2.2 Health, Wellness, and Disease Prevention

The World Health Organization (WHO) defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”^[1] Holistic health is an approach to wellness that recognizes the interconnectedness of the physical, mental, emotional, intellectual, social, spiritual, cultural, and environmental components of health.^[2],[3]

• • Physical health: What are the client’s physical needs for nutrition, sleep, exercise, and rejuvenation? What are potential underlying causes of physical pain, and what steps can be taken to eliminate or manage pain? Additionally, what actions can be taken to prevent injury, illness, and disease?^[4]
  • Mental health: How well does the client cope with the normal stresses of life, work productively, and contribute to their community?^[5]
  • Emotional health: Emotional health is one aspect of mental health. How well does the client use positive coping mechanisms and stress management strategies to manage negative emotions?^[6]
  • Intellectual health: What are the needs of the client’s mind for stimulation, curiosity, and creative expression?^[7] Nurses also consider the client’s level of education, academic achievements, and career opportunities when planning effective care.
  • Social health: How is the client connected to others? In what ways can ties with family, friends, loved ones, and neighbors be strengthened or repaired?^[8]
  • Spiritual health: Spirituality includes a sense of connection to something bigger than oneself and typically involves a search for meaning and purpose in life.^[9] What practices and rituals does the client participate in to connect with the divine, nature, and other sources of deep purpose and meaning beyond themselves?^[10]
  • Cultural perspective on health: What is the client’s cultural inheritance? What values and traditions would they like to incorporate to achieve wellness?^[11]
  • Environment: What are the unique features of the space where the client lives (i.e., the neighborhood, geography, flora, and fauna?) How does this space affect the client’s health? For example, is it clean, welcoming, loud, harsh, disruptive, joyful, or peaceful? What changes need to occur in this environment for it to be healthy?^[12]

Health promotion is the process of empowering people to control their determinants of health and increase their healthy behaviors. Health promotion efforts by nurses typically focus on health teaching to reduce risk factors such as tobacco use, physical inactivity, obesity, and nutrient-poor diet choices. Disease prevention refers to specific, population-based and individual-based interventions for minimizing the burden of disease and reducing associated risk factors, also referred to as primary and secondary prevention.^[13] For nurses, primary prevention interventions commonly include activities such as vaccination, dental hygiene, and nutrition education, while secondary prevention activities include disease-specific screenings.

Healthy People 2030 is a national strategy aimed at improving the health and well-being of Americans through health promotion and disease prevention. The initiative includes 359 objectives focused on health-related behaviors such as child and adolescent development, use of drugs and alcohol, injury prevention, healthy eating, preventative care, and vaccination. Additionally, the plan identifies objectives related to specific health conditions, different client populations, various health-related settings and systems, and social determinants of health.^[14]

Nurses should never underestimate the influence they have to impact health outcomes. At the individual client level, nurses provide needed education that can help clients change their health-related attitudes and behaviors. At the community level, nurses can implement programs and practices to improve the health outcomes of large groups of people. Nurses should be aware of local community resources and recommend them to clients to help enhance their health. Organizationally, the perspective of the nurse is important when developing health promotion policies and resources. At a governmental level, the nurse can influence legislation and regulation by sharing the nursing perspective with legislators and other policy makers.

Factors Affecting Health

The Centers for Disease Control and Prevention (CDC) identifies broad categories of factors that affect health, including genetics and biology, behavior, access to medical care, culture, environmental and physical influences, and social determinants of health.4 When working with clients to improve outcomes, nurses should recognize these factors that influence personal health.

Genetics and Biology

An individual’s genetic makeup can play an important role in their health. A client may have genetics that predispose them to certain conditions. For instance, some health conditions run in families due to their genetic composition. These conditions may be referred to as hereditary. Examples of genetic conditions include certain types of cancers, cystic fibrosis, hyperlipidemia, or specific birth defects (i.e., spina bifida, cleft lip).^[15]

The gender of a client is determined by their DNA. A client’s biological classification, as either a male (XY chromosomes) or female (XX chromosomes), can influence their health, as all cells in the body, including those that make up tissues and organs, are either male or female. The National Institutes of Health describes the influence gender has on health outcomes in its example of the difference in the blood vessels in a female heart compared to those in the heart of a male. The vessels in the female heart are smaller in diameter and more branched. These differences explain why blockage in the female heart may present differently than that in the male heart, resulting in different symptoms and, in turn, different outcomes for female clients.^[16]

Gender differences can predispose clients to certain health conditions. For example, females are known to be at an increased risk for conditions such as heart disease, stroke, diabetes, and osteoporosis, while men have higher incidence of Parkinson’s disease, melanoma, pancreatic cancer, and aortic aneurysm.

It is important for clients to understand how their genes and biological gender interact with the environment, increasing their risk for certain conditions. While clients cannot change their genetics or biological gender, they can make health choices to support overall health and decrease their risk for disease. For instance, females can control their risk for heart disease by eating healthy foods, limiting sodium, avoiding tobacco use, limiting alcohol intake, maintaining a healthy weight, and engaging in regular physical activity.

Behavior

Personal health practices significantly influence the risk for developing disease. According to the American Public Health Association, four behaviors contribute most to the development of chronic disease: physical inactivity, poor eating habits, tobacco use, and alcohol consumption. The nurse can influence a client’s risk by helping them develop a plan to manage behaviors that negatively impact health.^[17]

Access to Medical Care

Access to health services is vital for preventing and managing disease. Several factors can affect a client’s access to health care, including health insurance coverage, availability of services in the community, timeliness in receiving the care, and a health care workforce. Clients who are not covered by health insurance are less likely to receive the care they need and tend to have poorer health outcomes. Clients also need a consistent source for their care in their community, meaning they should have a primary health care provider who can ensure they are receiving appropriate preventative services and screenings. Clients without a consistent primary care provider are less likely to receive these important services and are at risk for developing a variety of chronic diseases. Timeliness refers to the ability to receive health care when it is needed, such as having urgent care facilities available in the community. A health care workforce refers to the availability of qualified health care providers, nurses, and other health care professionals. Health care workforce shortages continue to raise concerns, as there are deficiencies in the numbers of providers, nurses, and other health care professionals needed to care for clients.^[18]

Cultural and Religious Beliefs

Cultural and religious beliefs influence how clients manage their health. Based on their cultural and/or religious beliefs, individuals may have diverse attitudes and values relating to health and illness, including when it is appropriate to seek health care, who provides health care, and what the preferred treatments will be. For example, clients who are Jehovah Witnesses may refuse blood transfusions based on their religion, but other treatments may be acceptable.

Lifestyle choices that influence a client’s health can also be influenced by cultural beliefs. Nurses should be knowledgeable of how culture and religion can affect health, but they shouldn’t make assumptions on client preferences based on their culture and religion. Nurses assess and respect a client’s cultural beliefs, attitudes, and values in terms of how they impact health and integrate this information into the nursing care plan that includes health promotion.^[19]

Environmental and Physical Influences

A person’s environment can have a significant effect on health outcomes. Clients may be at increased risk for certain diseases as a result of their place of employment or working conditions. For example, agricultural workers may be exposed to environmental hazards such as chemicals, poor air quality, or extreme temperatures. Health care providers are at risk for musculoskeletal injuries, drug exposure, violence, and sharps injuries. Gathering information about a client’s work and home environment is important to determine their risk for certain conditions.

The physical environment can also play an important role in healthy child development. The cleanliness of the environment and the condition of housing can put developing children at risk. For example, children who are exposed to lead in water, paint, contaminated soil, or consumer products have increased risk for brain and nervous system damage, slowed growth, and learning difficulties.^[20]

Social Determinants of Health

As discussed in Chapter 1, social determinants of health are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes. Social determinants of health impact health in many ways^[21]:

• Economic stability: Those who live in poverty have limited access to health services, nutritious foods, and adequate housing.
• Education access and quality: Higher levels of education correlate to better health outcomes, both physically and mentally.
• Health care access and quality: Lack of health insurance is a barrier to health care access. Uninsured clients are less likely to have a primary care provider and are less likely to be able to afford their medications. They also more frequently miss important screenings, such as cancer screenings.
• Neighborhood and built environment: Safety is crucial to maintaining and improving health. Clients who live in environments where there are high levels of violence, unsafe water or air, or other health risks are at increased risk for poor outcomes.
• Social and community context: Positive relationships support health and well-being. These relationships within the family and community can lessen the impact of some of the other determinants.