What is health? And how do you define it?
October 13, 2018
What is understood by health, and how is it defined or categorized? Some might say it's the ability to move without pain, while others might say it's being able to perform one's job.
For each person, health has a different meaning, and thus, all these answers are, in a way, correct. The term health is diverse, variable, and different for each individual.
Science has attempted to categorize and standardize these views through various bio-psycho-social models.
In the late 1980s, Wimmers & de Vries introduced the MDBB model (Multidimensional Load-Tolerance Model or Action Model by Wimmers & de Vries). This model viewed load-tolerance not only from a medical-biological perspective but also from a biological-psychosocial perspective. It posits that the human organism can adapt: the biological ability to adjust tolerance to load!
Another model, which is now internationally recognized and used in physiotherapy, is the World Health Organization (WHO)'s ICF, which was developed over several years and introduced in 2001. The abbreviation stands for International Classification of Functioning, Disability and Health.
The bio-psycho-social model, which was a part of the ICIDH (International Classification of Impairments, Disabilities, and Handicaps, the predecessor of the ICF), was significantly expanded with the ICF and thus better adapted to the real-life situation of those affected. Specifically, there is an attempt to consider the entire life context of the affected persons.
Definition of Functioning According to the ICF
The term functioning of a person encompasses all aspects of functional health. A person is functionally healthy when:
their bodily functions (including mental functions) and body structures correspond to those of a healthy person (concept of body functions and structures),
they do or can do everything expected from a person without a health problem (ICD) (concept of activities),
they can unfold their existence in all life areas that are important to them in the manner and scope expected from a person without health-related impairments of body functions and structures or activities (concept of participation in life areas).
The ICF has thus evolved from a classification of 'disease consequences' in the ICIDH to a classification of 'health components'.
Health components describe the aspects of health, while 'consequences' guide the impacts of diseases or other health problems that may arise from them as a result.
Scope of Application of the ICF
The ICF provides a description of situations regarding human functioning and its impairments and serves as a framework for organizing this information.
Information in the ICF is divided into two parts. One part deals with functioning and disability, while the other encompasses contextual factors. Each part has two components:
1. Components of Functioning and Disability
The body component consists of two classifications, one for the functions of body systems and one for body structures. The chapters of both classifications are structured according to body systems.
The component of activities and participation covers the full range of domains that describe aspects of functioning from both an individual and societal perspective.
2. Components and Contextual Factors
The first component of contextual factors is a list of environmental factors. These environmental factors influence all components of functioning and disability and are arranged in order from the most immediate environment of the individual to the general environment.
Personal factors are also a component of the contextual factors. However, due to their significant socio-cultural diversity, they are not classified in the ICF.
Overview of the Components of the ICF
In relation to health, the following definitions apply:
Body Functions: Are the physiological functions of body systems (including psychological functions).
Body Structures: Are anatomical parts of the body, like organs, limbs, and their components.
Impairments: Are problems in body function or structure, such as a significant deviation or loss.
Activity: Refers to the execution of a task or action by a person.
Participation: Is the involvement in a life situation.
Activity Limitation: Are difficulties an individual may experience in executing activities.
Participation Restriction: Are problems an individual may experience in involvement in life situations.
Environmental Factors: Represent the physical, social, and attitudinal environment in which people live and conduct their lives.
The last two factors thus classify the ability to be engaged in a life situation and describe limitations in individual life domains, such as mobility or independence.
Besides physical factors, there are also contextual environmental and personal factors, all of which influence one another and interact with each other.
Environmental factors describe individual limitations at the workplace, school, or in the home environment, as well as societal assistance, laws, and worldviews.
Personal factors are not precisely defined but are considered in many other elements.
→ The ICF has two parts, each with two components:
Part 1: Functioning and Disability
Body Functions and Structures
Activities and Participation
Part 2: Contextual Factors
Environmental Factors
Personal Factors
Each component can be expressed in positive or negative terms!
Body functions and body structures are classified in two different sections. Both classifications are designed for parallel use. Body functions, for instance, include the fundamental human senses such as 'visual functions'. Their structural correlates are 'the eye and related structures'.
This biopsychosocial model aims to portray and describe health holistically through the mentioned categories.
It seeks not only to depict deficits but also to describe the resources that are important to the individual.
It's not about measuring the disease, but rather describing limitations within the individual context.
Due to these varied backgrounds and factors, everyone experiences the same symptoms differently. An Achilles tendon problem means something different to a physically active individual compared to a less active one (see also our blog on pain – an introduction).
The ICF can be used as a tool for objectifying a personally unique clinical picture.
A quick look at a created clinical picture allows for multidisciplinary work and also helps us in practice to develop a better treatment strategy, understanding each individual’s goals and expectations better.
For illness is not the same for everyone. Remember, impairments are not the same as the underlying pathology, but rather a manifestation of it – and how you handle it matters.
When you need us, we are here for you!
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Image Credit
Henry Vandyke Carter creator QS:P170,Q955620 Henry Gray creator QS:P170,Q40319, Gray501, marked as public domain, details at Wikimedia Commons
