Concept of Health,

wellness,
illness & disease
 Definition
“Health is a state of complete
physical, mental and social well being
and not merely the absence of disease
or infirmity”. WHO’s 191 member
states have endorsed this
statement.
 Physical Health
It means adequate body weight, height and
circumference as per age and sex with
acceptable level of vision, hearing, locomotion
or movements, acceptable levels of pulse rate,
blood pressure, respiratory rate,
chest circumference, head
circumference, waist hip ratio.
 It means The body structure and functions
confirming to laid down standards within the
range of normal development and functions of
all the systems.
Mental health
 Mental health is defined “as a state of
well being in which the individual realized
his or her own abilities, can cope with
normal stresses of life, can work
productively and fruitfully and is able to
make a contribution to his or her
community”.
 A mentally normal person has the ability to
mix up with others, he/she makes friendship,
behaves in a balanced manner, keeps himself
tidy and observes adequate personal hygiene,
well oriented to time, place and person and
environments and he is unduly not suspicious of
others.
 He is cheerful and happy and enjoys life
with a purpose and he thinks positively and
has normal development and contributes
fully and is useful and productive to society
and nation.
 SOCIAL HEALTH

 It refers the ability to make and maintain

relationships with other people or
communities.
 It states that harmony and integration
within and between each individuals and
other members of the society.
 Social dimension of health includes the
level of social skills one possesses, social
functioning and the ability to see oneself
as a member of a larger society.
9
 SPIRITUAL HEALTH
 Spiritual health is connected with religious
beliefs and practices. It also deals with
personal creeds, principles of behavior and
ways of achieving peace of mind and being at
peace with oneself.
 It is intangible “something” that transcends
physiology and psychology.
 It includes integrity, principle and ethics, the
purpose of life, commitment to some higher
being, belief in the concepts that are not subject
to “state of art” explanation.
1
0
 DETERMINANTS OF
HEALTHby multiple factors.
 Health is determined
 The health of an individual and community is
influenced by: individual (internal) and
external factors.
 The individual factors include by his own
genetic factors and the external factors include
environmental factors.
 These factors interact and these interactions
may be health promoting or deleterious.
 Thus, the health of individuals and whole
communities may be considered to be the
result of many interactions.
11
DETERMINANTS OF
HEALTH

Communitie
s
Families
Societie
s

Individuals

1
2
 BIOLOGICAL
DETERMINANTS
 The health of an individual partly
depends on the genetic constitutions.
 A number of diseases e.g.
chromosomal anomalies, inborn error of
metabolism, mental retardation and
some types of diabetes are some
extent due to genetic origin.

1
3
 ENVIRONMENTAL
FACTORS
 Biological: disease producing agent (e.g.
bacteria, virus, fungi), intermediate host
(e.g. mosquito, sand fly), vector (e.g.
housefly), reservoir (e.g. pig ).
 Physical:
Air, water, light, noise, soil, climate, altitude,
radiation housing, waste etc.
 Psychosocial: psychological make up of
individual and structure and functioning of
society. E.g.habit, beliefs, culture, custom,
religion etc.
1
4
 LIFE
STYLE
 Behavioral pattern and life long
habits e.g. smoking and alcohol
consumption, food habit, personal
hygiene, rest and physical exercise,
bowel and sleeping patterns, sexual
behavior.

1
5
 SOCIO-ECONOMIC
CONDITIONS
 It consist of education, occupation and income.
 The world map of illiteracy closely coincides
with the maps of poverty, malnutrition, ill health,
high infant and child mortality rates.
 The very state of being employed in productive
work promotes health, because the
unemployed usually show a higher incidence of
ill-health and deaths.
 There can be no doubt that economic progress
has positive impact factor in reducing
morbidity, increasing life expectancy and
improving the quality of life. 1
6
 Availability of health and family
welfare Service
 Health and family welfare services cover a wide
spectrum of personal and community services
for treatment of diseases, prevention of
disease and promotion of health.
 The purpose of health services is to improve
the health status of population.
 For example, immunization of children can
influence the incidence/prevalence of particular
disease.
 Provision of safe water can prevent mortality
and morbidity from water-borne diseases. 1
7
 Aging of the
population
 By the year 2020, the world will have
more than one billion people aged sixty or
over and more than two-thirds of them
living in developing countries.
 A major concern of rapid population aging
is the increased prevalence of chronic
diseases and disabilities both being
condition that tend to accompany the
aging process and deserve special
attention.
1
8
 OTHER DETERMINANTS OF
HEALTH
 Except above discussed determinants,
there are many more determinates of
health and disease of an individual and
community. These include:
 Science and technology
 Information and communication
 Gender
 Equity and social justice
 Human rights etc.

1
9
 RESPONSIBILITY FOR
HEALTH
 Individual responsibility: self care for
maintaining their own health.
 Community responsibility: health care for
the people to the health care by the
people.
 State responsibility: constitutional rights.
 International responsibility: Health for All
through PHC.
2
0
 INDICATORS OF
HEALTH
 A variable which helps to measure changes
directly or indirectly (WHO,1981).
 A statistic of direct normative interest which
facilitates concise , comprehensive, and
balanced judgments about conditions of major
aspects of the society(H.E.W./USA,1969).
 The health indicators are defined as those
variables which measures the health status
of an individual and community.
2
1
 INDICATORS OF
HEALTH
Mortality Indicators: Crude Death rate,
Life Expectancy, Infant mortality rate,Child
mortality rate, Under five mortality rate,
Maternal mortality ratio, Disease specific
mortality, proportional mortality rate etc.
Morbidity Indicators: Incidence and
prevalence rate, disease notification rate,
OPD attendance rate, Admission,
readmission and discharge rate, duration
of stay in hospital and spells of sickness or
absence from work or school. 2
2
 INDICATORS OF
 Disability HEAL TH Sullivan's index, HALE (Health
Indicators:
Adjusted Life Expectancy), DALY (Disability Adjusted
Life Year).
 Sullivan's index is a expectation of life free from
disability.
 HALE is the equivalent number of years in full health
that a newborn can expected to live based on the
current rates of ill health and mortality.
 DALY expresses the years of life lost to premature
death and years lived with disability adjusted for the
severity of disability.

2
3
 INDICATORS OF
HEALTH
Nutritional Status Indicators: Anthropometric
measurement of preschool children,
Prevalence of low birth weight etc.
Health Care Delivery Indicators: Doctor-
population ratio, Bed-nurse ratio, Population-
bed ration, Population per health facility etc.
Utilization Rates: immunization coverage,
ANC coverage, % of Hospital Delivery,
Contraceptives prevalence rate, Bed
occupancy rate, average length of stay in
hospital and bed turnover rate etc. 2
4
 INDICATORS OF
HEALTH
 Indicators of social and mental health: Rates of
suicides, homicides, violence, crimes, RTAs, drug
abuse, smoking and alcohol consumption etc.
 Environmental indicators: proportion of
population having access to safe drinking water
and improved sanitation facility, level of air
pollution, water pollution, noise pollution etc.
 Socio Economic Indicators: rate of population
increase, Per capita GNP, Dependency ratio, Level
of unemployment, literacy rate, family size etc.

2
5
 INDICATORS OF
HEALTH
 Health policy Indicators: proportion of GNP
spent on health services, proportion of
GNP spent on health related activities
including safe water supply, sanitation,
housing, nutrition etc. and proportion of
total health resources devoted to primary
health care.
 Indicators of Quality of Life: PQLI, IMR,
Literacy rate, Life Expectancy at age one
etc.
2
6
 CONCEPT OF WELLBEING
 Wellbeing of an individual or group of
individuals have several components and
has been expressed in various ways, such
as ‘standard of living’ or ‘level of living’ and
‘quality of live’.

2
7
STANDARDOF
LIVING
•  Income and occupation, standards
of housing, sanitation and nutrition,
the level of provision of health,
educational, recreational and other
services all be used individually as
measures of socioeconomic status,
and collectively as an index of the
standard of living.

2
8
 LEVEL OF
LIVING
 It consists of nine components : health,
food consumption, education, occupation
and working conditions, housing, social
security, clothing, recreation and leisure
human rights.
 These objective characteristics are
believed to influence human wellbeing. It is
considered that health is the most
important component of the level of living
because its impairment always means
impairment of the level of living. 2
9
QUALITY OF
LIFE
 The condition of life resulting from the
combination of the effects of the
complete range of factors such as
those determining health, happiness
(including comfort in the physical
environment and a satisfying
occupation), education, social and
intellectual attainments, freedom of
action, justice and freedom of
expression.
- WHO (1976)
3
0
 QUALITY OF
LIFE
 A composite measure of physical, mental
and social wellbeing as perceived by
each individual or by group of individuals-
that is to say, happiness, satisfaction and
gratification as it is expressed in such life
concerns as
health, marriage, family work, financial
situation, educational opportunities, self-
esteem, creativity, belongingness, and
trust in others.
3
1
WELLBEIN
G
 Wellbeing of an individual or group of
individuals have objective (standard of living
or level of living) and subjective (quality of
life) components.
 Thus, a distinction is drawn between the
concept of ‘level of living’ consisting of
objective criteria and of ‘quality of life’
comprising the individual’s own subjective
evaluation of these.
3
2
 TWO ASPECTS OF
HEAL
• Subjective: TH
It is formed by sensations and
feelings of a person suffering from
disease.
• Objective: Its basis is formed by objective
parameters obtained by measurement of
structures and functions of a person
during disease.
 The quality of life can be evaluated by
assessing the persons subjective feeling
of happiness or unhappiness about the
various life concerns. 3
3
 CONCEPT OF
DISEASE

 Ecological point of view disease is

defined as “a maladjustment of the
human organism to the environment.”
 The simplest definition is that disease is
just the opposite of health: i.e. any
deviation from normal functioning or state
of complete physical or mental well-
being.
3
4
 CONCEPT OF
DISEASE
 Webster defines disease as “a condition in
which body health is impaired, a departure
from a state of health, an alteration of the
human body interrupting the performance of
vital functions”.
 The oxford English Dictionary defines disease
as “ a condition of the body or some part or
organ of the body in which its functions are
disturbed or deranged”.
3
5
 Distinction between
Disease, Illness and
Sickness
 The term disease literally means “without ease’’
(uneasiness), when something is wrong with
bodily function.
 Illness refers to the presence of a specific
disease, and also to the individual’s perceptions
and behavior in response to the disease, as
well as the impact of that disease on the
psychosocial environment.
 Sickness refers to a state of social dysfunction.
3
6
 Distinction between
Disease, Illness and
Sickness
 Disease is a physiological/psychological
dysfunction.
 Illness is a subjective state of the person
who feels aware of not being well.
 Sickness is a state of social dysfunction
i.e. a role that the individual assumes
when ill (sickness role).

3
7
 The environment related
to disease

This refers not only to the environment the man

lives. Various environmental factors are
categorized as follows.
 1. Physical Environment

Physical aspects of environment

Air, water, light, heat, radiation, gravity,

pressure, and chemical agents etc.

man tries a great deal to control these factors.

2. Biological Environment

Certain diseases do not occur in some areas

because agents or vectors can not exist in that
environment due to biological reasons.
 Biological environment
includes

Infectious agents of diseases, reservoirs of

infective agents, vectors that transmit
diseases, plants and animals.
 3. Social Environment

The social factors relevant to health include

socio-economic status, social customs,
traditional believes, etc.
 Natural History of Disease

Refers to the course of a disease over a

period of time, unaffected by treatment.
 Disease occurrence is usually insidious. Chronic
diseases evolve over a long period and have their
own progression. The history and time period that it
spread is different from disease to disease. Most
of the diseases pass through the
following pattern.
 1. Stage of susceptibility

Risk factors that favors the occurrence of a

disease are operating in this stage.

Host factors:- Age, sex, race,

family history, nutritional status

Environmental Exposure to infectious

factors:- agents, (infections) obesity, (HT,
DM, coronary artery diseases)
During this stage the person remains free of clinical
diseases
 2. Stage of pre-symptomatic
disease

Three important factors i.e.. Host, agent and

environment interact to initiate pathogenic changes
that is adequate to cause a disease.

Still the disease does not clinically manifest.

 3. Stage of clinical disease

In this stage, the particular signs and symptoms

develop. During this stage a disease can be sub
classified in to its own severity grades.
 E.g. Cancers
Stage

I. Localized
II. Local Lymph nodes are involved

III. Involvement of other organs within the

same region

IV. Distant metastases

 4. Stage of terminations

Disease terminates and follow the following

trend

1. Spontaneous resolution –No sequels

2. Settles down but with some sequels.

3. Result in death of the patient.

 5. Stage of sequels
Disease may extinct but aftermath remains
may be an impairment is left.

Disability

Handicap
 Sequence of events
Disease Impairment Disability Handicap

Impairment
“Any loss or abnormality of psychological,
physiological or anatomical structure or function”.

e.g. Loss of foot, defective vision, mental retardation.

Impairment will be

 visible or invisible

 temporary or permanent

 progressive or regressive
Disability

“Any restriction or lack of ability to perform an

activity in the manner or within or within the range
considered normal for a human being”.
Handicap

Definite disadvantages for a given individual

resulting from an impairment or a disability that
limits or prevents the fulfillment of a role that is
normal for him/her depending on his/her age,
sex, social and cultural factors or for that
individual.

e.g. Accident Disease

Loss of foot Impairment
Cannot walk Disability
Unemployed Handicap
 CONCEPT OF
CONTROL
DISEASE CONTROL: The term disease
control refers ongoing operation aimed
at reducing:
 The incidence of disease.
 The duration of disease and the
consequently the risk of transmission.
 The effect of infection including physical
and psychological complication.
 The financial burden to the community.
5
5
• Reducing the number of new infections, the number of
people currently infected, and the number of people who
become sick or die from a disease in local settings.
• This is achieved through deliberate efforts such as
vaccines, medications, contact isolation, or other public
health interventions.
• Malaria is a good example of a disease that can be
controlled in local settings. You can't get rid of malaria
entirely because the mosquito-borne parasites that
transmit the disease can develop drug resistance. But you
can control it through health care and prevention
strategies such as bed nets and anti-malaria medications.
5
6
ELIMINATION: Elimination means stopping
the transmission of a disease in a specific
geographic area or country, but not
worldwide.
ERADICATION: Disease eradication is the
permanent reduction of a disease to zero
cases through deliberate measures such as
vaccines. Once a disease has been
eradicated, intervention measures are no
longer needed. The only disease to ever be
fully eradicated in human history has been
smallpox, which was declared officially
eradicated by the World Health Organization
(WHO) in 1980 5
7
 CONCEPT OF
CONTROL
MONITORING: Defined as “the performance
and analysis of routine measurement
aimed at detecting changes in the
environment or health status of
population.” e.g. growth monitoring of child,
Monitoring of air pollution, monitoring of
water quality etc.
SURVEILLANCE: Defined as “the
continuous scrutiny of the factors that
determine the occurrence and distribution
of disease and other conditions of ill
health.”E.g. Poliomyelitis surveillance 5
8
 Leavell’s Levels of
Prevention
Stage of disease Level of prevention Type of response

Pre-disease Primary Prevention Health promotion and

Specific protection

Latent Disease Secondary prevention Pre-symptomatic

Diagnosis and
treatment

Symptomatic Disease Tertiary prevention • Disability limitation for

early symptomatic disease
• Rehabilitation for late
Symptomatic disease
Levels of prevention

Primordial prevention

Primary prevention

Secondary prevention

Tertiary prevention
 Primordial prevention
• Primordial prevention consists of actions
and measures that inhibit the emergence
of risk factors in the form of environmental,
economic, social, and behavioral
conditions and cultural patterns of living
etc.
 Primordial prevention (cont.)
• It is the prevention of the emergence or
development of risk factors in countries or
population groups in which they have not
yet appeared

• For example, many adult health problems

(e.g., obesity, hypertension) have their
early origins in childhood, because this is
the time when lifestyles are formed (for
example, smoking, eating patterns,
physical exercise).
 Primordial prevention (cont.)
• In primordial prevention, efforts are
directed towards discouraging children
from adopting harmful lifestyles

• The main intervention in primordial

prevention is through individual and mass
education
 Primary prevention
• Primary prevention can be defined as the action
taken prior to the onset of disease, which
removes the possibility that the disease will ever
occur.
• It signifies intervention in the pre-pathogenesis
phase of a disease or health problem.
• Primary prevention may be accomplished by
measures of “Health promotion” and “specific
protection”
 Primary prevention (cont.)
• It includes the concept of "positive health", a
concept that encourages achievement and
maintenance of "an acceptable level of health
that will enable every individual to lead a socially
and economically productive life".
• Primary prevention may be accomplished by
measures designed to promote general health
and well-being, and quality of life of people or by
specific protective measures.
 Primary prevention

Achieved by

Health promotion Specific protection

Immunization and seroprophylaxis

Health education
chemoprophylaxis
Use of specific nutrients or supplementations
Environmental modifications
Protection against occupational hazards

Nutritional interventions Safety of drugs and foods

Life style and behavioral changes Control of environmental hazards,

e.g. air pollution
 Health promotion
• Health promotion is “ the process of
enabling people to increase control over
the determinants of health and thereby
improve their health”.
 Approaches for Primary Prevention

• The WHO has recommended the following

approaches for the primary prevention of
chronic diseases where the risk factors
are established:

– a. Population (mass) strategy

– b. High -risk strategy
 Population (mass) strategy
• “Population strategy" is directed at the whole population
irrespective of individual risk levels.

• For example, studies have shown that even a small

reduction in the average blood pressure or serum
cholesterol of a population would produce a large
reduction in the incidence of cardiovascular disease

• The population approach is directed towards socio-

economic, behavioral and lifestyle changes
 High -risk strategy

• The high -risk strategy aims to bring

preventive care to individuals at special
risk.
• This requires detection of individuals at
high risk by the optimum use of clinical
methods.
 Secondary prevention
• It is defined as “ action which halts the progress of a disease at its
incipient stage and prevents complications.”

• The specific interventions are: early diagnosis (e.g. screening tests,

and case finding programs….) and adequate treatment.
 early detection and treatment are the main interventions of disease
control, besides being critically important in reducing the high
morbidity and mortality in certain diseases like hypertension,
cancer cervix, and breast cancer.
 The earlier the disease is diagnosed and treated the better it is from
the point of view of prognosis and preventing the occurrence of
further cases (secondary cases) or any long term disability.
 Secondary prevention (cont.)
• Secondary prevention attempts to arrest the
disease process, restore health by seeking out
unrecognized disease and treating it before
irreversible pathological changes take place,
and reverse communicability of infectious
diseases.

• It thus protects others from in the community

from acquiring the infection and thus provide at
once secondary prevention for the infected ones
and primary prevention for their potential
contacts.
 Early diagnosis and treatment
• WHO Expert Committee in 1973 defined early
detection of health disorders as “ the detection
of disturbances of homoeostatic and
compensatory mechanism while biochemical,
morphological and functional changes are still
reversible.”

• The earlier the disease is diagnosed, and

treated the better it is for prognosis of the case
and in the prevention of the occurrence of other
secondary cases.
 Tertiary prevention
• It is used when the disease process has
advanced beyond its early stages.
• It is defined as “all the measures available to
reduce or limit impairments and disabilities, and
to promote the patients’ adjustment to
irremediable conditions.”
• Intervention that should be accomplished in the
stage of tertiary prevention are disability
limitation, and rehabilitation.
Disability limitation
disease

impairment

disability

handicap
 Impairment
• Impairment is “any loss or abnormality of
psychological, physiological or anatomical
structure or function.”
 Disability
• Disability is “any restriction or lack of
ability to perform an activity in the manner
or within the range considered normal for
the human being.”
 Handicap
• Handicap is termed as “a disadvantage for
a given individual, resulting from an
impairment or disability, that limits or
prevents the fulfillment of a role in the
community that is normal (depending on
age, sex, and social and cultural factors)
for that individual.”
 Rehabilitation

• Rehabilitation is “ the combined and

coordinated use of medical, social,
educational, and vocational measures for
training and retraining the individual to the
highest possible level of functional ability.”
 Rehabilitation

Medical Vocational Social Psychological

rehabilitation rehabilitation rehabilitation rehabilitation
 Strategy for Prevention
Identify
Populations

As
Modify Existing at High

sess nt
Disease Risk
Intervention (based on demography /
family history,

me
Programs host factors..)
ion
Intervent

Assess
Evaluate Exposure
Intervention
Programs

Conduct
Research on
Apply Mechanisms
(including the study of
Population-Based genetic susceptibility)
Intervention
Programs

Epidemiology Division
 Control
• Concept of control:
The term disease control describes ongoing
operations aimed at reducing:
– The incidence of disease
– The duration of disease and consequently the risk of
transmission
– The effects of infection, including both the physical
and psychosocial complications
– The financial burden to the community.
• Control activities focus on primary
prevention or secondary prevention, but
most programs combine both.
control

elimination

eradication
 Disease Elimination

• Between control and eradication, an

intermediate goal has been described, called
"regional elimination"
• The term "elimination" is used to describe
interruption of transmission of disease, as for
example, elimination of measles, polio and
diphtheria from large geographic regions or
areas
• Regional elimination is now seen as an
important precursor of eradication
 Disease Eradication
• Eradication literally means to "tear out by roots".

• It is the process of “Termination of all transmission

of infection by extermination of the infectious
agent through surveillance and containment”.

• Eradication is an absolute process, an "all or

none" phenomenon, restricted to termination of an
infection from the whole world. It implies that
disease will no longer occur in a population.

• To-date, only one disease has been eradicated,

that is smallpox.
 Monitoring
• Monitoring is "the performance and analysis of
routine measurements aimed at detecting
changes in the environment or health status of
population" (Thus we have monitoring of air
pollution, water quality, growth and nutritional
status, etc).

• It also refers to on -going measurement of

performance of a health service or a health
professional, or of the extent to which patients
comply with or adhere to advice from health
professionals.
 Surveillance
• surveillance means to watch over with great
attention, authority and often with suspicion

• According to another, surveillance is defined as

"the continuous scrutiny (inspection) of the
factors that determine the occurrence and
distribution of disease and other conditions of ill-
health"
 Objectives of Surveillance
• The main objectives of surveillance are:

– (a) to provide information about new and changing trends

in the health status of a population, e.g., morbidity,
mortality, nutritional status or other indicators and
environmental hazards, health practices and other
factors that may affect health

– (b) to provide feed-back which may be expected to

modify the policy and the system itself and lead to
redefinition of objectives, and

– (c) provide timely warning of public health disasters so

that interventions can be mobilized.
 Control of infectious diseases (the 4
“C”s

Control

Cases Contacts Carriers Community

Diagnosis
notification standard
strict Epidemiological
isolation observation detection
protective Investigation &
disinfection containment
treatment
follow up
release
 Evaluation of control
• Evaluation is the process by which results are compared
with the intended objectives, or more simply the assessment
of how well a program is performing.
•
• Evaluation should always be considered during the planning
and implementation stages of a program or activity.

• Evaluation may be crucial in identifying the health benefits

derived (impact on morbidity, mortality, sequelae, patient
satisfaction).

• Evaluation can be useful inidentifying performance

difficulties.

• Evaluation studies may also be carried out to generate

information for other purposes, e.g., to attract attention to a
problem, extension of control activities, training and patient
management, etc.
 To summarize
• The goals of medicine are to promote health, to preserve
health, to restore health when it is impaired, and to minimize
suffering and distress.

• These goals are embodied in the word "prevention"

• Successful prevention depends upon a knowledge of

causation, dynamics of transmission, identification of risk
factors and risk groups, availability of prophylactic or early
detection and treatment measures, an organization for
applying these measures to appropriate persons or groups,
and continuous evaluation of and development of
procedures applied

• The objective of preventive medicine is to intercept or

oppose the "cause" and thereby the disease process. This
epidemiological concept permits the inclusion of treatment
as one of the modes of intervention