Topic X Dimensions of

Health and
Indicators of
Being Healthy

LEARNING OUTCOMES
By the end of this topic, you should be able to:
1.

Explain the dimensions of health;

2.

Discuss the indicators of health for individuals and family;

3.

Describe variables influencing illness and its behaviour; and

4.

Identify the impact of illness on individuals and their family.

X INTRODUCTION
There are many ways to describe the dimensions of health and how to recognise
the indicators of health for individuals and family members. The opposite of
health is understood as being ill and an individual or family member who is ill
will demonstrate behaviours that are influenced by age, gender, genetics, culture
or beliefs and religious practices, and even education.
It is imperative to have a clear understanding of the behaviours demonstrated by
each individual so as to assist in their journey towards wellness.

TOPIC 2

2.1

DIMENSIONS OF HEALTH AND INDICATORS OF BEING HEALTHY

15

DIMENSIONS OF HEALTH

The absence of illness is a common indicator of health, as believed by the

majority of the population. As advances of technology and knowledge are made
available easily with Internet access, the concept of health has been extended to
have a broader meaning, which now includes psychological health, physical
health and psychosocial health. These three elements interact with one another in
order for an individual to achieve complete good health as well as to attain a
satisfying and balanced life. These three elements are further subdivided and
categorised as having seven dimensions or four dimensions (depending on
writers). The seven dimensions of health are (Donatelle & Davis, 1998):
(a)

Physical;

(b)

Emotional;

(c)

Intellectual;

(d)

Spiritual;

(e)

Social;

(f)

Occupational; and

(g)

Environmental.

On the other hand, some writers have described the four dimensions of health as:
(a)

Physical;

(b)

Emotional;

(c)

Social; and

(d)

Spiritual.

Although these classifications differ in the numbers of dimensions, there are no

differences in the variables described for each dimensions. In this topic, the seven
dimensions of health will be discussed.

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2.2

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DIMENSIONS OF HEALTH AND INDICATORS OF BEING HEALTHY

PHYSICAL DIMENSION

The physical dimension of health or wellness refers to the way a person describes
his body condition at that time and is a very important health dimension. It
involves identifying activities to support ones well-being and ability to keep fit.
Some of the descriptions to demonstrate the physical dimension of health are I
feel great, I do not have any pain and I am eating well. Some may describe
their physical dimension as being able to sleep well and performing daily
activities that are suitable for their age group. Some also believe that if they are
able to eat well and exercise well to keep themselves free from illness, they have
attained the physical dimension of good health. People who are aware of the
physical dimension of health will engage in regular exercise activities like
enrolling in a gym or making certain they follow a regime of scheduled exercise,
counting their calorie intake, avoiding food or habits believed to contribute
illness and many more. Taking additional supplements is also part of this
physical dimension.
The physical dimension of health will be described differently by people from
different age groups. Take the example of someone who is in their twenties. Their
description of physical health is to be able to perform a routine high impact
exercise schedule at least three times a week. Failure to do so may cause them to
think they have not fulfilled their definition of physical health. For an individual
who is 70 years old and has heart disease, a regular exercise schedule may mean
to be able to spend at least fifteen minutes of slow walking three times a week,
and have a lot of rest and relaxation. As you can see, the value given to physical
health differs from one individual to another.

ACTIVITY 2.1
What are your descriptors of the physical aspect of health? Compare
your descriptors with those of a coursemate of similar age group and
gender.

TOPIC 2

2.3

DIMENSIONS OF HEALTH AND INDICATORS OF BEING HEALTHY

17

EMOTIONAL DIMENSION

Having emotional stability is another health dimension. The emotional aspect is

considered a very crucial aspect especially with the challenges of modern life.
These challenges include the fast paced activities expected at work and at home,
as time and productivity are the ultimate measurement of ones value and
commitment to work. Failure to achieve expected levels of performance may
mean the inability to perform, which may eventually result in stress and anxiety.
Stress and anxiety may present in many different forms, such as anger,
temperamental behaviour, abuse or in a worse scenario, depression.
Stress is a term used to describe a nonspecific demand on the body called
stressors, which may be physical or psychological (Selye, 1976). Non-specific
demand means the body reacts to an event by releasing the fight or flight
response, which is also known as the adrenaline hormone. Physical stressors
include lack of sleep, starvation, physical injury and many more.

ACTIVITY 2.2
Can you identify other physical stressors that may affect you?

Anxiety, on the other hand, is a feeling of discomfort related to stress which is

mild and caused by an individuals internal environment. Everyone experiences
anxiety during their life. The cause can originate from a situational stressor or a
developmental stressor. A situational stressor may take the form of an event
affecting a person like a divorce, death of a loved one, loss of job, loss of chance
of a promotion or even when diagnosed to have a serious illness. The effects can
be short term but there are some people who will always be anxious for a long
time. This is what we call chronic anxiety. An example is the anxiety felt before
one has to go for an interview or write an examination. Even meeting a new
person for the first time can elicit anxiety. It is said that one needs to have some
anxiety to be motivated and to be aware of ones surroundings. A serious form of
anxiety is called panic, when the person suffers from a very high level of anxiety
and stress and this may have serious consequences. It can impair the persons
speech coherence making communication difficult.

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DIMENSIONS OF HEALTH AND INDICATORS OF BEING HEALTHY

Depression is a common manifestation of mental derangement and can have

temporary or long-term effects. It can be temporary if the cause of depression is
related to feelings of loss, disappointment or failure. Long-term depression
usually has pathological causes, with symptoms such as a continuous feeling of
unhappiness. People who suffer from depression will have their body, moods
and thoughts affected during that period.
Temporary depression mentioned above may normally last for two weeks. The
symptoms include loss of appetite or overeating, fatigue, feelings of
worthlessness or guilt, hopelessness, irritability, poor concentration, sleep
disturbances or insomnia. A common type of depression associated with
motherhood is called post-partum blues. This is experienced by mothers
immediately after delivery. The symptoms include mood swings, crying,
sadness, anxiety and insomnia, and may last for a week. No specific treatment is
given but emotional support from close family members and spouse is essential.

2.4

INTELLECTUAL DIMENSION

The intellectual dimension of health is achieved when one is able to participate in

activities that stimulate the mental as well as the creative facilities. This will
expand the knowledge and skills of an individual, particularly in the areas of
critical thinking and problem solving. Intellectual health is not about academic
knowledge alone. One can gain intellectual health even by listening to or
attending talks related to health, religion or any other subject matter of interest.
Listening to the music and the lyrics in a song, having a hobby and sharing the
hobby with others can provide intellectual health. A person who engages in the
intellectual dimension of health will demonstrate this by taking part in learning
activities, reading, discussions or debate and having an interest in the current
developments in their surroundings, community and the world. They have high
levels of curiosity and are willing to try and learn from their mistakes. They take
challenges, are committed to their activities and interests, do not give up easily
and persevere until they achieve success. Using their thought processes
positively results in positive outcomes, while excessive thinking may sometimes
produce negative results that may affect ones emotional health.

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DIMENSIONS OF HEALTH AND INDICATORS OF BEING HEALTHY

19

Learning is a continuous activity and people who are intellectually healthy

believe in life-long learning. There is no specific way about how individuals learn
but it is more common to note that attending formal lessons, reading and
participating in a learning group are acceptable ways of learning. Informal
learning activities like discussion, debate and sharing views can be more
stimulating as they creates a common interest and the learning is clearly
understood with good retention due to self-interest. An adult individual can
cultivate the intellectual health of younger ones in their early years, in order to
develop their interest for education besides being a role model to them. If you
wish to be a role model, you should be able to identify those around you who
will benefit from such actions.

2.5

SPIRITUAL DIMENSION

Some people associate the spiritual dimension of health to ones beliefs and
values, while others may also include religious beliefs as part of the spiritual
dimension. How does one explain spirituality? This is a question that has been
attempted by many and more often than not more questions have been asked
than answered.
In simple terms, spirituality is related to belief, values, faith and hope that an
individual learns and adopts throughout his years of life. This depends on a
persons environment, the people surrounding him and the way the people
closest to him (like parents, family members, teachers and friends) project and
impose their values and beliefs. Each individual is exposed to the different
spiritual concepts at the different stages of life. Just look around us and one can
see the different demonstrations of spirituality based on cultural beliefs, religious
beliefs, family practices and individual personality types.
One can sometimes assume the level of another persons spirituality based on
their physical movements, communication, attributes and presentation. It is
usually the positive aspect of beliefs and values that are associated with having
good spiritual health. An example would be when a person shows respect for the
different religious practices of others and accepts them. This may indicate that an
individual has good spiritual health. This also includes accepting and respecting
another persons eating habits and dietary practices. Different religions have
different beliefs, but the basic tenet or golden rule is do unto others as you
would have them do unto you and always remember to do not do harm to
others.

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DIMENSIONS OF HEALTH AND INDICATORS OF BEING HEALTHY

When one has a good spiritual health, one will always remember to conduct
themselves in the same way even when no other human is watching, as there is
always an omniscient presence that is observing ones movement. This will mean
that someone with a strong spiritual health will behave differently when he is
alone and when he is among a group of people.

ACTIVITY 2.3
Can you identify some of the actions that people will do when they
think they are alone and no one is watching?

2.6

SOCIAL DIMENSION

As mentioned earlier, we do not wish to segregate the different dimensions of

health as the isolated dimensions even though there is a thin line dividing each of
them. Social health refers to a society that allows its members the access to goods
and services available for a fulfilling life and in which all members can interact
with each other, and with different social institutions available in the community
and worldwide. Having accessibility to health and wealth is a top priority for
individuals as these are determinants of productivity and emotional health.
Having access to similar groups or communities globally provides a source of
growth for intellectual health.
With the current technological advances, one can be in touch with the world at a
touch of a button and there are many social networks available to select from.
One can choose the different categories of social interests offered and it is the
intellectual dimension that assists one in making the right choice of social
networks to develop the social dimension of health. Failure to identify or select
the right social network may rebound and impact the other health dimensions,
namely the physical, emotional spiritual, occupational and environmental health
dimensions. The negative impact of social health may lead to disruptions of
emotional health like stress, anxiety or depression, while spiritual disruptions
may lead one to change beliefs, values or religious practices and this has far
greater consequences to health.

ACTIVITY 2.4
Can you describe the impact of negative social health on the physical
and intellectual dimensions?

TOPIC 2

2.7

DIMENSIONS OF HEALTH AND INDICATORS OF BEING HEALTHY

21

OCCUPATIONAL DIMENSION

An occupation is an activity one engages in or performs for the purpose of

earning a living. Occupational health is related to work that has potential harm to
the person performing the task, usually over a long period of time. Among the
aspects related to this dimension are safety and a healthy work environment as
well as protection of the worker, relating to the specific job being performed.
Workers in Malaysia are protected by Malaysias Occupational Safety and Health
Act (OSHA) (1994) that deliberates on the rights and protection of the workers, as
provided by employers to their employees. The Act covers regulations and
guidelines to provide a safe and healthy work environment. As an individual, it
is not sufficient to depend on the organisation or employer to abide by the
regulations cited by the OSHA to provide safety measures while at work. The
individual is equally responsible to look after his own safety and health through
adequate understanding of the job he is doing and the associated health effects of
the job. Consideration of how his job impacts the well-being of family members
and all those related to his job and the community must be included.
In discussing on how the occupational dimension of health is affected by an
individual, the specific areas looked into are the individuals ability to balance
his job to his emotional, spiritual and physical needs. While some jobs may have
a high level of stress, the individual must be able to cope so as not to be affected
emotionally, spiritually and physically. Avoiding the impact of high stress may
mean that the individual has to identify how his job affects him emotionally and
proceed to find acceptable means to reduce the stress. One option is to meet with
the employer to discuss changes in work routine and if that is not possible,
perhaps a rotation to other areas can be arranged. Vacation leave is another option.
What the individual needs to remember is he/she must be able to find a balance
between work and his other recreational activities, which include family and
community life. In relation to the challenges at the workplace in the current work
environment, there is a study which shows that Malaysians spend longer hours
at work than with their families which eventually leads to burnout or stress.
Technological advances can sometimes contribute to an imbalance at work,
especially during vacation, where technology allows an individual to be
contacted even when on vacation. This can culminate in abrupt termination of
the vacation, or leaving with a short notice, and if the vacation involves family
matters, many other related issues will be experienced, such as disappointment
felt by family members and feelings of dissatisfaction. If the individual cuts short
the vacation, the possible impacts include additional financial cost in cancellation
of accommodation and travelling in a hurry with dissatisfied family members.
The latter can cause some emotional friction and emotional instability which are

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DIMENSIONS OF HEALTH AND INDICATORS OF BEING HEALTHY

potentially harmful on the road. The individual may be accused of breaking

promises and his children or his spouse may feel that the individual does not
prioritise the familys needs.
Working extra hours for a long time can give an impact on the family life as well as
the health of an individual. Sometimes, the failure of the individual to abide by the
rules and regulations set by the organisation may expose him to hazards of the
workplace. An example is the refusal to wear earphones in an extremely noisy
workplace, which may cause hearing deficits in the long term (see Figure 2.1).

Figure 2.1: Workers wearing earphones at a noisy workplace

Source: www.softnoise.com

A very pertinent fact to remember in preventing the negative impact of

occupation is constant reminders by the employer as well as members of the
workforce to lead a balanced life.

2.8

ENVIRONMENTAL DIMENSION

Being aware of ones environment and the effects of environmental change to the
lives of the individual, community and the world can impact the way an
individual perceives his contribution toward a healthy lifestyle. Any neglect to
the impact of environmental changes can affect the lives of the individual, family
and community. Being aware of current issues like climate change and pollution
of air and water, or substance abuse and many other issues, will encourage the
individual to participate in activities to conserve the environment and to help
prevent its effects on himself, his family and his community. Other variables that
affect the environment include politics, legislation and economics, as well as
housing, which has a determinant effect on the quality of life.

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23

This dimension of health enables one to critically analyse the variables within his
environmental surroundings that can impact his life, his family and his
community, so necessary interventions can be planned and executed in addition
to involving oneself in the intervention activities.
One example is taking steps to improve the quality of water so that the
individual, family and community reap the benefits of clean water, for example,
the absence of water-borne diseases. Examples of water-borne diseases are
cholera, typhoid and leptospirosis. Water-borne diseases can be transmitted from
one individual to another through an infected water supply (see Figure 2.2). How
can one contribute to help keep the water supply clean?

Figure 2.2: Infected water supply

Source: www.panama-guide.com

2.9

INDICATORS OF HEALTH FOR

INDIVIDUALS AND FAMILY

What are the indicators of health for an individual and his or her family? An
individual who is able to identify the health indicators for a healthy and wellbalanced life will certainly be able to assist his family members in leading a
healthy and balanced life too. Identification alone without practicing these
indicators will result in negative outcomes; thus, the individual must be a role
model for the family and community. Some of the indicators of health are
discussed below:
(a)

Monitor the body function as well as those of family members for any
indication of physical deficit, such as fever, poor appetite, lack of sleep or
agitation and stress. Take early actions for any of those early signs and
symptoms;

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(b)

Participate and encourage the family members to participate in activities as

a group, for example, going on vacation, attending family functions or
social functions or even exercising together. Sometimes, it is good to
communicate with each other and have some personal space as an
individual or even have quiet moments of solidarity to reflect upon and
discuss solutions to any issues. For couples, ensuring good communication
and having the occasional time out together is another form of therapy to
attain the physical and emotional health; and

(c)

Diversional therapy, for example, engaging in a new hobby such as games,

fishing, gardening, cooking or reading and attending religious classes, is
another means of balancing the emotional, physical and spiritual health
dimensions.

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DIMENSIONS OF HEALTH AND INDICATORS OF BEING HEALTHY

ACTIVITY 2.5
What other activities can you identify that will assist you in attaining
the balance of health in life?

2.10

VARIABLES INFLUENCING ILLNESS AND

ILLNESS BEHAVIOUR

People who are ill usually manifest some form of behaviour change that medical
sociologists call illness behaviour. As mentioned in the early part of this topic,
health and illness can be influenced by an individuals differences in age, gender,
social or cultural orientation, economic standing, and education. Each individual
responds differently when in illness and exhibits different behaviour, and these
differences exist even among siblings and close family members.
The illness behaviour can be affected by internal or external variables:
(a)

Internal variables include the beliefs that the individual has about the
illness and its severity. Both can have positive and negative impact. For
example, an individual who becomes ill and worried about the effects of the
illness to his body and his daily life will seek assistance to help cure the
illness. Negatively, if the individual perceives that the illness is not going to
disrupt his life, is bearable and will subside on its own, he will not seek any
help. This can have some other consequences, as failure to seek help from
an expert may lead to an undiagnosed severe condition, which can be
detrimental to ones health outcomes. For example, someone who has been

TOPIC 2

DIMENSIONS OF HEALTH AND INDICATORS OF BEING HEALTHY

25

coughing continuously and finds relief by self-medicating with cough

mixture may find that, when the symptoms worsen and he seeks help, he is
already in the advance stage of cancer.
A person who has an acute illness tends to seek help as opposed to
someone who has a chronic illness.
(b)

Some of the external variables that may influence illness are social or
cultural orientation, economic standing and education. Social or cultural
orientation may lead to different responses to an illness. Some ethnic
groups believe that one should not show any weakness when he or she falls
ill and should hide any associated symptoms, for example, by suffering
pain in silence. In contrast, there are ethnic groups that believe one should
express illness or pain verbally by voicing it out or yelling out, even if the
pain is minor.

How does ones illness affect the behaviour?

Infants and toddlers are unable to fend for themselves. When they are ill, they
demonstrate it through excessive crying, tantrums, refusing feedings and clinging
onto the one closest to them. Younger children and teenagers may show a lack of
enthusiasm for their activities, refuse food or ask for something new and prefer
isolation. The behaviour also depends on an individuals normal reaction and
orientation. The older they are, the more capable their coping mechanisms will be.
Adults and the elderly may not demonstrate extreme behaviour when ill. This
depends on whether they want to use the illness as an excuse from doing their
routine chores or job, or some people may pretend to be well and ignore the
illness as they cannot afford to change any of their routines. Some adults who are
technologically savvy will seek out their own interpretation from the readily
available information and respond accordingly based on their findings. Some
individuals do not want to admit their illness for fear of the impact it may have
on their family and ability to perform as a family member. Some spouses do not
want to show they are ill for fear it may affect their prescribed role as the
provider or the carer for the family. The elderly may not want to exhibit their
illness to prevent their spouse and family members worrying about their
condition.
In relation to economic status, the decision to seek health assistance depends on
the funds available and the types of illness. The affluent will not only seek
assistance when ill, but are also willing to purchase health goods believed to
prevent the occurrence of illness. These choices about health assistance will be
determined by the availability of funds. For those with limited funds, only the
essentials will be sought.

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DIMENSIONS OF HEALTH AND INDICATORS OF BEING HEALTHY

ACTIVITY 2.6
Have you ever been ill before? How would you describe your
behaviour when you were ill?

2.11

IMPACT OF ILLNESS ON INDIVIDUALS

AND FAMILIES

When an individual or a family member is ill, there are changes in the routine
activities within this family unit. In a nuclear family setup, which include only
the parents and children, the implications of an illness have far reaching
consequences for the family. For example, if a child is sick and hospitalised, the
routine will be disrupted. The mother will stay in the hospital with the sick child
and leave the father and other children at home. When the father has to leave for
work, he will have to think of alternative ways to have the other children cared
for during his absence. Should earlier arrangements have been made with a
caretaker or a nursery, the care during the day will be taken care of, but other
family activities at night will be affected.
The father may have to go to the hospital to relieve the mother and will be late to
pick-up the other children from nursery or care centre. He will have to think of
how the night meals will be served. If he bought the food from the stalls or
restaurants, he may have to worry about the hygiene, food value and taste. For
some, this may incur additional costs.
The father may also have to anticipate a midnight emergency call, think about
how long the child will be hospitalised, or seek financial support that is available
for the hospital costs. This may lead to lack of sleep. Going to work the next day
will be a chore. His exhaustion and the demands at work will result in stress and
anxiety.
Therefore, the aspects related to the emotional dimension of health will be
affected.

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27

There are other impacts to consider when different family members are ill.
Basically the factors can be categorised as emotional factors, financial factors and
environmental factors. The emotional behaviour of individual during illness
depends on the nature of illness and the individuals attitude to illness, the
length of illness and severity. Short term illness like fever and cold may limit the
participation of the individual in any other normal activities at work or with
family, while long term illness like cancer may subject the individual to
withdrawal symptoms, denial, anger and shock.

ACTIVITY 2.7
Can you describe the impact illness has had on two individuals in your
family list, and decide whether it will have impact on your daily
activities, work or environment?

2.12

COPING STRATEGIES

How does one cope with the ordeals described earlier and perform all necessary
activities as a normal and acceptable individual? How do you keep your life
balanced?
As mentioned earlier, a little amount of stress and anxiety is good for any
individual to motivate him to achieve his ambitions, career pathway, future
planning and future undertakings.
Among common coping strategies mentioned are talking about the life issues
with another person who may be a good listener and not one who will use the
information to gain an extra mileage for his or her own cause. In developed
nations, where there are adequate counsellors or psychologists, one may go to
them for professional help. A psychiatrist is another option, but usually a visit to
a psychiatrist may cause the person to be labelled as having mental disorder.
This can happen because of stereotyping.
Sometimes, there are online help sites or call centres which you can access to
express feelings and discuss issues. Some people even use helplines over the
radio to seek redress over their problems anonymously.

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It does not really matter what options one takes to address issues related to any
of the health dimensions mentioned above as long as it provides positive
outcomes.
Other means of coping include the following:
(a)

Have a good balanced diet to prevent overeating, obesity or under-eating.

Check your health status on a regular basis, more so if you have a strong
family history of diabetes, hypertension, heart disease or any other
hereditary diseases. Get professional advice on what specific nutrition you
can follow;

(b)

Schedule some vacation and time spent with the family, and clarify all
matters before going on vacation so there will be no disruptions on the
vacation schedule;

(c)

Perform regular exercise to keep fit, and ensure that this is within the limits
of your capabilities. If you are above forty, you must get a health status
check before embarking on any strenuous forms of exercise. You should
also quit smoking and alcohol or substance abuse. There are many options
of exercise, to name a few, high impact exercise, Qi Gong and Tai Chi; and

(d)

Identify ways to manage your anxiety and stress, for example through
diversional therapy like music or taking up new hobbies. Learn to laugh
and include humour in your life. Moderation in everything is the best.

How one defines health and uses health dimensions to achieve a balanced
and healthy life is dependent on a few variables like age, gender, social or
cultural orientation, environment and economic status.

For each variable there are justifications by the individual on why they have
chosen this variable to help attain a healthy and balanced life.

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DIMENSIO
ONS OF HEALTH AND INDICA
ATORS OF BEIN
NG HEALTHY

Coping
g strategies

Heealth indicato
ors

Dimenssions of health
h

Illn
ness behaviou
ur

29

Donatellle, R. J., & Davis,

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Selye, H. (1976). The stress
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of life. New
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WHO. (1948). Intern
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