HEALTH

COMMUNITY
DENTISTRY
5HT SEMESTER
DEFINITION OF HEALTH
 The World Health Organization (WHO)
defines health as a “state of complete
physical, mental, and social well-being,
not merely the absence of disease or
infirmity” (WHO, 1947).
 In recent years, this definition has been
amplified to include “the ability to lead
socially and economically productive
life”.
CONCEPT OF HEALTH
• An understanding of health is the basis
of all the health care.
• Health is not perceived the same way
by all the members of a community
including various professional groups
(like biomedical scientists, social
scientists, health administrators,
ecologists) giving rise to confusion
about the concept of health.
 Health has evolved over the centuries
from the concept of individual concern
to a worldwide social goal.
 The various changing concepts of
health are as follows:
1. Biomedical concept
2. Ecological concept
3. Psychosocial concept
4. Holistic concept
1. BIOMEDICAL CONCEPT
 Traditionally health has been considered
as an absence of the diseases and if
someone was free from disease, then
that person was considered healthy.
 This concept is known as biomedical
concept, and it is based on the “germ
theory of the disease.”
 Health means “absence of disease.”
 The medical profession viewed the
human body as a machine and disease
is an outcome of the breakdown of the
machine, and one of the doctor’s tasks
was to repair the machine.
 This concept has minimized the role of
the environment, social and cultural
determinants of the health.
2. ECOLOGICAL CONCEPT
 Deficiencies in the biomedical concept
gave rise to other concepts.
 The ecologists put forward the concept
of ecological concept.
 Ecologists viewed health as a dynamic
equilibrium between man and his
environment, and the disease as a
maladjustment of the human organism
to environment.
3. PSYCHOSOCIAL
CONCEPT
 Advances in social sciences showed that
health is not only a biomedical
phenomenon, but one which is
influenced by social, psychological,
cultural, economic and political factors
of the people concerned.
 These factors must be taken into
consideration in defining and measuring
health.
 Thus health is both a biological and
social phenomenon
4. HOLISTIC CONCEPT
 The holistic model is a synthesis of all
the above concepts.
 Holistic concept recognizes the strength
of social, economic, political and
environmental influences on health.
 It has been variously described as
multidimensional process involving the
wellbeing of the person as a whole.
 The emphasis is on the promotion and
protection of health
 The holistic approach implies that all
sectors of the society have an effect on
health, in particular, agriculture, animal
husbandry, food, industry, education,
housing, public works and other sectors.
DIMENSIONS OF HEALTH
 Health is multidimensional.
 World Health Organization explained
health in three dimensional
perspectives: physical, mental, social
and spiritual.
 Besides these many more may be cited,
e.g. emotional, political, philosophical,
cultural, socioeconomic, environmental,
educational, nutritional, curative and
preventive..
PHYSICAL DIMENSION
 Physical dimension views health from
physiological perspective.
 It conceptualizes health that as
biologically a state in which each and
every organ even a cell is functioning at
their optimum capacity and in perfect
harmony with the rest of body.
 Physical health can be assessed at
community level by the measurement of
morbidity and mortality rates.
 MENTAL DIMENSION
 Ability to think clearly and coherently.
This deals with sound socialization in
communities. 
 Mental health is a state of balance
between the individual and the
surrounding world, a state of harmony
between oneself and others,
coexistence between the relatives of the
self and that of other people and that of
the environment.
 Mental health is not merely an absence
of mental illness.
FEATURES OF MENTALLY
HEALTHY PERSON
 Free from internal conflicts.
 Well – adjusted in the external
environment.
 Searches for one’s identity.
 Strong sense of self-esteem.
 Knows himself: his mind, problems and
goal.
 Have good self-controls-balances.
 Faces problems and tries to solve them
intellectually.
SOCIAL DIMENSION
 It refers the ability to make and
maintain relationships with other people
or communities.
 It states that harmony and integration
within and between each individuals and
other members of the society.
 Social dimension of health includes the
level of social skills one possesses,
social functioning and the ability to see
oneself as a member of a larger society.
SPIRITUAL DIMENSION
 Spiritual health is connected with
religious beliefs and practices. It also
deals with personal creeds, principles of
behavior and ways of achieving peace of
mind and being at peace with oneself.
 It is intangible “something” that
transcends physiology and psychology.
 It includes integrity, principle and
ethics, the purpose of life, commitment
to some higher being, belief in the
concepts that are not subject to “state
of art” explanation.
INDICATORS OF HEALTH
 Indicators are required not only to
measure the health status of a
community, but also to compare the
health status of one country with that of
another,
 For assessment of health care needs,
 For allocation of resources,
 For monitoring and evaluation of health
services,
 Activities and programs,
CHARACTERISTICS OF
INDICATORS
 Ideal indicators should be:
 Valid—should measure what they are
supposed to measure.
 Reliable—answer should be the same
when measured by different people in
similar circumstances.
 Sensitive—should be sensitive to the
changes in the situation concerned.
 Specific—should reflect changes only in
the situation concerned
 Feasible—should have the ability to
obtain data needed.
 Relevant—should contribute to the
understanding of the phenomenon of
interest.
CLASSIFICATION
 The indicators of health may be
classified as:
 Mortality indicators
 Morbidity indicators
 Disability rates
 Nutritional status indicators
 Health care delivery indicators
 Utilization rates
 Indicators of social and mental health
 Environmental indicators
 Socioeconomic indicators
 Health policy indicators
 Indicators of quality of life
 Other indicators
1. MORTALITY
INDICATORS
 Crude death rate:
 It is defined as number of deaths per
1000 population per year in a given
community.

 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 rate
persists.
1. MORTALITY
INDICATORS
 Infant mortality rate:
 Infant mortality rate is the ratio of
deaths under 1 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.
 Child mortality rate:
 It is defined as the number of deaths at
age 1–4 years in a given year per 1000
children in that age group at the
midpoint of the year concerned.
1. MORTALITY
INDICATORS
 Under 5 proportionate mortality rate.
 Maternal mortality rate.
 Disease-specific mortality rate.
 Proportional mortality rate.
2. MORBIDITY
INDICATORS
 The following morbidity rates are used
for assessing ill health in community.
 Incidence and prevalence.
 Notification rates.
 Attendance rates at out-patient
departments, health centres, etc.
 Admission, readmission and discharge
rates.
 Duration of stay in hospital.
 Spells of sickness or absence from work
or school
3. DISABILITY RATES
 The commonly used disability rates fall into two
groups:
 Event-type indicators.
 Work loss days, bed disability days, Number of
work loss day due to restricted activity)

 Person-type indicators.
 1. Limitation of mobility
 (Confined to bed, confined to home)
 2. Limitation of activity:
 Limitation of perform activities of daily living
e.g.
 Washing, dressing, and eating
 Sullivan’s index: This index is computed
by subtracting from the life expectancy
the probable duration of bed disability
and inability to perform major activities,
according to cross sectional data from
the population surveys.
4. NUTRITIONAL STATUS
INDICATORS
 They are:

 Anthropometric measurements of
preschool children.

 Heights of children at school entry;

 Low height indicated= Chronic
malnutrition

 Prevalence of low birth weight. Low

body Weight indicate = Acute
5. HEALTH CARE DELIVERY
INDICATORS
 The frequently used indicators are:
 Doctor-population ratio. E.g. 1; 1000
 Doctor-nurse ratio. E.g. 1;4
 Population-bed ratio. E.g. 5; 1000
 Population per health/sub center.
 E.g. , One PHC for every 30000
 Population per traditional birth
attendant.
6. UTILIZATION RATES
 Utilization of services or actual coverage
is expressed as the proportion of people
in need of a service who actually receive
it in a given period, usually a year.
 7. Indicators of Social and Mental
Health These include suicide, homicide,
other acts of violence and other crimes;
road traffic accidents, alcohol and drug
abuse, smoking, consumption of
tranquilizers and obesity.
8. ENVIRONMENTAL
INDICATORS
 Environmental indicators reflect the
quality of physical and biological
environment in which diseases occur
and in which the people live.
 They include pollution of water and air,
radiation, solid wastes, noise, and
exposure to toxic substances in food
and drink.
9. SOCIOECONOMIC INDICATORS

 These include:
 Rate of population increase
 Level of unemployment
 Family size

 10. Health Policy Indicators

 The single most important indicator of
political commitment is “allocation of
adequate resources.”
11. INDICATORS OF
QUALITY OF LIFE
 It consolidates three indicators, namely:
 Infant mortality
 Life expectancy at age one
 Literacy.

12. Other Indicators

 Social indicators,
 Basic needs indicators e.g. Food,
Housing, health, education and security
 Health for all indicators.