Health – modern concept
Health is a state of complete physical and social well being and not merely an absence of disease or infirmity. – World Health Organization (1984).
Operational definition of Health by WHO – a condition or quality of the human organism expressing the adequate functioning of the organism in given conditions, genetic or environmental.
Positive health – it implies the notion of perfect health in body and mind. It cannot become a reality, it always remain a mirage because everything in our life is subject to change.
Dimensions of health
Health is multidimensional- mainly physical, mental and social (also spiritual, emotional, vocational, political, cultural, socioeconomic, environmental, philosophical, educational, nutritional, curative and preventive dimensions).
Physical dimension – it implies the notion of “perfect functioning” of the body. A good complexion, clean skin, bright eyes, firm flesh, not too fat, a sweet breath, good appetite, sound sleep, regular activity of bowels and bladder and co-coordinated bodily movements. All organs are of unexceptional size and functions normally, all intact special senses, normal pulse rate, blood pressure and exercise tolerance.
Mental dimension – mental health is not mere absence of mental illness. A mentally healthy person is one who is free from internal conflicts, well adjusted ( i.e. able to get along well with others and he accepts criticism and is not easily upset), searches for identity, a firm sense of self esteem, knows himself ( his needs, problems and goals), good self control and faces problems and tries solve them intelligently.
Social dimension – it implies harmony and integration with in the individual, between each individual and other members of the society and between individuals and the world in which they live.
Spiritual dimension – it refers to that part of individual which reaches out and strives for meaning and purpose in life.
Emotional dimension – mental health can be seen as ‘knowing’ or ‘cognition’ while emotional health relates to ‘feeling’.
Vocational dimension – it’s a new dimension of life. It refers to mental and physical adaptation to work (human goals, capacities and limitations).
Determinants of health
Health is multifactorial. Determinants of health are
1. Heredity- the genetic make up is unique and cannot be altered after conception. A number of diseases like chromosomal abnormalities, errors of metabolism, mental retardation, some types of diabetes are of genetic origin. 2. Environmental- the “internal” environment of man pertains to every tissue, organ, organ-system, parts and their harmonious functioning. The “external” environment pertains to all that is external to the human host.
3.Life style-the way people live. It composed of cultural and behavioral patterns and life long personal habits (smoking, alcoholism etc) that have developed through the processes of socialization.
4.Socio-economic conditions – the health status is determined primarily by socioeconomic development. Important socioeconomic factors are;
a) Economic status: the economic progress is the major factor in reducing morbidity, increasing life expectancy & improving quality of life.
b) Educational status: second major factor influencing health is education. Literacy coincides with poverty, malnutrition, ill health, high infant and child mortality rates.
c) Occupation: unemployed people usually show higher incidence of ill health and death. It can cause psychological and social damage.
5. Health Services – it helps in the treatment of disease, prevention of illness and promotion of health.
Ecology of health
Ecology is defined as the science of mutual relationship between living organisms and their ecology. Health according to ecological concept is a state of dynamic equilibrium between man and his environment. Prevention of disease through ecological or environmental manipulations or interventions is safer, cheaper and a more effective rational approach. it is through environmental manipulations that disease such as cholera, typhoid, malaria etc. are brought under control or eliminated.
Indicators of health
Indicators of health are used to measure the health status of a community and also to compare the health status of one country to another. They are as follows,
- 1. mortality indicator 7. indicator of social and mental health
- 2. morbidity indicator 8. environmental indicators
- 3. disability rates 9. socio-economic indicators
- 4. nutritional status indicator 10. health policy indicators
- 5. health care delivery indicator 11. indicators of quality of life
- 6. utilization rates 12. other indicators
FACTORS AFFECTING HEALTH— Modern concept.
Germ theory of disease:- This theory emphasis microbe as the sole cause of disease. But its demerit is that it cannot explain the multifactorial disease conditions.
Epidemiological triad:- It is a triad of environment, agent and host
Multifactorial causation:- multiple factors are responsible for a disease, ie microbes, physical, mental, social, economic, genetic and psychological factor. e.g, coronary heart diseases, lung cancer, c/c bronchitis etc.
Web of causation:- This model is ideally suited in the study of c/c diseases where the disease agent is often not known, but is the outcome of interaction of multiple factors.
Agent factor: – Defined as a substance, living or non living, or a force, tangible or intangible, the excessive presence or relative lack of which may initiate or perpetuate a disease process. They are –
- 1.Biological agents– Living agents of disease, viz. bacteria, viruses, rickettsiae, fungi, protozoa and metazoa.
- 2. Nutrient agents – The excess or deficiency of proteins, fats, vitamins, minerals and water may results in nutritional disorders.
- 3. Physical agents – exposure to excessive heat, cold, humidity, pressure, radiation, electricity, sound, etc may result in illness.
- 4. Chemical agents – i) endogenous: ie, formed in the body as a result of derangement of functions. eg, urea (uremia),bilirubin (jaundice), etc…
ii) Exogenous; agents outside the human host, eg. allergens, metals, fumes, dust, insecticides, etc..
- 5. Mechanical agents – sprains, dislocations, c/c friction, etc…
- 6. Absence or insufficiency or excess of factor necessary to health – these may be i) chemical factors eg. hormone, ii) nutrient factors, iii) lack of structure iv) lack of part structure, v) chromosomal factors eg. Turner’s syndrome and vi) immunological factors eg. agammaglobulinaemia.
- 7. Social agents – these are poverty, smoking, abuse of drug and alcohol, social isolation, maternal deprivation, etc.
Host factor (intrinsic)- host is ‘soil’ and disease agent is ‘seed’. It includes age, sex, ethnicity biological characteristics such as genetic factors, blood groups, etc, socio-economic factors such as status, education, occupation, stress, etc and life style such as personality traits, drugs, alcohol, smoking behavior patterns etc.
Environmental factors (extrinsic)- it is complex and all-embracing. Defined as all that which is external to individual human host, living and non living and with which he is in constant interaction. Environment of man is divided into three components – physical, biological and psychological.
Risk factors- defined as an attribute or exposure that is significantly associated with the development of the disease. Risk factors are often suggestive, ie, presence of a risk factor does not imply that the disease will occur, and in its absence diseases will not occur. Risk factors may be causative (eg, smoking for CA lung), contributory (lack of physical exercise for CHD) or predictive (eg, illiteracy for prenatal mortality).
Health – Homoeopathic concept
Homoeopathy is a therapeutic system which implies a particular way of applying drug to disease according to a specific principle- ‘similia similibus curentur’; and it implies as well the theories of vital force, chronic miasms and dynamisation of drugs. It considers two important phenomena – the drug phenomenon and the disease phenomenon.
Homœopathy, or homœotherapy, is the department of science in general medicine which has for its principal objects the observation and study of the action of remedial agents in health and disease, and the treatment and cure of disease by medication, according to a fixed law or general principle.
Homœopathy the principles of the Inductive Method of Science as developed by Lord Bacon. Its practice is governed by the principle of Symptom-Similarity, which is the application in medicine of the universal principle of Mutual Action formulated by Sir Isaac Newton in his Third Law of Motion: “Action and reaction are equal and opposite.” Homœopathy, as a science, rests fundamentally upon four general principles: Similarity, Contrariety, Proportionality and Infinitesimality, reducible to the universal principle of Homœosis, or Universal Assimilation. (Fincke.) – Dr. Stuart Close
Dr. Samuel Hahnemann was a great humanitarian. If we go through his life and works, we can see his quest for a divine therapeutic system for the removal of disease and preservation of health. His prime concern was health. Hahnemann gave extreme importance to the heath in all levels of homoeopathic philosophy.
In the introduction of “The Friend Of Health” (1792) Hahnemann says – ‘My mission is only to preach upon the greatest of corporeal blessings – health’ i.e. regarding the rational care about the health. In this book, we can see how seriously and comprehensively Hahnemann wished to see all questions of health and public hygiene treated even in the earlier years of his activity.
Vital force and health - “Organon of Medicine” is the book containing the concept of health, disease and its cure – the authority of homoeopathic philosophy. Homoeopathy explains the various dimensions of health in terms of vital force. In 9th aphorism- “In the healthy condition of man, the spiritual vital force, the dynamis that animates the material body, rules with unbounded sway, and retains all the parts of the organism in admirable, harmonious, vital operation, as regards both sensations and functions, so that our indwelling, reason-gifted mind can freely employ this living healthy instrument for the higher purpose of our existence”. ie, health condition in which all the harmonious vital operations are going on were vital force is the supreme power, which animates and rules providing normal sensations and functions.
The material, organism without vital force, is capable of no sensation, no function, no self preservation; it derives all sensation and functions of life solely by means of the immaterial being (the vital force). In disease the vital force is primarily deranged by the dynamic influence upon it of a morbific agent inimical to life. The resulting abnormal sensations and functions are expressed as morbid symptoms. So symptoms are the outcry of vital force in disease.
Disease is the alternation in state of health of the healthy individual which is expressed by signs and symptoms. Cure is only possible by a change in diseased individual by medicines. Thus health, disease and cure all phenomena are operating in the dynamic plain.
H A Roberts says, In order to obtain a thorough knowledge of these vital functions we must study them in their manifestations during health. From the earliest period of its existence growth is manifest from within the cell out; it is never observed growing from without in. The one point most vital to observe is the course and direction of its expression-always from within outward. This is true in the embryonic state and is always maintained as long as life exists. This is equally true in the specialization of functions. The especial organs are developed and their functions maintained by the expression of the vital energy as the life-giving principle. All expression of the mind are such manifestations. Indeed, it is the expression of the vital force in and through the mind and intellect that has a very great influence in the functioning of all life and of the special organs. In health all expressions of vital force may be expressed by perfect functioning of all parts of the body and by a sense of general well-being.
Physician’s mission and heath- In 1st aphorism he says – the physician’s high only mission is to restore the sick to health. Beside a therapeutist, physician has others functions also, like diagnostician, a prognosticator, a preventive and public health officer, and a medico-legal jurist as well. But the chief duty is concerned with curing the sick ie, to restore the sick to health.
Ideal cure and health – In 2nd aphorism he says- the cure must be rapid, gentle and permanent ie, removal of disease in it whole extent, in shortest, most reliable and most harmless way on easily comprehensive principle. Cure should be affected in the most harmless way- harmless to the patient, to his bystanders and to the society. We can see a lot of examples of it, from the old school medicine to the modern medicine. Thus in the treatment level also health has got prim importance.
The 5th aphorism deals with the cause of the disease or factors affecting health. In acute disease the exciting cause and in chronic disease the fundamental cause ie the chronic miasm. For this the physical constitution of the patient, his moral and intellectual character, his occupation, mode of living and habits, his social and domestic relations, age, sexual functions etc are to be taken into consideration.
According to Stuart close health is the balanced condition of living organism in which the integral harmonious performance of the vital functions tends to the preservation of the organism and the normal development of the individual. A healthy man, who lives in a favorable environment moves, feels, thinks acts and reacts in an orderly manner. But when he becomes the victim of an unfavorable environment, deterioration of health is the result.
Life, health and disease – According to Dr. Stuart Close, Health is that balanced condition of the living organism in which the integral, harmonious performance of the vital functions tends to the preservation of the organism and the normal development of the individual.
Life is the invisible, substantial, intelligent, individual, co-ordinating power and cause directing and controlling the forces involved in the production and activity of any organism possessing individuality.
Disease is an abnormal vital process, a changed condition of life, which is inimical to the true development of the individual and tends to organic dissolution.
“Power resides at the center, and from the center of power, force flows.” The phenomena of life, as manifested in growth, nutrition, repair, secretion, excretion, self-recognition, self-preservation and reproduction, all take their direction from an originating center. From the lowest cell to the highest and most complex organism, this principle holds true. Cell wall and protoplasmic contents develop from the central nucleus and that from the centrosome, which is regarded as the “center of force” in the cell. All fluids tissues and organs develop from the cell from within outwards, from center to circumference.
Organic control is from the center.- In the completely developed human organism vital action is controlled from the central nervous system. The activities of the cell are controlled from, the centrosome, which may be called the brain of the cell. The central nervous system may be compared to a dynamo. As a dynamo is a machine, driven by steam or some other force, which, through the agency of electro-magnetic induction from a surrounding magnetic field, converts into electrical energy in the form of current the -mechanical energy expended upon it, so the central nervous system is a machine driven by chemical force derived from food which, through the agency of electro-vital induction from a surrounding vital field, converts into vital energy, in the form of nerve current or impulses, the chemico-physical energy expended upon it.
Diseases an electrical transportation system depends for its working force upon the dynamo located in its central power station, so the human body depends for the force necessary to carry on its operations upon the central power station, located in the central nervous system.
Any disturbance of conditions at the central power station is immediately manifested externally at some point in the system; and any injury to or break in the external system is immediately reflected back to the central station.
In health and disease it is the same, both being essentially merely conditions of life in the living organism, convertible each into the other. In each condition the modifying agent or factor acts primarily upon the internal life principle, which is the living substance of the organism. This reacts and produces external phenomena through the medium of the brain and nervous system which, extends to every part of the body. Food or poison, toxins or antitoxins, therapeutic agents or pathogenic micro-organisms, all acts upon and by virtue of be existence of the reacting life principle or living substance of the organism.
Cure of disease, or the restoration of health, likewise begins at the center and spreads outwardly, the symptoms disappearing from within outward, from above downward and in the reverse order of their appearance.
Resistance to morbific agents is from the center where life reigns. Vital resistance is the defensive reaction of living substance to noxious elements and organisms and to disease-producing causes and agents in general, in obedience to the inherent instinct or law of self-preservation, which belongs to life in organism.
Strictly speaking, it is not against disease that we struggle, but against the causes of disease – the actual causes of disease. They do not exist in the life substance itself. They become operative or effective in the organism conditionally, by virtue of the existence of the vital principle of susceptibility, reaction and resistance, and of a living organism in and through which action and reaction can take place.
Health and susceptibility
In aphorisms 30, 31 & 32 of Organon of medicine, Master Hahnemann explains the susceptibility in relation to health, disease and cure.
The human body appears to admit of being much more powerfully affected in its health by medicines (partly because we have the regulation of the dose in our own power) than by natural morbid stimuli for natural diseases are cured and overcome by suitable medicines.
The inimical forces, partly psychical, partly physical, to which our terrestrial existence is exposed, which are termed morbific noxious agents, do not possess the power of morbidly deranging the health of man unconditionally; but we are made ill by them only when our organism is sufficiently disposed and susceptible to the attack of the morbific cause that may be present and to be altered in its health, deranged and made to undergo abnormal sensations and functions, hence they do not produce disease in every one, nor at all times.
But it is quite otherwise with the artificial morbific agents which we term medicines – Every real medicine, namely, acts at all times, under all circumstances, on every living human being, and produces in him its peculiar symptoms (distinctly perceptible if the dose be large enough) so that evidently every human organism is liable to be effected, and, as it were, inoculated with the medical disease, at all times and absolutely (unconditionally), which, as before said, is by no means the case with the natural disease.
According to Dr. Stuart Close, susceptibility is the general quality or capability of the living organism of receiving impressions; the power to react to stimuli. In health- Upon it depends all functioning, all vital processes, physiological and pathological. Digestion, assimilation, nutrition, repair, secretion, excretion, metabolism and catabolism, as well as all disease processes arising from infection or contagion depend upon We power of the organism to react to specific stimuli.
The cure and alleviation of diseases depend upon the same power of the organism to react to the impression of the curative remedy. Men we give a drug to a healthy person for the purpose of making a homœopathic “proving” or test, the train of symptoms which follows represents the reaction of the susceptible organism to the specific irritant or stimulus administered. When a homœopathically selected medicine is administered to a sick person, the disappearance of the symptoms and restoration of the patient to health represents the reaction of the susceptible organism to the impression of he curative remedy.
“Susceptibility in organism, mental or bodily, is equivalent to state, which involves the attitude of organizations to internal causes and to external circumstances. It is all the resource of defense or the way of yielding. “In health we live and act and resist without knowing it. In disease we live but suffer; and know ourself in conscious or unconscious exaggeration.”
We must also predicate a state of normal susceptibility to remedial as well as toxic agencies, which it is the duty of the physician to conserve and utilize. No agent or procedure should be used as a therapeutic measure which has the power to, diminish, break down or destroy the normal susceptibility or reactibility of the organism, because that is one of the most valuable medical assets we possess. Without it all our efforts to cure are in vain. To use agents in such a manner or in such a form or quantity as to diminish, impair or destroy the power of the organism to react to stimuli, is to align ourselves with the forces of death and disintegration. Conservation of the power of the organism to react defensively to a toxin, a contagion, or an infection is as important as it is to conserve the power to react constructively to food and drink, or curatively to the homœopathic remedy. It is as normal and necessary for the organism to react pathogenetically to a poison, in proportion to the size and power of the dose, as it is to react physiologically to a good dinner.
According to H A Roberts, We may define susceptibility primarily as the reaction of the organism to external and internal influences. In analyzing susceptibility, we find it is very largely an expression of a vacuum in the individual. This is illustrated by the desire for food. The vacuum attracts and pulls for the things most needed, that are on the same plane of vibration as the want in the body. Susceptibility varies in degree in different patients, and at different times in the same patient. Susceptibility can be increased, diminished or destroyed. It therefore becomes a state of lowered resistance or attraction.
It is incumbent upon us to recognize, conserve and utilize normal susceptibility, to physical environments, to foods, to remedies and to toxic agencies. It should be our aim never to use any agent or anything of any nature, or to adopt any procedure, that would in the least diminish or destroy this power of susceptibility and the reaction of the organism in its normal manner. Upon this normal susceptibility and reaction depends the status of health. It is just as much the province of the physician to exercise conservation of susceptibility in the organism that it may act defensively against a toxin, contagion or infection, as it is to have this susceptibility react constructively to food and drink or to the curative remedy. Again, it is just as natural and important for the organism to react pathogenically to the size and power of a dose of poison as it is for it to react to the demand for food.
Health and drug proving-
In the aspect of proving also health has got prime importance, because in Homoeopathy drug are proved in healthy human beings. Aphorisms 105 to 145 deals with drug proving. Proving in lower animals will not gives exact symptoms, especially the subjective symptoms; also their body is different from that of man. Proving in sick persons will give you the mixed symptoms of disease and the drug.
“ There is, therefore, no other possible way in which the peculiar effects of medicines on the health of individuals can be accurately ascertained – there is no sure, no more natural way of accomplishing this object, than to administer the several medicines experimentally, in moderate doses, to healthy persons, in order to ascertain what changes, symptoms and signs of their influence each individually produces on the health of the body and of the mind; that is to say, what disease elements they are able and tend to produce, (1) since, as has been demonstrated (Aphorism 24-27), all the curative power of medicines lies in this power they possess of changing the state of man’s health, and is revealed by observation of the latter” (Aphorism 108). Before Hahnemann Albrecht von Haller was the only man who mentioned about it.
Three essential things for proving- 1. The quality of the drug must be pure, 2.The prover must possess the proper balance in functions and be in a normal, healthy state, so that we can estimate and weigh the amount of the disturbance caused when we deliberately upset the balance of health. 3. The circumstances surrounding the prover must be those of his normal surroundings. The ordinary habits of life must be observed, and his ordinary work maintained; otherwise changes from his routine might cause some deviation from his normal balance which would be attributed to the drug action.
Qualities of prover – The prover must be intelligent enough properly to appreciate and record the subjective symptoms as deviations from his normal conditions of life, as these subjective symptoms are of the utmost value. Honesty is a prerequisite of a good prover, for he must be very careful to record all phenomena as fact. Remember always to treat a fact as a fact and do not try to add to or subtract from its importance; it is not for the prover to sift the symptoms produced. At the beginning of this work, the prover must be in that state of mental, moral and physical equilibrium that is characteristic of a normal, healthy being. One who is subject to rapidly changing equilibrium on any one or all of these planes will not make a good prover.
Homoeopathic physician and preserver of health
Prevention is better than cure- is a truism. 4th Aphorism deals with the social and preventive medicine. “He is like wise a preserver of health if he knows the things that deranges health and cause disease and how to remove them from persons in health”
The cause of disease is internal (chronic miasm), but many of the disturbances that aggravate the disorder are external (e.g. – improperly selected food, living in damp cellars etc.). These are the measures that disturbing him, making him sick and aggravating his chronic miasm, i.e. things “which keep up disease”. Any ordinary physician with a well knowledge in hygiene can remove these external obstacles and preserve his patient’s health.
The book “The Friend Of Health” published in 1792 Hahnemann deals with both individual and social hygiene and its measures. Hahnemann gives clears cut directions for prevention of contagious and other epidemic diseases.