Positive Health

1. Machteld Huber - A new concept of health2. Donna Stewart - Resilience in the physically ill3. Anne-Sophie Dybdal - Enhancing child resilience

DiscussionJuly 2 2014

ECPP 2014 - Key Symposium – July 2

Introduction of the new concept of health

&

the broad perception of Positive health

Machteld Huber, MD, senior-researcher

Louis Bolk Institute, Driebergen

www.louisbolk.nl

The Animals - Results

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KLH challenge. After that the Feed A-group took over

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How is health defined?

Since then often criticized, but never changed.

Health is still defined by the WHO definition of 1948:

“A state of complete physical, mental, and social

well-being and not merely the absence of disease,

or infirmity.”

Parelfilm

http://youtu.be/qoJ_zywh9uM

Machteld Huber, arts, senior-onderzoeker

Louis Bolk Instituut, Driebergen

www.zonmw.nl/gezondheid

Invitational Conference:

Limitations of the WHO definition:

1. The word complete in “states of complete well-being”

“would leave most of us unhealthy most of the time”

and it supports medicalisation, as always something can be

found to be treated.

2. The demography of diseases changed since 1948Ageing with chronic diseases becomes the norm.

This formulation denies the human’s capacity to cope.

3. This definition is impracticable as ‘complete’ is neither

operational nor measurable

Chosen as the general concept, expressing

the dynamic nature of health:

“Health as the ability to adapt

and to self managein the face of social, physical and

emotional challenges”

Invitational Conference:

And published in the BMJ:

As BMJ’s cover showed … Health is in the air

In a follow-up study 7 Stakeholder Domains were identified:

- Patients

- Healthcare professionals

- Health insurances

- Citizens

- Policymakers

- Public health actors

- Researchers

They were questioned in a qualitative and a quantitative part.

These stakeholder domains were questioned in semi-structuredinterviews and focusgroup meetings, with 3 questions:

1. What is positive and what is negative about this new concept of health?

2. What are to you indicators for health?

3. Do your indicators and the concept match?

Question 1: Your opinion about the new concept?

• Positive: “The focus is on the person, not on the disease” , etc.

• Negative: “Is everybody capable of this? Large groups do lack the basic health literacy

that is needed for this”, etc.

Advise: Take health as a mean to, not as an aim in itself …

Results of the Qualitative part:

Question 2: Indicators of health

• In total 556 indicators of health from seven stakeholder domains

were collected.

• These were concentrated and categorized in a consensus process

in cooperation with two independent researchers of Research Institute

NIVEL.

• This resulted in six main dimensions of health, differentiated into

32 aspects.

Results of the qualitative part:

The six main dimensions of health:

o Bodily functions

o Mental functions & perception

o Spiritual/existential dimension

o Quality of Life

o Social & societal participation

o Daily functioning

Results of the qualitative part: Question 2

Results of the qualitative part:

The differentation of six domains in aspects of health:

Bodily functions:

Medical facts, medical observations, physical functioning,

complaints and pain, energy.

Mental functions & perception:

Cognitive functioning, emotional state, esteem/self respect,

experiencing to be in charge/manageability, self management ,

resilience & ‘sense of coherence’.

Spiritual/existential dimension:

Meaning/meaningfulness, striving for aims/ideals, future prospects,

acceptation.

Results of the qualitative part:

The differentation in aspects of the main dimensions of health:

Quality of Life:

Quality of life/well being, experiencing happiness, enjoyment,

perceived health, flourishing, zest for life, balance.

Social & societal participation:

Social and communicative skills, meaningful relationships,

social contacts, experiencing to be accepted, community involvement,

meaningful work.

Daily functioning:

Basic ADL, instrumental ADL, ability to work, healh literacy.

Note: These are indicators, collected bottom up!

The Quantitative part:

Based on the quantitative results a survey questionnaire was established,

The response counted 1938 reactions:

– 643 Healthcare providers (doctors, physiotherapeuts, nurses) (panels)

– 575 Patients (panel)

– 430 Citizens (panel)

– 106 Researchers

– 89 Public health actors

– 80 Policymakers

– 15 Insurers

Generally the positive and negative opinions were confirmed.

Results of the quantative part:

Importance of health dimensions as viewed by stakeholders

Conclusions:

There is ample support for the new concept, but attention is needed.

Persons who have (had) an illness/disease consider health to be a

broad concept, broader than the medical model.

Health can exist besides disease.

A person’s capability to be healthy can strengthened, if desired.

Support must be fitting; not one size fits all.

Visualize the six main dimensions.

Discriminate the broad concept of health in such a way that it

discriminates from “health as absence from disease”: Positive health!

Pillars for Positive Health

The next step: Experimenting in pilots

Thank you for your attention!