UNIT 1: INTRODUCTION TO HEALTH

Define health and optimum health

Health
Health is a state of complete physical, mental and social wellbeing and not merely absence of
disease or infirmity.
-WHO(1946)
Health is a state of being well and free from illness in the body and mind.
-Oxford English Dictionary.
The definition of health is changed from each society, family and individual. Many factors
influence definition of health like economic status, level of education, food availability of health
services, etc.

Optimum Health
A person who is physically, mentally, socially and spiritually healthy is said to be in state of
optimum health. Optimum health means the best physical, mental, social and spiritual health that
can be achieved.
Health and disease lie in a continuum and there is no single cut off point. In this continuum,
optimum health is on one end and death on other end. Highest point corresponds to WHO
definition of positive health. All people fall somewhere on continuum depending on their level of
health or illness.

Wellness Illness
Optimum health Death

Positive Health
Better Health
Freedom from sickness

Unrecognized sickness
Mild sickness
Severe sickness
Death
Positive health refers to perfect functioning of body and mind. Wellness is ability to live life to
fullest and to maximize personal potential in a variety of ways. The health fluctuates within a
range of optimum wellbeing to various level of dysfunction. The transition of health from
optimum health to ill health is often gradual, and where one state ends and the other begins.

Definition of terms used in community health

Community:
The word community is derived from Latin word communis meaning ready to serve. A
community is a social group determined by geographical and physical boundaries with having
common values and interest, where they are abided by the same laws.
Community is a social group determined by geographical boundaries and or common values
and interests. Its members know and interact with each other. It functions within a particular
social structure and exhibits and creates certain norms, values and social institutions.
-Oxford Dictionary

Community Health
Community health is a science and art of preventing disease, prolonging life and promoting
health and efficiency through organized effort.
Community health refers to the health status of the members of the community, to problems
affecting their health and to the totality of health care provided for the community.
-WHO

Public Health
Public health refers to all organized measures (whether public or private) to prevent disease,
promote health and prolong life among the population as a whole.
-WHO
Public health is art and science dealing with protection and improvement of community health
by organized community efforts and including preventive medicine and sanitary and social
science.
-Medical Dictionary
Activities of public health aim to provide conditions in which people can be healthy and focus on
entire populations, not an individual patients or disease. So, it is concerned with total system, not
only eradication of the particular disease.
Community Health Nursing
Community health nursing is a field of nursing practice for which there exists a body of
knowledge and related skills which is applied in meeting the health needs of communities,
families and individuals in their normal environment such as at home, at school and at place of
work.
-American Nurses Association (ANA)
Community health nursing is a synthesis of nursing and public health practice applied to promote
and preserve the health of people. It is not limited to particular age group or diagnosis and is
continuing, not episodic. The practice is general and comprehensive.

Public Health Nursing

Public health nursing is a field of nursing concerned with health needs of community as a whole.
Public health nursing is an integrated community involvement and knowledge about the entire
population with personal, clinical understandings of health and illness experiences of individuals
and families within the population.
-Medical Dictionary
Public health nursing is an integrated community involvement and knowledge about the entire
population with personal, clinical understandings of health and illness experiences of individuals
of health and illness experiences of individuals and families within the population.
-American Public Health Association

Family
Family is the basic (primary) unit in all societies. It is the most powerful example of social
cohesion.
Family is a group of individuals living under one roof and usually under one head.
-Webster

Family Health Nursing

Family health nursing is that level of community health nursing practice directed or focused on
family as the unit of care, with health as the goal and nursing as the medium channel or provider
of care.

There are three levels of client in community health nursing practice:

1. The individual
2. The family
3. The community
Family health nursing is concerned with the total health of an individual, family and
community. The community nurse provides a comprehensive care by maintaining promotive,
preventive, curative and rehabilitative care to the client.

Factors influencing health in Nepal

Health is multifactorial. The health of an individual and community is affected by a wide range
of contributory factors. The factors which influence healt lie both within the individual and
externally in the society in which he/she lives. Different factors interact for health and these
interactions may be health promoting or deleterious. Thus, conceptually the health of individuals
and whole communities may be considered to be the result of many interactions.
The main factors influencing health are as follows:
1 Hereditary/Biological
4. Environment
5. Lifestyles
6. Socio-economic status
7. Health services
8. Ageing population
9. Gender
10. Other factor
11.

12.
Biologic
13. al
Human Rights
14. Behavioural
15.

16.Equity and
social justice Environmental
17. Communities

18.
Families Societies
19. Health
Gender Socio-economic
20. Individuals

21.
Information and 22. Health System
communication
23.

24. Socio-cultural
Science and
Technology 25.
Ageing of the
26.
Population
27. Fig: Conceptual Framework of Factors Affecting Health

28.
1. Hereditary/Biological
Body size
Special abilities
Disease resistance
Disease susceptibility
Genetic diseases
General healthiness

29. The physical and mental traits of every human being are to some extent determined by the
nature of his genes at the moment of conception. The genetic makeup is unique in that it
cannot be altered after conception. A number of diseases are known to be of genetic origin
e.g. chromosomal anomalies, errors of metabolism, mental retardation etc. Therefore health
of person depends partly on the genetic constitution of man.

2. Environment
30. Environment can be defined as any factor in which human being comes in contact either
directly or indirectly. According to ecological concept, health is positive interaction between
man and his environment.
31. Environment can be classified as external and internal environment. External environment
means all that which is external to human hosts and where they are exposed after conception.
Internal environment includes each and every component, part, tissue, organ and system and
their hormones functioning within the system.
32. The external environment can be divided into physical, biological and psycho-social
components. These components have direct impact on physical, mental and social well-being
of those living in it. For good health, environment must be well balanced so that they can
make full use of their mental and physical capabilities.

33. Social Environment

Religion
Race/Gender
Socioeconomic status
Education
Occupation
Family composition

34. Social factors have strong impact on health. The way societies are governed affects policy
decisions, which have implications for distribution of resources and access to health care.
35. Religion
36. Some religions have guidelines that impact on health. The practice of specific health habits
according to religious belief helps in better health outcomes.

37. Gender
38. Throughout world, women have low mortality rates and longer life expectancies than men.
This may be due to tendency to seek medical advice sooner than men do. But reason for
difference in mortality rates is not yet identified.

3. Lifestyles
39. Lifestyles denote the way people live, reflecting a whole range of social values, attitudes
and activities. It is composed of social, cultural, behavioral patterns and lifelong personal
habits i.e. smoking, alcoholism etc. that have developed through process of socialization.
Lifestyles are learnt through social interaction with parents, friends and siblings, school and
mass media.
40. Healthy lifestyle helps in better health in developed countries. Coronary heart disease,
obesity, lung cancer, drug addictions are associated with life style change. Similarly in
developing countries, there are risks of illness and death due to lack of sanitation, poor
nutrition, personal hygiene, customs and cultural patterns.

4. Socioeconomic status
41. For majority of worlds people, health status is primarily determined by level of
socioeconomic development e.g. housing, political system, education etc. of the country.
42. Major important socioeconomic factors are:

43. Economic status

44. The economic status determines purchasing power, standard of living, quality of life, family
size and pattern of disease and unusual behavior in the community. It is important factor in
seeking health care. People with higher socioeconomic status are also suffering from
hypertension, diabetes, heart diseases etc. Persons with low socioeconomic status have poor
education, poor nutrition leading to poor hygienic practice.

45. Education
46. Major factors affecting health status is education, especially female education. Illiteracy
coincides with poverty, malnutrition, ill health, high infant and child mortality rates. Higher
education lowers morbidity and increase life expectancy of individual. So, education has
direct relation with health status of an individual.
47. Occupation
48. The employment in productive work promotes health. Unemployment leads to higher
incidence of ill health and death. Loss of work leads to loss of incomes and status and cause
psychological and social damage.

49. Political system

50. Health is directly related to countries political system. Decision concerning resource
allocation, manpower and choice of technology, availability and accessibility of services is
always determined by political system.

5. Health services
51. The term health and family welfare services cover a wide spectrum of personal and
community services for treatment of disease, prevention of illness and promotion of health.
Health services help to improve the health status of population by promoting health,
preventing disease and restoring health. E.g. immunization of children prevents from
particular disease; provision of safe water prevents mortality from water-borne diseases. To
be effective health services must reach social periphery, equally distributed, accessible at a
cost the country and community can afford and socially acceptable. This is now also included
in concept of primary health care to provide better health.

6. Ageing population
52. By the year 2020, world will have more than one billion people aged 60 and over and more
than two-thirds of them living in developing countries. Although, elderly in many countries
enjoy better health than till now, a major concern is increased prevalence of chronic diseases,
and disabilities both being conditions that occurs as ageing proceeds and deserve special
attention.

7. Gender
53. Men and women are susceptible to some different diseases, conditions and physical
experiences, which play a role in our general health. The agenda for women health include
nutrition, reproductive health, health consequences of violence, ageing, lifestyle related
condition and occupational environment. It has brought an increased awareness among policy
makers of womens health issues and encourages their inclusion in all development plans as
priority.

8. Others
54. The transition from past industrial age to an information age has led to revolution in
information and communication. It contributes to dissemination of information worldwide,
serving the needs of many physicians, health professionals, researchers, biomedical
scientists, mass media and the public.
55. Other contribution to health of population derive from system outside the formal health care
system i.e. health related system (e.g. food and agriculture, education, industry, social
welfare, rural development) as well as adoption of policies in the economic and social fields
that would assist in raising the standards of living. This would assist in raising the standards
of living. This would include employment opportunities, increased wages, prepaid medical
programs and family support system.

56.Goals of community health nursing

Assess the health of general community to identify health care needs and concerns.
Monitor spread of disease, keep vigilant watch for environmental hazards, and educate
community on how to care for and treat themselves, and train for community disasters.
Respond to priorities that emerge from a comprehensive assessment of health issues and
concerns of the public served.
Focus on improving population health in the environments in which people live, work, learn
and play.
Prevent and manage diseases, injuries and other health conditions through surveillance of
cases and the promotion of healthy behaviors, communities and environments.
Improve health and quality of life through prevention and treatment of disease and other
physical and mental health conditions, through surveillance of cases and health indicators.
Promotions of hand washing and breastfeeding, delivery of vaccinations, distribution of
condoms to control the spread of sexually transmitted diseases are examples of common
public health measures.
Collaborate with other disciplines to plan, organize and evaluate programs to meet the needs
of the community.

57.Functions of community health nurse

Assess the health and health care needs of the population in order to identify sub-populations,
families and individuals who would benefit from health promotion or who are at risk of
illness, injury, disability or premature death.
Develop a plan with the community to meet the identified needs taking into account available
resources.
Implement the plan at the community, family or individual level.
Evaluate the impact of the intervention.
Use the results of the evaluation to influence and direct current delivery of care, deployment
of health resources and the development of local, state and national health policy and
resources to promote health and prevent disease.

58.
 59.Roles of community health nurse
60. In community health care setting the various roles of community health nursing are corporate
into nursing practices.

1. Advisor
61. Community health nurse work with families in the community, they naturally develop a good
inter-personal relationship with the people of particular community. And nurse as an advisor,
she gives advice in practical and emergency matters which related to health. For example,
maintaining position and providing support in fracture cases, importance of maintenances of
personal hygiene etc.

2. Advocate
62. Community health nurse as an advocate, she encourages the individual to take right food for
maintaining health, right duties for maintaining health, right drugs for treatment and refer to
right services at right places, wherever needed. Including these things, the nurse provides the
patient sufficient information to the patient to make appropriate health decision. The nurses
also explain, protect and defend the rights of the patient.

3. Caregiver
63. Community health nurse provide care to individuals, families and community or vulnerable
populations in variety of settings. E.g. religious places (temples, church) etc., home,
homeless shelters, migrant health camps, schools and work sites. This care includes a range
of activities such as physical care, educating a client about his or her health problems and
screening for undiagnosed health problems.

4. Manager
64. The community health nurse assumes the role of manager in a variety of situations. This may
include managing a caseload of clients, managing health clinics, managing a staffs of health
care providers etc. She is expected to organize and provide planned program of health to the
clients.

5. Counselor
65. Community health nurses are often in unique position to help clients cope with normative
and non-normative stressors that could lead to crisis and to adapt to changes in the
environment. This role help to client to express their emotions and feelings, clarify facts in
the situation, confront the stress in manageable way and accept the situation.

6. Case finder
66. Community health nurses conducted targeted outreach to identify clients in need of service
and to assist clients in accessing appropriate care. They also observe for clients who may
have potential or actual service needs during their daily course of activities.
7. Coordinator
67. Nurse as a coordinator, she encourages to use of variety of agencies and discourages
duplication of services. She works collaboratively with patients and also with members of the
health team in assessing, planning, implementing and evaluating interventions. She also
provides coordinate effort to solve the health problems such as social service, community
mental health center, nutrition services, clubs, peer support groups etc.

8. Educator
68. Nurse as an educator, she apply the principles of teaching and learning to promote
positive health action and to facilitate the behavioral changes. They uses this principles
continue to help clients about new events and healthy functioning and apply new knowledge.

9. Observer
69. Community health nurse is expected to be alert to any deviation from expected behavior with
respect to illness, growth and development, response to drugs and general well-being of an
individual, family and community. As an observer, the nurse is supposed to be aware of her
surroundings and reports to the occurrence of disease symptoms, the environmental threats,
and unusual stress in the community which may cause threats to the health of the community.