PAHS 423

PRINCIPLES OF HEALTHCARE
QUALITY ASSURANCE
STUDY GUIDE
Session 2 – Understanding ‘health’
Lecturer: Nana Nimo Appiah-Agyekum (PhD), UGBS
Contact Information: [email protected]

College of Education
School of Continuing and Distance Education
2014/2015 – 2016/2017
 Session Overview
This session focuses on providing students with a foundation
on the meaning of health. This is necessary to contextualize
quality within healthcare delivery. Aside going over the
definitions of health and the associated challenges, the
session also focuses on the measurement of health
At the end of the session, the student will
• Understand the inherent difficulty in arriving at a single
definition of health
• Explain the models that may be used to define health
• Become familiar with the indices for measuring health
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 Session Outline
The key topics to be covered in the session are as follows:
• Topic One : The definition of health
• Topic Two : Models for defining health 1
• Topic Three : Models for defining health 2
• Topic Four : The measurement of health

Slide 3
 Reading List
• Larson, J. S. (1999). The conceptualization of
health. Medical Care Research and Review, 56(2), 123-
136.
• Larson, J. S. (1991). The measurement of health:
Concepts and indicators (Vol. 31). Greenwood Publishing
Group. New York
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC161593
9/pdf/healthservrep00037-0022.pdf

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Topic One

THE DEFINITION OF HEALTH

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 The definitional problem
The definition of health is, at best, problematic because
• Health is very complex
• Health is continuously subject to change
• Health has many components (medical, social,
economic, spiritual, and many others)
• Its meaning depends on the discipline and methods
being used
• Its meaning depends on the historical period in question
• Its meaning depends on the society and culture in
which it is defined. Slide 6
 Scope of definitions of health
Health and how it is defined
• reflects the ideology and culture of the most
powerful or dominant groups in society
• covers both quantity (length) and quality of life
• covers the absence of illness, having strength and
robustness and high quality of life
• Consists of the absence of physical disability,
psychological disability, and pain
• is ever expanding to include more dimensions in
Slide 7
modern societies
 Arriving at a definition of health
• Generally, definitions are inconclusive and getting more
complex as societies evolve and develop
• The focus of health has shifted from the treatment of disease
and disability to positive well-being, mental health,
preventive medicine, health promotion, patient rights, and
environmental influences on health
• Rising expectations have changed the definition of health
from ‘survival’ to ‘freedom from disease’ to ‘ability to perform
daily activities’ to a ‘sense of happiness and wellbeing’
(McDowell & Newell, 2006)
• Consequently, no single definition is adequate and models
present a better means of defining health
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 Topic Two

MODELS FOR DEFINING HEALTH 1

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 Medical model
• Defines health as the absence of disease or disability
• Distinguishes between disease, illness, and health
(Wood, 1986)
• Measures health using mortality, morbidity and
disability statistics
• Classifies health into communicable/ non-
communicable, and chronic/ acute patterns
• It is however not sensitive to social health and
healthy interaction with others
• It also overlooks health promotion and prevention
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 Holistic model
• Idealistically defines health in the positive sense to
mean “wellbeing, efficiency and willingness to work”
(Pflanz & Keupp, 1977)
• Sees health in terms of a whole person – including
physical, mental and social aspects
• Focuses on the positive aspects of health and
wellbeing instead of the negative aspects of health
(disease and infirmity) in the medical model
• It differs slightly from the WHO model by including
other dimensions like spiritual health
• Its criticisms include its utopian and complicated ideals
Slide 11
 Wellnes model
• It aims at higher levels of health and wellness
• Sees health subjectively as a state of feeling or an
internal experience which people may enjoy or lack
• Defines health as strength and ability to overcome
illness, having a “reserve of health (Larson, 1999).
• It recognizes the important linkage between body,
mind and spirit and how these elements integrate to
ensure a total functioning of the individual
• Criticised for the difficulty in measuring subjective
feelings and
• Expanding the meaning of health to include
happiness, quality of life and other global matters
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 Topic Three

MODELS FOR DEFINING HEALTH 2

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 Environmental model
• health is related to stresses and interaction with the
environment (Basch 1978)
• The essence of the environmental model is individual
adaptation to the environment—physical, social, and other
environments
• Wylie (1970) defines health here as “the perfect continuing
adjustment of an organism to its environment”
• According to the environmental model, health is related to
the ability of an organism to maintain a balance with its
environment, with relative freedom from pain, disability, or
limitations, including social abilities
• criticised for being ambiguous, abstruse and difficult to
measure Slide 14
 WHO model
• It is a holistic approach drawn from the Constitution
of the WHO.
• sees the highest standard of health—physical, mental,
and social—as a fundamental right of all persons
(Basch 1990)
• Defines health as “a state of complete physical,
mental and social well-being and not merely the
absence of disease or infirmity”
• Remains the most popular and comprehensive
definition of health worldwide.
• Criticised for being utopian, lacking consensus on the
meaning of key terms involved, idealistic and
unmeasurable Slide 15
 Eclectic model
• A catchall category for all other definitions of health
that do not fit under any of the other models
• Most of the definitions here are unusual,
controversial and lacks broad concensus
• According to Dreitel for instance “health is
institutionally defined as the capacity to help
produce the very surplus the owners of the means
of production appropriate” (Larson, 1991)
• Presently, the eclectic model is repository for
unusual definitions of health which may be accepted
and seen as normal as definitions of health expand
over time
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 Topic Four

THE MEASUREMENT OF HEALTH

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 Challenges of measuring health
• To know the level of quality of health, we must first
be able to measure it and clearly see its full extents.
• However, the measurement of health is a complex
affair because it requires
 decisions to be made about the meaning of
health
 a choice among the various indicators of health
 decisions about the weighting of indicators in
forming an overall measurement of health
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 Why measure health
• To determine the level of quality of health and
healthcare
• determine the health status of individuals,
communities and general populations
• To lay the groundwork for future research into the
health status of populations and individuals
• To aid academicians and students of health
• To aid planners and health administrators in
determining health care needs
• To aid planners and administrators in the efficient
allocation of scarce health resources
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 Sources of information to measure
health
• Vital statistics
• Government publications
• Hospital data
• Private surveys
• Academic studies and researches
• Independent statistical agencies
• Other sources
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 Sample Question
• Looking at the definitions provided above,
which one do you think is applicable to Ghana
and why?
• How would you define health in your own
words?

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 References
• Basch, P. 1978. International Health. New York: Oxford University Press.
• Basch, P. 1990. Textbook of International Health. New York: Oxford University Press.
• Larson, J. S. (1991). The measurement of health: Concepts and indicators (Vol. 31).
Greenwood Publishing Group. New York
• Larson, J. S. (1999). The conceptualization of health. Medical Care Research and
Review, 56(2), 123-136.
• McDowell, I., & Newell, C. (2006). Measuring health: A guide to rating scales and
questionnaires. Oxford University press, New York
• Pflanz, M., & Keupp, H. (1977). A sociological perspective on concepts of
disease. International Social Science Journal, 29(3), 386-396.
• WHO (1948) Preamble to the Constitution of the World Health Organization as
adopted by the International Health Conference, New York, 19–22 June, 1946;
signed on 22 July 1946 by the representatives of 61 States (Official Records of the
World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.
Retrieved Dec. 11, 2017
• Wood, P. H. (1986). Health and disease and its importance for models relevant to
health research. Scientific approaches to health and health care, 57-70.
• Wylie, C. M. (1970). The definition and measurement of health and disease. Public
health reports, 85(2), 100. Slide 22