Health and Wellbeing in Childhood

Introduction

For many years, researchers, clinicians and educators have debated the relative influence of nature (biology) versus nurture (the social environment) in children's health and development. Those who emphasise the importance of biological factors are guided by a model of health known as the medical model. Within the medical model, disability is regarded as ‘a problem of the person, directly caused by disease, trauma or other health condition, which requires medical care’ (World Health Organization (WHO), 2007, p. 15). Those who emphasise the importance of the environment/ context are guided by a social model. Within the social model of health, disability is regarded as ‘a complex collection of conditions, many of which are created by the social environment’ rather than an individual attribute (WHO, 2007, p. 18).

These two models of health and disability differ in their identification of where the health problem lies (the individual or the environment), differ in how it should be addressed (medical care/ social action) and by whom (health professionals/ society). However, very often both medical needs and social needs must be considered. Take for example, the case of childhood communication impairment. Many children with communication impairment benefit from direct intervention to address their speech or language difficulties. However, this is most beneficial when undertaken in conjunction with environmental interventions such as family education about the impairment – educating family members on how to stimulate language skills and support communication attempts. Thus, when we think about the health and wellbeing of children, we need a model of health that is holistic in its conceptualisation and comprehensive in its design in order to ensure we gain the best understanding of their health needs and can provide the most effective support. The International Classification of Functioning, Disability and Health (ICF) (WHO, 2001) was developed by the WHO to provide a comprehensive and holistic framework for conceptualising health. The WHO first defined health in a holistic way in 1946, regarding it as ‘the state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’ (p. 100); however, more recently, they recognised a need for a framework to enable professionals, services and governments to enact that definition. The ICF is based on a biopsychosocial framework, and aims to integrate the medical and social models of health.