2.2 Health, Wellness, and Disease Prevention

Health and Wellness

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.^[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 and Disease Prevention

Health promotion is the process of empowering people to control factors that impact their health and increase their healthy behaviors. In nursing, health promotion efforts often focus on health teaching aimed at reducing risk factors – such as tobacco use, physical inactivity, obesity, and nutrient-poor diet choices – while also addressing broader aspects of wellness. ^[13] Health promotion spans a spectrum of preventive strategies:

• Primary Prevention: Preventing illness and injury before they occur by encouraging healthy behaviors (e.g., good nutrition, regular physical activity, and stress management), immunizations, and pre-/post-operative education.
• Secondary Prevention: Focusing on early detection through education about diagnostic testing and screening (e.g., mammograms, PAP testing, and colonoscopies) to improve outcomes.
• Tertiary Prevention: Reducing the severity of established disease by teaching self-care, sharing community resources (e.g., support groups), providing education on managing chronic conditions (e.g. diabetes education or wound care), and coping with associated stresses.

Disease prevention refers to targeted, population-based, or individual interventions that minimize disease burden by reducing risk factors. It is closely linked to primary and secondary prevention strategies.^[14]

Healthy People 2030 is a national strategy aimed to improve the health and well-being of Americans through coordinated efforts in health promotion and disease prevention. With 359 objectives addressing diverse areas – from child and adolescent development to vaccination and specific health conditions – Healthy People 2030 also emphasizes the role of social determinants of health.^[15]

Social Determinants of Health (SDOH) are the non-medical factors that influence health outcomes, defined as the the conditions in which people are born, grow, work, live, and age. Research shows that these factors can account for 30-55% of health outcomes, often exceeding the impact of health care or lifestyle choices. SDOH are commonly grouped into five key domains, as illustrated in Figure 2.1^[16]:

• Economic Stability: Limited income and job opportunities can restrict access to health services, nutritious foods, and adequate housing.
• Education Access and Quality: Higher education levels correlate with better physical and mental health outcomes, partly through improved language and literacy skills.
• Health Care Access and Quality: Barriers such as lack of health insurance can impede access to primary care, screenings, treatments, and medications.
• Neighborhood and Built Environment: Safe housing, reliable transportation, and secure neighborhoods support health. In contrast, environments with high levels of violence, polluted air or water, or limited access to nutritious food and recreational opportunities increase health risks.
• Social and Community Context: Positive relationships and supportive communities promote well-being, while experiences of racism, discrimination, and violence can undermine health.

When providing health teaching, nurses must assess clients’ strengths and barriers – including those arising from SDOH – to support equitable health outcomes.

Factors Affecting Health

In addition to social determinants of health (SDOH), 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.^[17]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).^[18]

The sex 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 sex 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.^[19]

Sex-based 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 males 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 sex interact with the environment, increasing their risk for certain conditions. While clients cannot change their genetics or biological sex, 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.^[20]

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.^[21]

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.^[22]

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.^[23]

Role of Nurses

Nurses play a pivotal role by acting at all levels of health promotion and disease prevention:

• Individual Level: Providing education that helps clients change health-related attitudes and behaviors.
• Community Level: Implementing programs to improve the health outcomes of larger groups.
• Organizational Level: Influencing the development of health promotion policies and resources.
• Governmental Level: Shaping legislation and regulations by sharing the nursing perspective with legislators.