CONCEPT OF HEALTH
The concept of health has evolved over the centuries PSYCHOSOCIAL CONCEPT
as a concept from a individual concern to a world
wide social goal. The changing concepts of health is
furnished below.
1. BIO MEDICAL CONCEPT.
2. ECOLOGICAL CONCEPT.
3. PSYCHO SOCIAL CONCEPT.
4. HOLISTIC CONCEPT.
BIO MEDICAL CONCEPT
Bio medical concept views health as absence of
disease.
Bio medical concept has the basis in the germ theory
of disease.
Human body is viewed as a machine & disease as a
consequence of the breakdown of the machine & the
doctor repairs the machine.
The criticism leveled against the concept is that it
has minimized the role of environment, social,
psychological & cultural determinants of health
ECOLOGICAL CONCEPT
Ecological concept views health as a dynamic
equilibrium between man & his environment.
Humans ecological & cultural adaptations
determine the occurrences of disease.
The ecological concept rises two issues-- 1. Imperfect
man & 2. Imperfect environment.
Development in social sciences focused on factors
influencing health such as social, psychological,
cultural, economic & political factors of the
individuals.
Psychosocial concept views health as both a
biological & social phenomenon
HOLISTIC CONCEPT
The holistic model is a synthesis of bio medical,
ecological & psycho social concept.
It recognizes the role of social, economical, political
& environmental influences on health.
It views that health implies a sound mind in a sound
body, in a sound family in a sound environment.
The emphasis is on promotion & protection of
health.
DIMENSIONS OF HEALTH
Physical
Mental
Social
Spiritual
Emotional
Vocational
Political
 PHYSICAL DIMENSION
The state of physical health implies the notion of Mental dimension
perfect functioning of the body Mental health is not mere absence of mental illness
Every cell and every organ functioning at optimum Ability to respond to varied experiences of life
capacity and perfect harmony with the rest of the body. a state of balance between the individual and
Sign of physical health surrounding world, a state of harmony between oneself
A good complexion and others Mental well being
Clean skin Characteristics of Mentally healthy person :
bright eyes Free from internal conflicts
lustrous hairs Well adjusted
body with firm flush Searches for identity
not too fat Strong sense of self-esteem
Sweet breath Knows himself, his needs, problems and goals
Good appetite Good self control
Sound sleep Coping with stress and anxiety
Regular activity of bowel and bladder
Smooth easily coordinated bodily movements Social Dimension
All organs of normal size and functioning normally
Pulse rate, BP exercise tolerance within normal ranges Harmony and integration a) within the individual b) between
each individual and other members of the society c) between
Evaluation of physical health individuals and world in which they live
Self assessment of overall health Definition :- Quantity and quality of an individuals
Inquiry into symptom of ill health risk factors interpersonal ties and the extent of involvement with the
Inquiry into Medication community
Inquiry into Fitness Characteristic of social health
Inquiry into Medical services Possession of social skills, social functioning
Standardized questionnaire for CVD, RD Ability to see oneself as a member of community
Clinical examination Focuses on social and economic conditions
Nutrition & dietary assessment
 Spiritual Dimension
Spiritual Dimension Refers to that part of individual CONCEPT OF WELLBEING
which reaches out and strives for meaning and purpose Standard of Living
in life . As per WHO, Income and occupation, standards of
It is the intangible something that transcends housing, sanitation and nutrition, the level of provision
Physiology and Psychology Includes integrity, of health, educational, recreational and other service
principles, ethics, purpose in life, commitment and collectively as an index of the standard of living.
Level of Living
Emotional Dimension As per United Nations documents level of living
The emotional dimension of wellness emphasizes an consists of nine components: health, food consumption,
awareness and acceptance of one's feelings education, occupation and working conditions, housing,
social security, clothing, recreation and leisure, and
Vocational Dimension : human rights.
Quality of Life
Work fully adapted to human goals, capacities and Quality of life as defined by WHO, The condition of
limitations life resulting from combination of the effects of the
Work often plays a role in promoting both physical and complete range of factors such as those determining
mental health health, happiness , education, social and intellectual
Sudden loss of Job / after Retirement attainments, freedom of action, justice and freedom of
expression.
Other dimension Physical Quality of Life Index
Philosophical It includes three indicators such as
Cultural Infant mortality
Socioeconomic Life expectancy at age one
Environmental Literacy.
Educational nutritional For each component, performance of individual countries is
Curative dimension placed on a scale of 0 to 100,
Preventive dimension Human Developmental Index
It includes
 longevity (life expectancy at birth)
knowledge (adult literacy rate)
income (real GDP per capita)
The HDI value ranges from 0 to 1.
SPECTRUM OF HEALTH
This concept of health emphasizes that health of an
individual is a dynamic phenomenon and a process of
continuous change, subject to repeated, fine variations
Transition from optimum health to ill health is often
gradual, and where one state ends and other begins is a
matter of judgment.
Different stages are positive health, better health,
freedom from sickness, unrecognized sickness, mild
sickness, severe sickness, and death.
Health Care
It is defined as a multitude of services rendered to
individuals, families or communities by the professions,
for the purpose of promoting, maintaining, monitoring
or restoring health.
Health care should be appropriate, comprehensive,
adequate, available, accessible, affordable and feasible.
It can be delivered by appropriate planning of health
systems with the aim of health development.
Health systems are based on contemporary ideas and
concepts and available resources.
LEVELS OF HEALTH CARE
Primary health care.
It is the first level of contact between the individual
and the health system where essential or primary health care is
rendered.
Secondary health care.
At this level, more complex problems are dealt with.
This care comprises essentially curative services and is
provided by the district hospitals and community health
centres.
This level serves as the first referral level in the health
system.
Tertiary health care.
This level offers super specialist care.
This care is provided by regional/central level
institutions.
These institutions provide not only highly specialized
care, but also planning and managerial skills and
teaching for specialized staff.
HEALTH PROMOTION
The process of enabling people to increase control
over and improve health.
It is not directed against any particular disease, but is
intended to strengthen the host through a variety of
approaches such as :
Health education: A large number of diseases could be
prevented with little or no medical intervention
 if people were adequately informed about them
if they were encouraged to take necessary precautions
in time.
Targets for educational efforts may include general public,
patients, priority groups, health providers, community leaders
and decision makers.
Environmental modifications: Provision of safe water;
installation of sanitary latrines; control of insects and rodents;
improvement of housing, etc. promote health.
Nutritional interventions: This refers to food distribution and
nutrition improvement of vulnerable groups; child feeding
programs; nutrition education, etc.
Lifestyle and behavioral changes:
CONCEPT OF DISEASE
Webster defines disease as a condition in which body
health is impaired, a departure from a state of health, an
alteration of the human body interrupting the
performance of vital functions.
The oxford English Dictionary defines disease as a
condition of the body or some part or organ of the body
in which its functions are disturbed or deranged.
CONCEPT OF DISEASE
Ecological point of view disease is defined as a
maladjustment of the human organism to the
environment.
The simplest definition is that disease is just the
opposite of health: i.e. any deviation from normal
functioning or state of complete physical or mental
well-being.
Distinction between Disease,
Illness and Sickness
The term disease literally means without ease
(uneasiness), when something is wrong with bodily
function.
Illness refers to the presence of a specific disease, and
also to the individuals perceptions and behavior in
response to the disease, as well as the impact of that
disease on the psychosocial environment.
Sickness refers to a state of social dysfunction.
Distinction between Disease,
Illness and Sickness
Disease is a physiological/psychological dysfunction.
Illness is a subjective state of the person who feels
aware of not being well.
Sickness is a state of social dysfunction i.e. a role that
the individual assumes when ill (sickness role).
THEORIES OF DISEASES CAUSATION
 1. Supernatural theory of disease
Disease is due to super power e.g. gods, evil
spirits.
2. Tridosha theory of disease
The doshas or humors are: Vaata (Wind), Pitta
(gall), and Kapha (mucus).
Perfect balance of tridosha is healthy
Disturbance in balance is disease
THEORY OF DISEASES CAUSATION
3. Theory of Contagion
Spreading of disease by being close to or
touching other people.
4. Miasmatic theory of disease causation
Disease is due to noxious air and vapors
These concepts were prevailing before Louis
Pasteur (1822-1895).
THEORY OF DISEASES CAUSATION
5. Germ Theory of disease
In 1860, Louis Pasteur demonstrated the
presence of bacteria in air.
This theory emphasized that the sole cause of
disease is microbes.
The theory generally referred to as one-to-one
relationship between disease agent and disease.
Disease agent Man Disease
THEORY OF DISEASES CAUSATION
6. Epidemiological Triad concept
The germ theory of disease has many limitations
For example it is well known that not all
exposed to tuberculosis bacilli develops
tuberculosis ,the same condition in an
undernourished person may result in clinically
manifest.
Epidemiological Triad
MULTI-FACTORIAL ETIOLOGY
The germ theory of disease or single cause of disease is
always not true.
The germ theory of disease was overshadowed by
multi-factorial cause theory in 19th century.
As a result of advancement in public health,
communicable diseases began to decline and are
replaced by new type of diseases so called modern
disease of civilization.
MULTI-FACTORIAL ETIOLOGY
Example: Lung cancer, CHD, Mental illness etc. The
disease could not be explained on the basis of germ
theory of disease and can not be controlled or prevented
on that basis. The realization began that multiple
factors are responsible for disease causation where
there is no clear single agent.
The purpose of knowing multiple factors of disease is
to quantify and arrange them in priority sequence for
modification to prevent particular disease.
 WEB OF CAUSATION
This model of disease causation was suggested by Mac
Mohan and Pugh.
]This model is ideally suited in the study of chronic
disease where the disease agent is often not known, but
is the outcome of interaction of multiple factors.
The web of causation considers all the predisposing
factors of any type and their complex interaction with
each other.
The basic tenets of epidemiology are to study the
clusters of causes and combinations of efforts and how
they relate to each other.
The web of causation does not imply that the disease
can not be controlled unless all the multiple causes or
chain of causation or at least a number of them are
appropriately controlled.
Sometimes, removal of one link may be sufficient to
control disease.
DISEASE CONTROL: The term disease control
refers ongoing operation aimed at reducing:
The incidence of disease.
The duration of disease and the consequently
the risk of transmission.
The effect of infection including physical and
psychological complication.
The financial burden to the community.
CONCEPT OF CONTROL
In disease control, the disease agent is permitted to
persist in the community at a level where it ceases to be
a public health problem according to the tolerance of
local community. For example Malaria control
programme. Disease control activities focus on primary
prevention
ELIMINATION: Reduction of case
transmission to a predetermined very low level
or interruption in transmission. E.g. measles,
polio, leprosy from the large geographic region
or area.
ERADICATION: Termination of all
transmission of infection by extermination of
the infectious agent through surveillance and
containment. All or none phenomenon. E.g.
Small pox
MONITORING: Defined as the performance
and analysis of routine measurement aimed at
detecting changes in the environment or health
status of population. e.g. growth monitoring of
child, Monitoring of air pollution, monitoring of
water quality etc.
SURVEILLANCE: Defined as the
continuous scrutiny of the factors that determine
the occurrence and distribution of disease and
other conditions of ill health. E.g.
Poliomyelitis surveillance programme of WHO.
 Early Diagnosis and Adquate Treatment
LEVELS OF PREVENTION Disability Limitation
Primordial Prevention : Rehabilitation
Prevention from Risk Factors.
Prevention of emergence or development of Risk HEALTH PROMOTION
Factors. It is the process of enabling people to increase control
Discouraging harmful life styles. over diseases, and to improve their health. It is not
Encouraging or promoting healthy eating habits. directed against any particular disease but is intended to
LEVELS OF PREVENTION strengthen the host through a variety of
Primary Prevention: approaches(interventions):
Pre-pathogenesis Phase of a disease. Health Education
Action taken prior to the onset of the disease: Environmental Modifications
Immunization & Chemo-prophylaxis Nutritional Interventions
LEVELS OF PREVENTION Lifestyle and Behavioral Change
Secondary Prevention: SPECIFIC PROTECTION
Halt the progress of a disease at its incipient phase. Some of the currently available interventions aimed at
Early diagnosis & Adequate medical treatment. specific protection are:
Tertiary Prevention: Immunization
Intervention in the late Pathogenesis Phase. Use of specific Nutrients
Reduce impairments, minimize disabilities & suffering. Chemoprophylaxis
Protection against Occupational Hazards
Avoidance of Allergens
MODES OF INTERVENTION Control of specific hazards in general
Intervention is any attempt to intervene or interrupt the environment
usual sequence in the development of disease. Five Control of Consumer Product Quality & Safety
modes of intervention corresponding to the natural EARLY DIAGNOSIS & TREATMENT
history of any disease are: Though not as effective and economical as Primary
Health Promotion Prevention, early detection and treatment are the main
Specific Protection interventions of disease control, besides being critically
 important in reducing the high morbidity and mortality
in certain diseases like hypertension, cancer cervix, and
breast cancer.
The earlier the disease is diagnosed and treated the
better it is from the point of view of prognosis and
preventing the occurrence of further cases (secondary
cases) or any long term disability.
DISABILITY LIMITATIONS
The Objective is to prevent or halt the transition of the
disease process from impairment to handicap.
Sequence of events leading to disability & handicap:
Disease Impairment Disability Handicap promotive,curative and rehabilitative services to the people
Impairment: Loss or abnormality of psychological,
physiological/anatomical structure or function.
Disability: Any restriction or lack of ability to perform
an activity in a manner considered normal for ones age,
sex, etc.
Handicap: Any disadvantage that prevents one from
fulfilling his role considered normal.
REHABILITATION
Rehabilitation has been defined as the combined and
coordinated use of medical, social, educational and
vocational measures for training and retraining the
individual to the highest possible level of functional
ability
Areas of concern in rehabilitation:
Medical Rehabilitation
Vocational Rehabilitation
Social Rehabilitation
Psychological Rehabilitation
Community:
Group of people living together in a particular
geographical area.
Community Health:
Health of peoples in terms of physical, mental,
social and spiritual health.
Definition :
1. Community health nurses provide preventive,
.they provide these services directly to individual, family or
community.
Community health nursing
According to American Nursing Association,
Community health nursing is a synthesis of nursing
practice and public health practice applied in
promoting and preserving the health of populations.
the nature of this practice is general and
comprehensive. it is not limited to a particular age or
diagnostic group. It is continuous and not episodic.
The dominant responsibility is to the population as a
whole. Therefore Nursing directed to individuals,
families or groups contributes to the health of the
total population. Health promotion, health
maintenance, health education, coordination and
continuity of care are utilized in a holistic approach to
 the management of the individual, family group and
community. The nurses actions acknowledge the
need for comprehensive health planning, recognize
the influences of social and ecological issues, give
attention to populations at risk and utilize dynamic
forces which influence change
Aim of community health nursing
The aim of community health nursing practice is to
promote health and efficiency, prevent and control
diseases and disabilities and prolong life by providing
need based, well balanced comprehensive health care
services to community at large through organized
community efforts
Objectives:
1. To increase the capability of community to deal
with their own health problems.
2.To strengthen community resources .
3.To control and counteract environment .
4. To prevent and control communicable and non-
communicable diseases .
5.To provide specialized services
6. To conduct research to build up knowledge and
contribute to further refinement and improvement
of community health practice.
7.To prepare Health personnel in the community for
community health care services.
Principles of community Health Nursing :
Principles of community Health Nursing
1) Community health nursing is an established based on
recognized needs and functioning within the total health
programme.
2) The community health nursing agency has clearly
defined objectives and purposes for its services
3) An active organized citizens group of the community
group is an integral part of the community health
programme.
4) Community health nursing services are available to
the entire community regardless of origin, culture or
social and economic resources, and age, sex, creed,
nationality, political affiliation
5) Community health nursing recognized the family and
community as units of service.
6) Health education and counseling for the individual,
family and community are the integral part of
community health nursing.
7) Recipients of health care should participate in
planning relating to goals for the attainment of health
8) The community health nurse should qualify as a full-
fledged nurse.
9) The community health nursing service should be
based on the needs of the patient and there should be
proper continuity of services to patients.
 10) Periodic and continuous appraisal and evaluation of
health situation of the patients are basic to community
health nursing.
11) The community health nurse should function/serve
as an important member of the health team.
12) There should be provision for qualified nurse to
make supervision for community health services.
13) The community health nurse does not provide
material relief to patients, but directs the patient to
appropriate community resources for necessary
financial and social assistance.
14) The community health nurse should not accept gifts
or bribes from the patients
15) The community health nurse should not belong to
one particular section or political group.
16) Community health agency should provide a
continuing education programme for nurse
17) The nurses assume responsibilities of their own
continuing professional development through acquiring
higher and higher education and forming and
strengthening the professional associations
18) The community health nursing services should
develop proper guidelines, in maintaining records and
reports.
19) There should be proper facilities and job conditions.
20) The community health nurse should maintain
professional relationship with all leaders in the
community and maintain ethics at all times.