Contemporary definitions
of
health, concept of disease
doc. PhDr. Kateřina Ivanová, Ph.D.
PhDr. Miloslav Klugar, Ph.D.
Department of Social Medicine and Health care
Policy
Social risks
Try to indicate specific examples of risks:
economic
 enviromental
 merit
 demographic
 political
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Social risks
Sociology  specifies these social risk:
 economic – different living standards and
poverty (especially women povely),
discrimination and social exclusion,
unemployment and kind of work
 environmental - globalization,
environmental threats, social stress, traffic
problems, genetic experiments
merit – social inequality, excessive
consumerism, emotional burnout, relativity
of values
 demographic – aging population,
protection of life
 political - non-functioning institutions,
terrorism, etc.

(cp. Bourieu, Giddens, Tofflerovi, Bauman, Beck, Lorenz, Habermas,
Riesman et al.)
Health
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What is health?
Health
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Manifestation of living organism
Has dynamics and interactions with the
environment
Multidimensional and very complex
Difficult definable
Individual and community level
Reflects an external conditions
Social and working relationships
Availability and quality of health services
Freedom of the individual
Biological predisposition
Definitions of Health
• Health is multidimensional: it is not only
merely the presence or absence of
disease, but also has social, psychological
and cultural determinants and
consequences.
• The WHO defined Health as:
„A complete state of physical, mental
and social well-being and not merely
absence of illness.“
Definitions of Health

The definition is derived from bio-psycho-social health
model of George L. Engel (1977), who suggested it as an
alternative to biomedical model, whose limits are
reflected in case of chronic and psychiatric
diseases.
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However, the definition is criticized for its generality,
particularly it is not clear what is meant by well-being;
health dynamics and spiritual human health are not
captured and the definition has a lack of motivational
character (Křivohlavý, 2003).
Definitions of Health
• New definition of health recognizes the
inextricable links between an individual and
her/his environment - it is known as
„socio-ecological“ definition.
• Health is defined as:
„The ability to identify and realize aspirations, to
satisfy needs, and to change or cope with
environment. Health is therefore a resource for
everyday life, not the objective of living. Health
is a positive concept emphasizing social and
personal resources.“
Definitions of Health
• Health encompass social and political concerns
and the relationship of individuals to the
environment in which they live.
• From this perspective, health is not just the
responsibility of the traditional „health“ sector,
but of all the sectors, institutions, and
organizations that may influence the well-being
of individuals and communities.
Approaches to Health
Approaches to Health
•
Psychology = perceive health from the
perspective of individual situation
interpretation
•
Biomedicine = demonstrates the
examined person´s disease from medical
perspective, because only the absent state
of disease is considered a health
•
Sociology = social construct that varies in
different social groups and its main aim is to fulfill
social roles
•
Anthropology (physical) = examines health
during human phylogeny and ontogeny
•
Anthropology (clinical) = studies the ill
individuals´ deviation of physical features from
the standard
•
Anthropology (cultural and social) =
determines the cultural and social impact on the
perception of human health and disease
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Theology = examines person´s ability to
come to terms in a healthy way with
something that transcends him; study the
integration of human thinking when accepting the
meaning of life and human destiny
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Philosophy (ethics) = includes moral
aspirations of a man and his ability to accept
ethical decisions, then also competence to
reflect ethically on their own thoughts and
acts and the impact on the life satisfaction
associated with health.
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Economics = verifies the value of health as a
fundamental prerequisite of the manpower, thus
of the gross domestic product.
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Ecology = perceives health as a consequence
of the external environment impact
Health as a Concept
Human
being and
his/her
health
Global
concept
Psychology system
Biophysical System
Internal
nerves
blood
bones
Emotion
External
etc.
meal
cloths
etc.
anger
live
Intelligence
thought
understanding
Social System
Economy
etc.
etc.
Ethics
etc.
General
concept
Religion
etc.
Simple
concept
Individual
experiences
Examining influences on Health
The most important health benefits in history, by
Thomas McKeown (England and Wales):
• Behavioural changes – family restriction
• Environmental changes - improvement of
nutrition and healthier environment
• Health Care changes – preventive and
therapeutic measures
Determinants of Health
(HORIZONTAL CONCEPT FROM LALONDE IN WHO)
Human
Biology
The
Environment
Health care
Organization
Health Status
Lifestyles,
Behaviours and
Risk Factors
Determinants of Health
(HORIZONTAL CONCEPT FROM LALONDE IN WHO)
Human
Biology
The
Environment
Health care
Organization
Lifestyles,
Behaviours and
Risk Factors
10 - 15%
20 – 25%
10 – 15%
50 – 60%
Health Status
Disease
•
What is disease?
Disease
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Term is the central concept of
contemporary medicine
as a deviation from the norm
observable signs (symptoms) are
quantifiable
associated with incapacity of work
• Pointed to Parsons´definition of heatlh: either
one is healthy and perform their social role,
or is sick and is exempt from them (Parsons,
1981).
Definitions of Disease?
•
Disease – morbus (lat.), nosos, pathos (gre.)
•
Injury – health failure, usually caused by oneoff or short-acting harm of organism
•
Defect – physical or mental defect, usually
permanent in nature (congenital, acquired effect of disease or injury)
DISEASE, ILLNESS, SICKNESS
•
Disease
• Professionally defined physiological or psychological
dysfunction
•
Illness
• Subjective state of the
individuals who feels
aware of not being well
•
Sickness
• State of social dysfunction
based on
professional-social arrangement
Factors and Disease Processes
•
•
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Etiology = summary of findings about
disease causes.
Pathogenesis = rational interpretation
of the internal mechanism that leads from
health to disease.
Etiopathogenesis of disease is often
mentioned because both processes are
closely related (and often confused).
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Monocausality = a disease caused by a specific
reason
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Multicausality = a disease caused by a number
of reasons, evident in chronic civilization
diseases
Disease and its terms
•
Syndrome = complex of symptoms that
occure together
•
Nosology = branch of medicine dealing
with disease classification and context
•
International Statistical Classification
of Diseases and Related Health
Problems (ICD)
- (revisions in 2003) divides diseases and
related health problems, and is used to
indicate the cause of the disease, cause of
death, etc.
Approaches to Disease
1)
Biomedical Disease Model
the reference system of medicine – disease
• corresponds to the natural scientific
approach and perceives the disease primarily
as a biological disorder or also as the failure
or inadequacy of human adaptive
mechanisms in response to stimuli from its
environment
•
Etiological Disease Triangle
(Biomedical Model)
The onset of the disease is determined by condition
and impact of three factors:
a) disease initiator (specific agent) - produces
disease not only by its presence but also by its
absence (avitaminosis)
b) human - demographic characteristics,
physiological states, immunological experience, genetic
predisposition, lifestyle
c) external environment – including natural and
social aspects; in terms of disease origin probability
are defined risk factors or characteristics and risk
persons.
Approaches to Disease
2. Psychological
•
•
Disease Model
the reference system of person – rather illness
according to Špatenková (2000) includes these
parts:
 Sensitive – problems perception, pain
 Emotional – fear, anxiety, hope
 Volitional - efforts to resist disease, the
decision to see a doctor
 Informative - knowledge of disease and its
treatment
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The behavior of people in disease is
influenced by different factors such as age,
gender, mental stability, personality,
but also the confidence in physicians
and other healthcare professionals and
willingness to cooperate (called
compliance).
Approaches to Disease
3.
Sociological Disease Model
• the reference system of disease
causing – sickness
• consider the onset of the disease as a
change of social situation for both
society and an individual
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To define (find) disease, to determine what
is composed of, and decide what is needed
for its termination, this is an assignment of
physician.
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Via the physician society can then check the
stability of the social system.
Health vs. Disease
•
Borders between health and disease are
not always easily measurable.
•
According to Žáček are disease and health
concepts that can not be separated from the
human being in his integrity of life, composed
of physical condition, social functions and
roles, attitudes and behaviors, feelings and
emotions.
Control questions
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Define health and disease.
What is ICD?
Name the main factors of Etiological Triangle
(Biomedical Model)
What is syndrome?
Explain the concept of monocausality.
How sociology approaches to disease?
Questions?