Tara White's Portfolio
Reflections on the Definitions of Health
The World Health Organization (WHO) defined health in 1948 as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (World Health Organization [WHO], 1948). Although revolutionary for its time, this definition has not been updated since its adoption. When we consider the period in which the definition was developed, the post-war era, it becomes evident that global health and our understanding of health have evolved significantly over the past 80 years. As a result, the relevance of the WHO definition in today's healthcare environment has been questioned and critiqued by numerous scholars. In exploring this topic, I found three articles that challenged the 1948 definition and proposed alternative perspectives on health. The fourth article was particularly interesting because it argued in favour of maintaining the current WHO definition and provided several reasons why it remains relevant today.
The first article I reviewed was by Habersack and Luschin (2013), who argued that health should be recognized as a fundamental human right deserving legal protection. Rather than challenging the WHO definition itself, the authors questioned why it has never been fully incorporated into national legislation. They suggest that this contributes to “unequal access to health care, and ultimately social inequality, by excluding most potential users from the development of standards and policy” (Habersack & Luschin, 2013). I agree with the concerns raised in this article. If we compare access to healthcare across different countries, it becomes apparent that legislation plays a significant role in determining equity. Nations with universal healthcare systems often provide more equitable access to care than those with limited or fragmented healthcare coverage.
The second article I examined was written by Krahn et al. (2021), who offered several critiques of the WHO definition of health. One criticism was that the definition presents health as an absolute state and is therefore limited. The authors argue that while the definition was groundbreaking in recognizing health as more than the absence of disease, the wording also implies that the presence of disease or infirmity may prevent an individual from achieving good health. They note that “the definition affirmed health as a positive state that is not defined merely by the absence of disease or infirmity; however, use of the phrase ‘not merely’ also implied that having a disease or infirmity would preclude good health” (Krahn et al., 2021).
To address this limitation, Krahn et al. (2021) proposed a new definition of health: “Health is the dynamic balance of physical, mental, social, and existential well-being in adapting to conditions of life and the environment.” I found myself strongly agreeing with this perspective. The COVID-19 pandemic exposed weaknesses in healthcare systems around the world and demonstrated that health is influenced by much more than physical illness alone. We saw how individuals' health was affected not only by contracting COVID-19, but also by social isolation, disrupted relationships, economic uncertainty, and environmental factors. Even now, I believe we have not fully understood all of the long-term impacts the pandemic has had on individuals and communities.
In a more recent article published in The Lancet, LeFrançois et al. (2025) argue that “human health is still predominantly viewed through the prism of disease affecting humans and related care activities.” The authors suggest that this approach is overly restrictive because “interdependencies and holistic approaches are crucial for the prevention and preservation of human health, particularly in relation to interlinked climate, biodiversity, pollution and health crises” (LeFrançois et al., 2025). Between the lessons learned from the COVID-19 pandemic and the growing recognition that human health is closely connected to our ecosystems and environment, it is difficult to deny that the WHO's 1948 definition could benefit from modernization.
At the same time, not all scholars agree that the WHO definition is outdated. Schramme (2023) argues that many criticisms of the WHO definition stem from how people interpret the word “complete.” Rather than suggesting that individuals must achieve perfect physical, mental, and social well-being, Schramme argues that the definition was intended to promote a holistic understanding of health rather than a perfectionist one. While I appreciate this perspective, I still believe the definition is too broad and open to interpretation. The concept of complete well-being can be difficult to define and may not reflect the realities of individuals living with chronic illness, disability, or ongoing health challenges.
Overall, I believe the WHO definition was progressive and groundbreaking for its time because it recognized that health extends beyond the absence of disease. However, modern healthcare has demonstrated that health is dynamic and influenced by a wide range of social, environmental, cultural, and personal factors. Contemporary definitions that emphasize adaptation, resilience, and interconnectedness better reflect the realities of health in the 21st century while still maintaining the holistic principles that made the original WHO definition so influential.
References
Habersack, M., & Luschin, G. (2013). WHO-definition of health must be enforced by national law: A debate. BMC Medical Ethics, 14(24). https://doi.org/10.1186/1472-6939-14-24
Krahn, G. L., Robinson, A., Murray, A. J., & Havercamp, S. M. (2021). It's time to reconsider how we define health: Perspective from disability and chronic condition. Disability and Health Journal, 14(1), Article 101129.https://doi.org/10.1016/j.dhjo.2021.101129
LeFrançois, T., Angot, J.-L., Autran, B., Bukachi, S. A., Claverie de Saint-Martin, E., Giraudoux, P., et al. (2025). A new definition of human health is needed to better implement One Health. The Lancet, 406(10504), 672–675.
Schramme, T. (2023). Health as complete well-being: The WHO definition and beyond. Public Health Ethics, 16(3), 210–218.
World Health Organization. (1948). Constitution of the World Health Organization. https://www.who.int/about/governance/constitution
A comparison of the Determinants of Health
References
Hastings Prince Edward Public Health. (2024.). The social determinants of health report. https://www.hpepublichealth.ca/the-social-determinants-of-health-report/
Hastings Prince Edward Ontario Health Team. (2024). Fast facts: Hastings Prince Edward Ontario Health Team. https://hpeoht.ca/wp-content/uploads/2024/08/HPEOHT_Fast-Facts-Two-Pager.pdf
Nova Scotia Department of Health and Wellness. (2023). Health equity framework. Government of Nova Scotia. https://novascotia.ca/just/publications/docs/health-equity-framework.pdf
Ontario Health. (2025). Social determinants of health framework and resource guide. https://www.ontariohealth.ca/system/equity/social-determinants-framework.html
Ontario Ministry of Health. (2021). Ontario public health standards: Requirements for programs, services, and accountability. Government of Ontario. https://files.ontario.ca/moh-ontario-public-health-standards-en-2021.pdf
Public Health Agency of Canada. (2024, July 18). Social determinants of health and health inequalities. Government of Canada. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
Public Health Ontario. (2026). Health equity.
https://www.publichealthontario.ca/en/Health-Topics/Health-Equity
According to the Canadian government, the determinants of health “are the broad range of personal, social, economic and environmental factors that determine individual and population health. The main determinants of health include: income and social status, employment and working conditions, education and literacy, childhood experiences, physical environments, social supports and coping skills, healthy behaviours, access to health services, biology and genetic endowment, gender, culture and race/racism” (Public Health Agency of Canada, 2024). Although this definition applies to Canada and its population as a whole, each province and territory has also defined its determinants of health according to the unique challenges within its borders. Even more specifically, public health agencies within each region of a province or territory often identify social determinants of health that reflect the demographics and issues affecting their local populations.
The overarching goal of both the Canadian government and provincial health systems is health equity. Health equity is “created when individuals have the fair opportunity to reach their fullest health potential. Achieving health equity requires reducing unnecessary and avoidable differences that are unfair and unjust. Many causes of health inequities relate to social and environmental factors including: income, social status, race, gender, education and physical environment. We offer expertise and resources for integrating health equity in health promotion programs and policies” (Public Health Ontario, 2026).
I looked at both the province of Ontario, where I live, and the province of Nova Scotia, which I have always been curious about, and I noticed a few differences between the two. In Ontario, the guiding documents for health equity are the Ontario Public Health Standards (OPHS) and Ontario Health’s Social Determinants of Health Framework. These documents outline health equity as a foundational requirement and recognize income, education, housing, employment, and other social conditions as key drivers of individual health outcomes. Ontario also places a strong emphasis on public health units and Ontario Health Teams to promote health equity and has made it a standard of care (Ontario Health, 2025).
In another part of the country, Nova Scotia, a province much smaller than Ontario, the guiding documents are the Health Equity Framework and the Action for Health Plan. This framework addresses the social determinants of health while also placing a strong emphasis on racism, discrimination, cultural competence, and equitable access for diverse populations (Nova Scotia Department of Health and Wellness, 2024). Nova Scotia approaches health equity through a province-wide integrated model involving Nova Scotia Health and government partnerships. This differs from Ontario’s approach, and I wonder if the difference is related to the province’s smaller population and healthcare structure.
I also examined the framework surrounding the determinants of health within my local region. I live in Hastings and Prince Edward Counties in southeastern Ontario. “The Hastings Prince Edward Public Health Social Determinants of Health Report highlights local concerns such as income, housing, employment, education, and social inequities affecting health outcomes in the region” (Hastings Prince Edward Public Health, 2024). Hastings County faces unique challenges because it is the second-largest county in Ontario geographically, while much of its population is considered rural. Another challenge identified by the Hastings Prince Edward Ontario Health Team (2024) is that 71% of residents fall within a high-risk social determinants of health group, compared with only 16% across Ontario. Residents are more likely to experience low income, inadequate housing, lower educational attainment, and labour-force participation challenges. As a nurse who has worked in this county for more than 10 years, I have witnessed these challenges firsthand within the patient population and age demographics cared for in hospital settings.
No matter which province or territory a person lives in, there are frameworks and guidelines developed to address the specific needs of the population within that area. There is no denying that health equity is strongly connected to the social determinants of health and the geographic area in which a person lives. Understanding these differences is important for healthcare professionals because it allows us to better recognize the factors that influence health outcomes and advocate for more equitable care within our communities.
Healthcare Associated Infections Through a Social Ecological Lens
Healthcare associated infections (HAIs) remain a significant challenge within the Canadian healthcare system and can negatively impact patient outcomes, increase healthcare costs, and place additional strain on healthcare capacity. Sonpar et al. (2025) state that "health care-associated infections are among the most common adverse events in health care, with a significant impact on mortality and economy." Infection prevention and control (IPAC) programs play a critical role in reducing the spread of infections in acute care settings and within the community.
McLeroy et al. (1988) proposed an ecological model of health promotion that recognizes health behaviours and outcomes are influenced by multiple levels of factors, including individual, interpersonal, organizational, community, and public policy influences. Rather than focusing solely on individual behaviour change, the model emphasizes the interaction between people and their social environments in shaping health outcomes. Healthcare-associated infections provide a useful example of how factors operating at multiple levels can influence patient safety and infection prevention efforts.
Individual
In the hospital setting, many factors influence a patient's behaviour and understanding of their own health journey. Personal habits, or a lack thereof, can place patients at a higher risk of acquiring a healthcare-associated infection. One example is hand hygiene. If an individual has come from a poor socioeconomic situation and has had limited access to basic necessities, such as running water, these circumstances may influence their hygiene practices when they are admitted to hospital. Limited access to resources within their social and physical environment may contribute to poor hygiene habits, and as a result, they may not fully appreciate the importance of routine hand hygiene, increasing their risk of acquiring an HAI.
Another individual factor is a patient's underlying health conditions. Comorbidities that affect immune function can increase the risk of developing an HAI, regardless of the reason for hospital admission. Patients with multiple comorbidities are generally at greater risk than those with one or two chronic conditions. In addition, poor management of conditions such as diabetes can delay wound healing, and compromised skin integrity increases the risk of developing a healthcare-associated infection.
Interpersonal
At the interpersonal level, communication and interactions between patients, families, and healthcare providers influence infection prevention practices. Healthcare workers play an important role in educating patients and families about hand hygiene, isolation precautions, and other infection prevention measures. Open communication among members of the healthcare team also encourages adherence to IPAC practices, allows concerns to be addressed promptly, and promotes shared accountability for patient safety. These positive interactions contribute to reducing the risk of HAIs and improving patient outcomes.
Organizational
Healthcare organizations play a critical role in preventing healthcare-associated infections through the implementation of IPAC programs, surveillance systems, education, and environmental cleaning practices. In Ontario, hospitals are required to have an IPAC program with standards, policies, and procedures designed to reduce the risk of HAIs. IPAC departments work closely with Environmental Services to ensure cleaning and disinfection practices follow evidence-based guidelines.
Beyond policies and procedures, organizational culture also influences infection prevention practices. The WHO Multimodal Improvement Strategy (2009) identifies institutional safety climate as a key component of successful infection prevention initiatives, emphasizing leadership support, staff engagement, accountability, and a shared commitment to patient safety. Organizations that foster a positive safety culture are more likely to achieve sustained improvements in infection prevention practices.
Unfortunately, budget cuts and staffing shortages can negatively impact these efforts. Reduced staffing may result in fewer environmental cleaning staff, higher staff turnover, gaps in education and training, and fewer opportunities to monitor compliance with IPAC practices such as appropriate use of personal protective equipment (PPE) and isolation precautions.
Community
In my region, the community itself also influences healthcare-associated infections. Hastings and Prince Edward Counties have an aging population. Despite a large influx of immigration around the time of the COVID-19 pandemic, 35.2% of the population is over the age of 65 (Statistics Canada, 2022). As the population ages, there is an increased need for congregate living settings such as retirement homes and long-term care facilities. Many residents in these settings have multiple comorbidities or are immunocompromised, placing them at increased risk of colonization and infection with antimicrobial-resistant organisms (AROs) such as methicillin-resistant Staphylococcus aureus (MRSA) and carbapenemase-producing organisms (CPOs). When residents from these facilities require hospitalization, these organisms may also be introduced into the acute care setting.
Community inequities and access to healthcare also influence the risk of healthcare-associated infections. Moloughney (2016) explains how the social determinants of health affect exposure to infectious diseases, vulnerability to infection, and access to healthcare services. Even within Canada's universal healthcare system, barriers such as geographic location, transportation, financial constraints, and trust in healthcare providers can influence when and how individuals seek care, ultimately affecting infection prevention and overall health outcomes.
Policy
At the policy level, provincial governments and public health agencies influence healthcare-associated infection prevention by establishing standards, legislation, surveillance requirements, and funding priorities. For example, hospital-associated Clostridioides difficile infections are subject to mandatory provincial surveillance and reporting requirements, creating accountability for healthcare organizations and supporting quality improvement efforts.
Organizations such as Public Health Ontario, PIDAC, and provincial Ministries of Health develop evidence-informed guidance that supports standardized infection prevention and control practices across healthcare settings. Policies requiring surveillance and reporting of specific HAIs enable organizations to benchmark infection rates, identify trends, and implement targeted quality improvement initiatives. Although policies do not directly prevent infections, they create the framework that supports consistent infection prevention practices throughout the healthcare system.
Ontario vs. Nova Scotia
While both Ontario and Nova Scotia use evidence-based infection prevention and control practices, Ontario relies heavily on guidance developed by Public Health Ontario and PIDAC, whereas Nova Scotia's infection prevention programs are supported through Nova Scotia Health and the provincial Department of Health and Wellness. Despite differences in governance and organizational structure, both provinces aim to reduce HAIs through standardized infection prevention policies, surveillance, and quality improvement initiatives. Although each province has its own approach to healthcare delivery, both recognize that strong policy frameworks are essential to improving patient safety and reducing healthcare-associated infections.
Healthcare-associated infections cannot be prevented through individual action alone; prevention requires interventions at multiple levels. As Bridgen et al. (2025) state, "Hospital acquired infections (HAIs) contribute to increased patient morbidity and mortality, and undermine community confidence in healthcare." Preventing HAIs requires action at every level of the Social Ecological Model. Individual behaviours, supportive relationships between patients and healthcare providers, strong organizational IPAC programs, healthy communities, and evidence-informed public policy all contribute to reducing infection risk. Together, these interacting levels create an environment that supports safer patient care and improved health outcomes.
References
Bridgen, J., et al. (2025). Hospital-acquired infections: A public health challenge requiring coordinated prevention strategies. Antimicrobial Resistance & Infection Control, 14, Article 229. https://doi.org/10.1186/s44263-025-00229-8
McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351–377. https://doi.org/10.1177/109019818801500401
Moloughney, B. W. (2016). What can public health do to address inequities in infectious disease? Canada Communicable Disease Report, 42(Suppl. 1), S22–S26. https://www.canada.ca/content/dam/phac-aspc/migration/phac-aspc/publicat/ccdr-rmtc/16vol42/dr-rm42s-1/assets/pdf/16vol42s-1_ar-03-eng.pdf
Sonpar, A., et al. (2025). Multimodal strategies for the implementation of infection prevention and control interventions—update of a systematic review for the WHO guidelines on core components of infection prevention and control programmes at the facility level. Canadian Journal of Infection Control. https://doi.org/10.1016/S1198-743X(25)00016-3
Statistics Canada. (2022). Census profile, 2021 Census of Population: Hastings and Prince Edward Counties, Ontario. Government of Canada. https://www12.statcan.gc.ca/census-recensement/2021/dp-pd/prof/details/page.cfm?Lang=E&DGUIDlist=2021A00033512,2021A00053513020,2021A000235&GENDERlist=1,2,3&STATISTIClist=1&HEADERlist=0
World Health Organization. (2009). WHO guidelines on hand hygiene in health care: Part I. The WHO multimodal hand hygiene improvement strategy. https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/infection-prevention-and-control/core-components/ipc-cc-mis.pdf