PRACTICAL № 1

DEFINITION OF HEALTH. HEALTH CONTINUUM.

At the end of the class you should be able to:

1. Define the terms health, disease, well-being, impairment, disability, handicap;

2. Compare different definitions of health;
3. Discuss critically the WHO definition of health and characterize the dimensions of health;
4. Differentiate between health and well-being;
5. List the stages of health continuum and be able to apply them to yourself and others;
6. Differentiate between impairment, disability and handicap as consequences of disease
and identify them on the basis of case vignettes.

I. DEFINITION OF HEALTH
“Health” is a central concept in medicine and in life. Defining health is not straightforward.
Notion of health is context-dependent and varies by sex, age, place, time etc.
1. Write down your own definition of health. What does it mean to you to be healthy? Do not
describe health simply as the opposite to disease.
Health can be defined as a state ofcomplete physical, mental, and
………………………………………………………………………………………………………….
Social
being,merely the absence ofdisease or infirmity.
and not
………………………………………………………………………………………………………….
well
Being
healthy means balanced harminous state of and
having
………………………………………………………………………………………………………….
a in
being
which all aspects ofa persons life,
includingtheir physical, mental, emotional
………………………………………………………………………………………………………….

well-being,
are
functioning
………………………………………………………………………………………………………….
and social optimally
2. Have a group discussion on the definitions of health you have created. Identify 3 categories
most used in the presented definition of health and write them down:
Process
1. ……………………………………………………………………………………………………..

State
2. ……………………………………………………………………………………………………..

Vitality or Personal ability

3. ……………………………………………………………………………………………………..

 Comment on how these categories reflect the nature of health. Did you notice differences
in the content and complexity of definitions of health by sex?
 Could health be defined with a positive definition (describing its characteristics?
 Could health be defined with a negative definition (as the absence of certain qualities)?
3. There are various definitions of health reflecting different theories of health. Commonly
accepted definition of health affects the practice of medicine, the physician-patient
communication, the scope and the goals of health policy, health care and health
management. More recently emerged views on health can be summarised into three major
groups – bio-medical, holistic and ecological.

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 Types of definitions of health:
1. Health as an ideal state
2. Health as a process
3. Health as a physical and mental fitness
4. Health as a personal ability, strength, or vitality
5. Health as a basis for achieving personal potential
6. Health as a commodity that can be purchased, given, sold or lost
7. Health as a summary statistical measure.

Determine the type of each of the following definitions of health. Fill in the number of the
respective type at the end of the definition.
1. “The condition of being sound in body, mind or spirit, especially freedom from physical
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disease or pain” (Webster dictionary) …………
2. “This is a condition of perfect homeostasis (equilibrium).” (Sigerist,H., 1945) …………
3. “This is a soundness of body or mind; that condition in which its functions are duly and
efficiently discharged” (Oxford English Dictionary) ………….
S

4. “The health consists of the abilities of the organism to maintain homeostasis in accordance
to age and social needs, by which the organism is equally free of dissatisfaction, discomfort,
illness and abilities for surviving of the type.” (Blum,H., 1961). ………….
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5. “The health of the individual - this is a dynamic phenomenon, varying with the continuation
of the well-being till the extreme illness. The changes in the health status are controlled by
variable laws, that is why for the adequate description of the health of the individual is
necessary to mark not only the time factor, but also accidental mechanism of the process.”
(Chiang,D., 1971). …………. 2

6. “This is a state of relative equilibrium of body form and function which results from its
successful dynamic adjustment to forces tending to disturb it. It is not passive interplay
between body substance and forces impinging upon it but an active response of body forces
working toward readjustment” (Perkins). ………….2 ,

7. “This is a condition of quality of the human organism expressing the adequate functioning of
the organism in given condition, genetic and environment.” (WHO, 1957). 3
8. “This is a modus vivendy enabling imperfect man to achieve a rewarding and not too painful
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existence while they cope with an imperfect world” (R.Dubos, 1968). ………….

4. WHO definition of health

The concept of health is outlined in the official definition by the World Health Organization
(1948), written in the Preamble of its Constitution:
“Health is a state of complete physical, mental and social well-being and not merely an
absence of disease or infirmity.”
This definition has not been changed since 1948, although WHO added in some official
documents that health is “…the ability of a person to lead a socially and economically
productive life” (1977) and “…it is a positive concept, emphasizing social and personal
resources, as well as physical capacities” (1986). The definition has been widely criticised
for presenting health as an unattainable ideal, unmeasurable and a synonymous for total well-
being.
Analyse the definition of health by WHO and answer the following questions:
positively
 How is health defined by WHO – positively or negatively?................................................

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  What are the 3 dimensions (the triad) of health in the definition?......................................
mental;physical;social
………………………………………………………………………………………………………
 Fill in the table with a brief description of each dimension of health. Discuss them with your
colleagues. On which dimension you have reached the best agreement?
Dimensions of health in the definition of WHO

1. Mental
2. 3. Social
physical To friends
A
person able to
be to
able make and
belong
needs to be have a healthy sleep schedule to social
groups, the individual should
rest, be able to
to understand the potential and
getenough theyshould function in
cooperative ways,
Should posess
and should be able to
have the
proper nutrition and have adequate communication
manage enough water.
The person
and display respectto themselves and
everyday stress and problems. to be
physically active
needs
other individuals
the person and maintain
should play a functional a healthy
role in Society Work workoutroutine
effectively

 Do these 3 dimensions in the definition describe sufficiently the nature of human health?
What other dimensions of health could you think of? Write down your ideas.
Yes, they do. By providing full spectrum ofthe dimentions that
……………………………………………………………………………………………………… a essential to overall health a re

………………………………………………………………………………………………………
other dimentions:

financial, environmental, spiritual

……………………………………………....
->

 What are the advantages of the definition of health by WHO and what are the limitations
for which it is criticised?

Advantages Disadvantages
Iti s It
a summary of the mostimportant shows an
equal display the
of important
dimentions ofh ealth and itemphasizes dimensions that
existi n every-day life
them.

 How does wellbeing relate to health? What are the differences between the terms “health”
and “well-being”?
II. HEALTH CONTINUUM
Health is a dynamic phenomenon. It changes constantly over time and has many different
levels. Health fluctuates within a range of all possible states from optimum towards total
dysfunction thus forming health continuum. The next figure presents graphically the concept of
health continuum.

Fig. 1 Health continuum

1. Describe briefly the meaning of the designated levels on the health continuum.
2. What direction (-s) can be the shifts in the health status of an individual?

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3. Tag the health state of each of the following cases on the health continuum by the
corresponding letter:
A. A 23-years old man, living a healthy life style, with excellent functioning, fast and
successful adaptation to changing environment, no clinical signs of any disease; Positive - health

B. A 45-years old man, no signs of any disease, living healthy life style in a city with a high
level of air pollution. freedom of sickness
-

C. A 33-years old woman, with upper respiratory tract infection, running nose, throat pain,
normal bodily temperature.
D. A 64-years old man, suffering a stroke, left side paralysis, unable to speak, to move and
to feed himself. mild sickness
-

E. A 75-years old woman, with chronic heart failure, fatigue while moving, shortage of
breath, moderate decline in memory, moderate limitations in the performance of complex
activities of daily living. Severe sickness
-

F. Your own health at the moment. freedom from sickness

-

III. DISEASE AND ITS CONSEQUENCES – IMPAIRMENT, DISABILITY, HANDICAP

Defining the disease and its consequences on functioning also is a difficult task since they
are complex terms, which have to be explored not only from the medical point of view but from
the point of view of the affected person. Disease and illness are related concepts, presenting
these two points of view - patients suffer from ‘illnesses’ and doctors diagnose and treat
diseases.
1. For each definition presented below determine the correct term – illness, disease,
impairment, disability or handicap and write it in the appropriate place.

Any temporary or permanent loss or abnormality of a body structure or

Impairment
function, whether physiological or psychological.
A failure of the adaptive mechanisms of an organism to counteract
adequately, normally or appropriately to stimuli and stresses to which the
organism is subjected, resulting in a disturbance in the function or
Disease structure of some part of the organism.
A person's own perceptions, experience and evaluation of a disease or
Illness condition, or how he or she feels.
A restriction or inability to perform an activity in the manner or within the
Handicap range considered normal for a human being.
A result that limits or prevents the fulfilment of one or several roles
regarded as normal, depending on age, sex and social and cultural
factors.
Disability
2. Illustrate by examples the concepts of impairment, disability and handicap.

LITERATURE AND SOURCES OF DATA:

1. Balog, J. E. The concept of health and the role of health education. The Journal of School Health, 9, 1981, 462-
464.
2. Boyd, K.M. Disease, illness, sickness, health, healing and wholeness: exploring some elusive concepts. J Med
Ethics: Medical Humanities, 2000; 26:9–17.
3. Tikkinen KAO, Leinonen JS, Guyatt GH,et al. What is a disease? Perspectives of the public, health professionals
and legislators. BMJOpen 2012; 2:e001632. doi: 10.1136/bmjopen-2012-001632
4. World Health Organization. Constitution. World Health Organization, Geneva, (1948).
5. World Health Organization. International classification of impairments, disabilities, and handicaps, 2nd ed.
Geneva: WHO, 2000.
6. World Health Organization. Resolution WHA40.43 - Technical Cooperation. World Health Organization, Geneva,
May, 1977.