Every month we meet at REHUNO Health to explore and reflect on different health issues, with the intention of promoting exchange and access to humanist perspectives that allow us to have a coherent vision of our aspirations. On this occasion, the topic of discussion is the bio-psycho-social model of health.
By Jordi Jiménez
The bio-psycho-social model of health has been talked about for a long time. This model refers not only to good physical functioning, but to an integral system of health that includes psychological and social elements.
In 2001, the WHO published the International Classification of Functioning (ICF), which, together with the International Classification of Diseases (ICD), is a complementary system for describing health and health-related elements.
“Many people mistakenly believe that the ICF only applies to people with disabilities, but it applies to all people. Health and the ‘health-related’ conditions associated with any health condition can be described using the ICF. In other words, the ICF is universally applicable”.
“It is important to remember that in the ICF, persons are not the units of classification; that is, the ICF does not classify persons, but rather describes each person’s situation within a set of health domains or “health-related” domains.” [International Classification of Functioning, Disability and Health: ICF. World Health Organization, 2001. Published by: Ministry of Labour and Social Affairs. Secretary General for Social Affairs. Instituto de Migraciones y Servicios Sociales (IMSERSO), Spain].
However, what interests us about this classification is that it has concretised and operationalised the biopsychosocial model in an organised and interrelated structure.
Therefore, by noting its components and its structure, we will better understand the concept of health behind it, we will better understand the model.
As they say in their introduction, “The ICF provides a description of situations related to human functioning and its limitations, and serves as a framework for organising this information”. i
This perspective goes beyond the physiological model, which is based on the absence of illness, and extends it to aspects of psychological wellbeing, but also to the environmental aspects of the person, i.e. the elements or situations that surround the person, in his or her immediate and mediated environment. This does NOT mean that psychosocial factors affect health, but that these factors ARE health, they are part of it.
Health is a multifactorial continuum, so it cannot be thought of in a binary format (to have health or not to have health). These different components are interconnected and form a structure.
Components:
Body functions: these are the physiological functions of the body systems, including mental functions.
Body structures are the anatomical structures of the body that make the functions possible. For example, bone is one structure, muscle is another structure, neural circuitry is another… and arm movement is the bodily function performed by these structures. These two components are the “bio” part of the model and relate exclusively to the body.
Activity: is the performance of a task or action by the individual. For example, picking up a glass and drinking.
Participation: is the act of engaging in a life situation. For example, I pick up a glass to drink my coffee when I am chatting with friends in a café. These two components are the most “psychological” part of the model.
Environmental factors: refers to the physical, social and attitudinal environment in which people live and conduct their lives. For example, I am with my friends in a very bright and spacious café (physical environment), which contrasts with the neighbourhood in which it is located, which is very populous and multicultural (social environment), and whose owner is a very friendly and attentive guy who always gives us the space we need (attitudinal environment). You are the “social” part of the model. i
Each of these components of health can change at different times in life, forming a multifactorial continuum that is very dynamic.
Consequences of this model
This vision tells us that a state of health does not necessarily mean being ill, understanding illness as a physiological condition. There are health conditions in people who are not ill, either physically or psychologically. How does this happen?
Starting with the most global and external, this model of health implies, for example, that the cultural codes (values, intangibles) transmitted in a society generate social and personal attitudes (such as discrimination) that have an impact on the environmental health of that society and also on the participation of the people who live there.
It also means, for example, that architectural barriers or the design of cities are related to the health of the population, especially the elderly or those with physiological problems, as they can make access, mobility, etc. more difficult.
All services such as education, food or access to housing are environmental elements that are part of people’s health. It is clear that if a person has difficulty accessing housing, a balanced diet or a public health service, their participation in the community suffers and their physical health suffers. In other words, due to the absence or ‘barriers’ of environmental factors, overall health is compromised.
This is what is interesting about the bio-psycho-social perspective, which is integral and conceptualises everything that surrounds the human being as ‘health’.
On the other hand, the concept of participation that we have mentioned is a central concept in this vision of health, because it is what allows people to develop their projects, their life plans and, in short, their human intentionality. There are many cases of people who are in a situation of social isolation, who do not find ways to participate, or who are discriminated against, as we have said, because of their race, gender, religion, disability, and so on.
Participation is more than activity. One can do things without participating in a wider social or community sphere. Participation means ‘taking part’ in something bigger, whether it is a group of friends, a family environment, a neighbourhood environment, etc.
As we have already said, a universal and solvent public health system (which would be an environmental factor), together with adequate scientific development, are also elements that interact with the good state of the physiological-bodily components to prevent illness or to reverse it when preventive measures have been insufficient. In other words, environmental factors also have an impact on physical factors, which in turn facilitate or hinder participation.
In this sense, we attach the greatest importance to prevention and healthy habits, as opposed to the medicalisation and chronification of physiological problems that so many industries are interested in.
But in order to have a good health system, it is necessary to include in its concept the psychosocial dimension, not only the medical one, to understand their interrelationship and to understand that this structure is dynamic and in constant change.
In fact, taking the model to an extreme (this is not what the ICF says, but we are interested in seeing it this way), we could speak of “social health” or “cultural health”. Social health as those social systems that, for example, place the human being as a central value. Cultural health as those values and intangibles that are fostered in a society and that promote, for example, reconciliation and good treatment between fellow citizens.
Pain and suffering
There is, however, a very important aspect for us as health humanists, and that is the question of human suffering.
A great distinction has been made between pain and suffering, with the former encompassing all bodily ailments. Pain is everything that happens to the body, while suffering is mental and is expressed in phenomena such as anxiety, fear, etc.
How can we include the question of human suffering in such a model of health?
Given the model we have described, we could say that bodily functions and structures fall within what we generally call “pain” because they affect the body.
But it was also said at the time that it is the development of science and the development of justice that will alleviate human “pain”. This is related to medical and scientific progress, but also to social progress, the universalisation of this knowledge and its application to society (environmental factors). Therefore, overcoming pain also involves environmental elements of the model.
But overcoming human suffering goes beyond the simple psychological health that this model will propose, beyond the simple activity and participation of the person in his or her environment. One can suffer from having an illness, from feeling lonely or isolated, from lacking the most basic elements of survival, or from living in a state of meaninglessness.
Human suffering has to do with something deeper than mere psychological discomfort. It has to do with desires, with expectations, with the fear of losing things and people, with possessions… it has to do with certain beliefs, with certain illusions about life, about the length of life, about the meaning that life can have, and so on.
The overcoming of suffering, given by the possessive mechanics of consciousness, thus escapes the model of health studied, which is why it should be integrated in some way as a fundamental factor in a new definition of human health. That is, to introduce an existential, even spiritual, aspect into the definition of health.
You could say that human health is understood as
The physiological state of my body, the degree of activity and participation I have in my daily environment, the physical, social and attitudinal environmental conditions that allow me to participate, and the state of inner unity and meaning I register towards existence and life.
Finally, here is a series of questions that can be used as a basis for developing these themes.
Could it be said that the degree of health is the degree of pain and suffering, and that health is the overcoming of pain and suffering (in this general sense)?
How might we include the issue of suffering in the concept of health?
Would we be interested in talking about social health or cultural health? How would we develop these concepts, what components would they have?
If you would like to participate in the REHUNO Health Cycle of Open Meetings, please write to us: rehuno.salud@gmail.com
i International Classification of Functioning, Disability and Health: ICF. World Health Organization, 2001. Published by: Ministry of Labour and Social Affairs. Secretary General for Social Affairs. Instituto de Migraciones y Servicios Sociales (IMSERSO), Spain.