Introduction
Health is a basic requirement for an individual to live, work and participate in family and community life. It is not simply the absence of disease. A person may have no diagnosed illness but may still have poor health because of problems related to nutrition, mental well-being, social conditions or the environment.
The concept of health has therefore changed over time. Earlier, health was mainly understood in relation to disease and physical functioning. Modern health care considers the physical, mental and social well-being of a person and also recognizes the influence of family, community, environment and socioeconomic conditions.
1. Concept of Health
Definition of Health
According to the World Health Organization (WHO), health is:
“A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
This definition was included in the WHO Constitution and reaffirmed in the Declaration of Alma-Ata.
The definition shows that health has a broader meaning than simply being free from disease.
For example:
A person without fever but suffering from severe anxiety may not have complete health.
A person who is physically healthy but socially isolated may have a problem affecting well-being.
A person with a chronic disease who is able to manage the condition and maintain physical, mental and social functioning can still have important aspects of health.
2. Changing Concepts of Health
The understanding of health has developed gradually.
2.1 Biomedical Concept
The biomedical concept mainly considers disease and physical functioning.
According to this view:
Health means absence of disease.
Disease is mainly caused by biological or physical factors.
Diagnosis and treatment are the major approaches.
Medical treatment is given importance.
Example
If a person has malaria, the biomedical approach focuses on identifying the disease and treating the infection.
Limitation
This concept does not adequately consider mental, social, environmental and behavioural factors affecting health.
2.2 Ecological Concept
The ecological concept considers health as a relationship between the person and the environment.
Health is influenced by the interaction between:
Human beings
Physical environment
Biological environment
Social environment
Example
Unsafe drinking water can increase the risk of diarrhoeal diseases. Improving the water supply can therefore improve community health.
2.3 Psychosocial Concept
The psychosocial concept recognizes that health is influenced by psychological and social factors in addition to physical factors.
Important factors include:
Family relationships
Social support
Education
Occupation
Economic conditions
Stress
Cultural practices
Living conditions
Example
A person experiencing continuous family stress may develop sleep problems, anxiety or poor appetite even without an infectious disease.
2.4 Holistic Concept
The holistic concept considers the whole person rather than only a particular disease.
It includes:
Physical health
Mental health
Social well-being
Environmental influences
Lifestyle
Emotional well-being
Spiritual aspects where relevant to the person
The focus is on maintaining overall well-being rather than treating disease alone.
3. Dimensions of Health
Health has several interconnected dimensions. The major dimensions are physical, mental and social health. Other dimensions are also used to describe health more broadly.
3.1 Physical Health
Physical health refers to the proper functioning of the body and its systems.
A physically healthy person generally has:
Normal functioning of body organs
Adequate nutrition
Sufficient energy
Good physical fitness
Appropriate body growth and development
Ability to perform daily activities
Example
A person who is adequately nourished, physically active and able to perform normal daily activities demonstrates good physical health.
3.2 Mental Health
Mental health refers to a person’s emotional and psychological well-being and ability to deal with normal stresses of life.
Good mental health helps a person to:
Think clearly
Make appropriate decisions
Manage emotions
Deal with stress
Maintain relationships
Perform daily responsibilities
Mental health is not simply the absence of mental illness.
3.3 Social Health
Social health refers to the ability of a person to maintain healthy relationships and function effectively in family and society.
It includes:
Good interpersonal relationships
Cooperation with others
Effective communication
Participation in family and community activities
Ability to adjust to social situations
Example
A person who communicates effectively with family members and participates in community activities demonstrates good social functioning.
3.4 Emotional Health
Emotional health is the ability to understand, express and manage emotions appropriately.
A person with good emotional health can:
Recognize emotions
Express feelings appropriately
Manage anger and fear
Handle disappointment
Develop healthy relationships
3.5 Spiritual Health
Spiritual health relates to a person’s sense of meaning, purpose, values and inner well-being.
It may be influenced by:
Personal values
Beliefs
Sense of purpose
Inner peace
Relationship with oneself and others
Spiritual health may differ from person to person according to individual beliefs and values.
3.6 Environmental Health
Environmental health concerns the conditions in which people live and work.
Important factors include:
Safe drinking water
Sanitation
Clean air
Proper waste disposal
Safe housing
Healthy working conditions
Control of environmental hazards
Example
Providing safe drinking water and proper sanitation can reduce the occurrence of water-borne diseases.
4. Determinants of Health
Determinants of health are the factors that influence the health of individuals and communities.
Health does not depend on medical treatment alone. It is influenced by a combination of personal, social, economic and environmental factors.
Major Determinants of Health
4.1 Heredity
Heredity refers to characteristics transmitted from parents to children through genes.
It may influence:
Physical characteristics
Certain genetic disorders
Susceptibility to some diseases
Growth and development
4.2 Environment
The environment includes the physical, biological and social surroundings of a person.
It includes:
Air
Water
Food
Housing
Sanitation
Climate
Workplace
Social surroundings
Poor environmental conditions can increase the risk of disease.
4.3 Lifestyle and Behaviour
Lifestyle includes the way a person lives and the habits and behaviours that affect health.
Examples include:
Diet
Physical activity
Sleep
Personal hygiene
Tobacco use
Alcohol use
Sexual behaviour
Health-seeking behaviour
Healthy behaviour can reduce many preventable health risks.
4.4 Socioeconomic Conditions
Economic and social conditions strongly influence health.
Important factors include:
Income
Education
Occupation
Housing
Employment
Social support
Access to resources
For example, inadequate income may affect a family’s ability to obtain nutritious food, safe housing and health services.
4.5 Health Services
Availability and accessibility of health services influence the health of individuals and communities.
Important factors include:
Availability of health facilities
Accessibility of services
Affordability
Quality of care
Availability of medicines
Availability of trained health workers
Referral services
4.6 Age and Sex
Health needs vary according to age and sex.
For example:
Infants require immunization and appropriate nutrition.
Adolescents have specific physical and emotional needs.
Pregnant women require antenatal care.
Older adults may require care for chronic conditions.
5. Primary Health Care
Meaning
Primary Health Care (PHC) is an approach to organizing health care so that essential health services are available as close as possible to where people live and work.
It is not limited to treatment of disease. It includes health promotion, disease prevention, treatment, rehabilitation and palliative care, while also addressing broader factors that influence health.
The concept of primary health care was strongly established internationally through the Declaration of Alma-Ata in 1978. It described primary health care as essential health care made universally accessible to individuals and families in the community with their participation.
6. Definition of Primary Health Care
The Alma-Ata Declaration described primary health care as essential health care based on practical, scientifically sound and socially acceptable methods and technology, made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford.
In simple terms:
Primary Health Care = Essential health care + Community participation + Accessibility + Appropriate methods + Affordability
7. Main Components of Primary Health Care
The traditional Alma-Ata approach identifies the following essential components of primary health care:
7.1 Health Education
People should receive information about:
Common health problems
Methods of prevention
Healthy lifestyle
Nutrition
Hygiene
Available health services
Health education helps people make informed decisions about their health.
7.2 Adequate Nutrition
PHC includes activities to promote adequate nutrition.
These include:
Promotion of balanced diets
Identification of nutritional problems
Nutrition education
Prevention and management of malnutrition
7.3 Safe Water and Basic Sanitation
Primary health care includes access to:
Safe drinking water
Proper sanitation
Waste disposal
Hygienic surroundings
These measures help prevent many communicable and water-borne diseases.
7.4 Maternal and Child Health Care
This includes care related to:
Pregnancy
Childbirth
Postnatal period
Newborn care
Child health
Family planning
7.5 Immunization
Immunization protects individuals and communities from vaccine-preventable diseases.
It forms an important part of preventive health services.
7.6 Prevention and Control of Locally Endemic Diseases
Health services should identify and control diseases that are common in a particular area.
This may involve:
Early identification
Treatment
Prevention
Health education
Surveillance
Community participation
7.7 Appropriate Treatment of Common Diseases and Injuries
Primary health care provides appropriate care for common illnesses and minor injuries.
When a condition requires care beyond the available level, the person should be referred to an appropriate higher-level facility.
7.8 Provision of Essential Drugs
Essential medicines should be available for the treatment of common health conditions and for important preventive and public health services.
8. Principles of Primary Health Care
8.1 Equitable Distribution
Health services should be available to all sections of the population.
People should not be deprived of essential health care because of:
Place of residence
Economic status
Social status
Gender
Other social disadvantages
8.2 Community Participation
People should actively participate in decisions and activities related to their health.
Community participation may include:
Identifying health problems
Planning health activities
Participating in health programmes
Maintaining healthy surroundings
Using available health services
8.3 Intersectoral Coordination
Health is influenced by sectors other than health.
Therefore, health improvement may require cooperation between:
Health
Education
Water and sanitation
Agriculture
Women and child development
Local government
Social welfare
8.4 Appropriate Technology
Health services should use methods and technologies that are:
Scientifically appropriate
Practical
Acceptable to the community
Affordable
Suitable for local conditions
8.5 Accessibility
Health services should be available as close as reasonably possible to where people live and work.
Accessibility includes:
Geographic accessibility
Economic accessibility
Social acceptability
Availability of appropriate services
9. Primary Health Care and Primary Care
The two terms are related but are not identical.
Primary Care
Primary care is the first-contact health care provided to individuals and families. It provides continuing, comprehensive and coordinated care.
Primary Health Care
Primary health care is broader. It includes primary care together with essential public health functions, action across different sectors, and empowerment of individuals, families and communities.
Therefore:
Primary care is a part of primary health care.
10. Significance of Primary Health Care
Primary health care is important because it:
Brings health services closer to the community.
Promotes health and prevents disease.
Provides early identification and management of health problems.
Supports maternal and child health.
Promotes community participation.
Connects individuals with higher levels of care through referral.
Addresses health problems at an early stage.
Supports continuity of care.
Helps address social and environmental determinants of health.
Provides care throughout the life course.
11. Application of Primary Health Care in the Community
Primary health care is applied through activities that address the health needs of individuals, families and communities.
Examples include:
Health Promotion
Health education
Nutrition education
Promotion of hygiene
Promotion of healthy behaviours
Disease Prevention
Immunization
Early detection
Screening
Disease-control activities
Maternal and Child Health
Antenatal care
Postnatal care
Newborn care
Child health services
Family planning
Environmental Health
Safe water
Sanitation
Waste disposal
Clean surroundings
Treatment and Referral
Management of common illnesses
First aid
Identification of danger signs
Referral to appropriate health facilities
Community Participation
Involving families and community members
Identifying local health problems
Supporting health programmes
Encouraging appropriate use of health services
12. Role of Primary Health Care in the Health System
Primary health care acts as an important connection between the community and the wider health system.
A person may first receive care in the community. If the condition can be managed there, appropriate care is provided. If specialized care is required, the person is referred to a higher level.
Community → Primary level → Secondary level → Tertiary level
The referral process helps ensure that a person receives the level of care required for the health problem. WHO describes primary care as an important first-contact point and emphasizes coordination and referral between levels of care.
13. Difference Between Health and Disease
Health | Disease |
State of well-being | Abnormal condition affecting the body or mind |
Includes physical, mental and social aspects | May affect one or more body systems |
Can exist with a chronic condition when it is well managed | May disturb normal functioning |
Influenced by many determinants | May have infectious, genetic, environmental, behavioural or other causes |
Focuses on overall well-being | Focuses on a particular health disorder |
14. Key Points to Remember
Health is more than the absence of disease.
WHO defines health in terms of physical, mental and social well-being.
Health has multiple dimensions.
Health is influenced by heredity, environment, lifestyle, socioeconomic conditions and health services.
Primary health care brings essential health care closer to the community.
PHC includes promotion, prevention, treatment, rehabilitation and palliative care.
Important traditional PHC components include health education, nutrition, safe water and sanitation, maternal and child health, immunization, control of endemic diseases, treatment of common diseases and injuries, and essential drugs.
The major principles of PHC include equitable distribution, community participation, intersectoral coordination, appropriate technology and accessibility.
Primary care is a part of the broader concept of primary health care.
Quick Revision
Health → Physical + Mental + Social well-being
Determinants → Heredity + Environment + Lifestyle + Socioeconomic conditions + Health services
PHC → Accessible + Affordable + Appropriate + Community-based + Participatory
PHC services → Promotion + Prevention + Treatment + Rehabilitation + Palliative care