CONCEPT OF HEALTH

Presented by,
Dr Aparna Ramachandran
MDS-2
Dept. of Public Health Dentistry
Krishnadevaraya college of dental sciences
1
 CONTENTS
PART 1

Introduction
Changing concepts of health
Definitions of health
Dimensions of health
Concept of wellbeing
Quality of life indices
Determinants of health
Responsibility to health 2
 CONTENTS
PART 2

Indicators of health
Urban rural divide in health and development
Health service philosophies
Levels of health care
Health promotion
Millennium development goals
Sustainable development goals 3
 INTRODUCTION
Health is a common theme in most cultures. In
fact all communities have their concepts of
health ,as part of their culture.

Modern medicine is often accused for its

preoccupation with the study of disease, and
neglect the study of health.

4
 INTRODUCTION
However during the past few decades there has been a reawakening that health
is a fundamental human right and a worldwide social goal.

With the adoption of health as an integral part of socio economic development

by the United Nations in 1979,health while being an end in itself ,has also
become a major instrument of overall socio-economic development and
creation of a new social order.

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 CHANGING CONCEPTS OF HEALTH

An understanding of health is the basis of all health care

In a world of continuous change ,new concepts are bound to emerge based
on new patterns of thought

Health has evolved over the centuries as a concept from an individual

concern to a worldwide social goal and encompasses the whole quality of
life
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 CHANGING CONCEPTS OF HEALTH
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.
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 BIOMEDICAL CONCEPT

 The main criticism against this concept is that it has minimized the role of
the environmental ,social, psychological and cultural determinants of health .

 Even though it is a success in treating disease it was found to be inadequate

in solving some major health problems of mankind.

 Developments in medical and social sciences led to the conclusion that the
biomedical concept of health was inadequate.
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 ECOLOGICAL CONCEPT

Deficiencies in the biomedical concept gave rise to other concepts

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

between human being and environment, and disease 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.”
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 ECOLOGICAL CONCEPT

The ecological concept raises two issues, imperfect man and imperfect
environment.

The improvement in human adaptation to natural environments can lead to

longer life expectancies and a better quality of life –even in the absence of
modern health delivery services.

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 PSYCHOSOCIAL 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.”

Thus health is both a biological and social phenomenon.

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 HOLISTIC CONCEPT

This concept is the synthesis of all the above concepts.

It recognizes the strength of social, economic, political and environmental

influences on health.

It described health as a unified or multi dimensional process involving the

wellbeing of whole person in context of his environment .

Emphasis on health promotion.

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 HOLISTIC CONCEPT

This view corresponds to the view held by the ancients that health implies a
sound mind ,in a sound body in a sound family in a sound environment.

The holistic approach implies that all sectors of society have an effect on
health in particular, agriculture ,animal husbandry ,food,
industry,education,housing ,public works, communications and other sectors.

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 DEFINITIONS OF HEALTH

“Soundness of body or mind that condition in which its are duly and
efficiently discharged .” - Oxford English Dictionary

Health can be defined negatively ,as the absence of illness , functionally as the
ability to cope with everyday activities ,or positively as fitness and well-being-
Blaxter(1990)

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 DEFINITIONS OF HEALTH

A pioneering French study (Herzlich 1973) identified that health was described in a
variety of ways by lay people:

Health as something to be had – a reserve of strength, a potential to resist illness,

determined by temperament or constitution;

Health as a state of doing – the full realisation of a person's reserve of strength,

characterised by equilibrium, wellbeing, happiness, feeling strong, getting on well with
other people;
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Health as a state of being – the absence of illness.
 DEFINITIONS OF HEALTH

“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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 DEFINITIONS OF HEALTH

The original WHO definition was criticized as being unrealistic ,unworkable

and un achievable

Based upon this definition almost any defect or problem meant that a person
would be considered not healthy

However the definition move beyond the concept that no disease is equivalent
to health and that health has other dimensions beside physical.

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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 world-wide social goal 20
 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.

At the community level ,the state of health may be assessed by indicators as
death rate, infant mortality rate, and expectation of life.
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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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 MENTAL DIMENSION

Although mental health is an essential component of health ,scientific foundations

of mental health are not yet clear.

Therefore there are no precise tools to assess the state of mental health unlike
physical health.

Assessment of mental health at the population level may be made by

administering mental status questionnaires seek to determine the presence and
extent of organic disease and of symptoms that could indicate psychiatric disorder.
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 MENTAL DIMENSION

One of the keys to good health is a positive mental health.

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 SOCIAL DIMENSION
 Social well-being implies harmony and integration within the individual,
between each individual and other members of the society and between
individuals and the world in which they live.

It can be defined as “the quantity and quality of an individual’s interpersonal ties
and the extent of involvement with community”.

The social dimension of health includes the levels of social skills one possesses,
social functioning and the ability to see oneself as a member of larger society.
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 SPIRITUAL DIMENSION
 Spiritual health in this context refers to the part of individual which
reaches out and strives for meaning and purposes .

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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 EMOTIONAL DIMENTION

Historically the mental and emotional dimensions have been seen as one
element or as two closely related elements.

However as more research becomes available a definite difference is

emerging.

Mental health can be seen as knowing or cognition while emotionalhealth

relates to feeling.
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 EMOTIONAL DIMENTION

Experts in psychobiology have been relatively successful in isolating these

two separate dimensions

With this new data .the mental and emotional aspects of humanness may have
to be viewed as two separate dimensions of human health.

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 VOCATIONAL DIMENSION

The vocational aspect of life is a new dimension .

When work is fully adapted to human goals, capacities and limitations, work
often plays a role in promoting both physical and mental health.

Physical work is usually associated with an improvement in physical

capacity ,while goal achievement and self realization in work are a source of
self esteem.
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 VOCATIONAL DIMENSION

For many individuals the vocational dimension may be merely a source of

income .

To others this represents the culmination of efforts of other dimensions as they
function together to produce what the individual considers life success.

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 OTHER DIMENSIONS
Philosophical dimension
Cultural dimension
Socio economic dimension
Environmental dimension
Educational dimension
Nutritional dimension
Curative dimension
Preventive dimension
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 POSITIVE HEALTH

The state of positive health implies the notion of “ perfect functioning” of the
body and mind.

It conceptualizes, health biologically as a state in which every cell and every
organ is functioning at optimum capacity and in perfect harmony with rest of
the body

Psychologically as a state in which the individual feels a sense of perfect

wellbeing and of mastery over his environment
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 POSITIVE HEALTH

Socially, as a state in which the individual’s capacities for participation in

the social system are optimal.

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The concept of perfect positive health cannot become a reality
because man will never be so perfectly adapted to his
environment that his life will not involve struggles, failures
and sufferings”

Dubos

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 CONCEPT OF WELLBEING

Well being of an individual or group of individuals have objective and

subjective components .

The objective components related to such concerns as are generally known

by the term standard of living or level of living.

The subjective component of well being is referred to as quality of life

36
 STANDARD OF LIVING

The term “standard of living” refers to the usual scale of our expenditure ,the
goods, we consume and the services we enjoy .it includes the level of education,
employment status, food ,dress, house ,amusements and comforts of life .

Income and occupation, standards of housing, sanitation and nutrition ,the level of
provision of health ,educational ,recreational and other services may be used
individually as measures of socio economic status and collectively as anindex of
standard of living. (WHO)
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 LEVEL OF LIVING

The parallel term for standard of living is used in united nations is level of
living

It consists of nine components : health, food consumption ,education,

occupation and working conditions ,hosing, social security,clothing,recreation,
leisure and human rights.

These objective characteristics are believed to influence human wellbeing

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 QUALITY OF LIFE
It is the subjective component of well being

Quality of life was defined by WHO as: “the condition of life resulting from the
combination of the effects of the complete range of factors such as those
determining health,happiness,education ,social and intellectual attainments,
freedom of action, justice and freedom of expression.

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 QUALITY OF LIFE

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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 PHYSICAL QUALITY OF LIFE INDEX

Physical quality of life index consolidates three indicators, infant mortality, life
expectancy at age one, and literacy.

These three components measure the results rather than inputs. As such they lend
themselves to international and national comparison.

For each component ,the performance of individual countries is placed on a scale

of 0-100,where 0 represents an absolutely defined worst performance and 100
defines the best performance. 41
 PHYSICAL QUALITY OF LIFE INDEX

The composite index is calculated by averaging the three indicators ,giving

equal weight to each of them .

PQLI does not measure economic growth ,it measures the results of social
economic and political policies .

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 HUMAN DEVELOPMENT INDEX

It is a tool used to measure a country's overall achievement in its social and
economic dimensions.

Devised and launched by Pakistani economist Mahbub-ul- haq in 1990.

The human development index (HDI) is a composite statistic of life

expectancy, education, and per capita income indicators,.

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HUMAN DEVELOPMENT INDEX

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 HUMAN DEVELOPMENT INDEX

The HDI is a comprehensive measure than per capita income.

The human development index value ranges between 0-1.

The HDI value of a country shows the distance it has already travelled
towards maximum possible value of 1 .

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 HUMAN DEVELOPMENT INDEX

The HDI is a comprehensive measure than per capita income.

The human development index value ranges between 0-1.

The HDI value of a country shows the distance it has already travelled
towards maximum possible value of 1 .

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 CALCULATION OF HDI

STEP 1

Minimum and maximum values are set in order to transform the indicators into
indices between 0 and 1.

The minimum values are set at 20 years of life expectancy at 0 years for both
education variables and at $100 for per capita gross national income.

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 GOAL POST FOR HDI

After defining the minimum and maximum values the sub

indices are calculated as
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 CALCULATION OF HDI

 Step 2
Aggregating the sub indices to produce the human development
index.
It is the geometric mean of three dimension indices.

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CALCULATION OF HDI

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 HUMAN DEVELOPMENT INDEX

RANK COUNTRY HDI

1 NORWAY 0.954
2 SWITZERLAND 0.946
3 IRELAND 0.942
4 GERMANY 0.939
5 HONGKONG( CHINA) 0.939
129 INDIA 0.647
189 NIGER 0.377 52
 SPECTRUM OF HEALTH

Health and disease lie along a continuum ,and there is no single cut off point.

The lowest point on the health –disease spectrum is death and the highest point
corresponds to positive health .

The spectral concept of health emphasises that the health of an individual is

not static; it is a dynamic phenomenon and a process of continuous
change.subject to frequent subtle variations.
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SPECTRUM OF HEALTH

54
DETERMINANTS OF HEALTH

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 BIOLOGICAL DETERMINANTS

 The physical & mental traits of every human being are determined by the
nature of his genes at the moment of conception.

The genetic makeup is unique in the sense it cannot be altered after

conception.

 A number of diseases are now known to be of genetic origin, E.g.,

Chromosomal anomalies, errors of metabolism, mental retardation.
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 BIOLOGICAL DETERMINANTS

Medical genetics offers hope for prevention & treatment of a wide

spectrum of diseases, thus the prospect of better medicine & longer &
healthier life.

 A positive health advocated by WHO implies that a person should be able

to express as completely as possible the potentialities of his genetic
heritage.

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 BEHAVIOURAL AND SOCIOCULTURAL
CONDITIONS

Life style denotes “ the way that people live”, reflecting a whole range of
social values, attitudes & activities.

It is composed of cultural & behavioural patterns & life long personal
habits (Alcoholism,smoking)that have developed through the process of
socialization.

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 BEHAVIOURAL AND SOCIOCULTURAL
CONDITIONS

 Life styles are learnt through social interaction with parents & peer groups,
friends, siblings & through school & mass media.

Many current health problems such as coronary heart disease, obesity, lung
cancer, drug addiction are associated with life style.

 In countries like India risk of illness & death are connected with lack of
sanitation, poor nutrition, personal hygiene, elementary human habits,
customs & cultural patterns. 59
 ENVIRONMEMT

 It was Hippocrates who first related disease to environment, climate, water, & air.

Later Pettenkoffer in Germany revived the concept of disease – environment

association.

 Environment is classified as “internal” & “external”.

 Internal environment of a man pertains to each & every component part, every
tissue organ & organ system & their harmonious functioning within the system.

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 ENVIRONMEMT

 External or macro environment consists of those things to which man is

exposed after conception.

It is defined as “all that which is external to the individual human host”.

It can be divided into physical, biological & psychosocial components , any
or all of which affect can affect the health of man & his susceptibility to
illness.
61
 ENVIRONMEMT

 Some epidemiologists use the term “micro environment” or domestic environment or

personal environment which reflects a person’s way of living & lifestyle. E.g., eating
habits, personal habits.

The other environment includes occupational environment, socio economic environment,

moral environment.

The environmental factors range from housing, water supply psychosocial stress and
family structure through social and economic support systems to the organization of
health and social welfare services in the community. 62
 SOCIO ECONOMIC STATUS

 The health of a person is primarily dependent upon the level of socio economic
development.

E.g., Per Capita income, GNP, education, nutrition, employment, housing &
political system of the country.

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 SOCIO ECONOMIC STATUS
Economic status

 The per capita GNP is the most widely accepted as 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
behaviour in the community.
64
 SOCIO ECONOMIC STATUS
Economic status

The economic status determines the purchasing power ,standard of living,

quality of living, family size and pattern of disease and deviant behaviour in the
community.

It is also an important factor in seeking health care.

65
 SOCIO ECONOMIC STATUS
Education

 Education is the second major influencing factor in affecting the health of the
population.

 The world map of illiteracy closely coincides with the maps of poverty,
malnutrition, ill health, high infant & child mortality rates.

Studies indicate that education to some extent compensates the effects of poverty
on health, irrespective of the availability of health facilities. 66
 SOCIO ECONOMIC STATUS
Occupation

Unemployment usually shows a higher incidence of ill health & death.

For many, loss of work may mean loss of income & status.

It causes both psychological and social damage.

67
 SOCIO ECONOMIC STATUS
Political system

Health is closely related to the political system of a country.

Often the main obstacles to the implementation of health technologies are not technical
rather political.

 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. 68
 SOCIO ECONOMIC STATUS
Political system

The percentage of GNP spent on health is a quantitative indicator of political

commitment.

The WHO has set target of at least 5 percent expenditure of each country’s
GNP on health care.

However India spends only 2 % of its GNP in public health and family
welfare. 69
 HEALTH SERVICES
 Health services are seen as essential for social & economic development. There is a
strong correlation between GNP & Expectation of life at birth & the overall health status
of the given population.

To be effective the health services must reach the social periphery equitably distributed,
accessible at a cost the country and community can afford.

Epidemiological perspective emphazises that health services ,no matter how technically
elegant or cost effective are ultimately pertinent only if they improve health.

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 AGEING OF THE POPULATION

 By the year 2020 the world will have more than one billion people aged 60 & over.

More than two thirds of them living in the developing countries.

A major concern of rapid population aging is the increased prevalence of chronic

disease & disabilities.

 Therefore aging process needs a special attention

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 GENDER

The 1990 have witnessed an increased concentration on women’s issues. In

1993 The Global Commission on women’s Health was established.

 The Commission drew up an agenda for action on women’s health covering

nutrition, reproductive health, the health consequences of violence, aging, life
style related conditions & occupational environment.

 Inclusion of women’s health issues is a major breakthrough in the

developmental plans. 72
 OTHER FACTORS
The revolution in information & Communication Technology offers tremendous
opportunities in providing an easy & instant access to medical information once difficult
to retrieve.

It contributes to the dissemination of information world wide, serving the needs of
many physicians, health professionals, bio medical scientists & researchers, the mass
media & the public.

Health is not the sole contributor to the health & wellbeing of population, the potential
of inter sectoral contributions to the health of communities is increasingly recognized.
73
 ECOLOGY OF HEALTH

Ecology is defined as the science of mutual relationship between living

organisms and their environments.

The human ecosystem includes in addition to the natural environment, all the
dimensions of the man made environment- physical, chemical, biological and
psychological.

Health according to ecological concepts is visualized as a state of dynamic

equilibrium between man and his environment. 74
 ECOLOGY OF HEALTH

By constantly altering his environment or ecosystem by activities like

urbanization, industrialization, deforestation, land reclamation, man has created
new health problems .

The greatest threat human health in India is the rapid unplanned urbanization.

Man’s intrusion in to the ecosystem have resulted in to a lot of zoonotic

diseases.
75
 ECOLOGY OF HEALTH

Prevention of diseases through ecological or environmental manipulations or

intervention is much cheaper and a more effective rational approach.

The greatest improvement in human health thus may be expected from an

understanding and modification of the factors that favour disease occurence in
human ecosystem.

76
 RIGHT TO HEALTH

The right to health was one of the last to be proclaimed in the constitution of
most countries in the world.

At the international level the universal declaration of human rights established
a breakthrough in 1948 by stating in article 25,

“Everyone has the right to a standard of living adequate for the health and
wellbeing of himself and his family”
77
 RIGHT TO HEALTH

The preamble to the WHO constitution also affirms that it is one of the
fundamental rights of every human being to enjoy “the highest attainable
standard of health”

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 RESPONSIBILITY TO HEALTH
1.Individual responsibility

Although health is now recognized a fundamental human right, it is essentially

an individual responsibility.

In large measure health has to be earned and maintained by the individual
himself ,who must accept the broad spectrum of responsibilities ,now known as
self care.

79
 RESPONSIBILITY TO HEALTH

Self care is defined as those health generating activities that are undertaken by
the persons themselves.

Self care activities comprise observance of simple rule of behaviour relating to

diet ,sleep, exercise,weight,alcohol,smoking,drug.

The shift in disease pattern from acute to chronic diseases make self care both
logical necessity and an appropriate strategy.
80
 RESPONSIBILITY TO HEALTH
2.Community responsibility

Health can never adequately protected by health services without active

understanding and involvement of communities whose health is at stake .

The current trend is to ‘demedicalize’ health and involve the communities in a

meaningful way. This implies a more active involvement of families and
communities in health matters.

81
 RESPONSIBILITY TO HEALTH
2.Community responsibility
 There are 3 ways in which a community can participate

1. The community can provide in the shape of facilities ,manpower ,logistic

support and possibly funds

2. It also means the community can be actively involved planning management

and evaluation.

82
 RESPONSIBILITY TO HEALTH
2.Community responsibility

3. An equally important contribution that people can make is by joining and

using the health services.

83
 RESPONSIBILITY TO HEALTH
3.State responsibility

The responsibility for health does not end with the individual and community
effort.

The constitution of India provides that health is a state responsibility .

The national health policy approved by parliament in 1983 and later on 2002
have resulted in a greater degree of state involvement in the management of
health services. 84
 RESPONSIBILITY TO HEALTH
3.Country responsibility

The health of mankind requires the co operation of governments ,the

people ,national and international organizations both within and outside the UN
in achieving the health goals.

The TCDC,ASEAN and SAARC are important regional mechanisms for such
co operation.

85
 RESPONSIBILITY TO HEALTH
3.Country responsibility
The WHO is a major factor fostering international co operation in health.

In keeping with its constitutional mandate, WHO acts as a directing and co
coordinating authority on international health work

86
 HEALTH AND DEVELOPMENT

Health is essential to socio economic development has gained increasing

recognition.

During 1973-1977 there was profound modification of the economic theory .

It became increasingly clear that economic development alone cannot solve
the major problems of poverty hunger and malnutrition.

87
 HEALTH AND DEVELOPMENT

The experiences of a few developing countries illustrate dramatically the way

in which health forms part of development.

This was because efforts in health field were simultaneously reinforced by

developments in other sectors such education ,social welfare and land reforms.

Literacy especially female literacy has played a key role in improving the
health situation.
88
 REFERENCES

Park’s textbook of preventive and social medicine

Morris D.Morris ,A physical quality of life index,urban ecology,1978;225-
240
Essentials of public health dentistry-Soben peter
http://
hdr.undp.org/en/content/2019-human-development-index-ranking assessed
on 7/2/2020

89
CONCEPT OF HEALTH PART 2
Presented by,
Dr Aparna Ramachandran
MDS-2
Dept. of Public Health Dentistry
Krishnadevaraya college of dental sciences
90
 CONTENTS
PART 2
Indicators of health
Health for all
Millennium development goals
Sustainable development goals
Urban rural divide in health and development
Health service philosophies
Levels of health care
Health promotion 91
 INTRODUCTION

Health is defined as “a state of complete physical, mental & social wellbeing, and not merely an
absence of disease or infirmity” (WHO)

 This statement has been amplified to include the ability to lead a “socially and economically
productive life”

Health cannot be measured in exact measurable forms

 Hence measurement have been framed in terms of illness (or lack of health), consequences of
ill-health (morbidity, mortality) & economic, occupational & domestic factors that promote ill
health- all the antithesis of health. 92
 INDICATORS OF HEALTH

Health Indicator is a variable, susceptible to direct measurement, that reflects

the state of health of persons in a community.

Indicators help to measure the extent to which the objectives and targets of a
programme are being attained.

Indicator is only an indication of a given situation or a reflection of that

situation.
93
 INDICATORS OF HEALTH

USES OF INDICATORS OF HEALTH

▪ Measurement of the health of the ▪ Identification of health needs and
community. prioritizing them.

▪ Description of the health of the ▪ Evaluation of health services.

community.
▪ Planning and allocation of health
▪ Comparison of the health of different resources.
communities.
▪ Measurement of health successes.
94
 CHARACTERISTICS OF AN INDICATOR
 Valid – they should actually measure what they are supposed to measure.

 Reliable – the results should be the same when measured by different people in
similar circumstances.

 Sensitive – they should be sensitive to changes in the situation concerned.

 Specific – they should reflect changes only in the situation concerned.

Feasible – they should have the ability to obtain data when needed.

 Relevant – they should contribute to the understanding of the phenomenon of interest.

95
 CHARACTERISTICS OF AN INDICATOR

Since we have problems in defining health we have problems in measuring

health also.

Therefore, measurements of health have been framed in terms of illness ,the

consequence of illness and economic and occupational and domestic factors
that promote ill health – all the antithesis of health

96
 CHARACTERISTICS OF AN INDICATOR

Further ,health is multidimensional ,and each dimension is influenced by

numerous factors, some known and many unknown.

So we should measure health multidimensionaly.

97
 CLASSIFICATION OF INDICATORS

▪ Mortality Indicators ▪ Indicators of Social And

Mental Health
▪ Morbidity Indicators
▪ Environmental Indicators
▪ Disability Rates
▪ Socio-economic Indicators
▪ Nutritional Indicators
▪ Health Policy Indicators
▪ Health Care Delivery Indicators
▪ Indicators of Quality of
▪ Utilization Rates Life
▪ Other Indicators
98
 1 MORTALITY INDICATORS
CRUDE DEATH RATE

Crude Death Rate is considered a fair indicator of the comparative health of the people.

 It is defined as the number of deaths per 1000 population per year in a given
community, usually the mid-year population

The usefulness is restricted because it is influenced by the age-sex composition of the

population, socioeconomic and socio-cultural environment of the communities.

Crude death rate of India- 7.27 ( 2019)

99
 MORTALITY INDICATORS
EXPECTATION OF LIFE
Expectation of life is the average number of years that will be lived by those born alive into
a population if the current age specific mortality rates persist.

Life expectancy at birth is highly influenced by infant mortality .

Life expectancy at 1 excludes influence of infant mortality .

Estimated for both sexes separately.

 Good indicator of socioeconomic development

Male -67.4 years, female- 70.2 years

100
 MORTALITY INDICATORS
AGE SPECIFIC DEATH RATES

Death rates can be expressed for specific age groups in a population which
are defined by age.

An age specific death rate is defined as total number of deaths occurring in
a specific age group of a population in a defined area during specific period
per 1000 estimated total population of the same age group of the
population in the same area during the same period
101
 MORTALITY INDICATORS
INFANT MORTALITY RATE

The ratio of deaths under 1yr of age in a given year to the total number of live
births in the same year, usually expressed as a rate per 1000 live births

Indicator of health status of not only infants but also whole population &
socioeconomic conditions

Sensitive indicator of availability, utilization &effectiveness of health care,

particularly perinatal and postnatal care.

India- 34 102
 MORTALITY INDICATORS
CHILD DEATH RATE

The number of deaths at ages 1-4yrs in a given year, per 1000 children in
that age group at the mid-point of the year.

 Correlates with inadequate MCH services, malnutrition, low immunization

coverage and environmental factors

Correlates with inadequate antenatal care and perinatal care.

103
 MORTALITY INDICATORS
UNDER 5 PROPORTIONATE MORTALITY
RATE
It is the proportion of total deaths occurring in the under 5 age group .

This reflects both infant and child mortality dates.

High rate reflects reflect high birth rates ,high child mortality rates and
shorter life expectancy.

Current rate-39/1000

104
 MORTALITY INDICATORS
ADULT MORTALITY RATE

Adult mortality rate is defined as the probability of dying between the age of
15 and 60 years per 1000 population

The adult mortality rate offers way to analyse health gaps between countries
in the main working group.

105
 MORTALITY INDICATORS
MATERNAL MORTALITY RATE

 Ratio of number of deaths arising during pregnancy or puerperal period per

100000 live births

Accounts for the greatest number of deaths among women of reproductive

age in developing

 Current MMR – India -178/100000 live births

106
 MORTALITY INDICATORS
DISEASE SPECIFIC MORTALITY RATE

 Mortality rates can be computed for specific diseases.

That is deaths from cancer, road traffic accidents, cardiovascular

diseases,diabetis etc.

107
 MORTALITY INDICATORS
PROPORTIONAL MORTALITY RATE

 Proportional Mortality Rate is the proportion of all deaths attributed to the

specific disease

E.g. Coronary heart disease causes 25 to 30 % of all deaths in developed

world.

108
 MORTALITY INDICATORS
CASE FATALITY RATE

 Case fatality rate measures the risk of persons dying from a certain disease
within a given time period .

Case fatality rate is calculated as

The case fatality rate is calculated as number deaths from a specific disease
during a specific time period divided by number of cases of the diseases
during the same time period, usually expressed per 100.
109
 MORTALITY INDICATORS
YEARS OF POTENTIAL LIFE LOST

 Years of life lost due to premature death.

It is defined as the one that occurs before the age of to which a dying
person could have expected to survive.( usually taken as 75)

110
 2 MORBIDITY INDICATORS

To describe health in terms of mortality rates only is misleading

Mortality indicators do not reveal the burden of ill health in a community.

Therefor morbidity indicators are used to supplement mortality data to describe

the health status of a population.

The disadvantage of morbidity indicators is that it overlooks a large number of

subclinical or inapparent conditions.
111
 MORBIDITY INDICATORS

Incidence and prevalence

Notification rates
Attendance rates at OPDs,health centers etc
Admission ,readmission and discharge rates
Duration of stay in hospital
Spells of sickness or absence from work or school.

112
 3 DISABILITY RATES

The disability rates are based on the premise that health implies a full range of
daily activities
The commonly used disability rates falls into 2 categories,
1) Event type indicators: 2) Person –type indicators
-Number of days of restricted activity -limitation of mobility
-Bed disability days -limitation of activity
-Work‐loss days within a specified period

113
 HALE –HEALTH ADJUSTED LIFE EXPECTANCY

Based on the framework of WHO’s ICIDH (International Classification of

Impairments, Disabilities, and Handicaps )

Based on life expectancy at birth but includes an adjustment for time spent in
poor health.

It is the equivalent number of years in full health that a new-born can expect
to live based on current rates of ill-health and mortality.
114
 QUALITY ADJUSTED LIFE YEARS( QALY)

• It is the most commonly used to measure the cost effectiveness of health

interventions .

• It estimates the number of years of life added by a successful treatment or

adjustment for quality of life.

• Each year in perfect health is assigned a value of 1.0 down to a value of

0.0 for death.

115
 DISABILITY FREELIFE EXPECTANCY

It is the average no of years an individual is expected to live free of disability

if current pattern of mortality and disability continue

116
 DISABILIY ADJUSTED LIFE YEARS (DALY)

It is the measure of overall disease burden.

It is defined as the number of years of healthy life lost due to all causes whether
from premature mortality or disability.

It is the simplest and the most commonly used measure to find the burden of
illness in a defined population and the effectiveness of the interventions.

It was developed by Harvard university for world bank in 1990 and adopted by
WHO in 2000. 117
 DISABILIY ADJUSTED LIFE YEARS (DALY)

The major measurement in DALY combines,

 Years of lost life – calculated from the number of deaths at each age
multiplied by the expected remaining years of life according to a global
standard of life expectancy.

Years lost due to disability- where the number of incident cases due to injury
and illness is multiplied by the average duration of the disease and a
weighting factor reflecting the severity of the disease on a scale from118 0 -1
 4. NUTRITIONAL STATUS INDICATORS

Nutritional Status is a positive health indicator.

a) Anthropometric measurements of pre-school children
i. Weight – measures acute malnutrition
ii. Height – measures chronic malnutrition
iii. Mid-arm circumference - measures chronic malnutrition
b) Heights of children at school entry

c)Prevalence of low birth weight (less than 2.5 kg ) 119

 5. Health Care Delivery Indicators

These indicators reflect the equity of distribution of health resources in different

parts of the country and of the provision of health care.

a) Doctor - population ratio

b) Doctor –nurse ratio

c) Population – bed ratio

d) Population per health /sub centre

e) Population per trained birth attendant 120

 6. UTILIZATION RATES

Utilisation of services or actual coverage is expressed as the proportion of people

in need of a service who actually receive it in a given period, usually a year

It depends on availability & accessibility of health services and the attitude of an
individual towards health care system

They direct attention towards discharge of social responsibility for the

organization in delivery of services.
121
 7.INDICATORS OF SOCIAL AND MENTAL HEALTH
As valid positive indicators are scares, indirect measures are used

These include rates of suicide, homicide, other crime, road traffic accident, juvenile
delinquency, alcohol and substance abuse, domestic violence, battered-baby
syndrome, etc.

These indicators provide a guide to social action for improving the health of people.

Social and mental health of the children depend on their parents.

E.g. Substance abuse in orphan children 122

 8. ENVIRONMENTAL INDICATORS

These reflect the quality of physical and biological environment in which diseases
occur and people live.

The most important are those measuring the proportion of population having access
to safe drinking water and sanitation facilities.

These indicators explains the prevalence of communicable diseases in a community.

The other indicators are those measuring the pollution of air and water, radiation,
noise pollution, exposure to toxic substances in food and water.
123
 9.SOCIOECONOMIC INDICATORS

These do not directly measure health but are important in interpreting health
indicators,These are

Rate of growth of population: India- 1.13% (2017)

Per capita GNP (gross national income) -9.45 lakh crores PPP dollars (2017)

Dependency ratio – 49.2{

124
 9.SOCIOECONOMIC INDICATORS

Literacy rates: India - 74.04% (2011)

Housing – the number of persons per room

Per capita “calorie” availability

Countries with favourable socioeconomic indicators have reported less health

related problems.

125
 10.HEALTH POLICY INDICATORS

The single most important indicator of political commitment is allocation of

adequate resources.The relevant indicators are

Proportion of GNP(gross national product) spent on health services.

Proportion of GNP spent on health related activities like water supply and
sanitation & housing and nutrition.

Proportion of total health resources devoted to primary health care.

126
 11.INDICATORS OF QUALITY OF LIFE
Life expectancy is now less important.
The Quality of Life has gained its importance.
Physical Quality of Life Index
Human development index

127
 12.SOCIAL INDICATORS

 Population ▪ Social security & welfare services

 Family formation ▪ Health services &nutrition
 Families & households ▪ Housing & its environment
 Learning & educational services ▪ Public order & safety;
 Earning activities ▪ time use
 Distribution of income ▪ Leisure and culture
 Consumption & accumulation ▪ Social stratification & mobility
132
 BASIC INDICATOR SERIES

Basic Needs Indicators are used by ILO and include calorie consumption,
access to water, life expectancy, deaths due to disease, illiteracy, doctors
and nurses per population, rooms per person, GNP per capita.

133
 SPECIAL INDICATORS SERIES

1. Health for all indicators

2. Millennium development goals

3. Sustainable development goals

4. Global reference list of core health indicators

134
 “HEALTH FOR ALL”

The world health assembly in may 1977 decided that the main social goal of
governments and WHO in the coming years should be

The attainment by all the people of the world by the year 2000 AD “a level of
health that will permit them to lead a socially and economically productive
life”.

This goal has come to be popularly known as “Health For All by 2000 AD”.
135
 “HEALTH FOR ALL”

The background of this philosophy was the unacceptably

low levels of health status of the world’s population
especially the rural poor and gross disparities in health
between the rich and poor, urban and rural population.

The essential concept of “EQUITY IN HEALTH” i.e., all

people should have an opportunity to enjoy good health

136
 “HEALTH FOR ALL”

In 1981, a global strategy for HFA was evolved by WHO.

The global strategy provides a global framework that is broad enough to apply
to all member States and flexible enough to be adapted to national and regional
variations of conditions and requirements.

This was followed by each member countries developing their own strategies
for achieving HFA and synthesis of national strategies for developing regional
strategies.
137
 “HEALTH FOR ALL”

NATIONAL STRATEGY FOR HFA/2000

As a signatory to the Alma-Ata Declaration in 1978, the Govt of India was
committed to taking steps to provide HFA to its citizens by 2000 AD.

In pursuance of this objective various attempts were made to evolve suitable
strategies and approaches.

In this connection two important reports appeared.

138
 “HEALTH FOR ALL”

NATIONAL STRATEGY FOR HFA/2000

1. Report on the Study Group on “Health For All- an alternative strategy”,

sponsored by ICSSR and ICMR

2. Report of Working Group on “Health For All by 2000 AD” sponsored by

the Ministry of Health and family Welfare, Govt of India.

139
 “HEALTH FOR ALL”

NATIONAL STRATEGY FOR HFA/2000

Both the groups considered in great detail the various issues involved in
providing primary health care in the Indian context.

These reports formed the basis of the National health Policy formulated by
the Ministry of Health & family Welfare, Govt of India in 1983 which
committed the Govt and people of India to the achievement of HFA.
140
 “HEALTH FOR ALL”

Foremost among the goals to be achieved by 2000 AD were :

1. Reduction of IMR from the level of 125 (1978) to below 60.

2. To raise the expectation of life at birth from the level of 52 years to 64.

3. To reduce the crude death rate from the level of 14 per 1000 pop to 9 per
1000 pop.

4. To reduce the crude birth rate from the level of 33 per 1000 pop to 21.
141
 “HEALTH FOR ALL”

5. To achieve a net reproduction rate of one.

6. To provide portable water to the entire rural population.

142
“HEALTH FOR ALL” INDICATORS

143
“HEALTH FOR ALL” INDICATORS

144
 MILLENNIUM DEVELOPMENT GOALS

The Millennium Development Goal adopted by the United Nations in the year 2000
provides an opportunity for concerted action to improve global health.

The Millennium Declaration adopted by the General Assembly of the United

Nations in its Fifty-fifth session during September 2000 reaffirmed its commitment
to the right to development, peace, security and gender equality, to the eradication
of many dimensions of poverty and to overall sustainable development.

145
 MILLENNIUM DEVELOPMENT GOALS
The eight millennium development goals are
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality And empower women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV /AIDS ,malaria and other diseases
7. Ensure environmental sustainability
8. Develop global partnership for development 146
147
 MILLENNIUM DEVELOPMENT GOALS

India has achieved the target for reducing poverty by half (Goal 1) by official
national estimates

 We have also achieved reversing the spread of priority communicable diseases,

such as, HIV/AIDS, malaria and tuberculosis (TB) (Goal 6)

India also halved the proportion of population without access to clean drinking
water (Goal 7)
153
 MILLENNIUM DEVELOPMENT GOALS

By contrast, India is lagging behind on

 Targets for primary school enrolment & completion and universal youth
literacy by 2015 (Goal 2)
 Empowering women through wage employment & political participation
(Goal 3);
Reducing child & infant mortality (Goal 4);
 Improving maternal health (Goal 5)
 improving access to sanitation facilities (Goal 7).
154
 SUSTAINABLE DEVELOPMENT GOALS (SDG)

On 25th September 2015, the UN General Assembly adopted the new
development agenda “transforming our world: the 2030 agenda for sustainable
development.”

This new agenda is of unprecedented scope and ambition, and applicable to all
countries.

It comprises of 17 goals and 169 targets, including one specific goal for health
with 13 targets 155
 SUSTAINABLE DEVELOPMENT GOALS (SDG)

Health is centrally positioned within the 2030 agenda with one comprehensive goal.

SDG3- ensures healthy lives and promote wellbeing for all ages .

Goal 3 includes 13 targets covering all major health priorities with four targets on
unfinished millennium development goals ,four targets to address non-
communicable disease,mental health ,injuries,and environmental issues four means
of implementation targets

156
SUSTAINABLE DEVELOPMENT GOALS (SDG)

157
 SUSTAINABLE DEVELOPMENT GOALS (SDG)
NITI Aayog, the Government of India’s premier think tank, has been entrusted with the
task of coordinating the SDGs.

NITI Aayog has undertaken a mapping of schemes as they relate to the SDGs and their
targets, and has identified lead and supporting ministries for each target.

They have adopted a government-wide approach to sustainable development,

emphasising the interconnected nature of the SDGs across economic, social and
environmental pillars.

States have been advised to undertake a similar mapping of their schemes, including
158
 GLOBAL REFERENCE LIST OF CORE HEALTH
INDICATORS

The Global Reference List is a standard set of 100 core indicators prioritized
by the global community to provide concise information on the health situation
and trends, including responses at national and global levels.

It contains indicators of relevance to country, regional and global reporting

across the spectrum of global health priorities relating to the post-2015 health
goals of the Sustainable Development Goals.

159
 GLOBAL REFERENCE LIST OF CORE HEALTH
INDICATORS

The main objectives are :

To guide monitoring of health results nationally and globally.
To reduce excessive and duplicative reporting requirements.
To enhance efficiency of data collection investments in countries.
To enhance availability and quality of data on results.
To improve transparency and accountability.

160
 GLOBAL REFERENCE LIST OF CORE HEALTH
INDICATORS

The global reference list presents the indicators according to multiple dimensions.

First each indicator belongs to one of four domains :health status, risk factors,
service coverage and health systems.

Second each indicator is further categorised into subdomains like communicable

disease ,reproductive,maternal,newborn ,child and adolescent health ,non
communicable disease, injuries and violence and the environment.
161
 GLOBAL REFERENCE LIST OF CORE HEALTH
INDICATORS

The third dimension presents indicators according to levels of the result chain
framework( input, output, outcome,impact )

162
163
 The urban- rural divide in health and development

Majority of worlds population live in urban areas, a milestone that was

reached only within the last decade.

There is no universal definition of “urban". Countries differ in their definition

of urban .

Across indicators ,those living in the urban areas usually fare better than their
rural counter parts.
164
 The urban- rural divide in health and development

The urban poor frequently remain marginalized and may fare no better than
rural dwellers .

In many rapidly urbanizing countries, infrastructure and services including

healthcare water and sanitation cannot keep pace leaving the urban poor
unable to find or afford services.

165
The urban- rural divide in health and
development

166
The urban- rural divide in health and
development

167
 HEALTH SERVICE PHILOSOPHIES
Health care

Health care is defined as a multitude of services rendered to communities by the

agents of the health service professions ,for the purpose of promoting,
maintaining ,monitoring or restoring health.

Health care includes “medical care ”, it is a subset of a health care system .

It refers chiefly to those personal services that are provided directly by
physicians or rendered as a result of the physicians' instructions. 168
 HEALTH SERVICE PHILOSOPHIES
Characteristics of health care

i. Appropriateness- whether the service is needed at all in relation to essential

human needs, priorities and policies.

ii. Comprehensiveness-whether there is an optimum mix of preventive ,curative,

promotional services.

iii. Adequacy-if the service is proportionate to requirement.

169
 HEALTH SERVICE PHILOSOPHIES
iv. Availability-ratio between the population of an administrative unit and the health facility.

v. Accessibility-this may be geographic accessibility ,economic accessibility or cultural

accessibility.

vi. Affordability- the cost of health care should be within the means of individual and the
state.

vii. Feasibility-operational efficiency of certain procedures ,logistic support ,manpower and

material resources.
170
 HEALTH SYSTEM

The health system is intended to deliver health services ; in other words ,it
constitutes the management sector and involves organizational matters,eg
planning ,determining priorities ,mobilizing and allocating resources ,translating
policies into services ,evaluation and health education.

The components of health service include concepts,ideas,objects and persons .

The aim of a health system is health development – a process continuous and

progressive improvement of health status of a population 171
 LEVELS OF HEALTH CARE
Primary health care

Also called as essential health care or health care at door step.

It is the first level of contact of individual, the family and community with
national health system, where primary health care is provided.

A level of health care, it is close to the people, where most of the health
problem can be dealt with and resolved.

172
 LEVELS OF HEALTH CARE
Primary health care

It provided at village level and through primary health centers and their sub-centers
through the agency of multi-purpose health worker, village health guide, ASHA worker
and trained dais.

The measures of health promotion and prevention are taken a maximum effort at this
level of health care.

Besides providing primary health care the villages “health team” bridge the cultural and
community gap between rural people and organized health sector.
173
 LEVELS OF HEALTH CARE
Secondary health care

The next higher level of care is the secondary (intermediate) health care level.

At this level more complex problem are dealt with.

Care is generally provided in district hospital and community centers which

also serves as the first referral level.

Curative services are provided at this level.

174
 LEVELS OF HEALTH CARE
Tertiary health care

The tertiary level is a more, specialized specific facilities and attention of

highly specialized health workers.

This care is provided by regional /central level institutions.

These institutions provide not only highly specialized care, but also planning
and managerial skills and teaching for specialized staff.

175
 HEALTH TEAM CONCEPT

The practise of modern medicine has become a joint effort of many groups of
workers, both medical and non medical (physicians,dais,nurses,social
worker,health assistants)

Whether its hospital team or a community health work team,it is important for
each team member to have a specific and recognised function in the team and to
have the freedom to exercise his or her particular skills.

176
 HEALTH TEAM CONCEPT

“A group of persons who share a common objectives determined by community

needs and toward the achievement of which each member of the team contributes
in accordance with her/his competence and skills, and respecting the functions of
the other.”

The health team concept ahs taken a firm root in the delivery of health services
both in developing and developed countries.

177
 PRIMARY HEALTH CARE

The concept of primary health care was introduced at international level jointly
by WHO and UNICEF at the Alma Atta conference in 1978 to achieve the goal
of HFA by the year 2000A.D.

This approach has been described as “health by the people” and placing “peoples
health in peoples hand”.

Primary health care was accepted by the member countries of WHO as the key
to achieving the goal of HFA by the year 2000 AD 178
 PRIMARY HEALTH CARE

Primary health care is essential health care and technology based on practical
scientifically sound and social acceptable methods and technology made
universally accessible to individuals and families in the community by means
acceptable to them, through their full participation and at the cost that the
community and country can afford.

179
The Declaration of Alma –Ata stated the primary health care includes at least

 Education to the people concerning prevailing health problems and methods of

preventing and controlling them.
 Promotion of food supply and proper nutrition
 Adequate supply of safe water and basic sanitation
 Maternal and child health care and family planning
 Immunization against the major infectious diseases
 Prevention and control of endemic disease
 Appropriate treatment of common diseases and injury
 Provision of essential drugs
180
PRINCIPLES OF PRIMARY HEALTH CARE

Equitable distribution

Community participation

Intersectorial co ordination

Appropriate technology 181

 PRINCIPLES OF PRIMARY HEALTH CARE
Equitable Distribution

Health services must be shared equally by all people irrespective of their

ability to pay, and all (rich or poor, rural or urban) must have assess to the
health services.

Removal of social injustice and equal distribution of services all over the
country. Needy and vulnerable population should be given preference

Services must be accessible to all. 182

 PRINCIPLES OF PRIMARY HEALTH CARE

Horizontal equity and vertical equity.

Horizontal equity- “equal access for equal health” ie equal resources and
equal access to health care.

Vertical equity-unequal should be treated in proportion to their inequality, ie

individuals with more needs should have more treatment

183
Examples of equitable distribution in access to health care in India
Tripura- helicopter service to reach remote set of tribal hamlets
Andhra Pradesh-free buspasses to pregnant women for antenatal visits
Assam –Akha – described also as “A ship of hope in a valley of flood” to
provide mobile health services to the poor and the marginalized on the river
islands in Dibrugarh district of Assam. The focus has been children as well as
vulnerable adult groups.
Tamil nadu- birth resorts in hilly and tribal areas to provide institunalised birth.

184
 PRINCIPLES OF PRIMARY HEALTH CARE

Community participation

Involvement of the individuals, family, communities in the promotion of

their own health and welfare and not merely the government.

It determines both collective needs and priorities.

It has an important role in formulating a health problem , make informed

choices and objectives based on community priorities.
185
 PRINCIPLES OF PRIMARY HEALTH CARE

Community participation

The village health guides, trained dais and ASHA workers are examples of
community participation in India.

They will be selected by the local community and trained locally.

They are an essential feature of health care in India.

186
 PRINCIPLES OF PRIMARY HEALTH CARE

Barefoot doctors

In China lack of availability of rural health services from 1965 to 80 was
combated by the development of bare foot doctors.

Rural farm workers were given the basic health training to provide a
combination of traditional and western medicine.

This is regarded as a model for development of community health workers.

187
 PRINCIPLES OF PRIMARY HEALTH CARE

Inter sectorial coordination

Involves in addition to health sector, all related sectors and aspects of national and
community development, in particular agriculture, animal husbandry, food, industry,
education, housing etc.

To have intersectorial co ordination there should be proper orientation of programmes and
policies.

The disadvantage with intersectorial co ordination is that it will create conflicts and
disequilibrium 188
PRINCIPLES OF PRIMARY HEALTH CARE

Inter sectorial coordination

189
 PRINCIPLES OF PRIMARY HEALTH CARE

An outstanding example of intersectorial co ordination is the use of

anganwadi workers in ICDS programme.

190
 PRINCIPLES OF PRIMARY HEALTH CARE

Appropriate technology

It is defined as “technology that is scientifically sound, adaptable to local

needs, and acceptable to those who apply it and those for whom it is used,
and that can be maintained by the people by themselves in keeping with the
principle of self reliance with the resources the community and country can
afford”

191
 PRINCIPLES OF PRIMARY HEALTH CARE

Some of the examples for the use of appropriate technology are

Simple water purification

Cost effective mosquito repellents

Smoke less cooking chulhas

Telemedicine

Various immunization programmes. 192

PRIMARY HEALTH CARE IN INDIA

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 PRIMARY HEALTH CARE IN INDIA

 Long before the Declaration of Alma‑Ata, India adopted a primary healthcare

model based on the principle that inability to pay should not prevent people from
accessing health services.

Based on the bhore commity report of 1946 the GOI resolved to concentrate
services on rural people. This committee report laid emphasis on social
orientation of medical practice and high level of public participation.
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 PRIMARY HEALTH CARE IN INDIA

 With the first five year plan formulation (1951-1955) Community Development
Programme was launched in 1952. It was envisaged as a multipurpose program covering
health and sanitation through establishment of primary health centers (PHCs) and
subcenters.

By the second five year plan (1956-1961) (Mudaliar Committee) was appointed,major
recommendations of this committee report was to limit the population served by the PHCs
with the improvement in the quality of the services provided and provision of one basic
health worker per 10,000 population
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 PRIMARY HEALTH CARE IN INDIA

The Jungalwalla Committee in 1967 gave importance to integration of health services. The
committee recommended the integration from the highest to lowest level in services,
organization, and personnel.

The Kartar Singh Committee on multipurpose workers in 1973 laid down the norms about
health workers.

Shrivastav Committee (1975) suggested creation of bands of para‑professionals and

semi‑professional worker from within the community like school teachers and postmasters.

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 PRIMARY HEALTH CARE IN INDIA

 Rural Health Scheme was launched in 1977, where in training of community health,
reorientation training of multipurpose workers,and linking medical colleges to rural health
was initiated.

The Alma‑Ata Declaration of 1978 launched the concept of health for all by year 2000.

Alma‑Ata declaration led to formulation of India’s first National Health Policy in 1983.
The major goal of policy was to provide universal, comprehensive primary health services

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 PRIMARY HEALTH CARE IN INDIA

 Nearly 20 years after the first policy, the second National Health Policy was
presented in 2002. The National Health Policy, 2002 set out a new framework to
achieve public health goals in socioeconomic circumstances currently prevailing
in the country.

The third national health policy was given in 2017.

198
 NATIONAL HEALTH POLICY- 1983

India had its first national health policy in 1983 i.e. 36years after independence.

• In the circumstances then prevailing, this policy provided the initiatives like:

a. Comprehensive health care linking with extension and health education.

b. Intermediation by health volunteers

c. Decentralisation to reduce burden of high level referral system

d. To make government facility limited to eligible poor, by private investment for patients
who can pay. 199
 NATIONAL HEALTH POLICY- 1983

 NATIONAL HEALTH POLICY 1983 suggested the necessity of complete

integration of all plans for human development with socioeconomic
development.

National health policy 1983 stressed the need for providing primary health care
with special emphasis on prevention , promotion and rehabilitation aspects.

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 NATIONAL HEALTH POLICY- 1983

It suggested Planned time bound attention

5.Immunisation Programme
to the following
6.Maternal and Child Health
1.Nutrition, prevention of food adulteration.
Services
2.Mainatince of quality of drug

3.Water supply and sanitation 7.School Health Programme

4.Environmental protection
8.Occupational Health
201
NATIONAL HEALTH POLICY 1983
GOALS SUGGESTED/
ACHIEVED

202
NATIONAL HEALTH POLICY 1983
GOALS SUGGESTED/
ACHIEVED

203
NATIONAL HEALTH POLICY 1983
GOALS SUGGESTED/
ACHIEVED

204
NATIONAL HEALTH POLICY 1983
GOALS SUGGESTED/
ACHIEVED

205
 NATIONAL HEALTH POLICY-2002

A revised health policy for achieving better health care and unmet goals has
been brought out by government of India- National Health Policy 2002.

According to this revised policy, government and health professionals are

obligated to render good health care to the society.

Optimizing the use of health service to a large group rather than a small
group is a foreseen event by the NHP 2002.
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 NATIONAL HEALTH POLICY-2002

Objectives:

Achieving an acceptable standard of good health of Indian Population.

Decentralizing public health system by upgrading infrastructure in existing
institutions.

Ensuring a more equitable access to health service across the social and geographical
expanse of India.

Enhancing the contribution of private sector in providing health service for people
who can afford to pay.
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 NATIONAL HEALTH POLICY-2002

Objectives:

Emphasizing rational use of drugs.

Increasing access to tried systems of Traditional Medicine

208
NATIONAL HEALTH POLICY-2002

209
 ACHIEVEMENTS

Eradication of Poliomyelitis was missed ,however there is zero reporting of yews since
2004.

Leprosy has been declared eliminated according to the criteria fixed by WHO. However,
more efforts are required.

Integrated Disease Surveillance Project has been launched .

Decentralized implementation of public health Programs:National Rural Health Mission

has been launched in thisdirection
210
 HEALTH PROMOTION

Health promotion is the process of enabling people to increase control over, and
to improve, their health, To reach a state of complete physical, mental and social
wellbeing, an individual or group must be able to identify and to realize
aspirations, to satisfy needs, and to change or cope with the environment.

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 HEALTH PROMOTION
Ottawa charter for health promotion

The first International Conference on Health Promotion, was held in Ottawa, Ontario,
Canada from November 17-21, 1986.

This conference was primarily a response to growing expectations for a New public
health movement around the world.

It was built on the progress made through the Declaration on Primary Health Care at
Alma-Ata;and the debate at the World Health Assembly on intersectorial action for health.

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 HEALTH PROMOTION

It incorporated three basic strategies for health promotion. “Enabling,

mediating and advocacy” which are needed and applied to all health
promotion action areas

213
 HEALTH PROMOTION
ADVOCATE

Good health is a major resource for social, economic and personal development
and an important dimension of quality of life. Political, economic, social,
cultural, environmental, behavioural and biological factors can all favour health
or be harmful to it. Health promotion action aims at making these conditions
favourable through advocacy for health.

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 HEALTH PROMOTION
ENABLE
 Health promotion focuses on achieving equity in health. Health promotion action

aims at reducing differences in current health status and ensuring equal opportunities
and resources to enable all people to achieve their fullest health potential.

This includes a secure foundation in a supportive environment, access to information,

life skills and opportunities for making healthy choices.

This must apply equally to women and men.

215
 HEALTH PROMOTION
MEDIATE
 The prerequisites and prospects for health cannot be ensured by the health sector
alone. More importantly, health promotion demands coordinated action by all
concerned: by governments, by health and other social and economic sectors, by
nongovernmental and voluntary organization, by local authorities, by industry
and by the media.

Professional and social groups and health personnel have a major responsibility
to mediate between differing interests in society for the pursuit of health
216
 HEALTH PROMOTION

The Ottawa charter incorporates five key action areas in health promotion.
1. Build Healthy Public Policy
2. Create Supportive Environments
3. Strengthen Community Actions
4. Develop Personal Skills
5. Reorient Health Services

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 HEALTH PROMOTION
BUILD HEALTHY PUBLIC POLICY

Health promotion goes beyond health care. It puts health on the agenda of
policy makers in all sectors and at all levels, directing them to be aware of
the health consequences of their decisions and to accept their responsibilities
for health.

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 HEALTH PROMOTION
BUILD HEALTHY PUBLIC POLICY

Health promotion policy requires the identification of obstacles to the

adoption of healthy public policies in non-health sectors, and ways of
removing them.

The aim must be to make the healthier choice the easier choice for policy
makers as well.

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 HEALTH PROMOTION
CREATE SUPPORTIVE ENVIRONMENT

Systematic assessment of the health impact of a rapidly changing environment-

particularly in areas of technology ,work ,energy production and urbanization-
is essential and must be followed by action to ensure positive benefit to health
of public.

The protection of the natural and built environment s and the conservation of
natural recourses must be addressed in any health promotion strategy.
220
 HEALTH PROMOTION
STRENGTHEN COMMUNITY ACTIONS

Health promotion works through concrete and effective community action in

setting priorities, making decisions, planning strategies and implementing them
to achieve better health.

 At the heart of this process is the empowerment of communities - their

ownership and control of their own endeavours and destinies.

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 HEALTH PROMOTION

DEVELOP PERSONAL SKILLS

 Health promotion supports personal and social development through providing

information, education for health, and enhancing life skills.

By doing so, it increases the options available to people to exercise more
control over their own health and over their environment, and to make choice
conducive to health.
222
 HEALTH PROMOTION
REORIENT HEALTH SERVICES

The responsibility for health promotion in health services is shared among individuals,
community groups, health professionals, health service institutions and governments.

The role of health sector should move in the direction of health promotion beyond its
responsibility for providing clinical and curative services.

 A stronger attention to health research as well as changes in professional education

and training are also required.
223
 HEALTH PROMOTION

A logo was created for Ottawa conference. Since then, WHO kept this symbol
as the health promotion logo,as it stands for the approaches to health
promotion as outlined in Ottawa charter.

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 HEALTH PROMOTION
JAKARTA DECLARATION ON HEALTH PROMOTION

The fourth conference held in July 1997 offered a vision and focus for health promotion into
21st century.

The determinants of health; new challenges in the 21st century ;and the fundamental
conditions and resources for health are peace ,shelter ,education ,social relations,
food ,income, the empowerment of women ,a stable ecosystem, sustainable resource
use ,social justice ,respect for human rights and equity above all poverty is the greatest threat

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 HEALTH PROMOTION

Priorities for health promotion in the 21st Century

1. Promote social responsibility for health

2. Increase investments for health development

3. Consolidate and expand partnerships for health

4. Increase community capacity and empower the individual

5. Secure an infrastructure for health promotion

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 HEALTH PROMOTION
The Bangkok charter for health promotion in a globalized world

The Bangkok Charter for Health Promotion in a Globalized World is the name of
an international agreement reached among participants of the 6th Global
Conference on Health Promotion held in Bangkok, Thailand in August 2005,
convened by the World Health Organization.

The Bangkok Charter identifies actions, commitments and pledges required to

address the determinants of health in a globalized world through health promotion.
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 HEALTH PROMOTION
The Bangkok charter for health promotion in a globalized world
The Bangkok Charter recognizes
•The health inequality between developed and developing nations
•The changing trend of communication and consumption in a globalized world
•Urbanization
•Global environmental change
•Commercialization

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 HEALTH PROMOTION
The Bangkok charter for health promotion in a globalized world
 Five key areas of action for a healthier world:

 Partner and build alliances with private, non-private, non-governmental or international

organizations to create sustainable actions
 Invest in sustainable policies, actions and infrastructure to address the determinants of health
 Build capacity for policy development, health promotion practice and health literacy
 Regulate and legislate to ensure a high level of protection from harm and enable equal
opportunity for health and well being
 Advocate health based on human rights and solidarity
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 HEALTH SERVICE RESEARCH

Health research includes many things. it may include,

1. Biomedical research-to elucidate outstanding health problems and develop new

or better ways of dealing with them

2. Intersectorial research- for which relationships would have to be established

with the institutions concerned with the institutions concerned with other sectors.

3. Health services research

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 HEALTH SERVICE RESEARCH

The concept of health service research was developed during 1981-1982.

It has been defined as the systematic study of the means by which
biomedical and other relevant knowledge is brought to bear on the health of
individuals and communities under a given set of conditions.

The concept of HSR is holistic and multidisciplinary

It essential for the continuous evolution and refinement of health services.
231
 REFERENCES

Park K. Park’s textbook of preventive and social medicine. 24th ed, India: Bhanot Publishers; 2017.
National health profile-2019
India and the MDGs Towards a sustainable future for all-United Nations, February 2015
Nath A, India's Progress Toward Achieving the Millennium Development Goals,Indian J Community
Med. 2011 Apr-Jun; 36(2): 85–92
www.census.gov.in/2011
World Health Organization. http://www.who.int/en/
MDG-Final Country report of India
https://niti.gov.in/verticals/sustainable-dev-goals

232
 REFERENCES

Declaration of Alma-Ata, International Conference on Primary Health Care, Alma-

Ata, USSR, 6-12 September 1978 accessed
fromhttps://www.who.int/publications/almaata_declaration_en.pdf.
H T Pandve, T K. Pandve; Primary healthcare system in India: Evolution and
challenges,int journal of health system and disaster management,2013;1(3) 125-128
https://www.nhp.gov.in/sites/default/files/pdf/nhp_1983.pdf
S P Agarwal- Viewpoints: National Health Policy 2002, the national medical
journel of india,2003
https://www.who.int/healthpromotion/milestones_ch4_20090916_en.pdf
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THANK YOU

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