EFEcTIvO y EFEcTIvO EqUIvALENTE

By reviewing some recent publications about health and health promotion, it

becomes clear that well-being is a central concept in health promotion. As a result of dissatisfaction about the clear meaning of health, significant arguments were found advocating the concept of well being. Buchanan, (2000) argued that “well-being” is more suitable to use than health as it implies a positive meaning such as life

satisfaction and happiness. This argument has been taken forward by Chaves et al, (2005) who claim that well-being offers considerable potential for unifying diverse sectors and interests around the goal of improving health and thus health promotion and health research (Chaves, et al, 2005). The former authors examined the meaning of well-being within a range of disciplines such as psychology, economics, health studies, society anthropology and biomedicine (Chaves, et al, 2005). Although the review’s comprehensiveness is constrained by excluding nursing literature, the results were that most disciplines tended to be biased towards one or two aspects of physical, social and psychological well-being with the main exception being child well-being studies. It was noted that economics made a significant contribution to the element of well-being in linking the affect of the economy on people’s well-being. On the other hand, psychology and biomedicine were more concerned about disease related issues in a well-being context. Chaves et al, (2005) argue further that

understanding of the concept of well-being could have significant implications for structuring an improved meaning of health and therefore health promotion. Although there is little consensus about the meaning of well-being, Bowling (2005) supports Chaves et al’s, (2005) suggestion but she warns that well-being should not be seen as the absence of physical problems or psychological morbidity such as depression. This warning is not new and has been cited elsewhere in the nursing literature (Pender, 1996). What Bowling has argued is that well-being includes dimensions of self-esteem and sense of coherence.

These dimensions have been explored in depth elsewhere and it is not possible to cover their debate in this section (Bowling 2005). The important point to address is that the previous components of well being are subjective experiences; for instance, people’s happiness and satisfaction cannot be entirely understood unless they are asked about their feelings. This argument has been adequately explored in the work of Tones and Tilford (2001) which focused on the development of health and well being in relation to health promotion.

They argue that the concepts of health as well as the concept of well-being are subjective experiences defined by people’s “hedonistic feelings”. That is, it is not possible to understand the meaning of health and related issues such as health promotion unless they are examined from the people own perspective. However, whilst well-being and health are often used interchangeably and are closely related, Buchanan, (2000) stressed that it is important to distinguish between them. For example, physical fitness does not necessarily imply a high level of well-being. He writes that:

“well-being is resulted through living well [and] through engaging in social practices that embody the values we wish to bring to being”(P:49).

Chaves et al, (2005) came to an interesting conclusion which stresses that well-being could be used from now on as an alternative to the concept of health. These

commentators of well-being concept justified this “replacement” by considering other changes that happened to similar concepts. For example, Chaves et al (2005) point out that the terminology surrounding health education has changed to health promotion over the past decade. Thus, in their opinion, it might be possible that the concept of health could be replaced by well-being. Whilst it is acknowledged that well-being has a positive meaning of health, adhering to the Chaves et al’s

suggestion at the present time is risky.

As indicated earlier in this review, the meaning of health has been underdeveloped for a long time and, despite this, it is still a heated subject of debate. The concept of well-being on the other hand has not yet been fully examined in other disciplines

with special reference to nursing, explicitly, due to the lack of sufficient theoretical and empirical debate about the meaning of well-being.

It seems therefore, that it is too early to consider well-being as an alternative concept to health. In fact, shifting the concept of health to well-being could lead to further confusion rather than clarity about other concepts. If, for example, health promotion has changed to “well-being promotion” and health education to “well-being

education”. In light of this, throughout this thesis therefore the term of health will be used.

In conclusion, , the ideology of health from the medical perspective is “negative” and is no longer acceptable because of its failure to capture broader factors that affect people’s health such as environmental and socio-economic. Nurses’ role in health promotion therefore might be limited as a result of the extensive use of the medical view of health. This might explain the dominance of the medically informed health education ideas in nurses’ role in health promotion (Furber, 2000, Cross, 2005, Casey, 2007). This is to be fully examined in the next chapter.

With the reported flaws associated with the medical model view of health in mind, the literature now moves on to examine the meaning of health from the social perspective. Doing so is driven by evidence indicating that the meaning of health is rooted in people’s social norms (Tones and Green, 2004, Laverack, 2004) and its meaning would remain vague without a sound understanding of its social

construction.