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Assessment of Holistic
(Wholistic) Health and Fitness
By R. P. Deolankar
Not to repeat story of blind men examining the elephant
Not to perform unnecessary procedures on patients
for better income but to provide simple solutions!
Disease is a deviation from Health

Health is a process of gaining of physical, mental,
social, emotional or spiritual wellbeing

The regular complete health checkup provides the
right assessment

The deviation in the process of health is a
progression towards disease

WHO states: Promoting and protecting health and
respecting, protecting and fulfilling human rights are
inextricably linked
Health policy is a guiding principle
(Applies to the public health rather than family or individual)





Principle of Policy: Holistic or Isolated /
Fragmented
Program Policy: Time Bound, Phased Manner
or Random
Economics and Finance Policy: distribution of
funds among research, service, training and
extension
Personnel Policy: who shall perform the task,
of what kind and for whom
Communication Policy: Language, Mode of
Communication and What to Communicate etc
Setting Health Goals: Depends
on the Health Policy
Examples:
 Earth: Health and the Millennium Development Goals
provided by WHO

National: Nutritional goal like 5+ a day, achieving clean
air and water as per standard, media propaganda for
clean hands, tobacco control etc

Community:
Vaccination,
special
supplements, mosquito control

Family and Individual: Provided through family doctor,
barefoot doctor, health worker or family head
foods
and
No Solution Without Appropriate Training

1st : Capability of health worker to provide solution
through his or her expertise could be Upgraded

2nd : Continuing education and refresher courses
could be provided

3rd : Ability of a Health Worker to have perfect
communication with specialists i.e. translating the
correct problem from land to lab and feasible and
sustainable solution from bench to bedside / field
could be improved
Realization by a Health Worker

Health worker could provide self assessment
tools to the people through health education
thereafter observe horizontally or vertically the
processes in individuals, families or groups

Fixes the health goals for target populace of a
health worker as per the health policy

How to fill the gap between the health goal and
the actuality is a health problem

"A problem shared is a problem halved”. Help
could be sought for a difficult problem
Health Worker is a Translator





Translating problem from land to lab
“Simple problem – complex solution” model is
to consider a single morbidity separately and
develop solution for each
“Complex problem – simple solution” model is
to consider disease as a whole and find a
feasible solution
The later model matches with the policy word
“Translation”
Sometimes solution is provided but the
science is not understood. However,
“Translation” is achieved
From Bench to Bedside

Problem based learning” (PBL) at the “problem
location” (PL) facilitated by the problem solvers and
complimentary facilitators is required for research
worker

Only feasible solutions developed in the labs could
be translated to the hospitals or individuals through
health worker

The solution also needs to be sustainable

Public funded research institutes trapped by the
fragmented policy and lack of holistic view fail to
provide feasible and sustainable solutions
Dilemma: Super-Specialists

Companies and high-tech labs employ specialists to
work on profitable diseases

Likely to be pushed by their dreams or profit rather
than actual problem (Risk of performing caesarean
when normal delivery is possible)

Public funded research labs publish isolated work in
specialized journals and produce impact on similar
labs rather than public health

“Science... never solves a problem without creating
ten more.” …George Bernard Shaw
Human Rights and Health
Violations or lack of attention to human rights
can have serious health consequences
 Harmful traditional practices, slavery and torture,
inhuman and degrading treatment, violence against
women
Health policies and programs can promote or
violate human rights in their design or
implementation
 Freedom from Discrimination, Rights to Participation,
Privacy and Information
Health Promotion
Vulnerability to ill health can be reduced by
taking steps to respect, protect and fulfill human
rights
 Freedom from discrimination on account of ethnicity,
sex and social status
 The rights to food and nutrition, water, education,
adequate housing (and sex-life)
Dr. B. R. Ambedkar
Assessment of Health
•
The result of an interaction between the assessors (A) and
subject (S)
•
Self assessment means A and S are same
•
Otherwise, when A and S work together towards the
assessment
the product is not A + S but it is A + S + AS
•
Assessment SOP / questionnaires cannot be rigid with all
close ends; it must have open ends, bias of assessor needs
to be checked
•
To manage these open ends is a challenge for Disease
Informatics
Will more doctors or super-specialists mean
better health for all?

Quality of health information depends on the level of
education of a community member

Education: Food and nutrition, sports and exercise,
hygiene, toxins and pollution, stress and natural
feeling

It has been realized that better health education for
all rather than more doctors or scientists would result
in better health for the community

Know the elephant as a whole and not to repeat
story of blind men examining the elephant
Skills required for Health AssessmentI: Spiritual
 “Laughter
composed of peace, joy and
compassion is the best medicine” and hence
“Laughing man” is the symbol of spiritual health

Case file begins here; with a short remark on
spirituality

Spiritual test Ξ assessment performed by the
subject himself + spiritual master

Interaction of man with self
Spiritual: Meaningful living by
human form of life
Real spirituality improves quality of life
 Spirituality: Ordinary → Motivated →
Seeker of truth → Spiritually uplifted man
 Inspired health worker or organization
guided by scientific temper and actual self
experience provides practical, wise and
prudent solution (attempt to perform normal
delivery and avoid caesarean)

Spiritual: Pointers in the life of a
human being
Morality (Dharma)
 Prosperity (Artha)
 Instincts (Kama)
 Freedom (Moksha)

Spiritual: Traditional Spiritual Protocols
(Mythologies and superstitions are regretted)
Example: Rishi Panchami Vrata (one of the spiritual
module for motivated individuals, a general
prescription by ancient sages)
 Rishis (Ancient sages) in India lived longer by
sustaining on Paleolithic diet and lifestyle
 Rishi Panchami is the day when motivated
Indian individuals, particularly women, live like
Rishis
 Rituals: Take prolonged bath in the river or lake,
expose to Sun, clean the teeth with the stick of a
herb Aghada (Achyranthes aspera Linn), do not
eat agricultural produce but eat food gathered
from forest
 Health
benefits are seen particularly in
gynecological problems in women
Spiritual advice to the person
having problem (Vaikalya)
Priest / Sage learns the problem of an
individual
 Recommends regimen of fasting or special
food, nature worships, pilgrimage etc.
 Health outcome depends on knowledge of
an advisor

Spiritual: Religious Festivals

Festivals are local and seasonal

Points to seasonal changes in food and
lifestyle or pre-seasonal detoxification to
prevent seasonal diseases

Migrants need to match festivals to the
season rather than calendar else adopt
new local culture for certain health benefits
Spiritual: Harmful Superstitions
While certain religious and spiritual
traditions
are
beneficial,
certain
superstitions are harmful
 Example:
Menstruating
women
are
regarded unclean and are isolated. They
cannot enter the kitchen or temple till they
are ‘clean’ again

Skills required for Health AssessmentII: Social

Social exam Ξ assessment of a subject performed
by the anthroposociologist (Trained teachers and
social workers)

Socioeconomic status of an individual is recorded
in the case file

The interaction of the individual with the
environment, with the members of society, with
respect to social structure, language, law, politics,
religion, magic, art, and technology

Social causes of a particular human behavior and
thoughts relating to the health and disease
Social: Appraisal of a domestic
environment
Health of a person depends on an
environment
 Availability of sunlight, clean air, clean
water, clear mind and happy thoughts
 This environment is of a very small
residential area
 Called as micro-environment

Social: Appraisal of a toxic exposure

Living in a world composed of toxic air,
water and food

Exposure to the toxin can occur at home,
at work place or during transit

Vices and habits
Social: Food, Nutrition and Agriculture

Availability of 5+ a day (more than 5 servings of
fruits, salads and vegetables)

Food help during draught and calamities is
mostly of cereal grains causing diet deficient in
vitamins, minerals and protein

Excessive and aggressive agriculture causing
mineral deficient soils, susceptible crops, toxic
foods
Social: Habits and Habitat

Physical habits e.g. impotence associated
with cycling

Pornography and health

Cell phone towers and mobile phone
radiation, radio frequency radiation from TV
and radio transmitters
Social: Migration

The associations between disease, travel
and migration have historical roots

Health disparities between a place of origin
and its destination

May import a disease that was never seen
in local population
Skills Required for Health Assessment
III: Mental and emotional

Mental and emotional exam Ξ clinical assessment of
a subject performed by the psychiatrist

Human is considered more than an animal

Reveals
endogenous
backend
e.g.
faulty
interpersonal
relationships
resulting
in
psychosomatic process

Records
interaction
between
psychological
processes and the nervous and immune systems of
the human body
Mental and Emotional: Types and
Tests

Addiction to Internet, sex, vices

Anxiety,
Depression,
Assertiveness

Disorders pertaining to Attention deficit,
mood, obsessive compulsion, personality
and sex
Self
Esteem,
Mental and Emotional: Stigma

Mental and
stigmatized
emotional
disorders
are

Dignity of a patient suffering from a mental
problem is denied that unable them to mix
in the society

Patient as well as relatives may not
cooperate during assessment unless
health worker gains confidence of the
family and patient
Mental and Emotional:
Perfectionist, EQ and IQ

Perfectionists are displeased with anything that is not
perfect or does not meet extremely high standards

He or she may have high IQ but may not have tact and
skill in managing delicate situations and handling people,
provide limited output and likely to suffer from emotional
issues

Family members or acquaintances of a perfectionist may
turn rebellious spoiling family environment and health

Hence assessment of Emotional Intelligence is better
determinant of health
Mental and Emotional: Stress in
the Modern World

Stress is harmful when it is beyond the
coping capability of an individual

Stress in the modern world is being
recognized as a killer

Measurement and management of stress
are important issues of health
Skills Required for Health Assessment
IV: Physical

Physical exam Ξ clinical exam of a subject
performed by the doctor without reading the case
file to begin with

Sign is an objective evidence of disease especially
as observed and interpreted by the physician rather
than by the patient or lay observer

Symptom is a subjective evidence of disease or
physical disturbance observed by the patient

Test is a proof or disproof for the clinical diagnosis
Physical: Tests and Examinations

Laboratory tests are performed by medical
laboratory technicians and pathologists

Physical examinations are performed
physiotherapists and physicians

Fitness tests are performed by physiotherapists,
physicians and sports people

Fitness tests for laborer and farmer are required
but rarely performed
by
Physical: If health is wealth then
fitness is money
Fitness is measured in terms of
 Body composition, cardiovascular fitness,
flexibility, muscular endurance, and muscle
strength
 Agility,
balance, coordination, power,
reaction time, and speed
 Job specific requirement for fitness
Physical: Popular Anthropometry

It is easy to perform, cheap but sometimes time
consuming

Useful in determining size, shape, somatotype,
strength, working capacity and body composition

Advances in 3-D imaging technology has replaced
traditional anthropometry

Equipment: Bone Calipers, Measuring Rods,
Skinfold Calipers, Tapes, Scales, Segmometer,
Stadiometer, Steel Rulers, Surgical Skin Marker, or
3-D image scanner
Physical: Aerobic Endurance Tests

Markers of healthy heart

Markers of healthy lungs

Tests: run, walk, cycle, step etc

Equipment: Tapes for measuring distance
and stop watches
Physical: Flexibility Assessment

Trunk and lower body flexibility

Upper body flexibility

Equiment: Goniometer or flexometer, sit
and reach boxes
Physical: Muscular Endurance and
Strength

The ability of the muscle to perform heavy
work (strength) and continue to perform
without fatigue (endurance)

Different tests for different groups of
muscles

Weights, pushups, sit ups
Physical: Agility, Balance and Co-ordination
Agility is the ability to perform a series of
explosive power movements in rapid
succession
in
opposing
directions
assessed by ZigZag running or cutting
movements
 Balance is the ability to control the body's
position, either stationary or while moving
 Co-ordination is the ability to integrate so
that effective movements are achieved

What about time?
Too
many
parameters!
Won’t
assessment become clumsy? What
about time?
 Application of statistics and Information
Science
(Disease
Informatics)
is
required to reduce the parameters
without loosing the truth
 Upgrade wisdom provided by Holistic
Ancient
Medicine
to
perform
assessment with a few parameters

Family doctor as a Source of
Information
Knows subject in the context of the family
and the community: contacted by each
family member at regular interval
irrespective of occurrence of sickness
 Keeps record of a family and their
members by performing spiritual, social,
mental and emotional, and physical
assessment of a patient
 He or she understands the disease
process before the disease event occurs
i.e. disease causal chain: Should be worthy
in keeping touch with epidemiologist for
exchange of information

Features of a Good Family Doctor
Specialist in family medicine: comprehensive
health care to people of all ages including
immunizations and screening tests, routine
checkups and assessment of risk to the health,
personalized counseling on sex-libido and other
confidential issues at affordable cost
 Wide knowledge and multiple skill set to treat
individuals and family as a whole; Provides
guidance on diet, exercise and change in lifestyle
modalities , manages chronic illness and
coordinates specialists
 Respect for human rights and love for human
relations
 Bears administrative load, spends lot of time with
people

Family Doctor and Health Problem
Modern doctor is focused more on disease
rather than health
 Few doctors monitor exercise and lifestyle
but tend to prescribe drugs
 Traditional doctor is focused more on
health -- diet,
native herbal and
environmental resources and physicalmental and spiritual exercises

Family Health Aides or Part-time
Health Workers
Health Aides are supposed to be persons
complementing skill-set of a family doctor
 Could be focused on diet, exercise and lifestyle
factors and concerned with needs and availability
of health services
 Social workers, educationist and spiritual workers
could be groomed as health aides
 Should have good communication with family
doctor to form a team under the leadership of the
doctor (Health Team)

Ideal Reward and Punishment of
a Health Team
The amount of money one might have spent on
fees for specialists and super-specialists, drugs
and medicines, tortures of medical procedures
and surgeries, hospitalizations will be saved
because of the activities of a health team and
will act as their reward (say A)
 If he or she fails then the cost of medical
treatment should be recovered from his reward
or he or she should bear the burden of
expenditure (say B)
 Earnings = A - B

Is there a reward policy for a health team?




No. Providing simple solutions to the disease
problem fetches less income and performing
procedures on a patient fetches better income
(Compare vaginal vs. caesarean delivery)
Subspecialties generally are considered more
glamorous — and lucrative in terms of wealth;
shift from wealth to health is problematic
Many a times, admissions to a medical college
is competitive and not dependent on talent
and motivation but on money power and
corruption
Reward of health aides is meager
What is the result of lack of reward policy?




Matter of health is getting commercialized and
only rich can afford it; mushrooming superspecialized research institutes rather than solution
providers
Number of family doctors is going down day by
day
Family doctor is an important source of information
for epidemiologist hence collection of information
would be difficult with a few family doctors
The challenge is to shift the role of family doctor to
community health aides or barefoot doctors and
reward them properly
What is so special about Mahatma Gandhi?





The greatest public health scientist
Gandhian approach: The health plans
should suit the poorest of poor
Be your own doctor: a complementary
policy to barefoot doctor
How to live naturally in the artifact world
How you can help your body ‘stay healthy’
and cure it naturally if you are currently ill
etc
Aarogya swaraj (Self-ruling the health)
-- SEARCH model

Model developed by Drs. Abhay and Rani
Bang

Save yourself from predatory practices of
super-specialists and pseudo-scientists, form
your own policy, set your own health goals,
and find appropriate means to stay healthy

Targeting Tuberculosis, Malaria, HIV, Acute
Respiratory Illnesses, Diarrhea and other
vaccine preventable diseases does not require
very high clinical expertise, or expensive and
high-tech diagnostic aids
Thanks
•
•
•
•
•
•
•
•
•
Lecture no. 36261: Disease Informatics: Living in the Toxic World,
November 6, 2009
Lecture no. 35791: Disease Informatics: The burden of disease,
September 11, 2009
Lecture no. 34141: Disease Informatics: Brush up the terms
describing techniques and resources, February 19, 2009
Lecture no. 34011: Disease Informatics: Terms and Jargon to
begin with, February 1, 2009
Lecture number -31981: Disease Informatics: ICD-11 at the
doorstep, February 26, 2008
Lecture number-30331: Disease Informatics: Phytates driving from
the back-end to Influenza, Encephalitis, Hepatitis, Anemia at the
front-end, July 10, 2007
Lecture number-28921: Disease Informatics: Host factors
simplified, February 07, 2007
Lecture number-25381: DIG for Disease Informatics group; Part-II,
November 07, 2006
Lecture number-25371: DIG for Disease Informatics group; Part-I,
November 07, 2006