UNIT1 CONCEPTS OF HEALTH AND HYGIENE: COMMUNITY

HEALTH AND SYSTEMS OF MEDICINE

*
Shaila Parveen

Contents

1.0 Objectives
1.1 Introduction
1.2 Concept of Health and Hygiene
1.3 Evolution of the Concept of Health and Hygiene
1.4 Changing Philosophy in the Field of Health and Health Care Services
1.5 Health Work in community and Brief Description of the system of Medicine
1.6 Various Models of Community Health Work
1.7 Identifying Basic Health and Hygiene Problems and Making Appropriate Intervention
1.8 Let Us Sum Up
1.9 Key Words
1.10 Suggested Readings
1.11 Answers to Check Your Progress

1.0 OBJECTIVES

This unit aims to provide you with an understanding of the concept of health and hygiene.
After going through the unit, you should be able to:

 explain the meaning of health and hygiene:

 understand the indigenous health system in India;
 indicate the various health and hygiene problems in India;
 describe the health care delivery system in India;
 understand the role of social-workers in prevention; and
 making appropriate intervention.

1.1 INTRODUCTION
Health is a common theme in the elements of culture. In fact, all communities have their own
concept of health as a part of culture, yet health continues to be a neglected area. However,
during the past few decades there has been a reawakening that health is a fundamental human
right and a world wide social goal. It is essential to the satisfaction of basic human needs and
to an improved quality of life and is to be attained by all. This unit gives an idea about the
concept of health and hygiene and it also deals with the role that can be played by social
workers in promotion of health and hygiene.

*
Ms. Shaila Parveen, M.G. Kashi Vidyapith, Varanasi
This unit also throws light on education and changing philosophy of health, the various
models for community health-work and identifying the basic health and hygiene problems in
India and making appropriate interventions.

1.2 CONCEPT OF HEALTH AND HYGIENE

World Health Organization (WHO-1946) defined health as a “state of complete physical,
mental and social well-being and not merely the absence of disease or infirmity”. Thus, it is a
basic human right. Providing conducive condition for achieving normal health is the duty of
state and society. In fact, the deep urge of humanity is to be healthy. Health is one of the
essentials of life without which nothing can be achieved. The sick and hungry child cannot
learn and the sick and hungry adult cannot produce. In other words, we can say that health is
a condition of equilibrium between physical fitness, mental balance and social adjustment of
human being.

Concept of Hygiene

The term ‘hygiene’ is derived from “hygeia”, the goddess of health in Greek mythology.
Hygiene has been variously defined, such as hygiene is “the science of health and embraces
all factors which contributes to healthful living”. According to another definition hygiene is
“the science of preventing disease and promoting health”. Thus, the aim of hygiene is not
only to preserve health but also to improve it.

An individual may be called a healthy person if he/ she is physically fit, mentally sound and
socially well adjusted. Any change in either components i.e., physical, mental or social may
result in discomfort or disease. It may also be regarded as the disease that is an interruption in
the state of equilibrium of all the three components of health. This concept may easily be
understood through a triangle of 60 degree each with the physical, mental and social arms.
Any variation in either angle or contraction/ elongation in any one of the arms will produce
imbalance (State of illness) in any individual and on the other hand exact degree and equal
arms are the sign of totally healthy person. Let us examine the physical, mental or social
aspects of health.

Physical Health

Crew (1965) observed that the sign of physical health in an individual constitutes a good
complexion, a clean skin, bright eyes, lustrous hair with a body well clothed with firm flesh
neither too thin nor too fat, a sweet breath, a good appetite, sound sleep, regular activity of
bowels and bladder and smooth, easy coordinated movements. All the organs of the body are
unexceptional in size and function normally. All the special senses are intact. The resting
pulse rate, blood pressure and tolerance etc., are all within the range of ‘normality’ in the
context of the individual’s age and sex. In the young and growing individual, there is a steady
gain in weight.

On the basis of the above signs, the basic health needs include a hygienic and balance diet,
pure or safe water, a good habitat, neighbourhood and community with basic sanitation,
suitable clothes, well regulated life-style, exercise and personal hygiene. A periodic health
check up is also very essential for good health.

Mental Health

The old saying “healthy mind in a healthy body” confirms the inter-relationship between
mental and physical health. Poor mental health affects physical health and vice-versa.
According to WHO Technical Report (1964), the psychological factors are considered to play
a major role in disorders such as hypertension, peptic ulcer and asthma. A mentally healthy
person is free from internal conflicts and external mal-adjustments. He is not swayed by
emotions; and has good self-control.

As such mental health primarily needs physical health. The other important needs are a good
home, a good neighbourhood, a good community and job satisfaction. The psychologists are
of the opinion that the dissatisfaction of instinctual and basic life needs leads to insanity.

Social Health
The social health of the people in a community is determined and judged on the basis of their
personal and social characteristics. One who plays one’s roles, according to one’s status and
is apt in establishing and maintaining harmonious relationship in family and community and
on job, is considered socially a healthy person. On the contrary, when he fails to perform
these roles, neglects social relations, indulges in bad habits and gets involved in homicide,
suicide, crime, gambling, drinking, etc., he is considered abnormal.

Therefore, family and social welfare services are important. Social health needs to deal with
the problems connected with social existence of individuals. But these needs are seldom
integrated with health services which is a great weakness of health care delivery system in
most societies. Some of the determinants of health are—heredity, environment, life-style,
socio-economic conditions, health and family welfare services together with other factors
such as food, agriculture, education, industry, social development, social welfare, etc.

Definitions of Health
Webster’s Dictionary, defines health as “The condition of being sound in body mind or spirit
specially freedom from physical disease and pain”. Oxford dictionary states health as the
state of being free from illness or injury and a person’s mental or physical condition.
Whereas, according to WHO-1946, “Health is a state of complete physical, mental and social
well being and not merely the absence of disease or infirmity”.

Thus, to achieve the optimum health condition there is a need of not only caring for the sick,
but also prevention of illness, and promotion and maintenance of health. Health promotion
and maintenance enables individuals, families and communities to develop their full health
potential. Its scope goes beyond the prevention and treatment of disease. It encompasses
cultivation of healthy habits and life-styles and other social, economic, environmental and
personal factors conducive to health. Health maintenance does not depend solely on
individual behaviour; the family and community also have a major role in influencing
individual choices and actions. From the care of the sick, social work is moving towards
prevention and promotion of health of individual and community.

1.3 EVOLUTION OF THE CONCEPT OF HEALTH AND HYGIENE

All communities have a concept of health as part of their culture. In 1977, the 30th World-
Health Assembly decided that the main social target of Government and WHO in the coming
decades should be “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.” Health,
while being an end in itself has also become a major instrument of overall socio-economic
development in the creation of new social order. A brief account of the changing concepts of
health is given below:

1) Bio-medical Concept
Traditionally health has been viewed as an “absence of disease”. This concept was known as
the bio-medical concept of health which dominated medical thought during 20th Century.
The medical profession viewed the human body as a machine and disease as a consequence
of the breakdown of the machine and one of the doctors’ tasks as repair of the machine. Thus,
health in this narrow view became the ultimate goal of medicine.

The criticism that is leveled against the bio-medical concept is that it has minimized the role
of the environmental, social, psychological and cultural determinants of health. The bio-
medical model, despite its spectacular success in treating disease was found inadequate to
solve some of the major health problems of man-kind such as, malnutrition, chronic diseases,
accidents, drug abuse, mental-illness, environmental pollution, population explosion, etc.

2) Ecological Concept
Deficiencies in the bio-medical concept gave rise to other concepts. The ecologist put
forward an attractive hypothesis which viewed health as a dynamic equilibrium between
individual and his environment and disease as a maladjustment of human organism to
environment. Ecologists Dubos said, “Health implies the relative absence of pain and
discomfort and a continuous adaptation and adjustment to the environment to ensure
optimum functions”. Human ecological and cultural adaptations determine not only the
occurrence of diseases but also the availability of food and the population composition. The
ecological concept also captures imperfect man and imperfect environment. History testifies
that improvement in human adaptation to natural environments can lead to greater modern
delivery services.

3) Psycho-Social Concept
Contemporary development in social science reveals that health is not only a bio-medical
phenomenon, but one which is influenced by social, psychological, cultural, economic and
political factors of the people concerned. These factors must be taken into consideration
while defining and measuring health. Thus, health is both a biological and social
phenomenon.
4) Holistic Concept
The holistic model is a synthesis of the all above concepts. It recognizes the strength of
social, economic, political and environmental influences on health. It has been variously
described as a multidimensional process involving the well-being of a person in the context
of his environment. This view corresponds to the traditional view that health implies sound
mind in a sound body and a sound family in sound environment. The holistic approach
implies that all sectors viz. agriculture, animal husbandry, food, industry, education, housing,
public work, communications, etc., have a great effect on health.

Check Your Progress I

Note: a) Use the space provided for your answer.

b) Check your answer with those provided at the end of this unit.

1) List the characteristics of a healthy individual.

…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………

2) What are the essential requirements for good health?

…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………

3) What are the various approaches to health?

…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………

Activity I

Visit a slum area around you and enlist the unhygienic living conditions and health problems
observed there.
1.4 CHANGING PHILOSOPHY IN THE FIELD OF HEALTH AND HEALTH
CARE SERVICES

Changing Philosophy
The period following 1500 AD was marked by political, industrial, religious and medical
revolutions. Political revolutions demanding individual’s right took place in France and
America. The industrial revolution in the West brought great benefits leading to an
improvement in the standard of living. Along with this, the concept of health and hygiene
also evolved.

Revival of Medicine
For many historians the revival of medicine encompasses the period from 1453-1600 AD. It
was an age of individual scientific endeavour. The period during 17th and 18th centuries were
full of even more exciting discoveries e.g. Harvey’s discovery of circulation of blood (1628).

Sanitary Awakening
Another historic milestone in the evolution of medicine is the “great sanitary awakening”
which took place in England in the mid-nineteenth century and gradually spread to other
countries. The industrial revolution of 18th century sparked of numerous problems such as
creation of slums, overcrowding with all its ill-effects, accumulation of filth in cities and
towns, high sickness and death rate especially among women and children, industrial and
social problems, etc., causing deteriorated health of the people. Anti-filth crusade “the great
sanitary awakening” led to the enactment of Public Health Act of 1848 in England. A new
thinking began to take shape i.e. the state has a direct responsibility for the health of people.

Rise of Public Health

Around 1840, the above events led to the concretization of public health concepts in England.
While Public health made rapid strides in the western world, its progress has been slow in the
developing countries such as India, where the main health problems continued to be those
faced by western world 100 years ago. The establishment of the WHO providing a Health
charter for all people provided a great fillip to the public health movements in these countries.
There are three components of modern health concept which include curative aspect,
preventive aspect and social medicine.

Changing Concept in Public Health

When we look into the history of public health, we identify the following four distinct phases:
a) Disease control (1880-1920)
b) Health promotional (1920-1960)
c) Social Engineering (1960-1980)

d) Health for all (1981-2000)

Changing Philosophy in the Field of Health and Health Care Services: (Indian
Perspective)
Health Services in India began in the middle of the 18th century with the advent of British
rule. Through public drainage and public baths existed in ancient cities and a hospital system
was maintained during the rule of King Ashoka, focus was on the concept of individual cure
in earlier days. In 1919, the Montague-Chelmsford Constitutional reforms led to the transfer
of public health, sanitation and vital statistics to the provinces (now State Govt.) under the
control of an elected minister. This was the first step towards decentralization of health
administration in India.

It was only after the independence, the health services began to develop on the basis of health
needs of the country. The guidelines for organising the health services in the country were
based on the following reports:-

1. The Bhore Committee-1943

2. The Mudaliar Committee-1962
3. The Chaddha Committee-1963
4. The Mukherji Committee-1965
5. The Mukherji Committee-1966
6. Jungal Walla Committee-1967
7. Kartar Singh Committee-1973
8. Srivastava Committee-1975
9. Rural Health Scheme-1977
10. Health for All by 2000 AD—Report of the working group-1981

New Philosophy of Health

In recent years we have acquired a new philosophy of health which may be stated as below:

 Health is a fundamental human right. Health is intersectoral.

 Health is an integral part of development.

 Health is central to the concept and quality of life.

 Health involves individual, state and international responsibility.

 Health and its maintenance is a major social investment.

 Health is a world-wide social goal.

Health Care Services
There is broad agreement on the issue that health services should be comprehensive,
accessible and acceptable which should provide scope for community participation and be
available at a cost that community and country can afford. The purpose of health care
services is to contribute to the improvement of the health condition of the population and
wider the scope of health services so that it includes ever changing national, state and local
health problems. In India, the health care services is represented by the five major sectors or
agencies applying distinct health technology and having difference sources of funds for
operation. A brief classification of these sectors is given below. However, it may be noted
that there could be sectoral overlapping i.e. indigenous system can be found in public as well
as private sector and so on.

1) Public Sector

a) Primary Health Care:

 Primary health care 10,000-20,000 population
 Sub Centre Village Level

 5000 population Village Health Guide, (Male and

Female), Trained Dais and
Integrated Child Development
Services (ICDS).

b) Hospitals/Health Centres:
 Community Health Centre — 1,00,000 population

 Rural Hospital
 District Hospital/Health Centre Specialist Hospital
 Teaching Hospital.

c) Health Insurance Schemes:

 Employees State Insurance
 Central Govt. Health Scheme
d) Other Agencies
 Armed Forces Medical Services
 Railway hospitals, Health Units and clinics
2) Private Sector
 Private Hospitals, Polyclinics (Nursing Homes and Dispensaries)

 General Practitioners
3) Indigenous System of Medicine
 Ayurveda and Siddha
 Unani and Tibbiya
 Homeopathy
 Unregistered Practitioners.

4) Voluntary Health Agencies

 Indian Red Cross Society
 Family Planning Association of India

 The All India Blind Relief Society

 Tuberculosis Association of India etc.

5) National Health Programmes

 National Malaria Eradication Programme

 National Tuberculosis Programme

 National Family Welfare Programme

 Expanded Programme on Immunization

 National Filarial Eradication Programme

 National Programme for Control of Blindness

 National AIDS Control Programme etc.

Health Care Delivery System and its Structure in India

In India health being state subject, the states are autonomous in matter of the delivery of
health care services to the people. Each state, therefore, is free with regard to formation,
planning, guiding, assisting, evaluating and coordinating health care services. However, the
central govt. also owns certain responsibilities. The health system in India has three main
levels i.e., Central, State and Peripheral.
 Health System Infrastructure in India
NATIONAL LEVEL
Ministry of Health and Family Welfare

STATE and UNION TERRITORY

Ministry of Health and Family Welfare

DISTRICT HEALTH ORGANISATION

ALL SPECIALISTS
CMO, DMO’S/ DMEO/DHE/PHN and OTHERS

SUB-DISTRICT/TALUKA HOSPITALS
SOME SPECIALIST

Community Health Centre

ALL SPECIALISTS

PRIMARY HEALTH CENTRES

AT BLOCK LEVEL
MO/BEE/H. ASSISTANT
(Male & Female Health Worker)
SUB CENTRES-
HEALTH WORKER (M)
HEALTH WORKER (F)

HEALTH GUIDE
DAI/TBA

1.5 HEALTH WORK IN COMMUNITY AND A BRIEF DESCRIPTION OF THE

SYSTEM OF MEDICINE

Disease and death are as old as man. Every society develops its own measures to cope with
these miseries which form an essential part of health culture in that society. Health Culture,
according to Polgar (1963) is of two types, “the popular health culture and the professional
health culture”. The measures which the members of a community take to alleviate their
suffering are known as popular health culture, whereas the professional health culture is
developed and practiced by medical experts. The popular health culture develops through a
process and on the basis of personal experience which pass through one generation to the
other. It consists of the body health rules, folk saying and family prescription (Gharelu-
Nuskhas). Since it develops in local condition, it differs from culture to culture.

Ayurveda
Ayurveda as a professional health system of medicine developed in India in the ancient times.
The services were delivered by individual practitioners only till king Ashoka established a
hospital system in 3rd Century B.C. Ayurveda by definition implies the knowledge of life or
by which life may be prolonged.

Ayurvedic practitioners used to give self-made herbal indigenous medicine for treatment. A
great emphasis was laid on prevention of disease by regulating the diet and life-style of
people. Ayurveda is practiced throughout India but the siddha system is practiced in the
Janul-speaking areas of south India.

Hygiene was given an important place in ancient Indian medicine. The laws of Manu also
contained a code of personal hygiene. Archeological excavation at Mohenjo-Daro and
Harappa in the Indus valley uncovered cities of two thousand year old which revealed rather
advance knowledge of sanitation, water supply and engineering.

Unani-Tibb
Unani system of medicine owes its origin to Greece. Among the founders of this school of
medicine were Hippocrates and Glen who laid the foundation of scientific medical research
in the west. Unani medicine got enriched from its interaction with the traditional medicines of
Egypt, Syria, Iraq, Persia, India, China and other Middle East and Far East countries. Unani
Medicine had its hey-day in India during the medieval period. The British rule, withdrew
governmental patronage and Unani Medicine suffered a setback. Since the system enjoyed
faith among the masses, it continues to be practiced.

The development of Unani Medicine as well as other Indian systems of medicine gained
considerable momentum after independence. In 1969, the government established a Central
Council for Research in Indian Medicine and Homeopathy (CCRIMH) to develop scientific
research in different branches of Indian systems of medicine viz. Unani Medicine, Ayurveda,
Siddha, Yoga, Naturopathy and Homeopathy. The research activities in these systems
continued under the aegis of the CCRIMH till 1978 when it was split up into four separate
research Councils, one each for Unani Medicine, Ayurveda and Siddha, Yoga and
Naturopathy and Homeopathy. Further, the Government set up, by an Act of Parliament—
Indian Medicine Central Council Act 1970, the Central Council of Indian Medicine (CCIM).

At present, the Unani system of medicine, with its own recognized practitioners, hospitals
and educational and research institutions, forms an integral part of the national health care
system.
Siddha
The ancient Sidha system of medicine flourished in South India. The word Siddha comes
from the word Siddhi which means an object to attain perfection or heavenly bliss. Siddha
science considers nature and man as essentially one. According to Siddha medical science,
the Universe originally consisted of atoms which contributed to the five basic elements, viz.,
earth, water, fire, air and sky corresponding to the five senses of the human body. They were
considered to be the fundamentals of all the corporeal things in the world.

Homeopathy
Homeopathy, a system of medicine propounded by Samuel Hahnemann, (1755-1843) came
to India sometimes in the mid-18th century. This system could not get wide popularity in
those times. Homoeopathy is an alternative method of treatment, based on the nature’s Law
of Cure, namely ‘Like Cures Like’. It is a revolutionary natural medical science. The
medicines are prepared from natural substances to precise standards and work by stimulating
the body’s own healing power. But today many people utilize the services as they believe that
homeopathic drugs carry no side effects and are cheaper and easily administrable.

Modern Medicine and Public Health

During the early period of British rule in India, which was still dominated by Indian systems,
the western system of medicine could not get wide publicity. The British had introduced
modern medicine (allopathic system in India) systematically in the later half of the eighteenth
century.

The need to provide public health services was felt only when there was an outbreak of
plague, cholera and small-pox. During those days, there was widespread prevalence of
malaria, tuberculosis, leprosy, small-pox, cholera, gastro-intestinal infection and infestations
and filariasis. A considerable change occurred in the health needs of the society due to vast
changes in the socio-economic scene of the country. The demand for medical aids was also
caused by man’s attitude towards life and needs.

The first organised step to meet the demand for public health was taken by the then British
Government through the appointment of a Royal Commission in 1859. The commission was
entrusted the task of investigating the cause of extremely unsatisfactory health condition in
India.

Health Work in Community

Health has been declared a fundamental human right. It implies that the state has a
responsibility for the health of its people. Since health is influenced by a number of factors
such as adequate food, housing, basic sanitation, healthy life-style, protection against
environmental hazard and communicable diseases, the frontiers of health extended beyond
the narrow limits of medical care. Community participation is now recognized as a major
component in the approach to the whole system of health care.

Levels of Health Care

Primary Level Care: It is the first level of contact of individuals, the family and community
with the national health system, where primary health care (essential health care) is provided.
As a level of care, it is close to the people where most of their health problems can be dealt
with and resolved. In Indian context, primary health care is provided by the complex of
primary health centre and their sub-centres through Multipurpose Health Worker, Village
Health Guides and Trained Dais. Primary health care system has been recognized as the most
effective health care delivery system.

Secondary Level Care: At this level, more complex problems are dealt with. In India, this
kind of care is generally provided in community Health Centres and district hospital which
also serve as the first referral level.

Tertiary Level Care: The tertiary level is a more specialized level than secondary care level
and requires specific facilities and attention of high regional or central level institution e.g.,
Medical College Hospital, All India Institutes, Specialized Hospitals, etc.

Check Your Progress II

Note : a) Use the space provided for your answer.
b) Check your answer with those provided at the end of this unit.
1) What is the new philosophy on health?
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
2) List the indigenous system of medicine in India.
…………………………………………………………………………………………………
………………………………………………………………………………………………….
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
3) What are the various levels of health care?
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
Activity 2
Visit a Community Health Centre. Describe briefly its main work and staff involved. Also
give your comments.

1.6 Various Models of Community Health Work

The term community health work has emerged during the past few decades; community
treatment or community health work is the sum of steps decided upon to meet the health
needs. The community takes into account resources available and the wishes of the people as
revealed by community diagnosis. A number of community health models have been
developed. They include the following :

1) Medical Model
Most health education in the past has relied on knowledge transfer to achieve behaviour
change. Originally health education developed at the community level along the lines of the
bio-medical views of health and disease. The assumption was that people would act on the
information supplied by health professionals to improve their health condition. In this model
social, cultural and psychological factors were thought to be of little or no importance. The
medical model failed to bridge the gap between /knowledge and behaviour.
2) Motivation Model
When people did not act upon the information they received, health education started
emphasising “motivation” as the main force to translate health information into the desired
health action. But the adoption of a new behaviour or idea is not a simple act. It is a process
consisting of several stages through which an individual is likely to pass. In this regard,
sociologists have described 3 stages in the process of change in behaviour.

1. Awareness Interest
2. Motivation Evaluation, Decision making
3. Action Adoption or acceptance
3) Social Intervention Model
Soon it was realized that the public health problems are so complex that the traditional
motivation approach is insufficient to achieve behavioural change. Adoption of small family
norm, cleanliness, raising the age of marriage, immunization, safe drinking water, etc., were
areas where progress was dismal. The motivation model ignored the fact that in a number of
situations, it is not the individual who needs to be changed but the “social environment”
which shapes the behaviour of individual or the community.

In sum, a coherent strategy needs to be developed involving all the ways of changing
behaviour. A combination of approaches using all methods to change life - style is required
for which appropriate use of medical care and other non-medical inputs will be necessary.
1.7 Identifying Basic Health and Hygiene Problems and Making
Appropriate Intervention

The etiology of ill health lies in the malfunctioning of the social system in terms of poverty,
ignorance, population explosion, unemployment, old age, unhygienic living conditions, bad
housing, poor nutrition and incompatible dietary habits, poor quality of drinking water and
sanitary facilities, etc. Thus, we can say that ill health is only a symptom of social
disequilibrium and not a phenomenon independent of social affairs of man. Generally, health
is misunderstood with treatment which is not necessarily a precondition of good health but it
involves prevention, education, rehabilitation and a number of other interventions in terms of
social services which ensures the vitality of human health.

The main causes of health and hygiene problems in India may be enumerated as below:
1) Environmental Causes
– lack of safe drinking water
– lack of basic sanitation
– crowded, unsanitary living conditions
– pollution of water, food, soil and air

2) Social Economic Causes

– poverty
– illiteracy
– ignorance
– prejudicial customs, traditions, beliefs and cultural pattern

– inadequate nutrition
– lack of personal hygiene
– rapid population growth

3) Others
– uneven development of health care services and social care

– inadequate primary health care

Identifying Basic Health and Hygiene Problems

An assessment of the health status and health problem is the first requisite for any planned
effort to develop health care services. This is also known as Community Diagnosis. The
analysis of data relating to health situation and health problems comprises:

– Morbidity and Mortality statistics

– Demographic conditions of the population
– Environmental conditions which have a bearing on health

– Socio-economic factors which have a direct effect on health

– Cultural background, attitudes, beliefs and practices which effect health

– Medical and health services available
– Other services available
A number of committees have been constituted to look into health problems. In the light of
the reports submitted by the committees, National Policies have also been formulated. Let us
look into the brief summary.

Bhore Committee (1946): The government of India appointed this committee in 1943 to
survey the then existing health conditions and health organisations in the country and to make
recommendation for further improvement. The report published in 1946 recommended a
primary health unit for a population of 20,000, a secondary unit for a population of 6,00,000
and a district headquarter for a population of three million as long-term programme. The
committee in its short-term programme recommended a primary unit for a population of
40,000, a secondary unit for a population of one and a half million (and a district
headquarters organisation for a population of three million).

Mudaliar Committee (1962): The committee was appointed by the Ministry of Health to
undertake a review of the developments since the publication of the health survey and
development committee report in 1946, and to formulate further health programme for the
third and subsequent five year plan periods.

The Mudaliar Committee found the quality of services provided by the primary health centres
inadequate and stressed the need to strengthen the existing primary health centres before new
centres are created. It also stressed the need to strengthen sub divisional and district hospitals
so that these could effectively function as referred centres.

Chaddha Committee (1963): The committee was appointed by the Government of India to
study the arrangements necessary for the maintenance phase of the National Malaria
Eradication Programme. The committee recommended that the “vigilance” operations of the
malaria eradication programme should be the responsibility of primary health centres at block
level and should be implemented through basic health workers. These workers were
envisaged as “multipurpose workers” to look after additional duties of collection of vital
statics and family planning in addition to malaria vigilance.

Mukherjee Committee (1965): The committee was appointed by the Government of India to
review the strategy for the family planning programme and also to delink malaria vigilance
operations from family planning.
Mukherjee Committee (1966): The committee worked out the details of the “basic health
service” which should be provided at the block level, and some consequential strengthening
required at higher levels of administration.

Jungalwala Committee (1967): The committee on “Integration of Health Services” was

appointed in 1964 under the chairmanship of Dr. M. Jungalwala to examine the various
problems including those of service conditions. It recommended integration of organisations
and personal in the field of health from the highest to the lowest level in the service.

Kartar Singh Committee (1973): “The Committee on Multipurpose Workers under Health
and Family Planning” made recommendations on the structure for integrated services at the
peripheral and supervisory levels. The committee also gave recommendations on the
functions of the newly designated” and “Male Health Supervisors”. The committee
recommended on PHC for a population of 50,000, which should be divided into 16 sub
centres, each catering to a population of about 3,000 to 3,500 depending on the topography
and means of communication.

Shrivastava Group Report (1975): The most significant policy changes followed the report
of this group on Medical Education and Support Manpower. Its recommendations included a
nation-wide network of efficient and effective services suitable for our conditions be created,
steps be taken to create bands of para professionals or semi-professional health workers from
the community itself to provide protective, preventive and creative services, needed by the
community and there be two cadres of health workers and health assistants between the
community and the primary health centres, development of a “Referral Services Complex” by
establishing proper linkages between the PHC and higher level referral and service centres,
namely taluka tehsil, district, regional and medical college hospitals, and establishment of a
Medical and Health Education Commission for planning and implementing the reforms
needed in health and medical education.

Ramalingaswami Committee Report (1981): It is also called ICSSR-ICMR report. The

committee noted that in the last thirty years the capacity for change and progress was
wrongly equated in India with our capacity to reproduce the western type of institutions,
service and values. It suggested that health cannot be achieved through a linear expansion of
the existing system and even by tinkering with it through minor reforms. It laid exclusive
emphasis on allopathic system and recommended for the community health centre and
allopath or para professionals as support manpower to sustain the allopathic system.

The National Health Policy (1983): The initiatives taken under this policy were: A phased
time bound programme for setting up a well dispersed network of comprehensive primary
health care services linked with extension and health education, designed in the context of the
ground reality that elementary health problems can be resolved by the people themselves;
intermediation through ‘Health Volunteer’ having appropriate knowledge, simple skills and
requisite technologies; an integrated network of evenly spread speciality and super-speciality
services; encouragement of such facilities through private investment for patients who can
pay so that the draw on the governments facilities is limited to those entitled to free use.

National Health Policy 2002: It acknowledged globalization as a concern with a critical

view of TRIPS and its impact. It recommended for the doubling of Central Government
expenditure and suggested to increase health expenditure by all concerned in general. It
suggested increased proportions of expenditure on primary health care. It also envisaged
regulations of the private health care sector.

National Health Policy 2017: The focus of the National Health Policy, 2017, is to shift from
‘sick care’ to ‘wellness’ by promoting prevention of disease and promotion of good health of
the people. The aim is to strengthen the public health care system by making it patient
centric, efficient, effective and affordable. It aims to ensure a comprehensive package of
services and products that meet immediate health care needs of most people. The
government seeks to enhance the healthcare services through access to technologies,
developing human resources, encouraging medical pluralism, building knowledge base,
developing better financial protection strategies, strengthening regulation and health
assurance.

Major Causes of Morbidity and Mortality

The major causes of morbidity and mortality of India may be conveniently grouped under the
following heads –

Communicable Diseases: Malaria, Tuberculosis, Diarrhoea, Leprosy, Filarial, AIDS etc.

Nutritional Problems: Protein-energy malnutrition, nutritional anemia, low birth weight,
xerophalmia (nutritional blindness), iodine deficiency disorder.
Environmental Sanitation: The most difficult problem to tackle in this country is perhaps
the environmental sanitation problem. The great sanitary awakening which took place on
England in 1840’s is yet to be born in India.

Medical Care Problems: India has a national policy;it does not have a national health
service. The existing hospital based disease oriented health care model has provided health
benefits mainly to the urban elite.

Population Problem: The population problem is one of the biggest problems faced by the
country, with its inevitable consequences on all aspects of development, especially
employment, education, housing, health care, sanitation and environment.

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 in the form of
treatment, education, help or social support. Generally, there are five methods of intervention:
1) Health Promotion: Health promotion is the process of enabling people to increase
control over and to improve health. The well known intervention in this area are:

i) health education,

ii) environmental modification,

iii) nutritional intervention,
iv) Life-style and behavioural changes.

2) Specific Protection: Through this intervention we take some special measure to

avoid disease altogether. The following are some of the currently available
intervention aimed at specific protection (a) immunization, (b) specific nutrients, (c)
protection against accidents, (d) control of specific hazards in the general environment
e.g. air pollution, noise pollution.

3) Early Diagnosis and Treatment: Early detection and treatment are the main
interventions of disease control. The earlier a disease is diagnosed and treated the
better it is from the point of view of prognosis and preventing the occurrence of
further case or any long-term disability. For effective and lasting results, proper
supervision, follow-up are essential.

4) Disability Limitation: When a patient report late in the pathogenesis phase, the mode
of intervention is to prevent or halt the transition of the disease from impairment to
handicap.

5) Rehabilitation: Rehabilitation has been defined as the “combined and coordinated use
of medical, social, educational and vocational measures for training and retraining the
individuals to the highest possible levels of functional ability”. It includes all measures
aimed at reducing the impact of disability and handicapping conditions and enabling the
disabled and handicapped to achieve social integration. Such as, establishing schools for
the blind, reconstructive surgery in leprosy, etc.

It is recognized that intervention at earlier stage is feasible, results oriented and less
demanding of scare resources.

Social Work Implications

Being a professional social worker, we can use the various methods of social work in
prevention and promotion of health. Social workers also play very important role in social
intervention and rehabilitation. At individual level, use, can use social case work whereas
social group work can be used for groups and community organisation.

Social Casework

Social case work may be defined as “social treatment of a maladjusted individual involving
an attempt to understand his personality, behaviour and social relationship, and to assist him
in working out a better social and personal adjustment”. A one-to-one relationship becomes
the medium through which a caseworker helps his/her client. A case worker helps his/her
client to find practical solutions to the distress causing situations, the client finds
himself/herself in. The distress causing problems could be either health related, familial,
interpersonal or financial. Through the nature of help is therapeutic, concrete help has
primary and specific place in case work.
By using the various techniques i.e. – personal contact, home visits, personal letters, etc. we
can prevent the disease such as drug-addiction, Cancer, TB, AIDS. Apart from prevention,
casework can be used for support to patient while undergoing treatment and follow-up.

Group Work

Social group work is defined as “a method through which individuals in groups in social
agency settings are helped by a worker who guides their interaction in programme activities
so that they may relate themselves to others and experience growth opportunities in
accordance with their needs and capacities to the end of the individual, group and community
development” (Trecker, 1955). In social group work, a group experience is used to affect
changes in the attitude and behaviour of individuals. Democratic values such as equality,
opportunity and liberty are built through group activities. Social group work serves as an
effective method for the holistic development of personality.
Group teaching is an effective way of educating the community. We can use certain group
work techniques i.e. lectures, demonstration, discussion methods, group discussion, panel
discussion, symposium, workshop conferences, seminars, role play, etc., to communicate to
the people about health and hygiene, their life-style, environmental problem, etc. To create
awareness among the community for prevention of disease and promotion of health, the
social workers play very important role by educating the community against the various
problems related to health through awareness programmes.

Check Your Progress III

Note: a) Use the space provided for your answer.

b) Check your answer with those provided at the end of this unit.

1) What are the various health and hygiene problems in India?

…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………

2) What do you understand by Community Health?

…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………

1.8 LET US SUM UP

In this unit, we first discussed the meaning and concept of health and hygiene. We saw that
health is a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity. It is a basic human right. Health and hygiene are the
essentials of life without which nothing can be achieved. We also examined the evolution of
the various concepts of health like, bio-medical concept, ecological concept, psycho-social
concept and holistic concept.

In the category of indigenous system of health evolved in India, we have discussed Ayurveda,
Unani-Tibbiya and Homeopathy. We also studied the three levels of promotion of health at
primary level, secondary level and tertiary level.

We considered the changing philosophy in the field of health i.e. revival of medicine, sanitary
awakening, rise of public health. Besides, the unit also dealt with the changes in the concept
on health in Indian perspective. It covered the period from Bhore-Committee-1943 to Health
for All by 2000. With regard to models of community health, we have examined medical
model, motivation model and social intervention model.

We have attempted to identify the basic health and hygienic problems in India. We have also
analysed various models of intervention such as health promotion, specific protection, early
diagnosis and treatment, disability limitation, rehabilitation.

1.9 KEY WORDS

Community : The group of people living in a particular geographical area.

Diagnosis : The process whereby a disease or disorder is provisionally

identified on the basis of its symptoms and the patient’s
medical history.

Disease : Lack of health, a disorder or illness caused by infection, or

deficiency with characteristics/symptoms.

Health : A state of physical, mental and social well-being and free from
illness or pain.

Hygiene : The practice of preserving one’s health and preventing the

spread of disease especially by keeping oneself and one’s
surroundings clean.

Intervention : An act to involve oneself in something which is happening in

order to affect the outcome.

Model : A small scale presentation of something that serves as a guide

in constructing the full scale version.

Morbidity : The ratio of deaths in an area to the population of that area;

expressed per 1000 per year.

Prevention : To stop the occurrence of something before hand.

Promote : to work for the cause of something to upgrade something.

1.10 SUGGESTED READINGS

K. Park (17th edition) Nov. 2002 Preventive Medicine, Banarsidas Bhanot Publishers,
Jabalpur.

1.11 ANSWERS TO CHECK YOUR PROGRESS

Check Your Progress I

1) An individual who is physically fit, mentally sound and socially well adjusted may be
called healthy. Any change in either component i.e. physical, mental or social may
result discomfort means disease.

2) - A hygienic and balance diet

- Safe potable drinking water

- Good habitat

- Neighbourhood and community with basic sanitation

- Well regulated life style

- Exercise and personal hygiene

- A periodic health check up

3) - Bio-Medical Approach - based on germ theory

- Ecological Approach - based on equilibrium between

environment and disease/mal-adjustment.

- Psycho-Social Approach - based on both biological and social

phenomenon

- Holistic Approach - a synthesis of all the above concepts.

Check Your Progress II

1) In recent years we have acquired a new philosophy of health which is as follows:

 Health is a fundamental human right

 Health is intersectoral
  Health is an integral part of development
 Health involves individual, state and international responsibility
 Health is a world wide social goal

2) Following are the indigenous system of medicine in India.

 Ayurveda and Siddha

 Unani and Tibbi
 Homeopathy
 Traditional Healers

3) Primary prevention- action taken prior to the onset of disease, which removes the
possibility of occurrence of the disease.

Secondary prevention – action which halts the progress of a disease at its incipient
stage and prevents complication- the specific interventions are early diagnosis and
adequate treatment.

Tertiary prevention- all measures available to reduce or limit impairment and

disabilities to minimize suffering caused by existing departures from good health and
to promote the patient’s adjustment to irremediable conditions.

Check Your Progress III

1) Communicable disease

 Nutritional problem
 Environmental sanitation problem
 Medical care problem
 Population problem.

2) A Euro symposium in 1966 defined community health as “all the personal health and
environmental services in any community, irrespective of whether such services were
public or private one”.