Medicine and Social Sciences

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Concept of Health and Disease:

Concept of Health and Disease Health – WHO Definition- Health is a state of complete physical, mental and social wellbeing and not merely an absence of disease or infirmity. Dimensions of Health - Physical- all organs are functioning at optimum level and in perfect harmony with the rest of the body.

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- Mental – a 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 the other people and that of the environment. Psychological factors can induce all kinds of illnesses like essential hypertension, peptic ulcer, bronchial asthma, etc.

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-Social – Quantity and quality of an individuals interpersonal ties and the extent of involvement with the community. Rooted in- - Positive Material Environment-focusing on financial and residential matters, and - Positive Human Environment, concerned with social network of the individual.

Concept of Wellbeing:

Concept of Wellbeing Concept of wellbeing that can be assessed subjectively and objectively. Objectively - assessment is standard of living. Measured easily. Subjectively - assessment is Quality of life.

Standard of Living:

Standard of Living Refers to the usual scale of expenditure, the goods we consume and the services we enjoy. It also includes level of education, employment, food, dress, house, amusement, etc. Measured or evaluated by comparison of per capita GNP usually in US$.

Quality of life:

Quality of life The condition of life resulting from the combination of the effects of the complete range of factors such as those determining health, happiness (including comfort in physical environment and a satisfying occupation), education, social and intellectual attainments, freedom of action, justice and freedom of expression. It can be evaluated by assessing a person’s subjective feelings of happiness or unhappiness about various life concerns. A rise in the standard of living of the people is not enough to achieve satisfaction or happiness

Physical Quality of life Index:

Physical Quality of life Index It is an attempt to measure Quality of Life It is derived from following indicators Infant mortality Rate Life Expectancy at age one Literacy It has not taken GNP in consideration as ‘Money is not every thing’. It measures the result of Social, Economic and Political Policies.

Human Development Index:

Human Development Index Is a composite of index combining indicators representing three dimensions Longevity- life expectancy at birth Knowledge- Adult Literacy Rate Mean Years of Schooling Income-Real GDP Per Capita in purchasing power Parity (PPP) in US $ It looks beyond income and treats income as a proxy for a decent standard of living Gives a more comprehensive picture than just income.

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Possible Human Development Index value ranges from 0 – 1. Minimum and maximum values are established for each indicator- Life Expectancy at Birth =25-85 years Adult Literacy Rate= 0-100 percent Combined Gross Enrollment Ratio = 0-100 percent Real GDP per capita =$100-$40,000

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Individual indices can be computed by general formula- Index=(actual value)-(minimum value)/(Maximum value)-(Minimum value) Using 2005 figures- Life Expectancy at birth for India = 63.7 years Life Expectancy Index = 63.7 – 25 / 85- 25 = 38.7 / 60 = 0.645

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Education Index is calculated by combining Adult Literacy Index and Combined Gross Enrollment Index Adult Literacy Index = 61.0 – 0 / 100 – 0 = 61/100 = 0.61 Combined Gross Enrollment Index =63.8-0 / 100-0 = 0.638 Education Index =(0.61*2/3) + (.638*1/3) = 0.62

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GDP Index is calculated by using Adjusted GDP Per Capita (PPP in US $ for India is $3452) GDP Index = (log 3452 – log100) / (log40,000 – log 100)= 0.591 Human Development Index is average of above 3 indices = (0.645 + 0.62 + 0.591)/3 = 1.856/3 = 0.619 Out of 177 countries in 2005 India was 128 Iceland, Norway and Australia were on the top of HDI, and Sierra Leon, Niger and Burkina Faso were at the bottom.

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Human Development Index 0.80 or more – 70 countries 0.5 - .799 – 85 countries Less than 0.5 – 22 countries

Human Poverty Index:

Human Poverty Index HDI measures average achievements in basic dimensions of human development; HPI measures deprivation in those dimensions. HPI-1 for developing countries HPI-2 for developed countries.


HPI-1 A long and healthy life- probability at birth of not surviving to age 40 Knowledge- Adult illiteracy rate A decent standard of living- Unweighted average of - % of population not using an improved water source and % of children under weight for age.

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Formula used for HPI-1 is- HPI-1=[1/3(P 1 a +P 2 a +P 3 a )] 1/a Where - P 1 =Probability at birth of not surviving to age 40 (times 100) = 16.8 P 2 = Adult illiteracy rate=39.0 P 3 = unweighted average of population not using an improved water source and children under weight-for-age=30.5 Putting these in formula =31.3%

HPI-2 Developed Country:

HPI-2 Developed Country 4 dimensions-Probability at birth of not surviving to age 60 Adult illiteracy rate Percentage of people living below the income poverty line (50% of the median adjusted household disposable income) Social Exclusion - rate of long term unemployment (12 months or more)

Spectrum of Health:

Spectrum of Health Positive Health Better Health Freedom from sickness --------------------------------------------- Unrecognized sickness Mild Sickness Severe sickness Death

*Determinants of Health:

*Determinants of Health Health of individuals and whole communities may be considered to be the result of many interactions

1. Biological Determinants:

1. Biological Determinants Genetic makeup OR Karyotype A number of diseases are genetic in origin, Chromosomal Anamolies Mental Retardation Types of Diabetes

2. Behavioral & Sociocultural conditions:

2. Behavioral & Sociocultural conditions Lifestyles are learnt through social interactions with parents, peer groups, friends, siblings Through School and mass media Smoking, alcoholism, drug addiction; diseases like coronary heart disease, obesity, lung cancer are associated with life style changes

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Adequate nutrition, enough sleep, sufficient physical activity, etc. are good lifestyle Healthy lifestyle leads to Optimum Health

3. Environment:

3. Environment Factors like housing, water supply, psychosocial stress, Family structure, social & economic support system, Organization of health & social welfare services have a direct impact on the physical, social and mental health or wellbeing of those living in it.

4 Socio-economic Condition:

4 Socio-economic Condition Per capita GNP / economic status Education Nutrition Employment Housing Political System

a. Economic Status:

a. Economic Status Per capita GNP is directly related to- Decrease in morbidity Increase in life expectancy Improving Quality of Life Upper Socioeconomic groups have more- Coronary heart disease Diabetes Obesity

b. Education:

b. Education Education to some extent, compensates the effect of Poverty on health, irrespective of the availability of health facility. Kerala IMR is 12 Female Literacy is 88% India IMR is 50 female literacy is 54%

c. Occupation:

c. Occupation Unemployed have higher incidence of ill health and death

d. Political System:

d. Political System India spends 3% of its GNP on health and family welfare WHO has set a target of 5% or more for Health for All (HFA)

5 Health Services:

5 Health Services The purpose of health service is to improve the health status of the population. To be effective the health services must – Reach the social periphery Be equitably distributed Be accessible at a cost the country and community can afford Be socially acceptable Are pertinent only if they improve health

6 Aging of the population:

6 Aging of the population By 2020 the world will have more than one billion people over 60 This will cause increased prevalence of chronic diseases and disabilities.

7 Gender:

7 Gender 1993 Global Commission on women’s health was established It focused on Nutrition, Reproductive health, Life Style Conditions, Occupational Environment & Increased Awareness among Policy Makers of women’s health issues

8. Other Factors:

8. Other Factors Revolution in information & communication technology Health Related Systems Food and Agriculture Education Industry Social Welfare Rural Development Medicine is not the sole contributor to the health and well being of the population. That is why we need Intersectoral Coordination.

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