CONCEPTS OF HEALTH

MDS (PUBLIC HEALTH DENTISTRY)

1. CONCEPTS OF HEALTH 1

2. 2 CONTENTS CHANGING CONCEPTS OF HEALTH DEFINITION OF HEALTH NEW PHILOSOPHY OF HEALTH DIMENSIONS OF HEALTH POSITIVE HEALTH CONCEPTS OF WELL BEING SPECTRUM OF HEALTH DETERMINANTS OF HEALTH INDICATORS OF HEALTH DEVELOPED & DEVELOPING REGION HEALTH SERVICES PHILOSOPHIES CONCLUSION

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4. CHANGING CONCEPTS OF HEALTH 4

5. Health -“absence of disease” Basis of “ germ theory of disease ” Human body - machine Disease - consequence of the break down of the machine Doctor’s task - repair of machine. Criticism- it has minimized the role of environmental, social, psychological & cultural determinants of health. Eg : malnutrition, environmental pollution, mental illness. Biomedical Concept 5

6. 6 Health is not only a biomedical phenomenon, but one which is in influenced by social, psychological, cultural, economic and political factors of the people concerned

7. Biomedical + Ecological + Psychosocial concept. It has been defined as unified or multidimensional process involving the well being of the whole person in the context of his environment. It implied that, all sectors of society have an effect on health Emphasis is on protection and promotion of health 7

8. DEFINITION OF HEALTH WHO Definition (1948)- “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 of “positive” health. Operational Definition of Health: “ A condition or quality of the human organism expressing the adequate functioning of the organism in given conditions, genetic or environmental”. 8

9. NEW PHILOSOPHY OF HEALTH Health is a fundamental human right an essence of productive life inter sectorial an integral part of development central to the concept of quality of life involves individuals, state and international responsibility its maintenance is a major social investment and a worldwide social goal 9

10. DIMENSIONS OF HEALTH 10

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12. 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, a coexistence between the realities of the self and that of other people and that of the environment ” . Psychological factors can induce all kinds of illness not simply mental ones which may include: Essential Hypertension; Peptic Ulcer and Bronchial Asthma Attributes of a Mentally Healthy Person include: Free from internal conflicts, is not at war with him or herself Well adjusted: Is able to get along well with others. Accepts criticism and is not easily upset Searches for Identity Has a strong sense of self esteem Knows oneself, ones needs, problems and goals (this is known as self actualization) Has good self control, balances rationality and emotionality Faces problems and tries to solve them intelligently, i.e., coping with stress and anxiety One of the keys to good health is Positive Mental Health. 12 Mental Dimension

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14. Spiritual health in this context, refers to that part of the individual which reaches out and strives for meaning and purpose in life . This dimension seems to defy concrete definition. It includes: Integrity Principles of Ethics Purpose in life Commitment to some higher being Belief in concepts that are not subject to “ state of the art ” explanation 14 Spiritual Dimension

15. Importance of this dimension is exposed when individuals suddenly loose their jobs or are faced with mandatory retirement. For some this dimension may merely be a source of income but for others it may be source of self worth and life success. Goal achievement and self realization in work are source of satisfaction and enhanced self esteem Other Dimensions include Philosophical, Cultural, Socioeconomic, environmental, educational, nutritional, curative and preventive. 15 Vocational Dimension

16. POSITIVE HEALTH • The state of positive health implies the notion of “perfect functioning of the body and mind”. • It includes all the three aspects which are in a perfect state and include Biological Psychological Social • Health is a Relative Concept – Health is not an ideal state but normal state, based on statistics. For example Newborn Baby in Pakistan weighs 2.8Kg on an average compared to 3.5Kg in developed countries and yet compares favorably in health 16

17. CONCEPTS OF WELL BEING WHO definition of health introduces the concept of “ well being ” . S ubjective components Objective components Standard of Living: Spiritual , educational, recreational and other services may be used individually as measures of socioeconomic status and collectively as an index of the standard of living. It depends on the per capita GNP. Level of Living: It consists of nine components: health, food consumption, education, occupation and working conditions, housing, social security, clothing, recreation and leisure and human rights. These are believed to influence human well being. Quality of Life is defined by WHO as “ 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. ”

18. 18 Physical Quality of Life Index (PQLI) It consolidates Infant mortality, Life expectancy at age of 1 year and Literacy. For each component the performance of individual country is placed on a scale of 0 to 100. The composite index is calculated by averaging the three indicators giving equal weight to each of them. The result is placed on the 0 to 100 scale. The PQLI does not consider the GNP.

19. 19 DIMENSION OBSERVED MAX MINIMUM ACTUAL VALUE (INDIA)-2015 Life expectancy 83.2 20.0 68.3 Mean years of schooling 13.2 6.3 Expected years of schooling 20.6 11.7 Combined education index 0.951 0.547 Per capita income (PPP $) 108,211 163 5,663 HDI=0.611 Dimension index = (actual value – minimum value ) ( maximum value – minimum value ) HDI = geometric mean of all the 3 dimension indices HDI values ranges between 0 and 1 HDI value of India is 0.61 Maximum value - highest observed value during 1980 to 2011 Minimum value - 20 years of life expectancy - 0 years for both education variables - US $163 for per capita GNI HDI RANKING-2015 188 COUNTRIES VERY HIGH 51 (NORWAY,AUS,SWITZERLAND) HIGH 54 MEDIUM 42 (INDIA-Rank-131) LOW 41 (NIGER, CENTRAL AFRICAN REPUBLIC)

20. 20 SPECTRUM OF HEALTH POSITIVE HEALTH BETTER HEALTH FREEDOM FROM SICKNESS UNRECOGNISED SICKNESS MILD SICKNESS SEVERE SICKNESS DEATH

21. 21 DETERMINANTS OF HEALTH

22. 22 Individual responsibility ‘Self-care’- Health related activities undertaken by the persons themselves - Promoting their own health - Preventing their own disease - Limiting their own illness - Restoring their own health  Community responsibility Active involvement of families and communities in health matters Three ways Provide manpower, logistics, funds Take part in planning Utilizing the services Emphasis has shifted from health care for the people to health care by the people. RESPONSIBILITY FOR HEALTH Diet Sleep Exercise Period checkups Vaccination Early care seeking Health must begin with the individual.

23. 23 Health care for the people, to the healthcare by the people. State responsibility Constitution of India says that maintaining the health of the people is the responsibility of the state Alma Ata declaration gave rise to the Health of All for state responsibility International responsibility Cooperation between different countries Experts, drugs, control of communicable diseases Eg. , Smallpox, HIV/AIDS, Tobacco

24. 24 INDICATORS OF HEALTH Indicator- variable which help to measure changes (WHO) To measure the health status of a community To compare the health status of country with that of another. Health care Indicators Health care index (indices) In relation to health trend Amalgamation of health indicators  vs

25. 25 CHARACTERISTICS OF INDICATORS Ideal Indicators should be • Valid - Measure what they are actually supposed to measure • Reliable - Answers should be the same if measured by different individuals in same circumstances • Sensitive - Sensitive to the changes in the situation concerned • Specific - Reflect changes only in the situation concerned • Feasible - Have the ability to obtain data needed • Relevant - Contribute to the understanding of the phenomenon of interest USES OF INDICATORS OF HEALTH Measurement of the health of the community. Description of the health of the community. Comparison of the health of different communities. Identification of health needs and prioritizing them. Evaluation of health services. Planning and allocation of health resources. Measurement of health successes

26. 26 Classification of indicators: Mortality Morbidity Disability Nutritional status Health care delivery Utilization rates Indicators of Social and Mental health Environmental Socio-economic Health Policy Indicators of Quality of life Other (Basic needs, Health for All, Millennium Development Goals and now Sustainable development goals)

27. 27 MORTALITY INDICATORS Crude death rate . 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 by those born alive into a population if the current age specific mortality rates persist. 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 Child mortality rate . Under – 5 proportionate mortality rate Maternal Mortality rate Disease specific mortality rate Proportional mortality rate Case fertility rate Years of potential life lost (YPLL) 1

28. 28 MORBIDITY INDICATORS These reveal the burden of the disease in the community. Thus these are used to supplement the mortality rates. The following morbidity rates are used for assessing ill-health in the community Incidence and prevalence rate, D isease notification rate, OPD attendance rate, Admission, R eadmission and discharge rate, D uration of stay in hospital and Spells of sickness or absence from work or school. 2

29. 29 DISABILITY RATES 3

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31. 31 Uses of DALYs • To assist in selecting health service priorities • To identify the disadvantaged groups • Targeting health interventions • Measuring the results of health interventions • Providing comparable measures for planning & evaluating programs • To compare the health status of different countries One DALY = One year of healthy life lost

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35. 35 SPECIAL INDICATOR SERIES HEALTH FOR ALL INDICATORS For monitoring the progress towards the goal of Health For All by 2000 , the WHO has listed the following four categories of indicators.

36. 36 MILLENNIUM DEVELOPMENT GOALS INDICATORS

37. 37 SUSTAINABLE DEVELOPMENT GOALS

38. 38 100 CORE HEALTH INDICATORS SDG

39. 39 HEALTH INDEX OF INDIA (NITI AAYOG)

40. 40 Social & Economic Characteristics Variable Developing Countries Developed countries Place of residence Mostly Rural Mostly Urban Major occupation Agriculture Industry Standard of living Low High GNP per capita 200 to 6,000 US $ 5,000 to 40,600 US $ Adult literacy Low High Women Economically dependent Economically independent Demographic Characteristics Variable Developing Countries Developed countries Growth Rate Above global GR (>1.3%) Below global GR (<1.3%) Young population (under 15 yrs of age) 24% (2016) 16% Elder population (over 65 yrs of age) 5% 18% DEVELOPED & DEVELOPING REGION

41. 41 Contrast in Health (Health Gap) Developed countries have longer life expectancy and lower IMR and child mortality rate and it is opposite in developing . The pattern of burden of disease differs in world substantially this is known as epidemiological transition.

42. 42 HEALTH CARE “Multitude of services rendered to individuals, families or communities by the agents of the health services or professions for the purpose of promoting, maintaining or restoring health.” Characteristics of health care • Appropriateness • Comprehensiveness • Adequacy • Availability • Accessibility • Affordability • Feasibility HEALTH SERVICES PHILOSOPHIES HEALTH SYSTEM To deliver health services Constitute the management sector & involve Organizational matters e.g. planning , determining priority, mobilizing & allocating resources, translating policies in services, evaluation &health education. Components of health system Concepts Ideas Objects Persons Aim of health system- health development

43. 43 HEALTH TEAM CONCEPT Group of persons who shares common health goals & objectives, determined by community need & toward the achievement of which each member of the team contributes in accordance with her/his competence & skill, and the respecting the functions of others. LEVELS OF HEALTH CARE • Primary health care – “Essential” health care PHC, Sub centers • Secondary health care- mostly curative services CHC, District hospitals • Tertiary health care- super- speciality care provide managerial skill teaching specialized staff HEALTH FOR ALL • May 1977-World health assembly • “Attainment by all the people of world by the year 2000 AD of level of health that will permit them to lead socially & economically productive life” • Health for all by 2000- essential principle is the concept of “equity in health”

44. 44 PRIMARY HEALTH CARE • 1978-Alma-Ata,USSR Essential health care based on practical, scientifically sound & socially acceptable methods & technology made universally accessible to individuals & families in the community through their full participation & at the cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-determination • Accepted to achieve the goal of “Health for all by 2000” • “Health by people” and “placing people’s health in people’s hands” Declaration of Alma Ata Primary health care include at least • Education about prevailing health problems and methods of preventing & controlling them • Promotion of food supply & proper nutrition • An adequate supply of safe water basic sanitation • Maternal & child health care ,including family planning • Immunization against infectious diseases • Prevention & control of endemic diseases • Appropriate treatment of common diseases & injuries • Provision of essential drug

45. 45 HEALTH PROMOTION

46. 46 HEALTH SERVICES RESEARCH HSR is holistic and multidisciplinary. It is essential for the continuous evolution and refinement of health services. It includes: Biomedical research: to elucidate outstanding health problems and develop new or better ways of dealing with them Intersectoral research: for which relationships would have to establish with the institutions concerned with the other sectors Health services research: or health practise research or “health systems research”

47. 47 CONCLUSION The health care should focus on four major health-related goals:

48. 48 Developed and developing regions -https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7122505/#:~:text=In%20developing%20countries%2C%20nearly%2050,%2C%20diarrhea%2C%20malaria%20and%20tuberculosis. REFERENCES Park, Park’s Textbook of Preventive &Social Medicine, 25th Edition, Jabalpur: Banarsidas Bhanot,2019.