The World Health Organisation defines health as, “A state of complete physical, mental and social well-being and not merely the absence of disease and infirmity” (WHO 1948). This definition continues to be referred to in academic text books and commonly referred to by health professionals. However it could be argued that, a large proportion of any population are unlikely to feel completely healthy at any one time.
An opposing definition states health is “Functioning effectively in many different environments, which we can only do if we come to accept our various aches and pains in less than perfect physical and mental condition” (Illich, 1976). The above views could be categorised into Positive and Negative views of health, The WHO refer to those in which health is defined as something that is achieved or gained, this would be considered to be a positive view. A negative definition would be described as the absence of something.
There are also two main ways of seeing health negatively; the first equates it with the absence of disease or bodily abnormality. The second is the absence of any illness. Therefore according to this people are healthy as long as they show no signs of bodily abnormalities. Maclntye (1986 ) definition could be considered as a negative view as it suggests that “abnormal” is unhealthy, implying that a person in a wheelchair is unhealthy, as is having HIV, or early signs of cancer. There are a variety of definitions that people measure as healthy and these perceptions have changed over time, but an open ended question cannot be measured.
Health was never really taken into consideration historically, as people generally only ever focused on treating illness and disease. Before the 1700’s popular belief of illness and disease would have been the presence of evil spirit or curse interned inside the patient. Trepanning was a method where a hole was drilled into the skull of the patient to let the evil spirits leave the body, also losing blood was considered to be beneficial to health. This practice was called bloodletting and was the most common procedure performed by surgeons for almost two thousand years.
They did it to balance the humours, as a surplus was thought to cause ill health. All four classical elements – fire, earth, water and air – were thought to be present in the blood, and so bloodletting was believed to return the patient to general good health. According to Galen, fevers, apoplexy and headache were a result of too much blood, so the surgeon would tie the arm to make the veins swell, cut the patient and drain out a certain amount of blood, a process which was called ‘breathing a vein’.
It was not until Ignaz Semmelweis who was a Hungarian physician whose work demonstrated that hand-washing could drastically reduce the number of women dying after childbirth. This work took place in the 1840s, while he was Director of the maternity clinic at the Vienna General Hospital in Austria. The surgeons did not scrub up before surgery or even wash their hands between patients, causing infections to be transferred from one patient to another. Doctors and medical students routinely moved from dissecting corpses to examining new mothers without first washing their hands, causing death by puerperal or ‘childbed’ fever as a consequence.
As dissection became more important to medical practice in the 1800s, this only increased. Through vigorous statistical analysis, Semmelweis figured out where the problem lay and introduced rigorous hand-washing rules in the maternity ward. Deaths were drastically reduced; this was considered as the age of enlightenment as belief shifted from spirituality and took a more scientific view thus paving the way for the modern biomedical model of health. In western societies our approach towards health has an Individualistic view and be in mechanical terms, which is a culture that places more emphasis in the individual and values independence.
Whereas other cultures talk about health in a different ways therefore have different concepts of health or have a Collectivist view. For example in Chinese medicine, the crucial issue is balance. The two universal forces of yin and yang regulate the universe and must be balanced to achieve harmony within the body and in nature. So a collectivist view places more importance on the group or community collectively, emphasising on sharing whilst giving a sense of belonging. This is opposed to the biomedical model which sees the body as individual parts that need replacing when they become faulty.
Part Two The biomedical model of health views the body as a machine; if it becomes dysfunctional it can be fixed. The biomedical model which was developed predominantly in Western Europe, between the late 1700’s to the late 1800’s, is based on research and discoveries, using scientific methods. Thus leading to the belief that illness was caused by bacteria, viruses’, genetic predisposition, trauma or degenerative conditions. These could be treated with medication or surgery based firmly on the scientific understanding of the physiology and bio-chemistry of the human body.
This model lead to vast advances in medicine, for example, cures for many of the pre-war diseases such as Typhoid, Tuberculosis and Cholera were developed. However, this definition of health has been criticised for its one dimensional approach as it focuses purely on the physical aspects of the patient and fails to take account of the psychological, environmental and natural deteariation of the human body concerning the individual. Ivan Illich (1976) proposed that modern medicine has become detrimental to society, by amongst other things, “launching … an inhuman attempt to defeat death, pain and sickness.
” By doing so, he argued, medicine had deprived individuals and societies of their ability to cope with sickness and death. The biomedical model suggests that the mind cannot influence the body; instead it reacts in an involuntarily manner to prevent the invading pathogens, this implies that the individual is passive and therefore not responsible for one’s own health, it is beyond their control. With this in mind the medical profession maintain responsibility for the treatment and recovery of the individual as the patient lacks any power or knowledge to prevent or treat illness.
The second assumption is that medical experts or officials identify illness not laypersons. A symptom is diagnosed in relation to a model of objective ideas of identified classifications of illnesses, and requires little or no discussion between the doctor and patient to produce an agreement. The model also claims illness can be treated or cured. In contrast the social model of health demonstrates a healing approach as an alternative to the biomedical model. This social approach is often used in conjunction with holistic medicine, as both healing modalities reject conventional modern medicine.
However the controversial aspect of the model is its focus on spiritual health, which is unrelated to religious views or beliefs, alternatively it predominantly concentrates on personal wellbeing and wholeness. It encourages individuals to take a proactive role in preventing ill health and maintaining optimum wellbeing. The model advocates an idealistic state of wellness taking into account the emotional, mental and spiritual requirements of the patient as well as the physical aspects.
Contrary to the Biochemical model it suggests that a person who is physically fit but suffering from depression cannot be entirely healthy; however a person who is disabled or wheelchair dependent may be considered essentially fit and well. Furthermore it suggests that the bio medical model lays too much emphasis on identifying and curing the disease or illness that it fails to prevent it from happening, for example reducing poverty to prevent illness. The social model focuses on living standards as the key to improving health.
(Mc Keown, 1976) argues the main reason for a decline in infectious diseases in the late 19th & early 20th century was due to social response, for example improved sewage and improved living conditions. Mc Keown also looked at mortality between 1838 -1970 and argues mortality improvements were mostly to do with preventive medicine and public hygiene, and doubts medicine had any significant effect. This would suggest that the biomedical model neglects social causes of health and illness. However one could argue that not all illnesses have social causes.
Another model which challenges the bio medical approach called Iatrogenesis which basically states “Doctors-caused illness” (Illich, 1976). It believes health professions have a vested interest in ensuring there is plenty of illness. Illich claims that iatrogenesis outweighs any positive benefits of medicine. He distinguishes three major types of iatrogenesis. Clinical iatrogenesis concerns ill-health contracted in hospital; largely to the unwanted side-effects of medications and doctor ignorance, neglect, or malpractice, which poison, maim, or even kill the patient.
Social iatrogenesis refers to the process by which ‘medical practice sponsors sickness by reinforcing a morbid society that encourages people to become consumers of curative, preventive, industrial and environmental medicine’. It makes people hypochondriac and too willing to place themselves at the mercy of medical experts, a dependence on the medical profession that allegedly undermines individual capacities. Finally, cultural iatrogenesis implies that societies weaken the will of their members, by paralysing ‘healthy responses to suffering, impairment and death’.
Here, the whole culture becomes ‘overmedicalised’, with doctors assuming the role of priest, and political and social problems entering the medical domain. In contrast ……… The biopsychosocial model of health is based in part on social cognitive theory. The biopsychosocial model implies that treatment of disease processes. For example type two diabetes and cancer, requires that the health care team address biological, psychological and social influences upon a patient’s functioning.
In a philosophical sense, the biopsychosocial model states that the workings of the body can affect the mind, and the workings of the mind can affect the body. This means both a direct interaction between mind and body as well as indirect effects through intermediate factors. The biopsychosocial model determines someone’s current state of health. This view is contrary to the model embraced by the Biomedical model stating that “we are our genes, and our genes determine our future health. It is the biopsychosocial, and the medical models, against our genes. ”