Definition of Health and Dimensions of Health (Community/Preventive Medicine Perspective)

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."

Critique of the WHO Definition

• It has been criticized as being too broad and idealistic.
• 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 - it helps people live well, work well and enjoy themselves.
• Despite limitations, it sets out the standard of "positive health" and represents an overall objective towards which nations should strive.

Operational Definition of Health

1. Broad sense: "A condition or quality of the human organism expressing the adequate functioning of the organism in given conditions, genetic or environmental."
2. Narrow sense (for measurement):
   • (a) No obvious evidence of disease, and the person is functioning normally within normal limits of variation for their age, sex, community, and geographic region; and
   • (b) The several organs of the body are functioning adequately in themselves and in relation to one another - a kind of equilibrium or homeostasis.

Evolving Concepts of Health

Modern Philosophy of Health (New Concept)

• Health is a fundamental human right
• Health is the essence of productive life, not the result of ever-increasing medical expenditure
• Health is intersectoral
• Health is an integral part of development
• Health is central to the concept of quality of life
• Health involves individual, state, and international responsibility
• Health and its maintenance is a major social investment
• Health is a worldwide social goal

Dimensions of Health

"Health is multidimensional. The WHO definition envisages three specific dimensions - the physical, the mental and the social. Many more may be cited, viz. spiritual, emotional, vocational and political dimensions."

• Park's Textbook of Preventive and Social Medicine

1. Physical Dimension

• The easiest to understand.
• Implies "perfect functioning" of the body - every cell and organ functioning at optimum capacity and in perfect harmony with the rest of the body.
• Signs of physical health: good complexion, clean skin, bright eyes, lustrous hair, well-clothed body with firm flesh, sweet breath, good appetite, sound sleep, regular bowel/bladder activity, smooth coordinated bodily movements.
• All organs are of unexceptional size and function normally; special senses intact; resting pulse, blood pressure, and exercise tolerance within normal range for age and sex.

2. Mental Dimension

• Mental health is not mere 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 and that of the environment."
• Psychological factors can induce physical illness (e.g., hypertension, peptic ulcer, bronchial asthma).

• Free from internal conflicts
• Well-adjusted; gets along with others, accepts criticism
• Searches for identity
• Strong sense of self-esteem
• Self-aware (self-actualization)
• Good self-control - balances rationality and emotionality
• Faces problems and tries to solve them intelligently (copes with stress and anxiety)

3. Social Dimension

• Social well-being implies harmony and integration within the individual, between individuals and other members of society, 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, and the ability to see oneself as a member of a larger society.
• Rooted in:
  • Positive material environment (financial and residential matters)
  • Positive human environment (social network of the individual)

4. Spiritual Dimension

• Refers to that part of the individual which reaches out and strives for meaning and purpose in life.
• Transcends physiology and psychology - it is the intangible "something."
• Includes: integrity, principles and ethics, purpose in life, commitment to some higher being, and belief in concepts not subject to "state of the art" explanation.

5. Emotional Dimension

• Historically lumped with mental health, but research shows a definite difference.
• Mental health = "knowing" (cognition)
• Emotional health = "feeling"
• Experts in psychobiology have isolated these as two separate dimensions.

6. Vocational Dimension

• A newer dimension - part of human existence.
• When work is adapted to human goals, capacities and limitations, it promotes both physical and mental health.
• Physical work improves physical capacity; goal achievement and self-realization in work enhance self-esteem.
• Its importance becomes clear when individuals lose their jobs or face mandatory retirement.

7. Other Dimensions (suggested)

• Philosophical dimension
• Cultural dimension
• Socio-economic dimension
• Environmental dimension

Summary Table