In the 1970s and 1980s, Thomas McKeown, a physician and historian of medicine, published the idea that increased life expectancy and growing populations were due more to improvements in standards of living, diet, and nutrition, than to medical advancements. His analysis came to the conclusion that economic improvements were a stronger predictor of good health than medical care, including sanitary reforms and vaccinations. While McKeown’s conclusions are still a subject of debate, his research continues to have a powerful impact on public health policies.
Of course, heredity and personal behaviors also play a significant role in an individual’s health. However, community leaders, hoping to influence public health policies, continue to research community factors that affect public health. Their primary focus falls on four areas.
- Social environment
- Economic environment
- Cultural environment
- Physical environment
What makes up a social environment? The social determinants that affect public health include all the conditions in which people live, work, learn, and play. These may include where a person goes to school and how much education a person gets. Determinants may include exposure to violence or feelings of belonging. The social factors most likely to affect public health are education, income, housing, and access to health care, according to the American Academy of Family Physicians, drawing information from the Centers for Disease Control and Prevention and the U.S. Office of Disease Prevention and Health Promotion.
Of course, there are other factors that have a strong impact on personal health and well-being.
- Access to nutritious foods and clean water
- Cultural and family support
- Gender and sexual identification
- Job and home security
- Social status and stressors
- Socioeconomic status
- Culture and language
To some degree, individuals and communities share an economic environment, such as in neighborhoods where most of the population lives in extreme poverty or affluent neighborhoods where each community member enjoys the benefits of easily accessed resources. However, there are certainly variations in economic status within any community. Some of the economic environmental factors linked to public health include access to or a lack of top-quality education, affordable housing, affordable healthcare, and the results of or freedom from economic hardship. Certainly, families living in impoverished neighborhoods are more likely to experience poor overall health than those living in wealthier neighborhoods.
A person’s culture is his or her pattern of customs, behaviors, and ideas that are shared by specific people or society. The cultural environment has a powerful impact on health. Cultural beliefs affect how individuals perceive health and illness, beliefs about how diseases are caused, and how to treat health concerns. These beliefs also affect how pain and illness are viewed and treated. Some people may hesitate to seek certain types of treatment for medical concerns.
The United States government’s environmental health objectives for 2020 focus on the interaction between individuals and their physical environment. Information from the World Health Organization defines environment as “all the physical, chemical, and biological factors external to a person, and all the related behaviors.” The improvements targeted by healthypeople.gov are directed toward outdoor air quality, water quality, toxins and waste, healthy homes and communities, infrastructure and surveillance, and global environmental health.
Environmental Changes Led by Community Members
Dr. Rohit Varma, an ophthalmologist who focuses on public health as well as those issues that directly impact his patients, has worked to bring awareness and improvement to environmental issues affecting his community. As other influential community members follow Varma’s lead, overall public health may see many positive improvements.
Thomas McKeown’s conclusions may be widely debated, but his works have made an impact on modern-day public health policies. Today, healthcare providers recognize there are several factors that have an impact on a person’s health and well-being. As community leaders work to improve these environmental areas, individual and public health may continue to improve.