Life These concepts are evolving in line with our thinking about changing roles of the physician Conceptions of health have broadened over time Medical model absence of disease anatomical integrity ID: 535150
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Slide1
Definitions: Health, Disability, Quality of Life
These concepts are evolving, in line
with our thinking about
changing roles of the physician. Slide2
Conceptions of ‘health’ have broadened over time
“Medical model” (absence of disease; anatomical integrity)
Holistic model (adds mental & social function)
Wellness or ecological models (functioning within an environment)
Note: These
conceptions can apply to health of individuals
and to the health of populations
Health as resource for coping with challengesSlide3
Examples of “medical model” definitions
“Health is the absence of disease”
Health is… "A state characterized by anatomic, physiologic and psychological integrity…”
But:‘Disease’ is no longer simple to define (how do you define hypertension? ‘Non-disease’ conditions; treatment products lead to redefining disease; …)Slide4
Medical conception of disease
Diagnosis
Therapy
begun
‘Outcome’
(alive,
dead, cured, etc)
Symptoms
appear
Biological
onset of
disease
Clinical Phase
Preclinical
PhaseSlide5
Holistic definitions of health
“A state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity"
(WHO, 1948)Slide6
Ecological definition
“A sustainable state of equilibrium or harmony
between humans and their physical, biological,and social environments that enables themto coexist indefinitely.” (Last J. Dictionary of Public Health. Oxford, N.Y., 2007)Themes:- Health as a quality of a group- Present & future state- EmpoweringSlide7
‘Health-as-a-resource’ definitions
"The extent to which an individual or group is able to realize aspirations and satisfy needs, and to change or cope with the environment.
Health is a resource for everyday life
, not the objective of living; it is a positive concept, emphasizing social and personal resources, as well as physical capacities." (WHO. Health promotion: a discussion document. Copenhagen, WHO, 1984)Slide8
Clarifying Disability
WHO, 1976:
Impairment Disability Handicap
(International Classification of Impairments, Disability, & Handicap: ICIDH)WHO, 2001:Impairment Activity Participation(International Classification of Functioning: ICF)Slide9
Expanding conception of disease (2)
Diagnosis
Therapy
begun
‘Outcome’
(alive,
dead, cured, etc)
Symptoms
appear
Biological
onset of
disease
Clinical Phase
Preclinical
Phase
Impairment
Disability
HandicapSlide10
How broad should we get?
Physician roles widening to include advocacy, etc.
What are the limits to this?
What is the overall goal of medicine? Concept ‘quality of life’ borrowed from social sciences in the 1980s. Now used as outcome measure in clinical trials.Slide11
Definitions of Quality of Life“An essentially subjective judgment of the way people perceive themselves as contented and happy or otherwise, and able to function physically, emotionally, and socially”
(J. Last, Dictionary of Public Health, 2007)
“The degree to which a person enjoys the important possibilities of his or her life” (Centre for Health Promotion, U. of Toronto http://www.utoronto.ca/qol/concepts.htm, 2009/09/17)Slide12
The expanding conception of disease (3)
Diagnosis
Therapy
begun
‘Outcome’
(alive,
dead,
cured, etc)
Symptomsappear
Biological
onset of
disease
Clinical Phase
Preclinical
Phase
Impairment
Disability
Handicap
Social
Determinants
Individual
Risk factors
Prevention
Health Promotion
Population HealthSlide13
The Debate Continues
Jadad and O’Grady. ‘How should health be defined?’ BMJ 2008; 337:a2900
BMJ Group blog:
“ A global conversation on defining health: Alex Jadad and Laura O’Grady” http://blogs.bmj.com/bmj/2008/12/10/alex-jadad-on-defining-health/