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


SOURCED FROM: ... WHO definition of health- health is a state of complete physical, mental and social well being and not mere absence of disease or infirmity. – PowerPoint PPT presentation

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

Health dimensions, determinants, concept of well
being and health indicators
  • 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.

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

  • 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.

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.

  • 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
  • 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.

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

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

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.

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)

  • Level of living includes health, food
    consumption, education, occupation , housing,
    social security , clothing , recreation and human
  • 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

  • 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.

  • 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
  • The index helps to compare quality of life
    between countries , both international and

  • 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.

  • 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.

  • 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.

  • 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

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

  • The indicators for measuring this parameters
    should satisfy the following criteria-
  • Validity- actually measure what it suppose to
  • 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

  • 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

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

  • 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

  • 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.

  • 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.

  • 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.

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

  • Indicators to measure quality of care- health
    care delivery, health care utilization and health
  • 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.

  • 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
  • Proportion of total health resources spent
    towards health care.
  • .

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

  • Health gaps- it is the contrast in health
    scenario between developing and developed
  • 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.

  • 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.

  • 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