Concept of health : Introduction

CONCEPT OF HEALTH
By
Md Tanwir Alam, MD
Assistant Professor, Dept. of Tahaffuzi Wa Samaji Tib
Govt. Tibbi College & Hospital (GTCH)
27-07-2016 1tanveernium@gmail.com

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
• Similarly to a clinician it means no
abnormality in structure and function of theb ody.
When a clinician fails to detect
anything abnormal by his clinical wisdom
and laboratory tests he labels a person
no abnormality detected (NAD).

• To a psychiatrist
It means well adjusted and a balanced personality

What is ‘Health’
 Oxford dictionary
State of being well in body or mind
 Webster
The condition of being sound in body, mind or spirit
especially freedom from physical disease or pain
 Perkins
“A state of relative equilibrium of body, form and
function which result from its successful dynamic
adjustment to forces tending to disturb it. It is not
passive interplay between body substance and forces
impinging upon it but an active response of body
forces working towards readjustment.”

Definition
“Health is a state of complete
physical, mental and social well being
and not merely the absence of disease
or infirmity”. July 1946.
WHO’s 191 member states
have endorsed this statement.
now added
“the ability to lead a socially and
economically productive life.”

Ye wo haiyyat e tabai haijis ki wajah se badan
insaan mizaj wa tarkeeb k lehaaz se aisi halat
me hota hai k badan k saare afaal sahee aur
durust tareeqe par anjaam paate hain
27-07-2016 tanveernium@gmail.com 9

Sehat aza ki aisi halat haijisme unke afaal
fitri shaqaqal me anjaam paate hain aur
unke infalaat(radde amal) bhi tabai hote
hain

Components/dimension of Health
• Physical
• Mental
• Social
• Spiritual
• Emotional
• Vocational
Balance these and you will have a good state of health

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.

He is cheerful and happy and enjoys life
with a purpose and he thinks positively and
has normal development and contributes
fully and is useful and productive to society
and nation.

Social
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 (as discussed under socio
economic status of family).

Positive health
Better health
Freedom from sickness
Unrecognised sickness
Mild sickness
Severe sickness
Death
SPECTRUM OF HEALTH
The health sickness spectrum

Determinants of health
Heredity
Health services
 Promotive,
preventive,
curative,
rehabilitative
Environment
 Physical, social,
biological and man-
made
Behavior
 Actions
 Habits
 Reactions
 Belief,
attitudes
 Practices
(Lifestyles)
Health

Changing concepts of Health
 Health - Changing concepts
 Biomedical
 Ecological
 Psychological
 Holistic

 Biomedical Concept- “absence of disease”
 human body = machine,
 disease = consequence of the break down
 Doctor’s task = repair of machine.
 Limitation- it has minimized the role of environmental, social,
psychological & cultural determinants of health.

• Ecological Concept-
– Health = is a dynamic equilibrium between man & his
environment,
– Disease = maladjustment of the human organisms to the
environment.
• The concept supports the need for clean air, safe water, ozonic
layer in the atmosphere, etc. to protect us from exposure to
unhealthy factors.

• 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.

• Holistic Concept:
• 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.
• Holistic concept implies that, all sectors of society have an
effect on health

Health Paradigm
(model/set of pattern)

Determinants of Health
Biological
Behavioral
Environment
al
Socio-
economic
Health
system
Socio-
cultural
Ageing of
population
Science &
technology
Information
&
communicati
on
Gender
Equity &
Social justice
Human rights

Concept of Well-being
Components
Objective components
 Standard of living
 level of living
Subjective component
 Quality of life

Standard of living
 Refers to the usual scale of our expenditure, the goods we
consume and the service we enjoy. It includes the level of
education, employment status, food, dress, house,
amusement and comforts of modern living.
 WHO: “Income & occupation, standard of housing, sanitation
and nutrition, the level of provision of health, educational,
recreational and other services.

Level of living
 Used in US
 9 Components
 Health,
 food consumption,
 education,
 occupation and working condition
 Housing,
 Social security
 Clothing
 Recreation and leisure
 Human right

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 the satisfying occupation),
education, social and intellectual attainments, freedom of
action, justice and freedom of expression.
 A composite measure of physical, mental and social well-
being as perceived by each individual or group of individuals.

Indicators of Health

Physical Quality of Life Index(PQLI)
 Includes
 Infant mortality
 Life expectancy at age one and
 Literacy
 Scale 0 to 100 = worst to best
 ‘Money is not everything’
 Does not measure economic growth
 Measures social, economic and political policies

Human Development Index (HDI)
 Combines indicators representing 3 dimensions
1. Longevity – Life expectancy at birth
2. Knowledge – adult literacy rate & mean year of schooling.
3. Income – real GDP Per Capita in Purchasing Power
Parity(PPP) in US dollars
 Index = (Actual value) – (Minimum Value)
(Maximum value) – (Minimum Value)

Human Poverty Index
 Introduced in 1997
 Measures deprivation in basic dimensions (Longevity,
Knowledge, Income)
 For developing countries(HPI-1)-
1. A long & healthy life – vulnerability to death at a
relatively early age.
2. Knowledge – adult literacy rate
3. Standard of living – average of- %age of population not
using an improved water source & %age of children
under weight-for-age.

CONCEPT OF DISEASE

Concept of Disease
“A condition in which body function is impaired, departure
from a state of health, an alteration of the human body
interrupting the performance of the vital functions.”
Webster.
“The condition of body or some part of organ of body in which
its functions are disrupted or deranged.
Oxford English Dictionary
‘a maladjustment of human organism to the environment’
Ecologically
Simplest definition – ‘opposite to Health’.

HEALTH AND ILLNESS

The Health-Sickness spectrum

Historical Theories for
causation of disease
1. “Supernatural causes”& Karma
2. Theory of humors (humor means fluid)
3. The miasmatic theory of disease
4. Theory of contagion
5. Germ theory
6. Epidemiological Triad
7. Multi-factorial causation
8. Web of causation
………Supernatural to multi-factorial causes…
Environment
Agent Host

Epidemiological triad
Agent Factors
Physical Agents
Chemical Agents
Biological Agents
Nutritional agents
(moassar)
Host Factors
Socio-demographic Factors
Psycho-social Factors
Intrinsic Characteristics
(istedade badan)
Environmental Factors
Physical Environment
Biological Environment
Social Environment
(makhsoos waqt darkkar)

Asbab-e-marz
Sabab wo hai jo muqaddam aur bilzaat ho aur uski wajah se
badan insaan me koi haalat paida ho jayeya ya koi sabqa
halat barqaraar rahe
• Asbabe sehat wa marz:
– Asbab sabqa: through waseela/body matter (mawad e humma)
– Asbabe wasla: without waseela / body matter (ufoonat humma)
– Asbabe badiya: outside matter/with or without waseela: (asbabe kharjiya-kaifyat, I
nfection, mental cause, makool mashroob)
– Asbabe badaniya: asbabe dakhliya/ghair tabai mizaj-ye badiya k hi tabe hoti hai
• Asbaabe badan insaan
– Asbabe madiiya: arkan, akhlat, a’za, arwaah
– Asbabe faila: asbabe zarooriya wa ghair zarooriya
– Asbabe sooriya: mizaj, quwa, tarkeeb.
– Asbabe tamamiya: af’al

• Asbabe mukhaliffa wa ghair mukhallifa:
– Asbabe mukhaliffa: badan se juda hone k bad v asar baqi- post chickenpox
spot
– Asbabe ghair mukhaliffa: badan se juda hote hi asar ghayab- bukhar k
saath headache v ghayab
• Asbabe zarooriya wa ghair Zarooriya:
Zarooriya: Asbab-e-sitta zarooriya (six essential of life)
1. Hawa/Air (ambient air)
2. Makool wa mashroob (Food & drink
3. Harkat wa sakoon badni (physical movement & rest)
4. Harkat wa sakoon Nafsaani (mental response and rest)
5. Naum wa yakza (sleep & awakefullness)
6. Ehtebaas wa istafragh (retension & evacuation)

Web of causation
Change in life style Stress
Abundance of food Smoking Emotional Aging &
D Disturbance other factor
Obesity Lack of physical activity Hypertension
Hyperlidemia Increase catacholamine Changes in walls of
arteries
thrombotic activity
Coronory atherosclerosis
Coronary occlusion
Myocardial Infarction
Myocardial Infarction27-07-2016 46tanveernium@gmail.com

Natural History of Disease

Disease in many Forms..
• Acute
• Chronic/insidious
• Carrier
Spectrum of disease

Subclinical Case: ICEBERG
PHENONMENON
Example: Cholera , Polio, hypertension, malnutrition etc.

Some terms..
• Disease: biological concept. Means physiological/psychological
dysfunction
• Illness: socio-pathological concept. Means subjective feeling of not
being well.
• Sickness: Biological concept of social dysfunction.

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with me…
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Concept of health : Introduction

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