Biomedical And Biopsychosocial Health Models Health And Social Care Essay

Biomedical And Biopsychosocial Health Models Health And Social Care Essay The medical model of health is a negative one: that is, that health is essentially the absence of disease. Despite bold attempts by bodies such as the World Health Organisation (WHO) to argue for a definition of health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, most medically related thought remains concerned with disease and illness. -The main point of this model of disease is that it attempts to uncover underlying pathological processes and their particular effects. -The pathologically based and causally specific medical model became increasingly dominant. In the medical model of disease, tuberculosis is defined as a disease of bodily organs following exposure to the tubercle bacillus. The development of the illness involves symptoms such as coughing, haemoptysis (coughing up blood), weight loss and fever. In this model the underlying cause of the illness is the bacillus, and its elimination from the body (through anti-tubercular drugs) is aimed to restore the body to health. -In the case of tuberculosis, the symptoms described above are also found in other diseases, and this problem of linking symptoms to specific underlying mechanisms frustrated medical development. -Today, these are often referred to as forms of complementary medicine herbalism and homeopathy, for example that treat symptoms holistically but do not rest on the idea of underlying, specific pathological disease mechanisms. -The medical model was essentially individualistic in orientation and, unlike earlier approaches, paid less attention to the patients social situation or the wider environment. This narrowing of focus (towards the internal workings of the body, and then to cellular and sub-cellular levels), led to many gains in understanding and treatment, especially after 1941, when penicillin was introduced, and the era of antibiotics began. But it was also accompanied by the development of what Lawrence calls a bounded medical profession, that could pronounce widely on health matters and could act with increasing power and autonomy. Doctors now claimed exclusive jurisdiction (authority) over health and illness, with the warrant of the medical model of disease as their support. This situation meant that modern citizens were increasingly encouraged to see their health as an individual matter, and their health problems as in need of the attention of a doctor. It is this which Foucault (1973) saw as constituting the medical gaze which focused on the individual and on processes going on inside the body its volumes and spaces. Wider influences on health, such as circumstances at work or in the domestic sphere, were of less interest to the modern doctor. This gaze (extended in due course to health-related behaviours) underpinned the development of the modern doctor-patient relationship, in which all authority over health matters was seen to reside in the doctors expertise and skill, especially as shown in diagnosis. This meant that the patients view of illness and alternative approaches to health were excluded from serious consideration. Indeed, the patients view was seen as contaminating the diagnostic process, and it was better if the patient occupied only a p assive role. It is for this reason that the medical model of disease has been regarded critically in many sociological accounts. The power of the medical model and the power of the medical profession have been seen to serve the interests of medical dominance rather than patients needs (Freidson 1970/1988, 2001) and to direct attention away from the wider determinants of health. However, before we proceed, two caveats need to be entered. Whilst medicine in the last 20 years has continued to focus on processes in the individual body, such as the chemistry of the brain or the role of genes in relation to specific diseases, the current context is clearly different from that which existed at the beginning of the twentieth century. Today, in countries such as the UK and the USA, infectious diseases are of far less importance as threats to human health. The biopsychosocial model in medical research: the evolution of the health concept over the last two decades 1. Introduction The traditional biomedical paradigm has its roots in the Cartesian division between mind and body, and considers disease primarily as a result of injury, infection, inheritance and the like. Although this model has been extraordinarily productive for medicine, its reductionistic character prevents it from adequately accounting for all relevant medical aspects of health and illness [1 and 2]. One of the most criticised consequences of adopting the biomedical model is a partial definition of the concept of health. If disease consists only of somatic pathology-or, more strictly and according to the influential work of Virchow [3], cellular pathology-health must be the state in which somatic signs and symptoms are not present. According to this view, the World Health Organization defined health simply as the absence of disease [4]. In his classic papers, Engel [1 and 5] explicitly warned of a crisis in the biomedical paradigm and conceptualised a new model which regards social and psychological aspects as giving a better understanding of the illness process [6]. In recent years, the so-called biopsychosocial model has found broad acceptance in some academic and institutional domains, such as health education, health psychology, public health or preventive medicine, and even in public opinion. It is now generally accepted that illness and health are the result of an interaction between biological, psychological and social factors [7, 8 and 9]. Many authors now include mental and social aspects in their definitions of health [10, 11, 12 and 13]. It might be expected that, in the two decades since Engels call for a biopsychosocial framework, the concept of health implying social and psychological components would also have extended to practical contexts. The purpose of the present study is to find out whether and to what extent the biopsychosocial concept of health has spread among medical researchers. 4. Discussion and conclusions In western culture, at least since the advent of Cartesian dualism, medicine has used a mechanistic approach to human nature and has centred its interest around illness and its signs. -The main reason for the failure of psychological and social measures in the reports examined lies in the still deep-rooted dominance of the biomedical model which, despite the criticism of its reductionism, remains useful and still enables advances in medicine. This dominance has surely been reinforced in recent years because of the push of genetic research and therapies. Perhaps, holistic and biological-reductionistic models should not compete but try to coexist, as two different but not necessarily incompatible possibilities for approaching health questions. The result would be, however, a reduction of biomedical terrain. First, clinical and health psychology have demonstrated their capacity to explain and treat many somatic symptoms. Second, some holistic medical models-such as Traditional Chinese Medicine or Hannemans homeopathy-are gaining ground because of patients who do not find satisfactory solutions in biomedical care. Third, biomedical care implies enormous and rapidly-ri sing costs that are beginning to exceed the budget of the health care systems. 4.2. Practice implications The biopsychosocial model has been successfully applied to obtain a better understanding of the disease processes and their causes [18], and also for public health purposes [19 and 20], or to improve physician-patient relations [21 and 22], but medical practitioners are still reluctant to incorporate it into treatment plans [16]. Holistic approaches remain till now restricted to chronic illness management [23], which is the field of medical care where regaining health, in a biomedical sense, is not the main goal. For the medical practitioner, the difficulties attached to the change from a biomedical to a biopsychosocial model of health can be well understood. First, this change necessarily implies taking into account a much wider spectrum of the factors influencing health and the healing process, which in turn demands greater knowledge and time investment. Second, the new paradigm implies a new style of the patient-doctor relationship, a style which enables, among other things, the doctors attention to the patients psychosocial circumstances, in order to better manage his or her situation, and not only his or her illness. Undoubtedly, this kind of interaction requires a greater effort from practitioners, but also from the health care systems, which should provide the necessary context and resources for it, such as communication skills training, adequate settings, or enough personnel. Despite these hindrances, which will probably continue to relegate the biopsychosocial model to a secondary place in medical practice, the broadening of the doctors perspective to encompass psychological and social aspects would be really beneficial for the patient, since as Engel [24] lucidly pointed out, even though both patient and doctor may culturally adhere to the biomedical model, the patients needs and ultimate criteria are always psychosocial. What Is the Biomedical Model? (wise geec) The biomedical model is a theoretical framework of illness that excludes psychological and social factors. Followers of this model instead focus only on biological factors such as bacteria or genetics. For example, when diagnosing an illness, most doctors do not first ask for a psychological or social history of the patient. The biomedical model is considered to be the dominant modern model of disease. According to this model, good health is the freedom from pain, disease or defect. It focuses on physical processes that affect health, such as the biochemistry, physiology and pathology of diseases. It does not take social or psychological factors into account. The biomedical model is often referred to in contrast with the biopsychosocial model. In 1977, George L. Engel published an article in the well-known journal Science that questioned the dominance of the biomedical model. He proposed the need for a new model that was more holistic. Although the biomedical model has remained the dominant model since that time, many fields, including medicine, nursing, sociology and psychology, use the biopsychosocial model at times. In recent years, some professionals have even begun to adopt a biopsychosocial-spiritual model, insisting that spiritual factors must be considered as well. Proponents of the biopsychosocial model look at biological factors when assessing and treating patients, just like users of the dominant model do. They also look at other areas of patients lives, however. Psychological factors include mood, intelligence, memory and perceptions. Sociological factors include friends, family, social class and environment. Those who examine spiritual factors also assess patients based on their beliefs about life and the possibility of a higher power. Scholars in disability studies describe a medical model of disability that is part of the general biomedical model. In this medical model, disability is an entirely physical occurrence. According to the medical model, being disabled is negative and can only be made better if the disability is cured and the person is made normal. Many disability rights advocates describe a social model of disability, which they prefer. This social model opposes the medical model. In the social model, disability is a difference neither good nor bad. Proponents of the social model see disability as a cultural construct. They point out that a persons experience of disability can decrease through environmental or societal changes, without the intervention of a professional and without the disability being cured. Explain the main determinants of health: age, sex and hereditary factors, lifestyle, housing, social class etc.: The determinants of health Introduction Many factors combine together to affect the health of individuals and communities. Whether people are healthy or not, is determined by their circumstances and environment. To a large extent, factors such as where we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family all have considerable impacts on health, whereas the more commonly considered factors such as access and use of health care services often have less of an impact. The determinants of health include: the social and economic environment, the physical environment, and the persons individual characteristics and behaviours. The context of peoples lives determine their health, and so blaming individuals for having poor health or crediting them for good health is inappropriate. Individuals are unlikely to be able to directly control many of the determinants of health. These determinants-or things that make people healthy or not-include the above factors, and many others: Income and social status higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health. Education low education levels are linked with poor health, more stress and lower self-confidence. Physical environment safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health. Employment and working conditions people in employment are healthier, particularly those who have more control over their working conditions Social support networks greater support from families, friends and communities is linked to better health. Culture customs and traditions, and the beliefs of the family and community all affect health. Genetics inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain illnesses. Personal behaviour and coping skills balanced eating, keeping active, smoking, drinking, and how we deal with lifes stresses and challenges all affect health. Health services access and use of services that prevent and treat disease influences health Gender Men and women suffer from different types of diseases at different ages. Success of NHS was also its Achilles heel demand increased The scale and nature of the problem: Incidents involving incorrect medication dosage Incidents involving the use of technical procedures A number of women became pregnant following failure of earlier sterilisations which had been carried out by laparoscope (keyhole surgery). The surgeon had attached the sterilisation clips to the wrong part of the Fallopian tube. Incidents involving failures in communication A man admitted to hospital for an arthroscopy (an exploratory operation) on his knees had a previous history of thrombosis (blood clots). This was noted by a nurse on his admission form, but was not entered on the operation form which had a section for risk factors and known allergies. The operation was carried out and the patient was discharged from hospital the same day. Given his history of thrombosis the patient should have been given anticoagulant drugs following his operation, but because his history had not been properly recorded none were given. Two days later he was admitted to the intensive care unit of another hospital with a blood clot in his lungs The impact of adverse events on individuals 2.15 Adverse events involve a huge personal cost to the people involved, both patients and staff. Many patients suffer increased pain, disability and psychological trauma. On occasions, when the incident is insensitively handled, patients and their families may be further traumatised when their experience is ignored, or where explanations or apologies are not forthcoming. The psychological impact of the event may be further compounded by a protracted, adversarial legal process. Staff may experience shame, guilt and depression after a serious adverse event, which may again be exacerbated by follow-up action. [20,21] 2.16 The effect of adverse events on patients, their families and staff is not sufficiently appreciated and more attention should be given to ways of minimising the impact of adverse events on all those involved. These issues, while of great importance, cannot be fully addressed within this report and may require separate attention, though we made some limited comment in the context of our discussion on litigation in chapter 4. Conclusion Information on the frequency and nature of adverse events in the NHS is patchy and can do no more than give an impression of the problem.   Information from primary care is particularly lacking; The financial costs of adverse events to the NHS are difficult to estimate but undoubtedly major probably in excess of  £2 billion a year; There is evidence of a range of different kinds of failure, and of the recurrence of identical incidents or incidents with similar root causes; Case studies highlight the consequences of weaknesses in the ability of the NHS as a system to learn from serious adverse events; There is a need for further work focusing specifically on how the impact of adverse events on patients, their families and staff can be minimised. From the cradle to the grave, increasing aging population etc: Britains population is ageing fast, with statisticians predicting a huge increase in the number of 100 year olds by the next century. With people living longer and longer because of medical and other advances, health experts believe the number of people suffering from debilitating conditions such as cancer and heart disease will grow and could mean a rising demand for nursing care. Health experts are worried that as people get older, they could become prone to an increasing number of debilitating conditions if they do not keep active. The WHO has launched a campaign to promote good health in old age. Doctors in the UK say people have an over-gloomy picture of old age and that there is no reason why they should have a lower quality of life than other people if they keep healthy. People do have anxiety that there will be a period of disability at the end of their lives. But there is no evidence that that is the case if they are encouraged to live a healthy life and this generation of elderly people are in better nick than the previous generation. Beating the ageing process Organisations which campaign for the elderly are in favour of policies which support old people to be as independent as possible and allow them more choice and power over their future. They say cuts in local authority and health budgets mean services like home helps have been whittled (cut) away. Without a boost in those services which support independence, there is likely to be increasing pressure on those that cater for dependence: our hospitals, nursing and residential homes. The organisation wants a national strategy which sets a framework that encourages independence and inclusion. It says that such a strategy would be much cheaper than putting people into care homes. They want to see a wider debate on issues such as who funds long-term care, rationing of care particularly in the light of increasing technological change, and health promotion. They argue that the present division between social and health services over long-term care is artificial and damaging. It means people in places funded by social services have to contribute towards their care costs, whereas those in places funded by the NHS get free care.

A Communist Society Essay -- Karl Marx Communism Manifesto Essays

A Communist Society A communist society is very different than the society Americans find themselves living in today. Communism is a term of ancient origin and is not a form of political party, but a type of socialism where the whole is greater than the sum of its parts. Therefore, the individual members of this, foreign, society blend into one greater populist all striving to succeed the same goal. In a communist neighborhood everyone shares and there is no wealth, or poverty, no social status at all. This concept of communism comes from a man, Karl Marx, the author of The Communist Manifesto. He shares his ideas of a utopian society and how to achieve it. For Karl Marx the individual man is a being he has the power to forge himself into what he desires, or what is desired for him. Marx decided men could be changed unlike things in nature that remain the same throughout time, "Yet, man does change in the course of history; he develops himself; he transforms himself; he makes his history; he is his own product..." (Fromm 26) It is here that Marx decided that this is what happened to the capitalist society. They chose to forge themselves to be the evil and greedy men communists believe they are today. Now that men can choose how they are to develop it is time for the individual in communism to be born. And the prototypical man for a communist society looks something like this: hardworking, always does his share of the work, never late to work, never leaves early, never complains that his pay is the same as the guy who works half as hard. A man who knows his place and understands that the good of the group comes before his own personal good. See, communists share everything, on paper communism is perfect... ...ite simply. The steps they take and methods to their madness are for them to understand. And if the people for which the society stand are knowingly involving themselves then it is nobody's place or right to tell them that they are wrong. It is no-one's business but their own. If a society can survive through the troubles of today's world, all the better and though it is different it does not mean wrong. FOOTNOTES - Fromm, Erich. Marx's Concept of Man. Fredrick Ungar Publishing Co. New York, 1966 - Dupre, Louis. Marx's Social Critique of Culture. Yale University Press. New Haven and London, 1983 - Gonzalez, Gilbert G. Progressive Education: A Marxist Interpretation. Marxist Educational Press. Minneapolis, 1982 - Zaretsky, Eli. Capitalism the Family and Professional Life. Harper and Row Publishers. New York, 1976

So close to the Border

Pavel lay in the frost frozen. The frost spitting and eating away at the skin on his face and hands. Too dangerous to move. Undressed, just the upper body covered with a think pyjama like shirt, sleeves too small only reaching just below the elbows. The shirt soaked though with icicles dangling off the edges. He lay there motionless with no thought about how cold it was, just concentrating on those guards, standing there wrapped in their thick coats smoking slowly. With no moon this night there is only two faint body like structures with two orange circles floating in the air. Not much longer to wait for the change of guards. These eager but nerve racking moments, with the urge to just to run from the camp but thinking if he could just wait a few moments. Freedom was waiting for him just over the border. The scent of waffles wafting through the air making his stomach really churn. With the wire cutters in his hands, which were buried at least a foot into the snow just waiting†¦ All it needs is a few snips and there's a whole in the thick barbed wire. He lay there watching as the guards threw away their cigarettes. He had precisely 3mins to get out of the camp to a small amount of safety. He knew that he would only be safe once he had crossed the border. Pavel had no idea what date it was, he could only tell that it was probably about 7:00 for the sun had set along time ago. Now was his only chance. He began cutting away at the wire, panicking. Finally the hole is cut. Crouching low so that he doesn't give away his silhouette, he slowly moves across an open plain, which goes on for about 75 yards. Once he reached the brush he gets out his secretly hidden map. It is sewn in on a handkerchief, which his Uncle gave him just before he died. He could not see the map. He knew that the direction he was heading in was south which was the general direction he was going in. He could tell that he was going south for the south wall was where the people who were going to be gassed had to line up before being taken away. He had escaped from the direction of the south wall. Pavel is a seventeen-year-old boy. He was born through a Christian family but adopted by a Jewish family about 14 years before the war broke out. They counted him as Jewish even though he had not been circumcised because he was found in a Jewish temple and his records were found of his life and about being adopted. He was straight away sent to the camp in Auschwitz and sentenced to death after a few years of labour. He escaping for it almost time for him to meet his death and he wants to find the rest of his family. He was caught in the church. His family got away. I am frozen with fear now. I had got the main part done which was getting out of the camp. I can't think what to do. I lay still, huddled up on the ground, just staring out into the night. It's a big country, but now made small for there are troops stationed everywhere. The sirens might even go of back at the camp in about 30 minutes. I started walking when a German sentry walked on to a path directly coming my way. I could tell there was no news of an escape; otherwise these soldiers would be looking a lot more alert. They rifles were slung up on their shoulders and dangling while they were smoking calmly. I waited for them to move past me. I didn't want to give myself away already. The footsteps died out in a just a matter of seconds. I struggled to get back up and when I did I staggered in the brush along the path in the southern direction. I was walking for about an hour now and had past quite a few machine gun posts. My aim was to get to Hungary, I don't know how but I was going to do my best. I heard noises and smoke from the chimney of a hut. For a moment a thought it was just drunk soldiers. I crossed the path and came close up to an open window. The soldiers were not drunk. I saw them loading rifles and magazines with bullets and from my faint knowledge of German language they were talking about an escape from Auschwitz. I knew this was I. I waited for the Germans to go. I heard their motorbikes revving up and watched them leave up the windy path. I didn't have a clue where I. I went close to the light coming out from the window and I took out my handkerchief. I found the area that I was in. I was astonished by how good this map was to me. It had fooled the guards at Auschwitz and now it was going to get me past the border. I realised I sill had around 100 kilometres to go before I reached the border. It sounded a long way. I saw nobody inside the hut. I could see German trench coat near the window and I reached across to grab. A voice suddenly in a gentle tone said, â€Å"Food? † I didn't reply. I was paralysed with fear and a turned around after a few seconds. Again came the voice of a young man, â€Å"Would you like some food? † I replied, â€Å"You're Polish? † His accent seemed a bit funny but I assumed he was a decent person. â€Å"Yes†, said the man, â€Å"You have runaway haven't you. You're Jewish aren't you? Would you like some food? † Ignoring the offer I carried on the conversation. † I am. Do you think there is any way I could get to the border quickly? My feet have worn out. I have no shoes. Will the Germans be coming back here? † † They will, but don't worry your safe here. You must be so tired and cold. You can stay in my cellar; the Germans think this will be the last place someone would stay. I have wine going to the Germans a the border, you might be able to hitch a lift. † I didn't yet know if I could trust this man and his ideas for me. â€Å"Could I have some food and some shoes? † I asked. He stood there thinking. † I don't have shoes but I do have some food. Here. † He lay down some bread and butter. I was happy. There was about half a loaf. In Auschwitz we only got about 3 slices of bread without butter a day. I had suffered bad symptoms. I kept on fainting. I finished eating all I could and got up. I was being very cautious of this man. He led me outside the hut and there was a little door entering the ground. I jumped in. His last words ever to me were, â€Å"You can stay here for the night. The delivery truck will beep when he gets here so you will hear it and wake up. I will tell him of the situation. † â€Å"Thank you. Thank you so much. † The door shut and me last glimpse of light faded to nothing. BEEP! I heard the sound of the truck and there was light coming through the cracks of the door. I opened the door slightly and peered out through the gap. There was a black truck there. I knew what to do. I climbed out and jumped into the back. There were some empty cargo boxes and full ones. The full ones were at the back of the truck and the empty were towards the front. I jumped into an empty box. I was worried. I didn't know who was driving, what if it was a German in disguise and this whole thing was a set up to get me returned back to the camp. The engine started off and the vehicle started moving. I never realised it but there was food in the box. There was some bread and cheese. I thought this was a luxury. The truck had been driving for about half a day. I thought we were lucky because we had not been stopped once. The truck glided gently into a halt and I heard some voices. I heard the driver explaining that we have wine for the officers on the border. The back of the truck opened up. I could see a German officer through the holes in the box. He stepped into the back and opened up a box. I could tell by his face that he was satisfied. He took two bottles and gave thumbs up to somebody. I heard the back door slam and the truck started off again. The driver gave a tap to the wall between the front and back of the truck. I assumed this was my call to get out. I slipped out of the box into the night. I could see the watchtowers and there were lights moving all over the fields. The place was swarming with Germans. I thought this was going to be the last of me. I knew I wasn't going to make it. I heard the truck go off and I started to make my way out of the area because it could be the centre of attention to the Germans. I was trundling my way through deep snow when I spotted a German post. I avoided it and found my self in the middle of a spotlight. My instincts were just to run. I heard bullet fire. I then got shot in the back. I was just at the barbed wire and I started hacking away at it with my wire cutters. At this moment Pavel was shot in the back of his neck. He carried on cutting through. Eventually a hole was made. Shots were landing all around him from MP40 fire. He jumped through the barbed wire and his ragged trench coat got stuck on the wire. He tried to set himself free and got shot in the back. There was just a little whole in his back but the round exploded in his stomach as it came out. HE carried on trying to set himself free when six German soldiers approached with their rifles locked into their soldiers. Each of them aimed at Pavel and fired. Pavel lay there strewn along the barbed wire. He did not know this but he died two days before his eighteenth birthday and his family had all died in concentration camps. This is not based on a true story but this would have happened a lot in the world war two in Poland.

Primary Actors in International Society Essay - 1246 Words

After the end of World War II, two nations remained dominant: the United States and the Soviet Union. From roughly 1945 to 1990, The U.S. and the Soviet Union did not engage in direct military conflict, but they prepared for it. After massive military build-ups and periods of mounting tensions, the Cold War subsided as Communist regimes collapsed and Germany became whole again. Since then, emerging actors have joined states to collectively impact international society, and an important question to ask is: Are non-state actors becoming more important than state actors? Although non-state actors, such as terrorists and region states, have become increasingly important in the modern world, states remain the primary actors since they†¦show more content†¦Consequently, non-state actors such as Osama bin Laden and his terrorist team, revealed the states inability to fulfill one of its most paramount responsibilities: ensuring national security. Thomas Friedman, author and commentator, holds that globalization can have negative effects on countries that are not alert to change and that it has forced states to reconsider the effectiveness of a centralized decision-making system. He argues that by ignoring innovations and adhering to accepted norms, nations will only witness the disadvantages of globalization. Instead, Friedman suggests that the only way to manage globalization is to accept the inevitability of democratization of decisionmaking and information flows, and the deconcentration of power (62). Friedman emphasizes that the heads of a country are not necessarily the individuals possessing the most knowledge. He writes that even lower-level employees are skillful in analyzing situations and finding solutions; therefore in order to create a more efficient system of operations, information should flow from the top to the bottom. 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