Concepts of Health and Disease

Dr. S Shahani

Health
Oldest concept- in traditional medicinedisturbed body harmony As per modern medicine- past Absence of disease- physical

Health
State of complete physical, mental and social wellbeing and not merely a an absence of disease of infirmity-WHO Added ability to lead a socially & economically productive life Being sound in body, mind, or spirit, specially freedom from physical disease or pain-Webster

Changing Concepts of Health

Biomedical concept Absence of disease- till that time knowledge of disease was limited to physical dysfunction Ecological concept Absence of pain and discomfort and a continuous adaptation in environment to ensure optimal function This also includes population explosion and food avaialability

Changing Concepts of Health

Psychosocial concept- influence of social, psychological, cultural, political, economic factor Holistic concept Combination of all the above sound mind, sound body, sound family, sound environment

Dimensions of Health
Multidimensional, each one interact to one another Physical Mental Social Spiritual Emotional Vocational

Physical dimension
Perfect functioning of every organ, cell of body to optimum Assessed byself assessment History taking- symptoms, activity, medication Questionnaires regarding- visit to hospital Clinical & lab examination Nutrition assessment Community level- infant mortality, life expectancy

Mental dimension
Related to cognitive function Assessing balance between individual & surrounding Presence of psychosomatic diseases indicates relation between body & mind Assessment using mental status questionnaire To find if there is cognitive or affective impairment

Social dimension
Harmony & integration with individual , family & society Indicated quantity & quality of interpersonal ties extent of involvement to community

Spiritual dimension
Integrity Principles Ethics Commitments Beliefs Purpose of life

Emotional dimensions
Related to affective function Deals with feelings

Vocational dimension
Work helps in promoting physical & mental health Physical work improves physical health Goal achievement, self realization in workprovide satisfaction &self esteem Not only a source of income-to improve physical health

Positive Health
Biologically every cell and organ functioning at optimal capacity Psychologically sense of well being Socially participating in the social system

Concept of Wellbeing
Objective component 1. Standard of Living 2. Level of Living Health, food, occupation, education, social security, housing, clothing, recreation and human rights Subjective component 3. Quality of Life-happiness, satisfaction, trust

Physical Quality of Life Index - PQLI

Composite index of health indicators Infant mortality rate Life expectancy at age one Literacy The Physical Quality of Life Index (PQLI) is an attempt to measure the quality of life or well-being of a country. The value is the average of three statistics: basic literacy rate, infant mortality, and life expectancy at age one, all equally weighted on a 0 to 100 scale. Scale of 0 to 100 Money not included Data can be compared to various regions, countries

Human Development Index - HDI

Reflect achievement in human capabilities Longetivity-life expectancy at birth Knowledge-literacy Income-per capita The Human Development Index (HDI) is a composite statistic of life expectancy, education, and income indices to rank countries into four tiers of huma development. It was created by economist Mahbub ul Haq, followed by economist Amartya Sen in 1990 Values range between 0 to 1 Comparison can be done

Health /Sickness Spectrum

Positive health Better health Freedom from sickness Unrecognized sickness Mild sickness Sever sickness Death

Determinants of Health
Biological-genetic heritage Behavioral and Social-cultural, habits, lifestyle Environment-occupational, housing, stress Socio economic Health service availability Age-aging leading to more geriatric disorder Gender- physical health, nutrition, voilence

Right to Health
Universal Declaration of Human Rights, 1948, Article 25 Everyone has a right to a standard of Living adequate for the health and wellbeing of the individual and his family

Include right to Medical care, healthy environment, food, etc

Responsibility for Health

Individual responsibility-self care diet exercise , alcohol, hygiene, smoking, life style Community responsibility-man power, funds, logistic support, State responsibility-provide right to work, education, security Assistance during violence, sickness, International responsibility-irradication of disease- WHO, Unicef

Ideal indicator
Valid should actually measure what it is supposed to measure Reliable Results should be the same if measured by different individuals Sensitive should not miss out information Specific should not gather wrong information Feasible Easy to use Relevant

Mortality indicators
Crude death rate number of deaths per 1000 population per year in a given community Life expectancy Average number of years by a person born in a community Infant mortality rate Ratio of death of infants in one year to the number of live births in that year, expressed as rate per 1000 live births per year

Mortality indicators
Child mortality rate number of deaths of age 1-4 in a year per 1000 children in that age group in the year Under 5 mortality rate Maternal mortality rate Disease specific mortality rate Proportional mortality rate-in proportion to total mortality

Morbidity indicators
Incidence number of new cases in a year Prevalence total number of case in that year OPD attendance Indoor admission Duration of hospitalization Spell of sickness /absence from work

Disability rates
Event type No. of days of restricted activity Bed disability days Work loss days Person type Limitation of mobility Limitation of activity

Disability rates
Sullivan index expectation of life free of disability ( life expectancy number of years free from disability) HALE Health adjusted life expectancy Life expectancy years spent in poor health DALY Disability adjusted life years years of life lost due to premature death

Other indicators
Nutritional indicators-anthropometric measurements Health care delivery indicators Doctor: population Doctor : Nurse Population: bed Population per health center

Access to care
Age Sex Class Urban vs rural

Indicators of social & mental health

Rates of Suicide , homicide, Violence, crime Abuse Family violence

Characteristics of ideal health care

Appropriate Comprehensive Adequate Availability Accessible Affordable Feasible

Levels of Health care

Primary Health care- first contact to individual to provide essential health care Secondary health care-referral level Tertiary Health care-super-speciality service, planning & managerial skill, teaching to staff

Concepts of causation
Germ Theory ( Agent Human Disease ) Epidemiological triad (Agent Environment Host ) Multi-factorial or Web of causation cancer, heart disease

Natural history of Disease

Pre-pathogenesis phase Pathogenesis phase

Iceberg of Disease

Prevention
Primordial Prevention Prevention of development of risk factors Primary prevention Addresses the risk factor, prevents the disease Secondary prevention Addresses the disease, prevents complication Tertiary prevention reduce the disability with the disease

Modes of Intervention
Health Promotion Specific protection Early diagnosis and treatment Disability limitation Rehabilitation

Health Promotion
Health education-live a healthy life Environmental modification-sanitation, water, housing, insect control Nutritional intervention-food improvement of vulnerable group Lifestyle or behavioral changes-for target group, risk individuals,

Early diagnosis & treatment

Disability limitation & rehabilitation

disease impairment disability handicap Aim is to halt transition of disease to handicap

Rehabilitation Combined & coordinated use of medical, social, educational & vocational measures for training to achieve highest level of functional ability

Thank you!

Our job is improving quality of life not just delaying death!