What it takes to be healthy

This is a long blog post. I hope readers take the time to read the post completely.

The Media

I watch the news on a regular basis. I read newspapers (e.g., Vancouver Sun, The Province, Kelowna Capital News) and magazines (Time, Macleans) when they are available to my curious eyes. I listen to the radio (CBC Radio One/Two) when I’m driving in a 2000 pound hunk of metal.

The news stations and outlets love stories about health. Likely because news consumers (us) love to hear ways to be healthier, live longer, be happier. There’s stories telling us to exercise more (and the #TakeTheActivePledge). Eat more healthy (MacDonald’s – nope). Don’t have unprotected sex. Live above the eight floor if you live in an apartment building.

This is what caught my attention recently making many headlines across British Columbia’s news outlets. I had never heard this before during my undergrad degree at UBC, or in any reading I do about health and lifestyle. What does living on a higher floor in an apartment building help increase one’s health?

Before going on, take a few minutes and brainstorm some ideas of your own. Why does this phenomenon occur?

Apartment Buildings

Here’s an example of a news article (click here) by our UK counterparts (I will make a blog post in a few weeks why I took an article from the UK – hint, perhaps?). Recent research in the European Journal of Epidemiology released an article about the relationship between living on the 8th floor or higher and health. A link to the article High life in the sky? Mortality by floor of residence is posted on this blog post (click here).

Many media personalities and journalists, along with the researchers, described several reasons they thought floor level was connected to mortality and health. A higher floor is further away from traffic and sidewalks so sleep is of higher quality as occupants of the higher floors are not disturbed by cars honking, people yelling, and sirens racing to a vehicle accident. Another explanation, power outages made those on higher floor walk up more stairs and get more physical activity when the elevators aren’t functioning (no power, no elevator).

These are two characteristics of housing, that are in one’s control (get more physical activity, and have a more quiet room so sleep is easier). What many articles, though not all, failed to mention, were some of the social determinants that may influence the relationship between housing and health.

An apartment on the 20th floor is likely more expensive than one on the 5th floor, though not always. Income is a strong predictor of health. We can assume those in higher floors make more as they can afford a more expensive apartment.

Another determinant of the housing-health relationship not discussed, was the better view of higher apartments. The 18th floor apartment is higher than the 10 story buildings surrounding your building, so the view of the lake from your apartment is unobstructed. The evenings are splendid as the sunset glides across the mountain range, slowly decreasing the level of light in the valley. The light slowly disappears behind thousands of feet of earth, and not before providing an absolutely stunning view of the lake and surroundings. Who wouldn’t enjoy this majestic view of the lake and valley? I definitely would want this view in the mornings! My friends probably would enjoy the view, too.

This is another determinant of health not talked about in mainstream media – a social safety net and the absence of social exclusion. With such a beautiful view, those weekly BBQs amongst your network of friends is held on your 8th floor apartment so everyone can enjoy the best view in the city. This increases the bonds within your social network. When you suddenly need an emergency loan from friends to pay for a car repair when your par cheque is late, all those dinners hosted make it easy to ask to borrow some funds for a few days.

Common Health Tips

Before going on too much, first the common sense health tips. The ‘common sense’ health tips go a little something like this (in no particular order):

  1. Don’t smoke. If you do, try to stop or cut down on the amount of cigarettes;
  2. Eat a balanced diet of fruit and vegetables and the 3 other food groups;
  3. Keep physically active;
  4. Manage stress;
  5. Drink alcohol in moderation;
  6. Get adequate sleep;
  7. Protect your skin in the sun;
  8. Practice safer sex;
  9. Follow the rules of the road;
  10. Get screened for cancer; and
  11. Learn first aid.

Next, the research-based social health tips. Before going too much further, prepare yourself to read some things that may offend you or make you scratch your head. I’ve had several individuals read this list over the past few years and most of their jaws drop at first before taking a few moments to think and reflect.

The social determinants of health

The research evidence-based health tips (in no particular order):

  • Don’t be poor. If you can, stop. If you can’t, try not to be poor for long;
  • Don’t have poor parents;
  • Own a car;
  • Don’t work in a stressful, low paid manual job;
  • Don’t live in a damp, low quality home;
  • Be able to afford to go on a vacation and sunbathe;
  • Practice not losing your job and don’t become unemployed;
  • Take up all the benefits you are entitled to, if you are unemployed, sick, or retired; and
  • Don’t live next to a busy major road or near a polluting factory.

Which Are More Correct

The ‘common sense’ health tips are the ones we learn in school, hear from government agencies, non-profit organizations/charities, and media. These things we can control.

The second set of tips are based on social constructs, and are not hings we can control, directly. These are based on the social determinants of health.

The correct answer to which are correct is very complicated. You will find tons of research showing that more exercise (to an extent as over-exercise can be just as bad as no exercise) helps with better health outcomes. Less smoking (even better, no smoking) decreases chances for lung disease.

However, this starts the debate, what is health. Is it merely the absence of illness/ailments? No, it is not. Let’s take a short break and look at what is health.

What is Health

Health is like happiness. It is a construct extremely hard to describe and define. The World Health Organization defines health as:

Health is a state of complete physical, mental, and social well-being and not merely the absence of disease

I don’t think this is the perfect definition, but it points us in a good direction. As many people will point out, health is not about a complete state of well-being. The other issue is that the definition doesn’t speak about the spiritual aspect of humans (this does not mean religion for those that seem allergic to spirituality/religion – for the many people who have such a ignorant view of this word (I have spoken to too many), I hope you educate yourself soon so I can stop feeling sorry for you). In this context, I mean spirituality in having and knowing your sense of purpose in life.

Based on this definition, you realize how funny the phrase ‘health care’ truly is. It’s really illness care as they treat illness instead of preventing illness and trying to maintain society’s health. Using the health definition from above, health care would be health clinics that include psychologists, sociologists, kinesiologists, nutritionists, life coaches, and other health-related professionals.

Social Determinants of Health

Back to the question of what is correct, the `common sense`health-tips or the evidence-based health tips. The evidence-based health tips are based on the social determinants of health. These are social constructs that play a role in determining one`s health.

The social determinants of health are (in alphabetical order):

  • Aboriginal status
  • early life
  • education
  • employment and working conditions
  • food security
  • gender
  • health care services
  • housing
  • income and its distribution
  • social safety net
  • social exclusion

What this means for health

What does this mean for health? Have years and years of wives’ tales been incorrect?

Not necessarily.

The social determinants of health are a much better predictor of the health of a group of individuals than the amount of exercise or the healthiness of a diet of an individual. The social determinants of health will help predict some of your health habits.

Just like having a higher income allows you to buy a higher apartment so that you have to walk more stairs and can get a better sleep due to less noise pollution, your health habits can be highly predicted by looking at one`s social determinants.

The answer is a mix of things. It`s a little bit like life. A balance of ying and yang. There`s no one correct answer, but everything and everyone is connected in an intricate web of thoughts, ideas, services, people, places, and things.

Don’t stop exercising. If you do exercise, this could be highly influenced by where you live (which is based on your income and job, in part). Continue to eat healthily. However, these aren’t the only things impact your health.

Other references:
WHO – Social determinants of health
Government of Canada – What determines health
Government of Canada – Social determinants of health
Romanow, R., Bennett, C., & Raphael, D. (2008). Social determinants of health: Canadian perspectives (2nd ed.).


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Adam Goodwin is changing the world by growing the local #TakeTheActivePledge to a global movement. He is currently Marketing Coordinator for Okanagan Elite Athlete. Along with his start-up one3ag, he is changing the lives of individual children, teen, youth, adults, and older adults with the #TakeTheActivePledge movement. Join him today to help save a generation.


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