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Health, and the factors which influence health.
The mind and body are no longer seen by the medical professional as existing independently of each other. The shift from what was known as a bio-medical notion of health has now been overtaken through the embrace of the biopsychosocial model by the healthcare system and its practitioners. Such a theoretical framework views both illness and health as the complex interaction between biological, psychological and social domains, in determining ones health (Ogden, 2004). The model thus holds a number of propositions in regards to health and illness. Firstly, that illness is multi-causal in its initiation - a number of factors may work together in order for illness to result (Coolican, 1999) The interaction of the individual's social world such as relationships, spirituality and socio-economic status (financial resources and position within the community) are also involved in the health process and this is seen at a macro-level of process (e.g. available social support) which then interacts with more micro-level processes (biological factors such as chemical imbalances in the body) to result in subsequent health or illness.
In regards to nursing specifically, amongst health practitioners, traditionally attention has been focused on meeting patients physical and mental health needs but with substantial evidence pointing to the combination and interaction of macro and micro level processes on our health and in the cause of illness, this means that nurses need to understand health from a more holistic approach. A holistic approach in regards to health can be explained and defined by "the need to consider the person as a whole if one is to fully understand his or her health status," (Coolican, 1999: p171) and therefore in regards to ill-health, nurses are thus required to understand the illness of the individual under their care, from the perspective of the patients actual life-situation.
A large body of literature has proven that a number of factors and variables impact upon health status (current state of health) and health outcome (long-term health and well-being), and these will now be discussed with examples from each of the three domains; biology, psychology and the social context. For the purposes of this essay, health will be viewed as a spectrum with well-being on one pole, and illness on the other.
One of the major categories within the biological domain of factors that can influence health status is our genetic make-up – and more specifically the case of genetic disorders which predispose individuals to various conditions that can be damaging to health if not fatal Genetic disorders have been found to exist for the majority of the bodies systems, and are wide ranging in the numbers of individuals they affect, and the degree to which the compromise health. Examples of such conditions include Blood and Lymph system disorders such as Sickle Cell Anemia (SCA) which through an abnormality of the blood's hemoglobin shape can cause pain, chronic anemia and increased experience of severe infections. Genetic disorders can also involve a predisposition to some cancers; breast cancer has an especially high incidence of running in families, with genetic predisposition thought to account for up to 10% of breast cancer cases in the West. (McPherson, Steel & Dixon, 2000)
Psychological factors have also been well-documented as contributing to health, both through the way in which our beliefs about the causes of health can affect behavior such as what we attribute illness to (and so influences our choice of course of action), and through our lifestyle choices and the impact these can exert on heath status. Lifestyle factors that we choose to engage in, or that are the result of coping strategies we employ, can be positive or negative in their effect. Increased engagement in consumption of alcohol or fatty foods or smoking behavior can lead to an increased risk of Coronary heart disease (Bhopal et al, 1999) with obesity linked to a two-fold increase in the risk of breast cancer in women (McPherson, Steel & Dixon, 2000) However choosing a lifestyle of exercise and moderation in regards to food and drink will have a positive effect by lowering obesity and hence predisposition to conditions such as CHD and cancer. People have also been found to differ in the types of causes they attribute illness to, and also linked with this, they amount of control they have over their own health. The Health Locus of Control Model (Wallston & Wallston, 1982) demonstrates how people can have what is called an internal or external health locus of control; individuals with an external locus of control see their health status as resulting from chance or under the control of others, and subsequently see their own role as minimal and believe they are not in a position to make any changes to their health. As a result these individuals tend not to be able to make behavioural changes to their lifestyle which may be affecting their health without significant help. Conversely, individuals with an internal locus of control see their health status as resulting from their own actions, and are therefore may be in a stronger psychological position to initiate changes in their behavior and lifestyle in order to improve their health. This type of person can however be affected by feelings of guilt and anger through attributing illnesses to their own actions, and therefore there are a number of implications for the way in which health professional's need to deal with both types of individual in relation to their illnesses and associated treatment programs .
Socially, health has been found to be affected through standards of housing, and employment status, which can be seen to fall under the general category of the relevance of income. One finding from a large scale study of the impact of standards of housing on health found that adults currently living in a good standard of housing were more likely to be ill if they experienced adverse housing conditions earlier in life – thus the effect on health can be long term and demonstrates the need to tackle housing problems to improve health as early as possible, and that housing may be particularly important to health during childhood. (Nettleton, 2000) Employment status in the form of unemployment has also been found to have the potential to exert a negative impact on health, with one study demonstrating that unemployed workers (from an originally employed sample) showed a substantial increase in long-standing illness and visited their GP's on more occasions than those who were not made unemployed in the study sample. (Ferrie et al, 2001)
In conclusion, evidence that such a wide ranging and diverse base of factors have the potential to influence health, ensures the need for those involved in the care of others (nurses) to practice from a holistic approach in order to ensure that all patient's needs are met. An understanding and appreciation by nurses of the complex interplay of the factors that impact health, mean that they will be in a better position to aid in the treating and healing of their patients holistically, which gives the individuals under their care the greatest potential for achieving a successful health outcome.
Bhopal, R. Unwin, N. White, M. Yallop, J. Walker, L. Alberti, K. Harland, J. Patel, S. Ahmed, N. Turnet, C, Watson, B. Kaur. D. Kulkarni, A. Laker, M. & Tavridou. (1999) 'Heterogeneity of coronary heart disease risk factors in Indian, Pakistani, Bangladeshi and European origin populations: Cross-sectional study' British Medical Journal
Coolican, H (1999) 'Applied psychology' Hodder & Stoughton
Ferrie, J. Martikainen, P. Sipley, M. Marmot, M. Stansfield, S & Davey-Smith, G (2001) 'Employment status and health after privatization in white collar civil servants:prospective cohort study' British Medical Journal
Lundeen, S (1999) 'An alternative paradigm for promoting health in communities: The Lundeen Community Nursing Center Model' Family Community Health Vol. 21 No. 4
McPherson, K. Steel, C & Dixon, J (2000) 'Breast cancer – epidemiology, risk factors, and genetics' British Medical Journal
Nettleton, S (2000) 'Home sweet home? The impact of poor housing on health' British Medical Journal
Ogden, J (2004) 'Health Psychology: A text book' Open University Press
Wallston & Wallston (1982). 'Who is responsible for your health? The construct of health locus of control.' cited in Sanders, G & Suls, J (Eds.), 'Social psychology of health and illness.' Hillsdale Erlbaum.