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Presenter: Dr. Anil Moderator: Dr. Chetna Maliye Slide 2 Framework Introduction Changing Concept of Health WHO definition of health Positive Health Health Paradigm Determinants of Health Concept of Well-being Indicators of Health Concept of Disease Causation of disease Health and Illness Natural History of Disease References Slide 3 Introduction Health in history Why we are concerned about health Health - Changing concepts Biomedical Ecological Psychological Holistic Slide 4 Changing concepts of Health Biomedical Concept- absence of disease human body = machine, disease = consequence of the break down Doctors task = repair of machine. Limitation- it has minimized the role of environmental, social, psychological & cultural determinants of health. Slide 5 Changing concepts of Health Ecological Concept- 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. Slide 6 Changing concepts of Health Psychosocial Concept 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. Slide 7 Changing concepts of Health Holistic Concept 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. Holistic concept implies that, all sectors of society have an effect on health Slide 8 What is Health Oxford dictionary State of being well in body or mind Webster The condition of being sound in body, mind or spirit especially freedom from physical disease or pain Perkins A state of relative equilibrium of body, form and function which result from its successful dynamic adjustment to forces tending to disturb it. It is not passive interplay between body substance and forces impinging upon it but an active response of body forces working towards readjustment. Slide 9 Definition of health Health is a state of complete physical, mental and social well-being and not merely the absence of disease or Infirmity. Constitution of the World Health Organization, July 1946. WHO Definition of health Slide 10 -The state of perfect functioning of body or state in which every cell & every organ is functioning at optimum capacity & in perfect harmony with the rest of the body. Physical component Slide 11 Mental Health- Is a state of balance between individual and surrounding.. Easy to say if its grossly abnormal but difficult in minor disturbances. Distinction between mental and physical health is artificial. Mental component- Slide 12 Social component Social health is an aspect of health that includes social relationships as part of broader concept of health. It has two elements: Individual and societal The less isolated, the greater the sense of control & empowerment, & the more socially integrated a person is, the less they suffer from a range of physical & mental disorders. Slide 13 The Regional framework for health promotion in the Western Pacific Region 2002-05 stresses the role of social capital in health promotion. social capital - trust, social interaction & social connections Social component (Contd.) Slide 14 Spiritual Vocational Socio-economic.etc Other components/dimensions Slide 15 Positive health describes a state beyond the mere absence of disease. Operationalised by a combination of excellent status on biological, subjective, and functional measures Positive health predicts increased longevity (correcting for quality of life), decreased health costs, better mental health in aging, and better prognosis when illness strikes. Positive Health Slide 16 Health Paradigm Slide 17 Determinants of Health BiologicalBehavioral Environmen tal Socio- economic Health system Socio- cultural Ageing of population Science & technology Information & communicat ion Gender Equity & Social justice Human rights Slide 18 Concept of Well-being Components Objective components Standard of living level of living Subjective component Quality of life Slide 19 Standard of living Refers to the usual scale of our expenditure, the goods we consume and the service we enjoy. It includes the level of education, employment status, food, dress, house, amusement and comforts of modern living. WHO: Income & occupation, standard of housing, sanitation and nutrition, the level of provision of health, educational, recreational and other services. Slide 20 Level of living Used in US 9 Components Health, food consumption, education, occupation and working condition Housing, Social security Clothing Recreation and leisure Human right Slide 21 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 the satisfying occupation), education, social and intellectual attainments, freedom of action, justice and freedom of expression. A composite measure of physical, mental and social well- being as perceived by each individual or group of individuals. Slide 22 Indicators of Health Slide 23 Physical Quality of Life Index Includes Infant mortality Life expectancy at age one and Literacy Scale 0 to 100 = worst to best Money is not everything Does not measure economic growth Measures social, economic and political policies Slide 24 Human Development Index (HDI) Combines indicators representing 3 dimensions 1. Longevity Life expectancy at birth 2. Knowledge adult literacy rate & mean year of schooling. 3. Income real GDP Per Capita in Purchasing Power Parity(PPP) in US dollars Index = (Actual value) (Minimum Value) (Maximum value) (Minimum Value) Slide 25 Human Poverty Index Introduced in 1997 Measures deprivation in basic dimensions (Longevity, Knowledge, Income) For developing countries(HPI-1)- 1. A long & healthy life vulnerability to death at a relatively early age. 2. Knowledge adult literacy rate 3. Standard of living average of- %age of population not using an improved water source & %age of children under weight-for-age. Slide 26 Slide 27 Concept of Disease A condition in which body function is impaired, departure from a state of health, an alteration of the human body interrupting the performance of the vital functions. - Webster. Oxford English Dictionary the condition of body or some part of organ of body in which its functions are disrupted or deranged. Ecologically a maladjustment of human organism to the environment Simplest definition opposite to Health. Slide 28 HEALTH AND ILLNESS Slide 29 The Health-Sickness spectrum Slide 30 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 Slide 31 Epidemiological triad Agent Factors Physical Agents Chemical Agents Biological Agents Nutritional agents Host Factors Socio-demographic Factors Psycho-social Factors Intrinsic Characteristics Environmental Factors Physical Environment Biological Environment Social Environment Slide 32 Web of causation Change in life style Stress Abundance of food Smoking Emotional Aging & D Disturbance other factor Obesity Lack of physical activity Hypertension Hyperlidemia Increase catacholamine Changes in walls of arteries thrombotic activity Coronory atherosclerosis Coronary occlusion Myocardial Infarction Slide 33 Natural History of Disease Slide 34 Disease in many Forms.. Acute Chronic/insidious Carrier Spectrum of disease Slide 35 Subclinical Case: ICEBERG PHENONMENON Example: Cholera, Polio, hypertension, malnutrition etc. Slide 36 Some terms.. Disease- biological concept. Means physiological/psychological dysfunction Illness socio-pathological concept. Means - subjective feeling of not being well. Sickness Biological concept of social dysfunction. Slide 37 References 1. WHO. Tech. Report Series 137. WHO. 1952. 2. WHO.Constitution Of World Health Organization. 1946. 3. WHO. Role of Health sector in Food and Nutrition. Tech. Report Series 137. Geneva. 1980. 4. IGNOU. Concepts in Nursing. Available online at: http://www.ignou.ac.in/edusat/BNS/BNS101-Blk2-3-4/Block1en/38- 66color.pdf http://www.ignou.ac.in/edusat/BNS/BNS101-Blk2-3-4/Block1en/38- 66color.pdf 5. WHO. Ageing and Health. A health promotion approach for developing countries. WHO, Regional Office for the Western Pacific United Nations Avenue.Manila, Philippines;2000.11-15. 6. Ghai OP, Gupta P. Essential Preventive Medicine. Vikas Publishing House Pvt Ltd. India;1999:23,817-819. 7. Park K. Parks textbook of preventive and social medicine. 20 th edition, 2009. Banarsidas Bhanot publishers, Jabalpur, India Slide 38 Thank you