Seminar 1_Topic 3_Unpacking Health.pdf

1
TOPIC 3: UNPACKING THE TERM ‘HEALTH
Recap
In Topic 1 we addressed the reality that each individual has a philosophical
underpinning that shapes their identity. What you think and know about health, how
you live, and what you do have a foundation that comes from somewhere.
In Topic 2 we addressed the issue that each individual has a worldview. Your
worldview affects the way in which you interact with others, perceive others, and how
they perceive you. Let’s look at the following example
(Chakona & Shackleton, 2019)
Food taboos and cultural beliefs influence food choice and dietary preferences among
pregnant women in the Eastern Cape, South Africa
In 209, Chakona and Shackleton conducted a study about food taboos and beliefs
amongst pregnant isiXhosa women from five communities in the Kat River Valley,
South Africa. In South Africa, cultural beliefs and food taboos followed by some
pregnant women influence their food consumption, which impacts the health of
mothers and children during pregnancy and immediately afterwards. The researchers
found that the most commonly avoided foods were meat products, fish, potatoes,
fruits, beans, eggs, butternut, and pumpkin, which are rich in essential micronutrients,
protein, and carbohydrates. Most foods were avoided for reasons associated with
pregnancy outcome, labour and to avoid an undesirable body form for the baby.
Some pregnant women consumed herbal decoctions for strengthening pregnancy,
facilitating labour, and overall health of both themselves and the foetus. Most learnt of
the taboos and practices from their mother or grandmother, but there was also
knowledge transmission in social groups.
As an individual, you know food, what people should eat, what a pregnant woman
should eat to take care of herself and her baby etc. Your knowledge and beliefs have
shaped your knowing, being and doing. However, the beliefs of these pregnant isiXhosa
women and the isiXhosa community may be the opposite of what you believe.
From this scenario, it is evident that health, health care, and wellness, are viewed within
different worldviews. If you (for example as a dietician, pharmacist, biokineticist,
psychologist, social worker, nurse etc.) were to engage with this isiXhosa community
and/or these isiXhosa women, having different worldviews about what to eat to ensure
the health and wellness of both mother and unborn child, may affect how you interact
with each other, how you perceive these individuals and how they perceive you as a
health professional. These cultural beliefs may be detrimental to the delivery of health
care and/or services.

2
In Topic 3, we will look at how health, health care, wellness, and illness are viewed
within different worldviews. As noted earlier, there are many different worldviews,
and please keep in mind that within these broad worldviews, there are numerous
sub-worldviews. It is impossible to cover all the different iterations of worldviews.
For the purpose of this module, the lecturing team has selected four broad
worldviews namely: Western, Eastern, African, and South Asia worldviews as it is
representative of the largest population groups in South Africa.
Disclaimer
The information presented in the table below is grounded in literature (see reference
list). The information presented is broad generalizations, may not apply to every
member of that broad grouping, and should not be used to stereotype any individuals.
The information shared in this table are those of the authors and does not necessarily
reflect the views of the North-West University, the lecturing team, and any individuals
within the broad groupings.

3
A bit of Theory...
As of 2021, South Africa's population increased and counted approximately 60 million
inhabitants in total, of which the majority (roughly 48.6 million) were Black Africans.
5,2 million South Africans are colored and 4,6 million white. Individuals with an Indian
or Asian background formed the smallest population group, counting approximately
1.54 million people overall.
Table 1: Viewing health, health care, wellness, and illness from different worldviews
Source: © Statista 2022

4
Western Philosophy
Health
Western (or ‘conventional’) medicine evolved in ancient Greece and forms the basis of many of the world’s modern health systems. While
health and ill health was initially thought to be dictated by the Gods, the ancient Greeks were the first to look at the body through the lens
of human biology. They studied health by looking at four bodily fluids or ‘humors’ — blood, black bile, yellow bile and phlegm.
Western physicians make decisions about which treatment will be most helpful to their patients based on controlled, scientific studies. This
approach is known as evidence-based medicine. Evidence-based treatment plans may include prescription medication, surgery, infusions,
and other conventional procedures and therapies. Understanding the connection between lifestyle and physical health, western medicine
practitioners are also more commonly encouraging lifestyle modifications – especially diet and exercise.
Despite the objectivity implied by the scientific principles underlying western medicine, it is still underpinned by a host of assumptions and
beliefs developed through living in western culture. The white coat worn by doctors is a potent symbol of efficiency and hygiene, for
instance, and the bleeping medical machines found in the hospital setting convey their own meanings of high technological prowess.
(Lupton, 2013)
Illness
Western industrialized societies see disease as a result of natural scientific phenomena and advocate medical treatments that combat
microorganisms or use sophisticated technology to diagnose and treat disease.
In any cultural context, people with some medical conditions are assumed to be “responsible for their illness”. From a western view a
person with lung cancer for example can be assumed to be a smoker, therefore viewed as “bringing it on themselves” This leads to less
compassion and people may delay seeking treatment because of the stigma that clings to the disease they are suffering from.
How illness is viewed from a western philosophy are inevitably underpinned by sociocultural meanings. The understanding and beliefs of
concepts are shaped by encounters with health-care professionals and factors such as personal experiences, interaction with others,
information derived from mass media and the internet, social class, gender, generation or ethnic group. (Lupton, 2013).
A system in which medical doctors and other healthcare professionals (such as nurses, pharmacists, and therapists) treat symptoms and
diseases using drugs, radiation, or surgery. Also called allopathic medicine, biomedicine, conventional medicine, mainstream medicine, and
orthodox medicine. The term medicine can be used to describe any substance or drug used to treat disease or injury to the body or mind.
As important as these acknowledgements of culture are, it should be recognised that culture, more broadly, can also be understood as the
meanings, technologies and practices that gather around medicine within western societies. Despite the objectivity implied by the

5
Healthcare scientific principles underlying western medicine, it is still underpinned by a host of assumptions and beliefs developed through living in
western culture. The white coat worn by doctors is a potent symbol of efficiency and hygiene, for instance, and the bleeping medical
machines found in the hospital setting convey their own meanings of high technological prowess.
The quest to alleviate pain and suffering, to cure diseases considered incurable, enhance human capacities and to prolong life has always
been at the heart of the modern Western medical scheme.(Mbih & Tosam, 2014). However medical practice is also closely linked with
subjectivity and personal experience and there is a relation between a human being and his/her environment. Modern medicine has
concentrated on the disease and may have neglected the patient as if the decease and patient were two separate entities. A patient may,
for example be treated without taking any form of medication. (Mbih & Tosam, 2014)
Role of
Health care
worker
To be a good health care worker, rely on science, but also on experience, intuition, critical thinking to diagnose and treat. Medical thinking
requires some formal training in logic for better communication with patients, peers, and the health community and the public in general.
An important part of the job of physicians is decision-making, based on acquired knowledge and experience; and to do this efficiently,
medical practice requires skill in reasoning, imagination, intuition, and critical thinking. The lack of this skill results in all forms of
misjudgements and egregious errors in diagnosis and treatment. (Mbih & Tosam, 2014)
Health care workers includes physicians, physician assistants, registered nurses, dentists, midwives, radiographers, pharmacists,
physiotherapists, optometrists and others.
Wellness
A person is in good health when all the organs and systems of the body are functioning properly.
Most accounts of disease, and health, rely on the physical, quantifiable and measurable aspects of a person, they do not relate disease to
the patient—the person.
Eastern Philosophy
The eastern philosophy on health and healthcare as a whole is difficult to allocate to one single country. According to the WHO (2013), the
eastern philosophy has been adopted in as many as 11 countries in Southeast Asia (Bangladesh, Bhutan, the Democratic People’s Republic
of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste) and 37 countries in the Western Pacific region
(American Samoa, Australia, Brunei Darussalam, Cambodia, China, Cook Islands, Fiji, French Polynesia, Guam, Hong Kong (China), Japan,
Kiribati, the Lao People’s Democratic Republic, Macao (China), Malaysia, the Marshall Islands, the Federated States of Micronesia,
Mongolia, Nauru, New Caledonia, New Zealand, Niue, the Commonwealth of the Northern Mariana Islands, Palau, Papua New Guinea, the

6
Health
Philippines, the Pitcairn Islands, the Republic of Korea, Samoa, Singapore, Solomon Islands, Tokelau, Tonga, Tuvalu, Vanuatu, Viet Nam, and
Wallis and Futuna). Thus, in the modern era, eastern philosophy is not only limited to the Chinese as most westerners believe.
However, it should be noted that the eastern philosophy is adopted by many countries that are predominantly oriental as an ethnic group.
Oriental people have always been holistically minded in terms of what is health. Patrick (1995) points out that often people mistake health
as the absence of diseases. Not so according to Oriental tradition that sees person as a combination of body, mind and spirit.
Illness
Any off-balance of the integral unity of body, mind and spirit, will make a person feel sick, therefore, a person must maintain a harmonious
relationship within himself and his surroundings. The concept of the harmony and unity of Yin and Yang reflects this understanding. For
example, high blood pressure is the result of hyperactivity of Yang caused by a lack of Yin. In therapy, if a disease is caused by the heat
pathogen, it is treated with cool or cold agents according to the principle that cold can counteract heat. Similarly, disorders caused by cold
pathogens are treated with warm or hot agents since heat can overcome cold.
Another key concept is the belief of Chi. Carteret (2010) explains that Chi is the basic element by which all movements and mutations of all
phenomena in the universe arise. In the context of medicine, chi moves the energy of the vital substance of life throughout the whole
body. All movements, either internally or outwardly, are due to the circulation of chi. The easiest way to understand this is, for instance,
that if a person sprains his ankle, he will suffer from pain and limp when he walks. This is because the chi that circulates to the ankle has
been blocked. Once this blockage is removed, the individual will recover.
Healthcare
Eastern medicine considers both patient’s symptoms and an individualized diagnosis of a patient’s chi. Diagnostic indicators are always
viewed holistically to accurately assess physical and emotional imbalances of internal organs and restore a patient’s chi.
Role of
Health care
worker
Jin et al. (2002) implies that our understanding of what a person is subject to change as medical findings advance. The arrival of Western
medicine in the East has challenged Eastern traditional care systems to the point that they are losing their influence. In conclusion, Tai
(2012) advises that integrative medicine that includes the Eastern approach supports the importance of a holistic approach to health.
Healing cannot be isolated by a specific physical method. Instead, any illness must be understood and treated holistically and in balance.
Oriental medicine practitioners use natural forms of treatment that typically include herbs, acupuncture, nutrition, mind/body exercise
(e.g., tai chi, yoga).

7
Wellness
Health is perceived as a harmonious equilibrium that exists between the interplay of 'yin' and 'yang': the internal elements, the
environmental conditions, other external sources of harm, and the emotions.
Middle Eastern (Indian) Philosophy
Health
Islam is a dominant force in the lives of many Middle Easterners.
Muslim individuals live in a manner in which their religious beliefs pervade all of their actions and all facets of human life.
Actions like abstinence of certain foods and prayer provides ways to become not only bodily healthy and clean, but also spiritually.
Since good health is a gift from God, Muslims believe that taking care of one’s health is a religious duty. The individual must maintain a
well-integrated holistic perspective of life. They must work hard and pray but also find time for the family.
Illness
Muslims perceive illness, pain and dying as a test from Allah, and receive it with patience, prayer and meditation.
Healthcare
Seeking treatment for illness is not regarded as a sign of conflict with reliance on God for a cure. Medications are permissible, but it is
unlawful to use prohibited products based on alcohol or pork.
Role of
Health care
worker
A major aspect of being healed is being at peace with whatever happens for better or worse because God is the source of healing and
sickness. Bodies is seen as a loan from God to be returned upon death and protecting the body necessitates seeking treatment wherever it
may be found.

8
Wellness
For Muslims, good health involves the intertwining of physical, psychological, spiritual, and social factors. Good health is considered the
greatest blessing and gift God has given humankind.
African Philosophy
Health
The African philosophy is interwoven with its religion. This influences how people see the concepts of health and wholeness (Gregory Ajima
& Ubana, 2018). The African traditional view is that there is one God, but they also believe in in ancestral spirits who is in constant
relationship with living beings.(White, 2015).
Illness
The general belief is that illness is not caused by germs, but by breaching natural laws. To maintain and correct the disorder this law needs
to be restored through confession, rituals or the payment of fines. (Gregory Ajima & Ubana, 2018) Traditional healers and practitioners
are of the opinion that disobeying certain taboos, an important part of African traditional religion, is one of the reasons why people get
sick. Being disobedient and disloyal towards tradition will weaken the life force, whereas good moral behaviour maintains and enhances
one’s life force. If the ancestors are not treated well, neglected or forgotten for example, they get angry and could punish people with
disease. Their anger is usually appeased through prayers and rituals in the form of food and drinks. (White, 2015). For example: What is
diagnosed by Western medicine as a stroke is diagnosed from an African worldview as the wrath of the ancestors on a clan member who
cheated his deceased brother’s family out of their share of the estate. (Pobee, 2001).
Diagnoses of disease is twofold: first the physical cause is established by examination and questioning and second the divination of the
spiritual or cause (definition of divination: the art or practice that seeks to foresee or foretell future events or discover hidden knowledge
usually by the interpretation of omens or by the aid of supernatural powers)
Spell-casting and witchcraft can also cause sickness. People with evil powers can cause their enemies to become sick as a way of
punishment. These illnesses caused by the ancestors or witchcraft includes conditions/events like barrenness, infertility, headaches,
miscarriages, animal attacks and snake bites.(White, 2015, p. 2).
However, biomedical explanations (viruses, bacteria, parasites, cancer, high blood pressure) is accepted, but it is viewed as secondary
causes. (Gregory Ajima & Ubana, 2018)

9
Healthcare
African traditional religion is not against a Western medical way of treatment, but it is believed that there are some diseases Western
medicine cannot treat or cure and therefore needs spiritual attention. The treatment process is holistic which implies that the healer deals
with the complete person and provides treatment for the physical, psychological, spiritual and social symptoms. There isn’t a separation of
the natural from the spiritual of the physical from the supernatural (White, 2015)
Treatment can include sacrifices, rituals, spiritual cleansing, exorcism, counselling, provision of talismans for protection
Role of
Health care
worker
Diviners/traditional healers/medicine man: seek input from the spiritual world to understand the cause of the illness and prescribe a cure
They advise clients in all aspects of life physical, psychological, spiritual, moral, and legal matters.
Herbal healers: use plants to treat diseases.
More practices include bone settlers and traditional birth attendants
Wellness
An individual is seen as a collective member of the community and good health would also include good relationships with ancestors and
with the community (White, 2015). From an African philosophy, wellness entails all areas of human life – social, economic, physical,
psychological, cultural, emotional, intellectual, spiritual and even occupational. (Gregory Ajima & Ubana, 2018). To be healthy there must
by a wholeness where the spiritual and the physical aspects are in harmony.
Why a worldview matter:
When most of us think about the medical approach that dominates in Western countries, we tend to view it as scientific and therefore as neutral, not
influenced by social or cultural processes. Yet research undertaken by anthropologists and sociologists has revealed the influence that social and cultural
assumptions play in the western biomedical tradition. People of non-western cultures may come to western medicine holding different beliefs about the
causes and treatments of illness from those of scientific medicine, causing a “culture clash” between doctor and patient. Its attendant concept of
“cultural competence” is now commonly used in the medical literature. It highlights the importance of doctors and other health professionals
understanding that their patients from another culture that may hold different beliefs about illness and may experience poorer quality health care as a
result of communication breakdowns.
https://theconversation.com/the-cultural-assumptions-behind-western-medicine-7533
In dealing with patients from other backgrounds, the following recommendations may be useful (Jin et al. 2002):

10
• Do not make assumptions about the patient’s ethnic heritage and level of acculturation. When in doubt, ask the patient about his or her comfort with a
particular plan.
• Acknowledge differences in culture. Recall that biomedicine is also a “culture,” with its own premises that may not be congruent with those of the
patient.
• Use a translator when possible if language difficulties exist.
• Take a careful history, which should include the patient’s social situation and history, use of herbal medicines, use of alternative therapies, and how
health care decisions are made in the family. Take care to assess stressors the patient may be experiencing at home or at work.
• Learn about your patient’s culture through library research, just as you might research an unfamiliar medical issue. Do so with the understanding that
your patient may or may not fit the generalities provided in the literature.
Gregory Ajima, O., & Ubana, E. (2018). The Concept of Health and Wholeness in Traditional African Religion and Social Medicine. Arts and Social Sciences
Journal, 09. https://doi.org/10.4172/2151-6200.1000388
Lupton, D. (2013). The cultural assumptions behind Western medicine. The Conversation. https://theconversation.com/the-cultural-assumptions-behind-
western-medicine-7533
Mbih, J., & Tosam, M. (2014). The Role of Philosophy in Modern Medicine. Open Journal of Philosophy, 4, 75-84.
https://doi.org/10.4236/ojpp.2014.41011
Pobee, J. S. (2001). Health, Healing and Religion: An African View. International Review of Mission, 90, 55-64.
White, P. (2015). The concept of diseases and health care in African traditional religion in Ghana. HTS Theological Studies, 71, 01-07.
http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0259-94222015000100046&nrm=iso
Carteret, M. (2010). Traditional Asian health beliefs and healing practices. Carteret Marcia.- Аccess mode: http://www. dimensionsofculture.
com/2010/10/traditional-asian-health-beliefshealing-practices.
Jin, X. W., Slomka, J., & Blixen, C. E. (2002). Cultural and clinical issues in the care of Asian patients. Cleveland Clinic journal of medicine, 69(1), 50-61.
Patrick, H. (1995). Traditional Chinese medicine and public health: the Yin and the Yang. Journal of the Royal Society of Medicine, 88(9), 485.
Tai, M. C. T. (2012). An oriental understanding of health. Tzu Chi Medical Journal, 24(2), 92-95.
World Health Organization. Regional Office for South-East Asia. (2008). Health in Asia and the Pacific. WHO Regional Office for South-East Asia.
https://apps.who.int/iris/handle/10665/205227

11
Viewing health, health care, wellness, and illness from different
worldviews
In the table above you see that health, health care, wellness, and illness are viewed
differently within the different worldviews. It is also important to remember that
although individuals might share the same worldview, they can still view health, health
care, wellness, and illness differently from others. And these different viewpoints make
delivering quality health care and service very difficult. These different viewpoints
make delivering quality health care and service very difficult.
To deliver culturally competent care, health care professionals should be able to
identify how a patient’s experiences are influenced by culture, either through general
awareness or by asking questions about a patient’s preferences or expectations. and
then adapt their own behavior to fit within the norms of another culture
Common ground
For the purpose of this module, we need to find common ground on how we define
“health”. For this reason, we will use the definition by the World Health Organisation
(WHO), which is still used today.
Defining “health”
On 7 April 1948, the World Health Organisation (WHO) defined the concept of health
as: “Health is a state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity” (WHO, 1984:1).
Health is therefore stated in a holistic perspective in which there is a relationship
between the person's physical and emotional health and the environment in
which man lives and works. Health is stated as being positive and an asset.
Defining “wellness”
The WHO defines wellness as “the optimal state of health of individuals and groups,”
and wellness is expressed as “a positive approach to living.”

12
Drawing from the definitions of health and wellness, you will see that there is more to
health than just physical health. Health is seen as an active and holistic approach
where there is balance between the various dimensions of wellness.
Literature indicates that there are various dimensions of
wellness. These dimensions include
social wellness,
physical wellness,
emotional wellness,
occupational wellness,
intellectual wellness,
financial wellness,
environmental wellness,
spiritual wellness,
intercultural wellness, and
creative wellness.
Wellness adopts a salutogenic and proactive approach to health, focused on
prevention, healthy lifestyles and the pursuit of optimal wellbeing. Unfortunately,
and due to many reasons, individuals and the health care system has a
pathogenic and reactive approach, focused on causes, consequences, diagnosis,
and treatment of diseases and injuries. (Global Wellness Institute, 2022). Health is
regarded as a continuum of poor health to an optimal state of well-being. The
following wellness continuum provides a visual overview of a pathogenic (reactive)
approach and a salutogenic (proactive) approach to health and well-being.

13
(Global Wellness Institute, 2022). Adapted from Jack Travis’ Illness-Wellness Continuum.
Defining “care”
The Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health
defines care as: “the services rendered by members of the health professions for
the benefit of a patient”
According to the Medical Dictionary for the Health Professions and Nursing. (2012),
“care” refers to “the general term for the application of knowledge to benefit a
person, family, or a community” and “to provide medical or healthcare-related
service to a patient”.

14
Defining “health care”
Efforts made by trained and licensed professionals to maintain or restore physical,
mental, or emotional well-being.
(Medical Dictionary for the Health Professions and Nursing, 2012; Miller-Keane
Encyclopedia and Dictionary of Medicine, 2003)
Determinants (also known as factors) influencing health
An optimal state of well-being is not determined by a single factor. There are a broad
range of factors that can influence health and make it easier, or more difficult to make
changes to your health. These factors can be personal, social, economic and
environmental.
The main determinants of health include:
• Income and social status
• Employment and working conditions
• Education and literacy
• Childhood experiences
• Physical environments
• Social supports and coping skills
• Healthy behaviours
• Access to health services
• Biology and genetic endowment
• Gender
• Culture
• Race / Racism
Social determinants of health refer to a specific group of social and economic factors
within the broader determinants of health. These relate to an individual's place in
society, such as income, education or employment. Experiences of discrimination,
racism and historical trauma are important social determinants of health.
Watch the following video https://youtu.be/8PH4JYfF4Ns
Health promotion tries to improve health, by targeting individuals to change behaviour
and addressing a broad spectrum of health determinants and factors.

15
In summary
In Topic 3 we investigated how health, health care, wellness, and illness are viewed
within four purposively selected worldviews. The reality is that the concepts “health,
health care, wellness, and illness” are viewed differently and that these different
viewpoints make delivering quality health care and service very difficult. We then
defined the concepts “health, health care, wellness, and illness” and realised that
health is more than just absence of disease but a state of complete physical, mental
and social well-being. Functioning as a continuum, it is also important that individuals
and health care professionals adopt a salutogenic (proactive) approach to health and
not a pathogenic (reactive) approach, focusing on causes, consequences, diagnosis,
and treatment of diseases and injuries. Optimal well-being is influenced by personal,
social, economic and environmental. determinants (factors) and these factors
sometimes makes it difficult for an individual to improve their health. Health is a holistic
and positive approach where there is balance between the various dimensions of
wellness. To achieve optimal health, health care professionals play a critical role to
help their patient or client to maintain or restore physical, mental, or emotional well-
being.

Seminar 1_Topic 3_Unpacking Health.pdf

Recommended

Recommended

More Related Content

Similar to Seminar 1_Topic 3_Unpacking Health.pdf

Similar to Seminar 1_Topic 3_Unpacking Health.pdf (13)

Recently uploaded

Recently uploaded (20)

Seminar 1_Topic 3_Unpacking Health.pdf