The theoretical background to arts in health
Theoretical developments in health
What is health?
Arguably the most famous definition of health was published in a preamble to the Constitution of the World Health Organization (WHO) at the International Health Conference in New York in 1946, entering into force on 7 April 1948. Signed by representatives of 61 states, showing the largest-scale agreement on a definition seen to date, health was described as ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirm- ity’.(1) This definition has now been in use for nearly 70 years, which could on the surface suggest that our understanding and conceptualization of health has enjoyed a period of relative stability. However, not only was the WHO definition a contrast to the views of just a few decades earlier, but ‘health’ has since become one of the most debated concepts within science.
A biomedical model of health
As discussed in Chapter 1, the eighteenth and nineteenth centuries saw huge advances in the theory and practice of medicine across Europe. As just one example, in the early nineteenth century, Italian scientist Agostino Bassi showed for the first time that disease could be caused by microorganisms.(2) This came to be known as ‘germ theory’ and was famously further advanced by chemist and microbiologist Louis Pasteur.(3) Germ theory was revolutionary for laboratory science, hospital medicine, and surgery, leading to more accurate diagnoses and safer surgical conditions. Germ theory also focused people’s attention onto individuals and specifically onto the aetiology of disease and its immediate cause. Microorganisms, germ theory, and the seemingly unending capabilities of other new medical techniques led to a shift in attitude towards illness and disease that came to be known as the biomedical model.(4)
According to the biomedical model, disease was seen as an externality, either as an invader of the body or the result of involuntary internal physical changes.
Treatment for these conditions resided with medical professionals, with patients seen as victims; out of control of what was happening inside them. Health was, as a consequence, seen as the absence of disease, and was often categorized as a binary: well or ill. The role of the mind was little considered within this model of health. So although illness was seen as capable of having psychological consequences, it was not seen as having psychological causes.(5)
There were many positives to the rise of this model of health in terms of the development of medicine. First, by placing responsibility on the physician to cure illness, it encouraged yet more research, leading to a wave of scientific advances. Alongside this, more regulations came into force, the discipline of medicine was further professionalized and there was a rise of professional bod- ies.(6) For example, in the UK, the Provincial Medical and Surgical Association (later renamed the British Medical Association) was founded in 1832 and the General Medical Council established in 1858. It also led to more support for people with health conditions, especially certain health conditions that had previously been dismissed as moral weakness or sin, such as alcoholism, but were now taken more seriously and considered as something that could be treated.(7)
However, there were also many issues that arose under the biomedical model that were not fully addressed. For example, by placing responsibility for health and illness in the hands of professionals, it diminished some of the responsibility among individuals. The development of a larger scientific vocabulary also increased the mystification around medicine and decreased public accessibility, further distancing people from their own health. Furthermore, while scientific advances under the biomedical model did reduce mortality associated with surgery, there was limited immediate impact on reducing mortality from disease and many conditions remained chronic or incurable.(8) As a result, alternative therapies continued to hold thrall, and, unsurprisingly, other areas of medicine also grew in prominence.
For more information about the biomedical model the Encyclopedia of Health Psychology contains an entry that can be read alongside other models of health.(9)