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Arun Kumar ShramaKumar Ravi Priya

Tracing Back the ‘Psychosocial’ in Definitionof Health: Its Aims and Implications

The problem

The aim of this paper is to stress the role of

psychosocial factors in definition of health and illness.

This is a theoretical paper and its argument is that for

universal care health has to be defined in a more

holistic manner, incorporating psychosocial factors,

community support and the cultural context. In

traditional India, as in other traditions, this happened

to be the case. During the last two centuries, however,

the ideas of health and illness became unidimensional and

statistical. This happened as implicitly or explicitly

the definition of health accepted the biomedical model of

health as axiomatic. This model focuses on disease and

locates pathology or the symptoms of diseases in the

biological processes. Thus a negative definition of

health emerged. This definition of health, though

producing a large number of quantitative and descriptive

studies has marginalized the vulnerable groups by

decontextualizing health. The paper suggests that there

is now a need to develop a positive definition of health,

congruent with the social and cultural context and the

importance of human agency.

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Under the aegis of modernization, a number of factors

contributed to emergence of medical perspective which got

recognized as a true approach to health and illness,

rejecting all other discourses. There are several reasons

behind this. The major ones are: (a) constructs of

scientific validity of the biomedical discourse against

other ‘pre-scientific’ discourses; (b) concern for public

health and desire to fight communicable diseases; (c)

applied social science’s increased dependence on

indicators; (d) donor driven health policies, discarding

cultural traditions and history of the developing

countries (with which operations research is commonly

associated); and (e) global priority-setting for

research. This shift in conceptualization produced

certain problems and now the postmodern turn is re-

inventing the plural cultural conceptualizations of

healthy life to mitigate the problems caused by various

forms of vulnerabilities caused by the loss of agency.

Thus this paper takes a critical look at the

paradigmatic debates in theorization about health and

illness and the adherence of the positivist method-driven

approaches in social science of health that is

responsible for not doing justice to the potential of

social studies of health – something that promised and

promises a voice to the sufferers’ experiences in their

socio-historical context. At the end, the paper suggests

a few questions which the new perspective presents before

the sociologists and psychologists to ponder.

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Tradition and health

In the past, definition of health has been a part of

the overall religious and cultural philosophies.

Buddhism, Hinduism, Christianity and Islam have had their

own understandings of health. For example, in Buddhism

health is associated with bodhi (the true understanding)

and in Vedantic Hinduism it is associated with existing

in Brahman (the true self). The Sanskrit term for health

is swasthya which means existing in self. This

understanding lacked the body-mind dualism and the

obsessive concern with the body. This issue is explored

latter in more depth. It must be recognized that if (and

when) the traditional communities did not suffer from

natural calamities and epidemics they seemed to have

lived a good life. More research is needed on status of

health among the traditional peoples in normal times.

Public policy, operationalization of health and shift

from health to diseases

One most frequently cited definition of health in

social sciences is the World Health Organization (WHO)

definition. This definition clearly echoes the

conventional wisdom on the matter. Initially, WHO had a

broad definition of health, consistent with literature

supporting psychosocial model of health and illness. WHO

constitution defines health as follows: ‘Health is a

state of complete physical, mental, and social well-being

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and not merely the absence of disease or infirmity’

(Grad, 2002). The WHO constitution in 2006 also confirms

the same. This definition draws heavily from the pre-

biomedical perspectives of health which were part of

culture and tradition of diverse peoples.

In the second part of the 20th century, however, the

concept of health changed. For good reasons, WHO

constitution talked about health as a fundamental human

right of every human being. This diverted attention of

state towards control of diseases and particularly

communicable diseases (Grad, 2002) worldwide.

Communicable diseases afflicted the poor nations most and

WHO programme to raise life expectancy for the major

parts of the world had to concentrate on fighting against

them on priority basis. This explains why although WHO

defines health in a broader sense than absence of disease

the WHO policies and strategies have resulted in the

mortality and morbidity based conceptualization of

health.

Historically, the constitution of WHO was a response to

Brazilian and Chinese delegates’ proposal to establish an

international health organization which was unanimously

accepted. It is also the result of Europe’s concern about

cholera, plague and sanitation including provisions

against smallpox and typhus (WHO, 2012). Before the

formation of WHO in 1948, International Health Conference

in New York approved the Constitution of the World Health

Organization (WHO) and WHO Interim Commission organized

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assistance to Egypt to combat cholera epidemic. In 1970s

WHO took up immunization to protect children from

poliomyelitis, measles, diphtheria, whooping cough,

tetanus and tuberculosis. In 1979 health was seen as ‘a

powerful lever for socioeconomic development and peace’.

Then gradually WHO’s attention was shifted specifically

towards HIV and non-communicable diseases. It may be

noted that for practical purposes the WHO Constitution

2006, Chapter 2, Article 2(f) includes providing help in

technical, epidemiological and statistical services. The

subsequent articles seem to draw attention to

pharmaceutical and biological aspects rather than social

and spiritual aspects (WHO, 2006).

In India there were independent but parallel

developments in conceptualization of health. Bhore

Committee which was appointed in 1943 to examine the

health conditions in India and which submitted its report

in 1946 (Bhore Committee Report, 1946), defined health in

a manner that included ‘a state of harmonious functioning

of the body and mind in relation to his physical and

social environment, so as to enable him to enjoy life to

the fullest possible extent and to reach his maximum

level of productive capacity’. Yet, the Bhore Committee

had to confine to statistics of ill health and deaths as

a positive concept of health was lacking. It however

included in its ambit environmental hygiene, nutrition,

cooperation from people, health education and preventive

health services apart from provisions for specific

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services (MoH, u.d.a). Bhore Committee examined the

health scenario in terms of investment in health,

prevalence of diseases, health infrastructure, standards

of medical facilities in India as compared to the West,

and suggested certain quantitative targets. Ministry of

Health’s Report of the Health Survey and Planning Committee, Vol. 1,

August 1959-October 1961, found these targets to be a bit

ambitious. The report also recommended that since it was

not possible to provide services of primary health

centres due to paucity of funds, the programme should

utilize mobile health vans from the district and taluq

headquarters, but it did not critique the basic framework

of the Bhore Committee.

Bhore Committee Report of 1946 (Government of India,

1946) shows the shift from positive to negative

conceptualization of health very vividly. In the context

of positive mental health, it says that ‘The pursuit of

positive mental health requires the harmonious

development of man’s physical, emotional and intellectual

equipment.’ The next sentence of the report shifts the

focus from health to ill-health when it says: ‘Measures

designed to create and maintain an environment conducive

to healthful living and to control the specific causes

responsible for all forms of physical and mental ill-

health are essential for promoting such development.’

Thus the idea of positive health was lost.

National Health policies of 1983 and 2002, and Eleventh

and Twelfth Five Year Plan drafts in India (MoH, u.d.b)

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show the same operations research approach to health and

population issues unabated.

Causes behind the shift from health to ill-health

There are several reasons behind the shift from a

positive to a negative conceptualization of health. The

major ones are:

(a) constructs of scientific validity of the

biomedical discourse against other ‘pre-

scientific’ discourses;

(b) concern for public health and desire to fight

communicable diseases;

(c) applied social science’s increased dependence on

indicators;

(d) donor driven health policies, discarding

cultural traditions and history of the

developing countries (with which operations

research is commonly associated); and

(e) global priority-setting for research.

Firstly, during the early nation building process in

the developing countries, catching up with the Western

countries by adopting scientific rational and techno-

economic model had a high appeal. With industrial

revolution the West had already accepted the supremacy of

science over tradition and culture. Medical knowledge,

based on science of chemistry, quantum physics, biology

and other experimental sciences established as one

superior to endogenous knowledge forms. This contributed

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to validity claims of the biomedical discourse against

other any other pre-scientific discourse. The body-mind

dualism is the product of this context. Cassell (2004),

in his landmark book, The Nature of Suffering and the Goals of

Medicine, contends that the reasons for reducing health and

illness to the physiological condition can be traced back

to Western medicine’s continued reliance on the classic

dualism (contained in the Hipporcatic tradition of

Greece; 450 B.C.) of ‘disease as object and patient as

subject’. Kleinman (1988) elaborated on the implications

of this dualism, ‘The biomedical system replaces this

“soft,” therefore devalued, psychological concern with

meanings with the scientifically “hard,” therefore

overvalued, technical quest for the control of symptoms’

(p. 9).

Cassell points out,

The idea that what is objective – in this sense,what can be seen, touched, or measured – is moreimportant than what is subjective – inwardly felt,sensed, or intuited – goes back to the origins ofWestern scientific medicine in classical Greece.Since the beginning the body has been seen as objectthat could be sensibly understood apart from each ofus as embodied subjects at once in and part of ourbodies. (pp. xii-xiii, emphasis added)

The excessive inclination toward focusing on or

examining solely the body continues to prevail in the

modern Western medicine as it is supported by the

philosophical positivism (with its realist ontology) that

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has dominated every scientific discipline as its

philosophical basis (Cassell, 2004; Gergen, 1994;

Kleinman, 1988). Cassell indicates this:

The medical science of our era has delivered onthe general promise of science that nature can beknown – all truth revealed. So much so that whensomething like (say) the cause of Alzheimer’sdementia is not known, in medicine we generally donot say it is unknown but rather it is not yet known …If this test doesn’t reveal whatever it is, thenanother will. If not that one, still another test ordiagnostic method can, for sure, show what is wrong.Why not? Doesn’t the world of disease, like all ofdepersonalized nature, wait only to be read? (p.xiii, emphasis added)

Secondly, as said above, the concern for public health

and desire to fight communicable diseases put application

of DDT spray, antibiotics, anaesthesia and surgery on top

of the agenda. This required monitoring health in terms

of rates and ratios and various measures of life

expectancy, and efforts to improve those rates and

ratios. Difficulties in operationalization of well-being

have certainly been a major reason why health got defined

in terms of absence of disease. One may also apply the

conspiracy theory to explain this by saying that the

public health approach converged with the interests of

pharmaceutical companies, capitalist industry and the

experts from medical profession.

Thirdly, there is a methodological reason: the

unavoidable dependence of social sciences on indicators.

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Health planners, epidemiologists and experts felt that

inclusion of terms like ‘complete’ and ‘social well-

being’ make the definition of health vague (Callahan,

1973). Callahan argued that while a minimum level of

health is necessary for human happiness, one can be seen

to be healthy ‘without being in a state of “complete

physical, mental, and social well-being”’. He proposes:

I suggest we settle on the following: “health is astate of physical well-being.” That state need notbe “complete,” but it must be at least adequate,i.e., without significant impairment of function. Italso need not encompass “mental” well-being; one canbe healthy yet anxious, well yet depressed. And itsurely ought not to encompass “social well-being,”except insofar as that well-being will be impairedby the presence of large-scale, serious physicalinfirmities.

Fourthly, one cannot doubt that donor driven health

policies, discarding cultural traditions and history of

the developing countries, with which operations research

is commonly associated, are also responsible for the

shift towards quantification, and exploring linkages

between social conditions and risks.

Fifthly, research requires transborder flow of

knowledge and funds. International health agencies,

health departments of the developed nations, and

international NGOs decide the priorities for research.

This paralyzes the psychosocial and cultural context of

knowledge.

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The above causes of why biomedical model gained at the

cost of cultural or psychosocial are all intertwined.

Quest for science, need for indicators, interest of

pharmaceutical companies, agendas of international bodies

and state policies are all interdependent factors.

Occasionally, there have been attempts to be flexible to

incorporate the subjective experiences of illness,

suffering and healing but, these have met deaf years. As

Cassell points out, the sociologist, Renee C. Fox (1957)

accentuated the need to outgrow the belief in certainty

of biological reductionism prevalent in medical

education. Clearly, an openness to exercise patience in

reaching out to the experiences or meanings of illness or

health could not be emphasized more. But Fox’s appleal

soon got marginalized and not much attention was paid to

such an openness in medical education. Recently health

psychologists such as Stanton et al. (2007) made an

appeal for adopting ‘more culturally anchored approaches’

for studying adjustment to chronic illness (p. 581) and

Leventhal et al. (2008) urged fellow researchers to

understand selfhood of patients within their cultural

contexts for improving the effectiveness of cognitive

behavioural interventions for patients of chronic

illness. Nevertheless, the openness these health

psychologists showed to cultural and selfhood was plagued

by their obsession with ‘hard’ biological entities or the

ones that could only be amenable to experimental or

statistical techniques of research.

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Some consequences of the dominance of biomedical model of

health

At the moment, in countries like India, there is an

utter lack of incorporation of paradigmatic debates in

theorization about the science of health and illness and

the adherence of the positivist method-driven approaches

in social science of health that is responsible for not

doing justice to the potential of social studies of

health – something that promised and promises a voice to

the sufferers’ experiences in their socio-historical

context. Measures like disability adjusted life years are

opening a new area of research which links health with

larger issues of society and life. Larson (1996) argues

that before the WHO defined health in a certain way

traditions defined health covering three things – mind,

body and spirit. The commonly accepted component of the

WHO definition focused on body, recognized the importance

of mind and completely ignored spirit. He also argued

that if empirical psychology has not taken the concept of

spirit seriously because it could not be operationalized,

time has come to include this in the concept of health

first and then operationalize it. Citing studies of

health he avers that religion affects health and well-

being through its effects on the health-beliefs. To him

spiritual ways of measuring health are also important and

they need to be brought out in studies. Ustun and Jacob

(2005) too show that even today among many people a

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divine view of health (for example, Islamic view of

health) persists. They argue for giving due attention to

the community health and spiritual well-being as the

‘core aspects of the definition of health’.

One major consequence of working within the biomedical

framework of health was the silencing of the experiences

of illness, suffering and healing. Ignoring the

‘psychosocial’ while conceptualizing or researching

health and illness is tantamount to ignoring or silencing

the experiences of illness, suffering and healing. The

core characteristics of the ‘psychosocial’ in the

definition of health and illness is clear from the

sociologist, Arthur Frank’s (2000) observations in his

research on illness experiences that a sufferer seeks

commonality of experiences rather than a conversation for

the sake of analysis of his or her experiences. According

to Frank, an ill person seeks relatedness through which

his or her miseries can be listened to and empathized

with. Ignoring this relational or psychosocial element of

illness experiences not only leads to ignorance of

suffering but, it also curbs the possibilities of healing

that might be initiated within the relational space as

the development of a new enabling meaning and value to

the sufferer’s experiences (Cassell, 2004; Ellingson,

2000; Kleinman, 1988).

Not just in the research on health and illness, but in

medical practice and training too, the significance of

the psychosocial or the relational elements of the health

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and illness experiences has been acknowledged. Cassell

(2004) contends,

Knowledge, however, whether of medical science or

the art of medicine, does not take care of sick

persons or relieve their suffering; clinicians do in

whom these kinds of knowledge are integrated. (p.

ix, emphasis added)

Unless the experiential or relational aspect of

suffering (and not just the symptoms) and healing is

recognized and addressed, the ill persons’ stake remains

untouched. However, an issue that is so pertinent from

the standpoint of the patients remains a non-issue in

biomedicine. Cassell points out the gap in the

expectations of the laypersons from and the perceptions

of medical teachers and students about health care,

When I discussed the problem of suffering withlaypersons, I learned that they were shocked todiscover that it was not directly addressed inmedical education. My colleagues of a contemplativenature were surprised at how little they knew aboutthe problem and how little thought they had givenit, whereas medical students were not sure of therelevance of the issue of suffering to their work.(pp. 30-31)

Coming back to the nature of suffering that is usually

ignored by igoring the psychosocial elements of health,

Cassell defines suffering as a threat to the intactness

of the personhood or selfhood within its socio-cultural

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context. Clearly, meanings that are a part of one’s self-

construal (and what is meaningful and valued in that) are

shaped within one’s socio-cultural context. Two aspects

of suffering that are associated with physical illnesses

that have been highlighted in the literature are ‘low

moral status’ (Charmaz, 1999) and ‘agony of perceived

future’ (Cassell, 2004).

According to the sociologist, Kathy Charmaz (1999) in

the beginning, illness and associated suffering may not

make the person feel measureable as suffering may create

opportunities for being taken as a hero emerging from a

battle of life. However, with time, the myth of hero

gives way to decline in moral status as suffering results

in demanding work for chronically ill, caregivers and co-

workers. Charmaz provides an example:

A professor in an understaffed department suffereda rapid decline that resulted in his colleaguestaking over his classes. Although they said they didso willingly, he sensed how burdened they were andfelt that he had let them down. Meanwhile, hiscolleagues banged at the dean’s door, saying, “Howcan we get him out of here?” Moral claims ofsuffering seldom long preserve a person’s publicstatus. (p. 369)

Charmaz also indicates that as illness may lead to low

moral status, the ill persons may not share their life

stories of their suffering to evade moral judgement. This

avoidance of moral judgement results in silenced

suffering.

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Cassell (2004) indicates how the treatment and its

experiential and relational consequences may be agonizing

for the patients. He provides an example of a thirty-

five-year-old sculptor with an advanced stage of breast

cancer who was receiving chemotherapy:

At every stage, the treatment as well as thedisease was a source of suffering to her. She wasfrightened and uncertain about her future but couldget little information from her physicians, and whatshe was told was not always the truth. She wasunaware, for example, that the radiation therapy tothe breast (in lieu of a mastectomy) might be sodisfiguring. After her ovaries were removed and aregimen of medications that were masculinizing, shebecame obese, grew facial hair and body hair of amale type, and her libido disappeared. When tumorinvaded the nerves near her shoulder, she loststrength in the hand she used in sculpting andbecame profoundly depressed. . . . Three facts standout: The first is that this woman’s suffering wasnot confined to physical symptoms. The second isthat she suffered not only from her disease but alsofrom its treatment. The third fact is that one couldnot anticipate what she would describe as a sourceof suffering; like other patients, she had to beasked. (pp. 29-30)

The traditional view of health in India

Without going into Durkheimian, Weberian, Kuhnian,

Fleckian and Foucauldian ideas of distinct discourses it

can certainly be said that biomedical is just one view of

health and illness and several other discourses of health

exist even today which address the psychosocial needs of

people that the biomedical discourse has failed to do. It

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is a truism that people commonly follow pragmatic

practices and medical pluralism and a positive view of

health entails exploring all options (i.e. medical

pluralism including acceptance of alternative systems

such as AYUSH). For the holistic and positive thinking,

and to search for alternatives, here an attempt is made

to explore the traditional understanding of health in

India.

According to Bhramachari (2001) tradition in India

defines health as situating (or existing) in Self. To

quote: swasmin tishthateeti swasthai (i.e., one who is sitting

in Self is healthy). There are several implications of

this traditional thinking. First of all, this

understanding defines health in a holistic manner

covering needs of the body (swabhavik) such as thirst,

hunger, sleep, wakefulness and death; diseases of the

body (roga) such as fever, jaundice etc.; problems of mind

(maanasik roga) such as desire, egoism, jealousy, fear,

anger, depression etc.; and external factors (aagantuk)

such as accidents, injuries and snake bite. Secondly,

this understanding joins all types of diseases –

physical, mental and accidental – and life practices.

Thirdly, it rejects life expectancy as the indicator of

health as it says that death is not the end of life.

There is rather a continuity of lives. Buddha told that

birth is the main cause of death. The goal of life is to

attain liberation from the cycles of birth and death. And

for this purpose special care has to be taken of the

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emotional, mental and spiritual conditioning of the

sufferer. For more than two and half thousand years most

of the Indian philosophies have subscribed to this view –

Buddhist, Jaina or other Hindu philosophies. For Indians

the body is the embodiment of diseases and is the result

of the sins of the previous life.

In the first half of the 20th Century Gandhi was

forcefully fighting against the Western institutions

including medical institutions.

To quote Gandhi (2001a):

Hospitals are institutions for propagating sin.Men take less care of their bodies and immoralityincreases. European doctors are the worst of all.For the sake of a mistaken care of the human body,they kill annually thousands of animals. Theypractise vivisection. No religion sanctions this.All say that it is not necessary to take so manylives for the sake of our bodies.

Gandhi (1954) believed that Ladha Maharaj whom his

father met in Porbandar cured of leprosy himself

completely by using bilva leaves, reciting the name of Ram

(God) and devotional reading of Ramayana. One may say

that Gandhi was a fanatic or one may say that to put

forward his point at a time India was moving towards

westernization he took an extreme view but this view is

part of all traditions – Hindu, Christian and Islamic.

Quoting Charak, Gandhi (1949) wrote in 1946 in Harijan

Sevak that by reciting any one name of Vishnu, the lord of

the universe, all types of diseases are stopped. One day

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before his death Gandhi had written to Kishorelalbhai

that both his liver and kidney were affected due to

unripe faith in Ramanama (i.e. reciting the name of God).

It may be noted that for Gandhi there is no difference

between Ram, God of Christianity, and Allah of Islam.

These are all different names of the same God. For Gandhi

(2001b) as such body is only a dirty pot containing

bones, flesh and blood and both the water and breath

coming out of body are poisonous. But if it is used

properly it becomes chintamani (which can fulfil all your

desires and lead to freedom and God realization).

Among the major visionaries of the twentieth century

Gandhi had a very different understanding of health

towards which he devoted a major part of his struggle.

This was far away from Parson’s sick role theory or a

need to take allopathic medicine to recover and come back

to normal role. This was also different from astrological

and magical practices promoted by free-floating Hinduism

(a term coined by M. N. Srinivas). Gandhi’s views on

health can be discerned from four books, Hind Swaraj, Key to

Health, Nature Cure, Ramanama, and several other writings.

To quote Kumarappa (1954): ‘… Gandhiji viewing man a

whole finds that disease of the body is chiefly due to

mental or spiritual causes and can be permanently cured

only when the man’s entire attitude to life is changed’.

Revealing a similarity with Foucauldian view Gandhi

linked the practice of medical profession with power. In

Hind Swaraj he equated the western civilization with the

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Upas tree (i.e., a poisonous tree) and legal and medical

profession as its branches.

Psychosocial model of health contextualizes health and

defines it in the context of culture, society, political

economy, biographical conditions, beliefs and

religiosity. It posits that concept of health goes beyond

the biomedical condition of the absence of disease, and

it includes individual’s ability to conform to norms

(Weiss and Lonnquist, 1997), potential for psychosocial

and spiritual development (Chen, 2006) and cultural

health (Tamang and Broom, 2011; Wong et al., 2006). In

the late twentieth century there has been a strong

influence of the interpretive turn in social sciences on

the incorporation of ‘psychosocial’ in theorization of

health and illness experiences. Yet, even today the

dominance of biological factors in theorization of health

and illness persists.

As observed throughout this article, incorporating

‘psychosocial’ (or the experiential and relational

dimensions) in the definition of health – that is

necessary to include the voice of the health-care

receivers – has theoretical and methodological

implications. What follows from the arguments and

examples given above is that theorizing about health must

include a concern to study empathy, context and the

spirituality or transcendence (that has been an integral

element of meanings of health in traditional societies).

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The concern for empathic connection with the sufferer can

not be overemphasized. Cassell (2004) explicates,

Centuries of trying to disengage the person fromknowledge born of experience through science orother means have not been successful. The solutionto the problem lies in remembering that only anotherperson can empathetically experience the experienceof a person. In medicine the triad is inseparable –patient, experience, physician.

Implications and recommendations

There are several implications of adopting the

psychosocial model of health. Some are of methodological

nature, some are political, and some are theoretical. As

far as the methodological implications of incorporating

the ‘psychosocial’ elements are concerned, researchers

and practitioners of health-care may have some heart even

in following the qualitative paradigms of research. For

Kleinman (1988), taking care of (or providing medical

psychotherapy) of patients and researching their psycho-

social or relational worlds are not two distinct

processes. In fact, he has recommended qualitative

techniques such as writing mini-ethnography and brief

life history to be employed to provide meaningful

experience-near care to the chronically ill patients.

Besides this, traditional experiential methods such a

meditation and yogic practices as prescribed by Mahatma

Gandhi may be employed to explore the spiritual or

transcendental elements of health and illness

experiences. Politically, it brings to the centre stage

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discussion of chronic illness, and health of terminally

ill patients, cancer patients, people living with

HIV/AIDS and women, etc. Theoretically, it helps in

raising new questions and empowering people. It also

stresses that narratives are as important as statistics

and that knowledge as reality is always co-constructed

(i.e. actively produced by both the researcher and the

subject).

The new issues which have been ignored under the

disease based paradigm are:

What are social representations of health under

the diverse settings?

How do health beliefs impact on representations

of health, and health choices?

Is there a link between social status, social

condition, stress, individual life style, risks,

beliefs and social and cultural capital?

How do people cope in various illness

conditions?

In case of terminally ill patients, what is the

state of palliative care and in what best manner

it can be organized in different settings?

These are a few questions which the sociologists and

positive psychologists may explore in the future. It is

recommended that along with the quantitative studies of

health which have so far focused on social class aspects

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of mortality, morbidity, anaemia, stunting, stuttering

and underweight, qualitative aspects of health and

suffering should also be explored. The issue of

empowerment of the ill is also another issue which needs

attention. This includes concern to study empathy,

context and the spirituality or transcendence. It must be

recognized that the ultimate aim of the health

intervention is to empower the ill and not just improving

the statistics of deaths and diseases.

Conclusion

While the WHO definition provides a holistic and

multidimensional definition of health, due to impact of

bio-medical model, over the years health has acquired a

negative definition (in terms of disease). This

definition has produced a large number of quantitative

studies of health and immense data on health inequalities

but has decontextualized health; it has ignored the

social and subjective needs of the people. Using the

ideas from Usturn and Jacob, Frank, Cassell and Kleinman

and presenting some ideas from Indian tradition, the

paper argues for building a more psychosocial and

positive view of health. This also brings into its ambit

a due recognition of the qualitative studies and the

people’s representations.

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