Introduction to Public

Health –
Health as a concept
Human Biology III
Lesson 2

Yeetey Enuameh MD, MSc DrPH

Email: yeetey@yahoo.com
Outline of lesson
1. Concept of health
2. Concept of disease
3. Definition of health
4. Dimensions of health
5. Health systems
6. Partners in public health
1. Concept of health
• The understanding and appreciation of health have
evolved over the generations
• Health as a concept has over the years gone
through several transitions.
• Some of the conceptual transitions include:
• Biomedical
• Ecological
• Psychosocial
• Biopsychosocial
• Holistic
 1a. Health as a “biomedical”
concept
• This focuses on the biological factors influencing health
• Health traditionally was “the absence of disease”
• Implying an individual is healthy when he/she is free from
disease
• Takes its origins from the “germ theory of disease”
• Views disease from the perspectives of
• pathology, biochemistry and physiology
• Perceives the human body as a machine, disease causes
the body to break down and the physician’s job is to fix it
• The biomedical concept does not consider other factors
such as psychological, social and environmental that
contribute to health
 1b. Health as an “ecological”
concept
• Views health as a dynamic equilibrium between man
and the physical environment within which he resides
• Perceives disease as a maladjustment between man
and his environment
• This concept emphasizes the need for harmony
between man and his environment for him to attain
health – e.g.,
• Cholera from contaminated water sources
• Stagnant waters breeding mosquitos that transmit malaria
• Stressful work environments and their effects
1c. Health as a “psychosocial”
concept
• Views health beyond the biomedical sphere
• Social, cultural, mental, emotional and
spiritual factors influence health
• Psychosocial health is defined as a state of
mental, emotional, social and spiritual well-
being
• This concept broadens the scope of factors
that influence the health of man
1d. Biopsychosocial concept of
health
• This concept looks at health from the
perspectives of
• Biological factors
• Psychological factors
• Social factors
• It was proposed by George Engel an
American internist and psychologist in
1977
1e. Health as a “holistic” concept
• The holistic concept looks at health as an
amalgamation of the biomedical, ecological and
psychosocial concepts
• Health is a unified and multidimensional process
involving the wellbeing of man within the context
of his environment
• All sectors of society, therefore impact on the
health of man
1f Other concepts
• One health
• Link between humans, animals and the environment
• Eco health
• Interactions between humans and their environment/
ecosystem
• Planetary health
• Draw on the distinctions between the health of the
planet and that of humankind, and emphasize the
synergy between them
 2. Concept of disease
• Some definitions of disease include:
• A condition in which the health of the body is impaired, a
departure from a state of health, an alteration of the
human body interrupting the performance of vital
functions
• A condition of the body or some part or organ of the body
in which its functions are disturbed or deranged
• Disease is simply the opposite of health i.e., any deviation
from normal functioning or state of complete physical or
mental well-being
• From the ecological perspective, disease is defined as a
maladjustment of the human organism to the environment
 2a. Differences between disease,
illness and sickness
• Disease
• Literally means “without ease” (uneasiness) - when something is
wrong with bodily function
• It is a physiological/psychological dysfunction
• Illness
• Refers to the presence of a specific disease
• The individual’s perceptions and behavior in response to the
disease
• And the impact of that disease on the psychosocial environment
• It is a subjective state of the person who feels aware of not being
well
• Sickness
• Refers to a state of social dysfunction
• i.e., a role that the individual assumes when ill (sickness role)
 2b. Historical Theories of disease causation
• The cause of disease has over time moved from the
supernatural to the multi-factorial
• Supernatural causes & Karma
• Theory of humors (fluid)
• The miasmatic [pollution/bad or night air] theory of disease
• Theory of contagion [transfer of disease by contact]
• Theory of spontaneous generation [diseases produced
bacteria]
• Germ theory [micro-organisms causing diseases]
• Epidemiological Triad
• Multi-factorial causation
• Web of causation
Assignment related to previous
slide
• Read on and review the theories on the previous slide
along the structure below:
• Structure of review
• Define/describe the theory
• Who was/were the originators of the theory
• Time period within which the theory was developed
• How is health viewed from the perspective of the theory?
• Your perspective on how the theory ultimately influenced/
still influences health as we have it today
• References
• Share them among your study groups
• Each group should email a one-page summary to me!
3. Definition of health
• Definition of Health
• Health is a state of complete physical, mental
and social well-being and not merely the
absence of disease or Infirmity

[The Constitution of the World Health Organization (WHO), 1946].

3a. Shortfalls of the WHO
definition
• It is too broad – health cannot be a state, but a
dynamic process involving changing demands and
meanings to life
• It is not realistic – rarely will any one individual be
in a perfect state of biological, physical, mental or
social functionality… implicitly all are sick at one
point in time
• It is not operational – the components of the
definition are difficult to measure and quantify
 3b. New concept of health
• Health is currently looked at from the following
perspectives:
• A fundamental human right
• It is of essence to a productive life
• It is inter-sectorial
• It is an integral part of development
• It is central to quality of life
• It involves individuals, state and international responsibility
• Health and its maintenance is major social investment
• Health is a world-wide social goal
4. Dimensions of health
• Health is multidimensional. Commonly stated
dimensions are:
• Three dimensions from the WHO constitution:
• Physical
• Social
• Mental
• Other dimensions include:
• Spiritual
• Intellectual
• Emotional
• Environmental
• Occupational
4a. Physical dimension
• Under the physical dimension, health is viewed
from the physiological perspective
• Health is conceptualized biologically as a state
in which every organ is functioning at their
optimum capacity and in perfect harmony with
the rest of body – e.g., ideal body weight,
heartbeat, blood pressure, respiratory rate, etc.
• Physical health can be assessed at the
community level by measuring morbidity and
mortality rates
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4b. Mental dimension
• Mental health is a state of balance between
the individual and the surrounding world, a
state of coexistence and harmony between
oneself, others and the environment
• The mental dimension includes the ability to
think clearly and coherently
• It also deals with sound socialization in
communities
• Mental health is not merely an absence of
mental illness
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4c. Social dimension
• Social health refers to the ability to make and
maintain relationships with other people or
communities
• It has two components – the individual and
societal, and their interaction and interrelation
• When one is less isolated, the greater their sense of control
and empowerment
• Also, the more socially integrated a person is the less they
suffer from a range of mental and physical disorders
• Social health includes the level of social skills
one possesses, social functioning and the
ability to see oneself as a member of a larger
society.
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4d. Spiritual dimension
• Spiritual health has to do 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
• The spiritual dimension includes the following:
• Integrity
• Principles and ethics
• The purpose of life
• Commitment to some higher being
• Belief in the concepts that are not necessarily
explained in physical terms
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4e. Environmental dimension
• Environmental health includes the ability to
promote health measures that improve the
standard of living and quality of life in the
community
• These include laws and agencies the safeguard the
physical environment
4f. Emotional dimension
• Emotional health entails the ability to control stress
and to express emotions appropriately and
comfortably
4g. Occupational dimension
• Occupational health comprises aspects of wellness
that help achieve a balance between work and
leisure in a way that promotes health and a sense
of personal satisfaction
5. The Health System
• The health system comprises of organizations,
institutions and resources that are devoted to
producing health actions
• A health action is any of the following efforts
whose primary aim is to improve health and
secondly provide good health
• Personal healthcare
• Public health services
• Inter-sectorial initiatives
 5a. Overall goals of National
Health Systems
• Good health
• The best available level of health for the populace
• Responsiveness to the expectations of the population
• Individuals and populations receive the care they expect
from the system – satisfaction with services
• Fairness
• The smallest feasible differences between individuals and
populations i.e., responds equitably to everyone in society
without discrimination
5b. Building blocks of the health
system
• The WHO provides six building blocks
• Service delivery
• Health workforce
• Information
• Medical products, vaccines and technology
• Financing
• Leadership and governance (stewardship)
5c. Priority areas of health systems in
Africa
• The 2008 Ouagadougou declaration on primary
healthcare and health systems in Africa provides nine
priority areas
• Leadership and governance for health
• Health services delivery
• Human resources for health
• Health financing
• Health information systems
• Health technologies
• Community ownership and participation
• Partnership for health development
• Research for health
6. Partners/stakeholders in Public Health

• The field of public health is broad and

interdisciplinary.
• Government provides the infrastructure including
transportation, housing, schools, city planning,
policies, law enforcement, etc.
• Beyond government, stakeholders with skills in
intervention programs, policies, research,
evaluation, and education are required.
 6a. Partners/stakeholders in Public Health

Clinical Care
Community groups Delivery System

Government Ensuring the Conditions Employers

Public Health for Population Health and Businesses
Infrastructure

Academia The Media

Institute of Medicine. The future of the public's health in the 21st century. Washington, DC: The National Academies Press; 2002.
30
6b. Nongovernmental Organization Examples

Organization Type Example

Professional membership American Public Health
organizations Association/ Ghana Medical
Association
Associations related to a American Cancer Society/
specific health concern Ghana Diabetes Association
Organizations of citizens Americans for Nonsmokers Rights
focused on health
concerns
Foundations that support Bill and Melinda Gates Foundation
health projects and
influence public policy
development
Institute of Medicine. Who will keep the public healthy? Workshop summary. Washington, DC: The National Academies Press; 2003. 31
6c. Health Care as a Partner in Public Health

Public Health Health Care

Population focus Individual patient focus

Public health ethic Personal service ethic

Prevention or public Diagnosis and treatment

health emphasis emphasis
Joint laboratory Joint laboratory
and field involvement and patient involvement
Clinical sciences Clinical sciences essential to
peripheral to professional professional training
training
Public sector basis Private sector basis

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 6c. Other Partners in Public Health
• Vehicle for public discourse
Media • Health education and promotion
• Health communication
• Social media as catalyst
• Employer-sponsored health insurance
Employers programs
and Businesses • Wellness initiatives and benefits
• Healthy workplaces and communities

• City planning
Government
• Education
Agencies • Health in all policies

• Education
• Training
Academia • Research
• Public Service

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References
• CDC. Public health 101 series. Introduction to
Public Health
• The health system. African health observatory
[http://www.aho.afro.who.int/profiles_information
/index.php/Ghana:The_Health_System]