CONCEPT OF HEALTH: DIMENSIONS, DETERMINANTS, AND INDICATORS – A TEACHER’S COMPREHENSIVE GUIDE
Welcome, future pharmacists and healthcare professionals!
The concept of health has evolved significantly over the years. Traditionally, health was viewed simply as the absence of disease. However, the modern understanding of health is far more comprehensive. The World Health Organisation (WHO) defined health as, “a state of complete physical, mental, and social well-being and not merely an absence of disease or infirmity.” This definition, adopted in 1948, revolutionized the way we think about health and healthcare. World Health Day is celebrated globally every year on 7th April to commemorate the founding of WHO.
As a pharmacy educator with years of experience teaching Social Pharmacy, I have observed that students often equate health with the absence of illness. However, health is a multidimensional concept that encompasses physical, mental, social, and spiritual well-being. Understanding the concept of health is essential for every pharmacist because it shapes how we approach patient care, public health, and community engagement. In this comprehensive guide, I will walk you through the dimensions, determinants, and indicators of health. Let us begin our journey.
Dpharmguru’s exam insights:
The concept of health is one of the most frequently tested topics in social pharmacy exams. Remember: WHO defines health as complete physical, mental, and social well-being—not merely absence of disease. World Health Day is celebrated on 7th April annually. The National Health Programme was declared in 1983. Understanding the dimensions, determinants, and indicators of health is essential for every pharmacist!
NATIONAL HEALTH PROGRAMME, 1983
The National Health Programme was declared by the Indian Government in 1983 with the following aims:
- To provide proper health services for checking infectious diseases.
- To establish health sub-centres, primary health centres, and community health centres having trained manpower.
- To provide proper treatment measures in rural and sub-rural areas.
- To conduct vaccination programmes.
Dpharmguru’s exam insights:
The National Health Programme, 1983 is frequently tested. Remember the four aims: (1) Check infectious diseases, (2) Establish health centres with trained manpower, (3) Treatment in rural areas, (4) Vaccination programmes. This laid the foundation for India’s primary healthcare system.
NEW PHILOSOPHY OF HEALTH
The new philosophy of health can be expressed through the following principles:
- Health is a fundamental human right.
- Health is the core of productive life—not the result of increasing expenditure on medical care.
- Health is intersectoral (non-comparable)—it requires collaboration across multiple sectors.
- Health is an integral part of development.
- Health is central to the concept of quality of life.
- Health involves individual, state, and international responsibility.
- Health and its maintenance is a major social investment.
- Health is a social goal throughout the world.
DIMENSIONS OF HEALTH
The World Health Organisation in 1948 recognised some parameters for measuring an individual’s functionality. WHO has identified the following 4 dimensions of health:
1. Physical Health
Physical health is defined as a state indicating perfect functioning of the body. Signs of physical health include:
- Regular activity of bowel and bladder.
- Smooth and easy coordinated movements.
- Normal size and functioning of all organs.
- Normal pulse rate, blood pressure, and body weight as per age and sex.
2. Mental Health
Mental health is defined as a state of balance between the individual and the surrounding world. Characteristics of a mentally fit individual include:
- No internal conflicts.
- Well-adjusted with the surroundings.
- Strong sense of self-esteem and identity.
- Knows their own needs, problems, and goals.
- Good self-control.
- Tries to solve problems intelligently.
3. Social Health
Social health is defined as the quantity and quality of an individual’s interpersonal relationships and the extent of involvement with the community. It indicates:
- Harmony and integration within the individual.
- Harmony between the individual and other members of society.
- Harmony between the individual and the surrounding world.
4. Spiritual Health
Spiritual health is defined as a personal matter involving values and beliefs that provide purpose in an individual’s life. It is the connecting link between physiology and psychology. It includes:
- Integrity, principles, and ethics.
- Purpose in life.
- Commitment to some higher being.
- Belief in concepts not subject to “state-of-the-art” explanation.
Dpharmguru’s exam insights:
The four dimensions of health—Physical, Mental, Social, and Spiritual—are frequently tested. Remember: Physical health is about perfect body functioning; Mental health is about balance with the environment; Social health is about interpersonal relationships; Spiritual health is about values and purpose. The WHO definition emphasizes physical, mental, and social well-being—spiritual health was added later by scholars.
DETERMINANTS OF HEALTH
There are many factors which affect the health of individuals and communities in a combined form. The circumstances and environment of an individual determine whether or not he/she is healthy. The factors influencing health (either positively or negatively) are known as the determinants of health. The World Health Organisation has identified the following 12 determinants of health:
1. Income and Social Status
As income and social hierarchy increases, the health of an individual improves. Living conditions like safe housing and ability to buy good food are determined by high income. Those individuals having prosperous and equitable distribution of wealth are considered the healthiest populations.
2. Employment
Poor health arises due to unemployment, underemployment, and working under stressed conditions. Individuals are comparatively healthy if they can control their work conditions and have relatively few stress-related job demands.
3. Education
Health of an individual is also determined by education level. Education increases opportunities for income and job security, and provides a sense of control over life circumstances. Low education levels often result in poor health, more stress, and lower self-confidence.
4. Social Environment
Values and norms of a society also affect an individual’s health and well-being. Social stability, diversity recognition, safety, good working relationships, and cohesive communities establish a supportive society that reduces potential risks to good health.
5. Physical Environment
Air and water quality are physical factors in the natural environment which impact health. Housing, workplace safety, and road design are factors in the human-built environment which also show important influences.
6. Healthy Child Development
The effect of pre-natal and early childhood experiences has a very powerful impact on health, well-being, coping skills, and competence. Children born in families having low income have low birth weights, eat less nutritious food, and have more difficulty in school.
7. Personal Health Practices and Coping Skills
Health is greatly influenced by eating a balanced diet, being active, smoking, drinking, and the way of dealing with life’s stresses and challenges.
8. Health Services
Health is also influenced when an individual makes use of the services provided for preventing and treating diseases.
9. Social Support Networks
Better health results from support provided by families, friends, and communities. Responding effectively to stress conditions and having family and friend support provides a caring and supportive relationship that acts as a buffer against health problems.
10. Biology and Genetic Endowment
Inheritance determines lifespan, healthiness, and probability of developing certain illnesses.
11. Gender
Men and women at different ages suffer from different types of diseases.
12. Culture
Culture is defined as all the ways of life including arts, beliefs, and institutions of a population passed down from generation to generation. Health is influenced by customs, traditions, and beliefs of family and community.
Dpharmguru’s exam insights:
The 12 determinants of health are frequently tested. Remember them using the mnemonic “I E S P H P S B G C” – Income, Employment, Social Environment, Physical Environment, Healthy Child Development, Personal Health Practices, Health Services, Social Support Networks, Biology/Genetics, Gender, Culture. These determinants show that health is influenced by far more than just medical care!
INDICATORS OF HEALTH
A health indicator is a direct or indirect measure of an individual, group, or environment’s health characteristics such as quality, quantity, and time. The status of health can be measured using the following indicators:
1. Mortality Indicators
- Crude Death Rate: Number of deaths per 1000 population per year. A fair indicator for comparing health of individuals.
- Life Expectancy: Average number of years a newborn will live. A good indicator of socio-economic development and a global health indicator.
- Infant Mortality Rate: Ratio of deaths occurring in infants in a given year to the number of live births, expressed per 1000 live births.
- Child Mortality Rate: Number of deaths of 1-4 years old children per 1000 children of the same age group.
- Under-5 Proportionate Mortality Rate: Proportion of total deaths of children below 5 years of age—a combination of infant and child mortality rates.
- Maternal Mortality Rate: Proportion of deaths of women of reproductive age; varies with socio-economic status.
- Disease-specific Mortality: Mortality rates determined for specific diseases.
- Proportional Mortality Rate: Proportion of all deaths attributed to a specific cause; the simplest indicator for estimating burden of disease.
2. Morbidity Indicators
Morbidity indicators concern the rate of disease in a population. They are used for improving mortality data to properly describe health status, especially in cases of mental illness, rheumatoid arthritis, asthma, epilepsy, etc.
- Incidence and occurrence.
- Attendance rates in out-patient departments and health centres.
- Rates of admission, re-admission, and discharge.
- Stay duration in hospitals.
- Spell of sickness or absence from work or school.
- Notification rates.
3. Disability Rates
Disability rates are used for increasing mortality and morbidity indicators. Sullivan’s Index indicates life expectancy free of disability, calculated by subtracting the probable period of bed disability and inability to perform major activities from life expectancy.
4. Nutritional Status Indicators
- Anthropometric measurements of pre-school children (weight, height, mid-arm circumference).
- Height and weight of children at school entry.
- Occurrence of low birth weight (less than 2.5 kg).
5. Healthcare Delivery Indicators
- Doctor: Population ratio.
- Doctor: Nurse ratio.
- Population: Hospital bed ratio.
- Population covered by a health centre.
- Population per traditional birth attendant.
6. Utilisation Rates
- Proportion of infants fully immunised against the 6 diseases (tetanus, diphtheria, whooping cough, polio, tuberculosis, measles).
- Proportion of pregnant women receiving proper pre-natal care.
- Rate of bed occupancy in hospitals.
- Population percentage using family planning methods.
7. Indicators of Social and Mental Health
These include rates of suicides, homicides, juvenile delinquency, alcohol or drug abuse, smoking, road traffic accidents, family violence, battered-baby and battered-wife syndromes. These indicators provide guidance for social action, thus aiding in improving health status.
8. Environmental Indicators
These indicators describe the quality of physical and biological environment—air and water pollution, radiation, solid wastes, noise, exposure to toxic substances in food and drinks, etc.
9. Socio-economic Indicators
- Rate of population increase.
- Unemployment level.
- Dependency ratio.
- Literacy rate.
- Family size.
- Housing (number of persons per room).
- Per capita availability of calories.
10. Health Policy Indicators
A most essential health policy indicator is allocation of adequate resources by a healthcare government. This includes the proportion of GNP (Gross National Product) spent on health services, health-related activities (water supply, sanitation, housing, nutrition), and on primary healthcare.
11. Health for All Indicators
WHO introduced four indicators for monitoring progress towards the goal of “Health for All by 2000 AD”:
- Health policy indicators.
- Social and economic indicators related to health.
- Indicators for provision of healthcare.
- Health status indicators.
Dpharmguru’s exam insights:
Health indicators are frequently tested. Remember the 11 types: Mortality (death rates), Morbidity (disease rates), Disability, Nutritional Status, Healthcare Delivery, Utilisation Rates, Social/Mental Health, Environment, Socio-economic, Health Policy, and Health for All indicators. Pay special attention to Infant Mortality Rate, Life Expectancy, and Maternal Mortality Rate—these are key global health indicators!
COMPARISON: DIMENSIONS, DETERMINANTS, AND INDICATORS OF HEALTH
| Aspect | Dimensions of Health | Determinants of Health | Indicators of Health |
|---|---|---|---|
| Definition | Parameters measuring individual functionality | Factors influencing health | Measures of health status |
| Number | 4 (Physical, Mental, Social, Spiritual) | 12 | 11 types |
| Focus | Individual well-being | Social, economic, environmental factors | Population health status |
| Examples | Physical functioning, mental balance, social harmony, spiritual purpose | Income, education, environment, genetics | Mortality rates, morbidity rates, utilisation rates |
FREQUENTLY ASKED QUESTIONS (FAQs)
1. What is the WHO definition of health?
WHO defines health as “a state of complete physical, mental, and social well-being and not merely an absence of disease or infirmity.” World Health Day is celebrated on 7th April annually.
2. What are the four dimensions of health?
The four dimensions of health are: Physical Health (perfect body functioning), Mental Health (balance with environment), Social Health (interpersonal relationships), and Spiritual Health (values and purpose).
3. What are the determinants of health?
Health is determined by 12 factors: Income and Social Status, Employment, Education, Social Environment, Physical Environment, Healthy Child Development, Personal Health Practices, Health Services, Social Support Networks, Biology and Genetics, Gender, and Culture.
4. What is Infant Mortality Rate?
Infant Mortality Rate (IMR) is the ratio of deaths occurring in infants in a given year to the number of live births in the same year, expressed per 1000 live births.
5. What is Life Expectancy?
Life Expectancy is the average number of years a newborn will live in a population if the current age-specific mortality rates persist. It is a good indicator of socio-economic development.
6. What is the National Health Programme, 1983?
The National Health Programme was declared by the Indian Government in 1983 with the aims of providing proper health services, establishing health centres with trained manpower, providing treatment in rural areas, and conducting vaccination programmes.
7. What are the four indicators for “Health for All”?
WHO introduced four indicators for monitoring progress towards “Health for All by 2000 AD”: Health policy indicators, Social and economic indicators, Indicators for provision of healthcare, and Health status indicators.
SUMMARY
The concept of health has evolved from a narrow focus on the absence of disease to a comprehensive understanding of physical, mental, social, and spiritual well-being. The WHO definition of health as “a state of complete physical, mental, and social well-being” remains the gold standard for understanding health globally.
The dimensions of health (Physical, Mental, Social, and Spiritual) provide a framework for assessing individual well-being. The determinants of health (income, education, environment, etc.) remind us that health is influenced by far more than just medical care. The indicators of health (mortality, morbidity, disability, etc.) provide tools for measuring and monitoring population health.
As I always tell my students: “Health is not just the absence of disease—it is a state of complete well-being that requires attention to physical, mental, social, and spiritual aspects. Understanding the concept of health is the first step towards becoming a holistic healthcare provider.”
REFERENCES AND FURTHER READING
- World Health Organization (WHO). (2022). Constitution of WHO: Principles of Health. Retrieved from https://www.who.int.
- World Health Organization (WHO). (2022). Health Indicators and Health Determinants. Retrieved from https://www.who.int.
- Ministry of Health and Family Welfare. (2022). National Health Policy. Government of India.
- Park, K. (2022). Park’s Textbook of Preventive and Social Medicine (25th ed.). Banarasidas Bhanot Publishers.
- International Pharmaceutical Federation (FIP). (2022). Social Pharmacy Guidelines. Retrieved from https://www.fip.org.
Disclaimer: This article is for educational purposes only and does not constitute medical advice. Always consult qualified healthcare professionals for medical concerns.
written by:
Dr. N. Sujith Kumar
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