MolecularIn

divid

u

al

Famil

y

Society

Measurements of disease factors

influencing health

ObjectivesObjectives

To understand the importance of parameters measuring healthy conditions; social, cultural and economical.

You students should also be capable to understand the role of human genetics, food and nutrition, infectious agents, environment and education in health status.

What is Health?What is Health?

MolecularIn

divid

u

al

Famil

y

Society

Health is a state of complete Physical, Mental, and Social well-being and not merely the absence of disease or infirmity.

WHO, 1948

The Metaphysical Context of the Universe

The Secular Dimensions of Health

Physical Mental

Social

Two Major Aspects ofTwo Major Aspects ofHealthHealth

Feeling Well

Ability to Function

Determinants of HealthDeterminants of Health

the complex inter-relationships of genetics social environmentphysical environmentbehaviorhealth/illness services

that determine the level of health and sense of well-being in an individual

GeneticsGenetics

Body Size Special Abilities Disease Resistance Disease Susceptibility Genetic Diseases General Robustness

Physical EnvironmentPhysical Environment

Macro-environmentFood and WaterAir Pollution

Micro-environmentHomeWorkplace

Social EnvironmentSocial Environment

Religion Race/Gender Socioeconomic Status Education Occupation Family Composition

Socioeconomic Status, Socioeconomic Status, Income and HealthIncome and Health

Socioeconomic StatusAs GDP increases, the health of a nation

increases In times of economic hardship, the

incidence of disease increases

Health CareHealth Care

Quality Availability “Health has improved NOT because of

steps taken while we are ill, but because we are ill less often.”

Thomas McKeown, 1978

Primary PreventionPrimary Prevention

Measures taken to prevent the disease from occurring such as:healthy lifestyle habits Immunizations

Secondary PreventionSecondary Prevention

Measures undertaken to facilitate early detectionScreeningsDiagnostic tests

Tertiary PreventionTertiary Prevention

Measures to minimize complications or exacerbation of injury or disease.Rehabilitation TherapyPatient counseling

Rising Life Expectancy Rising Life Expectancy

Source: United Nations (U.N.) Population Division, Demographic Indicators, 1950-2050 (The 1996 Revision) (U.N., New York, 1996).

Prevention and ReligionPrevention and Religion

Washing Hands Hands should be washed when one

touches something polluted or unclean; likewise, before or after eating.The Prophet, Peace Be Upon Him, said:

“Whoever sleeps and his hands are not clean from fat and thereby gets harmed should blame no one but himself”

“The Prophet, Peace Be Upon Him, used to wash his hands before eating”

Historical Examples of Global Historical Examples of Global Prevention ActivitiesPrevention Activities

*Model for acute infectious agents

AHECSOUTHCAROLINA

Vaccinationavailable

Streptomycinintroduced

Koch identifiedtuberclebacillus

Death rate for Tuberculosis, 1860-1960, United States, Source: US Bureau of the Census, Historical Statistics of the United States; Colonial Times to 1970 (Washington, D.C: Government Printing Office, 1975), Part 1 pp58,63.  Note: Data between 1860 and 1900 for Massachusetts only.

The Sanitary Revolution and The Sanitary Revolution and the Ascendancy of Public the Ascendancy of Public

HealthHealthThe sanitary revolution produced the greatest

transformation in the pattern of disease that the world had known since nomadic hunter-gatherers settled in permanent villages, and

ultimately developed modern urban industrial communities

Death Rates for Measles in Children Under Age Death Rates for Measles in Children Under Age

15, England and Wales, 1850-197015, England and Wales, 1850-1970

Source: Thomas McKeown, The Modern Rise of Population (Academic Press, San Francisco, 1976), pp. 93, 96.

Epidemiologic Transition, MexicoEpidemiologic Transition, MexicoDecline in Communicable, Rise of NCDsDecline in Communicable, Rise of NCDs

1

10

100

1000

1932 1952 1972

Diarrhea

Malaria

TB

Typhoid

CHD

CA

Example of successful prevention Example of successful prevention program in Cubaprogram in Cuba : : VACCINATION VACCINATION

PROGRAM RESULTPROGRAM RESULT

POLIO ELIMINATED SINCE 1962DIPHTHERIA ELIMINATED SINCE 1969NEWBORN TETANUS ELIMINATED SINCE 1972CONGENITAL RUBELLA ELIMINATED SINCE 1989MENINGITIS POST MUMPS ELIMINATED SINCE 1989MEASLES ELIMINATED SINCE 1993

WHOOPING COUGH TRANSMISSION INTERRUPTED SINCE 1994RUBELLA TRANSMISSION INTERRUPTED SINCE 1995MUMPS TRANSMISSION INTERRUPTED SINCE 1995

MORBIDITY

MENINGOCOCCICAL DISEASE REDUCTION 93%TYPHOID FEVER REDUCTION 75%B HEPATITIS REDUCTION 52%

IntroductionIntroduction

Cervical cancer is the 2nd most common cancer among women globally

Higher cervical cancer mortality in developing countries due to lack of effective screening programs

Estimated impact of AIDS on under-5 child Estimated impact of AIDS on under-5 child mortality ratesmortality rates – – Selected African countries, 2010Selected African countries, 2010

Source: US Bureau of the Census

250

200

150

100

50

0

per 1000 live births with AIDS

Botswana Kenya Malawi Tanzania Zambia Zimbabwe

without AIDS

NZ

FRANSPN

USSR

CHN

SING

HK

USAAUST

CAN

FIN

ITY

SCOT

750

500

250

0

Death Rates for Coronary Heart Disease by Country Men Ages 35-74, 1970 and 1993 (Rate/100,000)

JPN

““Genes load the gun.Genes load the gun.Lifestyle pulls the trigger”Lifestyle pulls the trigger”

Dr. Elliot Joslin

Lifestyle Factors

What is the future of prevention?What is the future of prevention?

Globalization of Prevention

Networking of people in prevention

Sharing of data, knowledge and wisdom

ObjectivesObjectives

To understand the importance of parameters measuring healthy conditions; social, cultural and economical.

You students should also be capable to understand the role of human genetics, food and nutrition, infectious agents, environment and education in health status.