CONCEPT ON

HEALTH & DISEASE

Dr. Rajan Bikram Rayamajhi

Department of Community MedicineB. P. Koirala Institute of Health Sciences

Dharan, Nepal 1

Changing Concept

Biomedical Concept

It is based on Germ Theory of Disease .

[ Human body: a Machine , Disease: Breakdown of Machine ]

Limitation : minimized role of environment , psychology , social structure , culture in determining health.

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Ecological Concept

Health is viewed as dynamic equilibrium between human & environment .

(imperfect human versus imperfect environment)

It depends on human adaptability to natural environment

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Psychosocial Concept Health is influenced by Social , Psychological , Cultural , Economic & Political factors.Health is both biological and social phenomenon.

Holistic concept

It’s a unified or multidimensional and includes all the concept. It implies sound mind, in a sound body, in a sound family, in sound environment.It emphasis on the promotion and protection of health.

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Definition of Health

A state of complete physical, mental & social wellbeing & not merely an absence of disease or infirmity that enables an individual to lead socially & economically productive life.

(WHO Definition of Health)

Infirmity – weakness/ illness over a long period.

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Definition of Health by WHO is Idealistic but not Realistic.

Operational Definition:

Condition or Quality of the human organism expressing the adequate functioning of the organism in given conditions genetic or environmental”

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Health :

No obvious evidence of disease. Person functioning normally.

Several organs functioning adequately in equilibrium.

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New Philosophy of Health

Fundamental Human Right , an essence of productive life & an Integral part of Development.

Intersectoral

Central to the concept of quality of life Involves Individuals, State & International

Responsibility, a world-wide Social goal.

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Dimensions of Health

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Dimensions of Health

Physical Dimension Perfect functioning of body. Every cell / organ functioning at an optimum

capacity & in perfect harmony with rest of the body.

Mental Dimension

A state of balance between the Individual and surrounding world, Harmony between oneself and others.

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Social Dimension

Quantity & Quality of an Individual’s Interpersonal ties and extent of involvement with Community , Degree of social functioning.

Spiritual Dimension• Individual striving for meaning in Life , commitment

to some higher being.

• It also includes ethics, integrity, principles and purposes in life.

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Emotional Dimension Refers to feeling. Mental is related to knowing and cognition.

Vocational Dimension :Work is fully adapted to human goals, capacities &

limitations, it often plays role in promoting health.

Goal achievement and self realization at work are a source of satisfaction and enhanced self esteem.

Others: Philosophical, Cultural, Environmental, Nutritional, Educational, Socio- Economic, Curative, Preventive.

Various “non medical” dimensions have to be considered to make an individual lead healthy life 12

Positive Health

Perfect functioning of body and mind

[Depends also upon Economic, Cultural, Social factors operating in community]

Health is a Relative Concept Positive health is a mirage as everything in life is

subject to change.

‘Dubos’: Concept of perfect positive health can’t come in reality because man will never be so perfectly adapted to his

environment that his life will not involve struggles, failures and sufferings. 13

Concept of Well Being

It has objective and subjective components.

1) Standard of LivingStandard of Living [ WHO ]

1) Income : Per capita GNP 2) Occupation 3) Housing Standard 4) Nutrition 5) Sanitation 6) Health 7) Education, 8) Recreation

Refers to the usual scale of our expenditure, the goods we consume and the services we enjoy.

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2) Level of Living Level of Living [ UN ]

All of the above except Sanitation plus Clothing , Human Right & Social Security

Health impairment lowers level of living

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3) Quality of Life :

A composite measure of physical, mental and social wellbeing as perceived by each individual or group of individuals.

For ex: Happiness /gratification experienced in life concerned with health, marriage , family work, financial situation, educational opportunities, self esteem, creativity, belongingness, trust in others.

Individual’s own subjective evaluation

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Human Development Index (HDI)

A composite index combining indicators representing 3 dimensions

Longevity : life expectancy at birth

Knowledge: adult literacy rate and mean years of schooling

Income

Income is only means to human development , not an end

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Physical Quality of Life Index (PQLI) 1. Infant Mortality

2. Life Expectancy at age One

3. Literacy

Theme: Money is not everything

Oil rich countries of Middle East Asia have high per capita income and Low PQLI

BUT

Sri Lanka , Kerala of India have low per capita income and high PQLI 18

Human Poverty Index: measures deprivation in 3 basic dimensions

1) Probability of dying before 40 years

2) Adult Illiteracy Rate

3) Percentage of underweight children.

4) Percentage of population not using improved water source

Gender Empowerment Measure (GEM)Gender related Development Index(GDI)

Kerala – High female literacy played key role in improving health situation

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Determinants of Health

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Concept of Disease

oA condition where body or any of its part has its functions disrupted or deranged.( Oxford Dictionary)

oMal-adjustment of human organism to the environment. (Ecology)

oAny deviation from normal functioning(complete physical & mental well being)

oIt has many shades (spectrum of disease) ranging from inapparent (subclinical) cases to severe manifested illness

oFinal outcome of disease – Recovery , Disability, and Death.

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Disease: Disease: Physiological/Psychological dysfunction; a condition that is diagnosed by physician

Illness:Illness: Subjective state of the person who feels aware of not being well.

Sickness:Sickness: State of social dysfunction, i.e., a role that the individuals assumes when ill (“sickness role”)

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Concept of Causation

Before Louis Pasteur (1822 -1895 AD)

Supernatural theory of disease,Theory of humor

Miasmatic theory – disease due to noxious airTheory of spontaneous generation .

Discoveries of microbes:(Germ theory of disease)

GonococcusTyphoid bacillusPneumococcusVibrio Cholera

Tubercle Bacillus23

Epidemiological Triad

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o Not everyone exposed to germs develop disease - other factors relating to host & environment equally important in determining whether disease will occur or not

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Agent Factorso Biological agents:

Viruses, Bacteria, Protozoao Nutrient agents:

Proteins, Fats, Vitamins o Physical agents:

Heats, Cold, Pressureo Chemical agents:

Dust, Gases, Insecticides o Mechanical agents:

Forces, Crushing, Tearing o Absence or insufficiency or excess of a necessary to

health: Hormones (Insulin) 26

o Social agents: Poverty, Smoking, Abuse of Drugs

o HOST Factors (Intrinsic)o Demographic:

o : Age, Sex, Ethnicity

o Social & economic factors:Income, Education, Occupation, Stress

o Lifestyle factors: Living Habits, Physical Exercise, Smoking, Nutrition

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Environmental Factors (Extrinsic)

• Physical environment: air, water, heat, noise, climate, soil

• Biological environment: insects, rodents, dogs

• Psychosocial environment: culture, beliefs habits, attitudes, education, health services

• Events like loss of close ones, loss of employment, sudden exposure to stressful conditions anxiety, depression, frustration - psychosomatic disorder Duodenal ulcer, HTN, mental disorder

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Disease/Health Related Events

Risk factors

Heart Disease Smoking , High BP, Obesity , Lack of Exercise, High Serum Cholesterol

Cancer Smoking, Alcohol, Radiation, Environmental Pollution

Vehicle Accidents High Speed, Poor Road Quality, Vehicle Design, Alcohol Use

Reference: Park’s textbook of Preventive & Social Medicine29

Risk Factoro For many disease “agent” unidentified example –

cancer , peptic ulcer , coronary heart disease.

o Etiology discussed in terms of Risk factors.

o Attribute/exposure significantly associated with development of Disease.

o Some can be modified by intervention, reducing the possibility of disease occurrence 30

Web of Causation

oMulti factorial causation

Lung cancer : Genetic predisposition, Smoking habit (No. of cig./day, Different forms of Tobacco) ,

Environmental Factors

Chronic disease: Outcome of Interaction of multiple factors

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Sometimes removal of just only one link/chain sufficient to control the disease provided that the link is important

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Natural history of disease :

The way in which a disease evolves over time from earliest stage of its pre-pathogenesis phase to its termination as recovery, disability or death, in the absence of treatment or prevention.

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Natural history of disease

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