Health, Illness and
Disease
Amer Eltwati Ben Irhuma,*
Objectives:
After
completing this article, the reader will be able to:
· Analyze the term health.
· Evaluate the consistency of healthy people 2010 goals
with definition of health.
· Analyze the progress made in this regard.
· Differentiate among health, illness, disease
disability and premature death.
Exploring the Concepts of Health:
Health is a core concept in society. This concept is
modified with qualities such as excellent, good fair or poor, based on a
variety of factors. These factors include age, gender, race or ethnic heritage,
comparison group, current health or physical condition, past conditions, social
or economic situation, or the demands of various roles in society.
Newman states that medical literature can be classified
brocodly within two major paradigms.1-3
The first is the wellness illness continuum ranging
from high-level wellness to depletion of health and death. High-level wellness
is conceptualized further as a sense of well-being, life satisfaction, and
quality of life. Movement towards the negative end of the continuum includes
adaptation to disease and disability through various levels of functional
ability.4
The second paradigm characterized health as a
unidirectional development phenomenon of unitary patterning of the
person-environment. Although not endorsing the development perspective to the
extent of Rogers5 and Reed,6 several authors state that
health is an outcome of ongoing patterns of person-environment interaction
throughout the life span.7-9 Health can be better understood if each
person is seen as a part of a complex interconnected biological, and social
system.
People involved in health promotion should consider
the meaning of health for themselves and for others, because a focused
definition clarifies their work and enhances the quality of the health care
system. Because the term health is used to describe a number of entities, such
as a philosophy of care (health promotion and health maintenance), a system
(health care delivery system), practices (good health practices), behaviors
(health behaviors), costs (health care costs), and insurance, the reason that
confusion continues regarding its use becomes clear. People's experience with
health in all of its entities have also changes over time.10 There
has been a more recent emphasis on the quality of a person's life as a
component of health.
Research on self-rated health11 and
self-rated function12 indicates that numerous factors contribute to
a person's perception of health. In addition to the ability to function
cognitively and physically (that is functional health), fulfill social roles
and obtain health services, health is related to environment, socioeconomic
level, race, and geographical location. Health is also directly linked to how
providers perceive the recipients of services and the options that providers
offer.
Models of Health:
Throughout history, society has entered a variety of
concepts of health.13 Smith describes four distinct models of health.4
Clinical Model:-
In the clinical model, the absence of signs and
symptoms indicates health. Illness would be the presence of conspicuous signs
and symptoms of disease. People who use this model may not seek preventive health
services, or they may wait until they are very ill to seek care. The clinical
model is the conventional model of the discipline of medicine.
Role Performance Model:
In the role performance model, health is indicated by
the ability to perform social roles. Role performance includes work, family and
social roles, with performance based on societal expectations. Illness would be
the failure to perform a person's role at the level of others in society. This
model is the basis for work and school physical examinations and physician-excused
absences.
*)
Professor and Head Surgical Department, Dean, Faculty of Medicine, Sebha University ,
Sebha , Libya
Adaptive Model:
In this model, the ability to adapt positively to
social, mental and physiological change is indicative of health. Illness occurs
when the person fails to adapt or becomes maladaptive towards these changes.
Eudaimonistic Model:-
In this model, health is indicated by exuberant
well-being. Derived from Greek terminology, this term indicates a model that
embodies the interaction and inter-relationships among the physical, social,
psychological and spiritual aspects of life and the environment. Illness is
indicated by a denervation or languishing, a wasting away, or lack of
involvement with life.
Wellness-illness Continuum
Wellness-illness continuum is a dichotomous depiction
of the relationship between the concepts of health and illness. In this
paradigm wellness is a positive state in which incremental increases in health
can be made beyond the midpoint. These increases represent improved physical
and mental health states. The opposite end of the continuum is illness, with
the possibility of incremental decreases in health beyond the midpoint. A
second dimension, high-level wellness was added to the health-illness continuum,
in which a matrix of a favorable environment allows high-level wellness to
occur whereas an unfavourable environment allows low-level wellness to exist.
The concept demonstrates that a person can have a
terminal disease and be emotionally prepared for death, while acting as a support
for other people and achieving high-level wellness. High-level wellness
involves progression towards a higher level of functioning, an open-ended and
ever-expanding future with its challenge of fuller potential, and the
integration of the whole being.14
Health Ecology:
An evolving view of health recognizes the
interconnection among people and their physical and social environments.
New-man3 expressed this interconnection within a development
framework, and the work of Gordon15 applies this interconnection to
functional health patterns.
Health from an ecological perspective is
multidimensional extending from the individual into the surrounding community
and including the context within which the person functions. This view of
health expands on high-level wellness by recognizing that social and
environmental factors can enhance or limit health and healthy behaviours. For
example, most people can benefit from physical activity such as walking. People
are more likely to walk in areas where there are sidewalks or pathways and
where they feel safe.
Functioning:
One of the defining characteristics of life is the
ability to function. Similar to the concept of health, functional health can be
characterized as being present or absent, at high level, or at low level.
Functioning is integral to health. Physical, mental,
and social levels of function are reflected in terms of performance and social expectations.
For example, sudden loss of the ability to move an arm or leg may indicate a
stroke. The inability to leave the house may indicate overwhelming fear.12
Health:
Health, as defined above is a state of physical, mental
and social functioning that realizes a persons potential. Health is an individual's
responsibility, but it requires collective action to ensure a society and an
environment in which people can act responsibly. The culture and beliefs of the
people can also influence health. This definition is consistent with the World Health
Organization definition of health as the state of complete physical, mental,
and social well-being and not merely the absence of disease and infirmity. In
addition, to being measurable in process and outcomes, this definition is
applicable across the lifespan, particularly for older adults whose functional
abilities may determine needed services.16
Illness, Disease, and Health
It is easy to think of health or wellness as the lack
of disease and to consider illness and disease interchangeable terms. However,
health and disease are not simply antonyms, and disease and illness are not
synonyms. Disease may be defined as the failure of a person's adaptive
mechanisms to counteract stimuli and stresses adequately, resulting in
functional or structural disturbances. This definition is an ecological concept
of disease, which uses a multifactorial perspective rather than a search for a
single cause. This approach increases the chances of discovering the various
factors that may be susceptible to intervention. Health and disease must be
viewed as inseparable variations of development over time. If disease does not exist,
then there is no need to discuss health. Illness is a social construct in which
people are in an imbalanced, unsustainable relationship with their environment
and are failing in their ability to survive and create a higher quality of
life. Illness is a response characterized by a mismatch between a person's
needs and the resources available to meet those needs. Additionally, the
illness signals to individuals and populations that the present balance is not
working. Disease is a biomedical term indicating the presence of a recognizable
health deviation, whereas illness is a state of being. Illness has social,
psychological, and biomedical components. A person can have a disease without feeling
ill (e.g., asymptomatic hypertension). The theory that health and illness are
dynamic patterns that change with time and social circumstances leads to the
conclusion that health assessments must be made frequently during the life
cycle. Most health evaluations are relative and based on a series of
perceptions and observations rather than a limited standard of measurement.
Health arises from a finely graded continuum of functional ability and
disability, not from mutually exclusive categories. Health, illness, and
disease are neither static nor stationary. Behind every condition is the
phenomenon of almost constant alternation.10
Health
|
High level wellness
Favorable environment
Illness
|
Low level wellness
Unfavorable environment
|
|
Fig 1: Wellness – Illness continuum with high-level
wellness added. Movement from the center to the left demonstrates movement
toward health, movement from the center to the right demonstrates movement
toward illness. Moving above the line demonstrates movement toward increasing
wellness. Moving below the line demonstrates movement toward decreasing
wellness.
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M. Health conceptualizations in U.A. McLean (ed.) Classification of Nursing
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Newman M. A word of no boundaries. ANS Advances in Nursing Science, 2003; 26:
240-246.
4.
Smith J. A. The idea of health. New York : Columbia University
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Reed P.G. Implications of the life span development framework for well-being in
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Pender N.J. Murdough C.L., & Parsons M.A. Health promotion in nursing
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13.
David H. Keynote address: Leadership for innovation in health care. Local
innovation in health care conference. Ford Foundation. Cambridge MA
14. Ardell
D.B. What is wellness? Retrieved June 18, 2004. http://www.seekwellness.
com/ wellness.articles/what is wellness.htm.
15. Gordon
M. Nursing diagnosis: Process and application (3rd ed.) St. Louis New York
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World Health Organization. Accessed July 18, 2004, from: http://www.who. int/ about/en/.
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