1 Concept of Health

Course Code: BP802T
Course Title: Social and Preventive Pharmacy
Lecture speaker
Dr. Lakshmi Prasanna Marise V
1
Faculty of Pharmacy © Ramaiah University of Applied Sciences
Course Details
• Course: Pharm D
• Department: Pharmacy Practice
• Head of the Department: Dr. Maheswari E
• Faculty: Pharmacy
• Dean: Dr. S Bharath (dean.ph@msruas.ac.in)
2
CONCEPT OF HEALTH
• Health is evolved over the centuries as a concept from individual concern to world
wide social goal and encompasses the whole quality of life
• Changing concept of health till now are:
1. Biomedical concept
2. Ecological concept
3. Psychosocial concept
4. Holistic concept
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BIOMEDICAL CONCEPT
• 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”
• 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
• Limitations: it has minimized the role of environmental, social, psychological and
cultural determinants of health
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ECOLOGICAL CONCEPT
• From ecological point of view; health is viewed as a dynamic equilibrium between

human being and environment, and disease is a 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
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ECOLOGICAL CONCEPT
• The concept supports the need for clean air, safe water and good environment etc
to protect us to prevent exposure to unhealthy factors
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PSYCHOLOGICAL CONCEPT
• According to psychosocial concept “health is not only biomedical phenomenon, but

is influenced by social, psychological, cultural, economic and political factors of the
people concerned”
• Mental health is a state of balance between individual and surrounding
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HOLISTIC CONCEPT
• Holistic concept is the synthesis of all the above concepts

• It recognizes the strength of social, economic, political and environmental
influences on health
• It describes health as a unified or multi dimensional process involving the wellbeing
of whole person in context of his environment
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DEFINITIONS OF HEALTH
• “The condition of being sound in body, mind or spirit especially freedom from
physical disease or pain.” - Webster
• “Health is a state of complete physical, mental, social well-being and not merely the
absence of disease or infirmity.” - World Health Organization
• In recent years, this definition has been amplified to include “the ability to lead
socially and economically productive life”.
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OPERATIONAL DEFINITION
• Broad Sense: Health can be seen as “A condition or quality of human organism

expressing the adequate functioning of the organism in given condition, genetic or
environmental”
• Narrow sense: There is no obvious evidence of disease, and that a person is
functioning normally. Several organs of the body are functioning adequately in
themselves and in relation to one another, which implies a kind of equilibrium or
homeostasis
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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 a world-wide social goal
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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
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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
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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
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SOCIAL DIMENSION
• 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
• 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
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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
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CONCEPT OF DISEASE
• Webster defines disease as “a condition in which body health is impaired, a

departure from a state of health, an alteration of the human body interrupting the
performance of vital functions”
• Ecological point of view disease is defined as “a maladjustment of the human
organism to the environment”
• The simplest definition is that disease is just the opposite of health: i.e. any
deviation from normal functioning or state of complete physical or mental well-
being
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DISTINCTION BETWEEN DISEASE, ILLNESS AND
SICKNESS
• The term disease literally means “without ease” (uneasiness), when something is
wrong with bodily function
• Illness refers to the presence of a specific disease, and also to the individual’s
perceptions and behavior in response to the disease, as well as the impact of that
disease on the psychosocial environment
• Sickness refers to a state of social dysfunction
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DISTINCTION BETWEEN DISEASE, ILLNESS AND
SICKNESS
• Illness is a subjective state of the person who feels aware of not being well
• Sickness is a state of social dysfunction i.e. a role that the individual assumes when
ill (sickness role)
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CONCEPT OF WELLBEING
• Wellbeing of an individual or group of individuals have several components and has

been expressed in various ways, such as ‘standard of living’ or ‘level of living’ and
‘quality of live
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STANDARD OF LIVING
• Income and occupation, standards of housing, sanitation and nutrition, the level of
provision of health, educational, recreational and other services all be used
individually as measures of socioeconomic status, and collectively as an index of the
standard of living
22
LEVEL OF LIVING
• It consists of nine components : health, food consumption, education, occupation

and working conditions, housing, social security, clothing, recreation and leisure
human rights
• These objective characteristics are believed to influence human wellbeing
• It is considered that health is the most important component of the level of living
because its impairment always means impairment of the level of living
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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 a satisfying occupation), education, social and intellectual
attainments, freedom of action, justice and freedom of expression
• A composite measure of physical, mental and social wellbeing as perceived by each
individual or by group of individuals- that is to say, happiness, satisfaction and
gratification as it is expressed in such life concerns as health, marriage, family work,
financial situation, educational opportunities, self- esteem, creativity, belongingness,
and trust in others
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TWO ASPECTS OF HEALTH
• Subjective: It is formed by sensations and feelings of a person suffering from

disease
• Objective: Its basis is formed by objective parameters obtained by measurement of
structures and functions of a person during disease
• The quality of life can be evaluated by assessing the persons subjective feeling of
happiness or unhappiness about the various life concerns
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DETERMINANTS OF HEALTH
• Genetic factors (biological)

• Environmental factors
• Life style
• Behavioral & socio-cultural
• Gender & Age
• Socioeconomic conditions Education, Occupation, Income
• Health services –utilization Immunization, Family welfare ,nutritional
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OTHER DETERMINANTS OF HEALTH
• Food & agriculture
• Education
• Science & technology
• Standard of living
• Social justice, equity, human rights
• Govt Polices to raise stand of living
• Inter sectoral contributions
• Dissemination of information (IEC)

27
BIOLOGICAL DETERMINANTS
• Genetic make-up (Heredity)

• It is permanent & can not be altered
• Transmitted hereditarily
• No treatment
• Prevented to some extent
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ENVIRONMENTAL FACTORS
• Internal environment/Micro
•External environment/Macro
 Physical-air, water, soil
 Biological- plants, animals, microbes
 Social- culture, belifes, traditions
Dynamic equilibrium is Health
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BEHAVIORAL & SOCIO-CULTURAL (LIFE STYLE)
• Depends on economic status (rich & poor)

• Cultural values vegetarianism-Non-vegetarianism
• Social values and status of women
• Personal habits
• Behavioral pattern High risk behavior
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LIFE STYLE
• Learnt by observations from –parents, teachers, peer groups, mass media…..

Includes cultural pattern, social value & behavior
• The way people thinks & live - developed through process of socialization& social
interaction (traditional lifestyles)
• Cultivate healthy lifestyles - proper nutrition & sleep, exercise, avoid drug abuse
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LIFE STYLE MAKES THE DIFFERENCE
• Malnutrition
• Population explosion
• Mental health problems
• Reproductive and child health
• Cancer
• Diabetes mellitus
• Cardiovascular diseases
• AIDS & STDs
• Environmental pollution. 32
SOCIOECONOMIC CONDITIONS
• Determined by-Income (per capita)
1. Literacy
2. Occupation
3. Purchasing capacity
• Indirectly by-religion & caste - Housing - Political support
• Per capita GNP
• GNP directed to wards health care
• Political commitment
• Efficient leadership 33
SOCIOECONOMIC CONDITIONS
• Economy & literacy
• Determines quality of life by -Employment ,housing, nutrition
• Productive work promotes health - Finally determine health status
34
ECONOMIC STATUS
• The per capita GNP is the most widely accepted measure of general economic
performance
• The economic progress of many countries has been a major factor in reducing the
morbidity, mortality, increase in life expectancy & improving of the quality of life,
family size, & the pattern of disease & deviant behavior in the community.
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EDUCATION
• 2nd major factor influencing health status
• Especially female education
• Illiteracy can be a major cause of poverty, malnutrition, ill health, high infant and
child mortality rates
• Low education levels are linked with poor health, more stress and lower self-
confidence
• Studies indicate that education to some extent compensates the effects of poverty
on health, irrespective of the availability of health facilities
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OCCUPATION
• Un employment usually shows a higher incidence of ill health & death
• For many, loss of work may mean loss of income & status
• It can cause psychological & social damage
• The very state of being employed in productive work promotes health
• Occupation can lead to disorders like : Silicosis, Coal workers pneumonia,
Asbestosis, Byssinosis etc
37
POLITICAL SYSTEM
• Main obstacle to the implementation of health technologies are not technical, but
rather political
• Percentage of GNP = Quantitative indicator
• India spends about 3% of its GNP on health and family welfare
• Decisions concerning resource allocation, man power policy, choice of technology &
the degree to which health services are made available & accessible to different
segments of the society are examples of the manner in which the political system
can shape community health services - If poor health patterns are to be changed,
then changes must be made in entire sociopolitical system
38
HEALTH SERVICES
• Availability & utilization of health services
• Should include comprehensive services
• Need based
• Must reach to social periphery
• Equitably distributed
• Accessible at affordable cost
• Socially acceptable
39
HEALTH SERVICES
• Should promote health & prevent illnesses
• Eg:- Immunization of children
• Provision of safe drinking water
• Antenatal care-will reduce maternal mortality ratio & infant mortality rate
• Services must reach to all sections
40
FAMILY WELFARE SERVICES
• Covers spectrum of personal & community services for treatment, prevention &
promotion of health like immunization, family planning, maternal and child health,
integrated child health services, nutrition
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GENDER & AGE
In 1993, the Global Commission on Women’s Health was established with an agenda
for action on women’s health covering
• Nutrition & development
• Violence
• Social status
• Economic independence
• Reproductive health
• Aging
• Lifestyle related conditions and the occupational environment 42
GENDER & AGE
• Even though health service prolong the life of the people , aging of population itself
a matter of concern because chronic diseases and disabilities accompany the aging
process and deserve special attention
• Some diseases of aged include : Diabetes, Hypertension, Coronary Heart Disease
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INDICATORS OF HEALTH
• To measure health status
• To compare
• To assess the health needs
• To plan & implement
• To evaluate health care
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INDICATORS OF HEALTH-CLASSIFICATION
Health is measured multi-dimensionally & indirectly
Health Indicators are classified as
• Mortality indicator
• Morbidity indicators
• Disability indicators
• Nutritional status indicators
• Health care delivery indicators
• Utilization rates
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OTHER HEALTH INDICATORS
• Indicators of social & mental health
• Socio-economic indicators
• Health policy indicators
• Environmental indicators
• Indicators of quality of health
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MORTALITY INDICATORS
• Crude death rates
• Infant mortality rates
• Maternal mortality rates
• Child mortality rates
• Proportional mortality rates
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MORBIDITY INDICATORS
• Incidence rate
• Prevalence rate
• Notification rate
• Out patients attendance rate
• Hospital admission rate
• Duration of stay in the hospital
48
DISABILITY RATES
• Event type - No of days of restricted activity
- Bed disability days
- Sickness absenteeism
• Person type - Limitation of mobility

- Limitation of daily activity
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NUTRITIONAL STATUS INDICATORS
• Incidence of LBW
• Incidence of LBW
• Anthropometric measurements of < 5 mid arm circumference height & weight with
age
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HEALTH CARE DELIVERY INDICATORS
• Doctor : Population. 1:2500
• Nurse: Population 1:5000
• Health worker: Population 1:3000
• Sub centers: Population 1:3000
• P H C : Population 1:30000
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INDICATORS OF SOCIAL & MENTAL HEALTH
• Rates of crimes - murder, theft, suicides, prostitution, gambling, drug abuse
• Rates of accidents
• Rate of divorces, family violence
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SOCIOECONOMIC INDICATORS
• Growth rate of population
• Per capita income / GNP
• Percentage of people below poverty line
• Level of unemployment
• Dependency ratio
• Literacy rate
• Family size
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HEALTH POLICY INDICATORS
• Proportion of the budget (NGP) spent on Health services— Reproductive and Child
Health, Revised National Tuberculosis Control Programme, Integrated Child
Development Services, Pulse polio programme
• Health related services— Water supply, Sanitation, Nutrition, Housing, Community

development.
54
ENVIRONMENTAL INDICATORS
• Indicators relating pollution of air, water, noise, soil, radiation solid waste
• Percentage of houses having safe water supply, adequate sanitary facilities
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ENVIRONMENTAL INDICATORS
• Indicators relating pollution of air, water, noise, soil, radiation solid waste
• Percentage of houses having safe water supply, adequate sanitary facilities
• Thus there is no single comprehensive indicator to assess or to measure the health
status of country
• Each indicator reflects one aspect of health

• Ideal indicator is yet to be developed
• Thus there is no single comprehensive indicator to assess or to measure the health
status of country
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UTILIZATION RATES
• Proportion of infants “fully immunized”
• Proportion of mothers with adequate ANC
• Proportion of Deliveries conducted by TBA
• “Bed occupancy” rate in the hospital
• Coverage with insecticidal spraying
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1 Concept of Health

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Course Code: BP802T

Course Title: Social and Preventive Pharmacy

• From ecological point of view; health is viewed as a dynamic equilibrium between

• According to psychosocial concept “health is not only biomedical phenomenon, but

• Holistic concept is the synthesis of all the above concepts

• Broad Sense: Health can be seen as “A condition or quality of human organism

• Health is a fundamental human right

• Physical dimension views heath form physiological perspective

• Ability to think clearly and coherently

• Free from internal conflicts

• Spiritual health is connected with religious beliefs and practices

• Webster defines disease as “a condition in which body health is impaired, a

• Wellbeing of an individual or group of individuals have several components and has

• It consists of nine components : health, food consumption, education, occupation

• Subjective: It is formed by sensations and feelings of a person suffering from

• Genetic factors (biological)

• Food & agriculture

• Science & technology

• Social justice, equity, human rights

• Govt Polices to raise stand of living

• Inter sectoral contributions

• Dissemination of information (IEC)

• Genetic make-up (Heredity)

Dynamic equilibrium is Health

• Depends on economic status (rich & poor)

• Learnt by observations from –parents, teachers, peer groups, mass media…..

• Person type - Limitation of mobility

• Health related services— Water supply, Sanitation, Nutrition, Housing, Community

• Each indicator reflects one aspect of health

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