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the absences of disease or infirmity.” Approaches to health Medical model – focuses on absence of disease. Assumptions: a. b. c. d. there must be observable, objective signs of disease only physicians can diagnose disease. It is solely a physiological phenomenon. It is appropriate to focus on nonhealth as opposed to health.
Critics: Too mechanistic, treat patients like machines. Doctors cannot and should not try to diagnose or treat unobservable conditions – cannot be identified/tested. Excludes how patient feels. Sociocultural model – focuses on the capacity to functions socially (patient in the center) a. Social performance and functioning are primary importance. b. Health is relative depending on one’s role and its requirements c. Nonperformance of one’s role is deviant; therefore, being unhealthy is deviant (and socially sanctionable or punishable). Critics: people with chronically disease but socially active is healthy. Doctors define a set of conditions as healthy and not other set. Those who claim to be sick but not recognized as sick are subjected to social disapproval and sanction. Disregard the presence or absence of disease (focus on how the patient act). Stress model – focuses on a general feelings of well-being. (The importance of feeling is central to this approach). a. Well-being depends on the situational context, which can only be determined by an individual’s own view of the situation; that is ultimately establishes whether the person experiences stress and whether that experience will have detrimental health effects. Critics: Measure not well developed to measure stress level - not objective. No single instrument to measure feeling. Nothing like blood test. Focuses on the whole person, but does not point out who is sick and what kinds of treatments are needed. Morbidity and Mortality – the non-health indicators. Measure these to understand health. Non-health are easier to measure.
Mortality – usually measured with death certificate. Morbidity – nonhealth side of the coin that raises all the same issues that we encountered in trying to define health. Count person with disease, but what do you do with those who do not know they have a disease, or those who deny the disease (e.g., HIV/AIDS) Self-assessed health – use more often now than before. Life expectancy – indicator of health of large group of people. Years of Potential Life Lost (YPLL) – sum of number of years “lost” when people die before a given year, and it reflects the expected life span for the whole population or specific portion of a population. YPLL is calculated as the difference between the actual age of death and some specific, expected age of death, for example, seventy-five. The number of years lost by whole categories of people is summed to capture the impact of premature death on specific populations. Infant mortality – “how well a society cares for its most vulnerable member is generally regarded as the best indicator of a society’s ability to care for all of its members” (25). Data – mortality – death certificate Morbidity – Method 1: Health Records Survey - initiated in 1962. Records of hospital visits. Problems with this data: not representative of general pop. Method 2: National Health and Nutritional Examination Survey (NHANES) (formerly the Health Examination Survey established in 1961) – Three repots: NHANES I, II, and III – covering 1971-1974, 1976-1980, and 1988-1994. Method 3: The National Health Interview Survey (NHIS) – established in 1957 and redesigned in 1997. Collects info on all household members in the population in the “family core” portion. In another section, the “child core” portion, an adult reports info on a randomly selected child under 18. Collects data on health conditions, health related behaviors, and health seeking experiences. Health care coverage (insurance) and weather respondents have had difficulty getting care. These two questions address the family’s level of access to care.
John snow – contaminated water source of cholera in London in 18th century.