First MBBS Lectures

1. Concepts of
Health & Disease
1

2. 2
What is Health?

3. What is health?
• Absence of disease?
• Harmony ? “ being at peace with self,
community, god and cosmos”
3

4. Changing concepts
• Biological concept
• Ecological concept
4

5. • Psycho-social concepts
• Holistic concepts
5

6. 6
Health: Definition
World Health Organization
It is a state of complete physical, mental
and social wellbeing and not merely
absence of disease or infirmity.
1. Mere absence of disease is NOT Health
2. Three dimensions of health
3. Complete wellbeing on three dimensions
4. Fourth dimension ‘spiritual’ now added

7. 7
Health: Definition: Major criticism
1. Only four dimensions considered (emotional
& vocational omitted)
2. Too idealistic, not reachable in practice
3. Health considered as “a state” i.e. a static
entity. (In practice it is a dynamic concept)
• “Ability to lead socially & economically
productive life” is also now added to this
definition.

8. HEALTH
PHYSICAL
MENTAL
SOCIAL
VOCATIONAL
EMOTIONAL
SPIRITUAL
Dimensions of Health

9. 9
Physical Dimension
Individual level Group (Community) Level
Easily understood & measurable

10. 10
Physical Dimension:
Individual level
1. Every organ of ‘normal’ shape and size
2. Every organ & system functions at optimum
level
3. Individually & in coordination
4. E/o growth in children

11. 11
Physical Dimension
Community Level
Indicated by the indicators of:
1. Morbidity
2. Mortality
3. Fertility
4. Disability

12. 12
Mental Dimension
Individual level Group (Community) Level

13. 13
Mental Dimension
Individual Level
Perception
Confidence
Self control
Decision making
Meaningfulness
Coordination

14. 14
Perception
Correct perception of own:-
1. Abilities: Neither underestimates
nor overestimates
2. Emotions & feelings
3. Strengths & weaknesses

15. 15
Decision making
1. Right decision at
right moment
2. Realistic goals &
ambitions
Meaningfulness
1. Leading life with
‘purpose’
2. Dependable

16. 16
Confidence in :
1. Own abilities
2. Own strengths
3. Neither
overconfident
4. Nor under confident
Self control
1. Does not loose control
easily
2. Controls emotions
3. Faces frustration &
conflict gracefully
Coordination
1. Leading life harmoniously with others
2. Adjusting with others
3. Rare conflicts

17. 17

18. 18

19. 19
Mental Health
Community Level
Indicators:
1. Suicides
2. Homicides
3. Drug dependence
4. Offences related to women & children
5. Morbidity due to mental illnesses
6. Morbidity due to psychosomatic illnesses

20. 20
Social Dimension
Individual level Group (Community) Level

21. 21
Social Health
Individual Level
• Defined as quantity and quality of an
individuals interpersonal ties and the extent
of involvement with the community.
• Development of Social skills & functions
(Socialization)
• Performance of ‘Social roles’

22. 22
Social Health
Community Level
Equity in distribution of resources
Indicators:
1. Per capita GDP
2. Literacy rates
3. Status of women
4. Employment / unemployment

23. 23
Spiritual Dimension
Most difficult dimension to explain & quantify
Includes such aspects like:
1. Ethics
2. Principles
3. Integrity
• Spiritual healthy person is fulfilled,
contented and relaxed

24. 24
Emotional Dimension
Emotion:
Sudden forces of feelings emerging in mind
Types:
Positive: Love, Joy
Negative: Hatred, Sadness, Dejection
Expression of correct emotion, at correct place,
in controlled form =
Emotional health

25. 25
Emotional Dimension
Common forms of emotional disturbances:
Anxiety: Inability to concentrate, insomnia
Depression: Sadness, dejection , suicidal
tendency
Mood swings: Sadness / joy on trivial incidences,
sometimes hostile

26. 26
Vocational Dimension
1. Concerned with job
2. Job & person ‘made for each other’.
3. Expression of frustration, unhappiness
over job
4. Frequent changes in job
5. Maladjustment with job
6. Occupational disorders

27. 27

28. 28
Positive Health
Better Health
Freedom From Sickness
Unrecognized Illness
Mild Illness
Severe Illness
Death
Spectrum of Health

29. 29
Positive Health
• Not a new concept. Explained in Ayurveda as
the concept of ‘Swastha Purush.”
• Highest degree of health in all six
dimensions
• Equivalent of scoring 100 % marks in all 6
subjects (dimensions)

30. 31
Better Health
1. Not 100% in all dimensions, but
near it
2. Equivalent of getting distinction in
ALL 6 subjects (dimensions),
probably 100% in one or two
3. Practically attainable

31. 32
Freedom From Sickness
1. No evidence of any physical, mental,
social or emotional illness
2. No evidence of such illness even under
stress
3. Equivalent of passing in all 6 subjects
(dimensions), probably with distinction
in one or two

32. 33
Unrecognized Illness
No clinical e/o illness
Proof of illness by biophysical / bichemical or
other tests only
Illness under stress (e.g. Stress test for IHD)

33. 34
Mild & Severe Illness
Mild Illness
1. Illness without
complications
2. Reversible?
Severe Illness
1. Illness with
complications
2. Multiple
illnesses
3. Not reversible?

34. Health- A relative concept
• Individualized standards for each country
instead setting of an universal health
standards.
35

35. 36

36. Concept of wellbeing
• Can the wellbeing measured?
• Components of well being
37
Wellbeing
Objective
Standard
of living
Level of
living
Subjective
Quality of
life

37. Wellbeing objective components
• Standard of living:-
It is refer as usual scale of our expenditure,
goods we consume and the services we enjoy.
 level of education, employment of status,
food, dress, house, comforts of modern living
Measure in per capita GNP and is expressed in
currency of U.S. dollars
38

38. • Level of living:-
• Parallel term used for standard of living
• Nine components:-health, food consumption,
education, occupation and working
conditions, housing, social security, clothing,
recreation and leisure and human rights
39

39. Wellbeing subjective components
• Quality of life:-
Health, marriages, financial or educational
opportunities, self-esteem and trust in others.
Perceived sense of happiness, satisfaction,
and gratification by the person.
Subjective feeling of happiness of
unhappiness about life
40

40. Disease: Concepts
• Disease # Illness # Sickness
• Disease: Without ease/ uneasiness
• Illness: It is a subjective feeling of not
being well.
• Sickness: - It is a state of 'social
dysfunction' when person assumes
'sickness role' and unable to perform
social role
41

41. • Difficulties in defining disease
 Spectrum of disease (in-apparent to sever)
Onset acute or gradual
Carrier state
Single organism may cause many clinical
manifestation
Single disease may cause by many organism
Short duration or Prolong duration
42

42. Impairment/Disability/Handicap
• Impairment: - It is the loss or abnormality of
physiological, psychological function, anatomical
structure or function
• Disability: - It is the inability to carry-out activities
relevant to age and sex
• Handicap: - It is the disadvantage due to impairment
or disability
43
Loss of type writer job
Loss of right upper limb
Un able to hold an object

43. 44
Loss of Rt. Upper Limb Unable to hold an object Loss of Job

44. Cause of Disease
45
Event Condition Characteristic
Accident
Exposure to
infected person
Eating stale
food
Unimmunized
status
Age
Gender

45. Cause of Disease
• Necessary cause: Disease cannot be
produced without it
• Sufficient cause: Produces/ initiates
disease. May be single or a group
- A combination that leads to disease
46

46. Risk factor
• An attribute or exposure associated with
development of disease/ disorder
• Value as predictor
• Modifiable; Non-modifiable
• Susceptible/At risk person, Susceptible/at
risk groups
47

47. Theories of Disease Causation
1. Old theories
2. Theories in Ayurvedic / Greek/ Chinese
Medicine
3. Germ Theory
4. Epidemiological triad
5. Web of disease causation
48

48. Theories in Traditional medicine
• Tridoshas in Ayurveda: Cough/ Pitta/
Waata: Balance= Health
• Greek: Humors: phlegm, yellow bile,
black bile and blood.
• Chinese: Principles: Yang (Male Principle)
Yin (Female Principle)
49

49. Germ Theory
• Robert Koch showed
that anthrax is caused
by bacteria.
i. The organism must be
constantly associated
with the lesions of the
disease.
ii. It should be possible
to isolate the
organisms from pure
culture of the lesions.
• iii) Inoculation of the
pure culture in suitable
animal should
reproduce the lesions of
the disease.
• iv) It should be possible
to re-isolate the
organisms in pure
culture from the lesions
produced in
experimental animals.
50

50. Theories of Disease Causation
51
Epidemiological
triad

51. Web of Disease causation
52