Edelman Ch 1
1. Margaret Newman: define of health in 2 paradigms:
a. Wellness-illness continuum
i. Dichotomized portrayal of health and illness ranging from high- level
wellness to depletion of health
1. High-level wellness is a sense of well-being, life satisfaction, and
quality of life
a. Involves progression toward higher level of functioning, an
open-ended and ever-expanding future with its challenge of
fuller potential and integration of whole being
i. Contains ideas similar to eudaimonistic model
ii. Emphasizes interrelationship between environment
and ability to achieve health on both personal and
societal level
2. Negative end is the adaptation to disease and disability through
levels of functional ability
3. Used to conform to scientific methods that seek to control
contextual effects, provide basis for causal explanations, and
predict future outcomes
4. Adding second dimension of favorability of person’s environment
for health and wellness crates a matrix where favorable
environment allows high-level wellness to occur and an
unfavorable environment allows low-level wellness to exist
a. Now it became possible to combine clinical model of
health with models based on social and environmental
parameters
ii. Characterizes health as a perspective developmental phenomenon of
unitary patterning of the person-environment
1. Conceptualized as expanding consciousness, pattern or meaning
recognition, personal transformation, and self-actualization
2. Seeks to address dynamic whole of health experience through
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behavioral and social mechanisms over time
3. Each person is seen as a part of a complex, interconnected
biological and social system
2. Ecological model of health
a. Useful for promoting health at individual, family, community, and societal levels
b. Emphasizes social determinants of health
i. Factors in society that have an influence on health and the options
available to people to improve or maintain their health
c. Health as adaptation and eudomonia (self-actualization)
d. Social determinants of health forms basis for Healthy People 2020
3. Before 1940:
a. Infectious diseases claimed lives of many children and young adults
b. Health viewed as absence of disease
c. Physician- independent practice, primary provider of health care services,
provided in private office
d. Federal government- only beginning to establish role in working with states to
address public health and welfare issues
4. 1940-1950:
a. Health became linked to person’s ability to fulfill role in society
b. Physician- asked to complete physicals for school, work, military, and insurance
c. Federal government- expanded role through funding for hospital expansion and
establishment of new Department of Health, Education, and Welfare (DHEW)
d. Recognized that a person might recover from a disease and still be unable to
fulfill family or work roles because of residual changes from illness
e. Disability and rehabilitation entered as concepts
f. Work or school was viewed as possible contributors to health, illness, disability,
and death
5. 1960- present
a. Federal and state governments attempted to control spending and health care costs
b. Primary care providers now attempt to involve individuals and families in
delivery of person-centered care and teaching individuals about individual
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responsibilities and lifestyle choices
c. Health care became interdisciplinary endeavor
d. Health became linked to individual’s reactions to environment rather than a fixed
state
6. Models of Health
a. Clinical
i. Health defined by absence and illness by conspicuous presence of signs
and symptoms of disease
ii. Don’t seek preventive health services and wait until are very ill to seek
care
b. Role Performance
i. Health defined in erms of individual’s aility to perform social roles
ii. Includes work, family, and social roles, wit performance based of societal
expectations
iii. Illness would be failure to perform roles at level of others in society
iv. Basis for occupational health evaluations, school physical examinations,
and physician-excused absences
c. Adaptive
i. People’s ability to adjust positively to social, mental, and physiological
change is the measure of their health
ii. Illness occurs when person fails to adapt or becomes maladaptive to these
changes
iii. Spirituality can be useful in adapting to decreased level of functioning in
older adults
d. Eudaimonistic
i. Exuberant well-being indicates optimal health
ii. Emphasizes interactions between physical, social, psychological, and
spiritual aspects of life and environment that contribute to goal attainment
and create meaning
iii. Illness reflected by denervation or languishing, lack of involvement with
life
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