Defining Health: Core Concepts for Nurses

This lecture provides an introduction to the fundamental concepts of health and the evolving field of Mobile Health (M-Health), with a specific focus on the health situation in Pakistan. We will cover definitions of health, the current state of healthcare infrastructure and challenges in Pakistan, and the sources, advantages, and disadvantages of M-Health, all crucial for nursing students and educators.

World Health Organization (WHO) Definition

For examination purposes, nursing students must memorize the World Health Organization (WHO) definition of Health, established in 1948, word-by-word:

  • Health is defined as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity".

Other Definitions and Concepts

  • Health can also be defined simply as the state of being free from illness or injury.
  • WHO revised the definition in 1948 to also define health as the condition in which an individual or group is empowered to actualise their aspirations, satisfy their needs, and cope with a changing environment.

Benefits of Being Healthy

When an individual is healthy, their performance is better, leading to greater efficiency and productivity. Key benefits include:

  • Reduced Disease Risk: Healthy individuals typically possess better immunity and are less susceptible to contracting diseases.
  • Longevity and Productivity: Healthy individuals tend to live longer, enabling them to be more efficient and productive members of society.
  • Reduced Absenteeism: Improved health directly correlates with lower absenteeism from the workplace.
  • National Contribution: A healthy population makes a positive contribution to a country's workforce and overall development.
  • Decreased Healthcare Burden: Good health helps alleviate the burden on healthcare professionals, which is often caused by the prevalence of communicable and non-communicable diseases.
  • Universal Importance: Maintaining good health is vital for individuals across all age groups, including children, adults, and the elderly.

Health Conditions in Pakistan

Socioeconomic Status and Health Rankings

  • Developing Country Status: Pakistan is classified as a developing country (tarraqi pazeer mulk), facing struggles across multiple domains, which significantly impacts its healthcare system.
  • Compromised Health: The health status of the population is frequently compromised due to widespread poverty, inadequate housing, and poor infrastructure.
  • Global Rankings (MCQs):
    • According to the WHO performance report, Pakistan is ranked 122nd out of 190 countries.
    • A Lancet Study, assessing accessibility and quality of healthcare facilities, ranked Pakistan 154th among 195 countries.

Demographic and Economic Data

  • Life Expectancy: The average life expectancy at birth in Pakistan is 68 years. For males, it is 65.8 years, and for females, it is 67.9 years.
  • Poverty: Out of an approximate population of 185 million, over 70 million people live below the poverty line.

Healthcare Spending

  • Pakistan allocates only 2% of its Gross Domestic Product (GDP) fund to health, which is considered very low.
  • An economic survey from 2014-2015 revealed that out of a total allocated amount of 3.95 trillion by the Government to improve the health sector, only 1.23 billion was actually invested.

Spending Breakdown (by category)

  • 40% is spent on maternity (pregnant women).
  • 10% is spent on overweight/obese adults.
  • 35% is spent on children under five.
  • 10% is spent on the underweight population.

Infrastructure and Staff Ratios (2014-2015 Survey)

  • Hospitals: There were 1096 hospitals for a population of 182.1 million people, meaning approximately one million people were dependent on a single hospital.
  • Doctors: The total number of doctors until 2015 was 177,759.
  • Patient/Doctor Ratio: The ratio was around 9% per doctor.
  • Patient/Hospital Bed Ratio: This ratio was approximately 1647, which was worse than the 1617 ratio of the previous year.

Community Impact and Disease Burden

Barriers to Healthcare

Individuals and communities in Pakistan face several issues in accessing healthcare:

  • Financial Issues: Poverty remains a major barrier.
  • Geographical Issues: A significant lack of transport hinders access.
  • Socio-Cultural Barriers: Certain cultural norms, such as preferring to consult only a female doctor (e.g., in Pathan culture), can limit access.

Disease Spread and Burden

  • Rapid Spread of Communicable Diseases: Diseases like AIDS, HIV, measles, and Tuberculosis (TB) are rapidly increasing. This is attributed to a lack of precautionary behavior, overcrowded areas, poor sanitation, lack of clean water, low socioeconomic conditions, and insufficient health care awareness.
  • Inadequate Vaccination Coverage: This issue is exacerbated by financial difficulties, transport challenges, and cultural beliefs (e.g., the belief that vaccines or drops are forbidden).
  • Infectious Disease Statistics (2006): Acute Respiratory Infection (ARI) was the highest at 51%, followed by Malaria (6%), Diarrhea/Dysentery (6%), Scabies (4%), and Other diseases (3%).
  • Double Burden of Disease: Non-communicable diseases (NCDs) such as cardiovascular disease, diabetes, cancer, and coronary artery disease collectively account for 20.5% of the total disease burden.

Healthcare Delivery System in Pakistan

The healthcare delivery system in Pakistan is structured into three distinct types (a critical MCQ point):

1. Primary Health Care System

This is the smallest level of care, focusing on initial and basic health services.

  • Facilities: Includes Basic Health Units (BHUs), Rural Health Centres (RHCs), dispensaries, Community Health Centres, and Sub Health Clinics.
  • Staffing: Lady Health Workers (LHWs) and midwives primarily work here, with staff nurses usually numbering only one or two.
  • Services: BHUs offer normal delivery facilities and generally operate in the morning or evening, with night shifts primarily for deliveries. RHCs are slightly larger, have more beds, include laboratory testing capabilities, and cover morning, evening, and night shifts.

2. Secondary Health Care System

These hospitals are larger and provide more comprehensive services than primary facilities.

  • Facilities: Includes District Headquarter Hospitals (DHQ Hospitals) and private hospitals.
  • Services: They have many beds and nurses. Services encompass X-ray, ultrasound, normal deliveries, and C-sections.

3. Tertiary Health Care System

This represents the largest and most advanced level of care.

  • Facilities: Includes Teaching Hospitals (THQ services).
  • Services: These facilities are well-equipped, offering advanced care, including major operations, MRI, and CT scans.

Government Initiatives

  • National Health Services Regulation and Coordination (NHSRC): Formed in 2011 (an MCQ point).
    • Purpose: To provide health services that are efficient, equitable (based on equality), accessible, and affordable (low-cost).
  • Sehat Sahulat Program: Started by the Government of Pakistan to increase welfare and help people achieve better health through initiatives such as health cards.

Introduction to Mobile Health (M-Health)

Definition and Terminology

  • Mobile Health (M-Health) is the term used to describe the practice of medicine and public health supported by mobile devices.
  • M-Health utilizes mobile communication devices, such as electronic media and apps, to promote health.

Devices and Scope

M-Health involves the use of devices that are easy to carry and allow for immediate data entry and transmission.

  • Examples of Devices: Mobile phones, tabs, computers, smartwatches, Personal Digital Assistants (PDAs), Glucometers, Pulse Oximeters, and BP apparatus.
    • Note: PDA stands for Personal Digital Assistant (an MCQ point).
  • Foundation: The National Institute of Health (NIH) was established in 2010 to deliver health care services using mobile communication devices.

Applications of M-Health

M-Health applications utilize mobile devices for various functions:

  • Data Collection: Gathering data from community and clinical settings.
  • Information Delivery: Disseminating health care information and research findings.
  • Patient Monitoring: Monitoring patient vitals and providing direct care.
  • Training: Providing training and collaboration to healthcare workers using slides or videos.

Examples of M-Health Devices and Apps

The mobile health category includes several innovative devices and applications:

  • Augmented Reality Surgery: An iPad app that guides liver surgery using augmented reality (an MCQ point).
  • In-Ear Speakers: Small speakers worn in the ear, similar to hearing aids, for people with hearing impairments.
  • On-Skin Sensors: Non-medical or medical devices temporarily or permanently attached to the skin to measure biological functions like heart rate and temperature (e.g., Holters monitor heartbeat continuously for 24 hours).
  • iPhone Blood Glucose Monitoring Device.
  • On-Eye Projector: A contact lens-like device that projects images directly onto the eye.

Health Care Apps

Apps are used for remote monitoring and diagnostic assistance:

  • Remote Monitoring: Applications for monitoring the records of patients with diabetes, remote heart monitoring, ECG viewing, and remote oxygen level checking.
  • Diagnostic Support: Apps include symptom checkers, digital imaging viewing abilities (MRI, X-ray), and lab results viewers.

The Role of GPS (Global Positioning System) in Mobile Health

GPS plays a very important role in mobile health:

  • Apps can track hospitals, specialized doctors, and specific services.
  • Emergency Feature: In an emergency, a user can press a panic button on their mobile phone, and the app automatically provides the ambulance with the location of the nearest hospital.

Advantages of Mobile Health

Mobile health provides multiple benefits, primarily related to efficiency and access:

  • Improved Decision Making: Leads to better clinical decision making and improved accuracy.
  • Enhanced Efficiency: Increases efficiency and productivity because less time is spent waiting or travelling.
  • Rapid Information Spread: Allows for speedier and faster separation and delivery of information. Data can be accessed with a single click.
  • Record Management: Helps maintain proper records and keeps track of day-by-day conditions.
  • Educational Tool: Apps are convenient and educative, providing information about drugs, dosage, purpose, and more.
  • Reminders: Allows users to set reminders (alarms) for appointments and medication times.
  • Data Security (Relative): Data can be saved within the system.

Disadvantages and Challenges of Mobile Health

Despite its benefits, M-Health faces significant challenges, particularly in developing countries:

  • Socioeconomic Barriers: Widespread poverty and illiteracy in Pakistan mean that many people cannot afford mobile devices, smartwatches, network connectivity (internet packages), or lack the knowledge/skills to use the apps.
  • Lack of Human Interaction: Remote consultation via phone or electronic media is often less effective than a physical examination and in-person discussion with a doctor.
  • Security Issues: Patient information (especially sensitive details regarding diseases like HIV/AIDS) can be leaked.
  • Technical Errors: Digital machinery and apps may contain errors, which can lead to mistakes. Apps cannot replace human judgment.
  • Data Loss: If a phone is lost, stolen, or misused, all stored health information can be lost.

Analogy to Clarify Understanding

To better understand the healthcare delivery system in Pakistan, consider it as a three-tiered transportation network:

  • The Primary Health Care system (BHUs/RHCs) is like local rickshaws and motorbikes, providing essential, neighborhood-level service.
  • The Secondary Health Care system (DHQs) is like city buses, offering a wider range of services with greater capacity.
  • The Tertiary Health Care system (Teaching Hospitals) is like the advanced motorway network and airports, handling the most complex situations and offering state-of-the-art facilities.
  • Mobile Health, in this analogy, is like a GPS system that integrates all these transport methods, helping patients find the right level of care quickly, monitor their journey, and manage their travel schedule.