PICTURES OF HEALTH
TOWARDS A CONTEMPORARY
PERSPECTIVE TO UNDERSTANDING
HEALTH AND WELL-BEING
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.
• 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
• Ada's family judge her health
according to a number of
comparisons, such as:
o What are the typical functional abilities of an 85
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.
Absence of disease, impairment and
• 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
• 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.
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
o She has never spent any time in hospital
as an in-patient.
• Although she has had a fall, this was
o The answer is to be more careful in future.
Ada consequently sees assistive
technology as a sign of weakness and
loss of independence.
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-
2) "Not merely the absence of disease or infirmity“
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.
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
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
• Again - is this too idealistic?
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-
• 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
o Her GP sees technology as a useful way of preventing
THE OTHER SIDE OF THE COIN:
SOCIAL MODELS OF HEALTH
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
• The biomedical model is thought to be flawed
• It places the 'problem' of disability within the person.
• It sees the cause of this problem as the impairment.
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
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.
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
• 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.
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
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.
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
• 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.