Concepts of Health,

Wellness & Well-Being, Illness & Disease

After the end of this chapter the student will
be able to:

 Differentiate health, wellness, and well-being, illness

& disease.
 Describe five dimensions of wellness.
 Compare various models of health.
 Identify factors affecting health status, beliefs, and
practices.
 Identify health care adherence.
 Differentiate illness from disease and acute illness
from chronic illness.
 Explain Suchman's stages of illness.
Introduction

 Health, wellness & well-being ,illness, & disease

have many definitions and interpretations. The
midwife should be familiar with the most common
aspects of the concepts and consider how they may
be individualized with specific clients.
Given the following set of patients, who among
them are considered healthy?

 A 72 years old takes hypertensive medication to treat high

blood pressure. She is a member of the neighborhood
organization who makes handicrafts for charity and for a
living as well.
 A 72 years old is paralyzed from waist down and used a
wheelchair for mobility. He is living alone with his pets. He
is able to earn money for his needs.
 A 13 years old with diabetes takes injectable insulin each
morning. He plays on the school soccer and he is also the
editor in chief of the school publication
 Ando is a regular student of sksu. He is presentable by
appearance no sign of any disease. He doesn’t socialize
with others and frequently seen talking to his self.
HEALTH
 There is no consensus (agreement) about any
definition of health. There is knowledge of how to
attain(reach) a certain level of health, but health
itself cannot be measured.
 Traditionally health has been defined in terms of the
presence or absence of disease. Nightingale defined
health as a state of being well and using every power
the individual possesses to the fullest extent
The World Health Organization (WHO)
defined health (1948)

 as a state of complete physical,

mental, and social well-being, and
not merely the absence of disease
or infirmity.
American Nurses Association defined health

 a dynamic state of being in which

the developmental and behavioral
potential (possible) of an
individual is realized to the fullest
extent possible
 Note: Health is considered as the
goal of public health in general
and of community health nursing in
particular
Most people define and describe health
as the following:
• Being free from symptoms of
disease and pain as much as
possible.
• Being able to be active and to do
what they want or must.
• Being in good spirits most of the
time.
LAY FILIPINO DEFINITIONS OF HEALTH
HEALTH IS MULTIDIMENSIONAL

Mainly physical, mental

and social(also spiritual,
emotional, vocational,
political, cultural,
socioeconomic,
environmental,
philosophical, educational,
nutritional, curative and
preventive dimensions)
DEFINITION OF ILLNESS
ILLNESS AND DISEASE
 Is a highly personal state in which the
person's physical, emotional, intellectual,
social, developmental, or spiritual
functioning is thought to be diminished.
 Illness is usually associated with disease
but may occur independently of it. Illness
is a highly personal state in which the
person feels unhealthy or ill.
 Illness is defined as a product of disharmonious interaction
(disease) between mind, bod, emotions and spirit.
 Illness is a product of complimentary interaction between mind and
body
 Illness can be a signal that important needs are not being met.
 Illness is not merely the presence of disease process. An abnormal
state in which a person’s physical, emotional, intellectual, social
development or spiritual functioning is diminished nor impaired
compared with the person’s previous experience
 Illness includes disease and also its effect on functioning and well-
being in dimension
 Illness is a manifestation of human state; physical, mental,
emotional and spiritual discomforts
 Illness is a representation of the negative relationship between a
man and his snatural and supernatural environment
 An unhealthy condition of body and mind(Merriam)
 Is the response of the person to a disease; it is an abnormal
process in which the person’s level of functioning is changed when
compared with a previous level (Taylor et al)
DEFINITION OF…………
Wellness & Well-Being

 Wellness further describes health status. It allows

health to be placed on a continuum from one’s
optimal level (“wellness”) to a maladaptive state
(“illness”)
Wellness
 is a dynamic process that is ever changing.
 The well person usually has some degree of
illness and the ill person usually has some
degree of wellness.
 This concept of a health continuum negates
the idea that wellness and illness are
opposite because they may occur
simultaneously in the same person in
varying degrees
Dimensions of
Wellness

Copyright 2008 by Pearson Education, Inc.

1. Physical
 The ability to carry out daily tasks, achieve fitness
(e.g. pulmonary, cardiovascular, gastrointestinal),
maintain adequate nutrition and proper body fat,
avoid abusing drugs and alcohol or using tobacco
products, and generally to practice positive lifestyle
habits.
2. Social
 The ability to interact successfully with people and
within the environment
3. Emotional
 The ability to manage stress and to express
emotions appropriately, Emotional wellness involves
the ability to recognize, accept, and express
feelings.
4. Intellectual.
 The ability to learn and use information effectively
for personal, family, and career development
OCCUPATIONAL

 - Involves the suitability of our work of

interest, skills and values and the
fulfillment we gain from our professions
6. Occupational.
 The ability to achieve a balance between work and
leisure time, A person's beliefs about education,
employment, and home influence personal
satisfaction and relationships with others.
7. Environmental.
 The ability to promote health measures that improve
the standard of living and quality of life in the
community
ENVIRONMENTAL
 -is the ability to recognize our own responsibility for
the quality of the air, the water and the land that
surrounds us.. the ability to make a positive impact
on the quality of environment, be it our homes, our
communities or our planet contributes to our
environmental wellness
5. Spiritual.
 The belief in some force (nature, science, religion, or
a higher power) that serves to unite human beings
and provide meaning and purpose of life
DIFFERENT MODELS OF HEALTH
1. SMITH’S 4 MODELS OF HEALTH
2. AGENT HOST ENVIRONMENT MODEL
3. HEALTH BELIEF MODEL
4. HEALTH ILLNESS CONTINUUM
5. NEEDS FULFILLMENT MODEL
6. HEALTH PROMOTION MODEL
Clinical Model
 Provides the narrowest interpretation of health
 People viewed as physiologic systems
 Health identified by the absence of signs and
symptoms of disease or injury
 State of not being “sick”
 Opposite of health is disease or injury

Copyright 2008 by Pearson Education, Inc.

VS.
Role Performance Model
 Ability to fulfill societal roles
 Healthy even if clinically ill if roles fulfilled
 Sickness is the inability to perform one’s role
Adaptive Model
 Creative process
 Disease is a failure in adaptation or maladaption
 Extreme good health is flexible adaptation to the
environment
 Focus is stability
 The aim of treatment is to restore the ability of
the person to adapt.
Eudemonistic Model
 Comprehensive view of health
 Condition of actualization (make real) or
realization of a person’s potential
 Illness is a condition that prevents self-actualization
 Actualization is the apex of the fully developed
personality

Copyright 2008 by Pearson Education, Inc.

 Agent-Host-Environment Model
 Each factor constantly
interacts with the others
 When in balance,
health is maintained
 When not in balance,
disease occurs

Copyright 2008 by Pearson Education, Inc.

AGENT
 -also called as the ecologic model. This model is
used primarily in predicting illness rather than in
promoting wellness.
 -when in balance, health is maintained
 When not in balance, disease occurs
HOST
 - person who may not/may be in risks of acquiring
a disease: family history, age, and lifestyle or habits
influence the host’s reaction
ENVIRONMENT

 - all factors external to the host that may

create or may predispose the person to
the development of diseases
HEALTH BELIEF MODEL(becker, 1975)

 this model assumes that there is a

relation
 between a person’s belief and

actions(behavior)
Health-Illness Continuum
Measure person’s perceived level of wellness
Health and illness/disease opposite ends of a health continuum

Move back and forth within this continuum day by day

Wide ranges of health or illness

Copyright 2008 by Pearson Education, Inc.

TRAVIS ILLNESS WELLNESS
CONTINUUM
•Most important is the direction faced by the
individual on the pathway
DUNN’S HIGH LEVEL WELLNESS GRID
HIGH LEVEL WELLNESS GRID
 The classic description of wellness was developed
by Dunn in the early 1960s. According to Dunn
(1961), high-level wellness means functioning to
one’s maximum health potential while remaining in
balance with the environment.
composed of two axis's
a. a health axis which
ranges from peak
wellness to death
b. a environmental axis
which ranges from
very favorable to very
unfavorable
The two axis form four quadrants
A. high-level wellness in
a favorable
environment
 e.g., a person who
implements healthy
life-style behaviors
and has the
biopsychosocialspiritu
al resources to
support this life-style
The two axis form four quadrants
B. Emergent high-level
wellness in an
unfavorable
environment
 e.g., a person who
implements healthy
life-style behaviors
and has the
biopsychosocialspirital
resources to support
this life-style
The two axis form four quadrants
C. Protected poor health
in a favorable
environment
 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
The two axis form four quadrants
D. Poor health in an
unfavorable
environment
 e.g., a young child
who is starving in a
drought ridden
country
NEEDS FULFILLMENT MODEL BY
ABRAMHAM MASLOWS
 Maslow's hierarchy of needs is a motivational theory in
psychology comprising a five-tier model of human
needs, often depicted as hierarchical levels within a
pyramid.
 Needs lower down in the hierarchy must be satisfied
before individuals can attend to needs higher up. From
the bottom of the hierarchy upwards, the needs are:
physiological, safety, love and belonging, esteem, and
self-actualization.

Rosenstock/Becker's Health-Belief
Model
 Health belief model proposed Rosenstock (1974). It
is based on what people perceived or believe to be
true about them in relation to health. The health
belief model is based on motivational theory.
1. Individual
perception
2. Modifying
factors
3. Likelihood of
action
1. Individual perceptions
Perceived susceptibility
- A family history of a certain disorder, such as diabetes or heart disease,
may make the individual feel at high risk.
Perceived seriousness
- In the perception of the individual, does the illness cause death or has
serious consequences? For example - the spread of acquired immune
deficiency syndrome (AIDS) reflects the general public's perception of
the seriousness of this illness.
Perceived threat
 - perceived susceptibility and perceived seriousness combine to
determine the total perceived threat of an illness to a specific individual.
For example, a person who perceives that many individuals in the
community have AIDS may not necessarily perceive a threat of the
disease; if the person is a drug addict or a homosexual, however, the
perceived threat of illness is likely to increase because the
susceptibility is combined with seriousness.
2. Modifying factors
Demographic variables
- Demographic variables include age, sex, race, and ethnicity. For example,
an adolescent may perceive peer approval as more important than family
approval and as a consequence may participate in hazardous activities or
adopt unhealthy eating and sleeping patterns.
Sociopsychologic variables
- Social pressure or influence from peers or other reference groups (e.g., self-
help or vocational groups) may encourage preventive health behaviors
even when individual motivation is low. Expectations of others may motivate
people. For example, not to drive an automobile after drinking alcohol.
Structural variables
- Knowledge about the target disease and prior contact with it are structural
variables that are presumed to influence preventive behavior.
2. Modifying factors
Cues to action
- Cues can be either internal or external.
A. Internal cues include feelings of fatigue,
uncomfortable symptoms, or thoughts about the
condition of an ill person who is close.
B. External cues are mass media campaigns, advice
from others, reminder postcard from a physician or
dentist, illness of family member or friend,
newspaper or magazine article.
3. Likelihood Of Action
The likelihood of a person's taking recommended
preventive, health action depends on the perceived
benefits of the action minus the perceived barriers to
the action.
A. Perceived benefits of the action - Examples include
refraining from smoking to prevent lung cancer, and
eating nutritious foods and avoiding snacks to
maintain weight.
B. Perceived barriers to action - Examples include cost,
inconvenience, unpleasantness, and lifestyle changes.
Factors influencing health status, beliefs,
and practices:
 Internal factors
 External factors
INTERNAL FACTORS
 Biologic dimension
 genetic makeup
 age
 sex
 developmental level
 race
 Psychological or Emotional dimension
 Mind-body interaction
 Self-concept and self-perception
 Cognitive or Intellectual dimension
 Life style
 Spiritual and religious beliefs and values
 External variables
 Environmental
 family and cultural
 Geographical location belief's
 Housing  pattern of daily
 Sanitation living
 Climate
 Pollution of air, food, water  social dimension
 Standard of living  Social network
 Class of family (Family, Friends )
 Occupation
 Job satisfaction
 Economic levels
 education
FACTORS AFFECTING HEALTH
1. INTERNAL FACTORS
• GENETICS
• GENDER
• AGE AND DEVELOPMENTAL AGE
• MIND BODY INTERACTIONS
• LIFESTYLE
• SPIRITUAL AND RELIGIOUS BELIEF
• SERIOUS ILLNESS
• EDUCATION
•2. EXTERNAL FACTORS

• GEOGRAPHY
• PHYSICAL ENVIRONMENT
• HEALTH SERVICES
• INCOME AND SOCIAL STATUS
• SOCIAL SUPPORT NETWORK
Well-being

 "Well-being is a subjective perception of vitality

(energy) and feeling well.....can be described
objectively, experienced, and measured......and can be
plotted ( design) on a continuum". It is a component
of health.
1. Internal factors
 Biologic dimension genetic makeup, sex, age,
and developmental level all significantly
influence a person's health.
 Psychological dimension emotional factors
influencing health include mind-body
interactions and self-concept.
 Cognitive dimension include lifestyle choices
and spiritual and religious beliefs.
2. External factors

Environment.
Standards of living. Reflecting occupation, income, and
education.
Family and cultural beliefs. Patterns of daily living and
lifestyle to offspring( children).
Social support networks. Family, friends, or confidant
(best friend) and job satisfaction helps people avoid
illness.
Health Care Adherence

 Adherence (obedience) : is the extent to which an

individual's behavior for example, taking
medications, following diets or making lifestyle
changes. Degree of adherence may range from
disregarding (ignoring) every aspect of the
recommendations to following the total therapeutic
plan.
 Disease
 Disease can be described as an alteration in
body functions resulting in a reduction of capacities
or shortening of the normal life span.
 The causation of a disease is called its etiology.
There are many ways to classify illness
and disease:

 Acute illness is typically characterized by severe

symptoms of relatively short duration.
 A chronic illness is one that lasts for an extended
period, usually 6 months or longer, and often for
person's life.
Suchman describes five stages of illness:
 Stage 1 symptoms experiences.
 Stage 2 assumption of the sick role confirmation
from family and friends.
 Stage 3 medical care contact.
 Stage 4 dependent client role.
 Stage 5 recovery or rehabilitation.
There are several approaches to health
maintenance:
 • Health promotion
 • Health protection
 • Disease prevention
Impact of Illness
On the Client On the Family
Behavioral and emotional Depends on:
changes  Member of the family
Loss of autonomy
who is ill
 Seriousness and length of
Self-concept and body
the illness
image changes
 Cultural and social
Lifestyle changes customs the family follows
 Impact of Illness: Family Changes
 Role changes
 Task reassignments
 Increased demands on time
 Anxiety about outcomes
 Conflict about unaccustomed responsibilities
 Financial problems
 Loneliness as a result of separation and pending loss
 Change in social customs
ILLNESS
 A state in which a person’s physical, emotional,
intellectual and social development or spiritual
functioning is diminished compared to previous
experience.
 Stage I – Symptom Experience

Believes something is wrong

Experienced symptoms
Fear and anxiety
Stage II Assumption of a Sick Role

Seek Help
Excused from normal duties and roles
Not held responsible
for their condition
 Stage III Medical Care Contact
Seeking Medical advise
 - to validate
illness
 - explanation of
symptoms
 - relief of the
illness
 - may accept or
deny diagnosis
Stage IV Dependent Client Role
 Give out dependence
 Accepts treatment plan
Stage V – Recovery or Rehabilitation

 Back to normal function

COMMON RESPONSE TO STRESS
AND ILLNESS
3 Levels of Prevention
 Primary – Health promotion and protection

 Secondary – Early detection, diagnosis and treatment

 Tertiary - Rehabilitation
 Primary Prevention
 EMPHASIS ON:
1. Generalized health promotion and specific protection
2. Encourage optimal health & increase person’s resistance to illness
3. Seeks to prevent disease or condition at a pre-pathologic state
4. Recipients are GENERALLY HEALTHY PEOPLE
 WHEN GIVEN:
Before onset of illness or before onset of disease
 Secondary Prevention
- known as health maintenance
seeks to identify specific illness/condition at an early stage
with prompt intervention to prevent or limit disability
Emphasis placed on:
1. Early Diagnosis, Detection, Screening, Prompt Treatment
2. Prompt treatment
3. Health maintenance of persons already having health
problems
4. Prevention of complications
 Tertiary Prevention
 Support client’s achievement of successful adaptation
to known risks, optimal reconstitution or establishment
of high-level wellness
 occurs after a disease or disability has occurred &
recovery process has begun
 seeks to halt the disease or injury process & obtain
optimal health status
 Tertiary Prevention
Emphasis on:
Support of the client to achieve the following:
1. Successful re-adaptation

2. Optimal reconstitution

3. Regain high-level wellness

4. Therefore, the purpose is more of REHABILITATION

IDENTIFY WHICH OF THE FOLLOWING HEALTH LEVELS
OF PREVENTION…

1. Have regular (yearly) PE/Papsmear and BSE

2. Men: regular testicular examination
3. Annual dental examination
4. Exercise regularly at least 3x per week for 30
mins.
5. Do not smoke.
6. Avoid alcohol
7. Reduce fat and increase fiber in the diet.
8. Sleep regularly 7 to 8 hours/ night
A. Primary
9. Eat breakfast B. Secondary
10. Maintain an ideal body weight C. Tertiary