White, Norman F., "The Relationship Between Health Care Interventions and Morbidity: Some Counter-Intuitive Implications of a Socio-Ecological Model", 1988

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The most fundamental health studies issue is the discrepancy between expected and actual performances of the Health Care System: the deployment of curative biomedicine is expected to decrease morbidity and costs, but we see everywhere a rise in both. Technological lag, environmental damage, administrative slippage, professional pressures, and new wealth consumption are conventional but, at best, partial explanations. It appears that the rationale is flawed by the use of an inappropriate image of the system out of which morbidity phenomena emerge. The Socio-Ecological Model proposed here links HCS operations with a more appropriate morbidity construct. The individual's subsystems interact with the social-physical environment to create two distinguishable types of morbidity: anatomico-physiological conditions constituting the 'lesions' of the disease process, and interacting experiential, behavioural, and role changes of the illness state. The HCS becomes a significant part of the sick person's environment, and affects the four resulting sub-populations differentially. Care and prevention goals are to move sick individuals/populations toward illness-free and disease-free quadrants and to prevent/slow movement away from them. The counter-intuitive HSC production of morbidity (through, e.g., coronary care, increased life expectancy, pursuit of fitness, early diagnosis, and psychosocial counselling) is no longer surprising. The model suggests a revision of health planning goals, with major shifts in resource allocation.

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  • 1988
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