Unformatted text preview: 9/30/2019 Health and Disease, Inﬂuence of Family and Community | Disease Prevention and H… Disease Prevention and Healthy Lifestyles
Introduction to Personal Health Health and Disease, In uence of Family and
Community ﬂuen… 1/21 9/30/2019 Health and Disease, Inﬂuence of Family and Community | Disease Prevention and H… Your Own Views on Health
Note down your responses to the following questions:
What does health mean to you?
How important is health to you?
What do you do (if anything) to stay healthy? Illness and Disease
Although clearly related, the concepts of illness and disease are distinct.
People have illness and physicians diagnose and treat disease.
Disease is an objective term which implies a malfunctioning of the
body or part of the body. Disease is pathological and is diagnosed
on the basis of recognizable signs and symptoms.
Illness is the subjective experience of pain, discomfort or disorder.
Although it is mostly safe to say that illness is the subjective experience
of disease, it is possible to experience illness without having a disease
and it is possible to have a disease and not feel ill. LEARNING ACTIVITY Think of a time when you were ill.
Can you think of an illness experience which is not disease related?
Can you think of a disease which may not make you feel
ill? ﬂuen… 2/21 9/30/2019 Health and Disease, Inﬂuence of Family and Community | Disease Prevention and H… Health Education: Basic Principles
In this session you will learn about the nature of health, health education,
health promotion and some related concepts. This will help you to
understand the social, psychological and physical components of health. De nition and Concepts of Health
In the Oxford English Dictionary health is de ned as: ‘the state of being
free from sickness, injury, disease, bodily conditions; something
indicating good bodily condition.”
Now stop for a moment and think about someone you think is
healthy and someone else who you would consider to be not
Look at the de nition of health again.
Is it similar to the things you thought about when you thought
of a healthy and an unhealthy person?
This de nition of health is a widely publicized one. But you may have
thought of someone who has a disability or wondered about someone
who looks OK but who you know does no exercise. Clearly health is not
quite as simple as the de nition implies.
The concept of health is wide and the way we de ne health also
depends on individual perception, religious beliefs, cultural values,
norms, and social class. Generally, there are two di erent perspectives
concerning people’s own de nitions of health: a narrow perspective and
a broader perspective. Narrow Perspectives of Health
People with a narrow perspective consider health as the absence of
disease or disability or biological dysfunction. According to this view (or
model), to call someone unhealthy or sick means there should be
evidence of a particular illness. Social, emotional and psychological
factors are not believed to cause unhealthy conditions. This model is ﬂuen… 3/21 9/30/2019 Health and Disease, Inﬂuence of Family and Community | Disease Prevention and H… narrow and limits the de nition of health to the physical and
physiological capabilities that are necessary to perform routine tasks.
According to this de nition, the individual is healthy if all the body parts,
cells, tissues and organ systems are functioning well and there is no
apparent dysfunction of the body.
Using this model people view the human body in the same terms as a
computer, or mechanical device when something is wrong you take it to
experts who maintain it. Physicians, unlike behavioral experts, often
focus on treatment and clinical interventions with medication rather than
educational interventions to bring about behavior change. SERENA’S STORY About two months ago Serena lost her six month old
twins. She is grief stricken. She was always slender but
now she looks very thin. She cannot sleep, she cannot
eat and she doesn’t want to talk to anyone.
Do you think the view of health you have just read
about applies to Serena?
This view of health ignores many of the social and
psychological causes of ill health. Serena’s grief is not an
illness but it is certainly a ecting her health. In the next section we will discuss the broader perspective of health
which includes other factors in addition to physical ones. Broader Perspectives of Health
In the previous section you read about a narrow de nition of health. This
section will help you understand the concept of health in a broader and
more holistic way. ﬂuen… 4/21 9/30/2019 Health and Disease, Inﬂuence of Family and Community | Disease Prevention and H… De ning Health The most widely used of the broader de nitions of health is that within
the constitution of the World Health Organization (1948), which de nes
health as: A state of complete physical, mental, and social well-being,
and not merely the absence of disease or in rmity. This classic de nition
is important, as it identi es the vital components of health. To more fully
understand the meaning of health, it is important to understand each of
its individual components. SERENA’S STORY Think back to Serena.
Describe her state of health.
Serena is mentally distressed. She does not by any
means have mental and social well-being. Physical Health To understand physical health you need to know what is considered to
be physically unhealthy so that you can contrast the two. Physical health,
which is one of the components of the de nition of health, could be
de ned as the absence of diseases or disability of the body parts.
Physical health could be de ned as the ability to perform routine tasks
without any physical restriction.
The following examples can help you to understand someone who is
A person who has been harmed due to a car accident
A farmer infected by malaria and unable to do their farming duties
A person infected by tuberculosis and unable to perform his or her
Think about someone with physical damage, perhaps due to a car ﬂuen… 5/21 9/30/2019 Health and Disease, Inﬂuence of Family and Community | Disease Prevention and H… accident. According to the WHO de nition, do you see them as healthy? Also think about someone in your community who you would
consider to be physically disabled.
While both of these people may be restricted in their movement and
ability to do routine tasks they may still be in a state of physical and
mental well-being. Health is not limited to the biological integrity and the physiological
functioning of the human body. Psychological health is also an important
aspect of a health de nition.
Psychological Health Think about people in the community who are showing behavior
that may indicate they are going through a period of mental distress in their lives.
Or think about Serena again.
Do you think that everyone in distress shows the same sorts of
Sometimes it can be really hard from the outside to tell if the person is
struggling with mental health issues, but at other times they show
symptoms that suggest a lack of self-awareness or personal identity, or
an inability of rational and logical decision-making.
At other times it might be apparent that they are not looking after
themselves and are without a proper purpose in their life. They may be
drinking alcohol and have a non-logical response to any request. You
may also notice that they have an inability to maintain their personal
autonomy and are unable to maintain good relationships with people
Social component ﬂuen… 6/21 9/30/2019 Health and Disease, Inﬂuence of Family and Community | Disease Prevention and H… The social component of health is considered to be the ability to make
and maintain ‘acceptable’ and ‘proper’ interactions and communicate
with other people within the social environment. This component also
includes being able to maintain satisfying interpersonal relationships and
being able to ful ll a social role. Having a social role is the ability that
people have to maintain their own identity while sharing, cooperating,
communicating and enjoying the company of others. This is really
important when participating in friendships and taking a full part in family
and community life.
Which of the following examples could be considered to contribute to
social health? Explain your answers.
1. Mourning when a close family member dies
2. Going to a football game or involvement in a community meeting
3. Celebrating traditional cultural events within your community
4. Shopping in the market
5. Creating and maintaining friendship.
In reality all these events could have a social component and help
towards building people’s social view of health. They all involve
interacting with others and gaining support, friendship and in many
instances joy from being with other people.
The World Health Organization in its Ottawa Charter said that health
promotion is de ned as the process of enabling people to increase
control over, and to improve, their health. The aim of health promotion is
to reduce the underlying causes of ill-health so that there is a long-term
reduction in many diseases. SUMMARY Health is a broad concept containing several di erent aspects.
Physical and mental health issues are often interrelated and ﬂuen… 7/21 9/30/2019 Health and Disease, Inﬂuence of Family and Community | Disease Prevention and H… wellness is expressed through the integration of mental,
physical, emotional, spiritual and social health components. SELF-ASSESSMENT QUESTION What do you understand by the following terms?
Show Answer De nitions of Health
If there are complexities in de ning disease, there are even more in
de ning health. De nitions have evolved over time. In keeping with the
biomedical perspective, early de nitions of health focused on the theme
of the body’s ability to function; health was seen as a state of normal
function that could be disrupted from time to time by disease. An
example of such a de nition of health is: “a state characterized by
anatomic, physiologic, and psychological integrity; ability to perform
personally valued family, work, and community roles; ability to deal with
physical, biologic, psychological, and social stress.”
Just as there was a shift from viewing disease as a state to thinking of it
as a process, the same shift happened in de nitions of health. Again, the
WHO played a leading role when it fostered the development of the
health promotion movement in the 1980s. This brought in a new conception of health, not as a state, but in dynamic terms of resiliency, in
other words, as “a resource for living.” The 1984 WHO revised de nition
of health de ned it as “the extent to which an individual or group is able
to realize aspirations and satisfy needs, and to change or cope with the
environment. Health is a resource for everyday life, not the objective of
living; it is a positive concept, emphasizing social and personal
resources, as well as physical capacities. Thus, health referred to the ﬂuen… 8/21 9/30/2019 Health and Disease, Inﬂuence of Family and Community | Disease Prevention and H… ability to maintain homeostasis and recover from insults. Mental,
intellectual, emotional, and social health referred to a person’s ability to
handle stress, to acquire skills, to maintain relationships, all of which form
resources for resiliency and independent living. Wellness
Many practitioners have expanded their focus to include wellness at the
positive end of the health continuum. Some distinguish two interacting
dimensions: disease versus non-disease and well-being versus ill-being;
others expand the number of dimensions to include spiritual, emotional,
social, and mental. Last commented that wellness is “a word used by
behavioral scientists to describe a state of dynamic physical, mental,
social, and spiritual well-being that enables a person to achieve full
potential and an enjoyable life.”
But with so much disease to treat, should physicians concern themselves
with wellness? Is it appropriate for medicine to seek ways to promote
positive health states? Some academics distinguish between a medical
care system and a health care system, arguing that, to constrain costs,
public funding should be limited to treating illness and restoring the
patient’s functional capacity. Others note that activities such as
counseling and educating healthy individuals on diet and exercise
promote wellness and resiliency, and so fall within the scope of normal
practice as a part of preventive medicine. Some go further and argue
that physicians should advocate for improved work and environmental
conditions, such as promoting walking and cycling rather than driving,
and should advocate for policies that redistribute income, limit access to
unhealthy foods, and support children’s programs.
As concepts of health and disease continue to broaden, there will no
doubt be pressure for physicians to expand their role to include the
promotion of positive health states in their patients. Re ecting this trend,
clinical trials evaluating new pharmaceuticals must now include improved quality of life as an outcome, which obviously extends beyond
simply improving biomedical indicators of pathology.
Discussions of wellness eroded the hold of the biomedical model. In its ﬂuen… 9/21 9/30/2019 Health and Disease, Inﬂuence of Family and Community | Disease Prevention and H… place, ecological models of health appeared; these recognize the
complex interactions among people, their personal characteristics and
the environment, and how these in uence health. LEARNING ACTIVITY Questions to ponder
1. If no symptoms are produced, is it a disease?
2. Are health and disease di erent entities or merely different points along a continuum?
3. If so, should we abandon the notion of disease and
think only of di erent levels of health, changing from a
categorical to a dimensional model? Disease or Syndrome?
As we learn more about the biological basis for a patient’s illness, it may
be reclassi ed as a disease. For example, constant feelings of tiredness
became accepted as the medical condition of chronic fatigue syndrome.
Sometimes when a doctor formally labels (diagnoses) a patient’s
complaint, the complaint is legitimized and this may reassure the patient.
Often, however, a set of signs and symptoms eludes biomedical
understanding. If the set is frequent enough to be a recognized pattern,
it is termed a syndrome instead of a disease.
A syndrome refers to a complex of symptoms that occur together more
often than would be expected by chance alone. Whereas diseases often
receive explanatory labels (such as hemorrhagic stroke), syndromes are
often given purely descriptive labels (e.g., Restless Leg Syndrome).
Confusingly, the label ‘syndrome’ often persists long after the cause is
discovered, as with Down syndrome, AIDS (Acquired Immunode ciency
Syndrome) or SARS (Severe Acute Respiratory Syndrome). Meanwhile,
Chronic Fatigue Syndrome, Fibromyalgia, Irritable Bowel Syndrome, and ﬂue… 10/21 9/30/2019 Health and Disease, Inﬂuence of Family and Community | Disease Prevention and H… Restless Leg Syndrome remain syndromic conditions which, so far, are
not well explained by conventional biomedical models. LEARNING ACTIVITY Watch these videos – Population Health Population Health: T…
T… Population Health: T…
T… These videos by Vancouver Coastal Health are an exploration
of di erences in health between people and their relationship
to things such as income, education, and the neighborhoods in
which we live. Residents share real examples about how the
social determinants of health impact their lives. ﬂue… 11/21 9/30/2019 Health and Disease, Inﬂuence of Family and Community | Disease Prevention and H… How has your belief about the relationship between
health and other factors changed as a result of watching
these videos? Well-being Concepts
Well-being is a positive outcome that is meaningful for people and for
many sectors of society, because it tells us that people perceive that
their lives are going well. Good living conditions (e.g., housing,
employment) are fundamental to well-being. Tracking these conditions is
important for public policy. However, many indicators that measure living
conditions fail to measure what people think and feel about their lives,
such as the quality of their relationships, their positive emotions and
resilience, the realization of their potential, or their overall satisfaction
with life—i.e., their “well-being.” Well-being generally includes global
judgments of life satisfaction and feelings ranging from depression to joy.
Why is well-being useful for public health? Well-being integrates mental health (mind) and physical health
(body) resulting in more holistic approaches to disease prevention
and health promotion.
Well-being is a valid population outcome measure beyond morbidity, mortality, and economic status that tells us how people perceive
their life is going from their own perspective.
Well-being is an outcome that is meaningful to the public.
Advances in psychology, neuroscience, and measurement theory
suggest that well-being can be measured with some degree of
Results from cross-sectional, longitudinal and experimental studies
nd that well-being is associated with:
Longevity ﬂue… 12/21 9/30/2019 Health and Disease, Inﬂuence of Family and Community | Disease Prevention and H… Healthy behaviors
Mental and physical illness
Factors in the physical and social environment
Well-being can provide a common metric that can help policy makers
shape and compare the e ects of di erent policies (e.g., loss of
greenspace might impact well-being more so than commercial
development of an area).
Measuring, tracking and promoting well-being can be useful for multiple
stakeholders involved in disease prevention and health promotion.
Well-being is associated with numerous health-, job-, family-, and
economically-related bene ts. For example, higher levels of well-being
are associated with decreased risk of disease, illness, and injury; better
immune functioning; speedier recovery; and increased longevity.
Individuals with high levels of well-being are more productive at work
and are more likely to contribute to their communities.
Previous research lends support to the view that the negative a ect
component of well-being is strongly associated with neuroticism and that
positive a ect component has a similar association with extraversion.
This research also supports the view that positive emotions—central
components of well-being—are not merely the opposite of negative
emotions, but are independent dimensions of mental health that can,
and should be fostered. Although a substantial proportion of the
variance in well-being can be attributed to heritable factors,
environmental factors play an equally if not more important role.
How does well-being relate to health promotion? Health is more than the absence of disease; it is a resource that allows
people to realize their aspirations, satisfy their needs and to cope with
the environment in order to live a long, productive, and fruitful life. In this
sense, health enables social, economic and personal development ﬂue… 13/21 9/30/2019 Health and Disease, Inﬂuence of Family and Community | Disease Prevention and H… fundamental to well-being. Health promotion is the process of enabling
people to increase control over, and to improve their health.
Environmental and social resources for health can include: peace,
economic security, a stable ecosystem, and safe housing. Individual
resources for health can include: physical activity, healthful diet, social
ties, resiliency, positive emotions, and autonomy. Health promotion
activities aimed at strengthening such individual, environmental and
social resources may ultimately improve well-being.
How is well-being de ned? There is no consen...
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