Health Definition & Dimensions Dr. HARIVANSH CHOPRA PROFESSOR COMMUNITY MEDICINE LLRM MEDICAL COLLEGE MEERUT harichop@gmail.com The objective of this presentation is to: Discuss various definitions of health, and To learn about the dimensions of health.

OBJECTIVE TO LEARN DEFINITIONS OF HEALTH TO LEARN DIMENSIONS OF HEALTH 25-Mar-17 DR.HARIVANSH CHOPRA

Health: Definition Webster: The condition of being sound in body, mind or spirit, especially freedom from physical disease or pain. Body: Physical health Mind: Mental health Spirit: Spiritual health Webster’s Dictionary defines health as “a condition of being sound in body, mind or spirit, especially freedom from physical disease or pain. The definition implies three dimensions of health namely physical health that is related to body; mental health that is related to mind and spiritual health that is related to spirit. 25-Mar-17 DR.HARIVANSH CHOPRA

Health: Definition Oxford English Dictionary: Soundness of body or mind, that condition in which its functions are duly and efficiently discharged. Body: Physical health Mind: Mental health Efficient functioning Oxford Dictionary defines health as “soundness of body or mind, and that condition in which its functions are duly and efficiently discharged. It considers health in its two dimensions namely, physical and mental. Efficient functioning on these two dimensions is considered as essential pre-requisite for health. 25-Mar-17 DR.HARIVANSH CHOPRA

Health: Definition Perkins: Relative equilibrium of body form and function which results from its successful dynamic adjustment to forces tending to disturb it. Body form : Anatomy Body function : Physiology Health : Interaction of body to environment Perkins defines health as a “relative equilibrium of body form and function which results from its from its successful dynamic adjustment to forces tending to disturb it.” Here, health is considered as resultant of dynamic interplay between the individual and factors that tend to disturb the equilibrium. These factors are presumably, the environmental factors. Another highlight of this definition is that it considers two aspects of health; anatomical and physiological. 25-Mar-17 DR.HARIVANSH CHOPRA

Health: Definition Dubos A modus vivendi enabling imperfect men to achieve a rewarding and not too painful existence while they cope with an imperfect world Coping with imperfect world = Interaction with environment Dubous defines health as the “modus vivendi enabling imperfect men to achieve a rewarding and not too painful existence while they cope with an imperfect environment.” Like precious definition, this definition stresses the importance of environment and the person. “Imperfect environment” points to the manmade and natural changes in the environment. 25-Mar-17 DR.HARIVANSH CHOPRA

Health: Definition World Health Organization It is a state of complete physical, mental and social wellbeing and not merely absence of disease or infirmity. Mere absence of disease is NOT Health Three dimensions of health Complete wellbeing on three dimensions Fourth dimension ‘spiritual’ now added World health organization defines health as “state of complete physical, mental and social weebeing and not merely absence of disease or infirmity.” The definition makes it clear that mere absence of disease is not to be equated to health. Health is thus some thing more and different than the mere absence of disease or infirmity (disability) WHO considers health in three dimensions : physical, mental and social. Complete wellbeing on these three dimensions (and not one or two) is equated with health. Spiritual dimension has been added to the list recently. 25-Mar-17 DR.HARIVANSH CHOPRA

Health: Definition Only four dimensions considered (emotional & vocational omitted) Too idealistic, not reachable in practice Health considered as “a state” i.e. a static entity. (In practice it is a dynamic concept) “Ability to lead socially & economically productive life” is also now added to this definition. The major criticisms on the definition given by WHO are: It does not consider emotional and vocational dimensions. It apperas to be too idealistic to be reachable in practice. Health is considered as ‘a state’ i.e. a static entity. We know that health is the result of dynamic interplay between the individual and environment. WHO now considers health as an ability to lead socially and economically productive life. This highlights the link between health on one side and social and economic development on the other side. 25-Mar-17 DR.HARIVANSH CHOPRA

Dimensions of Health Physical Vocational Mental Social Emotional Health can be considered to have six dimensions: physical, mental, social, spiritual, emotional and vocational. Spiritual 25-Mar-17 DR.HARIVANSH CHOPRA

Physical Dimension Individual level Group (Community) Level Most of the dimensions of health can be measured at individual and community level. Physical dimension of health is most easily understood and is comparatively easy to measure. Easily understood & measurable 25-Mar-17 DR.HARIVANSH CHOPRA

Physical Dimension: Individual level Every organ of ‘normal’ shape and size Every organ & system functions at optimum level Individually & in coordination E/o growth in children At individual level physical health means; Every organ in the body is of ‘normal’ shape and size. Every cell, organ and system functions at optimum level. The systems and organs not only function optimally individually, but also in coordination with other system. In children, there must be an evidence of ‘normal’ growth and development. 25-Mar-17 DR.HARIVANSH CHOPRA

Physical Dimension Community Level Indicated by the indicators of: Morbidity Mortality Fertility Disability At community level the physical health can be measured by: Morbidity indicators Mortality indicators Fertility indicators, and Disability indicators. 25-Mar-17 DR.HARIVANSH CHOPRA

Mental Dimension Individual level Group (Community) Level Mental dimensions can be considered at individual and community level. 25-Mar-17 DR.HARIVANSH CHOPRA

"a state of balance between the individual and the surrounding world, a state of harmony between oneself and others, a coexistence between the realities of the self and that of other people and that of the environment" 25-Mar-17 DR.HARIVANSH CHOPRA

a. a mentally healthy person is free from internal conflicts; he is not at "war" with himself. 25-Mar-17 DR.HARIVANSH CHOPRA

b. he is well-adjusted, i. e b. he is well-adjusted, i.e., he is able to get along well with others. He accepts criticism and is not easily upset. 25-Mar-17 DR.HARIVANSH CHOPRA

c. he searches for identity. d. he has a strong sense of self-esteem. 25-Mar-17 DR.HARIVANSH CHOPRA

e. he knows himself: his needs, problems and goals (this is known as self-actualization). 25-Mar-17 DR.HARIVANSH CHOPRA

f. he has good self-control-balances rationality and emotionality. g. he faces problems and tries to solve them intelligently, i.e., coping with stress and anxiety. 25-Mar-17 DR.HARIVANSH CHOPRA

Mental Dimension Individual Level Perception Confidence Self control Decision making Meaningfulness Coordination At individual level the measurement of mental health is done with the aspects like: Perception, confidence, self control, decsion making and cooordination. 25-Mar-17 DR.HARIVANSH CHOPRA

Perception Correct perception of own Abilities: Neither underestimates nor overestimates Emotions & feelings Strengths & weaknesses By perception we mean that the person has correct perception of his abilities, emotions and strengths. He would thus neither underestimate nor overestimate himself. He understands emotions and feelings. He has correct judgement of own strengths and weaknesses. 25-Mar-17 DR.HARIVANSH CHOPRA

Right decision at right moment Realistic goals & ambitions Decision making Right decision at right moment Realistic goals & ambitions Meaningfulness Leading life with ‘purpose’ Dependable Person can make right decision at right time. He has realistic goals and ambitions. He has goals, so he leads life with purpose. Others can depend on him. 25-Mar-17 DR.HARIVANSH CHOPRA

Neither overconfident Nor under confident Self control Confidence in : Own abilities Own strengths Neither overconfident Nor under confident Self control Does not loose control easily Controls emotions Faces frustration & conflict gracefully Coordination Leading life harmoniously with others Adjusting with others Rare conflicts The person has confidence in his own abilities and strengths. He is neither over confident nor under-confident. He does not loose control easily. He can control his emotions and can face frustration and conflict gracefuly. He can lead life harmoneously and can adjust with others. He is rarly in conflict with others. 25-Mar-17 DR.HARIVANSH CHOPRA

Mental Health Community Level Indicators: Suicides Homicides Drug dependence Offences related to women & children Morbidity due to mental illnesses Morbidity due to psychosomatic illnesses At community level the measurement of mental health is done with indicators like: Suicide rate, homicide rate, drug dependence, offences related to women and children, morbidity due to mental illnesses, and morbidity due to psychosomatic illnesses. 25-Mar-17 DR.HARIVANSH CHOPRA

Social Dimension Individual level Group (Community) Level Social dimension can also be considered at individual and community level. 25-Mar-17 DR.HARIVANSH CHOPRA

Social dimension It has been defined as the "quantity and quality of an individual's interpersonal ties and the extent of involvement with the community" 25-Mar-17 DR.HARIVANSH CHOPRA

Social Health Individual Level Development of Social skills & functions (Socialization) Performance of ‘roles’ Education, Occupation Economic status At individual level, the social health of the individual can be assessed by the development of social skills and knowledge. Sociologists call it as a process of ‘socialization.” Each individual is required to perform certain ‘social roles’ like father, son, teacher, student. There are norms and standards for these roles. These are called as ‘role expectations’ Role performance of a person is assessed against these role expectations. Educational status, occupation and economic status of the individual are some of the objective indicators of assessment of ‘social status’ of an individual. 25-Mar-17 DR.HARIVANSH CHOPRA

Social Health Community Level Equity in distribution of resources Indicators: Per capita GDP Literacy rates Status of women Employment / unemployment At community level the indicators used to assess the social status of a community are: GDP, GNP, Literacy rates, Indicators of the status of women, unemployement rates etc. 25-Mar-17 DR.HARIVANSH CHOPRA

Spiritual Dimension Most difficult dimension to explain & quantify Includes such aspects like: Ethics Principles Integrity Relates to certain informal social controls like Hippocrates’s Oath for doctors. Spiritual dimension of health is most difficult to explain and assess. It relates to the part of individual that reaches out and strives for meaning and purpose in life. It includes such aspects as ethics, principles and integrity. These also relate to certain informal social controls like Hippocrates’s oath for doctors. 25-Mar-17 DR.HARIVANSH CHOPRA

Spiritual Dimension 1 who am I ? 2 what do I want ? 3 what is the purpose of life ? 4 how this purpose can be fulfilled ? 25-Mar-17 DR.HARIVANSH CHOPRA

Emotional Dimension Emotion: Sudden forces of feelings emerging in mind Types: Positive: Love, Joy Negative: Hatred, Sadness, Dejection Expression of correct emotion, at correct place, in controlled form = Emotional health Emotions are sudden forces of feelings that emerge in mind. These are of two types: Positive and negative. Feeling of love, joy, affection are the examples of positive affection. Negative emotions include those like hatred, sadness, dejection etc Expression of correct emotion, at correct time/ place in controlled form is equated with emotional health. 25-Mar-17 DR.HARIVANSH CHOPRA

Emotional Dimension Common forms of emotional disturbances: Anxiety: Inability to concentrate, insomnia Depression: Sadness, dejection , suicidal tendency Mood swings: Sadness / joy on trivial incidences, sometimes hostile Common forms of emotional disturbances are: Anxiety: This is indicated by inability to concentrate and insomnia. Physical indicators include rise in pulse rate and BP, perspiration and tachypnea. Depression is indicated by sadness, dejection, loss of interest, suicidal tendency. In mood swings person shows sadness or joy on trival instances. Some times he may become hostile. 25-Mar-17 DR.HARIVANSH CHOPRA

Vocational Dimension Concerned with job Job & person ‘made for each other’. Expression of frustration, unhappiness over job Frequent changes in job Maladjustment with job Occupational disorders Vocational dimension is concerned with job. If job and person look to be made for each other we can say that the person is enjoying good vocational health. Poor vocational health is indicated by: frequent changes of job, maladjustment with the job and occupational disorders. 25-Mar-17 DR.HARIVANSH CHOPRA

CONCLUSION HEALTH IS TO BE UNDERSTOOD IN PHYSICAL ,MENTAL, SOCIAL,AND SPRITUAL CONTEXT. IT IS NOT STATIC . IMPORTANCE OF HEALTH IS NOT REALISED TILL IT IS LOST . 25-Mar-17 DR.HARIVANSH CHOPRA