Healthy People Initiative


Health is a debatable subject since professionals in the medical field seem to hold contradicting views concerning its definition. While some health practitioners argue that a certain definition is accurate, others believe that more non-medical concepts need to be integrated into the definition. However, a number of studies have adopted models that seem to help in defining health. These models include the epidemiologic model and the social ecologic model. Having diverse definitions of health is a clear indication that some proposed definitions leave some information unclear. However, this does not necessarily call for critiques, but for the facts to be tabled so that we can arrive at one definition that would enhance health promotion through the Healthy People Initiative.


Definition of Health

In 1947, the World Health Organization (1986) endeavored to enlighten people on the definition of health, stating that a person cannot be considered healthy simply because he lacks infirmity or disease. Instead, a person is only termed as healthy if he/she demonstrates physical, mental, as well as social wellbeing. The Alliance Institute for Integrative Medicine does not only define health as a state of physical wellbeing but also states that a healthy person must demonstrate emotional stability, capacity to love others, capacity to embrace environmental changes, ability to think clearly, have a high degree of exercising intuition, and be able to embrace spirituality (Blane & Wilkinson, 1996).

The National Wellness Institute, on the other hand, defines health explicitly by affirming that it encompasses the ability to recognize a successful venture and to take the approach of pursuing it (Blane & Wilkinson, 1996). The National Wellness Institute, however, adds that each person has the responsibility of determining his/her own success depending on his/her personal goals. Furthermore, the National Wellness Institute alleges that health can be considered as a six dimensions phase, namely, physical, emotional, intellectual, social, occupational, and spiritual phase.

The Influence of the Evolving Definition of Health on the Practice of Health Promotion

The evolving definition of health has influenced the practice of health promotion significantly, as majority of health promotion programs are currently basing their performance on physical, mental, social, as well as psychological wellbeing (Green et al., 1996). Hence, the health promotion programs have adopted the initiative of coming up with a number of objectives, which include decreasing the burden of the disadvantages members of the community [poverty levels], increasing the health care intervention resources, and limiting the mortality and morbidity rates amongst members of the society.

In turn, this has facilitated improved nutrition amongst the members of the community, improved nursing care emanating from knowledge on how social and environmental factors affect people’s health, improved access to health care centers and facilities, improved health education for the community members, and increased collaboration between the health promotion programs and other community programs. More so, the effectiveness of the health promotion programs is based on health indicators with respect to physical, social, and mental wellbeing of people.

A Historical Perspective of Relevant Definitions from Key Leaders and Organizations in the Field

While assessing the morbidity and mortality rate, Salomon & Murray (2000) found out that despite efforts to increase validity and reliability of carrying out a study using the epidemiologic model, the data collected still suffers from one major discrepancy: coming up with a strategy that facilitates viable comparison of data relative to morbidity and mortality rate of the disease in question. According to Salomon & Murray (2000), this discrepancy stems from the fact that self reported data on health is highly influenced by three key variables, namely, gender, age bracket, and the social-economic status. This discrepancy has further triggered a transition from epidemiologic to social ecological model, as social ecological model puts much emphasis on understanding people’s behaviors, environmental changes, and policies that contribute to good decision making for people’s health on an individual as well as on a group level (Reifsnider, 2005).

Socio-Ecological Models of Health Promotion

The social ecological model is a health promotion concept that puts much emphasis on environmental changes, people’s behaviors, as well as policies that contribute to good decision making for the health of individuals in their day-to-day lives (Reifsnider, 2005). This model was discerned in 1970, and it was first implemented in field of psychology before being adopted in the field of health promotion. Since then, the social ecologic model assesses health on an individual level, interpersonal level, organizational level, community level, and on the public policy level. Because of this, it facilitates addressing multiple factors that influence health, thus highlighting a more comprehensive approach of providing health care information. Therefore, applying social ecological model helps to create a link between the health promotion and health protection because it facilitates a change of behavior as well as adaptation to environment.

Green et al. (1996) have pointed out some environmental factors that may influence the targeted health behavioral change by coming up with four assumptions:

  1. That multiple facets of physical environments, including technology, geography, architecture, as well as social environment play a crucial role in the social ecological analysis. This helps to highlight that a person’s health status is not only influenced by environmental factors but also diverse personal attitudes, which include genetic heritage, behavioral patterns, as well as psychological disposition.
  2. The second assumption involves understanding the complexities of environment, which are characterized by a number of components. Hence, a person’s health status is influenced by factors such as lightening and temperature.
  3. The third assumption states that the social ecological perspective has the capacity of incorporating multiple levels of analysis as well as diverse methodologies. Therefore, coordination of individuals and groups acting at various levels of the model can enhance its effectiveness.
  4. The fourth assumption incorporates concepts from system theory and notes the relationship of the immediate and distant environments, as well as the relationship of people with the environment.

Epidemiology model

The epidemiologic model analyzes the frequency of disease pattern in a given population (Reifsnider, 2005). However, it does not provide profound evidence as compared to the social ecological model because it emphasizes on analyzing the driving force and the environmental factor contributing to the presence of health discrepancies. Though it forms the basis for ecological model, it does not provide information on a broader context. Focusing on physical factors such as low quality foods or low quantity of food is one of the examples of using the epidemiologic model in assessing health discrepancies in children. The ecological model, on the other hand, provides an in depth information of factors contributing to health disparities on biological sphere, environmental sphere, people’s behaviors, and healthcare organizations with respect to health promotion (Reifsnider, 2005).

Notwithstanding the fact that the epidemiologic model associates the environment with the causes of the disease in question, its inferences are opposed to the social ecological model simply because the social ecological model addresses the disease in question by correlating the disease with the social factors and the physical environment (Reifsnider, 2005). As such, the social and the environmental factors form the center stage of addressing health implications and discrepancies. Thus, the social ecological model is an exclusive model that addresses health in an exceptional way since it shares great information on how people should judge situations in a logical manner through analyzing the five levels of health promotion: individual level, interpersonal level, organizational level, community level, and the public policy level.

Even though the epidemiological model and the social ecological model aim at promoting health, there has been a significant difference between their success rates with regard to health promotion. For case in point, chronic stress caused by racism can lead to health disparities such as high blood pressure, low immunity, as well as changes in social behavior as demonstrated by frequent smoking, overdrinking, and overreacting, among others. In this case, these health disparities and changes of social behavior result from poor personal and inter personal relationships. For instance, the social ecological model can be used to enhance personal relationship by adopting a positive behavior that seeks to forgive other people because failure to do so creates an avenue for health disparities that are related to stress. In contrast, the epidemiological model does not address on taking such an approach.

While the epidemiologic model has been successful in eradicating the communicable diseases in the United States, it has been unable to address on effective control of chronic diseases as compared to the social ecological model (MacDougall, 2007). This mainly stems from the fact that it does not address the personal as well as interpersonal relationships with regard to health. With this in mind, it is clear that a suitable health promotion model should not focus on one dimension of health promotion: studying of disease pattern through environment and motivating factors.

Critical Events, individuals, or documents in the Development, Implementation, and Sustainability of the Healthy People Initiative


The onset of healthy People Initiative is marked by a document known as “The Surgeon General’s report on Health Promotion and Disease Prevention.” This document played a crucial role in highlighting the health priorities relative to the national health. More over, the document addresses on matters pertaining to individual health. In a bid to promote health through the Healthy People Initiative, this document facilitated a shift of focus from epidemiologic model to social ecological model, as it takes due diligence in analyzing the health requirements for diverse age groups.


Various events of the Healthy People Initiative have facilitated a decrease in chronic diseases amongst the elderly people. Some of these events include promoting changes in lifestyle and adopting healthy eating habits. Koh (2010) affirms that the Healthy People Initiative has made considerable outcomes through a number of successful events. A significant reduction of coronary heart disease through educative programs is a case in point. The reduction is attributed to adopting the social ecological model. Through this model, the patients are able to learn diverse ways of handling coronary heart disease. These events facilitate attainment of objectives of the Healthy People Initiative.


Despite a number of research studies documenting tobacco as the major cause of morbidity and morality rate in the United States, the Healthy People Initiative has recorded a significant reduction of tobacco smoking amongst people of all age groups (Koh, 2010). This reduction is attributed to collaboration efforts between the Healthy people Initiative and the community. The tobacco victims have influenced greatly the Healthy People Initiative while explaining the negative side effects related to smoking. As a result, the Healthy People Initiative is able to offer quality education.

Implications for the Current Progress and Sustainability of the Healthy People Initiative Based On the Passage of the Patient Protection and Affordable Care Act

Owing to the fact that the implementation of social ecological model is faced with a number of shortcomings, including high medical cost and high cost of drugs from pharmaceutical companies (MacDougall, 2007), the passage of Patient Protection and Affordable Act has helped to create a link between the health promotion and health protection for the citizens of the United States. With the implementation of the Affordable Care Act, the success of the public health will soon be evident because the Act is mandated to provide healthcare to a considerable number of people through the Public health investments. The Affordable Care Act creates an avenue for smooth running of the National Prevention plans, thus helping to finance the Healthy People Initiative. As from 2010, it was projected that this fund would continue to enhance health protection and promotion (Rosenbaum, 2011).

Additionally, the Affordable Care Act aims at targeting specific people, especially the minority population, thus encouraging the Medicaid insurance towards adopting community based care. More so, the Act plays a crucial role in creating a collaboration effort between the nonprofit health care organizations and community health projects as it monitors the ways in which the healthcare institutions invest their resources in the healthcare community projects (Rosenbaum, 2011). Therefore, with this Act in place, the Healthy People Initiative is able to demonstrate prospects of promoting health and reducing health disparities significantly.

Comments on the History of the Development of the Initiative as the Basis for My Projections

Given that the Healthy People Initiative has managed to protect and promote health for a period of three decades, it is in a position to set achievable goals. This is attributed to the fact that the Healthy People Initiative has a proper mechanism of evaluating the factors that hinder achievement of goals, including the role of personal responsibility towards health promotion (Minkler, 1999). More so, it has managed to create unanimity amongst various health care sectors countrywide, as well as to device new ways that facilitate health promotion such as self-care, mutual aid, and a healthy environment. Since its launch in 1979, the Initiative has played a critical role in setting goals that are evaluated after a period of 10 years (Koh, 2010). Considering the fact that the Healthy People 2000 and Healthy People 2010 have managed to evaluate health priorities in the United States, the Healthy People Initiative has the capacity to highlight objectives that are congruent with the health behavioral patterns on a short-term and on a long-term basis. More so, the Healthy People Initiative seeks to promote health for all citizens irrespective of their economic status. Therefore, it is able to reduce health discrepancies countrywide.


Blane, D., Brunner, E., & Wilkinson, R. G. (1996). Health and social organization: Towards a health policy for the twenty-first century. London: Routledge.

Green, L., Richard, L., & Potvin, L. (1996). Ecological foundations of health promotion. American journal of health promotion, 10 (4), 270-81.

Koh, H. (2010). A 2020 Vision for healthy people. The new England journal of medicine, 1653-1656.

MacDougall, H. (2007). Reinventing public health: A new perspective on the health of Canadians and its international impact. J Epidemiol Community Health, 61, 955-959.

Minkler, M. (1999). Personal responsibility for health: A review of the arguments and the evidence at century’s end. Health education and behavior, 26, 121–140.

Reifsnider, E. (2005). Using ecological models in research on health disparities. Journal of professional nursing, 21(4), 216–222.

Rosenbaum, S. (2011). The patient protection and affordable care Act: Implications for public health policy and practice. Public health reports, 126, 130-134.

Salomon, J., & Murray, C. (2000). The epidemiological transition revisited: New compositional models for causes of death by age and sex. The global burden of disease 2000 in aging populations research paper No. 01.17. Web.

World Health Organization. (1986). The Ottawa charter for health promotion. Web.

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