# Concept of Health > Concept of health for FMGE PSM: WHO definition, dimensions, spectrum of disease, determinants, health indicators and Alma-Ata made exam-ready. - Canonical URL: https://prepelephant.com/topics/fmge/community-medicine/concept-of-health-fmge - Exam / course: FMGE · Subject: Community Medicine - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Concept of Health", PrepElephant, https://prepelephant.com/topics/fmge/community-medicine/concept-of-health-fmge ## Direct answer Health, per the World Health Organization's 1948 constitution, is "a state of complete physical, mental and social well-being and not merely an absence of disease or infirmity" — a definition crafted to make health a positive resource for living, not a negative state. It has physical, mental, social, spiritual and emotional dimensions; it is dynamic and relative rather than absolute, because each person sits somewhere on a spectrum running from positive health through subclinical disease to obvious sickness and death. Health is produced mostly by determinants outside hospitals — income, education, environment, behaviour and genes — which is why the Alma-Ata Declaration of 1978 made health a fundamental human right and routed it through primary health care. ## What you must remember - **The WHO definition (1948):** quote it verbatim — "complete physical, mental and social well-being, and not merely an absence of disease or infirmity"; critics call it utopian, examiners call it the answer. - **Dimensions:** physical, mental, social (the WHO trio), plus spiritual and emotional; the spiritual dimension entered Indian teaching through Park's textbook widely used for PSM. - **Spectrum of disease:** positive health → better health → freedom from sickness → subclinical (unrecognised) sickness → mild → severe sickness → death; screening exists to pull the hidden part of this iceberg above the waterline. - **Determinants (Lalonde's 1974 health field concept):** human biology, environment, lifestyle and health care organisation — with health services contributing the smallest share of the four. - **Wider determinant list for viva:** political, economic, social, cultural, environmental, behavioural, genetic, gender, nutrition and health services; poverty is the gravest single determinant. - **Indicators of health:** mortality (IMR, MMR, life expectancy), morbidity, disability (HALE — health-adjusted life expectancy), nutritional status, service utilisation, literacy (especially female literacy) and environmental indicators; no single indicator captures health. - **Rights framing:** Alma-Ata 1978 — "Health for All by 2000 AD" and primary health care; in India the right to health flows judicially from Article 21 (right to life) of the Constitution. - **Responsibility is tripartite:** the individual, the community and the state all carry it — a favourite one-mark assertion–reason stem. ## How the spectrum explains screening and prevention Take hypertension in an Indian district. For every patient who walks into a PHC with headache and a recorded blood pressure, several silently carry the same disease in the subclinical band of the spectrum — the underwater mass of the iceberg phenomenon. Levels of prevention attach neatly to this picture: primordial prevention stops the risk factor itself from entering the community (salt-reduction advocacy before hypertension exists), primary prevention blocks the risk factor in individuals (diet, exercise, no tobacco), secondary prevention is screening plus early treatment (the 30-plus NCD screening now delivered through Ayushman Arogya Mandirs), and tertiary prevention limits damage in established disease (physiotherapy after stroke). Rehabilitation is sometimes counted as a fourth level. The concept of health thus converts directly into programme design — the same population, sliced by where it sits on the spectrum, receives different services. ## The FMGE lens Assertion–reason and "which is NOT" questions dominate this topic. The classic trap offers "WHO defines health as absence of disease" — wrong, because the definition deliberately adds the positive phrase. A second trap lists determinants and asks which is least amenable to medical care: the expected answer is heredity or the broader socio-economic environment, not the health care system, which is itself the smallest determinant. Third, distinguish wellness (an active pursuit) from well-being (a state), and remember that the WHO definition has been criticised for making health unattainable — a statement phrased as fact in one option and as the test-taker's opinion in another. Know the difference between health indicators (measures of health) and determinants (causes of health). ## Frequently asked questions ### Which dimensions of health does the WHO definition include? Physical, mental and social well-being; spiritual and emotional dimensions were added later by public health scholars to broaden the construct. ### What is the iceberg phenomenon of disease? The hidden, subclinical bulk of disease in a population that never reaches a facility — the justification for screening programmes and community surveys. ### Who gave the health field concept and what are its elements? Marc Lalonde in 1974: human biology, environment, lifestyle and health care organisation — the last contributing least to population health outcomes. ### What did the Alma-Ata Declaration of 1978 state? It defined primary health care and committed nations to "Health for All by 2000 AD", later extended through the sustainable development goals. ### Why is female literacy used as a health indicator? It correlates strongly with child survival, fertility decline and service utilisation, reflecting the social determinants of health better than hospital statistics.