in more depth in chapters 6 and 8. Complete the following learning task, which will help you to think about how you personally perceive and rate health threats.
Learning task 2.1
The significance of health threats
Place in rank order which you think are the most significant threats to health at the current time, where 1 is the most significant and 14 the least significant.
Obesity
Poverty
Climate change
Extreme weather (flash flooding, wildfires)
HIV
Malaria
Unequal societies
Mental illness
Social policy changes – austerity and health-care expenditure cuts
New infectious diseases
Road traffic collisions
Loneliness/social isolation
Depression
Crime
What kind of things influenced your ranking order and decision-making?
You should have seen from the above learning task that deciding what are the most important threats to health is not easy and there are a numbers of factors that can and do influence our decisions. You may have decided to rank topics higher up the scale that affected most people, or based your decisions upon the perceived seriousness or importance of the threats from the list. You could have been influenced by what you read and see in the media on a daily basis when making your decision. A number of factors that can influence both our perceptions and conceptualization of contemporary health threats are outlined in the next section.
Conceptualizing the identifying of threats
Nature and determinants of health
As we have seen in chapter 1, defining what we may see as a threat to health will be intrinsically linked to how we define health. Even the word ‘threat’ is linked to negative, commodity, pathogenic and biomedical concepts of health. Implicit in this discussion is that full health is compromised by a threat and that it can be restored by preventive treatment and curative interventions. If, however, we consider health under more positive and salutogenic (what generates health and well-being, as discussed in chapter 1) conceptual frameworks, then the word ‘threat’ is not as appropriate, as we are concerned with the creation of health not the avoidance of disease, illness and disability (Antonovsky, 1996). Often an understanding of the word health in the popular sense is limited to notions of physical health, with increasing recognition of mental illness, although social and community health is relatively neglected in popular discourses of health (see chapter 9 for a discussion of community as a determinant of health). This can shape what are defined as threats to health.
The COVID-19 pandemic was quickly perceived as a threat to biological health. However, it also uncovered related health threats – such as those relating to mental health – and soon demonstrated the social determinants of health as different groups were affected to varying degrees.
Similarly, if we define the influences on our health as ultimately biological in nature, leading to ill-health and malfunctioning of the healthy physiological state of the body, then the threats will be conceived as factors influencing our biological states. For example, eating too much saturated fat in our diet leads to increased plasma cholesterol, resulting in atherosclerosis and an increased risk of coronary heart disease (Hu, Manson and Willett 2001; NHS, 2017).
However, if we subscribe to the social model of health and acknowledge the importance of socio-economic factors in determining well-being and disease, then we will view threats more broadly and shaped by the social world in which we live (see chapter 4 for a more detailed discussion of how society influences health). Continuing with the previous example and applying the social model of health, we should recognize that the influences on eating high levels of saturated fats are shaped by societal demands for inexpensive, tasty and convenient patterns of eating (Glanz et al., 1998). Laestadius and Wolfson (2019) outline several health-damaging trends, such as high demand for non-animal-derived products, convenience foods, nonregional foods and large serving sizes. Similarly, levels of activity are influenced by town planning, the configuration of leisure space and the organization of transport systems, which are all analysed within the scope of the social model of health. Mueller et al. (2020) point out that car-dependent city planning causes environmental pollution and encourages sedentary lifestyles, which are damaging to public health.
Examining the causal pathways for health and illness can aid our understanding of the diversity of threats to health. Bhopal (2008) provides a useful model for analysing the complexity of causal pathways called a web of causation, which visualizes the interconnectedness of factors that influences health and illness. Bhopal’s (2008) diagram represents a complex group of health determinants, such as the environment, behaviour and the workplace. It also shows the inter-relatedness of these factors in terms of how they contribute to the occurrence and spread of disease. The web of causation can help us to understand aetiology by linking social determinants as well as biomedical factors (Ventriglio et al., 2016). Now complete learning task 2.2, which demonstrates the complexity of health determinants in relation to a specific illness, hypertension (high-blood pressure).
Hypertension and health
Consider stage 2 hypertension as a threat to health. Outline as many influences as you can think of in relation to what determines the development of hypertension among individuals. Use the internet to help you explore the causes of hypertension. Represent these influences in a diagram, for example a ‘spider web of causation’, following Bhopal (2008), showing the connections between different influences.
Finally, think about how you conceptualize these influences. Do you see the influences that you listed as threats?
The dominant contemporary discourse for health is one of threats and disease. Giddens (1999) argues that the societal focus upon health risks leaves both governments and individuals debating the outcomes of such risks because there are no definitive answers. This is not entirely surprising, as generating positive health appears for many to be a less important
