Concept of Health & Disease copy by dr. Aysha.pdf

Concept of health and disease

2. LEARNING 0BJECTIVES
At the end of the session the students will be able to:
•Define health and positive health
•Describe new philosophy, changing concepts of health
•Explain the dimensions, determinants, indicators and spectrum of health
•Describe in brief the ecology to health, right to health, responsibility for health,
health & development and health system

3. LEARNING 0BJECTIVES
At the end of the session the students will be able to:
•Define and explain changing concept of disease
•Define illness, sickness and disease
•Explain the concept of causation and natural history of disease
•Describe the different types of prevention with their intervention

4. HEALTH
"Healthisnotmainlyanissueofdoctors,socialservicesandhospitals.Itisan
issueofsocialjustice.“
DefinitionbyWHO:
"Healthisastateofcompletephysical,mentalandsocialwell-beingandnot
merelyanabsenceofdiseaseorinfirmitythatleadsanindividualtoasociallyand
economicallyproductivelife"

5. CHANGING CONCEPT OF HEALTH
Biomedicalconcept:
•Traditionally,healthhasbeenviewedasan"absenceofdisease",andifonewasfreefromdisease,
thenthepersonwasconsideredhealthy.
•Thisconcept,knownasthe"biomedicalconcept"hasthebasisinthe"germtheoryofdisease"
whichdominatedmedicalthoughtattheturnofthe20thcentury.
•Thecriticismthatislevelledagainstthebiomedicalconceptisthatithasminimizedtheroleofthe
environmental,social,psychologicalandculturaldeterminantsofhealth.

6. CHANGING CONCEPT OF HEALTH
EcologicalConcept:
•Deficienciesinthebiomedicalconceptgaverisetootherconcepts.
•Theecologistsputforwardanattractivehypothesiswhichviewedhealthasa
dynamicequilibriumbetweenmanandhisenvironment,anddiseasea
maladjustmentofthehumanorganismtoenvironment.

7. CHANGING CONCEPT OF HEALTH
PsychosocialConcept
•Contemporarydevelopmentsinsocialsciencesrevealedthathealthisnotonlya
biomedicalphenomenon,butonewhichisinfluencedbysocial,psychological,
cultural,economicandpoliticalfactorsofthepeopleconcerned.
•Thesefactorsmustbetakenintoconsiderationindefiningandmeasuringhealth.
thushealthisbothabiologicalandsocialphenomenon.

8. CHANGING CONCEPT OF HEALTH
HolisticConcept
•Theholisticmodelisasynthesisofalltheaboveconcepts.itrecognizesthe
strengthofsocial,economic,politicalandenvironmentalinfluencesonhealth.
•Theholisticapproachimpliesthatallsectorsofsocietyhaveaneffectonhealth,
inparticular,agriculture,animalhusbandry,food,industry,education,housing,
publicworks,communicationsandothersectors.
•Theemphasisisonthepromotionandprotectionofhealth.

9. NEW PHILOSOPHY OF HEALTH
In contemporary times, new philosophies of health have surfaced.
✓Health is regarded as a fundamental human right.
✓Health is regarded as an essence of productive life and minimizing the
expenditure on medical care.
✓Health is not in isolation rather it is inter-sectoral and regarded as an essential
component of social development.

10. NEW PHILOSOPHY OF HEALTH
✓Health is the focal point of quality of life.
✓It is regarded that health is not only the concern of the individual, but also the
responsibility of state and international society
✓Investment in health is investment for society and its development.
✓Health is a worldwide and global phenomenon

11. POSITIVE HEALTH
•Thestateofpositivehealthimpliesthenotionof"perfectfunctioning"ofthe
bodyandmind.
•Itconceptualizeshealthbiologically,asastateinwhicheverycellandevery
organisfunctioningatoptimumcapacityandinperfectharmonywiththerestof
thebody:psychologically,asastateinwhichtheindividualfeelsasenseof
perfectwell-beingandofmasteryoverhisenvironment,andsocially,asastatein
whichtheindividual'scapacitiesforparticipationinthesocialsystemare
optimal.

12. DIMENSIONS OF HEALTH
•Healthismultidimensional.
•TheWHOdefinitionenvisagesthreespecificdimensions-the
physical,thementalandthesocial.manymoremaybecited,viz.
spiritual,emotional,vocationalandpoliticaldimensions.

13. PHYSICAL DIMENSION
•Thephysicaldimensionofhealthisprobablytheeasiesttounderstand.
•Thestateofphysicalhealthimpliesthenotionof'·perfectfunctioning"ofthe
body.
•Itconceptualizeshealthbiologicallyasastateinwhicheverycellandevery
organisfunctioningatoptimumcapacityandinperfectharmonywiththerestof
thebody.however,theterm"optimum"isnotdefinable.

14. MENTAL DIMENSION
•Mentalhealthisnotmereabsenceofmentalillness.
•Goodmentalhealthistheabilitytorespondtothemanyvariedexperiencesof
lifewithflexibilityandasenseofpurpose.
•Morerecently,mentalhealthhasbeendefinedas"astateofbalancebetweenthe
individualandthesurroundingworld,astateofharmonybetweenoneselfand
others,acoexistencebetweentherealitiesoftheselfandthatofotherpeopleand
thatoftheenvironment"

15. CHARACTERISTICS OF MENTALLY HEALTHY
PERSON
✓Mentally healthy person is free from internal conflicts.
✓He is well-adjusted,
✓He searches for identity.
✓He has a strong sense of self-esteem.
✓He knows himself: his needs, problems and goals.
✓He has good self-control-balances.
✓He faces problems and tries to solve them intelligently, i.e., coping with stress and anxiety.

16. SOCIAL DIMENSION
•Thesocialdimensionofthehealthincludesthelevelofsocialskills,social
functioningoftheindividualandone’sabilitytoseeoneselfasamemberofthe
wholesociety.
•Overallthesocialdimensionofhealthisprimaryrelatedwiththeindividualasa
group.
•Italsofocusesonsocialandeconomicconditionsandwell-beingofthesociety
whichisultimatelyrelatedwiththenetworkofsocialrelationships.

17. SPIRITUAL DIMENSION
•Thisisanewdimensionwhichisimportantinthepresentsocietyaslifehas
becomeverycomplex.
•Togetreleasedfromthesecomplexities,oneneedstohavespiritualismwhichin
turnaffectshealth.thethoughtofspiritualismdirectsthemindtothinkorreach
outfortheconstructivemeaningoflife.
•Theworthinlifeultimatelytranscendsintogoodphysicalwell-beinganda
healthylife.
•Thisisnotanoldphilosophyofhealth,ratherithasemergedinthecontemporary
times.
•Inshort,spiritualismincludesintegrity,principles,ethics,andthepurposeinlife.
•Italsoincludescommitmenttosomehigherbeing.

18. EMOTIONAL DIMENSION
•Emotionaldimensionofhealthisthedomainunderpsychology.humanbeingsaresocialbeings
andemotionalbeings.Therefore,emotionalelementsareindispensablefromahealthyhuman
being.emotionalwell-beingistheabilityinthehumanbeingtoadjustandcopewithourownand
othersfeelings.
•Emotionsarepresentinallhumanbeingsandvaryindifferentperiodsoftimeandindifferent
situations.Theyrequireacourseofactiontocopewiththem.emotionsarepresentinpleasant
situationsandindespair.manytimesemotionsarevisible,butincertainsituationssuchas
depression,andanxietytheyarenoteasilyvisibleandcanleadtomentalillnesswhichultimately
affectsthehealth.Therefore,oneshouldbeawareofone’sweaknessesandstrengthswhichcan
behelpfulincopingfromemotionallydisturbingsituations.

19. VOCATIONAL DIMENSION
•Thevocationalaspectoflifeisanewdimension.
•Itispartofhumanexistence.whenworkisfullyadaptedtohumangoals,
capacitiesandlimitations,workoftenplaysaroleinpromotingbothphysicaland
mentalhealth.
•Physicalworkisusuallyassociatedwithanimprovementinphysicalcapacity,
whilegoalachievementandself-realizationinworkareasourceofsatisfaction
andenhancedself-esteem

20. DETERMINANTS OF HEALTH
1)Biological determinants
2)Behavioral and socio-cultural conditions
3)Environment
4)Socio-economic conditions
5)Health services
6)Aging of population
7)Gender

21. DETERMINANTS OF HEALTH

22. SPECTRUM OF HEALTH
•Healthanddiseaseliealongacontinuum,andthereisnosinglecut-offpoint.The
lowestpointonthehealth-diseasespectrumisdeathandthehighestpoint
correspondstothewhodefinitionofpositivehealth.
•Itisthusobviousthathealthfluctuateswithinarangeofoptimumwell-beingto
variouslevelsofdysfunction,includingthestateoftotaldysfunction,namelythe
death.Thetransitionfromoptimumhealthtoill-healthisoftengradual,and
whereonestateendsandtheotherbeginsisamatterofjudgment.

23. SPECTRUM OF HEALTH

24. SPECTRUM OF HEALTH

25. INDICATORS OF HEALTH
•Indicatorsareonlyanindicationofagivensituationorareflectionofthatsituation.InWHO's
guidelinesforhealthprogramevaluation.Theyaredefinedasvariableswhichhelptomeasure
changes.Oftentheyareusedparticularlywhenthesechangescannotbemeasureddirectly.Asfor
examplehealthornutritionalstatus.
•Indicatorsarerequirednotonlytomeasurethehealthstatusofacommunity,butalsotocompare
thehealthstatusofonecountrywiththatofanother;forassessmentofhealthcareneeds;for
allocationofscarceresources;andformonitoringandevaluationofhealthservices,activities,and
programs.Indicatorshelptomeasuretheextenttowhichtheobjectivesandtargetsofaprogram
arebeingattained.

26. CHARACTERISTICS OF INDICATORS
Indicators have been given scientific respectability; for example ideal indicators
✓should be valid
✓should be reliableand objective,
✓should be sensitive
✓should be specific
✓should be feasible
✓should be relevant

27. CLASSIFICATION OF INDICATORS
•mortality indicators
•morbidity indicators
•disability rates
•nutritional status indicators
•health care delivery indicators
•utilization rates
•indicators of social and mental health
•environmental indicators
•socio-economic indicators
•health policy indicators
•indicators of quality of life, and
•other indicators.

28. ECOLOGY OF HEALTH
•Ecologyisdefinedasthescienceofmutualrelationshipbetweenlivingorganismsandtheir
environments.Humanecologyisasubsetofmoregeneralscienceofecology.Itisdefinedasthe
studyofhumangroupsasinfluencedbyenvironmentalfactors,includingsocialandbehavioural
factors.
•Afullunderstandingofhealthrequiresthathumanitybeseenaspartofanecosystem.Thehuman
ecosystemincludesinadditiontothenaturalenvironment,allthedimensionsoftheman-made
environment-physical.chemical,biological,psychological:inshort,ourcultureandallits
products.Diseaseisembeddedintheecosystemofman.Health,accordingtoecologicalconcepts,
isvisualizedasastateofdynamicequilibriumbetweenmanandhisenvironment.

29. RIGHT TO HEALTH
•WiththeestablishmentofWHO,forthefirsttimetherighttohealthwasrecognized
internationally.
•TheWHOconstitutionaffirmsthat"theenjoymentofthehighestattainablestandard
ofhealthisoneofthefundamentalrightofeveryhumanbeing,withoutdistinction
ofrace,religion,politicalbelief,economicorsocialcondition".
•Overthetimethisrecognitionwasreiteratedinawidearrayofformulationinseveral
internationalandregionalhumanrights.

30. RIGHT TO HEALTH
The steps to be taken to achieve the full realization of the right to health include those necessary for
a)the provision for the reduction of stillbirth rate and infant mortality, and for the healthy
development of the child;
b)the improvement of all aspects of environmental and industrial hygiene;
c)the prevention, treatment and control of epidemic, endemic, occupational and other diseases;
and
d)the creation of conditions which would assure to all medical service and medical attention in
the event of sickness.

31. RESPONSIBILITY FOR HEALTH
•Health is on one hand a highly personal responsibility and on the other hand a major public
concern. It thus involves the joint efforts of the whole social fabric, viz. the individual. the
community and the state to protect and promote health.
1.Individual responsibility
2.Community responsibility
3.State responsibility
4.International responsibility

32. HEALTH AND DEVELOPMENT
•“Healthisessentialtosocio-economicdevelopment"hasgainedincreasingrecognition.
•Itbecameincreasinglyclearthateconomicdevelopmentalonecannotsolvethemajorproblemsof
poverty,hunger,malnutritionanddisease.Initsplace,"noneconomic"issues(e.g..education,
productiveemployment,housing,equity,freedomanddignity,humanwelfare)haveemergedas
majorobjectivesindevelopmentstrategies.
•Sincehealthisanintegralpartofdevelopment,allsectorsofsocietyhaveaneffectonhealth.In
otherwords,healthservicesarenolongerconsideredmerelyasacomplexofsolelymedical
measuresbuta"subsystem"ofanoverallsocio-economicsystem.Inthefinalanalysis,human
healthandwell-beingaretheultimategoalofdevelopment.

33. HEALTH SYSTEM
•The"healthsystem"isintendedtodeliverhealthservices.Itcanbedefinedas"thehumanand
materialresourcesthatanationorcommunitydeploystopreserve,protect,andrestorehealthand
tominimizesufferingcausedbydiseaseandinjury,andthecorrespondingadministrativeand
organizationalarrangements".
•Thecomponentsofthehealthsysteminclude:concepts(e.g.,healthanddisease);ideas(e.g.,
equity,coverage,effectiveness,efficiency,impact);objects(e.g.,hospitals,healthcenters,health
programs)andpersons(e.g.,providersandconsumers).together,theseformawholeinwhichall
thecomponentsinteracttosupportorcontroloneanother.
•Theaimofahealthsystemishealthdevelopment-aprocessofcontinuousandprogressive
improvementofthehealthstatusofapopulation.

34. HEALTH SYSTEM
Health services are usually organized at three levels, each level supported by a
higher level to which the patient is referred. These levels are:
1)Primary health care level
2)Secondary health care level
3)Tertiary health care level

35. CONCEPT OF DISEASE
✓Theterm"disease"literallymeans"withoutease"(uneasiness)-disease,the
oppositeofease-whensomethingiswrongwithbodilyfunction.
✓Websterdefinesdiseaseas"aconditioninwhichbodyhealthisimpaired,a
departurefromastateofhealth,analterationofthehumanbodyinterruptingthe
performanceofvitalfunctions".
✓TheoxfordEnglishdictionarydefinesdiseaseas"aconditionofthebodyor
somepartororganofthebodyinwhichitsfunctionsaredisruptedorderanged".
✓Fromanecologicalpointofview,diseaseisdefinedas"amaladjustmentofthe
humanorganismtotheenvironment"

36. CONCEPT OF DISEASE
✓Diseaseisaphysiological/psychologicaldysfunction;
✓Illnessisasubjectivestateofthepersonwhofeelsawareofnot
beingwell:
✓Sicknessisastateofsocialdysfunction,i.e.,arolethatthe
individualassumeswhenill("sicknessrole").

37. CONCEPT OF CAUSATION
❑Germ theory of disease
❑Epidemiological triad
❑Multifactorial causation
❑Web of causation

38. GERM THEORY OF DISEASE
•The concept of cause embodied in the germ theory of disease is generally
referred to as a one-to-one relationship between causal agent and disease. The
disease model accordingly is :
Disease agent Man Disease

39. EPIDEMIOLOGICAL TRIAD
The germ theory of disease has many limitations. This demanded a broader concept of
disease causation that synthesized the basic factors of agent, host and environment.

40. MULTIFACTORIAL CAUSATION
•Themoderndiseasescouldnotbeexplainedonthebasisofthegermtheoryof
diseasenorcouldtheybepreventedbythetraditionalmethodsofisolation,
immunizationorimprovementsinsanitation.
•Therealizationbegantodawnthatthe·'singlecauseidea"wasan
oversimplificationandthatthereareotherfactorsintheaetiologyofdiseases-
social,economic,cultural,geneticandpsychologicalwhichareequally
important.

41. WEB OF CAUSATION
The "web of causation" considers all the
predisposing factors of any type and their
complex interrelationship with each other

42. NATURAL HISTORY OF DISEASES
❑The natural history of disease is the uninterrupted progression in an individual
of the biological development of disease from the moment that it is initiated by
exposure to the casual agents.
❑It signifies the way in which a disease evolves over time from the earliest stage
of its pre-pathogenesis phase to its termination as recovery, disability or death, in
the absence of treatment or prevention.
❑Each disease has its own unique natural history, which is not necessarily the
same in all individuals.

43. NATURAL HISTORY OF DISEASES
In case of the contact with an external agent there are four types of outcomes
➢There will be no change after interaction with the agent, perhaps because:
•dose of exposure was very low
•the host was not susceptible to the agent
➢Damaging effect of agent can be cured
➢Illness occurred but is controlled by the body due to strong immune system
➢Illness progresses and ends in an irreversible dysfunction or demise.

44. NATURAL HISTORY OF DISEASES
Four common stages in natural history there are four stages in the natural progression of a
disease:
a.stage of susceptibility
b.stage of pre-symptomatic disease
c.stage of clinical disease
d.stage of reduced capacity

46. CONCEPTS OF PREVENTION
•The goals of medicine are to promote health, to preserve health, to restore health when it is
impaired, and to minimize suffering and distress. These goals are embodied in the word
"prevention". Successful prevention depends upon a knowledge of causation, dynamics of
transmission, identification of risk factors and risk groups, availability of prophylactic or early
detection and treatment measures, an organization for applying these measures to appropriate
persons or groups, and continuous evaluation of and development of procedures applied .
•The objective of preventive medicine is to intercept or oppose the "cause" and thereby the disease
process. This epidemiological concept permits the inclusion of treatment as one of the modes of
intervention.

47. LEVELS OF PREVENTION
In modern day, the concept of prevention has become broad-based. it has become
customary to define prevention in terms of four level:
1)Primordial prevention
2)Primary prevention
3)Secondary prevention
4)Tertiary prevention

48. PRIMORDIAL PREVENTION
•Primordial prevention, a new concept, is receiving special attention in the
prevention of chronic diseases.
•This is primary prevention in its purest sense, that is, prevention of the
emergence or development of risk factors in countries or population groups
in which they have not yet appeared.
•The main intervention in primordial prevention is through individual and
mass education.

49. PRIMARY PREVENTION
•Primary prevention can be defined as "action taken prior to the onset of disease,
which removes the possibility that a disease will ever occur''.
•It signifies intervention in the pre-pathogenesis phase of a disease or health
problem

50. SECONDARY PREVENTION
•Secondary prevention can be defined as "action which halts the progress of a
disease at its incipient stage and prevents complications".
•The specific interventions are early diagnosis (e.g., screening tests, case finding
programmes) and adequate treatment. by early diagnosis and adequate treatment,
secondary prevention attempts to arrest the disease process; restore health by
seeking out unrecognized disease and treating it before irreversible pathological
changes have taken place; and reverse communicability of infectious diseases

51. TERTIARY PREVENTION
•When the disease process has advanced beyond its early stages, it is still possible
to accomplish prevention by what might be called "tertiary prevention.
•It signifies intervention in the late pathogenesis phase.
•Tertiary prevention can be defined as "all measures available to reduce or limit
impairments and disabilities, minimize suffering caused by existing departures
from good health and to promote the patient's adjustment to irremediable
conditions"

52. MODE OF INTERVENTION
“Intervention" can be defined as any attempt to intervene or interrupt the usual sequence in the
development of disease in man. This may be by the provision of treatment, education, help or social
support.
1)Health Promotion
2)Specific Protection
3)Early Diagnosis and Treatment
4)Disability Limitation
5)Rehabilitation

53. Thank you