Concepts in Nursing

UNIT 2 CONCEPTS OF HEALTH AND

DISEASES
Structure
2.0 Objectives
2.1 Introduction
2.2 Definition of Health and Ill Health
2.3 Changing Concepts of Health
2.3.1 Biomedical Concept
2.3.2 Ecological Concept
2.3.3 Psychosocial Concept
2.3.4 Holistic Concept .
2.4 Models of Health and Illness
2.4.1 Health-Illness Continuum Model
2.4.2 High Level Wellness Model
2.4.3 Health Belief Model
2.4.4 Agent-Host Environment Model
2.4.5 Paradigm of Health Model
2.5 Dimensions of Health
2.5.1 Physical Dimension
2.5.2 Mental Dimension
2.5.3 Social Dimension
2.5.4 Spiritual Dimension
2.5.5 Emotional Dimension
2.5.6 Vocational Dimension
2.5.7 Other Dimensions
2.6 Factors Influencing Health/Determinants of Health
2.6.1 Heredity/Human Biology
2.6.2 Environment
2.6.3 Life Style
2.6.4 Resources
2.6.5 Other Factors
2.7 Health Indicators
2.7.1 Mortality Indicators
2.7.2 Morbidity Indicators
2.7.3 Disability Rates
2.7.4 Nutritional Status Indicators
2.7.5 Health Care Delivery Indicators
2.7.6 Utilisation Health Indicators
2.7.7 Indicators of Social and Moral Health
56
 2.7.8 Environmental Factors Concepts of Health and
Diseases
2.7.9 Socio-economic Indicators
2.7.10 Health Policy Indicators
2.7.11 Indicators of Quality of life
2.7.12 Others Indicator Series
2.8 Health Promotion Practices
2.8.1 Promotion of Healthful Living
2.8.2 Factors Affecting, One’s Level of Wellness
2.9 Epidemiological Aspects of Disease
2.9.1 Epidemiological Models of Causation of Disease
2.9.2 Natural History of Disease
2.9.3 Levels of Prevention of Disease
2.9.4 Risk Factors
2.10 Let Us Sum Up
2.11 Activities
2.12 Answers to Check Your Progress
2.13 Further Readings

2.0 OBJECTIVES
After completing this unit, you should be able to:
 define health and ill health;
 describe the various concepts of health;
 explain the models of health and illness;
 describe the various dimensions of health;
 enumerate the various factors influencing health;
 explain the health indicators; and
 list health promoting behaviours.

2.1 INTRODUCTION
In the previous unit, you have learnt about nursing as a profession and the trends in
nursing practice and education. You are familiar with the definition of nursing as “the
unique function of the nurse is to assist the individual sick or well, in the performance of
those activities contributing to health or its recovery (or to peaceful death) that he
would perform unaided if he had the necessary strength, will or knowledge (Hendresan,
1966)”. Further nursing involves those activities that assist an individual to gain
independence as rapidly as possible. In this unit you will learn about health and illness,
concepts of health, various models of health, the dimensions and factors influencing
health, indicators of health and health promotion practices.
57
Concepts in Nursing
2.2 DEFINITION OF HEALTH AND ILL HEALTH
Let us begin with definition of health
Health
We understand the meaning of health but still we find difficult to define it. Different
people have different perceptions of health. Some feel that when an individual is free
from any sickness or disease he is healthy; other feel that an individual is said to be
healthy if s/he is able to perform activities of daily living normally. Still others feel that an
individual is healthy if s/he is well adjusted in social life and can function effectively even
in stressful situation. What exactly is meant by health? You will be able to understand
better if you go through the following definitions.
Health is defined as:
a) A series of successful and continuous adaptation to a continuously changing environment.
b) The conditions of being sound in body, mind or spirit and especially free from
physical disease or pain (Webster).
c) Soundness of body or mind; that condition in which their functions are duly and
efficiently discharged (Oxford English Dictionary).
d) “A state of relative equilibrium of body, form and function which result from its
successful dynamic adjustment to forces tending to disturb it. It is not passive
interplay between body substance and forces impinging upon it but an active
response of body forces working towards readjustment.” (Perkin)
e) Health is a relative concept; this may be due to ecological conditions and the fact
that standards of health vary among cultures; social classes and age groups.
This implies that health is not an ideal state and there are no international standards
fixed for health. We cannot say that individuals of the same age, belonging to
different countries and cultures will have the same health standard. There may be
variations in weight and height of an individual belonging to different countries and
socio-economic groups but both are healthy. We can further clarify this concept
by the following example:
The above mentioned definitions give varied views of health. We shall now try to
look into the most widely accepted definition of health given by World Health
Organization (WHO) which states:
Health is a state of complete physical, mental, social and spiritual
well-being and not merely an absence of disease or infirmity.

If you look at the definitions carefully, you will realize that four aspects or dimensions
emerge from it. These are: (a) Physical (b) Mental (c) Social and Spiritual.
Physical well-being means having the physical strength, endurance and energy to work
towards your goals. Mental well-being is ability to cope with the world in a way that
brings you satisfaction; social well-being means development of relationships with others
- both with people in your immediate surroundings and with the larger community
through cultural, spiritual and political activities.
This also implies that goal of health now calls for not only the cure or alleviation of
disease. It calls for even more than prevention of disease. Rather it looks beyond to
strive for maximum physical, mental, social and spiritual efficiency for the individual,
58 for his family, and for the community.
 Concepts of Health and
Check Your Progress 1 Diseases

Health is defined by the World Health Organization as: ...........................................

............................................................................................................................
............................................................................................................................
............................................................................................................................

A new born baby in India weighs 2.8 kg on an average compared to

3.5 kg in the developed countries and yet compares favourably in
health.

Traditionally, the majority of health care was focused on treatment of acute and chronic
conditions at the illness end of the continuum. Gradually the emphasis shifted to include
attention to the wellness end of the continuum .
f) Health a State of Being: -
Health refers to a state of being, which describes a person as energetic, outgoing,
enthusiastic, beautiful, caring, loving and intense. Together, these qualities become
the essence of a person’s existence, they describe a state. of being. So also,
health, as a set of qualities involves the total person i.e. Physical, Psychological,
spiritual and sociocultural influences ones present condition. Thus. an individual’s
placement on the wellness illness continuum can only be known, if we consider
that person from a holistic perspective.
g) Subjective and Objective Dimension of Health
Health involves subjective and objective dimensions. Subjective (i.e. feeling well
or ill) and objective (function) dimensions together provide us with a clear picture
of peoples health. Let. us see these dimensions in detail. Subjectively, a healthy
person is one who feels well, who experiences the sensation of vital, positive
state. Healthy people are full of life and vigor, capable of physical and mental
productivity. They feel minimal discomfort and displeasure with the world around
them, even this state of feeling well fluctuates. Some mornings we wake up
feeling more energetic and enthusiastic than other mornings. How a person feels
varies day by day, even hour by hour, nevertheless it can be a strong indicator of
that person’s health state.
A workable definition of health is required if we are to provide services which effectively
meet health needs of individuals, family and community. From the definition given above
you are aware of ways of defining health.
Since the WHO definition of health has been widely criticized for its lack of specificity,
the WHO later produced a more specific definition stating that health is a condition or
quality of the human organism which enables adequate functioning under given hereditary
and environmental conditions.

Thus health can be defined as a series of successful and continuous

adaptations to a constantly changing environment; appears to be a
more realistic definition of health and more complete since health
is a dynamic rather than a static state.
59
Concepts in Nursing Ill Health
Ill health has been defined by Radford as the state in which a person is unable to adopt
to the stresses of everyday living because of either lack of ease or signs of disease.

2.3 CHANGING CONCEPTS OF HEALTH

In many countries health has become a major social and political issue. Health is a
common theme in most countries. The most earlier concept of health was “absence of
disease.”
In some cultures, health and harmony are considered equivalent, harmony being defined
as “being at peace with the self, community, God and Cosmos.” The ancient Indians
and Greeks shared this concept and attributed disease to disturbances in bodily
equilibrium of what they called “humors”.
The word “health” ‘as it is commonly used today did not appear in writing until about
1000 A.D. Being healthy was considered the norm, sick people were ostracized. The
idea of mental health as we know today, did not exist until the latter part of I 8-19th
century. People who acted strangely were also ostracized.
With the birth of scientific era in the 19th century, more and more discoveries led to a
better understanding of human physiology and the origin of disease. At the same time,
society to treat illness with less disgust. The notion that health and illness were two
ends of a continuum existed for many years. In fact, it may still be used today. A
seemingly healthy person may have an early form of a disease that does not yet have
clinical manifestations. For example, young people in our society have heart disease,
such as arteriosclerosis’. They may be only 20 yrs old, and no evidences of disease is
present. Although they appear healthy, without proper diet and exercise, heart disease
will continue to develop until clinical manifestations appear.
An understanding is the basis of all health care. In a world of continuous change, new
concepts are bound to emerge based on new patterns of thought, The changing concept
of health are mainly of four types:

2.3.1 Biomedical Concept

Traditionally health has been viewed as “absence of disease” if one person is free from
disease, s/he is considered as healthy. This concept is known as “Biomedical Concept”,
and has basis in germ theory of disease. The medical profession viewed the human
body as machine, disease as a consequence of the break down of the machine and one
of the Doctor’s task as repair of machine. Thus health in a narrow view, became
ultimate goal of medicine.
The limitation of this concept is that, it has minimised the role of environmental, social,
psychological and cultural determinants of health.

2.3.2 Ecological Concept

The ecologist put forward another hypothesis which viewed health as a dynamic
equilibrium between man and his environment, and disease as a maladjustment of the
human organisms to the environment. Ecological and cultural adaptations determine
not only the occurrence of disease but also the availability of food and the population
60 explosion. History argues that improvement in human adaptation to natural environment
can lead to longer life expectancies and a better quality of life. The concept supports Concepts of Health and
Diseases
the need for clean air, safe water, ozonic layer in the atmosphere, etc. to protect us
from exposure to unhealthy factors.

2.3.3 Psychosocial Concept

Contemporary developments in social sciences revealed that health is not only a
biomedical phenomenon, but one which is in the need by social psychological, cultural,
economic and political factors of the people concerned. Health is both a biological and
social phenomenon.

2.3.4 Holistic Concept

Holistic model is a synthesis of biomedical & ecological model & psychosocial concept.
It recognizes the strength of social, economic, political and environmental influence on
health. It has been defined as unified or multidimensional process involving the well
being of the whole person in the context of his environment. Holistic concept implies
that, all sectors of society have an effect on health, in particular, agriculture, animal
husbandry, food, industry, education, housing, public works, communications and health
sectors the emphasis is on promotion and protection of health.
Check Your Progress 2
1) List the four concepts of health.
a) .............................................................................................................
b) .............................................................................................................
c) .............................................................................................................
d) .............................................................................................................
Fill in the blanks:
a) Health of an individual means back and forth along a...............................
................ through out life.
b) Holistic model of health is a synthesis of..................................................
and ..................................................concepts.

2.4 MODELS OF HEALTH AND ILLNESS

A model is a theoretical way of understanding a concept or idea. Because health
and illness are complex concepts, models are used to understand the relationships
between these concepts and the client’s attitudes towards health and health
practices.
Health beliefs are a person’s ideas, convictions and attitudes about health and illness.
They may be based on factual information or misinformation, common sense or
myths or reality or false expectations. Because health behaviours usually result from
health beliefs, they can positively or negatively affect health. Positive health behaviours
are activities related to maintaining, attaining or regaining good health and preventing
illness such as proper sleep patterns and adequate exercise, diet and. nutrition.
Negatively health behaviours include practices actually OR potentially harmful to 61
Concepts in Nursing health such as smoking, drug or alcohol abuse, poor diet and refusal to take necessary
medications.
The following health models can help to understand clients health behaviours and beliefs
so they can provide effective health care.

2.4.1 Health-illness Continuum Model

Health always involves a continuum, a range of degrees from optimal health at one end
to death or total disability at the other. The health of an individual moves back and forth
along this continuum throughout life.

Fig. 2.1: Wellness-illness Continuum

According to health-illness continuum model health is a dynamic state that fluctuates as

a person adapts to changes in the internal and external environments, to maintain a
state of total well being. Internal environment refers to physiological system, body
temperature, blood preserve, etc. and external refers to atmospheric temperature,
humidity, dust, etc.
High level wellness and severe illness are at opposite ends of the continuum. According
to Neuman (1990), “health on a continuum is the degree of client’s wellness that exists
at any point in time, ranging from an optimal wellness condition, with available energy
at its maximum to death, which represents total energy depletion.” A nurse can determine
a clients level of health at any point on the health-illness continuum. Risk factors are
important in identifying level of health. They include genetic and physiological variables
such as age, life-style and environment. For example an adolescent is more likely than
an adult to experience stressors, related to body image and self-concept and an older
adult is more likely than a child to develop cardiac illness. The nurse helps clients
identify their positions on the health illness continuum to set goals for optimal health
(Meleis, 1990). This model is most effective when used to compare a clients present
level of health with previous levels of health.

2.4.2 High Level Wellness Model

The high-level wellness model developed by Halpert Dunn (1977) focuses on maximizing
the health potential of an individual, family or community. It requires the individual to
maintain a continuum of balance and purposeful direction within the environment.
Halpert Dunn defined ‘high-level wellness’ as “an integrated method of functioning
which is oriented towards maximizing the potential of which an individual is capable
62 within the environment where he is functioning”. Dunn stressed that wellness is an
ongoing process, directed towards higher potential, not a static goal, and that high- Concepts of Health and
Diseases
level wellness is a feeling of being “alive to the tips of the fingers with energy to burn,
tingling with vitality. He conceptualized wellness model as given in Fig. 2.2.

Fig. 2.2 : Wellness Model (Medical)

The model above represented on the left side of the figure bring the client back
from illness or disease to a neutral point. The right side represents the potential
for high level health and wellness. The objective of this model is to demonstrate
how people can move from the point of illness or neutrality into the realm of
high-level wellness and to reduce the occurrence or recurrence of illness and
disease.

Fig. 2.3 : High Level Wellness Model

Health care directed at helping a client achieve high level wellness emphasizes health
promotion and illness prevention rather than treatment. High level wellness is a dynamic
process not a passive, static state. No one ever reaches the point of perfect health, but
there is constant attempt to achieve at optimal level of health as possible. Health is a
dynamic process-that varies as interactions between the individuals and their
environment changes.

2.4.3 Health Belief Model

Rosenstoch’s (1974) and Becker and Mauman’s (1975) Health belief model addresses
the relationship between a person’s belief and behaviour. It is a way of understanding
and predicting how client’s will behave in relation to their health and how they will
comply with health care therapies. Use of this model is based on a person’s perception
of the susceptibility to an illness, the seriousness of the illness, and the benefits of taking
action to prevent the illness. For example, this model helps nurse’s to understand factors
influencing client’s perceptions, beliefs and behaviour and to plan the most effective
care. 63
Concepts in Nursing

Fig. 2.4 : Health belief model

The first component of this model describes the client’s needs to recognize the familial
or hereditary basic of Diabetes mellitus. If the father and an elder brother are diabetic
the client. has a personal risk of becoming diabetic and also the seriousness of the
disease. Here the Modifying factor could be his age, sex, stress, coping and life style,
influencing the perennial threat of illness. The causes to action, i.e. his knowledge/
awareness through mass media, advice from doctors and relatives or friends may also
influence his perennial threat, which is further affected by the previous action. The state
of perennial threat may result in person’s likelihood of falling action.

2.4.4 Agent-Host Environment Model

Deficiencies in the biomedical concept gave rise to other concepts. The ecologists put
forward an hypothesis which viewed health as a dynamic equilibrium between man
and his environment, and disease as a maladjustment to environment.
The agent, host, environment model describes the cause of illness in other health areas,
It states that the level of health or illness of an individual or group depends on the
dynamic relationship of the agent, any internal or external factors that can lead to
illness, the group who may be susceptible to the illness, and the environmental factors
that may increase the risk of the Illness. When the agent, host and environment factors
are in balance health is maintained. When these are out of balance, disease occurs and
thus health is an ever changing state.

64 Fig. 2.5 (a) : Ecological model of health equilibrium

 Concepts of Health and
Diseases

Fig. 2.5 (b) : The agent-host-environment triangle

Agents
Agents can be Biological, Chemical, Physical, or Psychosocial.
Host Factors
Host factors are physical or psychosocial situations or conditions putting people at risk
for illness,
Environment
This includes external factors that make illness more or less likely to occur for example
environmental sanitations, generic cleanliness etc. In the absence of any measures all
diseases (specially infections, follow a natural cause of events which is referred as
‘Natural History of Disease’. It starts with the interaction of agent, host and
environment.

2.4.5 Paradigm of Health Model

The epidemiologists have stated that health is influenced by a variety of factors such as
human biology, environment, life styles and health and health related sources as shown
in this Fig. 2.6.

Fig. 2.6 : Health paradigm

These four factors are related to each other and also interact with each other in causation
of health and illness. These four factors must be in balance for people to remain
healthy. 65
Concepts in Nursing As health cannot be seen in isolation as a separate entity and we know that health is
influenced by a large number of factors, hence a coordinated and integrated approach
is required so as to render comprehensive services. Health development requires and
influences the joint efforts of Water supply, Sanitary Public works, Agriculture, Industry,
Housing, Education, Recreation and Human resources for the optimal level of wellness.
The shift in health concepts from superstitions to germ theory and later to multifactorial
causation resulted in health promotion programs at the community levels such as MCH
Family Welfare, School Health Program, Occupational Health Services, Integrated
Child Health Development Services and so on.
With focus on ‘Primary Health Care’ approach much emphasis was laid on Community
Participation to obtain self-reliance by placing health in people’s hands, empowerment
of women, matters of health became the concern of all, right from the planners to the
consumers of health services.

2.5 DIMENSIONS OF HEALTH

There are mainly three1dirnensions of health. They are the physical, the mental and
social. In addition to this there are many more dimensions like spiritual, emotional,
vocational and political dimensions. Since human being has all the aspects, all the
dimensions of health are interrelated and interdependent, and has its own nature.

Fig. 2.7 : Dimensions of Health

The state of positive health implies the notion of perfect functioning of the body and
mind. It conceptualizes health.
i) Biologically as a state in which every cell and every organ is functioning at optimum
capacity and in perfect harmony with the rest of the body.
ii) Psychologically as a state in which the individual feels a sense of perfect well being
and of mastery over his environment.
iii) Socially as a state in which the individual’s capacities for participation in the social
system are optimal.
Positive health will remain mirage, because everything in life is subject to change. Positive
health depends not only on medical action, but on all the other economic, cultural and
66 social factors operating in the community.
2.5.1 Physical Dimension Concepts of Health and
Diseases
The physical dimension of health implies perfect functioning of the body. Biologically it
is a state in which every cell and every organ is functioning at optimum capacity and in
harmony with the rest of the body.
Signs of Physical Health
Signs of physical health are: good complexion, clean skin, bright eyes, lustrous hair
with a body well clothed, with firm flesh, not too fat, a sweet breath, a good appetite,
sound sleep, regular activity of bowels and bladder and smooth and easy co-ordinated
bodily movements. All organs of the body are unexceptional size and function normally,
all the special senses are intact, a resting pulse rate, blood pressure and exercise
tolerance are all within the range of normality for individuals age and sex. In the young
and growing, there should be a steady weight gain.
Evaluation of Physical Health
Various tools and techniques are used in various combinations for assessment of physical
health. They include self-assessment, clinical examination, assessment of risk factors,
listing of ill health and medication, nutrition and dietary assessment, etc.
At the community level various indices and health rate such as MMR, morbidity pattern,
IMR and expectation of life can be used for assessment of health of the community.

2.5.2 Mental Dimension

Good mental health is the ability to respond to many varied experiences of life with flexibility
and a sense of purpose. Mental health is defined as state of balance between individual and
the surrounding world, a state of harmony between oneself and others, a coexistence between
the realities of self and that of other people, and that of the environment.
Characteristics of a Mentally Healthy Person
There are certain characteristics of a mentally healthy person:
a) Mentally healthy person is free from internal conflicts.
b) S/He is well adjusted.
c) S/He searches for identity.
d) S/He has strong sense of self esteem.
e) S/He knows himself, needs, problems and goals.
f) S/He has good self control.
g) S/He faces problems and solves them intelligently.
Assessment of mental health can be done by mental status examination and various
other standardized tests such as adjustment scale, self esteem/self concept, tasks on
problem solving ability, intelligent and personality test.

2.5.3 Social Dimension

Social well being implies harmony and integration within the individual, between each
individual and other members of the society and between individuals and the world in
which they live. 67
Concepts in Nursing Social health is defined as the quantity and quality of an individuals interpersonal ties
and the extent of involvement with the community.
Social Dimensions include the levels of social skills one possesses, social functioning
and the ability to see oneself as a member of the larger society. Social dimension takes
into account an individual as a part of family and wider community and focuses on well
being of whole person including social and economic conditions. Social health is rooted
in a positive material environment and positive human environment which is concerned
with social network of the individual.

2.5.4 Spiritual Dimension

Spiritual health refers to that part of the individual which reaches out and strives for
meaning and purpose in life. This transcends psychology and physiology Spiritual health
includes integrity, principles and ethics, the purpose of life, commitment to some higher
being and belief in concepts that are not subject to state of art explanation.

2.5.5 Emotional Dimension

Emotional dimension is related to feelings of an individual. Even though closely associated
with mental health, it is a separate entity from cognition.

2.5.6 Vocational Dimension

Vocational dimension is a new dimension and is a part of human existence. Physical
work is associated with improvement in physical capacity and goal achievement and
self-realization are source of satisfaction and enhanced self- esteem. Capacities and
limitations of work plays an important role in promoting both physical and mental
health. Vocational dimension represents the culmination of the efforts of other
dimensions as they function together to produce life success or may be merely a
source of income.

2.5.7 Other Dimensions

There are many non-medical dimensions of health. These dimensions symbolize a huge
range of factors to which other sectors besides health must [Link] all people are
indeed to attain a level of health that will permit them to lead a socially and economically
productive life. The main other dimensions are:
1) Philosophical dimensions
2) Cultural dimensions
3) Socio-economic dimensions
4) Environmental dimensions
5) Educational dimensions
6) Nutritional dimensions
7) Curative dimensions
8) Preventive dimensions.
Therefore the concept of health cannot become a reality because man can never
be so perfectly adapted to his environment. Health is the ability of an individual or
68
social group to modify himself or itself continually, in the face of changing conditions Concepts of Health and
Diseases
of life.

Check Your Progress 3

1) List any three health illness models.

a) .............................................................................................................

b) .............................................................................................................

c) .............................................................................................................

2) Draw a diagram of health-illness continuum, indicating various states of health

or illness.

3) What are the basic concepts of Rosenstocla’s Health Belief Model.

a) .............................................................................................................

b) .............................................................................................................

c) .............................................................................................................

4) List three major dimensions of health.

a) .............................................................................................................

b) .............................................................................................................

c) .............................................................................................................

5) List any four characteristics of a mentally healthy person.

a) .............................................................................................................

b) .............................................................................................................

c) .............................................................................................................

d) .............................................................................................................

e) .............................................................................................................

2.6 FACTORS INFLUENCING HEALTH/

DETERMINANTS OF HEALTH
Health has multiple dimensions as we have just seen and therefore health is
multifactoral, The factors which influence health are both within the individual and
externally in the society in which he or she lives. The factors influencing health can be
broadly classified into genetic factors and environmental factors to which he is
exposed. Interactions of these factors may be having deleterious effects or may be
health promotive.
Health of individual and communities are due to many interactions. The important
determinants are: 69
Concepts in Nursing

Fig. 2.8 : Determinants of Health

2.6.1 Heredity/Human Biology

Health i.e., physical and mental health is determined to a large extent by genetic make
up. There are a number of diseases of genetic origin. The state of health, therefore
depends partly on the genetic constitution of man.
From the genetic standpoint health can be defined as that state of individual which is
based upon the absence from the genetic constitution of such genes as corresponds to
characters that takes the form of serious defects and derangement and to the absence
of any aberration in respect to the total amount of chromosome material in the karyotype
as states in positive terms from the presence in the constitution of the genes that
correspond to the normal characterization and to the presence of normal karyotype. A
person should be able to express as completely as possible the potentialities of his
genetic heritage Gender: In the last decades it is found that women consistently record
higher rates of chronic and acute sickness and has a higher mortality rate. The psychiatric
admissions due to depression, deliberate self-harm, suicidal attempts etc. are also
higher in women. Life circumstances influencing mental health of women, poverty,
employment status, marital status or motherhood probably combines to create an
atmosphere of stress.

2.6.2 Environment
Environment has a close relation with the health of an individual. Environment can be
external or internal. The internal environment is pertaining to each and every component
part, every tissue, organ and organ system and their harmonious functioning within the
system. External environment consists of those things which man is exposed after
conception. It is all that which is external to the individual human host.
It can be divided into:
a) Physical
b) Biological

70 c) Psychological
The internal environment constitutes personal environment i.e., individuals way of living Concepts of Health and
Diseases
and life style. The environment has a direct impact on the physical, mental and social
well being of those living in it. In the environment favourable to the individual, he can
make full use of his physical and mental capabilities.

2.6.3 Life Style

Life style denotes the way people live, reflecting a whole range of social values, attitudes
and activities. Lifestyles are learnt through social interaction with parents, peer, groups,
friends and siblings and through school and mass media. Life style is composed of
cultural and behavioural patterns and life long personal habits, that have developed
through processes of socialization.
Many of the health problems are associated with life style changes. Risk for illness and
death are related with life styles such as lack of sanitation, poor nutrition, personal
hygiene, elementary human habits, customs and cultural patterns. Certain life styles like
adequate nutrition, enough sleep, sufficient physical activity to promote health.
Achievement of optimum health demands adoption of healthy styles.

2.6.4 Resources
The resources which help in maintaining and determining health of an individual are
explained below.
Socio Economic Conditions
Socio economic conditions influence human health. Health status is primarily
determined by the level of socio-economic development like per capita income,
political system, economy etc. The important socio-economic factors that are of
major importance are:
Economic Status: The per capita income is accepted measure of socio-economic
performance. The socio-economic development has a major role in reducing morbidity,
increasing life expectancy and improving quality of life. Socio-economic status
determines the purchasing power, quality of life, standard of life, family size and pattern
of disease and deviant behaviour in the community.
Education: Education is an important factor affecting health. Lack of education closely
coincides with ill health, high IMR, malnutrition etc. Education compensates the effects
of poverty on health irrespective of availability of health facilities.
Occupation: Occupation promotes health and unemployment shows higher incidence
of ill health and death. Loss of work means loss of income and status resulting in
psychological and social damage.
Political System: Health is related to country’s political system as it can affect the
implementation of health technologies. Political system shapes the community health
services or decisions concerning resource allocation, manpower policy, choice of
technology and the degree to which health services are made available and accessible
to different segments of society. For example, adoption of policies related to gender
equalities is a political issue.
Political commitment and leadership should be oriented towards social development,
not merely economic development. If health patterns are to be changed, changes must
be made in the entire socio-political system. The social, economic and political action
are required to eliminate health hazards in working and living environments. 71
Concepts in Nursing Health Services
Health services are directed towards treatment of diseases, prevention of illness and
promotion of health. Purpose of health services is to improve the health status of the
population and make health services available to all sectors of the population.
Health services are essential for social and economic development. To be effective,
the health services must reach the social periphery that the community can afford and
be socially acceptable. Health services is termed as primary health care, for example,
immunization to reduce the incidence/prevalence of particular diseases, care of pregnant
women and children to reduce the maternal and child mortality and morbidity etc.
Health services how technically elegant or cost effective are ultimately pertinent if they
improve health.

2.6.5 Other Factors

There are other factors such as culture, language, dietary pattern, hygienic status, health
habits and stress that contribute to the determination of health of a community.
i) Language: Difference in language may create barriers to communication where
verbal communication is difficult, non-verbal communication becomes an important
aspect of interaction.
ii) Diet: Many cultures, religious beliefs put limitations on diet and food preparation
and prohibition of some foods. In some cultures there is requirement to fast at
certain times which can have an effect on health.
iii) Hygiene: Healthy hygiene practices such as daily bath, washing of hands after
defecation, using right hand for eating food and left for washing, aids for maintenance
of positive health.
iv) Habits:
a) Smoking: Smoking causes death and considerable impairment to quality of
life for those suffering from smoking related diseases. Cost of smoking is very
high and harmful. Effects of smoking extend beyond individual himself and
dangers of ‘side stream’ or passive smoking are being increasingly identified.
There are higher incidences of lung cancers, LBW babies, miscarriages,
pregnancy complications, respiratory tract infections etc.
b) Alcohol: Drinking too much or even drinking a small amount at the wrong
time can lead to tragedy and ill health. Alcohol leads to impairment of physical,
psychological and social functioning.
v) Stress: Stress is a very important factor which affects health directly and indirectly.
Stress leads to cardiovascular problems, diabetes, skin problems etc. Due to
stress people change life-style habits like indulging in to alcohol consunption,
smoking etc. Several sleep disordes are also a reselt of stress.
Certain other factors include employment opportunities, increased wages, prepaid
medical programmes and family support systems.

2.7 HEALTH INDICATORS

“A wise man ought to realize that his health is his most valuable possession.”
72 (Hippocrates 460-377 BC)
Here arises the question “How health is measured? For measuring the health status of Concepts of Health and
Diseases
a community, certain indicators are used. These indicators help to measure the extend
to which the objectives and targets of a programme are being attained.
Characteristics of Indicators
Ideal indicators have the following characteristics.
1) Ideal indicators should be valid i.e.
They should actually measure what they are supposed to measure.
2) Should be reliable and objective:
The answers should be the same if measured by different people in similar
circumstances.
3) Should be sensitive. .
They should be sensitive to changes in the situation concerned.
4) Should be specific.
They should reflect changes only in the situation concerned.
Classification of Indicators
Health is multi-dimensional and each dimension is influenced by numerous factors.
Hence health cannot be measured by a single indicator. This clearly indicates that
many factors - indicators - are required to describe health. These indicators are classified
as follows:

Fig. 2.9 : Indicators of Health

2.7.1 Mortality Indicators

1) Crude Death Rate
It is the number of deaths per 1000 population per year in a given community. It
indicates the rate at which people are dying. Although it is not a perfect measure of
health status as it is influenced by the age-sex composition of the population, a decrease
in death rate provides a good tool for assessing the overall health improvement in a
population.
73
Concepts in Nursing 2) Expectation of Life
Life expectancy at birth is “the average number of years that will be lived by those born
alive into a population if the current age-specific mortality rates persists”. Life expectancy
at birth is highly influenced by the infant mortality rate where that is high. An increase in
the expectation of life is regarded as an improvement in health status.
3) Infant Mortality Rate
It is one of the most universally accepted indicators of health status not only of infants,
but also of whole population and of the socio-economic conditions under which they
live. It is a sensitive indicator of the availability, utilisation and effectiveness of perinatal
health care.
It is basically the number of deaths under one year of age in a given year to the total
number of live births in the same year; usually expressed as a rate per 1000 live births.
4) Child Mortality Rate
It is defined as the number of deaths at ages 1-4 years in a given year per 1000
children in that age group at the mid-point of the year concerned. Apart from its
correlation with inadequate MCH services it is related to insufficient nutrition, low
coverage by Immunization IMR may be more than 10 times higher than, the developed
countries, the mortality rate may be as much as 250 times higher. This indicates the
magnitude of the gap and the room for improvement.
5) Under 5 Proportionate Mortality Rate
It is the proportion of total deaths occurring in the under-5 age group. This rate can be
used to reflect both infant and child mortality rates. It communicates with poor hygiene
the proportion may exceed 60 percent. This rate reflects high birth rates, high child
mortality rates and shorter life expectancy.
6) Maternal Mortality Rate
Maternal mortality rate accounts for the greatest proportions of deaths among women
of reproductive age in most of the developing world, although its importance is not
always evident from official statistics.
7) Disease Specific Mortality
Mortality rates can be computed for specific diseases. As countries begin to extricate
themselves from the burden of communicable disease, a number of other indicator’s
such as deaths from cancer, cardio-vascular disease, accidents, diabets etc. has merged
as specific disease problem.
The simplest measure of estimating the burden of a disease in the community is
proportional mortality rate, i.e. the prop0I”!ion of all deaths currently attributed to it.
For example, coronary heart disease is the cause of 25 to 30 per cent of all deaths in
most western countries. The proportional mortality rate from communicable diseases
has been suggested as a useful health status indicator, it indicates the magnitude of
preventable mortality.
2.7.2 Morbidity Indicators
The traditional mortality indicators are not completely enough to represent the health
74 status of community, as they do not reveal the burden of any type of ill-health in the
community. Therefore morbidity indicators are used to supplement mortality data to Concepts of Health and
Diseases
describe the health status of the population.
Morbidity Rates Used for Health Assessment
The following morbidity rates are used for assessing ill health of the community.

Fig. 2.10 : Morbidity Rates

In the recent years, despite the massive health expenditures, disability rates are
increasing. Disability rates are based on the notion that health implies a full range of
daily activities.
Classification of Disability Rates
Commonly used disability rates are grouped into two types :
a) Event type indicators, such as Number of days of restricted activity, Bed disability
days and Work-loss days.
b) Person type indicators, such as limitation of daily activity (ADL) and limitation
of mobility.
Confined to bed
Limitation of mobility Confined to house
Varies from Special aid in getting around the house

2.7.4 Nurtitional Status Indicators

Nutritional status is a positive indicator. Three nutritional status indicators are important
as indicators of health status. These are given in Fig. 2.11 Anthropometry measures
include height, weight, head and chest circumferences, mid arm circumferences.

Fig. 2.11 : Nutritional Status Indicators 75

Concepts in Nursing 2.7.5 Health Care Delivery Indicators
The frequently used indicators of health-care delivery are:
Population – bed ratio
1) Doctor — population ratio
2) Doctor — nurse ratio
3) Population — bed ratio
4) Population per health centre/sub centre
5) Population per traditional birth attendant.
These indicators reflect the equity of distribution of health resources in different parts
of the country, and of the provision of health care.

2.7.6 Utilisation of Health Indicators

Health care utilisation is affected by factors such as availability and accessibility of
health services and the attitude of an individual towards his health and health care
system.
For example
1) Proportion of pregnant women who receive antenatal care.
2) Percentage of population using various methods of family planning.
These indicators direct attention away from the biological aspects of disease in a
population towards the discharge of social responsibility for the organization in delivery
of health care services.

2.7.7 Indicators of Social and Moral Health

It is not an easy task to measure the social and mental health with some direct indicators.
Hence few indirect indicators are used to measure the social and mental pathology in
the area (Fig 2.12).

76 Fig. 2.12 : Indicators of Social and Mental Pathology

2.7.8 Environmental Factors Concepts of Health and
Diseases
Environmental indicators reflect the quality of physical and biological environment in
which diseases occur and in which the people live. They include indicators relating to
pollution of air and water, radiation, solid wastes, noise, exposure to toxic substance in
food / drink. Among these the most useful ones are the measuring the proportion of
population having access to safe water and sanitation facilities.

2.7.9 Socio-economic Indicators

These indicators play a significant role in the interpretation of the indicators of health
care.
They are:
1) Rate of population increase.
2) Per capita GNP (Gross National Production)
3) Level of unemployment
4) Dependency ratio
5) Literacy rates (especially female literacy rates)
6) Family size
7) Housing - No. of persons per room
8) Per capita “calorie” available.

2.7.10 Health Policy Indicators

The single most important indicators of political commitment is “allocation of adequate
resources”.
These indicators are:
1) Proportion of GNP spent on health services.
2) Proportion of GNP spent on health related activities (water supply, nutrition,
sanitation)
3) Proportion of total health resources devoted to primary health care.

2.7.11 Indicators of Quality of Life

Rather than restricting ourself to mortality and morbidity rates to measure health, we
should be giving due attention to the quality of life enjoyed by individuals and
communities. It is difficult to define as well as measure. Physical quality of life index
consolidates three indicators i.e., 1) Infant mortality rate 2) Life expectancy at age
and 3) Literacy rate.

2.7.12 Other Indicator Series

1) Social Indicators
These-as defined by the United Nations Statistical Office, have been divided into 12
categories. Population, family formation, families and households, learning and educational
services, earning activities, distribution of income, consumption, social security and welfare 77
Concepts in Nursing services, health services and nutrition, housing and its environment, public order and
safety, time use, leisure and culture, social stratification and mobility.
2) Basic Need Indicators
These are used by ILO. These mentioned in ‘Basic Need Performance’ include calorie
consumption, access to water, life expectancy, deaths due to disease, illiteracy GNP
per capita and doctors and nurses per population.
Till date, the secrets for a single global index of health status could not be derived and
the efforts are in process. Hence, for assessing the health status the above mentioned
indicators are used and thus. with the help of these we are able to derive some
conclusions regarding the health status of a particular community.

Check Your Progress 4

1) List the determinants of health or the factors influencing health care.
a) .............................................................................................................
b) .............................................................................................................
c) .............................................................................................................

2) Define health indicators.

....................................................................................................................
....................................................................................................................
....................................................................................................................
3) Give any five examples of health indicators.
....................................................................................................................
....................................................................................................................
....................................................................................................................
....................................................................................................................
....................................................................................................................
4) How do you measure nutritional status of children?
....................................................................................................................
....................................................................................................................
....................................................................................................................

2.8 HEALTH PROMOTION PRACTICES

The term health promotion indicates the process of enabling people to increase control
over and to improve health. This emphasizes on preventive approaches by adopting
various healthy habits.
The Goal for health promotion is to raise individual’s, families’, groups’and communities’
78 level of wellness to:
a) increase understanding of health, Concepts of Health and
Diseases
b) raise standards for health, and
c) assist in developing more positive health practices.
Health promotion aims at improvement and protection of health. It involves
organisational, political, social and economic interventions designed to facilitate
environmental and behavioural adaptations that will improve health and protect it.

2.8.1 Promotion of Healthful Living

Promotion of healthful living includes various activities such as health education,
environmental modification, good nutrition and healthful life style and behavioural
changes. Nurses always come in the forefront of health promotion.
a) Health Education
It includes educational activities, which enhance well-being and diminish ill health as
well as those which influence the knowledge of policy makers and health professionals.
It is one of the most cost-effective interventions. The targets for educational efforts
may be the general public, patients, priority groups etc. Health education must provide
opportunity and resources that encourage healthful practices.
b) Environmental Modifications
A comprehensive approach to health promotion requires environmental modifications
such as provision of safe water, installation of sanitary latrines, improvement of housing,
and control of vectors and rodents.
c) Nutritional Interventions
It includes providing supplementation of food through mid-day meal programmes and
providing iron and vitamin supplementation etc. Nurtrition education is an important
factor to promote good nutrition and health.
d) Lifestyle and Behavioural Changes
By imparting knowledge about above interventions there should be some positive
changes in lifestyle and behaviour (related to health).
Efforts have been made by providing the following health promotive services:
a) Preventive Health Services
Family Planning
Pregnancy and infant care
Immunizations
Sexually transmitted diseases
High Blood Pressure Control.
b) Health Protection
Toxic agent control
Occupational safety and health
Accidental injury control
79
Concepts in Nursing Fluoridation of community water supplies.
Infectious agent control.
c) Health Promotion
Smoking cessation
Reduction of alcohol and drug abuse
Improved Nutrition
Personal and Environmental Hygiene
Exercise and fitness
Stress Control.

2.8.2 Factors Affecting One’s level of Wellness

Some of the factors are listed below:
a) Presence of physical or mental disabilities: The need for eye glasses is a
visual disability. Many persons function everyday with the disability of being more
than 10% overweight. It is the level of functioning within that disability that is an
indicator of the level of wellness.
b) One’s living habits and general life style can effect and influence one’s level of
wellness. Stop smoking or decrease intake of alcohol would improve our level of
wellness.
c) Occupation: Inhaling particles in an asbestos factory all day will effect wellness.
d) Exercise: The amount of exercise one ~does contribute to one’s wellness.
e) Heredity: Health functioning is to a great degree dependant on heredity. Degree’s
of stamina, basal metabolism, and inherited diseases or traits all contribute positive
and negative forces towards one’s level of wellness.
f) The Health Care System: That is available and the way in which it is utilized
also affects the level of wellness, although it has more to do with sickness than with
wellness. Sickness can however be interpreted as an absence of wellness. It does
stand to reason that if a health care system does not encourage maintenance of
health and wellness, the population it serves is likely to have a lower level of
wellness than one in which health maintenance is encouraged.
g) Environmental: It effects tremendously one’s level of wellness. In cities there is
more pollution and increased incidence of respiratory diseases and certain kinds
of cancer in highly industrialized areas. Socio-economic conditions plays a large
part in one’s level of wellness. Living in crowded areas, slums certainly does not
contribute to one’s mental. physical or emotional health.
h) Homeostasis of the individual: Homeostasis is the ability to maintain the
constancy of one’s internal milieu (environment) despite changes in the external
milieu. It usually refers to the physical and chemical properties of body tissues and
fluids, but emotional homeostasis is a definite and palpable entity, organisms must
interact with their environment. If self-regulatory mechanism is working wellness
exists; if it goes out of control. sickness (or non wellness exists).
80
 Concepts of Health and
Check Your Progress 5 Diseases

1) Define health promotion.

....................................................................................................................
....................................................................................................................
....................................................................................................................

2) List the ways of health promotion.

a) .............................................................................................................
b) .............................................................................................................
c) .............................................................................................................

d) .............................................................................................................

2.9 EPIDEMIOLOGICAL ASPECTS OF DISEASE

With the progress of civilization from the primitive period to modern time the concept
of disease and health have changed from supra-natural to mulfifactorial causes and
holistic health approach. But these old concepts still prevail among people in the world
who are under-developed and uneducated. The concept of disease and health have
great bearance on health promotion, health protection and health maintenance. The
concept of health is already discussed. In this section, emphasis will be put in to clarify
disease causation, natural history of disease and risk factors.

2.9.1 Epidemiological Models of Causation of Disease

Before the discovery of microorganisms in 19th century diseases were associated with
supranatural and spiritual forces. The germ theory became popular during the 19th and
early part of 20th century. According to this theory there is one single specific causative
agent to every disease as shown in the model given below. Examples are:
Disease agent ................................... Man ...................................... Disease
tuberculosis due to tuberculosis bacilli, cholera due to cholera vibric, diphtheria due to
mycobacterium diphtheria etc.
But this theory has many limitations. For example every one exposed to disease agent
does not get the disease say like tuberculosis, only those were undernourished,
susceptible and lived in slum got the disease. This means in additon to specific causative
agent there are many other factors related to host and environment which contribute to
causation of disease as shown in the model given in Fig. 2.13.
This model is known as Epidemiological Triad. According to this model disease is
caused by the interaction of agent, host and environment. This means that disease
will occur only when the host is weak, the agent is strong and enters the host through
the right channel and in sufficient amount and when environmental conditions facilitate
the interaction of host and agent. For example, for pulmonary tuberculosis, the organisms
must enter through respiratory tract and in sufficient amount, the host should not have
specific resistance and should have weak general body resistance, poor, dark and
dingy environment is conducive to the prevalence of tuberculosis in patients.
81
Concepts in Nursing

Fig. 2.13 : Epidemiological Triad Model ‘of Causation of Disease

This model in other words implies that disease will not occur without the optimal
interaction of these three factors and remain in balanced state. This refers to state of
health equilibrium and is represented in Fig. 2.5(a).
This model is applicable to infectious diseases and not to new types of chronic and
degenerative diseases which are a result of modem civilization, for example cancer,
cardiac diseases, diabetes, nephrotic syndrome, mental disorders, etc. These diseases
could not be prevented and controlled by the traditional methods of isolation, curative,
immunization and environmental sanitation, etc.

82 Fig. 2.14 : The Web of Causation for Myocardial Infarction

It has been epidemiologically recognised that these diseases are caused due to complex Concepts of Health and
Diseases
interaction of multiple factors related to life style, human behaviour and the environment
conditions as shown in model Fig. 2.13. Agent is regarded as an integral part of total
environment.
This refers to web of causation as suggested by MacMohan and Pugh. This model
suggests clusters of causes and combinations of effects related to each other. It also
suggests’ variety of intervention e.g. avoidance of smoking, diet control, exercise, regular
health check ups, etc. for prevention and control of cardio-vascular diseases,
corpumonary disease, etc.

2.9.2 Natural History of Disease

In the absence of any intervention (i.e. prevention or treatment) almost all disease
follow a natural course of events which refers to “natural history of disease”. It starts
with the interaction of agent, host and environment i.e. epidemiological triad as discussed
earlier.
The disease process in man depends on the characteristics of these three factors. The
natural history of disease has two phases: (i) Prepathogenesis phase, and (ii)
Pathogenesis Phase.
i) Prepathogenesis Phase: This phase is before the onset of disease in man and
it is in the environment. The disease agent has not yet entered the host (man).
But the factors that favour its (agents) interaction with the human host exist in the
environment (Fig. 2.5) e.g. poor physical environment, climate condition and
prevalence of insects, pests and rodents, etc. unhygienic habits and health
behaviour, traditional practices and biological factors i.e. age, sex, marital status,
genetic traits, physiological status, etc. We are always exposed to the risk of
disease but disease process in man starts only when there is interaction among
agent, host and environmental factors as shown in the model Epidemiological
Triad Fig 2.13 and 2.15.

Fig. 2.15 : Prepathogenesis and Pathogenesis Periods of Natural History

ii) Pathogenesis Phase: This phase begins with the entry of the disease agent in the
human host. As the agent e.g. ‘measles virus’ enter the body through appropriate
83
Concepts in Nursing channel e.g. in case of measles virus, the respiratory tract, the agent in this
case i.e. the virus grow and multiply and bring in physiological changes in the
body. These changes are subclinical i.e. clinical signs and symptoms of the
disease are absent. The host remains apparently healthy and ambulent. After a
lapse of some period, which differ in various diseases, the health equilibrium
within the body is disturbed, the signs and symptoms of disease begins to
appear. This period is called as incubation period. The signs and symptoms
are vague during the first few days (1 to 4 days) of illness e.g. in measles,
running nose, watering of eyes, etc. This period is called as prodomal period
and it is early prepathogenesis phase. But as the disease advances, the signs
and symptoms usually become clear cut and clinical diagnosis can be made
with ease e.g. skin ashes allover the body in measles. This stage of pathogenesis
(disease process) refer to Fastegium. Its duration varies from disease to
disease and in case of same disease in different people depending upon the
virulence of causative agent and the susceptibility of the human host. The end
results of disease process may be complete recovery which refers to
defervescence and convalescence or it may end into some kind of disability/
defect, chronic state or death. From this discussion of pathogenesis phase of
a disease We learn that each disease has a series of stages as shown in the
Fig. 2.15.

2.9.3 Levels of Prevention of Disease

The Goal of medicine is to promote health, positive health, to restore health when it is
impaired and to minimise suffering and distress. These goals are embodied in the word
“Prevention”. Successful prevention depends upon the knowledge of causation,
dynamics of transmission, identification of risk factors and risk groups, availability of
prophylaxis or early detection and treatment measures.
In modern day, the concept has become broad based and includes four levels of
prevention:
i) Primordial Prevention
This is a new concept and is receiving special attention in the prevention of chronic
diseases. This is primary prevention in its purest ‘sense, i.e. 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 like obesity, hypertension have their early
origin in childhood. In primordial prevention efforts are devoted towards discouraging
children from adopting harmful life styles like smoking, alcohol consumption, lack of
exercise and unhealthy eating pattern, physical exercise.
ii) Primary Level of Prevention
It refers to measures undertaken during prepathogenesis phase so that man remains
healthy and comprise of (a) Health promotion and (b) Specific protection.
a) Health promotion includes factors like balanced diet, clean and safe environment
to live, healthful life style and adequate use of resources.
b) Specific protection refers to specific measures undertaken to prevent illness and
injury, such as timely immunization, Vit. A prophylaxis, wearing ear plugs, helmets,
gloves etc.
84
iii) Secondary Level of Prevention Concepts of Health and
Diseases
These are the measures taken during pathogenesis phase to control the progress or
spread of disease. It includes early identification of cases and their contacts, giving
them adequate and complete treatment along with follow up. These measures assist to
help in recovery, prevent complications, prevent further ,spread of disease and
occurrence of fresh cases.
iv) Tertiary Level of Prevention
The aim here is to halt the progress of disease so as to limit/prevent disability occurrence
and also to assist the individual to cope with the body/system reserves so as to lead a
socially and economically productive life. This is known as rehabilitation and can be of
physical, vocational and psychosocial nature so that the person is well adjusted to self,
job and society.
a) Disability Limitations
When the patient reports late in the pathogenesis phase, the mode of prevention is
disability limitation. The objective is to prevent/halt the transition of the disease process
from impairment to handicap.
Disease Impairment Disability Handicap.
Impairment is defined as “any loss or abnormality of psychological, physiological or
anatomical structure or function”.
Disability is the result of an impairment. The affected person may be unable to carry
out certain activities considered normal for his age, sex. This inability to carry out
certain activities is termed as ‘disability’.
Handicap is a result of disability. The person experiences certain disadvantages in life
and is unable to discharge the obligations required of him/her and play the role expected
of him/her in society.
For example,
Gangrene – Disease
Loss of foot – impairment
Cannot walk – Disability
Unemployed – Handicap
b) Rehabilitation
It is defined as the “combined and coordinated use of medical, social, educational and
vocational measures for training and retraining the individual to the highest possible
level of function ability”.
The areas/types of concerns in Rehabilitation are:
a) Medical Rehabilitation i.e. Restoration of function.
b) Vocational Rehabilitation i.e. Restoration of capacity to earn a livelihood.
c) Social Rehabilitation i.e. Restoration of family and social relationship.
d) Psychological Rehabilitation i.e. Restoration of personal dignity and confidence.
85
Concepts in Nursing 2.9.4 Risk Factors
There are so many risk factors which affects the health of the individual. Risk factors can
generally be classified according to six categories. There are six categories as given Fig.
2.16. Some of these risk factors are modifiable, such as health holistic (e.g. stop smoking
and alcohol consumption) and life style (e.g. appropriate exercise and right food and
stress management). Some risk factors are not modifiable, such as age, sex, etc.

Fig. 2.16 : Risk factors to health

Risk factors are a key to health promotion. Once identified, risk factors can be
individually addressed and a primary prevention program initiated. There are some
social problems which affect the health and well being. They are following:
a) Demise of the extended family.
b) The increasing disappearance of the small, tightly knit community.
c) The numbers of mothers in the work place.
[The National Centre for Health Statistics (1990) Reports that in 1988, 13.3
million children 60% of all those age 5 or younger were in a regular day care
arrangement; this included half of all those children younger than age two.]
d) Dissatisfaction with so many jobs. The primary gratification is the money, an extrinsic
motivation, which adds to an increasing mercenary attitude.
e) Divorce
f) Excessive competitiveness in all areas of American life.
g) Jobs being more important than family.
h) An increasing materialistic society.
Check Your Progress 6
1) List the epidemiological models of disease causation.
....................................................................................................................
....................................................................................................................
....................................................................................................................
....................................................................................................................
2) Briefly describe the epidemiological triad theory of disease causation. How
does it differ from germ theory?
....................................................................................................................
....................................................................................................................
....................................................................................................................
....................................................................................................................
86
 Concepts of Health and
3) List four levels of prevention. Diseases

....................................................................................................................
....................................................................................................................
....................................................................................................................
....................................................................................................................

4) List four examples of modifiable risk factors.

....................................................................................................................
....................................................................................................................
....................................................................................................................
....................................................................................................................

2.10 LET US SUM UP

In this unit on the Health Concepts, we have defined and explained the meaning of
health and illness. Changing concepts of health i.e. Biomedical, Ecological, Psychosocial
and Holistic concepts were discussed. Various models of health and illness were
explained. Further the health demensions were described. Determinants of health i.e.
heredity/human biology, environment, life style and resources are discussed. You have
also learnt about the various indicaters of health and health promotion practices.

2.11 ACTIVITIES
1) What does the term ‘health’ mean to you. Compare your definition with the definition
of your friends and other people in the community.
Ask other health professionals, how they define ‘health’. What differences do you
identify between your definition and the definitions given by other health professionals.
2) Conduct a life style survey often people. List their health behaviours. From this list
identify health-positive and health-negative behaviour. Identify what actions they
are taking (if taking) to change their health-negative behaviour.

2.12 ANSWERS TO CHECK YOUR PROGRESS

Check Your Progress 1
Health is a state of complete physical, mental, social and spiritual well-being and not
merely an absence of disease or infirmity.
Check Your Progress 2
1) a) Biomedical
b) Ecological
c) Psychosocial
d) Holistic 87
Concepts in Nursing 2) a) continuum
b) Biomedical, ecological, psychosocial
Check Your Progress 3
1) Health-illness continuum
High level wellness model
Health belief model
Agent-host environment model
Paradigm of health
2)

3) a) Perceived susceptibility
b) Perceived threat of the disease
c) Perceived benefit of preventive action
d) Perceived barriers to preventive action
e) Modifying factors
t) Cures to disease
g) Likelihood of taking preventive action

4) a) Physical
b) Mental
c) Social

5) a) Free from internal conflict

b) Well adjusted
c) Has self identity
d) Has self esteem
e) Knows needs and goals
t) Good self control
g) Solves problems in telling gently
88
Check Your Progress 4 Concepts of Health and
Diseases
1) a) Heredity/Human biology
b) Environment
c) Lifestyle
d) Resources
2) Indicators of health care are defined as variable which help to measure changes in
health status.
3) a) Mortality
b) Morbidity
c) Disability
d) Nutrition
e) Health care delivery
4) Nutritional status is measured by anthropometeric measures such as height, weight,
head, chest and midarm circumferenes.
Check Your Progress 5
1) Health promotion has been defined as efforts made to enhance positive health and
prevent ill-health through health measures, and awareness to healthful living and
activities leading to prevention of diseases and health protection.
2) a) Health education
b) Environmental modification
c) Nutritional intervention
d) Life style and behavioural changes.
Check Your Progress 6
1) Epidemiological triad, Web of causation.
2) Epidemiological triad theory explains that the disease is caused due to interaction
of three categories of factors which include host, agent and environment. This
theory differs from germ theory which explains that there is one single specific
causative agent to every disease i.e. one cause-one effect whereas according to
epidemiological triad in addition to one single specific cause there are other factors
which are responsible for causing disease i.e. three categories of causative factors

to cause a disease i.e. effect.

3) a) Primordial Prevention
b) Primary Level
c) Secondary Level
d) Tertiary Level
89
Concepts in Nursing 4) a) Appropriate diet
b) Exericse
c) Stop smoking
d) Control alochol consumption

2.13 FURTHER READINGS

Black M. Joyce & Jacobs Matassarin Esther Sorensen’s & Luckrnann, ‘Medical
Surgical Nursing, A Psychophysiologic Approach’, 4th edn., W B Saunders
Company, Philadelphia 1993, Chapter 2, 3,4,5.
Concepts Basic to Nursing Practice, Chapter 27.
Joyce M. Black & Esther Matassarin, ‘Medical Surgical Nursing: Clinical
Management for Continuity of Care , 5th edn., W.B. Saunders Company, 1999,
Ch 2.
K. Park, ‘Park’s Text Book of Preventive and Social Medicine”; 15th edn.,
Banarsidas Bhanot Publications, 1998, Ch. 2. Jabalpur.
Phipps, Long, Woods, ‘Shafers Medical Surgical Nursing’, 7th edn., Mosby
Company, 1994, Ch. 1,2,3.
Smelter C. Susanne and Bare, ‘c. Brenda Brunner and Siddarth ‘s Text Book of
Medical Surgical Nursing’ , 8th edn., Lippincott Company, 1995 Ch. 2 + 3.
Susane, Williams, Understanding Nursing Care, 2nd edn., ELBS.

90