UNIT I INTRODUCTION TO HEALTH AND ILLNESS

Learning Objectives

At the end of the chapter on the introduction of Health and illness you should be able know and
understand the following
 Changing concepts of Health;
 Definitions of Health[WHO]
 Dimensions of Health; Positive Health
 Maslows hierarchy of need
 Health illness continuum
 Factors influencing health
 Causes and risk factors for developing illness
 Illness and its types ,illness behaviours
 Impact of illness on patient and family
Concepts of Health
Origin of health
The concept of health as a balance between a person and the environment, the unity of
soul and body, and the natural origin of disease, was the backbone of the perception of
health in ancient Greece
During ancient times, health was largely under the influence of religion and was
equivalent to gaining favor with deities. Religious healers believed that in order to
achieve health, it was necessary for individuals to pray and sacrifice to the gods in
order to propitiate.The rod of Asclepius, an international symbol of medicine, is a
reminder of humanity’s ancient belief that health was endowed by deities of medicine
and healing .The first major break from supernatural concepts of health came from the
school of Hippocrates around the fifth century BCE. Considered the “Father of Modern
Medicine,” Hippocrates was the first to separate Greek medicine from magical and
religious beliefs and establish the relationship between environmental/personal
cleanliness and the origin of disease.The scientific progress made during the era of the
Roman Empire in the first century BCE to fifth century CE further transformed
humanity’s understanding of health. The most prominent physician of the Roman
Empire, Galen, expanded upon the Hippocratic definition of health by stating that the
balance between the four bodily fluids also determined temperament and personality.
Through Roman innovations in sanitation and public health, the focus of healthcare
began to shift from a single individual to an entire society .The discovery of cells (1665
CE), microorganisms (1676 CE), and genes (1866 CE), along with the uncovering of
many chemical and molecular entities that keep the human body and mind in
equilibrium, further refined the concepts of health put forth by Hippocrates and Galen
As additional scientific discoveries were made and healthcare delivery methods
improved, new definitions of health were also developed to apply healthcare on a
societal scale. Although many definitions of health were developed during this
transformation, a discussion of health in the modern era must include what many
consider the cornerstone of health definitions - the one developed by the World Health
Organization (WHO).
An understanding of health is the basis of all the health care and it is not perceived the same way by all the
members of a community including various professional groups (like biomedical scientists, social scientists,
health administrators, ecologists) giving rise to confusion about the concept of health.
Since Health has evolved over the centuries from the concept of individual concern to a worldwide social
goal. There various changing concepts of health such as :
1. Biomedical concept
2. Ecological concept
3. Psychosocial concept
4. Holistic concept

1. Biomedical concept • Traditionally health has been considered as an absence of the diseases and if
someone was free from disease, then that person was considered healthy. • This concept is known as
biomedical concept, and it is based on the “germ theory of the disease.”
• Health means “absence of disease.” • The medical profession viewed the human body as a machine and
disease is an outcome of the breakdown of the machine, and one of the doctor’s tasks was to repair the
machine. • This concept has minimized the role of the environment, social and cultural determinants of the
health.
• Developments in medical and social sciences led to the conclusion that the biomedical concept of health
was inadequate

2. Ecological Concept • Deficiencies in the biomedical concept gave rise to other concepts. • The ecologists
put forward the concept of ecological concept. • Ecologists viewed health as a dynamic equilibrium between
man and his environment, and the disease as a maladjustment of the human organism to environment.

3. Psychosocial Concept •Advances in social sciences showed that health is not only a biomedical
phenomenon, but one which is influenced by social, psychological, cultural, economic and political factors of
the people concerned. •These factors must be taken into consideration in defining and measuring health.
•Thus health is both a biological and social phenomenon

4. Holistic Concept • The holistic model is a synthesis of all the above concepts. •Holistic concept recognizes
the strength of social, economic, political and environmental influences on health. •It has been variously
described as multidimensional process involving the wellbeing of the person as a whole. •The emphasis is
on the promotion and protection of health.
• The holistic approach implies that all sectors of the society have an effect on health, in particular,
agriculture, animal husbandry, food, industry, education, housing, public works and other sectors.

The modern understanding of health became official when the World Health
Organization (WHO), at the time of its establishment in 1948, included the definition of
health in its Constitution. The definition was proposed by Dr Andrija Š tampar, a
prominent scholar from Croatia in the field of social medicine and public health and one
of the founders of the WHO. This generally accepted definition states that “health is a
state of complete physical, mental, and social well-being and not merely the absence of
disease or infirmity” (11). This definition promoted for the first time that, in addition to
physical and mental health, social welfare is an integral component of the overall
health, because health is closely linked to the social environment and living and
working conditions.

Definitions of Health • WHO Definition: “ Health is a state of complete physical, mental and
social wellbeing and not merely an absence of disease or infirmity and the ability to lead a
socially and economically productive life”. • Operational Definition of Health: “ A condition or
quality of the human organism expressing the adequate functioning of the organism in given
conditions, genetic or environmental”. • Thus Health means (a) No obvious evidence of disease
and that the person is functioning normally (b) Several organs of the body are functioning
adequately as well as in relation to one another (Equilibrium or Homeostasis).

New Philosophy of Health • Health is a fundamental Human Right • Health is the essence of
productive life • Health is inter sectorial • Health is an integral part of development • Health is
central to the concept of quality of life • Health involves individuals, state and international
responsibility • Health & its maintenance is a major social investment • Health is a worldwide
social goal

Dimensions of Health • Health is multidimensional, WHO definition envisages three (3) specific
dimensions, however there are many more dimensions: •

1. Physical (Perfect functioning of the body). What does physical health mean? Perfect
functioning of the body in which each organ is working in harmony with the maximum
capacity How is it achieved? By exercise, healthy diet, adequate rest & sleep, and no
addictions.
What are the Signs of Physical Health? What are the signs of good physical health? A
healthy skin texture Bright eyes Not too thin or fat A good appetite Regular bowel
and bladder activities Smooth and easy coordinated movements The resting pulse rate,
blood pressure and exercise tolerance are all within the range of "normality" for the
individual's age and sex. Steady gain in weight till 25 years and constant thereafter •
Evaluation of Physical Health: • i) Self assessment of overall health ii) Inquiry into
symptoms of ill health and risk factors iii) Inquiry into medications iv) Inquiry into level
of activity v) Inquiry into use of medical services vi) Standardized questionnaires for
cardiovascular diseases vii) Standardized questionnaires for respiratory diseases viii)
Clinical examination ix) Nutrition and dietary assessment and x) Biochemical and
laboratory investigations

Community Assessment: At the Community Level, state of health may be assessed by such
indicators as: • Death Rate; Infant Mortality Rate and Expectation of Life •
 2. MentalWhat is good mental health? the ability to respond to the many varied
experiences of life with flexibility and a sense of purpose Definition: "A state of balance
between the individual and the surrounding world, a state of harmony between oneself
and others, a coexistence between the realities of the self and that of other people and
that of the environment"
3. (Mental Health has been defined as “ a state of balance between the individual and the
surrounding world, a state of harmony between oneself and others, a coexistence between
the realities of the self and that of other people and that of the environment”.)
Psychological factors can induce all kinds of illness not simply mental ones which may
include: Essential Hypertension; Peptic Ulcer and Bronchial Asthma • Some major
Psychiatric Illnesses like Depression and Schizophrenia have biological component

Attributes of a Mentally Healthy Person include: • A) Free from internal conflicts, is not at war
with him or herself • B) Well adjusted: Is able to get along well with others. Accepts criticism
and is not easily upset • C) Searches for Identity • D) Has a strong sense of self esteem • E)
Knows oneself, ones needs, problems and goals (this is known as self actualization) • F) Has
good self control, balances rationality and emotionality • G) Faces problems and tries to solve
them intelligently, i.e., coping with stress and anxiety • One of the keys to good health is Positive
Mental Health.

4. Social
5. SOCIAL DIMENSION: harmony and integration within the individual, between each
individual and other members of society and between individuals and the world in
which they live Definition: "Quantity and quality of an individual's interpersonal ties
and the extent of involvement with the community"
(Social wellbeing implies “ Quality and quantity of an individuals interpersonal ties and
the extent of involvement with the community”. • Social health takes into account that
every individual is a part of a family and a wider community and focuses on social and
economic conditions and well being of the “Whole Person” in the context of his social
network. • Social Health is rooted in “Positive material environment” (focusing on
financial and residential matters) and “Positive human environment” which is concerned
with social network of the individual.

4. Spiritual SPIRITUAL DIMENSION: It includes integrity, principles and ethics, the purpose in
life, commitment to some higher being and belief in concepts that are not subject to "state of the
art" explanation

(Spiritual health in this context, refers to that part of the individual which reaches out and strives
for meaning and purpose in life) This dimension seems to defy concrete definition. It includes: •
i)Integrity ii)Principles of Ethics iii)Purpose in life iv)Commitment to some higher being v)
Belief in concepts that are not subject to “state of the art” explanation

• 5. EmotionalEMOTIONAL DIMENSION Mental health can be seen as "knowing" or

"cognition" while emotional health relates to "feeling"

(Initially mental and emotional dimensions were seen one in the same thing but as more research
becomes available a definite difference is emerging. Mental health can be seen as “Knowing” or
“Cognition”, while Emotional health refers to “Feeling”).

6. Vocational 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. the culmination of the efforts of other dimensions as they function together to
produce what the individual considers life "success"
(Importance of this dimension is exposed when individuals suddenly loose their jobs or
are faced with mandatory retirement. For some this dimension may merely be a source of
income but for others it may be source of self worth and life success. Goal achievement
and self realization in work are source of satisfaction and enhanced self esteem) •

7. Other Dimensions include Philosophical, Cultural, Socioeconomic, environmental,

educational, nutritional, curative and preventive.

Concept of Well Being • WHO definition of health introduces the concept of “well being”. It has
both subjective and objective components. • Standard of Living (Spiritual , educational,
recreational and other services may be used individually as measures of socioeconomic status
and collectively as an index of the standard of living”. The standard of living depends on the per
capita GNP) • Level of Living (It consists of nine components: health, food consumption,
education, occupation and working conditions, housing, social security, clothing, recreation and
leisure and human rights. These objective characteristics are believed to influence human well
being) • Quality of Life (It is a subjective component and is defined by WHO as “ 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 a
satisfying occupation), education, social and intellectual attainments, freedom of action, justice
and freedom of expression.”)

Wellness
Wellness & Well-BeingWellness‫ العافية‬further describes health status. It allows health to be
placed on a continuum from one’s optimal level (“wellness”) to a maladaptive state (“illness”)
9 Wellness is a dynamic process that is ever changing
Wellness is a dynamic process that is ever changing. The well person usually has some degree of
illness and the ill person usually has some degree of wellness.
10 This concept of a health continuum negates the idea that wellness and illness are opposite
because they may occur simultaneously in the same person in varying degrees
11 The classic description of wellness was developed by Dunn in the early 1960s. According to
Dunn (1961), high-level wellness means functioning to one’s maximum health potential while
remaining in balance with the
The individual’s state of health is one of continual change.

He moves back and forth from health to illness and back to health again. His condition is rarely
constant. He may wake up feeling great, develop a headache mid-morning, and feel fine again by
noon.

The health-illness continuum (see figure 1-1) illustrates this process of change, in which the
individual experiences various states of health and illness (ranging from extremely good health
to death) that fluctuate throughout his life.