Caoncept of health

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Concept of Health

Source: Park's Textbook of Preventive and Social Medicine

Introduction

Health is a common theme in most cultures. Among the oldest definitions still in use is that health is the "absence of disease." In some cultures, health and harmony are considered equivalent - harmony being defined as "being at peace with the self, the community, god and cosmos." Ancient Indians and Greeks shared this concept and attributed disease to disturbances in the bodily equilibrium of what they called "humors."

Modern medicine has been criticized for its preoccupation with studying disease and neglecting health. Our ignorance about health remains profound - the determinants of health are still not fully clear, current definitions remain elusive, and there is no single yardstick for measuring health.

In recent decades, there has been a reawakening that health is a fundamental human right and a worldwide social goal, essential to satisfying basic human needs and improving quality of life.

Changing Concepts of Health

Health has evolved as a concept from an individual concern to a worldwide social goal, encompassing the whole quality of life.

1. Biomedical Concept

Traditionally, health was viewed as the "absence of disease." This concept, rooted in the germ theory of disease (dominant in the early 20th century), viewed the human body as a machine, disease as a breakdown of the machine, and the doctor's task as repair of the machine.

Criticism: This concept minimized the role of environmental, social, psychological, and cultural determinants of health. It was found inadequate to address major health problems such as malnutrition, chronic diseases, accidents, drug abuse, mental illness, and environmental pollution.

2. Ecological Concept

The ecologists viewed health as a dynamic equilibrium between man and his environment, with disease being a maladjustment of the human organism to the environment.

Dubos defined health as: "Health implies the relative absence of pain and discomfort and a continuous adaptation and adjustment to the environment to ensure optimal function."

This concept raises two issues: imperfect man and imperfect environment.

3. Psychosocial Concept

Contemporary social science revealed that health is not only a biomedical phenomenon, but one influenced by social, psychological, cultural, economic, and political factors. Health is both a biological and social phenomenon.

4. Holistic Concept

The holistic model is a synthesis of all the above. It recognizes the strength of social, economic, political, and environmental influences on health. Health is a unified or multidimensional process involving the well-being of the whole person in the context of his environment - a sound mind, in a sound body, in a sound family, in a sound environment. The emphasis is on the promotion and protection of health.

Definition of Health

WHO Definition (1948)

"Health is a state of complete physical, mental and social well-being and not merely an absence of disease or infirmity."

This has been amplified in recent years to include the ability to lead a "socially and economically productive life."

Criticism of the WHO definition:

It has been called too broad
Some argue health cannot be defined as a "state" but must be seen as a process of continuous adjustment to the changing demands of living
It is a dynamic concept

Value of the WHO definition: It is broad and positive in its implications; it sets a standard of "positive health" and symbolizes the aspirations of people.

Operational Definition

The WHO definition is not operational (not directly measurable). An operational definition was devised by a WHO study group. Health in the narrow, measurable sense means:

(a) No obvious evidence of disease; person is functioning normally within accepted limits for one's age, sex, community, and geographic region
(b) The several organs of the body are functioning adequately in relation to one another - a state of equilibrium or homeostasis

New Philosophy of Health

Health is a fundamental human right
Health is the essence of productive life, not the result of ever-increasing expenditure on medical care
Health is intersectoral
Health is an integral part of development
Health is central to the concept of quality of life
Health is a major social investment
Health is a worldwide social goal

Dimensions of Health

Health is multidimensional. The WHO definition recognizes three specific dimensions (physical, mental, social), but more have been cited:

1. Physical Dimension

Probably the easiest to understand
Conceptualizes health as "perfect functioning" of the body - every cell and organ functioning at optimum capacity in harmony with the rest
Signs include: good complexion, clean skin, bright eyes, sound sleep, normal organ function, normal pulse, BP, and exercise tolerance

Evaluation tools: clinical examination, laboratory investigations, symptom inquiry, nutrition assessment, questionnaires, community-level indicators (infant mortality rate, life expectancy)

2. Mental Dimension

Mental health is NOT merely the absence of mental illness
Defined as "a state of balance between the individual and the surrounding world, a state of harmony between oneself and others, a coexistence between the realities of the self and that of other people"
Characteristics of a mentally healthy person:
- Free from internal conflicts
- Well-adjusted; gets along with others
- Has a strong sense of self-esteem
- Self-aware (self-actualization)
- Good self-control - balances rationality and emotionality
- Copes with stress and anxiety

3. Social Dimension

Social well-being implies harmony and integration within the individual, between individuals and others, and between individuals and the world
Defined as the "quantity and quality of an individual's interpersonal ties and the extent of involvement with the community"
Includes social skills, social functioning, ability to see oneself as a member of larger society
Rooted in both a "positive material environment" (financial/residential) and "positive human environment" (social network)

4. Spiritual Dimension

Refers to the part of the individual that reaches out and strives for meaning and purpose in life
Transcends physiology and psychology
Includes integrity, principles, ethics, purpose in life, and commitment to a higher being

5. Emotional Dimension

Distinct from mental health: mental health relates to "knowing" (cognition), while emotional health relates to "feeling"
Researchers in psychobiology have isolated these as two separate dimensions

6. Vocational Dimension

Work adapted to human goals, capacities, and limitations promotes both physical and mental health
Physical work improves physical capacity; goal achievement and self-realization at work enhance self-esteem
Loss of job or mandatory retirement can adversely affect this dimension

7. Other Dimensions

Philosophical, cultural, socio-economic, environmental, educational, nutritional, curative, and preventive dimensions

Positive Health

Positive health implies "perfect functioning" of body and mind:

Biologically: every cell and organ functioning at optimum capacity
Psychologically: individual feels a sense of perfect well-being and mastery over environment
Socially: individual's capacity for participation in the social system is optimal

However, Dubos stated: "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." Positive health will therefore always remain a mirage. Health in this context is a potentiality - the ability to modify oneself continually in the face of changing conditions.

Health as a Relative Concept

Health is not an absolute but a biologically "normal" state based on statistical averages. Health standards vary among cultures, social classes, and age groups. A newborn in India weighs 2.8 kg on average vs. 3.5 kg in developed countries - and yet compares favorably in health. This implies that health in any society should be defined in terms of prevailing ecological conditions.

Well-Being, Standard of Living, and Quality of Life

The WHO definition introduces the concept of "well-being," which has two components:

Component	Term	Description
Objective	Standard/Level of Living	Education, employment, food, housing, sanitation, services
Subjective	Quality of Life	Individual's perception of their own life conditions

Quality of Life (WHO): "The product of the interplay between social, health, economic, and environmental conditions which affect human and social development" - incorporating a person's physical health, psychological state, level of independence, social relationships, and personal beliefs.

Park's Textbook of Preventive and Social Medicine, pp. 17-22

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