1- Understand the spectrum of health in relation to health and sickness 2- Define; health, disease, illness and wellbeing 3- Define and understand the determinants’ of health; biological, behavioural, socio and cultural, environmental, socioeconomic, health services, and ageing and gender 4- Understand the concepts of “right to health “ and “health for all” 5- Ice-berg phenonmenon of disease

2. SPECTRUM OF HEALTH & ICE-BERG
PHENOMENON OF DISEASE
DR. SINDHU ALMAS
MBBS, MPH (PHD)
DEPARTMENT OF PUBLIC ADMINISTRATION
UNIVERSITY OF SINDH JAMSHORO

3. SETTING
RULES
No cross talks
Cell phone on silent
Hand raise if any question

4. OBJECTIVE
S
1- UNDERSTAND THE SPECTRUM OF HEALTH IN
RELATION TO HEALTH AND SICKNESS
2- DEFINE; HEALTH, DISEASE, ILLNESS AND WELLBEING
3- DEFINE AND UNDERSTAND THE DETERMINANTS’ OF
HEALTH; BIOLOGICAL, BEHAVIOURAL, SOCIO AND
CULTURAL, ENVIRONMENTAL, SOCIOECONOMIC,
HEALTH SERVICES, AND AGING AND GENDER
4- UNDERSTAND THE CONCEPTS OF “RIGHT TO
HEALTH “ AND “HEALTH FOR ALL”
5- ICE-BERG PHENONMENON OF DISEASE

5. SPECTRU
M OF
HEALTH
• HEALTH AND DISEASE LIE ALONG A CONTINUUM, AND
THERE IS NO SINGLE CUT-OFF POINT
• THE LOWEST POINT ON THE HEALTH-DISEASE SPECTRUM
IS DEATH AND THE HIGHEST POINT CORRESPONDS TO
THE WHO DEFINITION OF POSITIVE HEALTH
• “A STATE OF COMPLETE PHYSICAL, MENTAL AND SOCIAL
WELL-BEING AND NOT MERELY THE ABSENCE OF DISEASE
OR INFIRMITY”
• THE HEALTH OF AN INDIVIDUAL IS NOT STATIC; IT IS A
DYNAMIC PHENOMENON AND A PROCESS OF
CONTINUOUS CHANGE
• THERE ARE DEGREES OR "LEVELS OF HEALTH" AS THERE
ARE DEGREES OR SEVERITY OF ILLNESS.
• AS LONG AS WE ARE ALIVE THERE IS SOME DEGREE OF
HEALTH IN US.

7. • HEALTH & DISEASE LIE
ALONG A CONTINUUM, &
THERE IS NO SINGLE CUT
OFF POINT.

8. HEALTH IS
A
RELATIVE
CONCEPT
!
IT IS RELATIVE TO:
• WHERE ON THE SPECTRUM OF HEALTH THE
PERSON IS.
• THE HEALTH DIMENSIONS (PHYSICAL, MENTAL,
SOCIAL, SPIRITUAL, EMOTIONAL, VOCATIONAL
DIMENSIONS)
• LOCAL CONDITIONS AND HEALTH
STANDARDS.

9. DEFINITIONS: THE TRILOGY OF DISEASE, ILLNESS,
SICKNESS
THE DIFFERENCE DEPENDS ON WHO’S REPORTING

10. DETERMINANTS OF
HEALTH:
DEFINITION, TYPES,
AND LEVELS
• MANY FACTORS COMBINE
TO AFFECT THE HEALTH
OF INDIVIDUALS AND
COMMUNITIES.”
• HEALTH SERVICES ARE
NOT HEALTH
DETERMINANTS AND
KNOWING THE
DIFFERENCE WILL CREATE
HUGE DIFFERENCE IN THE
HEALTH CARE EFFICACY

13. “RIGHT TO HEALTH” & “HEALTH FOR ALL”
RIGHT TO HEALTH
• HISTORICALLY, THE RIGHT TO HEALTH
WAS ONE OF THE LAST TO BE
PROCLAIMED IN THE CONSTITUTIONS OF
MOST COUNTRIES.
• UNIVERSAL DECLARATION OF HUMAN
RIGHTS (1948): "EVERYONE HAS THE
RIGHT TO A STANDARD OF LIVING
ADEQUATE FOR THE HEALTH AND WELL-
BEING OF HIMSELF AND HIS FAMILY ..... ".
• WHO CONSTITUTION INTRODUCTION
AFFIRMS THAT IT IS ONE OF THE
FUNDAMENTAL RIGHTS OF EVERY HUMAN
BEING TO ENJOY "THE HIGHEST
HEALTH FOR ALL
• DECIDED BY THE 30TH WORLD
HEALTH ASSEMBLY IN YEAR
1977.
• THEY DECIDED THAT THE MAIN
SOCIAL TARGET OF
GOVERNMENTS AND WHO IN THE
COMING DECADES SHOULD BE
"THE ATTAINMENT BY ALL
CITIZENS OF THE WORLD BY THE
YEAR 2000 OF A LEVEL OF
HEALTH THAT WILL PERMIT THEM
TO LEAD A SOCIALLY AND
ECONOMICALLY PRODUCTIVE

14. ICEBERG CONCEPT OF DISEASE
OCCURRENCE
METHODS TO MEASURE SEVERITY &
PREVALENCE OF DISEASE IN A
POPULATION
• THE ANALOGY OF AN ICEBERG IS USED TO
DESCRIBE THE DISEASE PATTERN IN THE
COMMUNITY OR THE POPULATION.
• THE STUDY OF THE "ICEBERG PHENOMENON OF A
DISEASE“ TELLS OF THE PROGRESS (PATHOGENESIS
AND SPREAD) OF A DISEASE FROM ITS SUB-
CLINICAL STAGES TO APPARENT DISEASE STATE.
• THE TIP OF THE ICEBERG REPRESENTS WHAT THE
CLINICIANS SEE AND SUBMERGED IS THE PART
EXPLORED AND MADE VISIBLE BY THE
EPIDEMIOLOGISTS.
• THE LARGE HIDDEN PART OF THE ICEBERG IS
WHAT CONSTITUTES THE MASS OF
UNRECOGNIZED DISEASE IN THE POPULATION AND

15. CLINICAL
CASES
SUB-
CLINICAL
CASES
DISEASE
FREE GROUP
• DISEASES LIKE HYPERTENSION, DIABETES,
ANAEMIA, MALNUTRITION, PARASITIC
INFESTATION, CANCERS AND INFECTIOUS
DISEASES LIKE JOHN'S DISEASE WITH LITTLE
KNOWN MORBIDITY ARE PRESENTED BY LARGE
SUBMERGED PORTION OF ICEBERG. SIMILAR IS
THE CASE WITH DETECTION AND CONTROL
UNDIAGNOSED RESERVOIR OF DISEASE AND
ARE REAL CHALLENGE TO MODERN TECHNIQUE
FOR ELUCIDATION OF THE ICEBERG UNDER
COVER.

17. HOW TO
DETERMIN
E IN-
APPAREN
T CASES
• SCREENING SURVEYS: IT IS THE SEARCH FOR
UNRECOGNIZED DISEASE/SUB-CLINICAL
DISEASE IN A POPULATION BY MEANS OF RAPID
TEST.
• EARLY DETECTION OF DISEASE (PRESCRIPTIVE
SCREENING)
• WHOLE POPULATION (MASS SCREENING)
• TARGET POPULATION (STRATEGIC SCREENING)
• RAPID AND RELIABLE TEST (HIGH SPECIFICITY
AND SENSITIVITY)

18. MISTAKES MADE BY EPIDEMIOLOGIST WHILE
MAKING AN ICEBERG MODEL
Giving importance to
ills only.
2. No clinical signs no
disease.
3. Only a single agent is
cause of infection.
4. False interpretation
of clinical intervention.
5. Dependency on
clinical records.

19. USES
For detection of sub-clinical and in-
apparent cases
treatment of in-apparent cases
Control of diseases with a greater
number of sub- clinical cases
To have a detailed knowledge
regarding natural history of diseases