Dr. Vijay B. Lambole
Associate Professor,
Dept. of Pharmacology,
SNLPCP, Umrakh.

CONCEPT OF HEALTH
Health is evolved over the centuries as a concept
from individual concern to world wide social goal
and encompasses the whole quality of life.
Changing concept of health till now are:
Biomedical concept
Ecological concept
Psychosocial concept
Holistic concept

2

BIOMEDICAL CONCEPT
Traditionally, health has been viewed as an
“absence of disease”, and if one was freefrom
disease, then the person was considered
healthy.

This concept has the basis in the “germ theory
of disease”.
The medical profession viewed the human body
as a machine, disease as a consequence of the
breakdown of the machine and one of the
doctor’s task as repair of the machine.
3

ECOLOGICAL CONCEPT
Form ecological point of view; health is viewed
as a dynamic equilibrium between human being
and environment, and disease a maladjustment
of the human organism to environment.
According to Dubos “Health implies the relative
absence of pain and discomfort and a continuous
adaptation and adjustment to the environment
to ensure optimal function.”
The ecological concept raises two issues, viz.
imperfect man and imperfect environment.
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PSYCHOSOCIAL CONCEPT
According to psychosocial concept “health isnot
only biomedical phenomenon, but is influenced
by social, psychological, cultural, economic and
political factors of the peopleconcerned.”

5

HOLISTIC CONCEPT
This concept is the synthesis of all the above
concepts.
It recognizes the strength of social, economic,
political and environmental influences on
health.
It described health as a unified or multi
dimensional process involving the wellbeing of
whole person in context of his environment .
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DEFINITIONS OF HEALTH
“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 are duly and
efficiently discharged .” – Oxford English
Dictionary

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DEFINITIONS OF HEALTH
“Health is a state of complete physical, mental,
social well-being and not merely the absence
of disease or infirmity.”
– World Health Organization
In recent years, this definition has been
amplified to include “the ability to lead socially
and economically productive life”.

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DEFINITIONS OF HEALTH
The WHO definition of health has been
criticized as being too broad. Some argue that
can not be defined as a “state” at all, but must
be seen as a process of continuous adjustment
to the changing demands of living and of the
changing meaning we give to life. It is dynamic
concept. It helps people live well, work well
and enjoy themselves.
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DEFINITIONS OF HEALTH
It refers to a situation that may exist in some
individuals but not in everyone all the time, it
is not usually observed in a groups of human
beings and in communities. Some consider it
irrelevant to everyday demands, as nobody
qualifies as healthy, i.e., perfect
biological, psychological and social
functioning. That is, if we accept the WHO
definition, we are all sick.
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OPERATIONAL DEFINITION
The WHO definition of health is not an
“operational” definition, i.e. it does not
lend itself to direct measurement,
studies of epidemiology of health have
been hampered because of our
inability to measure health and
wellbeing directly.

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OPERATIONAL DEFINITION
Broad Sense: Health can be seen as “A condition
or quality of human organism expressing the
adequate functioning of the organism in given
condition, genetic or environmental.”
Narrow sense: There is no obvious evidence of
disease, and that a person is functioning
normally. Several organs of the body are
functioning adequately in themselves and in
relation to one another, which implies a kind of
equilibrium or homeostasis.
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NEW PHILOSOPHY OFHEALTH
Health is a fundamental human right.
Health is essence of productive life.
Health is inter- sectoral.
Health is integral part of development.
Health is central to quality of life.
Health involves individuals, state and
international responsibility.
Health and its maintenance is major social
investment.
Health is world-wide social goal.
13

DIMENSIONS OF HEALTH
Health is multidimensional.
World Health Organization explained health in
three dimensional perspectives:
physical, mental, social and spiritual.
Besides these many more may be cited, e.g.
emotional, vocational, political, philosophical, c
ultural, socioeconomic, environmental, educati
onal, nutritional, curative and preventive..

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PHYSICAL DIMENSION
Physical dimension views heath form
physiological perspective.
It conceptualizes health that as biologically a
state in which each and every organ even a cell
is functioning at their optimum capacity and in
perfect harmony with the rest of body.
Physical health can be assessed at community
level by the measurement of morbidity and
mortality rates.
15

MENTAL DIMENSION
Ability to think clearly and coherently. This
deals with sound socialization in communities.
Mental health is a state of balance between
the individual and the surrounding world, a
state of harmony between oneself and others,
coexistence between the relatives of the self
and that of other people and that of the
environment.
Mental health is not merely an absence of
mental illness.
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Features of mentally healthy person
Free from internal conflicts.
Well – adjusted in the external environment.
Searches for one’s identity.
Strong sense of self-esteem.
Knows himself: his mind, problems and goal.
Have good self-controls-balances.
Faces problems and tries to solve them
intellectually.
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SOCIAL DIMENSION
It refers the ability to make and maintain
relationships with other people or
communities.
It states that harmony and integration within
and between each individuals and other
members of the society.
Social dimension of health includes the level
of social skills one possesses, social functioning
and the ability to see oneself as a member of a
larger society.
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SPIRITUAL DIMENSION
Spiritual health is connected with religious beliefs
and practices. It also deals with personal
creeds, principles of behavior and ways of
achieving peace of mind and being at peace with
oneself.
It is intangible “something” that transcends
physiology and psychology.
It includes integrity, principle and ethics, the
purpose of life, commitment to some higher
being, belief in the concepts that are not subject
to “state of art” explanation.

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CONCEPT OF DISEASE
Webster defines disease as “a condition in
which body health is impaired, a departure from
a state of health, an alteration of the human
body interrupting the performance of vital
functions”.
The oxford English Dictionary defines disease as
“ a condition of the body or some part or organ
of the body in which its functions are disturbed
or deranged”.
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CONCEPT OF DISEASE
Ecological point of view disease is defined as
“a maladjustment of the human organism to
the environment.”
The simplest definition is that disease is just
the opposite of health: i.e. any deviation from
normal functioning or state of complete
physical or mental well-being.
21

Distinction between Disease,
Illness and Sickness
The term disease literally means “without ease”
(uneasiness), when something is wrong with
bodily function.
Illness refers to the presence of a specific
disease, and also to the individual’s perceptions
and behavior in response to the disease, as well
as the impact of that disease on the
psychosocial environment.
Sickness refers to a state of social dysfunction.
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Distinction between Disease,
Illness and Sickness
Disease is a physiological/psychological
dysfunction.
Illness is a subjective state of the person who
feels aware of not being well.
Sickness is a state of social dysfunction i.e. a
role that the individual assumes when ill
(sickness role).
23

CONCEPT OF WELLBEING
Wellbeing of an individual or group of
individuals have several components and
has been expressed in various ways, such as
‘standard of living’ or ‘level of living’ and
‘quality of live’.

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STANDARD OF LIVING
Income and occupation, standards of
housing, sanitation and nutrition, the
level of provision of health, educational,
recreational and other services all be
used individually as measures of
socioeconomic status, and collectively as
an index of the standard of living.

25

LEVEL OF LIVING
It consists of nine components : health, food
consumption, education, occupation and
working conditions, housing, social
security, clothing, recreation and leisure
human rights.
These objective characteristics are believed to
influence human wellbeing. It is considered
that health is the most important component
of the level of living because its impairment
always means impairment of the level of living.
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QUALITY OF LIFE
The condition of life resulting from the
combination of the effects of the
complete range of factors such as those
determining health, happiness (including
comfort in the physical environment and
a satisfying occupation), education, social
and intellectual attainments, freedom of
action, justice and freedom of expression.
– WHO (1976)

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QUALITY OF LIFE
A composite measure of physical, mental and
social wellbeing as perceived by each
individual or by group of individuals- that is to
say, happiness, satisfaction and gratification as
it is expressed in such life concerns as
health, marriage, family work, financial
situation, educational opportunities, selfesteem, creativity, belongingness, and trust in
others.
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WELLBEING
Wellbeing of an individual or group of
individuals have objective (standard of living or
level of living) and subjective (quality of life)
components.
Thus, a distinction is drawn between the
concept of ‘level of living’ consisting of
objective criteria and of ‘quality of life’
comprising the individual’s own subjective
evaluation of these.
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TWO ASPECTS OF HEALTH
• Subjective: It is formed by sensations and
feelings of a person suffering from disease.
• Objective: Its basis is formed by objective
parameters obtained by measurement of
structures and functions of a person during
disease.
The quality of life can be evaluated by
assessing the persons subjective feeling of
happiness or unhappiness about the various
life concerns.
30

DETERMINANTS OF HEALTH
Health is determined by multiple factors.
The health of an individual and community is
influenced by: individual (internal) and external
factors.
The individual factors include by his own genetic
factors and the external factors include
environmental factors.
These factors interact and these interactions may be
health promoting or deleterious.
Thus, the health of individuals and whole
communities may be considered to be the result of
many interactions.
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DETERMINANTS OF HEALTH

Communities
Families

Societies

Individuals

32

BIOLOGICAL DETERMINANTS
The health of an individual partly depends
on the genetic constitutions.
A number of diseases e.g. chromosomal
anomalies, inborn error of metabolism,
mental retardation and some types of
diabetes are some extent due to genetic
origin.

33

ENVIRONMENTAL FACTORS
Biological: disease producing agent (e.g.
bacteria, virus, fungi), intermediate host (e.g.
mosquito, sand fly), vector (e.g. house
fly), reservoir (e.g. pig in JE).
Physical:
Air, water, light, noise, soil, climate, altitude, rad
iation housing, waste etc.
Psychosocial: psychological make up of
individual and structure and functioning of
society. E.g.
habit, beliefs, culture, custom, religion etc.
34

LIFE STYLE
Behavioral pattern and life long habits e.g.
smoking and alcohol consumption, food
habit, personal hygiene, rest and physical
exercise, bowel and sleeping patterns, sexual
behavior.

35

SOCIO-ECONOMIC CONDITIONS
It consist of education, occupation and income.
The world map of illiteracy closely coincides with
the maps of poverty, malnutrition, ill health, high
infant and child mortality rates.
The very state of being employed in productive work
promotes health, because the unemployed usually
show a higher incidence of ill-health and deaths.
There can be no doubt that economic progress has
positive impact factor in reducing morbidity,
increasing life expectancy and improving the quality
of life.
36

Availability of health and family
welfare Service
Health and family welfare services cover a wide
spectrum of personal and community services for
treatment of diseases, prevention of disease and
promotion of health.
The purpose of health services is to improve the
health status of population.
For example, immunization of children can influence
the incidence/prevalence of particular disease.
Provision of safe water can prevent mortality and
morbidity from water-borne diseases.
37

Aging of the population
By the year 2020, the world will have more
than one billion people aged sixty or over and
more than two-thirds of them living in
developing countries.
A major concern of rapid population aging is
the increased prevalence of chronic diseases
and disabilities both being condition that tend
to accompany the aging process and deserve
special attention.
38

OTHER DETERMINANTS OF HEALTH
Except above discussed determinants, there
are many more determinates of health and
disease of an individual and community. These
include:
Science and technology
Information and communication
Gender
Equity and social justice
Human rights etc.
39

RESPONSIBILITY FOR HEALTH
Individual responsibility: self care for
maintaining their own health.
Community responsibility: health care for the
people to the health care by the people.
State responsibility: constitutional rights.
International responsibility: Health for All
through PHC.

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INDICATORS OF HEALTH
A variable which helps to measure changes
, directly or indirectly (WHO,1981).
A statistic of direct normative interest which
facilitates concise , comprehensive, and balanced
judgments about conditions of major aspects of
the society (H.E.W./USA,1969).
The health indicators are defined as those
variables which measures the health status of an
individual and community.
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National Socio-Cultural, Economic,
Demographic and Environment Indicators
Health
Supply

(2)
Inputs
Indicators

Resources

Health
Policy
Development

(3)
Process
Indicators

Activities &
Management
Quality

Health Demand

(5)
Outcomes
Indicators

(4)
Outputs
Indicators

Products
& Services

(a) Effects

(b) Impact

Indicators

Indicators

Change in
behaviour

Change in
health status

Health system
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INDICATORS OF HEALTH
Mortality Indicators: Crude Death rate, Life
Expectancy, Infant mortality rate, Child
mortality rate, Under five mortality rate,
Maternal mortality ratio, Disease specific
mortality, proportional mortality rate etc.
Morbidity Indicators: Incidence and prevalence
rate, disease notification rate, OPD attendance
rate, Admission, readmission and discharge
rate, duration of stay in hospital and spells of
sickness or absence from work or school.
43

INDICATORS OF HEALTH
Disability Indicators: Sullivan’s index, HALE (Health
Adjusted Life Expectancy), DALY (Disability Adjusted
Life Year).
Sullivan’s index is a expectation of life free from
disability.
HALE is the equivalent number of years in full health
that a newborn can expected to live based on the
current rates of ill health and mortality.
DALY expresses the years of life lost to premature
death and years lived with disability adjusted for the
severity of disability.
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INDICATORS OF HEALTH
Nutritional Status Indicators: Anthropometric
measurement of preschool children, Prevalence of
low birth weight etc.
Health Care Delivery Indicators: Doctorpopulation ratio, Bed-nurse ratio, Population-bed
ration, Population per health facility etc.
Utilization Rates: immunization coverage, ANC
coverage, % of Hospital Delivery, Contraceptives
prevalence rate, Bed occupancy rate, average
length of stay in hospital and bed turnover rate etc.
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INDICATORS OF HEALTH
Indicators of social and mental health: Rates of
suicides, homicides, violence, crimes, Road
Traffic Accidents (RTAs), drug abuse, smoking
and alcohol consumption etc.
Environmental indicators: proportion of
population having access to safe drinking water
and improved sanitation facility, level of air
pollution, water pollution, noise pollution etc.
Socio Economic Indicators: rate of population
increase, Per capita Gross National Product (GNP),
Dependency ratio, Level of unemployment,
literacy rate, family size etc.
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INDICATORS OF HEALTH
Health policy Indicators: proportion of GNP
spent on health services, proportion of GNP
spent on health related activities including safe
water supply, sanitation, housing, nutrition
etc. and proportion of total health resources
devoted to primary health care.
Indicators of Quality of Life: Physical Quality of
Life Index (PQLI), Infant Mortality Rate (IMR),
Literacy rate, Life Expectancy at age one etc.
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THEORIES OF DISEASES CAUSATION
1. Supernatural theory of disease

Disease is due to super power e.g. gods, evil
spirits.
2. Tridosha theory of disease
The doshas or humors are: Vaata (Wind),
Pitta (gall), and Kapha (mucus).
Perfect balance of tridosha is healthy
Disturbance in balance is disease
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THEORY OF DISEASES CAUSATION
3. Theory of Contagion

Spreading of disease by being close to or
touching other people.
4. Miasmatic theory of disease causation
Disease is due to noxious air and vapors
These concepts were prevailing before
Louis Pasteur (1822-1895).

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THEORY OF DISEASES CAUSATION
5. Germ Theory of disease

In 1860, Louis Pasteur demonstrated the
presence of bacteria in air.
This theory emphasized that the sole cause of
disease is microbes.
The theory generally referred to as one-toone relationship between disease agent and
disease.
Disease agent
Man
Disease

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THEORY OF DISEASES CAUSATION
6. Epidemiological Triad concept

The germ theory of disease has many
limitations
For example it is well – known that not all
exposed to tuberculosis bacilli develops
tuberculosis, the same condition in an
undernourished person may result in
clinically manifest.
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Epidemiological Triad
Environment

Agent

Host
52

MULTI-FACTORIAL ETIOLOGY
The germ theory of disease or single cause of
disease is always not true.
The germ theory of disease was overshadowed
by multi-factorial cause theory in 19th century.
As a result of advancement in public
health, communicable diseases began to
decline and are replaced by new type of
diseases so called modern disease of
civilization.
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MULTI-FACTORIAL ETIOLOGY
Example: Lung cancer, CHD, Mental illness etc.
The disease could not be explained on the
basis of germ theory of disease and can not be
controlled or prevented on that basis. The
realization began that multiple factors are
responsible for disease causation where there
is no clear single agent.
The purpose of knowing multiple factors of
disease is to quantify and arrange them in
priority sequence for modification to prevent
particular disease.
54

WEB OF CAUSATION
This model of disease causation was suggested
by Mac Mohan and Pugh.
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.
The web of causation considers all the
predisposing factors of any type and their
complex interaction with each other.
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WEB OF CAUSATION
The basic tenets of epidemiology are to study
the clusters of causes and combinations of
efforts and how they relate to each other.
The web of causation does not imply that the
disease can not be controlled unless all the
multiple causes or chain of causation or at
least a number of them are appropriately
controlled.
Sometimes, removal of one link may be
sufficient to control disease.
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WEB OF DISEASE CAUSATION
C h a n g e s in life s t y l e

Stress
S mo k i n g
E mo t i o n a l s t r ess

A g in g
HTN

Obesity
H y p e r l ip id emi a
C o r o n a r y O c c l us io n
Coronary
At h e ro s c le ro s is

M y o c a r di al i s c h emi a

C h a n g e s in t h e w a l ls
o f arteries

M y o c a r di al Is c h e mi a

F i g : W e b of c a u s a t io n of M I

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CONCEPT OF CONTROL
DISEASE CONTROL: The term disease control
refers ongoing operation aimed at reducing:
The incidence of disease.
The duration of disease and the consequently
the risk of transmission.
The effect of infection including physical and
psychological complication.
The financial burden to the community.
58

CONCEPT OF CONTROL
In disease control, the disease agent is
permitted to persist in the community at a
level where it ceases to be a public health
problem according to the tolerance of local
community. For example Malaria control
programme. Disease control activities focus on
primary prevention

59

CONCEPT OF CONTROL
ELIMINATION: Reduction of case transmission to
a predetermined very low level or interruption
in transmission. E.g. measles, polio, leprosy from
the large geographic region or area.

ERADICATION: Termination of all transmission of
infection by extermination of the infectious
agent through surveillance and containment.
“All or none phenomenon”. E.g. Small pox
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CONCEPT OF CONTROL
MONITORING: Defined as “the performance
and analysis of routine measurement aimed at
detecting changes in the environment or health
status of population.” e.g. growth monitoring of
child, Monitoring of air pollution, monitoring of
water quality etc.
SURVEILLANCE: Defined as “the continuous
scrutiny of the factors that determine the
occurrence and distribution of disease and
other conditions of ill health.” E.g. Poliomyelitis
surveillance programme of WHO.
61

CONCEPT OF PREVENTION
Primordial prevention
Primary prevention
Secondary prevention
Tertiary Prevention

62

LEVELS OF PREVENTION
Primordial Prevention :
Prevention from Risk Factors.
Prevention of emergence or development of
Risk Factors.
Discouraging harmful life styles.
Encouraging or promoting healthy eating
habits.

63

LEVELS OF PREVENTION
Primary Prevention:
Pre-pathogenesis Phase of a disease.
Action taken prior to the onset of the disease:
Immunization & Chemo-prophylaxis

64

LEVELS OF PREVENTION
Secondary Prevention:
Halt the progress of a disease at its incipient
phase.
Early diagnosis & Adequate medical
treatment.
Tertiary Prevention:
Intervention in the late Pathogenesis Phase.
Reduce impairments, minimize disabilities &
suffering.
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MODES OF INTERVENTION
Intervention is any attempt to intervene or
interrupt the usual sequence in the development
of disease. Five modes of intervention
corresponding to the natural history of any disease
are:

Health Promotion
Specific Protection
Early Diagnosis and Adquate Treatment
Disability Limitation
Rehabilitation
66

HEALTH PROMOTION
It is the process of enabling people to increase
control over diseases, and to improve their
health. It is not directed against any particular
disease but is intended to strengthen the host
through a variety of approaches(interventions):
Health Education
Environmental Modifications
Nutritional Interventions
Lifestyle and Behavioral Change
67

SPECIFIC PROTECTION
Some of the currently available interventions
aimed at specific protection are:
Immunization
Use of specific Nutrients
Chemoprophylaxis
Protection against Occupational Hazards
Avoidance of Allergens
Control of specific hazards in general
environment
Control of Consumer Product Quality & Safety
68

EARLY DIAGNOSIS & TREATMENT
Though not as effective and economical as ‘Primary
Prevention’, early detection and treatment are the
main interventions of disease control, besides being
critically important in reducing the high morbidity
and mortality in certain diseases like hypertension,
cancer cervix, and breast cancer.
The earlier the disease is diagnosed and treated the
better it is from the point of view of prognosis and
preventing the occurrence of further cases
(secondary cases) or any long term disability.
69

DISABILITY LIMITATIONS
The Objective is to prevent or halt the transition
of the disease process from impairment to
handicap.
Sequence of events leading to disability &
handicap:

Disease → Impairment → Disability→ Handicap

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DISABILITY LIMITATIONS
Impairment: Loss or abnormality of
psychological, physiological/anatomical
structure or function.
Disability: Any restriction or lack of ability to
perform an activity in a manner considered
normal for one’s age, sex, etc.
Handicap: Any disadvantage that prevents one
from fulfilling his role considered normal.

71

REHABILITATION
Rehabilitation has been defined as the ‘combined
and coordinated use of medical, social,
educational and vocational measures for training
and retraining the individual to the highest
possible level of functional ability”
Areas of concern in rehabilitation:
Medical Rehabilitation
Vocational Rehabilitation
Social Rehabilitation
Psychological Rehabilitation
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Thank You…
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