The concept of health and health promotion

An individual perceives health based on her or his experiences of ill health. This means that a person who has experienced ill health may appreciate health more than a person who has never experienced ill health. A person, who has not experienced ill health takes health for granted and does not reflect on health according to the Swedish proverb ‘Health keeps silent’. This assertion depends on the fact that health looses its meaning if the concept is only defined as something pleasurable without contradiction (1). The concept of health has developed over time becoming more and more directed towards the quality of life and an individual perspective of health. As early as in 1947 the World Health Organisation (2) described health as a complete state of physical, mental and social wellbeing and not only as the absence of disease. The ‘health for all by the year 2000’ declaration (3: 23) states that health ‘ensures equity in health, adds life to years, adds health to life and adds years to life’. The individual perspective emphasises in the Ottawa Charter (4), which assumes health as a resource for everyday life, emphasising social and personal resources, as well as physical capacities. Lastly, ‘Health 21’ (5) states clearly, that health is one of the fundamental rights of every human being. It affirms the dignity and worth of every person, equal rights, equal duties and shared responsibility for the health of all. In the approach that health is a resource Pörn (6) suggested an equilibrium theory in which the nature of health is an agreement between ability and planning. He saw the human being as an active subject, where the relationship with the environment and with oneself determines one's actions. Good health implies that the individual has the repertory necessary to meet her or his overall adaptation demands. Nordenfelt (7) means that the individual must have the ability as well as the opportunity to take action and judge their own ability in a realistic way. Another approach to health is to view health as having an existential dimension due to experiences of meaning in life (8, 9). The human being is a whole, made up of body, mind and spirit, which is the ontological basis of health. The whole of health means to be physically healthy and mentally sound, enabling the individual to act in a way that promotes health. Individual should also believe in their own or others’ ability and have expectations for the future. A synthesis of 35 phenomenological studies (10) showed that the meaning of health is vitality, harmony and balance, experience of wholeness, fulfilment, sense of control and change. In that way health is closely related to well-being, which is identified as the positive aspects of being in the world and grounded in lived experiences (11). Well-being can be seen as happiness, positive stress, intellectual stimulation and tranquillity. Happiness results when the individual has the ability to realize desired projects and therefore experiences satisfaction with herself or himself. When positive stress appears, the individual finds challenges and tries to meet them. Education and environment, where new learning is possible, provide intellectual stimulation. A relaxed attitude and ability to deal with stress lead to tranquillity (12). The individual's experience of health varies from one situation to another. Eriksson (8) connects the subjective experiences of health in a more holistic view. Health can be experienced when the individual enjoys a sense of well-being but has objective signs of ill health, whereas real health is when the individual experiences well-being and has no objective signs of ill health. In that view there are no clear limits between the concept of health and ill health. The understanding of the concept of health constitutes a basis for health promotion. Great Britain, Canada, Australia and New Zealand have been at the forefront in the development of a health promotion perspective. However, there are still differing opinions about its content. The first reason for this is that health promotion is understood as an overall concept that includes everything that may improve the health of society, namely curative, preventive and health promotion contributions. Secondly, according to Antonovsky (13, 14), health promotion is a more absolute concept, which encompasses resisting power, salutogenic factors and resources of actions that are necessary for movement towards the healthy pole, in contrast to the pathogenic pole of the continuum. From the statement of health promotion health on equal conditions care is according to the patient's needs and prerequisites as well as the caregivers’ possibilities, competence and abilities. In this context, knowledge of the concept of empowerment may be beneficial for patients and caregivers. Empowerment includes the individual's power to manage the situation and her or his ability to obtain the qualifications necessary to gain this power. Empowerment consists of collective and individual components, where the individual component has been described as psychological and the collective as community empowerment (15, 16). In summary, empowerment is a supportive process, in which individuals or groups are enabled to change their situation for the better. The process provides individuals with skills, resources, opportunities and authority. It is characterized by an interaction between individuals who respect both themselves and other human beings due to a positive conviction of their own worth and also mutual determination (17). This way of thinking could form another useful strategies for promoting health of patients, citizens and caregivers. A human being's previous experiences influence the perception of present time, which also has an impact on the future. Healthy and unhealthy processes continue for a whole lifetime (18). For instance, an unhealthy lifestyle can take 20 years to affect bodily functions. Due to the fact that health promoting and preventive actions often do not produce immediate results, long-range planning is necessary. In health care, the caregivers mostly concentrate on what happens during the visit to the hospital. However, considering the patient's history and planning for the future may further improve her or his health. Understanding that health is a subjective experience, which varies from situation to situation, enables healthcare professionals to manage difficult care situations by enhancing health of the patient and giving them the opportunity to be empowered.

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