Health –dimensions, determinants, concept of well being and health indicators

1
Health dimensions, determinants, concept of well
being and health indicators
2

• WHO definition of health- health is a state of
  complete physical, mental and social well being
  and not mere absence of disease or infirmity.
• Positive health- ability of man to lead a
  socially and economically productive life.
• Operational definition- health is a condition or
  quality of human organism expressing the adequate
  functioning of the organism in given conditions,
  genetic or environmental.

3
Dimensions of health.

• There are three major dimensions for health
  physical, mental and social.
• There are various other dimensions- spiritual,
  emotional , vocation, socioeconomic, environment
  and nutrition.
• Positive physical health- this is state in which
  every cell and organ functions at optimum
  capacity and perfect harmony with the rest of the
  body

4

• Signs of positive physical health include good
  complexion, clear skin, bright eyes, lustrous
  hair, firm fleshed body not too fatty , sweet
  breath, good appetite, sound sleep , regular
  activity of bowels and bladder , smooth, easy
  coordinated bodily movements.

5
Determinants of health

• Health is influenced by many factors .
• It is the result of interaction of these factors
  which may be positive or negative.
• A constant harmonious interaction of these
  factors determine health.
• Biological factors- health to certain extent is
  influenced by genetic make up of the individual.
• Positive expression of potentialities of genetic
  heritage is possible only by establishing healthy
  relationship with the environment in which the
  individual live.

6

• Behavioral and social factors-health is closely
  linked with the lifestyle of the individual.
• The concept of lifestyle is gaining prominence
  with the increasing incidence of non communicable
  diseases.
• Ischemic heart disease , obesity and lung cancer
  are related to lifestyle of an individual.
• Lifestyle- is the way people live, it influenced
  by cultural, behavioral patterns , personal
  habits which is related to the knowledge and
  attitude of individual.
• Promotion of healthy lifestyle ( primordial
  prevention) is the key for prevention of a
  multitude of diseases.

7

• Environment factors is an important determinant
  of health.
• Need healthy environment to achieve positive
  health.
• Physical, social, mental well being and
  environment are closely linked.
• There are 2 types of environment- internal and
  external.
• Internal environment involves interaction among
  various organs, tissues and systems of the body.
• microenvironment is a component of external
  environment.

8

• Socioeconomic factors- that influence health
  include literacy, occupational health and
  economic status.(GNP)
• Also the existing political system of the
  country.
• Policy decisions on health, GNP directed towards
  health care, political commitment and effective
  leadership have far reaching positive effect on
  health.

9
Spectrum of health

• Health is not static in an individual, it is a
  dynamic phenomenon subject to process of
  continuous change.
• No single cut off point and state of health needs
  to be reviewed.
• Lowest point is death and highest point is
  positive health.
• Transition from positive health to death is often
  gradual and difficult to point out where one
  state ends and other begins.
• It includes unrecognized sickness at midpoint and
  off shoot to mild, severe sickness and death .
• Another scenario is freedom from sickness, better
  health , positive health.

10
Concept of well being

• Two components- subjective and the objective.
• Objective component is the standard of living
  /level of living
• Subjective is the quality of life.
• Standard of living- WHO define it as income,
  occupation , housing standards , sanitation and
  nutrition, level of provision of health,
  educational , recreational and other services.
• It is expressed in per capita GNP. Nigeria has a
  per capita GNP of 620 US dollars( 2006)

11

• Level of living includes health, food
  consumption, education, occupation , housing,
  social security , clothing , recreation and human
  rights.
• Quality of life- is the subjective component of
  well being.
• It is defined by WHO as the condition of life
  resulting from combination of effects of complete
  range of factors such as those determining
  health, happiness, education, social and
  intellectual attainments , freedom of action,
  justice and freedom of expression

12

• Steps to improve quality of life include
  reduction in mortality and morbidity, provision
  of primary health care and improving physical,
  mental and social well being.
• Provision of primary health care- to all sections
  of the population i.e it must be equally
  distributed, accessible and acceptable to all at
  a cost, country and community can afford.

13

• Physical quality of life index is a health
  indicator for measuring quality of life.
• This indicator combine three indicators- infant
  mortality, life expectancy at age one and
  literacy.
• The index helps to compare quality of life
  between countries , both international and
  national.

14

• For each indicator , the score of individual
  countries is placed on a scale of 0 to 100.
• Zero indicates worst performance, the average
  of the three indicators are taken.
• The index is expressed in a scale ranging from 0
  to 100.
• It differs from standard of living because per
  capita GNP is not included.

15

• It measures the impact of social, economic and
  political policies.
• Attaining an index of 100 is the ultimate goal of
  achieving positive health.
• Present value in developing countries is 30-50
  and in developed countries is 90-98.

16

• Human development index- is composite index
  combining three indicators- life expectancy at
  one year, educational status , purchasing power
  of people ( adjusted real income).
• It is a more comprehensive measure than per
  capita income.
• It provides more comprehensive picture of human
  life than income does.

17

• The values range from 0 to 1
• Low HDI - lt.005 Niger and Ethiopia
• Medium HDI- lt.500-.799- India
• High HDI- gt.800- USA, Canada, Norway

18
Measurement of health health indicators

• Health may be broadly measured as follows-
• Measurement of death ( mortality indicators)
• Measurement of burden of ill health (morbidity
  indicators, disability rates)
• Measurement of social and economic factors
  influencing health.
• Measurement of quality of health care

19

• The indicators for measuring this parameters
  should satisfy the following criteria-
• Validity- actually measure what it suppose to
  measure.
• Reliability- same result when measured by
  different people.
• Sensitivity should reflect any change in the
  various factors affecting health
• Specificity should reflect changes only of a
  particular factor or situation affecting health.
• Feasibility- data should be easily available
• Relevance- should be useful and applicable to
  assess a particular health situation

20

• Mortality indicators include
• Crude death rate
• Life expectancy
• Infant mortality rate- sensitive indicator of
  health status of the community
• Child mortality rate
• Under five mortality rate
• Maternal mortality rate
• Disease specific mortality rate

21

• Life expectancy 46.8 (2006)
• Infant mortality rate-98.6/1000 live births
• Under five mortality rate- 191.4/1000 live births.

22

• Morbidity indicators include
• Incidence- measures rate of occurrence of new
  cases in a population
• Prevalence- measures disease load ( new and old
  cases ) in a population
• Hospital admission/ discharge
• Outpatient attendance in health centres/hospitals
• Mean duration of hospital stay
• Spells of sickness

23

• Disability indicators- measure burden of ill
  health due to handicap, pain, absenteeism
  ,residual paralysis from illness.
• The indicator for measuring disability is
  disability adjusted life years.
• It measures two aspects of morbidity loss of
  life years from premature death i.e difference
  between actual age at death and life expectancy
  at that age in a population of low morbidity.

24

• The other aspect is health life years lost due to
  the disability.
• It is a valid indicator of health
• The relationship between two aspects is such that
  one DALY is One lost year of healthy life.
• DALY loss resulting from death or disability of
  an infant is more when compared to in adults.
• DALY does not consider the multifactorial origin
  of disease , their multiple manifestations and
  the problem of inequity.

25

• The other measure of disability is the health
  adjusted life expectancy.
• This is a new indicator based on WHO
  international classification of impairments,
  disabilities and handicaps.
• It is the number of years a newborn expected to
  live in full health based on current rates of ill
  health and mortality.

26

• Indicators to measure social and economic
  factors-
• Family size, housing, per capita calorie
  availability, level of unemployment, dependency
  ratio.
• Per capita GNP, rate of population increase.
• Social and mental health- suicide, juvenile
  delinquency, increase in crime rate are indirect
  measures

27

• Indicators to measure quality of care- health
  care delivery, health care utilization and health
  policy.
• Health care delivery indicators- doctor
  population ratio, doctor-nurse ratio,
  population-bed ratio, population- PHC,
  population- skilled birth attendant.
• Health care utilization-assessed by population
  actually availing existing health care services.

28

• Common indicators used are proportion of infants
  immunized against VPDs, proportion of women
  receiving ANC, family planning acceptance
• Health care policy indicators- proportion of GNP
  spent on health care, proportion of GNP spent on
  health related activities like water supply and
  sanitation.
• Proportion of total health resources spent
  towards health care.
• .

29

• Environmental indicators- percentage of
  households with safe water and percentage of
  households wih adequate sanitary facilities
• Nutritional status indicators- height, weight and
  MUAC.
• Prevalence of low birth weight.

30

• Health gaps- it is the contrast in health
  scenario between developing and developed
  countries.
• Developed countries have a longer life
  expectancy, lower infant and child mortality
  rates when compared with developing countries.
• Health care advocates promotive and preventive
  activities as well as treatment and oriented to
  needs of entire population.

31

• Health care involves appropriate technology and
  broad range of health personnel including
  doctors, nurses, community health workers.
• Characteristics of health care- an ideal health
  system relevant to the local needs of the
  population, comprehensive ( preventive, promotive
  and curative), adequate, accessible and
  affordable to all sections of the community.

32

• For efficient delivery of health care ,
  coordinated effort among workers both medical and
  non medical is needed
• The members of the team are physicians, nurses,
  social workers, community health workers etc.
• The leader of the team being the doctor evaluates
  the work of the team and is the decision maker
  and planner.
• The goal of the team while carrying out their
  assigned responsibilities is towards achieving
  health for all