Concept of Health

FAC I L I TAT O R: D R. N E E LU M JA M A L ( M B BS , M S P H )
D E PA RT M E N T O F C O M M U N I T Y M E D I C I N E
F R P M C , KA RAC H I

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Objectives
By the end of the session, the students should be able to:
Classify and explain concepts of Health
Define health and describe its spectrum and philosophy
Describe the determinants of health
Discuss individual, community, state and international responsibility for health
Explain the need to use “indicators” to measure “health” status
State the characteristics of health indicators
List the uses of health indicators

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 Definitions of health
The oldest definition of health is “the
absence of disease

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 functions are duly and efficiently discharged
(Oxford)

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 Definitions of health (cont….d)
World Health Organization (WHO) defined Health as below (1948)

“Health is a state of complete physical, mental and social wellbeing and not merely absence
of disease or infirmity”

In the recent years, this definition has been amplified to include “the ability to lead socially
and economically productive life”

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 Changing Concepts of Health
Health is not perceived the same by all members of community including various professional
groups

The following concepts have evolved overtime

◦ Biomedical concept
◦ Ecological concept
◦ Psychosocial concept
◦ Holistic concept

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 Biomedical Concept

Traditionally if a person was free from disease, he/she was considered healthy
This concept has the basis in the “germ theory of disease”
Medical profession viewed human body as a machine
Disease as a consequence of breakdown of machine
Doctor was required to repair the machine

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 Ecological Concept

From ecological point of view; health is viewed as a

dynamic equilibrium between human being and
environment
Disease was considered a maladjustment to the environment
The ecological concept raises two issues, imperfect man and imperfect environment

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 Psychosocial Concept

Health is not only a biomedical phenomenon

It is influenced by social, psychological, cultural,

economic, and political factors of the people
concerned

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 Holistic Concept

This concept is the synthesis of all the above concepts

Recognizes the strength of social, economic, political and environmental influences on
health
Considers wellbeing of whole person in the context of his/her environment

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 New philosophy of health
In the recent years new philosophy of health considers it as:
A fundamental human right
intersectoral
integral part of development
central to the concept of quality of life
individuals’, state and international responsibility
essence of productive life, and not the result of ever increasing expenditure on medical care
major social investment

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 Dimensions of Health
Health is multidimensional
WHO definition has three dimensions:
◦ Physical (perfect functioning of the body)
◦ Mental (a state of balance between the individual and the surrounding world)
◦ Social (harmony and integration within the individual, between each individual & between individuals &
the world)

Other dimensions are, spiritual, emotional, vocational, political, nutritional etc.

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Spectrum of Health

Highest Point

Health is not a static

phenomenon but a dynamic
one

Lowest Point
What Determines Health?

DISTAL

PROXIMAL
 Concept of Wellbeing
Wellbeing of an individual has subjective and objective
components
Objective component:
◦ relates to monetary status such as income, occupation, housing, Nutrition, education etc.
◦ depends of gross national product (GNP)

Subjective component:
◦ relates to quality of life
◦ doesn’t depends on gross national product (GNP) (E.g Srilanka vs Oil rich countries)
◦ measured by Physical quality of life index (PQLI) which measures the result of social, economic and political
policies of any country
◦ Life expectancy at age 1
◦ Literacy
◦ Infant mortality rate
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Health indicators
Health indicators are
• Variables that measure indirectly a status which can not be measured directly

• They are a reflection of a given situation

• They are used to compare between areas or population groups at a certain time

• They are used to measure changes over a period of time

• Health indicators quantify the health of the population

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What is an ideal indicator?
1. Valid: They should actually measure what they are supposed to measure
2. Reliable: The answers should be the same if measured by different people
in similar circumstances.
3. Sensitive: They should be sensitive in the situation concerned
4. Specific: They should reflect changes only in the situation concerned
5. Feasible: They should have the ability to obtain data needed
6. Relevant: They should contribute to the understanding of the phenomenon of
interest.

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Uses of health indicators
• Reflect the health status of a given population
• Reflect changes in the health profile of the same population over time
• Provide international comparison
• Delimit areas of health priority
• Diagnosis of community needs
• Allow evaluation of health services and specific interventions
• Chart progress towards specific targets
• Allow future projection of the health status of the population

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Few basic terms
 Rate: Numerator (a) is a part of denominator (b) and multiplier is 1000 or 10,000 or
100,000 or so o n …

 Ratio: Numerator (a) is not a part of denominator (b) and BOTH numerator and
denominator are unrelated

 Proportion: Numerator (a) is a part of denominator (b) and multiplier is 100. and
Proportion is always expressed in percentage (%)

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Exampl
es
Types of Health indicators
1. Morbidity indicators
2. Mortality indicators
3. Disability indicators
4. Nutrition indicators
5. Healthcare delivery indicators
6. Healthcare utilization indicators
7. Social and mental health indicators
8. Socioeconomic indicators
9. Environmental indicators
10. Quality of life indicators

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 Responsibility of health
INDIVIDUAL
Community or state program can contribute but can not give health
All individuals have responsibility for “SELF CARE”
Preventing disease (healthy diet+ sound sleep + exercise + avoidance of substance abuse + personal hygiene
+ Immunization + Self Screening +
Limiting illness and Restoring health (Reporting early + Taking care of others + Following Treatment protocols
& abstinence)
COMMUNITY
 Communities have responsibility to take ownership and get involved in:
Planning (community hygiene + conveying needs and priorities)
Implementation (support access + resources + utilize/uptake services)
Monitoring and Evaluation (provide feedback)
Responsibility of health
STATE
State is responsible to provide conducive environment for Health:
Policy and Regulation
GLOBAL
Global responsibilities include co-operation between Government and International
Organizations
Sharing knowledge and expertise/ building capacity
Sharing resources
Control of disease spread (International Health Regulations)

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References
K. Park, Park’s Textbook of preventive and social medicine.25th edition. Banarsidas
Bhanot Publishers, (2019)
Irfsanullah Siddiqui, Public Health and Community Medicine. 8 th edition. Time traders,
(2018)
Centers for Disease Control and Prevention. Principles of epidemiology, 2nd ed. Atlanta:
U.S. Department of Health and Human Services;1992.
www.who.int
www.cdc.gov

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