Whether it’s being a better boss, having more energy for quality time with your kids or partner, or simply being a compassionate and conscientious human being, your health and happiness is in everyone’s best interest.
MORPH Complete Wellness 2013
Social Determinant of Health
Public Health research and intervention date back more than 3 centuries. In 1701, Massachusetts passed laws for isolation of smallpox patients and quarantine of ships. In the early 1800s, Edward Chadwick demonstrated in England that differences in social conditions led to a more than 2-fold difference in life expectancy between upper and lower classes. Also in the 1800s, governments began conducting investigations of housing conditions and garbage heaps and mapping them in relation to outbreaks of disease and by the end of the 19th century, state and local boards of health were being created to enforce sanitary regulations.
Today, we face very different but equally challenging preventable health challenges. In particular, chronic disease rates such as heart disease, diabetes and stroke have skyrocketed. People have never been more overweight, more stressed or less active, and the foods we eat and how we eat them has dramatically changed with the advent of food technologies which distance the consumer from their food origin, often with catastrophic impacts on their nutritional value and our planet.
These health issues, similarly to the communicable diseases epidemics plaguing mankind in previous centuries, are distributed unequally across populations. Some of us, by virtue of our race, income or education level, are less likely to be befallen by chronic illness and early death. More pointedly, the key message from the Public Health literature over the few decades, is that if you are poor; of a racial background other to that which predominates within your community (a minority racial group); have limited education (and in particular if your mother had limited education) or you live in a lower socio economic neighbourhood, then you have a much greater likelihood of:
It is a sad reality and reflection on many western societies particularly, that the most vulnerable people are often the most likely to experience suffering
The Social Determinants of Health is a concept and framework developed in the late 20th century that acknowledges and seeks to explain the complex interaction of socio-ecological factors and personal and population level health and wellbeing. In it, particular elements are highlighted which are known to have powerful associations with health. In recent literature, the Social Determinants of Health are summarised as follows: Education, Income, Housing, Work Status and Conditions of Work, Stress, Transport, Access to Healthy Food and Opportunities to be Physically Active, Early Life (the conditions we are exposed to in our first 4 years of life), Social Support and Social Exclusion and Discrimination (on the basis of race, gender, sexuality or religion).
The interaction of these determinants and health can also be accounted for using similar frameworks such as General Systems Theory, which is similarly concerned with the impact of system elements on its individual parts. However where Systems Theory doesn’t generally seek to identify particular cause and effect relationships within the System, the Social Determinants of Health examines further the impact of specific System elements on people’s health and wellbeing. Unlike the Social Determinants of health however, Systems Theory centralises the notion that the individual part (in the case of personal health, the individual) also influences the system (in this instance, broader societal health and wellbeing). This two way interaction of individuals with both proximal (close to) and distal (distanced) system elements is the focus of this Thought Leadership Article and a proposed wellness coaching framework is proposed which seeks to reconcile system level determinants of health and wellbeing with those traditionally addressed within the health and wellness coaching literature.
General Systems Theory
General Systems Theory (GST), and its many derivative theories including Family Systems Theory and Community Systems Theory, stem from the belief that all systems and parts are interrelated and their interactions are both transactional and dynamic. The concept of ‘system’ serves to identify those manifestations of natural phenomena and process that satisfy certain general conditions. In the broadest conception, the term connotes complex interacting components and the relationships among them that permit the identification of a boundary-maintaining entity or process (Laszlow & Krippner 1998). A more action oriented definition can be found in Russell Ackoff’s suggestion that a system is a set of two or more interrelated elements with the following properties:
- Each element has an effect on the functioning of the whole
- Each element is affected by at least one other element in the system
- All possible subgroups of elements also have the first two properties (Ackoff, 1981).
According to systems theory, all persons are in continual transaction with their environment, that is, the individual is forever influencing and providing feedback to the environment, and the environment is forever influencing and providing feedback to the individual. For further relevance to the coaching context, we might say that this system feedback is not necessarily positive or negative, but will sometimes serve to either reinforce limiting beliefs, patterns, or states or create circumstance within which the individual or environment can thrive and feedback to the system positively.
The practical implication of systems theory is that when you strengthen one element of the system, the entirety of the system reaps the rewards, and when one element of the system is compromised or operating sub-maximally, other parts of the system will in some way manifests this deficiency.
Applied to the spiritual coaching context, we might view the system as being the collective, dynamic energy that is present between all human beings. When the nature of the energy operating at any one point of the system is loving and kind, there is a ripple effect which radiates throughout the system, benefiting all system elements. Conversely, when the nature of the energy operating at any one point of the system is fearful or judgmental, there is a negative impact to system elements.
Self-Love
Unsurprisingly, self-love can be defined simply as “the love of oneself”. In 1956 psychologist and social philosopher Erich Fromm proposed that loving oneself is vastly different from being arrogant, conceited or egocentric. He proposed that loving oneself means caring about oneself, taking responsibility for oneself, respecting oneself, and knowing oneself (e.g. being reflective, realistic and honest about one’s own attributes). He proposed, further, that in order to be able to truly love and respect another person, a person needs first to love and respect oneself in this way. This can logically be expanded to include groups of people, and indeed all those we come in contact with, and when summarised in Systems Theory terminology we could say that when we are self-loving, all elements within our proximal and distal environments are positively impacted, and that this positive impact is then reflected back to us.
Self-efficacy
Self-efficacy is the personal measure of one’s ability to identify, prioritise and achieve or complete tasks and goals. Self-efficacy has been researched and published about from several perspectives, including public health, education, staff productivity and leadership development, and athlete coaching. Self-efficacy affects every area of human endeavour. By determining the beliefs a person holds regarding his or her power to affect situations, we can infer both the power a person actually has to face challenges competently, and the choices a person is most likely to make in relation to their goals and tasks. These effects are particularly apparent, and compelling, with regard to behaviours affecting health and wellbeing.
The theory of self-efficacy lies at the centre of Psychologist Albert Bandura’s social cognitive theory, which emphasizes the role of observational learning and social experience in the development of personality.
The main concept in social cognitive theory is that an individual’s actions and reactions, including social behaviours and cognitive processes, in almost every situation are influenced by the actions that individual has observed in others. Because self-efficacy is developed from external experiences and self-perception and is influential in determining the outcome of many events, it is an important aspect of social cognitive theory. Self-efficacy represents the personal perception of external social factors, which connects it conceptually to the Social Determinants of Health, and in particular, how people view themselves in relation to their social circumstances. According to Bandura’s theory, people with high self-efficacy—that is, those who believe they can perform well—are more likely to view difficult tasks as something to be mastered rather than something to be avoided, and adverse circumstances as being surmountable and within their personal locus of control.
For instance, choices affecting health, such as smoking, physical exercise, dieting, condom use, dental hygiene, seat belt use, and breast self-examination, are dependent on self-efficacy. Self-efficacy beliefs are cognitions that determine whether health behaviour change will be initiated, how much effort will be expended, and how long it will be sustained in the face of obstacles and failures. Self-efficacy influences how high people set their health goals (e.g., “I intend to reduce my smoking,” or “I intend to quit smoking altogether”).
To summarise in context, when a client’s self-efficacy is increased, so too is their capacity to mitigate and overcome adverse circumstances by assisting them to capitalize on their perceived locust of control. Through small achievements, self-efficacy grows and those circumstances previously deemed insurmountable become less so, and the realm of “possible” begins to expand.
Self-mastery
Closely related to Self-efficacy, and more commonly associated with coaching conversations, Self-mastery is concerned with actions. Where Self efficacy is concerned with belief in our own capacity, Self-mastery is about the translation of capacity to action and outcomes. Self-mastery also relates to mastering our thoughts, emotions and impulses, which are major influencers in our behaviours. When we have developed self-mastery, we have the ability to control ourselves in all situations, and we move forward consciously and steadily towards our goals through our everyday actions (MindTools 2013).