5(M)

1. Define health according to WHO and mention its limitations.

• WHO Definition (1948):
  Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
  (Amplified: Includes the ability to lead a socially and economically productive life.)
• Limitations:
  • Too broad.
  • Cannot be defined as a “state” at all — must be seen as a process of continuous adjustment to changing demands of living and changing meanings given to life.
  • It is a dynamic concept (helps people live well, work well, enjoy themselves).
  • Not operational (difficult to measure directly; hampers epidemiology of health studies).

2. Enumerate the dimensions of health with brief examples.

Health is multidimensional. WHO envisages three (physical, mental, social); others added as knowledge grows:

1. Physical — Notion of “perfect functioning” of body; every cell/organ at optimum capacity and in perfect harmony. Signs: good complexion, clean skin, bright eyes, lustrous hair, firm flesh (not too fat), sweet breath, good appetite, sound sleep, regular bowels/bladder, coordinated movements, normal resting pulse/BP/exercise tolerance for age/sex; steady weight gain in young, stable after ~25 years (±5 lbs/2.3 kg).
2. Mental — Not absence of mental illness; ability to respond to varied life experiences with flexibility and sense of purpose; state of balance/harmony with world, self, others, environment (coexistence of realities).
   Attributes: free from internal conflicts (not at “war” with self); well-adjusted (gets along with others, accepts criticism, not easily upset); searches for identity; strong self-esteem; knows self (needs, problems, goals — self-actualization); good self-control (balances rationality/emotionality); copes intelligently with stress/anxiety.
3. Social — Harmony and integration within individual, between individuals/society, and with world; quantity/quality of interpersonal ties and community involvement; rooted in positive material environment (financial/residential) and positive human environment (social network).
4. Spiritual — Reaches out for meaning/purpose; integrity, principles, ethics, commitment to higher being; transcends physiology/psychology; defies concrete definition.
5. Emotional — Relates to “feeling” (emerging as separate from mental “knowing”/cognition via psychobiology research).
6. Vocational — Work adapted to goals, capacities, limitations; promotes physical/mental health, satisfaction, self-esteem; importance exposed in job loss/retirement (may represent culmination of other dimensions for “life success”).

• Other suggested dimensions: philosophical, cultural, socio-economic, environmental, educational, nutritional, curative, preventive (many non-medical; other sectors contribute to productive life).

3. Write a short note on the biomedical concept of health.

• Biomedical concept (oldest definition still used):
  Health = absence of disease; if free from disease → person considered healthy.
  Basis: Germ theory of disease (dominated medical thought at turn of 20th century).
  Body viewed as machine; disease = breakdown of machine; doctor’s task = repair (ultimate goal of medicine).
• Dominant in 20th century; spectacular success in treating disease.
• Criticisms:
  • Minimized role of environmental, social, psychological, cultural determinants.
  • Inadequate to solve major problems: malnutrition, chronic diseases, accidents, drug abuse, mental illness, environmental pollution, population explosion.
  • Led to conclusion that biomedical model inadequate; gave rise to other concepts.

4. Define positive health and explain why it is considered a mirage.

• Positive Health:
  Beyond absence of disease or provision of diagnostic/curative/preventive services; includes physical, mental, social well-being (WHO definition).
  “Perfect functioning”: biologically (optimum cell/organ harmony), psychologically (perfect well-being/mastery over environment), socially (optimal participation in social system).
  Harmonious balance of individual integrated into environment.
• Why a mirage (Dubos):
  • Man never perfectly adapted — life involves struggles, failures, sufferings.
  • Everything subject to change; positive health = potentiality (ability to modify continually in changing conditions).
  • Work never done (like gardener facing insects, moulds, weeds).
  • Ideas of perfect positive health now appear slightly ridiculous.

5. What is PQLI? List its components.

• PQLI (Physical Quality of Life Index):
  Composite index consolidating three indicators; measures results of social/economic/political policies (not inputs like per capita GNP).
  Scale: 0–100 (0 = worst performance, 100 = best); ultimate objective = PQLI of 100.
  Complements GNP; shows “money is not everything” (e.g., high in Sri Lanka/Kerala despite low income; low in oil-rich Middle East despite high income).
• Components (equal weight):
  1. Infant mortality
  2. Life expectancy at age one
  3. Literacy
• Average of three indexed scores.

6. Enumerate the new philosophy of health.

New philosophy of health (acquired in recent years):

1. Health is a fundamental human right.
2. Health is the essence of productive life, and not the result of ever increasing expenditure on medical care.
3. Health is intersectoral.
4. Health is an integral part of development.
5. Health is central to the concept of quality of life.
6. Health involves individuals, state and international responsibility.
7. Health and its maintenance is a major social investment.
8. Health is a worldwide social goal.

7. Differentiate between standard of living and level of living.

8. Draw and label the spectrum of health.

Positive health (optimum well-being)  ↔  Better health  ↔  Freedom from sickness  ↔  Unrecognised sickness  ↔  Mild sickness  ↔  Severe sickness  ↔  Death (total dysfunction)

• Explanation:
  • Health-disease continuum; no single cut-off point.
  • Dynamic phenomenon — fluctuates with continuous change/subtle variations.
  • Transition gradual; matter of judgment where one state ends.
  • Degrees/levels of health & illness; as long as alive, some degree of health exists.

9. List the attributes of a mentally healthy person.

Attributes (from psychologists):

1. Free from internal conflicts (not at “war” with himself).
2. Well-adjusted (gets along well with others; accepts criticism; not easily upset).
3. Searches for identity.
4. Strong sense of self-esteem.
5. Knows himself (needs, problems, goals — self-actualization).
6. Good self-control (balances rationality & emotionality).
7. Faces problems and solves them intelligently (copes with stress & anxiety).

10. What is the holistic concept of health?

• Holistic concept:
  Synthesis of biomedical, ecological & psychosocial concepts.
  Unified/multidimensional process; well-being of whole person in context of environment.
  Corresponds to ancient view: sound mind in sound body in sound family in sound environment.
• Key features:
  • Recognizes strength of social, economic, political & environmental influences.
  • All sectors affect health (agriculture, animal husbandry, food, industry, education, housing, public works, communications, etc.).
  • Emphasis on promotion & protection of health (not just treatment).
  • Health both biological & social phenomenon.

10(M)

1. Describe the changing concepts of health with suitable examples.

Changing Concepts of Health (Evolved from individual concern to worldwide social goal; based on patterns of thought, confusion from different professional views — biomedical scientists, social specialists, ecologists).

• Historical Context: Health as "absence of disease" (oldest definition). Ancient cultures: Harmony = health (e.g., peace with self, community, god, cosmos). Indians/Greeks: Disease from "humors" imbalance. Modern medicine focused on disease study, neglecting health epidemiology (ignorance of determinants, no yardstick for measurement).

• Biomedical Concept (Traditional, 20th century dominant): Health = absence of disease. Body as machine; disease from germ theory (e.g., pathogens cause breakdown; doctor's role = repair via drugs/surgery). Example: Treating infections with antibiotics. Criticisms: Ignores environmental/social/psychological/cultural factors; inadequate for malnutrition, chronic diseases, accidents, drug abuse, mental illness, pollution, population explosion.

• Ecological Concept (From biomedical deficiencies; Dubos, 1965): Health = dynamic equilibrium between man and environment; disease = maladjustment. Human/ecological/cultural adaptations determine disease/food availability/population. Example: Improved adaptation in natural environments leads to longer life expectancy without modern services (e.g., tribal communities). Issues: Imperfect man/environment; history shows better quality of life via adaptation.

• Psychosocial Concept (From social sciences): Health influenced by social, psychological, cultural, economic, political factors (not just biological). Example: Stress from social isolation causing hypertension/peptic ulcer; community support improving mental well-being. Health as biological and social phenomenon.

• Holistic Concept (Synthesis of above; multidimensional): Well-being of whole person in environment (sound mind/body/family/environment). All sectors (agriculture, education, industry, housing) affect health; emphasis on promotion/protection. Example: Integrating medical + social interventions for chronic diseases like diabetes (lifestyle + community support). Aligns with ancient views; most comprehensive for modern challenges.

• Evolution Timeline: From individual (biomedical) to global social goal (Health for All by 2000, MDGs 2000, SDGs 2015). Reawakening: Health as human right, essential for quality of life, socio-economic development.

• Examples of Change: Biomedical failed in pollution-related illnesses (e.g., environmental maladjustment in ecological view). Psychosocial explains cultural differences in mental health (e.g., community ties in Indian villages vs. urban isolation).

(Exam Tip: Draw spectrum: Biomedical → Ecological → Psychosocial → Holistic; discuss with real-world examples for depth.)

2. Explain the WHO definition of health and its operational version.

WHO Definition of Health (1948, preamble to constitution; broad, positive implications).

• Standard Definition: "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Amplified: Includes ability to lead a socially and economically productive life.

• Positive Aspects: Sets standard for "positive" health; symbolizes aspirations; represents global objective for nations. Broad/positive implications: Focus on well-being beyond cure; ties to social justice, human rights, socio-economic development (e.g., Health for All 1977).

• Criticisms/Limitations: Too broad/elusive; "complete" well-being idealistic (few achieve it). Not a "state" — dynamic process of adjustment to living demands/meanings. Hampers measurement (no direct yardstick); aspirational, not practical for chronic conditions/disabilities.

• Operational Definition (For measurement; from WHO study group): Views health in two orders.

  • Broad Sense: Condition/quality of human organism expressing adequate functioning in given genetic/environmental conditions (e.g., homeostasis/equilibrium; adaptation to stimuli).
  • Narrow Sense (Useful for measuring): (a) No obvious disease evidence; functioning normally within age/sex/community/geographic norms. (b) Organs function adequately alone and in relation (stable equilibrium varying with adaptation). Example: Normal BP for Indian adult (120/80 mmHg) vs. variations in high-altitude regions.

• Comparison: WHO definition inspirational/global standard; operational version practical for epidemiology (e.g., surveys using symptoms/risk factors). Both emphasize multidimensional health, but operational enables tools like questionnaires/clinical exams.

• New Philosophy Alignment: Health as human right, intersectoral, integral to development/quality of life, social investment, worldwide goal (supports WHO's broad view).

(Exam Tip: Quote WHO exactly; discuss limitations with examples like chronic illness where "complete" well-being is unattainable.)

3. Discuss the physical and mental dimensions of health, including evaluation methods.

Physical Dimension (Easiest to understand; one of WHO's three specific dimensions).

• Concept: "Perfect functioning" of body — every cell/organ at optimum capacity/harmony. Not definable precisely; normality has wide limits from "normal" people observations.

• Signs: Good complexion, clean skin, bright eyes, lustrous hair, firm flesh (not too fat), sweet breath, good appetite, sound sleep, regular bowels/bladder, coordinated movements. Organs normal size/function; intact senses; normal vitals (pulse/BP/exercise tolerance) for age/sex. Young: Steady weight gain; adults: Stable weight (±5 lbs/2.3 kg from age 25).

• Evaluation Methods: Tools/techniques in combinations:

  • Self-assessment of overall health.
  • Inquiry into symptoms/risk factors/medications/activity levels (e.g., restricted days, fitness).
  • Use of medical services (physician visits/hospitalizations).
  • Standardized questionnaires (cardiovascular/respiratory diseases).
  • Clinical examination, nutrition/dietary assessment, biochemical/lab investigations.
  • Community level: Death rate, IMR, life expectancy.

Mental Dimension (Not mere absence of illness; essential component, but foundations unclear).

• Concept: Ability to respond to life experiences with flexibility/sense of purpose; balance/harmony between individual/world, self/others, environment. Psychological factors induce illnesses (e.g., hypertension, peptic ulcer, asthma). Biological/psychological/behavioral dysfunction; not just societal relationship disturbance.

• Attributes: Free from internal conflicts; well-adjusted (accepts criticism); searches for identity; strong self-esteem; knows self (needs/problems/goals — self-actualization); good self-control (rationality/emotionality balance); copes with stress/anxiety.

• Evaluation Methods: Mental status questionnaires by interviewers (assess organic disease, psychiatric symptoms, well-being). Focus: Mental functioning (cognitive/affective impairments on role/subjective quality) or psychiatric diagnosis. Example: Assessing dysfunction like depression's biological component.

• Interlink: Mind-body not independent (e.g., stress → physical illness); positive mental health key to overall health, but knowledge incomplete.

(Exam Tip: Compare: Physical = biological/optimum function; Mental = psychological/flexibility. Use table for evaluation methods.)

4. Compare and contrast PQLI and HDI as measures of well-being.

PQLI (Physical Quality of Life Index): Composite for well-being; consolidates three indicators, measures policy results (not inputs).

• Components: Infant mortality, life expectancy at age 1, literacy (equal weight). Scale: 0–100 (average of indexed scores; 0 = worst, 100 = best).
• Strengths: Simple; complements GNP (shows "money not everything"); international/national comparison. Example: High in Sri Lanka/Kerala (low GNP), low in Middle East (high GNP). Ultimate goal: PQLI 100.
• Limitations: Limited to three indicators; ignores income directly; measures results, not economic growth.

HDI (Human Development Index): Composite focusing on basic human development; more comprehensive than per capita income (income as means, not end).

• Components: Life expectancy at birth, knowledge (mean/expected years schooling), decent living (GNI per capita PPP US$). Geometric mean of indices (0–1). Categories: Low (<0.550), Medium (0.550–0.699), High (0.700–0.799), Very High (>0.800).
• Strengths: Reflects long/healthy life, knowledge, standard of living; comprehensive picture beyond income. Example: India 2019 HDI 0.645 (Medium, rank 131); Norway tops (2019). Allows comparisons; shows disparities (e.g., similar income ≠ similar HDI).
• Limitations: Goalposts fixed (e.g., life expectancy max 85/min 20); geometric mean; no inequality/environment factors (separate indices exist).

Comparison: Both measure well-being beyond GNP; PQLI simpler (3 indicators, average), HDI broader (3 dimensions, geometric mean). PQLI focuses on physical quality/results; HDI on human capabilities/achievements. Both scaled (PQLI 0–100, HDI 0–1); used for policy evaluation.

Contrast: PQLI excludes income (complements GNP); HDI includes GNI. PQLI literacy-based education; HDI schooling years. PQLI for quality of life; HDI for development. Example: Low-income high PQLI (Kerala); varying HDI in similar income countries.

(Exam Tip: Table: Components | Scale | Strengths | Limitations; examples for contrast.)

5. Elaborate on the concept of well-being, including quality of life.

Concept of Well-Being (Condition of individual/group; social/economic/psychological/spiritual/medical; objective/subjective components).

• Objective Components: Standard of living/level of living (measurable).

  • Standard of Living: Usual expenditure scale, goods/services (education, food, dress, house, amusements). Measured by per capita GNP; WHO: Income/occupation, housing/sanitation/nutrition, health/education/recreational services as socio-economic index. Inequalities via GNP comparisons.
  • Level of Living (UN term): 9 components — health (primary), food, education, occupation/working conditions, housing, social security, clothing, recreation/leisure, human rights. Influences well-being; health impairment affects all.

• Subjective Component: Quality of Life (QoL) — Individual's subjective happiness/unhappiness about life concerns. WHO: Condition from factors determining health, happiness (comfort/occupation), education, social/intellectual attainments, freedom, justice/expression. Recent WHO: Interplay of social/health/economic/environmental conditions affecting human/social development (physical health, psychological state, independence, relationships, beliefs, environment).

• Evaluation: QoL assessed by subjective feelings (happiness about health/education/freedom). Governments focus on improving via reduced morbidity/mortality, primary care; demands better QoL beyond standard rise (social policy/reformulation for liveable life).

• Indices for Well-Being: PQLI (infant mortality, life expectancy age 1, literacy; 0–100). HDI (life expectancy, education, GNI; 0–1). Both complement GNP; measure policy results/human capabilities.

• Broader View: Well-being tied to positive health; governments reduce inequalities. Example: High standard (high GNP) but low QoL if no freedom (e.g., restrictive societies); balanced in SDGs.

(Exam Tip: Differentiate objective vs. subjective; include PQLI/HDI as measures with examples.)

6. Describe the ecological and psychosocial concepts of health.

Ecological Concept (From biomedical deficiencies; attractive hypothesis by ecologists).

• Definition: Health = dynamic equilibrium between man and environment; disease = maladjustment of human organism to environment (Dubos: Relative absence of pain/discomfort; continuous adaptation for optimal function).

• Key Features: Human/ecological/cultural adaptations determine disease occurrence, food availability, population explosion. Raises issues: Imperfect man/environment. Example: Improvements in natural adaptation lead to longer life expectancy/better quality without modern services (e.g., historical populations in balanced ecosystems).

• Strengths: Emphasizes environment; history shows adaptation benefits (e.g., rural vs. urban pollution maladjustment causing diseases).

Psychosocial Concept (From contemporary social sciences developments).

• Definition: Health influenced by social, psychological, cultural, economic, political factors (not just biomedical). Health as biological and social phenomenon.

• Key Features: Factors considered in defining/measuring health. Example: Social isolation causing mental illnesses (depression); economic stress leading to hypertension. Psychological factors induce physical conditions (e.g., bronchial asthma from anxiety).

• Strengths: Explains non-biological diseases; e.g., cultural norms affecting health behaviors (community support in psychosocial harmony).

• Comparison: Ecological focuses on environment-human balance; psychosocial on social influences. Both address biomedical gaps; lead to holistic synthesis.

(Exam Tip: Examples: Ecological — pollution maladjustment; Psychosocial — cultural factors in mental health.)

7. Explain the steps to calculate HDI with an example.

Human Development Index (HDI) (Composite; 0–1; reflects long/healthy life, knowledge, decent living).

• Step 1: Creating Dimension Indices: Set goalposts (min/max values). Transform indicators to 0–1 indices.

  • Formula: Dimension Index = (Actual value - Min) / (Max - Min).
  • Goalposts: Life expectancy (85 max, 20 min); Mean years schooling (15 max, 0 min); Expected years schooling (18 max, 0 min); GNI per capita PPP $ (75,000 max, 100 min).
  • For education: Geometric mean of mean/expected years indices, then apply formula (min 0, max highest geometric mean).

• Step 2: Aggregating Subindices: HDI = Geometric mean of three indices: (Life^{1/3} × Education^{1/3} × Income^{1/3}).

• Example (India 2019):

  • Life expectancy 69.7: Index = (69.7 - 20) / (85 - 20) = 49.7 / 65 = 0.764.
  • Mean years schooling 6.5: Index = 6.5 / 15 = 0.433.
  • Expected years schooling 12.2: Index = 12.2 / 18 = 0.677.
  • Education Index: Geometric mean = √(0.433 × 0.677) = wait, actually average or geometric? PDF: (0.433 + 0.677)/2 = 0.555 (arithmetic in example, but geometric in method).
  • Income (GNI 6,681): Index = [ln(6,681) - ln(100)] / [ln(75,000) - ln(100)] = 0.634.
  • HDI = ∛(0.764 × 0.555 × 0.634) = 0.645 (Medium category).

• Categories: Low <0.550, Medium 0.550–0.699, High 0.700–0.799, Very High >0.800. Example: Norway top; India rank 131 (2019).

(Exam Tip: Draw Fig. 1 diagram: Life → Education → Income → HDI; use India data.)

8. Discuss health as a relative concept with illustrations.

Health as a Relative Concept (Alternative to positive health; not ideal/universal state, but biologically "normal" based on statistical averages).

• Concept: Health norms vary by culture, social class, age, ecological conditions (no universal standards). Defined per prevailing conditions; countries set own norms then achieve them.

• Illustrations:

  • Newborn weight: Indian baby 2.8 kg (healthy average) vs. Western 3.5 kg (norms differ).
  • Height/weight standards: Vary between countries/socio-economic groups (e.g., lower in low-income vs. affluent).
  • Normal findings: Heart murmurs/enlarged tonsils/X-ray shadows common in "normal" people without ill-health (relative to community norms).
  • Age variations: Elderly "healthy" with some limitations vs. young standards.
  • Cultural examples: Tribal diets healthy in context vs. urban (e.g., high-altitude adaptations).

• Implications: Health relative to ecological conditions (e.g., Indian vs. developed countries). Avoids universal ideals; focuses on achievable levels (e.g., IMR norms lower in developing nations).

• Contrast with Positive: Positive = perfect/absolute (mirage); relative = statistical/normal (practical).

(Exam Tip: Illustrations essential; discuss with examples from India vs. West.)

9. Describe the social and spiritual dimensions of health.

Social Dimension (WHO's third; implies harmony/integration).

• Concept: Harmony within individual, between individuals/society, and with world. Quantity/quality of interpersonal ties; community involvement. Every individual part of family/wider community; focuses on social/economic conditions, well-being of "whole person" in social network.

• Roots: Positive material environment (financial/residential); positive human environment (social relations). Example: Strong family ties reducing isolation/stress; community participation improving health (e.g., village support systems).

Spiritual Dimension (Newer in holistic health; time to consider seriously).

• Concept: Reaches for meaning/purpose in life; integrity, principles, ethics, commitment to higher being/beliefs. Transcends physiology/psychology; intangible "something" defying definition.

• Role: Plays in health/disease (e.g., faith providing purpose amid illness). Example: Belief in higher power aiding recovery (integrity/ethics in daily life promoting mental peace).

• Interlink: Social/spiritual interact (e.g., community rituals enhancing both). Both non-medical; contribute to productive life.

(Exam Tip: Examples: Social — interpersonal harmony; Spiritual — ethical purpose.)

10. Explain the determinants of health with a diagram.

Determinants of Health (Multifactorial; interactions health-promoting/deleterious).

• Concept: Factors influencing health within individual/society. Depend on genetic + environmental factors (biological, behavioral, socio-economic, cultural). Interactions determine disease vulnerability.

• Key Determinants:

  • Genetic: Inherited factors (e.g., predisposition to diabetes).
  • Environmental: Biological (pathogens), behavioral (lifestyle), socio-economic (income/education), cultural (norms).
  • Interactions: E.g., poor socio-economic + behavioral (smoking) → deleterious; good education + cultural support → promoting.

• Explanation: Health result of many interactions (truism: man/diseases from genetics + exposure). Communities' health from these sets.

20(M)

Here are clean, simple notes in easy-to-understand language for the 20M long essay questions from MUHS BHMS 4th Year PSM (Concept of Health and Disease).
These are structured like exam-style answers — detailed enough for 15-20 marks (full page length feel), using bullet points, short sentences, and clear headings for quick revision. All content is directly from the PDF (no extra invention), with simple words where possible.

1. Define health. Discuss its changing concepts, dimensions, and spectrum in detail.

Definition of Health

• Health is hard to define exactly — people know it when they feel it, but words are tricky.
• Oldest idea: Health = no disease.
• WHO Definition (1948): "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."
  • Later added: Ability to lead a socially and economically productive life.
• Good side: Broad and positive — sets high goal for "positive health"; shows health is more than no illness; inspires global work (human right, quality life).
• Problems: Too ideal ("complete" well-being almost impossible); seen as fixed state (but health is dynamic — constant adjustment to life changes); hard to measure directly.

Operational Definition (for practical use):

• Broad: Good body function in given genes/environment (homeostasis + adaptation).
• Narrow: No clear disease; normal function for age/sex/community/place; organs work well together.

Changing Concepts of Health
Health changed from personal issue → worldwide social goal (quality of life). Different experts see it differently → some confusion.

1. Biomedical Concept (traditional, 20th century main idea)

   • Health = absence of disease.
   • Body = machine; disease = breakdown (germ theory).
   • Doctor fixes it (drugs, surgery).
   • Example: Antibiotics cure infection.
   • Problem: Ignores environment, society, mind, culture.
     Cannot handle malnutrition, chronic diseases (diabetes), accidents, mental illness, pollution, population growth.
     Led to need for better ideas.

2. Ecological Concept

   • Health = dynamic balance between human and environment.
   • Disease = maladjustment (not fitting well).
   • Dubos: No pain + continuous adaptation for best function.
   • Example: Village people adapt to nature → longer life without big hospitals.
   • Problem: Human and environment both imperfect.

3. Psychosocial Concept

   • Health affected by social, psychological, cultural, economic, political things (not just body).
   • Health = biological + social.
   • Example: Loneliness → high BP or ulcer; good family support → better mind health.

4. Holistic Concept (most complete — mix of all)

   • Total well-being of whole person in environment.
   • Sound mind + body + family + surroundings.
   • All areas affect health: agriculture, education, industry, housing, food, etc.
   • Focus: Promote and protect health (not just cure).
   • Matches old Indian/Greek views; best for today's problems (pollution, chronic diseases).

New Philosophy (modern view):

• Human right.
• Needed for productive life (not just more medical money).
• Intersectoral (many sectors help).
• Part of development and quality of life.
• Duty of person, state, world.
• Big social investment.
• Worldwide goal (Health for All, SDGs).

Dimensions of Health (many sides — interact)
WHO: Physical, mental, social. Others added.

• Physical: Perfect body work (cells/organs harmony).
  Signs: Good skin/eyes/hair, appetite, sleep, bowels, normal weight/BP/pulse.
  Check: Self-check, questions, doctor exam, lab tests, community data (IMR, life expectancy).

• Mental: Flexible life response, purpose, harmony with world/self/others.
  Signs: No inner fights, well-adjusted, good self-esteem, knows self, controls emotions, solves problems.
  Check: Mental questionnaires.

• Social: Good relations with people/society, community help.
  Rooted in good money/home + human ties.

• Spiritual: Meaning/purpose, ethics, higher belief (beyond body/mind).

• Emotional: Feeling side (joy/sadness control) — separate from thinking.

• Vocational: Work fits ability → gives satisfaction (big if lose job).

• Others: Cultural, socio-economic, environmental, educational, nutritional, preventive (many non-medical — other sectors must help).

Spectrum of Health
Health-disease = continuous line (no sharp border).

• Dynamic — changes daily.
• Gradual shift.
• Alive = some health always.
• Helps understand prevention at every point.

2. Elaborate on the concept of well-being. Compare standard of living, level of living, and quality of life. Add notes on PQLI and HDI.

Concept of Well-Being
Well-being = condition of person/group (social, economic, psychological, spiritual, medical).

• Objective parts: Measurable (standard/level of living).
• Subjective part: Personal feeling (quality of life).
  Broader than health — includes happiness/satisfaction.
  Governments improve it by less sickness, primary care, better physical/mental/social life.
  Tied to positive health; need more than money rise (social changes for better life).
  Example: SDGs focus on well-being for all ages.

Compare Standard of Living, Level of Living, Quality of Life

• Standard of Living: Material side — money spent, things used (food, house, education, clothes, fun).
  Measured by per capita GNP (main).
  Example: High salary → better house/car.
  Quantitative (money-based).

• Level of Living (UN term): Actual life conditions.
  9 parts: Health (most important), food, education, job, house, security, clothes, leisure, human rights.
  Broader — qualitative + quantitative.
  Example: Good hospitals/schools → real better life.

• Quality of Life (QoL): Personal happiness feeling about life (health, education, freedom, relations, beliefs).
  WHO: Mix of social/health/economic/environment factors.
  Subjective — how you feel.
  Example: Good money but no freedom → low QoL.

Comparison Table (easy to remember):

Notes on PQLI and HDI

• PQLI: Physical Quality of Life Index.
  3 parts: Infant mortality, life expectancy at 1 year, literacy.
  Scale: 0–100.
  Measures policy results (not just money).
  Example: High in Kerala/Sri Lanka (low income), low in rich oil countries.
  Goal: 100.

• HDI: Human Development Index.
  3 parts: Life expectancy, education (mean + expected schooling), GNI per capita (PPP $).
  Scale: 0–1 (geometric mean).
  Categories: Medium 0.55–0.699, High 0.7+.
  Calculation: Indices = (actual - min)/(max - min); HDI = cube root of product.
  Example: India 2023 = 0.685 (rank 130, medium; life expectancy 72 years; up from 0.676 in 2022).
  Progress: +53% since 1990.
  Challenges: Inequality, gender gaps, malnutrition.

Both show well-being beyond money; PQLI simple/physical, HDI broader/human-focused.

3. Discuss positive health and its challenges. Explain how health is multidimensional, with emphasis on non-medical dimensions.

Positive Health

• Beyond no disease or treatment.
• WHO state: Complete physical/mental/social well-being + harmony with environment.
• "Perfect functioning":
  • Body: Optimum cell/organ harmony.
  • Mind: Perfect well-being + control over surroundings.
  • Society: Best social participation.
• Also: Quality of life improvement (health + economic/cultural/social factors).
• Seen as potential to adapt to changes.

Challenges

• Dubos: Mirage — impossible.
  • Life has struggles/failures/pain — no perfect adaptation.
  • Everything changes — health not fixed.
  • Work never ends (like farmer fighting weeds).
• Hard to measure — no single tool; determinants unclear.
• Relative norms (e.g., Indian baby 2.8 kg healthy vs. Western 3.5 kg).
• Modern problems (pollution, chronic diseases) need more than medicine.
• Few people reach "complete" well-being amid stress.
• Example: Chronic patient adapts but not perfect.

Health as Multidimensional
Health has many layers — interact; WHO: Physical/mental/social; others added.

Emphasis on Non-Medical Dimensions (many beyond doctors/hospitals — other sectors help)

• Spiritual: Purpose/meaning/ethics/higher belief (helps in illness recovery).
• Emotional: Feeling control (joy/sadness) — separate from thinking.
• Vocational: Suitable work → satisfaction/self-esteem (problem if lose job).
• Cultural: Traditions/behaviors affect health (e.g., food habits).
• Socio-Economic: Money/job level (poverty → poor health).
• Environmental: Fit with surroundings (pollution harms).
• Educational: Knowledge for good habits.
• Nutritional: Food quality (agriculture link).
• Preventive/Curative: Beyond medicine — community/society role.

Non-medical show health needs education/agriculture/industry too.
Example: Holistic view uses all for balance (matches homeopathy vital force).

4. Describe the WHO definition of health, its philosophy, and indices like HDI (including calculation). Analyze India's HDI status.

WHO Definition

• "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."
• Added: Socially/economically productive life.
• Broad/positive — high goal for positive health; inspires nations.

Philosophy

• Health = human right.
• Essence of productive life (not more medical spending).
• Intersectoral (many sectors help).
• Part of development/quality of life.
• Duty of person/state/world.
• Major social investment.
• Worldwide goal (Health for All, SDGs).
• Dynamic process; operational: Good function/no disease/normal equilibrium.

Indices like HDI

• HDI (Human Development Index): Measures long life, knowledge, decent living.
  Scale: 0–1 (geometric mean).
  Calculation:

  1. Indices = (actual - min)/(max - min).
     Goalposts: Life 85/20, Mean schooling 15/0, Expected 18/0, GNI 75,000/100.
  2. HDI = cube root (Life × Education × Income).
     Example: India 2023 — Life ~72 years, Education average, GNI — HDI 0.685.

• PQLI (similar): Infant mortality + life expectancy age 1 + literacy (0–100).

India's HDI Status (2025 Report, data 2023)

• Rank: 130 out of 193 countries.
• Value: 0.685 (medium category; close to high ≥0.700).
• Up from 0.676 in 2022 (rank 133).
• Progress: +53% since 1990 (faster than world/South Asia).
• Good: Life expectancy 72 years (up); education/income better.
• Challenges: Inequality (30.7% loss), gender gaps (rank low), malnutrition, regional differences.
• Link to economy not automatic — needs focus on equality for SDGs.

5. Explain the determinants of health. Discuss the health-disease spectrum and concepts like holistic health.

Determinants of Health
Health affected by many things — inside person + outside society.

• Genetic: From parents (e.g., family diabetes risk).
• Environmental:
  • Biological (germs).
  • Behavioral (smoking, eating).
  • Socio-economic (money, education).
  • Cultural (traditions).
    Interactions: Good (education + good habits = better health) or bad (poverty + smoking = disease).

Health-Disease Spectrum
Continuous line — no sharp border between health and disease.

• Dynamic — changes every day.
• Gradual shift.
• Alive = some health level always.
• Helps prevention at every stage.

Holistic Health Concept

• Mix of biomedical + ecological + psychosocial.
• Total well-being of whole person in environment.
• Sound mind/body/family/surroundings.
• All sectors affect: Agriculture, education, industry, housing.
• Focus: Promote/protect health (not just cure).
• Matches old views; best for modern issues (pollution, chronic diseases).
• Aligns with spectrum — dynamic balance for positive end.