Determinants of Health & Disease psm.pptx

Community medicine

1. DETERMINANTS OF HEALTH & DISEASE Dr. Ravish Ranjan (MBBS, MD) Senior Resident Department of Community Medicine SNMIH SAHARSA

2. Determinants of Health The various factors which determine health are called determinants of health. 1.Biological 2.Enviornmental 3.Lifestyle 4.Socio economic conditions 5.Health services 6.Aging of population 7.Gender 8.Others

3. BIOLOGICAL DETERMINANTS If any of the parts of the DNA is defective then the defect manifests as a genetic defect Age. Sex. Immunity status Family history of disease

4. ENVIRONMENT

5. Determinants of health - WHO HEALTH ENVIRONMENT HEREDITY HEALT SERVOCES BEHAVIOUR OF HOST

6. LIFESTYLE It reflects social values, attitudes, activities etc. Habits like smoking, alcohol etc.. reflect on the health of the person Many current day problems like coronary heart disease, obesity, lung cancer are associated with lifestyle changes. In developing countries lack of sanitation, poor nutrition, lack of personal hygiene, customs and cultural patterns are major risks for illness

7. SOCIO-ECONOMIC CONDITIONS ECONOMIC STATUS EDUCATION OCCUPATION POLITICAL SYSTEM

8. ECONOMIC STATUS Economic status determines : Purchasing power Standard of living Quality of life Deviant behavior in community Life expectancy

9. EDUCATION Illiteracy can be a major cause of poverty, malnutrition, ill health, high infant and child mortality rates. Female literacy has a very important role to play

10. OCCUPATION Occupation can lead to disorders like: Silicosis Coal workers pneumoconiosis Asbestosis Byssinosis etc

11. POLITICAL SYSTEM One of the main obstacles to the implementation of health technology is of political origin. Decisions concerning : resource allocation, man power policy, choice of technology etc

12. Degree to which health services can be made available are all decided by political system of community. The percentage of GNP spent on health is a quantitative indicator of political commitment. If poor health patterns are to be changed, entire socio- political system is to be changed POLITICAL SYSTEM

13. HEALTH SERVICES The purpose of health services is to improve health status of population. For example: immunization influence incidence & prevalence of disease. safe water prevent water borne diseases

14. To be effective : The health services must reach periphery, equitably distributed, cheaper in cost and socially acceptable HEALTH SERVICES

15. AGING OF POPULATION Major concern of rapid population aging is increased prevalence of chronic diseases disabilities Some diseases of aged include : Diabetes Hypertension coronary heart disease

16. GENDER Female health has a very great importance because, its female health that’s going to determine the health of a child. In 1993, the Global commission on women’s health was established with an agenda for action on women’s health. It covers aspects of nutrition, reproductive health etc..

17. OTHER FACTORS These may include : Science and technology Information and communication Food and agriculture Industry Social welfare Rural development Adoption of policies in economic and social fields.

18. Cultural factors Concept of etiology and cure Environmental sanitation Food habits Mother and child health Personal hygiene Sex and marriage

19. Relationship between health and SE development Improvement in health Increase in productivity reduction in health problems Decreased morbidity improvement in health services Decreased dependency decreased fertility Improvement in SE development

20. Relationship between health and SE development

21. DETERMINANTS OF DISEASE a) Predisposing factors are factors which create a state of susceptibility, so that the host becomes vulnerable to the agent or to necessary cause, e.g. age, sex, previous illness. b) Enabling factors are those which assist in the development of (or in recovery from) the disease; e.g. housing conditions, socio-economic status. c) Precipitating factors are those which are associated with immediate exposure to the disease agent or onset of disease, e.g. drinking contaminated water, close contact with a case of pulmonary TB.

22. d) Reinforcing factors are those which aggravate an already existing disease, e.g. malnutrition, repeated exposures e) Risk factors : A risk factor is defined as a condition, quality or attribute, the presence of which increases the chances of an individual to have, develop or be adversely affected by a disease process. A risk factor is not necessarily the cause of a disease but does increase the probability that a person exposed to the factor may get the disease. DETERMINANTS OF DISEASE

23. Models of disease causation Germ theory of disease Epidemiological Triad Epidemiological Tetrad BEINGS theory Web of Causation theory Wheel theory

24. Germ Theory of Disease Proposed by Robert Koch and Louis Pasteur. Every human disease is caused by a microbe or germ, which is specific for that disease and one must be able to isolate the microbe from the diseased human being

25. Epidemiological Triad

26. Epidemiological Triangle

27. Advanced Epidemiological T riangle

28. Agent Classification of agents: Biological Nutrient Physical Chemical Mechanical Absence or insufficiency or excess of a factor necessary to health Social

29. Agent characteristics Infectivity refers to the proportion of exposed persons who become infected. Pathogenicity refers to the proportion of infected persons who develop clinical disease. Virulence refers to the proportion of persons with clinical disease who become severely ill or die.

30. Host A person or other living animal, that affords subsistence or lodgment to an infectious agent under natural condition . Host factors: I ntrinsic factors that influence an individual’s exposure, susceptibility, or response to a causative agent

31. Host

32. Environment Physical environment Non living things and physical factors(air, water, soil, housing, heat, light, etc) Biological environment Microbial agents, insects, animals, plants and man himself. Psychosocial environment Lifestyle, poverty, urbanization, community life, income, education, stress etc.

33. The “BEINGS” Model of Disease Causation This concept postulates that human disease and its consequences are caused by a complex interplay of nine different factors – B iological factors innate in a human being, B ehavioural factors concerned with individual lifestyles, E nvironmental factors as physical, chemical and biological aspects of environment, I mmunological factors, N utritional factors, G enetic factors, S ocial factors, S piritual factors and S ervices factors, related to the various aspects of health care services.

34. The Theory of “Web of Causation McMahon and Pugh forwarded the theory of “epidemiological web of causation”, wherein the various factors (e.g. hypercholesterolemia, smoking, hypertension) are like an interacting web of a spider. Each factor has its own relative importance in causing the final departure from the state of health, as well as interacts with others, modifying the effect of each other.

35. The Theory of “Web of Causation

36. Wheel theory The theory visualizes human disease in the form of a wheel, which has a central hub representing the genetic components and the peripheral portion representing the environmental component. Like any wheel, the outer part (environmental component) has spokes (3 in this model) and the environmental component is thus divided into 3 sub components, representing the social, biological and physical components of the environment.

37. Wheel theory

38. Wheel theory

39. Thankyou