maintain strong relationships, keep an active mind, and find meaning in life.

The opposite situation also occurs. Excellent physical health alone does not equal wellness when emotional or social well-being suffers.

The Health Continuum

Health exists on a continuum.

At one end sits optimal health or wellness. At the other end sits extreme ill health.

A person’s position changes throughout life. Life circumstances and the person’s adjustment to those circumstances influence movement along the continuum.

Key fact: Health does not stay constant throughout life.

Culture, Illness, Disability, and Respect

Cultures have viewed illness, disability, aging, and social contribution differently throughout history.

Some societies have treated older and sick people with care and respect. Others have isolated or mistreated people who did not meet accepted social expectations.

Respect for human differences remains an important principle in Canadian society.

Five Personal Factors That Influence Health

Along with broader determinants, personal factors also influence health.

The five main personal factors described here are:

1. Personal lifestyle choices
2. Stress
3. Personal beliefs about health care
4. Social relationships and belonging
5. Sense of control

1. Personal Lifestyle Choices

Knowledge and education influence health choices. People sometimes learn habits from family members and carry those habits into later life.

Health care workers should have healthy habits regarding alcohol use and recreational drug use.

Number to remember: More than two alcoholic drinks a day is harmful for most people. Women who have more than 10 drinks a week have higher rates of cancer and other health problems than women who drink less. Men who have more than 15 drinks a week have higher rates of alcohol-related health problems.

2. Stress

Everyone experiences stress. The way a person responds to stress influences long-term health.

Examples of unhealthy responses include excessive alcohol use and cigarette smoking. Examples of healthier responses described here include jogging and meditation.

3. Personal Beliefs About Health Care

Beliefs and personal choices influence health decisions.

They influence whether a person seeks medical treatment, takes prescribed medication, uses herbal or nonmedicinal supplements, or accepts care from someone outside the family.

Beliefs also influence when and how a person accepts care.

Culture shapes many of these beliefs. Different approaches to health and healing place importance on different parts of the person, family, community, culture, nature, and spirituality.

4. Social Relationships and Belonging

Most people want acceptance and belonging.

Pressure from other people sometimes influences unhealthy choices. A person might take part in behaviour they would otherwise avoid because they fear rejection or want to remain part of a group.

This shows how relationships influence personal health choices.

5. Sense of Control

A person who feels powerless sometimes follows other people’s choices instead of making independent health decisions.

Personal empowerment means understanding and accepting that you have the ability to make your own healthy lifestyle choices without letting other people control those decisions.

Personal empowerment supports healthier decision-making.

Attitude and Health Choices

An attitude is a person’s beliefs, values, or opinions about taking part in healthy behaviours.

Attitude influences the choices a person makes about health. Knowledge, beliefs, relationships, stress, and sense of control also shape those choices.

Primary Prevention

Primary prevention strategies aim to prevent disease or illness by reducing the risk factors that cause it.

The focus sits on preventing the underlying cause rather than only treating illness after it develops.

For example, when many children in one community develop the same type of cancer, treating individual cancers does not remove the underlying cause. Primary prevention focuses on reducing or removing the risk factor responsible for the disease.

Common Mix-Ups

Wrong Idea	Better Idea
Health only means being free from disease.	Health includes well-being across several dimensions of life.
Excellent physical health automatically means wellness.	Wellness involves all five dimensions of health.
A disease or disability prevents high wellness.	A person with disease or disability still might reach a high level of wellness.
Personal choices fully determine health.	Personal and broader social, economic, biological, and environmental factors influence health.
Canada and the WHO use the same determinant list.	Canada lists 12 determinants, while the WHO list shown here contains 10.