CONCEPTS OF HEALTH AND WELLNESS

Concepts of health and wellness are based on both objective scientific measurements derived from large and varied population studies, as well as the subjective experience of individuals who describe themselves as being well or healthy. Scientific data provide information related to the determinants of health that include biological factors, health beliefs and behaviours as well as socioeconomic and environmental conditions accounting for health trends across societies and cultures. Studies of healthy people also contribute to what is referred to as indices of health, such as the body mass index (BMI). The BMI provides guidelines for healthy weight ranges as well as therapeutic ranges for blood cholesterol and blood sugar (see online Appendix 7: Height & weight/nutrition).

Such data have also provided a foundation for government-funded health screening and health promotion campaigns to raise public awareness of the interplay between lifestyle, nutrition, environmental health risks and disease. An example of such a program can be seen in the After School Care Nutrition Program encouraging children to become familiar with healthy food choices while raising parents’ awareness of the link between poor nutrition and obesity in school-age children and the rising incidence of type 1 diabetes in adolescents.

Health and wellbeing are integral elements of each person’s identity and, as such, influence actual and potential interactions with every aspect of life. The World Health Organization (WHO) promotes a positive concept of health, with defining characteristics that capture the many interrelated determinants of health as well as the importance of cultural and spiritual beliefs on health outcomes (WHO 1992). The WHO has actively supported a societal shift from focusing on illness to focusing on health, recognising that personal concepts of health are derived initially from family norms and values relating to health. For example, a child whose parents openly enjoy smoking cigarettes while denying any link with respiratory disease will share that belief until such a time that other events challenge those beliefs. Personal concepts of health are also shaped by geographical location, socioeconomic status and social structures, all of which influence and support family norms related to diet and lifestyle as well as health care access.

As children mature the values they ascribe to their health may be challenged by new information, role models outside their family of origin and by personal experience. Personal values also influence health behaviours, and a young person who prizes physical fitness may pay more attention to diet and exercise than a person in the middle years of life who attaches importance to being not ill. Older people may value health in relation to their functionality, or their ability to do things, and in enjoying life even in the presence of disease rather than focusing on the pathology of ageing.

To complete this broad overview of health and illness it is important to recognise the interrelatedness of physical and mental wellbeing as well as the interplay of both internal and external factors on each individual’s state of health. Each system and subsystem within the human body continuously exchanges information to maintain a steady state or homeostasis in the face of actual or perceived change. When these adjustment processes fail to maintain an adequate physiological balance, disease or illness may result. Responses to both internal and external challenges to homeostasis vary according to the magnitude of the challenge and the emotional readiness of each individual to cope with change. Nutritional status, age, pre-existing disease and social support also influence individual responses; thus, different dimensions of wellbeing are infinitely related and linked in the socio-physical dimensions of health (see Clinical Interest Box 8.1).

CLINICAL INTEREST BOX 8.1 Health and wellness

Health is defined not only by the absence of disease but also includes the importance of psycho-social wellbeing, including the ability to make and maintain healthy relationships, to cope with daily stresses and to remain generally optimistic and motivated. This can be seen in the following example.

Mrs N, 89, lives on her own since her husband’s death many years ago. Although she is almost blind from macular degeneration, she pursues an active lifestyle, walking her dog for at least 30 minutes every morning and participating in the administration of a day-care program for the elderly, even though many of the program participants are younger than she is.

Mrs N has evidence of rheumatoid arthritis in her hands, as well as loss of height from pronounced scoliosis of the spine, and often experiences pain from these deformities. She will often reflect on her sadness at no longer being able to knit, sew or read, as well as being annoyed with the clumsiness caused by her inflamed and disfigured finger joints.

However, while her body has a certain frailty that comes with advanced age, her voice is vibrant as she speaks animatedly to her neighbour who has come to visit. As she prepares fresh vegetables for her dinner, the smell of freshly cooked scones for the day centre pervades the kitchen. What sets Mrs N apart from many others her age is her philosophy on life — her commitment to reach beyond her physical limitations by actively contributing to her community. She has embraced the opportunities available through the use of audio tapes that substitute for letter writing, as well as being able to listen to ‘talking’ books. Mrs N maintains an interest in world affairs and keeps in touch with her daughter, grandchildren and, lately, her great grandchildren, all of who live overseas.

MODELS OF HEALTH AND WELLNESS

A model is a symbolic representation of a complex issue such as health and provides a framework for understanding and guidance. Models are developed from research studies that identify constant factors pertaining to an issue, with recognition of links to other factors that shape or influence the outcome. Models of health can, for example, be used to predict health needs and outcomes in relation to health-related behaviours. They may also facilitate nurses’ understanding of clients’ care requirements in relation to their health beliefs and practices.

Nurses’ work has traditionally been influenced by Western medical models of health that focus on the organic nature and cause of mental and physical disease rather than the influence of internal and external variables on the health of the whole person. This medical diagnostic-centred model is potentially disrespectful of the individual’s health beliefs and may disregard the internal and external variables that shape the social, psychological and behavioural influences on health outcomes.

Contemporary nursing care delivery is guided by a holistic model of health, which encompasses a broader reference to both traditional and non-traditional therapies and acknowledges the interplay of physical, psychological and spiritual dimensions on the client’s health. This model is client centred, respecting the individual’s health care beliefs and actively including the client, family and carers in health care planning. Ideally, this holistic model of health care delivery encourages clients to take responsibility for their behaviour in relation to health and illness, empowering them to assume a greater control over culturally appropriate health care options.

The health–illness continuum model of health assists nurses to recognise individuals’ states of health and wellness as a position on a continuum that ranges from a high level of wellness at one end to severe illness at the other (Figure 8.1).

Figure 8.1 Health–illness continuum model of health

(Elwin 2003)

This continuum represents mental and physical functionality based on vision, hearing, speech, mobility, dexterity, cognition, emotion, pain or discomfort. The health–illness continuum model can also represent the level of individual risk for disease or illness in relation to age, socioeconomic status, cultural beliefs and geographical location. By placing high risk at one end of the continuum and low risk at the other, the comparison of age with risk of infectious childhood diseases such as mumps or rubella identifies young children as being at high risk. Population statistics identify a greater risk associated with car accidents for young people between the ages of 16 and 26. Risk factors for infant mortality are related to socioeconomic status and geographical location, while the risk factors associated with tropical diseases such as malaria are far greater for people living near the equator. Cultural and religious beliefs related to health practices may prohibit groups of people from the benefits of specific care options, thus increasing their associated risk factors. A continuum does not provide us with an absolute measure, but by identifying their position on the continuum people can be encouraged to see a comparison between current and previous health states, or their position in relation to specific risk factors.

The health belief model (Crisp & Taylor 2005) demonstrates the link between people’s beliefs about health and their health-related behaviours or health practices. Health beliefs can be defined as the concepts or ideas about health that the individual believes as true. Health practices can be defined as the activities or behaviours that the individual will engage in as a result of, or in line with, their beliefs about health. Many health practices can become unconscious habits, such as cleaning teeth before going to bed, and for most people health beliefs are grounded in family health beliefs, values and practices. Family health beliefs usually reflect the dominant societal attitudes to health at that time.

Further information or experiences may either support these beliefs or contribute to a change. This model identifies two factors that influence change in health-related behaviours: personal readiness for change, and the strength of the stimulus. Readiness for change may be related to an event such as health breakdown or a close encounter with death, or it may arise from dissatisfaction with personal states of health. The strength of the stimulus for change is directly related to the individual’s perception of personal vulnerability to death or disease and it is precisely at this time that health education is most effective in the short term. This model may be best understood through the scenario in Clinical Interest Box 8.2.

CLINICAL INTEREST BOX 8.2 Application of the health belief model

Tom is a 50-year-old married man who has noticed a change in his personal level of fitness over the last few years. He acknowledged a gradual weight gain when his clothes were no longer comfortable and he began using the lift to his office because he became breathless when climbing a flight of stairs.