Health文档格式.docx

Health文档格式.docx

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DefinitionsandConceptsofHealth

InthepreambletotheconstitutionoftheWorldHealthOrganization（WHO）healthisdescribedas"

astateofcompletephysical,mental,andsocialwell-beingandnotmerelytheabsenceofdiseaseorinfirmity."

Thisdescriptionhasoftenbeencriticizedasbeingtoovague.Further,itdescribesanidealstaterarelyattainedbymostpeople,anditcontainsnoingredientsthatcanbereadilymeasuredorcounted,eitherattheindividualorthepopulationlevel.

Anotherdefinition,composedbyspecialistsinpreventivemedicine,specifiessometangiblecomponentsofhealth;

callingit"

astatecharacterizedbyanatomical,physiological,andpsychologicalintegrity;

abilitytoperformpersonallyvaluedfamily,work,andcommunityroles;

abilitytodealwithphysical,biological,psychological,andsocialstress;

afeelingofwell-being;

andfreedomfromtheriskofdiseaseanduntimelydeath"

（Stokes,Noren,andShindell,1982）.Everythingmentionedinthisdefinitioncanbemeasuredandcountedattheindividualandatthepopulationlevel,althoughassessing"

afeelingofwell-being"

maybeachallenge,and"

freedomfromtheriskofdiseaseanduntimelydeath"

isnotanachievablestate.

Anincreasinglevelofinterestinhealthpromotionintheearly1980sinspiredaWHOworkinggrouptocomposeadefinitionrecognizingtheroleofindividualsandcommunitiesindeterminingtheirownhealthstatus.Theycanbeparaphrasedtotheextenttowhichanindividualoragroupisabletorealizeaspirationsandsatisfyneedsandtochangeorcopewiththeenvironment.Healthisaresourceforeverydaylife,nottheobjectiveofliving;

itisapositiveconcept,emphasizingsocialandpersonalresourcesaswellasphysicalcapabilities（Last,ed.,2000）.Thisdefinitiondrawsattentiontotheneedforpartnershipsamongindividualsandcommunities,andtotheimportanceofprotectingtheintegrityoftheenvironmentinthecauseofpromotinggoodhealth.Moreover,manyaspectsofthisdefinitionaremeasurable.

Thehealthofhumanscannotbedissociatedfromthehealthofthelife-supportingecosystemswithwhichhumansinteractandareinterdependent.Moreover,nomatterhowhealthythepresentgenerationmaybe,thehealthoffuturegenerationsisdependentupontheintegrityandsustainabilityoftheseecosystems.Adefinitionof"

sustainablehealth"

thatrecognizesthisinterconnectednessstatesthathealthisasustainablestateofequilibriumamonghumansandotherlivingthingsthatsharetheearth（Last,ed.,2000）.Thekeywordinthisdefinitionis"

equilibrium"

meaningharmony.Humanbeingscannotlongremainhealthyinanenvironmentinwhichtheyareoutofharmonywithotherlivingthings,orifotherlivingthingsaredeadordyingasaconsequenceofpeople'

sactions.Thisistrueofalllifeforms,fromthesmallestmicroorganismstothelargestmammals.Sincethemid–twentiethcentury,medicalprofessionalshavebeentryingto"

conquer"

pathogenicmicroorganismswithantibiotics.Thisisawarthatultimatelycannotbewonbecausemicro-organismshaveveryshortgenerationtimes,measurableinminutes.Microorganismscanthereforeadapttothechallengeofantibioticsbyevolvingandproducingantibiotic-resistantstrainsmuchmorerapidlythannewantibioticscanbedeveloped.

Analternativetoantibiotics,whichisperhapsinsufficientlyimplemented,isbasedontheecologicalconceptthathumansareanintegralpartoftheglobalecosystem.Immunizationprogramsaimedatprotectingpeoplefromdiphtheria,tetanus,andotherdiseaseshavebeenveryeffective.Themicroorganismsresponsibleforthesediseasesarestillthere,inpeople'

sthroats,inthesoil,whereveristheirusualhabitat.Butonceprotectedbyimmunization,peoplecanliveinharmonywiththeseotherwisedangerousmicrobes.Thechallengeistodevelopmethodsthatwillenablehumanstoliveinharmonywithotherdangerousmicroorganismsandinsectvectorsofdisease.Thisisamorecertainwaytoensurelong-termhealthforthepopulationthantheimpossiblegoalofattemptingtoexterminatetheseotherlifeforms.Pathogensthathavenootherhostthanhumanscansometimesbeeradicated,asthesmallpoxviruswas,andasthepolioviruscouldsoonbe,atleastregionallyifnotglobally;

buteradicationisnotfeasiblewithmicroorganismsthatcansurviveout-sidehumanhosts.

HealthTheoriesandTheirPracticalApplication

Beliefsaboutthefoundationsofgoodhealthareinseparablefromtheoriesofdisease.Primitivebeliefsaboutgoodandevilspirits;

thebenevolentormalevolentinterventionoffate,gods,orancestors;

diseaseasapunishmentforsin（Murdock,1980）;

theoriessuchasthoseofAristotleandGalenaboutthebalanceofbodilyfluids（humors）andabouttheeffectsofmiasmasor"

badair"

surviveinthenamesbywhichweknowsomecommondiseases,includinginfluenza,malaria,cholera,andrheumatism.Apreferenceforholidayresortsandconvalescenthospitalsattheseasideorinthemountainsreflectsabeliefinthenotionthatsomeenvironmentsareinherentlyhealthierthanothers—as,indeed,abundantevidencedemonstrates.

Scientistscantracetheevolutionofmedicalscienceinthechangingnomenclatureofdisease.Somemoderndiagnosticlabelsindicateapreciseunderstandingofthecausalmechanismsofdisease—streptococalsepticemiais,literally,thepoisoningofthebloodbystreptococcusbacteria.Somethatsoundimpressive,suchasthrombocytopenicpurpura（bruisingassociatedwithadeficiencyofthrombocytes,orbloodplatelets）revealpartialknowledge:

scientistsknowwhatcausesthebleedingbutnotwhatcausesthedeficiencyofplatelets.Otherdiseasenamesaredeservedlyvague—essentialhypertensionconfessesoutignoranceaboutwhatactuallycauseshighbloodpressure.

Modernmedicineandpublichealthembraceseveraltheoriesthatareconfirmedbyabundantempiricalandexperimentalevidence,andmedicalprofessionalshaveanincreasinglybroadanddeepunderstandingofthewaysinwhichhealthofindividualsandpopulationscanbeimpaired,endangered,ofpermanentlylost.Scientistsknowthatmanydiseasesarecausedbyinvadingpathogenicmicroorganisms,whichareoftencommunicable.Somediseasesareduetoadisruptionorimbalanceamongendocrineglandsthatsecretehormonesneededtoensureefficientbodilyfunction,somearecausedbydietarydeficiencyofessentialvitaminsorminerals,andothersarecausedbyexposuretoharmfulchemicalsorphysicalinsultssuchasionizingradiationorexcessivenoise.Somediseasesaredueto,orstronglyassociatedwith,emotionalstress.Thereremainsaresidueofimportant,andsometimescommon,diseasesandcausesofdisabilityandprematuredeathforwhichthereisnoknowncause,althougheffectivetreatmentshavebeendevelopedforsomeoftheses,oftenthroughtrialanderrororguesswork.Highbloodpressureisonesuchdisease.

Theactivitiesofpublichealthservicesaimtominimizetheriskofseriousdeparturesfromgoodhealth.Thescopeandmethodsofmedicalandpublichealthpracticedemonstratethedepthandbreadthofcurrentunderstandingofthecausesofdisease,disability,andprematuredeath,andalsoofthecausesofgoodhealth.

Manywhoremainfitthroughoutalonglifetimeattributetheirgoodhealth（oftenincorrectly）totheirbehavior;

whetheritbetoanasceticorhedonisticwayoflife,toabstainingfrom（orindulgingin）alcoholortobacco,tovigorousexercise,ortoleadingaquiet,sedentarylife.Somecredittheirparentsorgeneticheritage—certainlyanimportantdeterminantoflongevity—alongwithmanyenvironmentalandbehavioralfactors.Infact,thecausesofgoodhealthareasdiverseandcomplexasthecausesofdisease.

Evenliterate,well-educatedpeoplesometimeshavemisguidedviewsaboutwhatmakesorkeepsthemhealthy,oftenbelievingthatregulardailyexercise,regularbowelmovements,oraspecificdietaryregimewillalonesufficetopreservetheirgoodhealth.TheNobellaureateLinusPaulingbelievedthatmassivedailydosesofVitaminCpreservedhishealth.Thosewhoarelesswelleducatedandmoregullibleareeasypreytohucksterswhopurveyallmannerofdubiousnostrumstoprolonglife,enhancevitalityorvirility,promotefitness,andeliminateailmentsrangingfromhalitosisandbodyodortofailingsexualpotencyandevencancerandheartdisease.

ModernapproachestohealtheducationandhealthpromotionmakeuseoftheHealthBeliefModelalongwithseveralothertheoreticalconstructstopredicthealth-relatedbehavior.Thesearebasedonassumptionsderivedfromempiricalstudiesofhowpeopleperceivetheirhealthandtheirunderstandingofwhathastobedonetopreserveandprotecttheirownhealth,orthatoftheirchildren.

ObjectiveandSubjectivePerceptionsofHealth

Awell-trainedphysician,oranobservantmemberofafamily,canoftentellataglancethatsomeoneisunwell.Thereareobvioussigns—pallor,sweating,unsteadygait,abone-shakingcough.Theconverseismorechallenging.Someonewhoappears