Case 4: Perspectives on defining health: out with the old, in with the new?
Learning goals
1. What different models exist to define health and how has our definitions of health changed
over time?
2. What are the strengths and limitations of each model?
3. Why are new perspectives on the meaning of health needed in the 21th century? Is it
possible to adequately define health for our time and, if so, what are promising new
directions?
4. What are the implications of how we define health for the organization of health systems
and the delivery of care? What does it mean for the role of healthcare actors (i.e., citizens,
state, providers)?
Literature
- Bambra C, Fox D, Scott-Samuel A. Towards a politics of health. Health Promotion International,
2005;20(2):187-93.
- Huber M, Knottnerus JA, Green L, Van der Horst H, Jadad AR, Kromhout D, Leonard B, Lorig K,
Loureiro MI, Van der Meer JWM, Schnabel P, Smith R, Van Weel C, Smid H. How should we define
health? British Medical Journal, 2011;343:d4163.
- Kickbusch I. Responding to the health society. Health Promotion International, 2007;22(2):89-91.
- Larson JS. The conceptualization of health. Medical Care Research and Review, 1999;56:123.
- Leonardi F. The definition of health: towards new perspectives. International Journal of Health
Services, 2018;48(4):735-48.
1. What different models exist to define health and how has our definitions of health changed over
time? & 2. What are the strengths and limitations of each model?
Models to define health (Larson, 1999)
1
, - The medical model
- The WHO model (holistic model)
- The wellness model
- The environment model
à The models are increasingly comprehensive + constitute development over time
The medical model
Defining health: “health is the absence of disease or disability”
- Mind and body dualism (Cartesian dualism – Rene Descartes):
o Mind: immaterial, thinking, indivisible (=self)
o Body: material, unthinking, divisible (=machine)
à The body is seen as a machine. A disease is a malfunction. When the body is in
health, there is absence of disease or infirmity.
à The mind steers the body
- Medical model as a paradigm: medicine = health.
- Impact on the health system:
o Reductionism:
§ We see more specialization in disease/work field and more fragmentation in
professions.
§ Fragmentation
o The mechanical approach leads to dehumanization and disempowerment
§ Limited attention to doctor and patient beliefs
§ Patient health beliefs/ personal circumstances are not considered
2
Learning goals
1. What different models exist to define health and how has our definitions of health changed
over time?
2. What are the strengths and limitations of each model?
3. Why are new perspectives on the meaning of health needed in the 21th century? Is it
possible to adequately define health for our time and, if so, what are promising new
directions?
4. What are the implications of how we define health for the organization of health systems
and the delivery of care? What does it mean for the role of healthcare actors (i.e., citizens,
state, providers)?
Literature
- Bambra C, Fox D, Scott-Samuel A. Towards a politics of health. Health Promotion International,
2005;20(2):187-93.
- Huber M, Knottnerus JA, Green L, Van der Horst H, Jadad AR, Kromhout D, Leonard B, Lorig K,
Loureiro MI, Van der Meer JWM, Schnabel P, Smith R, Van Weel C, Smid H. How should we define
health? British Medical Journal, 2011;343:d4163.
- Kickbusch I. Responding to the health society. Health Promotion International, 2007;22(2):89-91.
- Larson JS. The conceptualization of health. Medical Care Research and Review, 1999;56:123.
- Leonardi F. The definition of health: towards new perspectives. International Journal of Health
Services, 2018;48(4):735-48.
1. What different models exist to define health and how has our definitions of health changed over
time? & 2. What are the strengths and limitations of each model?
Models to define health (Larson, 1999)
1
, - The medical model
- The WHO model (holistic model)
- The wellness model
- The environment model
à The models are increasingly comprehensive + constitute development over time
The medical model
Defining health: “health is the absence of disease or disability”
- Mind and body dualism (Cartesian dualism – Rene Descartes):
o Mind: immaterial, thinking, indivisible (=self)
o Body: material, unthinking, divisible (=machine)
à The body is seen as a machine. A disease is a malfunction. When the body is in
health, there is absence of disease or infirmity.
à The mind steers the body
- Medical model as a paradigm: medicine = health.
- Impact on the health system:
o Reductionism:
§ We see more specialization in disease/work field and more fragmentation in
professions.
§ Fragmentation
o The mechanical approach leads to dehumanization and disempowerment
§ Limited attention to doctor and patient beliefs
§ Patient health beliefs/ personal circumstances are not considered
2
