Health conceptualizations in nursing can be classified into two groups. The first is the wellness-illness continuum, “a bipolar interactive portrayal of health and illness in myriad configurations ranging from high-level wellness to depletion of health (death)” (Fitzpatrick & Wallace, 2006, p. 244). High-level wellness is additionally conceptualized as a sense of wellbeing, life satisfaction, and quality of life. The movement toward the negative extreme of the continuum encompasses adjustment to disease and disability through different degrees of functional ability. The second paradigm conceptualizes health as a unidirectional developmental occurrence of person-environment interaction. Health is an important concept for nursing because it forms the foundation of a nurse’s goals, scope, and products of practice. Health conceptualization is the topic of discussion in this paper. The paper will discuss the various ways in which health has been conceptualized as well as the changing patterns and concepts of health across time and communities and their impact on public health intervention programs.
Personal Opinion about Health Conceptualization
On the most basic level, I used to perceive health as the absence of any physical manifestations of diseases such as a headache, stomachache, vomiting, and such symptoms. To me, as long as I did not have such symptoms, I viewed myself as being healthy. However, as I grew up and gained more knowledge, I came to understand health as a term that encompasses a broader meaning than the mere lack of diseases. Indeed, health is a multifaceted term that involves not only physical wellbeing but also emotional, spiritual, psychological, emotional, mental, and social wellbeing. It is a holistic state of being. As such, a person may lack physical manifestations of diseases but still be considered to be unhealthy. Many scholars have attempted to conceptualize health. Thus health conceptualizations are many and differ from one approach to another.
Further Understanding of Health Conceptualization
Health conceptualization has been defined in many ways in our society and includes physical, emotional, mental, spiritual, and social well-being. Health is what people in a society hold dear or long for; it is the optimization of one’s capability; it is a high state of wellness; the realization of a person’s personal goals; the successful execution of social roles; the successful interaction with the environment; and the optimum functioning. Health has also been perceived to be “subjective or relative, objective, comparative, classificatory, holistic, a state (condition), and a process that changes over time” (Murray & Evans, 2003, p. 314). Therefore, with these many, sometimes overlapping, superfluous, and conflicting notions of health, the term health needs to be understood based on the purpose to which it is being applied.
The functionalist approach to health is perhaps the earliest approach to conceptualizing health. This approach views health and its disparities in terms of the ability of human beings to carry out necessary duties. Maximum health is the normative reference point of required capability and performance. Health has been perceived as “a condition necessary for the realization of two of our regnant values: mastery of the world and fun” (Kim, 2000, p. 86). Health as a condition enables a person to do what he/she wants to do and to be what he/she wants to be. On the opposite end of the continuum, illness is viewed as an impediment to activity and as a limitation of a person’s independence. Illness is a state of dissatisfaction and deficiency. Moreover, health is perceived to be a moral good that is longed for by everyone but not clearly defined. Health also entails a state of involvement in everyday social life. According to this view, health is universally portrayed in social and functional conditions.
Another functional conceptualization of health is the one proposed by Parsons (1951; 1958). Parsons conceptualized health as a “socially desirable and normative state that is functionally important to the social system” (Novick & Mays, 2005, p. 17). According to Parsons, a person’s health is described based on his or her capability to take up roles and execute fundamental social duties adequately. Health is also a state of totality or veracity of the person in terms of his or her capability to offer self-care. Because a human being is perceived as a unity functioning biologically, symbolically, and socially, a person needs to be able to execute premeditated actions to be efficient and healthy. Health is thus achieved by adequate and acceptable self-care actions in reaction to changing demands for attention to self. Successfully executed self-care action leads to human integrity, human functioning, and personal growth (Tones & Green, 2004).
Changing Concepts of Health and their Influence on Public Health Interventions
Health is determined by various factors which range from social, economic, genetic, perinatal, nutritional, behavioral, infectious, and environmental. Health is thus a positive notion that emphasizes social and personal resources as well as physical abilities. Promoting health is thus a responsibility that should be shared by health providers, public health officials, and community members, and other players in the community who can make positive contributions to the general welfare of individuals and communities. The interaction between social, environmental, and biological factors influences the health of persons and populations. This fact is derived from the fundamental public health and epidemiologic model, which explains ill health as an outcome of an interaction between the host, the agent, and the environment. This model holds for both infectious and non-infectious diseases. Agents may be dietary shortages or excesses, poisons, substances, among others (Novick & Mays, 2005, p. 18).
The agent-host-environment model aids the establishment and implementation of public health intervention programs because diseases can be prevented or managed by dealing with one or more of these factors. For instance, a public health program that aims at addressing HIV transmission rates in a given community has to take into consideration the relationship between the agent (HIV virus), the host (HIV carriers), and the environment (an environment that encourages irresponsible sexual behaviors). The intervention program may thus choose to address one or all of these factors.
Changing Patterns and Understanding of Health, Well-being, and Disease across Time and Communities
The patterns of health, disease, and wellbeing change from time to time and from one community to another. In the last century, the majority of people viewed health as the nonexistence of disease (Brannon & Feist, 2009). This perception was influenced by the types of diseases that were most common then. These diseases were mainly infectious diseases that spread from one person to another either through contaminated water or foods or coming into contact with an ill person. As a result, people had little control over the diseases they suffered from. Once sick, people would seek medical care from doctors. However, the duration of the diseases was short in that people either died from the diseases or got healed in a matter of days/weeks. The situation however is no longer the same.
In this century, the types of diseases that have been most common are non-infectious diseases (Lin et al., 2007). These are diseases that are brought about by lifestyle and behavioral factors and include diseases such as coronary heart disease, diabetes, and cancer, among others. Unlike in the past, non-infectious diseases may exist in a person for a long period of time or they may recede and then recur again. The management of such diseases and their existence over a long period of time have been facilitated by advanced medical technologies and drugs. Another difference is that nowadays, people have more control over their health, wellbeing, and disease through the change of their behaviors and lifestyles. For instance, a person can prevent coronary heart disease by living an active life (through regular physical exercises) and eating foods that have low-fat contents.
In addition, patterns of health, wellness, and disease differ from one community to another due to different socio-economic factors that characterize the communities. These factors include poverty, income levels, and educational levels (Tones & Green, 2004). Communities with high poverty levels, and low income and educational levels are likely to experience diseases that are easily manageable and which result in ignorance. For instance, malaria in sub-Saharan countries can easily be contained by mosquito nets if only people knew about it and were in a position to afford the nets. On the other hand, communities with low poverty levels, and high income and educational levels are less likely to suffer from ignorance-related diseases. Instead, they are more likely to suffer from diseases that result from lifestyle and behavioral factors such as sedentary lifestyles. Because of these varying determinants of health, wellbeing, and diseases, the understanding that people have about these concepts differs from one community to another (Novick & Mays, 2005).
In conclusion, health conceptualization has evolved over time. It is not just the mere nonexistence of diseases but encompasses various other dimensions that include physical, emotional, psychological, mental, and social wellbeing. It is also the interaction of different factors with the environment. Health conceptualization differs from time to time, and from one community to another. Nevertheless, health conceptualization is important in public health because it provides a deeper understanding of health which then forms the basis upon which effective treatment, health promotion, and disease management interventions can be formed.
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