Introduction

The World Health Organization (WHO) defines health as "a state of complete physical,

mental and social well-being, and does not consist only of the absence of disease or
infirmity”. Though this is a useful definition, some would consider it idealistic and non-
realistic because using the WHO definition classifies 70-95% of people as unhealthy. There
can also be other definitions of health, e.g. statistical (systolic blood pressure and diastolic
blood pressure) and functional (ability to carry out Activities of Daily Living or ADLs). The
WHO definition also overlooks the fact that several factors influence both the definition of
health and standards of 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.”

Immunizations from various diseases have improved health worldwide. What it means to be
healthy can vary from culture to culture and is often connected with advances in technology
and cultural patterns of race, class, gender, and sexual inequalities. In some cultures, larger
body sizes are seen as a sign of healthiness as it indicates an individual has a preponderance
of food. In other cultures, largeness is more closely associated with unhealthy lifestyles (e.g.,
lack of exercise, poor eating habits, etc.). Advances in technology have also expanded the
idea of what it means to be healthy. What are understood today to be healthy practices were
not emphasized prior to clear understandings of disease and the contributions of lifestyles to
health, and some practices advanced as "healthy" today are the result of cultural beliefs that
benefit some at the expense of others (e.g., inequalities). Finally, sociologists have
demonstrated that access, utilization, education, and practices related to health and well being
are incredibly influenced by (and often seemingly determined by) prevailing cultural norms,
beliefs, and patterns that often have little or nothing to do with physiological health.

Theoretical perspectives:

Functionalism (Talcott Parsons ):

 Good health and effective medical care are essential for the smooth functioning of
society. Patients must perform the “sick role” in order to be perceived as legitimately
ill and to be exempt from their normal obligations. The physician-patient relationship

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 is hierarchical: The physician provides instructions, and the patient needs to follow
them.

Conflict theory:

 Social inequality characterizes the quality of health and the quality of health care.
People from disadvantaged social backgrounds are more likely to become ill and to
receive inadequate health care. Partly to increase their incomes, physicians have tried
to control the practice of medicine and to define social problems as medical problems.

Symbolic interactionism:

 Health and illness are social constructions: Physical and mental conditions have little
or no objective reality but instead are considered healthy or ill conditions only if they
are defined as such by a society. Physicians “manage the situation” to display their
authority and medical knowledge.

Health - Changing concepts:

 Biomedical
 Social
 Ecological
 Psychological
 Holistic

1. Biomedical Concept

 Biomedical Concept- “absence of disease”

 human body = machine,

 disease = consequence of the break down

 Doctor’s task = repair of machine.

Those who subscribe to the biomedical model place particular emphasis on the biological
causes and manifestations of disease and ill-health. Their basic premise is that the human
body is a machine made up of a number of divisible and abstractable parts. As such, any
malfunction (such as disease) is an ‘engineering’ problem which is capable of being tackled
by technical means. This, in turn, gave rise to the doctrine of specific aetiology: for every
disease there is a single and observable cause that can be isolated. The principal strength of
the biomedical model is that there is a considerable amount of evidence to support its basic
assumptions, in that specific causes for particular diseases have been found.

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.

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Traditionally, health has been viewed as an “absence of disease”, and if one was free from
disease, then the person was considered healthy. This concept has the basis in the “germ
theory of disease”.

Limitation- it has minimized the role of environmental, social, psychological & cultural
determinants of health.

The biomedical model is criticised for being

i) Repair- not prevention-oriented,
ii) Technology-centred,
iii) Expensive,
iv) Injurious,
v) Naively utopian

The 2 aspects of the biomedical approach are:

1. Diagnosis: identification of the disease or illness through doctor’s observations of

symptoms or through diagnostic tests e.g. X rays, Scans, blood tests

2. Intervention: action taken to improve health e.g. via medical treatment, hospitalisation,
prescriptions, surgery etc. medical intervention with a fix it approach

Examples of Bio medical model- X-rays, scan, blood test, Ultrasound, Mammograms tests,
Pap smear tests, Prescription, Surgery.

2. Social model of health:

In the social model the health of individuals and communities is seen as the result of complex
and interacting social, economic, environmental and personal factors. Thus, for those who
adhere to the social model, the determinants of health are far more varied and broader in
scope than those found in the biomedical model. Because of the range of its determinants,
the potential for allocating responsibility for ill-health is much greater.

Basic assumptions:
(1) A human being must not be taken as a mechanistic combination of biophysical functions
but as an organistic whole, in which the sum counts for more than its parts
(2) Social factors do not affect a human’s health from “outside” but partly constitute her/him
and her/his health

Problems of social models of health:

 The social model gives rise to many possibilities for apportioning blame and has resulted,
on the one hand, in ‘victim blaming’ and, on the other, in pointing the finger at
deficiencies in public policy and the behaviour of business and industry. With respect to
‘victim blaming’ there are those who argue that ill health is primarily, or even
exclusively, due to individual actions (such as smoking) or inaction (failure to wear a
crash helmet for example). In their view, far more responsibility should be placed on the

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 shoulders of individuals for adopting lifestyles which will minimize the risks of becoming
ill.
 Those who draw attention to the part played by government and business take the view
that responsibility for behaviour and health should not be laid solely at the door of the
individual. People are influenced and constrained by the social, economic and physical
environment in which they live and the organizational setting within which they work.
Thus the failure of governments to provide adequate housing may result in individual
behaviour which is damaging to health and can also lead directly to an increase in
respiratory disease. Similarly, in seeking to maximize profits some businesses will market
goods and services which are known to be damaging to health.

3. 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.

Form ecological point of view; health is viewed as a dynamic equilibrium between human
being and environment, and disease 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.

4. 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.

5. Holistic Concept

It is in other words -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.

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Holistic concept implies that, all sectors of society have an effect on health

New philosophy of Health:

 Health is a fundamental human right.

 Health is essence of productive life.

 Health is inter- sectoral.

 Health is integral part of development.

 Health is central to quality of life.

 Health involves individuals, state and international responsibility.

 Health and its maintenance is major social investment.

 Health is world-wide social goal.

Health as Wellness concept:

 Some distinguish two interacting dimensions: disease versus non-disease and well-being
versus ill-being; others expand the number of dimensions to include spiritual, emotional,
social, and mental.

 Wellness is "a word used by behavioural scientists to describe a state of dynamic

physical, mental, social, and spiritual well-being that enables a person to achieve full
potential and an enjoyable life".

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Health as Resource concept:

 The 1984 WHO revised definition of health defined it as "the extent to which an
individual or group is able to realize aspirations and satisfy needs, and to change or cope
with the environment. Health is a resource for everyday life, not the objective of living; it
is a positive concept, emphasizing social and personal resources, as well as physical
capacities“.

 Thus, health referred to the ability to maintain homeostasis and recover from insults.
Mental, intellectual, emotional, and social health referred to a person’s ability to handle
stress, to acquire skills, to maintain relationships, all of which form resources for
resiliency and independent living.

Positive Health:

 It is a state of physical , mental ,social and spiritual well being when a person enjoys an
equilibrium state with his environment
 Perfect functioning of body mind
 Ability to lead a socially and economically productive life

The Ottawa Charter for Health Promotion:

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 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.

1. Physical
2. Mental
3. Social
4. Spiritual
5. Vocational
6. Others:
1. Cultural
2. Socioeconomic
3. Environmental
4. Educational
5. Nutritional
6. Curative
7. Preventive

1. 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 perfect functioning of body or state in which every cell and every organ is
functioning at optimum capacity and in perfect harmony with the rest of the body.

2. 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 merely an absence of mental illness.

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Features of mentally healthy person:

 Free from internal conflicts.

 Well – adjusted in the external environment.
 Searches for one’s identity.
 Strong sense of self-esteem.
 Knows himself: his mind, problems and goal.
 Have good self-controls-balances.
 Faces problems and tries to solve them intellectually.

3. Social dimension:

Harmony and integration a) within the individual b) between each individual and
other members of the society c) between individuals and world in which they live

 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.

 The less isolated, the greater the sense of control and empowerment, and the more
socially integrated a person is, the less they suffer from a range of physical and mental
disorders.

 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.

4. Spiritual dimension:

 Spiritual health is connected with religious beliefs and practices. It also deals with
personal creeds, principles of behavior and ways of achieving peace of mind and
being at peace with oneself.

 It is intangible “something” that transcends physiology and psychology.

 It includes integrity, principle and ethics, the purpose of life, commitment to some
higher being, belief in the concepts that are not subject to “state of art” explanation.

5. 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.

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  Good working conditions- salary, benefits, rewards, scope for professional growth,
recreation, retirement etc; positively contribute to good health.

Positive Health:

 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.

Concept of Well-being:

Components

 Objective components

 Standard of living

 level of living

 Subjective component

 Quality of life

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.

Level of living :(Used in US)

9 Components

1. Health,

2. food consumption,

3. education,

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 4. occupation and working condition

5. Housing,

6. Social security

7. Clothing

8. Recreation and leisure

9. Human right

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.

New philosophy of Health:

 Health is a fundamental human right.

 Health is essence of productive life.

 Health is inter- sectoral.

 Health is integral part of development.

 Health is central to quality of life.

 Health involves individuals, state and international responsibility.

 Health and its maintenance is major social investment.

 Health is world-wide social goal.

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