RHP&EO is the electronic journal of the International Union for Health Promotion and Education

Health Promotion - The Hidden Road To Health

Skuli G. Johnsen M.D.M.F.C.M.

The Ecosystemic view and method of reasoning can help to expand the knowlegde and understanding of human and natural phenomena.

It allows us to see the dynamic and interdependent nature of the whole of existence. It also helps us to see and to understand the road from health problems to health.

In this as well as in other fields nature itself is our best teacher.

By expanding prof. Logans, "Iceberg of Disease" very many new things can be revealed.

Firstly it is found that there are three Icebergs instead of one.

1st. is the Iceberg of physical disorders
2nd. is the Iceberg of social disorders and
3th. is the Iceberg of mental disorders.

Once this is realized it becomes apparent that the traditional concept of disease is too narrow because we have to deal with human problems in a much more general sense. Therefore it is necessary to broaden our view very much.

Next we need to realize what kind of a medium it is that the Iceberg of human problems is embedded in. It is not liquid but in this case it is the total social, mental and physical environments. Here ten different factors are chosen to represent these environments. It is also discovered that it is the quality of these factors rather than quantity that determines the level of health. It is the quality which determines the degree of ice-formation or melting. In the study of quality in this respect it becomes apparent that it touches upon the prevalent value systems which differs from one group to another, from one religion to another, from one civilization to another and even from one nation to another. The human heritage is therefore a crucial factor. When the laws of nature are applied it is seen that the size of the iceberg and therefore also the size of its visible part, where most of our health care money is spent, depends on the "temperature" around the submerged part of the iceberg. This is a solution to the paradox that policy makers in health are faced with and it also explains the ever increasing demand for health care in the industrialized countries where traditional parameters of health indicate improvements. The determinants of the level of health as I see it comprise 10 different factors:

1. Age distribution.

2. Habitat (Rural-> Urban)

3. Occupation. Then there are two common factors

4. Family conditions

5. The physical environment

6. Lifestyles

7. Health services

8. Housing conditions

9. Education

10. Economy

This could be accepted as a holistic view and subsequently each group, community or nation can start to work on each of these components to improve their quality and thereby promote the quality of their lives. The Managerial Process for National Health Development (MPNHD) devised and constructed by WHO as a part of the Health for All Program is a suitable tool to prepare the implementation of the necessary measures in society.

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Last modified: October 07, 2000

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