What makes us healthy?

Being healthy doesn’t mean simply not being ill.  

Our health is influenced by a wide range of issues, much of which we understand as physical, such as disease or injury.  However the drivers and determinants of health go far beyond this, and include our mental wellbeing, our social connections, the support we receive as part of a community, our ability to understand and adapt to change, and our childhood experiences.  These are all important assets that provide us with resilience and help to create and maintain our health.

Scotland's health is not improving at the rates of other countries, and there are some significant inequalities how long people can expect to live, and how long they can expect to be healthy for, across the country.

Tackling the complex drivers behind these inequalities, in particular the cycles of poverty and deprivation in certain communities, is essential if these inequalities are to be removed.  

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Constitution of the World Health Organisation

What causes 'wellness'?

Sir Harry Burns, Professor of Practice at the University of Strathclyde and former Chief Medical Officer for Scotland, has played an influential role in developing thinking on the drivers that affect our health and wellbeing.

In this fascinating TEDx Talk, he explores some of the links between 'what makes us well' and our social, economic and physical circumstances.

Watch a longer lecture from Sir Harry Burns from the 2014 BEFS Annual lecture here

Place, community and health

The design and creation of good places has complex pressures and drivers. However, ensuring that the considerations of health are properly taken into account is essential if we are to improve the quality of life for people and to support decision-making and investment that
ensures the best outcomes over the long term.

Read more about place, community and health

The social determinants of health

Health is not created within our hospitals or our GP surgeries. It is widely understood that healthcare only accounts for around 10% of a population's health. Instead, health is created in our homes and in our communities. Our local environment can have a lasting impact on our health. 

The social determinants of health are the non-medical factors - living conditions and opportunities - that influence our health.  Research has shown that the social determinants can be more important than health care or lifestyle choices in influencing health

The places in which people live, work and play need to be designed to create good health and wellbeing for everyone. This requires a different way of working as part of a whole systems approach. Place-based approaches can support wider actions to tackle the social determinants of health.

The social determinants of health are the conditions in which we are born, we grow and age, and in which we live and work.  These include:

  • Childhood experiences
  • Housing
  • Education
  • Social support
  • Family income
  • Employment
  • Our communities
  • Access to health services

Although issues such as housing, planning, design and transport lie outside the traditional remit of the health service, they all have a significant role to play in achieving good health outcomes and need to be seen as an important and influential element of the public health workforce. 

The creation of safe places that nurture health has long been central to the public health agenda. Planning has always been central to efforts to improve public health, from the redevelopment of poor quality housing, to improving sanitation, water and air quality, and ensuring that we have access to health facilities. 

The Health Foundation Evidence Hub

The Health Foundation is an independent charity committed to improving health and health care for people in the UK.

Their website contains useful information on health and place, including a useful Health Inequalities Evidence Hub containing data, insights and analysis exploring how the circumstances in which we live shape our health.

Access the Health Foundation Evidence Hub here

Health Inequalities

Everyone has the right to health.

Yet, there are large differences in people’s health. 

  • On average, males born in the least deprived areas can expect to live an extra 25 years in good health. Females can expect to live an extra 21.5 years in good health. This is compared to those born in the most deprived areas.
  • The rates of early deaths in the most deprived areas are four times higher than the least deprived areas.
  • 24% of children living in the most deprived areas are at risk of obesity. This is compared to 9% in the least deprived areas.

Health inequalities are the unfair and avoidable differences in people’s health across social groups and between different population groups.  Health inequalities are not fair and they are avoidable.

Health inequalities can depend on factors such as where someone lives and their household income. They can also depend on their gender or race and if they have a disability.  The disadvantages someone faces can increase when they fit into more than one group. Using an intersectional lens is important to avoid excluding someone’s unique experiences.

They represent thousands of unnecessary premature deaths every year in Scotland, and for men in the most deprived areas nearly 24 fewer years spent in ‘good health’.

Housing and Health Inequalities

Access the Health Foundation Evidence Hub