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EOH 3401PRINCIPLES OF HEALTH

SEMESTER I 2015/2016

DR. IRNIZA RASDICOORDINATOR / SENIOR LECTURER

DEPARTMENT OF ENVIRONMENTAL AND OCCUPATIONAL HEALTHFACULTY OF MEDICINE AND HEALTH SCIENCESUNIVERSITI PUTRA MALAYSIA

2Contact Information

Dr. Irniza RasdiCoordinator for EOH3401

Laboratory Occupational Health and Safety,Level 4, Block C,

Faculty of Medicine and Health Sciences, UPMTel: 0123153360 – Whassap/msg onlyEmail: irniza@upm.edu.my

3Course Information

• Name of course: Principles of Health• Course Code: EOH3401

4Course Synopsis

• This course covers the concept and definition of health, wellness, disease processes, basic principles and strategies for disease prevention.

• The influence of environmental factors, risk factors, causative agents, lifestyles and behavioural factor; patho-physiology, impact, treatment, prevention and healthcare strategies are discussed by giving examples of infectious diseases, non-infectious diseases, cancer, injury and mental disorders.

5Overview of Lectures1. Public health threats

2. Brief history of medicine and public health

3. Definition & concept health, wellness, illness & disease in the community; determinants of health: Multiple causation of diseases

4. Global trends in Health and Diseases

5. Social, cultural and psychological aspects of health and wellness

6. Health indicators

7. Communicable diseases

8. Non-communicable diseases

9. Mental health

10. Health problems: Maternal health, child health, adolescent and elderly

11. Health care system in Malaysia

6Assessments

Assessments Percentage (%)

Mid-term examination 15

Continuous Assessments A 15

Continuous Assessments B 10

Continuous Assessments C 20

Final Examination 40

Total 100

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• Choose one communicable disease/illness and create a newsletter describing about the disease. The newsletter must at least contain the following information;

1. Definition of the disease

2. Statistics about the disease

3. Agent, host and environment

4. Mode of diseases transmission

5. Prevention and control mechanism for the disease

Assignment 1 (15%)

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• Send the newsletter via email : irnizaras@gmail.com

• The newsletter must include your name and matrix number

• Due date: By week 5

• Assessment will be based on the following;• Contents• Creativity/attractiveness

Assignment 1 (15%)

9Assignment 2 (10%)• Choose a non-communicable disease.

• Create a campaign poster to increase awareness about the disease for workers/public

• Size A0

• Send the softcopy via email: irnizaras@gmail.com by week 9

• Put your name and matrix number on the poster

• Assessment will be based on the following criteria;• Contents• Creativity/attractiveness

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• You as a human resource manager/officer are assigned by the top management to promote healthy lifestyle among workers at your workplace.

• Develop a proposal on how are you going to conduct such program

• The proposal must have at least 10 pages including pictures and table if available.

• Font: times new roman, 12 font size, 1.5 spacing.

• It can be in Malay or English

• Email the proposal to irnizaras@gmail.com by week 12

Assignment 3 (15%)

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Definition of HEALTH

…as “a dynamic state of well-being characterized by a physical and mental potential, which satisfies the demands

of life commensurate with age, culture, and personal responsibility”

(Bircher J. Towards a dynamic definition of health and disease. Med. Health Care Philos 2005;8:335-41.)

HEALTH

• HEALTH-ILLNESS CONTINUUM:

• Measure person’s perceived level of wellness• Health and illness/disease opposite ends of a health continuum• Move back and forth (forward) within this continuum day by day• Wide ranges of health or illness

• Wellness further describes health status. It allows health to be placed on a continuum from one’s optimal level (“wellness”) to a maladaptive state (“illness”)

Definition of WELLNESS

Copyright 2008 by Pearson Education, Inc.

a) emphasizes individual responsibility for wellbeing through the practice of health-promoting like style behaviors.

b) The holistic model of health

c) In this model define health in term of whole person

d) State of optimum health

WELLNESS

(Source: ‘Dimension of Wellness’, Copyright 2008 by Pearson Education, Inc.)

Encompass:

SPIRITUAL

• The belief in some force

(nature, science, religion, or

a higher power) that serves

to unite human beings and

provide meaning and

purpose of life

Dimension of Optimal Health

PHYSICAL• Biological make-up• physiological functions (e.g.

pulmonary, cardiovascular, gastrointestinal system)

• Nutrition• Lifestyle

Dimension of Optimal Health: Physical

EMOTIONAL

• The ability to manage stress and to express emotions appropriately, Emotional wellness involves the ability to recognize, accept, and express feelings.

Dimension of Optimal Health : Emotional

SOCIAL:

• The ability to interact successfully with people and within the environment.

• Personality trait.

• Health care services

• Food safety & security

• Disparities – gender

• Social support network

• Risky behaviour

Dimension of Optimal Health : SOCIAL

INTELLECTUAL

• Education

• The ability to learn and use information effectively for personal, family, and career development

Dimension of Optimal Health : Intellectual

ENVIRONMENTAL

• Living condition – housing, environment

• The ability to promote health measures that improve the standard of living and quality of life in the community.

Dimension of Optimal Health

OCCUPATIONAL

• Employment

• Economy

• Affects also the SOCIAL aspects

DIMENSION OF WELLNESS

24Definition: Public Health

• The art and science of preventing disease, prolonging life and promoting health through the organized efforts of society (WHO, 2011)

• Population• Complete physical mental and social well-being• To protect and improve health of the population

25Definitions

• Communicable disease: a disease that can be spread to a person from another person, an animal or object. Ex: common cold, influenza, mononucleosis, etc.

• Non-communicable disease: a disease that can NOT be spread from person to person. Ex: cancer, heart disease, cirrhosis, etc.

26Definitions Continued

• Disease: Any condition that interferes with the normal or proper functioning of the body or mind.

• Not all types of fungi, bacteria, viruses and protozoa are disease-causing agents

• Germs: The microorganisms that cause diseases. They are so small they can only be seen through a microscope.

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A case is a risk factor …Infection in one person can be transmitted to others

(www)

What is infectious disease?

28Infectious Diseases are Caused by Pathogens

What’s a pathogen?

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34What kills more people: infectious diseases or non-communicable diseases?

• Non-communicable diseases were responsible for 68% of all deaths globally in 2012.

• The 4 main NCDs are cardiovascular diseases, cancers, diabetes and chronic lung diseases.

• Communicable, maternal, neonatal and nutrition conditions collectively were responsible for 23% of global deaths,

• Injuries caused 9% of all deaths.

35Are cardiovascular diseases the number 1 cause of death throughout the world?

• Cardiovascular diseases killed 17.5 million people in 2012, that is 3 in every 10 deaths.

• Of these, 7.4 million people died of ischaemic heart disease and 6.7 million from stroke.

36Do most NCD deaths occur in high-income countries?

• 28 million of the 38 million of global NCD deaths in 2012 occurred in low- and middle-income countries.

• In terms of proportion of deaths that are due to NCDs, high-income countries have the highest proportion – 87% of all deaths were caused by NCDs.

• Followed by upper-middle income countries (81%).

• The proportions are lower in low-income countries (37%) and lower-middle income countries (57%).

37What are the main differences between rich and poor countries with respect to causes of death?

• In high-income countries, 7 in every 10 deaths are among people aged 70 years and older.

• People predominantly die of chronic diseases: cardiovascular diseases, cancers, dementia, chronic obstructive lung disease or diabetes.

• Lower respiratory infections remain the only leading infectious cause of death. Only 1 in every 100 deaths is among children under 15 years.

38What are the main differences between rich and poor countries with respect to causes of death?

• In low-income countries, nearly 4 in every 10 deaths are among children under 15 years, and only 2 in every 10 deaths are among people aged 70 years and older.

• People predominantly die of infectious diseases: lower respiratory infections, HIV/AIDS, diarrhoeal diseases, malaria and tuberculosis collectively account for almost one third of all deaths in these countries.

• Complications of childbirth due to prematurity, and birth asphyxia and birth trauma are among the leading causes of death, claiming the lives of many newborns and infants.

39How has the situation changed in the past decade?• Ischaemic heart disease, stroke, lower respiratory infections and

chronic obstructive lung disease - top major killers during the past decade.

• NCDs were responsible for 68% (38 million) of all deaths globally in 2012, up from 60% (31 million) in 2000.

• Cardiovascular diseases alone killed 2.6 million more people in 2012 than in the year 2000.

• HIV deaths decreased slightly from 1.7 million (3.2%) deaths in 2000 to 1.5 million (2.7%) deaths in 2012.

• Diarrhoea is no longer among the 5 leading causes of death, but is still among the top 10, killing 1.5 million people in 2012.

40How has the situation changed in the past decade?

• Tuberculosis, while no longer among the 10 leading causes of death in 2012, was still among the 15 leading causes, killing over 900 000 people in 2012.

• Maternal deaths have dropped from 427 000 in the year 2000 to 289 000 in 2013, but are still unacceptably high: nearly 800 women die due to complications of pregnancy and childbirth every day.

• Injuries continue to kill 5 million people each year. Road traffic injuries claimed nearly 3500 lives each day in 2012 – more than 600 more than in the year 2000 – making it among the 10 leading causes in 2012.

41How people got the disease?

42Why do we need to know the reasons people die?

• Assessing the effectiveness of a country’s health system.

• Help health authorities determine their focus for public health actions.

• Produce high quality cause-of-death data are crucial for improving health and reducing preventable deaths in these countries.

43Aetiology

• This is the study of what causes a disease.

• It is basically how scientists/doctors pinpoint what created the disease in order to better understand how to cure it or prevent it from spreading.

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Disease is the result of forces within a dynamic system consisting of:

agent of infection hostenvironment

Epidemiologic Triad

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Agent

Host

Environment

• Age• Sex• Genotype• Behaviour• Nutritional status• Health status

• Infectivity• Pathogenicity• Virulence• Immunogenicity• Antigenic stability• Survival

• Weather• Housing• Geography• Occupational setting• Air quality• Food

(www)

Factors Influencing

Disease Transmission

46Epidemiologic Triad Concepts

• Infectivity – ability to invade a host (# infected / # susceptible) X 100

• Pathogenicity – ability to cause disease(# with clinical disease / # of infected) X 100

• Virulence – ability to cause death(# of deaths / # with disease (cases)) X 100

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•Chain of Infection

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Chain of Infections

49Modes of Disease Transmission

• Direct contact

• Indirect contact

• Droplet

• Airborne

50Direct Contact Transmission

• Microbes directly transferred from an infected person to another person

• Examples• Contact with blood or other body fluids• Ungloved contact with a scabies-infested patient• Ungloved contact with wounds or mucous membranes

51Indirect Contact Transmission

• Microbes transferred through contaminated intermediate object/living things

• Examples• Healthcare personnel not performing adequate hand hygiene

between patients• Sharing medical equipment without cleaning or disinfection

between patients• Defective medical equipment allowing for inadequate disinfection or

sterilization

52Vector

• The item that transfers the pathogen to its host.

• Vectors are “vehicles” that transport pathogens from one host to another.

• Examples: water, blood, ticks, mosquitoes…

53Droplet Transmission

• Respiratory droplets carrying infectious pathogens• Generated during coughing, sneezing, talking, or certain medical

procedures (e.g. suctioning)• Droplets traditionally defined as > 5 µm• Typically refers to distances within 3 feet of infected patient

54Airborne Transmission

• Dissemination of droplet nuclei containing infectious agents• Dispersed over long distances• Face-to-face contact not required• Special ventilation systems are required to prevent airborne

transmission

55Think about it:Where Do Pathogens Hide When Not Infecting People and Animals?

The soilBodies of waterSurfaces like farm equipmentThe skin of people and animalsIn the airIn body fluids

Where are those

pathogens?

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Susceptible

Susceptible host

Dynamics of infectiousness

Latentperiod

Infectious period

Non-infectious

Infe

ctio

nTime

Timeline for Infection

Subclinical disease

Clinical Death/recovery

Incubation

57Timelines for Infection and Disease

Latent period: time interval from infection to development of infectious (note: this definition differs from that used for non-infectious diseases).

Infectious period: time during which the host can infect another host.

Incubation period: time from infection to development of symptomatic disease.

Symptomatic period: period in which symptoms of the disease are present.

58Infections

Endemic: Habitual presence of a disease in a given geographic area.

Epidemic: Occurrence of a group of illnesses of similar nature within a given community or region in excess of normal expectancy, and derived from a common or from a propagated source.

Pandemic: A worldwide epidemic.

Herd immunity: Resistance of a group of to an attack by a disease to which a large proportion of members of the group are immune.

Chain of Infection Filariasis

The painful and profoundly disfiguring visible manifestations of the disease, lymphoedema, elephantiasis and scrotal swelling occur later in life and lead to permanent disability. These patients are not only physically disabled, but suffer mental, social and financial losses contributing to stigma and poverty.

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62Immune System

• The Immune System is a combination of body defenses made up of cells, tissues, and organs that fight pathogens in the body.

• It’s purpose is to help you get better when you are ill and to prevent you from becoming ill in the first place.

63How does our body protect us from pathogens?

• Our body is an amazing machine which has five main barriers (first line of defense) for keeping our body healthy. They are:

• Skin – acts as a protective barrier • Mucous Membranes – line the mouth, nose, throat, eyes and

other body parts. These trap germs. Coughing and sneezing gets rid of the germs trapped by these mucus membranes.

• Saliva – contains enzyme that destroy many harmful organisms. • Tears – wash away germs. Contains enzymes that kill some

harmful organisms.• Stomach Acid – acid kills many germs

64Antigens and Antibodies

• What’s the difference between the two?• Antigens: a substance that sends your

immune system into action when your body is invaded by pathogens. The body sees these as “invaders”.

• Antibodies: proteins that attach to antigens, keeping them from harming the body. How our body responds to antigens, by producing antibodies – our body’s “army of soldiers”.

65Iceberg Concept of Infection

66Social Aspects of Health

Source: Dahlgren, G. and Whitehead, M. (1993) Tackling inequalities in health: what can we learn from what has been tried?

67Social, culture and psychological aspects of health and well-being

Interaction between individuals and groups within society

Traditional behavior which has been developed by the race and successfully learned by each generation

The study of the soul or mind

Social

Culture

Psychology

Social Determinants

Availability of resources to meet daily needs, such as educational and job opportunities, living wages, or healthful foods

Social norms and attitudes, such as discriminationExposure to crime, violence, and social disorder, such as the presence of

trashSocial support and social interactionsExposure to mass media and emerging technologies, such as the Internet

or cell phonesSocioeconomic conditions, such as concentrated povertyQuality schoolsTransportation optionsPublic safetyResidential segregation

Unequal Access toAffordable, Nutritious Food

• Lack of convenient access to affordable urban supermarkets

• Communities, left with corner convenience stores that do not carry a large or varied stock.

• Surviving on convenience store food, usually canned or processed, or fast food

• How to address this issue?

Community Environments thatPromote Quality of Life

• Unsafe, substandard living environments

• Fear of crime keeps many people indoors

• Lack of safe and pleasant parks and green spaces

• Poorly maintained sidewalks

• Difficult to afford memberships at fitness centers

• Difficult to travel to cleaner, safer neighborhoods with good facilities.

Quality, Affordable Housing

• Difficulties to obtain a safe, secure place to live• Financial• Distance to workplace, schools• Accessibility• Facilities

• Cheaper houses usually located at less quality areas

Education, Literacy, and employment Policies that Contribute to Employment Status

• Barriers to employment

• Illiteracy or lack of education

• Low employment rate

Social and Health Gradient

• The higher the social position, the better health.

• Infection diseases in poor countries and diseases of a rich person

• Private hospital versus government hospital

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74Thank You