CONCEPTS,

DIMENSIONS,

DETERMINANTS,

ECOLOGY OF HEALTH

DR.SREESUPRIA.P.R
I yr Post graduate
Dept of community medicine
SRMC & RI
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 HEALTH
• Absence of disease
• State of being free from illness or injury
-Oxford english dictionary

• Health = Harmony
Being at peace with the self,the
community,the God, cosmos

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HEALTH THROUGH YEARS

• In 1800s -
health was associated with poor
hygiene and unsanitary conditions: health was
the opposite of sickness
• Medical Model – health is viewed on the basis
of germ theory of disease

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HEALTH THROUGH YEARS
• In 1900s -
Suspicion of environmental factors as a
cause of sickness
Ecological Model –viewed diseases & other
negative health events as a result of an
individuals interaction with his/her social or
physical environment

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 WHO DEFINITION
• In 1948 ,
“ HEALTH IS A STATE OF COMPLETE
PHYSICAL , MENTAL , AND SOCIAL WELL
BEING AND NOT MERELY AN ABSENCE OF
DISEASE OR INFIRMITY ”

ABILITY TO LEAD A SOCIALLY AND

ECONOMICALLY PRODUCTIVE LIFE

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CONCEPT OF WELL BEING
• Objective components :
- Level of living
- Standard of living
• Subjective component:
- Quality of life

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NEW PHILOSOPHY OF HEALTH:
• A fundamental human right
• Is an integral part of development
• A world wide social goal
• Is intersectoral
• An essence of productive life
• Is central to the concept of quality of life
• Involves individual.state,international
responsibility
• A major social investment
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 SPECTRUM OF HEALTH
POSITIVE HEALTH
BETTER HEALTH
FREEDOM FROM SICKNESS

UNRECOGNISED SICKNESS
MILD SICKNESS
SEVERE SICKNESS
DEATH
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DIMENSIONS OF HEALTH

EMOTIO
NAL VOCATI
ONAL
SPIRUT
UAL
HEALTH

SOCIAL
PHYSIC
MENTA AL
L
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 PHYSICAL DIMENSION
• Implies Perfect functioning of the body
• A state in which every cell and every organ is
functioning at optimum capacity and in
perfect
harmony with rest of the body.
• Assessment :
- Individual level (physiological
parameters)
- Community level (indicators)
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 MENTAL DIMENSION
• a state of balance between the individual and
the surrounding world ,state of harmony

between oneself and others

• A mentally healthy person

-free from internal conflicts
-well-adjusted
-copes well with stress and anxiety
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 MENTAL DIMENSION
-searches for identity
-good self control
-self perception
-preserves self esteem
• Deals with the cognitive behaviour
• Assessmemt :
-Individual level(questionnaire,
interviews)
-Community level(problems)
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 SOCIAL DIMENSION
• quantity and quality of an individual's
interpersonal ties and the extent of involvment
with the community

• Level of health ,that enables a person to live in

harmony with surroundings

• Involves income,education,occupation,,marital
relation,relation with the social groups
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 SPIRITUAL DIMENSION
• It is that part of the individual which reaches
out and strives for meaning and purpose in life

• It includes integrity,principles ,belief in

supreme being

• Spiritually healthy person is fulfilled and

contented
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 EMOTIONAL DIMENSION
• Emotions are neuro-hormonal reactions
occurring in response to some physical or
mental stimulus, which in turn, affect our
response to the same stimulus
• Relates to FEELINGS
• An emotionally healthy person is -
1) able to show correct emotional
response
2) able to express the thoughts
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 VOCATIONAL DIMENSION
• Concerned with occupation and livelihood

• Work,if fully adapted promotes physical and

mental health

• Man and job – made for each other,he is

vocationally healthy

• Has an impact during

unemployment ,retirement,dissatisfaction 16
 DETERMINANTS OF HEALTH
• The factors that lead to differences in health
status are collectively known as THE
DETERMINANTS OF HEALTH

• Health of an individual is based on

Uncontrollable Factors (genetics, gender)

Controllable Factors (diet, smoking status,

exercise levels)
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 MODELS ON DETERMINANTS
OF HEALTH
• The biomedical view
• The lifestyle approach
• The socio economic approach
• The population health model

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 Biological
Human Rights Behavioural

Equity & Social Environmental

Justice Communities

Socio-economic
Gender Families Health Societies

Information & Individuals

Health System
Communication

Science &
Technology Socio-cultural
Aging of
Population 19
 HEREDITARY DETERMINANT
• Initial significant contribution to one’s state of
health
• the presence in the genetic constitution of the
genes that correspond to the normal
characterization and to the presence of normal
karyotype
• Defective genes reults in diseases
• Prenatal genetic counselling,
gene therapy
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 ENVIRONMENTAL
DETERMINANT
• Main component of epidemiological triad
• In developed countries - particulate air
pollution, ground-level ozone depletion,
environmental tobacco smoke, radiation, lead
from pertrol
• In developing countries – biological agents in
air,water,soil

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INTERVENTIONS:
• Environmental protection act 1986
• Central pollution control board(CPCB)
• The central rural sanitation programme
• Total sanitation campaign
• Imparting education

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 SOCIAL DETERMINANT
• A condition in which the people are
born,grow,live,work

• Economic status
- people are sick because they are poor and
poor because they are sick
- determines the purchasing power,standard of
living,level of living
- per capita GNP
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• Education
• Occupation – productive work promotes health

• Family circumstances,marital status

• Social support and social interactions
• Housing ,tranport
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COMMISSION ON SOCIAL DETERMINANT OF
HEALTH

• By WHO, headed by Sir Michael marmot 2005

• Goal - to lay foundations for health equity
• Reported in Aug 2008 to,
1)Improve daily living conditions
2)Tackle inequitable distribution of
power,money,resources
3) Measure,understand the problem and
assess the impact of action

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BEHAVIOURAL DETERMINANT
-refers to the changes people make in their life
-includes attitudes ,beliefs,lifestyle
habits,cultural values
HEALTHY HARMFUL

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INTERVENTIONS:
• Behaviour change communication
• Policy making:
- Six tanes in1993
- the National Traffic and
Motor Vehicle Safety Act

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 HEALTH SERVICES
• The purpose is to improve the health status of
the population

• Equitably distributed,accessible,affordable,
acceptable

PRIMARY HEALTH CARE

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 POLITICAL DETERMINANT
• Political decisions shape the social and
economic environments and health systems
• Resource allocation,organisation and delivery
of health services,insurance programmes
• Percentage of GNP spent on health- indicator
• India -3% of GNP on health and family
welfare

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 GENDER DIFFERENCES
• Physiological differences
• Women live longer than men, but don’t
necessarily enjoy better quality of life
• Little research went towadrs women’s health
prior to 1990
• Global commission on women’s health 1993

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 OTHERS
• Aging
• Policy making
• Information technology
• Communication
• Industrialisation
• Food and agriculture

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 ECOLOGY OF HEALTH
• Greek word ,meaning OIKOS –a house
• Defined as the science of mutual relationship
between the living organisms and their
environment
• WHO estimation - > ¼ th global burden of
disease is due to modifiable environmental
factors in air,water,soil
-more in children,low economic countries

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ECOLOGICAL FOOT PRINT
• A measure of human impact on environment
• i.e ,how many units of environment are
required to meet the needs of a specified
human population.
• Recent assessment shows an ECOLOGICAL
DEFICIT – depleting earth’s stock to meet our
demands

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GLOBAL ENVIRONMENTAL CHANGES

• Changes to atmospheric composition

• Biodiversity changes
• Changes in food producing ecosystem
• Land degradation
• Depletion of fresh water supplies
• Urbanisation
• Desertification

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GLOBAL CLIMATE CHANGE
• concentration of green house gases-manifests as
heat, which warms the earth surface
• Direct health effects: Thermal
stress,storms,floods,cyclones
• Indirect health effects:
-range and activity of vector borne
diseases may change (mosquito)
-rate of transmission of food,water
borne pathogen increases(salmonella,cholera)
-decreased agricultural
productivity(rice yields 10% per 1degC rise) (35
STRATOSPHERIC OZONE DEPLETION:
- due to green house gas accumulation in the
lower atmosphere
- causes an increase in the UV irradiation at
the earth’s surface
-Health effects : sun burn,skin cancers,eye
disorders,immuno suppression
BIODIVERSITY CHANGES:
-loss of natural habitats of many species
-changes the ecology of vector borne
infections
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 INDUSTRIAL AGRICULTURE:
- extensive use of nitrogenous fertilizers
- farming practices
LAND DEGRADATION:
- reduces food supplies
• Large development projects – dams,irrigation
schemes potentiate spread of infectious
diseases.

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DEPLETION OF FRESH WATER SUPPLIES:
-increased population,intensification of
food and industrial production demands , more
fresh water supplies

URBANISATION:
- over crowding,poor sanitation(infectious
diseases)
- increase exposure to toxic
chemicals ,due to industrialisation
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 DEFORESTATION:
- increased exposure of populations to
infectious diseases
- zoonotic diseases

• PREVENTION OF DISEASES THROUGH

ECOLOGICAL OR ENVIRONMENTAL
INTERVENTION IS CHEAPER,MOST
EFFECTIVE

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THANK YOU
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REFERENCES:

1) Park’s textbook of preventive and social

medicine ,21st edition
2) Sunderlal’s textbook of community medicine ,3rd
edition
3) Textbook of community
medicine ,Dr.A.P.Kulkarni ,3rd edition
4) Piyush gupta’s textbook of PSM ,3rd edition
5) Oxford textbook of public health ,5th edition by
Robert Beaglehole,Mary Ann,Lansang,Martin
Gulliford

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