20141217035953_06. MPU3313 MPU2313 Topic 2

8/10/2019 20141217035953_06. MPU3313 MPU2313 Topic 2

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INTRODUCTION

There are many ways to describe the dimensions of health and how to recognisethe indicators of health for individuals and family members. The opposite ofhealth is understood as being ill and an individual or family member who is illwill demonstrate behaviours that are influenced by age, gender, genetics, culture

or beliefs and religious practices, and even education.

It is imperative to have a clear understanding of the behaviours demonstrated byeach individual so as to assist in their journey towards wellness.

TTooppiicc

22

Dimensions ofHealth andIndicators ofBeing Healthy

LEARNING OUTCOMES

By the end of this topic, you should be able to:

1. Explain the dimensions of health;

2. Discuss the indicators of health for individuals and family;

3. Describe variables influencing illness and its behaviour; and

4.

Identify the impact of illness on individuals and their family.

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TOPIC 2 DIMENSIONS OF HEALTH AND INDICATORS OF BEING HEALTHY 15

DIMENSIONS OF HEALTH

The absence of illness is a common indicator of health, as believed by themajority of the population. As advances of technology and knowledge are madeavailable easily with Internet access, the concept of health has been extended tohave a broader meaning, which now includes psychological health, physicalhealth and psychosocial health. These three elements interact with one another inorder for an individual to achieve complete good health as well as to attain asatisfying and balanced life. These three elements are further subdivided andcategorised as having seven dimensions or four dimensions (depending onwriters). The seven dimensions of health are (Donatelle & Davis, 1998):

(a) Physical;

(b) Emotional;

(c) Intellectual;

(d) Spiritual;

(e) Social;

(f) Occupational; and

(g) Environmental.

On the other hand, some writers have described the four dimensions of health as:

(a) Physical;

(b) Emotional;

(c) Social; and

(d) Spiritual.

Although these classifications differ in the numbers of dimensions, there are nodifferences in the variables described for each dimensions. In this topic, the sevendimensions of health will be discussed.

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TOPIC 2 DIMENSIONS OF HEALTH AND INDICATORS OF BEING HEALTHY16

PHYSICAL DIMENSION

The physical dimension of health or wellness refers to the way a person describeshis body condition at that time and is a very important health dimension. Itinvolves identifying activities to support oneÊs well-being and ability to keep fit.Some of the descriptions to demonstrate the physical dimension of health are „Ifeel great‰, „I do not have any pain‰ and „I am eating well‰. Some may describetheir physical dimension as „being able to sleep well‰ and „performing dailyactivities‰ that are suitable for their age group. Some also believe that if they areable to eat well and exercise well to keep themselves free from illness, they haveattained the physical dimension of good health. People who are aware of thephysical dimension of health will engage in regular exercise activities like

enrolling in a gym or making certain they follow a regime of scheduled exercise,counting their calorie intake, avoiding food or habits believed to contributeillness and many more. Taking additional supplements is also part of thisphysical dimension.

The physical dimension of health will be described differently by people fromdifferent age groups. Take the example of someone who is in their twenties. Theirdescription of physical health is to be able to perform a routine high impactexercise schedule at least three times a week. Failure to do so may cause them tothink they have not fulfilled their definition of physical health. For an individualwho is 70 years old and has heart disease, a regular exercise schedule may mean

to be able to spend at least fifteen minutes of slow walking three times a week,and have a lot of rest and relaxation. As you can see, the value given to physicalhealth differs from one individual to another.

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ACTIVITY 2.1

What are your descriptors of the physical aspect of health? Compareyour descriptors with those of a coursemate of similar age group andgender.

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EMOTIONAL DIMENSION

Having emotional stability is another health dimension. The emotional aspect isconsidered a very crucial aspect especially with the challenges of modern life.These challenges include the fast paced activities expected at work and at home,as time and productivity are the ultimate measurement of oneÊs value andcommitment to work. Failure to achieve expected levels of performance maymean the inability to perform, which may eventually result in stress and anxiety.Stress and anxiety may present in many different forms, such as anger,temperamental behaviour, abuse or in a worse scenario, depression.

Stress is a term used to describe a nonspecific demand on the body calledstressors, which may be physical or psychological (Selye, 1976). Non-specificdemand means the body reacts to an event by releasing the „fight or flight‰response, which is also known as the adrenaline hormone. Physical stressorsinclude lack of sleep, starvation, physical injury and many more.

Anxiety

on the other hand, is a feeling of discomfort related to stress which ismild and caused by an individualÊs internal environment. Everyone experiencesanxiety during their life. The cause can originate from a s

ituational stressor

or adevelopmental stressor. A situational stressor may take the form of an eventaffecting a person like a divorce, death of a loved one, loss of job, loss of chanceof a promotion or even when diagnosed to have a serious illness. The effects can

be short term but there are some people who will always be anxious for a longtime. This is what we call chronic anxiety. An example is the anxiety felt beforeone has to go for an interview or write an examination. Even meeting a newperson for the first time can elicit anxiety. It is said that one needs to have some

anxiety to be motivated and to be aware of oneÊs surroundings. A serious form ofanxiety is called panic, when the person suffers from a very high level of anxietyand stress and this may have serious consequences. It can impair the personÊsspeech coherence making communication difficult.

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ACTIVITY 2.2

Can you identify other physical stressors that may affect you?

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Depression is a common manifestation of mental derangement and can havetemporary or long-term effects. It can be temporary if the cause of depression isrelated to feelings of loss, disappointment or failure. Long-term depression

usually has pathological causes, with symptoms such as a continuous feeling ofunhappiness. People who suffer from depression will have their body, moodsand thoughts affected during that period.

Temporary depression mentioned above may normally last for two weeks. Thesymptoms include loss of appetite or overeating, fatigue, feelings ofworthlessness or guilt, hopelessness, irritability, poor concentration, sleepdisturbances or insomnia. A common type of depression associated withmotherhood is called „post-partum blues‰. This is experienced by mothersimmediately after delivery. The symptoms include mood swings, crying,

sadness, anxiety and insomnia, and may last for a week. No specific treatment isgiven but emotional support from close family members and spouse is essential.

INTELLECTUAL DIMENSION

The intellectual dimension of health is achieved when one is able to participate inactivities that stimulate the mental as well as the creative facilities. This willexpand the knowledge and skills of an individual, particularly in the areas ofcritical thinking and problem solving. Intellectual health is not about academic

knowledge alone. One can gain intellectual health even by listening to orattending talks related to health, religion or any other subject matter of interest.Listening to the music and the lyrics in a song, having a hobby and sharing thehobby with others can provide intellectual health. A person who engages in theintellectual dimension of health will demonstrate this by taking part in learningactivities, reading, discussions or debate and having an interest in the currentdevelopments in their surroundings, community and the world. They have highlevels of curiosity and are willing to try and learn from their mistakes. They takechallenges, are committed to their activities and interests, do not give up easilyand persevere until they achieve success. Using their thought processespositively results in positive outcomes, while excessive thinking may sometimesproduce negative results that may affect oneÊs emotional health.

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Learning is a continuous activity and people who are intellectually healthy believe in life-long learning. There is no specific way about how individuals learn but it is more common to note that attending formal lessons, reading and

participating in a learning group are acceptable ways of learning. Informallearning activities like discussion, debate and sharing views can be morestimulating as they creates a common interest and the learning is clearlyunderstood with good retention due to self-interest. An adult individual cancultivate the intellectual health of younger ones in their early years, in order todevelop their interest for education besides being a role model to them. If youwish to be a role model, you should be able to identify those around you whowill benefit from such actions.

SPIRITUAL DIMENSIONSome people associate the spiritual dimension of health to oneÊs beliefs andvalues, while others may also include religious beliefs as part of the spiritualdimension. How does one explain spirituality? This is a question that has beenattempted by many and more often than not more questions have been askedthan answered.

In simple terms, spirituality is related to belief, values, faith and hope that anindividual learns and adopts throughout his years of life. This depends on a

personÊs environment, the people surrounding him and the way the peopleclosest to him (like parents, family members, teachers and friends) project andimpose their values and beliefs. Each individual is exposed to the differentspiritual concepts at the different stages of life. Just look around us and one cansee the different demonstrations of spirituality based on cultural beliefs, religious

beliefs, family practices and individual personality types.

One can sometimes assume the level of another personÊs spirituality based ontheir physical movements, communication, attributes and presentation. It isusually the positive aspect of beliefs and values that are associated with havinggood spiritual health. An example would be when a person shows respect for thedifferent religious practices of others and accepts them. This may indicate that anindividual has good spiritual health. This also includes accepting and respectinganother personÊs eating habits and dietary practices. Different religions havedifferent beliefs, but the basic tenet or golden rule is „do unto others as youwould have them do unto you‰ and always remember to „do not do harm toothers‰.

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When one has a good spiritual health, one will always remember to conductthemselves in the same way even when no other human is watching, as there isalways an omniscient presence that is observing oneÊs movement. This will mean

that someone with a strong spiritual health will behave differently when he isalone and when he is among a group of people.

SOCIAL DIMENSION

As mentioned earlier, we do not wish to segregate the different dimensions ofhealth as the isolated dimensions even though there is a thin line dividing each ofthem. Social health refers to a society that allows its members the access to goodsand services available for a fulfilling life and in which all members can interactwith each other, and with different social institutions available in the communityand worldwide. Having accessibility to health and wealth is a top priority forindividuals as these are determinants of productivity and emotional health.Having access to similar groups or communities globally provides a source ofgrowth for intellectual health.

With the current technological advances, one can be in touch with the world at atouch of a button and there are many social networks available to select from.One can choose the different categories of social interests offered and it is theintellectual dimension that assists one in making the right choice of socialnetworks to develop the social dimension of health. Failure to identify or selectthe right social network may rebound and impact the other health dimensions,namely the physical, emotional spiritual, occupational and environmental healthdimensions. The negative impact of social health may lead to disruptions of

emotional health like stress, anxiety or depression, while spiritual disruptionsmay lead one to change beliefs, values or religious practices and this has fargreater consequences to health.

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ACTIVITY 2.3

Can you identify some of the actions that people will do when theythink they are alone and no one is watching?

ACTIVITY 2.4

Can you describe the impact of negative social health on the physicaland intellectual dimensions?

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OCCUPATIONAL DIMENSION

An occupation is an activity one engages in or performs for the purpose ofearning a living. Occupational health

is related to work that has potential harm tothe person performing the task, usually over a long period of time. Among theaspects related to this dimension are safety and a healthy work environment aswell as protection of the worker, relating to the specific job being performed.Workers in Malaysia are protected by MalaysiaÊs Occupational Safety and HealthAct (OSHA) (1994) that deliberates on the rights and protection of the workers, asprovided by employers to their employees. The Act covers regulations andguidelines to provide a safe and healthy work environment. As an individual, itis not sufficient to depend on the organisation or employer to abide by the

regulations cited by the OSHA to provide safety measures while at work. Theindividual is equally responsible to look after his own safety and health throughadequate understanding of the job he is doing and the associated health effects ofthe job. Consideration of how his job impacts the well-being of family membersand all those related to his job and the community must be included.

In discussing on how the occupational dimension of health is affected by anindividual, the specific areas looked into are the individualÊs ability to balancehis job to his emotional, spiritual and physical needs. While some jobs may havea high level of stress, the individual must be able to cope so as not to be affectedemotionally, spiritually and physically. Avoiding the impact of high stress may

mean that the individual has to identify how his job affects him emotionally andproceed to find acceptable means to reduce the stress. One option is to meet withthe employer to discuss changes in work routine and if that is not possible,perhaps a rotation to other areas can be arranged. Vacation leave is another option.

What the individual needs to remember is he/she must be able to find a balance between work and his other recreational activities, which include family andcommunity life. In relation to the challenges at the workplace in the current workenvironment, there is a study which shows that Malaysians spend longer hoursat work than with their families which eventually leads to burnout or stress.

Technological advances can sometimes contribute to an imbalance at work,especially during vacation, where technology allows an individual to becontacted even when on vacation. This can culminate in abrupt termination ofthe vacation, or leaving with a short notice, and if the vacation involves familymatters, many other related issues will be experienced, such as disappointmentfelt by family members and feelings of dissatisfaction. If the individual cuts shortthe vacation, the possible impacts include additional financial cost in cancellationof accommodation and travelling in a hurry with dissatisfied family members.The latter can cause some emotional friction and emotional instability which are

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potentially harmful on the road. The individual may be accused of breakingpromises and his children or his spouse may feel that the individual does notprioritise the familyÊs needs.

Working extra hours for a long time can give an impact on the family life as well asthe health of an individual. Sometimes, the failure of the individual to abide by therules and regulations set by the organisation may expose him to hazards of theworkplace. An example is the refusal to wear earphones in an extremely noisyworkplace, which may cause hearing deficits in the long term (see Figure 2.1).

Figure 2.1: Workers wearing earphones at a noisy workplaceSource: www.softnoise.com

A very pertinent fact to remember in preventing the negative impact ofoccupation is constant reminders by the employer as well as members of theworkforce to lead a balanced life.

ENVIRONMENTAL DIMENSION

Being aware of oneÊs environment and the effects of environmental change to thelives of the individual, community and the world can impact the way anindividual perceives his contribution toward a healthy lifestyle. Any neglect tothe impact of environmental changes can affect the lives of the individual, familyand community. Being aware of current issues like climate change and pollutionof air and water, or substance abuse and many other issues, will encourage theindividual to participate in activities to conserve the environment and to helpprevent its effects on himself, his family and his community. Other variables thataffect the environment include politics, legislation and economics, as well ashousing, which has a determinant effect on the quality of life.

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This dimension of health enables one to critically analyse the variables within hisenvironmental surroundings that can impact his life, his family and hiscommunity, so necessary interventions can be planned and executed in addition

to involving oneself in the intervention activities.

One example is taking steps to improve the quality of water so that theindividual, family and community reap the benefits of clean water, for example,the absence of water-borne diseases. Examples of water-borne diseases arecholera, typhoid and leptospirosis. Water-borne diseases can be transmitted fromone individual to another through an infected water supply (see Figure 2.2). Howcan one contribute to help keep the water supply clean?

Figure 2.2: Infected water supplySource: www.panama-guide.com

INDICATORS OF HEALTH FORINDIVIDUALS AND FAMILY

What are the indicators of health for an individual and his or her family? Anindividual who is able to identify the health indicators for a healthy and well-

balanced life will certainly be able to assist his family members in leading a

healthy and balanced life too. Identification alone without practicing theseindicators will result in negative outcomes; thus, the individual must be a rolemodel for the family and community. Some of the indicators of health arediscussed below:

(a) Monitor the body function as well as those of family members for anyindication of physical deficit, such as fever, poor appetite, lack of sleep oragitation and stress. Take early actions for any of those early signs andsymptoms;

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(b) Participate and encourage the family members to participate in activities asa group, for example, going on vacation, attending family functions orsocial functions or even exercising together. Sometimes, it is good to

communicate with each other and have some personal space as anindividual or even have quiet moments of solidarity to reflect upon anddiscuss solutions to any issues. For couples, ensuring good communicationand having the occasional time out together is another form of therapy toattain the physical and emotional health; and

(c) Diversional therapy, for example, engaging in a new hobby such as games,fishing, gardening, cooking or reading and attending religious classes, isanother means of balancing the emotional, physical and spiritual healthdimensions.

VARIABLES INFLUENCING ILLNESS ANDILLNESS BEHAVIOUR

People who are ill usually manifest some form of behaviour change that medicalsociologists call „illness behaviour‰. As mentioned in the early part of this topic,health and illness can be influenced by an individualÊs differences in age, gender,social or cultural orientation, economic standing, and education. Each individualresponds differently when in illness and exhibits different behaviour, and thesedifferences exist even among siblings and close family members.

The illness behaviour can be affected by internal or external variables:

(a) Internal variables include the beliefs that the individual has about theillness and its severity. Both can have positive and negative impact. Forexample, an individual who becomes ill and worried about the effects of theillness to his body and his daily life will seek assistance to help cure theillness. Negatively, if the individual perceives that the illness is not going todisrupt his life, is bearable and will subside on its own, he will not seek anyhelp. This can have some other consequences, as failure to seek help froman expert may lead to an undiagnosed severe condition, which can bedetrimental to oneÊs health outcomes. For example, someone who has been

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ACTIVITY 2.5

What other activities can you identify that will assist you in attainingthe balance of health in life?

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coughing continuously and finds relief by self-medicating with coughmixture may find that, when the symptoms worsen and he seeks help, he isalready in the advance stage of cancer.

A person who has an acute illness tends to seek help as opposed tosomeone who has a chronic illness.

(b) Some of the external variables

that may influence illness are social orcultural orientation, economic standing and education. Social or culturalorientation may lead to different responses to an illness. Some ethnicgroups believe that one should not show any weakness when he or she fallsill and should hide any associated symptoms, for example, by sufferingpain in silence. In contrast, there are ethnic groups that believe one shouldexpress illness or pain verbally by voicing it out or yelling out, even if thepain is minor.

How does oneÊs illness affect the behaviour?

Infants and toddlers are unable to fend for themselves. When they are ill, theydemonstrate it through excessive crying, tantrums, refusing feedings and clingingonto the one closest to them. Younger children and teenagers may show a lack ofenthusiasm for their activities, refuse food or ask for something new and preferisolation. The behaviour also depends on an individualÊs normal reaction andorientation. The older they are, the more capable their coping mechanisms will be.

Adults and the elderly may not demonstrate extreme behaviour when ill. Thisdepends on whether they want to use the illness as an excuse from doing theirroutine chores or job, or some people may pretend to be well and ignore theillness as they cannot afford to change any of their routines. Some adults who aretechnologically savvy will seek out their own interpretation from the readilyavailable information and respond accordingly based on their findings. Someindividuals do not want to admit their illness for fear of the impact it may haveon their family and ability to perform as a family member. Some spouses do notwant to show they are ill for fear it may affect their prescribed role as the

provider or the carer for the family. The elderly may not want to exhibit theirillness to prevent their spouse and family members worrying about theircondition.

In relation to economic status, the decision to seek health assistance depends onthe funds available and the types of illness. The affluent will not only seekassistance when ill, but are also willing to purchase health goods believed toprevent the occurrence of illness. These choices about health assistance will bedetermined by the availability of funds. For those with limited funds, only theessentials will be sought.

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IMPACT OF ILLNESS ON INDIVIDUALSAND FAMILIES

When an individual or a family member is ill, there are changes in the routineactivities within this family unit. In a nuclear family setup, which include onlythe parents and children, the implications of an illness have far reachingconsequences for the family. For example, if a child is sick and hospitalised, theroutine will be disrupted. The mother will stay in the hospital with the sick childand leave the father and other children at home. When the father has to leave forwork, he will have to think of alternative ways to have the other children caredfor during his absence. Should earlier arrangements have been made with acaretaker or a nursery, the care during the day will be taken care of, but otherfamily activities at night will be affected.

The father may have to go to the hospital to relieve the mother and will be late topick-up the other children from nursery or care centre. He will have to think of

how the night meals will be served. If he bought the food from the stalls orrestaurants, he may have to worry about the hygiene, food value and taste. Forsome, this may incur additional costs.

The father may also have to anticipate a midnight emergency call, think abouthow long the child will be hospitalised, or seek financial support that is availablefor the hospital costs. This may lead to lack of sleep. Going to work the next daywill be a chore. His exhaustion and the demands at work will result in stress andanxiety.

Therefore, the aspects related to the emotional dimension of health will beaffected.

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ACTIVITY 2.6

Have you ever been ill before? How would you describe your behaviour when you were ill?

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There are other impacts to consider when different family members are ill.Basically the factors can be categorised as emotional factors, financial factors andenvironmental factors. The emotional behaviour of individual during illness

depends on the nature of illness and the individualÊs attitude to illness, thelength of illness and severity. Short term illness like fever and cold may limit theparticipation of the individual in any other normal activities at work or withfamily, while long term illness like cancer may subject the individual towithdrawal symptoms, denial, anger and shock.

COPING STRATEGIES

How does one cope with the ordeals described earlier and perform all necessaryactivities as a normal and acceptable individual? How do you keep your life

balanced?

As mentioned earlier, a little amount of stress and anxiety is good for anyindividual to motivate him to achieve his ambitions, career pathway, futureplanning and future undertakings.

Among common coping strategies mentioned are talking about the life issueswith another person who may be a good listener and not one who will use theinformation to gain an extra mileage for his or her own cause. In developednations, where there are adequate counsellors or psychologists, one may go tothem for professional help. A psychiatrist is another option, but usually a visit toa psychiatrist may cause the person to be labelled as having mental disorder.This can happen because of stereotyping.

Sometimes, there are online help sites or call centres which you can access toexpress feelings and discuss issues. Some people even use helplines over theradio to seek redress over their problems anonymously.

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ACTIVITY 2.7

Can you describe the impact illness has had on two individuals in yourfamily list, and decide whether it will have impact on your daily

activities, work or environment?

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It does not really matter what options one takes to address issues related to anyof the health dimensions mentioned above as long as it provides positiveoutcomes.

Other means of coping include the following:

(a) Have a good balanced diet to prevent overeating, obesity or under-eating.Check your health status on a regular basis, more so if you have a strongfamily history of diabetes, hypertension, heart disease or any otherhereditary diseases. Get professional advice on what specific nutrition youcan follow;

(b) Schedule some vacation and time spent with the family, and clarify allmatters before going on vacation so there will be no disruptions on thevacation schedule;

(c) Perform regular exercise to keep fit, and ensure that this is within the limitsof your capabilities. If you are above forty, you must get a health statuscheck before embarking on any strenuous forms of exercise. You shouldalso quit smoking and alcohol or substance abuse. There are many optionsof exercise, to name a few, high impact exercise, Qi Gong and Tai Chi; and

(d) Identify ways to manage your anxiety and stress, for example throughdiversional therapy like music or taking up new hobbies. Learn to laugh

and include humour in your life. Moderation in everything is the best.

How one defines health and uses health dimensions to achieve a balancedand healthy life is dependent on a few variables like age, gender, social orcultural orientation, environment and economic status.

For each variable there are justifications by the individual on why they have

chosen this variable to help attain a healthy and balanced life.

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