Holistic Health Care

What is it, and how can we achieve it? Summary This paper develops a systematic and logically consistent model of holistic healthcare. Holism refers to an approach to health which acknowledges that health depends upon many interrelated components which interact in such a way that the overall effect constitutes health (or illness). The current understanding of illness is, in contrast, linear and reductionist. It assumes that all illness starts with a disorder within the body causing bodily symptoms that lead on to disability and restrictions on social life. This is the biomedical model. This paper demonstrates that this model is flawed in several ways: the underlying assumptions are false, it cannot explain functional (so-called non-organic) illnesses which are common, and it does not lead to well-managed healthcare systems. The biopsychosocial approach to illness is then explored, with a detailed description of one specific model based on the model underlying the World Health Organisation's International Classification of Functioning. The model is expanded to recognise four systems centred on the person – organs, the whole person, behaviour, and social role function – and four contextual factors that influence these systems – personal factors, physical environment, social environment, and time. The new model also draws attention to two important components of any holistic model of health, choice (free-will) and quality of life. Illness is then shown to be a socially determined state whereby the patient may initiate being ill but it requires others, usually healthcare professionals to validate illness before it is fully accepted. The paper then emphasises some lessons that follow from this model, illustrating its utility. Finally there is an analysis of healthcare which emphasises that healthcare is an active problem-solving process. The implications of the holistic model of health care both for clinical care and for the management of healthcare systems are then discussed, emphasising the complex nature of healthcare and the social aspects of illness. The important overall conclusion from this paper is that health and illness should be seen as socially construed states that involve a whole person in their own context, and that effective health care requires both a full analysis of a person's illness to identify all factors relevant to its genesis and a wide range of interventions across several domains. In people with complex or long-term conditions effective management will usually require many interventions delivered by different organisations, including those outside normal healthcare, over a …