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Concept of health and disease

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Concept of health and disease

  2. 2. Concept of Health • Biomedical concept • Ecological concept • Psychosocial concept • Holistic concept
  3. 3. Biomedical concept • Health is “absence of disease” ie if one is free from disease than he is considered healthy. • Based on germ theory of disease. • Question – malnutrition, chronic disease, accidents, drug abuse, mental illness , environmental pollution etc which lead to ecological concept
  4. 4. Ecological concept • Ecologists – health is dynamic equilibrium between man and his environment, and disease is maladjustment of the human organism to his environment. • “Health implies the relative absence of pain and discomfort and a continuous adaptation and adjustment to the environment to ensure optimal function”
  5. 5. Ecological concept • Raised two questions – Imperfect man – Imperfect environment • History shows that improvement in human adaptation to natural environment can lead to longer and better quality of life- even with the absence of modern health delivery services.
  6. 6. Psychosocial concept • Development in social science – Health is not only a biomedical phenomenon, but it is influenced by • social, • psychological, • cultural, • economic and • political factors of the people concerned, • “Health is both a biological and social phenomenon”
  7. 7. Holistic concept • Synthesis of all the above concepts, • It recognizes the strength of social, economic, political and environmental influences on health • Then came a many definitions of health
  8. 8. Definitions of Health • “the condition of being sound in body, mind or spirit, especially freedom from physical disease or pain” (webster) • “soundness of body or mind; that condition in which its functions are duly and efficiently discharged” ( oxford) • “ a condition or quality of the human organism expressing the adequate functioning of the organism in given conditions, genetic and environmental” ( operational def by WHO)
  9. 9. Health Definition WHO define health “Health is a state of complete physical, mental and social well-being and not merely an absence of disease or infirmity”
  10. 10. Dimension of Health • Health is Multidimensional. • WHO definition envisages Physical dimension Mental Dimension Social Dimension
  11. 11. Physical dimension • The state of physical health implies the notion of “perfect functioning” of the body. It conceptualizes health biologically as a state in which every cell and every organ is functioning at optimum capacity and in perfect harmony with the rest of the body. http://images01.trafficz.com/cache/h3w4/500_1189535325_running.jpg
  12. 12. Mental Dimension • Mental health is not mere absence of mental illness. • Good mental health is ability to respond to the many varied experience of life with flexibility and sense of purpose. http://cms.mumbaimirror.com/portalfiles/7/3/200710/Image/Mental%20Health.jpg
  13. 13. • “A state of balance between the individual and the surrounding world, a state of harmony between oneself and others, a coexistence between the realities of the self and that of other people and that of the environment”
  14. 14. Social dimension • Social well-being implies harmony and integration within the individual, between each individual and other members of society and between individuals and the world in which they live. • “quantity and quality of an individual’s interpersonal ties and the extent of involvement with the community.”
  15. 15. Spectrum of Health Health and disease lie along a continum, and there is no single cut-off point. Positive health Better Health Freedom from sickness Unrecognized sickness Mild sickness Severe sickness Death The Health sickness spectrum
  16. 16. Spectrum concept of health • Emphasizes that the health of an individual is not static. • It is a dynamic phenomenon and a process of continuous change.
  17. 17. Determinants of Health • Health is multifactorial. • The factors which influence health lie both within the individual and externally in the society in which he or she lives. • The factors interact and these interactions may be health- promoting or deleterious.
  18. 18. http://www.parl.gc.ca/information/library/PRBpubs/images/prb05101_1-e.gif
  19. 19. http://www.ncahs.nsw.gov.au/images/imglib/public/determin%20health.jpg
  20. 20. How is health in a given community? Health Indicatores
  21. 21. Indicators of Health • Required to measure the health status of a community. • Compare health status of one country with others • For assessment of health care needs • For allocation of resource • Monitoring and evaluation of health services
  22. 22. Indicators • Mortality indicators • Morbidity indicators • Disability rates • Nutritional status indicators • Health care delivery indicators • Utilization rates • Indicators of social and mental health
  23. 23. • Environmental indicators • Socio-economic indicators • Health policy indicators • Indicators of quality of life • others
  24. 24. Concept of disease • Webster defines disease as “ a condition in which body health is impaired, a departure from a state of health, an alteration of human body interrupting the performance of vital functions.” • Ecological point=“a maladjustment of the human organism to the environment.”
  25. 25. WHO definition • WHO defined health but not disease because: • Sprectrum of disease ( many stages) • Some acute, some insidious • Carrier state, infect. • Some are related to organisms, some other cause.
  26. 26. Concept of Causation • Up to the time Louis Pasteur (1922-1985), • Super natural theory • Theory of Humors • Contagion • Miasmatic • Micro organisms. • Germ Theory
  27. 27. Epidemiological Triad • Germ theory has limitation- • Not everyone exposed to TB develops Agent Host Environment
  28. 28. http://www.askdatasystems.com/EPIDEMI/ep/epimod1.htm
  29. 29. The Agent • “an organism, a substance or a force, the presence or lack of which may initiate a disease process or may cause it to continue.” • May be single or multiple. • Living or biological agests • Nonliving or inanimate, ( nutrients, chemical or physical agent)
  30. 30. Biological agents Arthropods- Scabies http://upload.wikimedia.org/wikipedia/commons/9/9d/Cholera_bacteria_SEM.jpg Bacteria- Vibrio Cholerae Fungi, Virus etc
  31. 31. Chemical Agents External Internal Arsenic http://www.hedegaard.com/Minerals/Species/ArsenicJachymov.jpg Alcohol Endocrine glands
  32. 32. Physical Agents • Atmospheric pressure, • Temperature • Humidity • Friction • Radiation • Sound http://academic.reed.edu/physics/courses/phys100/Lab%20Manuals/Friction/friction.jpg
  33. 33. The Host • Man him self • Demographic characterisitics • Genetic factors • Socio economic factors • Life style.
  34. 34. Environment • Internal • External
  35. 35. Multifactorial causation • Not a new concept • Pettenkofer of Munich (1819-1901) was the early proponent of this concept. • Germ theory overshadowed this concept • Now back to multifactorial causation. ( Aetiology- Social, economic, cultural, genetic and psychological ect.)
  36. 36. Web of Causation • Suggested by MacMahon and Pugh in their book “Epidemiologic Principles and Methods” • Concept ideally suits in the study of chronic disease. • Where the disease agent is not known. • Web of Causation considers all the predisposing factors of any typeand their complex interrelationship with each other.
  37. 37. Web of Causation Change in life style Abundance of food Lack of physical exercise Smoking Stress Emotional disturbances Aging and other factors Obesity Hyper Tension Hyperlipidaemia Increased catacholamines Thrombotic tendency Changes in walls of arteries Coronary occlusion Myocardial ischaemia Myocardial infarction Coronary Arteriosclerosis Web of causation for myocardial infarction
  38. 38. Natural History of Disease • Disease results from a complex interaction between man, an agent and the environment. • Natural history of disease signifies the way in which a disease evolves over time from the earliest stage of its prepathogenesis phase to its termination as recovery, disability or death, in the absence of treatment or prevention.
  39. 39. Natural history of disease Period of pre-pathogenesis Period of Pathogenesis D is ea se Pr o ce ss Agent Host Environment Signs & symptoms Illness Disability Defect Chronic state Death Recovery Levels of prevention Primary prevention Secondary Prevention Tertiary Prevention Modes of Intervention Health Promotion Early Diagnosis Disability limitation Rehabilitation
  40. 40. Iceberg of disease
  41. 41. Concept of Control • Disease control describes operations aimed at reducing: 1. The incidence of disease 2. The duration of disease, and consequently the risk of transmission 3. The effects of infection, including both the physical and psychosocial complications 4. The financial burden to the community.
  42. 42. Disease elimination • Between control and eradication, an intermediate goal = elimination. • Elimination is used to describe interruption of transmission of disease • Eg: elimination of measles, polio.
  43. 43. Disease eradication • Literally means to “tear out by roots” • Implies termination of all transmission of infection by extermination of the infectious agent • Till now small pox has been eradicated.
  44. 44. Concept of prevention Prevention depends on • Knowledge of causation, • Dynamics of transmission • Identification of risk factors and risk groups • Availability of prophylactic or early detection and • Treatment measures.
  45. 45. Level of Prevention • Primordial prevention • Primary prevention • Secondary prevention • Tertiary prevention
  46. 46. Primordial prevention • Prevention of the emergence or development of risk factors in countries or population groups in which they have not yet appeared. • Eg; obesity, hypertension- prevented by avoiding smoking, physical exercise.
  47. 47. Primary prevention • Action taken prior to the onset of disease, which removes the possibility that a disease will ever occur. • Eg reduction in BP. For CVD.
  48. 48. Secondary prevention • Action which halts the progress of a disease at its incipient stage and prevents complications • Early diagnosis– through- screening tests
  49. 49. Tertiary prevention • When the disease process has advanced beyond its early stages. • All measures available to reduce or limit impairments and disabilities, minimise suffering caused by existing departure from good health and to promote the patients adjustment to irremediable conditions • Disability-- leprosy