There have been many definitions of health, and models based on this. Depending on where research is started, health can be defined as “the state of being free from illness or injury” in the Oxford dictionary, although this does not appreciate the holistic approach to health, and does not take into consideration the physical, mental and social wellbeing that the World Health Organisation defined in 1948 ‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.’ Blaxter (2010) spoke about health being perceived by the holder, in which and how they see illness defines their health. Levy (2007) thought that capabilities of people are different depending on what they need to do; therefore a natural baseline definition of health cannot be established.
Ill health can be defined as “a condition of inferior health in which some disease or impairment of function is present but is usually not as serious in terms of curtailing activity as an illness”(Merriam Webster medical dictionary),generally in society when a person speaks of ill health, people usually refer to a mental illness rather than a physical illness, such as Freud did in the 19th century, where it was very common for women to be diagnosed with hysteria, although in the 21st century it would be unthinkable to blanket diagnose a gender with an umbrella title such as hysteria.
Biomedical model treats the illness or injury itself, and believes that and ill health can be cured, because of the scientific knowledge needed to treat ill health, the doctor has more control of the situation than the patient, which can cause conflict with giving patients informed choice. Biomedical definitions of health could be accused of only caring for the medical problem of a person, rather than the person as a whole, which Yuill, Crinson and Duncan (2010) describe the biomedical model as limiting, and explaining that the social model includes all aspects of the person, including their social, cultural and psychological background.
In relation to the case study, Emma’s lump on the breast is the main cause of physical ill health, with the family history of breast cancer within in the family, the doctors appeared to approach this with the biomedical model of health, focusing on the lump being removed, and possible surgery in future, rather than taking into account Emma’s holistic needs because of a complex family life and mental health that appears to have deteriorated in the previous months, although compared with theÂ WHO definition of ill health, Emma has not yet been diagnosed with an illness, so therefore it could seem that she is healthy, as she is free from diagnosable illness or injury.
This model focuses on the person as a whole, with their bio-physio-social issues being taken into account to assess health, rather than just a physical illness or injury. Maslow defined a hierarchy of needs, although was criticised for it being too simple for the intellect of humans as a whole, although when judging mental health it becomes very useful. Therefore Henderson brought forward 14 activities of living, which included worship, recreation and sense of accomplishment.
Within 21st Century nursing, a holistic model would only be complete with a multidisciplinary team being involved in a person’s care, and working together to achieve this, making sure that Emma’s confidentiality is maintained and she gives permission for this help to take place.
Within the case study, there are several issues that can be related the holistic model, with a recent relationship breakdown affecting the children, lack of childcare and finances, depressed feelings, lack of support network and the older children’s behaviour which could be a result of the relationship breakdown with the father. The holistic model would imply that Emma needs support in various areas of her life, so that she can lead a healthy life as it does not match Hendersons 14 activities of living, although with Maslow’s theory, physiological and safety/security needs are met, although these are basic and does not include mental health, which in the 21st century is an important element on a person’s total health.
Personal Behaviour Model (Health Model)
The health belief model assumes that people will take action if they believe that they a health deterioration can be avoided, therefore making themselves healthier by their own definition. Kasl and Cobb (1966) explain three categories; Preventative health behaviour, illness behaviour and sick-role behaviour. For example in the early 20th century, pregnant mothers were advised to smoke during pregnancy believing they would have an easier labour and smaller baby, as medical understanding has evolved, smoking was no longer considered a healthy pastime.
The health model works well to educate society in preventable illnesses and diseases, in the case study, Emma sought medical help when she discovered the lump on her breast as she would have known about her family history, and educated what to do if she discovers this. In turn, the health model can work well with the Holistic model to provide education and resources so that people can become healthier, and seek help when needed, and stopping preventable diseases from occurring.
Reactions can vary depending on the severity of ill health. Talcott Parsons (1951) explained that the patient would take on a role, not participate in regular activates, but assume the submissive role of the patient. He continued that that the patient should act like a patient, and ensure that they get better. Within the case study, Emma is noted to be worried because of previous history with family cancer and anxious with the business of the hospital. It appears with the case study that Emma is reacting in the same way as described in the structuralist theory where she sees a threat with the breast lump, having an impact on her and her children, and seeking help in response to the threat it could pose. Also when Emma retorts to the nurse about better things to do doing than reading letters, Emma’s focus is on the lump and getting better, seeing the nurse as a threat in not being cured.
The functionalist perspective is based on the understanding that people who are ill assume the “sick role” and must want to get better, or they cannot undertake the ‘sick role’. Parsons compared the role of the patient with deviant behaviour, and considered that for they must follow a doctor’s instructions, they must want to get better and return to putting into society when they are better. In the case study, there is a functionalist perspective where Emma has eaten when the letter they sent told her not to before her operation. On the basis of the functionalist perspective, it could imply that Emma does not want to get better, because she has defied doctor’s orders and her operation having delayed.
The Lay Health belief explains that if a person was to get ill, then they would seek out advice from their peers, culture or family, to find an easy explanation of their symptoms before seeking medical advice. Blaxter (2010) stressed the importance of this, as illness can be defined differently, depending on how it is affecting them. In the case study, Emma has a lack of support from her mother, due to distance; however Emma went to the doctors because of her mother’s past medical history, which can be seen as educational advice.
The contrast between functional and lay perspective is vast, although both have important roles within the health sector. The lay belief could help the NHS in reducing waiting times to see the GP, as in a recent survey GP’s predict in 2018 the average wait could be 2 weeks for an appointment[i], however the functionalist perspective function could persuade doctors to give a diagnosis and medication so that the illness goes away, therefore returning to work and not needing another appointment.
In the case study it highlights a lot of different approaches to health, and with the NHS being more in the news recently over waiting times and lack of beds at hospitals, the country is on the verge of a crisis. In a news report from the BBC, mental health problems are taking up more time than GP’s once thought[ii]. Within a holistic approach within a GP surgery, potentially a lot more appointments could be referred to other professions within the surgery if they set up a multidisciplinary team. Referring back to the case study, this means Emma could also have got help with her depression feelings, problems with children’s behaviour and financial advice, so that Emma could make her whole lifestyle healthier, much like the health model.
Blaxter, M. (2010) “Health (Key Concepts)”, 2nd edition, Polity UK
Kasl, S.A. & Cobb, S. (1966). Health behaviour, illness behaviour, and sick role behaviour: 1. Health and illness behaviour. Archives of Environmental Health
Leigh, H (2013) “The Patient” Springer Science & Business Media
Yiull, C Crinson, I Duncan, E (2010) “Key Concepts in Health Studies”, E=book, SAGE.