Presentation1 community health nursing dgnm

concept and dimensions of health

1. CONCEPT AND DIMENSIONS OF HEALTH

2. Definition Of Health “Health is a state of complete physical, mental and social wellbeing and not merely an absence of disease or infirmity.” - W.H.O(1948) “ Health is the condition of being sound in body, mind and spirit, especially freedom from physical disease or pain.” - Webster

3. Concepts of Health Biomedical concept Ecological concept Psychosocial concept Holistic concept

4. 1. Biomedical concept: Traditionally, health has been viewed as an “absence of disease” and if one has free from disease, then the person was considered healthy. This concept, known as the “biomedical concept” has the basis in the ‘germ theory of disease’. Microorganism Enters Human Body Cause Illness/Disease

5. Criticism Of Biomedical Concept: According to biomedical concept, one factor, i.e. germ is responsible for illness, but other factors which contribute to the illness or not considered. But it has been that some of the health problems such as accidents, nutritional deficiency disorders, mental disorders, disease due to environment pollution also occurs. Even germs also get an opportunity to multiply and therapy cause disease, it get appropriate environment inside the body to grow.

6. 2. Ecological concept: The ecologist put forward an attractive hypothesis which viewed health as a dynamic equilibrium between man and his environment. Disease a maladjustment of the human organism to environment. The ecological concept raises two issues, imperfect man Imperfect environment. So in the view of ecologists health problems occurs due to environmental pollution or mans maladjustment or imperfect man environment.

7. Criticism of ecological concept: Ecologists have considered the external environment of human beings, but internal environment is also responsible for disease. e.g. ; Genetic inheritance, Hemophilia Mental retardation

8. 3. Psychosocial concepts: Health is not only a biomedical phenomenon, but one which is influenced by social, psychological, cultural, economic and political factors of the people concerned.

9. 4. Holistic concept: The holistic model is a synthesis of all above concepts. It recognized the stronger of social, economic, political and environmental influences on health. The holistic approach implies that all sectors of society have an effect on health in particular, agriculture, animal husbandry, food, industry, education, housing, public works, communications and other sectors. The emphasis is on the promotion and protection of health.

10. DIMENSIONS OF HEALTH Dimensions of health Social Physical Mental Spiritual Emotional Vocational

11. 1.Physical dimensions: Physical health means perfect functioning of the body in which each organ is working in harmony with the maximum capacity. Physical health is achieved by the exercise, healthy diet, adequate rest and sleep and no smoking or alcohol intake. To maintain proper physical health there is need for taking safety precautions, and regular follow up with the health care providers. Signs of physical health: A good complexion A clean skin Bright eyes Not too fatty A sweet breath A good appetite Sound sleep Regular activities of bowels and bladder Smooth, easy and coordinated bodily movements

12. Evaluation of physical health Self assessment of overall health. Inquiry about ill health and risk factors. Inquiry in to medications. Standardized questionnaire for cardiovascular and respiratory diseases. Clinical examinations Nutritional and dietary history

13. 2. Mental dimensions: Mental health is a state of balance between body and mind earlier the body and mind where considered two separate entities. But these are interrelated as physical illness can result mental illness and vice versa. How mental illness influence physical health has been shown in fig:

14. Characteristics of mentally healthy person: Mentally healthy person will be capable of making personal and social adjustment. Mentally healthy person is free from internal conflicts. He faces problems and tries to solve them intelligently. He has good self control balances rationally and emotionally. He knows him self his needs problems and goals. He has strong sense of self esteem. He serches for identity. He lives a well balanced life means able to maintain the balance between work rest and recreation.sssssssssssss

15. 3. Social dimensions: An individuals is socially healthy if he is able to maintain harmonious relationship with other members of society in which he lives. Social health rooted in “positive material environment” and “positive human environment” which is concerned with the social network of the individual. The social dimensions of health includes; Communication Intimacy Respect Equality Social functioning .

16. 4. Spiritual dimensions: Spirituality means in touch with deeper self and exploration the purpose of life, as people believe in some force that transcend physiology and psychology of human beings. It includes love, charity, purpose, principles, ethics, integrity, hope of life. Meditations, prayers, or spiritual gatherings are organized to maintain spiritual health.

17. 5. Emotional dimensions: Emotional health is closely related to the mental health and is considered as an important element of health. Mental and emotional aspects of health are now viewed as two separate entities for human life. Cognition is related to the mental health whereas emotional health is related to the feelings of a person. Emotional health includes: An emotionally healthy person has a positive thinking and is capable of coping and adjusting self. An emotionally healthy person participates in all the activities which are related to personal growth and his self esteem. Emotionally well people have the ability to express feelings freely and manage feelings effectively. They are also aware of and accept a wide range of feelings in themselves and others.

18. 6. Vocational dimensions: The choice of profession, job satisfaction, career ambitions and personal performance are all important components of this dimension. To be occupationally well, a person is ultimately doing exactly with what they want to do in life and are comfortable with their future plans. Vocational dimensions of health can be assessed by: Assessing the satisfaction level at job, Facilities attached to the job, Behavior of the management and administrator and for colleagues at job.

19. 7. Other dimensions: A few other dimensions also suggested such as: Cultural dimensions Socio-economic dimensions Environmental dimensions Educational dimensions Nutritional dimension Preventive dimensions

20. vital statistics and measurement Vital statistics: The basic measures for assessing the health of a community and its needs for health services are the size and composition of the human population and the counts of vital events occurring within them (births, deaths, morbid disorders, etc). Such measures are known as vital statistics. Indices, that is summary statistics, derived from such raw data in terms of rates, ratios and proportions are of use to many workers in the health field. Understanding these indices and their uses should help towards efficient provision and use of resources and to appropriate preventative measures targeted at susceptible sections of the community. By themselves, the raw data are of little use until they are transformed to standard indices for valid comparisons.

21. Population and demographics Population size: There is only one accurate way to estimate the size of the relevant population, and describe as demographic characteristics, and that is to count it at a particular point in time. This is known as a census and is usually done once every ten years. The more recent census in the UK took place in 2001. Inter- censal events: The second major problem of measurement in public health is to record the demographic events that occur within the community: births, deaths, marriages and migration both in and out of the area. If these are measured accurately and continuously then the changes in population from year to year can be determined, and the frequent need for censuses eliminated. In the united kingdom, every birth, marriage and death in the country is registered. From these registers it is possible to calculate the rates at which births and deaths are occurring in different areas, social groups, ages and at different times of the year. Immigration and emigration are measured only for the whole country by sample estimates at ports and airports. population size estimates between census years are only an approximation. Some estimates, such as the numbers in different occupations, are so unreliable that mortality data for them is only tabulated in census years.

22. Incidence, prevalence and rates Rates A rate is defined as the number of events, for example deaths or cases of disease, per unit of population, in a particular time spam. To calculate a rate we require: A defined period of time A defined population, with an accurate estimate of size of the population during the defined period. The number of events occurring over the period. rate= No. events Total person-time at risk For a fixed time period Δ t, an average size of the population at risk during that period N and the number of events A the rate is rate= A N x Δ t

23. Incidence The incidence rate refers to the number of disease that exist at a specified point in time. It is the proportion of the population who have a disease at a given time. Prevalences may also be calculated over a time period; for example the number of events within a time period. prevalence = Number of cases Number at risk Diseases with high incidence rates may have low pevalences if they are rapidly fatal.

24. Crude mortality rate The crude mortality rate is usually calculated as deaths per 1000 population per year. Let D be the number of deaths in a given time period of length Δ t, and N be the average size of the population at risk during that period (often approximated by the number in the population at the mid-point of the time period). Then the crude mortality rate is given by r = d x 1000 N x Δ t

25. Specific rates Rates may be required for particular sections of a community and these are referred to as specific rates; that is, where the populations are specified: that is the denominators. For example, age- specific or age- and sex- specific rates may be used for comparison of different populations. Other common specific rates are area, occupation or social class specific (and combinations of these).

26. Other commonly-used rates infant mortality rate number of deaths under one year of age after live birth, divided by the number of live births neonatal mortality rate number of deaths at 0 to 27 days after live birth, divided by the number of live births stillbirth rate number of stillbirths, divided by the total number of births, live and still perinatal mortality rate number of stillbirths and deaths at days 0 to 6, divided by the total number of births birth rate number of live births per year, divided by total population fertility rate number of live births per year, divided by number of women 15-44 ( ie of childbearing age)

27. Mortality Data by Age Group for South West of England 2003 Age Group Population (1000s) % in age group Deaths Age-specific mortality rate 0-4 259.7 5.2 244 5-14 609.3 12.2 59 15-24 591.0 11.8 251 25-44 1319.3 26.4 1219 45-64 1282.2 25.6 5944 65-74 470.7 9.4 8668 75+ 467.1 9.3 39480 All 4999.3 100 55865

28. Standardization Age Group Population (1000s) % in age group Deaths Age-specific mortality rate 0-4 2848.2 5.7 3682 1.3 5-14 6299.8 12.6 725 0.1 15-24 6304.0 12.6 2634 0.4 25-44 14485.7 29.1 14001 1.0 45-64 11971.3 24.0 62755 5.2 65-74 4158.6 8.3 87714 21.1 75+ 3788.3 7.6 331898 87.6 All 49855.9 100 503409 10.1 When comparing populations, we can eliminate the effects of, for example, different age structures by looking at age- specific rates. However, this can be cumbersome, and it is often easier to compare a single summary figure .

29. Direct Standardisation For direct standardisation , we use a standard population structure for reference. We then calculate the overall mortality rate that this reference population would have observed if it had the age specific mortality rates of the population of interest. Suppose the reference population has population counts in each age-group k. We calculate the age-specific mortality rates r k for the population of interest. The directly standardised rate is given by

30. Indirect Standardisation For indirect standardisation , we take the age-specific rates from the reference population and convert them into the mortality rate we would observe if those reference rates were true for the age-structure of the population of interest. This gives us the expected rate for the population of interest, if age-specific mortality rates were the same as for the reference population. We calculate the age-specific mortality rates r’ k for the reference population. Suppose the population of interest has population counts in each age-group k. The expected rate of deaths in the population of interest is

31. Standardised Mortality Ratio We can compare the expected number of deaths, using the indirect standardisation method, with the observed number using the standardised mortality ratio (SMR). Let O be the observed number of deaths in the population of interest, and E be the expected number of deaths when indirectly standardised with respect to some reference population. The SMR is a ratio, not a rate or a percentage. An SMR of 100 means that the population of interest has the same number of deaths as we would expect from the reference population. If it is greater than 100, we have more deaths than expected; if it is less than 100 we have less.

32. Confidence Intervals for SMRs Suppose that deaths are independent of one another, and occur randomly in time so we can use the Poisson distribution with unknown parameter λ: O ∼ Poisson(λ) with E[O] = λ var (O) = λ and so we can approximate var (O) ≈ O. Since the expected number of deaths is calculated from a large sample we can treat it as a constant (since its variance is small enough to be negligible) so

33. Provided the number of deaths is large enough, say O > 10, we can use the Normal approximation and obtain a 100(1 − α)% confidence interval for the SMR:

34. Conclusion: instead of the great evidence of research identified with anxiety, our capacity to predict about this issue is constrained. Although, knowledge of risk factors like environmental factors and genetic factors, may point to vulnerability factors that create in people. Nervousness is a circumstance which does not leave without anyone else’s interference.