Slide 2:Presented by Dijo Augustine Rajagiri college of Social Sciences, Cochin, Kerala dijokaps@gmail.com


The Right to Health Services :The Right to Health Services “Everyone has the right to a standard of living adequate for health and well being of himself and his family” -Article:25 Universal Declaration of Human Rights,1948 Right to health is one of the fundamental rights of every human being to enjoy the highest attainable standard of health. Preamble:- WHO


Slide 4:When resources are limited the governments cannot provide all the needed health services. So governments (especially in developing countries) provides equal right to avail health care services.


Responsibility for health. :Responsibility for health. Individual responsibility. 2. Community responsibility. 3. State responsibility. 4. International responsibility.


Individual Responsibility :Individual Responsibility Although health is now recognize a fundamental human right, it is essentially an individual responsibility. It is now known self care.


Self Care in Health. :Self Care in Health. A recent trend in health care is self care. "self care is those health generating activities that are under taken by the persons themselves" It refers to those activities individuals undertake in promoting their own health, preventing their own disease, limiting their own illness, and restoring their own health.


Self care activities :Self care activities Diet Sleep Exercise Weight Alcohol Smoking Drugs


Slide 9:Personal hygiene Cultivation of healthful habits and life styles Selective medical examinations and screening. Accepting immunization and carrying out other specific disease prevention measures. Reporting early when sick and accepting treatment under taking measures for the prevention of relapse or of the spread of the disease to others.


Slide 10:Family Planning (Yes, an essential individual responsibility)


Community responsibility :Community responsibility Community participation in a meaningful way . This implies a more active involvement of families and communities in health matters, viz. planning, implementation, utilization, operation and evaluation of health services. The shift from health care for the people to health care by the people.


Ways of community participation :Ways of community participation The community can provide in the shape of facilities, manpower, logistic support, and possibly funds. Active involvement in planning, management, and evaluation. An equally important contribution that people can make is by joining in and using the health services.


State responsibility :State responsibility Constitution of India provides that health is a state responsibility. The relevant portions are to be found in the D.P.S.P. India is a signatory to Alma -Ata Declaration of 1978. The National Health Policy, approved by parliament in 1983 clearly indicates India's commitment to the goal of health for all by 2000 AD.


International responsibility :International responsibility National and international organizations both within and outside united nations. T.C.D.C ( Technical co operation in developing countries) ASEAN and SAARC. WHO


Indicators of Health :Indicators of Health Indicators are required not only to measure the health status of the community, but also to compare the health status of one country with another,; for assessment of health care needs; for allocation of scarce resources; and for monitoring and evaluation of health services, activities and programmes..


Slide 16:Indicators help to measure the extent to which the objectives and target of a progrmme attained.


Characteristics of indicators. :Characteristics of indicators. Valid :- they should actually measure what are supposed to measure Reliable and objective:- the answers should be the same if measured by different people in similar circumstances. Sensitive:- they should be sensitive to changes in the situation concerned. Specific:- they should reflect changes only in the situation concerned


Slide 18:No existing definition contains criteria for measuring health. This is because, health like happiness, cannot be defined in exact measurable terms. Its presence or absence is so largely a matter of subjective judgement. Health is multidimensional, and each dimension is influenced by numerous factors some are known and some are unknown. This means we must measure health multi diomensionally.


Indicators of health :Indicators of health Mortality Indicators Morbidity Indicators Disability rates Nutritional status Indicators Health care delivery Indicators Utilization rates Environmental Indicators Indicators of social and mental health Socio- economic Indicators Health policy Indicators Indicators of quality life Other Indicators


Mortality Indicators :Mortality Indicators Crude death rate. Expectation of life. Infant mortality rate. Child mortality rate. Under -5 proportionate mortality rate. Maternal ( puerperal) mortality rate. .


Slide 21:g. Disease specific mortality rate. h. Proportional mortality rate.


Morbidity Indicators :Morbidity Indicators Incidence and prevelance Notification rates Attendance 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.


Disability rates :Disability rates Event –type indicators: i) Number of days of restricted activity ii) Bed disability days iii) Work loss days Person-type indicators: i) Limitation of mobility. ii) Limitation of activity. Sullivan’s index.


Nutritional status Indicators :Nutritional status Indicators Anthropometric measurements of preschool children, e.g. weight and height, mid- arm circumference; Heights ( and some times weights) of children at school entry. Prevalence of low birth weight.


Health care delivery Indicators :Health care delivery Indicators Doctor- population ratio Doctor -nurse ratio Population- bed ratio Population per health centre Population per traditional birth attendant


Utilization rates :Utilization rates Utilization of services expressed as the proportion of people in need of a service who actually receive it in a given period. ex. Proportion of infants who are fully immunized. Percentage of the population using the various methods of family planning.


Indicators of social and mental health :Indicators of social and mental health These include suicide, homicide, other acts of violence and other crime; road traffic accidents, juvenile delinquency, alcohol and drug abuse; smoking consumption of tranquilizers, obesity, etc. These social indicators provide a guide to social action for improving the health of the people.


Environmental Indicators :Environmental Indicators Quality of physical and biological environment in which the people live. They include indicators relating to pollution of air and water, radiation, solid wastes, noise, exposure to toxic substances in food or drink.


Socio- economic Indicators :Socio- economic Indicators Rate of population increase Per capita GNP Level of unemployment Dependency ratio Literacy rates, especially female literacy rates Family size


Slide 30:Housing: the number of persons per room Per capita "calorie" availability


Health policy Indicators :Health policy Indicators Proportion of GNP spent on health services Proportion of GNP spent on health related activities (including water supply and sanitation, housing and nutrition, community development) Proportion of total health resources devoted to primary health care.


Indicators of quality life :Indicators of quality life Primarily it consists of three elements Infant mortality Life expectancy at age one Literacy


Other Indicators :Other Indicators a) Social indicators:- i. Population ii. Family formation, families and house holds, learning and educational services, earning activities, distribution of income, consumption and accumulation, social security and welfare services, health services and nutrition, housing and its environment etc.


Slide 34:b) Basic needs indicators :- Calorie consumption, access to water, life expectancy, deaths due to disease, literacy, doctors and nurses per population, rooms per person GNP and per capita income


Health Status measurement :Health Status measurement


Natural History of Disease :Natural History of Disease


Prepathogenesis phase :Prepathogenesis phase It is the preliminary period to the onset of disease in man. The disease agent has not yet entered man, but the factors which favor it’s interaction with the human host are already existing in environment.


Causative factors :Causative factors Agent Host Enviornment


Pathogenesis Phase :Pathogenesis Phase It begins with the entry of the disease agent in the susceptible human host. The further events in the pathogenesis phase are clear cut in infectious diseases, ie., the disease agent multiplies and induces tissue and physiologic changes, the disease progress through a period of incubation and later through early and late pathogenesis.


Slide 40:The final outcome of the disease may be recovery, disability or death. The pathogenesis phase may be modified by intervention measures such as immunization and chemotherapy.


Agent :Agent


Agent factors :Agent factors The first link in the chain of disease transmission is a disease agent. The disease agent is defined as a substance, living or non-living, or a force, tangible or intangible the excessive presence or relative lack of which may initiate or perpetuate a disease process.


Biologic agents :Biologic agents Living agents of disease, viz. viruses, fungi, bacteria, prozota and metazoa. i. infectivity ii. Pathogenicity iii. virulence


Nutrient agents :Nutrient agents Proteins, fats, carbohydrate, Vitamins, minerals, and water. Any excess or deficiency of the intake of nutritive elements may result in nutritional disorders.


Physical agents :Physical agents Exposure to excessive heat, cold, humidity, pressure, radiation, electricity, sound, etc may result in illness.


Chemical agents :Chemical agents Endogenous: Chemicals produced inside the human body as a result of derangement of function, e.g., urea (uraemea), serum bilirubin ( jaundice), ketones ( ketosis), uric acid (gout), calcium carbonate (kidney stone) Exogenous: Agents arising outside of human host, e.g., allergens, fumes, dust etc.


Mechanical agents :Mechanical agents Exposure to chronic friction and other mechanical forces may result in crushing, tearing, sprains, dislocations and even death.


Absence/insufficiency/excess of a factor necessary to health :Absence/insufficiency/excess of a factor necessary to health Chemical factors: Hormones, Enzymes Nutrient factors: fats, proteins, carbohydrates, water Lack of structure: e.g. cardiac defects Chromosomal factors. Immunological factors.


Social agents :Social agents i. Poverty, smoking, abuse of drugs and alcohol, unhealthy life styles, social isolation, maternal deprivation.


Host :Host


Host factors ( intrinsic) :Host factors ( intrinsic) In epidemiological terminology, the human host is referred to as “soil” and the disease agent as seed. Demographic Biological Social and economic Life style factors.


Environment :Environment


Environment factors ( Extrinsic) :Environment factors ( Extrinsic) Physical environment. Biological environment. Psychological environment.


Iceberg of disease :Iceberg of disease According to this concept disease in a community may be compared with an iceberg. The floating tip of the ice berg represents what the physician sees in the community. The vast submerged portion of the iceberg represents the hidden mass of diseases.


Thank you :Thank you