COMMUNITYHEALTHNURSING For B.Sc. Nursing and DIPLOMAINGENERALNURSING &MIDWIFERY By Kailash Nagar

1. Mr. Kailash Nagar
Assistant Professor
Dinsha Patel College of Nursing

3. Health is an asset for any individual, family
and community. Healthy individual, family or
community can carry out their daily living
activities easily and can also contribute to
the social and economic development of the
country. Health is therefore accepted as a
fundamental right of every individual and
“Health For All is the goal of all nations in
the world”

4.  Health is a state of complete physical,
mental and social wellbeing and not merely
the absence of disease or infirmity.
World Health Organization, 1946
A fourth dimension i.e. spiritual dimension was
added to this definition later on.

5. Health is not perceived the same way by all
members of the community including various
professional groups. In a world of continues
change new concepts of health are emerging,
that are as follows:
1. Biomedical concept
2. Ecological concept
3. Psychosocial concept
4. Holistic concept

6. 1. Biomedical concept:
 Traditionally health has been “viewed as an
absence of disease”, and if one was free from
disease then the person was considered
healthy.
 This concept is known as biomedical concept
and has the basis in the germ theory of the
disease.
 The medical profession viewed the human body
as a machine, disease as a result of the
breakdown of the machine and one of the
doctor‟s tasks was the repair of the machine.
 Thus in this narrow view health became the
ultimate goal of the medicine.

7. Criticism:
 It has minimized the role of the
environmental, social, psychological and
cultural determinants of health.
 It was found inadequate to solve some of the
major health problems of mankind like
malnutrition, chronic diseases, accidents etc.
 Development in medical and social sciences
led to the conclusion that the biomedical
concept was inadequate.

8. 2. Ecological concept:
 According to ecological concept, health is
considered as a dynamic equilibrium between
man and his environment and disease is the
maladjustment of human organism to the
environment.
 Ecologist defined health as the relative
absence of pain and discomfort and a
continuous adaptation and adjustment to the
environment to ensure optimal functions.
 History argues strongly that improvements in
the human adaptation to natural environments
can lead to longer life expectancies and a
better quality of life – even in the absence of
modern health delivery services.

9. 3. Psychosocial concepts:
 Developments in social sciences revealed
that health is not only a biomedical
phenomenon, but one which is influenced
by social, psychological, cultural, economic
and political factors of the people
concerned. Thus health is both a biological
and social phenomenon.

10. 4. Holistic concept of health
 The holistic concept is a synthesis of all the
above concepts of health.
 It recognizes the strength of social,
economic, political and environmental
influences on health.
 According to this concept health implies a
sound mind, in a sound body, in a sound
family in sound environment.
 This approach implies that all the sectors of
the society has an impact on health.
 The emphasis is on the protection and
promotion of health.

11. The WHO definition denotes four dimensions or
components of health:
 Physical dimension
 Mental dimension
 Social dimension
 Spiritual dimension
Many more can be sited
 Emotional dimension
 Vocational dimension
 Cultural dimensions
 Socio-economic dimension
 Environmental dimension
 Educational dimension
 Nutritional dimension
 Curative dimension
 Preventive dimensions

12.  The physical health or wellbeing is related to
body structure and its physiology.
 It refers to normal functioning of all the
organs and systems of the body resulting in
optimal functioning of the body.

13. The physically healthy individual has the
following characteristics:
 All the vitas signs are normal
 Chemistry of body fluids are within normal range
 The skin is neither too dry nor too oily, it is firm and
clean.
 Hair lustrous
 Eyes are bright
 Weight is within normal range
 There is good appetite, sound sleep and regularity of
bowel and bladder.
 Body movements are coordinated
 Immunity is good

14. Assessment of physical health
It can be assessed by:
 Making observations
 Asking questions
 Examinations
 Investigations
 Nutrition and dietary assessment

15.  The mental health or wellbeing is related to
mind.
 The mind is an integral and essential part of
human being which is concerned with mental
functions such as thinking, feeling,
understanding, making judgments,
formulation of attitudes, habits etc.
 Mental health refers to normal and
harmonious functioning of mind and not
merely the absence of mental illness.

16. The mentally healthy individual has the
following characteristics:
 He knows himself
 He accepts his short comings and is free from
internal conflicts and tensions.
 He feels comfortable with himself and feels happy
and cheerful
 He is self confident, has self identity and strong
sense of self esteem.
 He is able to control his emotions.
 He feels interested in others and forms relationships
with his family members and others.
 He is well adjusted, able to meet his demands of life
and able to solve his problem intelligently.

17. Assessment of mental health
 Unlike physical health mental health is not
very easy and simple to measure.
 There are no precise tools to assess various
mental health characteristics.
 Some mental health tools have been
developed to assess various mental health
characteristics.

18.  The social health or wellbeing refers to
individual‟s ability to become a whole person
and become part of existing social structure.

19. The socially healthy individual has the following
characteristics:
 He is able to make friendship which is healthy,
lasting and satisfying.
 He achieves success and happiness from day to day
task of living effectively with others.
 He is able to live in harmony with others and his
surroundings.
 He is able to learn from his society about socio
cultural, socio economic aspects of life, social
skills and social values.
 He contributes in enriching socio-cultural and
economic aspect of life.

20.  Like mental health, social health is also
difficult to measure.

21.  The spiritual health or well being relates to
soul or spirit of man.
 It is concerned with religious beliefs of an
individual which provide philosophy of life,
directions, ethical values and principles of
high living.
 Spiritual health gives strength and
determination to face realities of life and
live gracefully and meaningfully.
All these dimensions of health are interrelated
and independent. In fact all these dimension
cannot be isolated and function as one whole
in an individual.

22.  Disease: literary it means “without ease”-------
disease- the opposite of ease------- when
something is wrong with the body function.
Definition of disease
 “Disease is defined as the condition in which the
body health is impaired, departure from the
state of health, an alteration of the human body
interrupting the performance of vital function”
- Webster
 “A condition of the body or some part of the
body in which its functions are disrupted or
deranged.”
- The Oxford English Dictionary

23.  Illness: Illness refers to emotional,
psychological, and/or spiritual reactions to
sickness. it refers not only to the presence of
specific disease but also to the individual‟s
perceptions and behavior in response to the
disease, as well as the impact of the disease
on psychosocial environment. It is a
subjective state of a person who feels aware
of not being well.
 Sickness: Sickness is when the body or part
of body is malfunctioning. Any medical
diagnosis or psychiatric disorder is a sickness.

24.  Risk factors: risk factor is any situation,
habit, environmental condition, or other
variable that increases the vulnerability of an
individual or a group to an illness or
accident.

25. An acute illness:
 It is usually short term
 May be sever
 The symptoms appear abruptly, are intense
and often subside after a short period.
 Some examples of acute illness are: Flu
syndrome, Ear infection, Bladder infection,
cervical and thoracic lumbar sprain/strain,
Acute Bronchitis, Heart attack etc.

26. Chronic Illness
 Chronic illness is prolonged in duration, does
not often resolve spontaneously, and is rarely
cured completely.
 Its progression is slow.
 A long development period may be present,
for which there may be no symptoms
 Associated functional impairment or
disability can be seen.
 Examples of chronic illnesses are arthritis,
asthma, chronic heart disease, chronic
bronchitis, HIV and diabetes.

27.  Genetic and physiological risk factors
 Age
 Physical environment
 Life style

28. Genetic and physiological factors
 It involves the physical functioning of the
body. E.g. physical condition like obesity.
 Hereditary or genetic predisposition to
specific illness is a major physical risk factor.
E.g. history of cancer in the family, heart
diseases, kidney diseases, diabetes etc.

29. Age
 Age increases susceptibility to certain illness.
Age factors are often closely associated with
other risk factors, such as family history and
personal habits.
For E.g.
 The risks for birth defects and complications of
pregnancy increases in women bearing children
after age of 35years.
 Many kind of cancers pose a great risk for
persons over 45 years of age than for younger
persons.
 The risk for heart diseases increases with age.

30. Physical environment
 The physical environment in which the person
lives increases the likelihood that certain illness
will occur. E.g.
 Unclean environment
 Lack of proper drainage facility
 Over crowding or lack of proper ventilation
 Exposure of industrial workers to certain
chemicals, radiations, noise etc
 Exposure to toxic waste
 Exposure to infections as in case of health care
providers.

31. Life style
 Lifestyle practices and behaviors have positive or
negative effect on health. Practices with
potential negative effects are risk factors. E.g.:
 Over eating or poor nutrition
 Insufficient rest and sleep
 Poor personal hygiene
 Physical inactivity
 Use of tobacco, alcohol, drugs etc
 There is tremendous effect of lifestyle on risk of
developing diseases and patients of all ages are
vulnerable to the influences of unhealthy
lifestyle patterns

33.  Health determinants are the factors that
influence health of an individual and
determines his health status at given point of
time. The health status of the individual is
determined by many factors, some of which
they can control but many of which are a
result of their individual circumstances of
where they live and of their upbringing. The
factors which influence health can be
categorized as:
 Intrinsic factors
 Extrinsic factors

34. In order to 'promote and prevent' health, it is
necessary to understand that the various
determinants (causal element or factor) of
health are interrelated, and therefore any
strategy to improve health requires
consideration of all factors that influence
health.

35.  Biological determinants of health
 Environment
 Socio- economic conditions
 Behavioral and socio cultural conditions
 Health services
 Aging of the population
 Gender

36.  Biological determinants of health include those factors
that influence the health status of an individual through
genetics or as a result of the effect of micro-organisms.
 Genetically, an individual's health status is influenced by
various traits that are passed on from the parents. These
include: Skin pigmentation, DNA composition that
determines blood type, Certain cancers, Allergies
 The effect of micro-organisms is both positive and
negative. Many micro-organisms are necessary for such
processes as breaking down complex chemicals in foods.
Harmful micro-organisms, however, have the potential to
cause disease resulting in chronic illness or death.
 The body's immune system develops antibodies to fight
disease, but the success of this process is depend on a
person's health status. For example, an individual whose
body is deprived of adequate nutrition will be unable to
produce effective immune defense mechanisms. This
makes the body more vulnerable to the effect of invading
micro-organisms and the resultant health problems that
may follow.


37.  Environmental determinants of health refer to the physical
conditions of where we live that influence the health
status of an individual.
Environment is classified as internal or external
 The internal environment pertains to each and every
component part, every tissue, organ and organ system and
their harmonious functioning with in the system.
 External environment consists of those things to which
man is exposed after conception. It is defined as all those
which is external to human. It can be divided into:
physical, biological and psychological component, any or
all of which can affect the health of man and his
susceptibility to illness.
 Environment has a direct impact on the physical, social
and mental well being of human being. If the environment
is favorable to individual he can make full use of his
physical and mental capacities. Promotion and protection
of family and environmental health is one of the major
issue today.

38. Social determinants of health include economic and social
conditions under which people live. Examples of social determinants
that impact on a person's health and wellbeing include:
 Level of education
 Unemployment
 Working conditions
 Stress levels
 Access to adequate housing
 Income levels
 Access to healthcare services
 Access to sufficient food supplies
 Transportation options
 Public safety
 Exposure to crime, violence
 Exposure to mass media and emerging technologies
 The earlier a person is exposed to the positive conditions in
which they live, work and play, the stronger the impact on their
quality and length of life. In Australia, the majority of diseases
and injury occurs in groups that are socially disadvantaged.

39.  The term „lifestyle‟ denotes „the way people live‟. It
is composed of cultural and behavioral patterns and
life long personal habits (smoking and alcoholism).
Lifestyles are learned through social interaction with
parents, peer groups, friends and siblings and through
school and mass media.
 Health requires the promotion of healthy life style.
Many current health problems (e.g. coronary heart
disease, obesity, lung cancer) especially in developed
countries are associated with life style changes. In
developing countries like India where traditional life
style still persists, risk of illness and death are
connected with lack of sanitation, poor nutrition,
personal hygiene, customs and cultural pattern.
Achievement of optimal health demands adoption of
healthy life style.

40.  The purpose of health service is to improve the
health status of the population. For example,
immunization can influence the prevalence or
incidence of particular disease, provision of safe
water can prevent mortality and morbidity from
water born diseases.
 To be effective the health services should reach
the social periphery, equitably distributed,
accessible at a cost the country and community
can afford and socially acceptable.


41.  By the year 2020, the world will have more
than one billion people aged 60 years and
above, and more than two third of them are
living in developing countries. Although the
elderly in many countries enjoy better
health, a major concern of rapid population
aging is the increased prevalence of chronic
diseases and disabilities both being
conditions that tends to accompany the aging
process and deserve special attention.

42.  In 1990s, India witnessed an increased
concentration of women‟s issues.
 In 1993, Global Commission on Women‟s
health was established.
 The commission drew up an agenda for
covering the women‟s health covering
nutrition, reproductive health, the health
consequences of violence, aging, lifestyle,
related conditions and the occupational
environment.