Summary Functioning as the focus of allied health care

The COVID-19 pandemic has made it clear that a focus on biomedical parameters only (i.e., morbidity and mortality rates) is insufficient to cope with the consequences of COVID-19. This applies both to the people who are infected as well as to the health of all citizens. We need a broader and more integrative view on health, such as Positive Health, the Capability Approach, and the International Classification of Functioning, Disability and Health (ICF).

In 2001, the World Health Organization (WHO) published the ICF, which consists of a scheme/ model and four classifications. The conceptual ‘biopsychosocial’ ICF model represents health as the result of a dynamic interaction between functioning, a disorder (when present) and contextual (environmental and personal) factors.

‘Functioning’ – the central concept of the ICF – is about everything you have (body level/ functions and structure), everything you do (personal level/ activities), and everything you are or want to be (societal level/ participation). Functioning is influenced by the disorder, environmental factors and personal factors. With the ICF it is possible to describe health in an integrative, biopsychosocial manner.

The ICF can be used on a micro level (an individual client), meso level (level of an organisation or department), and macro level ((inter)nationally). On a micro level, the ICF can be used to describe the findings of the client him-/ herself, the findings of the professional, the functional diagnosis, the treatment goals (as part of the treatment plan) and the treatment results/ outcomes. On a meso level, the ICF can be used for management information. On a macro level, the ICF is used in research, the development of guidelines and measurement instruments, and in policy (e.g., in the selection criteria for assistive products).

By using the ICF concept of functioning as the third indicator of health, we can truly accelerate a broadly implemented and patient-led, health-in-all care system and health equity for all. By using functioning we can monitor the functioning of individuals with (long lasting results of) a (chronic) disease, such as survivors of COVID-19, but also the functioning of the population as a whole, and we can promote health equity.

To do so, we need a healthcare system that enables people to really shape their life in a way that is meaningful to them, considering the physical, emotional and social challenges they face, and to a society that stimulates them in doing so.

Although many allied health professionals are already using the biopsychosocial approach, it remains necessary to train all (allied) health care professionals in such a way that they can help people to shape their lives and to put the wishes and possibilities of clients in the center of their care. This means a shift from a biomedical approach to a biopsychosocial approach.

Integrative views on health

This text is an excerpt of the book: 'Functioneren als focus van zorg en welzijn. Met ICF-voorbeelden' (Functioning as focus of care and well-being. With examples of the use of the ICF). Stallinga G & Heerkens Y (eds.), Houten: Bohn Stafleu Van Loghum (2021).

For additional reading on integrative views on health, the following papers are recommended:

Positive Health: Huber et al., BMJ 343 (2011) d4163. (How should we define health?)

Capability Approach: Sen, Eur Econ Rev (1988) 269-294 (Freedom of choice: Concept and content)

More information on the ICF:

Functioning as the focus of allied health care

A plea for a transition to ‘health-in all’ care based on an integrative concept of health

Integrative views on health