1. Positive Health
1. Machteld Huber - A new concept of health
2. Donna Stewart - Resilience in the physically ill
3. Anne-Sophie Dybdal - Enhancing child resilience
Discussion
July 2 2014
2. ECPP 2014 - Key Symposium – July 2
Introduction of the new concept of health
&
the broad perception of Positive health
Machteld Huber, MD, senior-researcher
Louis Bolk Institute, Driebergen
www.louisbolk.nl
3. The Animals - Results
• Growth: Animals on the Feed B grew stronger till the
KLH challenge. After that the Feed A-group took over
(catch-up growth).
Growth of body weight 2nd gen: mean ± SEM
Age in weeks
gramperweek
0 5 10
20
40
60
80
100
120
140
* * *
KLH
lineH
0 5 10
20
40
60
80
100
120
140
******* **
KLH
lineC
0 5 10
20
40
60
80
100
120
140
** *
KLH
lineL
A
B
5. Since then often criticized, but never changed.
Health is still defined by the WHO definition of 1948:
“A state of complete physical, mental, and social
well-being and not merely the absence of disease,
or infirmity.”
7. Invitational Conference:
Limitations of the WHO definition:
1. The word complete in “states of complete well-being”
“would leave most of us unhealthy most of the time”
and it supports medicalisation, as always something can be
found to be treated.
2. The demography of diseases changed since 1948
Ageing with chronic diseases becomes the norm.
This formulation denies the human’s capacity to cope.
3. This definition is impracticable as ‘complete’ is neither
operational nor measurable
8. Chosen as the general concept, expressing
the dynamic nature of health:
“Health as the ability to adapt
and to self manage
in the face of social, physical and
emotional challenges”
Invitational Conference:
11. In a follow-up study 7 Stakeholder Domains were identified:
- Patients
- Healthcare professionals
- Health insurances
- Citizens
- Policymakers
- Public health actors
- Researchers
They were questioned in a qualitative and a quantitative part.
12. These stakeholder domains were questioned in semi-structured
interviews and focusgroup meetings, with 3 questions:
1. What is positive and what is negative about this new concept of health?
2. What are to you indicators for health?
3. Do your indicators and the concept match?
13. Question 1: Your opinion about the new concept?
• Positive: “The focus is on the person, not on the disease” , etc.
• Negative: “Is everybody capable of this? Large groups do lack the basic health literacy
that is needed for this”, etc.
Advise: Take health as a mean to, not as an aim in itself …
Results of the Qualitative part:
14. Question 2: Indicators of health
• In total 556 indicators of health from seven stakeholder domains
were collected.
• These were concentrated and categorized in a consensus process
in cooperation with two independent researchers of Research Institute
NIVEL.
• This resulted in six main dimensions of health, differentiated into
32 aspects.
Results of the qualitative part:
15. The six main dimensions of health:
o Bodily functions
o Mental functions & perception
o Spiritual/existential dimension
o Quality of Life
o Social & societal participation
o Daily functioning
Results of the qualitative part: Question 2
16. Results of the qualitative part:
The differentation of six domains in aspects of health:
Bodily functions:
Medical facts, medical observations, physical functioning,
complaints and pain, energy.
Mental functions & perception:
Cognitive functioning, emotional state, esteem/self respect,
experiencing to be in charge/manageability, self management ,
resilience & ‘sense of coherence’.
Spiritual/existential dimension:
Meaning/meaningfulness, striving for aims/ideals, future prospects,
acceptation.
17. Results of the qualitative part:
The differentation in aspects of the main dimensions of health:
Quality of Life:
Quality of life/well being, experiencing happiness, enjoyment,
perceived health, flourishing, zest for life, balance.
Social & societal participation:
Social and communicative skills, meaningful relationships,
social contacts, experiencing to be accepted, community involvement,
meaningful work.
Daily functioning:
Basic ADL, instrumental ADL, ability to work, healh literacy.
Note: These are indicators, collected bottom up!
18. The Quantitative part:
Based on the quantitative results a survey questionnaire was established,
The response counted 1938 reactions:
– 643 Healthcare providers (doctors, physiotherapeuts, nurses) (panels)
– 575 Patients (panel)
– 430 Citizens (panel)
– 106 Researchers
– 89 Public health actors
– 80 Policymakers
– 15 Insurers
Generally the positive and negative opinions were confirmed.
19. Results of the quantative part:
Importance of health dimensions as viewed by stakeholders
20. Conclusions:
There is ample support for the new concept, but attention is needed.
Persons who have (had) an illness/disease consider health to be a
broad concept, broader than the medical model.
Health can exist besides disease.
A person’s capability to be healthy can strengthened, if desired.
Support must be fitting; not one size fits all.
Visualize the six main dimensions.
Discriminate the broad concept of health in such a way that it
discriminates from “health as absence from disease”: Positive health!
