CONCEPT OF HEALTH AND DISEASE

Definition of Health
According to WHO, Health is defined as a state of complete physical, mental, and
social well-being and not only in absence of disease or infirmity.

According to WHO, health has three parameters,

 Physical Health- Physical health of a person is defined as, a good complexion, a

clean skin, bright eyes, lustrous hair with a body well clothed with firm flesh, regular
activity of bowels and bladder and smooth, easy, coordinated bodily movements. All
the organs of the body are of adequate size and function normally.
 Mental Health-The mental health of a person is defined as, self-satisfaction, self-
confidence, no conflict within himself, happy, calm, and cheerful personality, well-
adjusted with others, understanding, having self-control.
 Social Health-Social concept means those having abilities making friendship with
others that are satisfying and lasting, living effectively with others, and showing
socially considerate behaviour.

Concept of Health

Health is evolved over the centuries as a concept from individual concern to world-
wide social goal and encompasses the whole quality of life.

Changing concept of health till now are:

 Biomedical concept
 Ecological concept
 Psychosocial concept
 Holistic concept

BIOMEDICAL CONCEPT

Traditionally, health has been viewed as an “absence of disease”, and if one was
free from disease, then the person was considered healthy. The medical profession
viewed the human body as a machine, disease as a consequence of the
breakdown of the machine and one of the doctor’s task as repair of the machine. It
minimized the role of environment, social cultural( life-long personal habits,
economic status, education) determinants of health. Biomedical model was found
inadequate to solve some of the major health problems.
For example: A person catches the flu or even a cold when facing major mental
stress or distress. In terms of a biological idea, if somebody recovers from a cold or
the flu, even though he continues to experience emotional stress and despair, he will
be seen as healthy.

This notion is sufficient to provide a thorough picture of health because it disregards

other components of health (such as environmental, psychological, social, etc.) as
well as other significant issues facing humanity (such as drug misuse, starvation,
accidents, etc.).

ECOLOGICAL CONCEPT

Form ecological point of view; health is viewed as a dynamic equilibrium between

human being and environment, and disease a maladjustment of the human
organism to environment. According to Dubos “Health implies the relative absence of
pain and discomfort and a continuous adaptation and adjustment to the environment
to ensure optimal function. The ecological concept raises two issues, viz. imperfect
man and imperfect environment. Improvement of human adaptation to environments
improve longer life and better quality of life.

For example: Compared to the environmental conditions that prevailed when human
activities were paused during the COVID-19 pandemic and the better health
conditions, health issues that are quite prevalent today are caused by environmental
conditions (ignoring the COVID-19 condition).

They argued that good health entails adjusting to one's surroundings in order to
perform at its best. The population explosion and the availability of food are both
influenced by this. It makes a compelling case that human adaptation to the
environment increases lifespan and improves quality of life.

PSYCHOSOCIAL CONCEPT

According to psychosocial concept “health is not only biomedical phenomenon, but is

influenced by social, psychological, cultural, economic and political factors of the
people concerned. Health is both a biological and social phenomenon.

For example: An introvert cannot be perceived as healthy because they might not
ask for assistance or speak up for themselves if necessary, which could be harmful
to them in any of the ways stated above.
 As a result, health is both a biological and a social phenomenon, and the lack of
even one of the two will classify a person as "not healthy”.

HOLISTIC CONCEPT

This concept is the synthesis of all the above concepts. According to this view,
health implies a sound mind, in a sound body, in a sound family, in sound
environment.

 It recognizes the strength of social, economic, political and environmental influences

on health. The holistic approach implies that all sectors of society have an effect on
health, such as agriculture, Food, Industry, education, housing and other sectors.

 It described health as a unified or multi-dimensional process involving the wellbeing

of whole person in context of his environment.

for example: The ideal illustration of a healthy person is someone who lives in
Chicago (the whiz, cleanest city in the world), is disease-free, and has a stable
social, mental, and financial existence.

It indicates that all facets of society, particularly those involved in agriculture, animal
husbandry, food production, industry, education, housing, public works, and
communications, have an impact on people's health. This places a focus on health
promotion and protection.

DIMENSIONS OF HEALTH

 Health is multidimensional.
 World Health Organization explained health in three dimensional perspectives:
physical, mental, social and spiritual.
 Besides these many more may be cited, e.g. emotional, vocational, political,
philosophical, cultural, socioeconomic, environmental, educational, nutritional,
curative and preventive.

PHYSICAL DIMENSION
 Physical dimension views heath form physiological perspective.
 It conceptualizes health that as biologically a state in which each and every organ
even a cell is functioning at their optimum capacity and in perfect harmony with the
rest of body.
 Physical health can be assessed at community level by the measurement of
morbidity and mortality rates. The state of health may be assessed by such
indicators as death rate, infant mortality rate and expectation of life.

MENTAL DIMENSION
 Ability to think clearly and coherently. This deals with sound socialization in
communities.
 Mental health is a state of balance between the individual and the surrounding world,
a state of harmony between oneself and others, coexistence between the relatives
of the self and that of other people and that of the environment.
 Mental health is not merelyan absence of mental illness. Good mental health is the
ability to respond to the many varied experiences of life with flexibility and a sense of
purpose.

SOCIAL DIMENSION
 It refers the ability to make and maintain relationships with other people or
communities.
 It states that harmony and integration within and between each individuals and other
members of the society and between individuals and the world in which they live.
 Social dimension of health includes the level of social skills one possesses,
social functioning and the ability to see oneself as a member of a larger society.

SPIRITUAL DIMENSION
Spiritual health is connected with religious beliefs and practices. It also deals with
personal creeds, principles of behaviour and ways of achieving peace of mind and
being at peace with oneself.
It includes integrity, principle and ethics, the purpose of life, commitment to some
higher being, belief in the concepts.

DETERMINANTS OF HEALTH
 Health is determined by multiple factors.
 The health of an individual and community is influenced by: individual(internal) and
external factors.
 The individual factors include by his own genetic
 Factors and the external factors include environmental factors.
 Environmental factors range from housing, water supply, psychosocial stress and
family structure through social and economic support systems, to the organization of
health and social welfare services in the community.
 These factors interact and these interactions may be health promoting or deleterious.
 Thus, the health of individuals and whole communities may be considered to be the
result of many interactions.
 Indicators of Health

 Indicators of health are required not only to measure the health status of a
community, but also to compare the health status of one country with that of another,
for assessment of health care needs, for monitoring and evaluation of health
services, activities and programmes.
 Mortality indicators such as (Crude Death rateCrude death rate-it is defined as the
number of death per 100 population per year in a community .It indicates the rate at
which people are dying) Life Expectancy, Infant mortality rate, Child mortality rate,
Under five mortality rate, Maternal mortality ratio, Disease specific mortality,
proportional mortality rate etc), morbidity indicators such as ( Incidence and
prevalence rate, disease notification rate, OPD attendance rate, Admission,
readmission and discharge rate, duration of stay in hospital and spells of sickness
or absence from work or school), disability rates, nutritional status indicators, health
care delivery indicators, utilization rates etc.

CONCEPT OF DISEASE

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.

 Natural history of a disease consists of two phases namely prepathogenesis phase

and pathogenesis phase.
 Prepathogenesis phase is the period prior to the onset of a disease in which the
causative agent has not entered in the human body but favourable factors for the
disease agent to interact with the human host already exist in the environment. In
this phase the man is exposed to the risk of disease.
 Agent, host and environment are the important causative factors in the production of
a disease
 Pathogenesis Phase starts with the entry of the disease agent into the human host.
The time interval from the entry of agent in the host to the appearance of disease is
termed as incubation period.
 During this period the disease agent multiplies and induces tissues and physiological
changes.
 The incubation period is followed by the pathological changes in the form of early
and late pathogenesis. Finally a disease leads to recovery, chronicity, disability or
death.

 Physical agents include heat, cold, humidity, electricity, Pressure etc. Exposure to
excessive heat, cold, humidity, pressure, radiation, electricity ,sound, may result in
illness
 Nutrient agents –These are proteins, fats, carbohydrate, vitamins, minerals, and
water. Any excess or deficiency of the intake of nutritive elements may result in
nutritional disorders
 Chemical agents-Endogenous: some of the chemicals may be produced in the body
as a result of derangement of function, eg, urea ( uremia),serum
bilirubin( jaundice),ketones ( ketosis), uric acid ( gout),calcium carbonate ( kidney
stones) etc.
 Exogenous: Agents arising outside of human host. Eg, allergens, metals, fumes,
dust, gases, insecticides etc. These may be acquired by inhalation, ingestion or
inoculation.
 Mechanical agents: Exposure to chronic friction and other mechanical forces may
result in crushing tearing, sprains, dislocations and even death.
 Host factors: host factors play major role in determining the outcome of an individual
exposure to infection.
 classified as demographic factors like age ,sex
 Biological factors like Biochemical levels of the blood such as cholesterol, enzymes,
blood groups, blood cells count
 Life style factors like living habits, use of alcohol and drug ,smoking
 Socioeconomic status like education, occupation, stress etc.
 Environmental factors- the concept of environment is complex, air, water, soil, social,
and economic conditions under which we live form the environment.

1. Germ Theory of Disease- The concept of cause embodied in the germ theory of
diseases is generally referred to as a one-to-one relationship between causal agent and
disease.
2. Epidemiological Triad- This concept illustrates the triad of causal agent, environmental
condition and the host.

3. Multifactorial Causation- The concept that disease is due to multiple factors and is an
extension of Epidemiological Triad.
4. Web of Causation- This model considers all the predisposing factors of any type and
their complex, interrelationship with each other.