CONCEPTS OF HEALTH AND DISEASES

CONTENTS INTRODUCTION• DEFINITION• CHANGING CONCEPT OF HEALTH• DIMENSIONS OF HEALTH• CONCEPT OF WELLBEING• SPECTRUM OF HEALTH • DETERMINANTS OF HEALTH• RESPONSIBILITY FOR HEALTH• INDICATORS FOR HEALTH

• HEALTH SERVICE PHILOSOPHIES• CONCEPT OF DISEASE• CONCEPT OF CAUSATION• CONCEPT OF PREVENTION• CONCLUSION• REFERENCES

INTRODUCTION

• Health is a common concern in most communities.

• In fact, all communities have health as a part of their customs and traditions.

• Health continues to be a neglected issue despite hypocrisy.

• Traditionally health has been considered as absence of diseases.

DEFINITIONS OF HEALTH

“Health is a state of complete physical, mental and social wellbeing and not merely an absence of diseases or infirmity” WHO 1948

Operational definition of health by WHO - “ a

condition or quality of the human organism expressing the adequate functioning of the organism in given conditions, genetic or environmental”

CHANGING CONCEPTS OF HEALTH

• Health is evolved over the centuries as a concept from individual concern to world wide social goal and encompasses the whole quality of life.

• Changing concepts of health are: Ecological concept Biomedical concept Psychosocial concept Holistic concept

ECOLOGICAL CONCEPT

• From ecological point of view, health is viewed as a dynamic equilibrium between man and his environment and diseases as maladjustment of human organism to the environment .

• It focuses on imperfect man and imperfect environment.

• Improvement of human adaptation can lead to better quality of life.

BIOMEDICAL CONCEPT

• Health is viewed as “absence from disease” i.e if a person is free from disease he is considered healthy”

• This concept does not take into consideration the environmental, social and cultural determinants of health.

• However developments in medical science have concluded that this concept is inadequate.

PSYCHOSOCIAL CONCEPT

According to psychosocial concept “health is

not only biomedical phenomenon, but is influenced by social, psychological, cultural, economic and political factors”

HOLISTIC CONCEPT

• This concept is the synthesis of all the above concepts.

• It recognizes the strength of social, economic, political and environmental influences on health.

• It describes health as a unified or multidimensional process involving the wellbeing of whole person in context of his environment.

DIMENSIONS OF HEALTH

• Health is multidimensional.• WHO explained health in three dimensional

perspectives.

HEALTH

PHYSICAL

SOCIAL

EMOTIONAL

MENTAL

PHYSICAL DIMENSION

• Physical dimension implies the concept “perfect functioning” of the body.

• It conceptualizes health biologically as a state in which each and every organ even a cell is functioning at optimum capacity and in perfect harmony with the rest of the body.

MENTAL DIMENSION

• Mental health has been defined as “ a state of balance between individual and the surrounding world, a state of harmony between oneself and others, coexistence between the realities of the self and that of other people and that of environment”.

SOCIAL DIMENSION

• It is defined as “ quantity and quality of an individual’s interpersonal ties and the extent of involvement with the community”.

• Social wellbeing implies harmony and integration within and between each individuals and other members of the society.

EMOTIONAL DIMENSION

• Emotional health relates to “feeling”.

• This dimension reflects emotional aspects of humanness.

CONCEPT OF WELLBEING

• Wellbeing of an individual or group of individuals have several components and has been expressed in various ways, such as

Standard of living Level of living Quality of life Physical quality of life Human development index

STANDARD OF LIVING

• As per WHO, “Income and occupation, standards of housing, sanitation and nutrition, the level of provision of health, educational, recreational and other services all be used individually as measures of socioeconomic status, and collectively as an index of the ‘standard of living’.”

LEVEL OF LIVING

It consists of nine components: • Health• Food consumption • Education• Occupation and working conditions• Housings• Social security• Clothings • Recreation and• Leisure human rights

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 a satisfying occupation), education, social and intellectual attainments, freedom of action, justice and freedom of expression.”

PHYSICAL QUALITY OF LIFE INDEX

• Physical quality of life index(PQLI) includes three indicators such as infant mortality, life expectancy and literacy.

• For each component, performance of individual countries is placed on a scale of 0 to 100, where 0 represents an absolutely defined “worst” performance, and 100 represents an absolutely defined “best” performance.

HUMAN DEVELOPMENTAL INDEX

• Human development index (HDI) includes longevity (life expectancy at birth), knowledge(adult literacy rate and mean years of schooling), and income.

• HDI value ranges from 0 to 1.

SPECTRUM OF HEALTH

• This concept of health of an individual is a dynamic phenomenon and a process of continuous change, subject to repeated, fine variations.

• Transition from optimum health to ill health is often gradual and where one state ends and other begins is a matter of judgement .

Different stages of spectrum of health are:• Positive health• Better health• Freedom from sickness• Unrecognized sickness• Mild sickness• Severe sickness• Death

DETERMINANTS OF HEALTH• Health is influenced by multiple factors.

• The health of an individual and community is influenced by: individual (genetic factors) and external factors (environmental factors).

• Determinants of health are: 1) Biological determinants 2) Behavioural and sociocultural conditions 3) Environmental factors 4) Socioeconomic conditions

5) Health services 6) Aging of population 7) Gender 8) Other factors

BIOLOGICAL DETERMINANTS

• Physical and mental traits of every human being are to some extent determinants by the nature of the genes at the moment of conception.

• The state of health therefore depends partly on the genetic constitution of man and his relationship with his environment.

BEHAVIOURAL AND SOCIOCULTURAL CONDITIONS

• Health requires promotion of healthy lifestyle.• Evidence indicates that there is an association

between health and lifestyle of individuals. • Healthy lifestyle includes adequate nutrition,

enough sleep, sufficient physical activity etc.• Health is a result of individual lifestyle and

factors determining it.

ENVIRONMENTAL FACTORS

• Environment has a direct impact on the physical, mental and social wellbeing of those living in it.

• Environment factors range from housing, water supply, psychosocial stress and family structures through social and economic support systems and social welfare services in the community.

SOCIOECONOMIC CONDITIONS

• Socioeconomic conditions influence health such as:

• ECONOMIC STATUS• EDUCATION • OCCUPATION• POLITICAL SYSTEM

HEALTH SERVICES

• Purpose of health services is to improve the health status of population.

• To be effective, the health services must reach the masses, equitably distributed, accessible at a cost the community can afford and socially acceptable.

AGING OF THE POPULATION

• A major concern of rapidly aging population is increased prevalence of chronic diseases and disabilities that deserve special attention.

GENDER

• Women’s health is gaining importance in areas such as nutrition, reproductive health, aging, lifestyle related conditions and occupational environment.

• There is increased awareness among policy makers of women’s health issues.

OTHERS FACTORS

• Information and communication technology provides access to medical information serving the needs of many health professionals, biomedical researchers and the public.

RESPONSIBILITY OF HEALTH

• Health involves joint effort of the individuals, community, state and the international level to protect and promote health.

Individual responsibility Community responsibility State responsibility International responsibility

INDICATORS OF HEALTH

• Indicators are:1) MORTALITY INDICATORS 2) MORBIDITY INDICATORS3) DISABILITY RATES4) NUTRITIONAL STATUS INDICATORS5) UTILIZATION RATES6) INDICATORS OF SOCIAL AND MENTAL HEALTH

7) HEALTH CARE DELIVERY INDICATORS8) ENVIRONMENTAL INDICATORS9) SOCIOECONOMIC INDICATORS10) HEALTH POLICY INDICATORS 11) INDICATORS OF QUALITY OF LIFE12) OTHER INDICATORS

HEALTH SERVICE PHILOSOPHIES

Health care is defined as “ a multitude of services rendered to individuals, families or communities by the agents of health services or professions, for the purpose of promoting maintaining, monitoring or restoring health.”

LEVELS OF HEALTH CARE

SECONDARY LEVEL

TERTIARY LEVEL

PRIMARY LEVEL

• PRIMARY HEALTH CARE: It is the first level of contact between the individual and the health system.

• SECONDARY HEALTH CARE: At this level, care comprises essentially curative services provided by district hospitals and community health centers.

• TERTIARY HEALTH CARE: This level offers super specialist care. Care is provided by regional or central level institutions.

HEALTH TEAM CONCEPT

• Health team has been defined as “ a group of persons who shares a common health goal and common objectives, determined by community needs and toward the achievement of which each member of the team contributions in accordance to her/his competence and skills and respecting the functions of the other.”

HEALTH FOR ALL

• On 12th SEPTEMBER 1978, the joint WHO-UNICEF International conference at Alma-Ata called for acceptance of the WHO goal of health for all by 2000 AD.

• In MAY 1977, World Health Assembly decided main goal of governments and WHO in the coming years should be the “attainment by all people of the world by the year 2000 AD of a level of health that will permit them to lead a socially & economically productive life”

PRIMARY HEALTH CARE

• “Essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-determination.”

Alma-Ata 1978

MILLENNIUM DEVELOPMENT GOALS

• At Millennium Summit in SEPTEMBER 2000• 189 countries gathered to adopt UN

Millennium Declaration• GOAL- reduce extreme poverty and setting

out a series of time-bound targets.

CONCEPT OF DISEASES

• Webster defines disease as “ a condition in which body health is impaired, a departure from a state of health, an alternation of the human body interrupting the performance of vital functions.”

• Disease literally means “without ease ”(uneasiness), when something is wrong with bodily function.

• Illness refers to the presence of a specific diseases, and also to the individual’s perceptions and behaviour in response to the disease, as well as the impact of that disease on the psychosocial environment.

• Sickness refers to state of social dysfunction.

CONCEPT OF CAUSATION

1) EPIDEMIOLOGICAL TRIAD 2) MULTIFACTORIAL CAUSATION 3) NATURAL HISTORY OF DISEASE 4) WEB OF CAUSATION 5) RISK FACTORS AND RISK GROUPS 6) SPECTRUM OF DISEASE 7) ICEBERG OF DISEASE

EPIDEMIOLOGICAL TRIAD

AGENT

• Agent is defined as “ an organism, a substance or a force, the presence or lack of which may initiate a disease process or may cause it to continue.”

• May be classified into: a) Living or Biological agents [Eg: bacteria, virus, fungi] b) Non living or inanimate

# Nutrient agents [ eg: protein, fat,

carbohydrates]

#Chemical agents [eg: lead arsenic etc]

# Physical agents [eg: atmospheric pressure, temperature.]

HOST

• The characteristics of a human being that determine how he reacts to the agents in the environment are called “host factors”

Host factors are:

• Demographic characteristics: Age, sex etc

• Biological characteristics: genetic background, nutritional status, immune status etc.

• Socio-economic characteristics: social class, religion, education, marital status.

• Life Style: Living habits, food habits etc.

ENVIRONMENT

• Environment is the source or reservoir for the agents of disease.

• It helps in the transmission of agents to the host, bringing about their contact and interaction.

• Environment of man is of two types: External Internal

MULTIFACTORIAL CAUSATION

• This concept was put forth by PETTENKOFER OF MUNICH (1819- 1901)

• This concept offers multiple approaches for the prevention of diseases.

NATURAL HISTORY OF DISEASE

• This model signifies the way in which a disease evolve over time from the period of its earliest stage to its termination as recovery or death.

It consists of 2 phases: Period of pre pathogenesis Period of pathogenesis

WEB OF CAUSATION

• This was coined by Mac Mahon and Pugh.

• Applicable in certain diseases where the causative agent is unknown and the disease is the result of interaction of multiple factors.

• Removal of some of them or even one of them may be sufficient to control the disease.

RISK FACTORS AND RISK GROUPS

Risk factors means an attribute or exposure that is significantly associated with the development of a disease.

Risk groups are those exposed to risk factors.

SPECTRUM OF DISEASES

• It is a graphic representation of the variations in the manifestations of a disease.

• It may be defined as the sequence of events that occur in human host from the time of contact with the etiologic agent up to the point of the ultimate outcome, which may be fatal in extreme cases.

• Spectrum extends from subclinical to the fatal.

ICEBERG OF DISEASE

• Health professionals see only a small part of illness in the community, just as a small part of an iceberg is visible above the surface of the water. This is called as “the tip of the iceberg.” as information on the submerged portion is not available.

CONCEPTS OF PREVENTION

• Goals of prevention : to promote health, to restore health and to preserve health.

• Prevention can be studied under three levels:PRIMARY PREVENTION SECONDARY PREVENTIONTERTIARY PREVENTION

PRIMARY PREVENTION

• Defined as “action taken prior to the onset of disease, which moves the possibility that a disease will ever occur”

• Primary prevention is designed to promote health or protect against specific disease and hazards in environment.

• ADVANTAGES:Low costSafe Individual is not yet exposed to pain and suffering.

Approaches for primary prevention recommended by WHO:

PRIMORDIAL PREVENTION POPULATION(MASS) STRATEGY HIGH-RISK STRATEGY

SECONDARY PREVENTION• Defined as “action which halts the progress of a disease

at its incipient stage and prevents complications”

ADVANTAGES: Important in reducing the high mortality and morbidity of

certain disease.

DISADVANTAGES: Patient is subjected to pain and suffering and community

to loss of productivity.

TERTIARY PREVENTION

• Defined as “all measures available to reduce or limit impairments and disabilities, minimize sufferings caused by existing departures from good health and to promote the patient’s adjustment to irremediable conditions”

• Specific modes of interventions are: 1) Disability limitation 2) Rehabilitation

CONCLUSION

• As the time progress all concepts and principles make way for the new.

• Universal Declaration of Human Right “everyone has the right to a standard of living adequate for the health and wellbeing of himself and his family” is yet to be realized.

• Health development contributes to and results from social and economical development.

REFERENCES

• ESSENTIALS OF PUBLIC HEALTH DENTISTRY 5th EDITION – SOBEN PETER, Chapter Introduction to public health (page no: 27)

• TEXTBOOK OF PREVENTIVE AND COMMUNITY DENTISTRY 2nd EDITION- S.S.HIREMATH, Chapter Concept of health and disease and prevention(page no: 4)