PRIMARY HEALTH CARE 1

I. Concept of Health and Illness

Health - is a state of complete physical, mental and social well-being and not merely the
absence of disease.

Illness - a disease or period of sickness affecting the body or mind.

Wellness - is the act of practicing healthy habits on a daily basis to attain better
physical and mental health outcomes, so that instead of just surviving, you're thriving.

Five dimensions of Health

Physical

Health Continuum

The physical dimension of health refers to the bodily aspect of health. It refers to

the more traditional definitions of health as the absence of disease and injury. Physical
health ranges in quality along a continuum where a combination of diseases such as
cancer, diabetes, cardiovascular disease or hypertension are at one end and a person
who is at optimum physical condition (think health not fitness) is at the other.

Physical health can affect the other dimensions of health as a decline in physical
health can result in a decline in other forms of health. E.g. a person who suddenly gets
the flu is often isolated socially as to not infect others, struggles to focus in order to
study or learn anything new, and may feel sad as a result of their isolation.

Emotional

Emotional health is about the person’s mood or general emotional state. It is our
ability to recognized and express feelings adequately. It relates to you self-esteem as
well as your ability control your emotions to maintain a realistic perspective on
situations. The relationship between emotional and mental health is clear and as such
some illnesses relate to both, such as: depression and anxiety.

Emotional health affects the other dimensions of health as a person with a good
self-esteem is more confident in social settings, makes friends quickly and often
performs better in physical activity.

Mental

Mental health refers to the cognitive aspect of health. Often mental health is
linked to or includes emotional health, I want to distinguish the two. Mental health is
more the functioning of the brain, while emotional health refers to a person’s mood often
connected to their hormones. Mental health then includes many mental health issues
such as Alzheimer’s and dementia. It refers to the person’s ability to use their brain and
think. This may be to solve problems or to recall information, but the focus is on the
cognitive aspect of the person.

Mental healthcare affect the other dimensions of health. An increase in mental

health can come as a result of increased physical activity, and good mental health can
then lead to an increase in self-esteem as mental performance improves. Greater self-
esteem then leads to more confidence in social situations and can lead one to ask the
larger questions about life leading to increased spiritual health.

Social

The social dimension of health refers to our ability to make and maintain
meaningful relationships with others. Good social health includes not only having
relationships but behaving appropriately within them and maintaining socially
acceptable standards. The basic social unit of relationship is the family, and these
relationships impact a person’s life the most. Other key relationships are close friends,
social networks, teachers, and youth leaders.
 Social health affects the other dimensions of health in many ways. A bad social
life can lead a person to question their purpose in life or feel isolated and unwanted.
Such feelings can demotivate people from physical activity and lead them towards
depression.

Spiritual

Spiritual health relates to our sense of overall purpose in life. People often find
this purpose from a belief or faith system, while others create their own purpose. A
person who has purpose to life is said to be healthier than those who don’t see a
purpose to life.

Spiritual health will very easily affect emotional and mental health as having a
purpose in life can help you to apply yourself to achieving goals. Having a purpose to
life can also help people to maintain a proper perspective on life and overcome
adversity. Often people who are spiritual meet together regularly around their spiritual
purpose, which helps to improve their social health.

8 Dimensions of Wellness
Emotional Wellness

Emotional wellness is one of the eight dimensions that contribute to overall

health and wellness. Emotional wellness encompasses the knowledge and skills to
identify personal feelings and the ability to handle those emotions. National Institutes of
Health describe emotional wellness as “the ability to successfully handle life’s stresses
and adapt to change and difficult times” (NIH, 2018). The resources listed in this section
are opportunities designed to optimize your physical wellness status, which can
positively impact your overall health and wellness.

Physical Wellness

Physical wellness is one of eight dimensions that contribute to overall health and
wellness. This dimension encompasses all areas of health that relate to physical
aspects of the body including, nutrition, exercise, weight management, ergonomics,
tobacco use, disease, disease prevention, and more. The resources listed in this
section are opportunities designed to optimize your physical wellness status, which can
positively impact your overall health and wellness.

Occupational Wellness

Occupational wellness is one of eight dimensions that contribute to overall health

and wellness. Occupational wellness encompasses all aspects of wellbeing pertaining
to personal satisfaction in your job/career.  The resources listed in this section are
opportunities designed to optimize your occupational wellness status, which can
positively impact your overall health and wellness.

Social Wellness

Social wellness is one of eight dimensions that contribute to overall health and
wellness. Social wellness encompasses all aspects of wellbeing pertaining to social
connections, relationships, and personal expression. The resources listed in this section
are opportunities designed to optimize your social wellness status, which can positively
impact your overall health and wellness.

Spiritual Wellness

Spiritual wellness is one of eight dimensions that contribute to overall health and
wellness. Spiritual wellness encompasses all aspects of wellbeing pertaining to the
search for purpose and meaning in life. This may include the belief in a higher power,
but spiritual wellness does not have to be aligned with a religion. The resources listed in
this section are opportunities designed to optimize your spiritual wellness status, which
can positively impact your overall health and wellness.

Intellectual Wellness

Intellectual wellness is one of eight dimensions that contribute to overall health

and wellness. Intellectual wellness encompasses all aspects of wellbeing pertaining to
brain health and growth via thought-provoking mental activities. The resources listed in
this section are opportunities designed to optimize your intellectual wellness status,
which can positively impact your overall health and wellness.

Environmental Wellness

Environmental Wellness is one of eight dimensions that contribute to overall

health and wellness. This dimension encompasses all areas of health that relate to the
environment and in turn, how the environment can impact human health. Environmental
wellness includes eco-friendly considerations, active participation in recycling and
proper disposal of electronics and medicine, energy, fuel, and water conservation, and
the use of sustainable products. The resources listed in this section are opportunities
designed to optimize your overall health and wellness as it pertains to natural resources
and environmental preservation.
Financial Wellness

Financial wellness is one of eight dimensions that contribute to overall health and
wellness. Financial wellness encompasses all aspects of wellbeing pertaining to
finances including knowledge and skills of financial planning and managing expenses.
The resources listed in this section are opportunities designed to optimize your financial
wellness status, which can positively impact your overall health and wellness.

The Four Models of Healthcare 

The healthcare systems of different countries are based off four models:  

 Beveridge 

 Bismarck 

 National Health Insurance 

 Out-of-Pocket 

Often times, it is not one or the other, but a blend that is employed in most
countries. 
Beveridge Model

The Beveridge model is known as “socialized medicine” because all

citizens of a country will have healthcare that is financed by their government
using tax payments. Since the government owns hospitals and other medical
centers, most physicians are considered government employees. Healthcare
costs are also low because the government is the sole payer, which eliminates
market competition. The idea behind this system is that healthcare is a human
right and citizens are guaranteed universal coverage. Because patients
contribute through taxes, they do not have to pay anything out of pocket after
medical services. 

Additionally, a disadvantage of a system that provides equal access to

everyone is long waiting lists and over-use that can lead to higher costs. In
times of a crisis, a decrease in public revenue can lead to a decrease in funding
for services while patient numbers increase, causing a burden on the system.
This model was developed in the United Kingdom and has spread to Northern
Europe and other countries such as Spain, New Zealand, and Cuba. 

Bismarck Model

In the Bismarck model, an insurance system is funded by both

employers and employees as deductions are made from payroll to form a
sickness fund. Profit is not made from this and the insurance covers every
citizen regardless of preexisting conditions. Unlike the Beveridge model, this
model has private physicians and hospitals instead of government owned
hospitals. Furthermore, there is a shift as healthcare is considered a privilege
instead of a right because it benefits individuals who can financially contribute
to their own care. This results in concerns about how to provide care for people
unable to work or unable to afford the payments.
 Countries that use the Bismarck model also have differences in their
insurance systems. For example, France has a single insurer while Germany
has competing insurers and Japan has non-competing insurers.  

National Health Insurance Model  

The National Health Insurance model blends together aspects from

both the Beveridge and Bismarck models. Government run insurance programs
collect a premium or tax from citizens which is comparable to the Beveridge
model. However, the providers are from a private sector which resembles the
Bismarck model. This type of universal insurance is less expensive because
profit is not made and claims are not denied, allowing patients to choose their
providers. Because everyone is covered regardless of income level, costs are
controlled by limiting the types of services paid for and having waiting lists. The
waiting lists for services such as hip replacements for the elderly and
neurosurgery appointments can be very long and this is often seen as a
significant health policy issue. Countries that use this type of insurance system
and face these issues are Canada, Taiwan, and South Korea.  

Out-of-Pocket Model 

The Out-of-Pocket model is common in less developed nations that do

not have the resources to organize a national healthcare system. Patients pay
for the cost of their treatment or procedure out-of-pocket. The unfortunate result
is that the wealthy get treated while the poor either remain sick or die. This is
seen in rural South America, India, Africa, and China.

The United States incorporates all of these models to form a patchwork.

Veterans in America are treated using the Beveridge model where the
government finances care. The eldery over 65 have Medicare like the National
Health Insurance model while working Americans have insurance funded by
employees and employers as seen in the Bismarck model. Healthcare
disparities in impoverished neighborhoods are observed where people are
either underinsured or uninsured, which corresponds to the Out-of-Pocket
model.  

MODELS of HEALTH

“Health is a state of complete physical, social and mental well-being and not merely the
absence of disease or infirmity. The enjoyment of the highest attainable standard of
health is one of the fundamental right of every human being, without distinction of race,
religion, political beliefs or economic and social conditions.” (Source: World Health
Organisation 1948)

SOCIAL MODEL OF HEALTH: This model emerged from the social model of disability,
which has been strongly advocated by the disability rights movement. It was developed
as a reaction to the traditional medical model. The social model of health examines all
the factors which contribute to health such as social, cultural, political and the
environment.

MEDICAL MODEL: Developed during the age of Enlightenment in the 18th Century,
when the traditional natural sciences began to dominate academia and medical
practice. The belief that science could cure all illness and disease has remained a core
element of modern medicine. This concept of health may be easier to understand as it
makes health an attribute you can measure simply by determining if a disease is
present or not. However the strong emphasis on the absence of disease as an indicator
of good health, and the overdependence on the influence of medical science in health,
ignores the power of other important influences

BIOPSYCHOSOCIAL MODEL: Developed by psychiatrist George Engel in 1977, and

recognizes that many factors affect health. It pays “explicit attention to humanness”
(Engel, 1997). It views health as a scientific construct and a social phenomenon. The
model looks at the biological factors which affect health, such as age, illness, gender
etc. The psychological factors: individual beliefs & perceptions. The social: the
community, the presence or absence of relationships.
SALUTOGENIC MODEL: Developed by sociologist Aaron Antonovsky and focuses
how and why we stay well. This model increases understanding of the relationship
between stressors, coping and health.

ECOSYSTEM HEALTH MODEL: Humanity is part of and one among many in an

environment that is being changed as result of human activity: land use, climate
change, population growth, resource depletion, pollution, urbanization, loss of
biodiversity, and other local and global processes all disrupt the natural self-regulation
of the biosphere. These changes harm people, domestic animals, wildlife, the oceans,
and the forests. The crucial response has to be to redesign our relations with the rest of
nature. (Levins and Lopez 1999).

Levels of Prevention

Primordial Prevention:

In 1978, the most recent addition to preventive strategies, primordial prevention,

was described. It consists of risk factor reduction targeted towards an entire population
through a focus on social and environmental conditions. Such measures typically get
promoted through laws and national policy. Because primordial prevention is the earliest
prevention modality, it is often aimed at children to decrease as much risk exposure as
possible. Primordial prevention targets the underlying stage of natural disease by
targeting the underlying social conditions that promote disease onset. An example
includes improving access to an urban neighborhood to safe sidewalks to promote
physical activity; this, in turn, decreases risk factors for obesity, cardiovascular disease,
type 2 diabetes, etc.

Primary Prevention:

Primary prevention consists of measures aimed at a susceptible population or

individual. The purpose of primary prevention is to prevent a disease from ever
occurring. Thus, its target population is healthy individuals. It commonly institutes
activities that limit risk exposure or increase the immunity of individuals at risk to prevent
a disease from progressing in a susceptible individual to subclinical disease. For
example, immunizations are a form of primary prevention.

Secondary Prevention:

Secondary prevention emphasizes early disease detection, and its target is

healthy-appearing individuals with subclinical forms of the disease. The subclinical
disease consists of pathologic changes, but no overt symptoms that are diagnosable in
a doctor's visit. Secondary prevention often occurs in the form of screenings. For
example, a Papanicolaou (Pap) smear is a form of secondary prevention aimed to
diagnose cervical cancer in its subclinical state before progression.  

Tertiary Prevention:

Tertiary prevention targets both the clinical and outcome stages of a disease. It is
implemented in symptomatic patients and aims to reduce the severity of the disease as
well as of any associated sequelae. While secondary prevention seeks to prevent the
onset of illness, tertiary prevention aims to reduce the effects of the disease once
established in an individual.

II. Health as a Multi-factorial Phenomenon

Factors Affecting Health

Many factors combine together to affect the health of individuals and

communities. Whether people are healthy or not, is determined by their circumstances
and environment. To a large extent, factors such as where we live, the state of our
environment, genetics, our income and education level, and our relationships with
friends and family all have considerable impacts on health, whereas the more
commonly considered factors such as access and use of health care services often
have less of an impact.
The determinants of health include:

 the social and economic environment,

 the physical environment, and
 persons’ individual characteristics and behaviors.

The context of people’s lives determine their health, and so blaming individuals
for having poor health or crediting them for good health is inappropriate. Individuals are
unlikely to be able to directly control many of the determinants of health. These
determinants—or things that make people healthy or not—include the above factors,
and many others:

 Income and social status - higher income and social status are linked to better
health. The greater the gap between the richest and poorest people, the greater
the differences in health.
 Education – low education levels are linked with poor health, more stress and
lower self-confidence.
 Physical environment – safe water and clean air, healthy workplaces, safe
houses, communities and roads all contribute to good health. Employment and
working conditions – people in employment are healthier, particularly those who
have more control over their working conditions
 Social support networks – greater support from families, friends and communities
is linked to better health. Culture - customs and traditions, and the beliefs of the
family and community all affect health.
 Genetics - inheritance plays a part in determining lifespan, healthiness and the
likelihood of developing certain illnesses. Personal behavior and coping skills –
balanced eating, keeping active, smoking, drinking, and how we deal with life’s
stresses and challenges all affect health.
 Health services - access and use of services that prevent and treat disease
influences health.
 Gender - Men and women suffer from different types of diseases at different
ages.