MDS (PUBLIC HEALTH DENTISTRY)

1. CONCEPTS OF HEALTH
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CONTENTS
• CHANGING CONCEPTS OF HEALTH
• DEFINITION OF HEALTH
• NEW PHILOSOPHY OF HEALTH
• DIMENSIONS OF HEALTH
• POSITIVE HEALTH
• CONCEPTS OF WELL BEING
• SPECTRUM OF HEALTH
• DETERMINANTS OF HEALTH
• INDICATORS OF HEALTH
• DEVELOPED & DEVELOPING REGION
• HEALTH SERVICES PHILOSOPHIES
• CONCLUSION

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4. CHANGING
CONCEPTS
OF
HEALTH
Biomedical Concept
Ecological Concept
Psychosocial Concept
Holistic Concept
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5. • Health -“absence of disease”
• Basis of “germ theory of disease”
• Human body - machine
Disease - consequence of the break down of the machine
Doctor’s task - repair of machine.
• Criticism- it has minimized the role of environmental, social, psychological & cultural
determinants of health. Eg: malnutrition, environmental pollution, mental illness.
Biomedical Concept
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6. • Health - is a dynamic equilibrium between man & his environment,
• Disease - maladjustment of the human organisms to the environment.
• “Health implies the relative absence of pain and discomfort and a continuous adaptation and
adjustment to the environment to ensure optimal function”. -Dubos
Ecological Concept
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Psychosocial Concept
Health is not only a biomedical phenomenon, but one which is in influenced by social, psychological,
cultural, economic and political factors of the people concerned

7. Holistic Concept
ECONOMIC
POLITICAL
ENVIRON-
MENTAL
PHYSICAL
SOCIAL
•Biomedical + Ecological + Psychosocial concept.
•It has been defined as unified or multidimensional process
involving the well being of the whole person in the context of
his environment.
•It implied that, all sectors of society have an effect on health
•Emphasis is on protection and promotion of health
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8. DEFINITION
OF
HEALTH
• WHO Definition (1948)-
“Health is a state of complete physical, mental and
social wellbeing and not merely an absence of disease or
infirmity.”
• Now added “the ability to lead a socially and
economically productive life.”
• The concept of health as defined by WHO is broad and
positive in its implications; it sets out the standard of
“positive” health.
• 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”.
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9. NEW
PHILOSOPHY
OF HEALTH
Health is
• a fundamental human right
• an essence of productive life
• inter sectorial
• an integral part of development
• central to the concept of quality of life
• involves individuals, state and international responsibility
• its maintenance is a major social investment and
• a worldwide social goal
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10. DIMENSIONS
OF HEALTH
Physical Dimension
Mental Dimension
Social Dimension
Spiritual Dimension
Emotional Dimension
Vocational Dimension
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11. • Perfect functioning of the body
• Evaluation of Physical Health:
• Self assessment of overall health
• Inquiry into symptoms of ill health and risk factors
• Inquiry into medications
• Inquiry into level of activity
• Inquiry into use of medical services
• Standardized questionnaires for cardiovascular diseases
• Standardized questionnaires for respiratory diseases
• Clinical examination
• Nutrition and dietary assessment and
• Biochemical and laboratory investigation
• Community Assessment: At the Community Level, state of health may be assessed by
indicators such as: Death Rate; Infant Mortality Rate and Expectation of Life
Physical Dimension
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12. • Mental Health has been defined as “ a state of balance between the individual and the
surrounding world, a state of harmony between oneself and others, a coexistence between
the realities of the self and that of other people and that of the environment”.
• Psychological factors can induce all kinds of illness not simply mental ones which may include:
Essential Hypertension; Peptic Ulcer and Bronchial Asthma
Attributes of a Mentally Healthy Person include:
1.Free from internal conflicts, is not at war with him or herself
2.Well adjusted: Is able to get along well with others.
3.Accepts criticism and is not easily upset
4.Searches for Identity
5.Has a strong sense of self esteem
6.Knows oneself, ones needs, problems and goals (this is known as self
actualization)
7.Has good self control, balances rationality and emotionality
8.Faces problems and tries to solve them intelligently, i.e., coping with stress and
anxiety
9.One of the keys to good health is Positive Mental Health.
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Mental Dimension

13. • Social wellbeing implies “ Quality and quantity of an individuals interpersonal
ties and the extent of involvement with the community”.
• It takes into account that every individual is a part of a family and a wider community and
focuses on social and economic conditions and well being of the “Whole Person "in the
social network.
• It is rooted in “Positive material environment” (focusing on financial and residential matters)
and “Positive human environment” concerned with social network of the individual.
Social Dimension
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14. Spiritual health in this context, refers to that part of the individual which reaches out
and strives for meaning and purpose in life.This dimension seems to defy concrete
definition.
It includes:
1.Integrity
2.Principles of Ethics
3.Purpose in life
4.Commitment to some higher being
5.Belief in concepts that are not subject to “state of the art” explanation
• Initially mental and emotional dimensions were seen one in the same but as more
research becomes available a definite difference is emerging. Mental health can be
seen as “Knowing” or “Cognition”, while Emotional health refers to “Feeling”.
Emotional
Dimension
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Spiritual
Dimension

15. • Importance of this dimension is exposed when individuals suddenly loose their jobs or
are faced with mandatory retirement.
• For some this dimension may merely be a source of income but for others it may be
source of self worth and life success.
• Goal achievement and self realization in work are source of satisfaction and enhanced
self esteem
Other Dimensions include Philosophical, Cultural, Socioeconomic, environmental,
educational, nutritional, curative and preventive.
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Vocational Dimension

16. POSITIVE
HEALTH
• The state of positive health implies the notion of
“perfect functioning of the body and mind”.
• It includes all the three aspects which are in a perfect
state and include
1. Biological
2. Psychological
3. Social
• Health is a Relative Concept –
Health is not an ideal state but normal state, based on
statistics.
For example Newborn Baby in Pakistan weighs 2.8Kg on an
average compared to 3.5Kg in developed countries and yet
compares favorably in health
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17. CONCEPTS OF WELL BEING
WHO definition of health introduces the concept of “well being”.
Subjective
components
Objective
components
Standard of Living: Spiritual , educational, recreational and
other services may be used individually as measures of
socioeconomic status and collectively as an index of the standard
of living. It depends on the per capita GNP.
Level of Living: It consists of nine components: health, food
consumption, education, occupation and working conditions,
housing, social security, clothing, recreation and leisure and
human rights. These are believed to influence human well being.
Quality of Life is defined by WHO as “ 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.”

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Physical Quality of Life Index (PQLI)
• It consolidates
 Infant mortality,
 Life expectancy at age of 1 year and
 Literacy.
• For each component the performance of individual country is placed on a scale of 0 to 100.
• The composite index is calculated by averaging the three indicators giving equal weight to each of
them.
• The result is placed on the 0 to 100 scale.
• The PQLI does not consider the GNP.

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DIMENSION OBSERVED MAX MINIMUM ACTUAL VALUE (INDIA)-2015
Life expectancy 83.2 20.0 68.3
Mean years of schooling 13.2 0 6.3
Expected years of schooling 20.6 0 11.7
Combined education index 0.951 0 0.547
Per capita income (PPP $) 108,211 163 5,663
HDI=0.611
Dimension index = (actual value – minimum value )
( maximum value – minimum value )
• HDI = geometric mean of all the 3 dimension indices
• HDI values ranges between 0 and 1
• HDI value of India is 0.61
• Maximum value
- highest observed value during 1980 to 2011
• Minimum value
- 20 years of life expectancy
- 0 years for both education variables
- US $163 for per capita GNI
HDI RANKING-2015 188 COUNTRIES
VERY HIGH 51 (NORWAY,AUS,SWITZERLAND)
HIGH 54
MEDIUM 42 (INDIA-Rank-131)
LOW 41 (NIGER, CENTRAL AFRICAN REPUBLIC)

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SPECTRUM OF HEALTH
POSITIVE HEALTH
BETTER HEALTH
FREEDOM FROM SICKNESS
UNRECOGNISED SICKNESS
MILD SICKNESS
SEVERE SICKNESS
DEATH

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DETERMINANTS OF HEALTH
•Biological determinants:
• Physical, mental, genetic makeup
Behavioural & Socio-cultural conditions:
Health requires promotion of healthy life style.
Environmental:
Internal: tissues, organs, systems.
External: everything to which humans are exposed to after
conception.
Social–economic conditions:
Economic status, education, occupation, political system
Health services:
Improve the health status of population.
Aging of population:
Increases chronic diseases & disability
Gender:
Consequences of violence, reproductive health , ageing, nutrition

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Individual responsibility
‘Self-care’- Health related activities undertaken by
the persons themselves
-Promoting their own health
-Preventing their own disease
-Limiting their own illness
-Restoring their own health
Community responsibility
• Active involvement of families and communities
in health matters
• Three ways
1. Provide manpower, logistics, funds
2. Take part in planning
3. Utilizing the services
• Emphasis has shifted from health care for the
people to health care by the people.
RESPONSIBILITY FOR HEALTH
• Diet
• Sleep
• Exercise
• Period checkups
• Vaccination
• Early care seeking
Health must begin with the individual.

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Health care for the people, to the healthcare by the people.
State responsibility
• Constitution of India says that maintaining the health
of the people is the responsibility of the state
• Alma Ata declaration gave rise to the Health of All for
state responsibility
International responsibility
• Cooperation between different countries
• Experts, drugs, control of communicable
diseases
• Eg., Smallpox, HIV/AIDS, Tobacco

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INDICATORS OF HEALTH
• Indicator- variable which help to measure changes (WHO)
• To measure the health status of a community
• To compare the health status of country with that of another.
Health care Indicators Health care index (indices)
In relation to health trend Amalgamation of health indicators
vs

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CHARACTERISTICS OF INDICATORS
Ideal Indicators should be
• Valid -Measure what they are actually supposed to measure
• Reliable -Answers should be the same if measured by different individuals in same circumstances
• Sensitive -Sensitive to the changes in the situation concerned
• Specific -Reflect changes only in the situation concerned
• Feasible -Have the ability to obtain data needed
• Relevant -Contribute to the understanding of the phenomenon of interest
USES OF INDICATORS OF HEALTH
• Measurement of the health of the community.
• Description of the health of the community.
• Comparison of the health of different communities.
• Identification of health needs and prioritizing them.
• Evaluation of health services.
• Planning and allocation of health resources.
• Measurement of health successes

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Classification of indicators:
1. Mortality
2. Morbidity
3. Disability
4. Nutritional status
5. Health care delivery
6. Utilization rates
7. Indicators of Social and Mental health
8. Environmental
9. Socio-economic
10. Health Policy
11. Indicators of Quality of life
12. Other (Basic needs, Health for All, Millennium Development Goals and now Sustainable development
goals)

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MORTALITY INDICATORS
1. Crude death rate. The number of deaths per 1000 population per year in a given community.
2. Expectation of life. The average number of years that will be lived by those born alive into a
population if the current age specific mortality rates persist.
3. Infant mortality rate- Is the ratio of deaths under 1 year of age in a given year to the total number of
live births in the same year; usually expressed as a rate per 1000 live births
4. Child mortality rate.
5. Under – 5 proportionate mortality rate
6. Maternal Mortality rate
7. Disease specific mortality rate
8. Proportional mortality rate
9. Case fertility rate
10. Years of potential life lost (YPLL)
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MORBIDITY INDICATORS
These reveal the burden of the disease in the community. Thus these are used to supplement the mortality
rates. The following morbidity rates are used for assessing ill-health in the community
• 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.
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DISABILITY RATES
Disability Rates
Event Type
Indicators
No. of days of
restricted activity
Bed disability rates
Work-loss days
within a specified
period
Person Type
Indicators
Limitation of
mobility
e.g. confined to bed,
confined to house
Limitation of activity
e.g. limitation to
perform the basic
activities of daily
living (ADL)
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HALE - HEALTH ADJUSTED LIFE EXPECTANCY
• Based on the framework of WHO’s ICIDH (International Classification of Impairments, Disabilities, and Handicaps )
• Based on life expectancy at birth but includes an adjustment for time spent in poor health.
• It is the equivalent number of years in full health that a newborn can expect to live based on current rates of ill-health and
mortality.
QALY - QUALITY ADJUSTED LIFE YEAR
• It is the most commonly used to measure the cost effectiveness of health interventions .
• It estimates the number of years of life added by a successful treatment or adjustment for quality of life.
• Each year in perfect health is assigned a value of 1.0 down to a value of 0.0 for death.
1 year of life x 1 utility value= 1 QALY
DISABILITY-FREE LIFE EXPECTANCY
• Active life expectancy
• Average number of years an individual is expected to live free of disability if current pattern of mortality and disability
continue to apply.

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DALYs: DISABILITY ADJUSTED LIFE YEARS.
• It is defined as the number of years of healthy life lost due to all causes whether from premature mortality or
disability.
• It is the simplest and the most commonly used measure to find the burden of illness and the effectiveness of the
interventions
YEAR OF LIFE LOST: no of death at each age multiplied by the expected remaining years of life according to a global
standard life expectancy.
YEARS LOST TO DISABILITY: no of incident cases due to injury and illness is multiplied by the average duration of disease
and a weighing factor reflecting the severity of disease on a scale from 0 (perfect health) and 1(dead).
DALY = years of life lost + years lost to disability
Uses of DALYs
• To assist in selecting health service priorities
• To identify the disadvantaged groups
• Targeting health interventions
• Measuring the results of health interventions
• Providing comparable measures for planning
& evaluating programs
• To compare the health status of different countries
One DALY = One year of healthy life lost

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NUTRITIONAL STATUS INDICATORS:
Anthropometric measurement of preschool children, Prevalence of low birth weight etc.
HEALTH CARE DELIVERY INDICATORS
The frequently used indicators of health care delivery are:
1. Doctor – Population ratio
2. Doctor – nurse ratio
3. Population – bed ratio
4. Population per health / Sub-centre
5. Population per traditional birth attendant
UTILISATION RATES
- Proportion of infants who are fully immunized against 9 EPI diseases.
- Proportion of pregnant women's who receive ANC (antenatal care) or have their deliveries supervised by
trained birth attendant.
- Percentage of population using the various methods of family planning .
- Bed occupancy rate .
- Average length of the stay.
- Bed turn over ratio.
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5
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INDICATORS OF SOCIAL & MENTAL HEALTH
• Suicide , homicide, violence ,alcohol ,drug abuse, smoking
• Family violence ,battered baby or battered wife syndrome
ENVIRONMENTAL INDICATORS
Air pollution & Water pollution.
Radiation hazards .
Solid wastes .
Exposure to toxic
Access to safe water and sanitation.
SOCIO – ECONOMIC INDICATORS
Rate of population increase .
Per capita GNP.
Level of unemployment.
Dependency ratio.
Literacy rates.
Family size.
Housing .
Per capita calorie availability
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HEALTH POLICY INDICATORS
- Proportion of GNP spent on health services.
- Proportion of GNP spent on health related services .
- Proportion of total health resources devoted to PHC.
INDICATORS OF QUALITY OF LIFE
- It is difficult to define and even more difficult to measure .
- It is subjective component of well being.
- Quality of life eg PQLI, HDI etc
OTHER INDICATORS
- Social indicators .
- Basic needs indicator.
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11
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SPECIAL INDICATOR SERIES
HEALTH FOR ALL INDICATORS
For monitoring the progress towards the goal of Health For All by 2000 , the WHO has listed the following four categories of
indicators.
1. Health policy indicators
- Political commitment to
Health for all
- Resource allocation
-Degree of equity of
distribution of health
services
- Community involvement
- Organizational framework
and managerial process
2. Social and economic
indicators related to health
- Rate of population growth
- GNP or GDP
- Income distribution
- Work conditions
- Adult literacy rate
- Housing
- Food availability
3. Indicators for the
provision of health care
- Availability
- Accessibility
- Utilization
- Quality of care
4. Health status indicators
-Low birth weight
-Nutritional status and
psychosocial development
of children
- Infant mortality
-Child mortality rate (1-4yrs)
-Life expectancy at birth
Maternal mortality rate
-Disease specific mortality
-Morbidity – incidence and
prevalence
-Disability prevalence

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MILLENNIUM DEVELOPMENT GOALS INDICATORS

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SUSTAINABLE DEVELOPMENT GOALS

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100 CORE HEALTH INDICATORS SDG

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HEALTH INDEX OF INDIA (NITI AAYOG)

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Social & Economic Characteristics
Variable Developing Countries Developed countries
Place of residence Mostly Rural Mostly Urban
Major occupation Agriculture Industry
Standard of living Low High
GNP per capita 200 to 6,000 US $ 5,000 to 40,600 US $
Adult literacy Low High
Women Economically dependent Economically independent
Demographic Characteristics
Variable Developing Countries Developed countries
Growth Rate Above global GR (>1.3%) Below global GR (<1.3%)
Young population (under 15 yrs of age) 24% (2016) 16%
Elder population (over 65 yrs of age) 5% 18%
DEVELOPED & DEVELOPING REGION

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Contrast in Health (Health Gap)
• Developed countries have longer life expectancy
and lower IMR and child mortality rate and it is
opposite in developing .
• The pattern of burden of disease differs in world
substantially this is known as epidemiological
transition.

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HEALTH CARE
“Multitude of services rendered to individuals, families
or communities by the agents of the health services or
professions for the purpose of promoting, maintaining
or restoring health.”
Characteristics of health care
• Appropriateness
• Comprehensiveness
• Adequacy
• Availability
• Accessibility
• Affordability
• Feasibility
HEALTH SERVICES PHILOSOPHIES
HEALTH SYSTEM
o To deliver health services
o Constitute the management sector & involve
Organizational matters e.g. planning , determining
priority, mobilizing & allocating resources,
translating policies in services, evaluation &health
education.
Components of health system
• Concepts
• Ideas
• Objects
• Persons
Aim of health system- health development

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HEALTH TEAM CONCEPT
Group of persons who shares common
health goals & objectives, determined by
community need & toward the achievement
of which each member of the team
contributes in accordance with her/his
competence & skill, and the respecting the
functions of others.
LEVELS OF HEALTH CARE
• Primary health care –
“Essential” health care PHC, Sub centers
• Secondary health care-
mostly curative services CHC, District
hospitals
• Tertiary health care-
super-speciality care provide managerial
skill teaching specialized staff
HEALTH FOR ALL
• May 1977-World health assembly
• “Attainment by all the people of world by the year 2000 AD of
level of health that will permit them to lead socially &
economically productive life”
• Health for all by 2000- essential principle is the concept of
“equity in health”

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PRIMARY HEALTH CARE
• 1978-Alma-Ata,USSR
Essential health care based on practical, scientifically sound & socially acceptable methods &
technology made universally accessible to individuals & families in the community through their full
participation & at the cost that the community and the country can afford to maintain at every
stage of their development in the spirit of self-determination
• Accepted to achieve the goal of “Health for all by 2000”
• “Health by people” and “placing people’s health in people’s hands”
Declaration of Alma Ata Primary health care include at least
• Education about prevailing health problems and methods of preventing & controlling them
• Promotion of food supply & proper nutrition
• An adequate supply of safe water basic sanitation
• Maternal & child health care ,including family planning
• Immunization against infectious diseases
• Prevention & control of endemic diseases
• Appropriate treatment of common diseases & injuries
• Provision of essential drug

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HEALTH PROMOTION

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HEALTH SERVICES RESEARCH
• HSR is holistic and multidisciplinary.
• It is essential for the continuous evolution and refinement of health services.
It includes:
• Biomedical research: to elucidate outstanding health problems and develop new or better
ways of dealing with them
• Intersectoral research: for which relationships would have to establish with the institutions
concerned with the other sectors
• Health services research: or health practise research or “health systems research”

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CONCLUSION
The health care should focus on four major health-related goals:
1)Prevention of premature death and disability,
Maintenance or improvement of quality of life,
Maximization of personal growth and development and
Improving the chances of a good death

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• Developed and developing regions -
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7122505/#:~:text=In%20developing%20countries%2C%20ne
arly%2050,%2C%20diarrhea%2C%20malaria%20and%20tuberculosis.
REFERENCES
• Park, Park’s Textbook of Preventive &Social Medicine, 25th Edition, Jabalpur: Banarsidas Bhanot,2019.