CONCEPT
OF
HEALTH &
DISEASE
Dr. Abhishek De
Assistant Professor
Deptt. of Community Medicine,
State Surveillance Team Member for HIV Sentinel
Surveillance in India &
Former Extramural Research Scientist, ICMR
What is the most important
thing in your life?
Response
s
Health is a neglected
topic UNTIL it is
LOST
Concepts of health
What is health according to
you?
Responses
CONCEPT OF HEALTH
Definitions:
“Absence of disease”
In some cultures, health and
harmony are considered
equivalent,
Harmony: "being at peace with the
self, the community, god and
cosmos". (Indian Ayurveda and
Greek)
Modern medicine: Studies disease,
and neglects of the study of health.
In 1977, the 30th World Health
Assembly decided that the main
social target of governments and
WHO :
"the attainment by all citizens of the world
by the year 2000
of a level of health
that will permit them to lead
a socially and economically productive
life”,
Changing concepts of health
Biomedical concept
Ecological concept
Psychosocial concept
Holistic concept
Changing concepts (1/4):
Biomedical concept:
"Absence of disease" based on "germ
theory of disease“
Drawback: minimized the role of
the environmental, social,
psychological and cultural
determinants of health.
Changing concepts (2/4):
Ecological concept:
According to ecologists:
Health is a dynamic equilibrium
between man and his
environment, and
Disease is a maladjustment of the
human organism to environment.
Changing concepts (3/4):
Psychosocial concept:
Health is not only a biomedical
phenomenon, but one which is
influenced by
social,
psychological,
cultural,
economic and
political factors of the people concerned.
Changing concepts (4/4)…
Holistic concept :
It recognizes the strength of social,
economic, political and environmental
influences on health.
Implies that all sectors of society
have an effect on health
Ancient view: Sound mind, in a sound
body, in a sound family, in sound
environment.
DEFINITION OF HEALTH:
Health is a state of
Complete physical,
Mental and
Social wellbeing and
Not merely an absence of
disease or infirmity
To be able to lead a "socially
and economically
productive life"
"Operational definition" of health:
(a)No obvious evidence of disease, and
that a person is functioning normally,
i.e., within normal limits of variation
(b)the several organs of the body are
functioning adequately in themselves
and in relation to one another
New philosophy of health
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 intersectoral
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
End of
Part 1
Dimensions of
Health
Physical
Vocationa
l Mental
DIMENSIONS
OF HEALTH
Social Emotional
Spiritual
PHYSICAL DIMENSION:
What does physical
health mean?
Perfect functioning of
the body in which each
organ is working in
harmony with the
maximum capacity
How is it achieved?
By exercise, healthy
diet, adequate rest &
sleep, and no
Physical Dimension:
What are the signs of good
physical health?
A healthy skin texture
Bright eyes
Not too thin or fat
A good appetite
Regular bowel and bladder activities
Smooth and easy coordinated movements
The resting pulse rate, blood pressure and
exercise tolerance are all within the range of
"normality" for the individual's age and sex.
Steady gain in weight till 25 years and
constant thereafter
Physical Dimension:
How can proper physical health
be maintained?
By various preventive measures and
regular follow up with health care
providers
Evaluation of physical health
self assessment of overall health
inquiry into symptoms of ill-health
and risk factors
inquiry into medications
inquiry into levels of activity
inquiry into use of medical services
standardized questionnaires for
cardiovascular diseases
standardized questionnaires for
respiratory diseases
clinical examination
nutrition and dietary assessment,
and
MENTAL DIMENSION:
What is good mental health?
the ability to respond to the many
varied experiences of life with
flexibility and a sense of purpose
Definition:
"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"
Attributes of a mentally healthy
free from internal conflicts; he is not at
person:
"war" with himself.
he is well-adjusted, i.e., he is able to get
along well with others. He accepts criticism
and is not easily upset.
he searches for identity.
he has a strong sense of self-esteem.
he knows himself: his needs, problems and
goals (this is known as self-actualization).
he has good self-control-balances
rationality and emotionality.
he faces problems and tries to solve
them intelligently, i.e., coping with stress
SOCIAL DIMENSION:
harmony and integration
within the individual,
between each individual and
other members of society
and
between individuals and the world in
which they live
Definition:
"Quantity and quality of an
individual's interpersonal ties
and the extent of involvement
with the community"
SPIRITUAL DIMENSION:
It includes integrity, principles and
ethics, the purpose in life,
commitment to some higher being
and belief in concepts that are not
subject to "state of the art"
explanation
EMOTIONAL DIMENSION
Mental health can be seen as
"knowing" or "cognition" while
emotional health relates to "feeling"
VOCATIONAL DIMENSION
When work is fully adapted to
human goals, capacities and
limitations, work often plays a
role in promoting both physical
and mental health.
the culmination of the efforts of
other dimensions as they function
together to produce what the
individual considers life "success"
Other dimensions
philosophical
dimension
cultural dimension
socio-economic
dimension
environmental
dimension
educational dimension
nutritional dimension
curative dimension
End of Part 2
CONCEPT OF WELL-BEING
WHO definition of health
What is well being?
“the state of being comfortable,
healthy, or happy”
Has Subjective and Objective
components
Objective components of well being
1.Standard of living: Measures of socio-
economic status:
Income and occupation,
Standards of housing, sanitation and
nutrition,
The level of provision of health,
educational, recreational and other
services
Collectively used as an index of the
"standard of living”
The extent of differences in SOL are usually
measured through the comparison of per
capita GNP on which the standard of
Concept of wellbeing: Objective component
2. Level of living: Nine
components:
Healt
Occupation
h Food
and working
consumpti
conditions
on
Educatio Level Housin
n of g
living
Leisure Social
and
human securit
rights y
Recreatio Clothin
n g
Concept of wellbeing: Subjective component
Quality of life :
A composite measure of physical, mental and
social wellbeing as perceived by each
individual
Evaluated by:
Assessing a person's subjective feelings
of happiness or unhappiness about the
various life concerns
Improvement of quality of life means
increased emphasis on social policy and
on reformulation of societal goals to make
life more liveable for all.
Indices for
measuring
Quality of
life
HPI:
Measures
deprivatio
HDI
PQLI Q n in the
basic
dimensions
of
human
Concept of wellbeing:
Physical quality of life index consolidates
three indicators,
Infant mortality,
Life expectancy at age one
Literacy
Pneumonic: PILL
Physical quality of life index
Each indicator is given equal weight from 0-
100
PQLI is the average of all indicators.
Ranges from 0-100.
Does NOT take per capita GNP into
consideration.
Aim: To attain a PQLI of 100.
India – 43, Kerala – 67 (highest)
Measures: Social, economic & political
policies
PQLI does not measure economic growth.
HDI: Human Development Index (Pneumonic: KIL)
K: Knowledge (expected years of schooling &
mean years of schooling)
I: Income (real GNI per capita in PPP in US $)
L: Life expectancy at birth.
HDI: Human Development Index
HDI values range from 0-1. (http://
hdr.undp.org/en/composite/HDI)
Very High: ≥0.800: 51 countries
(Norway : 0.949)
High: 0.700- 0.799: 54 countries
Medium: 0.550- 0.699: 42 countries- India
131 no. (0.624)
Low: <0.550: 41 countries
Measures average achievements in
Minimum and Maximum values for each indicators:
Expected years of schooling: 0 and 18.0
Mean years of schooling: 0 & 13.1 (Czech
Republic)
Combined education index: 0 & 0.978 (New
Zealand)
GNI per capita (PPP$): 100$ & 107721$
(Qatar) - Log values are taken
Life expectancy at birth: 20 yrs & 83.4 yrs
(Japan) Formula for calculating Individual
indices:
Index = {(Actual value) – (Minimum value)}
{(Maximum value) – (Minimum value)}
The HDI is the geometric mean of the three
HDI
calculati
on for
India
2010
Human poverty index: Measures deprivation in
dimensions of human basic
development. HPI 1 HPI 2
Used for Developing countries Developed countries
Dimensions used 3 4
Probability at birth 40 60
of
not surviving to age
Knowledge Adult illiteracy rate % of adults (16-
exclusion 65) lacking
functional
literacy skills
SOL deprivation Unweighted average of: % of people
- % of population not living below
using an improved the income
water source poverty line
- % of children
under weight-
for- age
Social exclusion NA Proportion of long
term
Other indices:
Gender Related Development Index :
Achievements in the basic human
development adjusted for gender inequalities
Gender Empowerment Measure: gender
inequalities in economic and political
opportunities.
Summary
Health is a neglected topic
UNTIL it is LOST
There have been changing concepts
of health: Biomedical- ecological-
psychosocial- holistic
Dimensions of health: Physical,
Mental, Social, Emotional, spiritual,
Vocational etc..
Well Being: Subjective &
Objective components
Thank
You
