Health in Society; The new public health, Baum
Understanding Health: Definitions and perspectives, Chapter 1
Health is a social, economic and political issue and a fundamental human right. Bad policies,
economics and politics is the largest cause for the majority of people in the world to not
enjoy good health.
The word health has a cultural, social and professional baggage. The word holds important
ideas about strongly held values. Definitions of health structure the ways in which the world
is viewed and how decisions are made.
The clockwork model of medicine
In the clockwork definition of medicine, the body is studied through its component parts.
Health is defined as the body operating efficiently like a machine. Any breakdowns in the
body system mean that it is not healthy. It does not consider disease within the context of
the lives of people with disease.
Health as the absence of illness
Biomedicine does distinguish between disease and illness.
Disease: Involves a set of signs and symptoms and medically diagnosed pathological
abnormalities.
Illness: Is primarily about how an individual experiences the disease. Illness can be culturally
specific and may have social, moral or psychological aspects.
→ Both disease and illness can detract from health.
Behavioral psychology added another dimension. The need to protect and maintain the body
by appropriate lifestyle behaviours that minimise risk of disease. Behavioural change and the
promotion of healthy lifestyles have become major factors in the professional perspective on
health over the past three decades.
Limitations of clockwork model
- Too mechanistic
- Ignoring social, psychological and spiritual aspects.
→ If a body is not diseased then it must be healthy.
The biomedical model of health assumes a mind/body dichotomy, and it does not place
much emphasis on how an individual’s mental health might affect physical health status.
The biomedical model of health has less legitimacy than it has in the past. An increasing
number of critics are demonstrating that the medical definition of health reflects its culture.
Biomedical critique:
- Extending the definition of disease.
→ The absence of disease may be part of health, but health is more than the
absence of disease.
,Health and Well-being
Health Organization (WHO): Disease’ Complete state of physical, mental and social well-
being, and not merely the absence of disease or infirmity.
- Too utopian
- Unachievable
Vichealth: Mental health is the embodiment of social, emotional and spiritual well-being.
Mental health provides individuals with the vitality necessary for active living, to achieve
goals and to interact with one another in ways that are respectful and just.
Measuring health
Bowling reviewed measures that have been developed to view health in relation to quality of
life. He divided them into 5 categories.
1. Measures of functional ability.
2. Broader measures of health status.
3. Measures of psychological well-being.
4. Measures of social networks and support.
5. Measures of life satisfaction and morale.
→ All have limitations in terms of reliability, validity and techniques of analysis.
Health: Ordinary people’s perspectives
People find it harder to define health than illness. Being healthy requires no action. Three
main domains relating to the definition of health are found: Health is not being ill, it is a
necessary prerequisite for life’s functions and it is a sense of well-being expressed in
physical and mental terms.
Definitions of health (Blaxter’s survey of British sample)
Health as not ill/diseased You don’t have a cold or health is when you don’t feel tired
and short of breath.
Health as a reserve If someone becomes sick, they are able to recover quickly.
Health as behaviour, health I call her healthy because she goes jogging and doesn’t eat
as the healthy life fried food.
Health as physical fitness Physical strength and fitness.
Health as energy, vitality Physical and psycho -social energy to do things, signified by
being able to get up easily, not feeling tired and getting on
with activities.
Health as social Relationships with other people, and more likely to be
relationships expressed by women.
Health as function Health is the ability to do things.
Health as psycho-social Mental state.
well-being
,Being healthy is having the resources for everyday life and ‘a social construction that helps
us understand our place in the world and that of others. Another feature of lay definitions of
health is that people with some disability or disease often describe themselves as healthy,
especially on days when their disabilities seem less severe. People assess their own health
subjectively and in terms of a reasonable expectation for their age and disability.
Public and private lay accounts
Public accounts: Biomedical model.
Moral components and divided causes of illnesses into those that were of were not the
individual’s fault.
Private theories: Based on their own experiences or those of people they knew.
A more complex view of health.
Health in cultural and economic contexts.
Interpretations of health reflect the cultural and economic context of people’s lives. For more
people health represents a status, socially recognised and admired. Crawford found two
main discourses of health.
- Health as a means of exerting self-control. Health as something to be achieved
through healthy behaviour. Thinness is believed to be an unmistakable sign of self-
control, discipline and willpower. Fat is a confirmation of the loss of control, an oral
failure, a sign of impulsiveness, self-indulgence and sloth.
- Health as a release mechanism: Life is seen as a series of pressures, anxiety,
frustration and worry, and as leaving no time for health-promoting activity. Health is
not rejected as a value but is often repudiated as a goal to be achieved through
instrumental action.
Spiritual aspects
Some people saw their health as dominated by external religious or supernatural powers.
Healing could result from intervention by god or some other supernatural power, as could
falling ill in the first place. Indigenous people are particularly to have a belief system that is
related to health and illness, which emphasised spiritual dimensions.
Health: Critical perspective
Critical perspectives on health are those that seek to explain the purpose that are achieved
through particular means of defining health. They are critical in the sense that they look
beneath the surface appearance of a concept or phenomenon and offer an explanation as to
why it is this way.
Perspective on health that has been particularly influential is that which maintains that is
defined in such a way by the dominant forces in a capitalist society that it becomes a
defining and controlling mechanism. Capitalist societies are structured in such a way that
they produce illness.
Dominant global economic structures in the world are seen to have a massive effect on
shaping ordinary people’s health experiences. In contemporary western society the pursuit
of good health is both a right and an obligation. Individuals are obligated to remain healthy
because being ill means they cannot be good citizens, and may become an economic
burden.
, The political economic view sees health in terms of its distribution in society. In terms of the
structural factors that create or detract health, such as environmental, housing and
occupational conditions. From this perspective, studying the health of individuals is less
valuable than studying the collective health of societies and the social and economic forces
that affect collective health. The political economy view stresses the connections between
the health of peoples in rich countries and those in poor countries as the processes of
economic globalization continue apace.
Health as outcomes
Generally a randomised controlled design can only be used to study clinical interventions.
Ethical and practical grounds restrict their use in most other circumstances. Health in clinical
trials is invariably reduced to an absence of the particular ailment the clinical intervention
was designed to cure. Many of the measures used to measure health within the health care
system present a health service provider rather than user perspective. For people
themselves, crucial factors not covered might be their ability to function, their quality of life
and the extent to which they can live their lives normally.
→ Most of the outcomes measured relate to individuals and not populations.
The world bank and the WHO have used economic measures of health as a yardstick for the
success of their programs. This reflects and udnelrying assumptions that economic
productivity is paramount. This is nowhere better illustrated than in the use of disability
adjusted life years (DALYs) or DALEs (disability adjusted life expectancy) to determine the
value of a health intervention. DALYs are calculated by assigning values to years of life lost
at different ages.
- Very young, elderly and people with disabilities do not contribute much to
economic development → Results in fewer DELYs than treatment aimed at
people in their early twenties.
Health and Place: Defining collective health
- Healthy cities
- Healthy schools
- Healthy workplace
WHOs list of the qualities of a healthy city:
- Clean, safe, physical environment of high quality.
- Ecosystem that is stable now and sustainable in the long term.
- A strong, mutually supportive and non-exploitative community.
- High degree of participation in and control by the citizens over the decisions affecting
their lives, health and well-bing
- The meeting of basic needs for all the city’s people.
- Access by the people to a wide variety of experiences and resources, with the
chance for a wide variety of contract, interaction and communication.
- A diverse, vital and innovative city economy.
- Connectedness with thepast, with the cultural and biological heritage of city dwellers
and with other groups and individuals.
- A form that is compatible with and enhances the preceding characteristics.
- An optimum level of appropriate public health and sick care services accessible to all.
Understanding Health: Definitions and perspectives, Chapter 1
Health is a social, economic and political issue and a fundamental human right. Bad policies,
economics and politics is the largest cause for the majority of people in the world to not
enjoy good health.
The word health has a cultural, social and professional baggage. The word holds important
ideas about strongly held values. Definitions of health structure the ways in which the world
is viewed and how decisions are made.
The clockwork model of medicine
In the clockwork definition of medicine, the body is studied through its component parts.
Health is defined as the body operating efficiently like a machine. Any breakdowns in the
body system mean that it is not healthy. It does not consider disease within the context of
the lives of people with disease.
Health as the absence of illness
Biomedicine does distinguish between disease and illness.
Disease: Involves a set of signs and symptoms and medically diagnosed pathological
abnormalities.
Illness: Is primarily about how an individual experiences the disease. Illness can be culturally
specific and may have social, moral or psychological aspects.
→ Both disease and illness can detract from health.
Behavioral psychology added another dimension. The need to protect and maintain the body
by appropriate lifestyle behaviours that minimise risk of disease. Behavioural change and the
promotion of healthy lifestyles have become major factors in the professional perspective on
health over the past three decades.
Limitations of clockwork model
- Too mechanistic
- Ignoring social, psychological and spiritual aspects.
→ If a body is not diseased then it must be healthy.
The biomedical model of health assumes a mind/body dichotomy, and it does not place
much emphasis on how an individual’s mental health might affect physical health status.
The biomedical model of health has less legitimacy than it has in the past. An increasing
number of critics are demonstrating that the medical definition of health reflects its culture.
Biomedical critique:
- Extending the definition of disease.
→ The absence of disease may be part of health, but health is more than the
absence of disease.
,Health and Well-being
Health Organization (WHO): Disease’ Complete state of physical, mental and social well-
being, and not merely the absence of disease or infirmity.
- Too utopian
- Unachievable
Vichealth: Mental health is the embodiment of social, emotional and spiritual well-being.
Mental health provides individuals with the vitality necessary for active living, to achieve
goals and to interact with one another in ways that are respectful and just.
Measuring health
Bowling reviewed measures that have been developed to view health in relation to quality of
life. He divided them into 5 categories.
1. Measures of functional ability.
2. Broader measures of health status.
3. Measures of psychological well-being.
4. Measures of social networks and support.
5. Measures of life satisfaction and morale.
→ All have limitations in terms of reliability, validity and techniques of analysis.
Health: Ordinary people’s perspectives
People find it harder to define health than illness. Being healthy requires no action. Three
main domains relating to the definition of health are found: Health is not being ill, it is a
necessary prerequisite for life’s functions and it is a sense of well-being expressed in
physical and mental terms.
Definitions of health (Blaxter’s survey of British sample)
Health as not ill/diseased You don’t have a cold or health is when you don’t feel tired
and short of breath.
Health as a reserve If someone becomes sick, they are able to recover quickly.
Health as behaviour, health I call her healthy because she goes jogging and doesn’t eat
as the healthy life fried food.
Health as physical fitness Physical strength and fitness.
Health as energy, vitality Physical and psycho -social energy to do things, signified by
being able to get up easily, not feeling tired and getting on
with activities.
Health as social Relationships with other people, and more likely to be
relationships expressed by women.
Health as function Health is the ability to do things.
Health as psycho-social Mental state.
well-being
,Being healthy is having the resources for everyday life and ‘a social construction that helps
us understand our place in the world and that of others. Another feature of lay definitions of
health is that people with some disability or disease often describe themselves as healthy,
especially on days when their disabilities seem less severe. People assess their own health
subjectively and in terms of a reasonable expectation for their age and disability.
Public and private lay accounts
Public accounts: Biomedical model.
Moral components and divided causes of illnesses into those that were of were not the
individual’s fault.
Private theories: Based on their own experiences or those of people they knew.
A more complex view of health.
Health in cultural and economic contexts.
Interpretations of health reflect the cultural and economic context of people’s lives. For more
people health represents a status, socially recognised and admired. Crawford found two
main discourses of health.
- Health as a means of exerting self-control. Health as something to be achieved
through healthy behaviour. Thinness is believed to be an unmistakable sign of self-
control, discipline and willpower. Fat is a confirmation of the loss of control, an oral
failure, a sign of impulsiveness, self-indulgence and sloth.
- Health as a release mechanism: Life is seen as a series of pressures, anxiety,
frustration and worry, and as leaving no time for health-promoting activity. Health is
not rejected as a value but is often repudiated as a goal to be achieved through
instrumental action.
Spiritual aspects
Some people saw their health as dominated by external religious or supernatural powers.
Healing could result from intervention by god or some other supernatural power, as could
falling ill in the first place. Indigenous people are particularly to have a belief system that is
related to health and illness, which emphasised spiritual dimensions.
Health: Critical perspective
Critical perspectives on health are those that seek to explain the purpose that are achieved
through particular means of defining health. They are critical in the sense that they look
beneath the surface appearance of a concept or phenomenon and offer an explanation as to
why it is this way.
Perspective on health that has been particularly influential is that which maintains that is
defined in such a way by the dominant forces in a capitalist society that it becomes a
defining and controlling mechanism. Capitalist societies are structured in such a way that
they produce illness.
Dominant global economic structures in the world are seen to have a massive effect on
shaping ordinary people’s health experiences. In contemporary western society the pursuit
of good health is both a right and an obligation. Individuals are obligated to remain healthy
because being ill means they cannot be good citizens, and may become an economic
burden.
, The political economic view sees health in terms of its distribution in society. In terms of the
structural factors that create or detract health, such as environmental, housing and
occupational conditions. From this perspective, studying the health of individuals is less
valuable than studying the collective health of societies and the social and economic forces
that affect collective health. The political economy view stresses the connections between
the health of peoples in rich countries and those in poor countries as the processes of
economic globalization continue apace.
Health as outcomes
Generally a randomised controlled design can only be used to study clinical interventions.
Ethical and practical grounds restrict their use in most other circumstances. Health in clinical
trials is invariably reduced to an absence of the particular ailment the clinical intervention
was designed to cure. Many of the measures used to measure health within the health care
system present a health service provider rather than user perspective. For people
themselves, crucial factors not covered might be their ability to function, their quality of life
and the extent to which they can live their lives normally.
→ Most of the outcomes measured relate to individuals and not populations.
The world bank and the WHO have used economic measures of health as a yardstick for the
success of their programs. This reflects and udnelrying assumptions that economic
productivity is paramount. This is nowhere better illustrated than in the use of disability
adjusted life years (DALYs) or DALEs (disability adjusted life expectancy) to determine the
value of a health intervention. DALYs are calculated by assigning values to years of life lost
at different ages.
- Very young, elderly and people with disabilities do not contribute much to
economic development → Results in fewer DELYs than treatment aimed at
people in their early twenties.
Health and Place: Defining collective health
- Healthy cities
- Healthy schools
- Healthy workplace
WHOs list of the qualities of a healthy city:
- Clean, safe, physical environment of high quality.
- Ecosystem that is stable now and sustainable in the long term.
- A strong, mutually supportive and non-exploitative community.
- High degree of participation in and control by the citizens over the decisions affecting
their lives, health and well-bing
- The meeting of basic needs for all the city’s people.
- Access by the people to a wide variety of experiences and resources, with the
chance for a wide variety of contract, interaction and communication.
- A diverse, vital and innovative city economy.
- Connectedness with thepast, with the cultural and biological heritage of city dwellers
and with other groups and individuals.
- A form that is compatible with and enhances the preceding characteristics.
- An optimum level of appropriate public health and sick care services accessible to all.
