MODELS OF HEALTH AND ILLNESS
INTRODUCTION
Health refers to the extent of a person’s physical, mental, and social well-being. From this definition it is clear that to be health requires more than a single aspect. A person has to be physically fit, mentally and psychologically in a good condition and he should be able to keep socially stable relationship. According to world health organization a state of complete physical, mental, and social well being, not merely the absence of disease. There are different models to explain health and illness. Models of why and how individuals carry out behaviors to promote health and prevent illness are useful in helping healthcare providers understand health-related behaviors and adapt care to people from diverse economic and cultural backgrounds. A model is a theoretical way of understanding a concept or idea. Models represent different ways of approaching complex issues. There are different models of health. These models of health and illness are as under.
BIOMEDICAL MODEL OF HEALTH
According to Baggott (2004) the biomedical model of health looks at individual physical functioning and describes bad health as the presence of disease and illness symptoms as a result of physical cause such as injury or infections and attempts to ignore social and psychological factors. Baggott (2004) states that the features of biomedical model rest mainly on biomedical changes, which can be defined, measured and isolated. In effect this is directed towards the dysfunction of the organs and tissues of the body rather than the overall condition of the patient.
Biomedical treatments often involve the removal of the cause, for instance the virus or bacteria. The biomedical model is based on the belief that there is always a cure and the idea that illness is temporary, episodic and a physical condition.
The basic values of the biomedical model of health consist of the theory called doctrine of specific aetiology, which is the idea that all disease is caused by theoretically identifiable agents such as germs, bacteria or parasites (Naidoo & Wills 2004).
ADVANTAGE OF BIOMEDICAL MODEL
The advantage of biomedical model shows disease as representing a major public health problem facing our society. This model sees disease state as an issue that needs to be treated, and that disease can be readily diagnosed and quantified (Ewles & Simnett 2003 & 2010). This approach appears narrow, negative and reductionist. In an extreme case, it implies that people with disabilities are unhealthy and that health is only about the absence of morbidity. Further, this model is limited in its approach by its omission of a time dimension
Modern biomedicine rests upon two major developments, both of which remain influential to this day. It is first important to consider the Cartesian revolution after the seventh century French philosophy Rene’ Descarts. The Cartesian revolution encouraged the idea that the body and mind are independent or not closely related (NRC 1985). In this mechanistic view, the body is perceived to function like a machine with its various parts individually treatable, and those that treat them considered engineers (Naidoo & Wills 2004). Biomedical also concentrates on the individual unlike the social model. Biological model adopts a negative perspective on health as it views health more in terms of the absence of disease than the possession of healthy attributes (Baggott 2004). This model stresses the importance of advancing technology both in the diagnosis and treatment of disease, an approach that has undoubtedly improved both the knowledge and understanding of numerous diseases. Biomedical model has led to the improvements in the treatment of patients, which has favoured gains both in the length and quality of life of people. Despite the aforementioned feats, the biomedical model has received considerable criticism, as many writers have argued that it was inappropriate to modern, complex health problems (Inglis 1981).
The medical model, in terms of specific health risks, does not encompass all of what health means to an individual. For instance, a physician speculating on what, based on current knowledge at the time, would be the composite picture of an individual with a low risk of developing coronary artery disease.
Further criticisms of this theory focused principally on the suggestion that it over simplified biological processes now known to be very intricate. For many diseases there are multiple and interacting causes. Moreover, such a theory looks only to the agent of disease, and ignores the host, and the possibilities of biological adaptation. The theory is much more easily applicable to acute conditions than to chronic ill-health and is difficult to apply to mental disorders.
The second theory of the biomedical model is called the assumption of generic disease. This is when each disease has its own distinguishing features that are universal, at least within the human species. These will be the same in different cultures and at different times, unless the disease-producing agent itself changes. Criticisms of this focus on the rather obvious point that diseases are differently defined in different cultures and those medical definitions of disease have clearly changed over time. Each new advance in knowledge of physiology and each new wave of technology have added new definitions of ill health to the accepted canon. Despite the doctrine of specific aetiology many conditions, which are still only symptoms or syndromes, are recognized within medicine as diseases. Generally, it can be seen that what is viewed as illness in any particular society and at any historical time depends on cultural norms and social values (Naidoo & Wills 2004).
Thus new diagnoses such as alcohol, post-traumatic stress disorder, chronic fatigue syndromes are born through an interaction of new knowledge about both their possible causes and how they might possibly be helped. As a definition of disease what doctors treat has obvious problems, however, it implies that no one can be ill until recognised as such and leaves the concept at the mercy of idiosyncratic individual medical decisions.
The third theory is the scientific biomedicine, which accepts the model of all ill-health as deviation from the normal especially the normal range of measurable biological variables. There is an association with the definition of health as equilibrium and disease as a disturbance of the body’s function, with the purpose of medical technology the restoration to equilibrium. The immune or endocrine, or neuropsychological systems attempt to restore the normal and the purpose of medicine is to instigate or assist this process. But medical science now realizes that the human organism has no set pattern for structure and function, and it is often unclear where normal variation ends and abnormality begins.
The fourth theory of medical model is based on the principles of scientific neutrality. Medicine adopts not only the rational method of science but also its values – objectivity and neutrality on the part of the observer, and the view of the human organism as simply the product of biological processes over which the individuals themselves have little control. The reply to this is that the practice of medicine, whatever its theory, is always deeply embedded in the larger society. It cannot be neutral, for there are wider social, political and cultural forces dictating how it does its work and how the unhealthy are dealt with.
Biomedicine now admits multiple and interactive causes, and that the whole may be more than simply the sum of the parts. Social and psychological causes of ill health- stress, unhappiness, life events- are admitted as agents of disease or contributing factors, but they are not themselves defined as ill health. Modern medicine has moved on, to incorporate elaborate ideas about the various and interrelated causes of ill health. Studies of the way in which doctors make diagnoses demonstrate this, while at the same time lip service is paid to the importance of the social. Moreover, even when social and psychological influences are admitted this is still a very negatively oriented approach to health.
SOCIAL MODEL OF HEALTH
A social health model is aimed at incorporating the social and economic, as well as biophysical context of health status. It is based on knowledge of the experience, views and practices of people with disabilities. It locates the problem within society, rather than within the individual with a disability. Rules are determined within a framework of choice and independent living with strong support from organized disability communities. The biases of the social model include: limiting the causes of disability either exclusively or mainly to social and environmental policies and practices, or advancing perceptions of disability that emphasize individual rights rather than advancing broader economic rights.
The social model came about in mid twentieth century when there was increasing dissatisfaction with the dominant model of health offered by biomedicine. The preoccupation with disease and illness made it less able to deal with any positive concept of health. The ideology, which viewed the individual in mechanistic ways justified ever-increasing use of medical technologies, precluding the exercise of other therapies and diminishing the importance attached to positive health or preventive medicine.
Since the last decade medical professional practice has become a major threat to health. Depression, infection, disability and other specific estrogenic disease now cause more suffering than all accidents from traffic or industry by transforming pain, illness and death from a personal challenge into a technical problem, medical practice expropriates the potential of people to deal with their human condition in an autonomous way and becomes the sources of a new kind of un-health. The emphasis on health as simply the absence of disease encouraged thinking about only two categories the health and the disease.
As we are meant to believe that science can produce a utopia of disease free and lengthy life meaning scientists only look for their magic bullet. There is a feeling that the angriest critiques of the biomedical model was wilfully ignoring the contributions of modern science to human welfare. But claims to the unique truth of biomedicine were weakened by some loss of faith in scientific objectivity and a distrust of a Frankenstein technology that could run out of control, and this was part of the modern movement towards a new model usually called social health.
Social model of health imbibes social constructs and relativity in its approach to health. It tends to define and redefine health in a continuous manner, and views health differently between individuals, groups, times and cultures. Some supporters of Social model have written extensively about sickness having a role to play in various societies (Parsons 1951) as this helps to determine the structure of and functionality of the society.
The concept of social health incorporates many differences of emphasis though it has to be noted that it is more than simply the recognition that social factors such as poverty have to be included in a model of the causes of ill health. The social model is a different construction, locating biological processes within their social contexts and considering the person as a whole rather than a series of distinct bodily systems.
The social model is organic and holistic rather than reductionist mechanical method. A mechanical system acts according to its programming, its instructions, or natural laws. The social model allows for mental as well as physical health and wider sphere of taking part in active life. This model also allows for more subtle discrimination of individuals who succeed in leading productive lives in spite of a physical impairment. Another disadvantage of this model is that the conception runs the risk of excessive breadth and of incorporating all of life. Thus they do not distinguish clearly between the state of being healthy the consequences of being healthy nor do they distinguish between health and the determinants of health (Ewles & Simnett 2010).
The medical profession is a social institution, which cannot be separated from the values, pressures and influences of the society in which it practices. As health has been defined in various ways, most part rests on the ideas of the normal and of seeing health as opposed to disease or illness. In practice, the definition of health has always been the territory of those who define its opposite: healers, or practitioners of medicine as a science or a body of practical knowledge. Since medicine is one of society’s major systems, it is obvious that it is these definitions which will be institutionalised and embodied in law and administration, though the extent to which lay models adds to or diverge from this body of ideas is significant to the individual in respect of their perception of health.
Whilst the medical model built on the Cartesian theory of the body as a machine disorders can be corrected by repairing or replacing parts of the organism, holism describes the view that the whole cannot be explained simply by the sum of the parts, just as healthiness cannot be explained by a list of risk factors. Every disturbance in a system involves the whole system. Human beings are living networks formed by cognitive processes, values, and purposive intentions, not simply interacting components (Blaxter 2004). The development of this social model has been accompanied among the public, by a growing enthusiasm for alternative therapies, which tend to rest on holistic theories. Gradually, these too have been integrated to some extent into the mainstream model.
In order to have a comprehensive understanding of health, one has to look at the phenomenon from various premise of health definition, as just one aspect may not provide complete answer to the enquiry about our health at a particular given time. It is therefore important to consider the various aspects of health when making judgement and decision about the health status of an individual.
PSYCHOLOGICAL MODEL
Self evaluation of the individual. If the individual feel well he is well. Much of physiological diseases are the result of psychological stress. The psychological model explains psychological and behavioral processes in health, illness, and healthcare. It is concerned with understanding how psychological, behavioral, and cultural factors contribute to physical health and illness.
Psychological factors can affect health directly. For example, chronically occurring environmental stressors affecting the hypothalamic–pituitary–adrenal axis, cumulatively, can harm health. Behavioral factors can also affect a person’s health. For example, certain behaviors can, over time, harm (smoking, excessive alcohol consumption) or enhance health (exercise, low fat diet).[2] Health psychologists take a biopsychosocial approach. In other words, health psychologists understand health to be the product not only of biological processes (e.g., a virus, tumor, etc.) but also of psychological (e.g., thoughts and beliefs), behavioral (e.g., habits), and social processes (e.g., status and ethnicity).
By understanding psychological factors that influence health, and constructively applying that knowledge, health psychologists can improve health by working directly with individual patients or indirectly in large-scale public health programs. In addition, health psychologists can help train other healthcare professionals (e.g., physicians and nurses) to take advantage of the knowledge the discipline has generated, when treating patients.
Health psychologists work in a variety of settings: alongside other medical professionals in hospitals and clinics, in public health departments working on large-scale behavior change and health promotion programs, and in universities and medical schools where they teach and conduct research.
BIOPSYCHOSOCIAL MODEL OF HEALTH
The biopsychosocial model (abbreviated “BPS”) is a general model or approach stating that biological, psychological (which entails thoughts, emotions, and behaviors), and social (socio-economical, socio-environmental, and cultural) factors, all play a significant role in human functioning in the context of disease or illness. It posits that, health is best understood in terms of a combination of biological, psychological, and social factors rather than purely in biological terms.
This is in contrast to the biomedical model of medicine that suggests every disease process can be explained in terms of an underlying deviation from normal function such as a virus, gene or developmental abnormality, or injury. The concept is used in fields such as medicine, nursing, health psychology, occupational therapy and physiotherapy as well as sociology, and particularly in more specialist fields such as psychiatry, health psychology, family therapy, chiropractic, clinical social work, and clinical psychology.
The biopsychosocial paradigm is also a technical term for the popular concept of the “mind–body connection”, which addresses more philosophical arguments between the biopsychosocial and biomedical models, rather than their empirical exploration and clinical application. The model was theorized by psychiatrist George L. Engel at the University of Rochester, and putatively discussed in a 1977 article in Science, where he posited “the need for a new medical model.” He discusses his model in detail in his paper in the American Journal of Psychiatry where he discusses the fate of a hypothetical patient, a 55 year old man who has a second heart attack six months after his first.
Engel elegantly indicates that the patient’s personality helps to interpret his chest pain, that he is in some degree of denial and that it is only the intervention of his employer that gives him permission to seek help. Whereas reductionistically his heart attack can be understood as a clot in a coronary artery, the wider personal perspective helps to understand that different outcomes may be possible depending on how the person responds to his condition. Subsequently, the patient in the emergency room develops a cardiac arrest as a result of an incompetent arterial puncture. Once again systems theory can analyse this event in wider terms than just a cardiac arrhythmia. It sees the event as due to inadequate training and supervision of junior staff in an emergency room. Thus while there may be “no single definitive, irreducible model has been published,” Engel’s elegant exposition of his model in this paper gives plenty of scope for this broader understanding of clinical practice. The novelty, acceptance, and prevalence of the biopsychosocial model varies across cultures.
THE ECOLOGICAL MODEL OF HEALTH
According to Trevor Hancock one of the ecosystem model’s chief architects:
The mandala of public health was developed by The Department or Public Health, City of Toronto, as a tool to conceptualise and explain public health at a time when the Department was undergoing reorganization and revising its role and priorities. The tool is useful in teaching health science students and the general public, as well as in raising a number of contemporary public health issues (Hancock 1985, p.2).
This model is based on the broad field of the human ecology, which is the study of the interaction of the people and human society with the environment. It is concerned with the quality of life in relation to the development of biological and geological resources, of urban and rural settlement, of industry and technology, and of education and culture.
An ecological approach focuses on both population-level and individual-level determinants of health and interventions. It considers issues that are community-based and not just individually focused (National Association of Student Personnel Administrators [NASPA], 2004, p. 3). Health is determined by influences at multiple levels (e.g., public policy, community, institutional, interpersonal, and intrapersonal factors) (McLeroy, Bibeau, Steckler & Glanz, 1988, p. 355).
This approach identifies environmental factors and influences, which interact and affect individual behavior. These factors may be the physical setting or place, the human aggregate or characteristics of the people, organizational and social climate, and/or characteristics of the surrounding community. Because significant and dynamic interrelationships exist among these different levels of health determinants, interventions are most likely to be effective when they address determinants at all levels. Historically, the health field has focused on individual-level health determinants and interventions. (U.S. Department of Health and Human Services, 2008, para. 18)
CONCLUSION
Health refers to the extent of a person’s physical, mental, and social well-being. From this definition it is clear that to be health requires more than a single aspect. A person has to be physically fit, mentally and psychologically in a good condition and he should be able to keep socially stable relationship. . There are different models to explain health and illness. Models represent different ways of approaching complex issues. There are different models of health. These models of health and illness are as under.
The biomedical model of health looks at individual physical functioning and describes bad health as the presence of disease and illness symptoms as a result of physical cause such as injury or infections and attempts to ignore social and psychological factors.
A social health model is aimed at incorporating the social and economic, as well as biophysical context of health status. It is based on knowledge of the experience, views and practices of people with disabilities. It locates the problem within society, rather than within the individual with a disability. Rules are determined within a framework of choice and independent living with strong support from organized disability communities. The biases of the social model include: limiting the causes of disability either exclusively or mainly to social and environmental policies and practices, or advancing perceptions of disability that emphasize individual rights rather than advancing broader economic rights.
Psychological model self evaluation of the individual. If the individual feel well he is well. Much of physiological diseases are the result of psychological stress. The psychological model explains psychological and behavioral processes in health, illness, and healthcare. It is concerned with understanding how psychological, behavioral, and cultural factors contribute to physical health and illness.
The biopsychosocial model (abbreviated “BPS”) is a general model or approach stating that biological, psychological (which entails thoughts, emotions, and behaviors), and social (socio-economical, socio-environmental, and cultural) factors, all play a significant role in human functioning in the context of disease or illness. It posits that, health is best understood in terms of a combination of biological, psychological, and social factors rather than purely in biological terms.
Ecological model is based on the broad field of the human ecology, which is the study of the interaction of the people and human society with the environment. It is concerned with the quality of life in relation to the development of biological and geological resources, of urban and rural settlement, of industry and technology, and of education and culture.
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Wikipedia the Free Encyclopedia, Biopsychosocial model, Retrieved on May 25, 2015, from http://en.wikipedia.org/wiki/Biopsychosocial_model
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