Health and Disease: A Biopsychosocial Perspective and the Natural History of Disease

2. Health and disease as a biopsychosocial category. The value of health. Natural history of disease. Influencing pathological process

Health and Disease as a Biopsychosocial Category:

•   The promotion and destruction of health is a complex and multi-level process

•   In the past, “health” referred only to the absence of disease

•   Today, it has a broader meaning – a state of complete physical, mental and social well-being

•   Health Definition

o According to WHO, 1946: health is a property or state of a given individual, of her or his physical, psychological and social well- being

 This definition needs to be revised: health is not a state but an “ability to cope”. The issues defining and measuring health and illness go far beyond methodological and technical problems

o According to Bure : health is the ability to adapt to the demands and conditions of the environment without origin of disease

o According to Antonovsky: sense of coherence, feeling of self-confidence, style of thinking
 The biopsychosocial model → health is best understood in terms of a combination of biological, psychological, and social factors rather than purely in biological terms

o It is a general model or approach stating that biological, psychological (which entails

thoughts, emotions, and behaviors), and social (socio-economical, socio- environmental, and cultural) factors, all play a significant role in human functioning in the context of disease or illness

o This is in contrast to the biomedical model of medicine that suggests every disease process can be explained in terms of an underlying deviation from normal function such as a virus, gene or developmental abnormality, or injury

Natural history of disease (NHD):

•   It expresses the process of biological changes

•   It begins from a state of health and continues with the origin and stage of development of the disease

•   The physiological stages (phases) evolve continuously to the pathological stage

•   NHD requires knowledge of the following:

o Epidemiology
o Pathogenesis
o Symptomatology
o Duration of the Disease
o Forms and types of the disease

 NHD can be divided into 4 Periods:
o Pre-pathogenesis – risk factors (primary prevention)
o Early Pathogenesis – asymptomatic period (secondary prevention – screening) o Developing Pathogenesis:

•   Prodromal Period – subjective and objective signs of disease

•   Manifesting Period – the typical clinical image of the disease is present

  •   Secondary prevention – effective treatment

  •   Tertiary prevention – rehabilitation

 The end of the pathological process – 4 possible end results

o Return to health o Some sequelae

o Chronic illness

o Death  Note:

o All periods have different durations, varying from hours in some diseases (e.g. bacterial food intoxication) to years (e.g. ischemic heart disease)

o Each period isn’t necessarily present for all diseases (e.g. Hepatitis C progressing over the first three phases of chronic illness without previous manifestations)