• Health is determined by multiple factors.
  • The health of an individual and community is influenced by: individual (internal) and external factors.
  • The individual factors include by his own genetic factors and the external factors include environmental factors.
  • These factors interact and these interactions may be health promoting or deleterious.
  • Thus, the health of individuals and whole communities may be considered to be the result of many interactions.


  • The health of an individual partly depends on the genetic constitutions.
  • A number of diseases e.g. chromosomal anomalies, inborn error of metabolism, mental retardation and some types of diabetes are some extent due to genetic origin.


  • Biological: disease producing agent (e.g. bacteria, virus, fungi), intermediate host (e.g. mosquito, sand fly), vector (e.g. house fly), reservoir (e.g. pig in JE).
  • Physical: Air, water, light, noise, soil, climate, altitude, rad iation housing, waste etc.
  • Psychosocial: psychological make up of individual and structure and functioning of society. E.g. habit, beliefs, culture, custom, religion etc.


  • Behavioural pattern and lifelong habits e.g. smoking and alcohol consumption, food habit, personal hygiene, rest and physical exercise, bowel and sleeping patterns, sexual behavior.


  • It consist of education, occupation and income.
  • The world map of illiteracy closely coincides with the maps of poverty, malnutrition, ill health, high infant and child mortality rates.
  • The very state of being employed in productive work promotes health, because the unemployed usually show a higher incidence of ill-health and deaths.
  • There can be no doubt that economic progress has positive impact factor in reducing morbidity, increasing life expectancy and improving the quality of life.

Availability of health ad family welfare Service

  • Health and family welfare services cover a wide spectrum of personal and community services for treatment of diseases, prevention of disease and promotion of health.
  • The purpose of health services is to improve the health status of population.
  • For example, immunization of children can influence the incidence/prevalence of particular disease. Provision of safe water can prevent mortality and morbidity from water-borne diseases.

Aging of the population

  • By the year 2020, the world will have more than one billion people aged sixty or over and more than two-thirds of them living in developing countries.
  • A major concern of rapid population aging is the increased prevalence of chronic diseases and disabilities both being condition that tend to accompany the aging process and deserve special attention.


  • Except above discussed determinants, there are many more determinates of health and disease of an individual and community. These include:
  • Science and technology
  • Information and communication
  • Gender
  • Equity and social justice
  • Human rights etc.


  • Individual responsibility: self-care for maintaining their own health.
  • Community responsibility: health care for the people to the health care by the people.
  • State responsibility: constitutional rights.
  • International responsibility: Health for All through PHC.


  • A variable which helps to measure changes, directly or indirectly (WHO, 1981).
  • A statistic of direct normative interest which facilitates concise, comprehensive, and balanced judgments about conditions of major aspects of the society (H.E.W./USA, 1969).
  • The health indicators are defined as those variables which measures the health status of an individual and community.
  • Mortality Indicators: Crude Death rate, Life Expectancy, Infant mortality rate, Child mortality rate, under five mortality rate, maternal mortality ratio, Disease specific mortality, proportional mortality rate etc.

  • Morbidity Indicators: Incidence and prevalence rate, disease notification rate, OPD attendance rate, Admission, readmission and discharge rate, duration of stay in hospital and spells of sickness or absence from work or school.
  • Disability Indicators: Sullivan’s index, HALE (Health Adjusted Life Expectancy), DALY (Disability Adjusted Life Year).
  • Sullivan’s index is a expectation of life free from disability.
  • HALE is the equivalent number of years in full health that a newborn can expected to live based on the current rates of ill health and mortality.
  • DALY expresses the years of life lost to premature death and years lived with disability adjusted for the severity of disability.
  • Nutritional Status Indicators: Anthropometric measurement of preschool children, Prevalence of low birth weight etc.
  • Health Care Delivery Indicators: Doctor- Population ratio, Bed-nurse ratio, Population-bed ration, Population per health facility etc.
  • Utilization Rates: immunization coverage, ANC coverage, % of Hospital Delivery, Contraceptives prevalence rate, Bed occupancy rate, average length of stay in hospital and bed turnover rate etc.
  • Indicators of social and mental health: Rates of suicides, homicides, violence, crimes, RTAs, drug abuse, smoking and alcohol consumption etc.
  • Environmental indicators: proportion of population having access to safe drinking water and improved sanitation facility, level of air pollution, water pollution, noise pollution etc.
  • Socio Economic Indicators: rate of population increase, Per capita GNP, Dependency ratio, Level of unemployment, literacy rate, family size etc.
  • Health policy Indicators: proportion of GNP spent on health services, proportion of GNP spent on health related activities including safe water supply, sanitation, housing, nutrition etc. and proportion of total health resources devoted to primary health care.
  • Indicators of Quality of Life: PQLI, IMR, Literacy rate, Life Expectancy at age one etc.

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