A new framework for health.

Abstract

In summary, it has been proposed that the concept of health be conceived of not as a single continuum, but rather in terms of a two-dimensional space whose dimensions are defined in relation to the two underlying system processes that they reflect. Such a conceptualization has several important implications. First, it views health as a function of the operation of system processes, and is conceptually isomorphic to a more general theory of systems. That is, health is seen as the result of the operation of system processes; and the definition is consistent with a theory of system processes. The traditional one-dimensional conception of health ignores the distinction between the two fundamentally different processes and treats them as though they were the same. This inattention to the nature of the processes whose operation results in health as an outcome has created much of the conceptual confusion--i.e., it has led to situations in which the conceptualization is not powerful enough to account for observed variability. For example, it is obvious to all concerned that all people who have no detectable morbidity are not equally healthy, although a disease-oriented definition of health (e.g., health as the absence of disease) offers no way of differentiating conceptually between such people. A second implication of the conceptualization is that it eliminates some of the contradictions between one-dimensional definitions and real-world experiences. Health need no longer be seen as either the absence of disease or the expression of developmental processes. Under the proposed conception, the contributions of both negative and positive forces are acknowledged as vital components of general health. Furthermore, analogies drawn from work in other areas suggest a model of how the processes underlying the dimensions interact--that actualization becomes possible when equilibrium is reasonably well maintained. Probably the most far-reaching implication, however, involves the broadening of the scope of the term "health" and the potential impact of the potential impact of that broadening on the kind of data used in making community health level assessments. The measurement of health levels in the past has centered on aggregate mortality and morbidity rates as surrogates for "health9" In terms of the proposed framework, such measures may provide some insight into the equilibrium dimensions but are clearly inadequate for assessing actualization.