1 CONCEPT OF HEALTH Full

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CONCEPT OF HEALTH
• Health is evolved over the centuries as a concept from individual concern to world
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wide social goal and encompasses the whole quality of life
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• Changing concept of health till now are:
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1. Biomedical concept
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2. Ecological concept
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3. Psychosocial concept
4. Holistic concept
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LastBenchPharmacist.blogspot.com
BIOMEDICAL CONCEPT
• Traditionally, health has been viewed as an “absence of disease”, and if one was
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free from disease, then the person was considered healthy
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• This concept has the basis in the “germ theory of disease”
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• The medical profession viewed the human body as a machine, disease as a
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consequence of the breakdown of the machine and one of the doctor’s task as
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repair of the machine La
• Limitations: it has minimized the role of environmental, social, psychological and

cultural determinants of health
ECOLOGICAL CONCEPT
• From ecological point of view; health is viewed as a dynamic equilibrium between
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human being and environment, and disease is a maladjustment of the human
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organism to environment
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• According to Dubos “Health implies the relative absence of pain and discomfort and
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a continuous adaptation and adjustment to the environment to ensure optimal
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function”
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• The ecological concept raises two issues, viz. imperfect man and imperfect
environment
ECOLOGICAL CONCEPT
• The concept supports the need for clean air, safe water and good environment etc
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to protect us to prevent exposure to unhealthy factors
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PSYCHOLOGICAL CONCEPT
• According to psychosocial concept “health is not only biomedical phenomenon, but
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is influenced by social, psychological, cultural, economic and political factors of the
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people concerned”
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• Mental health is a state of balance between individual and surrounding
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HOLISTIC CONCEPT
• Holistic concept is the synthesis of all the above concepts
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• It recognizes the strength of social, economic, political and environmental
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influences on health
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• It describes health as a unified or multi dimensional process involving the wellbeing
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of whole person in context of his environment
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DEFINITIONS OF HEALTH
• “The condition of being sound in body, mind or spirit especially freedom from
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physical disease or pain.” - Webster
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• “Health is a state of complete physical, mental, social well-being and not merely the
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absence of disease or infirmity.” - World Health Organization
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• In recent years, this definition has been amplified to include “the ability to lead
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socially and economically productive life”.
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OPERATIONAL DEFINITION
• Broad Sense: Health can be seen as “A condition or quality of human organism
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expressing the adequate functioning of the organism in given condition, genetic or
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environmental”
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• Narrow sense: There is no obvious evidence of disease, and that a person is
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functioning normally. Several organs of the body are functioning adequately in
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themselves and in relation to one another, which implies a kind of equilibrium or
homeostasis
NEW PHILOSOPHY OF HEALTH
• Health is a fundamental human right

• Health is essence of productive life
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• Health is inter- sectoral
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• Health is integral part of development
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• Health is central to quality of life
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• Health involves individuals, state and international responsibility
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• Health and its maintenance is major social investment

• Health is a world-wide social goal
DIMENSIONS OF HEALTH
• Health is multidimensional
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• World Health Organization explained health in three dimensional perspectives:
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physical, mental, social and spiritual
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• Besides these many more may be cited, e.g. emotional, vocational, political,
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philosophical, cultural, socioeconomic, environmental, educational, nutritional,
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curative and preventive
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PHYSICAL DIMENSION
• Physical dimension views heath form physiological perspective
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• It conceptualizes health that as biologically a state in which each and every organ
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even a cell is functioning at their optimum capacity and in perfect harmony with
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the rest of body
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• Physical health can be assessed at community level by the measurement of
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morbidity and mortality rates
MENTAL DIMENSION
• Ability to think clearly and coherently
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• This deals with sound socialization in communities
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• Mental health is a state of balance between the individual and the surrounding
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world, a state of harmony between oneself and others, coexistence between the
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relatives of the self and that of other people and that of the environment
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• Mental health is not merely an absence of mental illness
FEATURES OF MENTALLY HEALTHY PERSON
• Free from internal conflicts
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• Well – adjusted in the external environment
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• Searches for one’s identity
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• Strong sense of self-esteem
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• Knows himself: his mind, problems and goal
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• Have good self-controls-balances
• Faces problems and tries to solve them intellectually
SOCIAL DIMENSION
• It refers the ability to make and maintain relationships with other people or
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communities
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• It states that harmony and integration within and between each individuals and
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other members of the society
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• Social dimension of health includes the level of social skills one possesses, social
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functioning and the ability to see oneself as a member of a larger society
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SPIRITUAL DIMENSION
• Spiritual health is connected with religious beliefs and practices
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• It also deals with personal creeds, principles of behavior and ways of achieving
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peace of mind and being at peace with oneself
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• It is intangible “something” that transcends physiology and psychology
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• It includes integrity, principle and ethics, the purpose of life, commitment to some
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higher being, belief in the concepts that are not subject to “state of art”
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explanation
CONCEPT OF DISEASE
• Webster defines disease as “a condition in which body health is impaired, a
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departure from a state of health, an alteration of the human body interrupting the
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performance of vital functions”
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• Ecological point of view disease is defined as “a maladjustment of the human
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organism to the environment”
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• The simplest definition is that disease is just the opposite of health: i.e. any
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deviation from normal functioning or state of complete physical or mental well-
being
DISTINCTION BETWEEN DISEASE, ILLNESS AND

SICKNESS
• The term disease literally means “without ease” (uneasiness), when something is
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wrong with bodily function
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• Illness refers to the presence of a specific disease, and also to the individual’s
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perceptions and behavior in response to the disease, as well as the impact of that
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disease on the psychosocial environment
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• Sickness refers to a state of social dysfunction
DISTINCTION BETWEEN DISEASE, ILLNESS AND

SICKNESS
• Illness is a subjective state of the person who feels aware of not being well
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• Sickness is a state of social dysfunction i.e. a role that the individual assumes when
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ill (sickness role)
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CONCEPT OF WELLBEING
• Wellbeing of an individual or group of individuals have several components and has
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been expressed in various ways, such as ‘standard of living’ or ‘level of living’ and
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‘quality of live
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STANDARD OF LIVING
• Income and occupation, standards of housing, sanitation and nutrition, the level of
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provision of health, educational, recreational and other services all be used
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individually as measures of socioeconomic status, and collectively as an index of the
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standard of living
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LEVEL OF LIVING
• It consists of nine components : health, food consumption, education, occupation
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and working conditions, housing, social security, clothing, recreation and leisure
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human rights
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• These objective characteristics are believed to influence human wellbeing
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• It is considered that health is the most important component of the level of living
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because its impairment always means impairment of the level of living
QUALITY OF LIFE
• The condition of life resulting from the combination of the effects of the complete range of
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factors such as those determining health, happiness (including comfort in the physical
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environment and a satisfying occupation), education, social and intellectual attainments,
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freedom of action, justice and freedom of expression
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• A composite measure of physical, mental and social wellbeing as perceived by each
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individual or by group of individuals- that is to say, happiness, satisfaction and gratification
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as it is expressed in such life concerns as health, marriage, family work, financial situation,
educational opportunities, self- esteem, creativity, belongingness, and trust in others
TWO ASPECTS OF HEALTH
• Subjective: It is formed by sensations and feelings of a person suffering from
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disease
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• Objective: Its basis is formed by objective parameters obtained by measurement of
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structures and functions of a person during disease
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• The quality of life can be evaluated by assessing the persons subjective feeling of
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happiness or unhappiness about the various life concerns
DETERMINANTS OF HEALTH
• Genetic factors (biological)
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• Environmental factors
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• Life style
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• Behavioral & socio-cultural
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• Gender & Age
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• Socioeconomic conditions Education, Occupation, Income
• Health services –utilization Immunization, Family welfare ,nutritional
OTHER DETERMINANTS OF HEALTH
• Food & agriculture
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• Education
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• Science & technology
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• Standard of living
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• Social justice, equity, human rights
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• Govt Polices to raise stand of living
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• Inter sectoral contributions

• Dissemination of information (IEC)
BIOLOGICAL DETERMINANTS
• Genetic make-up (Heredity)
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• It is permanent & can not be altered
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• Transmitted hereditarily
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• No treatment
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• Prevented to some extent
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ENVIRONMENTAL FACTORS
• Internal environment/Micro
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•External environment/Macro
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 Physical-air, water, soil
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 Biological- plants, animals, microbes
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 Social- culture, belifes, traditions
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Dynamic equilibrium is Health
BEHAVIORAL & SOCIO-CULTURAL (LIFE STYLE)
• Depends on economic status (rich & poor)
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• Cultural values vegetarianism-Non-vegetarianism
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• Social values and status of women
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• Personal habits
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• Behavioral pattern High risk behavior
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LIFE STYLE
• Learnt by observations from –parents, teachers, peer groups, mass media…..
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Includes cultural pattern, social value & behavior
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• The way people thinks & live - developed through process of socialization& social
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interaction (traditional lifestyles)
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• Cultivate healthy lifestyles - proper nutrition & sleep, exercise, avoid drug abuse
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LIFE STYLE MAKES THE DIFFERENCE

• Malnutrition
• Population explosion
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• Mental health problems
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• Reproductive and child health
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• Cancer
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• Diabetes mellitus
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• Cardiovascular diseases
• AIDS & STDs
• Environmental pollution.
SOCIOECONOMIC CONDITIONS
• Determined by-Income (per capita)
1. Literacy
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2. Occupation
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3. Purchasing capacity
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• Indirectly by-religion & caste - Housing - Political support
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• Per capita GNP
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• GNP directed to wards health care
• Political commitment
• Efficient leadership
SOCIOECONOMIC CONDITIONS
• Economy & literacy
• Determines quality of life by -Employment ,housing, nutrition
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• Productive work promotes health - Finally determine health status
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ECONOMIC STATUS
• The per capita GNP is the most widely accepted measure of general economic
performance
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• The economic progress of many countries has been a major factor in reducing the
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morbidity, mortality, increase in life expectancy & improving of the quality of life,
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family size, & the pattern of disease & deviant behavior in the community.
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EDUCATION
• 2nd major factor influencing health status
• Especially female education
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• Illiteracy can be a major cause of poverty, malnutrition, ill health, high infant and
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child mortality rates
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• Low education levels are linked with poor health, more stress and lower self-
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confidence
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• Studies indicate that education to some extent compensates the effects of poverty
on health, irrespective of the availability of health facilities
OCCUPATION
• Un employment usually shows a higher incidence of ill health & death
• For many, loss of work may mean loss of income & status
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• It can cause psychological & social damage
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• The very state of being employed in productive work promotes health
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• Occupation can lead to disorders like : Silicosis, Coal workers pneumonia,
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Asbestosis, Byssinosis etc
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POLITICAL SYSTEM
• Main obstacle to the implementation of health technologies are not technical, but
rather political
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• Percentage of GNP = Quantitative indicator
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• India spends about 3% of its GNP on health and family welfare
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• Decisions concerning resource allocation, man power policy, choice of technology &
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the degree to which health services are made available & accessible to different
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segments of the society are examples of the manner in which the political system
can shape community health services - If poor health patterns are to be changed,
then changes must be made in entire sociopolitical system
HEALTH SERVICES
• Availability & utilization of health services
• Should include comprehensive services
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• Need based
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• Must reach to social periphery
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• Equitably distributed
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• Accessible at affordable cost
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• Socially acceptable
HEALTH SERVICES
• Should promote health & prevent illnesses
• Eg:- Immunization of children
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• Provision of safe drinking water
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• Antenatal care-will reduce maternal mortality ratio & infant mortality rate
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• Services must reach to all sections
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FAMILY WELFARE SERVICES

• Covers spectrum of personal & community services for treatment, prevention &
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promotion of health like immunization, family planning, maternal and child health,
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integrated child health services, nutrition
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GENDER & AGE

In 1993, the Global Commission on Women’s Health was established with an agenda
for action on women’s health covering
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• Nutrition & development
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• Violence
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• Social status
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• Economic independence
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• Reproductive health
• Aging
• Lifestyle related conditions and the occupational environment
GENDER & AGE

• Even though health service prolong the life of the people , aging of population itself
a matter of concern because chronic diseases and disabilities accompany the aging
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process and deserve special attention
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• Some diseases of aged include : Diabetes, Hypertension, Coronary Heart Disease
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INDICATORS OF HEALTH
• To measure health status
• To compare
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• To assess the health needs
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• To plan & implement
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• To evaluate health care
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INDICATORS OF HEALTH-CLASSIFICATION
Health is measured multi-dimensionally & indirectly
Health Indicators are classified as
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• Mortality indicator
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• Morbidity indicators
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• Disability indicators
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• Nutritional status indicators
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• Health care delivery indicators
• Utilization rates
OTHER HEALTH INDICATORS

• Indicators of social & mental health
• Socio-economic indicators
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• Health policy indicators
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• Environmental indicators
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• Indicators of quality of health
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MORTALITY INDICATORS
• Crude death rates
• Infant mortality rates
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Maternal mortality rates
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Child mortality rates
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Proportional mortality rates
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MORBIDITY INDICATORS
• Incidence rate
• Prevalence rate
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Notification rate
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Out patients attendance rate
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Hospital admission rate
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• Duration of stay in the hospital
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DISABILITY RATES
• Event type - No of days of restricted activity
- Bed disability days
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- Sickness absenteeism
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Person type - Limitation of mobility
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- Limitation of daily activity
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NUTRITIONAL STATUS INDICATORS

• Incidence of LBW
• Incidence of LBW
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Anthropometric measurements of < 5 mid arm circumference height & weight with
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age
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HEALTH CARE DELIVERY INDICATORS

• Doctor : Population. 1:2500
• Nurse: Population 1:5000
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Health worker: Population 1:3000
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Sub centers: Population 1:3000
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P H C : Population 1:30000
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INDICATORS OF SOCIAL & MENTAL HEALTH

• Rates of crimes - murder, theft, suicides, prostitution, gambling, drug abuse
• Rates of accidents
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Rate of divorces, family violence
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SOCIOECONOMIC INDICATORS
• Growth rate of population
• Per capita income / GNP
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Percentage of people below poverty line
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Level of unemployment
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Dependency ratio
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• Literacy rate
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• Family size
HEALTH POLICY INDICATORS

• Proportion of the budget (NGP) spent on Health services— Reproductive and Child
Health, Revised National Tuberculosis Control Programme, Integrated Child
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Development Services, Pulse polio programme
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Health related services— Water supply, Sanitation, Nutrition, Housing, Community
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development.
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ENVIRONMENTAL INDICATORS
• Indicators relating pollution of air, water, noise, soil, radiation solid waste
• Percentage of houses having safe water supply, adequate sanitary facilities
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ENVIRONMENTAL INDICATORS
• Indicators relating pollution of air, water, noise, soil, radiation solid waste
• Percentage of houses having safe water supply, adequate sanitary facilities
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Thus there is no single comprehensive indicator to assess or to measure the health
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status of country
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• Each indicator reflects one aspect of health
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Ideal indicator is yet to be developed
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• Thus there is no single comprehensive indicator to assess or to measure the health
status of country
UTILIZATION RATES
• Proportion of infants “fully immunized”
• Proportion of mothers with adequate ANC
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Proportion of Deliveries conducted by TBA
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“Bed occupancy” rate in the hospital
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Coverage with insecticidal spraying
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LastBenchPharmacist.blogspot.

• Limitations: it has minimized the role of environmental, social, psychological and

• From ecological point of view; health is viewed as a dynamic equilibrium between

• According to psychosocial concept “health is not only biomedical phenomenon, but

• Holistic concept is the synthesis of all the above concepts

• Broad Sense: Health can be seen as “A condition or quality of human organism

NEW PHILOSOPHY OF HEALTH

• Health is a fundamental human right

• Health and its maintenance is major social investment

• Physical dimension views heath form physiological perspective

• Ability to think clearly and coherently

FEATURES OF MENTALLY HEALTHY PERSON

• Free from internal conflicts

• Faces problems and tries to solve them intellectually

• Spiritual health is connected with religious beliefs and practices

• Webster defines disease as “a condition in which body health is impaired, a

DISTINCTION BETWEEN DISEASE, ILLNESS AND

DISTINCTION BETWEEN DISEASE, ILLNESS AND

• Wellbeing of an individual or group of individuals have several components and has

• It consists of nine components : health, food consumption, education, occupation

TWO ASPECTS OF HEALTH

• Subjective: It is formed by sensations and feelings of a person suffering from

• Genetic factors (biological)

• Health services –utilization Immunization, Family welfare ,nutritional

OTHER DETERMINANTS OF HEALTH

• Food & agriculture

• Inter sectoral contributions

• Genetic make-up (Heredity)

BEHAVIORAL & SOCIO-CULTURAL (LIFE STYLE)

• Depends on economic status (rich & poor)

• Learnt by observations from –parents, teachers, peer groups, mass media…..

LIFE STYLE MAKES THE DIFFERENCE

• Determines quality of life by -Employment ,housing, nutrition

• Especially female education

• Should include comprehensive services

• Eg:- Immunization of children

FAMILY WELFARE SERVICES

GENDER & AGE

GENDER & AGE

Health Indicators are classified as

• Health care delivery indicators

OTHER HEALTH INDICATORS

• Infant mortality rates

- Bed disability days

NUTRITIONAL STATUS INDICATORS

HEALTH CARE DELIVERY INDICATORS

• Nurse: Population 1:5000

INDICATORS OF SOCIAL & MENTAL HEALTH

• Per capita income / GNP

HEALTH POLICY INDICATORS

• Percentage of houses having safe water supply, adequate sanitary facilities

• Percentage of houses having safe water supply, adequate sanitary facilities

• Proportion of mothers with adequate ANC

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