CONCEPT OF HEALTH AND ILLNESS

Definitions

 Health: The World Health Organization (WHO) gave the most widely accepted definition
of health; they defined health as “a state of complete physical, mental and social
wellbeing, not merely the absence of disease or infirmity.”
Health is also defined as a dynamic state in which the individual adapts to changes in
internal and external environment to maintain a state of wellbeing (Potter and Perry,
2014).
Florence Nightingale (1960) viewed health as a state of being well and using every power
the individual possesses to the fullest extent.
 Wellness: Wellness is an active process through which people become aware of and
make choices toward a more successful existence (National wellness Institute).
A more lucid definition however is the one given by Carroll and Miller (1991) which
states that term wellness connotes good physical self-care, using one’s mind
constructively, expressing one’s emotion effectively, interacting creatively with others
and being concerned about one’s physical and psychological environment.
Though health and wellness have often been used interchangeably to mean the same
thing, differences exist between the two terms. While health is a state of being, wellness
is a practical way of achieving health. The main aspects of health are physical, mental
and social wellbeing. However, wellness goes a few steps further, emphasizing the
physical, mental, social as well as occupational, intellectual and emotional wellbeing.

Concepts of Health

Health is the not perceived the same way by all the members of a community. Over the centuries,
the concepts of health have evolved from the concept of individual concern to a worldwide social
goal. The various changing concepts of health are as follows;

1. Biomedical concept: Traditionally, health has been considered as an absence of diseases

and if someone was free from disease, then that person was considered healthy. This
concept is known as biomedical concept and it is based on the “germ theory of disease”.
Health simply means absence of disease. However, this concept has minimized the role
 of environment, social and cultural determinants of health. Development in medical and
social sciences led to the conclusion that the biomedical concept of health is inadequate.
2. Ecological concept: Health, as proposed by the ecologist, is a dynamic equilibrium
between man and his environment. Disease is maladjustment of human organism to the
environment. History has proven that improvement in human adaptation to natural
environment can lead to longer life expectations and better quality of life. The concept
supports the need for clean air, safe water, ozone layer in the atmosphere etc to protect us
from exposure to unhealthy environmental factors.
3. Psychosocial concept: According to this concept, health is both a biological and social
phenomenon. Here, health is influenced by social, psychological, cultural, economic and
political factors of the people concerned.
4. Holistic concept: The holistic concept is a synthesis of all the above concepts. It
recognizes the strength of social, economic, political and environmental influences on
health. Health is described as a unified or multidimensional process involving the
wellbeing of whole person in context of his environment.

Illness

The terms illness and disease are often used interchangeably by layman to mean the same thing
but they are not. Illness is a state in which a person’s status (e.g., physical, emotional, spiritual,
developmental, intellectual, social) is diminished or impaired experience compared with
previous. It is a highly personal state and a socio-psychological concept. Illness is not a disease
but a response to a disease. Disease on the other hand is maladjustment (physiologic or
psychological) or alteration in the human body functions to specific agents often characterized
by signs and symptoms.
Illness and disease can be caused by various factors known as etiology. These include

 Inherited genetic defects e.g. cleft palate

 Developmental defects/Congenital malformations. Example – Atria Septal Defect
 Biological agents or toxins e.g. microorganisms
 Physical agents such as temperature extremes, chemicals, or radiations
 Generalized response of tissues to injury or irritation e.g. fear, anxiety
  Physiological and psychological reactions to various stressors
 Biochemical imbalances within the body.

Classification of illness and disease

Illness may be classified according to duration as acute, chronic or terminal. Could also be
classified as Primary (1o) or Secondary (2o); Hereditary, congenital or idiopathic
An acute illness is one that comes on suddenly and last a relatively short time. Example:
Bacterial conjunctivitis, Gastroenteritis to mention a few. Acute illnesses are usually severe but
curable; some however lead to long-term problems because of their sequelae. Sequelae are ill
effects that result from permanent or progressive organ damaged cause by a disease or its
treatment. A chronic illness on the other hand, is one that is gradual in onset and last a relatively
long time. They are illnesses that lead to at least some of the following characteristics: (1)
permanent impairment or deviation from normal, (2) irreversible pathological changes, (3) a
residual disability, (4) requires special rehabilitation, and (5) long term medical and/or nursing
management. Examples include Arthritis, Chronic renal failure [CRF], Hypertension, and
Diabetes Mellitus. A terminal illness is one in which there is no known cure. The terminal stage
of an illness is one in which death has become inevitable. A 1o illness is one that has developed
independently of any other disease. Any subsequent disorder that develops from a pre-existing
condition is referred to as 2o illness Example - Hypertension leading to Congestive Cardiac
Failure (CCF). Furthermore, illness could be classified according to their etiological factors as
follows: Hereditary, Congenital and Idiopathic. Hereditary – A hereditary condition is one that
is transmittable down the family tree i.e. from parent to their offspring through their genetic
code. A common example in our environment is sickle cell anaemia. Hereditary illnesses may be
manifested immediately after birth or develop at some time later. Congenital – Congenital
disorders are those that are present at birth and are products of faulty embryonic development
especially during the first three month of intrauterine life otherwise referred to as period of
organogenesis. Example includes Tetralogy of Fallot. Idiopathic – An idiopathic illness is one
that for which there is no known cause. Treatment is usually palliative (directed at relieving
symptoms alone). A typical example is cancer.
Models of health and illness

A model is a theoretical way of understanding a complex concept or idea such as health and
illness. They help in understanding the relationships between these concepts and a patient’s
attitudes toward health and health behaviors.
Nurses use several health models to understand patients’ unique attitudes and values about health
and illness and to provide effective health care. These models allow you to understand and
predict patients’ health behaviors, including how they use health services and adhere to
recommended therapy. The various models include;
 Health belief model
The health belief model addresses the relationship between a person’s belief and behaviors.
There are three components of the model as shown in the diagram below;

Individual perceptions Modifying factors Likelihood of action

Demographic variables Perceived benefits of

(e.g. age, gender, race, preventive action
ethnicity) Minus
Sociopsychological Perceived barriers to
variables (e.g. preventive action
personality, social class,
peer and reference group
pressure

Perceived susceptibility Likelihood of taking

to disease X Perceived threat of
recommended
Perceived seriousness disease X
preventive health action
(severity) of disease X

Cues to action
Mass media campaigns, advice from others,
reminders postcards from physician or
dentist, illness of family member or friend,
newspaper or magazine article
The first component of this model involves an individual’s perception of susceptibility to an
illness. For example, a patient whose family history includes one parent and two siblings who
have died from a myocardial infarction recognizes the familial link for coronary artery disease
and perceives a personal risk of heart disease.
The second component is an individual’s perception of the seriousness of the illness. This
perception is influenced and modified by demographic and sociopsychological variables,
perceived threats of the illness, and cues to action (e.g., mass media campaigns and advice from
family, friends, and medical professionals). For example, a patient may not perceive his heart
disease to be serious, which may affect the way he takes care of himself.
The third component is the likelihood that a person will take preventive action. This component
results from a person’s perception of the benefits of and barriers to taking action. Preventive
actions include lifestyle changes, increased adherence to medical therapies, or a search for
medical advice or treatment. A patient’s perception of susceptibility to disease and his or her
perception of the seriousness of an illness help to determine the likelihood that the patient will
adopt healthy behaviors. This model helps you understand factors influencing patients’
perceptions, beliefs, and behaviors to plan care so that you can more effectively help patients
maintain or restore health and prevent illness.
 High Level Wellness Grid
This model allows a patient’s status to be plotted along an axis from peak wellness to death and
against an intersecting axis from a very favorable environment to a very unfavorable
environment. Based on the intersection of the two axes, four quadrants of health and wellness are
formed as follows;
a. Protected poor health (very favorable environment).
b. Poor health (very unfavorable environment).
c. High-level wellness (very favorable environment).
d. Emergent high-level wellness (very unfavorable environment).
Examples of environments;
Favorable: Health insurance to pay for health services; supportive, caring family members; clean,
uncrowded home environment.
Unfavorable: Indigence or poverty; role responsibilities that interfere with health-seeking
behaviors; lack of family; dirty, crowded home environment.
Nursing implications
a. Allows nurses to identify environmental factors that influence a patient’s level of wellness.
b. Facilitates prediction of whether patients’ health will likely improve or decline on the basis of
support or lack of support within the environment.
 Agent-Host-Environment model
In this model, there are three factors that are constantly interacting with each other. When in
balance, health is maintained. When not in balance, disease/illness occurs.
The model is used primarily in predicting illness rather than promoting wellness. The three
dynamic, interacting factors are shown in the diagram below;

AGENT

ENVIRONMENT HOST

 Agent: Refers to an environmental stressor or factor that must be present or absent for an
illness to occur. Example virulent, infectivity of a pathogen, addictive quality of a
substance of abuse etc.
 Host: Refers to a living organism capable of being infected or affected by the agent. For
example, the genetic susceptibility, resilience, nutritional status, behavior etc. of an
organism
 Environment: Refers to the situation or circumstance where the host live. Example the
sanitary conditions, social context, availability of health care etc.
  Health-Illness continuum
A continuum is defined as a continuous whole. Health is in a dynamic state of continuity and
changes constantly being challenged, stresses, abused and even enhanced by our genetic make-
up and lifestyle, and by our wider ecological environment (Watkinson, 2002). Fluctuations of
health and illness can be illustrated on a health-illness continuum below:

Prematurecritical illnessIllness normal healthGood healthHigh-level

Death wellness
Wellness axis

Illness axis

People do not tend to be totally healthy or totally ill at any given time. Individual’s state of
health however falls somewhere on a continuum from high-level wellness to death. There is no
exact point at which health ends and illness begins. Both are relative in nature, and for each
individual there is range and latitude in which he may be considered ill or well (Fuerst, Wolff &
Weitzel, 1974). When needs are blocked or threatened, one moves towards the “illness” end of
the continuum and vice versa. The body adapts to change in an attempt to maintain homeostasis
but high-level wellness is optimum. Nursing actions involving health promotion and illness
prevention assist the patient/client not only in maintaining and increasing the existing level of
health but also in achieving an optimal health (Heath, 1995). However to assist the patient/client
in health maintenance and promotion, illness prevention, and adaptation to the changes that
illness produces in every dimension of functioning, the nurse must understand all the
aforementioned dimensions.