The Rainbow Model of Health Examined with Reference to
Healthy Pregnancy and Premature Birth
Defining health is a very complex and challenging concept that involves the evaluation of
many different influential elements. Over time, a variety of health models have been developed to assist in identifying the best picture of health. A more basic medical model example explains that health is “an attribute you can measure simply by determining if a disease is present or not” (Models of Health, 2017). Further developed models begin to dig deeper in discovering other details that contribute to the health of both individuals and populations. It is encouraged that “health is not seen in a narrow form, as the presence or absence of disease. Rather the acceptance that disease can be used as one measurement of health.” (Models of Health, 2017). Expanding on this idea, we can investigate the effects of the multiple determinants of health, including physical and environmental aspects, along with “psychosocial factors such as social networks, social status and individual lifestyle.” (Models of Health, 2017).
The determinants of health are well identified in a health model by Dahlgren and Whitehead, often referred to as the ‘Rainbow Model’ seen in Figure 1. Using the different layers of this model, we can explain how health is influenced at many different levels. For example, we can look at the multiple social, environmental, and lifestyle factors that influence one’s health during pregnancy, and help identify the risks and prevention of premature labor in women.
Age, Sex and Genetics
The most specific and centre level of this models identifies the biological components of each individual. This includes age, sex and genetic make-up of a person, but are fixed factors in which we have little control over (Dahlgren & Whitehead, 1991). With regards to one’s sex, there are some diseases that are more prevalent in women than men, or vice versa. A Canadian study identified in 2005 that 37,085 women were diagnosed with breast cancer, while only 306 men were diagnosed with the same. (Ellison & Wilkins, 2009). Gender and the difference in genetics can considerably impact one’s risk of a specific illness or disease.
Some women experience early miscarriages due to the body’s inability to host a fetus. Possible causes of this include, but are not limited to, genetics and hormonal imbalance or insufficiency. Another cause of premature labor may be due to maternal age and the changes the body goes through while maturing. In today’s society, many women are choosing to reproduce at later stages in their lives. A study by McIntyre, Newburn-Cook, O’Brien, & Demianczuk identified that “women delivering their first child between the ages of 40 to 44 years rose from 23% to 29% between 1991 and 2005 (McIntyre et al., 2009 p. 671). Gaining higher education and becoming more established in their careers are substantial reasons for this. As a woman gets older, the risk of giving birth early or going into labor prematurely increases. A study performed in the United Stated found that “preterm rates were lowest among births to women aged 25–29, and highest among births to women aged 40 and over” (Martin, Hamilton, & Osterman, 2017) displayed in Figure 2. The previously mentioned study on maternal age by McIntryre et al. discovered that “older maternal age had a direct and independent effect on spontaneous preterm labor” (McIntyre et al., 2009 p. 671) for both high and low-risk nulliparous women. As our bodies age, our ability to achieve and maintain health alters.
Individual Lifestyle Factors
The next level on this health model explores how different lifestyle choices can impact an individual’s health. Getting proper exercise, maintaining a healthy diet and choosing healthy habits can all benefit one’s health. Comparing premature birth to exercise, a variety of positive benefits have been recognized. An article titled Land-Based Exercise During Pregnancy stated prenatal exercise improves sleep, increases energy, helps keep weight within recommended limits, reduces constipation, decreases back pain, and may be associated with an easier and shorter labor and delivery (Binkley, Binkley, & Wise, 2015). All of these benefits contribute to a healthier pregnancy, and the reduction of risk of prematurity.
Making the choice to continue the use of drugs or alcohol during pregnancy has shown negative consequences on health. A study executed in Australia discovered that 24.2% of pregnant women using opioids delivered prematurely, while only 5.8% of women who did not do drugs had premature births (Baer et al., 2017). The article stated that during pregnancy “women who used drugs were 90% more likely to deliver before 37 weeks.” (Baer et al., 2017). Alcohol during pregnancy has also shown negative associations with fetal development, which has been acknowledged by health providers for many years. The fetus is put at risk for fetal alcohol syndrome, delayed development and low birth weight. Lifestyle choices can have significant and direct influence on the health of an individual.
Social and Community Networks
Support systems and community resources can play a large part in health promotion, illness prevention, education and coping skills. An individual’s social network, including friends and family, can provide the psychological and emotional support needed through illness, or while actively trying to improve health. The effects of insecurity, anxiety and social isolation can negatively impact health. In pregnancy, having a poor support system can trigger “maternal psychosocial stress, depression, and anxiety” which can be “caused by both domestic and neighborhood-level social and environmental deprivation” and “are considered leading causes of pre-term birth in high-income countries” (Baker, Story, Walser-Kuntz, & Zimmerman, 2018, p. 3). Being supported by your community and your loved ones can positively impact an individual’s physical, mental and social health.
Receiving proper prenatal care and education on pregnancy can reduce maternal stress and improve the health of the mother and her fetus. Various societies differ in the types and amount of resources that are available. A study performed regarding the effects of stress on premature birth discovered “a significant association between preterm birth and stress biomarkers during pregnancy” and that “maternal stress seems to have an important role on preterm birth in healthy women”. (García-Blanco et al., 2017) Stress reduction is important, and finding relevant community resources and support groups to share experiences and fears with can help to decrease negative feelings around pregnancy, birth and encourage health improvement.
Living and Working Conditions
The environment around us has a tremendous impact on our lives and our health. This section of the Rainbow Model identifies how elements such as education, work environments or unemployment, sanitation and access to health services impact overall health. In Canada, we have the resources and ability to access clean water, large amounts of food and resources, medicine and shelter. We are able to receive the nutrition we need, maintain proper hygiene and access the medical care that assists us in maintaining a healthy body and mind. In some other parts of our world, the living conditions are not as established or achievable. When a woman is trying to stay healthy during her pregnancy “the struggle to address basic water, sanitation, and hygiene” is known to be “a major contributor to adverse birth outcomes” (Baker et al., 2018, p. 2). Struggling to access the daily needs we all reach for can poorly contribute to the delivery of a healthy baby. “Stressful living conditions could cause women’s bodies to increase expression of corticotrophin releasing hormone and immune inflammatory markers” which “stimulate myometrium contractions and/or rupture of chorioamniotic membranes, resulting in premature labor” (Baker et al., 2018, p. 3).
The environments in which we work can also pose a threat to our physical and mental health. Many jobs involve long hours and high levels of stress and anxiety, while others demand a lot of physical work, putting workers at risk for physical injury. Over the last century, women have expanded the diversity in their careers, working more labor intensive jobs and in established positions involving more responsibility. “With growing labor force participation among women in western countries, many women will work during their reproductive years. This will increase the likelihood that during pregnancy women will be exposed to a variety of risk factors at work that may affect pregnancy outcome” including spontaneous abortion, and preterm birth (Burdorf et al., 2011, p. 197). While professional equality is more easily achieved in today’s society, there are more risks and stressful situations that women can experience in their work environments. This may increase the exposure to potential harm during their pregnancy. In these work environments, education around safety and stress management may be extremely beneficial, and provide the opportunity to prevent undesirable health outcomes.
All of these conditions and elements impact our health in different ways, but all are significant in developing and maintaining our health. By evaluating and addressing all of a society’s needs, we can generate a more wholistic healthy state.
References
Baer, R. J., Chambers, C. D., Ryckman, K. K., Oltman, S. P., Norton, M. E., & Jelliffe-Pawlowski, L. L. (2017). Risk of preterm birth among women using drugs during pregnancy with elevated α-fetoprotein. Journal of Perinatology, 37, 220–225. Retrieved March 04, 2019 from https://0-www-nature-com.aupac.lib.athabascau.ca/articles/jp2016224#article-info
Baker, K. K., Story, W. T., Walser-Kuntz, E., & Zimmerman, M. B. (2018). Impact of social capital, harassment of women and girls, and water and sanitation access on premature birth and low infant birth weight in India. PLOS ONE, 13(10). Retrieved from https://0-doi-org.aupac.lib.athabascau.ca/10.1371/journal.pone.0205345
Binkley, H. M., Binkley, J. L., & Wise, S. L. (2015). Land-Based Exercise During Pregnancy. International Journal of Childbirth Education, 30(3), 37–41. Retrieved from http://0-search.ebscohost.com.aupac.lib.athabascau.ca/login.aspx?direct=true&db=awh&AN=108725510&site=eds-live
Burdorf, A., Brand, T., Jaddoe, V., Hofman, A., Mackenbach, J., & Steegers, E. (2011). The effects of work-related maternal risk factors on time to pregnancy, preterm birth and birth weight: The Generation R study. Occupational and Environmental Medicine, 68(3), 197-204. Retrieved from http://0-www.jstor.org.aupac.lib.athabascau.ca/stable/25802169
Dahlgren, G., & Whitehead, M. (1991). Policies and strategies to promote social equity in health: Background document to WHO - Strategy paper for Europe. Institute for Futures Studies, 14. Retrieved from https://www.researchgate.net/profile/Goeran_Dahlgren/publication/5095964_Policies_and_strategies_to_promote_social_equity_in_health_Background_document_to_WHO_-_Strategy_paper_for_Europe/links/569540f808aeab58a9a4d946.pdf
Ellison, L. F., & Wilkins, K. (2009). Cancer prevalence in the Canadian population. Health Reports, 20(1), 7–19. Retrieved from http://0-search.ebscohost.com.aupac.lib.athabascau.ca/login.aspx?direct=true&db=rch&AN=37565000&site=eds-live
García-Blanco, A., Diago, V., Serrano De La Cruz, V., Hervás, D., Cháfer-Pericás, C., & Vento, M. (2017). Can stress biomarkers predict preterm birth in women with threatened preterm labor? Psychoneuroendocrinology, 83, 19–24. Retrieved from http://0-eds.b.ebscohost.com.aupac.lib.athabascau.ca/eds/detail/detail?vid=2&sid=ff1f8ef1-22b9-4dd9-bc3a-6c6bc5ebb83d%40sessionmgr101&bdata=JnNpdGU9ZWRzLWxpdmU%3d#AN=S0306453017300823&db=edselp
Martin, J.A., Hamilton, B.E., & Osterman, M.J.K. (2017). Births in the United States, 2017. National Centre for Health Statistics: Data Brief, no 318. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db318.htm
McIntyre, S.H., Newburn-Cook, C.V., O’Brien, B., & Demianczuk, N.N. (2009). Effect of older maternal age on the risk of spontaneous preterm labor: a population-based study. Health Care for Women International, 30(8), 670–689. Retrieved March 03, 2019 from https://0-doi-org.aupac.lib.athabascau.ca/10.1080/07399330802596473
Models of Health. (2017). In Community Development & Health Network. Retrieved March 3, 2019 from https://www.cdhn.org/sites/default/files/downloads/FACTSHEETS%201_Screen%20View%281%29.pdf
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