A paradigm shift: from disease to health orientation.
The history of science has been described as 'paradigm shifts' of sequential overthrow, each new paradigm replacing the previous one. A paradigm is an overarching view-point which guides the articulation of theories and other activities in a particular field. In the exploration of health, two different types of approach can be identified. The pathogenic view, which has dominated the orientation of medicine over the last hundred years, focuses on disease states and underlying factors that modify the chances of entering into one of those states. The competing salutogenic view appears to be undergoing a renaissance in the new strategies of public health and health promotion, and producing theories of health based on more holistic approaches and diverse methods. The two paradigms exist side by side, and both are in a constant state of flux. The advocates of the health-oriented paradigm say it is difficult to reach a true, in-depth understanding of human health on the basis of a disease-oriented approach or from the traditional vantage-point of risk-factor epidemiology, whereas opponents point out that health does not lend itself to exact measurements or experimentation in keeping with the Galilean natural science ideal. The importance and utility of health orientation need to be explored and ascertained in further research. The approach seems, however, to have a number of crucial assets that might help avoid the limitations of the established disease and risk-factor epidemiology approaches and promote new directions of pursuit, including a better understanding of the complex relationships between aging and health, and other current challenges in creating healthy public policy.
Heikkinen
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Department of Health Sciences and the Finnish Center for Interdisciplinary Gerontology, University of Jyväskylä, Jyväskylä, Finland.