For m.sc nursing community health nursing speciality. For b.sc nursing

1. PRESENTED BY
MANASI DEKA
AIN/MSc/0073
First Year MSc Nsg
ARMY INSTITUTE OF NURSING, GUWAHATI
COMMUNITY HEALTH NURSING-I
SEMINAR
ON
TOPIC: HEALTH- CONCEPTS AND ISSUES

3. HEALTH

4. DEFINITION AND MEANING
• Historically, the term health is derived from an old English
word ‘Health’ meaning the condition of being ‘safe and
sound’ or ‘whole’.
• Dolfman 1973, Keller 1981
Health implies a sound mind, in a sound body, in a sound
family, in a sound environment.
• WHO 1948
“Health is a state of complete physical, mental and social
wellbeing and not merely the absence of disease or
infirmity”.

5. PHILOSOPHY OF HEALTH
• Health is a fundamental human right
• Health is intersectoral
• 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 is worldwide social goal

6. EVOLUTION OF HEALTH CONCEPT
• Religious healers believed that in order to achieve health,
it was necessary for individuals to pray and sacrifice to the
Gods in order to propitiate them.
• In Ancient Egypt, headaches were attributed to the actions
of demons and supernatural forces that had to be
appeased in order to be cured.
• In 1948, WHO defined health that expanded the concept
of health from mere concern about physical characteristics
of a disease to a consideration of the social determinants
which affects a patients health.

7. • In India, Ministry of Health was established with
independence in 1947
• The National Health Policy was endorsed by Parliament in
1983.
• National Rural Health Mission was launched in 2005. This
was expanded to the urban population through the
National Urban Health Mission in 2013 and now as
National Health Mission.

8. CHANGING CONCEPTS
 BIOMEDICAL CONCEPT
This biomedical concept is based on the Germ Theories of
disease.
• For long, man was groping in darkness about the causation
of disease. In 1873, Pasteur advanced the "germ theory of
disease". In 1877, Robert Koch showed that anthrax was
caused by bacteria.
• Microbe after microbe was discovered in quick succession
- gonococcus in 1847; typhoid bacillus, pneumococcus in
1880; tubercle bacillus in 1882; cholera vibrio in 1883;
diphtheria bacillus in 1884, and so on.

9. • Medicine finally shed the rags of dogma and superstition
and put on the robes of scientific knowledge.
• According to this theory, there is one single specific
microorganism (causative agent) to every disease.
• The criticism that is faced is that it minimized the role of
environmental, social, psychological and cultural
determinants of health. It was inadequate to solve major
health problems e.g. malnutrition, mental illness, accident.
Thus, biomedical concept of health was inadequate.

10.  ECOLOGICAL CONCEPT
• The word ‘eco’ derived from Greek word ‘Oikos’ meaning
‘house’ and the word ‘logos’ meaning ‘study’.
• Ecologically, health is not static.
• The state of equilibrium will depend upon the nature of
interaction between the host, the agent and the
environment.
AGENT HOST
ENVIRONMENT

11. Example of disequilibrium
• Disequilibrium in the agent: This can be shown by the virus
SARS-CoV-2, as this disease has caused a pandemic and is still
prevailing.
• Disequilibrium in the host: This can be shown by the
coronavirus that is primarily transmitted between people
through direct, indirect or close contact with infected people
through infected secretions.
• Disequilibrium in the environment: Temperature increase and
sunlight can facilitate the destruction of SARS-CoV-2.
According to a research, half-lives of SARS-CoV-2 were between
1.7 and 2.7 days at 20 degree Celsius, reducing to a few hours
when temperature was elevated to 40 degree Celsius.

12.  PSYCHOSOCIAL CONCEPT
• Psychosocial factors include cultural value, habits,
attitudes, religion, lifestyle, health services, beliefs and
political organisation.
• The beliefs, cultural value, tradition all regulate the
interaction among group of individual and families.
Lifestyles are learnt through social interaction.

13. Basic Traits of Psychosocial Health
• Like themselves
• Accept their mistakes
• Take care of themselves
• Have empathy for others
• Control their anger, hate, tension, and anxiety
• Are optimistic
• Can work alone and with others equally well

14.  HOLISTIC CONCEPT
• Holistic concept implies wellness in all dimensions of a
human being.
• The word holistic is derived from a Greek word holos,
which means ‘whole’.
• In Holistic concept, it is believed that the whole person is
made up of interdependent parts and if one part is not
working properly, all the other parts will be affected.

15. For example, when a person suffers from migraine
headaches, treatment plan may involve drugs to relieve
symptoms, but also lifestyle modifications to help prevent
the headaches from recurring. Holistic concept on health
implies
• lifestyle changes e.g. diet, exercise, relationship etc.
• Complementary and alternative therapies such as
acupuncture, homeopathy, massage therapy etc.
• Also includes Medications and surgical procedures

16. According to holistic health field,
HUMAN
BIOLOGY
ENVIRONMENT
LIFESTYLE
HEALTH AND
WEELNESS
HEALTH
AND ALLIED
SERVICES
HUMAN BIOLOGY
• Genetic inheritance
• Age
• Racial factors
• Self concept
HEALTH AND ALLIED SERVICES
• Health services
• Socio-economic condition
• Political system
• Health related services

17. DIMENSIONS OF HEALTH
 PHYSICAL HEALTH
A person who enjoys good physical health is one who:
• Is energetic
• Has good posture
• Weighs normal for age and height
• Has all body functioning normally
• Has a clear and clean skin
• Has bright eyes
• Has good textured and shining hair
• Has a clean breath
• Has a good appetite
• Gets sound sleep

18.  SOCIAL HEALTH
• It means that level of health which enables a person to live in
harmony with his surroundings.
• It is the ability to interact successfully with people, develop and
maintain intimacy with significant others, and develop respect
and tolerance for those with different opinions and beliefs.
 MENTAL HEALTH
It has two branch:
• Cognitive health
• Emotional health

19.  SPIRITUAL HEALTH
It pertains to the soul or spirit of man. It refers to beliefs in the
supernatural aspects of the universe which help an individual to
seek meaning and purpose in life. It is associated with the religious
beliefs of an individual which provide the philosophy of life,
directions, ethical values and high living. This gives strength and
determination to face the realities of life and live meaningfully.
It plays crucial role in maintaining healthy environment
around us. It also includes respecting values, morality, dignity,
ethical values, and harmonious temperament for all.

20.  VOCATIONAL HEALTH
It is part of human existence. When work is fully adapted to
human goals, capacities and limitations, work often plays a
role in promoting both physical and mental health. Physical
work is usually associated with an improvement in physical
capacity, while goal achievement and self-realization in work
are a source of satisfaction and enhanced self-esteem. The
importance of this dimension is exposed when individuals
suddenly lose their jobs or are faced with mandatory
retirement.

21. HEALTH ISSUES
Following are the major health issues or problems of India:
• Communicable disease problems
• Non-communicable disease problems
• Nutritional problems
• Environmental sanitation problems
• Medical care problems; and
• Population problems

22. COMMUNICABLE DISEASES

23. COVID-19
• First identified on 31st December 2019 in Wuhan, China.
• Infectious disease caused by SARS-CoV-2.
• Spreads primarily through droplets of saliva or discharge from
nose.
• Coronaviruses are named for the crown-like spikes on their
surfaces.
Variants of coronavirus
• Viruses constantly change through mutation and new variants
of a virus are expected to occur over time, which can persist or
can disappear.

24. According to Global Variant Reports, April 2021, These are the variants:
• B.1.1.7- This variant was first identified in UK on 20 Sept 2020 in South East
England.
• B.1.351- It evolved in South Africa on February 2021.
• P.1- First identified in US in Jan 2021. it was initially detected in Brazilian
travellers who travelled to Japan.
• B.1.427 and B.1.429- These were identified first in California in February
2021.
• B.1.617- This was initially detected in India with two mutations (double
mutant).
• Triple mutant variant- The triple mutant variant or the Bengal strain of
COVID 19 is predominantly circulating in West Bengal.

25. SYMPTOMS
• Most common symptoms- Fever, dry cough, tiredness
• Less common- aches, sore throat, diarrhoea, conjunctivitis,
headache, loss of taste or smell, a rash on skin, or discoloration of
fingers or toes.
• Serious symptoms- difficulty breathing or shortness of breath, chest
pain, loss of speech or movement.
NEW SYMPTOMS OF COVID-19
• The UK variant and the double variant are spreading faster.
• Symptoms- low grade fever, non—salivation, xerostomia, headaches.
• Another warning sign is ‘COVID-19 tongue’.

26. Who is at more risk?
• Older people and people with pre-existing medical conditions such as
asthma, diabetes, heart disease.
• Small children as they have low immunity.
• People with chronic lung disease including COPD, cystic fibrosis.
• Black and Asian ethnic groups are at increased risk.
Disease burden
• The weekly Epidemiological Update provides an overview of the
global, country- level and regional level COVID-19 cases and deaths. In
Assam, total cases are 2,440,00 out of which 1,233 people have died.
• In India (overall) total cases are 18 million out of which 201 thousand
people died.
• Globally, the total cases are 150 million out of which 3.15 million died.

27. MALARIA
• It is caused by Plasmodium parasites that are transmitted to
people through the bites of infected female Anopheles
mosquitoes.
Species of Plasmodium parasite:
• Plasmodium falciparum- greatest threat
• Plasmodium malariae
• Plasmodium vivax- greatest threat
• Plasmodium ovale
• Plasmodium knowlesi

28. • Symptoms usually appear 10–15 days after the infective
mosquito bite. The first symptoms- fever, headache, and chills –
may be mild.
• If not treated within 24 hours, P. falciparum malaria can
progress to severe illness, often leading to death.
• Children with severe malaria: severe anaemia, respiratory
distress in relation to metabolic acidosis, or cerebral malaria. In
adults, multi-organ failure is also frequent.
• In malaria endemic areas, people may develop partial
immunity, allowing asymptomatic infections to occur.

29. Who is at more risk?
• Most cases are in sub-Saharan Africa.
• The WHO regions of South-East Asia, Eastern Mediterranean,
Western Pacific, and the Americas are also at risk.
• Infants, children under 5 children, pregnant women and
patients with HIV/AIDS, non-immune migrants, mobile
populations and travellers.
Disease burden
• According to World malaria report, 30 November 2020, there
were 229 million cases of malaria in 2019 compared to 228
million cases in 2018. The estimated number of malaria deaths
stood at 409 000 in 2019, compared with 411 000 deaths in
2018.
• In 2019 under 5 children accounted for 67% (274 000) of all
malaria deaths worldwide.

30. • Targets
Reduction of malaria case incidence globally compared with 2015,
At least 40% by 2020 (3% reduction achieved); at least 75% by 2025.

31. TUBERCULOSIS
• It is caused by bacteria (Mycobacterium tuberculosis) that most
often affect the lungs.
• When people with lung TB cough, sneeze or spit, they propel
the TB germs into the air.
Symptoms
• Common symptoms are cough that lasts more than 3 weeks,
cough with sputum and blood at times, chest pains, weakness,
weight loss, fever and night sweats.

32. Who is at more risk?
• Tuberculosis mostly affects adults in their most productive
years. However, all age groups are at risk. Over 95% of cases
and deaths are in developing countries.
• Low immune people for example, People who are infected with
HIV are 18 times more likely to develop active TB.
• Alcohol use disorder and tobacco smoking increase the risk of
TB disease by a factor of 3.3 and 1.6, respectively.
Disease burden
• A total of 1.4 million people died from TB in 2019 (including
208 000 people with HIV). Worldwide, TB is one of the top 10
causes of death.
• In 2019, an estimated 10 million people fell ill with
tuberculosis(TB) worldwide. 5.6 million men, 3.2 million women
and 1.2 million children.
• India is the highest TB burden country in the world having an
estimated incidence of 26.9 lakh cases in 2019 (WHO).

33. • Targets
The strategy aims to end the global TB epidemic with targets to reduce TB deaths by 95% and
to cut new cases by 90% between 2015 and 2035.

34. DIARRHOEA
• Can be caused by bacteria and parasites like Clostridium
defficile or viruses like Norwalk virus, cytomegalovirus and viral
hepatitis. Other causes are medication such as antibiotics,
lactose intolerance.
• Acute diarrhoea is the sudden onset of three or more loose
stools per day, lasting less than 14 days. Chronic diarrhoea last
for four weeks or more.
Symptoms
• In addition to frequent, watery bowel movements, the stool
may also contain mucus, pus, blood or excessive amounts of
fat.
• Diarrhoea can be accompanied by painful abdominal cramps,
nausea, fever, bloating and generalised weakness, dehydration.

35. Who is at more risk?
• Low economic status, lack of education, poor water
storage practices, not treating water in the home,
overcrowding and a high number of children under five
years of age living in a household.
Disease burden
• Each year diarrhoea kills around 525 000 children under
five. Globally, there are nearly 1.7 billion cases of
childhood diarrhoeal disease every year.
• Total diarrhoeal deaths in India among children aged 0-6
years were estimated to be 158,209 and proportionate
mortality due to diarrhoea in this age-group was 9.1%.

36. LEPROSY
• It is caused by Mycobacterium leprae, an acid-fast, rod-shaped
bacillus. The disease mainly affects the skin, the peripheral
nerves, mucosa of the upper respiratory tract, and the eyes.
• Leprosy is likely transmitted via droplets, from the nose and
mouth, during close and frequent contact with untreated cases.
Symptoms
• Pain the joints, presence of blister, loss of skin colour, rashes,
ulcers, or redness, reduced sensation of touch, pins and
needles, or loss of temperature sensation, nerve injury or
weight loss.

38. Who is at more risk?
• People in close contact with leprosy patients increase the risk
of contracting the disease.
• Immunosuppressed patients
• Increased incidence between the ages of 5 and 15 years, and
then another increase after the age of 30
Disease burden
• According to WHO, There were 208 619 new leprosy cases
registered globally in 2018.
• India, which has the highest burden of the disease, has
reported a decreasing number of new cases for the past 2
years, by nearly 15,000 cases (135,485 in 2016 to 120,334 in
2017–2018).

39. ACQUIRED IMMUNE DEFICIENCY SYNDROME
(AIDS)
• It is caused by the Human Immunodeficiency Virus (HIV).
Symptoms
• The symptoms of HIV vary depending on the stage of infection.
In the first few weeks after initial infection people may
experience no symptoms or an influenza-like illness including
fever, headache, rash or sore throat.
• As the infection progressively weakens the immune system,
they can develop other signs and symptoms, such as swollen
lymph nodes, weight loss, fever, diarrhoea and cough. Without
treatment, they could also develop severe illnesses such as
tuberculosis (TB), cryptococcal meningitis, severe bacterial
infections, and cancers such as lymphomas and Kaposi's
sarcoma.

41. Who is at more risk?
• having unprotected anal or vaginal sex;
• having another sexually transmitted infection (STI) such as
syphilis, herpes, chlamydia, gonorrhoea and bacterial vaginosis;
• sharing contaminated needles, syringes and other injecting
equipment and drug solutions when injecting drugs;
• receiving unsafe injections, blood transfusions and tissue
transplantation, and medical procedures that involve unsterile
cutting or piercing; and
• experiencing accidental needle stick injuries, including among
health workers

42. Disease burden
• There were an estimated 38.0 million people living with
HIV at the end of 2019.
• In India, there are 1,04,66,595 confirmed cases including
1,51,160 deaths. The number of active cases is 2,22,526
and 1,00,92,909 have recovered as on January 11, 2021 at
2:30 am.

43. MEASLES
• It is caused by a virus in the paramyxovirus family and it is
normally passed through direct contact and through the air.
Symptoms
• The first sign of measles- high fever, which begins about 10 to
12 days after exposure to the virus, and lasts 4 to 7 days. A
runny nose, a cough, red and watery eyes, and small white
spots inside the cheeks can develop in the initial stage.
• After several days, a rash erupts, usually on the face and upper
neck. Over about 3 days, the rash spreads, eventually reaching
the hands and feet. The rash lasts for 5 to 6 days, and then
fades. On average, the rash occurs 14 days after exposure to
the virus.

45. Who is at more risk?
• Unvaccinated young children, Unvaccinated pregnant women are at
risk.
• Any non-immune person (who has not been vaccinated or was
vaccinated but did not develop immunity).
• Common particularly in parts of Africa and Asia. The overwhelming
majority (more than 95%) of measles deaths occur in countries with
low per capita incomes and weak health infrastructures.
Disease burden
• ‘Progress Towards Regional Measles Elimination Worldwide 2000-
2019’, states that cases across the world increased to 8,69,770 in
2019. Global measles deaths climbed nearly 50 per cent since 2016,
claiming an estimated 2,07,500 lives in 2019 alone, it said.
• A total of 1.2 million children did not receive the first dose of
measles-containing-vaccine in 2019 in India.

46. • Targets
India has targeted elimination of measles by 2020. India then
started vaccination for measles. There is 99% reduction in measles
cases compared with the pre-vaccine era.
• OTHERS: Kala-azar, meningitis, viral hepatitis, Japanese
encephalitis, dengue fever, enteric fever and helminthic
infestations are among the other important communicable
disease problems in India. But most of these diseases can be
either easily prevented or treated with minimum input of
resources.

47. NON-COMMUNICABLE DISEASES

48. CANCER
Symptoms
• Symptoms vary according to the types and grade of cancer. The
common symptoms found in patients with different cancers:
fatigue, weight loss, pain, skin changes, change in bowel or
bladder function, unusual bleeding, persistent cough or voice
change, fever, lumps, or tissue masses.
Who is at more risk?
• Older age, personal or family history of cancer, Using tobacco,
Alcohol, Some types of viral infections, such as human
papillomavirus (HPV), obesity, Exposure to radiation, including
ultraviolet radiation from the sun.

49. Disease burden
• IARC released on 14th December the updated Globocan 2020
with new estimates on the global cancer burden, indicating that
it has risen to 19.3 million cases and 10 million cancer deaths in
2020.
• According to the National Institute of Cancer Prevention and
Research (NICPR), an estimated 2.25 million people in India live
with cancer and more than 1,157,294 new cancer patients are
registered every year. The number of cancer cases in India is
estimated to be 13.9 lakh this year and may increase to 15.7
lakh by 2025.
• Incidence of cancer related to use of any form of tobacco was
the highest in the north-eastern region of the country and in
higher proportion in men. Cancer of lung, mouth, stomach and
oesophagus were the most common cancers among men.
Cancer of breast and cervix were the most common cancers
among women.

50. DIABETES MELLITUS
There are mainly two types of diabetes mellitus:
• Type 1 diabetes
• Type 2 diabetes
Symptoms
• The general symptoms of diabetes include increased hunger,
increased thirst, weight loss, frequent urination, blurry vision,
extreme fatigue, sores that don’t heal.
Who is at more risk?
• TYPE-1 DIABETES: You’re more likely to get type 1 diabetes if
you’re a child or teenager, you have a parent or sibling with the
condition, or you carry certain genes that are linked to the
disease.

51. The risk for type 2 diabetes increases if you:
• are overweight
• are age 45 or older
• have a parent or sibling with the condition
• aren’t physically active
• have had gestational diabetes
• have prediabetes
• have high blood pressure, high cholesterol, or high triglycerides
• have African American, Hispanic or Latino American, Alaska
Native, Pacific Islander, American Indian, or Asian American
ancestry

52. Disease burden
• In 2020, according to the International Diabetes Federation
(IDF), 463 million people have diabetes in the world and 88
million people in the Southeast Asia region. Of this 88 million
people, 77 million belong to India. The prevalence of diabetes
in the population is 8.9%, according to the IDF.

53. CARDIOVASCULAR DISEASES (CVD)
• Coronary heart disease
• Cerebrovascular disease
• Peripheral arterial disease
• Rheumatic heart disease
• Congenital heart disease
• Deep vein thrombosis and pulmonary embolism

54. Symptoms
• A heart attack or stroke may be the first warning of underlying
disease. Symptoms of a heart attack include pain or discomfort
in the centre of the chest, pain or discomfort in the arms, the
left shoulder, elbows, jaw, or back, difficulty in breathing or
shortness of breath; feeling sick or vomiting; feeling light-
headed or faint; breaking into a cold sweat; and becoming pale
• The most common symptom of a stroke is sudden weakness of
the face, arm, or leg, most often on one side of the body.

56. Disease burden
• Cardiovascular diseases (CVDs) are the number 1 cause of
death globally, taking an estimated 17.9 million lives each year.
• The annual number of deaths from CVD in India is projected to
rise from 2.26 million (1990) to 4.77 million (2020). Coronary
heart disease prevalence rates in India have been estimated
over the past several decades and have ranged from 1.6% to
7.4% in rural populations and from 1% to 13.2% in urban
populations.

57. NUTRITIONAL PROBLEMS

58. PROTEIN-ENERGY MALNUTRITION
Types include:
• Kwashiorkor
• Marasmus
• Marasmic kwashiorkor

59. Symptoms

60. Who is at more risk?
• Children who belong to these categories:
Poverty, family instability, poor environmental sanitation, faulty
weaning practices, illiteracy, ignorance, large family size and
preventable infections are the main factors responsible for
malnutrition.
Disease burden
• India is among 88 countries that are likely to miss global
nutrition targets by 2025, according to the Global Nutrition
Report 2020 released on Tuesday.
• In Global Nutrition Report 2018, revealed the prevalence of
stunting, wasting and overweight at national level as 37.9, 20.8
and 2.4% respectively. . The problem exists in all the States and
the nutritional marasmus is more frequent than kwashiorkor.

61. NUTRITIONAL ANAEMIA
• It is caused by a lack of iron, protein, vitamin B12, and other
vitamins and minerals that needed for the formation of
haemoglobin.
• Normal haemoglobin concentration is 10.9 to 15 g/dl in under-
5 children; 13.8 to 17 g/dl in adult males; 12 to 15 g/dl in adult
females and 12 to 16g/dl in pregnant women.
Symptoms
• Fatigue and lack of energy.
• However if symptoms progress, one may experience shortness
of breath, rapid pulse, paleness --especially in the hands,
eyelids and fingernails---, swelling of ankles, hair loss, light-
headedness, compulsive and atypical cravings, constipation,
depression, muscle twitching, numbness, or burning and chest
pain.

62. Who is at more risk?
• Gender and Age
• Pregnancy
• Diet
Disease burden
• The prevalence of anaemia ranges from 33% to 89% among
pregnant women and is more than 60% among adolescent girls.
A survey data showed that 84.9% of pregnant women were
anaemic, 13.1% had severe anaemia and 60.1% had moderate
anaemia. Among adolescent girls, overall prevalence of
anaemia was 90.1%, with 7.1% having severe anaemia.

63. • Global nutrition Targets by 2025
40% reduction in the number of children under five
50% reduction of anaemia in women of reproductive age group
No increase in childhood overweight
Increase the rate of exclusive breastfeeding up to at least 50%

64. ENVIRONMENTAL SANITATION

65. MEDICAL CARE PROBLEMS

66. POPULATION PROBLEM

67. • India 2021 population is estimated at 1,395,123,637 people at
mid-year according to UN data. India population is equivalent
to 17.7% of the total world population.
• Due to increasing population, it is estimated that 25 million
people are homeless and 171 million people have no access to
safe drinking water.
• According to Census 2011, national sex ratio (females per 1,000
males) is 940.