1. By Hatim Jaber MD MPH JBCM PhD 22-09-2016
Faculty of Medicine Introduction to Community Medicine Course ( ) Dimensions and Determinants of Health Disease and factors affecting occurrence of disease By
Hatim Jaber
MD MPH JBCM PhD

2. Presentation outline Last lecture feedback Dimensions of health
Time
Last lecture feedback
12:00 to 12:10
Dimensions of health
12:10 to 12:20
Determinants of health
12:20 to 12:30
Health and Disease
12:30 to 12:40
Factors affecting the occurrence of disease
12:40 to 12:50

3. 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 standard, the standard of “positive” health.

4. “germ theory of the disease.”
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.”

5. Holistic concept Health Social economic Health protection Envirnmental
Health promotion
Health
Envirnmental
Political
Holistic concept

6. 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

7. 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.

8. 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.

9. 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.

10. SPECTRUM OF HEALTH Better health Freedom from sickness
Positive health
Better health
Freedom from sickness
Unrecognised sickness
Mild sickness
Severe sickness
Death

11. 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
Copyright 2008 by Pearson Education, Inc. 11

12. DETERMINANTS OF HEALTH
Biological
Behavioral & sociocultural condition
Other factor
Health
Environment
Gender
Socioeconomic
Aging
Health services

13. 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.

14. Environmental factors range from housing, water supply, psychosocial stress and family structure
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

15. 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: ?

16. 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.

17. Premature mortality by Income

18. Parent Education and Children’s Health

19. US Mortality by Age
(per 100,000)
Source: National Center for Health Statistics,CDC: 2005

21. Cigarette Smoking by Education

22. Physical Activity/Nutrition
Source: USDA, 2006

23. U.S. Mortality by Gender
(per 100,000)
Source: National Center for Health Statistics, CDC, 2005

24. U.S. Mortality by Race
(per 100,000)
National Center for Health Statistics, CDC, 2005

25. Social Determinant: Education
Source: National Health interview Survey, Robert Wood Johnson Foundation, 2008

26. Education and Mortality

27. Parent Education and Children’s Health

29. Premature mortality by Income

31. Dimensions of Wellness
Copyright 2008 by Pearson Education, Inc. 31

32. 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.

33. 2. Social.
The ability to interact successfully with people and within the environment

34. 3. Emotional.
The ability to manage stress and to express emotions appropriately, Emotional wellness involves the ability to recognize, accept, and express feelings.

35. 4. Intellectual.
The ability to learn and use information effectively for personal, family, and career development

36. 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

37. 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.

38. 7. Environmental.
The ability to promote health measures that improve the standard of living and quality of life in the community

39. 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.

40. 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’.

41. Disease
Disease can be described as an alteration in body functions resulting in a reduction of capacities or shortening of the normal life span.
The causation of a disease is called its etiology.

42. 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.

43. 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.

44. 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 44

45. 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 45

46. HEALTH AND ILLNESS

47. The Health-Sickness spectrum

48. 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

49. Historical Theories for causation of disease
“Supernatural causes”& Karma
Theory of humors (humor means fluid)
The miasmatic theory of disease
Theory of contagion
Germ theory
Epidemiological Triad
Multi-factorial causation
Web of causation
………Supernatural to multi-factorial causes…
Environment
Agent
Host

50. Natural History of Disease
Period of prepathogenesis
Period of pathogenesis

51. Subclinical Case: ICEBERG PHENONMENON
Example: Cholera , Polio, hypertension, malnutrition etc.

52. 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.

53. Concept of Disease مرادفات كلمة مَرَض :
مرادفات كلمة مَرَض :
آفَة , إصَابَة , إِعَاقَة , إِعْتِلال , إِعْتِلاَل , اعتلال , بَلاَء , تَوَعُّك , داء , دَاء , دَنَف , سَقَم , سُقْم , شَكْوًى , ضَنًى , ضُرّ , عاهَة , عَيْب , عِلَّة , نَقْص , هُزَال , وَبَاء , وَبَلة , وَصَب , وَصَم , وَعْكَة ، سَقَام , سُقْم

54. Indicators of Health

55. Thank You