Factors and Issues Affecting Health and Illness (Chapter 20)

• In the late 19th century, the “how” of disease (pathogenesis) was the major concern of health professionals
• The 20th century focused on find ng cures for diseases
• Currently, healthcare providers are increasing their emphasis on preventing illness and pro

  oting health and wellness in individuals, families, and communities
• Traditionally, health was defined in terms of the presence or absence of disease
• Florence Nightingale (1860/1969) defined health as a state of being well and using
• The World Health Organization (WHO, 1948) takes a more holistic view of health. Its constitution defines health as “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.” This definition reflects concern for the individual as a total per on, functioning physically, psychologically, and socially
• Mental processes determine individuals’ relationships with their physical and social surroundings, their attitudes about life, and their interaction with others
• Health has also been defined in terms of role and per ormance. Talcott Parsons (1951), an eminent American sociologist and creator of the concept of “sick role,” con eptualized health as the ability to maintain normal roles
• In 1953, the U.S. President’s Commission on Health Needs of the Nation (1953) made the following statement about health: “Health is not a condition; it is an adjust

  ent. It is not a state but a process. The process adapts the individual not only to our physical but also our social.environments
• .In its 2010 social policy statement, the American Nurses Association (ANA) states, “Health and illness are human experiences. The presence of ill

  ess does not preclude health, nor does optimal health preclude illness
• Many people describe health as the following:

  • Being free from symptoms of disease and pain • Being able to be active and to do what they want or

  must • Being in good spirits most of the time
• Populations may be determined by geography, familial relationships, or other common characteristics
• These characteristics include the social, structural, physical, and behavioral determinants of health
• .The term population health has many definitions, but most include the concept of the health of a group of individuals linked to but dif erent from epidemiology, public health, and community health
• Fawcett and Ellenbecker (2015) describe the Con eptual Model of Nursing and Population Health, which is similar to some other models of population health but emphasizes the centrality of nursing over other health disciplines
• Conceptual Model of Nursing and Population Health:“population health is defined as lifespan wellness and disease experiences of aggre

  ate groups of people residing in local, state, national, or international geographic regions or those populations with common characteristics
• Population health includes aspects of public health, healthcare delivery systems, and determinants of wellness and illness, emphasizing promo ion, restoration, and maintenance of wellness and preven ion of disease
• WHO (n.d.) defines the social determinants of health as the “conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shap ng the conditions of daily life. These forces and systems include economic policies and systems, developmentagendas, social norms, social policies and political sys ems
• Poverty, unemployment, transportation, stress, social exclusion, lack of social support, substance use, and lack of adequate healthcare are among the most significant determinants
• Upstream determinants refer to macro-level factors, such as culture, housing, education, and government policies
• Midstream factors refer to social influences and individuals’ health behaviors and also the nature of health systems
• Downstream factors relate to biology and physiology at the individual level
• Wellness is a state of well-being. Basic aspects of well

  ess include self-responsibility; an ultimate goal; a dynamic, growing process; daily decision-making in the areas of nutrition, stress management, physical fitness, preventive healthcare, and emotional health; and most importantly, the whole being of the individual
• well-being has many definitions but is commonly viewed as a “function of life opportunities and achievements. It is multidimensional, reflecting people’s function ng...such as consumption and personal security— and their capabilities—the objective conditions in which choices are made and that shape people’s abili ies to transform resources into given ends, such as health
• Well-being also appears in the 2018–2022 strategic plan of the U.S. Department of Health and Human Services (2018) in the form of Goal 3: Strengthen the Economic and Social Well-Being of Americans Across the Lifespan
• The World Health Organization defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (WHO, 1946). This definition emphasizes the importance of all three dimensions of well-being.
• The narrowest interpretation of health occurs in the clinical model.
• Individuals are viewed as physiologic systems with related functions, and health is identified by the absence of signs and symptoms of disease or injury.
• In the clinical model, the opposite of health is disease or injury.
• Many practitioners have used the clinical model in their focus on the relief of signs and symptoms of disease and elimination of malfunction and pain.
• When these signs and symptoms are no longer present, the practitioner considers the individual’s health restored.
• Health is defined in terms of an individual’s ability to fulfill societal roles, that is, to perform his or her work.
• Individuals usually fulfill several roles (e.g., mother, daughter, friend), and certain individuals may consider nonwork roles the most important ones in their lives.
• According to this model, individuals who can fulfill their roles are healthy even if they have health problems.
• A man who works all day at his job as expected is healthy even though he has migraines.
• It is assumed in this model that sickness is the inability to perform one’s work role.
• In the adaptive model, health is a creative process; disease is a failure in adaptation, or maladaptation.
• The aim of treatment is to restore the ability of the individual to adapt, that is, to cope.
• According to the adaptive model, extreme good health is flexible adaptation to the environment and interaction with the environment to maximum advantage.
• The Roy adaptation model of nursing views the individual as an adaptive system.