PS252 - Perspectives on Health and Illness

What factors contributed to the decline in infectious diseases before medical interventions?

Economic, social and nutritional improvements from the industrial revolution plus sanitation and public health measures

How much has life expectancy at birth increased in Ireland (2000–2021)?

Improved by 5.19 years (from 76.4 to 81.6).

How much has life expectancy at birth increased in Europe (2000–2021)?

Improved by 3.78 years (from 72.5 to 76.3)

What does the term chronic mean?

Derived from the Greek chronos which refers to the passage of time itself

/What characterises chronic illness?

• Long duration

• Limited or no cure

• Sometimes stable or fluctuating with exacerbations or remission

Examples of chronic illnesses

• Cardiovascular diseases

• Diabetes

• HIV/AIDS

• Arthritis

• Respiratory problems

• Epilepsy

• Cancer

What is the WHO (1949) definition of health?

A state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.”

What are key features of the WHO definition?

• Positive view of health

• Multidimensional (physical, mental, social)

• Emphasizes quality of life and productivity

What are main criticisms of the WHO definition?

• Unrealistic “complete wellbeing”

• Health is relative, not absolute

• Ignores continuum between health and illness

• Overlooks personal beliefs and perceptions of health

Disease

A biological event characterized by pathology or functional changes in organs/systems; diagnosed scientifically.

Illness

The subjective, lived experience of symptoms and reduced wellbeing.

What is the main idea of the biomedical model?

The body is a machine; illness results from biological malfunction identifiable through objective investigation.

What are challenges to the biomedical model?

• Reductionist—focuses only on biology

• Ignores psychosocial/environmental factors

• Fails to explain symptoms without pathology

• Implies doctors need not address psychosocial aspects

• Overlooks prevention and health behaviours

What psychosocial factors influence treatment success?

• Placebo effects (Kirsch, 2019)

• Patient–clinician relationship (Kelley et al., 2014)

What model did Engel propose?

The biopsychosocial model, where biological, psychological, and social factors are interrelated and affect both care processes and outcomes.

What did “disability” mean in the 14th century?

Legally disqualified or incapable.

How did the meaning of “disability” evolve in the 15th–17th centuries?

Shifted from legal to physical/mental incapacity; associated with injury, disease, and inability to work.

How does the medical model define disability?

As a health problem to be treated or cured; focuses on changing the person with the disability.

How does the social model view disability?

As a result of social and environmental barriers; society must remove obstacles, not “fix” individuals

What are the main principles of the UNCRPD?

Non-discrimination, participation, accessibility, equality of opportunity, and respect for dignity.

What is the goal of the UNCRPD?

To transform societal views and promote inclusion through laws and awareness.

How does the WHO view disability?

As a complex, multidimensional issue involving biological, individual, and social levels (biopsychosocial approach).

What was the purpose of the ICIDH (1980)?

To classify impairments, disabilities, and handicaps.

Define impairment, disability, and handicap in the ICIDH.

• Impairment: Loss or abnormality of body structure/function.

• Disability: Restriction in performing normal activities.

• Handicap: Social disadvantage from impairment or disability.

What are criticisms of the ICIDH?

• Linear, medicalized model

• Neglects environmental factors

• Negative, pathology-oriented language

• “Handicap” stigmatizes and blames the individual

What model replaced the ICIDH?

The International Classification of Functioning, Disability and Health (ICF).

What is the focus of the ICF?

A positive model classifying human functioning at body, person, and social levels; includes contextual (environmental/personal) factors.