First chapter of community medicine syllabus for 4th year MBBS students.

1. Concept of Health
By :-
PROF. Dr. IJAZ AHMAD SHAH
HOD. COMMUNITY MEDICINE
Shahida Islam Medical
College,
Lodhran – PUNJAB-

3. WHAT IS
HEALTH?

4. Health
Health is difficult to define but easier to
understand. To many of us it may mean
absence of disease or infirmity and to many
it may mean sound body and sound mind
and sound function of the body.

5. What is Your Definition of
Health????
People commonly think of
“Health” as just the absence
of disease…. But it is much
more than that..

6. To an anatomist
Healthy body means it should
conform to normal anatomical
structures.
To a physiologist
Health means normal
body functions

7. To a biochemist
It means normal biochemical levels / values
To a pathologist
It means normal cellular make up.

8. To a geneticist
It means correct existence of genetic potential
Similarly to a clinician it means no
abnormality in structure and function of the
body. When a clinician fails to detect
anything abnormal by his clinical wisdom
and laboratory tests he labels a person
no abnormality detected (NAD).

9. To a psychiatrist
It means well adjusted and a balanced
personality

10. Concept Of Health
• An understanding of health is the basis
of all the health care.
• Health 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.

11. • Health has evolved over the centuries from
the concept of individual concern to a
worldwide social goal.
• The various changing concepts of
health as follows:
1. Biomedical concept
2. Ecological concept
3. Psychosocial concept
4. Holistic concept

12. 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.”

13. • 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.

14. • Developments in medical and social
sciences led to the conclusion that the
biomedical concept of health was
inadequate

15. 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.

16. 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

17. 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.

18. • This view says, a sound mind, in a sound
body, in a sound family, in a sound
environment
• 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.

20. Definition of health
• The World Health Organization (WHO)
defines health as a “state of complete
physical, mental, and social well-being, not
merely the absence of disease or infirmity”
(WHO, 1948).

21. Addition in WHO Definition
Regional Committee for the Eastern Mediterranean in
its 46th session redefined HEALTH and added
“THE SPIRITUAL DIMENSION”. (1998)

22. Further Addition
In recent years, this statement regarding health
has
been amplified to include “ the ability to lead a
socially
and economically productive life”.

23. What are the limitations of
these definitions?
‘Health is a state of complete
physical, mental and social
wellbeing, and not merely the
absence of disease or infirmity.’
What’s wrong with this definition?

24. What are the
limitations of this
definition?
 The use of the word ‘complete’, which suggests
‘total’ or ‘perfect’ health. Realistically this can not
be achieved. It has been suggested that perhaps the
word ‘optimal’ replace the word ‘complete’.
 The state of well being is difficult to measure and
 state indicates constant condition, while health keeps
on changing. It is suggested that word “dynamic”
should replace the word “state”

25. FINAL DEFINITION OF HEALTH
Health is defined as a “ dynamic process of
complete physical, mental, social and spiritual
well-being, not merely the absence of disease
or infirmity” and attain a level of health that
permits to lead a socially and economically
productive life.

26. DIMENSIONS of
HEALTH
 ---- PHYSICAL
 ---- MENTAL
 ---- SOCIAL
 ---- SPIRITUAL

27. 1-Physical Health
Physical health implies the notion of “ PERFECT FUNCTIONING” of the body.
 The signs of physical health are:
 A good complexion
 A clean skin
 Bright eyes
 Lustrous hairs
 Adequate body weight according to age and sex.
 A sweet breath
 Regular bowel and bladder activity
 Smooth and coordinated bodily movement
 Special senses are intact
 Resting pulse rate, BP and exercise tolerance
 are with in normality range according to age & gender.



28. Physical Health
 Sound sleep and rest
 Good appetite
 Adequate physical activity
 Maintenance of personal Hygiene
 Avoiding drugs
 Avoiding smoking

29. Mental health is defined “as a state of
well being in which the individual realized
his or her own abilities, can cope with
normal stresses of life, can work
productively and fruitfully and is able to
make a contribution to his or her
community”.
2- MENTAL HEALTH

30. @ Mental health is not mere absence of mental illness.
1, A mentally healthy person is one who is free from
internal conflict, he/she is not at “war” with him or
herself.
2, He is well adjusted , i.e., he is able to get along well
with others. He accepts criticism and not easily upset.
3, He searches for identity.
4, He has a strong sense of self-esteem.
5, He knows himself : his needs, problems and goal
( called self-actualization).
6, He has self good control: reacts rationally in sadness
and happiness.

31.  7, He faces problems and tries to solve these
intelligentally

 8, He is able to make good healthy decisions.
 9, He has a positive attitude.
 10, Keep mind alert
 11, Recognizes achievements.
 12, Learns from mistakes.
 13, Accepts new ideas.

32. 3- Social Health
It is the third dimension of health. It
means ability of a person to adjust with
others in his social life, at home, at work
place and with people. Men interact with
men and they inter-relate and inter
depend on each other and pay their
effective role in accordance with a
situation.

33. Social Health
Refers to how well you get along with others
….
1-You can communicate well.
2-You are able to share
your feelings with others.
3-You have loving relationships.
4-You have healthy friendships.
5-You are able to get along with others,
 even if they are different than you.
6-You ask for help when you
need it and are able to help
others when they need help.

34.  7-Respect others.
 8-Healthy family
 relationships.
 9-Confidentally move in

 society.
 10- Has pleasant manners


35. Social wellbeing is a composite
function of income level, literacy,
occupation and working conditions,
marital harmony, institution of a family,
social groups and have good cultural and
behavioral patterns of the society.

36. Social wellbeing can be measured on
scale by taking in to consideration of
indicators like income, literacy and
occupation.

37. 4- Spiritual Health
 It is the intangible “Something” that transcends physiology andpsychology
 The belief in some force (Allah, nature, science, religion) that serves to unite human
beings and provide meaning and purpose of life. Commitment to some higher being
 Spirit is what can not be defined as part of the body or as part of the mind. Body, mind,
and spirit all have an affect on one and other.
 By improving your spiritual life you can contribute to the healing process. Spirituality may
not be able to cure you, but it can help to cope with the pain and difficulties that
accompany illness. Spiritual health is achieved when you feel at peace with life. It is when
you are able to find hope and comfort in even the hardest of times. It can help to support
you as you experience life completely.

38. Some people find there spiritual health in practicing religion. Others
do not. It is whatever works for you. There is no right or wrong way
to achieve spiritual health. Some ways that may improve your
spiritual health include:
Being in nature: Some people feel very connected and at peace
when they are walking outdoors or are outside of the city.
Helping others: Some feel the largest sense of wellbeing when
they are of service to others. Being of service can take on many
forms. It can be doing volunteer work, being kind to strangers, or
offering a hand to a friend in need.
Gratitude: Some people find they feel the most connected when
they remain grateful. They may make lists of all the things they are
grateful for or say a thank you out loud for all they have.
Religion: Some find the meaning of life through the ritual and
practice of religion.

39. What ever helps to bring hope for the future can serve to keep you
spiritually healthy. Keeping a positive outlook and remaining hopeful
can help the healing process. As whole human beings all parts of us are
connected. By working to keep all parts healthy we can help our
bodies, minds, and souls to remain complete.
When facing a chronic illness it may be easy to lose your spiritual
health. There is a time in which you may be tempted to let go of your
beliefs. It is important to remember that by keeping a healthy spiritual
life you can better manage your physical health. Your spiritual life can
help you to cope with any issues that may arise with your physical
health. We are whole beings. Balance can keep us healthy and help us
to recover.

40. More about Spiritual Health
 What is spiritual health?
 The word "spiritual" refers to that core dimension of you
 - your innermost self
- that provides you with a profound sense of who you are
- where you came from,
- where you're going and
- how you might reach your goal.
You may not think much about spiritual health or well-being and what role it plays
in your life, but its significance is stronger than you may believe. Spiritual
wellness may mean different things to different people. For some, spirituality
may be synonymous with traditional religion, while for others it relates primarily
to the quality of personal relationships or love for nature. A basic foundation for
spiritual wellness may be the sense that life is meaningful and you have found
your place in it. The search for meaning and purpose in human existence leads
one to strive for a state of harmony with him/herself and with others while
working to balance inner needs with the rest of the world.

41. Many of the behaviors associated with wellness are key components of a healthy
spiritual life. Examples include volunteerism, social responsibility, optimism,
contributing to society, connectedness with others, feeling of belonging/being
part of a group, and love of self/reason to care for self.
Signs of Spiritual Health
- Insightful and nurturing relationship with self and others
- Strong personal value system
- Cultivation and fulfillment of purpose in life

42.  Assessing your spiritual health
 Take a moment to assess your own spiritual health by selecting the words in
the column that best describe your current spiritual condition. You decide
which column more accurately describes where you are in your spiritual
health

 Spiritual Health
- hope
- positive outlook
- acceptance of death
- forgiveness, self-acceptance
- commitment
- meaning and purpose
- clear values
- sense of worth
- peace
- worship, prayer, and meditation

43.  Spiritual Atrophy
- emptiness
- anxiety
- loss of meaning
- self-judgment
- self condemnation
- apathy
- long "dry" spells
- conflicting values
- needing to improve myself
- worried/annoyed/acting in haste
- without rituals that touch me

44. OPERATIONAL DEFINITION of
HEALTH
The WHO definition of health is not an
“operational” definition, i.e. itdoesnot
lend itself to direct measurement.

45. OPERATIONAL DEFINITION of
HEALTH
Broad Sense: Health canbe seenas“Acondition or
quality of human organism expressing the adequate
functioning of the organism in given conditions, genetic
orenvironmental.”
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.

46.  POSITIVE HEALTH
A person who is perfectly healthy physically, mentally and
socially and spiritually is said to be in a state of “Positive
Health” i,e.Highest standards of health.
Dubos (1965) said that concept of perfect positive health can
not become reality.
As human life will never be free from struggles, failures and
sufferings.
Everything in our life is subject to change.
Health in this context is – the ability of an individual or group
to modify himself continually, in the face of changing conditions
of life.
As such Doctors and Community health experts are in the
situation as the gardner/ farmer faced with insects, moulds
and weeds. This task never ends.