Promoting Wellness in Health and Illness 1. Defining wellness in health and illness a. definitions of health i.

"Health is a state of complete physical, mental, and social well-being and not merely the absence of disease" (WHO, 1947, p. 1) ii. complete is controversial iii. "Health is not a condition, it is an adjustment. It is not a state, but a process. The process adapts the individual not only to our physical, but also our social, environments" (Presidents Commission, 1953, most individuals define health as the following: a. being able to be active and able to do what they want or must do b. being free of symptoms of disease and pain as much as possible c. being in good spirits most of the time b. definition of wellness i. an active process by which an individual progresses towards maximum potential possible, regardless of current state of health ii. five dimensions of wellness: a. physical, e.g.: 1. ability to carry out daily tasks 2. achieve fitness 3. maintain nutrition and proper body fat 4. avoid abusing drugs, alcohol, or using tobacco products 5. generally to practice positive life-style habits b. sociocultural, e.g.: 1. ability to interact successfully with people and within the environment of which each person is a part 2. develop and maintain intimacy with significant others 3. develop respect and tolerance for those with different opinions and beliefs c. emotional, e.g.: 1. ability to manage stress and express emotions appropriately 2. ability to recognize, accept, and express feelings 3. ability to accept ones limitations d. intellectual, e.g.: 1. ability to learn and use information effectively for personal, family, and career development 2. striving for continued growth and learning to deal with new challenges effectively e. spiritual, e.g.: 1. belief in some force (nature, science, religion, or a "higher power") that serves to unite human beings and provide meaning and purpose to life 2. includes a persons morals, values, and ethics f. environmental 1. c. definition of disease i. pathologic change in the structure or function of the body or mind d. definition of illness i. the response a person has to a disease; it is an abnormal process in which the persons level of functioning is changed compared with a previous level ii. influenced by the following: a. self-perceptions b. others perceptions c. the effects of changes in body structure and function d. the effects of those changes on roles and relationships e. cultural and spiritual values and beliefs 2. Models of health and illness a. Smiths models of health and illness i. clinical model a. narrowest interpretation; medically-oriented model 1. health is seen as freedom from disease 2. illness is seen as the presence of disease ii. role performance model a. ability to perform work, that is fulfill societal roles, essential to the model; assumption of the model is that a persons most important role is their work role 1. health is seen as the ability to fulfill societal roles

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2. illness is seen as the inability to fulfill societal roles iii. adaptive model a. ability to adapt to the environment and interact with it to maximum advantage essential to the model 1. health is seen as adaptation 2. illness is seen as a failure of adaptation, or maladaptation iv. eudaemonistic model a. most comprehensive, holistic, view of health; ability to become self-actualized essential to the model 1. health is actualization or realization of ones potential 2. illness is seen as the failure to actualize or realize ones potential Leavell and Clarks ecologic model (agent-host-environment model) i. used primarily in predicting illness rather than promoting wellness ii. model is composed of three dynamic, interactive elements a. the agent 1. a factor (biologic, chemical, physical, mechanical, psychosocial) that must be present or absent for an illness to occur, e.g.: a. presence of the legionella bacillus b. the host 1. living beings (e.g., human or animal) capable of being infected or affected by the agent, e.g.: a. a Legionnaire at the Legionnaires Conference at the Bellevue-Stratford Hotel in Philadelphia c. environment 1. everything external to the host that makes illness more or less likely, e.g.: a. presence of stagnant water in the air conditioning system at the Bellevue-Stratford Hotel in Philadelphia iii. view of health and illness a. health is seen when all three elements are in balance b. illness is seen when one, two, or all three elements are not in balance Health-illness continua Dunns High-Level Wellness Grid i. composed of two axiss a. a health axes which ranges from peak wellness to death b. a environmental axes which ranges from very favorable to very unfavorable ii. the two axiss form four quadrants a. high-level wellness in a favorable environment 1. e.g., a person who implements healthy life-style behaviors and has the biopsychosocialspiritual resources to support this life-style b. emergent high-level wellness in an unfavorable environment 1. e.g., a woman who has the knowledge to implement healthy life-style practices but does not implement adequate self-care practices because of family responsibilities, job demands, or other factors c. protected poor health in a favorable environment 1. e.g., an ill person whose needs are met by the health care system and who has access to appropriate medications, diet, and health care instruction d. poor health in an unfavorable environment 1. e.g., a young child who is starving in a drought ridden country Travis Illness-Wellness Continuum i. composed of two arrows pointing in opposite directions and joined at a neutral point a. movement to the right on the arrows (towards high-level wellness) equals an increasing level of health and well-being 1. achieved in three steps: a. awareness b. education c. growth b. movement to the left on the arrows (towards premature death) equates a progressively decreasing state of health 1. achieved in three steps: a. signs b. symptoms c. disability

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5. a. a. b. c. d. b. a.

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d. 2. a. b.

ii. most important is the direction the individual is facing on the pathway a. if towards high-level health, a person has a genuinely optimistic or positive outlook despite his/her health status b. if towards premature death, a person has a genuinely pessimistic or negative outlook about his/her health status iii. compares a treatment model with a wellness model a. if a treatment model is used, an individual can move right only to the neutral point 1. e.g., a hypertensive client who only takes his medications without making any other life-style changes b. if a wellness model is used, an individual can move right past the neutral point 1. e.g., a hypertensive client who not only takes his medications, but stops smoking, looses weight, starts an exercise program, etc. Rosenstock/Beckers Health-Belief Model based on motivational theory composed of three components: i. an individuals perceptions, e.g.: a. of perceived susceptibility b. of perceived seriousness ii. modifying factors (factors that modify an individuals perceptions), e.g.: a. demographic variables 1. e.g., age, gender, race, ethnicity, etc. b. sociopsychologic variables 1. e.g., personality, social class, peer and reference group pressure, etc. c. structural variables 1. e.g., knowledge about the disease, prior contact with the disease, etc. d. perceived threat e. cues to action 1. e.g., mass media campaigns, advice from others, reminder postcard from a physician or dentist, illness of family member or friend, newspaper or magazine article iii. likelihood of action a. perceived benefits of the action MINUS b. perceived barriers to action EQUALS c. likelihood of taking recommended preventive health action Variables influencing health status, belief, and practices Physical genetic makeup age developmental age race gender Emotional Mind-body interaction Intellectual i. Cognitive abilities ii. Educational background iii. Past experiences Environmental i. Housing ii. Sanitation iii. Climate iv. Pollution of air, food, water Sociocultural i. Economic levels ii. Lifestyle iii. Family iv. Culture Spiritual i. Spiritual and religious beliefs and values Illness the response a person has to a disease; it is an abnormal process in which the person's level of functioning is changed compared with a preveious level types of illness

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i. acute illness a. has a rapid onset of symptoms that lasts for a limited and relatively short period of time 1. e.g., typically less than six months ii. chronic illness a. has a gradual onset of symptoms that lasts for an extended and relatively long period of time 1. e.g., typically six months or longer b. characterized by periods of remission and exacerbation 1. remission a. symptoms disappear 2. exacerbation a. symptoms reappear Igun's eleven stages of health seeking i. stage one (symptom experience) a. the person experiences symptoms and realizes there is a problem b. the person often gives meaning to the symptoms and labels them, responds emotionally to the symptoms ii. stage two (self-treatment or self-medication) a. the person begins self treatment b. if the person believes the symptoms are serious, he/she moves to the next stage iii. stage three (communication to others) a. the person communicates symptoms to significant others or a health professional iv. stage four (assessment of symptoms) a. the person assesses the symptoms to determine legitimacy and make tentative diagnosis v. stage five (sick-role assumption) a. the person assumes the sick-role, e.g.: 1. the person is not held responsible for his/her condition 2. the person is excused from certain social roles and tasks 3. the person is obligated to try to get well as quickly as possible 4. the person or his/her family are obligated to seek competent help vi. stage six (concern) a. the persons significant other(s) offer concern and support vii. stage seven (efficacy of treatment) a. the person assesses various treatments and sources of treatment viii. stage eight (selection of treatment) a. the person assesses various treatments and costs b. the person may defer to health professionals advice ix. stage nine (treatment) a. the person implements the treatment plan x. stage ten (assessment of effectiveness of treatment) a. the person assesses if treatment not effective b. the person may return to earlier stage xi. stage eleven (recovery and rehabilitation) a. the person returns to earlier health status before illness or experiences temporary or permanent disability Definition of disease pathologic change in the structure or function of the body or mind Health promotion and wellness health promotion is any activity undertaken for the purpose of achieving a higher level of health and well-being types of health promotion programs i. information dissemination a. health promotion programs that use a variety of media to offer information to the public about the risk or particular lifestyle choices and personal behavior, as well as the benefits of changing that behavior and improving the quality of life 1. e.g., billboards, posters, brochures, newspaper features, books, health fairs ii. health risk appraisal/wellness assessment programs a. health promotion programs that appraise individuals of the risk factors inherent in their lifestyles in order to motivate them to reduce specific risks factors and develop positive health habits 1. e.g., tools such as Health-Style: A Self-Test iii. lifestyle and behavioral change programs

health promotion programs geared toward enhancing the quality of life and extending the lifespan through implementation of a healthy lifestyle or behavioral change in the individual ii. environmental control programs i. health promotion programs developed in response to the recent growth in the number of contaminants of human origin that have been introduced into our environment 2. Healthy People 2010 a. three goals i. help individuals of all ages increase life expectancy and improve the quality of life a. particularly African-Americans 1. currently life expectancy is 74.9 years for European-Americans and 68 years for AfricanAmericans ii. eliminate health disparities among different segments of the population a. particularly African-Americans 1. currently, years of healthy life is 63 years for European-Americans and 62 years for Hispanics, and 56 years for African-Americans b. focus areas of healthy people 2010 a. access to quality health services b. arthritis, osteoporosis, and chronic back conditions c. cancer d. chronic kidney disease e. diabetes f. disability and secondary conditions g. educational and community-based programs h. environmental health i. family planning j. food safety k. health communication l. heart disease and stroke m. HIV n. immunzation and infectious disease o. injury and violence prevention p. maternal, infant, and child health q. medical product safety r. mental health and mental disorders s. nutrition and oveweight t. occupational safety and health u. oral health v. physical activity and fitness w. public health infrastructure x. respiratory diseases y. sexually transmitted diseases z. substance abuse aa. tocacco use bb. vision and hearing

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