Concept of Health and disease

Presenter: Dr. Anil Moderator: Dr. Chetna Maliye

Framework
Introduction Changing Concept of Health WHO definition of health Positive Health Health Paradigm Determinants of Health Concept of Well-being Indicators of Health Concept of Disease Causation of disease Health and Illness Natural History of Disease References

Introduction
Health in history

Why

we are concerned about health

Health - Changing concepts Biomedical Ecological Psychological Holistic

Changing concepts of Health

Biomedical Concept- absence of

disease

human body disease

down Doctors task = repair of machine. Limitation- it has minimized the role of environmental, social, psychological & cultural determinants of health.

= machine, = consequence of the break

Changing concepts of Health

Ecological ConceptHealth = is a dynamic equilibrium between

man & his environment, Disease = maladjustment of the human organisms to the environment.

The concept supports the need for clean

air, safe water, ozonic layer in the atmosphere, etc. to protect us from exposure to unhealthy factors.

Changing concepts of Health

Psychosocial Concept Health is not only a biomedical

phenomenon, but one which is in influenced by social psychological, cultural, economic and political factors of the people concerned.

Changing concepts of Health

Holistic Concept biomedical + ecological + psychosocial

concept.
It has been defined as unified or

multidimensional process involving the well being of the whole person in the context of his environment.

Holistic concept implies that, all sectors of

society have an effect on health

W h a t i H e a l s th
O xfo rd d i o n a ry cti vState of being well in body or mind Webster vThe condition of being sound in body, mind or spirit especially freedom from physical disease or pain Perkins vA state of relative equilibrium of body, form and function which result from its successful dynamic adjustment to forces tending to disturb it. It is not passive interplay between body substance and forces impinging upon it but an active response of body forces working towards readjustment.

WHO Definition of health Definition of health

Health is a state of complete physical, mental

and social well-being and not merely the absence of disease or Infirmity.

Constitution of the World Health Organization, July 1946.

Physical component
-The state of perfect functioning of body or

state in which every cell & every organ is functioning at optimum capacity & in perfect harmony with the rest of the body.

Mental componentMental Health- Is a state of balance between

individual and surrounding.. Easy to say if its grossly abnormal but difficult in minor disturbances. Distinction between mental and physical health is artificial.

Social component
Social health is an aspect of health that

includes social relationships as part of broader concept of health. It has two elements: Individual and societal The less isolated, the greater the sense of control & empowerment, & the more socially integrated a person is, the less they suffer from a range of physical & mental disorders.

Social component (Contd.)

The Regional framework for health promotion

in the Western Pacific Region 2002-05 stresses the role of social capital in health promotion.
social capital - trust, social interaction &

social

connections

Other components/dimensions
Spiritual Vocational Socio-economic.etc

Po si ve H e a l ti th
Positive health describes a state beyond the

mere absence of disease. Operationalised by a combination of excellent status on biological, subjective, and functional measures Positive health predicts increased longevity (correcting for quality of life), decreased health costs, better mental health in aging, and better prognosis when illness strikes.

Health Paradigm

Determinants

of

Health

Concept of Well-being

Components Objective components

Standard

of living level of living

Subjective component
Quality

of life

Standard of living
Refers to the usual scale of our expenditure,

the goods we consume and the service we enjoy. It includes the level of education, employment status, food, dress, house, amusement and comforts of modern living. sanitation and nutrition, the level of provision of health, educational, recreational and other services.

WHO: Income & occupation, standard of housing,

Level of living
Used in US 9 Components Health, food consumption, education, occupation and working condition Housing, Social security Clothing Recreation and leisure Human right

Quality of life
The condition of life resulting from the

combination of the effects of the complete range of factors such as those determining health , happiness(including comfort in the physical environment and the satisfying occupation), education , social and intellectual attainments , freedom of action , justice and freedom of expression. A composite measure of physical, mental and social well-being as perceived by each individual or group of individuals.

Indicators of Health

Physical Quality of Life Index

Includes vInfant mortality vLife expectancy at age one and vLiteracy Scale 0 to 100 = worst to best Money is not everything Does not measure economic growth Measures social, economic and political policies

Human Development Index (HDI)

Combines indicators representing 3 dimensions 1. Longevity Life expectancy at birth 2. Knowledge adult literacy rate & mean year of schooling. 3. Income real GDP Per Capita in Purchasing Power Parity(PPP) in US dollars

Index =

Value)

(Actual value) (Minimum Value) (Maximum value) (Minimum

Human Poverty Index

Introduced in 1997 Measures deprivation in basic dimensions

(Longevity, Knowledge , Income) For developing countries(HPI-1)-

1. A long & healthy life vulnerability to death at a relatively early age. 2. Knowledge adult literacy rate 3. Standard of living average of- %age of population not using an improved water source & %age of children under weightfor-age.

Concept of Disease

Concept of Disease
A condition in which body function is impaired,

departure from a state of health, an alteration of the human body interrupting the performance of the vital functions. Webster. Oxford English Dictionary the condition of body or some part of organ of body in which its functions are disrupted or deranged. Ecologically a maladjustment of human organism to the environment Simplest definition opposite to Health.

HEALTH AND ILLNESS

The Health-Sickness spectrum

Historical Theories for

causation of disease
Supernatural causes& Karma Theory of humors (humor means fluid) The miasmatic theory of disease Theory of contagion Germ theory Environment Epidemiological Triad Multi-factorial causation Web of causation
Host Supernatural to multi-factorial causes Agent

Epidemiological triad

Agent Factors
Biological Agents Nutritional agents

Physical Agents Chemical Agents

Environmental Factors

Physical Environment Biological Environment Social Environment

Host Factors

Socio - demographic Factors Psycho - social Factors Intrinsic Characteristics

Web of causation

Change in life style Stress Smoking D Emotional

Abundance of food Aging & Disturbance Obesity Hypertension Hyperlidemia Changes in walls of arteries Coronory atherosclerosis Coronary occlusion other factor

Lack of physical activity

Increase catacholamine thrombotic activity

Natural History of Disease

S p e ctru m o f d i a se se

Disease in many Forms..

Acute Chronic/insidious Carrier

Subclinical Case: ICEBERG PHENONMENON

Example: Cholera , Polio, hypertension, malnutrition etc.

Some terms..
Disease- biological concept. Means

physiological/psychological dysfunction
Illness socio-pathological concept. Means -

subjective feeling of not being well.

Sickness Biological concept of social

dysfunction.

R e fe re n ce s

1. WHO. Tech. Report Series 137. WHO. 1952. 2. WHO.Constitution Of World Health Organization. 1946. 3. WHO. Role of Health sector in Food and Nutrition. Tech. Report Series 137. Geneva. 1980. 4. IGNOU. Concepts in Nursing. Available online at: http://www.ignou.ac.in/edusat/BNS/BNS101-Blk2-3-4/Block1en/38-66colo 5. WHO. Ageing and Health. A health promotion approach for developing countries. WHO, Regional Office for the Western Pacific United Nations Avenue.Manila, Philippines;2000.11-15. 6. Ghai OP, Gupta P. Essential Preventive Medicine. Vikas Publishing House Pvt Ltd. India;1999:23,817-819.

7. Park K. Parks textbook of preventive and social medicine. 20th edition, 2009. Banarsidas Bhanot publishers, Jabalpur, India

Thank you