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-being
3) 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.

CONCEPTS OF HEALTH CONTD.

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.

CONCEPTS OF HEALTH CONTD.

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.

CONCEPTS OF HEALTH CONTD.

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.

Biological

behavioral

Human
rights
Equity and
social justice

environment

gender
Socio-economic

Information and
communication

Health system

Science and
technology

aging

Socio-culture

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 downs 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

DETERMINANTS OF HEALTH
CONTD
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.

DETERMINANTS OF HEALTH
CONTD
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.

DETERMINANTS OF HEALTH
CONTD
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 status
2. Education
3. Occupation
4. Political system

DETERMINANTS OF HEALTH
CONTD
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.

DETERMINANTS OF HEALTH
CONTD
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.

DETERMINANTS OF HEALTH
CONTD
7. GENDER:
1990s have witnessed an increased concentration on
womens issues. Various women health programmes
related to nutrition, reproductive health, aging,
lifestyle etc were started. This has brought awareness
among policy makers also.

DETERMINANTS OF HEALTH
CONTD
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 indicators
2. 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

MEASUREMENTS OF HEALTH
CONTD
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.

MEASUREMENTS OF HEALTH
CONTD
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

MEASUREMENTS OF HEALTH
CONTD
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 period

Incidence 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.

MEASUREMENTS OF HEALTH
CONTD
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.

MEASUREMENTS OF HEALTH
CONTD
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.

MEASUREMENTS OF HEALTH
CONTD
INFANT MORTALITY RATE:

Number of deaths to infants

under age 1 year
IMR=----------------------------------1000
total live births

MEASUREMENTS OF HEALTH
CONTD
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.

MEASUREMENTS OF HEALTH
CONTD
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

MEASUREMENTS OF HEALTH
CONTD
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.

MEASUREMENTS OF HEALTH
CONTD
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.

MEASUREMENTS OF HEALTH
CONTD
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.

MEASUREMENTS OF HEALTH
CONTD
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 diagnosis
Share present and potential needs and resources
related to the health of an individual and family.

ROLE OF COMMUNITY HEALTH

NURSE:
2. PLANNING:
Plans for comprehensive nursing care
Participate in planning for community health
nursing services
Contribute to the planning for the development and
operation of agencies.

ROLE OF COMMUNITY HEALTH

NURSE:
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.

ROLE OF COMMUNITY HEALTH

NURSE:
4. EVALUATION:
Appraisal of performance
Control and evaluate the nursing care.
5. Other functions are
a) 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.