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HPI4009 Health Systems Governance Case 4
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Summary HPI4009 Health Systems Governance case 4
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Health system governance (HPI 4009)Tutorial group 4 29-11-2019
Case 4: The politics of health
Models to define health and their strengths and limitations
Health can have medical, social, economic, spiritual and many other components, so it is hard to
define it. The way the politics are managed defines what sort of model the country uses.
How we organise health, influences how health is delivered.
Medical model Holistic model Newer models (wellness/environmental)
Health = medicine Health = politics Health = personal
Narrow definition of Broad definition of health Even broader definition of health system
health system system
Health professionals’ Shared responsibility Share responsibility, with changing roles
responsibility (patients, government etc) for, in particular, patients and providers
Disease, illness, health Example: NL = most environmental, but
also WHO model.
The Medical model
Definition health according to model: ‘the absence of disease or disability’.
Wood (1986) observed that the medical model distinguishes between disease, illness, and health:
Disease: a condition of the body in which its structure or function is disturbed or deranged.
Illness: an individual perception that one is suffering from a disease. Someone is suffering
from an illness. ‘How ill you are’.
Health: virtually undefinable and relative rather than absolute.
Strengths:
Most dominant model of health in US. It focuses on disease and disability; their causes,
prevention and cure.
Highly productive
Specialization in medical process
Clear distinction between health and not health you can compare different health system
Limitations:
1. The difficulty of adapting it to emotional and psychiatric disorders.
2. It deemphasizes preventive medicine.
3. It ignores the social causes of disease and social customs in defining disease.
4. It does not take into account that one can be ill without having a disease (perceiving symptoms
without pathology) or one can have a disease without being ill (having disease in pre-
symptomatic stage).
5. Fragmentation, as a consequence of specialization (negative).
The WHO model
Definition health according to model: ‘a state of complete physical, mental and social well-being and
not merely the absence of disease or infirmity’.
Health became a fundamental right of all persons more political. Diseases went from acute to
chronic, this does not fit the definition, because it would declare people with chronic diseases
definitely ill.
Strengths:
Most popular and most comprehensive
Improve medical research by developing more practical norms for mental and social well-
being.
Limitations:
1
, 1. The WHO definition includes social health as a factor to define one’s personal health status,
while social health are external factors and circumstances, which should not be used to define
personal health status.
2. There is no agreement on the meaning of ‘social well-being’ in the definition (is it the
environment of society or the functional status of individuals?).
3. The definition is too bread, because health is defined differently in different cultures.
4. It doesn’t define which states of health are better than others.
5. The euphoric definition of health as a state of complete wellbeing is readily falsified. The
average person experiences four symptoms in a 14-day period, so we are all sick then. Chronic
patients are then always ill.
6. The definition is too abstract and oversimplified; it is an ultimate goals more than a guideline
for action.
After the implementation of this model, there is more focus on prevention and anti-depressant (in
media) medicalization in phycological field. Every problem should be fixed (and diagnosed).
The Wellness model
Definition health according to model: ‘the strength and ability to overcome illness, health promotion
and progress toward higher functioning, energy, comfort, and integration of mind, body, and spirit.’
Look especially at environment, they recognize there is an environment that influences the individual.
This model recognizes the important linkage between mind and body that the practicing physician may
overlook.
Strengths:
Support medical research in future: focus on positive aspects of health, also health promotion
(preventative).
Look at individual person.
Limitations:
1. Measuring subjective perceptions: perceptions of wellness vary according to age and cultural
context.
2. Wellness ‘expands the meaning of health to include happiness, quality of life, and other global
matters’.
Wellness model: subjective, more focus on psychosocial. They also look at alternative medicine.
Example: when you break a leg, you can still feel healthy.
The Environmental model
Definition health according to model: ‘the ability of an organism to adapt to physical and social
surrounding and to maintain a balance free from pain, disability, or limitations, including social
abilities.’
Environment has an impact om the person, but this model connects the environment with the
individual.
The essence of the environmental model is an individual adaptation to the environment.
Positive health: the ability and will of the individual to perform needed tasks, i.e. to produce and
reproduce, in an environment over the span of a lifetime. An important measure is the Health-Related
Quality of Life (HRQoL), including: death and duration of life, impairment, health perceptions,
opportunity, and functional status.
Strengths:
Environmental factors also influence health
One environment may not be suitable for another environment
Physicians should become more adept at finding and controlling factors in the environment
that contribute to disease.
It looks at connection between individual and the environment and looks in how an individual
work in an environment in the best way possible.
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