Ada: Health and well being
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This document discusses different perspectives on health and well-being. It explores how Ada, her GP, and her family each view Ada's health differently based on their own criteria. The document then examines definitions of health from the World Health Organization and the UK government, which incorporate physical, mental, and social dimensions. It also introduces the social model of disability and how views of assistive technology differ between the biomedical and social models. Finally, it discusses the International Classification of Functioning as an attempt to synthesize biomedical, subjective, and social perspectives on health.
Ada: Health and well being
- 1. PICTURES OF HEALTH TOWARDS A CONTEMPORARY PERSPECTIVE TO UNDERSTANDING HEALTH AND WELL-BEING
- 2. What is health? • Instinctively, you may feel that it is obvious what health is. • However, each of the characters in our story seems to have a different stance towards Ada’s health. o This suggests that health may be a more complex concept than it first appears. • Health is a multidimensional concept (Boruchovitch & Mednick 2002:177). o The next slides will explore some of the different aspects of this concept.
- 3. Ada’s GP • Ada's GP tends to measure health according to specific criteria. He asks questions such as: o Does Ada have any form of physical or mental impairment at present? o Has she required his input very often in the past? o What are her functional abilities, when compared with other people of her age? • Using the criteria, he would agree that Ada is 'remarkably healthy‘. • However, he sees technology as being a useful preventative measure - especially considering Ada's isolation from medical services.
- 4. Ada’s family • Ada's family judge her health according to a number of comparisons, such as: o What are the typical functional abilities of an 85 year-old? o How likely is it that she will develop an illness or disability in the near future? o How do Ada's current abilities compare with when she was younger? o How likely is it that she will fall again? • Consequently, they view Ada as infirm and at risk; and therefore as being in relatively poor health.
- 5. Absence of disease, impairment and infirmity • Both Ada's GP and her family tend to view health according to a series of expectations of 'normality' o From their perspective, Ada's own views are secondary to these standards - Ada would be classed as unhealthy if tests, say, revealed a medical condition such as diabetes, even if she 'felt fine' • This view is sometimes known as the traditional biomedical model. • Whilst it has some advantages, (e.g. helping researchers classify and develop effective treatments for illnesses; and allowing early detection of particular conditions), the biomedical model can be disempowering to somebody like Ada - allowing others to decide what's best for her.
- 6. Ada’s own views • Ada judges her health in terms of her own experiences - if she feels well, then she must be well. o She describes herself as being 'as fit as a fiddle’. o She has never spent any time in hospital as an in-patient. • Although she has had a fall, this was only once: o The answer is to be more careful in future. Ada consequently sees assistive technology as a sign of weakness and loss of independence.
- 8. The World Health Organization definition • The World Health Organization (WHO 1946:2) recognised that a person's experience of health is as important as any underlying diagnosable condition. • They therefore built on the original biomedical model, defining health as: 1) "A state of complete physical, mental and social well- being"; 2) "Not merely the absence of disease or infirmity“ • However: o Well-being is not defined. o Some would suggest that there are other aspects to well- being (e.g. spiritual (Sein 2002:51); occupational ( Doble and Caron Santha 2008)); whilst others would argue that too many areas are addressed. o Complete well-being could be seen as an unattainable ideal.
- 9. What is well-being? • In the UK, all Government departments now have a 'common understanding' of well-being, based on a review of research on subjective well-being by Dolan et al (2006) for the Dept of Food, Environment and Rural Affairs. • Well-being is defined as: o 'A positive physical, social and mental state’. o 'Not just the absence of pain, discomfort and incapacity‘. (see DEFRA 2009:119) • Well-being is believed to require that: • Basic needs are met. • Individuals have a sense of purpose, and feel able to achieve important personal goals and participate in society.
- 10. Combining the definitions • Taken together, the two definitions suggest that, to be fully healthy, a person would: o Exhibit no features of disease or infirmity. o Experience no pain, discomfort or lack of ability to perform necessary or desired activities. o Feel positive regarding one's physical, social, and mental state • Again - is this too idealistic?
- 11. A point of agreement? • Although Ada, her family, and her GP all seem to hold different views regarding what health is, they all seem to agree that health is something that resides within the person. o They therefore appear to emphasise different parts of the combined WHO/DEFRA definition of health/well- being. • The environment is seen as a contributory factor to health and well-being - but is secondary to it: o Ada believes assistive technology would leave her feeling less independent. o Her family believe that she needs to move to a supported-living environment. o Her GP sees technology as a useful way of preventing deterioration.
- 12. THE OTHER SIDE OF THE COIN: SOCIAL MODELS OF HEALTH AND DISABILITY
- 14. Introducing the social model • As the video on the last slide makes clear, many disabled people become very angry with the biomedical view of health. • They feel that the causes of disability rest with a disabling society (e.g. Ada's family?) and environment - if these are changed, then the effects of any impairment or frailty can be removed • The biomedical model is thought to be flawed (Oliver 1990): • It places the 'problem' of disability within the person. • It sees the cause of this problem as the impairment.
- 15. Ada and the social model • From the social model's perspective, there are many barriers in Ada's home environment: o She is isolated from her family. o Her home is cold, damp and draughty. o She has to travel a great distance to access medical facilities. o If she has an accident or falls ill, it would be difficult for her to summon help. • These would all be problems for anyone, regardless of any clinical condition.
- 16. What about assistive technology? • The ideal towards which the social model strives is universal design - the creation of barrier-free environments wherein disability or infirmity would have a negligible impact on accessibility. • If this is not possible, then assistive technology would be seen as the next best option. • The more 'universal' an item of technology is, the less it will be seen to conform to a biomedical model; and the more likely it is that Ada would accept it. • We will consider this aspect of assistive technology later in this Unit.
- 17. Mind the gap • Although the social model has some definite strengths, it is unlikely that this will ever become the only model of health to be used. o No environment is likely to be fully suitable for all people's abilities. o Any person is likely to find some environments difficult. o Society's attitudes will favour some people over others. o Healthcare professionals are becoming increasingly skilled at preventing and remediating many forms of impairment; and we would often prefer to be treated for a condition rather than having an environment that we can function in better despite it.
- 18. International Classification of Functioning Disability and Health (ICF) • Maybe the answer to such limitations is to develop a model of health that synthesises the biomedical, subjective (experiential) and social viewpoints. • The World Health Organization have attempted such a synthesis in their International Classification of Functioning (see WHO 2001). • It has therefore been referred to as a biopsychosocial model (WHO 2002:9). The structure of the ICF is shown on the next slide.