Dr.

Nithin Manohar R
M.Pharm, PhD, MSc.Psychology,
Professor & Head
Dept Of Pharmacy Practice
Pushpagiri College Of Pharmacy
Concept of health and disease
 Health is a common theme in most
cultures. All communities have their
concepts of health ,as part of their culture.
 According to WHO, Health is defined as a
state of complete physical, mental, and
social well being and not only in absence of
disease or infirmity
 Disease is just opposite of health ie.,any
deviation from normal functioning or state
of complete physical and mental well being.
According to WHO , health has three parameters
Physical health- Physical health of a person is defined as”A good complexion, a
clean skin, bright eyes, lustrous hair with a body well clothed with firm flesh,
regular activity of bowels and bladder and smooth, easy ,coordinated bodily
movements. All the organs of the body are of adequate size and function
normally.
Mental health-The mental health of a person is defined as “ self satisfaction ,self
confidence, no conflict within himself, happy, calm, and cheerful personality,
well adjusted with others, understanding , having self control.
Social health-Social concept means those having abilities making friendship with
others that are satisfying and lasting, living effectively with others, and showing
socially considerate behaviour.

Health is not perceived the same way by all members of a community include
various professional groups, giving rise to confusion about the concept of
health.
 New concept are bound to emerge based on new pattern of thought
CONCEPT OF HEALTH
Health is evolved over the centuries as a concept from
individual concern to world wide social goal and
encompasses the whole quality of life.
Changing concept of health till now are:
Biomedical concept
Ecological concept
Psychosocial concept Holistic
concept

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 BIOMEDICAL CONCEPT

Traditionally, health has been viewed as an “absence of

disease”, and if one was freefrom disease, then the
person was considered healthy.
The medical profession viewed the human body as a
machine, disease as a consequence of the breakdown
of the machine and one of the doctor’s task as repair of
the machine.
It minimized the role of environment, social cultural( life long
personal habits, economic status, education) determinants of
health. Biomedical model was found inadequate to solve some
of the major health problems.

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ECOLOGICAL CONCEPT

Form ecological point of view; health is viewed as a dynamic

equilibrium between human being and environment, and disease
a maladjustment of the human organism to environment.
According to Dubos “Health implies the relative absence of pain and
discomfort and a continuous adaptation and adjustment to the
environment to ensure optimal function.”
The ecological concept raises two issues, viz. imperfect
man and imperfect environment.Improvement of human
adaptation to environments improve longer life and better
quality of life.

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PSYCHOSOCIAL CONCEPT
According to psychosocial concept “health isnot only
biomedical phenomenon, but is influenced by social,
psychological, cultural, economic and political factors
of the people concerned.”Health is both a biological
and social phenomenon.

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HOLISTIC
CONCEPT
This concept is the synthesis of all the above
concepts. According to this view, health implies a
sound mind, in a sound body , in a sound family, in
sound environment.
It recognizes the strength of social, economic,

political and environmental influences on health.The

holistic approach implies that all sectors of society
have an effect on health, such as agriculture, Food,
Industry, education, housing and other sectors.
Itdescribed health as a unified or multi dimensional
process involving the wellbeing of whole person in
context of his environment . 8
DEFINITIONS OF HEALTH
“The condition of being sound in body, mind
or spirit especially freedom from physical
disease or pain.” - Webster
“Soundness of body or mind that condition
in which its are duly and efficiently
discharged .” - Oxford English Dictionary.
‘ A condition or quality of the human
organism expressing the adequate
functioning of the organism in given
conditions, genetic and environment.

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DIMENSIONS OF HEALTH

Health is multidimensional.
World Health Organization explained health in
three dimensional perspectives:
physical, mental, social and spiritual.
Besides these many more may be cited, e.g.
emotional, vocational, political, philosophical, c
ultural, socioeconomic, environmental, educati
onal, nutritional, curative and preventive.

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PHYSICAL DIMENSION

Physical dimension views heath form

physiological perspective.
It conceptualizes health that as biologically a state in
which each and every organ even a cell is functioning
at their optimum capacity and in perfect harmony
with the rest of body.
Physical health can be assessed at community level
by themeasurement of morbidity and mortality
rates.The state of health may be assessed bby such
indicators as death rate, infant mortality rate and
expectation of life.
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The signs of physical health in an individual are

• A good complexion, a clean skin, bright eyes, lustrous hair with a

body well clothed with firm flesh, regular activity of bowels and
bladder and smooth, easy ,coordinated bodily movements.
• Evaluation of physical health
• They include self assessment of overall health, inquiry into
symptoms of ill-health and risk factors, inquiry into medications,
standardized questionnaires for cardiovascular disease
/respiratory disease, clinical examination, nutrition and dietary
assessment, biochemical and laboratory investigations. .
MENTAL DIMENSION

Ability to think clearly and coherently. This deals with sound

socialization in communities.
Mental health is a state of balance between the individual and
the surrounding world, a state of harmony between oneself and
others, coexistence between the relatives of the self and that of
other people and that of the environment.
Mental health is not merely an absence of mental illness.
Good mental health is the ability to respond to
the many varied experiences of life with flexibility
and a sense of purpose

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Features of mentally healthy
person
Free from internal conflicts.
Well – adjusted ie.,he is able to get along well
with others.He accepts criticism and to not easily
upsets.
Searches for one’s identity.
Strong sense of self-esteem.
Knows himself: his mind, problems and goal. Have
good self-controls-balances.
Faces problems and tries to solve them
intellectually.
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 Assessment of mental health at the population level may be
made by administering mental status questionnaires by
trained interviews. The most commonly used questionnaries
seek to determine the presence and extent of organic disease
and of symptoms that could indicate psychiatric disorder.
SOCIAL DIMENSION
It refers the ability to make and maintain
relationships with other people or communities.
It states that harmony and integration within and
between each individuals and other members of the
society and between individuals and the world in which
they live.
Social dimension of health includes the level of social
skills one possesses, social 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. It also deals with personal
creeds, principles of behavior and ways of
achieving peace of mind and being at peace
with oneself.

It includes integrity, principle and ethics, the

purpose of life, commitment to some higher
being, belief in the concepts .

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DETERMINANTS OF
HEALTH
Health is determined by multiple factors.
The health of an individual and community is
influenced by: individual (internal) and external factors.
The individual factors include by his own genetic factors and
the external factors include environmental factors.
Environmental factors range from housing, water supply,
psychosocial stress and family structure through social and
economic support systems, to the organization of health and
social welfare services in the community.
These factors interact and these interactions may be health
promoting or deleterious.
Thus, the health of individuals and whole communities may be
considered to be the result of many interactions.

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BIOLOGICAL DETERMINANTS
The physical and mental traits of every human
being are to some extent determined by the
nature of genes.
The health of an individual partly depends on
the genetic constitutions.
A number of diseases e.g. chromosomal
anomalies, inborn error of metabolism,
mental retardation and some types of
diabetes are some extent due to genetic
origin.
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ENVIRONMENTAL FACTORS

Environment can be internal and external. Internal environment of an individual

means his each and every component part, tissue ,organ and organ system and
their harmonious functioning. External environment consists of those things to
which man is exposed. External is divided into biological, physical, psychosocial

Biological: disease producing agent (e.g. bacteria, virus, fungi), intermediate

host (e.g. mosquito, sand fly), vector (e.g. housefly) etc.

Physical: Air, water, light, noise, soil, climate, altitude, radiation housing, waste

etc. Psychosocial: psychological make up of individual and structure and

functioning of society. E.g. habit, beliefs, culture, custom, religion etc.

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 The microenvironment or domestic environment
includes the individual way of living and lifestyles. e.g.
eating habits ,personal habits ( smoking),use of drugs
etc
 The socio- economic conditions , occupation and moral

values are also important components of environment.

 Environmental factors range from housing, water supply, psychosocial stress
and family structure through social and economic support systems, to the
organization of health and social welfare services in the community.
LIFESTYLE
Behavioral pattern and life long habits that have developed
through process of socialism e.g. smoking and alcohol
consumption,food habit, personal hygiene, rest and
physical exercise, bowel and sleeping patterns, sexual
behavior.

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 In developing countries, Risks of illness and death are connected with lack of
sanitation ,poor nutrition, personal hygiene, elementary human habits,
customs and cultural patterns.
 Not all life style factors are harmful, some can promote health.
Examples include adequate nutrition, enough sleep, sufficient
physical activity etc
 Life styles are learnt through social interaction with parents ,peer

groups, friends, and siblings and through school and mass media.
 Association exist btw health and life style of individuals. In

developed countries, obesity, lung cancer coronary drug disease etc

associated with life style changes
SOCIO-ECONOMIC
CONDITIONS
It consist of education, occupation and income.
Education-A second factor influencing health status is education.The world
map of illiteracy closely coincides with
the maps of poverty, malnutrition, ill health, high infant and child mortality
rates.
Studies shows that education compensates the effects of poverty on
health.In kerala low infant mortality rate due to female literacy rate of
87.86% compared to 54.16% for all India

Occupation-The very state of being employed in productive work promotes

health, because the unemployed usually show a higher incidence of ill-health
and deaths.Loss of work means loss of income and status. It can cause
psychological and social damage.

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 Economic progress has positive impact factor in reducing morbidity, increasing
life expectancy and improving the quality of life. The economic status determines
the purchasing power, std of living, quality of life, family size and pattern of disease.
 Economic status also a factor in seeking health care.

 Economic progress is the major factor in reducing morbidity,

increasing life span and improving quality of life.
 Political system: Health also related to the country’s political
system. Choice of technology, the degree of health services
made available and accessible to different segments of the
society are examples of the manner in which the political
system can shape community health services.
 Availability of health and
family welfare
Service
Health and family welfare services cover a wide spectrum of
personal and community services for treatment of diseases,
prevention of disease and promotion of health.
The purpose of health services is to improve the health
status of population.
To be effective, health services much reach all sectors of the
community, equally distributed, accessible at a cost the country
and community can afford and socially acceptable.

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For example, immunization of children can influence the
incidence/prevalence of particular disease.
Provision of safe water can prevent mortality and morbidity from
water-borne diseases.
The care of pregnant woman and children contribute the reduction of
maternal and child morbidity and mortality
Indicators of health
 Health indicators only give an indication about the health status of a
community .An indicator is only the reflection of a give situation.
According to WHO, they are variables which help to measure the
changes.
 They are used when changes cannot be measured directly. For
example. health and nutritional status.
 It indicates the direction and speed of changes and serve to compare
different areas or groups of people at the same moment in time. These
indicators are useful in measuring health status of a community, to
compare health status of two places or countries, for assessment of
heath care needs, for evaluating health services, activities and
programmes
Indicators of health
 Indicators of health are required not only to measure the health status of
a community, but also to compare the health status of one country with
that of another ., for assessment of health care needs., for monitoring and
evaluation of health services, activities and programmes.
 Mortality indicators such as (Crude Death rateCrude death rate-it is defined as
the number of death per 100 population per year in a community .It
indicates the rate at which people are dying) Life Expectancy, Infant mortality rate,
Child mortality rate, Under five mortality rate, Maternal mortality ratio, Disease specific mortality,
proportional mortality rate etc), morbidity indicators such as ( Incidence and prevalence
rate, disease notification rate, OPD attendance rate, Admission, readmission and discharge rate,
duration of stay in hospital and spells of sickness or absence from work or school), disability
rates, nutritional status indicators, health care delivery indicators,
utilization rates etc
Concept and evaluation of public health
 Public health is defined as the science and art of preventing diseases,
prolonging life ,promoting health and efficiencies through organized
community effort. It deals with the health of the whole population and
the prevention of disease from which the society suffers.
 Core activities in public health includes:
 1.preventing epidemics
 2.Protecting the environment, work place, food and water
 3.Promoting healthy behaviour
 4.Monitoring the health status of the population
 5.Mobilizing community actions
 6.Responding to disasters
 7.Assuring the quality, accessibility, and accountability of medical care
 Public health involves both direct and indirect
approaches. Direct measures in public health include
immunization of children, modern birth control,
hypertension and diabetes case findings.
 Indirect methods used in public health protect the

individual by community such as raising standards of

environmental safety, assurance of a safe water supply,
sewage disposal, and improved nutrition.
CONCEPT OF DISEASE
Webster defines disease as “a condition in which body
health is impaired, a departure from a state of health,
an alteration of the human body interrupting the
performance of vital functions”.
The oxford English Dictionary defines disease as “ a
condition of the body or some part or organ of the
body in which its functions are disturbed or
deranged”.Disease is any deviation from normal state of
complete physical, mental or social well being.
The term’ disease means without ease or uneasiness.

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Natural history of disease

 Natural history of a disease consists of two phases namely prepathogenesis

phase and pathogenesis phase.
 Prepathogenesis phase is the period prior to the onset of a disease in which
the causative agent has not entered in the human body but favourable
factors for the disease agent to interact with the human host already exist
in the environment. In this phase the man is exposed to the risk of disease.
 Agent, host and environment are the important causative factors in the
production of a disease
 Pathogenesis Phase starts with the entry of the disease agent into the
human host. The time interval from the entry of agent in the host to the
appearance of disease is termed as incubation period.
 During this period the disease agent multiplies and induces tissues and
physiological changes.
 The incubation period is followed by the pathological changes in the form
of early and late pathogenesis. Finally a disease leads to recovery,
chronicity, disability or death.
 Agent, host and environment are the important causative factors
in the production of a disease
 Agent means the disease agent is a substance living or non-

living or a force tangible or intangible, the excessive presence or

relative lack of which is the immediate cause of a particular
disease.
 Agents include biologic agents including bacteria, viruses, fungi,

protozoa etc.
 Physical agents include heat, cold, humidity, electricity, Pressure

etc. Exposure to excessive heat, cold, humidity, pressure,

radiation, electricity ,sound, etc may result in illness
 Nutrient agents –These are proteins, fats, carbohydrate, vitamins,

minerals, and water. Any excess or deficiency of the intake of

nutritive elements may result in nutritional disorders
 Chemical agents-Endogenous: some of the chemicals
may be produced in the body as a result of derangement
of function, eg., urea ( uremia),serum
bilirubin( jaundice),ketones ( ketosis), uric acid
( gout),calcium carbonate ( kidney stones) etc.
 Exogenous: Agents arising outside of human host.

Eg.,allergens, metals, fumes, dust, gases, insecticides

etc. These may be acquired by inhalation, ingestion or
inoculation.
 Mechanical agents: Exposure to chronic friction and

other mechanical forces may result in crushing ,tearing,

sprains,dislocations and even death.
 Host factors: host factors play major role in determining
the outcome of an individual exposure to infection.
 classified as demographic factors like age ,sex
 Biological factors likeBiochemical levels of the blood such
as cholesterol,enzymes,blood groups,blood cells count
 Life style factors like living habits,use of alcohol and drug
,smoking
 Socioeconomic status like education,occupation,stress etc
 Envirnmental factors- the concept of environment is
complex ,air,water,soil, social,and economic conditions
under which we live form the environment.
Concept of prevention
 The goal of medicine is to promote health,to preserve
health,to restore health when it is impaired,and to minimize
suffering and distress.
 Successful prevention depends on knowledge of
causation,dynamics of transmission,identification of risk
factors and risks groups,availability of prophylactic or early
detection,and treatment measuresetc.
CONCEPT OF
PREVENTION
Primordial prevention
Primary prevention
Secondary prevention
Tertiary Prevention

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LEVELS OFPREVENTION
Primordial Prevention :new concept in the prevention of
chronic disease like obesity,hypertension.
Prevention in the from Risk Factors.
Prevention of emergence or development of Risk Factors.
Many health problems occur early in the childhood so in
primordial prevention ,efforts are directed towards
Discouraging children from adopting harmful life styles.
Encouraging or promoting healthy eating habits.
The main primordial prevention is through individual
and mass education

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LEVELS OFPREVENTION
Primary Prevention:
Pre-pathogenesis Phase of a disease.
Action taken prior to the onset of the diseasewhich removes
the possibility that the disease will ever occur. Primary prevention
is achieved by health promotion and specific protection.
Health promotion ‘the process of enabling people to increase
control over the determinants of health and thereby improve their
health. It include health education, environment modification, life
style and behavioural changes,
Specific protection: Immunization & Chemo-prophylaxis
Use of specific nutrients and supplements
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LEVELS OFPREVENTION
Secondary Prevention:
Halt the progress of a disease at its incipient phase.Arrest the disease
process and treating it before irreversible pathological changes takes
place. It protects others in the community
Early diagnosis & Adequate medical treatment.

Tertiary Prevention:
When the disease process has advanced beyond its early
stages,it still possible to prevent called tertiary
prevention.It signifies Intervention in the late
Pathogenesis Phase.
Tertiary prevention means all measures available to Reduce
impairments, minimize disabilities & suffering.

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CONCEPT OF CONTROL
DISEASE CONTROL: The term disease
control refers ongoing operation aimed at
reducing:
The incidence of disease.
The duration of disease and the
consequently the risk of transmission.
The effect of infection including physical
and psychological complication.
The financial burden to the community.
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CONCEPT OF CONTROL
ELIMINATION: Reduction of case transmission to
a predetermined very low level or interruption
in transmission. E.g. measles, polio, leprosy from
the large geographic region or area.

ERADICATION: Termination of all transmission of

infection by extermination of the infectious
agent through surveillance and containment.The
disease is no longer occur in a population.
E.g. Small pox
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CONCEPT OF CONTROL

MONITORING: Defined as “the performance and analysis of

routine measurement aimed at detecting changes in the
environment or health status of population.”
e.g. growth monitoring of child, Monitoring of air pollution,
monitoring of water quality etc.

SURVEILLANCE: Defined as “the continuous scrutiny of the

factors that determine the occurrence and distribution of disease
and other conditions of ill health.” E.g. Poliomyelitis surveillance
programme of WHO.

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MODES OF INTERVENTION
Intervention is any attempt to intervene or interrupt the
usual sequence in the development of disease. Five
modes of intervention corresponding to the natural
history of any disease are:
Health Promotion
Specific Protection
Early Diagnosis and Adquate Treatment
Disability Limitation
Rehabilitation

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HEALTH PROMOTION
It is the process of enabling people to increase control over diseases, and to
improve their health. It is not directed against any particular disease but is
intended to strengthen the host through a variety of
approaches(interventions):

Health Education-large number of diseases can

be prevented with little or no medical intervention
if they were adequately informed or if they are
encouraged to take necessary precautions in time.

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 Environmental Modifications –provision of safe water, installation
sanitary latrines, control of insects and rodents, improvement of
housing etc
 Nutritional Interventions -distribution and nutrition improvement
to vulnerable groups, child feeding programmes
 Lifestyle and Behavioral Change
SPECIFIC PROTECTION
Some of the currently available interventions
aimed at specific protection are:
Immunization
Use of specific Nutrients
Chemoprophylaxis
Protection against Occupational Hazards
Avoidance of Allergens
Control of specific hazards in general
environment
Control of Consumer Product Quality
& Safety
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EARLY DIAGNOSIS &
TREATMENT
Though not as effective and economical as
‘Primary Prevention’, early detection and
treatment are the main interventions of disease
control, besides being critically important in
reducing the high morbidity and mortality in certain
diseases like hypertension, cancer cervix, and breast
cancer.
The earlier the disease is diagnosed and treated
the better way and preventing the occurrence of
further cases (secondary cases) or any long term
disability.
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REHABILITATION
Rehabilitation has been defined as the
‘combined and coordinated use of medical,
social, educational and vocational measures for
training
and retraining the individual to the highest
possible level of functional
ability.

 Reduce the impact of disabling and handicapping

conditions and enabling them to achieve social
integration

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Social causes of diseases
 Health, or lack of health, was once merely attributed to biological or
natural conditions. Sociologists have demonstrated that the spread of
diseases is heavily influenced by the socioeconomic status of
individuals, ethnic traditions or beliefs, and other cultural factors.
 Cockerham, a leading medical sociologist, assesses the evidence that
social factors (such as stress, poverty, unhealthy lifestyles, and
unpleasant living and work conditions) have direct causal effects on
health and many diseases.
 Examples of social conditions include poverty, quality of housing,
homelessness, educational attainment and quality, unemployment,
wage levels, lack of control over the organization of work, racial
residential segregation, and other forms of discrimination.
 The social determinants of health (SDH) are the non-medical
factors that influence health outcomes.
 They are the conditions in which people are born, grow, work,

live, and age, and the wider set of forces and systems
shaping the conditions of daily life.
 These forces and systems include economic policies and

systems, development agendas, social norms, social policies

and political systems.
 The following list provides examples of the social determinants of health, which can influence health
equity in positive and negative ways:
• Income and social protection.
• Education.
• Unemployment and job insecurity. Unemployed usually show a higher incidence of ill-health and
deaths. Loss of work means loss of income and status. It can cause psychological and social damage
• Working life conditions.
• Food insecurity.
• Housing, basic amenities and the environment.
• Risks of illness and death are connected with lack of sanitation ,poor nutrition
• Access to affordable health services of decent quality.
4 factors for social causes of diseases
 Socio economical status
 Physiological risk factors

 Behavioural risk factors

 Psychosocial risk factors

There are totally 4 important social causes that leads to the disease. All these factors either
directly or indirectly cause the disease.
1. Socioeconomic status
Social status ( relating to society) of a person indirectly responsible for disease.
Economical status ( relating to money) of a person indirectly cause the disease.
Examples :poverty, less income, poor housing, inadequate healthy food, low education, low
occupational status, dangerous work, stressful work, polluted environment ,discrimination.
 2.Physiological risk factors- means functioning of body.
Improper functioning of body leads to disease either directly
or indirectly. Ex. ,weak heart leads to hypertension, weak
immune system etc.
 3.Behavioural risk factors-The person behaviour with others

and his own life styles ,habits cause the disease both directly
and indirectly. Eg., smoking, alcohol, poor diet, lack of
exercise.
 4.Psychosocial risk factors

If a person is frequently scolding/blaming by society, friends,or

public, then his mental behaviour changes and leads to various
mental disorders and finally cause the disease. Eg., Isolation,
lack of social support, low self esteem,self blame, hopelessness.
Social problems of sick

 Sick is defined as inability of a person to mingle with

society due to physical or mental ill. There are 7
problems that causes sick
 Illiteracy
 Employment problem
 Social relationship
 Loss of independence
 Communication problem
 Illiteracy-If a person not educated, then he will feel guilty
to mingle wth society leads to stress and sick. The reasons
are inability to learn,lack of fund for his education,
expensive higher education, lack of good teachers.
 Employment problem-In India job opportunities are not
increasing as per the ratio of increasing of population.
Lack of job does not makesthe person to mingle with
others and society. This makes him to sick.
 Social relationship- Smaller persons, hearing impaired
persons ,mentally retarded persons generally not interact
with society because of threat of insulting by society and
this makes those person mentally ill and finally sick
 Loss of independence: Persons who are paralyzed lost their,
independence because they depend on other for their regular
activities. They failed to maintain the quality of life and not able to
live with dignity.
 Communication problem: people having numbness, lack of free
speech, stage fear, Mentally stressed or depressed people may have
difficulty in expressing themselves and thus other people find it
difficult to communicate with them. They cannot mingle with others
in the society feels them as guilty and become sick
 Dining problem: People who have chronic illness, need special diet
or control of diet such as low salt for higher blood pressure and
controlled glucose intake for people with diabetes. All restaurants
cannot provide meals of their choice. So such does not show
interest to take meals with friends .This make them sick.