community health nursing

1. CONCEPT AND DETERMINANTS OF HEALTH
ALTERNATE SYSTEM FOR HEALTH PROMOTION AND
MANAGEMENT OF HEALTH PROBLEMS
HEALTH ECONOMICS
PRESENTED BY
VERSHA CHAUHAN
MSc 1st year
RAKCON

2. OUTLINE OF THE PRESENTATION
 DEFINITION AND MEANING OF HEALTH
 COMPONENTS OF HEALTH
 CONCEPTS OF HEALTH
 CONCEPT OF WELL BEING
 POSITIVE CONCEPT OF HEALTH
 SPECTRUM OF HEALTH
 PHYLOSIPHY OF HEALTH DIMENSIONS OF HEALTH
 DETERMINANTS OF HEALTH
 HEALTH INDICATORS
 ALTERNATIVE SYSTEM FOR HEALTH PROMOTION
 MANAGEMENT OF HEALTH PROBLEMS

3. INTRODUCTION TO HEALTH
 Health is dynamic state and that is
individually perceived.
 Health is the condition of being
sound by body, mind or spirit,
especially free from physical
disease or pain. Soundness of body
or mind, that condition in which
their functions are duly and
efficiently discharged.
 Health is accepted as fundamental
right of every individual and
“HEALTH FOR ALL” is the goal
of all nations in the world.

4. MEANING OF HEALTH
 The meaning of health is misunderstood often it is considered as freedom
from diseases and disabilities or pain. But health is more than freedom
from illness, disabilities and pain. It includes the normal functioning of
all organs and systems of the body, harmonious functioning of both mind
and body resulting in physical strength, mental aspects and experiences.

5. DEFINITION OF HEALTH
ACCORDING TO WHO (1948)
Health is a state of complete physical, mental and social well-being and not merely
an absence of disease or infirmity.

7. OTHER DEFINITONS
 By Merriam Webster-
Health is the condition of being sound in body, mind, or spirit.
 By Collins dictionary-
A person’s health is the condition of their body and the extent to which it is free from illness or is
able to resist illness.
 By oxford dictionary-
Health is defined as the state of being free from illness and injury.
 According to Mahatma Gandhi-
It is health that is wealth and not pieces of gold and silver.

8. COMPONENTS OF HEALTH

9. CONCEPTS OF HEALTH
 Health was usually considered as “absence of disease”. An understanding of health is the basis
of all health cares.
 In changing concepts of health, new concepts are emerging on new patterns of thoughts, the
changing concepts of health has been identified as-
• Biomedical
• Ecological
• Holistic
• Psychosocial

10. BIOMEDICAL CONCEPT
 Health is an “absence of disease”, that is if one is free from disease, then the
person is 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.

11. CRITICISM OF BIOMEDICAL CONCEPT
 According to biomedical concept, one factor, i.e. Germ is responsible for illness, but other
factors which contribute to the illness are not considered.
 But it has been seen that some of the health problems such as accidents, nutritional deficiency
disorders, mental disorders, disease due to environment pollution also occur. Even germs also
get an opportunity to multiply and thereby cause disease, it get appropriate environment inside
the body to grow.

12. ECOLOGICAL CONCEPT:
 Ecologists- health is 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.

13. PSCHOSOCIAL CONCEPT
 “Health is not only biomedical phenomenon, but is influenced by
 Social
 Psychological
 Cultural
 Economic and
 Political factors of the people concerned,
 Health is both a biological and social phenomenon

14. 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.

15. CONCEPT OF WELL BEING
 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’.

16. STANDARD OF LIVING
 WHO defines standard of living as “income and occupation, standard of housing,
sanitation and nutrition, the level of provision of health, educational, recreational
and other services may all be used individually as measure of socio economic
status and collectively as an index of standard of living.

17. LEVEL OF LIVING
 The parallel term used for standard of living used in United Nations document is level of
living. It consist of nine components-
 Health
 Food consumption
 Education
 Clothing
 Recreation
 Occupation and working conditions
 Housing
 Social security
 Recreation and leisure and human rights

18. QUALITY OF LIFE
 Quality of life is defined as 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.”

19. PHYSICAL QUALITY OF LIFE INDEX
 It includes 3 indicators –
Infant mortality rate
Life expectancy at birth
Literacy

20. HUMAN DEVELOPMENT INDEX
 It includes-
Life expectancy at birth
Knowledge( adult literacy rate and mean years of schooling)
Income ( real GDP per capita)
 The HDI value ranges from 0 to 1.

21. POSITIVE CONCEPT OF HEALTH
 WHO defines health in four dimensions i.e. physical, mental, social and spiritual
well-being. A person who enjoys all the four dimensions of health is said to be in
a state of positive health.
 The concept of perfect positive health cannot become a reality because a person
can never be in the perfect state of all four dimensions. Though the health has
been described as the capacity of an individual to adjust to the changing
environment and keep the balance in environment and body.
 Biological component
 Psychological component
 Social component

22. POSITIVE CONCEPT OF HEALTH
 The state of Positive Health implies the notion of “Perfect Functioning” of the
body & mind.
 The concept of perfect positive health cannot become a reality because man will
never be so perfectly adapted to his environment that his life will not involve
struggles, failures and sufferings.
 Positive health will always remain a mirage (Unattainable Goal), because
everything in our life is subject to change.

23. HEALTH A RELATIVE CONCEPT
 Health is a relative concept and health standards vary among-
 Cultures
 Social Classes and
 Age Groups
 Instead of setting universal health standards, each country will decide on its own
norms for a given set of prevailing conditions and then look into ways of
achieving that level.

24. ECOLOGY OF HEALTH
 Ecology is defined as a mutual relationship between living organisms and their
environment. Ecology of health is the study of relationship between variations in
man’s environment and his state of health. Health is defined as a state of dynamic
equilibrium or adjustment between man and his environment.

25. ECOLOGICAL MODEL
 Man is surrounded by the social, biological, physical environment and change in
any of these environment may initiate change in the other, affecting the
relationship between man and agent and environment. As long as a state of
equilibrium exists between host, agent and environment a state of health is
maintained.

26. SPECTRUM OF HEALTH
 Health and diseases lie along a continuum, and there is no single cut-off point.
 The lowest point on health diseases spectrum is death and highest point
corresponds to the WHO definition of positive health.

29.  Health fluctuates within a range of optimum well-being to various
levels of dysfunction, including the state of total dysfunction, namely
death.
 The transition from optimum health to ill health is often gradual and
where one state ends and the other begins is a matter of judgement.

30.  The spectral concept of health emphasizes that the health of an individual is not
static, it is dynamic phenomenon and a process of continuous change, subject to
frequent subtle variations.
 It implies that health is a state not to be attained once and for all, but ever to be
renewed. There are degrees or “levels of health” as there are severity of disease.

32. AS LONG AS WE ARE ALIVE THERE IS
SOME DEGREE OF HEALTH IN US…..

33. NEW PHILOSOPHY OF HEALTH
 Health is a fundamental human right.
 Health is the essence of productive life.
 Health is inter sectorial.
 Health is an integral part of development.
 Health is central to the concept of quality of life.
 Health involves individual, state and international responsibility.
 Health and its maintenance is a Major social investment.
 Health is a worldwide social goal.

48. DETERMINANTS OF HEALTH
 Health determinants are the factors that influences the health of an individual and
determines his health status at any point of time. According to WHO committee
on community health nursing (1974), these determinants are categorizes as:
 Human biology
 Lifestyle or ways of living
 Socioeconomic status
 Environmental conditions
 Health and health related services

49. HUMAN BIOLOGY
It is related to biological factors which are not within the control of an individual
because these are from within the individual and also inherited. Some of the factors
are as under-
 GENETIC INHERITANCE
 SEXUALITY
 AGE
 RACE

50. LIFESTYLE OR WAYS OF LIVING
 The health of an individual has direct relationship to the lifestyle or ways of
living.
 A person who healthy practices of day to day living will remain healthy and vice
versa. Lifestyle refers to people’s way of living and is based in their knowledge,
attitude and practices.
 It include daily living activities, cultural practices including customs and
traditions.

51. ENVIORMENT
 PHYSICAL ENVIRONMENT
 BIOLOGICAL ENVIONMENT
 SOCIAL ENVIRONMENT

52. SOCIO ECONOMIC STATUS
 The health of community is also related to the social and economic conditions.
Many of the diseases are more prevalent among poor socio-economic status
because poverty leads to illiteracy, ignorance and lack of resources. Poverty also
predisposes to high maternal mortality, infant mortality, crime, drug abuse etc.
 Many chronic diseases like cardiovascular, diabetes, and hypertension are more
prevalent in high socioeconomic status due to their way of living.

53. HEALTH AND HEALTH RELATED SERVICES
 Health services
 Political system
 Health related services

55. HEALTH INDICATORS
 WHO defines indicators as, “variables which measures changes”.
 Health indicator is a variable, susceptible to direct measurement that reflects the
state of health of persons in a community.
 Various measures are adopted to assess the health of an individual, but it is very
difficult to assess the health of a community or country. Indicators are required to
measure the health status of the community as a whole.

56. PURPOSES OF HEALTH INDICATORS
 To assess the health care needs and planning the health care services.
 To allocate the scarce resources according to needs.
 To monitor and evaluate the health service activities.
 To measure the extent to which the objectives and targets of programme are being
attained.

57. CHARACTERSTICS OF HEALTH INDICATORS
 VALID- actually measure what they are supposed to be measure.
 RELIABLE- measurements should be stable if measured by different people in
similar circumstances.
 SENSITIVE- indicator should be sensitive to the situation for application.
 SPECIFIC- they should reflect changes only when situation is specific.
 OBJECTIVE- there must be objectivity in selecting classification and measuring
the indicators.
 RELEVANT- they should contribute to the understanding of phenomenon of
interest.
 FEASIBLE- they should have the ability to obtain data when needed.

58. 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.
 Concurrent evaluation and terminal evaluation of health services.
 Planning and allocation of health resources.
 Measurement of health successes.

59. CLASSIFICATION
 Mortality Indicators
 Morbidity Indicators
 Disability Rates
 Nutritional Status or Nutritional Indicators
 Health Care Delivery Indicators
 Utilization Rates
 Indicators of Social and Mental Health
 Environmental Indicators
 Socio-economic Indicators
 Health Policy Indicators
 Indicators of Quality of Life
 Other Indicators

61. LIFE EXPECTANCY
 Life expectancy at birth is the average number of years that will be lived by those
born alive into a population if the current age specific mortality rate persists.
 In 2016:- 67.4 (male)
 70.3 (female)
 68.8 (both sexes)

62. CRUDE DEATH RATE
 it is defined as “the number of deaths per 1000 mid-year population per year in a
given community.
 The decreased death rate indicate the advancement in the field of medicine and
health care. At present it is 7.33 deaths per thousand.

63. INFANT MORTALITY RATE
 It is most universally accepted indicator of health status not only for infants but of the whole
population. It is significant indicator to determine the availability, utilisation and effectiveness
of health care.
 It is defined as number of deaths under one year of age in a given year to the total number of
live births in the same year, usually expressed as a rate/1000 live births. At present it is 34 per
1000 live births.

64. NEONATAL MORTALITY RATE-
 It is defined as number of deaths under 1 year of age during a year per number of
live births during the same year. In 2016, it is 25.4 deaths per 1000 live births.

65. EARLY NEONATAL MORTALITY RATE
 This is defined as deaths of new-borns within first 7 days of delivery per 1000
live births.

66. STILL BIRTH RATE (FOETAL DEATH RATE)-
 The foetus is able to survive outside the womb after 28 weeks of
gestation and weighing more than 1000gm. In such a foetus dies in the
womb, it is called still birth. It is computed as under

67. CHILD MORTALITY RATE-
 It is defined as “ the number of deaths at ages 1 to 4 years in a given year per
1000 children in that age group at the midpoint of the year.
 The infant mortality rate is not included in it.
No. of deaths of children less than 5 years of age in a given year X 1000
No. of live births in the same year

68. PERINATAL MORTALITY RATE-
 It is defined as the number of foetal death of >28 weeks of gestation
plus infant death within <7 days of birth in a defined area in one year
per 1000”live births and still births in the same area and in the same
year.

69. UNDER FIVE PROPORTIONATE RATE-
 It is the proportion of total deaths occurring below 5 years of age. This rate can be
used to reflect both infant and child mortality rate.

70. POST NEONATAL MORTALITY RATE (PNMR)-
 Post neonatal death are death occurring from 28 days after birth till under 1 year.
Post neonatal mortality rate refers to number of death from 28 days of life to
under 1 year in a given year per 1000 live births in the same year.
 It is computed as under:-

71. MATERNAL MORTALITY RATE-
 The number of deaths of women during reproductive age due to maternal cause
per live births, usually expressed as a rate/lakh. Current maternal mortality rate in
India is 130 per 1, 00,000.
Total no. of female deaths due to complications of pregnancy,
childbirth or within 42 days of delivery from puerperal causes in an area during a given year X 1000(OR 100,000)
Total no. of live births in the same area and year

72. DISEASE SPECIFIC MORTALITY-
 Mortality which occurs due to specific diseases e.g. cancer, accidents etc.

73. AGE SPECIFIC DEATH RATE-
 Death rates can be expressed for specific age groups in a population
which are defined by age.
 An age-specific death rate is defined as total number of deaths
occurring in a specific age group of the population (e.g. 20-24 years) in
a defined area during a specific period per 1000 estimated total
population of the same age group of the population in the same area
during the same period.

74. CASE FATALITY RATE-
 It is calculated by dividing the number of deaths from a specified diseases over a
defines period of time by the number of individuals diagnosed with the diseases
during that time. The resulting rate is then multiplied by 100 to yield a
percentage.

75. PROPORTIONAL MORTALITY RATE
 The simplest measure of estimating the burden of a disease in the community is
proportional mortality rate, i.e., the proportion of all deaths currently attributed to
it.

76. YEARS OF POTENTIAL LIFE LOST (YPLL)
 Years of potential life lost is based on the years of life lost through premature
death. It is defined as one that occurs before the age to which a dying person could
have expected to survive (before an arbitrary determined age, usually taken age 75
years).

78. MORBIDITY INDICATORS
 Mortality indicators do not reveal the burden of ill-health in a community, as for
example mental illness and rheumatoid arthritis.
 Therefore morbidity indicators are used to supplement mortality data to describe
the health status of a population.

79. MORBIDITY INDICATORS
 The morbidity rate is used to assessing morbidity among community
are-
Incidence and prevalence of disease.
Notification rate
Patients admission, readmission and discharge of the indoors and outdoors
Hospital stay of patients
Sickness spells and absenteeism from work or school etc.

80. INCIDENCE
 It is the rate of new cases of the diseases. It is generally reported as the number of new cases
occurring within a period of time.
 Incidence conveys information about the risk of contracting the diseases, whereas prevalence
indicates how widespread the diseases is.

81. PREVALENCE
 Prevalence is the actual number of cases alive, with the disease either during a
time period (period prevalence) or at a particular time (point prevalence).
 Period prevalence provides the better measure of the diseases load since it
includes all new cases and all the deaths between two dates, whereas point
prevalence only counts those alive on a particular date.

82. POINT PREVALENCE
 It is defined as the number of all current cases (old and new) of a diseases at one
point in time in relation to a defined population.
Number of all current cases (old & new)of a specified
disease existing at a given point in time X 100
Estimated population at the same point in time

83. PERIOD PREVALENCE-
 A less commonly used measure of prevalence is period prevalence. It measure the
frequency of all current cases (old and new) existing during a defined period of
time e.g. annual prevalence, expressed in relation to a defined community.

85. DISABILITY INDICATOR
.
 The period of disability of a patient during illness, limitations of morbidity and
limitations of activity related illness or injury indicates the mortality and
morbidity of the community.
 The disability indicators include prevalence of blindness, deafness, dumbness etc.
it gives information about the people who are not able to perform full range of
activities due to any disease or any such problem.

86.  The commonly used disability rate fall into two groups:-
 Event type indicators
 Person type indicators:- limitation of mobility
limitation of activity

88.  It express years of life lost to premature death and years lived with disability
adjusted for the severity of the disability. One DALY is “one lost year of healthy
life”

91. NUTRITIONAL STATUS INDICATOR
 The nutritional status of the community also determines the general health status
of people. This a positive indicator which can be determine by-
 Anthropometric measurements of infants, preschool and school going children by
taking height, weight , mid arm circumference
 Prevalence of low birth weight babies

92. UTILIZATION RATE
 The health of people is also affected by the availability and accessibility of health
facilities and their utilization by the people. The health utilization rate can be
measured by-
 Percent of infants fully immunized
 Percent of pregnant women received antenatal, natal and postnatal care by trained
midwife
 Percent of family planning methods used by various eligible couples
 Bed occupancy rate
 Average length of stay i.e. the days of health care received by patient from trained
health personnel

93. SOCIALAND MENTAL HEALTH INDICATORS
 These indicators give information about the social and mental problems.
 These includes the prevalence of drug and alcohol abuse, juvenile delinquency,
child and women abuse, suicide, homicide etc.
 These indicators reflects the social and mental status of the community and
guides for social action to improve the community.

94. ENVIRONMENTAL INDICATORS
 These indicators measure the quality of physical and biological environment in
which people live in and is conductive to health or illness.
 It includes air pollution, water, noise pollution, exposure to toxic substances etc.
 Most important indicator is measuring the proportion of population accessible to
safe drinking water and sanitation facilities.

95. SOCIOECONOMIC INDICATORS
 These are not directly related to health of people, but is important in
interpretation of health care indicators which includes:
 Per capita gross national product
 Status of employment
 Education
 Family size and per capita family income

96. HEALTH POLICY INDICATOR
 The important indicator of political commitment as allocation of adequate
resources which includes:
 Gross net production spent on health care
 Health related activities like water supply, sanitation, nutrition etc.
 Proportion of total health care resources devoted to primary Health care.

97. OTHER INDICATORS
 HEALTH FOR ALL INDICATORS- for monitoring the goals for health for all
as per WHO guideline. These indicators will help to measure extent to
achievements for good health status of community.
 BASIC NEED INDICATOR- these includes the extent of basic needs being met
for people to maintain the health of people which includes nutrition, water
supply, housing, health facilities etc.
 SOCIAL INDICATORS- these indicators reflects the social health care like
social security, social welfare services, culture and social satisfaction etc.

125. DEFINITION
 Alternative system of health defines as the absence of disease is usually thought
to result from isolated factors and treatment often involves drugs and surgery.

127. AYURVEDA
 Ayurveda is system of medicine with historical roots in the Indian subcontinent.
Globalized and modernizes practices derived from Ayurveda traditions are a type
of complementary or alternative medicine.
 Ayurveda believes in the existence of 3 elements substances, the doshas (called
vata, pitta and kapha), and states that a balance of doshas results in health, while
imbalance results in disease.

128. THE ORIGIN AND NATURE-
 Ayurveda is an ancient system of medicine practised in India. Its documentation
dates back to Veda period. The word Ayurveda implies the science of life.
 The origin of Ayurveda is linked with the origin of universe and it is developed
from the hymns from Atharvaveda (one of four Vedas) describing fundamentals/
philosophies about the world and life, diseases and medicine.

129. THEORETICAL BASIS
 The Ayurveda takes the holistic view of health comprising 4 integrated
components namely physical, mental, social and spiritual, affecting one another.
The practice of Ayurveda is based on the theory of Panch Mahabhutas (five
elements).

130. BASIC PRINCIPLES OF AYURVEDA
 According to this theory all the objects and living beings are composed of 5
elements. The five elements are represented in combination in the form of
Tridosha e.g. Vata (ether and air), pitta (fire) and kaph (water and earth).

131. DIAGNOSIS AND TREATMNENT
 The treatment in Ayurveda is individualised. It requires not only diagnosis of
diseases to prescribe medicine but also study of various factors such as age and
sex, temperament , sleep , rest and work pattern, dietary , metabolic fire.
Treatment include preventive and curative measures.

132.  Preventive measure include personal hygiene, regular daily routine, appropriate use of
Rasayansa Sevana i.e. rejuvenating materials /food and Rasayans drugs. The curative measures
include 3 major measures including Aushadhi(drugs), Anna (diet) and Vihara(exercise and
general mode of life).

133. SPECIALITIES
It develop 8 branches of specialities during Charaka and Sushruta. These are-
 Kaya chikitsa ( internal medicine)
 Kaumar bhartya ( paediatrics)
 Graha chikitsa( psychiatry)
 Shalkya (eye and ENT)
 Shalya tantra ( surgery)
 Visha tantra( toxicology)
 Rasayana (geriatrics)
 Vagikarana (science of virility)

134. YOGA
 It is science as well as art of healthy living physically, mentally, morally and
spiritually.
 It is not limited by race, age, sex, religion, caste or creed and can be practiced by
those who seek fitness and well-being.
 It helps reduce high blood pressure, improve digestion, helps in weight
management, increase flexibility, improve posture and increase immunity. It also
helps in neutralizing the stress, improve memory and increase mental awareness
and confidence. Yoga is an ancient science.
 It has been described in Vedas. It was propounded by Patanjali about 2500 years
ago.

135. It consists of 8 components-
 Restraint in every sphere of life
 Austerity in every sphere of life
 Maintaining physical posture
 Breathing exercises
 Restraining of sense of organs
 Contemplation
 Meditation
 Smadhi
 A number of postures are described in yogic works to improve health, to prevent diseases and
to cure illness. These needed to be learnt under supervision and guidance. These need to be
chosen carefully and practised for prevention of diseases, promotion of health and for
therapeutic purposes.

136. NATUROPATHY
 Naturopathy is a form of alternative medicine that employs an array of
pseudoscientific practices branded as” natural”,” non-invasive” and as promoting
“self-healing”. It is also called nature cure treatment primarily stresses on the
curing of body in the most natural manner i.e. Giving the body time to heal on its
own. The 5 main modalities of treatment are air, water, heat, mud and space.

137.  It aim to prevent illness through stress reduction and changes in diet and lifestyle, often
rejecting the methods of evidence based medicine. Naturopathic practitioners generally
recommend against following modern medicine practices, including drugs, medical testing and
surgery.
 Naturopathy is holistic system and it helps promote physical, mental/emotional, social and
spiritual health by self-regulation of life activities on a normal and natural basis. It requires real
efforts, will power and proper discipline to follow a naturopathic way of life.
 In fact, some elements of naturopathy are practices by all systems of medicine all over the
world e.g. regulation of diet and life activities etc.

138. HOMEOPATHY
 Homeopathy is a system of alternative medicine created in 1796 by Samuel Hahnemann. it is
based on the concept that diseases can be treated with drugs ( in minute dose) with which are
capable of producing the same symptoms in healthy people as the disease itself. Remedies used
in homeopathy are derived from plants extract and minerals extremely low concentration are
prepared in a specific way the more dilute the homoeopathic medicine the stronger it is
considered to be.

139. ORIGIN AND NATURE
 Homeopathy has been in practice for 170 years by thousands of practitioners and
there are over 100 homeopathy journals and worldwide.
 It is based on the concept that diseases can be treated with drugs (in minute dose)
with which are capable of producing the same symptoms in healthy people as the
disease itself.

140. BASIC LAWS, DIAGNOSIS AND TREATMENT
 The law of direction of cure
 The law of single remedy
 The law of minimum doses
 The theory of chronic disease

141. UNANI
 Unani medicine is a term for perso-arabic traditional medicine as practiced in
Mughal India and in Muslim culture in south Asia and modern day central Asia.
 Unani postulates that the body contains a self-preservative power, which strives
to restore any disturbances within the limits prescribed by the constitution or state
of the individual.
 The physician merely aims to help and develop rather than supersede or impede
the action of this power.

142. ORIGIN AND NATURE
 The Unani system of medicine has its origin in Greece before Christ under the
patronage of Hippocrates and Galen.
 It was introduced in India around 11th century. Due to its acceptance and
continues use by the people, in course of time, it has become native to India and
is in great demand among people of certain states.

143. THEORETICAL BASIS-
 The unani, medicine is only therapeutic in nature but also deals with health
promotion and prevention of disease. It treats disease and provides remedies in a
systematic manner.
 Unani medicine is based on the concept of four humours i.e. phlegm, blood,
yellow bile and black bile. The hormones are assigned temperature i.e., blood is
hot and moist, phlegm is cold and moist, yellow bile is hot and dry and black bile
is cold and dry.
 Any change or disturbances in hormones brings about change in temperature of a
person affecting his health status. As long as 4 hormones are in balance the
individual remain healthy.

144. DIAGNOSIS AND TREATMENT-
 The diagnosis of a disease is done by feeling pulse, observation of urine, stool,
colour of skin and gait etc.
 The treatment compromises of 3 components namely preventive, promotive and
curative. Treatment is done out in 4 forms i.e. Pharmaco theory (natural drugs
mainly herbal), dieto therapy, regimental therapy and surgery.

145. SIDDHA-
 Siddha medicine is a system of traditional medicine originating in ancient
tamilakam (tamilnadu) in south India and Shri Lanka. It is very similar to
Ayurveda,
 The only difference appears to be that siddha medicine recognizes predominance
of Vaadham, Pittham and Kapam in childhood, adulthood and old age,
respectively, whereas in Ayurveda it is totally reversed. In the siddha system,
chemistry has been well developed into a science auxiliary to medicine.

146. ORIGIN AND NATURE
 Siddha is one of the oldest system of medicine in India.
 The term siddha implies achievement.
 It was practised by “sidharas” who aimed to maintain perfect health in order to
achieve siddhi or heavenly bliss.

147. BASIC PHILOSPHY
 The basic philosophy of siddha is that there is an intimate link between man and
environment.it believes that all objects in the universe including human body are
composed of 5 elements -earth, water, fire, air and space or ether.
 The food we eat and the drugs which are in use are also made up of these
elements.

148. DIAGNOSIS AND TREATMENT-
 The diagnosis of diseases include identifying its causes. Causative factors are
identified by examination of pulse, eye. Colour of body, tongue, status of
digestive system, urine and study of voice. . This system of medicine emphasizes
on patients, environment, age, sex, habits, mental framework, diet and
physiological constitution of diseases for its treatment which is individualistic in
nature.
 Siddha medicine makes use of mercury, silver, arsenic, lead, sulphur etc.,
minerals, plants and animal parts. It is effective in treating chronic cases of
rheumatic problems, anaemia, peptic ulcers, bleeding piles, liver and skin
diseases.

149. ACUPUNCTURE
 It is an ancient Chinese form of medicine, which involves the insertion of pins in
certain vital points of the body. It is used for the treatment for chronic pain
conditions such as arthritis, headache and posttraumatic and post-surgical pain.
 It generally used only in combination with other form of treatment.
 It is generally safe when done by an appropriately trained practitioner using
clean needle technique and single-use needles. When properly delivered, it has a
low rate of mostly minor adverse effects.

150. ACUPRESSURE
 It is an alternative medicine technique similar in principal to acupuncture.
 It is based on the concept of life energy which flows through meridians in the
body.
 It is the application of pressure or localized massage to specific sites on the body
to control symptoms such as pain or nausea.

151.  This therapy is also used to stop bleeding. It is derived from traditional Chinese
medicine, which is a form of treatment for pain that involves pressure on
particular points in the body known as acupressure points.

152. NATIONAL AYUSH MISSION (NAM)
 Department of AYUSH, Ministry of Health and Family Welfare, Government of India
has launched National AYUSH Mission (NAM) during 12th Plan for implementing
through States/UTs.
 The basic objective of NAM is to promote AYUSH medical systems through cost
effective AYUSH services, strengthening of educational systems, facilitate the
enforcement of quality control of Ayurveda, Siddha and Unani & Homoeopathy (ASU
&H) drugs and sustainable availability of ASU & H raw materials.

153. VISION
 To provide cost effective and equitable AYUSH health care throughout the country by
improving access to the services.
 To revitalize and strengthen the AYUSH systems making them as prominent medical streams in
addressing the health care of the society.
 To improve educational institutions capable of imparting quality AYUSH education.
 To promote the adoption of Quality standards of AYUSH drugs and making available the
sustained supply of AYUSH raw-materials.

154. OBJECTIVES
 To provide cost effective AYUSH Services, with a universal access through upgrading AYUSH Hospitals and
Dispensaries, co-location of AYUSH facilities at Primary Health Centres (PHCs), Community Health Centres
(CHCs) and District Hospitals (DHs).
 To strengthen institutional capacity at the state level through upgrading AYUSH educational institutions, State
Govt. ASU&H Pharmacies, Drug Testing Laboratories and ASU & H enforcement mechanism.
 Support cultivation of medicinal plants by adopting Good Agricultural Practices (GAPs) so as to provide
sustained supply of quality raw materials and support certification mechanism for quality standards, Good
Agricultural/Collection/Storage Practices.
 Support setting up of clusters through convergence of cultivation, warehousing, value addition and marketing and
development of infrastructure for entrepreneurs.

155. COMPONENTS OF THIS MISSION
MANDATORY COMPONENTS
a. AYUSH Services
b. AYUSH Educational Institutions
c. Quality Control of ASU &H Drugs
d. Medicinal Plants

156. FLEXIBLE COMPONENTS
a. AYUSH Wellness Centres including Yoga & Naturopathy
b. Tele-medicine
c. Sports Medicine through AYUSH
d. Innovations in AYUSH including Public Private Partnership
e. Reimbursement of Testing charges
f. IEC activities
g. Research & Development in areas related to Medicinal Plants
h. Voluntary certification scheme: Project based.
i. Market Promotion, Market intelligence & buy back interventions
j. Crop Insurance for Medicinal Plants

157. SCHEME OF GRANT-IN-AID FOR PROMOTION OF AYUSH
INTERVENTION IN PUBLIC HEALTH INITIATIVES.
 Increasing awareness about AYUSH’s strength in solving community health
problems resulting from nutritional deficiencies, epidemics and vector-borne
diseases have opened vistas for AYUSH in Public health.
 This scheme aims to provide grant-in-aid to Government / Non-Government
organizations for the roll out of only proven AYUSH interventions for improving
health status of the population through AYUSH interventions, like distribution of
medicines, organizing Health awareness camps etc.

158. OBJECTIVES OF THE SCHEME
 The scheme is being implemented with a district/block/Taluk as a unit
for the roll out of only proven AYUSH interventions by the following
methods:-
(i). Supporting innovative proposals for both Government organizations as
well as private organizations.
(ii). To promote AYUSH intervention for community health care.
(iii). To encourage institutionally qualified AYUSH practitioners.
 (iv). To encourage utilization of AYUSH practitioners in different public
health programmes.

170. ECONOMICS
 Economics is the science of scarcity. It analyses how choices are structured and prioritized to
maximize welfare within constrained resources.
 The discipline of economics deals with use of scarce resources to satisfy human wants and
needs how best to use the resources available.

171. OTHER DEFINITIONS
 Study of wealth
Economics as a science which studies the nature and causes of national wealth. BY ADAM SMITH
 Study of welfare
A study of mankind in the ordinary business of life; it examines that part of the individual and social
action which is most closely connected with the attainment and use of the material requisites of
wellbeing. BY MARSHALL
 Study of scarcity
The science which studies human behavior as a relationship between ends and scarce means which have
alternative uses. BY ROBBIN

172. HEALTH ECONOMICS DEFINITION
 Health economics is the study of distribution of health care. It is a branch of economics concerned with issues
related to efficiency, effectiveness, value and behavior in the production and consumption of health and health
care.
 Health economics is concerned with the use of resources affect the health care industry. (Jacobs-2002)
 Health economics is the discipline that determines the price and the quantity of limited financial and non- financial
resources devoted to the care of the sick and promotion of health(Gupta &Mohanjan-2003)

173.  Health economics is the study of how scarce resources are allocated among alternative uses for
the care of sickness and the promotion, maintenance and improvement of health, including the
study of how health care and health-related services, their costs and benefits, and health itself
are distributed among individuals and groups in society.

174. GOALS OF HEALTH ECONOMICS
 The goals of health economics is like the goals of public health - to
provide the best care to the largest number of people given
available resources.

175. FIRST GOAL
 Preventing The Deprivation of Care

176. SECOND GOAL
 Avoiding Wasteful Spending

177. THIRD GOAL
 Allowing Health Care to Reflect Patients' Preferences

178. USES OF HEALTH ECONOMICS
 Health economics is used to promote health
 Health economics can also be used to evaluate certain social problems
 Health economics can then be used to directly inform government
 The main focus of health economics is to provide the maximum benefits for the
money invested in health care

179. NEED FOR HEALTH ECONOMICS
 Medical advances
 Due to increase in life expectancy
 Changes in family structure and norms
 Advances in health research
 Higher expectation among people public awareness

180. IMPORTANCE OF HEALTH ECONOMICS
 To formulate health services
 To establish the true costs of delivering health care.
 To evaluate the relative costs and benefits of particular policy options
 To estimate the effects of certain economic variables on the utilization of health services.

181. FEATURES OF HEALTH ECONOMICS
 Health and medical care is considered as economic goods.
 Health is a private or a public good.
 Measurement of health is also considered in economics.
 Stock of health.
 Investment aspects of health.
 Loss due to ill health.
 Resource costs of different diseases, effects of health and medical care provision.
 Planning of health and medical care.
 Choice of technology in health care system, etc.
 Provision of equity in health outcomes and health care;

182. AREAS OF HEALTH ECONOMICS
 Economic aspects of relationship between health status and productivity.
 Financial aspects of health care services.
 Economic decision making in health and medical care institutions.
 Planning of health development and such other related aspects.

183. HEALTH CARE FINANCING
 Refers to the amount of money available for health care and related activities, the
medical education, health research, population control, nutrition improvement
etc.
 The Indian government is responsible for the most of the funding.

184. HEALTH ECONOMIC AT FAMILY LEVEL
 The family takes the advantage of the routine immunization services.
 Obtain health insurances for themselves.
 When they feel ill, they can seek consultation from a qualified medical practitioner.
 They follow healthy lifestyles by avoiding smoking, drinking, excess salt, junk foods and
indulge in meditation, exercises, yoga etc.

185. SCOPE OF HEALTH ECONOMICS
 What influences health? (other than health care)
 What is health and what is its value
 The demand for health care
 The supply of health care
 Micro-economic evaluation at treatment level
 Market equilibrium
 Evaluation at whole system level; and,
 Planning, budgeting and monitoring mechanisms.

186. FACTORS EFFECTING HEALTH ECONOMICS
 Population trends
 Growing numbers of dependent population
 Educational level
 Poverty
 Advancement in nursing
 Poor government support
 New and re-emerging infectious disease
 Disaster and natural calamities

187. THEORIES OF ECONOMICS

188. MICROECONOMICS:
 Microeconomics is the study of economic behavior of individual decision making units such as: consumers,
resource owners and business firms in a free enterprise economy.
 This can be measured by conducting market surveys, pilot and feasibility studies.
 It has following factors:-
 Supply and demand
 Efficiency

189. MACROECONOMICS
 Macroeconomics is the branch of economics that studies the behaviour and performance of an
economy as a whole.
 It focuses on the aggregate changes in the economy such as unemployment, growth rate, gross
domestic product and inflation.
 It deals with the large- scale or general economic factors, such as interest rates and national
productivity.
 It has two factors:-
 GNP
 GDP

190. ECONOMIC ANALYSIS
 There are four main types of economic analysis in health:
Cost- minimization
Cost benefit
Cost effectiveness
Cost utility

192. SCARCITY
 Scarcity exists in all walks of life. No one can buy or be provided with everything for indefinite time.
 In this context the economist's notion of scarcity is of special interest.
 The health needs (whether perceived from the angle of the professional providers or from the point of view of community
needs) are infinite whereas the resources are definitely limited in India as elsewhere.
 For this reason alone welfare government everywhere try to ensure that economic thinking is built more closely in planning
and decision making process, keeping the cardinal concept of scarcity in view.

193. DEMAND
 It is, the type, quantity and quality of services or commodities wanted or requested.
 But the demand for health and medical care in strict economic sense, is a function of:
 Consumer’s income
 The price of medical care relative to the prices of other goods
 Preferences of consumers, including their perceptions about health and health care.

194. POVERTY LINE
 Poverty line refers to, the cut-off point of income below which people are not able to
purchase food sufficient to provide 2400 kcal per head per day.
This income level has been fixed by the planning commission at Rs. 119.50 in rural areas and
at Rs. 138 in urban areas at 1987-88 prices.

195. COST
 It refers to the resources which are spent in carrying out health activities so far as the health care sector is concerned.
 In general, costs can be classified into two broad groups:-
 Capital costs: - These costs are borne irrespective of the workload of any health center and are fixed. These may include-
Building, i.e. the health centre, hospital etc.
 Operating costs: - These costs are related to the level or type of activity in a health institution. Some operating costs will
change daily and some from year to year.
 These operating costs include:
 Salaries, wages and allowances of health staff at different levels
 Medical supplies, drugs etc
 Transport operating costs
 Maintenance and repairs
 Training
 Power
 Other miscellaneous items

196. OTHER CONCEPTS RELATED TO COSTS
 MARGINAL COSTS: - These refer to the amount, at any given Volume of output, by which aggregate costs are
changed if the volume of output is increased or decrease by one unit. These costs occur when one more unit is
added.
 The concept of marginality is also applicable to benefits, value, income and production. It reflects the changes in
total cost at a given scale of output when a little more or little less output is produced.
 SOCIAL COSTS: - It is the cost of health activity to the society and not merely or solely to the agency, institution
or sector carrying out the activity.
 UNIT COSTS: - It is also known as average costs. It is the total cost of an activity divided by the number of units
of output produced.

197.  OPPORTUNITY COSTS: - It implies that the cost of providing one form of health care should always be
balanced against the benefits which have to be sacrificed. So, one possible economic approach for the health
manager is to consider:
 a. What is the most valuable thing we are doing?
 b. What is the most valuable thing we are not doing? And,
 c. What shift of health resources is needed if the latter is greater than the former, i.e., B is greater than A.
 Opportunity costs operate not from the angle of the provider manager alone but also from the angle of the
consumer or the beneficiary of health services. Nothing is free for the consumer even if it appears to be given free,
the consumer has to incur some opportunity cost in terms of travelling time, transportation cost, loss of leave or
wages etc.
 COST COUNTING: - Cost accounting can be defined as the process of manipulating or rearranging the data or
information in the existing accounts in order to obtain the cost of services rendered by an organization. Cost
accounting assists the health administrators in controlling the cost and monitoring the progress of various services.
Thereby, it can lead to rational allocation of scarce health resources.

198. BENEFIT
 The benefit of health program or project are the desired effects of the program.
 COST BENEFIT ANALYSIS
 It refers to a formalized way of comparing the advantages (benefits) and disadvantages (costs) of undertaking an activity,
project and program. It is an economic technique applicable to-
 Health planning
 Health management, and
 Evaluation
 Which scheme or combination of schemes will contribute most to achievement at a fixed given investments.
 COST- EFFECTIVE ANALYSIS
 It is formal planning and evaluation technique having both economic and technical component.
 It involves organizing information so that the costs of alternatives and their effectiveness in meeting a given objective can be
compared systematically.

199. BUDGET
 The budget is a systematic economic plan for a specific period of time.
 It incorporates politically and technically determine in what way and for what purpose various
health resources are to be used.
HEALTH FINANCING
 It refers to the raising of resources to pay for goods and services related to health. These
resources may be in the form of “cash” or “kind”.

200. HEALTH ECONOMICS IN NURSING
 Nurses play a central role in cost containment, care quality, and patient safety.
 Nurses actively engages in leading efforts to improve patient care and reduce costs.
 Health care Issues and Trends.
 Governing on Behalf of Stakeholders.
 Monitoring Financial Performance.
 Building a Culture of Quality and Safety.
 Monitoring Quality Performance.
 Set policy that guides care delivery.
 Set strategy to help ensure the future health of a vital community resource.
 Assume a valued community leadership role.
 Help the boards identify, clarify, and focus on the wants and needs of the patients.

201. BIBLIOGRAPHY
 PARK,K , TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE, BHANOT
PUBLISHERS, 2007
 GULANI, K.K COMMUNIT HEALTH NURSING: PRACTICES AND PRINCIPLES,
KUMAR PUBLISHERS
 PATNEY,S. TEXTBOOK OF COMMUNITY HEALTH NURSING, MODERN
PUBLISHERS,2005
 FREEMAN,RUTH B.COOMUNITY HEALTH NURSING PRACTICE, W.B
SAUNDERS
 https://en.wikipedia.org/wiki/Ministry_of_AYUSH
 https://www.slideshare.net/ancychacko89/health-economics-44873042
 MC GUPTA & BK MAHAJAN, TEXTBOOK OF PREVENTIVE AND SOCIAL
MEDICINE, JP PUBLISHERS