Health and Illness

Health and Illness ■ 63

workouts available at most gymnasiums and the notion of being fit. Figure 4–3 represents a resource from within the Asian-American communities—the game of Go. The game requires concentration and skill and is highly competitive. Figure 4–4 represents resources for primary care and over-the-counter remedies that may be used both for health maintenance and to restore health when everyday ailments occur.

There are countless images we can use to visualize comprehensive notions of health and illness. What do you do daily to maintain your health? Where do you go for help? What do you do when you experience a self-limiting ailment? How are ideas of health and illness reflected throughout the contemporary dominant culture in your family and home community? The community you work in? If you could pick four images relating to health and illness from your day-to-day experiences, what would they be?

■ Health The answers to the question “What is health?” are not as readily articulated as you might assume. One response may be a flawless recitation of the World Health Organization (WHO) definition of health as a “state of complete physi- cal, mental, and social well-being and not merely the absence of disease.” This answer may be recited with great assurance—a challenge is neither expected nor welcomed but may evoke an intense dispute in which the assumed right answer is completely torn apart. Answers such as “homeostasis,” “kinetic energy in bal- ance,” “optimal functioning,” and “freedom from pain” are open to discus- sion. Experienced health care providers may be unable to give a comprehensive, acceptable answer to such a seemingly simple question. It is difficult to give a definition that makes sense without the use of some form of medical jargon. It is also challenging to define health in terms that a layperson can understand. (We lack skill in understanding “health” from the layperson’s perspective.) It is not unusual to hear health care providers define health in a negative manner—“the absence of disease.”

When you google health, the response on the World Wide Web is that there have been over 4.400 billion results as of February 29, 2012. One basic dictionary definition for the term is “health (helth) a state of physical, mental, and social well-being” (Dorland’s Medical Dictionary, 2007).

As long ago as 1860, Florence Nightingale described health as “being well and using one’s powers to the fullest extent.” Health is “a condition of physical, mental, and social well-being and the absence of disease or other ab- normal condition.” It is not a static condition. Constant change and adap- tation to stress result in homeostasis. René Dubos, often quoted in nursing education, says, “The states of health or disease are the expressions of the suc- cess or failure experienced by the organism in its efforts to respond adaptively to environmental challenges.” Health can also be defined as high-level well- ness, homeostasis (Mosby’s Medical Dictionary, 2009).

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These definitions—varying in scope and context—are essentially those that the student practitioner and educator within the health professions agree convey the meaning of health; albeit, the most widely used and recognized definition is that of WHO. Within the socialization process of the health care deliverer, the denotation of the word is that contained in the WHO definition. For other students, the meaning of the word health becomes clear through the educational experience.

In analyzing these definitions, we are able to discern subtle variations in denotation. In fact, the connotation does not essentially change over time. If this occurs in the denotation of the word, what of the connotation? That is, are health care providers as familiar with implicit meanings as with more explicit ones? Historically, Irwin M. Rosenstock (1966) commented that the health pro- fessions are becoming increasingly aware of the lack of clarity in the definition of health. This situation has not changed. Surely, this is a contemporary and an accurate thought on the educational process, which is indeed deficient. He concluded, “Whereas health itself is in reality an elusive concept, in much of research, the stages involved in seeking medical care are conceived as completely distinct” (p. 49). Furthermore, it may be argued that the connotation of health is most frequently seen as a 2-dimensional phenomenon—body and mind—with the larger emphasis on the body.

The framework of both education and research in the health professions continues to rely on the more abstract definitions of the word health. When taken in a broader context, health can be regarded not only as the absence of disease but also as a reward for “good behavior.” In fact, a state of health is regarded by many people as the reward one receives for “good” behavior and illness as punishment for “bad” behavior. You may have heard something like “She is so good; no wonder she is so healthy” or a mother admonishing her child, “If you don’t do such and such, you’ll get sick.” Situations and expe- riences may be avoided for the purpose of protecting and maintaining one’s health. Conversely, some people seek out challenging, albeit dangerous, situa- tions with the hope that they will experience the thrill of a challenge and still emerge in an intact state of health. Examples of such behavior include driving at high speeds, ongoing tobacco smoking, and not wearing seat belts.

Health can also be viewed as the freedom from and the absence of evil. In this context, health is analogous to day, which equals good light. Conversely, illness is analogous to night, evil, and dark. Illness, to some, is seen as a punish- ment for being bad or doing evil deeds; it is the work of vindictive evil spirits. In the modern education of health care providers, these concepts of health and illness are rarely if ever discussed, yet, if these concepts of health and illness are believed by some consumers of health care services, understanding these varying ideas is important for the provider. Each of us enters the health care community with our own culturally based concept of health. During the educational and socialization process in a health care provider profession—nursing, medicine, or social work—we are expected to shed these beliefs and adopt the standard defi- nitions. In addition to shedding these old beliefs, we learn, if only by unspoken

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