Health.docx
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Health.docx
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Health
Health
Theword"health"derivesfromMiddleEnglishhelthe,meaninghale,hearty,soundinwindandlimb.Dictionarydefinitionsalludetosoundnessandefficientfunctioningandgivethesamemeaningtofinancialhealthastobodilyhealth.Modernmedicalpracticeandpublichealthareconcernedaboutthehealthofindividualsandpopulations.However,formostindividualsandformanycultures,healthisaphilosophicalandsubjectiveconcept,associatedwithcontentmentandoftentakenforgrantedwhenallisgoingwell.Healthinthissenseisdifficulttodescribeordefine,butitsabsenceisreadilyrecognizable,evenwhenreplacedbyminordeparturesfromanaccustomedlevelofhealth.
DefinitionsandConceptsofHealth
InthepreambletotheconstitutionoftheWorldHealthOrganization(WHO)healthisdescribedas"astateofcompletephysical,mental,andsocialwell-beingandnotmerelytheabsenceofdiseaseorinfirmity."Thisdescriptionhasoftenbeencriticizedasbeingtoovague.Further,itdescribesanidealstaterarelyattainedbymostpeople,anditcontainsnoingredientsthatcanbereadilymeasuredorcounted,eitherattheindividualorthepopulationlevel.
Anotherdefinition,composedbyspecialistsinpreventivemedicine,specifiessometangiblecomponentsofhealth;callingit"astatecharacterizedbyanatomical,physiological,andpsychologicalintegrity;abilitytoperformpersonallyvaluedfamily,work,andcommunityroles;abilitytodealwithphysical,biological,psychological,andsocialstress;afeelingofwell-being;andfreedomfromtheriskofdiseaseanduntimelydeath"(Stokes,Noren,andShindell,1982).Everythingmentionedinthisdefinitioncanbemeasuredandcountedattheindividualandatthepopulationlevel,althoughassessing"afeelingofwell-being"maybeachallenge,and"freedomfromtheriskofdiseaseanduntimelydeath"isnotanachievablestate.
Anincreasinglevelofinterestinhealthpromotionintheearly1980sinspiredaWHOworkinggrouptocomposeadefinitionrecognizingtheroleofindividualsandcommunitiesindeterminingtheirownhealthstatus.Theycanbeparaphrasedtotheextenttowhichanindividualoragroupisabletorealizeaspirationsandsatisfyneedsandtochangeorcopewiththeenvironment.Healthisaresourceforeverydaylife,nottheobjectiveofliving;itisapositiveconcept,emphasizingsocialandpersonalresourcesaswellasphysicalcapabilities(Last,ed.,2000).Thisdefinitiondrawsattentiontotheneedforpartnershipsamongindividualsandcommunities,andtotheimportanceofprotectingtheintegrityoftheenvironmentinthecauseofpromotinggoodhealth.Moreover,manyaspectsofthisdefinitionaremeasurable.
Thehealthofhumanscannotbedissociatedfromthehealthofthelife-supportingecosystemswithwhichhumansinteractandareinterdependent.Moreover,nomatterhowhealthythepresentgenerationmaybe,thehealthoffuturegenerationsisdependentupontheintegrityandsustainabilityoftheseecosystems.Adefinitionof"sustainablehealth"thatrecognizesthisinterconnectednessstatesthathealthisasustainablestateofequilibriumamonghumansandotherlivingthingsthatsharetheearth(Last,ed.,2000).Thekeywordinthisdefinitionis"equilibrium"meaningharmony.Humanbeingscannotlongremainhealthyinanenvironmentinwhichtheyareoutofharmonywithotherlivingthings,orifotherlivingthingsaredeadordyingasaconsequenceofpeople'sactions.Thisistrueofalllifeforms,fromthesmallestmicroorganismstothelargestmammals.Sincethemid–twentiethcentury,medicalprofessionalshavebeentryingto"conquer"pathogenicmicroorganismswithantibiotics.Thisisawarthatultimatelycannotbewonbecausemicro-organismshaveveryshortgenerationtimes,measurableinminutes.Microorganismscanthereforeadapttothechallengeofantibioticsbyevolvingandproducingantibiotic-resistantstrainsmuchmorerapidlythannewantibioticscanbedeveloped.
Analternativetoantibiotics,whichisperhapsinsufficientlyimplemented,isbasedontheecologicalconceptthathumansareanintegralpartoftheglobalecosystem.Immunizationprogramsaimedatprotectingpeoplefromdiphtheria,tetanus,andotherdiseaseshavebeenveryeffective.Themicroorganismsresponsibleforthesediseasesarestillthere,inpeople'sthroats,inthesoil,whereveristheirusualhabitat.Butonceprotectedbyimmunization,peoplecanliveinharmonywiththeseotherwisedangerousmicrobes.Thechallengeistodevelopmethodsthatwillenablehumanstoliveinharmonywithotherdangerousmicroorganismsandinsectvectorsofdisease.Thisisamorecertainwaytoensurelong-termhealthforthepopulationthantheimpossiblegoalofattemptingtoexterminatetheseotherlifeforms.Pathogensthathavenootherhostthanhumanscansometimesbeeradicated,asthesmallpoxviruswas,andasthepolioviruscouldsoonbe,atleastregionallyifnotglobally;buteradicationisnotfeasiblewithmicroorganismsthatcansurviveout-sidehumanhosts.
HealthTheoriesandTheirPracticalApplication
Beliefsaboutthefoundationsofgoodhealthareinseparablefromtheoriesofdisease.Primitivebeliefsaboutgoodandevilspirits;thebenevolentormalevolentinterventionoffate,gods,orancestors;diseaseasapunishmentforsin(Murdock,1980);theoriessuchasthoseofAristotleandGalenaboutthebalanceofbodilyfluids(humors)andabouttheeffectsofmiasmasor"badair"surviveinthenamesbywhichweknowsomecommondiseases,includinginfluenza,malaria,cholera,andrheumatism.Apreferenceforholidayresortsandconvalescenthospitalsattheseasideorinthemountainsreflectsabeliefinthenotionthatsomeenvironmentsareinherentlyhealthierthanothers—as,indeed,abundantevidencedemonstrates.
Scientistscantracetheevolutionofmedicalscienceinthechangingnomenclatureofdisease.Somemoderndiagnosticlabelsindicateapreciseunderstandingofthecausalmechanismsofdisease—streptococalsepticemiais,literally,thepoisoningofthebloodbystreptococcusbacteria.Somethatsoundimpressive,suchasthrombocytopenicpurpura(bruisingassociatedwithadeficiencyofthrombocytes,orbloodplatelets)revealpartialknowledge:
scientistsknowwhatcausesthebleedingbutnotwhatcausesthedeficiencyofplatelets.Otherdiseasenamesaredeservedlyvague—essentialhypertensionconfessesoutignoranceaboutwhatactuallycauseshighbloodpressure.
Modernmedicineandpublichealthembraceseveraltheoriesthatareconfirmedbyabundantempiricalandexperimentalevidence,andmedicalprofessionalshaveanincreasinglybroadanddeepunderstandingofthewaysinwhichhealthofindividualsandpopulationscanbeimpaired,endangered,ofpermanentlylost.Scientistsknowthatmanydiseasesarecausedbyinvadingpathogenicmicroorganisms,whichareoftencommunicable.Somediseasesareduetoadisruptionorimbalanceamongendocrineglandsthatsecretehormonesneededtoensureefficientbodilyfunction,somearecausedbydietarydeficiencyofessentialvitaminsorminerals,andothersarecausedbyexposuretoharmfulchemicalsorphysicalinsultssuchasionizingradiationorexcessivenoise.Somediseasesaredueto,orstronglyassociatedwith,emotionalstress.Thereremainsaresidueofimportant,andsometimescommon,diseasesandcausesofdisabilityandprematuredeathforwhichthereisnoknowncause,althougheffectivetreatmentshavebeendevelopedforsomeoftheses,oftenthroughtrialanderrororguesswork.Highbloodpressureisonesuchdisease.
Theactivitiesofpublichealthservicesaimtominimizetheriskofseriousdeparturesfromgoodhealth.Thescopeandmethodsofmedicalandpublichealthpracticedemonstratethedepthandbreadthofcurrentunderstandingofthecausesofdisease,disability,andprematuredeath,andalsoofthecausesofgoodhealth.
Manywhoremainfitthroughoutalonglifetimeattributetheirgoodhealth(oftenincorrectly)totheirbehavior;whetheritbetoanasceticorhedonisticwayoflife,toabstainingfrom(orindulgingin)alcoholortobacco,tovigorousexercise,ortoleadingaquiet,sedentarylife.Somecredittheirparentsorgeneticheritage—certainlyanimportantdeterminantoflongevity—alongwithmanyenvironmentalandbehavioralfactors.Infact,thecausesofgoodhealthareasdiverseandcomplexasthecausesofdisease.
Evenliterate,well-educatedpeoplesometimeshavemisguidedviewsaboutwhatmakesorkeepsthemhealthy,oftenbelievingthatregulardailyexercise,regularbowelmovements,oraspecificdietaryregimewillalonesufficetopreservetheirgoodhealth.TheNobellaureateLinusPaulingbelievedthatmassivedailydosesofVitaminCpreservedhishealth.Thosewhoarelesswelleducatedandmoregullibleareeasypreytohucksterswhopurveyallmannerofdubiousnostrumstoprolonglife,enhancevitalityorvirility,promotefitness,andeliminateailmentsrangingfromhalitosisandbodyodortofailingsexualpotencyandevencancerandheartdisease.
ModernapproachestohealtheducationandhealthpromotionmakeuseoftheHealthBeliefModelalongwithseveralothertheoreticalconstructstopredicthealth-relatedbehavior.Thesearebasedonassumptionsderivedfromempiricalstudiesofhowpeopleperceivetheirhealthandtheirunderstandingofwhathastobedonetopreserveandprotecttheirownhealth,orthatoftheirchildren.
ObjectiveandSubjectivePerceptionsofHealth
Awell-trainedphysician,oranobservantmemberofafamily,canoftentellataglancethatsomeoneisunwell.Thereareobvioussigns—pallor,sweating,unsteadygait,abone-shakingcough.Theconverseismorechallenging.Someonewhoappears
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