The Essentials
What is health? And how do you define it?
How do we understand health, and how do we define or categorize it? Some might say it is the ability to move without pain, while others believe it is being able to pursue their work.
Health has a different meaning for everyone, which is why all of these answers are correct in their own way. The concept of health is diverse, variable, and uniquely individual for every person.
Science has attempted to categorize and standardize these perspectives through various bio-psycho-social models.
At the end of 1980, Wimmers & de Vries introduced the MDBB model (Multidimensional Stress-Resilience Model or Action Model after Wimmers & de Vries). This model viewed stress and resilience not only from a medical-biological perspective but also through a biological-psychosocial lens. It assumes that the human organism has the power to adapt: the biological ability to align resilience directly with stress!
Another model, internationally recognized and widely used today – including in physical therapy – is the World Health Organization (WHO)'s ICF, developed over several years and launched in 2001. The abbreviation stands for International Classification of Functioning, Disability and Health.
The bio-psycho-social model, which was present in early forms within the ICIDH (International Classification of Impairments, Disabilities, and Handicaps, the predecessor of the ICF), was significantly expanded with the ICF to better align with the reality of those affected. In particular, it now strives to take the entire life background of the individual into account.
Definition of Functioning according to the ICF
The concept of a person's functioning encompasses all aspects of functional health. A person is functionally healthy when:
their body functions (including mental aspects) and body structures correspond to those of a healthy person (concept of body functions and structures),
they do or can do everything expected of a person without a health condition (ICD) (concept of activities),
they can experience and live their life in all areas that matter to them, in the manner and to the extent expected of a person without health-related impairments of body functions, structures, or activities (concept of participation in life areas).
The ICF has thus evolved from a classification of "consequences of disease" under the ICIDH to a classification of "components of health."
Components of health identify the elements of health, while "consequences" focus on the impacts of diseases or other health conditions that may result from them.
Scope of the ICF
The ICF provides a description of situations regarding human functioning and its limitations, serving as an organizational framework for this information.
In the ICF, information is structured 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 organized by body systems.
The activities and participation component covers the full range of domains describing aspects of functioning from individual and societal perspectives.
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, ordered from the individual's immediate environment to the general environment.
Personal factors are also a component of the contextual factors. However, due to the vast socio-cultural differences associated with them, they are not classified in the ICF.
Overview of the ICF Components
In the context of health, the following definitions apply:
Body functions: The physiological functions of body systems (including psychological functions).
Body structures: Anatomical parts of the body, such as organs, limbs, and their components.
Impairments: Problems in body function or structure, such as a significant deviation or loss.
Activity: The execution of a task or action by an individual.
Participation: Involvement in a life situation.
Activity limitations: Difficulties an individual may encounter in executing activities.
Participation restrictions: Problems an individual may experience in involvement in life situations.
Environmental factors: Make up the physical, social, and attitudinal environment in which people live and conduct their lives.
The last two factors classify the opportunity to be involved in a life situation and describe the limitations in specific areas of life, such as mobility or independence.
In addition to physical factors, there are contextual environmental and personal factors, all of which influence and interact with one another.
Environmental factors describe, on one hand, individual barriers in the workplace, school, or home environment. On the other hand, they describe societal supports, laws, and worldviews.
Personal factors are not defined in detail, but they are taken into account across 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, designed for parallel use. Body functions, for example, include basic human senses like "visual functions." Their structural correlates are "The eye and related structures."
This biopsychosocial model attempts to capture and describe the holistic nature of health through these categories.
In doing so, it strives not just to highlight deficits, but also to describe the resources that are important to each individual.
It is not about measuring the disease, but rather about describing limitations within a highly individual context.
Because of these varying backgrounds and factors, every person experiences the same symptoms differently. An Achilles tendon issue has a completely different impact on an active athlete than on someone who is less active (see also our Blog on Pain – An Introduction).
The ICF can be used as a tool to objectify a personally unique clinical picture.
A quick look at a mapped-out clinical picture enables multidisciplinary collaboration and helps us in practice to design a better treatment strategy, truly understanding the goals and expectations of each individual.
Because no two illnesses are the same. We should remember that impairments are not the same as the underlying pathology, but are manifestations of it – and how you manage it is what truly matters.
When you need us, we are here for you!
Your BodyLab Team, your contact point for physical complaints
Osteopathy and Physical Therapy | Rehabilitation and Training
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Cover Image Credit
Henry Vandyke Carter creator QS:P170,Q955620 Henry Gray creator QS:P170,Q40319, Gray501, marked as public domain, details on Wikimedia Commons
