This document discusses the concept of health according to the WHO definition and its four dimensions: physical, mental, social, and spiritual. It outlines the determinants of health including factors like age, sex, lifestyle, social networks, living/working conditions, and socioeconomic/environmental conditions. Finally, it discusses the principles of primary health care (PHC) as outlined at the International Conference on PHC in Alma-Ata in 1978, including equitable distribution of resources, community participation, intersectoral coordination, appropriate technology, and disease prevention/control.

1. Course:
Primary Health Care/Family Health
Sub-unit 1.1: Health care of people:
Concept of health
Unit 1: Primary Health Care (PHC)

2. Concept of health:
A multidimensional entity cannot be conceptualized through its
one facet. Health is concern of every body in the society.
Different may perceive health in different way.
WHO definition of health:
“Health is state of complete physical, mental, social and
spiritual well-being and not merely an absence of disease and
infirmity.”

3. Dimensions of health
1. Physical dimension:
Optimal physical normality, proper functioning of
body cell, tissue, organ, and system.
Dominated by mechanical and biomedical model
of body.
2. Mental dimension:
Optimal harmony between individual and the
surrounding reality leading to state of non-
conflicting situation. For example feeling good,
feeling able to cope.

4. 3. Spiritual dimension:
It is the recognition and ability to put into
practice moral or religious principles or beliefs.
The two outer circles are broader dimensions of
health, which affect the individual.
4.Social dimension:
It refers to the link between health and the way a
society is structured. This includes the basic
infrastructure necessary for health (for example:
shelter, peace, food, income etc.) and the degree
of integration or division within society.

5. DETERMINANTS OF HEALTH
Ill health does not happen by chance or through bad luck. There are
various factors, which affect health, and those factors are often
referred as determinants of health. They are:
 Age, sex and hereditary factors
 Individual life style factors
 Social and community networks
 Living and working conditions and access to facilities and
services
 Economic, cultural, and environmental conditions such as
standards of living or the labor market.

6. 1. Age, sex and hereditary factors:
Age determines person's exposure to different
environmental hazards, access to community services and
level of immunity.
The natural selection or genetic explanation suggests that
women are more resistant to infection and benefit from a
protective effect of estrogen accounting for their lower
mortality rates. Paradoxically, female hormones and the
female reproductive system are claimed to render women
more liable to physical and mental ill health.

7. cont…
Men are encouraged to be aggressive and risk taking both
at work and in their leisure time leading to higher rates
for accidents and alcoholism.
Women of old age suffer more from depression and
osteoarthritis than men of same age.
There are also some diseases, which are largely
determined by genetic make up. For example: cancer,
diabetes mellitus etc.

8. 2. Individual life style factors
It is composed of cultural and behavioral patterns and life
long personal habits developed through process of
socialization. Health requires the adaptation of healthy life
style. Many health problems like coronary heart disease,
obesity, lung cancer, drug addiction etc are associated with
lifestyle. Lifestyles affecting health are sanitation habit,
nutrition, personal hygiene, food choice, physical exercise
etc.

9. 3. Social and community networks:
It includes influences of religion, ethnic group, family, peer group etc.
Poor health of ethnic minority is associated with the low income,
poor working conditions or unemployment and poor housing shared
by those in lower social classes or ill health resulting from the
experience of racism and institutionalized discrimination in health
care and their culture too.
Religion: special traditional practices of religion also have both
positive and negative impact on individual health.
Family: size of family, economic status of family, intra household
resource distribution etc also has impact on health.
Peer group: peer pressure is very strong among adolescents and
youths. Health problems like drug addiction, risk-taking behavior
etc have strong peer influence.

10. 4. Living and working conditions and access to facilities
and services:
It includes agriculture and food production, education, work
environment, unemployment, water and sanitation, health care
services, housing etc.
• Agriculture and food production: It affects nutritional status of child
and mother, food security at household and community level etc
• Education: Educational status determinations know how about cause
of diseases and ill health, capacity to learn, access to services etc.
• Work environment: Occupational health problems like TB,
Brucellosis, injuries, silicosis, bagasosis etc are attached with work
environment.

11. • Unemployment: It leads to poor economic status, tension,
frustration, social problems, unfulfillment of basic need etc.
• Health care services: Provision of essential health care services,
accessibility and appropriateness of health services determines
the health status of people.
• Housing: Housing quality can damage health. The particular
problems of homelessness, which include respiratory illness,
depression, high rates of infection among children, accidents
etc. cold and damp housing have been shown to contribute to
illness.

12. 5. General socio economic, cultural, and environmental
conditions
It includes social class and health, income and
health, place of residence and health, social
cohesion and exclusion, culture, environmental
pollution etc.
• Social class and health: social class serves as an
indicator of the way of life and living standards
experienced by different groups. It correlates with
other aspects of social position such as income,
housing, education and working and living
environments. For example: hypertension, heart
problems among those of high social status. TB,
communicable diseases among lower groups.

13. • Income and health: income is a major determinant
of standard of living and variations in ill health and
premature death reflect differences in levels of
income, material deprivation: low income can affect
health through:
 Physiological: inadequate or unfit housing, lack of
food, lack of fuel
 Psychological: stress and lack of social support
 Behavioral: health damaging behaviors such as
smoking or drinking or giving children sweets are
ways of helping people to cope with the demands of
disadvantage. Poverty also reduces people's choices
of a healthier lifestyle.

14. • Place of residence and health: different in health status and health
problem in different ecological zone and developmental region.
Difference between urban and rural as well as between high
altitude and low altitude.
• Social cohesion and exclusion: there is a growing body of evidence
demonstrating that it is relative inequalities in income and material
resources, coupled with the resulting social exclusion and
marginalization which is linked to poor health. The degree to which
an individual is integrated in to society and has a social support
network has been shown to have a significant impact on health.
Research has shown that those with few friends or family are more

15. • Culture: it has both positive and negative impact on
health through shaping social practice, customs and
individual life style. For example during pregnancy,
childbirth, son preference, food distribution and
consumption pattern in home etc.
• Environmental pollution: it is great concern in the
present world. Air pollution, water pollution, radiation
hazard, noise pollution have direct negative impact on
health.

16. Characteristics features of a physically,
mentally and socially healthy person:
• Normal weight, Height and posture
• Vibrant and flawless skin, Clear Eyes
• Good flexibility
• Healthy habits
• Is free from sickness and diseases, social and mental stress.
• Shows no unnecessary anxiety.
• Has self- confidence.
• They feel good about themselves.
• They have lasting and satisfying personal relationships.
• They feel comfortable with other people.
• They can laugh at themselves and with others.
• Has organs and organ system which are healthy and function
properly.

17. In 1977, it was decided in the world health assembly to launch
a movement known as "health for all" by the year 2000.
Health for All
"Attainment of a level of health that will enable every
individual to lead a socially and economically productive life."
HFA means
• Health begins at home, in schools, and in factories. It is
there, where people live and work that health is made or
broken.
• People will use better approaches than they do now.
• There will be an equitable distribution of resources for
health.
• People will realize that they themselves have the power to
shape their lives and the lives of their families; free from the
avoidable burden of diseases and aware that ill health is not
inevitable.

18. The declaration of ALMA-ATA , adopted in 1978 at the
international conference on primary health care stated that
primary health care (PHC) was the key to attaining health for all
as part of overall development.
• The conference defined PHC as "An essential health care
based on practical, scientifically sound and socially
acceptable methods and technology made universally
accessible to individuals and families in the community
through their full participation and at a cost that the
community and the country can afford."

19. Principles of PHC
• Equitable distribution
• Community participation
• Intersectoral coordination
• Appropriate technology
• Disease Prevention & Control

20. 1. Equitable distribution:
• PHC as an approach emphasis equity and justice, believing
strongly that health is a basic right of every individual and
not just of those who can afford to pay for their own health
care. Services should be physically, socially and financially
accessible to everyone. People with similar needs should
have equal access to similar health services.
• to ensure equal access, the distribution of resources and
coverage of PHC services should be greatest in those areas
with the greatest need.

21. 2. Community participation:
PHC further believes that people must be given an opportunity to
exercise control over their own lives and their environment and take
responsibility for their own health. Community should participate in
the following:
• Creating and preserving a healthy environment
• Maintaining preventive and promotive health activities
• Sharing information about there needs and wants with higher
authorities.
• Implementing health care priorities and managing clinics and
hospitals

22. 3. Intersectoral coordination:
PHC recognizes that health is the outcome of a complex set of
socio-cultural and economic ,as well as physical and biological
factors. It requires a coordinated effort with other health related
sectors whose activities affect health for example agriculture,
water and sanitation, transportation, education etc.

23. 4. Appropriate technology:
Appropriate technology means that besides being scientifically
sound , the technology is also acceptable to those who apply it
and to those for whom it is used. This implies that technology
should be in keeping with the local culture. It must be capable of
being adapted and further development if necessary care givers
should be trained to deliver services using the most appropriate
and cost effective methods and equipment for their level of
care.

24. 5. Disease Prevention & Control
• The newly added principle of PHC is disease prevention and
control.
• It covers a wide range of social and environmental
interventions that are designed to benefit and protect
individual people’s health and quality of life by addressing and
preventing the root causes of ill health, not just focusing on
treatment and care. All these interventions can be achieved
by PHC.

25. ELEMENTS of PHC
1. Education concerning prevailing health problems and methods
of identifying, preventing and controlling them.
2. Locally endemic disease prevention and control.
3. Expanded program on immunization against major infectious
diseases.
4. Maternal and child health care including family planning.
5. Environmental sanitation, safe & wholesome water supply.

26. ELEMENTS of PHC
6. Nutritional food supplement, an adequate supply of safe and
basic nutrition.
7. Treatment of simple/minor disorder, communicable and non-
communicable diseases.
8. Supply of essential drugs
9. Mental health promotion
10. Dental health
11. School health

27. • Q. Define Prevention. Describe the
different levels of disease
prevention.

28. Concept of prevention
Hinder (stop) something from happening.
In public health:
• Prevention of disease
• Prevention of adverse events
• Prevention of unhealthy behaviors
Prevention: creating barriers between source and host through
the interventions at:
o Source
o Media
o Host
o At all

29. Controlling reservoir, interruption in mode of
transmission and protecting susceptible host.
Source of infection
or Reservoir
Mode of Disease
Transmission
Susceptible Host

30. The goals of medicine are to promote health, to preserve health, to
restore health when it is impaired, and to minimize suffering and
distress.
These goals are embodied in the word prevention. Successful
prevention depends upon a knowledge of causation, dynamics of
transmission, identification of risk factors and risk groups,
availability of prophylactic or early detection and treatment
measure, an organization for applying these measures to
appropriate persons or groups and continuous evaluation of and
development of procedure applied.

31. Definition of Prevention
• Activities to stop people from getting diseases or to stop a
disease from getting worse.
• ‘‘Prevention is the action aimed at eradicating, eliminating or
minimizing the impact of disease and disability’’.
- John M Last.

32. Level of disease Prevention
• Primordial Prevention
• Primary prevention
• Secondary prevention
• Tertiary prevention

33. 1. PREMORDIAL PREVENTION
It is the prevention of emergence or
development of risk factors that never yet
present. It is the behavioural change applied to
discourage from adopting harmful lifestyle such
as alcoholism, smoking, eating pattern etc.

34. 2. PRIMARY PREVENTION
It is the action taken prior to onset of disease that
will even occurs. It includes; health promotion
(Health Education, Environmental Sanitation,
Nutrition, Personality development etc), and
Specific Protection(Immunization, Contraception,
personal hygiene etc.)

35. 3. SECONDARY PREVENTION
It is the action that stop the progress of disease
at its incipient stage and prevent complication. It
includes; early diagnosis and Prompt and
adequate treatment, case finding and
surveillance, screening tests, laboratory
investigations etc.

36. 4. TERTIARY PREVENTION
It is the all measures available to reduce impairment
and disability, minimize the suffering caused by
existing departure from good health and promote
patient’s adjustment to immediate condition. It
includes disability limitation and rehabilitation.
Rehabilitation includes; Physical, Psychological, Social,
vocational and economic rehabilitation.

37. Level of
prevention
Stage of disease
progression
( Pathogenesis)
Mode of
intervention
Target
population
Example of
intervention
Primordial Before man is
involved
Health
promotion
Population Avoiding risk
behavious e.g.
smoking
Primary Early
pathogenesis
Specific
protection
Population
(risk
group)
Immunization
Secondary Late
pathogenesis
Early
diagnosis and
prompt
treatment
Patients Treatment of
TB
Tertiary Advanced
stage of disease
Different
aspects of
rehabilitation
Patients Social inclusion
of women
rescued from
brothels

38. Q. Define Prevention. Differentiate
preventive, promotive , curative and
rehabilitative health services with suitable
example.

39. Preventive Health Services:
• It covers promotion, preservation and
rehabilitation of health and minimizes suffering
and stress.
• It is mainly focus to reduce morbidity and mortality
of child and mother.
• It is the service that providing in an integrated
manner throughout health system up to the local
level.
• It works through different level of prevention such
as primordial, primary, secondary and tertiary
prevention.

40. Promotive Health Services:
• It is the process of enabling people to increase
control over their health.
• It is the service that providing to improve the health
of people.
• It works through different interventions such as
health education, environmental modification,
nutrition intervention and lifestyle and behaviour
change.

41. Curative Health Services:
• It means diagnosis, treatment and necessary health
care.
• It is the service which made available at all health
institution, Central/Provincial/Zonal/District
hospitals, PHCCs, Health Post, Private Hospitals and
Clinics etc.
• It is the service provided through Allopathic
medicine, Ayurvedic Medicine, Unani Medicine,
Homeopathic and Natural Medicine etc.
• The expansion of hospital will be based on density of
population, patient’s load, focused on remote area.

42. Rehabilitative Health Service
• it is the service provided to restore an affected
individuals to useful.
• It is the service provided for complicated or more
severe type of problem.
• It is provided for clients by keeping them with care
giver itself making available at rehabilitation centre.
E.g. drug addiction centre, TB rehabilitation centre,
Leprosy rehabilitation centre, HIV/AIDS rehabilitation
centre etc.

43. INDICATORS OF HEALTH
A question that is often raised is: How healthy is a given community?
Indicators are required not only to measure the health status of a
community, but also to compare the health status of one country with
that of another; for assessment of health care needs; for allocation of
scarce resources; and for monitoring and evaluation of health
services, activities, and programs. Indicators help to measure the
extent to which the objectives and targets of a programme are being
attained.
Health indicator is the variable that used to measure changes in
health status. The various health indicators used to compose health
profile of Nepal which are given below -

44.  1. Mortality indicators
 2. Morbidity indicators
 3. Disability rates
 4. Nutritional status indicators
 5. Health care delivery indicators
 6. Utilization rates
 7. Indicators of social and mental health
 8. Environmental indicators
 9. Socio-economic indicators
 10. Health policy indicators
 11. Indicators of quality of life, and
 12. Other indicators.

45. 1. Mortality indicators
(a) Crude Death Rate(CDR):
This is considered a fair indicator of the comparative health of
the people. It is defined as the number of deaths per 1000
population per year in a given community. It indicates the rate at
which people are dying. Strictly speaking, health should not be
measured by the number of deaths that occur in a community.
But in many countries, the crude death rate is the only available
indicator of health. When used for international comparison, the
usefulness of the crude death rate is restricted because it is
influenced by the age-sex composition of the population.

46. (b) Expectation of life :
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 rates
persist".
Life expectancy is a good indicator of socioeconomic
development in general. As an indicator of long-term
survival, it can be considered as a positive health
indicator. It has been adopted as a global health
indicator.

47. (c) Infant mortality rate :
infant mortality rate is the ratio of deaths under 1
year of age in a given year to the total number of
live births in the same year; usually expressed as a
rate per 1000 live births. It is one of the most
universally accepted indicators of health status not
only of infants, but also of whole population and of
the socio-economic conditions under which they
live. In addition, the infant mortality rate is a
sensitive indicator of the availability, utilization and
effectiveness of health care, particularly perinatal
care.

48. (d) Child Mortality Rate :
Another indicator related to the overall
health status is the early childhood (1-4
years) mortality rate. It is defined as the
number of deaths at ages 1-4 years in a given
year, per 1000 children in that age group at
the mid-point of the year concerned. It thus
excludes infant mortality.

49. (e)Under-5 Mortality Rate(U5MR):
It is the proportion of total deaths occurring in the
under-5 age group. This rate can be used to reflect
both infant and child mortality rates.
(f.)Maternal Mortality Rate (MMR):
Maternal mortality accounts for the greatest
proportion of deaths among women of
reproductive age in most of the developing world.
although its importance is not always evident from
official statistics. There are enormous variations in
maternal mortality rate according to countrys' level
of socioeconomic status.

50. (g)Disease-specific Mortality Rate:
Mortality rates can be computed for specific
diseases. As countries begin to extricate
themselves from the burden of communicable
diseases, a number of other indicators such as
deaths from cancer, cardiovascular diseases.
accidents, diabetes, etc have angered as
measures of specific disease problems.

51. 2. Morbidity indicators
To describe health in terms of mortality rates only is
misleading. This is because, 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. Morbidity
statistics have also their own drawback; they tend to
overlook a large number of conditions which are subclinical
or in-apparent, that is, the hidden part of the iceberg of
disease.

52. The following morbidity rates are used for
assessing ill health in the community.
a. incidence and prevalence
b. notification rates
c. attendance rates at out-patient departments, health
centers. etc.
d. admission, readmission and discharge rates
e. duration of stay in hospital and
f. spells of sickness or absence from work or school.

53. 3. Disability rates
Since death rates have not changed markedly in
recent years, despite massive health expenditures,
disability rates related to illness and injury have
come into use to supplement
mortality and morbidity indicators. The disability
rates are based on the premise or notion that health
implies a full range of daily activities. The commonly
used disability rates fall into two groups: (a) Event-
type indicators and (b) person-type indicators.

54. 4. Nutritional status indicators
Nutritional status is a positive health indicator.
Three nutritional status indicators are considered
important as indicators of health status. They are:
a. anthropometric measurements of preschool children,
e.g., weight and height, mid-arm circumference;
b. heights (and sometimes weights) of children at school
entry; and
c. prevalence of low birth weight (less than 2.5 kg).

55. 5. Health care delivery indicators
The frequently used indicators of health care delivery are:
a. Doctor-population ratio
b. Doctor-nurse ratio
c. Population-bed ratio
d. Population per health/sub-centre
e. Population per traditional birth attendant
These indicators reflect the equity of distribution
of health resources in different parts of the
country, and of the provision of health care.

56. 6. Utilization rates:
In order to obtain additional information on health
status, the extent of use of health services is often
investigated. Utilization of services - or actual coverage
- is expressed as the proportion of people in need of a
service who actually receive it in a given period, usually
a year.
7. Indicators of social and mental health:
As long as valid positive indicators of social and mental
health are scarce, it is necessary to use indirect
measures, viz. indicators of social and mental
pathology. These include suicide, homicide, other acts
of violence and other crime; road traffic accidents,
juvenile delinquency; alcohol and drug abuse; smoking;
consumption of tranquillizers: obesity, etc.

57. 8. Environmental indicators
Environmental indicators reflect the quality of physical and
biological environment in which diseases occur and in which
the people live. They include indicators relating to pollution of
air and water, radiation, solid wastes, noise, exposure to toxic
substances in food or drink. Among these, the most useful
indicators are those measuring the proportion of population
having access to safe water and sanitation facilities, as for
example, percentage of households with safe water in the
home or within 15 minutes' walking distance from a water
Stand point or protected well; adequate sanitary facilities in
the home or immediate vicinity.

58. 9. Socio-economic indicators
These indicators do not directly measure health.
Nevertheless, they are of great importance in the
interpretation of the indicators of health care. These
include :
a. rate of population increase
b. per capita GNP
c. level of unemployment
d. dependency ratio
e. literacy rates, especially female literacy rates
f. family size
g. housing: the number of persons per room
h. per capita "calorie" availability.

59. 10. Health policy indicators
The single most important indicator of political
commitment is "allocation of adequate
resources". The relevant indicators are:
• Proportion of GNP spent on health services
• proportion of GNP spent on health-related activities
(including water supply and sanitation, housing and
nutrition, community development) and
• proportion of total health resources devoted to primary
health care.

60. 11. Indicators of quality of life:
Increasingly, mortality and morbidity data have been questioned as
to whether they fully reflect the health status of a population. The
previous emphasis on using increased life expectancy as an
indicator of health is no longer considered adequate, especially in
developed countries, and attention has shifted more toward
concern about the quality of life enjoyed by individuals and
communities. Quality of life is difficult to define and even more
difficult to measure. It consolidates three indicators, viz. infant
mortality, life expectancy at age one, and literacy. Obviously more
work is needed to develop indicators of quality of life.
12. Other indicators:
(a) Socio/ indicators (b) Basic needs indicators etc.

61. Characteristics of indicators
a. should be valid (dfGo), i.e., they should actually measure what
they are supposed to measure:
b. should be reliable (e/kbf]{), i.e.. The answers should be
the same if measured by different people in similar
circumstances:
c. should be sensitive (;+j]bglzn), i.e., they should be
sensitive to changes in the situation concerned,
d. should be specific (ljlzi^), i.e., they should reflect changes
only in the situation concerned,
e. should be feasible (;+ej), i.e.. they should have the ability to
obtain data needed, and;
f. should be relevant (k|f;+lus), i.e., they should contribute
to the understanding of the phenomenon of interest.

62. HEALTH PROMOTION
“Health promotion is the process of enabling
people to increase control over and to improve
their health.’’ – WHO
GOAL:
Health promotion is not just the responsibility of
the health sector, but goes beyond healthy life-
style to well beings. The goal of health promotion
is to improve overall general health and wellbeing
of people.

63. Health Promoting Activities
• Environmental Sanitation
• Healthy eating and proper balanced diet
• Nutrition education
• Stoping of bad habits such as smoking, drinking alcohol,
chewing tobacco
• Health education
• Physical activities
• Mental health including psychosocial counselling
• Sexual and reproductive health, prevention and control of
HIV/AIDS or STIs.
• Community development & Community Participation
• Health trainers mobilization
• Personal hygiene such as tooth brushing and oral care, hand
washing
• School Health Programs such as environmental sanitation,
nutritional, de-worming, and health education etc.

64. COMMUNITY PARTICIPTION
“Community participation is defined as the
process by which individual and family assume
responsibilities for their own health and welfare
and for those community and develop the
capacity to contribute to their and community’s
development.” -WHO

65. Importance of community
participation in PHC
• Simply, community participation means the
involvement of community people in the activities
which are conducted for benefits of community by
health workers who are usually from the outside of
community.
• The importance of community participation in the
primary health care are as follows:
• Cost effectiveness method for extending the reach of
people.
• Health worker get greater support of people who
response their confidence in them.
• Community participation results in the success of
health project..

66. • People begin to more objectively thus they are
more likely to accept preventive approach for
health care.
• People become more reliant in their ability to
prevent approach for health care.
• Community participation provides basic for
increasing self confidence to the people.
• Community participation makes programs less
dependent on government.
• Community participation results more durable and
sustainable of health measures.
• Community participation helps to increment of
capacity of community people.

67. • Community participation gives practical force to the
idea of health as a human right, social justice to
develop positive health.
• Community participation is an approach to trap that
resources which are not trapped and use them to
make health care more accessible and acceptable to
poor and underprivileged groups.
• Community participation plays important role in more
rapid improvement in health will be achieved than by
increasing investment of service alone.

68. Strategies for promoting community participation
• Need assessment & prioritization:
For implementation of primary health care and promotion of
community participation in primary health car, we have to identify
the needs or problems of community & prioritizing of needs of
problems by ranking of problems of community.
E.g. Community problems of Nagarjun Municipality are ARI,
Diarrhoea, Anaemia, respectively the priority problem is top one
which is ARI.
• Identification of resources: Identify locally available resource
which is easily available in that community. Identify which
resources is needed for which community’s problem.

69. Planning course of actions: Then planning after to prioritization of
need and resource identification. Planning for most problems of
community people in planning of program that need to
implemented.
Implementation of program and utilization of local resources: Then
implementing program by utilizing local health resources which may
be easily available in community.
Evaluating Program: Evaluation of that program time to time during
early stage, middle stage and last stage of program.
Decision making to continue same program if needed or to stop it is
not needed.

70. Q. Describe the relationship
between health for all and PHC.
HFA PHC
It is a social goal set in 30th
world health assembly in may
1977 AD as Health for All By
year 2000.
It is a concept came after Alma
Ata declaration 1978.
Defined as attainment of a
level of health that will enable
every individual to lead
socially and economically
productive life.
It is a essential health care
accessible to individual and
family level in community
through their full
participation.

71. • The fundamental principle of health for all is equitable
distribution of health resources to all people and countries which
is one of the main principle of primary health care.
• The PHC reaffirmed HFA as a major social goal of government
and stated that the best approach to achieve the goal of HFA is
by providing primary health care, especially to rural people and
poor urban people.
• It is visualized that by year 2000, the essential health care
services should be accessible and affordable way, with their full
participation.

79. Goals and functions of Public Health
• What is public health?
Public health is "the science and art of preventing
disease, prolonging life and promoting health
through the organized efforts and informed
choices of society, organizations, public and
private, communities and individuals".

80. Goals of public health
• The goal of public health is achieved by
promoting healthy lifestyles, researching
disease and injury prevention, and detecting,
preventing and responding to infectious
diseases. Overall, public health is concerned
with protecting the health of entire
populations.

81. Functions of Public Health
1. It helps to identify the health problems and prioritize them,
promotion and prevention approach, how to prevent epidemics,
endemics, pandemics and injury etc.
2. Public Health studies plays a major role in fighting off the
biggest killers of humans.
3. It can battle against diabetes, cancer, heart disease and
dementia to maintain the health and well-being of the
population.

82. 4. Public Health is preventative in nature. Prevention is far more
effective and far less expensive than cure.
5. Public Health is important due to aiding and prolonging life. So that
peoples can spend more of their years in good health.
6. Public Health helps to detect health issues as early as possible and
responds appropriately to avoid the development of disease.
7. Public Health ensures everyone is aware of health hazards through
educational programs, campaigns and through influencing
government policies.
9. Public health ensures Health is a human right and as no one is
disadvantaged regardless of their socio-economic background.

83. Health as a right for all citizens
• No one should get sick and die just because they are poor, or because
they cannot access the health services they need.
• Good health is also clearly determined by other basic human rights
including access to safe drinking water and sanitation, nutritious foods,
adequate housing, education and safe working conditions.
• Which article of the Constitution sates health as a fundamental right?
Article 35 of Nepal’s constitution 2072, has describe the Right
relating to health:

84. 35. Right relating to health:
(1) Every citizen shall have the right to free basic health
services from the State, and no one shall be deprived of
emergency health services.
(2) Every person shall have the right to get information about
his or her medical treatment.
(3) Every citizen shall have equal access to health services.
(4) Every citizen shall have the right of access to clean drinking
water and sanitation.

85. Home-work
• Health Profile of Nepal?
• What are the PHC related national health
programs in Nepal?