The Essentials
What is health? And how do you define it?
What do we actually mean by health, and how do you define or categorize it? Some might say it means being able to move and having no pain, while others might say it means being able to do your job.
Health means something different to everyone, so in a way, all these answers are right. The concept of health is multifaceted, variable, and individually unique to you and everyone else.
Science has attempted to categorize and standardize these views using various biopsychosocial models.
In the late 1980s, Wimmers & de Vries introduced the MDBB model (multidimensional load-capacity model or action model according to Wimmers & de Vries). In this approach, load and load-bearing capacity were viewed not just medically and biologically, but also from a biological-psychosocial perspective. This model assumes that your organism can adapt: the biological ability to match your capacity to the demands placed upon you!
Another model that is internationally recognized and widely used today—including in Physiotherapy—is the ICF, developed over several years by the World Health Organization (WHO) and introduced in 2001. The abbreviation stands for International Classification of Functioning, Disability and Health.
The biopsychosocial model, which was present in basic forms within the ICIDH (International Classification of Impairments, Disabilities and Handicaps, the predecessor of the ICF), was significantly expanded with the ICF to better reflect real life. In particular, it now seeks to take your entire life background into account.
Definition of Functioning According to the ICF
The concept of human functioning encompasses all aspects of functional health. You are considered functionally healthy if:
your body functions (including mental functions) and body structures correspond to those of a healthy person (concept of body functions and structures),
you do, or can do, everything expected of a person without a health problem (ICD) (concept of activities),
you can lead your life in all areas that matter to you, in the manner and to the extent expected of someone without health-related impairments to body functions, structures, or activities (concept of participation in life situations).
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 what makes up health, whereas "consequences" focus on the impacts of diseases or other health problems that can result from them.
Scope of the ICF
The ICF provides a description of situations regarding human functioning and its restrictions, serving as an organizational framework for this information.
Within the ICF, information is divided into two parts. One part deals with functioning and disability, while the other covers contextual factors. Each part has two components:
1. Components of Functioning and Disability
The body component consists of two classifications: one for functions of body systems and one for body structures. The chapters of both classifications are organized by body systems.
The component of activities and participation covers the full range of domains describing aspects of functioning from 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 your immediate environment to the general environment.
Personal factors are also a component of contextual factors. However, due to the large sociocultural differences associated with them, they are not classified in the ICF.
Overview of ICF Components
In connection with 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, such as 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 an individual.
Participation: Is your involvement in a life situation.
Activity limitations: Are difficulties you may experience in executing an activity.
Participation restrictions: Are problems you may experience in involvement in life situations.
Environmental factors: Represent the physical, social, and attitudinal environment in which you live and conduct your life.
These last two factors classify the opportunity to be involved in a life situation and describe restrictions in specific areas of life, such as your mobility or independence.
Alongside physical factors, there are contextual environmental and personal factors, all of which influence and interact with one another.
Environmental factors describe individual restrictions at work, school, or in the home environment on the one hand, and societal supports, laws, and cultural attitudes on the other.
Personal factors are not explicitly 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 separate sections designed to be used in parallel. For example, body functions encompass basic human senses like "visual functions," while their structural correlates are "the eye and related structures."
This biopsychosocial model uses these categories to capture and describe health as a whole.
In doing so, it aims not only to show deficits, but also to describe the resources that are important to you as an individual.
It is not simply about measuring illness, but rather about describing limitations within your personal context.
Because of these varying backgrounds and factors, every person experiences the same Conditions differently. An Achilles tendon issue has a different meaning for an active athlete than for someone less active (take a look at our Pain – An Introduction blog).
The ICF can be used as a tool to objectively understand your unique clinical picture.
A quick overview of a mapped-out clinical picture enables multidisciplinary care and helps us in practice develop a better treatment strategy for you, understanding your personal goals and expectations more clearly.
Because no two illnesses are alike. Remember that impairments are not the same as the underlying pathology; they are a manifestation of it—and what matters most is how you manage it.
You can learn more about this on our page about chronic pain.
Whenever you need us, we are here for you!
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Featured Image Credit
Henry Vandyke Carter creator QS:P170,Q955620 Henry Gray creator QS:P170,Q40319, Gray501, marked as public domain, details on Wikimedia Commons
