CHAPTER 2
PREDOMINANTAMERICAN BELIEFS RELATED TO HEALTH CARE
1. Belief in science and technology as panaceas
3. Belief in individualism—responsibility for one’s own economic well-being
CONSEQUENCES FOR THE HEALTHCARE DELIVERY SYSTEM
1. Emphasis on disease rather than health (medical model)
Influence of the medical model:
• It has established the supremacy of curative medicine over the health promotion/disease
2. Private delivery of health care in which the government plays a lesser role
3. Achievement of health through personal means
• Privately financed health insurance that is mainly employment-based
• Publicly financed health insurance for the less fortunate (Medicaid and Medicare)
PERSPECTIVES ON HEALTH
• The physical view—essence of the medical model. Absence of disease. Focuses on diagnosis
and relief of symptoms.
• The social model—incorporates the physical and social elements of health. A person’s ability
to perform the expected social roles (attending school, doing housework, going to work) is
interpreted as health. Seeking medical help is recommended when a person is physically unable
CONCEPTS RELATED TO HEALTH
Illness and disease—recognized in reference to symptoms and discomfort
• Illness—self-perceived
• Disease—based on professional evaluation
Risk factor—an attribute that increases the likelihood (probability) that people would develop a
disease or a negative health condition. A risk factor may or may not cause disease; it merely
1. An understanding of the health consequences of risk factors associated with host, agent, or
environment.
• Host—person exposed to the agent and at risk of developing a disease; genetic makeup,
2. Appropriate interventions (behavior modification and therapeutic interventions) to counteract
key risk factors.
• Behavior modification is achieved by means of:
• Education
3. Public health—application of existing scientific knowledge regarding health and disease to
ensure conditions that will have the maximum positive impact on the health status of a
population; quality of life; overall satisfaction with life during (processes) and following
(outcomes) a person’s encounter with the healthcare system.
• Process—comfort, security, independence, autonomy
DETERMINANTS OF HEALTH: BLUM’S MODEL
In order of importance:
• Environment—physical, social, cultural, and economic factors
• Lifestyle—behaviors, attitudes toward health
• Heredity—current health and lifestyle practices are likely to impact future generations
• Medical care—healthcare delivery system (access, availability of services)
• WHO Commission on Social Determinants of Health Framework (see Figure 2-4)
MEASURES OF HEALTH STATUS
• Physical health (longevity, morbidity, disability, mortality, demographic change)
• Mental health
• Social health
EQUITABLE DISTRIBUTION (AVAILABILITY) OF HEALTH CARE
Distributive justice: a key concept related to access
• US—demand-side rationing (price rationing). Uninsured do not have access.
• National healthcare programs—supply-side rationing (planned rationing). Services are not
always available when needed.
Concepts of justice: United States—market justice
• Social justice becomes unavoidable when dealing with human problems:
Housing—subsidized public housing, shelters
Transportation—public transit systems
Education—public schools
Health care—program for underprivileged populations (Medicare, Medicaid, Indian Health
Service, Veterans)
COMMUNITY HEALTH
• Goal—to keep populations healthy by addressing a variety of issues related to the environment,
lifestyles, heredity (futuristic), and medical care. For medical care, it would require universal
ACA Takeaway
• Prevention and wellness are major components of the ACA, which requires health plans to cover
recommended preventive services without cost sharing.
TERMINOLOGY
• Activities of daily living (ADLs)—Measure a person’s ability to function independently,
especially in reference to one’s ability to perform six basic activities: eating, bathing, dressing,
toileting, maintaining continence, and getting into or out of a bed or chair.
• Acute condition—Relatively severe, of short duration, and often treatable.
• Agent—One of the factors of the epidemiology triangle, must be present in order for an
infectious disease to occur. In other words, an infectious disease cannot occur without an agent.
• Bioterrorism—Encompasses the use of chemical, biological, and nuclear agents to cause harm
place responsibility on society to provide healthcare services. The principle is used to support the
concept of market justice.
• Emigration—Means migration out of a defined geographic area.
• Environment—One of the factors of the epidemiology triangle, is external to the host. It
includes the physical, social, cultural, and economic aspects of the environment.
• Environmental health – The field that focuses on the environmental determinants of health.
• Epidemic—Occurs when a large number of people get a specific disease from a common
source.
prevention because it can be instrumental in developing avenues for motivating individuals
to alter their behaviors to more healthful patterns.
• Holistic health—Emphasizes the well-being of every aspect of what makes a person whole and
complete.
• Holistic medicine—Seeks to treat the individual as a whole person.
• Market justice—Ascribes the fair distribution of health care to the market forces in a free
economy. Medical care and its benefits are distributed on the basis of people’s willingness and
ability to pay.
• Medical model – The medical model of healthcare delivery presupposes the existence of
sickness. In other words, health care is delivered only when a person is sick. The model
• Prevalence—Measures the total number of cases (of death, disability, or disease) at a specific
point in time in the population at risk.
• Primary prevention—Refers to actions designed to reduce the odds that a disease will
subsequently develop. Its objective is to restrain the development of a disease or
negative health condition before it occurs. Smoking cessation, prenatal care, hand washing, and
negative health condition at some time in the future. Risk factors can be traced to the agent, the
host, and/or the environment.
• Secondary prevention—Refers to early diagnosis and treatment of disease. Health screening
plays a key role in secondary prevention. The objective is to block the progression of disease.
• Social contacts—Evaluated in terms of the number of social contacts or social activities a
limited resources, makes deliberate attempts, often referred to as “health planning,” to limit the
availability of healthcare services, particularly those beyond the basic level of care.
• Surge capacity— The ability of a healthcare facility or system to expand its operations to safely
treat an abnormally large influx of patients.
• Tertiary prevention—Refers to rehabilitative activities and the monitoring of treatment
regimens to prevent further complications.
REVIEW QUESTIONS
1. What is the role of health risk appraisal in health promotion and disease prevention?
Health risk appraisal is the process of evaluating risk factors and their health consequences in