Chapter 1 - What is health
Changing perspectives
Early understanding of illness: archaeological finds of human skulls from Stone Age: small
neat holes found in some skills attributed to process of trephination (hole made to release
evil spirits believed to have entered the body from outside & caused disease)
Mind-body relationships
Ancient Greek physician Hippocrates: attributed illness to the balance between 4 circulating
bodily fluids: humours: yellow bile, phlegm, blood & black bile
- Thought when a person health: 4 humours in balance
- When ill: balanced due to external pathogens - illness occurred
Humours attached to seasonal variations & conditions of hot, cold wet & dry
- Phlegm: winter, cold-wet
- Blood: spring, wet.hot
- Black bile: autumn; cold-dry
- Yellow bile: summer, hot-dry
Hippocrates considered mind & body as 1 unit & so thought that the level of specific bodily
humours related to particular personalities:
- excessive yellow bile linked to a choleric or angry temperament
- black bile was attached to sadness
- excessive blood associated with an optimistic or sanguine personality
- excessive phlegm with a calm or phlegmatic temperament
Healing involved attempts to rebalance the humours, (e.i: through bleeding or starvation, or
special diets and medicines.
→ Even this far back in time, eating healthily was considered helpful to the balance of the
humours. Humoral theory of illness attributed disease states to bodily functions but also
acknowledged that bodily factors impacted on the mind.
View continued with Galen: physical or pathological basis for all ill health (physical or mental)
Not only 4 bodily humours underpinned 4 dominant temperaments but also temperaments
can contribute to experience of specific illnesses
→ View: mind & body interrelated but only in physical & mental disturbance both having
underlying physical cause
- Mind itself: no role in illness aetiology: (etiology) cause of disease
Middle Ages: health became tied to faith & spirituality
Illness: God’s punishment for misdeeds or result of evil spirits entering one’s soul
→ religious views persisted until early 14th & 15th centuries
Renaissance: individual thinking increasingly dominant & religious view
Scientific revolution - early 1600s: growth in scholarly & scientific study & development in
physical medicine → so understanding of human body / explanations for illness increasingly
organic & physiological
Early 17th century: Descartes: mind (nonmaterial) & body (material) separate entities
(dualism) but interaction between the 2 domains possible
Communication between them: control of pineal gland in midbrain but process unclear
,Dualists developed notion of mechanistic: reductionist approach, reduces behavior to level
of the organ or physical function → associated with biomedical model of illness: view that
diseases & symptoms have underlying physiological explanation
Biomedical model of illness
Health = absence of disease, Any symptoms of illness = underlying pathology that will be
cured through medical intervention
Assumption that removal of pathology by medical intervention = restored health
→ Mechanistic view & reductionist: idea that mind, matter and human behavior can all be
reduced to & explained at level of cells, neural activity or biochemical activity
Reductionism: ignore evidence that different people respond in different ways to the same
underlying disease pathology because they vary in many things
Challenging dualism: psychosocial model of health & illness
Psychology played significant role in altering bidirectional relationship between mind & body
→ & Freud: redefined mind-body problem as 1 of consciousness & postulated existence of
unconscious mind: seen in conversion hysteria
Models of disability: biomedical to biopsychosocial
WHO 1980 Biomedical: I-D-H Model: impairments - lead to disability which create individual
handicap
- Disability placed within the individual & considered inevitable consequence of some
form of impairment
WHO 2001: ICF = universal, dynamic and non-linear model whereby alterations in bodily
structure or function (replaces impairment); activities & limitations therein (replaces
disability), & participation or restrictions therein (replaces handicap) can potentially all affect
each other.
ICF recognises that the relationship between structures, activities and participation are
influenced by both environmental and personal factors. a person’s ability to perform at
‘capacity’
Disability no longer resides within the individual, but is a response to other factors including
the physical, social and cultural environment the person is trying to function within, and on
their own personal characteristics, behavioural and illness related beliefs and feelings
,Biopsychosocial: view that diseases & symptoms can be explained by a combination of
physical, social, cultural & psychological factors
Biopsychosocial model of illness
Encompass & emphasize the interaction between body & mind, between biological &
psychological process & social influences
Increased recognition of the role individual behavior play in that experience
Behavior, death & disease
dramatic increases in life expectancy witnessed in Western countries in 20th century,
partially due to advances in medical technology & treatments, led to a general belief, in
Western cultures, in the efficacy of traditional medicine and its power to eradicate disease
- Most notable after introduction of antibiotics in 1940s
World Health Organization figures: worldwide average life expectancy at birth is 71 years
UK life expectancy at birth has increased from 47 years in 1900 to 81 years in 2013, which is
a huge change in a relatively short period of time
Cultural differences can be explained largely by differences in
lifestyle & diet & gender differences
Some concern that due to rising obesity in children &
consequent health effects in adulthood: life expectancy may
begin to show decreases in future generations
Fall in mortality: (death, presented as mortality statistics -
number of deaths in a given population and/or in a given year
ascribed to a given condition) →in developed world preceded
the major immunisation programmes & likely reflects public
health success following wider social & environmental changes
over time:
→ developments in education & agriculture: changes in diet &
improved public hygiene & living standards
Significant decline in Ireland: reductions in deaths from
cardiovascular & respiratory disease - improved living
standards & health-care investment
Biggest killers worldwide: heart, lung & respiratory disease
Worldwide in 2011: top 10 leading causes of death (all ages):
, → Ischaemic heart disease
→ Stroke
→ Lower respiratory infection
→ COPD
→ Diarrhoeal diseases
→ HIV/AIDS
→ Lung diseases (including cancer)
→ Diabetes mellitus
→ Road injury
→ Prematurity
Incidence: the number of new cases of disease occurring during a defined time interval –
not to be confused with prevalence, which refers to the number of established cases of a
disease in a population at any one time.
Our own behavior contributes significantly to our health & mortality
Individual, cultural & lifespan perspectives on health
Lay theories of health
study - “what does being healthy mean?” Found people diagnoses of serious illness made 3
types of response: 1) general sense of well-being, 2) identified with the absence of
symptoms of disease, 3) seen in the things that a person who’s physically fit is able to do”
→ Mazman argued that 3 types of response reveal health to be related to: feeling, symptom
orientation, performance
- Subjective health judgments were more tied to health behaviour in healthier
individual
Health behavior: behavior performed by an individual, regardless of their health status, as
mean of protecting, promoting or maintaining health (diet)
Krause & Jay: older respondents more often referred to health problems when making their
appraisals whereas younger referred to health behavior
Survey on health and lifestyles: Inability to describe what it’s like to feel health - evident in
young males: believed health to be a norm
Categories of health identified by the survey:
● Health is not ill: i.e. no symptoms, no visits to doctor, therefore I am healthy.
● Health as reserve: i.e. come from a strong family; recovered quickly from operation.
● Health as behaviour: i.e. usually applied to others rather than self; e.g. they are healthy
because they look after themselves, exercise, etc.
● Health as physical fitness & vitality: used more often by younger respondents & often in
reference to a male – male health concept more commonly tied to ‘feeling fit’, whereas
females had a concept of ‘feeling full of energy’ and rooted health more in the social world in
terms of being lively and having good relationships with others.
→ Health as psychosocial well-being: health defined in terms of a person’s mental state; e.g.
being in harmony, feeling proud, or, more specifically, enjoying others.
