LECTURE MODULE 3:

Concept of Health, Illness and Health Care; Levels of Service Delivery

Learning Objectives: At the end of this lecture, the students should be able to;

1. Define and differentiate the concepts of health, illness, and disease and explain their
implications for nursing care.

2. Explain the levels of healthcare delivery (primary, secondary, tertiary) and identify the
services provided at each level.

3. Discuss the role of the nurse in health promotion, illness prevention, treatment, and
rehabilitation across all levels of care.

4. Identify the determinants of health and how they influence the health status of individuals,
families, and communities.

1. INTRODUCTION

Health and illness are fundamental concepts in nursing and healthcare practice.

Understanding these concepts helps nurses assess, plan, and deliver appropriate care to

individuals, families, and communities.

Health is not merely the absence of disease, but a state of complete well-being — physically,

mentally, socially, and spiritually. Illness, on the other hand, represents a deviation from a

normal state of health and affects the individual’s ability to function normally.

Health care is the organized provision of medical and nursing services to maintain or restore

health. It is delivered at different levels of service (primary, secondary, and tertiary) to meet

diverse health needs of the population.

2. CONCEPT OF HEALTH
2.1 Definition of Health

According to the World Health Organization (WHO, 1948):

“Health is a state of complete physical, mental, and social well-being and not merely the

absence of disease or infirmity.”

This definition emphasizes the holistic nature of health — involving the body, mind, and

social environment.

2.2 Dimensions of Health

Health is multidimensional and includes:

1. Physical Dimension:

Efficient functioning of body systems.

Absence of disease, disability, or physical impairment.

Indicators: body weight, blood pressure, exercise tolerance, etc.

2. Mental (Psychological) Dimension:

Ability to think clearly, make decisions, and cope with stress.

Emotional stability and self-control.

3. Social Dimension:

Ability to form satisfying interpersonal relationships.

Adaptation to social norms and community participation.

A sense of purpose, inner peace, and connection with a higher power.

Faith, morals, and personal values.

5. Emotional Dimension:

Proper expression and control of emotions.

Maintaining self-esteem and confidence.

6. Environmental Dimension:

Living in a clean, safe, and supportive environment.

Access to safe water, air, housing, and sanitation.

7. Economic Dimension:

Availability of resources to meet basic needs.

Financial stability and access to health care.

2.3 Determinants of Health

Health is influenced by various factors (determinants), including:

1. Biological factors – genetics, age, gender, heredity.

2. Environmental factors – physical, chemical, and biological environment.

3. Lifestyle factors – diet, exercise, smoking, alcohol use, rest.

4. Socioeconomic factors – income, education, occupation, housing.

6. Health services – availability, accessibility, and quality of healthcare.

7. Political factors – health policies and government commitment.

2.4 Concept of Wellness

Wellness is the active process of becoming aware of and making choices toward a healthy

and fulfilling life.

It is a dynamic balance among physical, mental, and social well-being.

Wellness Continuum:

Illness <---------------------------> Wellness

(Death) (Neutral) (High-level wellness)

The nurse helps individuals move along this continuum toward optimal health.

3. CONCEPT OF ILLNESS

3.1 Definition of Illness

Illness is a subjective state in which a person feels unwell, experiences discomfort, or cannot

function normally due to disease, injury, or other conditions.

professional.

3.2 Types of Illness

1. Acute Illness:

Sudden onset and short duration (e.g., malaria, influenza).

May be severe but curable.

2. Chronic Illness:

Develops slowly, lasts long (often for life), and may be progressive.

Examples: diabetes, hypertension, arthritis.

3. Communicable Illness:

Caused by infectious agents and can be transmitted from person to person.

Examples: tuberculosis, HIV, cholera.

4. Non-Communicable Illness:

Not infectious; results from lifestyle or genetic factors.

Examples: cancer, heart disease, stroke.

3.3 Stages of Illness Behavior

When individuals experience symptoms, they pass through the following stages:
1. Symptom Experience:

The person recognizes signs of illness (e.g., pain, fever).

2. Assumption of the Sick Role:

The individual acknowledges being ill and seeks rest or care.

3. Medical Care Contact:

The person seeks advice or treatment from health professionals.

4. Dependent Patient Role:

The patient accepts treatment and care from health providers.

5. Recovery or Rehabilitation:

The person recovers and resumes normal roles or adapts to chronic conditions.

3.4 Impact of Illness

Illness affects:

Individuals (physically, emotionally, financially)

Families (role changes, stress, expenses)

Communities (loss of productivity, disease spread)

Healthcare systems (increased workload and cost)

4.1 Definition

Health care refers to the organized provision of preventive, promotive, curative, and

rehabilitative services to individuals, families, and communities to maintain or restore health.

4.2 Goals of Health Care

1. Promote, protect, and maintain health.

2. Prevent diseases and injuries.

3. Restore health when it is impaired.

4. Rehabilitate individuals to optimal functioning.

5. Improve quality of life and reduce mortality.

4.3 Components of Health Care

1. Promotive Health Care:

Activities aimed at maintaining and improving health.

Example: health education, good nutrition, exercise, sanitation.

2. Preventive Health Care:

Measures taken to prevent occurrence of disease.

Example: immunization, screening, environmental sanitation.

Treatment and management of diseases and injuries.

Example: medical and surgical interventions.

4. Rehabilitative Health Care:

Restoring patients to their highest possible level of functioning.

Example: physiotherapy, occupational therapy, counseling.

5. Supportive Health Care:

Providing comfort and palliative care for chronic or terminal illness.

5. LEVELS OF HEALTH CARE SERVICE DELIVERY

Health care services are delivered through a hierarchical system designed to provide

comprehensive care to the population.

5.1 Primary Level of Health Care

Definition:

This is the first level of contact between individuals and the health system — usually close to

where people live and work.

It is based on the concept of Primary Health Care (PHC) as declared at Alma-Ata

Conference, 1978.
Functions:

Health education on prevailing health problems.

Prevention and control of locally endemic diseases.

Immunization and maternal-child health.

Provision of essential drugs and basic curative services.

Safe water and sanitation promotion.

Examples of Facilities:

Health posts

Primary health centers (PHCs)

Dispensaries

Community clinics

Health Workers Involved:

Community health extension workers (CHEWs)

Nurses and midwives

Health educators

Environmental health officers

5.2 Secondary Level of Health Care

Definition:
This is the intermediate (referral) level, providing specialized medical services that are

beyond the scope of primary care.

Functions

Diagnosis and treatment of more complex diseases.

Laboratory, radiology, and emergency services.

Training and supervision of primary healthcare workers.

Referral services to tertiary institutions.

Examples of Facilities:

General hospitals

District hospitals

Health Workers Involved:

Medical officers, nurses, laboratory scientists, pharmacists, physiotherapists, etc.

5.3 Tertiary Level of Health Care

Definition:

This is the highest level of care, providing highly specialized and advanced medical services

for complex or rare conditions.

Functions:
Specialized investigations and surgical procedures.

Advanced diagnostic and therapeutic care.

Research, training, and development.

Referral services for lower levels.

Examples of Facilities:

Teaching hospitals

Specialist hospitals (psychiatric, orthopedic, cancer centers, etc.

Health Workers Ivolved:

Consultants, specialists, surgeons, advanced practice nurses, and researchers.

5.4 Relationship Among the Levels

Each level serves as a referral system for the next:

Primary → Secondary → Tertiary → (Back to Primary for follow-up)

This ensures continuity of care, efficient use of resources, and appropriate management at

every stage.

REFERENCES

1. World Health Organization. (1948). Preamble to the Constitution of the World Health
Organization. WHO.
2. Stanhope, M., & Lancaster, J. (2020). Public health nursing: Population-centered health
care in the community (10th ed.). Elsevier.

3. Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2021). Fundamentals of nursing (10th
ed.). Elsevier.

4. Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner & Suddarth’s
textbook of medical-surgical nursing (12th ed.). Lippincott Williams & Wilkins.

5. World Health Organization. (1978). Declaration of Alma-Ata: International Conference on