According to Richard, what was the concept of health before the 1940s?

Interviewer (W) Richard Johnson (M)
W: I am talking to Richard Johnson, an official of WHO, the World Health Organization. Today he will talk with us about the change of people’s understanding of health. Hello, Richard.
M: Hello.
W: Now Richard, the concept of health has been changing all the time. And different people and groups hold different opinions towards it. Would you mind telling us the original concept of health?
M: Of course not. (5 - 1) Health has long been viewed in the physical sense only. That is, good health has been connected to the smooth mechanical operation of body, while ill health has been attributed to a breakdown in this machine. In this sense, (1) health has been defined as the absence of disease or illness and is seen in medical terms. Therefore, creating health for people means providing medical care to treat or prevent disease and illness.
W: Then what was the emphasis of the work of the WHO during that period?
M: Well, the emphasis was of course on providing clean water, improved sanitation and housing.
W: I see. When did the concept begin to change?
M: (2) In the late 1940s, the WHO challenged this physically and medically oriented view of health. (5 - 2) They stated that health was a complete state of physical. mental and social well-being and not merely the absence of disease. (2) The mind, body and spirit of a person were seen holistically.
W: How long did this concept last?
M: It lasted until the 1970s. At that time, people focused their attention on the prevention of disease and illness by emphasizing the importance of the lifestyle and behavior of the individual. Specific behaviors which were seen to increase risk of disease, such as smoking, lack of fitness and unhealthy eating habits, were targeted. (5 - 3) Creating health meant providing not only medical health care, but health promotion programs and policies which would help people maintain healthy behavior and lifestyles.
W: It sounds reasonable. It must have been beneficial to people.
M: Unfortunately, not.
W: But why?
M: (3) You see, this individualistic healthy lifestyles approach did help the wealthy members of the society. But the majority were people experiencing poverty, unemployment or little control over the conditions of their daily lives. How could people afford the program if they lived under unfavorable social and environmental factors?
W: I’m beginning to see your point. A single lifestyle decides nothing if not integrated with a good environment.
M: That’s right. So during the 1980s and 1990s, there has been a growing swing away from seeing lifestyle risks as the root cause of poor health. While lifestyle factors still remain important, (4) health is being viewed also in terms of the social, economic and environmental contexts in which people live.
W: This is a new concept of health. And I heard it’s called the socio-ecological view, isn’t it?
M: Yes. In 1986, representatives from 38 countries gathered in Ottawa, Canada, to hold the first International Conference of Health Promotion. It was at that conference that (5-4) the broad socio-ecological view of health was endorsed.
W: What were the details of the endorsement?
M: Well, the representatives declared that the fundamental conditions and resources for health are peace, shelter, education, food, a viable income, a stable ecosystem, sustainable resources, social justice and equity. Moreover, improvement in health requires a secure foundation in these basic requirements. From this statement, we can find that the creation of health is about much more than encouraging healthy individual behaviors and lifestyles and providing appropriate medical care. It must include addressing such issues as poverty, pollution, urbanization, natural resource depletion, social alienation and poor working conditions.
W: Oh, I see. But how are they affecting health?
M: They do not operate separately. Rather, they are interacting and interdependent. The complex interrelationships between them determine the conditions that promote health. A broad socio-ecological view of health suggests that the promotion of health must include a strong social, economic and environmental focus.
W: That’s right.
M: As we all know, good health is a major source for social, economic and personal development and an important dimension of quality of life. Political, economic, social, cultural, environmental, behavioral and biological factors can all favor health or be harmful to it. The Ottawa Conference not only redefines the notion of health. More importantly, it brings practical meaning and action to this broad notion of health promotion. It presents fundamental strategies and approaches in achieving health for all.
W: Then what is the basic philosophy of this health promotion?
M: Very easy to understand. Just to enable people to increase control over and to improve their health.
W: The new concept of health you have told us today is very useful to our understanding of health. Thank you very much.
M: You are welcome.