This chapter explores the evolving and contested definitions of health, emphasizing its multidimensional and dynamic nature. In particular, it distinguishes between health conditions, health needs and health priorities. Health conditions are a broad set of situations, with both subjective and objective measures, related to present and future structures and functions of the human body, as well as the capacity to adapt to both the physical and social environment in which every human being lives. Health conditions occur on a gradient from an idealized state of perfect health to the total absence of health, which is death. Health needs are a subset of health conditions – they are the health conditions that require care. Using examples such as obesity, autism and fibromyalgia, the chapter shows how definitions can shift over time.

This chapter explores how elements of ‘sense of place’—place dependence, identity, and attachment—are essential for creating liveable, healthy communities. It discusses how community social interaction, cohesion (sense of community), and collective action enhance liveability. Addressing frequent shortcomings in defining and measuring ‘liveability’, the authors integrate recent geospatial population health research to establish connections between place, health, development, and policy. A framework linking community cognitions, attachment, and social action in response to environmental threats and disruptions is applied to brief case studies from Bulgaria and the United States illustrating varied community responses aimed at healthier, more liveable environments. Recommendations include leveraging liveability audits to evaluate local and regional impacts of disruptions, articulating threats to community identity and economic wellbeing, and embedding psychological conceptions of place into public-health and urban-planning assessments. This integrated, ecological approach aims to strengthen community responses and inform policy decisions supporting population health and wellbeing

Drawing on survey and interview evidence, this chapter explores the effect of coverage denials on patients’ health and economic security. Most Americans report an inability to pay an unexpected $1,000 bill, so, with notably expensive health care, denials can be devastating. Too often, when coverage is denied, patients abandon their treatments, a dynamic shown not only through physician surveys, but also through original survey evidence of patients, half of whom reported delaying or abandoning their prescribed care. Further, the people most likely to do so are typically Black or Hispanic or less affluent, and nearly half of patient respondents reported that their health condition declined. In fact, some patients may not survive at all. Marginalized patients are also more likely to postpone non-medical purchasing to accommodate unexpected health insurance barriers, suggesting the far-reaching consequences of prior authorization. The evidence shows not only that tools of managed care produce frequent coverage denials, but also that this practice shifts risk from insurers to patients, yielding new health and economic insecurities, especially for patients from marginalized backgrounds.

This chapter provides economic explanations of the level of total national health expenditures in the US and of population health outcomes. It helps managers explain the role of wage differences with other countries and the impact of income inequality and racism on spending and outcomes. Wages of healthcare workers are much higher in the US than abroad. The healthcare GDP share has stabilized after growing for many years, but beneficial yet costly new technology still matters for cost and health growth. Metrics of relative health spending are distorted by exchange rate mismeasurement. Evidence on the fraction of total spending that is wasteful is very uncertain because no managerial or policy actions as yet have been proven to reduce waste in ways that do more good than harm. Changes in insurance and pricing policy have the highest promise for improvement.

In this chapter, we discuss practical ways One Health approaches can be integrated into legal and policy action from the lens of the environment sector, to deliver improved human, animal, and ecosystem health outcomes. Relevance to specific processes are highlighted: (1) national implementation of global environmental conventions, including in laws and policy frameworks; (2) environmental and social impact assessment; and 3) local governance systems, including in and around protected areas. Examination of these topics is ground-truthed by national, regional, and subnational examples, including from Liberia, building on lessons from the country’s robust multi-sectoral One Health coordination platform that can guide One Health action at all levels. We also explore the relevance of One Health economics to guide law and policy decisions frameworks in reducing environmental degradation and other trade-offs and maximising societal co-benefits. Finally, we discuss how industry standards and voluntary frameworks, such as the IUCN Green List Standard and its accompanying One Health tools, can have a supporting role in advancing good governance and multi-sectoral management for conservation and health outcomes.

Matching available health resources to consumer needs is challenging. Governments and health bureaucracies with finite resources face increasing demands from their client populations, which often have complex health issues. No country prioritises resources to meet every single health need of every citizen; consequently, effective health service planning is critical to maximising population health outcomes and ensuring value for the available money. Due to the inherent contradictions existing between the high demand for and the limited responsive supply capacity by health services, health service planning is often characterised by negotiation, lobbying and compromise among various interest groups. A consensus can best be achieved if stakeholders agree upon a set of core values, and all involved in the process endorse principles and the procedures of planning. This chapter focuses on the practice of health service planning.

Group consultations are a form of community-integrated care that involve patients with similar health issues meeting with a clinician in a group setting. This approach enhances self-care and co-production, as patients learn from each other and participate in shared decision making. Group consultations have been shown to improve patient activation and evidence-based outcomes for long-term conditions such as diabetes and COPD, often at lower costs than individual consultations. Group consultations can be delivered in different ways, depending on the needs and preferences of the patients and the clinicians, including virtual sessions that allow for holistic care in the home environment. Case studies from various settings illustrate the effectiveness of group consultations in managing conditions like hypertension and diabetes. Group consultations are therefore a valuable method that combines the best of traditional care with the advantages of peer support and education, leading to better health outcomes in an efficient way.

Self-care is a broad concept that refers to the actions taken to preserve or improve health, which can vary depending on the academic literature. A useful framework to understand self-care is the Self-Care Matrix, which consists of four dimensions: activities, behaviours, context, and environment. Self-care activities are the specific practices that promote health, such as physical activity, healthy eating, hygiene, and rational use of health products. Self-care behaviours are the principles and actions that guide positive health behaviours and lifestyle choices. Self-care context is the degree of dependence or independence from external healthcare resources. Self-care environment is the external factor that influences self-care practices within the community. Self-care is closely related to Lifestyle Medicine, which supports individuals in adopting sustainable health practices and prioritises preventive strategies over reactive measures. Lifestyle Medicine and self-care play a crucial role in both primary and secondary prevention of diseases. The future of self-care envisions a healthcare landscape where technology and personalised approaches enhance self-care and Lifestyle Medicine. However, there are also challenges to address, such as potential inequalities and misconceptions that may arise as health systems pivot towards self-care.

Lifestyle Medicine is a practice grounded in evidence-based approaches, distinguishing it from unverified commercial wellness trends. It requires practitioners to critically interpret the evolving evidence base and communicate risks effectively to support shared decision making. While clinical trials for Lifestyle Medicine are less common than for pharmaceuticals, its interventions are nonetheless impactful and often preferred by patients. Epidemiology plays a crucial role in identifying associations between exposures and outcomes, although it cannot always establish causality. Understanding and communicating risk is vital, with absolute and relative risks offering different insights into the potential effects of interventions. The interpretation of evidence must consider both statistical and clinical significance, with confidence intervals providing a more nuanced understanding than p-values alone. Scepticism is necessary when interpreting clinical research to account for potential biases and confounding factors. Ultimately, consensus-driven approaches and trusted institutions guide practitioners in integrating Lifestyle Medicine into broader treatment guidelines.

For a case-control study to be a suitable design, we need a good idea about the outcome of interest (or condition) described by a strong case definition. But what if we know quite a bit about the exposures we are interested in, but we are a little hazy on the potential outcomes associated with those exposures? If we consider a scientific question like the one posed in this chapter – What happens if you eat pizza and chips every day?’ – we have specifically identified the exposures of interest, but can only guess what the outcomes might be. Okay, we could probably make fairly educated guesses about some of the potential outcomes (weight gain being foremost among these), but there remains a level of uncertainty about their timing, magnitude and variety. What is really needed to answer a question like this is a ‘cohort study’, a type of observational study in which ‘cohorts’ of people (population groups who share certain characteristics, such as being in the same work environment, or who are born in the same year) are sorted into groups on the basis of whether they have or have not been exposed to specific health-related factors.

Sex and gender have a significant relationship to health and health outcomes for women, men, and sexually and gender-diverse people. Sex relates to biological attributes, whether born female or male, while gender identity relates to how someone feels and experiences their gender, which may or may not be different to their physiology or sex at birth. Biological characteristics expose women and men to different health risks and health conditions. Gender also exposes people to different health risks, and gender inequity impacts on their potential to achieve health and well-being.

Sexual health nurses are employed to work in a range of practice settings and work with diverse population groups. Sexual and reproductive health care is considered a human right and is fundamental to positive well-being. The nurses role in sexual and reproductive health varies between settings within and across different jurisdictons. Work settings include dedicated sexual health clinics, family planning services, community health centres, women’s health services, correctional services, general practices and tertiary education settings. In some juristictions, nurses also provide care in publicly funded sexual health clinics aimed at providing services to specific priority population groups to increase their access to services and reduce the prevalence of adverse sexual and reproductive health outcomes including sexually transmitted infections and unplanned pregnancy.

The role of occupational health nurses is to improve mental and physical health outcomes and the well-being of workers. These benefits can often extend to family and community. Workers’ health is impacted by several factors including fatigue, gender, culture, age, language, living conditions, access to nutritious food, level of physical activity, sleep patterns, personal health practices and coping strategies, levels of social support and inclusion, personal safety and freedom from violence.