What It Truly Means To Be Healthy: The Biopsychosocial Model of Health
If my years of pursuing a public health and medical degree have taught me one thing, it’s that health is always going to be multi-factorial. A disease process is never brought about by just one cause, it is always going to be connected to others. For example, a patient does not simply develop cancer because it’s in their genes — their lifestyle and environment also play a role in this development. Of course, not everything can be accounted for, but little things eventually build up to develop one result. It’s just the way it is.
There is a concept in medicine called the biopsychosocial model of health, a concept commonly taught in our community medicine or psychiatry classes. It is a model that highlights the importance of how society, your community, your family, and your personal choices all play a role in your overall healthiness. Biologically, you can be predisposed to certain diseases, but your social and psychological well-being can affect the likelihood of the development of that disease you’re predisposed to. Essentially, everything in your life is connected to your health and, subsequently, your quality of life.
Cases presented as a way to explain this concept are always tragic, at least in my opinion. I encountered one today, and it’s what pushed me to write this piece.
The story of KK is just one of the many examples of how everything in your life is tied together — the people you surround yourself with; the country you live in and how the government manages it; and of course, small and seemingly insignificant everyday choices also build up to fortify the whole picture. KK is a lower to middle class mother who works as a bar waitress in Manila. She is married to KC and has two children — one from her previous relationship, and another from her current marriage. These children are young, at 12 and 9 years old, respectively. They live in a small shanty made of wood and corrugated metal with one bedroom and one bath, also an outdoor kitchen. She is a heavy drinker, and her husband as well. They are both unfaithful to each other, a chain reaction brought upon by KK’s alleged unfaithfulness to her husband inspiring retaliation from the latter.
To make the long story short, KK got cervical cancer, but her journey to recovery was peppered with false personal beliefs about medication and treatment (i.e., misinformation), familial stress, and lack of support.
This case, after being objectively discussed by our consultant, was concluded with the humanization of the patient and her family. I really appreciated that because it gave the characters in the case faces. Apparently, the index patient for the case was really KK’s 12 year-old daughter who experienced an attempted sexual assault by her father and his friends while they were having a drinking party at their house. The daughter was then able to escape to her aunt who lived nearby who then brought her to a nearby public hospital for consultation. Ultimately, KK died of cervical cancer and their family got “dissolved” because the father had to go to jail, and the children, to a child protection home.
Dissolved.
As far as I’m concerned, this term is only appropriate for use in the context of a chemistry class or mixing powdered drinks, not families.
This epilogue to the case really got me thinking, how often do I encounter this in real life? Families dissolving because of health issues and assault? This put things into perspective for me, how lucky I am that the people around me don’t experience this as frequently. But this is not about me. This is about the norms in our society. Things like this, once seen, cannot be ignored. It would be a denial of humanity to do so.
There are quite a lot of issues to look at when it comes to achieving the ideal public health and medical system. I can go on and on about primary and universal health care.
One example, to take things into perspective, is that a lot of Filipinos are just one hospitalization away from poverty. This is why so many people hold off treatment until their conditions are already fulminant and beyond definitive treatment. Getting sick for a lot of people is unimaginable. This isn’t because of the pain from the procedures they have to go through, but because of the costs that these would entail. What would life be after your savings have been consumed by chemotherapy? By maintenance medication? Where will you get the money for your next meal? The next rent payment? Debts?
Another one is misinformation, people will believe what they want to believe. Who can blame them? Expert opinions aren’t always accessible, let alone, free. In the age of social media and fake news, a lot of people fall on this cognitive bias where we tend to rely on proximity versus accuracy (and not even be aware of it).
There are definitely lots of things to think about and fix, not just in the health system, but in the system as a whole.
This is what it means to practice holistic health care.
It’s not just thinking about how surgery and chemotherapy treat cancer. It is to think about educating the public about how vaccines don’t cause autism, to communicate to governing bodies that effective urban planning can prevent communicable disease such as TB, to set up proper employment programs so the likelihood of developing anxiety and depression and resorting to poor coping habits can decrease, to convince individuals that seeking early treatment would not drain their resources (and actually mean it) because you, as their physician, knows that the government has effective and accessible programs in place to protect its citizens from going broke over healthcare. That is what it means to be holistic in the context of health. It is to think about preventing disease before it even gets you, and if it does, you can get access AND afford treatment.
We humans are social beings. Gone are the days that we need each other to really survive, but we still do need each other to thrive. Society is one huge entity made of smaller ones that come together to ensure proper function and goal attainment. We all need these things to work in a synchronized manner to be effective as a whole. Imagine a society where health is a priority. This would look like a functioning water distribution system and waste-management system, a good urban-planning system, good policies to ensure equal distribution of resources, infrastructure, and opportunities. It’s not just a nice hospital with a ton of doctors and nurses at the public’s service, it is everything else outside of the hospital that are up and running to make sure pathogens and toxins don’t kill its citizens. I think it’s fair to assume that this is what all people in healthcare dream of. Prevention is much better than a cure, after all.
Dissolved.
Does it also apply to the health system? When shit hits the fan, it’s easy to point fingers at everyone else — say the government is corrupt, that policymakers are lofty and not in touch with the people they’re supposedly helping, doctors aren’t doing their jobs well, the general public is hardheaded and cynical. This is an unproductive way to go about things. At the end of the day, cliché as it may seem, we all have to come together, perhaps precipitate to battle the problems in the system. Call me naive, bright-eyed, inexperienced; but, dare I say, to come together and to be optimistic about the health system is one step closer to a better, more holistic solution.
I get it now, when my developmental studies professors in college would say we are so far away from the ideal. It’s also so easy to be pessimistic about our country’s situation — ineffective governance, disconnection among the lower governing bodies, broken promises. Our provinces are still stuck in bygone eras with rudimentary knowledge, tools, and infrastructures. Imagine having to fend for yourself just because people in charge choose to concentrate their efforts in the cities, to other agendas. This is what inequality is. This is what it means when people say that health is political. Everything is.
I know reading about this topic is probably similar to listening to a broken record for most of my colleagues — it is consistently brought up in classes, how bad we have it as a country, our health system, collapsing, especially in the face of the pandemic. But perhaps this is the best I can do for now — to say something about it, let people know that there is a problem like this that exists. And soon, perhaps, fingers crossed, I can finally do my part.
