In contrast to the biopsychosocial model, the biomedical model views health as

The traditional biomedical paradigm has its roots in the Cartesian division between mind and body, and considers disease primarily as a failure within the soma, resulting from injury, infection, inheritance and the like. Although this model has been extraordinarily productive for medicine, its reductionistic character prevents it from adequately accounting for all relevant medical aspects of health and illness [1], [2]. One of the most criticised consequences of adopting the biomedical model is a partial definition of the concept of health. If disease consists only of somatic pathology—or, more strictly and according to the influential work of Virchow [3], cellular pathology—health must be the state in which somatic signs and symptoms are not present. According to this view, the World Health Organization defined health simply as the “absence of disease” [4].

In his classic papers, Engel [1], [5] explicitly warned of a crisis in the biomedical paradigm and conceptualised a new model which regards social and psychological aspects as giving a better understanding of the illness process [6]. In recent years, the so-called biopsychosocial model has found broad acceptance in some academic and institutional domains, such as health education, health psychology, public health or preventive medicine, and even in public opinion. It is now generally accepted that illness and health are the result of an interaction between biological, psychological and social factors [7], [8], [9]. Many authors now include mental and social aspects in their definitions of health [10], [11], [12], [13].

It might be expected that, in the two decades since Engel’s call for a biopsychosocial framework, the concept of health implying social and psychological components would also have extended to practical contexts. The purpose of the present study is to find out whether and to what extent the biopsychosocial concept of health has spread among medical researchers. With this aim, I reviewed articles published in The Lancet between 1978 and 1982 and between 1996 and 2000 and compared the concept of health employed. This journal was chosen because of its world-wide circulation and because it publishes research articles in every field of medicine. Generally, the study consisted of using Medline to select those empirical studies in which ‘health’ or ‘healthy status’ were reported as variables and identifying how these terms were defined or measured. For a similar study concerning nursing research, see Reynolds [14], and Hwu et al. [15]. The expected result was a greater use of the social and/or psychological dimensions of health in the second revised period.

Materials and methods

By means of the database Medline, articles published in The Lancet over the years 1978–1982 (period a) and 1996–2000 (period b) were examined. The first period covers the 5 years around the publication of Engel’s ideas and the second one covers the last 5 years before the beginning of the study, so an interval of 13 years, in which the biopsychosocial model extended among health scientists, separates the two studied periods. Search parameters comprised either the word ‘health’ or ‘healthy’

Results

Three reports in period a and four in b assessed health as a dependent variable (‘health’ studies). Reports considering ‘to be healthy’ or ‘having good health’ as a condition for subjects to take part in studies numbered 29 in period a and 16 in period b (‘healthy’ studies). Detailed information about the 52 papers included in the study can be seen in Table 1, Table 2.

Changes in the concept of health

Contrary to expectations, findings show no change in the conceptualization of health in medical research articles written 20 years ago and now. This result differs from the study by Hwu et al. [15], who found a significant increase in the number of papers on nursing research that included psychological and social dimensions in their operational definition of health, when comparing publication years 1977–1987 and 1988–1998. A holistic conception of health seems to be more prevalent among nursing

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