Determinants of health

DETERMINANTS OF HEALTH
BY : MS. RAMDINMAWII
SENIOR TUTOR

INTRODUCTION
• A person who is physically, mentally and socially healthy is said to be
in a state of optimum health.
• To achieve the highest degree of health should be the goal of every
human being.
• The health of an individual is not static. It is a dynamic phenomenon,
to maintain positive or optimum health, needs to discuss determinants
of health.
• Health is multifactorial. The factors which influence health lies both
internally and externally in the society in which he/she lives.

DEFINITION OF DETERMINANTS OF HEALTH
• Definition: Determinants of health include the range of personal, social,
economic and environmental factors which determine the health status
of individuals or populations.

Determinants of health includes:
• Income and social status: Higher income and social status are linked to
better health. The greater the gap between the riches and poorest
people, the greater the differences in health.
• Education: Low education levels are linked with poor health, more stress
and low self-confidence.
• Physical environment: Safe water and clean air, healthy work place, safe
houses, communities and roads all contribute to good health.
Employment and working conditions- people in employment are
healthier, particularly those who have more control over their working
conditions.

Determinants of health includes:
• Social support network: Greater support from families, friends and
communities is linked to better health. Culture customs and traditions, and
the beliefs of the family and community all affect health.
• Genetics: Inheritance plays a part in determining life span, healthiness and
the likelihood of developing certain illnesses. Personal behavior and coping
skills- balanced diet, keeping active, smoking, drinking, and how we deal
with life’s stresses and challenges all affect health.
• Health services: Access and use of services that prevent and treat disease
influences health.
• Gender: Men and women suffer from different types of diseases at different
ages.

EUGENICS
• The word eugenics etymologically derives from the Greek word ‘eu’
means ‘good or well’ and the ‘genes’ means ‘born’.
• The term eugenics was coined by Sir Francis Galton in 1883.

DEFINITION OF EUGENICS
• Eugenics is the study of hereditary improvement of the human race by
controlled selective breeding.
- American Heritage English Dictionary

TYPES OF EUGENICS
• POSITIVE EUGENICS: It is the selection of breeding between mates who
possessed favorable genes. The number of good people in the world is
increased by encouraging good people to breed. This is called positive
eugenics.
• Varies ways of positive eugenics are in vitro fertilization.
• NEGATIVE EUGENICS: It refers to decrease the number of bad people in
the world by finding ways to make it so that bad people would not
breed. This was called negative eugenics.
• Varies ways of negative eugenics are: abortion, sterilization, adoption of
family planning methods.

ENVIRONMENT
• The term environment refers to all external factors living and non living,
material and non material which surrounds man, e.g. air, water, soil and
also social, economical conditions under which we live.
• Environment is defined as all two external factors including living and
non living material which surrounds man.

TYPES/COMPONENTS OF ENVIRONMENT
• INTERNAL ENVIRONMENT:
• It refers to each and every component part, every tissues, organ and
organ system and their harmonious functioning within the system.
• EXTERNAL ENVIRONMENT:
• It is defined as all that which is external to the individual human host.
• External environment is divided into three components:
– Physical environment
– Biological environment
– Social environment

PHYSICAL ENVIRONMENT
AIR
• Air is one of the most important physical environments. It is the basis
for health and survival. To maintain healthy life, pure and clean
atmospheric air is necessary.
• Composition of air is the mixture of gases mainly oxygen, nitrogen that
surrounds the earth.
Percentage of Gases present in air
1. Nitrogen 20.96%
2. Oxygen 20.96%
3. Carbon dioxide 0.03%
4. Water vapors, rest of gases such as neon, krypton,
etc.
0.94%

FUNCTIONS OF AIR
• Air purifies the blood by interchange of oxygen with carbon dioxide in
the lungs and regulates body temperature.
• Human body is cooled by the air contact.
• Air act as a channel for carrying bacteria.
• Air helps the special senses of hearing and smell to function through air
transmitted stimuli.

AIR POLLUTION
• Air pollution is an excessive concentration of foreign matters in the air
which adversely affects the well-being of an individual or causes
damage to property.
- American Medical Association

SOURCES OF AIR POLLUTION/CAUSES OF AIR
POLLUTION
1. INDUSTRIES: There are many industries which emit various gases and
particulate matter. Some of the important industrial sources are:
i. Thermal power plant which produce Sulphur dioxide, nitrogen oxide
and ash particles.
ii. Cement factories which produce Sulphur dioxide, carbon monoxide
and particles.
iii. Steel plants which produce Sulphur dioxide, carbon monoxide and
particles.
2. CHEMICAL FERTILIZERS: The chemical fertilizers which are used to
increase agriculture production produce pollutants like nitrogen oxide,
Sulphur dioxide, ammonia and urea dust which pollute the air in the
community and neighborhood.

SOURCES OF AIR POLLUTION/CAUSES OF AIR
POLLUTION
3. COMBUSTION OF COAL, FUEL OIL AND NATURAL GAS: These are used
in factories, power plants, kitchens in some places, etc. These produce
carbon dioxide, carbon monoxide, Sulphur dioxide, ash particles and
thus pollute air.
4. TOBACCO SMOKE: Tobacco smoke released by smokers in the
households and public places pollute the air of the houses and public
places. The tobacco smoke emits nicotine which is very injurious to
health of the people.
5. OTHERS: Over population, nuclear explosion.

CONTROL OF AIR POLLUTION
1. CONTAINMENT: Control of air pollution at the point of its origin.
2. REPLACEMENT: Replacement of coal and gas by electricity will
minimize air pollution.
3. DILUTION: By growing vegetation and plants between the industrial
zone and the residential areas pollution can be minimized. These
areas are called green belts.
4. CONTROL OF POPULATION GROWTH: It helps to reduce congestion of
air and space, so that government has adopted the small family norm-
’we two we have one’.

PREVENTION OF AIR POLLUTION
• EDUCATION OF PEOPLE:
– Use smokeless chulhas is essential to reduce the pollution.
– Legislation act: Government has taken strict measures by passing suitable laws.
Government has planned for industrial areas and steps are taken to prevent air
pollution by industries.
– Avoid passive smoking.
• LOCATION OF INDUSTRIES, RESIDENTIAL AREAS:
– Proper planning of industries and housing colonies.
– Locate the plants in the outskirts of towns and cities to avoid nuisances due to
smoke, gases and dust.
– Residential areas are planned to be away from industries.

LIGHT
• Good light is necessary for effective vision. Imperfect light is one of the
causes of illness and accidents.
• Light factors essential for effective vision:
– Sufficiency: Light should be sufficient to enable the eye to discern the details of the
objects as well as the surrounding without eyestrain.
– Distribution: The distribution of light should be informed, having the same intensity over
the whole field of work.
– Absence of glare: Glare is excessive contrast. Glare may be a direct glare from a light
sources . Glare causes annoyance. One eye cannot tolerate glare because it causes
acute discomfort and reduces critical vision.
– Absence of sharp shadows: Shadow causes confusion to the eye and therefore should
not be present in field of vision.
– Steadiness: One source light should be constant.
– Color of light: Natural light has a soothing effect on the eye, the artificial light is not
very important.

VENTILATION:
• Ventilation may be defined as exchange of air between indoors and
outdoors.
IMPORTANCE:
• It will improve the health status both physically and mentally.
• It will prevent fatigue, instability, loss of working capacity, dizziness, loss
of appetite, insomnia.
• Good system of ventilation improves the knowledge.

TYPES OF VENTILATION:
• Natural ventilation:
– The wind: The wind is an active force of ventilation.
– Diffusion: Air passed through the smallest openings or spaces by diffusion.
– Inequality of temperature: Air flows from high density to low density, it rises when slightly
heated and escapes from openings provided high-up in the room.
• Mechanical ventilation:
– Exhaust ventilation: Air is extracted or exhausted to the outside by exhaust fans usually
driven by electricity.
– Plenum ventilation: Fresh air is blown into the room by centrifugal fans, so as to create a
positive pressure and displace the vitiated air.
– Balanced ventilation: This is a combination of the exhaust and plenum systems of
ventilation.
– Air conditioning: Air conditioning is defined as simultaneous control of all, or at least the
first 3 of those factors affecting both the physical and chemical conditions of the
atmosphere within any structure.

WATER
• Water is very necessary to lead a healthy life. Water helps in many
ways, i.e.:
– It replace loss of fluids from tissues.
– It maintains fluidity of blood and lymph.
– It helps in excretion of waste products.
– It acts as a vehicle of dissolving food.
– It helps in digestion and regulates body temperature.

PURPOSES/USE OF WATER:
• Domestic purpose: cooking, washing, bathing, personal cleanliness,
cleaning.
• Public/community purposes: cleaning of streets, washing of drains,
maintenance of public gardens, swimming pool, fire fighting etc.
• Industrial purposes: washing and producing electricity, for processing
and cooling.
• Agriculture purposes: growing plant, vegetables.
• Business purposes: hostel, hospital, restaurant etc.

SOURCES OF WATER:
• RAIN: It is the main source of water, the rain sinks into
the ground water.
• SURFACE WATER: The rain reach to the surface it is
called surface water, e.g. lakes, river, tank, ponds.
• GROUND WATER:
– Well’s
– Shallow well: It tapes the sub soil water from above the first impervious layer in
the ground.
– Deep well: Deep well which tapes the water from below the first impervious layer
of the ground.
– Artesian well: Water in between first and second impervious layer.
– Springs : when the ground comes to the surface and flow freely under natural
pressure is called springs. Springs are divided into:
– Shallow spring: present from first impervious layer.
– Deep spring: below impervious layer.
– Thermal spring: after volcanic eruptions the spring will form that is thermal spring.

WATER POLLUTION:
• Water pollution is defined as the presence of pollutants (organic,
inorganic or biological) in waters to such extent that it:
– Reduces the quality of water.
– Makes unfit for drinking
– Constitutes hazards to plants, animals and human beings.
– Water will be polluted because of industrial waste, domestic waste, and sewage.
These are affecting the physical and chemical properties of water.

CAUSES OF WATER POLLUTION:
• SEWAGE: The waste water from the house, agricultural land and
industries directly mix with the river water leads to water pollution and
also water borne diseases.
• INDUSTRIAL WASTE: Industrial waste like alcohol, sugar, paper, cloth,
water, chemicals, pump fertilizers and insecticides are polluting the
water.
• AGRICULTURAL WASTE: Excessive use of fertilizers and insecticides not
only polluting the soil but also the water sources.
• WATER BORNE DISEASES: Presence of microorganisms like bacteria,
virus, protozoa, spirochetal helminthic toxic substance leads to water
borne diseases.

HARDNESS OF WATER:
• Hardness of water is defined as the presence of impurities such as
chloride, sulfates, bicarbonates of calcium and magnesium in water.
CLASSIFICATION OF HARDNESS OF WATER:
• TEMPORARY HARDNESS: It is due to the presence of bicarbonates of Ca
and Mg.
• PERMANENT HARDNESS: It is due to the presence of sulfates, chlorides
and nitrates of Ca and Mg.

METHODS OF REMOVAL OF HARDNESS OF WATER:
• TEMPORARY HARDNESS:
– Boiling : boiling of water converts biocarbonates into insoluble carbonate. Carbondioxide is removed from water.
– Addition of lime: One ounce of lime is added to every 700 gallons of water for each degree of hardness.
– Addition of soda ash (sodium carbonate) : Soda ash (sodium carbonate) removes both temporary and permanent
hardness. Soda ash is added to remove carbonate, bicarbonate, sulfates and chlorides of Ca and Mg.
– Permutit process : Permutit is a complex compound of sodium, alluminium and silica. It is a base exchange process
for treatment of large water supply. When hard water is passed over it permutit readily exchanges calcium and
magnesium ions and give sodium ions to the water
• PERMANENT HARDNESS:
– Addition of soda ash (sodium carbonate): Soda ash (sodium carbonate) removes both temporary and permanent
hardness. Soda ash is added to remove carbonate, bicarbonate, sulfates and chlorides of Ca and Mg.
– Permutit process: Permutit is a complex compound of sodium, alluminium and silica. It is a base exchange process
for treatment of large water supply. When hard water is passed over it permutit readily exchanges calcium and
magnesium ions and give sodium ions to the water

WATER PURIFICATION:
• LARGE SCALE PURIFICATION:
– Storage
– Filtration
– Disinfection
• SMALL SCALE PURIFICATION:
• Boiling
• Chemical disinfection
• Filteration
• Disinfection of wells

LARGE SCALE WATER PURIFICATION:
• STORAGE: water is drawn out from the source and impounded in natural
or artificial reservoirs. Storage provided as reserve of water from which
further pollution is excluded.
• FILTRATION: Filtration is the second stage in the purification of water
and quite an important stage because 98-99 percent of the bacteria are
removed by filtration apart from other impurities.
– Slow sand or biological filters:
– Elements of a slow sand filter:
– Supernatant (raw) water
– A bed of graded sand
– An under-drainage system
– A system of filter control valves
– Rapid sand / mechanical filters:

SLOW SAND FILTER:
1. SUPERNATANT (RAW) WATER: the
supernatant water above the sand bed, whose
depth varies from 1 to 1.5 meter, serves two
important purposes:
2. SAND BED: the thickness of the sand bed is about one meter. The sand grain are
carefully chosen so that they are preferably rounded and have an affective diameter
between 0.2 and 0.3 mm.
• It provides a constant head of water so as to overcome the filter bed and thereby
promote the downward flow of water through the sand send bed.
• It provides waiting period of some hours (3 to 12 hours, depending upon the filtration
velocity) for the raw water to undergo partial purification by sedimentation, oxidation
and particles agglomeration. The level of supernatant water is always kept constant.

SLOW SAND FILTER:
3. UNDER DRAINAGE SYSTEM: At the bottom of the filter bed is the under drainage system. It
consists of porous or perforated pipes which serve the dual purpose of providing an outlet for
filtered water, and supporting the filter medium above.
4. FILTER CONTROL: The filter is equipped with certain valves and devices which are
incorporated in the outlet pipe system. The purpose of these devices is to maintain a
constant rate of filtration.

RAPID SAND / MECHANICAL FILTER:
1. COAGULATION: the raw water is first treated with a chemical coagulant such as alum, the dose of
which varies from 5-40 mg per liter, depending upon the turbidity, color, temperature and pH value of
the water.
2. RAPID MIXING: the treated water is then subjected to violent agitation in a mixing chamber for a few
minutes. This allows a quick and throw out the bulk of the water.
3. FLOCCULATION: it involves a slow and
gentle stirring of the treated water in a
flocculation chamber for 30 minutes.
This slow and gentle stirring results
in the formation of a thick copious
white flocculent precipitate of
aluminium hydroxide.

RAPID SAND / MECHANICAL FILTER:
4. SEDIMENTATION: the coagulated water is led into sedimentation tanks where it is detained
for 2-6 hours when flocculent together with impurities and bacteria settle down in the tank.
5. FILTERATION: the partly clarified water is now subjected to rapid sand filteration.
– Filter beds
– Chlorination
– Filteration
– Backwashing

FILTERATION:
• Filter beds: each unit of filter bed has a surface of about 80 to 90 m2. The size of sand particles
is between 0.4-0.7 mm. The depth is about 1 meter. Below the sand bed is a layer of granded
gravel 30-40 cm deep. The depth of the water on the top of the sand bed is 1.0-1.5 m. the rate
of filteration is 5-15 m3/hour.
• Chlorination: Water chlorination is the process of adding chlorine or chlorine compounds such
as sodium hypochlorite to water. This method is used to kill certain bacteria and other
microbes in tap water as chlorine is highly toxic.
• Filteration: as filteration proceeds the alum-flocculation not removed by sedimentation is held
back on the sand bed.
• Back washing: rapid second filters need
frequent washing dialy or weekly,
depending upon the loss of head, washing
is accomplished by reversing the flow of
water through the sand bed, which is
called bed washing.

DISINFECTION:
• Chlorination: chlorine is used to kill pathogenic bacteria, oxidized iron, manganese, cyanogens sulfate.
• Action: when chlorine is added, there is formation of hydrochloric and hypochlorous acid. The hydrochloric
acid is neutralized by the alkalinity of the water the hypochlorous acid ionizes to form hydrogen ions and
hypochlorides ions as follows:
– Chlorine demand of water: a fixed amount of chlorine is added according to the pH and temperature of water.
– Free residual chlorine: excess amount of chlorine present in water may be 0.5 mg/dl.
– Break point: the point which the chlorine amount of chlorine is fulfilled for water purification is called break point.
– Orthotoludine test: to find out the amount of free residual chlorine. In 1 ml of water 0.1ml of orthotoludine
reagent will be added. The solution changed into yellow color means cholrine is present in the water.
– Chlorine derivatives:
– Chlorine gas
– Chloramine
– Perchloron
– Bleaching powder

PURIFICATION OF WATER ON SMALL SCALE:
1. HOUSEHOLD METHODS PURIFICATION:
• Boiling: boiling of water for 5-10 minutes will kill the bacteria.
• Chemical disinfection:
– Bleaching powder: bleaching powder should be used in a dosage of 6.8gm/1000 L of water.
– Chlorine solution: chlorine solution may be prepared from bleaching powder. If 4kg of bleaching powder
with 25% available chlorine is mixed with 20L of water, it will give 5% solution of water.
– High test hypochlorite: this is a calcium compound which contains 60-70% available chlorine.
– Chlorine tablets: a single tablet of 0.5g is sufficient to disinfect 20L of water.
– Iodine: 2 drops of ethanol solution of iodine is sufficient for 1L of clear water for 20-30 minutes.
– Potassium permanganate: it may kill cholera vibrious, but is of little use against other disease organisms.
• Filteration: water can be purified through ceramic filter such as Pasteur chaberland filter,
berkefeld filter and katadyn filter.
2. DISINFECTION OF WELL:
• Double pot method:

Steps in well disinfection:
1. Find out the volume of water present in the well using the given
formula
liters
2. Find the amount of bleaching powder required for disinfection,
Using ‘Horrock’s Apparatus’
3. Dissolve the required amount of bleaching powder in water
4. Delivery of the chlorine solution into the well
5. Allow a “Contact period” – one hour
6. Orthotolidine Arsenite (OTA)test, to test if the ‘free’ residual
chlorine is > 0.5 mg/L

DOUBLE POT METHOD:
• By this method, it is possible to maintain continuous
chlorination of water for a period of 2-3 weeks. There are 2 cylindrical pots.
• Outer pot:
Inside height is 30 cm
Inside diameter is 25 cm
A hole (1 cm diameter) is made at 4 cm above the bottom
• The inner pot contains a mixture of 1kg of bleaching powder and 2kg of sand. The inner
pot is introduced into the outer pot and closed.
• There are 2 holes, one in each pot and each hole having a diameter of 1cm.
• The double pot so filled with bleaching powder and sand is lowered into the well for a
depth of 1 meter and fixed at that level by means of a rope.
• A constant supply of chlorine is provided by the double pot for a period of 2-3 weeks
depending upon the size of the well.

STANDARD OF HOUSING:
• Housing in the modern concept not only the physical structure providing shelter but
also the immediate surrounding and the related community services and facility.
1. Site:
– The site should be elevated its surroundings so that it is not subjected to flooding during rain.
– The site should have an independent access to a street of adequate width.
– It should be away from breeding places of mosquitoes and flies.
– It should be away from nuisances such as dust, smoke, smell, excessive noise and traffic.
– It should be in pleasing surroundings.
– The soil should be dry and safe for founding the structure and should be well drainage.
2. Setback: There should be open spaces all around the house.

3. Floor: the floor should be pakka and should be satisfying the following criteria:
– It should be impermeable so that easily washed and clean and dry.
– The floor must be smooth and must be free from cracks.
– The floor should be damp-proof.
– The height of the plinth should be 2-3 feet.
4. Walls: The wall should be:
– Reasonably strong
– Should have a low heat capacity
– Weather resistant
– Unsuitable for harbourage of rats and vermin.
5. Roof: the height of the roof should not be less than 10 feet. The roof should have a
low heat transmittance coefficient.

6. Room: the number and area of rooms should be increased according to size of family so that the
recommended floor space per person may be made available.
7. Floor area: The floor area of a living room should be at least 120 sq.feet. For occupancy by more than one
person and at least 100 sq.feet.
8. Windows: Every living room should be provided with at least 2 windows, and at least one of them should be
opened directly into the open space. The window should be placed at a height of not more than 3 feet above the
ground.
9. Lighting : the day light factor should exceed 1% over half floor area.
10. Kitchen : every house must have separate kitchen. It must be protected against dust and smoke.
11. Privy : a sanitary privy must be in every house.
12. Garbage and refuse: these should be removed from the dwelling at least daily.
13. Washing and bathing: the house should have facilities for bathing and washing exclusively providing privacy.
14. Water supply : water supply available at all time.

REFUSE DISPOSAL OR DISPOSAL OF WASTE:
• Refuse is discard waste matter. Refuse from houses, streets, sweeping, commercial, industrial
and agricultural operations is called solid refuse. Refuse is also called solid waste.
• Hazards of refuse: the accumulation of refuse in man environment is dangerous to health
because:
– It decomposes and increase fly breeding.
– It attracts rats and vermin.
– The pathogenic organism which are present in the refuse may be conveyed back to man’s food through
flies and dust.
– Water and soil may get polluted due to refuse.
– Heaps of refuse present an unsightly appearance and are a nuisance.
• Various methods of waste disposal
– Small scale methods: burning, feeding the animals, burial.
– Large scale methods: incineration, dumping, controlled tipping, composting.

REFUSE DISPOSAL OR DISPOSAL OF WASTE:
• Method of composting:
1. Bangalore method:
– This method was introduced by environment and sanitation committee of bangalore so it is called
bangalore method.
– In this method a trench will be made 90cm deep 1.5 to 2.5 broad and 10m long in that the excreta and
refuse can be disposed.
– In that trench the first layer should be waste in 15 cm thickness and excreta 5cm thickness. Like this
alternatively filled.
– The top layer should be refuse. It will take 7 days for decomposition the aerobic and anaerobic bacteria
digest the waste.
– It is also called hot fermentation method. This must be done away the city almost 800 m.
2. Mechanical composting:
– In this method a mechanical device will be used to grind items like stick, clay, plastic, glass, etc. After
grinding same method will be followed.

DISPOSAL OF DEAD BODIES
• TYPES:
1. CREMATION:
– It is the best method. The usual quantity of fuel required to dispose the body in a proper way will be about 400
pounds.
– If this much is not in used it will cause incomplete burning of the bodies.
– Half burnt remains of the dead will be thrown into the stream or rivers which will be very unsanitary.
– Nowadays bodies are cremated by the use of furnaces. Either by gas or electricity the bodies are exhumed.
This is easy and sanitary method.
2. BURIAL: burial of a dead body is a expensive method since the party have to pay for the ground
where the dead has to be buried and for the coffin, etc. follow these methods during burial:
– Location: it should not be too close to a residential area, but should be easily accessible by a road.
– Site: the land liable to flooding is not unsuitable, nor should it be too high to pollute water at a lower level by
natural drainage.
– Soil: the soil should be porous and light, free from water. Sandy loam soil is good where bacteria help in thee
disintegration of the body. Chalky and clay soil are to be avoided.
– Size: ¼ acre land 1000 population is minimum requirement. A pit of 3-5 feet depth never below 8 feet nor
within 2 feet of the surface soil.
– Coffins: it should be made of easily destroyable wood.

NOISE
• Noise is defined as the wrong sound in the wrong place at wrong time.
Effects of noise exposures:
1. Auditory effects:
• Auditory fatigue: it appears in the 90 ds region and greatest at 4000 Hz. It my be associated with
side effects such as whistling and buzzing in the ears.
• Deafness: most temporary hearing loss occurs in frequent range between 4000-6000 HZ.
Repeated exposure to noise around 100 decibels may result in a permanent hearing loss.
2. Nonauditory effects:
• Interference with speech: the frequencies causing most disturbance to speech communication lie
in 300-500 HZ range.
• Annoyance: neurotic people are most sensitive than balanced people.
• Efficiency: where mental concentration is to be undertaken, a low level of noise is always desired.
• Physiological changes: physiological changes like rise in BP, rise ICP, increase HR and breathing
and increase in sweating.
• Noise

FOOD HYGIENE
• The term food hygiene is used to describe the preservation and preparation of
foods in a manner that ensures the food is safe for human consumption.
AIMS:
– To prevent food poisoning
– To prevent food borne diseases
PRINCIPLES OF FOOD HYGIENE:
– Prevent contaminating food with pathogens spreading from people, pets, and pests.
– Separate raw and cooked foods to prevent contaminating the cooked foods.
– Cook foods for the appropriate length of time and at the appropriate temperature to kill
pathogens.
– Store food at the proper temperature.
– Do use safe water and cooked materials.

FOOD PRESERVATION
• Food preservation can be done at two methods:
• Household methods :
– Cold storage: the home refrigeration has now made it possible to store and preserve a
variety of foods. Fruits and vegetables should be kept just above freezing point i.e. 0 degree
C or 31-33 degree F. Meat and butter are kept at much lower temperature.
– Drying and dehydration: drying removes water and in the absence of water micro-organism
can’t grow.
– Smoking: smoke contains phenols which help in preservation.
– Salting and pickling: salt is a preservative.
– Canning: home canning is not recommended unless the technique employed is fool proof.
• Commercial methods:
– Canning: the food is first sterilized at high temperature (135-175°C) for a short time, then
cooled and filled is pre-sterilized containers in a sterile atmosphere.
– Freezing: at 17.8°C vegetables can be preserved from 8 to 10 months and meat for about 3
months.
– Chemicals: Certain chemicals like benzoic acid, sodium benzoate may be used for
preservation but their use is strictly limited by government.
– Irradiation: microorganisms are destroyed by gamma-rays. Wheat, potatoes and onions may
be preserved by irradiation.

MILK HYGIENE
MILK BORNE DISESES
• Infections of animals that can be transmitted to man:
– Tuberculosis
• Infections of primary to man that can be transmitted to milk:
– Typhoid
– Paratyphoid fevers
– Shigellosis
– Cholera
– Entero pathogenic escherichi coli (EEC)

MILK HYGIENE
PASTEURIZATION OF MILK:
• According to WHO pasteurization may be defined as the hearing of milk to
such temperature and for such periods of time as are required to destroy any
pathogens that may be present while causing minimal changes in the
composition, flavor and nutritive value.
Methods of pasteurization:
• Holder method: in this method milk is heated and kept t 63 – 66 degree C for
30 minutes and then quickly cooled to below 5 degree C.
• HTST method (High Temperature And Short Time Method): milk is heated
rapidly to a temperature of 72 degree C and then quickly cooled to below 5
degree C.
• UHT (Ultra High Temperature Method): the temperature of milk is raised to 125
– 150 degree C for a few seconds only and then rapidly cooled.

MEAT HYGIENE
• The diseases transmitted through unhygienic meat consumption are as
follows:
– Tape worm infestation
– Diarrheal diseases
– Anthrax
– Tuberculosis
– Food poisoning
Measures to maintain meat hygiene
– Meat inspection- before and after slaughter. It is necessary to identify the presence
of infection.
– Cleanliness of storage place.
– Clean transportation of meat.
– Clean the animals before slaughtering.

FRUITS AND VEGETABLES
• Measures to be taken to maintain hygiene of fruits and vegetables
include:
– Wash thoroughly before eating the fruits and vegetables.
– Vegetables can be immersed in saline water for few hours to neutralize the
pesticides.
– Fruits and vegetables must be stored in cool and dry places.

HYGIENE OF FOOD HANDLER
• Clean hands.
• Tie the hair or cover the head to prevent fall of hair in food.
• Use clean apron
• Avoid licking fingers.
• Avoid coughing or sneezing while cooking.

FOOD PREPARATION
METHOD OF COOKING:
– Boiling: cooking in water at 100°C.
– Simmering: cooking below boiling point.
– Steaming: cooking by steam.
– Stewing: cooking below boiling point with small quantity of water.
– Frying
– Roasting
– Baking
– Broiling or grilling

FOOD ADULTERATION
• Food adulteration is the deliberate contamination of food material with low quality, cheap
and nonedible or toxic substances is called food adulteration.
TYPES:
• Milk: it is adulterated by the addition of water, starch, skim milk powder and removal of
cream.
• Ghee: it is adulterated with Vanaspati and animal fats such as pig’s fat. In order to improve
the flavor of adulterated ghee tributyrin is added.
• Cereals: rice and wheat are mixed with stones, sand grit and mud to increase the bulk.
• Flour: wheat flour is mixed with soap stone and Bengal gram flour is adulterated with khesari
dal or lathyrus flour.
• Pulses: they are adulterated with khesari dal stones. Toxic chemical such as metanil yellow
are added to old stocks of pulses to improve their color appearance.
• Edible oil: they are mixed with cheaper oil, toxic oil and mineral oil.
• Tea and coffee: tea leaves are adulterated with saw dust and coffee with chicory.
• Honey: it is adulterated with sugar and jaggery.
• Medicines: even drugs are adulterated.

PREVENTION OF FOOD ADULTERATION ACT: 1954
• In 1954, the government of India enacted a central prevention of food
adulteration act.
• PURPOSE:
– To protect health of consumer and also to assure foods honest nutrient value.
• ADVANTAGES:
– Help in maintaining quality of food stuffs.
– Helps to provide punishment to the people and organization responsible for
adulteration.
– Helps in provide special rights to consumer and voluntary organization so that they can
play an effective.
– Checking the quality of imported edible stuff.
– Establishing public analysis, consumer tests and food testing labs and training their
workers.

THE DRUGS AND COSMETICS ACT, 1940
• This act control and maintain the standard and quality of drugs and
cosmetics.
• It prevents the counterfeiting of drugs and cosmetics.
• Food can transmit disease from person to person as well as serve as a
growth medium for bacteria that can cause food poisoning.
• It is necessary to maintain hygiene throughout the food chain to
prevent diseases and promote health.

DEFINITION
• Drug is a chemical substance used as a medicine to promote health and
to prevent, diagnose, to alleviate over cure disease.
• The word ‘drug’ is defined as any substance that when taken into the
living organism, may modify one or more of its function. (WHO)
• The Drug And Cosmetic Act 1954 is effective for standardization of
medicines and cosmetics, control of quality, give recognition to new
medicines and such activities. Under is the central drug standardization
control organization (CDSCO) is informed.

The functions of central drug standardization control
organization are as follows:
• Implementation of medicine laws and policies.
• Keeping control over the quality of imported medicines.
• Establishing better coordination in the work of drug control officers.
• Recognition to new drugs made in the country.
• Establishing standards of medicines and instruments
• Regulation of human blood transfusion, parental drugs.
• Providing license for the preparation and sale of serum and vaccines.

BIOLOGICAL ENVIRONMENT
• Biological environment refers to all living organisms surrounding man. It
includes arthropods, rodents, microorganism, etc.
ARTHROPODS:
– Arthropods are the invertebrate animals include insects and cyclops. Anthropods can
transmit many diseases to human being.
• MOSQUITO CONTROL MEASURES:
– The mosquito larva can be destroyed by maintaining proper sanitation, using chemical
insecticides and by using certain fish like guppy which eat the mosquito larvae.
– The adult mosquitoes can be controlled by residual insecticides.
– Mosquito nets, meshes and repellents can protect against mosquito bites.

FLY AND FLEA CONTROL MEASURES:
• The flies and fleas can be controlled by maintaining good
environmental sanitation and by using the residual sprays.
• Fly papers and meshes also are effective in control flies.
• Use of repellents and control of rodents (by trapping and fumigation)
are helpful in controlling the fleas.
RODENT CONTROL MEASURES:
– Rat poisons
– Traps
– Fumigation
– Environmental sanitation

RODENTS
• Diseases caused by rodents:
– Rat bite fever
– Salmonellosis
– Plague
– Murine typhus
– Leptospirosis
– Trichinosis
– Amebic
• Control of rodents:
– Trapping
– Rat poisons
– Fumigation (cyanogas)
– Improvement of sanitation

FOOD AND WATER BORNE DISEASE
FOOD BORNE DISEASES:
• Food borne infections and diseases may be classified as below:
– Bacterial: typhoid and paratyphoid, diarrhea, dysentery.
– Viral: viral hepatitis (jaundice), poliomyelitis.
– Protozoal: amebiasis
– Intestinal: tape worm and round worm
– Others: poisoning
• Preventive measures:
– Personal hygiene: a high standard of personal hygiene among individuals engaged in the
handling preparation and cooking of food is needed.
– Food handlers: they can spread disease by their unhygienic habits.
– Food handling techniques: the handling of ready to eat foods with bare hands should be
reduced to a minimum.
– Sanitary conditions: sanitation of all work surfaces utensils and equipment must be
ensured.

FOOD AND WATER BORNE DISEASES
WATER BORNE DISEASES:
A. Biological water borne diseases: those caused by presence of an infective
agent:
– Viral : viral hepatitis A, hep B, poliomyelitis, rotavirus.
– Bacterial: typhoid, parathyroid fever, dysentery, E.coli, diarrhea, cholera.
– Protozoal: amebiasis, giardiasis.
B. Helminthic: round worm, thread worm, hydatid disease.
– Leptospiral: Well’s disease.
– Those due to the presence of an aquatic host:
– Snail: schistosomiasis
– Cyclops: guinea worm
C. Chemical: this causes shigellosis, trachoma conjunctivitis, ascariasis,
scabies.

SOCIAL ENVIRONMENT
• The social environment of an individual or community is the culture
that he/she was educated and/or lives in, and the people and
institutions with whom the person interacts.
• The social environment includes the following components:
– Customs
– Taboos
– Values
– Norms
– Culture
– Traditions

SOCIOCULTURAL ASPECTS OF COMMUNITY
• The word ‘culture’ is widely used in sociology. It is the central concept
round which cultural anthropology has grown.
• Culture is defined as ‘learned behavior which has been socially
acquired’.

Cultural factors affecting health
• Supernatural causes:
– Spirit or ghost intrusion
– Gods goddesses
– Evil eye
– Past sins
– Breach of taboo
• Food habits
– Psychological roots
– Associated with love and affection
– Religion
– Social prestige
– Self-image
– Local conditions
– Beliefs
– Customs
• Cultural practices affecting health
– Early marriage of girl
– Low status of women
– Preference for male child
– Traditional folk
– Folk media

HYGIENE
• The word hygiene has evolved from Greek term ‘Hygia’ which means
‘Goodness of health’. Hygiene is the science of health and includes all
factors which contribute to healthful living.
• Hygiene can be defines as the science and art which is associated with
the preservation and promotion of health.
OR
• Hygiene is defined as that science of health which includes all the
factors contributing to the healthful living.

TYPES OF HYGIENE
1. SOCIAL HYGIENE: social medicine has replaced the word social hygiene, its objective to
study man as a social animal in its total social environment. The scope of social medicine
includes science of social structure and functions, social pathology and social treatment
etc.
2. INDUSTRIAL HYGIENE: its scope is extended up to the health of labor working in all types
of occupation and different aspects of health.
3. SCHOOL HYGIENE: it facilitates optimum health to school children.
4. PREVENTIVE MEDICINE: preventive medicine plays primary role in immunization a specific
protection and general methods of improvement in health.
5. PERSONAL HYGIENE: personal hygiene is not only limited to taking care of body and
keeping it clean, rather the mental and spiritual aspects are also an integral part of it.

PERSONAL HYGIENE
• Personal hygiene is defined as that ‘the healthy practices and lifestyle helps in the
maintenance and promotion of individual health physically, emotionally, socially
and spiritually.’
IMPORTANCE:
– To prevent illness
– To promote good health
– To improve the standard of health
– To maintain quality life of an individual
– To promote mental well-being
– To promote socially and spiritually health
– To improve the self-esteem in the society
– To maintain resistance and prevent from infections.

PRINCIPLES OF PERSONAL HYGIENE
1. Hygiene practices are learnt.
2. Changes occur throughout the life span, it also affects the health care
practices.
3. Individual differences exit from one individual to other.
4. Health practices of people vary with cultural values and personal
values.
5. Health practices directly influences the physical, mental, social and
spiritual health of an individual.
6. Good health practices prevent entry of microorganism into the body.
7. Nature act as a first line of defense on human health natural light and
ventilation.

DISEASES DUE TO POOR PERSONAL HYGIENE
• Skin diseases
• Leprosy
• Trachoma
• Conjunctivitis
• Dental carries
• Impetigo etc.

EXERCISE (PHYSICAL ACTIVITY)
• Exercise is defined as ‘the physical exertion done to improve the health or to correct the
physical deformities of the body.’
OBJECTIVES:
– To promote and harmonious development of the whole body.
– It also helps in correcting physical deformities.
– Maintenance of health especially in the growing child.
IMPORTANCE:
– To look good.
– To reduce the risk of heart diseases.
– To lower blood pressure
– To reduce risk of diabetes, osteoporosis.
– To increase longevity
– To improve balance and reduce the risk of injuries
– To remain productive
– To increase overall strength
– To be happy.

TYPES OF EXERCISE
1. ACTIVE EXERCISE
– Patient performs the exercise to move the joint without any assistance to the
muscles surrounding the joint.
2. PASSIVE EXERCISE
– Therapist or equipment moves the joint through the range of motion with no effort
from the patient.

RECREATION
• The word recreation means relaxation and amusing oneself.
• IMPORTANCE:
– It relieves mental tension.
– It relieves fatigue.
– It contributes to a feeling of well-being.
– It may be active or passive.
– It provides energy and freshness.
– Division or recreational therapy is used to cure many mental diseases.
– Physical exercise is an active form of recreation.

RECREATION
TYPES:
• Active recreation: exercise, indoor games, outdoor games, light work
like writing.
• Passive recreation: reading, watching, listening to radio, talking, playing
cards, enjoying the nature.
• Recreation centers are being provided in many cities for public use so
that people may use their leisure time for improvement of their physical
and mental health.

REST AND SLEEP
• For the maintenance of health, the body needs rest and sleep. These
can be defined as:
• Sleep: sleep is subjective or personal needs that provide the person a
feeling of rest or relaxation.
• Rest: rest can be expressed as the condition of reduced labor whether
it is physical, mental or both.

REST AND SLEEP
Advantage of rest and sleep:
• Improvement in health.
• Person feels fresh.
• Reduces the working capacity.
• Relieves pain.
• Fatigue disappears.
• Facilitates health and peace of mind.
• Enhance happiness, aging and ability to make decision.
• Assist in the growth and physical development.
• Sleep requirement: the amount of sleep required varies with age, sex,
environment, and the nature of work and the temperament of each individual:

REST AND SLEEP
• Infant: 20-22 hours
• Children: 12-14 hours
• School going boy: 9-10 hours
POINTS TO REMEMBERED DURING SLEEPING:
• Use flat beds and single pillow.
• Face should not be covered during sleep.
• Room should be dark and well-ventilated
• Use mosquito nets during sleep.
• Drug should not be taken to induce sleep.

SEXUAL LIFE
LIFE SKILLS EDUCATION PROGRAMS:
• Abstinence that is complete absence of sex before marriage and loyalty
and faithfulness within the marriage bond is the supreme principle of all
religions.
• People use this as an instrument to prevent the spread of HIV and other
sexually transmitted infections.
• People who follow moral and ethical guidelines in sexual relationship are
the real preventive boosters of sexually transmitted diseases.

Benefit of sex on health
• It lowers blood pressure and help in stress reduction.
• It boost immunity.
• Burn calories.
• Reduce the risk of heart attack.
• It boost self-esteem.
• It boost intimacy.
• Increased level of oxytocin causes hike in endorphin that reduces pain.
• Ejaculation reduce the risk of prostate cancer.
• It strengthen pelvic floor muscles.
• It promotes sleep.

Safest sex
• The safest way to prevent HIV or STI is abstinence, means no sex at all.
• Safest sex is sex that is shared between two people who are not infected
with any STIs including HIV who only have sex with each other, and who
do not use injectable drugs.

SELF-RELIANCE
• Self-reliance is defined as the capacity to manage one’s own affairs,
make one’s own judgements, and provide for oneself.
• Characteristics of a self-reliant person:
– Self-assurance: self-reliant person is self-confident in all his doings.
– Self-contained: he will try to accomplish things without leaning much on other
people for assistance unless it is very much essential.
– Independent: he self-ruled in all his thoughts and actions.
– Courageous: self-reliant person is courage enough to take up risks and find
solutions for problems.

SELF-RELIANCE IN COMMUNITY
• Self-reliance in community is defined as the development on the basis of a country’s
own resources, involving its populations based on the potentials of its cultural values
and traditions.
– The concept of self-reliance is the core concept of community development.
– Self-reliance supports people to improve their condition using locally available resources and
manpower.
– This is readily accepted as a new method for community development.
– It is most operative method that promotes people participation in their own development.
– Self-reliance in community development expects all community members to apply their
knowledge and skills using the available resources.
– Self-help empowers the local people to exploit their advantage resources which would lie
inactive and continue the awareness and poverty of the community.

DIETARY PATTERN
A combination of different food, drinks, and nutrients in diets, quantity, and the
frequency with which they are usually consumed constitutes dietary pattern.
There are a numerous factors that affect the choice of food. These are classified
under six key determinants:
• Biological determinants: includes hunger, appetite, taste and satiety.
– Taste/palatability: palatability increases individual’s pleasure from eating.
• Economic determinants: the cost of food and the ability of an individual to
purchase specific foods are primary factors that influence food choice.
• Physical determinants:
– Accessibility and availability
– Education and knowledge
– Time constraints.

DIETARY PATTERN
• Social determinants:
– Social class/socioeconomic: there are food choices between higher and lower
socioeconomic groups.
– Cultural influences: the traditions, beliefs and values are the main factors influencing
preference, mode of food preparation, and nutritional status of people.
– Social context: includes both people who have an impact on an individual eating
behavior and individual consumes their dietary choice.
• Psychological determinants:
– Stress: some people consumes more food and make unhealthy food choices and other
consume less food.
– Mood: food can change an individual’s temperament and mood and influences food
choice.
– Attitudes, belief and knowledge

EDUCATION
• Health education is defined as any combination of learning experiences designed to
help individuals and communities improve their health, by increasing their knowledge
or influencing their attitudes.
• Principles of health education:
– Credibility: it is the extent to which the message communicated is perceived as trustworthy by the
receiver.
– Interest: health programme should assess the felt needs of the people.
– Participation: it tend to create a sense of involvement, personal acceptance and decision
making.
– Motivation: in every person, there is a fundamental desire to learn. Awakening this desire is
called motivation.
– Comprehension: assess the level of understanding, education, and literacy of people to whom
the teaching is intended for.
– Reinforcement: messages that are repeated are more likely to remembered.
– Learning by doing
– Feed back: it provides the base to plan again.
– Leaders: leaders are agents of change and they can be made use of in health education work.

OCCUPATION
• Occupation refers to a group of purpose oriented daily activities which may be
related to any life area, such as leisure, education, or self-care, not necessarily
work alone.
• One of the key factors for promoting well-being lies in balancing one’s daily life
occupation and the nature of these occupations.
• An individual’s occupation can be a source of his happiness and income; at the
same time his mismatched occupation may become as a major source of his stress
and illnesses.
• Therefore, it is always necessary for a community health nurse to collect thorough
history about client’s occupation.

OCCUPATION
The results of joblessness:
• Psychological consequences
• Loss of identity and self-esteem
• Increased stress from various sources
• Greater future uncertainty
• Feeling of social isolation
• Many physical health problems like obesity, hypertension, diabetes
• Poor quality of well being.

DEFINITION OF FINANCIAL MANAGEMENT
• According to Guthman and Dougal, financial management means, “the
activity concerned with the planning, raising, controlling and administering
of funds used in the business.”

Objectives of financial management
• To ensure availability of adequate funds and effective utilization.
• To ensure adequate profit.
• To generate more funds for further expansion and growth.
• To coordinate the activities of the finance department with the activities of
other departments of the organization

INCOME
• Income is the flow of cash or cash-equivalents received from work
(wage or salary), capital (interest or profit), or land (rent).
• Net income is the excess of revenues over expenses.

NATIONAL INCOME
• National income is the total value of a country’s final output of all new goods and services
produced in 1 year.
Methods of calculating national income:
• The income method: This is generated by adding up all income received during a given
year.
• The output method: This is the combination of value of the new and final output resulted
in all sectors of the economy, including manufacturing, financial services, transport, leisure
and agriculture.
• The expenditure method: This method sum up all expenditure in the economy by
households and firms on new and final goods and services.

BUDGET
• CIMA defines a budget as “A plan quantified in monetary terms, prepared prior to a defined
period of time to attain a given objectives.”
• Budgeting helps us to control money that helps to lead our life. It gives a detailed picture
on how much money we have, how much we spend, and how to proceed further to make
money.
Uses of budgeting:
• Helps to settle debts quickly.
• Keep up with your bills.
• Save money for specific tasks.
• Able to settle unplanned expenses.
• Buy luxuries by matching with the money.

BUDGET
Purposes of budget:
– To plan and act accordingly.
– Keep up with your bills.
– Save money for specific tasks.
– Able to settle unplanned
expenses.
– Buy luxuries by matching with
the money.
Functions of budgets:
– Planning annual operations.
– Coordinating the activities of the various
parts of the organization and ensuring that
the parts are in harmony with each other.
– Communicating plans to the various
responsibility center managers.
– Motivating managers to strive to achieve
the organization goals.
– Controlling activities
– Evaluating the performance of managers.

PURCHASING POWER
• The value of a currency expressed in terms of the amount of goods or services that one unit of
money can buy is called as purchasing power.
• Price is the amount a buyer pays for a product or services.
INFLATION:
• Inflation is an increase in the general level of prices for goods and services.
• Inflation reflects price-rise.
• Consumer price index (CPI) is used to measure inflation.
Causes of inflation:
• Consumers may want to buy more goods or services than are available, increasing the prices.
• Producers may have to spend more to produce products leading to increase in prices.
• Both the above situations can lead to inflation.

PURCHASING POWER
DISINFLATION:
• In other words, prices are rising, but at a decreasing rate. Disinflation occurs when prices are
rising, but at a slow rate.
REFLATION:
• Reflation occurs when prices are high but then drop due to lower demand.
HYPERINFLATION:
• When prices are rising so rapidly they are out of control, this is called hyperinflation.
• Deflation is the lowering of overall price levels. In other words, prices are going down.
INFLATION AND EMPLOYMENT:
• When prices are high, producers can make more money.

FACTORS AFFECTING PURCHASING POWER
• COST-PLUS PRICING: Cost-plus pricing calculates the total cost of making and
distributing a product.
• VALUE-BASED PRICING: The seller determines the price based on consumer’s value for
the product.
• MARKET-BASED PRICING: The price is fixed to be competitive with prices of similar
products currently in the market.
• BUYING STRATEGIES BY CONSUMERS: Consumers use two basic strategies for buying
goods. They attempt to spend as little as possible, or they try to get maximum worthy
product for the money spent.
• ECONOMIZING: Consumers are saving as much as possible. So they buy only it is very
much necessary.
• Optimizing means getting the highest value for the money spent.

FACTORS AFFECTING PURCHASING POWER
• Strategies by sellers: Seller use many other strategies, apart from price, and promotion
of goods.
• Convenience:
– Provision of convenient and pleasant environment for customers.
– Store location is easily accessible.
– A clean, safe and comfortable, complex.
– Appointing people friendly sales persons.
– Accepting all modes of payment.
– Provision of refreshment.
– Popular people icons are used as promoters.
• Customer service: Good customer service includes many techniques. A warm, friendly
greeting and prompt and polite help are some of the examples.

BUYING STRATEGIES
• Before shopping:
– Prepare a shopping list.
– This list can resist impulse buying and helps to prevent forgetting.
• While shopping:
– While at the store, stick on to list.
– Check the unit prices.
– Avoid going to grocery shops when hungry. It may affect our choices.
– Stick on to budget.
• After shopping:
– Keep all the receipt and warranties for all items purchased.
– Open package carefully.
– Make sure the item/product functions properly.
– Evaluate whether the expense is within the budget.

BUYING STRATEGIES
• Security:
– A brokerage is defined as a financial institution that aids the buying and selling of financial securities
between a buyer and seller.
• Financial securities:
– A securities brokerage is defined as a firm trading stocks and bonds on behalf of its client.
• Brokerage firms:
– Brokerage firms provide assistance to their clients for buying or selling stocks, bonds and other securities.
• Full or discount brokers:
– Discount brokers help for those do their own research and need help in only in executing orders without
any investment advice.
• Broker versus dealer:
– While a broker act as an agent, implementing his clients orders, a dealer has his own account from which
he buys and sells securities for his client.

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