Defining health by addressing individual, social, and environmental determinants: new opportunities for health care and public health

Abstract

The Millennium Development Goals (MDGs) mobilized global commitments to promote health, socioeconomic, and sustainable development. Trends indicate that the health MDGs may not be achieved by 2015, in part because of insufficient coordination across related health, socioeconomic, and environmental initiatives. Explicitly acknowledging the need for such collaboration, the Meikirch Model of Health posits that: Health is a state of wellbeing emergent from conducive interactions between individuals' potentials, life's demands, and social and environmental determinants. Health results throughout the life course when individuals' potentials--and social and environmental determinants--suffice to respond satisfactorily to the demands of life. Life's demands can be physiological, psychosocial, or environmental, and vary across contexts, but in every case unsatisfactory responses lead to disease. This conceptualization of the integrative nature of health could contribute to ongoing efforts to strengthen cooperation across actors and sectors to improve individual and population health--leading up to 2015 and beyond.

Figure 1

The Meikirch Model of Health: Health occurs when individuals use their biologically given and personally acquired potentials to manage the demands of life in a way that promotes well-being. This process continues throughout life and is embedded within related social and environmental determinants of health. Health is constituted by all three dimensions – individual, social, and environmental determinants of health.

Figure 2

The time course of individuals' biologically given and personally acquired potentials is shown by three examples of possible time courses of the two potentials during the life of a human being. At the time of birth, biologically given potential (continuous line) has a finite value that differs from person to person, and at the time of death, it is zero. In the figure, the lines between these two points, the curves are drawn arbitrarily to illustrate these concepts. The personally acquired potential of a person (dotted lines) begins before birth, increases rapidly thereafter, and can increase throughout life, provided the individual is able to continually develop it to meet life's demands. It drops to zero at the time of death. The corresponding lines for biologically given potential in the Figure are also drawn arbitrarily for illustrative purposes. Both potentials and the demands of life are strongly influenced by social and environmental determinants as depicted in the Meikirch Model. This figure focuses on the interaction of the two potentials in the context of specific individuals. In the first example the individual has succeeded in enhancing personally acquired potential. The second may have had a crisis in puberty and later a myocardial infarction – indicated by drops in the two potentials. In the third case, both curves drop at some time due, for example, to alcoholism. At each moment in life, every individual uses her or his total potential, the composite ‘sum' of the two potentials, to try and effectively manage the demands of life.