MODULE 1

Chapter 1: Concepts of Health

Theme Concept of health and determinants of health
Objectives - By the end of the chapter, you should be able to:
Differentiate the differences between disease, illness and ill health
Question the implications of different concepts of health
Understand the key factors that determine health

CONTENT
Disease, illness and ill health
According to the World Health Organizations (WHO) definition of health, Health is a state of complete
physical, mental and social well-being, not merely the absence of disease. The WHO, a specialized agency
of the United Nations, introduced the idea of considering health as a global issue, and brought nations and
experts together to better develop the health of the world. In fact, health can be defined in positive and
negative ways. The negative definition is absence of disease or illness while positive definition is the state of
well-being. Different societies have different views of health. You are sure to receive different answers if
you ask people living in China, Africa, the United States and Hong Kong. This is considered common sense,
passed from generation to generation as part of the cultural heritage.
The terms disease, illness and ill health are used interchangeably by laypeople and even by health care
professionals. Disease and illness do not mean the same thing, although there is large degree of overlap in
their definitions.
Disease
Disease is the objective state of ill health, normally verified by accepted proof. For example, a woman is
diagnosed to have cervical cancer when a microscopic analysis shows evidence of changes in cell structure.
Though she may not have experienced any symptom of the disease, she is considered to have the disease.
Illness
Illness is the subjective experience of loss of health. General malaise, tiredness, sleeplessness, aches and
indigestion are examples of illness. Sometimes when patients visit doctors with the above problems, the
doctors are unable to give a definite diagnosis because no abnormalities have been detected in the physical
examination. Yet the patient feels unwell.
Ill health
Ill health is an umbrella term used to refer to the experience of disease plus illness. For example, a patient
complains of acute abdominal pain with the doctors diagnosis of appendicitis.
How did you do? Lets further explore different concepts of health.

Different concepts of health

Herzlich (cited in Naidoo & Wills, 2000) studied a group of middle-class Europeans and discovered that they
described health in different ways.
As a state of well-being and the absence of illness.

As something to have, an inner strength or resistance to ill health.

As a state of doing and being able to fulfil the maximum potential for life.

From the above, it was found that middle class people have a positive view of health. However, manual
laborers can have rather different concepts of health, because they pay more attention to functional status or
ability rather than the quality of being fit and active. For example, a mother is considered healthy if she is
able to take care of the family, and a worker is healthy if s/he is able to earn a living.
You should note that because different people may hold different views, there is no right or wrong or model
answer regarding the concept of health. If you look at the WHO definition of health from 1984, you will be
able to differentiate differences between past and more recent definitions. Health is the extent to which an
individual or group is able, on the one hand to realize aspirations and satisfy needs; and, on the other hand, to
change or cope with the environment. Health is therefore, seen as a resources for everyday life, not as an
object of living; it is a positive concept emphasizing social and personal resources, as well as physical
capacities (WHO, 1984).

Key factors that determine health

Do you think these people are enjoying same health status? Why?
Social factors
Social class
Occupation and social economic status are interchangeable. Because social class correlates with income,
housing and work environment, researchers have identified a positive correlation between social class
and health.
Gender
Gender specific diseases affect only a specific gender. For example, gynecological and breast diseases
affect womens health but not mens health.
Age
As people age they become more vulnerable to various kinds of diseases, such as hypertension, cardiac
problems, diabetes mellitus and decreases in the general body immune system.
Ethnicity
Sickle cell anemia occurs mostly in black populations, while thalassaemia primarily affects
Mediterranean populations.
Environmental factors
Food hygiene
Government policy has implications for the food industry. Strict inspection of food premises and food
markets ensures maximum food hygiene that affects health.
Waste disposal
Waste disposal includes the proper treatment and disposal of household, industrial and chemical waste.
Incinerators have been abolished and the percentage of recycling is increasing.
Air pollution
Given the incredible sources of air-pollution in Hong Kong and adjacent southern China, this is a
significant and growing problem. Air pollution is caused by emissions of particulate matter and harmful
gases. The most common air pollutants are total and respirable suspended particulates (TSP & RSP),
sulfur dioxide (SO 2), nitrogen dioxide (NO 2), carbon monoxide and (CO) ozone from traffic
(Environmental Protection Department, 2006). The concentration of these substances in the environment
is determined by the amount produced as well as by the rate of their removal by wind, rain or currents.

One way to improve the air quality in Hong Kong is to control traffic pollution by monitoring. Other
measures include improving diesel engines and shifting to liquid petrol gas.
Water quality
Strict monitoring of water quality. Water sources may include reservoirs, rivers and sea water.
Transport
The well-being of the community could be affected by the degree of traffic congestion. Accidents and
injuries result from motor vehicles on the road.
Working environment
A satisfying job in a safe and pleasant environment affects health and well-being. Work environments
with adequate occupational safety measures minimize injuries and loss of working time.
Living space
Overcrowded and damp living areas increase the likelihood of communicable diseases.

Lifestyle factors
Drug abuse, excessive alcohol consumption, cigarette smoking, poor driving behavior and consumption of
high fat and high calorie diet are behaviors that damage health. In addition, having casual sex or having
multiple sexual partners increase the chances of unwanted pregnancies, sexually transmitted disease and HIV
infection. Rokin (1991) stated that the risk of cancer of the cervix is increased by both early intercourse and
increased numbers of sexual partners (cited in Harper, Holman & Dawes, 1994). Therefore, monogamous
relationships ensure safer sexual relationships.
Socioeconomic factors
Education
People that attain higher educational levels demonstrate higher motivation and are more compliant with
treatment regimens. Mothers with less than a high school standard are more likely to give birth to low
birth weight infants due to their high incidence of smoking and receiving less attentive antenatal care.
Employment
Being employed and having a job affect well-being. Financial security enables people to obtain food, to
have access to appropriate housing and to be able to participate in social and leisure activities. A sense
of self-worth and self-esteem result from having satisfying employment.
Accessibility to health services
Access to basic health care services is fundamental to our health. Essential health services include
accident and emergency services, general outpatients clinics, general practitioner services, family
planning and well women clinics. Access to these services depends on health services policy and
affordability for individuals and families.
Peace
Peace and shelter are fundamental condition and resources for health. War is considered hazardous
causing damage to the physical and emotional well-being of people in the affected community.