What Is Health?

Question 1

What 3 things determine normality?

Answer 1

1. Statistical bias
2. Optimal health
3. Social (normative) bias

Question 2

In what way does statistical bias define normality?

Answer 2

Usual/average from measurements of populations -> normal ranges with upper + lower values

Question 3

What does the normal (Gaussian) distribution state?

Answer 3

95% of population should be within +/- 2 SDs

Question 4

In what way does optimal values define normality?

Answer 4

Normal value determined by what is required for optimal health, not what is the populations norm

Question 5

What are some examples of optimal health values?

Answer 5

BMI (healthy range)
GFR (>90ml/min)
Vitamin D

Question 6

When being a good doctor, how should you interpret a patients result value?

Answer 6

If it is a change from the person’s normal values, then usually something abnormal is going on

Question 7

How does social normality define normal?

Answer 7

What society finds acceptable/desirable - influenced by culture + time

Question 8

Define disease.

Answer 8

A pathological process confirmed by signs + investigations (objective)

Deviation from biological norm

Question 9

What do definitions of disease change over time?

Answer 9

Medical knowledge advances

Question 10

Define illness.

Answer 10

A subjective experience/feeling that is something personal

Symptoms defined + responded to differently by different people

May be experienced in absence of pathology

Question 11

Define sickness.

Answer 11

A social role adopted or assigned to people perceived to be ill

Question 12

What is WHOs 1948 definition of health?

Answer 12

A state of complete, physical, mental + social wellbeing + not merely the absence of disease or infirmity

Question 13

What is WHOs 1986 definition of health?

Answer 13

A resource for everyday life, not the objective of living

Question 14

What 4 aspects make up somebody’s health?

Answer 14

Physical health
Mental/emotional health
Social health
Spiritual health

Question 15

What are the 2 broad explanatory models of health?

Answer 15

1. Medical

2. Social

Question 16

Describe the medical model of health.

Answer 16

Health is absence of disease where disease is caused by biological/pathological changes; mono-causal model where A -> B

Causes of ill health identified by signs + symptoms along with process of diagnosis

Question 17

What are the pros of the medical model of health?

Answer 17

Medicine important for health (role to cure/treat to lessen effects or make some comfortable) + focuses on individual so patient is intervention target

Question 18

What are the cons of the medical model of health?

Answer 18

• Research documenting social + psychological causes of disease so need a multi-causal model
• Shift to chronic/degenerative conditions not associated with simple biological cause or medical cure
• Need to acknowledge + place power in hands of patients rather medical profession

Question 19

Describe the social model of health.

Answer 19

Accepts ill health + disease caused by social + psychological factors too so considers social + psychological determinants of health

Need for intervention at the population level

Question 20

What are some social determinants of health?

Answer 20

Income
Place in society
Living + employment conditions
Gender
Ethnicity
Culture
Education
Environment
Access to services

Question 21

What are some psychological determinants of health?

Answer 21

Beliefs
Cognitions
Dispositions
Resilience

Question 22

What are the pros of the social model of health?

Answer 22

• Takes into account lay knowledge + beliefs; people have own ideas about what causes ill-health
• Places people at centre + recognises their autonomy + rights
• Recognises a person can have disease/impairment but still consider self healthy

Question 23

What factors does the biopsychosocial model for clinical practice consider?

Answer 23

Biological
Social
Psychological

Question 24

How do people think about own health?

Answer 24

Contested conception meaning different things to different people + views change over time + with place + culture too

People emphasise social + emotional component of health as well as biological

Question 25

What are some lay views of health?

Answer 25

Absence of illness Functional ability Wellbeing/equilibrium Physical fitness

Question 26

What shapes peoples views on health?

Answer 26

Age Gender Ethnicity Place in society (socio-economic position)

Question 27

What must doctors understand in order to treat patients with regard to health perspectives?

Answer 27

- Normality can be socially + biologically defined - Doctors + patients have different views about health, illness + disease - Health is multidimensional - Need to understand patient's perspective on health

Question 28

What questions can you ask patients to gain an idea of their views on their health?

Answer 28

What do they think of their own health? Do they see themselves as healthy/unhealthy? What do they think has influenced their health?

Question 29

What does it mean if a patient believes health to be absence of illness?

Answer 29

If they are not sick, they consider themselves healthy

Question 30

What does it mean if a patient believes health to be about functional ability?

Answer 30

As long as they are able to carry out their daily functions e.g. going to work, taking care of the household, then they consider themselves healthy

Question 31

What does it mean if a patient believe health to be about wellbeing or equilibrium?

Answer 31

Mind, body + spirit are all connected - need to all be in sync for good health

Question 32

What does it mean if a patient believes health to be about physical fitness?

Answer 32

Keeping fit by going to the gym means that they are healthy