Health and Health Care: Beyond the Absence of Disease

When we think about health, what comes to mind? For many, it’s simply the absence of illness. But this limited view doesn’t capture the full picture. Over the past century, our understanding of health has transformed dramatically, moving from a narrow focus on disease treatment to a comprehensive approach that encompasses physical, mental, and social dimensions. This evolution reflects not just medical advances, but a fundamental shift in how we understand human flourishing and the systems designed to support it.

From biomedical to holistic: the evolving concepts of health
The WHO definition of health: a gold standard with criticisms
Health care vs. medical care: understanding the crucial difference
The three-tiered system: primary, secondary, and tertiary health care
Primary health care
Secondary health care
Tertiary health care
The evolution of health care approaches: from Bhore Committee to SDGs
The Bhore Committee and comprehensive health care
Alma-Ata Declaration and primary health care for all
Sustainable Development Goals and universal health coverage

From biomedical to holistic: the evolving concepts of health

The traditional biomedical model defined health simply as the absence of disease or infirmity. Under this framework, if you weren’t sick, you were healthy. This perspective dominated medical thinking for centuries and shaped how healthcare systems were designed and delivered.

However, this narrow definition proved inadequate. It failed to account for the complex factors that influence wellbeing, including social conditions, environmental circumstances, and psychological states. The ecological and psycho-social concepts of health emerged to address these gaps, recognizing that health is determined by socioeconomic, biological and environmental factors.

This shift represented a fundamental change in perspective. Health became understood not as a static condition, but as a dynamic set of resources for living well, emphasizing the ability to adapt and cope with life’s challenges rather than simply avoiding illness.

The WHO definition of health: a gold standard with criticisms

In 1948, the World Health Organization established what would become the most influential definition of health. The WHO constitution states that health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. This definition marked a revolutionary departure from purely biomedical thinking.

The WHO definition’s strength lies in its positive, aspirational nature. It expands health beyond the physical realm to include mental and social dimensions, recognizing that true wellbeing requires harmony across multiple aspects of life. This holistic approach has influenced health policies worldwide and helped shift focus toward preventive and promotive health measures.

Yet the definition has faced significant criticism. Academics like Prof. Imrana Qadeer and others have questioned its idealistic and absolute nature. Critics argue that it leaves most of us unhealthy most of the time, since few people achieve complete wellbeing in all three dimensions simultaneously. The definition struggles to account for individuals living fulfilling lives despite chronic conditions or disabilities.

Some scholars interpret the word “complete” quantitatively, suggesting the WHO promotes an unattainable state of perfect health. However, others argue that complete should be understood qualitatively, meaning health encompasses all its constitutive features rather than perfection in each area. This interpretation frames the WHO definition as promoting holistic rather than perfectionist health.

Health care vs. medical care: understanding the crucial difference

The terms “health care” and “medical care” are often used interchangeably, but understanding their distinction is essential for grasping how health systems function and what they aim to achieve.

Medical care focuses on treating illness and injury, typically provided by physicians and other licensed healthcare professionals. It includes diagnosis, treatment, surgeries, and prescriptions. Medical care is reactive, sought primarily when someone experiences symptoms or medical emergencies.

Health care, by contrast, represents a broader concept. It encompasses medical care plus all facilities, awareness, and environmental factors required to sustain a healthy lifestyle. Health care includes services from various institutions and sectors working to alleviate suffering and promote wellbeing. This includes public health campaigns, health education, sanitation, nutrition programs, and preventive services.

The distinction matters because health care is an ongoing process involving multiple stakeholders, while medical care represents the specific clinical services provided when health problems arise. Understanding this difference helps us recognize that achieving health requires coordinated efforts beyond the clinic walls.

The three-tiered system: primary, secondary, and tertiary health care

India’s health care delivery system follows a three-tiered structure designed to provide services from basic care to highly specialized treatment. This hierarchical organization aims to ensure accessible and appropriate care at each level.

Primary health care

Primary health care represents the foundation of the system and the first point of contact for most individuals. In India, primary level care is delivered through Sub-Centres and Primary Health Centres. Sub-Centres serve populations of 3,000 to 5,000 people, while PHCs cater to 20,000 to 30,000 individuals depending on geography.

These facilities provide essential services including maternal and child healthcare, immunization, treatment of common illnesses, health education, and disease prevention. Primary health care focuses on disease prevention, health promotion, and early diagnosis, making it crucial for community-level health management.

Secondary health care

Secondary care serves as the referral system for patients requiring specialized medical attention. Community Health Centres and district hospitals provide comprehensive care with specialist services in fields like obstetrics, pediatrics, surgery, and internal medicine. CHCs typically serve populations of 80,000 to 120,000 people and offer 30-bed inpatient facilities.

These facilities bridge primary and tertiary care, providing more advanced diagnostic capabilities, emergency services, and minor surgical procedures that exceed the capacity of primary health centres.

Tertiary health care

Tertiary care represents the highest level of specialized medical services. Advanced hospitals provide treatments for complex diseases like cancer, organ transplants, and neurosurgery. These institutions, including medical colleges and apex facilities like AIIMS, offer super-specialty care, advanced research facilities, and serve as teaching hospitals for medical education.

The evolution of health care approaches: from Bhore Committee to SDGs

The Bhore Committee and comprehensive health care

India’s modern health system traces its foundations to the Health Survey and Development Committee, established in 1943 under Sir Joseph Bhore’s chairmanship. The committee submitted its landmark report in 1946, emphasizing integration of curative and preventive medicine at all levels.

The Bhore Committee recommended establishing PHCs for every 40,000 people and introduced the concept of comprehensive health care. The report was guided by the principle that nobody should be denied access to health services for inability to pay, laying the groundwork for equitable health service delivery. Though many recommendations took years to implement, the committee’s vision shaped India’s public health infrastructure for decades.

Alma-Ata Declaration and primary health care for all

The global health landscape shifted dramatically in 1978 with the Alma-Ata Declaration. This international conference, attended by 134 countries, identified primary health care as the key to attaining health for all by the year 2000.

The declaration defined primary health care as essential health care based on practical, scientifically sound methods made universally accessible through community participation. It emphasized equity, community involvement, and multisectoral collaboration, recognizing that health improvement requires action beyond the health sector alone.

The Alma-Ata approach influenced health policies worldwide, though implementation faced challenges. Debates emerged about whether to pursue comprehensive primary health care or selective interventions targeting specific diseases, discussions that continue shaping health policy today.

Sustainable Development Goals and universal health coverage

The modern framework for global health is embodied in the Sustainable Development Goals, adopted by UN member states in 2015. SDG 3 aims to ensure healthy lives and promote well-being for all at all ages, addressing maternal and child health, communicable and non-communicable diseases, and health systems strengthening.

The centerpiece of SDG 3 is universal health coverage, which signifies that all people should receive quality health services without facing financial hardship. UHC encompasses preventive, promotive, curative, and rehabilitative services across all levels of care.

India’s National Health Policy 2017 and initiatives like Ayushman Bharat align with these global goals, working toward strengthening primary health care and expanding coverage. These efforts represent the latest chapter in the ongoing evolution from the Bhore Committee’s vision to contemporary approaches emphasizing equity, quality, and financial protection.

What do you think? How can we better balance medical care with the broader determinants of health in our communities? What role should individuals, healthcare providers, and governments each play in moving from disease treatment to holistic health promotion?

References

PDF 📄

Table of Contents

From biomedical to holistic: the evolving concepts of health 🔗

The WHO definition of health: a gold standard with criticisms 🔗

Health care vs. medical care: understanding the crucial difference 🔗

The three-tiered system: primary, secondary, and tertiary health care 🔗

Primary health care 🔗

Secondary health care 🔗

Tertiary health care 🔗

The evolution of health care approaches: from Bhore Committee to SDGs 🔗

The Bhore Committee and comprehensive health care 🔗

Alma-Ata Declaration and primary health care for all 🔗

Sustainable Development Goals and universal health coverage 🔗