This document discusses the concept of positive health and the determinants of health. It defines health according to the WHO as a state of complete physical, mental and social well-being. It describes positive health as having optimal biological, psychological and social functioning. The document outlines the many factors that influence health, including where we live, what we eat, our environment, genetics, relationships, and socioeconomic status. It categorizes the determinants of health as biological, behavioral, environmental, and social/economic factors.

1. Dr. Sharon Baisil
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2. OVERVIEW
• Introduction
• Concept of positive Health
• Spectrum of Health
• Determinants of Health
Definition
Types
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3. • Industrial revolution of 18th century sparked
numerous health problems due creation of slums,
over-crowding, accumulation of filth in cities and
towns leading to high burden of sickness and death
among women and children.
• Edwin Chadwick’s report “THE SANITARY
CONDITION OF THE LABOURING
POPULATION IN GREAT BRITAIN” a land mark in
the history of public health created tremendous
awareness among the people about the importance of
health.
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4. • Many factors like where we live, what we eat, how
much we earn, state of our environment, our genetic
composition, our relationship with friends and family
have a significant impact on our health.
• THE CONTEXT OF PEOPLE’S LIVES
DETERMINE THEIR HEALTH, and so blaming
individuals for having poor health or crediting them
for good health is in-appropriate.
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5. Definition of Health
According to WHO, “Health is a state of complete
physical , mental and social well-being and not
merely an absence of disease or infirmity and hence
an ability to lead a socially and economically
productive life.”
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6. CONCEPT OF POSITIVE HEALTH
• Biological-Every cell and organ is functioning at
optimum capacity and in perfect harmony with
rest of the body.
• Psychological-Individual feels a sense of well-
being and of mastery over his environment.
• Social-Individual’s capacity for participation in
social system is optimal.
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7. • It emphasizes that health of an individual is a
dynamic phenomenon.
• A process of continuous change subjected to frequent
subtle variations.
• A state , not to be attained once for all but renewed
for ever.
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8. contd
• Health fluctuates within a range of optimal 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 other state
begins.
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10. • Health is a multi-factorial state.
• It depends on multiple interactions and these
interactions may be Health-promoting or
deleterious.
Definition
Factors that contribute to a person’s current state
of health. These factors may be biological, socio-
economic, psychosocial, behavioral etc.
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11. IMPORTANCE OF HEALTH
DETERMINANTS
“ Common diseases have roots in lifestyle, social
factors and environment and successful health
promotion depends upon a population based
strategy of prevention.”
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12. A comprehensive health determinants frame
work should achieve the following
1. Identify the determinants of health and the
determinants of inequities in health.
2. Show how major determinants relate to each other.
3. Clarify the mechanisms by which social
determinants generate health inequities.
4. Provide criteria for evaluating which determinants
are the most important to address.
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13. HEALTH
Biological
Behavioral
Environment
Socio-
economic
Health
system
Socio-
cultural
Aging
Science &
Technology
Information
&Commun-
ication
Gender
Equity &
Social
justice
Human
Rights
societies
family
community
individuals
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14. 1. Biological
• It includes genetic composition of an individual.
• The genetic make-up is unique for every
individual and cannot be altered after conception.
• Any defect or derangement in the genetic
constitution may result in serious disorders.
Example-Downs syndrome, in born errors of
metabolism
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15. 2.Environmental
• Hippocrates- first person to relate
disease to environment.
• Has a direct impact on physical,
mental and social well-being.
Broadly classified into INTERNAL and EXTERNAL.
Internal- every component, tissue, organ and organ
system and their harmonious functioning within the
system
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16. External:
• Physical: components like clean air, clean water,
good houses, good roads and safe work environment
promote health.
• The changing climatic condition is also a matter of
major concern for health of the people.
• Biological: Infectious agents causing diseases like
bacteria, fungi, viruses, parasites etc.
• Psychosocial: Negative life-events, high debt burden,
lack of social support.
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17. • Environmental components are not water-tight
compartments.
• If the environment is favourable, Individual can
make full use of his physical and mental capabilities.
• A person should maintain a healthy relationship with
environment because- “Environment can transform
genotypic potentialities into phenotypic realities”.
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18. 3.Behavioral
• It includes the PERSONAL LIFESTYLE. Life long
personal habits that one develops through the process
of SOCIALISATION.
eg- smoking, alcohol consumption, use of drugs,
unhealthy food habits, sedentary lifestyle.
• Changing pattern of diseases can be mainly attributed
to behavioral determinants.
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19. High prevalence of chronic non-communicable
diseases are attributed to LIFESTYLE
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21. 3. Social Determinants
Broadly classified into 2 types
1. Socio-cultural determinants.
2. Socio-economic determinants.
The various social determinants are
1. Poverty.
2. Over-crowding.
3. Poor housing condition.
4. Malnutrition.
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22. 5. Social inequity.
6. Illiteracy.
7. Un-employment.
8. Political system of country.
9.Customs and traditions.
10. Lack of social support.
11. Health services.
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23. FRAMEWORK OF SOCIAL DETERMINANTS OF HEALTH
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24. POVERTY
Wields a destructive influence
from birth to grave.
Main cause for low birth weight
babies, un-vaccinated children, high maternal mortality,
mental illness, family disintegration and substance
abuse.
Leads to lack of access to health care, education, resources
and means to improve lives.
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25. Economic status determines the purchasing power,
standard of living, the family size and the pattern of
disease.
Economic progress is the major factor in reducing
morbidity, improving life expectancy and quality of
life
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26. Education:
• Critical in determining people’s social and
economic position and thus their health.
• Children who do well in education more likely to
make healthier choices in adult life.
• Illiteracy leads to poverty, malnutrition, ill-health,
high infant and child mortality rates.
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27. Occupation
• Main factor determining adequate income is participation
in productive employment.
• It enhances the social status, improves self-esteem,
provides social contact and a way of participation in
community life.
• Un-employment is detrimental to both physical and
mental health
Few occupations will have a negative impact on health
Eg- people working in asbestos industry prone to develop
lung cancer.
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28. Political system and Health services
• Political system is important in decisions concerning
1. Resource Allocation
2. Manpower policy
3. Choice of technology
4. Degree to which health services are made available
and accessible to different segments of the society.
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29. Health care services are the one performed by health
care professionals or by others under their directions
for promoting, maintaining or restoring health.
To be effective the health services should reach social
periphery, equitably distributed, accessible at a cost
the country and community can afford and socially
acceptable.
These are the ingredients of primary health care which
is a way to better health.
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30. Public health specialists play an important role in
planning and managing health services.
Social inequity is also a social health determinant of
major concern.
The Alma-ata declaration(1978) on primary health care
stressed upon the special health needs of poor and
vulnerable populations and hence health equity as a
policy goal emerged strongly in international debates.
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31. The declaration of Alma-ata
• Education about prevailing health problems and
methods to prevent them
• Promotion of food supply and nutrition
• Supply of safe water and basic sanitation
• Maternal and child health care
• Immunization against infectious diseases
• Prevention and control of endemic diseases
• Appropriate treatment of common diseases and
injuries; and
• Provision of essential drugs.
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32. ECOLOGY OF HEALTH
• Science of mutual relationship between living
organisms and environment.
• Dubos stated that, “health implies the relative absence
of pain and discomfort and a continuous adoptation
and adjustment to the environment to ensure optimal
function.”
• Disease is a mal-adjustment of the human organism
to environment.
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33. The Ecological concept of Health is based on 3
biological laws.
1. Disease results from an imbalance between disease
agents and host.
2. The nature and extent of the imbalance depends on
the nature and characteristics of the host and the
agent.
3. The characteristics of the agent and the host and
their interactions are directly related to and depend
largely on the nature of physical, social and biologic
environment.
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34. • The dynamic concept of ecology of health can be best
illustrated by the familiar principle of LEVER AND
FULCRUM.
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36. 36
DISEASE AGENTS
Parasitic, nutrient ,chemical, physical
or Mechanical
These affect equilibrium through
1. Their basic nature and character
2. Resistance and liability
3. Reservoirs and sources
4. Conditions of dissemination.
These determine the balance of health
and preventive attack
HUMAN HOST
1. Interaction with agents
2. Individual habits and group
custom
3. Age, sex and race
characteristics
4. Defense mechanisms
5. Constitution and heredity
6. Psychological characteristics
Changes upset balance
At Equilibrium
Environment
The aggregate of all external
conditions and influences affecting the
life and development of organism. Human
behavior or society
Variable
fulcrum
position
Variable
fulcrum
position

37. • Man’s intrusion into ecological system has
given raise to many health problems.
• Urbanization , deforestation, industrialization,
construction of irrigation canals and artificial
lakes have a devastating effect on the natural
environment.
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38. • Environmental factors and ecological considerations
must be built into total planning process to prevent
degradation of ecosystems.
• Prevention of disease through Ecological or
Environmental manipulations or interventions is
much safer, cheaper and a more effective rational
approach than all other means of control.
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39. RIGHT TO HEALTH
• Human Rights in the year 1948 stated that “Everyone
has the right to a standard of living adequate for the
health and well-being of himself and his family.”
• The preamble of WHO constitution also states that “It
is the fundamental rights of every human being to
enjoy the highest attainable standard of health.”
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40. THANK YOU
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