Health

Dr. Nisha Sangwan

Concept:
Health is a state of complete physical, mental
and social wellbeing and not merely an absence
of disease or infirmity.
now added
the ability to lead a socially and economically
productive life.
The concept of health as defined by WHO is
broad and positive in its implications; it sets out
the standard, the standard of positive health.

CHANGING CONCEPTS OF HEALTH

Health is perceived in different ways giving rise to
various concepts of health. Health has evolved over
the centuries as a concept from an individual concern
to a worldwide social goal.
Biomedical Concept
Health means absence of disease.
It was felt that human body is a machine and disease
is an outcome of the breakdown of the machine, and
one of the doctors tasks was to repair the machine.
Developments in medical and social sciences led to
the conclusion that the biomedical concept of health
was inadequate.

Ecological Concept
Ecologists viewed health as a dynamic equilibrium
between man and his environment, and disease a
maladjustment of the human organism to environment.

Health = is a dynamic equilibrium between

man & his environment,
Disease = maladjustment of the human
organisms to the environment.
The concept supports the need for clean air,
safe water, ozonic layer in the atmosphere,
etc. to protect us from exposure to unhealthy
factors.

Psychosocial Concept
Advances in social sciences showed that health is not
only a biomedical phenomenon, but one which is
influenced by social, psychological, cultural, economic
and political factors of the people concerned. Thus
health is both a biological and social phenomenon.
Holistic Concept
Holistic concept recognizes the strength of social,
economic, political and environmental influences on
health.
It has been variously described as multidimensional
process involving the wellbeing of the person as a
whole
The emphasis is on the promotion and protection of
health.

Social
Health
promotio
n

economi
c

Healt
h

Health
protectio
n

Envirnment
Politica
al
l

Holistic concept

DIMENSIONS OF HEALTH
Health is multidimensional and are interrelated, each has
its own nature
Physical Dimension
Perfect functioning of the body.
It conceptualizes health biologically as a state in which
every cell and every organ are functioning at optimum
capacity and in perfect harmony with the rest of the body.
Mental Dimension
Ability to respond to many varied experiences of life with
flexibility and a sense of purpose.
Mental health has been defined as a state of balance
between the individual and the surrounding world, a state
of harmony between oneself and others

Social Dimension
Harmony and integration with the individual, between
each individual and other members of society, and
between individuals and the world in which they live.
quantity and quality of an individuals interpersonal ties
and the extent of involvement with the community.
Spiritual Dimension
Spiritual health refers to something that transcends
physiology and psychology.

Emotional Dimension
Relates to feeling. it reflects emotional aspects of humanness.
Vocational Dimension
Work often plays a role in promoting both physical and mental
health.
Physical work is usually associated with an improvement in
physical capacity, while goal achievement and self-realization in
work are a source of contentment and enhanced self-esteem.
Others
A few other dimensions have also been suggested such as
philosophical dimension, cultural dimension, socioeconomic
dimension, environmental dimension, educational dimension,
nutritional dimension, and so on.

CONCEPT OF WELLBEING
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 service and
collectively as an index of the standard of living.
Level of Living
As per United Nations documents level of living
consists of nine components: health, food consumption,
education, occupation and working conditions, housing,
social security, clothing, recreation and leisure, and
human rights.

Quality of Life
Quality of life as defined 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.
Physical Quality of Life Index
It includes three indicators such as
Infant mortality
Life expectancy at age one
Literacy.
For each component, performance of individual countries is placed on
a scale of 0 to 100,

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.

SPECTRUM OF HEALTH
Positive health

Better health
Freedom from sickness
Unrecognised sickness
Mild sickness
Severe sickness
Death

DETERMINANTS OF HEALTH

Biological
Other
factor
Gender

Healt
h

Behavioral &
sociocultural
condition
Environmen
t
Socioeconomi
c

Aging
Health
services

Biological Determinants
Physical and mental traits of every human being are to some extent
determined by the nature of his genes at the moment of conception.
Behavioral and Sociocultural Conditions
Health requires promotion of healthy lifestyle. Modern health
problems especially in the developed countries and in developing
countries are mainly due to changes in lifestyles. Healthy lifestyle
includes adequate nutrition, enough sleep, sufficient physical activity
etc.
Environment
Environment has a direct impact on the physical, mental and social
wellbeing of those living in it.

 Environmental factors range from housing, water supply, psychosocial

stress and family structure
Socioeconomic Conditions
Economic status: Economic situation in a country is an important factor
in morbidity, increasing life expectancy and improving quality of life,
family size and pattern of disease
Education: Illiteracy correlates with poverty, malnutrition, ill health, high
infant and child mortality rates.
Occupation: Productive work provides satisfaction, promotes health and
improves quality of life.
Political system: timely decisions concerning, resource allocation, choice
of technology etc

Health Services
To be effective, the health services must reach the masses,
equitably distributed, accessible at a cost the country and
community can afford and social 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,
health consequences of violence, aging, lifestyle related conditions
and the occupational environment.
There is an increased awareness among policy makers of womens
health issues, and encourages their inclusion in all development as
a priority.

INDICATORS OF HEALTH
Indicators should be valid, reliable and objective, sensitive,
specific, feasible and relevant.
The indicators are:
1. Morbidity indicators
2. Disability rates
3. Nutritional status indicators
4. Health care delivery indicators
5. Utilization rates
6. Indicators of social and mental health
7. Environmental indicators
8. Socioeconomic indicators
9. Health policy indicators
10. Indicators of quality of life
11. Other indicators

Mortality Indicators
Mortality indicators represent the traditional measures of health
status:
Crude death rate: It is defined as the number of deaths per
1000 population per year in a given community.
Expectation of life: the average number of years that will be
lived
An increase in the expectation of life is regarded, inferentially, as
an improvement in health status. It can be considered as a
positive health indicator. It is a global health indicator.
Infant mortality rate: It 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.

Child mortality rate: It is defined as the number of deaths at ages 1-4

years in a given year, per 1000 children.
It is related to insufficient nutrition, low coverage by immunization,
etc.
Under-5 proportionate mortality rate: 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.
Maternal mortality rate: Maternal mortality accounts to the greatest
proportion of deaths among women of reproductive age.
Disease-specific mortality rate: Mortality rates can be computed for
specific diseases.

Morbidity Indicators
Morbidity indicators supplement mortality data to
describe the health status of a population.
Morbidity rates are incidence and prevalence,
notification rates, attendance rates at outpatient
departments, health centres, admission,
readmission and discharge rates, duration of stay in
hospital, and spells of sickness or absence from
work or school etc.

Definitions of disease

Disease can be defined as a biosocial phenomenon

characterized by interactions of pathological processes,
defensive and adaptation processes
resulting in damage of
the organism as a whole, in
limitation of the organism
ability to adapt to living condition.

Disease can be defined as a changes in individuals

that cause their health parameters to fall outside
the range of normal

The term disease means a deviation from

or an
absence of the normal state

HEALTH AND ILLNESS

The Health-Sickness spectrum

Epidemiology
Epidemiology is the study of distribution and determinants of disease and conditions among
populations.
Disease distribution is considered in terms of Persons, time and place (Who, when and
where). Persons who are affected by disease in terms of age, sex, race, occupation etc. The
common characteristics relating to those persons affected by disease. Time relates to when
the diseases is most likely to strike e.g. an epidemic, endemic, seasonal, cyclic etc Place refer
to the geographical distribution of a diseases and the common characteristics that are
favourable for that diseases in the given locality. Some diseases are localized, regional,
pandemic etc.

Agent refers to the disease causing organism characteristics e.g. habitation, breeding
migration, infectivity, climatic and environmental factors favouring its existence.
Host refers to the biological makeup of the individuals that make the vulnerable to
the specified illness e.g. physical condition, genetic make up, habits etc.
Environment refers to the ecological conditions that favour the interaction of host
and agent e.g. swampy areas, bushes within house holds, sanitation etc.
The natural history of disease consists of two phases:
1. Prepathogenesis - the process in the environment
2. Pathogenesis - the process in man

Natural History of Disease

Historical Theories for

causation of disease

Supernatural causes& Karma

Theory of humors (humor means fluid)
The miasmatic theory of disease
Theory of contagion
Germ theory
Epidemiological Triad
Multi-factorial causation
Web of causation

Supernatural to multi-factorial causes

Environment

Agent

Host

Epidemiological triad

Agent Factors
Physical Agents
Chemical Agents
Biological Agents
Nutritional agents

Environmental Factors
Physical Environment
Biological Environment
Social Environment

Host Factors
Socio-demographic Factors
Psycho-social Factors
Intrinsic Characteristics

The essential aspects of disease

1. disease is a new quality of life
Health is a friedom, disease is a prison

2. disease is the result of one or more

causes
(noxas) and suitable conditions
3. disease is the unity of damaging,
adaptive,
defensive and compensation
mechanisms

A picture of diseaase is created by:

pathologic reactions
pathologic processes
pathologic states

Pathologic reaction
- It is the most simple, mainly short-lasting,
quantitativly and/or qualitativly non-adequate
response of organisms to some noxa
Examples: syncopa, short-lasting increase of BP,
tachycardia, bradycardia, vomiting,
diarhoe, hyperventilation ...

Pathologic process
It is the complex of pathologic and defensive- adaptive reactions induced by influence of noxa
on organism
Examples: inflammation, fever, hypoxia, growth
of tumor, edema, acidosis, alkalosis...
Pathologic state
Pathological change which is stabile or it changes
very slowly and in very small range during time period
Examples: congenital valvular heart disease, deafness,
blindness, colour blindness...

Dynamics of disease
Disease is a definite morbid process haveing
a characteristic train of symptoms and signs
Dynamics of disease is characterized by
stages of disease:
1st stage: latent incubation (in infections diseases)

Its duration is measured by time passed between

beginning of noxa influence of body and
beginning
of first non-specific symptoms and signs of
disease
There are no manifestations of disease during this stage
2nd stage: prodromal

First non-specific symptoms and signs of disease

arise

3rd stage: manifestation of disease

There are specific symptoms and signs

characteristic for specific disease
4th stage: disease outcomes

a) healing and convalescence

b) chronic disease
c) death

Time course of disease

a) Peracute onset during few seconds or minutes
b) Acute onset during hours and days, duration up to
3 weeks
c)

Subacute duration up to 6 weeks

d) Chronic duration more than 6 weeks

Exacerbation of disease usually sudden increse

intensity of symptoms and signs of chronic
disease
Recidivation of disese returning of previosly
healed disease
Remision of disease: decrese intensity of simptoms
and signs of disease

ILLNESS AND DISEASE

It is more important to know what sort of patient

has a disease, than what sort of disease a patient has

A person may "feel ill" without a disease being evident or

diagnosed; likewise, a person may have a disease without
experiencing any illness or suffering

Illness tends to be used to refer to what is wrong with

the patient, disease to what is wrong with his body

Illness is what the patient suffers from, what troubles

him, what be complains of, and what prompts him to
seek medical attention

ILLNESS AND DISEASE

It is more important to know what sort of patient

has a disease, than what sort of disease a patient has

A person may "feel ill" without a disease being evident or

diagnosed; likewise, a person may have a disease without
experiencing any illness or suffering

Illness tends to be used to refer to what is wrong with

the patient, disease to what is wrong with his body

Illness is what the patient suffers from, what troubles

him, what be complains of, and what prompts him to
seek medical attention

When we say "a person is ill " we mean he feels

uncomfortable, he is suffering from
certain
symptoms such as nausea, headache, abdominal
cramps, or just

fatigue that can't be explained on the basis of

exertion
Disease refers to various structural disorders of the
individuals tissues and organs that give rise to the
signs of ill - health

 The principal factors accounting for nearly all

diseases are:
1. heredity - inherited (genetic) diseases,
2. infectious organisms - infectious
diseases,
nosocomial disease
3. lifestyle and personal habits - lifestyle
diseases
4. accidents
5. physical, chemical noxas (poisons and
toxins)

COMMUNICABLE OR NONCOMMUNICABLE

HOW MUCH DO YOU

KNOW ?

It is important to know whether a

disease is Communicable (able to
spread from one person to another), or
Non-communicable (not transmissible
from person to person).
In your book, copy down the listed
diseases. Then place a (C) next to it if
you think its Communicable or an (N)
for Non-communicable.
*Extra credit: Tell what pathogen or
life style factor is responsible for the

ATHEROSCLEROSIS
INFLUENZA
ASTHMA
RINGWORM
POLIO
LUNG CANCER
HEART ATTACK
DIARRHEA

ATHEROSCLEROSIS N Cholesterol
INFLUENZA

C Virus

ASTHMA

N Allergy/stress

RINGWORM

C Fungus

POLIO

C Virus

LUNG CANCER

N Tobacco use

HEART ATTACK

N Diet, Heredity

DIARRHEA

C Bacteria

EPILEPSY
KIDNEY STONES
SICKLE CELL
COLD
EMPHYSEMA
MEASLES
TUBERCULOSIS
A.I.D.S.

EPILEPSY

KIDNEY STONES

SICKLE CELL

COLD

EMPHYSEMA

MEASLES

TUBERCULOSIS

A.I.D.S.

Injury/congenit
al
Diet, water
intake
Heredity
Virus
Tobacco use
Virus
Bacteria

Definition of Communicable
diseases

A communicable disease is an illness

due to a specific infectious
(biological) agent or its toxic
products capable of being directly or
indirectly transmitted from man to
man, from animal to man, from
animal to animal, or from the
environment (through air, water,
food, etc..) to man.

Common Pathogens:
Viruses, Bacteria, Fungi & Protozoa
Virus:

smallest simplest life form. Not alive, and cause

upper respiratory infections and many other type of
diseases.

Bacteria:

simple one-celled organisms. They are

everywhere. Not all bacteria is bad.

Fungi:

more complex than bacteria, but cannot make

their own food. Thrive in warm, moist environments.

Protozoa:

one celled, animal like organisms.

Usually
The poor hygiene behaviors promote the
transmission of infectious diseases
The fecal-oral and respiratory routes are the most
common sources of transmission
Young children and adults may not wash their
hands after using toilets and before
eating/preparing food.

CD- Modes of transmission

Direct

Blood-borne or sexual HIV, Hepatitis B,C

Inhalation Tuberculosis, influenza, anthrax
Food-borne E.coli, Salmonella,
Contaminated water- Cholera, rotavirus, Hepatitis A

Indirect
Vector-borne- malaria, trypanosomiasis
Fomites

Zoonotic diseases animal handling and feeding

practices (Mad cow disease, Avian Influenza)

How are pathogens spread?

Direct Contact: hands and skin
ex: Scabies
Indirect Contact: coughs, sneezes, expelling
pathogens in the air ex: flu
Contact with animals or insects animal and
insect bites ex: Lymes disease (ticks) chills,
fever, headaches, discomfort, a skin eruption, and
inflammation with swelling of the joints.
Other contacts such as contaminated food or
water. Ex: Salmonellosis infection of the
digestive tract. Sharp pain, fever, and bloody,
watery diarrhea that occur 6 to 48 hours after
eating. Nausea and vomiting are common.

Few Important Terminologies related to Communicable Diseases

-Infection

Infection is the entry and development or

multiplication of an infectious agent in the
body of man or animals. An infection does not
always cause illness.
There are several levels of infection
(Gradients of infection):
Colonization (S. aureus in skin and normal
nasopharynx)

Subclinical or inapparent infection (polio)

Latent infection (virus of herpes simplex)
Manifest or clinical infection

Contagious disease
A contagious disease is the one that
is transmitted through contact.
Examples include scabies, trachoma,
STD and leprosy.

Vector of infection
An insect or any living carrier that
transports an infectious agent from
an infected individual or its wastes to
a susceptible individual or its food or
immediate surroundings. Both
biological and mechanical
transmissions are encountered.

Epidemic
The unusual occurrence in a
community of disease, specific health
related behavior, or other health
related events clearly in excess of
expected occurrence
(epi= upon; demos= people)
Epidemics can occur upon endemic
states too.

Endemic
It refers to the constant presence of
a disease or infectious agent within a
given geographic area or population
group. It is the usual or expected
frequency of disease within a
population.
(En = in; demos = people)

Pandemic and Exotic

An epidemic usually affecting a large
proportion of the population, occuring over a
wide geographic area such as a section of a
nation, the entire nation, a continent or the
world, e.g. Influenza pandemics.
Exotic diseases are those which are imported
into a country in which they do not otherwise
occur, as for example, rabies in the UK.

Dynamics of disease Transmission

(Chain of Infection)

Source or Reservoir

II

Modes of transmission

III

Susceptible host

Dynamics of disease Transmission

(Chain of Infection)

Source or Reservoir

II

Modes of transmission

III

Susceptible host

(III): Susceptible host

An infectious agent seeks a susceptible host

aiming successful parasitism.

Four stages are required for successful

parasitism:
1.
2.
3.
4.

Portal of entry
Site of election inside the body
Portal of exit
Survival in external environment

Example :
Agent (cold virus), leaves reservoir (throat of
infected person), when host sneezes (portal of
exit-nose and mouth). Direct transmission
(saliva droplets) enter respiratory tract of
susceptible host at close range (portal of entrymouth). New infection possibly established. If
one link is missing, chain is broken

Noncommunicable Diseases
Nations leading causes of death
Heart disease, stroke, cancer

Complex etiologies (causes)

Multicausation disease model
Host: inalterable, unique genetic endowment
Personality, beliefs, behavioral choices: impact
host
Complex environment: exposes host to risk factors

Multicausation Disease Model

Prioritizing Prevention and Control Efforts

Criteria used to judge importance of disease to
a community
Number of people who will die from a disease
Leading causes of death

Number of years of potential life lost

Captures issues affiliated with various groups

Economic costs associated with disease

Money spent at various levels of government; ex:
alcohol and other drugs

Prevention, Intervention,
Control, and Eradication of
Diseases

Prevention: planning for and taking action to

prevent or forestall onset of disease or health
problem
Intervention: effort to control disease in
progress; taking action during an event
Control - Containment of a disease; prevention
and intervention measures

Eradication: total elimination of disease from

human population

Levels of Prevention
Primary prevention
Forestall onset of illness or injury during
prepathogenesis period

Secondary prevention
Early diagnosis and prompt treatment before
disease becomes advanced and disability severe

Tertiary prevention
Aimed at rehabilitation following significant
pathogenesis; retrain, reeducate, rehabilitate

Primary Prevention of
Communicable Diseases

Strategies at each link in chain of infection

Individuals
Hand washing, using condoms, properly
cooking food
Communities
Chlorinating water supply, inspecting
restaurants, immunization programs for all
citizens, vector control, solid waste disposal

Secondary Prevention of
Communicable Diseases
Individuals
Self-diagnosis, self-treatment w/home remedies
Antibiotics prescribed by a physician

Communities
Controlling or limiting extent of an epidemic
Carefully maintaining records; investigating cases

Isolation, quarantine, disinfection

Tertiary Prevention of
Communicable Diseases
Individuals
Recovery to full health after infection; return to
normal activity

Communities
Preventing recurrence of epidemics
Removal, embalming, burial of dead
Reapplication of primary and secondary measures

Primary Prevention of
Noncommunicable Diseases
Individuals
Education and knowledge about health and disease
prevention, eating properly, adequate exercise,
driving safely

Communities
Adequate food and energy supplies, efficient
community services, opportunities for education,
employment, and housing

Secondary Prevention of
Noncommunicable Diseases
Individuals
Personal screenings (mammogram, pap test, PSA
test), regular medical and dental checkups, pursuit
of diagnosis and prompt treatment

Communities
Provision of mass screenings for chronic diseases,
case-finding measures, provision of adequate
health personnel, equipment, and facilities

Tertiary Prevention of
Noncommunicable Diseases
Individuals
Significant behavioral or lifestyle changes,
adherence to prescribed medications, following
rehabilitation requirements after surgery

Communities
Adequate emergency medical personnel and
services: hospitals, surgeons, nurses, ambulance
services