313394 Lecture Notes - Lecture 2: Biopsychosocial Model, Western Philosophy, Environmental Health
WEEK 2:
Concepts of Health and Wellbeing:
➢ Health is a complex issue. It is not static. Several concepts, definitions and models relating to
health exist.
➢ Health status is the level of health of an individual, person, group or population as assessed
by that individual or objective measures.
➢ Determinants of health are biological, behavioural, social and environmental. The
determinants interact.
➢ How we view the concepts of health and illness, how we think and feel, influence the types of
health behaviours we adopt. In this regard, note that socio-cultural factors influence the
meaning of health including age, gender, family beliefs, current health status,
religion/spirituality, history and subjective experiences as well as geographical location.
➢ Health therefore is not merely the absence of disease. Social and environmental factors
along with perceptions of well-being need to be incorporated into any definition of health.
➢ Health and illness are social concepts and they mean different things to different people.
➢ Culture significantly influences people’s beliefs about what factors contribute to health and ill
health.
➢ The WHO, (1946) grounded the idea of wellbeing within its broad concept of health. Health is
considered to be a positive state. It acknowledges the importance of preventative
behaviours in physical health
➢ Many of us share common factors but the differing cultural values and norms that surround an
Aboriginal and Torres Strait Islander collective philosophy differs from a more individualistic
Western philosophy.
➢ For Aboriginal and Torres Strait Islander people, connection to land, family and community
relationships relate to overall ‘wellbeing’ rather than health.
➢ Several conceptual frameworks (ways of thinking about health and wellbeing) have evolved
over time. These include the medical, bio psychosocial and ecological models.
Measurements of health status
Objective Measures
• Epidemiology offers examples of objective measures in terms of the distribution and frequency
of disease.
• Statistical measures include mortality, morbidity, prevalence and incidence.
• Health is also measured in terms of life expectancy and health inequalities identified using life
expectancy measures (Jones & Creddy, 2012)
Subjective Measures
• Health perceptions (or perceived health status) are subjective ratings.
• Objective and subjective measures allow for comparisons to be made between and within
countries and the information about the health status of a population helps governments shape
health policies to determine how health services should be delivered.
You will recall from the Workshop that you were asked to consider what health is, how it is perceived
and to identify factors that influence those perceptions. These are discussed below.
1. Health is the absence of disease in an individual
Health is understood as having two opposite states: either someone is ‘healthy’ or ‘ill’ – these are
mutually exclusive. This view suggests that health is static, it does not change and is dichotomous.
Health has in the past been related to the functioning of the body, health and illness (biomedical
perspective; Cartesian dualism – separation of mind and body). Health and illness are considered in
terms of a person’s medically defined pathology. This biomedical approach, links to the medical model
which is useful in identifying and reducing disease in individuals. When moving the focus away from
find more resources at oneclass.com
find more resources at oneclass.com
the individual to populations, the limitations of this model become apparent. Public health initiatives
aim to address population-wide health disadvantages.
2. Health as a dynamic degree of functional capacity and wellness along a continuum
Figure 1: Illness-Wellness Continuum. Adapted from “Wellness Workbook,” by J. Travis and R. Ryan,
2004.
The illness-wellness continuum compares a treatment model with a wellness model. It offers a
graphic illustration of a wellbeing concept. The model connects the treatment and wellness paradigms;
the middle is the neutral point. The wellness paradigm stretches across the model heading towards a
high level of wellness. The treatment paradigm links with the medical model. The neutral point is
where patients can stop. People can sit at this neutral ‘no illness’ state. For example, a person with a
high blood pressure may take medication to control this but there are no accompanying lifestyle
changes. In the wellness model the person would take the medication but also stop smoking and
maybe undertake some exercise. The level of motivation, knowledge and health beliefs are
instrumental in behaviour change.
Six components relating to personal health surround the continuum, these are physical (body
functioning as well as it should be), psychological health and emotional health (stress and coping
mechanisms), social wellbeing (family and friends support), environmental health (air and water,
quality and food safety) and spiritual health (following moral codes and values) (Hettler, 1976).
These components are captured in the bio psychosocial model, which identifies biological,
psychological and social factors that interact in complex ways to impact health in positive or
negative ways.
All people have the capacity to be functional and healthy although they may experience impairments at
different points in time which can temporarily or permanently impact their functioning capacity e.g. an
athlete who suffers a serious injury requiring surgical intervention can result in a temporary disability
but a disability is not an illness. An elderly person with arthritis and limited mobility may not consider
themselves to be ill, they may perceive themselves as having a high level of wellness.
3. Health as a population concept
This conceptualization focuses on communities and population groups rather than on individual
people. This approach considers how health is determined and what factors influence health. It
aims to improve the health of populations by introducing interventions that have the potential to
affect everyone.
4. Health as a holistic concept (broad conceptualisation)
find more resources at oneclass.com
find more resources at oneclass.com
Contemporary views of health are holistic recognizing the complex interaction of multiple social,
psychological, cultural, spiritual and biological factors. This view acknowledges that health is more
than a person’s biological functioning and that psychological and social components influence the
perception of health and that health and illness are not static dichotomous states. There is a complex
and dynamic interaction between biological, psychological and social factors.
• Health as the holistic wellbeing in the individual
Holistic wellbeing is feeling healthy, happy, or doing well in life and is separate from objectively
measured health or disease within the individual. It is a measure of general contentment with life.
5. Health is a subjective experience (perceptions)
• Health perceptions (or perceived health status) are subjective ratings.
• Perceptions of health are our own idea of what health is and what it means to be healthy.
• They change through our life time and are related to many factors e.g. age, gender, culture,
family, medical history, geographical location and media.
• They are socially constructed.
• Some people perceive themselves as healthy despite suffering from one or more chronic
diseases, while others perceive themselves as ill when no objective evidence of disease can be
found.
• Our experiences shape our perceptions. Perceptions of health are linked to health
behaviours
• Healthy/unhealthy behaviours are learnt/supported by parents/peers and are regarded as
modelling behaviours – e.g. peer’s binge drinking.
6. Health is related to the ecosystem
This connection between health, wellbeing and the environment is acknowledged by the WHO.
‘Basic determinants of human well-being may be defined in terms of: security; an adequate supply
of basic materials for livelihood (e.g. food, shelter, clothing, energy, etc.); personal freedoms; good
social relations; and physical health. By influencing patterns of livelihoods, income, local migration
and political conflict, ecosystem services impact the determinants of human well-being’ (WHO, 2005
p. 12).
The Ecosystems and Human Wellbeing WHO report (2005) acknowledges that a holistic,
interdependent basis for the provision of wellbeing exists through a relationship with the natural
environment. For example, people in general engage in recreation, appreciate ‘a sense of place’ and
aesthetic qualities of certain ecosystems e.g. a garden. These can have a positive impact on a sense of
wellbeing.
For Aboriginal and Torres Strait Islander peoples the interaction with land from a
cultural/spiritual perspective has been strongly linked to wellbeing.
‘The ability to be able to obtain food and other necessities, to have custodianship and support for
ecosystems by providing services, regulating some aspects and practising and observing cultural
heritage associations ensures a continuation of Indigenous wellbeing’ (Grieves, 2006 p. 15)
The concept of Indigenous wellbeing has been linked to human relationships to the natural world,
spirituality and health. The ‘traditional practices linked to ecosystem services play an important role in
developing social capital and enhancing (social) wellbeing’ (WHO 2005, p. 25).
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Several concepts, definitions and models relating to health exist. Health status is the level of health of an individual, person, group or population as assessed by that individual or objective measures. Determinants of health are biological, behavioural, social and environmental. How we view the concepts of health and illness, how we think and feel, influence the types of health behaviours we adopt. In this regard, note that socio-cultural factors influence the meaning of health including age, gender, family beliefs, current health status, religion/spirituality, history and subjective experiences as well as geographical location. Health therefore is not merely the absence of disease. Social and environmental factors along with perceptions of well-being need to be incorporated into any definition of health. Health and illness are social concepts and they mean different things to different people. Culture significantly influences people"s beliefs about what factors contribute to health and ill health.
