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As we have seen in chapter 1, defining what we may see as a threat to health will be intrinsically linked to how we define health. Even the word ‘threat’ is linked to negative, commodity, pathogenic and biomedical concepts of health. Implicit in this discussion is that full health is compromised by a threat and that it can be restored by preventive treatment and curative interventions. If, however, we consider health under more positive and salutogenic (what generates health and well-being, as discussed in chapter 1) conceptual frameworks, then the word ‘threat’ is not as appropriate, as we are concerned with the creation of health not the avoidance of disease, illness and disability (Antonovsky, 1996). Often an understanding of the word health in the popular sense is limited to notions of physical health, with increasing recognition of mental illness, although social and community health is relatively neglected in popular discourses of health (see chapter 9 for a discussion of community as a determinant of health). This can shape what are defined as threats to health.

The COVID-19 pandemic was quickly perceived as a threat to biological health. However, it also uncovered related health threats – such as those relating to mental health – and soon demonstrated the social determinants of health as different groups were affected to varying degrees.

Similarly, if we define the influences on our health as ultimately biological in nature, leading to ill-health and malfunctioning of the healthy physiological state of the body, then the threats will be conceived as factors influencing our biological states. For example, eating too much saturated fat in our diet leads to increased plasma cholesterol, resulting in atherosclerosis and an increased risk of coronary heart disease (Hu, Manson and Willett 2001; NHS, 2017).

However, if we subscribe to the social model of health and acknowledge the importance of socio-economic factors in determining well-being and disease, then we will view threats more broadly and shaped by the social world in which we live (see chapter 4 for a more detailed discussion of how society influences health). Continuing with the previous example and applying the social model of health, we should recognize that the influences on eating high levels of saturated fats are shaped by societal demands for inexpensive, tasty and convenient patterns of eating (Glanz et al., 1998). Laestadius and Wolfson (2019) outline several health-damaging trends, such as high demand for non-animal-derived products, convenience foods, nonregional foods and large serving sizes. Similarly, levels of activity are influenced by town planning, the configuration of leisure space and the organization of transport systems, which are all analysed within the scope of the social model of health. Mueller et al. (2020) point out that car-dependent city planning causes environmental pollution and encourages sedentary lifestyles, which are damaging to public health.

Examining the causal pathways for health and illness can aid our understanding of the diversity of threats to health. Bhopal (2008) provides a useful model for analysing the complexity of causal pathways called a web of causation, which visualizes the interconnectedness of factors that influences health and illness. Bhopal’s (2008) diagram represents a complex group of health determinants, such as the environment, behaviour and the workplace. It also shows the inter-relatedness of these factors in terms of how they contribute to the occurrence and spread of disease. The web of causation can help us to understand aetiology by linking social determinants as well as biomedical factors (Ventriglio et al., 2016). Now complete learning task 2.2, which demonstrates the complexity of health determinants in relation to a specific illness, hypertension (high-blood pressure).