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Concept of Health

Ankit Singh
Assistant Professor
Sikkim Manipal University

Concepts

Biomedical concept
Ecological Concept
Psychosocial Concept
Holistic Concept

Definitions of Health
Health is a state of Complete physical ,mental and social well being and not merely an absence
of disease or infirmity
In recent years, this statement has been amplified to include the ability to lead a Socially and economically
productive life
New Philosophy of Health :
1.
2.
3.
4.
5.
6.
7.
8.

Health is a fundamental human right


Health is the essence of productive life , and not the result of ever increasing expenditure on medical care
Health is inter-sectoral
Health is an integral part of development
Health is central to the concept of quality of life
Health involves individuals , state and international responsibility
Health and its maintenance is a major social investment
Health is worldwide social goal

Dimensions of Health
1. Physical Dimension : Perfect functioning of the body
2. Mental Dimension : A state of balance between the individual and the surrounding world, a state of harmony
between oneself and others , a coexistence between the realities of the self and that of other
people and that of the environment
3. Social Dimension : Implies the harmony and integration within the individual , between each individual and other
members of the society and between individuals and the world in which they live Can also be
defined as the Quantity & Quality of an individuals interpersonal ties and the extent of
involvement with the community.
4. Spiritual Dimension : Refers to the part of individual which reaches out and strives for meaning and purpose in life
It includes integrity, principles and Ethics.
5. Emotional Dimension : Mental Health : Knowing
Emotional Health : Feeling
6. Vocational Dimension : When work is fully adapted to human goals , capacities and limitations, work often plays a
roles in promoting both physical and mental health

Spectrum of Health
Positive Health
Better Health
Freedom from Sickness
Unrecognized Sickness
Mild Sickness
Severe Sickness
Death

Health Sickness Spectrum

Determinants of Health
1.
2.
3.
4.
5.
6.
7.

Biological Determinants
Behavioral and Socio-Cultural Conditions environment
Socio-Economic Conditions : Economic Status , Education , Occupation , Political System
Health Services :
Ageing of population
Gender
Other Factors : Information Revolution

In short medicine is not the sole contributor to the health and wellbeing of the population and
wellbeing of the population. The potential of inter-sectoral contributions to the health of communities
is increasingly recognized.

Right To Health
The preamble to the WHO constitution also affirms that it is one of the fundamental rights of every
human being to enjoy the highest attainable standard of health
Concept to Right to health has generated so many questions as Right to medical care , Right to
responsibility to health , Right to Healthy environment , Right to food , Right to
procreate , Right of the deceased persons , Right to die . Many of these issues have been
the subject of debate.

Responsibility for Health :


1.
2.
3.
4.

Individual Responsibility : Self Care


Community Responsibility
State responsibility
International Responsibility

Indicators of Health
Indicators are required to :
1.
2.
3.
4.
5.
6.

Measure the health status of the community


Compare the health status of one community with the other
For assessment of health care needs of the others
For allocation of scarce health care resources
For Monitoring and evaluation of Health Services, Activities and programs
It also helps in measuring the extent to which the objectives of a programms are being attained

Characteristics of Indicators
A.
B.
C.
D.
E.
F.

It should be Valid : Should measure what they are supposed to measure


Should be reliable : Answer should be same if measured by different people
Should be sensitive : Sensitive to the changes in the situations concerned
Should be specific : Should reflect changes only in the situations concerned
Should be feasible : Should have the ability to obtain the data needed
Should be relevant : Should contribute to the understanding of the phenomenon of interest

Indicators which may be classified as :


1. Mortality : Crude Death rate, Expectation of life , Infant MR, CMR, under 5 Mortality Rate, MMR, DS- MR,
Proportional MR
2. Morbidity : Incidence & Prevalence, Notification Rates, Attendance rates at OP , Admission , Readmission Rates
LOS , Spells of absence from work or school.
3. Disability : Event type indicators , Person type indictors (Limitation of mobility & Limitation for activity) ,
Sullivan's Index , DALE , HALE
4. Nutritional Status : Anthropometric measurements of preschool children's , ht & Wt of school children, BW
5. Health Care Delivery : DP Ratio, PB ratio, Population per traditional birth attendant ratio
6. Utilization : Fully Immunized against 6 EPI dis , Family planning, BOR , ALOS
7. Indicators of social and mental health : Suicide, Homicide, Drug Abuse , Battered Wife Syndrome
8. Environmental Indicators : Pollution , Access to safe water etc
9. Socio-Economic Indicators : Rate of pop inc, level of unemployment
10. Health Policy Indicators: GNP spent on health services
11. Indicators of quality of life : IMR, LE, Literacy (PQOL Index)
12. Other Indicators : Basic Needs Indi , Health for All Indi, MDG Indi

Health Service Philosophies


Definition of Health Care : A multitude of services rendered to individuals , families or communities by
the agents of the health service or professions , for the purpose of promoting , maintaining , monitoring, or
restoring health.
Characteristics of Health Care :
1.
2.
3.
4.
5.
6.
7.

Appropriateness : Relevance
Comprehensive : Mix of Preventive , Curative & promotion of services.
Adequacy : Proportionate to requirement
Availability : Ratio bet population and Health Facility
Accessibility : Geographic, Economic, or Cultural
Affordability : Cost within the means of individual and state
Feasibility : Operational efficiency of procedures, logistic support, manpower and material resources.

Health Systems
Components of Health Systems :
1.
2.
3.
4.

Concepts : e.g. Concepts of Disease , Concept of Health


Ideas : e.g. Equity , coverage, effectiveness, efficiency & impact
Objects : e.g. Hospitals, Health centers , Health programs
Persons : e.g. providers & consumers

The aim of health system is health development i.e. a process of continuous and progressive
improvement of the health status of a population.

Levels of Health Care


1. Primary Health Care : First point of contact between individual and health system, Majority of problems
addressed here
2. Secondary health Care : More complex problems are dealt, it includes essentially curative services, 1 st referral level
3. Tertiary health care : Offers Super Specialist care, other services such as
planning, managerial skills and teaching for specialized staff are carried out here.

Health Team :
Health team has been defined as a group of persons who share a common health goal and common objectives,
determined by community needs and towards the achievement of which each member of the tem contributes in
accordance with his/her competence and skills and respecting the functions of the other

Health Policy
A national health policy is an expression of goals for improving the health situations , the priorities among these
goals, and the main direction for attaining them.

Epidemiology : (As defined by John M last 1988) The study of the distribution and determinants
of health related states or events in specified populations, and the applications of this study to the control of
health problems

Morbidity

Morbidity is the extent of illness, injury , or disability in a defined population. Morbidity is also the state
of deviation from the state of health , well being , or the presence of a morbid condition. Morbidity is
usually expressed in terms of prevalence and incidence rates

Incidence
Number of new cases of a disease which came into existence within a certain period of time per specified unit of
population.
Incidence Rate = Number of new cases of a disease within a population in a given period of time

X 1000

Number of persons exposed to risk of developing the disease in the same time period
For example, the incidence of meningitis in the UK in 1999 could be calculated by finding the number of
new meningitis cases registered during 1999 and dividing that number by the population of the UK

Prevalence
Prevalence is the number of persons in a defined population who have a specified disease or condition at a point of
time.

For example, in the study above 6139 individuals completed the questionnaire (were examined). Of these 6139
people, 519 currently suffered incontinence and so had the condition at the particular time point of the study. Thus
the prevalence of incontinence was 519/6139 = 0.085.
The above study expresses prevalence as a percentage, thus the prevalence of incontinence is 8.5% (or rounded is
9%)

Concept of Disease
A condition in which body health is impaired, a departure from a state of a state of health , an alteration of the
human body interrupting the performance of vital conditions
Simplest definition : Disease is just the opposite of health. i.e. any deviation from normal functioning or
state of complete physical or mental well being since health and disease are mutually exclusive.

Disease : A physiological / psychological dysfunction


Illness : Subjective state of the person who feels aware of not being well
Sickness : A state of social dysfunction i.e a role that the individual assumes when ill

Concept of Causation

Environment

1. Germ theory of Disease :


Disease Agent Man Disease

2 . Epidemiological Triad

Agent

Host

3. Multifactorial Causation : Social , Economic , Cultural, Genetic , & Psychological are important , other
factors includes poverty, overcrowding and malnutrition.
e.g. : Coronary Heart Disease are due to multiple factors for example : Excess fat intake, smoking, lack f
physical exercise, obesity.
4. Web of Causation : This model is ideally suited in the study of chronic disease, where the disease agent is
often not known but is the outcome of interaction of multiple Factors.

Natural History of Disease


It signifies the way in which a disease evolves over time from the earliest stage of its pre-pathogenesis phase
to its termination as recovery , disability or death.
The natural history of disease consists of two phases :
1. Pre-pathogenesis phase: Process in the environment
2. Pathogenesis phase : process in the man

Agent Factors
1.
a.
b.
c.

Biological Agents : Agents exhibit host related activities such as :


Infectivity : Ability to invade and multiply in a host
Pathogenicity : Ability to induce clinically apparent illness
Virulence : proportion of clinical cases resulting in severe clinical manifestations

2. Nutrients Agents: any excess or deficiency e.g PEM ,anemia, Goiter, Obesity ,
3. Physical Agents : Exposure to excessive health, cold, humidity, pressure, radiation ,electricity etc
4. Chemical Agents :
d. Endogenous : Produced inside the body due to derangement of functions : Urea, Bilirubin (Jaundice) , Ketones
(Ketosis)
e. Exogenous : Agents arising outside the human host : Allergens, Metals, Fumes dust etc
5. Mechanical Agents : E.g Erushing, Teraing, Sprains, dislocation etc

6. Absence of insufficiency or excess of a factor necessary to health :


a. Chemical Factors : E,g Hormones
b. Nutrient Factors :
c. Lack of Structure : Thymus
d. Lack of part of structure : Cardiac Defects
e. Chromosomal Factors : e.g. Turners Syndrome
f. Immunological e.g. Agammaglobulianaemia
7. Social Agents : Poverty , Smoking, Abuse of drugs and alcohols

Host Factors (Intrinsic)


Human Body : Soil
Disease Agent : Seed
Host Factor Characteristics :
1. Demographic : Age, Sex ,Ethnicity
2. Biological : Genetic Factors, blood groups, enzymes, immunological factors,
3. Social and economic factors : Education, occupation, stress, marital status
4. Lifestyle factors : Personality traits, living habits , nutrition, physical exercise

Environmental Factors
Macro Environment : All that which is external to the individual human host, living, and non-living and with which
he is in constant interaction. This includes all of mans external surroundings such as air, water, food ,housing etc
Divided into 3 components :
1. Physical : Applied to non living things and physical factors ( air ,water ,soil, housing, climate, geography ,
heat ,light, noise, debris, radiation etc.
2. Biological Environment : Microbial agents, animals, rodents, insects & plants
3. Psychosocial environment : Cultural values, Customs, habits, beliefs, attitudes, morals, religion, education,
lifestyles, community life, health services, social and political organization
Social Environment : People

Risk Factors
1. An attribute or exposure that is significantly associated with the development of the disease
2. A determinant that can be modified by intervention thereby reducing the possibility of occurrence of
disease or other specified outcomes.
Risk Groups : Something for all , but more for those in need
E.G : At risk mothers, At risk infants, At risk families

Spectrum of Disease
A graphic representation of variation in the manifestation of disease. Akin to the spectrum of light where the
colors vary from one end to the other but difficult to determine where one color ends and the other begins
At one end there are subclinical infections which are not easily identified at other end or fatal illnesses .
In the middle of the spectrum lie illness ranging in severity from mild to severe.

Iceberg of Disease

Concept of Control
The term disease control describes ongoing operations aimed at reducing :
1.
2.
3.
4.

The incidence of disease


Duration and risk of transmission
The effects of infection , including both the physical and psychosocial complications
The financial burden of the community

Disease Elimination :term elimination describes interruption of transmissions of disease, as for example
elimination of measles, polio, and diphtheria.
Disease Eradication : Eradication means to Tear out by roots , Eradication of disease implies termination
of all transmissions of infection by extermination of the infectious agent. It is All or none Phenomenon
Smallpox is the only disease that has been eradicated.
Monitoring : The performance and analysis of routine measurements aimed at detecting
changes in the environment or health status of population
Monitoring of air pollution , water quality , growth and nutritional status , it also refers to on
going measurement of performance of a health service or a health professional

Surveillance : Surveillance means to watch over with great attention , authority, and often with suspicion , it is
defined as The continues scrutiny of the factors that determine the occurrence and distribution
of disease and other conditions of ill health
Main Objectives are :
1. To provide information about new and changing trends in the health status of a population e.g. morbidity ,
mortality, nutritional status or other indicators and environmental hazards.
2. To provide feedback which may be expected to modify policy and the system itself
3. Provide timely warning of public health disasters so that interventions can be mobilized.

Sentinel Surveillance : A method for identifying the missing cases and thereby supplementing the
notified cases is required This is known as Sentinel Surveillance.

Evaluation of Control : Evaluation is the process by which results are compared with the intended
objectives, or more simply the assessment of how well a programme is performing.

Concepts of Prevention
Successful prevention depends upon a knowledge of causation, dynamics of transmission, identification of risk
factors, risk groups, availability of prophylactic or early detection and treatment measures an organization for
applying these measures to appropriate persons and groups.
Levels of Prevention (4 ) :
1. Primordial Prevention : Primary prevention in purest sense , that is prevention of the emergence or development
of risk factors in countries or population groups in which they have not yet appeared. (e.g Obesity ,
Hypertension)
2. Primary Prevention : Action taken prior to the onset of disease, which removes the possibility that a disease will
ever occur It signifies intervention in the pre-pathogenesis phase of a disease or health problem (e.g. Low birth
weight)
A. Population Mass Strategy : Population Strategy directed at the whole population irrespective of individual
risk levels .
B. High risk Strategy : Aimed at brining preventive care to individuals at special risk.

Secondary Prevention : Action which halts the progress of a disease at its incipient stage and prevent
complications the specific interventions are early diagnosis (e.g. Screening tests, case finding programmes). by early
diagnosis and adequate treatment, secondary prevention attempts to arrest the disease process
Secondary prevention is largely the domain of clinical medicine. The health programs initiated by governments are
usually at the level of secondary prevention.
Tertiary Prevention : When the disease process has advanced beyond its early stages, it is still possible to
accomplish prevention by what might be called Tertiary prevention. It signifies intervention in the late
pathogenesis phase.
It can be defined as - All measures available to reduce or limit impairments and disabilities, minimize suffering
caused by existing departures from good health to promote the patients adjustment to irremediable conditions

Modes of Intervention
Intervention can be defined as any attempt to intervene or interrupt the usual sequence in the
development of disease in Man, This may be by the provision of treatment, education help or
social support.
5 Modes of Intervention have been described which form a continuum corresponding to the natural history of
any disease :
1.
2.
3.
4.
5.

Health Promotion
Specific Protection
Early Diagnosis & Treatment
Disability Limitation
Rehabilitation

1. Health Promotion : The process of enabling people to increase control over and to improve the health . It
is not directed against any particular disease but is intended to strengthen the host through a variety of
approaches
a.
b.
c.
d.

Health Education
Environmental Modifications
Nutritional Interventions
Lifestyle & Behavioral Changes

A . Health Education : WHO constitution state that The extension to all people of the benefits of medical ,
psychological and related knowledge is essential to the fullest attainment o health
The target for educational efforts includes general public, patients, priority groups, health providers, community
leaders, & decision makers.
B. Environmental Modifications : Provision for Safe Water, Installation of Sanitary Latrines, Control of
Insects & Rodents, Improvement of Housing Etc.

C. Nutritional Interventions : e.g. Child Feeding Groups, Food Fortifications, Nutrition Education
D. Lifestyle & Behavioral Changes : Avoidance of unhealthy life style activities

2. Specific Protection :
a.
b.
c.
d.
e.
f.
g.
h.

Immunization
Use of Specific Nutrients
Chemoprophylaxis
Protection against occupational hazards
Protection against accidents
Protection from carcinogens
Avoidance of Allergens
Control of Specific hazards of the general environment (Control of consumer product,
quality , and safety of foods, drugs, cosmetics

3. Early Diagnosis & Treatment : The detection of disturbances of homeostatic and compensatory
mechanism while bio chemical , morphological ,and functional changes are still reversible
E.G In hypertension , breast cancer, Tb, Leprosy & STD.

Disability Limitation :
Disease

Impairment

Disability

Handicap

Impairment : Any loss or abnormality of psychological, physiological, or anatomical structure or functioning


e.g. loss of foot, defective vision or Mental Retardation
Disability : Any restriction or lack of ability to perform an activity in the manner or within the range
considered normal for a human being

Handicap : A disadvantage for a given individual , resulting from an impairment or a disability that limits or
prevents the fulfilment of a role that is normal ( depending on age, sex & social and cultural factors)
Accident : Disease ( or Disorder)
Loss of Foot : Impairment
Cannot Walk : Disability
Unemployed : Handicap
4. Rehabilitation : The combined and coordinated use of medical ,social and educational and vocational
measures for training and retraining the individual to the highest possible level of functional ability
It involves disciplines such as physiotherapy, occupational therapy , speech therapy , audiology , psychology,
education , social work, vocational guidance & placement services
Areas of concern in Rehabilitation are :
1. Medical Rehabilitation Restoration of function
2. Vocational Rehab Restoration of capacity to earn a livelihood
3. Social Rehabilitation : Restoration of family and social relationships

Changing Pattern of Disease


Developed Countries : in 1900 out of the 10 leading causes of death 3 were primarily of infectious in
nature, in 2004 only 10 % were primarily communicable . Diseases such as CHD, cancer and accident have
surged.
Heart disease, Cancer and Cerebrovascular disease cause almost 60 % of death in USA
Morbidity pattern is changed , mental disorders have surged , social implications on society due to alcohol and
drug abuse have increased

Developing Countries : 40 % of deaths are from infectious , Parasitic & Respiratory diseases,
compared with 8 % in developed world.
There is no appreciable change in prevalence of Tb, Filarisis, viral hepatitis, etc., on the other hand there is an
increase in the frequency of new health problems such as coronary heart disease. Hypertension, cancer, diabetes
and accidents.
Occupational disease such as pneumoconiosis are on the increase

Factors Responsible for Changing Pattern


1.
2.
3.
4.
5.
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7.
8.

Changing Lifestyles
Living Standards
Demographic Factors
Urbanization
Industrialization
Medical Interventions
Maintenance of people with transmissible genetic defects
Widespread effect of technology on ecology

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