HEALTH (2)

HEALTH, ITS CONCEPTS DETERMINANTS AND MEASUREMENTS

HEALTH

DEFINITION: As per world health organization “Health is a state of complete physical, mental, social well being and not merely an absence of disease or infirmity.”

During last few years this statement has been amplified to include the ability to lead a “ socially and economically productive life”

HEALTH

"Health " is a multi-dimensional concept that is usually measured in terms of:

1) absence of physical pain, physical disability, or a condition that is likely to cause death,

2) emotional well-being3) satisfactory social functioning.

HEALTH

CONCEPT OF HEALTH:

Health is a common theme in many cultures yet it is not perceived the same way by all members of a community including professional groups etc.

It has evolved over the centuries as a concept from a individual concern to a world wide social goal.

CONCEPTS OF HEALTH CONTD….

Changing concepts of health are as following:

1. Biomedical concept: It has basis in the germ theory of disease.Medical profession viewed the human body as

a machine, disease as a consequence of the breakdown of the machine.

This model was found inadequate to solve some of the major health problems.


2. ECOLOGICAL CONCEPT:Deficiencies in biomedical concept gave rise

to ecological concept of health.Health as a dynamic equilibrium between

man and his environment.It raises two issues : a) imperfect man b) imperfect environment.


3. PSYCHOSOCIAL CONCEPT: Various developments in social

sciences revealed that health is influenced by social, psychological, cultural, economical factors. Health is a biological and social phenomenon.


4. Holistic concept: Synthesis of all the concepts. Recognizes the strength of social, economic,

political and environmental influences on health.

Emphasis on promotion and protection of health.

DETERMINANTS OF HEALTH:

Health is multifactorial. The factors which influence health lie

both within the individual and externally in the society.

These all factors interact with each other and these interactions may be health promoting or deleterious.

Biologicalbehavioral

Human rights

Equity and social justice

gender

Information and communication

Science and technology aging

Socio-culture

Health system

Socio-economic

environment

DETERMINANTS OF HEALTH

DETERMINANTS OF HEALTH CONTD…

1. BIOLOGICAL DETERMINANT:• Human traits are determined by nature of

genes at the moment of conception.• This genetic make-up is unique .• No. of diseases are known to be of genetic

origin such as down’s syndrome, thalasemia, PKU etc.

• From GENETIC point of view Health is defined as “state of individual which is based upon the absence from the genetic constitution of such genes as correspond to characters that takes the form of serious defect”


2. BEHAVIOURAL AND SOCIO-CULTURAL CONDITIONS:

Health requires the promotion of healthy lifestyle which is composed of cultural and behavioral patterns and life long personal habits.

some of the personal habits such as smoking, drinking etc poses a great risk for health.

In India risk of illness and death are associated with lack of sanitation, poor nutrition, personal hygiene, customs and cultural patterns.


3. ENVIRONMENT: Environment is classified as “internal” and

“external’’. Environment has a direct impact on the health of a person.

The environmental factors range from housing, water supply, psychosocial stress, family structure etc.


4. SOCIO-ECONOMIC DETERMINANTS: socio-economic conditions have

long been known to influence human health. In most of the countries of the world health status is determined by level of socio-economic development.

major determinants are:1.Economic status2.Education3.Occupation4.Political system


5. HEALTH SERVICES: Health and family welfare services cover a

wide spectrum of personal and community services for the treatment of disease, prevention of illness, promotion etc. these services must reach the social periphery, equally distributed, easily accessible to all.


6. AGING OF THE POPULATION: By the year 2020 the world will have 1 billion

people above 60 years of age and this will give rise to increased prevalence of chronic diseases, disabilities.


7. GENDER: 1990’s have witnessed an increased

concentration on women’s issues. Various women health programmes related to nutrition, reproductive health, aging, lifestyle etc were started. This has brought awareness among policy makers also.


8. OTHER DETERMINANTS: Advancements in technology Easy and instant access to medical

information Better health care facilities IEC activities etc also determine the health

status of an individual.

MEASUREMENT OF HEALTH:

Measurement of health of community is a very difficult task.

There is no single " standard " measurement of health status for individuals or population groups.

Individual health status may be measured by an observer (e.g., a physician), who performs an examination and rates the individual along any of several dimensions, including presence or absence of life-threatening illness, risk factors for premature death, severity of disease, and overall health.

MEASUREMENT OF HEALTH CONTD…

The health of an entire population is determined by aggregating data collected on individuals.

Measurement of health is done with help of various indicators as described by WHO. These are:

1.Comprehensive indicators2.Specific indicators

MEASUREMENT OF HEALTH CONTD…

1. COMPREHENSIVE INDICATORS:a) CRUDE DEATH RATE: Fair index of comparative health of people. It is the annual number of deaths per 1000

people. It indicates the rate at which people are dying. Death rates, or mortality rates can be

calculated for deaths from specific causes, and for specific age and gender groupings.

MEASUREMENTS OF HEALTH CONTD…

No. of deaths in a population during specified period

CDR=---------------------------------------------×1000 No of persons in population during specified period


b) EXPECTATION OF LIFE: Best single indicator of health status of community. Expectation of life at one year of age is considered

to be Best single indicator than Expectation of life at birth because of elimination of component of infant mortality.

An increase in expectation of life is regarded as an improvement in health status.

As an indicator of long term survival, it can be considered as a positive health indicator.

Adopted as a global health indicator.


d) PREVALENCE= Number of cases of disease present in the population at a specified period of time.

It is total no. cases( old+new)

no. of cases present in the population

at a specified period of time

Prevalence=------------------------------------×1000 no. of persons at risk of having the

disease at that specified time


e) INCIDENCE RATE = Number of new cases of a disease occurring in the defined population during a specified time period.

No of new cases of a specific disease occurring in the population During a specified time periodIncidence rate =------------------------------------×1000 Number of persons exposed to risk of developing the disease during that

period of time• It is not influence by duration of disease and its use is

basically restricted to acute conditions.


DISABILITY RATES:These are based on the notion that health implies a full range of daily activities.

HALE(HEALTH- ADJUSTED LIFE EXPECTANCY):

It is the equivalent no. of years in full health that a new born can expect to live based on current rates of ill health and mortality.

• DALY( DISABILITY-ADJUSTED LIFE YEARS):

years of life lost to premature death and years lived with disability adjusted for the severity of the disability.


SPECIFIC INDICATORS:

A)INFANT MORTALITY RATE: It is the no. of infant deaths per 1000 live

births in one year. one of the most sensitive indicator of health. As per SRS IMR in 2008= 53/1000 live births.


INFANT MORTALITY RATE:

Number of deaths to infants under age 1 year IMR=----------------------------------×1000 total live births


B) CHILD MORTALITY RATE: No. of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid point of the year concerned.

NO. of deaths of children aged 1-4 years during a year

CDR:----------------------------------------*1000 total no. of children aged 1-4 years at middle of the year.


C) MATERNAL MORTALITY RATE : It accounts for the greatest proportion of deaths among women of reproductive age group.

Total no. of female deaths due to complication

of pregnancy within 42 days of delivery in an

area during a given year MMR=---------------------------------------*1000 total no. of live births in same area and year


D) DEATHS FROM COMMUNICABLE DISEASES:

High death rate from communicable diseases reflects a low level of health.

Deaths due to infective and parasitic infections, diseases expressed as a percentage of total deaths from all causes is a useful indicator of health status.


E) INDICATORS OF HEALTH SERVICES AND ACTIVITIES:

The doctor-population ratio is considered the best indicator of medical manpower .

Indices such as hospital bed population ratio , hospital admission rates ,rates of incidence of illnesses, immunization statistics of population all reflect the health services and activities in a given region.


F) INDICATOR OF SOCIAL AND MENTAL HEALTH:

Homicides, suicides, accidents are regarded as fundamental indicators of social and mental health .

The social indicators provide a guide for social actions that must be planned for improving health of the people.

The search for more meaningful social indicator of health is continuing in several fields such as

housing, education, employment, environment etc.


OTHER INDICATORS:BASIC NEED INDICATORS: these are used

by ILO like calorie consumption, access to water, illiteracy, deaths due to diseases etc.

HEALTH FOR ALL INDICATORS: like health policy, provision of health care, health status indicators.

ROLE OF COMMUNITY HEALTH NURSE:

Community health nurse plays a vital role in maintaining the optimal level of health of community which is as following:

1.ASSESSMENT: Identifies present and potential needs and

resources related to the health of an individual and family.

Contribute to the method of diagnosisShare present and potential needs and

resources related to the health of an individual and family.


2. PLANNING:Plans for comprehensive nursing careParticipate in planning for community health

nursing servicesContribute to the planning for the

development and operation of agencies.


3. IMPLEMENTATION:Provides comprehensive nursing care to the

patients.Provides health education to inform

population on health problems.Participates in development and operation of

community health agency and community health programmes.


4. EVALUATION:Appraisal of performanceControl and evaluate the nursing care.

5. Other functions area)Keeps the record of vital statistics through

intensive data collection.b)Engages in surveys, research studies

SUMMARY:

Today we discussed about HEALTH, its definition, concepts, determinants and various measures of health. It is a multidimensional concept and is a common theme in many cultures .There are biological, environmental, socio-economic determinants of health. We can measure the health status of population with help of various measures as described by WHO.

HEALTH (2)

Documents

productive life health

healthconcept of health

protection of health

ecological concept of

concepts of health contd

changing concepts of

major health problems

genetic point of view