Faculty of Medicine Introduction to Community Medicine Course

(31505201)

Disease and factors affecting occurrence of disease Dimensions and Determinants of Health

By

Hatim Jaber MD MPH JBCM PhD

20-09-2017

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Presentation outline

Time

Last lecture feedback 08:00 to 08:10

Health and Disease 08:10 to 08:20

Factors affecting the occurrence of disease

08:20 to 08:40

Dimensions of health 08:40 to 09:00

Determinants of health 09:00 to 09:15

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WHO Definition

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

now added

“the ability to lead a socially and economically productive life.”

•The concept of health as defined by WHO is broad and positive in

its implications; it sets out the standards, the

standard of “positive” health.

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CONCEPT OF WELLBEING

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 service and collectively as an index of the ‘standard of living’.”

Level of Living

• As per United Nations documents “level of living” consists of nine components: health, food consumption, education, occupation and working conditions, housing, social security, clothing, recreation and leisure, and human rights.

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• Traditionally health has been considered as an

absence of the diseases and if someone was free

from disease, then that person was considered healthy.

This concept is known as biomedical concept, and it has a basis on the

“germ theory of the disease.”

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Health

Social economic

Environmental Political

Health promotion

Health protection

Holistic concept 7

Positive health Better health

Freedom from sickness Unrecognised sickness

Mild sickness

Severe sickness

Death

SPECTRUM OF HEALTH

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Copyright 2008 by Pearson Education, Inc.

Health-Illness Continuum • Measure person’s perceived level of wellness

• Health and illness/disease opposite ends of a health continuum

• Move back and forth within this continuum day by day

• Wide ranges of health or illness

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Illness and Disease Illness

• Is a highly personal state in which the person's physical, emotional, intellectual, social, developmental, or spiritual functioning is thought to be diminished.

• Illness is usually associated with disease but may occur independently of it.

• Illness is a highly personal state in which the person feels unhealthy or ill.

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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’.

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• Disease

• Disease can be described as an alteration in body functions resulting in a reduction of capacities or shortening of the normal life span.

•

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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.

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CONCEPT OF DISEASE

: مرض مرادفات كلمة

, داء , توعك , بالء , إعتالل , إعاقة , إصابة , آفة

, ضر , ضنى , شكوى , سقم , سقم , دنف , داء

, وبلة , وباء , هزال , نقص , علة , عيب , عاهة سقم ,وعكة ، سقام , وصم , وصب

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There are many ways to classify illness and disease:

• Acute illness is typically characterized by severe symptoms of relatively short duration.

• A chronic illness is one that lasts for an extended period, usually 6 months or longer, and often for person's life.

• Severe Illness, Moderate illness………..

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Suchman describes five stages of illness:

• Stage 1 symptoms experiences.

• Stage 2 assumption of the sick role confirmation from family and friends.

• Stage 3 medical care contact.

• Stage 4 dependent client role.

• Stage 5 recovery or rehabilitation.

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The Health-Sickness spectrum

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HEALTH AND ILLNESS

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Impact of Illness

On the Client

• Behavioral and emotional changes

• Loss of autonomy

• Self-concept and body image changes

• Lifestyle changes

On the Family

• Depends on:

– Member of the family who is ill

– Seriousness and length of the illness

– Cultural and social customs the family follows

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Impact of Illness: Family Changes

• Role changes

• Task reassignments

• Increased demands on time

• Anxiety about outcomes

• Conflict about unaccustomed responsibilities

• Financial problems

• Loneliness as a result of separation and pending loss

• Change in social customs

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Natural History of Disease

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Subclinical Case: ICEBERG PHENONMENON

Example: Cholera , Polio, hypertension, malnutrition etc.

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• The causation of a disease is called its

etiology.

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Historical Theories for

causation of disease • “Supernatural causes”& Karma

• Theory of humors (humor means fluid)

• The miasmatic (وبالي (theory of disease

• Theory of contagion

• Germ theory

• Epidemiological Triad

• Multi-factorial causation

• Web of causation

………Supernatural to multi-factorial causes…

Environment

Agent Host

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Factors affecting occurrence of disease

• Host Factors: 1- Heredity and genetic

2-Age and sex

3- Health Status

4- Immunity

5- physiological state; pregnancy..

6- Life style

7- Socio-economic

• Environmental Factors: physical, biological, social/cultural,

• Causative agent: biological, nutritional, chemical, physical, mechanical, metabolic, genetic, functional

• Risk factors

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DIMENSIONS OF HEALTH • Health is multidimensional and are interrelated, each has its own

nature

Physical Dimension

• “Perfect functioning” of the body.

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

Mental Dimension

• Ability to respond to many varied experiences of life with flexibility and a sense of purpose.

• Mental health has been defined as “a state of balance between the individual and the surrounding world, a state of harmony between oneself and others

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Social Dimension

•Harmony and integration with the individual, between each individual and other members of society, and between individuals and the world in which they live.

“quantity and quality of an individual’s interpersonal ties and the extent of involvement with the community.”

Spiritual Dimension

•Spiritual health refers to “something” that transcends physiology and psychology.

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Emotional Dimension •Relates to “feeling.” it reflects emotional aspects of humanness.

Vocational Dimension •Work often plays a role in promoting both physical and mental health. •Physical work is usually associated with an improvement in physical capacity, while goal achievement and self-realization in work are a source of contentment and enhanced self-esteem. Others •A few other dimensions have also been suggested such as philosophical dimension, cultural dimension, socioeconomic dimension, environmental dimension, educational dimension, nutritional dimension, and so on.

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Copyright 2008 by Pearson Education, Inc.

Dimensions of Wellness

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1. Physical.

• The ability to carry out daily tasks, achieve fitness (e.g. pulmonary, cardiovascular, gastrointestinal), maintain adequate nutrition and proper body fat, avoid abusing drugs and alcohol or using tobacco products, and generally to practice positive lifestyle habits.

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2. Social.

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

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3. Emotional. • The ability to manage stress and to express

emotions appropriately, Emotional wellness involves the ability to recognize, accept, and express feelings.

4. Intellectual.

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

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5. 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

6. Occupational.

• The ability to achieve a balance between work and leisure time, A person's beliefs about education, employment, and home influence personal satisfaction and relationships with others.

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7. Environmental.

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

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DETERMINANTS OF HEALTH

Health

Biological

Gender Environment

Health services

Behavioral & sociocultural condition

Socioeconomic Aging

Other factor

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

Behavioral and Sociocultural Conditions •Health requires promotion of healthy lifestyle. Modern health problems especially in the developed countries and in developing countries are mainly due to changes in lifestyles. Healthy lifestyle includes adequate nutrition, enough sleep, sufficient physical activity etc.

Environment •Environment has a direct impact on the physical, mental and social wellbeing of those living in it. Environmental factors range from housing, water supply, psychosocial stress and family structure

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Socioeconomic Conditions ● Economic status: Economic situation in a country is an important

factor in morbidity, increasing life expectancy and improving quality of life, family size and pattern of disease

● Education: Illiteracy correlates with poverty, malnutrition, ill

health, high infant and child mortality rates. ● Occupation: Productive work provides satisfaction, promotes

health and improves quality of life. ● Political system: timely decisions concerning, resource allocation,

choice of technology etc

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Environmental Determinants

• Biochemical effects (lead paint, diesel fumes.)

• Often overlooked rural-based pollutants

• New interest in the effects of the “Built Environment”: the use, layout & design of a community’s physical structures

– Urban: high crime and traffic

– Suburban: pedestrian “unfriendly”

– Rural: ?

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Health Services •To be effective, the health services must reach the masses, equitably distributed, accessible at a cost the country and community can afford and social 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, health consequences of violence, aging, lifestyle related conditions and the occupational environment. •There is an increased awareness among policy makers of women’s health issues, and encourages their inclusion in all development as a priority.

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Physical Activity

• Blacks less likely to engage in physical activity than Whites.

• Men 30% more likely than women.

• Married individuals 19% less likely than single individuals.

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Social Determinants

•Gender

•Race

•Marital status

•Physical abilities (also biological)

•Education

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“The Big Sort”

• Social and geographic segregation

• People have migrated to socially isolated areas.

• Divided by race, income, social perspectives.

• Possible adverse health effects?

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Economic Determinants

•Intersection between social (e.g. job) and economic (income) determinants is fuzzy.

•Concept of “social class” is less accepted here.

•Social status is more than income, though income is an important determinant.

•“Status Syndrome” (Marmot)

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Effects of Disparities

• Complex relationship between determinants and outcomes.

• Some “determinants” are likely outcomes of others.

• Parental income associated with educational attainment and health of child. Low education associated with high tobacco use. Tobacco use associated with…..

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Social effects of Disparities

• Discrimination?

• Stress?

• Low self-esteem?

• High-risk behaviors

• ??

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Biological Determinants

•Genes: much to learn

•Immunities or disposition

•Varying estimates of “nature”- effect on longevity.

•Age

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Behavioral Determinants

• Tobacco

• Nutrition and Physical Activity

• Alcohol

• Violence

• What is the origin or cause of behavior?

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Premature mortality by Income

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Parent Education and Children’s Health

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US Mortality by Age

0

1000

2000

3000

4000

5000

6000

7000

35-44 45-54 55-64 65-64 65-74

Source: National Center for Health Statistics,CDC: 2005

(per 100,000)

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Cigarette Smoking by Education

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Physical Activity/Nutrition

Source: USDA, 2006 55

U.S. Mortality by Gender

0

100

200

300

400

500

600

700

800

900

1000

Men Women

Source: National Center for Health Statistics, CDC, 2005

(per 100,000)

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U.S. Mortality by Race

0

200

400

600

800

1000

1200

1400

White Black

Male

Female

National Center for Health Statistics, CDC, 2005

(per 100,000)

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Social Determinant: Education

Source: National Health interview Survey,2001-05 Robert Wood Johnson Foundation, 2008 58

Education and Mortality

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Parent Education and Children’s Health

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Premature mortality by Income

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Indicators of Health

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