Health
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One of the key underlying assumptions of the North Hawaii Outcomes Project and of the national Community Health Improvement movement is a broad definition of health, beyond a narrower focus on medical care.
This World Health Organization’s definition of Health as a state of complete well-being in mental and social dimensions underscores this expanded view of health.
"Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."
-The World Health Organization
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| Multiple Influences on Health |
- Education
- Economy
- Environment (Social and Physical)
- Health behaviors
- Protective factors (Resilience)
- Genes
- Access to quality health care
There is increasing documentation of the multiple influences on individual and population health, well beyond biology and genes. There is strong evidence for the influence on health at the individual and population level from education, income, social support, spiritual life, resilience and access to quality health care.
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| As Education Goes Up, Income Goes Up |
The U.S. Census data for the 2006 U.S. population clearly shows a direct relationship between education and income for men, the blue line (top line) and women, the pink line (bottom line). As education increases on the horizontal axis, median household income increases on the vertical axis.
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As Personal Income Goes Up, Personal Health Status Goes Down
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According to the National Health Survey, 2006, data shows the direct relationship between household income and self-reported health. As income goes up, on the horizontal axis, perceived fair or poor health status goes down.
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| 13th Year of School linked to a longer life |
Every year of census data for 1994-2004 shows a similar health protective effect of education, especially the 13th year of school. The red bar (left bar for each year) shows the death rate for U.S. people with “less than 12 years of school,” roughly 550 deaths per 100,000 age-adjusted population. The yellow bar (middle bar for each year) shows a decrease in the death rate to approximately 450 for the population with 12 years of school. The lowest death rate occurs in the population with a 13th year of school as noted by the green bar (right bar for each year). With the 13th year, death rates drop to approximately 200 per 100,000 age-adjusted U.S. populations.
A 13th year of school includes college, military or vocational school.
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Reading Skills Early Predictor of Adult Success |
According to Werner’s (1992) study, longitudinal study of high risk children of Kauai identifies the protective effect of effective early education, in particular reading skills by grade four. If we agree with Werner’s (1992) conclusion, then as a community we will want to mobilize resources to support student reading success by grade four.
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| Wide Income Disparity is Associated with Poor Heatlh |
According to Kawachi (1999) analysis of health in the U.S. by county showed a strong correlation between counties with a large income disparity (Gini coefficient) and overall mortality rates (p< .01), neonatal mortality rates (p< .05), and stroke mortality rates. More economically homogenous counties had lower death rates in these categories (The Journal of Family Practice, April 1999, Vol. 48, No.4).
Economic Measures Health Measures
Disparity - Robin Hood Higher overall mortality
Index Gini Coefficient Stroke mortality
Infant mortality
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| Social Cohesion and Access to Primary Care |
According to Kawachi (1999) found that a higher ratio of primary care physicians to the population was associated with lower mortality rates. See access to physician per 1,000 population. The implication of this evidence for planning is that we need to develop strategies to increase recruitment and retention of primary care physicians on the Big Island. In addition, several studies have shown that higher levels of social cohesion are associated with better population health (Kawachi et. al., 1999). This further suggests support for community building to support social cohesion.
Social Measures Health Measures
-Social cohesion -Higher ratio of primary care
physicians/population
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| Family Income Disparity |
Family income disparity is calculated here by dividing the number of the population in the highest 20% of income by the number of the population in the lowest 20% of income.
