Rethinking Health Care Approach: From A Bio- Psychosocial Perspective

In today‘s world, one of the most grappling concerns is health care. According to WHO,  ̳health is not only absence of disease but also taking care of physical, mental and social wellbeing‘. This review article is to understand different health models that contributes to well-being. Biomedical model is found to be the most dominated approach, even though it is unidirectional and considers  ̳physicality‘ as the basic principle for the treatment. Research has been done to incorporate biological, psychological and social factors in treatment modalities in order to provide holistic health care. This paper aims to explorehow the biopsychosocial model can be used in the health care field with the help of empirical evidence.


Introduction
A very common but important saying, ‗Health is wealth' goes with everyone's life. Being healthy is not only about having proper physical health but it also involves mental and social stability. A healthy person is capable of living life to the fullest and can face life challenges in much better way. For many years health is used to be defined as the absence of any disease but recently WHO, defines health as not only about freeing from any illness or disease but to have holistic comfort that includes taking care of physical, mental and social wellbeing (Deep, 1999). Everyone can relate to the term ‗health' and is achieved when www.psychologyandeducation.net requires understanding of vulnerability level of patientand patient's perception of severity of illness. This model also helps to recognize whether a patient will follow the recommendation given to him/her by doctors or not. It depends on the patient's perceived benefits of treatment. (Jones et al.,2015). It implies, if patient feels that there is scope of benefit then the required actions will be taken by them.It is recommended that consideration of HBM dimensions should be a part of health education (Janz& Becker, 1984).
Biomedical model.This is a scientific model devised for the study of disease which believes in dealing with diseases using measurable biological variables independently, leaving social and psychological variables. It assumes that language of chemistry and physics can only be used to understand the biological bases of a disease. This model separates mental from somatic experiences and focuses on explaining biological phenomena to treat any disease. Hence, it can be concluded that the core principle of biomedical model is physicality.

Biopsychosocial
model.Biopsychosocial (BPS) model suggest that human health is impacted by biological factors (example: hormone disturbance), psychological factors (like stress, anxiety) and social factors (like family support, family environment). This model in addition to biomedical approach looks into patient health with holistic perspective (Engel,1977). It focuses on the patient and clinician relationship with psychological aspects like positive and negative affect, emotions etc. From social perspective it focus on the environment that surroundspatient (Dodge & Pettit, 2003).BPS approach holds the -biological, psychological, social, and structural processes operate in a matrix of nested and inextricably connected subsystems that influence all aspects of mental and physical health‖ (Suls, Krantz, & Williams, 2013). It encompasses internalization of the fact that every patient is more than just a biological being. This is the model that adds multiple approaches with medicines in treating and making the patient well by looking at all over well-being. Over the years, Biopsychosocial model has been discussed, debated, critiqued, and utilized in all specialties of medicine. Though various critics point to its shortcomings, the model has stood the test of time. BPS model has been highly accepted and appreciated within academic and institutional contexts but its execution into medical practices is taking longer to emerge. Execution of this practice is still a challenge withinareas of medicine. The model has been used to obtain a better understanding of the disease process, but its acceptance and incorporation into medical practice is taking longer to emerge.
Source: Rethinking the Biopsychosocial model of health: understanding health as a dynamic system (Lehman, David & Gruber, 2017).

Transactional Model of Stress and Coping (TMSC).
The TMSC looked into the relationship between person and environmental variables to understand the reason of stress. Person variables deals with personal attributes such as emotional health and Environmental variablesare the factors that is present in patient's surrounding such as social support (Blocker, 2017). This allows analysis of factors contributing of stress and thus, helps in preparing individual to cope with it.

Programming
Ecological systems theory.This theory suggests that an individual is a part of macrosystem, exosystem, mesosystem, and microsystem. These systems influence the outcomes of an individual l. The outermost level of the ecological model is macrosystem. It includes values, ideologies, institutional patterns, and cultural characteristics. The exosystem captures social groups and institutions that exert influence on the individual, such as community service. Mesosystem consists of interrelationships between microsystems and the microsystem that influence individual in a specific context (Njoku & Gloria, 2015). Integrated Health care model. Integrated behavioral healthcare focuses on biomedical and behavioral health care services. These services are dependent on the need of patient and medical setting. This model includes varieties of services like therapies, co-visits with care providers, providing psychoeducation, management calls and peer support (Blocker, 2017). Thus, this approach helps in overall wellbeing by providing other psychological and social variables.

Review of Literature
Health is the combination of biological, psychological and social wellbeing. All these variables are directly or indirectly impacting each other and are inseparable (Suls& Rothman,2004). To measure the health of a person it is important to see both biological and subjective health. How a person feels about his/her health helps to evaluate person's bodily and mental state (Nordenfelt, 2007  Papadimitriou (2017), suggested that psychological and environmental factors play a major role in the patient's severity of illness. Biopsychosocial model can be of help in treating mental disorders as this approach uses holistic approach that includes focusing on genetic susceptibility,with the patient's social context by being empathetic and compassionate. Peyrot, McMurry, and Kruger (1999) suggested a model of glycemic control to treat diabetes patients that is based on BPS principle.Suls and Rothman (2004) explored the biological, social and psychological aspects of health in which study revealed that four areas need more attention -research, training programs, practice and intervention, and policy making. This helps to utilize the link betweenpsychological, biological and social aspects of Biopsychosocial model efficiently (Margolis et.al, 2001).
Another study used the integrating behavioral health professional approach to address the hopes that would yield positive health outcomes. This includes working on www.psychologyandeducation.net consequences of poor health and patient's experience of the treatment. This results in enhancing satisfaction of patient without focusing much on cost (Blocker, 2017). Application of Transactional Model of Stress and Coping (TMSC), address the problem (problem-focused) or reduce the emotional reaction (emotion focused). This model helps to add contextual factors that creates stress or worry (Blocker, 2017).Understanding the background and emotions of the patient help to strengthen doctor-patient relation, which is the core belief of Biopsychosoical approach of treatment.This impact of power of physician on patient influences the health of a patient. Thus it can be established that relationship between patient and care taker plays an important role in the treatment.
Few studies show that biases among the care takers can have negative results in the treatment process, for example if a care taker get biased by the race or sex of the patient, can decide to not work with the patient in order to avoid any complications (Borrell-Carrió, Suchman& Epstein, 2004). Hence, both role of social factors and personal factors play a vital role in the recovery of disease. Researchers have found that biopsychosocial factors have a strong association with depression and anxiety (Bond et al., 2020). Any physical problem can leads to psychological issue if not focused in the psychological aspects. Thus, holistic approach towards different diseases like mental disorders, diabetes, thyroid, infertility, obesity etc. can help in better health recovery.
The World Health Organization (WHO) has projected that the rate of prevalence for various diseases are increasing in epidemic proportions especially in developing countries like India. The National Mental Health Survey was taken in twelve states across six regions of India-North, South, East and West in the year 2015-2016. The prevalence rate for any mental morbidity was found to be 13.7% lifetime and 10.6% current mental morbidity. It was dreadful to see that the gap in treatment ranged between 70% and 92% for different mental disorders (Murthy,2017). Rate of prevalence for Diabetes given by national Indian Council of Medical Researchwas highest in Chandigarh that has the maximum GDP (Anjana et.al, 2017). Other diseases like Thyroid is common worldwide (Unnikrishnan & Menon, 2011), infertility affects up to 15% ofreproductive-aged couples across the world and is being ignored usually. WHO estimates the overall prevalence of primary infertility in India is between 3.9 to 16.8% (Adamson et.al, 2011). Another serious public health concern throughout the world is regarding weight. Obesity is a risk factor for wide range of serious non communicable diseases. 5% of Indian population is obese and it is found to be predominant among women (62%) than men (59.7%) ( These diseases result in major psychological and social problems like worry and distress in both male and female. Hence, it is important to help individual to become equipped in dealing with stressful situation by taking care of holistic health and development. With increase rate of prevalence, it is important to control those potential factors that can impact the health rather than just focusing on treating diseases. To achieve this purpose, selfawareness and understanding of health from holistic perspective (biological, psychological and social aspects) is required.Though there are lot of challenges in applying this model in to real practice but research emphasis that health and wellness should remain the essence of Biopsychosocial model (Frazier,2020).

Conclusion
This review paper suggests that the overall wellbeing of an individual is a combination of biopsychosocial factors which enhances their quality of life. In order to provide holistic health care to the individual there is a requirement for paradigm shift. Hence it is important to use eclectic modalities in preventing and managing diseases. Thus, it is vital for the health care professionals to focus beyond the biomedical approach and to aim at improving overall wellbeing, quality of life and life satisfaction of people suffering from health issues.