The document discusses various concepts of health that have evolved over time, from traditional biomedical definitions focusing on disease absence to more holistic definitions. It outlines the WHO's definition of health as complete physical, mental and social well-being, and operationalizes health as adequate organism functioning. The document also discusses dimensions of health including physical, mental, social, spiritual and emotional. It explores concepts like positive health, health as relative, well-being components, and indexes for quality of life and human development.

1. Concept of Health
Dr. Sonam Aggarwal
MD Community Medicine

2. Contents:
• Concept of health
• WHO definition of “Health”
• Operational definition of “Health”
• New philosophy of health
• Dimensions of health
• Positive health
• Health – a relative concept
• Concept of well-being
• Spectrum of health
• Conclusion
• Bibliography

3. Concept of Health
• An understanding of health is the basis of all the health care.
• Health has been considered as “absence of disease”, traditionally.
• Oxford English dictionary describes health as “a state of being free
from illness or injury”.
• Health is not perceived the same way by all the members of a
community including various professional groups ( like biomedical
scientists, social scientists, health administrators, ecologists) giving
rise to confusion about the concept of health.

4. • Health has evolved over the centuries from the concept of individual
concern to a worldwide social goal.
• The various changing concepts of health as follows:
1.Biomedical concept
2.Ecological concept
3.Psychosocial concept
4.Holistic concept

5. Biomedical concept
• Traditionally health has been considered as “absence of disease” i.e.
if one is free from disease then he is considered healthy.
• Biomedical concept is based on “germ theory of disease”.
• This concept has minimized the role of the environment, social and
cultural determinants of the health.
• It was found inadequate to address major health problems like –
malnutrition, chronic disease, accidents, drug abuse, mental illness,
environmental pollution etc.
• Development in medical and social sciences led to the conclusion that
biomedical concept of health was inadequate.

6. Ecological concept
• Deficiencies in the biomedical concept gave rise to other concepts.
• The ecologists put forward the ecological concept of health.
• Ecologists viewed health as a dynamic equilibrium between man and
his environment, and the disease as a maladjustment of the human
organism to environment.

7. Psychosocial Concept
• Advances in social sciences showed 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.
• These factors must be taken into consideration in defining and
measuring health.
• Thus health is both a biological and social phenomenon.

8. Holistic Concept
• The holistic model is a synthesis of all the above concepts.
• Holistic concept recognizes the strength of social, economic, political
and environmental influences on health.
• It has been variously described as multidimensional process involving
the well being of the person as a whole.
• The emphasis is on the promotion and protection of health.
• The holistic approach implies that all sectors of the society have an
effect on health, in particular, agriculture, animal husbandry, food,
industry, education, housing, public works and other sectors.

9. WHO definition of ‘HEALTH’-
• “Health is a state of complete physical, mental and social well-being
and not merely an absence of disease or infirmity”. (given by: WHO,
1948)
• In 1978, the ability to lead a “socially and economically productive
life” was also added to the definition by WHO.
• The concept of health as defined by WHO is broad and positive in its
implications; it sets out the standard, the standard of “positive” health.
• However, the WHO definition of health is not an “operational
definition”.

10. Operational definition of “Health”
• In a broad sense, health can be seen as “a condition or quality of the
human organism expressing the adequate functioning of organism in
given conditions, genetic or environmental”.
• In a narrow sense, health means: a) there is no obvious evidence of
disease, and that a person is functioning normally, b) the several
organs of the body are functioning adequately in themselves and in
relation to one another, which implies a kind of equilibrium or
homeostasis.

11. New philosophy of health
New philosophy of health states that:
• Health is a fundamental human right
• Health is the essence of productive life, and not the result of ever increasing
expenditure on medical care
• Health is intersectoral
• Health is an integral part of development
• Health is central to the concept of quality of life
• Health involves individuals, state and international responsibility
• Health and its maintenance is a major social investment
• Health is a worldwide social goal.

12. DIMENSIONS OF HEALTH
• Health is multidimensional.
• These dimensions function and interact with one another, each has its
own nature.

13. PHYSICAL DIMENSION
• “Perfect functioning” of the body.
• It conceptualizes health biologically as a state in which every cell and
every organ are functioning at optimum capacity and in perfect
harmony with the rest of the body.
• Signs of physical health in an individual are: a good complexion, a
clean skin, bright eyes, lustrous hair etc.

14. MENTAL DIMENSION
• Good mental health is the ability to respond to many varied
experiences of life with flexibility and a sense of purpose.
• 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”.

15. SOCIAL DIMENSION
• Social well-being implies harmony and integration within the
individual, between each individual and other members of society, and
between individuals and the world in which they live.
• “Quantity and quality of an individual’s interpersonal ties and the
extent of involvement with the community.”

16. SPIRITUAL DIMENSION
• Spiritual health refers to “something” that transcends physiology and
psychology.
• It includes integrity, principles and ethics, the purpose in life,
commitment to some higher being and belief in concepts that are not
subject to “state of the art” explanation.

17. EMOTIONAL DIMENSION
• Emotional health relates to “feeling.” It reflects emotional aspects of
humanness.

18. VOCATIONAL DIMENSION
• Work often plays a role in promoting both physical and mental health.
• Physical work is usually associated with an improvement in physical
capacity, while goal achievement and self-realization in work are a
source of contentment and enhanced self-esteem.

19. OTHERS
• A few other dimensions have also been suggested such as:
philosophical dimension, cultural dimension, socio-economic
dimension, environmental dimension, educational dimension,
nutritional dimension, and so on.

20. POSITIVE HEALTH
• It is a state of physical, mental, social and spiritual well being when a
person enjoys an equilibrium state with his environment.
• “Perfect functioning” of body and mind.
• Ability to lead a socially and economically productive life

21. HEALTH- A RELATIVE CONCEPT
• Health is a relative concept and health standards vary among cultures,
social classes and age groups.
• For example, a new born in India weighs 2.8kg on an average
compared to 3.5 kg in the developed countries.

22. CONCEPT OF WELLBEING
COMPONENTS
OBJECTIVE SUBJECTIVE
-Level of Living -Quality of Life
-Standard of Living

23. STANDARD OF LIVING
• As per WHO, “Income and occupation, standards of housing,
sanitation and nutrition, the level of provision of health,
educational, recreational and other services may all be used
collectively as an index of the ‘standard of living’.”

24. LEVEL OF LIVING
• As per United Nations documents “level of living” consists of nine
components: health, food consumption, education, occupation and
working conditions, housing, social security, clothing, recreation and
leisure, and human rights.
• Health most important component of level of living.

25. QUALITY OF LIFE
• Quality of life as defined by WHO, “The condition of life resulting
from combination of the effects of the complete range of factors
such as those determining health, happiness, education, social and
intellectual attainments, freedom of action, justice and freedom of
expression.”
• Recent definition by WHO, “the product of the interplay between
social, health, economic, and environmental conditions which affect
human and social development. It is a broad- ranging concept,
incorporating a person’s physical health, psychological state, level of
independence, social relationships, personal belief and relationship to
salient features in the environment”.

26. PHYSICAL QUALITY OF LIFE INDEX(PQLI)
• One composite index from a number of health indicators.
• It includes three indicators:
-Infant mortality
-Life expectancy at age one
-Literacy.
• For each component, performance of individual countries is placed on
a scale of 0 to 100,
- 0 represents “worst” performance
- 100 represents “ best” performance

27. • PQLI has not taken per capita GNP into consideration, showing that:
“money is not everything”.
• For example, the Middle East countries have high per capita income
but do not have high PQLIs while Sri Lanka has low per capita income
but high PQLI.

28. HUMAN DEVELOPMENT INDEX(HDI)
• It includes -
longevity (life expectancy at birth)
knowledge (adult literacy rate)
income ( GNI per capita)
•The HDI value ranges from 0 to 1.
• HDI value for India 0.647 with rank 129.
•Norway with HDI value 0.954 is rank 1 among 189 countries.
•Niger with HDI value 0.377 is at rank 189.
Source: http://hdr.undp.org/en/content/2019-human-development-index-ranking

29. Components of HDI

30. Goalposts for Human Development Index
DIMENSION OBSERVED MAXIMUM MINIMUM
Life expectancy 83.2 20.0
Mean years of schooling 13.2 0
Expected years of schooling 20.6 0
Combined education index 0.951 0
Per capita income(PPP US $) 108,211 163

31. • Dimension index = Actual value – minimum value / maximum value – minimum
value
• The HDI is the geometric mean of the three dimension indices:
(Ilife
1/3 × IEducation
1/3 × IIncome
1/3 )

32. Calculation of HDI

33. SPECTRUM OF HEALTH
• This concept of health emphasizes that health of an individual is a
dynamic phenomenon and a process of continuous change, subject to
repeated, fine variations.
• Transition from optimum health to ill health is often gradual, and
where one state ends and other begins is a matter of judgment.
• Optimum health is a compromise between negative and positive
health. It represents the level of health that can be achieved under the
existing healthcare system.

34. Health sickness spectrum
Positive health
Better health
Freedom from sickness
Unrecognised sickness
Mild sickness
Severe sickness
Death

35. Conclusion:
• Health is an important concept and ultimate objective that is
universally accepted.
• Our actions in the form of health policies, programmes or acts must be
towards achieving health for communities.

36. Bibliography
• Textbook of public health and community medicine by AFMC, AFMC with
collaboration with WHO, New Delhi, first edition 2009
• Park K. Park’s textbook of preventive and social medicine. 25th ed, India:
Bhanot Publishers; 2019.
• Textbook of Community Medicine – Preventive and Social Medicine, Sunder
Lal, Adarsh, Pankaj, New Delhi , fifth edition
• Dhaar GM, Robbani I. Foundations of Community Medicine. Second edition,
India: Elsevier publishers; 2008.
• Maxcy, Rosenau, Last. Public Health & Preventive Medicine. Fifteenth edition,
2008.

37. Thank you