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CONCEPT OF HEALTH
❖ Changing Concepts of Health
• Biomedical Concept -Health has been viewed as an “absence of disease”, and if one was free from disease
the person was considered healthy
• Ecological Concept -Health implies the relative absence of pain and discomfort and a continuous adaptation
and adjustment to the environment to ensure optimal function
• Psychosocial Concept- Health is both a biological and social phenomenon
• Holistic Concept -A sound mind in a sound body, in a sound family, in a sound environment; All sectors of
society like agriculture, animal husbandry, food, industry, education, housing, public works, communication
& other sectors have an effect on health

❖ Definitions of Health
• WHO Definition: “ Health is a state of complete physical, mental and social wellbeing and not merely an
absence of disease or infirmity and the ability to lead a socially and economically productive life”.
• Operational Definition of Health: “ A condition or quality of the human organism expressing the adequate
functioning of the organism in given conditions, genetic or environmental”.
• Thus Health means
(a) No obvious evidence of disease and that the person is functioning normally
(b) Several organs of the body are functioning adequately as well as in relation to one another (Equilibrium
or Homeostasis).

❖ DIMENSIONS OF HEALTH

1. Physical Dimensions :
• Physical health means perfect functioning of the body in which each organ is working in
harmony with the maximum capacity.
• Physical health is achieved by the exercise, healthy diet, adequate rest and sleep and no smoking
or alcohol intake.
• To maintain proper physical health there is need for taking safety precautions, and regular
follow up with the health care providers.
• Signs of physical health :
→ A good complexion.
→ A clean skin.
→ Bright eyes.
→ Not too fatty.
→ A sweet breath.
→ A good appetite.
→ Sound sleep.
→ Regular activities of bowels and bladder.
→ Smooth, easy, and coordinated bodily movements.
2. Mental Dimensions :
• Mental health is a state of balance between body and mind .
• Earlier the body and mind were considered two separate entities. But these are interrelated as
physical illness can result mental illness and vice versa.
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• How mental illness influence physical health has been shown in fig;

• Characteristics of mentally healthy person :

i) Mentally healthy person will be capable of making personal and social adjustment.
ii) Mentally healthy person is free from internal conflicts.
iii) He faces problems and tries to solve them intelligently.
iv) He has good self control balances rationally and emotionally.
v) He knows him self his needs problems and goals.
vi) He has strong sense of self esteem.
vii) He serches for identity.
viii) He lives a well balanced life means able to maintain the balance between work rest and recreation.

3. Social Dimensions:
• An individual is socially healthy if he is able to maintain harmonious relationship with other
members of society in which he lives.
• Social health rooted in “positive material environment” and “positive human environment”
which is concerned with the social network of the individual.
• The social dimensions of health includes;
→ Communication
→ Intimacy
→ Respect
→ Equality
→ Social functioning

4. Spiritual Dimensions :
• Spirituality means in touch with deeper self and exploration the purpose of life, as people
believe in some force that transcend physiology and psychology of human beings.
• It includes love , charity, purpose , principles , ethics, intigrity, hope of life.
• Meditations ,prayers, or spiritual gatherings are organized to maintain spiritual health.

5. Emotional Dimensions :
• Emotional health is closely related to the mental health and is considered as an important
element of health.
• Mental and emotional aspects of health are now viewed as two separate entities for human life.
• Cognition is related to the mental health whereas emotional health is related to the feelings of a
person.
• Emotional health includes ;
i) An emotionally healthy person has a positive thinking and is capable of coping and
adjusting self.
ii) An emotionally healthy person participates in all the activities which are related to
personal growth and his self esteem.
iii) Emotionally well people have the ability to express feelings freely and manage feelings
effectively.
iv) They are also aware of and accept a wide range of feelings in themselves and others.
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6. Vocational Dimension :
• The choice of profession, job satisfaction, career ambitions and personal performance are all
important components of this dimension.
• To be occupationally well, a person is ultimately doing exactly with what they want to do in life
and are comfortable with their future plans.
• Vocational dimension of health can be assesed by ;
i) Assessing the satisfaction level at job ,
ii) Facilities attached to the job ,
iii) Behaviour of the management and administrator and of colleagues at job.

7. Other dimensions :
A few other dimensions also suggested such as ;
i) Cultural dimensions
ii) Socio-economic dimensions
iii) Environmental dimensions
iv) Educational dimensions
v) Nutritional dimensions
vi) Preventive dimensions

❖ DETERMINANTS OF HEALTH
• The factors influencing the health are known as determinates of health.
• Many factors affects the health of individual and communities in a combined form.
• The factor find their way either in the individual himself or in his surrounding (environment).
• The WHO has identifies the following determinants of health

A. Individual Determinants
1. Genetic
• Hereditary factor is one of causes of certain disease
• Inherited disease are responsible for giving rise to some kind of health issue.
• The state of health depends partly on the genetic constitution of the individual.
2. Life style
• The attitude towards life and awareness regarding healthy living, affects health of an individual.
• Life style affects in both the ways i.e. may promote and maintain health or adversely affect on
health.
• Life style partly governed by socio-cultural aspects but life style learn from experience.
• Habit not only detrimental may also leads to social problem for community health
B. Environmental
1. Socioeconomic Development
• Life of human beings is governed by the set of rules and regulations framed and accepted by society.
• Socioeconomic development and growth of society multifactorial in nature.
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• Improvement in economic, educational, cultural sectors collectively causes development of society.

• Economic condition determines standards of living.

• Nutrition, education, housing for healthy life fulfilled by economic growth of society.
• Development should not be limited to satisfaction of basic needs.
• By development people achieve greater control over their lives.
• Health and development are two sides of the same coin

➢ Income and Social Status

• If the income and social ranking increases, health of an individual improves.
• Condition like housing, ability to buy good food are determined by high income.
• Those individual having prosperous and an equitable distribution of wealth are consider the healthiest
populations

2. Political Will
• The poverty is root cause of ill health.
• Those people living in slums, lacking of good hygienic conditions are targets of disease agents.
• The policies framed and their implementation with the object of maintains and promoting health of these
people can certainly affect the health status of communities.

3. Availability of Health Care Services

• Health is fundamental right.
• The government of each nation provides the health care services to its subjects at an affordable cost.
• Health for all is goal of WHO.
➢ Primary Health Care Essential Components
→ Adequate supply of safe water and sanitation.
→ Food supply and proper nutrition.
→ Immunization against infectious diseases.
→ Family planning services
→ Maternal and child health care services.
→ Provision of essential drugs.
→ Educating peoples about prevention, controlling and health problems.
→ Appropriate treatment of commons diseases and injuries.

4. Others factors
• Health issue involves social, economic, political, cultural, educational, moral, nutritional,
development, psychological, biological, occupational, spiritual and many more.
• These factors directly and indirectly affects.
• Interrelation between these factors also important
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➢ Education
• Education increases opportunities for income and job security and provides with sense control over
life.
• Poor health, more stress and lower self-confidence results due to education levels.
➢ Employment
• Poor health arises due to unemployment, underemployment and working under stressed condition.
• Individual healthy if they control their work condition and few stress related job demand.
• Individual also live longer in comparison to those who have stressful or riskier work and activities.

❖ HEALTH INDICATORS
➢ Indicators-
• Indicator also termed as Index or Variable is only an indication of a given situation or a
reflection of that situation.
• Indicators help to measure the extent to which the objectives and targets of a programme
are being attained.
➢ Health indicator
• Health Indicator is a variable, susceptible to direct measurement, that reflects the state of
health of persons in a community
• Health status indicators measure different aspects of the health of a population. Examples
include life expectancy, infant mortality, disability or chronic disease rates.
• Health determinant indicators measure things that influence health. Examples include diet,
smoking, water quality, income and access to health services
• Numerical indication of the health of a given population derived from a specified composite
formula.
➢ Uses of indicators of health
• Measurement of the health of the community.
• Description of the health of the community.
• Comparison of the health of different communities.
• Identification of health needs and prioritizing them.
• Evaluation of health services.
• Planning and allocation of health resources.
• Measurement of health successes.
➢ CLASSIFICATION OF INDICATORS
i) Mortality Indicators
ii) Morbidity Indicators
iii) Disability Rates
iv) Nutritional Indicators
v) Health Care Delivery Indicators
vi) Utilization Rates
vii) Indicators of Social And Mental Health
viii) Environmental Indicators
ix) Socio-economic Indicators
x) Health Policy Indicators
xi) Indicators of Quality of Life
xii) Other Indicators
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1. MORTALITY INDICATORS
A. Crude death rate
• Crude Death Rate is considered a fair indicator of the comparative health of the people.
• It is defined as the number of deaths per 1000 population per year in a given community.
• The usefulness is restricted because it is influenced by the age-sex composition of the population,
socioeconomic and socio-cultural environment of the communities.
• CDR India - 7.0 deaths/1,000 population
B. Expectation of life
• It is the average number of years that will be lived by those born alive into a population if the
current age specific mortality rates persist.
• It is a statistical abstraction based on existing age- specific death rates.
• Estimated for both sexes separately.
• It is a good indicator of socioeconomic development
• Life expectancy at birth:
Male: 64 years (WHO Global Health Observatory ,2012)
Female: 68 years
C. Infant mortality rate
• The ratio of deaths under 1yr of age in a given year to the total number of live births in the same
year, usually expressed as a rate per 1000 live births
• It is indicator of health status of not only infants but also whole population & socioeconomic
conditions
• Sensitive indicator of availability, utilization &effectiveness of health care, particularly perinatal
and postnatal care.
• Current IMR :
India- 40/1000live birth
Haryana - 41/1000live birth
D. Under-5 Mortality rate
• Defined as no. of deaths occurring in the under-5 age group per 1000 live births.
• Reflects both infant and child mortality
• Current rate – 53/1000 live births (World Bank ,2013)
E. Child mortality rate
• The number of deaths at ages 1-4yrs in a given year, per 1000 children in that age group at the
mid-point of the year.
• Correlates with inadequate Maternal and child health services (MCH) services, malnutrition, low
immunization coverage and environmental factors
• Current rate – 18/1000
F. Other indicators are Perinatal mortality rate, Neonatal mortality rate, Stillbirth rate, etc.
G. Maternal Mortality Ratio
• Ratio of number of deaths arising during pregnancy per 100000 live births
• Accounts for the greatest number of deaths among women of reproductive age in developing
countries.
• Current MMR
India -178/100000 live births
Haryana - 146/100000 live births
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H. Disease Specific Death Rate

• It is mortality rate which is computed for specific diseases.
I. Proportional Mortality Rate
• It is the proportion of all deaths attributed to the specific disease
• E.g. Coronary heart disease causes 25 to 30 % of all deaths in developed world.

2. MORBIDITY INDICATORS
• Morbidity Indicators reveal the burden of ill health in a community, but do not measure the
subclinical or inapparent disease states.
• Incidence –
→ The number of new events or new cases of a disease in a defined population, within a
specified period of time.
→ Eg. The incidence of Tuberculosis in India is 176 per 100000.
• Prevalence
→ The total number of all individuals who have disease at a particular time divided by
population at risk of having disease at this point of time.
→ Eg. The prevalence of Tuberculosis in India is 230 per 100000 population.
3. DISABILITY RATES
• Disability Rates are of two categories
i) Event type Indicators
▪ number of days of restricted activity
▪ bed disability days
▪ work-loss days within a specified period
ii) Person type Indicators
▪ limitation of mobility e.g. confined to bed, confined to house, special aid in
getting around.
▪ limitation of activity e.g. limitation to perform the basic activities of daily living
(ADL) e.g. eating, washing, dressing, etc.
• Sullivan’s Index
• It is refers to “expectation of life free of disability”.
• Sullivan’s Index = life expectancy of the country − probable duration of bed disability
and inability to perform major activities.
• It is considered as one of the most advanced indicators currently available. .
4. NUTRITIONAL STATUS INDICATORS
• Nutritional Status is a positive health indicator.
• Newborns are measured for their – i) Birth weight ii) Length iii) Head circumference
• They reflect the maternal nutrition status
• Anthropometric measurements of pre-school children
i) Weight – measures acute malnutrition
ii) Height – measures chronic malnutrition
iii) Mid-arm circumference - measures chronic malnutrition
• Growth Monitoring of children is done by measuring weight-for-age, height-for-age, weight-for-
height, head & chest circumference and mid-arm circumference.
• In adults Underweight, Obesity and Anaemia are generally considered reliable nutritional indicators.
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5. HEALTH CARE DELIVERY INDICATORS

• These indicators reflect the equity of distribution of health resources in different parts of the
country and of the provision of health care.
• Doctor-population Ratio – 6/10000 (World Health Statistics Report 2011)
• Nurse-population ratio – 13/10000
• Population-bed Ratio – 8.9/10000

6. UTILISATION RATES
• Utilisation Rates or actual rates is expressed as the proportion of people in need of a service who
actually receive it in a given period, usually a year
• It depends on availability & accessibility of health services and the attitude of an individual towards
health care system
Examples
1. Proportion of infants who are fully immunized – 43.5%
2. Proportion of pregnant women who receive ANC care or have institutional deliveries
3. Percentage of population who adopt family planning
4. Bed occupancy ratio, bed-turn over ratio, etc.

7. INDICATORS OF SOCIAL AND MENTAL HEALTH

• These include rates of suicide, homicide, other crime, road traffic accident, juvenile delinquency,
alcohol and substance abuse, domestic violence, battered-baby syndrome, etc.
• These indicators provide a guide to social action for improving the health of people.
• Social and mental health of the children depend on their parents.

8. ENVIRONMENTAL INDICATORS
• These reflect the quality of physical and biological environment in which diseases occur and people
live.
• The most important are those measuring the proportion of population having access to safe drinking
water and sanitation facilities.
• These indicators explains the prevalence of communicable diseases in a community.
• The other indicators are those measuring the pollution of air and water, radiation, noise pollution,
exposure to toxic substances in food and water.

9. SOCIOECONOMIC INDICATORS
• These do not directly measure health but are important in interpreting health indicators.
• These are
i) Rate of growth of population: India- decadal(2001-2011)-17.64%, Haryana -19.9% (2001-
2011)
ii) Per capita GNI (gross national income) – 5350 US$(World Bank 2013)
iii) Dependency ratio –
iv) Literacy rates: India –
v) Housing – the number of persons per room
vi) Per capita “calorie” availability
• Countries with favourable socioeconomic indicators have reported less health related problems.
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10. HEALTH POLICY INDICATORS

• The single most important indicator of political commitment is allocation of adequate resources.
• The relevant indicators are
i) Proportion of GNP(gross national product) spent on health services.
ii) Proportion of GNP spent on health related activities like water supply and sanitation &
housing and nutrition.
iii) Proportion of total health resources devoted to primary health care.

11. Indicators of quality of life

• Human Development Index -It is defined as a composite index combining indicators representing 3
dimensions
i) Longevity( life expectancy at birth)
ii) Education (mean and expected years of schooling)
iii) Gross national income (GNI) per capita
• The result is placed on the 0 to 1 scale
• HDI for India was 0.702 (UNDP-2013)
• HDI ranking of India is 135
12. Other indicators
i) Social Indicators: UN Statistical Office • Consumption & accumulation
• Population • Social security & welfare services
• Family formation • Health services & nutrition
• Families & households • Housing & its environment
• Learning & educational services • Public order & safety; time use
• Learning activities  Distribution of • Social stratification & mobility
income
ii) Basic Needs Indicators
• It include calorie consumption, access to water, life expectancy, deaths due to disease, illiteracy,
doctors and nurses per population, rooms per person, GNP per capita.
iii) Health For All Indicators
• For monitoring the progress towards the goal of Health for All by 2000, the WHO had listed the
following four categories of indicators.
1. Health policy indicators
2. Social and economic indicators related to health
3. Indicators for the provision of health care
4. Health status indicators

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