Concept of Health

Dimension and Determinants of Health

Health is difficult to define but easier to

understand. To many of us it may mean
absence of disease or infirmity and to many
it may mean sound body and sound mind
and sound function of the body.
• To an anatomist -Healthy body means it should confirm to normal
anatomical structures.
• To a physiologist- Health means normal body functions
• To a biochemist- It means normal biochemical levels / values
• To a pathologist- It means normal cellular make up.
• To a geneticist -It means correct existence of genetic potential.
• To a psychiatrist - It means well adjusted and a balanced personality
• To a clinician - no abnormality in structure and function of the body.
• When a clinician fails to detect anything abnormal by his clinical
wisdom and laboratory tests he labels a person no abnormality
detected (NAD).
 Changing Concepts of Health
• Biomedical Concept (Health has been viewed as an “absence of disease”, and
if one was free from disease the person was considered healthy)
• Ecological Concept (Health implies the relative absence of pain and discomfort
and a continuous adaptation and adjustment to the environment to ensure
optimal function)
• Psychosocial Concept (Health is both a biological and social phenomenon)
• Holistic Concept (A sound mind in a sound body, in a sound family, in a sound
environment; All sectors of society like agriculture, animal husbandry, food,
industry, education, housing, public works, communication & other sectors
have an effect on health)
 Definitions of Health
• WHO Definition: “ Health is a state of complete physical, mental and social
wellbeing and not merely an absence of disease or infirmity and the ability to
lead a socially and economically productive life”.
• Operational Definition of Health: “ A condition or quality of the human
organism expressing the adequate functioning of the organism in given
conditions, genetic or environmental”.
• Thus Health means
(a) No obvious evidence of disease and that the person is functioning normally
(b) Several organs of the body are functioning adequately as well as in relation
to one another (Equilibrium or Homeostasis).
 Physical Health
It means adequate body weight, height and
circumference as per age and sex with
acceptable level of vision, hearing, locomotion
or movements, acceptable levels of pulse rate,
blood pressure, respiratory rate, chest circumference, head
circumference, waist hip ratio.
It means The body structure and functions
confirming to laid down standards within the
range of normal development and functions of
all the systems.
 Mental health
The positive dimension of mental health is stressed in WHO’s
definition of health as contained in its constitution.
Mental health is defined “as a state of
well being in which the individual realized
his or her own abilities, can cope with
normal stresses of life, can work
productively and fruitfully and is able to
make a contribution to his or her
community”.
A mentally normal person has the ability to mix up with others, he/she
makes friendship, behaves in a balanced manner, keeps himself tidy and
observes adequate personal hygiene, well oriented to time, place and
person and environments and he is unduly not suspicious of others.
 Social wellbeing
It is the third dimension of health.
It means ability of a person to adjust with others in his
social life, at home, at work place and with people.
Men interact with men and they inter-relate and inter
depend on each other and pay their effective role in
accordance with a situation.
 Essentially social wellbeing includes inter-relation and
interaction of human beings.
Social wellbeing is a composite function of income level,
literacy, occupation and working conditions marital harmony,
institution of a family, social groups and have good cultural
and behavioral patterns of the society.
Social wellbeing can be measured on scale by taking in to
consideration of indicators like income, literacy and
occupation
 Determinants of health
Heredity

Environment Health services

❖ Physical, social, ❖ Promotive,
biological and
Health preventive,
curative,
man-made rehabilitative

Behavior
❖ Actions
❖ Habits
❖ Reactions
❖ Belief, attitudes
❖ Practices
(Lifestyles)
 Environment
The environment is considered to be the most important
determinant and input of health.
Health is influenced in the man made environment or
artificial environment too.
It included items like housing,
transport, industries and
communication.
 A society is said to be healthy if it has:
• safe sources of improved water supply,
• safe method of waste water disposal,
• paved streets,
• disposal of garbage refuse and animal excreta by manure pits,
• people use sanitary latrines,
• female literacy is high,
• girls enrolment is universal,
• deliveries are conducted by trained persons,
• birth rate and death rate are within acceptable limits,
• immunization coverage is high and housing condition is good.
Health is a fundamental human right.
The attainment of highest possible level
of health is the most important world
wide social goal.
 Relation between the health and medicine
Health Medicine

A state of complete physical, mental and Any substance or substances used in

social well-being. treating disease or illness.
It is as much a social as a biological issue A social institution concerned with
What is defined as health and illness is combating disease and improving
influenced by culture. health.
1. People judge their health in relation to It emphasizes on prevention of illness
others they know. and takes account of the person’s entire
2. People define as “healthy” what they think physical and social environment.
of as morally good. Its founded on:
3. Cultural standards of health change over
time. 1. Patients are people.
4. Health relates to a society’s technology. 2. Responsibility, not dependency.
5. Health relates to social inequality 3. Personal treatment.
Classification of health
There are mainly six different types of Health includes
1. Physical health,
2. Mental health,
3. Emotional health,
4. Social health,
5. Environmental health,
6. Spiritual health.
Physical Health
Refers to the state of your physical body and how well it is operating. It is influenced
by levels of physical activity, adequate nutrition, rest, environments, etc.
Physical health consists of many components, like:
Physical activity – includes strength, flexibility, and endurance.
Nutrition and diet – includes nutrient intake, fluid intake, and healthy digestion.
Alcohol and drugs – includes the abstinence from or reduced consumption of these
substances.
Medical self-care – includes addressing minor ailments or injuries and seeking
emergency care as necessary.
Rest and sleep – includes periodic rest and relaxation, along with high-quality sleep.
 Mental health

• It is a level of psychological well-being or an absence of mental illness.

It is the “psychological state of someone who is functioning at a
satisfactory level of emotional and behavioral adjustment”
• Good mental health doesn’t just mean if you don’t have a mental illness.
• It’s about having a sense of purpose, getting involved with things, coping with
stress and setbacks, forming close relationships, and being in touch with your
own thoughts and emotions.
• To maintain mental health we have to be confident and accept ourselves.
• In this case, yoga and breathing exercises help us to focus and keep negative
thoughts out of our minds.
Emotional health
• refers to a person’s feelings which encompasses everything about you. It actually
governs all of your decisions, your mood, and who you are.
• Every single aspect of you is determinant of how you feel about something, what is
actually going on in your heart, not in your head.
• Basically, from your relationships to your mindset to your personality, to how you
want to show up in the world; all of these are run by your emotional health.
• And if you’re feeling thoughts of overwhelm, anxiety, stress, worthlessness, these
are all common negative emotions that can have a hugely detrimental effect on
your emotional health.
• But if you can rightly understand yourself, and find out from where these negative
emotions are coming, then you actually be setting yourself up for a lifetime of
consistent success.
Social health

• Social health is how you get along with other people, which involves
your ability to form satisfying interpersonal relationships with
others.
• It also relates to your ability to adapt comfortably to different social
situations and act appropriately in a variety of settings.
• If you want to really optimize your health, you need to go beyond
physical and mental strength and actually look at the strength of
your close social relationships.
• Research now shows that a lack of strong social ties puts you at a
greater health risk than obesity.
 Environmental Health
• is the field of science that studies how the environment influences
human health and disease.
• “Environment,” in this context, means things in the natural environment
like air, water, and soil, and also all the physical, chemical, biological,
and social features of our surroundings.
• According to the National Institute of Environmental Health Science, The
social environment encompasses lifestyle factors like diet and exercise,
socioeconomic status, and other societal influences that may affect
health.
 Spiritual health
• refers to possessing, meaning, and purpose in life; having a clear set of
beliefs and living in accordance with your morals, values, and ethics.
• Essentially it means understanding and having a clear definition of what
is right and wrong and living according to this understanding.
• The National Wellness Institute says spiritual wellness follows the
following tenets:
a. It is better to ponder the meaning of life for ourselves and to be tolerant
of the beliefs of others than to close our minds and become intolerant.
b. It is better to live each day in a way that is consistent with our values
and beliefs than to do otherwise and feel untrue to ourselves
OTHER KINDS
• child health,
• women health,
• health of aged people,
• public health
 Health care & Health Care System
Health Care:
means improvement of health through the prevention, diagnosis,
treatment, or cure of disease, illness, injury, and other physical and mental
impairments in people.
Health care is delivered by health professionals and allied health fields like:
Medicine, dentistry, pharmacy, midwifery, nursing, psychology, occupational
therapy, physical therapy, and other health professions all constitute health care.
Health Care System:
• According to the World Health Organisation a health system consists of all
organizations, people and actions whose primary intent is to promote, restore or
maintain health.
• This includes efforts to influence determinants of health as well as more direct
activities that improve health.
 Classification of health care systems
• primary and public healthcare :
• Primary health care is a whole-of-society approach to effectively organize and
strengthen national health systems to bring services for health and wellbeing closer
to communities. It has 3 components:
• integrated health services to meet people’s health needs throughout their lives
• addressing the broader determinants of health through multisectoral policy and
action
• empowering individuals, families and communities to take charge of their own
health.
• The private health care:
• is the individuals and organizations that are neither owned nor directly controlled by
governments and are involved in provision of health services.
• It can be classified into subcategories as for profit and not for profit, formal and in
formal, domestic and international
 Difference between
Private Health Care Public Health Care
The public health service is a chain of
Private health facilities are not owned or
health centres and hospitals run by the
controlled by the government.
government.
Better and faster service is available but Comparatively cheaper, delay in service
very expensive. due to over-crowding of people
They are well equipped with modern Lack of proper equipment and
machines and technologies technologies
Only rich people with good earnings can
Available at a cheaper cost for everyone
afford this service
 Types of health care
• Primary care: Primary care refers to the work of health professionals who act as a first point of
consultation for all patients within the health care system
• Secondary care: includes acute care: necessary treatment for a short period of time for a brief but
serious illness, injury, or other health condition. This care is often found in a hospital emergency
department. Secondary care also includes skilled attendance during childbirth, intensive care, and
medical imaging services
• Tertiary care: is specialized consultative health care, usually for inpatients and on referral from a
primary or secondary health professional, in a facility that has personnel and facilities for advanced
medical investigation and treatment, such as a tertiary referral hospital. Example. cancer
management, neurosurgery, cardiac surgery, plastic surgery etc.,
• Quaternary care: The term quaternary care is sometimes used as an extension of tertiary care in
reference to advanced levels of medicine which are highly specialized and not widely accessed.
Experimental medicine and some types of uncommon diagnostic or surgical procedures are
considered quaternary care.
• Home and community care: Many types of health care interventions are delivered outside of health
facilities. They include many interventions of public health interest, such as food safety surveillance,
distribution of condoms and needle-exchange programs for the prevention of transmissible diseases.
 Declaration of Alma-Ata
• Declaration of Alma-Ata was adopted at the International Conference
on Primary Health Care (PHC), Almaty (formerly Alma-Ata), Kazakh
Soviet Socialist Republic (present day Kazakhstan), Soviet Union 6–12
September 1978.
• It expressed the need for urgent action by all governments, all health
and development workers, and the world community to protect and
promote the health of all people.
• It was the first international declaration underlining the importance of
primary health care.
• The Alma-Ata Declaration of 1978 emerged as a major milestone of the
twentieth century in the field of public health, and it identified primary
health care as the key to the attainment of the goal of Health for All
 Features of the declaration
• The Conference strongly reaffirms that health, is a fundamental human
right and that the attainment of the highest possible level of health is a
most important world-wide social goal whose realization requires the
action of many other social and economic sectors in addition to the
health sector.
• The existing gross inequality in the health status of the people, is
politically, socially, and economically unacceptable and is, therefore, of
common concern to all countries.
• The people have a right and duty to participate individually and
collectively in the planning and implementation of their health care.
• Primary health care is essential health care based on practical,
scientifically sound, and socially acceptable methods and technology
made universally accessible to individuals and families in the community.
• It forms an integral part of the country's health system, of which it is the
central function and main focus, and of the overall social and economic
development of the community.
• It is the first level of contact of individuals, the family, and community with
the national health system bringing health care as close as possible to where
people live and work, and constitutes the first elements of a continuing
health care process.
• An acceptable level of health for all the people of the world by the year 2000
can be attained through a fuller and better use of the world's resources, a
considerable part of which is now spent on armaments and military conflicts.
• A genuine policy of independence, peace, détente, and disarmament could
and should release additional resources that could well be devoted to
peaceful aims and in particular to the acceleration of social and economic
development of which primary health care, as an essential part, should be
allotted its proper share.
 National healthcare laws & Regulation
of healthcare establishments
A. Health Facilities and Services
B. Disease Control and Medical Care
C. Human Resources
D. Ethics and Patients Rights
E. Pharmaceutical and Medical Devices
F. Radiation Protection
G. Hazardous Substances
H. Occupational Health and Accident Prevention
I. Health of the Elderly, Disabled, Rehabilitation and Mental Health
J. Families, Women and Children
K. Smoking, Alcoholism and Drug Abuse
L. Social Security and Health Insurance
M. Environmental Protection
N. Nutrition and Food Safety
O. Health Information and Statistics
P. Intellectual Property Rights
Q. Custody, Civil and Human Rights
R. Other Aspects that could not be grouped by any heading above
 National healthcare laws & Regulation of healthcare
establishments
A. Laws in relation to Health Facilities and Services:
• 1. Indian Red Cross Society Act, 1920
• 2. All India Institute of Medical Sciences Act, 1956
• 3. Post Graduate Institute of Medical Education and Research, Chandigarh, Act,1966
• 4. Bureau of Indian Standards Act and Rules, 1986, 1987
• 5. National Institute of Pharmaceutical Education and Research Act, 1998
• 6. Clinical Establishment Acts, 2010
B. Laws in relation to Disease Control and Medical Care:
• 1. Epidemic Diseases Act, 1897
• 2. Indian Aircraft Act and Rules, 1934, 1954
• 3. Indian Port Health Rules, 1955
• 4. Medical Termination of Pregnancy Act, 1971, 1975
• 5. Transplantation of Human Organs Act and Rules, 1994, 1995, 2002
• 6. Pre Conception, prenatal Diagnostic Techniques (Regulation and
Prevention of Misuse) Act, 2019
• C. Laws in relation to Ethics and Patients Rights
1. Consumer Protection Act and Rules, 1986, 1987, 2002
2. Ethical Guidelines for Biomedical Research on Human Subjects, 2000
3. Right to Information Act and Rules, 2005
4. Central Information Commission (Appeal Procedure) Rules, 2005
• E. Laws in relation to Pharmaceutical and Medical Devices:
• 1. Drugs and Cosmetics Act, 1940, 2005, 2006
• 2. Drugs Control Act, 1950
• 3. Drug and Magic Remedies (Objectionable Advertisement) Act, 1954
• 4. Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha and
Homeopathy (Ayush) Orders, 2005
• H. Laws in relation to Occupational Health and Accident Prevention
1. Workmen’s Compensation Act, 1923
2. Factories Act 1948, 1987
3. Mines Act, 1952, 1957
4. Motor Transport Workers Act, 1961
5. Personal Injuries (Emergency Provisions) Act, 1962, 1963
6. Beedi and Cigar Workers Act, 1966
7. Child Labour (Prohibition and Regulation) Act, 1986
8. Dock Workers (Safety, Health and Welfare) Rules, 1990
9. Public Liability Insurance Act and Rules, 1991
10. Building and Other Construction Workers Act, 1996
11. Fatal Accidents Act, 1855
12. Contract Labour (Regulation and Abolition) Central Rules, 1971
I. Laws in relation to Elderly, Disabled, Rehabilitation and Mental Health
1. Mental Health Act, 1987
2. Persons with Disabilities (Equal Opportunities, Protection of Rights and
Full Participation) Act, 1995, 1996
3. National Trust for Welfare of Persons with Autism, Cerebral Palsy,
Mental Retardation and Multiple Disabilities Act, 1999, 2000
K. Laws in relation to Smoking, Alcoholism and Drug Abuse
1. Cigarettes (Regulation of Production, Supply and Distribution) Act, 1975
• 2. Cigarettes and Other Tobacco Products (Prohibition of Advertisement
and Regulation of Trade and Commerce, Production, Supply and
Distribution) Act and Rules, 2003, 2004
• 3. Cigarettes and Other Tobacco Products (Prohibition of Sale on
Cigarettes and Other Tobacco Products around Educational Institutions)
Rules, 2004
N. Laws in relation to Nutrition and Food Safety
1. Prevention of Food Adulteration Act and Rules, 1954, 1955, 2001, 2002
2. Infant Milk Substitutes, Feeding Bottles and Infant Foods Act and Rules,
1992, 1993, 2003
3. Atomic Energy (Control of Irradiation of Food) Rules, 1996
4. Food Safety and Standards Act, 2006
O. Laws in relation to Health Information and Statistics
1. Births, Deaths and Marriages Registration Act, 1886
2. Registration of Births and Deaths Act, 1969
3. Collection of Statistics Act and Rules, 1953, 1959
4. Census Act, 1948, 1993