Human Development as the Beginning and End of Health

Human Development as the Beginning and End of Health

By Dr Héctor Lamas Rojas

The quality of life has been studied from different disciplines. Socially, quality of life has to do with a purchasing power that allows living with the basic needs covered in addition to enjoying good physical and mental health and a satisfactory social relationship.

Quality of life in the elderly

On the concept of quality of life

J. Grau (2003) states that the current trend in quality of life studies is centered on the measurement of subjective aspects that refract material living conditions. Also relevant in this approach is the question of who carries out the evaluation, an external observer or the person himself (external evaluation or internal evaluation, respectively, terminology proposed by González-Marín 1994).

Most of the researchers are inclined towards the second option, that is to say, by the person himself. Many authors, among them R. Pérez Lovelle (1987), advocate the undoubted advantage that human beings have of being able to directly glimpse some aspects of their own psychic life, which can serve to advance hypotheses about the mechanisms of psychic regulation that later they can be verified with other methods of observation and recording of the activity.

This impregnates with an unquestionable value then the study of phenomenology (subjectivity), this can be an effective antidote to avoid the simplification of the human psyche.

That is why the current trend of studying the quality of life category, focusing on the analysis from its internal evaluation (that is, by the subject himself), requires, from our point of view, to take into account in the study, the state and development of self-assessment on which the evaluation and the judgment issued are built.

Trujillo, Tovar and Lozano (2004) propose three thematic axes that they consider that psychology can contribute to the interdisciplinary dialogue on the quality of life. Each of these axes has two poles and relationships between them, and also has interactive relationships with the others. They are:

a) Person-society and the relationships between them refer to the different types of individuals, social groups and environments in which life passes, such as the family, the neighborhood, the church, the school, the town or city, the institutions, etc. This axis can be called ecological axis, following the inspiration of Urie Bronfenbrenner, and seeks to account for the different areas in which the quality of life is built or destroyed. Since it is individual people who can preserve or modify their own lifestyles, but they do not do so in isolation from the society in which they live, which proceeds to improve or worsen the conditions of existence of its members.

One can recognize (distinguish but not separate) "styles" of personal life, on the one hand, and immediate and mediate "conditions" of the environment, on the other, being possible to specify the quality of life from its personal to environmental and cultural components. . This axis could also be called the resolution level axis, since we can specify at what level we disaggregate the vital quality model into its components, for example, at the individual, family, group, community, social, synchronic or diachronic level, etc. In ecological language: microsystems, mesosystems, exosystems, macrosystems and chronosystems.

b) Objective-subjective, In this axis the poles are related according to the different forms and types of intersubjectivity. Since, just as there are aspects of the quality of life that can be objectified, some of which are quantifiable and measurable, there are also aspects of the quality of life that are not measurable, but rather constitute subjective evaluations of something that, internally or externally, affects vital quality. Thus, it is possible for us to find out how the effect of the same particular objective reality on well-being can be differentially valued by two or more people who are related to it. This is an epistemological axis insofar as it refers to the ways in which the subject interacts with the objects of his knowledge (which can be other subjects or himself), and therefore, it has to do with the old problem between reason and experience as sources of valid knowledge. After all, the objective quality of life does not always coincide with the subjective one.

It cannot be thought that this axis replicates the person-society poles of the ecological axis, since it is understood that, the objective of quality of life, can refer to characteristics of a person, a group, a society or a culture, As with respect to a person or a community, some subjective criteria of vital quality may be specified, for example, depending on a regional culture. On the other hand, it is found that society functions as a regulatory agent with a set of intersubjective agreements, on which a good part of the objective gaze rests, and also a shared social evaluation that is internalized and subjective (Brock, 1997). These agreements are made in favor of both individual and collective well-being, to this extent and following the approaches of Diener (2000), (who defines quality of life as well-being), the subjective nature of the quality of life would be given in terms of the satisfaction and perception that a subject has about their own life in domains such as work, affective, family and social, among others. What characterizes subjective judgment is that the value judgments concerning the person and their condition regarding material and psychological facts correspond to the same individual about how these affect their own quality of life (Brock, 1993). On the other hand, the objective character of the quality of life would be given by categories or quantifiable and measurable indicators such as aspects of health, housing, education, income, job stability and social functioning in general, among others. It is prudent to consider that "subjective" is not necessarily synonymous with "particular", since the universal also has a subjective dimension, or in other words, the subjective is also universal.

c) Biography-history: In seeking to represent the temporal dimension of the quality of life, the third axis is formulated, which could be called the axis of development through the life cycle. It distinguishes a historical pole, in the sense of collective history (historical time and social time) and a biographical pole, in the sense of the history of each individual (life time), in which we can recognize inherited characteristics, others learned and also those that are the result of decisions of each person, and that contribute to the improvement or worsening of the quality of life. From there it follows that in this axis of development, historical and ontogenetic, it is possible to include what happens in the course of life and what people do with what happens to them, from which it can easily be deduced that the quality of life it changes evolutionarily based on inherited and learned factors and the freedom that is possible thanks to the exercise of the will. Then, during the course of life its quality is transformed as a function of the dynamic interaction between the various factors that constitute it, since a necessary task in its study will be to identify these components and to recognize the different interrelationships and changes that they can assume throughout individual and collective becoming.

This theoretical model responds to an epistemological option for a dialectical contextual model of development, such as the one that characterizes the Life Cycle perspective, an option framed in a systemic paradigm as a possibility of approaching complexity, which allows the respectful use of different theories and Research Methods.

Quality of life in the elderly

The scientific study of old age from psychology made its appearance in the 19th century associated with the interest that arose around aging as part of developmental psychology (Riegel, 1977). In order to specify the historical development of the study of the psychology of old age and aging, a series of stages will be established for its description, following the classic work of Birren (1961) on the history of the psychology of aging. Thus, the following phases can be distinguished: an initial period, from 1835 to the end of the second decade of the 20th century, a stage referring to the beginning of systematic research, between 1918 and 1945, and a period of constitution from the end of the Second World War (1945-1960). A final phase of consolidation and development is added to the previous stages, which would begin in the 1960s and continue to the present day.

The quality of life has been studied from different disciplines. Socially, quality of life has to do with a purchasing power that allows living with the basic needs covered in addition to enjoying good physical and mental health and a satisfactory social relationship.

There is no consensus among researchers on the definition of "quality of life". A concept that involves many subjective variables satisfaction, happiness, self-esteem ... is difficult to measure. The objective variables are easier to measure: economy, socio-cultural level, functional deficits, health problems.

Clinically oriented researchers often define quality of life in terms of health and / or functional disability. Rivera, contributes that "there is no doubt that the health variable is the one with the greatest weight in the perception of well-being of the elderly and that health deficits constitute the first problem for them."

In societies that are aging at an increasing rate, promoting the quality of life in old age and in dependent old age is the most immediate challenge for social policies. The increasing increase in life expectancy, the historically unprecedented decrease in the birth rate, changes in the structure, size, and forms of the family, changes in the status of women, the increasing reduction of Labor activity rates among people aged fifty-five and over have made the aging of society a matter of utmost concern.

The consequences of all these processes are many, both at the macrosocial level and in individual experiences. How to give meaning to life after a retirement, often arrived in advance and unexpectedly, how to cope with the maintenance of a home -sometimes with dependent children- with a pension, how to face chronic illness and dependence on one or more elderly family members. These are just a few issues that need a responsible and rigorous theoretical and practical approach. Society faces new challenges for which it needs new instruments. A new concept of solidarity between generations and between different groups is required, in an increasingly complex, more insecure, more indeterminate world.

The quality of life in old age has to do with economic security and with social inclusion that is ensured through supportive infrastructures and social networks. All of this will promote the participation of older people as active members of the community, one of whose functions may be to transmit their experiences to the younger generations, while understanding their lifestyle and their own challenges. All this in a society immersed in processes that also lead her to learn to grow old.

R. Fernández-Ballesteros (1997) framed in a systemic paradigm, has formulated a specific theoretical model of quality of life for the elderly group, the result of a multidimensional analysis both in its objective and subjective aspects that circumscribe the differential reality of each person . These dimensions are associated either to a personal factor (health, functional abilities, satisfaction, social relationships and leisure activities) or to a socio-environmental factor (cultural factors, quality of the environment, health and social services, social support, relationships social, economic conditions).

Under these conditions, the construct "quality of life" is manifested as an active, open and dynamic process capable of transforming the daily reality of the person through promoting learning (Velázquez, Fernández, 1998) and enhancing the set of resources and habits that satisfy human needs (health, relationships, self-esteem, competence and trust in others, creativity, spaces for participation, educational opportunities, housing, economic situation), in accordance with the functioning of society (with the values, norms and advances social).

In the struggle for survival and the best adaptability to a given environment, every elderly person must, at least, maintain and seek minimum stability; since, in this generational group, any change associated with a certain risk implies a potential loss greater than in another generational group (Table 1)

Table Nº 1

Every individual (in its potential as a living organism) is mediated by an environment (Max-Neef, 1986) that it adapts and builds throughout life, becoming this existence (the personal-environmental binomial to which reference is made ) in unique and unrepeatable; becoming a differential (Fernández-Ballesteros, 1997) from any other.

Thus, each dimension included as a personal factor depends on and manifests itself in constant competition with a specific dimension of the environment; this is:
- Specific aspects of socio-cultural status will be influenced by different environmental qualities (continent, latitude, wealth, urban-rural, etc.)
- biopsychosocial health will depend on available and accessible social and health services
- the functional ability that a person demonstrates will be mediated by specific economic factors
- the social relationships you have, the social support you receive and resolve,
- The use and enjoyment of idle time (jubilant) will be ascribed to a generational supply / demand.

From a comprehensive analysis of this phase of evolutionary development, it is possible to detect situations of fragility, associated with the fundamental tendency of the individual, as age advances, to the loss of adaptability due to physiological changes (homeostatic, sensory-perceptual, accumulation of geriatric syndromes ..) and psychosocial (stressful life events, lifestyles, financial resources, social networks ...); in such a way that the probability of functional claudication increases when faced with different external aggressions. This implies that personal factors, as well as socio-environmental and socio-cultural specific to each environment (as well as specific for said age group) must be considered when detecting, assessing and understanding the needs of this sector of the population.

Psychosocial intervention

Development on a human scale incorporates the old along with other members of society in the definition and construction of their future.

This type of development supposes a direct and participatory democracy, it means carrying forward the concept of citizenship, understood as: ... "the historical competence to decide and specify the opportunity for sustainable human development, indicates the ability to critically understand reality and on the basis From this elaborated critical consciousness, to intervene in an alternative way, it is about transforming into a historical subject and as such participating actively, in this sense, organizational capacity is fundamental because it enhances innovative competition, on the other hand, the question would consist of the overcoming of the manipulable mass and political poverty. "

Thinking in terms of development on a human scale, according to the writings of Max Neff, means creating the conditions for the elderly to be the main protagonists in this development, this implies respecting the differences and the autonomy of the spaces in which they act, encouraging creative solutions that rise from the grassroots to the top.

The satisfaction of needs must be considered not only as overcoming deficiencies but also as the training of the elderly as active participants in the development of their society and as protagonists of the personal growth of each one as a human being, becoming subject persons and not object.

This development overcomes the antinomy between the individual and the social, encourages the adoption of measures that combine individual and social growth as two aspects of the same reality.

What is sought in development on a human scale is a global planning of local autonomy, with strategies capable of mobilizing the different organizations of the elderly so that they can transform their struggle to survive into vital options and alternatives based on dignity and creativity and not in poverty and human degradation.

As old age is a social construction, development on a human scale would change from the beginning the forces that stigmatize the old and push them to the margin of society. Advancing in this modality could give rise to the active exercise of the principles proposed by the United Nations in favor of the Elderly: "independence, participation, care, personal fulfillment and dignity".

In another aspect, and in relation to the health of the community, an important objective is to offer a conceptual and methodological framework for the work with the community, which involves a series of activities related to the team, the community and other sectors involved.

Regarding the equipment, the need arises to:
Recover the history of the group and make a diagnosis of the present situation, the inclusion of new members, the degree of rapprochement and commitment to the "community health" proposal.
- Survey the expectations and attitudes related to work in the health center.
- Promote interdisciplinary work spaces.
- Analyze the daily difficulties, the obstacles that prevent the accomplishment of the programmed tasks, reviewing the slogans that emerged in the team meetings.
- Register the activities, projects and programs collaborating in the establishment of priorities and the planning of the activities.
- Incorporate the sociocultural and historical dimension within the team, to broaden its conception of the health-disease-care processes.
- Encourage reflection processes on the institution: its history, organization, regulations, power relations.
- Provide information on the population of the program area in relation to sociodemographic composition, history, organizations, groups and institutions.
- Reflect on community work strategies in order to coordinate extra-wall activities.

This means with respect to the community, deepening the knowledge of history, forms of organization, institutions, leadership, networks, forms of communication, existing logic.

To advance in the knowledge of the different institutions, organizations and groups that were working in the neighborhood, trying as far as possible to coordinate actions.

Reflect on the community health center relationship, the degree of rapprochement, the images, expectations, experiences, the demands in care and in the programs, trying to strengthen the existing links and formulating an adequate work methodology.

Entering a world known from the social experience but from a different position, an experience that is associated with suffering, illness and death, which generates anguish, fear. Intervene, know to transform, to think alternatives, get involved.

This experience involves learning to work in a different way, often with problems stated by other disciplines, redefining a problem from different perspectives, working at a different pace, crossed by urgencies, contradictions, frustrations. The implicit theoretical assumption is to work on differences not as oppositions but as relationships (us-others), to work on the spaces of exchange, interactions, mediations between the individual and the social, the micro and the macro, the theory and the practice: relationships between the CS and the community, between social classes. The modalities through which the other is imposed on me, the place we occupy, the forms of communication, the distances, the power relations. Relate the macro and the micro-social, analyzing how the historical, political and economic context, the modifications in social policies, we can see in the daily life and in the breaks of that daily life, associated with collective experiences.

The resilience approach

Fundamentally, in intervention our work implies a change of focus. The one we propose: resilience. Promoting resilience aims to improve people's quality of life based on their own meanings, the way they perceive and face the world. So our first task is to recognize those qualities and strengths that have allowed people to positively face stressful experiences. Stimulating resilient behavior implies enhancing these attributes by involving all members of the community in the development, implementation, and evaluation of intervention programs.

The development of resilience is none other than the process of healthy and dynamic development of human beings in which the personality and the influence of the environment interact reciprocally.

Human development is a process and not a program. Rutter encourages the use of the term protective process, which understands the dynamic nature of resilience rather than the more common protective elements: "It does not refer to elements in a broad sense, but simply to mechanisms for developing the protective process" ( Rutter, 1987). Research is a hope that prevention, education and youth development programs do not revolve around the program itself, but rather on the process and on how we do what we do; that is, not concentrating on the content, but on the context.

There are internal factors such as self-esteem, optimism, faith, self-confidence, responsibility, the ability to choose or change cognitive skills. Once these aspects are strengthened, the possibilities of the group to support people as a whole, safe and capable human being are reinforced.

For this reason, it is important, in addition to developing internal factors, to strengthen external support. However, if self-esteem is low or does not combine well with social skills, or if hope in oneself does not flow, it is not channeled in the best way and if external support is removed from the individual, they collapse again.
Here are ten points that internally strengthen personal power:

1. Stable treatment with at least one of the parents or another reference person.
2. Social support from within and outside the family
3. Emotionally positive, open, guiding, and rule-governed educational climate.
4. Social models that encourage constructive behaviorism.
5. Balance of social responsibilities and demand for results.
6. Cognitive skills.
7. Behavioral traits that favor an effective attitude.
8. Experience of self-efficacy, self-confidence and positive self-concept.
9. Positive action against stress inducers.
10. Exercise of sense, structure and meaning in one's own growth.

External conditioning factors are those of a social, economic, family, institutional, spiritual, recreational and religious nature, which are promoted or facilitated by the environment, people, institutions and families involved in the care, treatment and treatment of groups and individuals who are at risk and vulnerability.

Apart from those already mentioned, there are other areas and keys that resilience generates. Not a few insist on the need to have good role models in daily life, especially when it comes to children, people of whom individuals or other children can to learn. Today some educators have developed these techniques with experiences in the field with forests, flowers and others. Risk factors, which can be many, which weaken mental, moral, and social integrity are also among the external factors.

It is not enough to share their daily life and be diluted in it, nor to reflect on their problems by identifying the risk factors that led them to take this option, since it would make their living conditions even more vulnerable, especially a double stigmatization is encouraged, marking them with a label like a street man, a drug addict, etc.

In these cases, it is the inner light that in certain cases serves to determine a decision and take a privileged opportunity that presents itself at the right time. This represents strengthening the protective factors that promote resilience, revaluing the internal and external potential of each person to rebuild their personal and community life project.

It can be considered that the main attitudes that strengthen the protective or resilient factors in humans are:

- Physical and verbal demonstrations of affection and affection in the first four years of life.
- Recognition and attention to their successes and abilities.
- Skills development opportunities.
- Attitude of cultivation, care and love on the part of all their peers and especially those in charge of their care and protection.
- Support of an ethical and moral frame of reference.

Basically, to have a project to genuinely live. These projects are possible today, without the need to go to sects or messianic voices for the solution to the great questions of life.

First we have to recognize ourselves as human beings with values ​​and potentials and in that mirror also look at others with a holistic vision that aims at growth, inner strengthening and the cultivation of self-esteem.

Resilience research is a call for social change - a blast of the trumpet to create relationships and opportunities for all human beings throughout a lifetime. If we want to change the "status quo" of society, this means changing paradigms, both personally and professionally, changing risks for resilience, control for participation, solving problems for positive development, not perceiving young people as problems, but as resources, building institutions, building communities, etc. Building resilience is a deep structural process that begins from the inside out, in which we change our way of thinking in order to perceive young people, their families and their culture as resources and not as problems.

However, building resilience also means working at the educational, social and economic justice policy level. Likewise, it means transforming not only our families, educational centers and communities, but also creating a society whose main interest is to respond to the needs of citizens, young people and the elderly. To make this a reality, our greatest hope lies in young people and in the credibility that they inspire us.
Although it is true that the actions to be taken will depend on the available resources and the current state of health care. We need clear policy and program guidelines that must be formulated based on updated and reliable information about the community, health indicators, effective treatments, prevention and promotion strategies, and health resources, to be periodically reviewed to modify or update them. if necessary.

* Dr. Héctor Lamas Rojas and Psic Alcira Murrugarra Abanto of the Peruvian Resilience Society Telephone: 051 01 5646761
Fax: 051 01 3305389 - Article by Fundación Unida

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