Lily Kiamanesh, Class of 2024
What does it mean to be healthy and how is health measured? According to the World Health Organization, health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”(WHO). The WHO takes into account different factors that make up overall health rather than using a diagnosis to confer health status. Yet mainstream health media is still focused on the biomedical concept of health, which is the view that health is the absence of disease (Brüssow 2013). News segments on health and medical talk shows are eager to discuss the latest breakthrough in cancer treatments or the new trending fad to lose weight during quarantine. Miraculous recoveries and popular lifestyle choices are common headlines, and they are framed as though they are curative and not simply one aspect of our health. Health in the WHO definition is hardly ever discussed, but is it even that the best definition of health? Like the biomedical concept, the WHO definition relies on health as a state of being, and I will argue that there is another notion of health that should be considered.
To start, a glaring problem with the biomedical conception is that health can then only exist in two states: healthy and unhealthy. The biomedical conception does not leave room for the spectrum of health. Healthy would describe a patient whose tumor is no longer detectable after a round of intense chemotherapy just as well as a patient who left the hospital without a diagnosis. Someone who is considered to be unhealthy would describe someone with the common cold in the same way as a newborn with a congenital birth defect. The dichotomy of health bleeds into everyday life. How often have you labelled a particular activity as ‘healthy’ or ‘unhealthy?’ Or said that one ‘healthy’ act will balance out one ‘unhealthy’ act? Categorizing behavior as one of two states reinforces the biomedical conception of health and can become a slippery slope to blaming healthproblems on behavior. And while behaviors can put populations at risk for disease, they must be seen in a broader context because eating an extra bag of chips is evidently not ‘unhealthy’ in the same way smoking is.
Another issue with the biomedical concept of health is that the focus on disease ignores the social determinants of health. It looks at disease rates and not the social conditions that may factor into them because it is only interested in the absence of disease and this has implications on the portrayal of health. A study in 2011 found mainstream media intentionally neglectful of the social determinants of health, partly because acknowledging social determinants takes health from an individualist perspective on health and places in the context of broader, social ills (Raphael 2011). By using the absence of disease as the sole marker of health, the media can say a population is growing unhealthy because of higher disease rates instead of saying the social conditions are fostering an unhealthy environment. For example, income inequality is growing in the U.S. and is linked with increasing adverse health outcomes (Pickett and Wilkinson 2015). In this case, a biomedical concept of health would mean treating every new instance of disease rather than reducing income inequality to prevent disease in the first place.
The failures of a biomedical concept of health calls for a better concept. Resilience-based conceptions see health as a measure of a person’s ability to overcome challenges (Cosco 2017). By framing health as the capacity to bounce back, a resilience-based conception takes into account the social determinants of health as well as the adversities individuals face. For example, a person with a college degree is more likely to bounce back from loss of employment than a person without one. Resilience-enhancing factors, also known as protective factors, increase a person’s ability to manage and/or overcome challenges (Antonio 2020). These include community support, cultural participation, and financial stability. A study on resilience-based conceptions of health in Native Hawaiians have found their conceptions of health to be a holistic approach on health, stressing the importance of maintaining balance between physical, mental, and spiritual health (Antonio 2020). Health is not whether or not a person has been diagnosed, but when one aspect of our health is unbalanced and how this affects their resilience. Resilience becomes important for overcoming the cause of unbalance, or in cases of chronic illness, managing it.
One thing to consider is that resilience is not a substitute for improved life conditions. We can and should advocate for better and more accessible public health care at the same time we build resilience within ourselves and our communities because better life conditions is its own form of resilience. Medical professionals have already begun to implement resilience-based conceptions and research has shown that resilience has a place in medicine. In a study on resilience for cancer patients, health interventions promoting resilience, such as supportive group therapy and mindfulness, had positive effects on post-traumatic growth (Ludolph 2019). Additionally, a meta-analysis found a positive correlation between resilience and mental health in patients with a somatic illness, which is an illness characterized by physical symptoms such as pain or fatigue (Färber 2018).
Viewing health as the absence of disease is a narrow approach and focuses on the individual. It fails to consider that health is made up of components like mental and spiritual health that can be poor, but may not lead to a diagnosis. This view is popular by its simplicity and because it is only concerned with the individual. Unlike resilience, it doesn’t concern itself with the social conditions of a patient. A resilience-based concept of health allows us to account for all the social conditions that contribute to one’s resilience, and allows us to help patients outside the clinic. Resilience doesn’t require a diagnosis, and offers ways to improve health that isn’t simply mitigating symptoms. Studies utilizing resilience are fairly new and by its broad definition, resilience can be beneficial not only in medical and hospital settings, but also for community and population health.
Sources
Brüssow H. What is health? Microbial biotechnology. 2013; 6(4); 341–348
World Health ORganization. Frequently Asked Questions. Retrieved from: https://www.who.int/about/who-we-are/frequently-asked-questions
Raphael D. Mainstream media and the social determinants of health in Canada: is it time to call it a day? Health promotion international. 2011; 26(2); 220–229
Cosco, T. D., Howse, K., & Brayne, C. Healthy ageing, resilience and wellbeing. Epidemiology and psychiatric sciences. 2017; 26(6); 579–583
Antonio, M.C.K., Keaulana, S., Chung-Do, J.J., Ho-Lastimosa, I. (Re)constructing Conceptualizations of Health and Resilience Among Native Hawaiians. Genealogy. 2020; 4(1); 8
Ludolph, P., Kunzler, A. M., Stoffers-Winterling, J., Helmreich, I., & Lieb, K. Interventions to Promote Resilience in Cancer Patients. Deutsches Arzteblatt international. 2019; 51-52(51-52), 865–872
Färber, F., & Rosendahl, J. The Association Between Resilience and Mental Health in the Somatically Ill. Deutsches Arzteblatt international. 2018; 115(38), 621–627
Pickett, K. E., & Wilkinson, R. G. Income inequality and health: a causal review. Social science & medicine (1982). 2015; 128, 316–326
To start, a glaring problem with the biomedical conception is that health can then only exist in two states: healthy and unhealthy. The biomedical conception does not leave room for the spectrum of health. Healthy would describe a patient whose tumor is no longer detectable after a round of intense chemotherapy just as well as a patient who left the hospital without a diagnosis. Someone who is considered to be unhealthy would describe someone with the common cold in the same way as a newborn with a congenital birth defect. The dichotomy of health bleeds into everyday life. How often have you labelled a particular activity as ‘healthy’ or ‘unhealthy?’ Or said that one ‘healthy’ act will balance out one ‘unhealthy’ act? Categorizing behavior as one of two states reinforces the biomedical conception of health and can become a slippery slope to blaming healthproblems on behavior. And while behaviors can put populations at risk for disease, they must be seen in a broader context because eating an extra bag of chips is evidently not ‘unhealthy’ in the same way smoking is.
Another issue with the biomedical concept of health is that the focus on disease ignores the social determinants of health. It looks at disease rates and not the social conditions that may factor into them because it is only interested in the absence of disease and this has implications on the portrayal of health. A study in 2011 found mainstream media intentionally neglectful of the social determinants of health, partly because acknowledging social determinants takes health from an individualist perspective on health and places in the context of broader, social ills (Raphael 2011). By using the absence of disease as the sole marker of health, the media can say a population is growing unhealthy because of higher disease rates instead of saying the social conditions are fostering an unhealthy environment. For example, income inequality is growing in the U.S. and is linked with increasing adverse health outcomes (Pickett and Wilkinson 2015). In this case, a biomedical concept of health would mean treating every new instance of disease rather than reducing income inequality to prevent disease in the first place.
The failures of a biomedical concept of health calls for a better concept. Resilience-based conceptions see health as a measure of a person’s ability to overcome challenges (Cosco 2017). By framing health as the capacity to bounce back, a resilience-based conception takes into account the social determinants of health as well as the adversities individuals face. For example, a person with a college degree is more likely to bounce back from loss of employment than a person without one. Resilience-enhancing factors, also known as protective factors, increase a person’s ability to manage and/or overcome challenges (Antonio 2020). These include community support, cultural participation, and financial stability. A study on resilience-based conceptions of health in Native Hawaiians have found their conceptions of health to be a holistic approach on health, stressing the importance of maintaining balance between physical, mental, and spiritual health (Antonio 2020). Health is not whether or not a person has been diagnosed, but when one aspect of our health is unbalanced and how this affects their resilience. Resilience becomes important for overcoming the cause of unbalance, or in cases of chronic illness, managing it.
One thing to consider is that resilience is not a substitute for improved life conditions. We can and should advocate for better and more accessible public health care at the same time we build resilience within ourselves and our communities because better life conditions is its own form of resilience. Medical professionals have already begun to implement resilience-based conceptions and research has shown that resilience has a place in medicine. In a study on resilience for cancer patients, health interventions promoting resilience, such as supportive group therapy and mindfulness, had positive effects on post-traumatic growth (Ludolph 2019). Additionally, a meta-analysis found a positive correlation between resilience and mental health in patients with a somatic illness, which is an illness characterized by physical symptoms such as pain or fatigue (Färber 2018).
Viewing health as the absence of disease is a narrow approach and focuses on the individual. It fails to consider that health is made up of components like mental and spiritual health that can be poor, but may not lead to a diagnosis. This view is popular by its simplicity and because it is only concerned with the individual. Unlike resilience, it doesn’t concern itself with the social conditions of a patient. A resilience-based concept of health allows us to account for all the social conditions that contribute to one’s resilience, and allows us to help patients outside the clinic. Resilience doesn’t require a diagnosis, and offers ways to improve health that isn’t simply mitigating symptoms. Studies utilizing resilience are fairly new and by its broad definition, resilience can be beneficial not only in medical and hospital settings, but also for community and population health.
Sources
Brüssow H. What is health? Microbial biotechnology. 2013; 6(4); 341–348
World Health ORganization. Frequently Asked Questions. Retrieved from: https://www.who.int/about/who-we-are/frequently-asked-questions
Raphael D. Mainstream media and the social determinants of health in Canada: is it time to call it a day? Health promotion international. 2011; 26(2); 220–229
Cosco, T. D., Howse, K., & Brayne, C. Healthy ageing, resilience and wellbeing. Epidemiology and psychiatric sciences. 2017; 26(6); 579–583
Antonio, M.C.K., Keaulana, S., Chung-Do, J.J., Ho-Lastimosa, I. (Re)constructing Conceptualizations of Health and Resilience Among Native Hawaiians. Genealogy. 2020; 4(1); 8
Ludolph, P., Kunzler, A. M., Stoffers-Winterling, J., Helmreich, I., & Lieb, K. Interventions to Promote Resilience in Cancer Patients. Deutsches Arzteblatt international. 2019; 51-52(51-52), 865–872
Färber, F., & Rosendahl, J. The Association Between Resilience and Mental Health in the Somatically Ill. Deutsches Arzteblatt international. 2018; 115(38), 621–627
Pickett, K. E., & Wilkinson, R. G. Income inequality and health: a causal review. Social science & medicine (1982). 2015; 128, 316–326
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