CONCEPTS OF HEALTH AND DISEASES

CONTENTS
INTRODUCTION
DEFINITION
CHANGING CONCEPT OF HEALTH
DIMENSIONS OF HEALTH
CONCEPT OF WELLBEING
SPECTRUM OF HEALTH
DETERMINANTS OF HEALTH
RESPONSIBILITY FOR HEALTH
INDICATORS FOR HEALTH

HEALTH SERVICE PHILOSOPHIES

CONCEPT OF DISEASE
CONCEPT OF CAUSATION
CONCEPT OF PREVENTION
CONCLUSION
REFERENCES

INTRODUCTION
Health is a common concern in most
communities.
In fact, all communities have health
as a part of their customs and
traditions.
Health continues to be a neglected
issue despite hypocrisy.
Traditionally health has been
considered as absence of diseases.

DEFINITIONS OF HEALTH
Health is a state of complete physical,
mental and social wellbeing and not merely
an absence of diseases or infirmity WHO
1948
Operational definition of health by
WHO - a condition or quality of the
human organism expressing the adequate
functioning of the organism in given
conditions, genetic or environmental

CHANGING CONCEPTS OF HEALTH

Health is evolved over the centuries
as a concept from individual concern
to world wide social goal and
encompasses the whole quality of life.
Changing concepts of health are:
Ecological concept
Biomedical concept
Psychosocial concept
Holistic concept

ECOLOGICAL CONCEPT
From ecological point of view, health is viewed as
a dynamic equilibrium between man and his
environment and diseases as maladjustment of
human organism to the environment .
It focuses on imperfect man and imperfect
environment.
Improvement of human adaptation can lead to
better quality of life.

BIOMEDICAL CONCEPT
Health is viewed as absence from disease i.e
if a person is free from disease he is considered
healthy
This concept does not take into consideration
the environmental, social and cultural
determinants of health.
However developments in medical science
have concluded that this concept is inadequate.

PSYCHOSOCIAL CONCEPT
According to psychosocial concept
health is not only biomedical
phenomenon, but is influenced by
social, psychological, cultural,
economic and political factors

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.
It describes health as a unified or
multidimensional process involving the wellbeing
of whole person in context of his environment.

DIMENSIONS OF HEALTH
Health is multidimensional.
WHO explained health in three
dimensional perspectives.
PHYSICAL

MENTAL

HEALTH

EMOTIONAL

SOCIAL

PHYSICAL DIMENSION
Physical dimension implies the
concept perfect functioning of the
body.
It conceptualizes health biologically
as a state in which each and every
organ even a cell is functioning at
optimum capacity and in perfect
harmony with the rest of the body.

MENTAL DIMENSION
Mental health has been defined as
a state of balance between individual
and the surrounding world, a state of
harmony between oneself and
others, coexistence between the
realities of the self and that of other
people and that of environment.

SOCIAL DIMENSION
It is defined as quantity and quality
of an individuals interpersonal ties
and the extent of involvement with
the community.
Social wellbeing implies harmony
and integration within and between
each individuals and other members
of the society.

EMOTIONAL DIMENSION
Emotional health relates to feeling.

This dimension reflects emotional

aspects of humanness.

CONCEPT OF WELLBEING
Wellbeing of an individual or group of
individuals have several components
and has been expressed in various ways,
such as
Standard of living
Level of living
Quality of life
Physical quality of life
Human development index

STANDARD OF LIVING
As per WHO, Income and
occupation, standards of housing,
sanitation and nutrition, the level of
provision of health, educational,
recreational and other services all be
used individually as measures of
socioeconomic status, and
collectively as an index of the
standard of living.

LEVEL OF LIVING
It consists of nine components:
Health
Food consumption
Education
Occupation and working conditions
Housings
Social security
Clothings
Recreation and
Leisure human rights

QUALITY OF LIFE
The condition of life resulting from
the combination of the effects of the
complete range of factors such as
those determining health, happiness
(including comfort in the physical
environment and a satisfying
occupation), education, social and
intellectual attainments, freedom of
action, justice and freedom of
expression.

PHYSICAL QUALITY OF LIFE INDEX

Physical quality of life index(PQLI) includes
three indicators such as infant mortality,
life expectancy and literacy.
For each component, performance of
individual countries is placed on a scale of
0 to 100, where 0 represents an absolutely
defined worst performance, and 100
represents an absolutely defined best
performance.

HUMAN DEVELOPMENTAL INDEX

Human development index (HDI)
includes longevity (life expectancy
at birth), knowledge(adult literacy
rate and mean years of schooling),
and income.
HDI value ranges from 0 to 1.

SPECTRUM OF HEALTH
This concept of health of an
individual is a dynamic phenomenon
and a process of continuous change,
subject to repeated, fine variations.
Transition from optimum health to ill
health is often gradual and where
one state ends and other begins is a
matter of judgement .

Different stages of spectrum of health are:

Positive health
Better health
Freedom from sickness
Unrecognized sickness
Mild sickness
Severe sickness
Death

DETERMINANTS OF HEALTH
Health is influenced by multiple factors.
The health of an individual and community is
influenced by: individual (genetic factors) and
external factors (environmental factors).
Determinants of health are:
1) Biological determinants
2) Behavioural and sociocultural conditions
3) Environmental factors
4) Socioeconomic conditions

5)
6)
7)
8)

Health services
Aging of population
Gender
Other factors

BIOLOGICAL DETERMINANTS
Physical and mental traits of every
human being are to some extent
determinants by the nature of the
genes at the moment of conception.
The state of health therefore
depends partly on the genetic
constitution of man and his
relationship with his environment.

BEHAVIOURAL AND SOCIOCULTURAL

CONDITIONS
Health requires promotion of healthy
lifestyle.
Evidence indicates that there is an
association between health and lifestyle of
individuals.
Healthy lifestyle includes adequate
nutrition, enough sleep, sufficient physical
activity etc.
Health is a result of individual lifestyle and
factors determining it.

ENVIRONMENTAL FACTORS
Environment has a direct impact on the
physical, mental and social wellbeing of
those living in it.
Environment factors range from housing,
water supply, psychosocial stress and
family structures through social and
economic support systems and social
welfare services in the community.

SOCIOECONOMIC CONDITIONS
Socioeconomic conditions influence
health such as:

ECONOMIC STATUS
EDUCATION
OCCUPATION
POLITICAL SYSTEM

HEALTH SERVICES
Purpose of health services is to
improve the health status of
population.

To be effective, the health services

must reach the masses, equitably
distributed, accessible at a cost the
community can afford and socially
acceptable.

AGING OF THE POPULATION

A major concern of rapidly aging
population is increased prevalence of
chronic diseases and disabilities that
deserve special attention.

GENDER
Womens health is gaining
importance in areas such as
nutrition, reproductive health, aging,
lifestyle related conditions and
occupational environment.

There is increased awareness among

policy makers of womens health
issues.

OTHERS FACTORS
Information and communication
technology provides access to
medical information serving the
needs of many health professionals,
biomedical researchers and the
public.

RESPONSIBILITY OF HEALTH
Health involves joint effort of the
individuals, community, state and the
international level to protect and
promote health.

Individual responsibility
Community responsibility
State responsibility
International responsibility

INDICATORS OF HEALTH
Indicators are:
1) MORTALITY INDICATORS
2) MORBIDITY INDICATORS
3) DISABILITY RATES
4) NUTRITIONAL STATUS INDICATORS
5) UTILIZATION RATES
6) INDICATORS OF SOCIAL AND
MENTAL HEALTH

7) HEALTH CARE DELIVERY

INDICATORS
8) ENVIRONMENTAL INDICATORS
9) SOCIOECONOMIC INDICATORS
10) HEALTH POLICY INDICATORS
11) INDICATORS OF QUALITY OF LIFE
12) OTHER INDICATORS

HEALTH SERVICE
PHILOSOPHIES
Health care is defined as a
multitude of services rendered to
individuals, families or communities
by the agents of health services or
professions, for the purpose of
promoting maintaining, monitoring or
restoring health.

LEVELS OF HEALTH CARE

TERTIARY
LEVEL

SECONDARY
LEVEL

PRIMARY LEVEL

 PRIMARY HEALTH CARE: It is the first level of

contact between the individual and the health
system.
SECONDARY HEALTH CARE: At this level, care
comprises essentially curative services provided
by district hospitals and community health centers.
TERTIARY HEALTH CARE: This level offers super
specialist care. Care is provided by regional or
central level institutions.

HEALTH TEAM CONCEPT

Health team has been defined as a
group of persons who shares a
common health goal and common
objectives, determined by
community needs and toward the
achievement of which each member
of the team contributions in
accordance to her/his competence
and skills and respecting the
functions of the other.

HEALTH FOR ALL

On 12th SEPTEMBER 1978, the joint WHOUNICEF International conference at Alma-Ata
called for acceptance of the WHO goal of health
for all by 2000 AD.
In MAY 1977, World Health Assembly decided
main goal of governments and WHO in the
coming years should be the attainment by all
people of the world by the year 2000 AD of a
level of health that will permit them to lead a
socially & economically productive life

PRIMARY HEALTH CARE

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 to maintain at every
stage of their development in the spirit of
self-determination.
Alma-Ata 1978

MILLENNIUM DEVELOPMENT GOALS

At Millennium Summit in SEPTEMBER
2000
189 countries gathered to adopt UN
Millennium Declaration
GOAL- reduce extreme poverty and
setting out a series of time-bound
targets.

CONCEPT OF DISEASES
Webster defines disease as a condition
in which body health is impaired, a
departure from a state of health, an
alternation of the human body interrupting
the performance of vital functions.
Disease literally means without ease
(uneasiness), when something is wrong
with bodily function.

 Illness refers to the presence of a

specific diseases, and also to the
individuals perceptions and
behaviour in response to the disease,
as well as the impact of that disease
on the psychosocial environment.
Sickness refers to state of social
dysfunction.

CONCEPT OF CAUSATION
1)
2)
3)
4)
5)
6)
7)

EPIDEMIOLOGICAL TRIAD
MULTIFACTORIAL CAUSATION
NATURAL HISTORY OF DISEASE
WEB OF CAUSATION
RISK FACTORS AND RISK GROUPS
SPECTRUM OF DISEASE
ICEBERG OF DISEASE

EPIDEMIOLOGICAL TRIAD

AGENT
Agent is defined as an organism, a substance or
a force, the presence or lack of which may initiate
a disease process or may cause it to continue.
May be classified into:
a) Living or Biological agents [Eg: bacteria, virus,
fungi]
b) Non living or inanimate

# Nutrient agents [ eg: protein, fat,

carbohydrates]
#Chemical agents [eg: lead arsenic
etc]
# Physical agents [eg: atmospheric
pressure, temperature.]

HOST
The characteristics of a human being that
determine how he reacts to the agents in the
environment are called host factors
Host factors are:
Demographic characteristics: Age, sex etc
Biological characteristics: genetic
background, nutritional status, immune
status etc.

 Socio-economic characteristics:
social class, religion, education,
marital status.
Life Style: Living habits, food habits
etc.

ENVIRONMENT
Environment is the source or
reservoir for the agents of disease.
It helps in the transmission of agents
to the host, bringing about their
contact and interaction.
Environment of man is of two types:
External
Internal

MULTIFACTORIAL
CAUSATION
This concept was put forth by
PETTENKOFER OF MUNICH (18191901)
This concept offers multiple
approaches for the prevention of
diseases.

NATURAL HISTORY OF DISEASE

This model signifies the way in
which a disease evolve over time
from the period of its earliest stage
to its termination as recovery or
death.
It consists of 2 phases:
Period of pre pathogenesis
Period of pathogenesis

WEB OF CAUSATION
This was coined by Mac Mahon and Pugh.
Applicable in certain diseases where the
causative agent is unknown and the disease
is the result of interaction of multiple
factors.
Removal of some of them or even one of
them may be sufficient to control the
disease.

RISK FACTORS AND RISK GROUPS

Risk factors means an attribute or
exposure that is significantly
associated with the development of a
disease.

Risk groups are those exposed to risk

factors.

SPECTRUM OF DISEASES
It is a graphic representation of the variations
in the manifestations of a disease.
It may be defined as the sequence of events
that occur in human host from the time of
contact with the etiologic agent up to the point
of the ultimate outcome, which may be fatal in
extreme cases.
Spectrum extends from subclinical to the fatal.

ICEBERG OF DISEASE
Health professionals see only a small
part of illness in the community, just
as a small part of an iceberg is visible
above the surface of the water. This
is called as the tip of the iceberg.
as information on the submerged
portion is not available.

CONCEPTS OF PREVENTION
Goals of prevention : to promote
health, to restore health and to
preserve health.
Prevention can be studied under
three levels:
PRIMARY PREVENTION
SECONDARY PREVENTION
TERTIARY PREVENTION

PRIMARY PREVENTION
Defined as action taken prior to the
onset of disease, which moves the
possibility that a disease will ever
occur
Primary prevention is designed to
promote health or protect against
specific disease and hazards in
environment.

 ADVANTAGES:
Low cost
Safe
Individual is not yet exposed to pain and suffering.
Approaches for primary prevention
recommended by WHO:
PRIMORDIAL PREVENTION
POPULATION(MASS) STRATEGY
HIGH-RISK STRATEGY

SECONDARY PREVENTION
Defined as action which halts the progress of a
disease at its incipient stage and prevents
complications
ADVANTAGES:
Important in reducing the high mortality and
morbidity of certain disease.
DISADVANTAGES:
Patient is subjected to pain and suffering and
community to loss of productivity.

TERTIARY PREVENTION
Defined as all measures available
to reduce or limit impairments and
disabilities, minimize sufferings
caused by existing departures from
good health and to promote the
patients adjustment to irremediable
conditions
Specific modes of interventions are:
1) Disability limitation

CONCLUSION
As the time progress all concepts and
principles make way for the new.
Universal Declaration of Human Right
everyone has the right to a standard of
living adequate for the health and
wellbeing of himself and his family is yet
to be realized.
Health development contributes to and
results from social and economical
development.

REFERENCES
ESSENTIALS OF PUBLIC HEALTH
DENTISTRY 5th EDITION SOBEN
PETER, Chapter Introduction to public
health (page no: 27)
TEXTBOOK OF PREVENTIVE AND
COMMUNITY DENTISTRY 2nd EDITIONS.S.HIREMATH, Chapter Concept of
health and disease and
prevention(page no: 4)