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2. Dr. Irniza Rasdi Coordinator for EOH3401 Laboratory Occupational Health and Safety, Level 4, Block C, Faculty of Medicine and Health Sciences, UPM Tel: 0123153360 – Whassap/msg only Email: irniza@upm.edu.my 2

3. Name of course: Principles of Health Course Code: EOH3401 3

4. 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. 4

5. 1.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 5

6. AssessmentsPercentage (%) Mid-term examination15 Continuous Assessments A15 Continuous Assessments B10 Continuous Assessments C20 Final Examination40 Total100 6

7. 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 7

8. 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 8

9. Assignment 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 9irnizaras@gmail.com Put your name and matrix number on the poster Assessment will be based on the following criteria; Contents Creativity/attractiveness 9

10. 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 12irnizaras@gmail.com 10 Assignment 3 (15%)

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13. 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.)

14. 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

15. 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.

16. 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:

17. 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

18. PHYSICAL Biological make-up physiological functions (e.g. pulmonary, cardiovascular, gastrointestinal system) Nutrition Lifestyle Dimension of Optimal Health: Physical

19. 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

20. 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

21. INTELLECTUAL Education The ability to learn and use information effectively for personal, family, and career development Dimension of Optimal Health : Intellectual

22. 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

23. OCCUPATIONAL Employment Economy Affects also the SOCIAL aspects DIMENSION OF WELLNESS

24. Definition: 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 24

25. Definitions 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. 25

26. Definitions 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. 26

27. A case is a risk factor …  Infection in one person can be transmitted to others (www)www What is infectious disease? 27

28. Infectious Diseases are Caused by Pathogens What’s a pathogen? 28

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34. What 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. 34

35. Are 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. 35

36. Do 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%). 36

37. What 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. 37

38. What 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. 38

39. How 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. 39

40. How 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. 40

41. How people got the disease? 41

42. Why 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. 42

43. Aetiology 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. 43

44. Disease is the result of forces within a dynamic system consisting of: agent of infection host environment Epidemiologic Triad 44

45. 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)www Factors Influencing Disease Transmission 45

46. Epidemiologic 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 46

47. Chain of Infection 47

48. Chain of Infections 48

49. Modes of Disease Transmission Direct contact Indirect contact Droplet Airborne 49

50. Direct 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 50

51. Indirect 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 51

52. Vector 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… 52

53. Droplet 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 53

54. Airborne 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 54

55. Think about it: Where Do Pathogens Hide When Not Infecting People and Animals?  The soil  Bodies of water  Surfaces like farm equipment  The skin of people and animals  In the air  In body fluids Where are those pathogens? 55

56. Susceptible Susceptible host Dynamics of infectiousness Latent period Infectious period Non-infectious Infection Time Timeline for Infection Subclinical disease Clinical Death/recovery Incubation 56

57. Timelines 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. 57

58. Infections 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. 58

59. 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. 59

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62. Immune 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. 62

63. How 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 63

64. Antigens 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”. 64

65. Iceberg Concept of Infection 65

66. Social Aspects of Health 66 Source: Dahlgren, G. and Whitehead, M. (1993) Tackling inequalities in health: what can we learn from what has been tried?

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

68. 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 discrimination  Exposure to crime, violence, and social disorder, such as the presence of trash  Social support and social interactions  Exposure to mass media and emerging technologies, such as the Internet or cell phones  Socioeconomic conditions, such as concentrated poverty  Quality schools  Transportation options  Public safety  Residential segregation

69. Unequal Access to Affordable, 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?

70. Community Environments that Promote 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.

71. 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

72. Education, Literacy, and employment Policies that Contribute to Employment Status Barriers to employment Illiteracy or lack of education Low employment rate

73. 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 73

74. Thank You 74