Script - Determinants of Health

Health: Definition

The widely accepted definition of health is that given by WHO (1948) in the preamble
of its constitution, which is as follows.

“Health is a state of complete physical, mental and social well being and not merely
an absence of disease or infirmity”, “with an ability to lead a socially and
economically productive life”

This definition is more of idealistic goal than of a realistic proposition.

• Biological Determinants
• Behavioural and socio-cultural conditions
• Environmental Determinants
• Socio-economic conditions
• Health services
• Age and Gender

Health can be protected by primary, secondary & Tertiary care which

includes

• Good environment
• Cleanliness
• Hygiene
• Good diet
• Proper immunization
• Good habits
• Health care services

If each individual takes care of his health, the country will be productive and the
nation will flourish.

This concept of health as defined by WHO

ü is broad and positive in its implications,

ü sets out a standard for “positive health”
ü Symbolizes the aspirations of the people
ü Represents an overall objective or goal towards which nations should survive

Operational definition for health as given by WHO:

“Health means –
ü There is no obvious evidence of disease and that the person is functioning normally
, i.e., within the normal limits of variation to the standards of health criteria
generally accepted for one’s age, sex, community and geographic region, and,
ü The several organs of the body are functioning adequately in relation to one
another.
Module 2: Dimensions of health
Dimensions of health

Health is multi dimensional. These dimensions function and interact with one
another, though they have their own nature.

• Physical dimension
• Mental dimension
• Social dimension
• Spiritual dimension
• Emotional dimension
• Vocational dimension
• others

1. Physical dimension

The state of physical health implies the notion of perfect functioning of the body. It
conceptualizes health biologically as a state in which every cell and every organ is
functioning at optimum capacity and in perfect harmony with the rest of the body.

The signs of physical health in an individual are:

• Good complexion
• Clear skin
• Bright eyes
• Lustrous hair
• Firm flesh and not too much fat
• Sweet breath
• Good appetite
 • Sound sleep
• Regular bowel activity
• Regular bladder activity
• Smooth, easily coordinated body movements

Measurement of physical health

• Self assessment of overall health

• Inquiry into symptoms of health and risk factors
• Inquiry into medications
• Inquiry into levels of activity
• Use of standardized questionnaire for assessment of certain disorders and
use of medical services
• Nutritional assessment
• Death Rate
• Infant mortality Rate
• Life expectancy
• Maternal Mortality Rate

2. Mental dimension

Good mental health is the ability to respond to the many varied experiences of life
with flexibility and a sense of purpose.

Attributes of a mentally healthy person:

• A mentally healthy person is free from internal conflict

• Well adjusted (get along well with others).Accepts criticisms and is not
easily upset.
• Searches for identity
•

Assessment of mental health

• Can be done using well framed questionnaire on mental status
• Psychological diagnosis

has a strong sense of self esteem

3. Social Dimension

Social well being implies harmony and integration within the individual, between
each individual and other members of society and between individuals and the world
in which they live.It has been defined as the quantity and quality of an individual’s
interpersonal ties and the extent of involvement with the community.

Assessment of social dimension

• Assessment of level of social skills
• Financial matters
• Residential matters
• Social network of the individual

4. Spiritual Dimension

Spiritual health refers to that part of the individual which reaches out and strives for
meaning and purpose in life. It is the intangible thing that transcends physiology and
psychology.

Spiritual dimension includes:

• Integrity.
• Principles and ethics.
• Purpose in life.
• Commitment to some higher being.
• Belief in certain concepts that are beyond explanation.

5. Emotional Dimension

While mental health is seen as “knowing” or “cognition”, emotional health relates to

“feeling”.

Study of psychobiology separates these two dimensions successfully.

6. Vocational Dimension:

When work is fully adapted to human goals, capacities and limitations, work often
plays a role in promoting both physical and mental health.
7. Others:
• Philosophical dimension
• Cultural dimension
• Socioeconomic dimension
• Environmental dimension
• Educational dimension
• Nutritional dimension
• Curative dimension
• Preventive dimension

Health is multifactorial, depends on the interplay of a number of complex

factors which exert their influence on life style of an individual.Both generic and
environmental factors interact with health of an individual and may either
promote or cause deleterious effects on health.

Module 3: Determinants of health

Determinants of health
1. Biological Determinants
2. Behavioural and socio-cultural conditions
3. Environmental Determinants
4. Socio-economic conditions
5. Health services
6. Age and Gender

1. Biological Determinants
• Hereditary
• Gender

2. Behavioural and socioeconomic conditions

Also known as “Life Style” or the way people live.

Life style reflects:

• Social values
• Attributes
• Activities
 Life style is learnt through:

• Social interaction with parents, peer groups, friends, siblings, teachers, etc.
• Social and Mass media

Life style disorders

• Coronary Heart Diseases
• Obesity
• Lung cancer
• Oral cancer
• Diabetes

Diseases related to behavioural defects:

• Infections, due to unsanitary conditions
• Fads, fallacies
• Ignorance
• Poor Nutrition
• Wrong food habits
• Customs
• Poor economic conditions

3. Environmental Determinants
• Internal environment:
Each and every component of the human system and its functioning
• External environment:
Physical, biological and psychological components.
• Micro environment:
Eating habits, Smoking, Drinking and Use of drugs
• Occupational environment:
Socioeconomic and moral environment

4. Socio-economic conditions

Various socioeconomic conditions that influence health include:

• Economic status
• Education
• Nutrition
• Employment
• Housing
• Political System
 Economic status:

GNP is a widely accepted measure of economic performance. Economic status

determines the purchasing power, standard of living, quality of life, family size,
pattern of disease and deviant behaviour in the community. Improvement in
economic status also can lead to increased incidence of disease of affluence, like
CHD, DM, Obesity, etc.

Education:

Female literacy has an influence on health.Lack of education may affect

personal decision making skills and lead to underuse of services, coupled with
binding to tradition and beliefs.

Employment or occupation:

Being occupied not only leads to economic benefit but also mental peace, hence
productive work promotes health.

Political systems:

Political influences are more in implementation of health

technologies.Decisions related to resource allocation, man power policy, choice
of technology and availability of health services, accessibility to health services

5. Health Services:

Health services that are provided include:

• Immunization
• Provision of safe water
• Care of pregnant and lactating mothers
• Care of infants, preschool children and adolescents

Providing nutrition and health services will facilitate people to seek help and thus
be preventive. Care has to be taken to avoid underutilization of these services.

6. Age and Gender:

Chronic diseases accompany the aged. The elderly population deserves special
attention.
 Other related fields which contribute to health of a population includes:
Agriculture and food

Education

Industry

Social welfare

Rural Development

Adoption of policies in economic and social fields such as Employment

opportunities, increased wages, prepaid medical programmes, Family support
systems.Thus, medicine is not the sole contributor to health and well being of
population.Communicable diseases are transmitted from the reservoir to
susceptible host.

Source of Reservoir

A reservoir is defined as any person, animal, arthropod, plant, soil, substance

or combination of these in which an infectious agent lives and multiplies.

Mode of Transmission

Direct Transmission includes:

• Direct contact
Infection may be transmitted from skin to skin, mucosa to mucosa, mucosa to
skin, e.g. STD, AIDS, leprosy, skin and eye infections.

• Droplet infection
Direct projection of spray of droplets of saliva and naso-pharyngeal secretions
during coughing, sneezing, spitting, e.g. respiratory infections, cold, fever,
tuberculosis etc.
 • Contact with soil
Direct exposure of susceptible skin to soil contaminated with agent, e.g. hookworm,
tetanus.

• Inoculation into skin or mucosa

Disease agents may be directly inoculated into the skin or mucosa, e.g. dog bite,
contaminated needles, syringes.

• Trans-placental or vertical.
Transmission of the agents through placenta, e.g. AIDS, hepatitis B, Syphilis.

Indirect Transmission includes:

• Vehicle borne
This implies transmission of the agent through water, food, ice, blood, serum and
biological products. Most common are food and water. Some agents develop in the
vehicle while some others use it purely as a vehicle, e.g. typhoid fever, diarrhea,
cholera, polio, malaria etc.

• Vector borne
Vector is defined as an arthropod, or any living carrier that transports an
infectious agent to a susceptible individual.

Mechanical vector borne: The vector carries the agent on its body, may be feet or
through its gastrointestinal tract passively excreting the vector without any
multiplication.

Biological vector borne: The agent undergoes replication and / or development in

the vector and hence requires incubation period.
 • Air borne
Droplet nuclei:

Tiny particles which represent dried residue droplet. Droplets remain floating
in the air, some may retain virulence, others may lose infectivity and virulence,
e.g. TB, influenza, chickenpox, measles, etc.

Dust: Larger particles expelled during talking, coughing, sneezing settle out on
carpets, furniture, clothes, bedding etc. A variety of infecting agents are reported
in hospital beds, wards, living rooms of houses. During dusting, sweeping, bed
making the agents become part of air or air borne.

Fomite borne:

Fomites are inanimate articles or substance (other than water or food),

contaminated by the infectious discharges from a patient and capable of
harboring and transferring agents to a healthy person. Fomites include soiled
clothes, towels, pens, pencils, taps, surgical dressings etc. Examples of diseases
transmitted by fomites include – diphtheria, typhoid fever, dysentery, eye and
skin infections.

Fingers and hands:

Fingers and hands are the most common agents transferring infections. Hands
and fingers act as media of transfer of agents to food. Examples include
infections, typhoid fever, dysentery, etc.

Lack of hygiene is implicated by cleanliness of hands. Poor sanitation, hygiene

and lack of cleanliness result in person to person transmission of the disease
causing agents.

Susceptible Host

Susceptibility of the host is another factor determining the transmission of disease

causing agents. Sequence of events occurring in the host includes-

• Portal of entry: The agent can find entry through respiratory tract, alimentary
canal, genito-urinary tract, skin etc. Some organisms may have multiple ways
of entry.
 • Site selection :Once entered the organism searches for appropriate site or
tissue for multiplication and survival.

• Portal exit: The agent must find a way out of the body and reach a new host.
If there is no way out, the infection becomes dead end infection, as in rabies.

• Survival of organism:The disease causing agent must survive in the external

environment till it finds a new host.

• Survival of organism: The infection becomes apparent only after a period of

incubation.

Period of incubation is defined as “the time interval between invasion by an

infectious agent and appearance of the first sign and symptom of the disease in
question”. The agent multiplies in the host and when it reaches sufficient density,
health equilibrium is disturbed and disease appears.