1. Concept of Health and disease
Presenter: Dr. Anil
Moderator: Dr. Chetna Maliye

2. Framework Introduction Changing Concept of Health
WHO definition of health
Positive Health
Health Paradigm
Determinants of Health
Concept of Well-being
Indicators of Health
Concept of Disease
Causation of disease
Health and Illness
Natural History of Disease
References

3. Introduction “Health “ in history Why we are concerned about ‘health’
Health - Changing concepts
Biomedical
Ecological
Psychological
Holistic

4. Changing concepts of Health
Biomedical Concept- “absence of disease”
human body = machine,
disease = consequence of the break down
Doctor’s task = repair of machine.
Limitation- it has minimized the role of environmental, social, psychological & cultural determinants of health.

5. Changing concepts of Health
Ecological Concept-
Health = is a dynamic equilibrium between man & his environment,
Disease = maladjustment of the human organisms to the environment.
The concept supports the need for clean air, safe water, ozonic layer in the atmosphere, etc. to protect us from exposure to unhealthy factors.

6. Changing concepts of Health
Psychosocial Concept
Health is not only a biomedical phenomenon, but one which is in influenced by social psychological, cultural, economic and political factors of the people concerned.

7. Changing concepts of Health
Holistic Concept –
biomedical + ecological + psychosocial concept.
It has been defined as unified or multidimensional process involving the well being of the whole person in the context of his environment.
Holistic concept implies that, all sectors of society have an effect on health

8. What is ‘Health’ Oxford dictionary Webster Perkins
State of being well in body or mind
Webster
The condition of being sound in body, mind or spirit especially freedom from physical disease or pain
Perkins
“A state of relative equilibrium of body, form and function which result from its successful dynamic adjustment to forces tending to disturb it. It is not passive interplay between body substance and forces impinging upon it but an active response of body forces working towards readjustment.”

9. WHO Definition of health Definition of health
“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or Infirmity.”
– Constitution of the World Health Organization,
July 1946.

10. Physical component…
-The state of perfect functioning of body or state in which every cell & every organ is functioning at optimum capacity & in perfect harmony with the rest of the body.

11. Mental component-
Mental Health- Is a state of balance between individual and surrounding..
Easy to say if its grossly abnormal but difficult in minor disturbances.
Distinction between mental and physical health is artificial.

12. Social component
Social health is an aspect of health that includes social relationships as part of broader concept of health.
It has two elements:
Individual and societal
The less isolated, the greater the sense of control & empowerment, & the more socially integrated a person is, the less they suffer from a range of physical & mental disorders.

13. Social component (Contd.)
The Regional framework for health promotion in the Western Pacific Region stresses the role of social capital in health promotion.
social capital - trust, social interaction & social
connections

14. Other components/dimensions
Spiritual
Vocational
Socio-economic….etc

15. Positive Health
Positive health describes a state beyond the mere absence of disease.
Operationalised by a combination of excellent status on biological, subjective, and functional measures
Positive health predicts increased longevity (correcting for quality of life), decreased health costs, better mental health in aging, and better prognosis when illness strikes.

16. Health Paradigm

17. Determinants of Health
Biological
Behavioral
Environmental
Socio-economic
Health system
Socio-cultural
Ageing of population
Science & technology
Information & communication
Gender
Equity & Social justice
Human rights

18. Concept of Well-being Objective components Subjective component
Standard of living
level of living
Subjective component
Quality of life

19. Standard of living
Refers to the usual scale of our expenditure, the goods we consume and the service we enjoy. It includes the level of education, employment status, food, dress, house, amusement and comforts of modern living.
WHO: “Income & occupation, standard of housing, sanitation and nutrition, the level of provision of health, educational, recreational and other services.

20. Level of living Used in US 9 Components Health, food consumption,
education,
occupation and working condition
Housing,
Social security
Clothing
Recreation and leisure
Human right

21. Quality of life
The condition of life resulting from the combination of the effects of the complete range of factors such as those determining health, happiness(including comfort in the physical environment and the satisfying occupation), education, social and intellectual attainments, freedom of action, justice and freedom of expression.
A composite measure of physical, mental and social well-being as perceived by each individual or group of individuals.

22. Indicators of Health

23. Physical Quality of Life Index
Includes
Infant mortality
Life expectancy at age one and
Literacy
Scale 0 to 100 = worst to best
‘Money is not everything’
Does not measure economic growth
Measures social, economic and political policies

24. Human Development Index (HDI)
Combines indicators representing 3 dimensions
Longevity – Life expectancy at birth
Knowledge – adult literacy rate & mean year of schooling.
Income – real GDP Per Capita in Purchasing Power Parity(PPP) in US dollars
Index = (Actual value) – (Minimum Value)
(Maximum value) – (Minimum Value)
Dimension

25. Human Poverty Index Introduced in 1997
Measures deprivation in basic dimensions (Longevity, Knowledge, Income)
For developing countries(HPI-1)-
A long & healthy life – vulnerability to death at a relatively early age.
Knowledge – adult literacy rate
Standard of living – average of- %age of population not using an improved water source & %age of children under weight-for-age.
Probability at birth not surviving to age 40

26. Concept of Disease

27. 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’.

28. HEALTH AND ILLNESS

29. The Health-Sickness spectrum

30. 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

31. Epidemiological triad
Agent Factors
Physical Agents
Chemical Agents
Biological Agents
Nutritional agents
Environmental Factors
Physical Environment
Biological Environment
Social Environment
Host Factors
Socio-demographic Factors
Psycho-social Factors
Intrinsic Characteristics

32. Web of causation Change in life style Stress
Abundance of food Smoking Emotional Aging & D Disturbance other factor
Obesity Lack of physical activity Hypertension
Hyperlidemia Increase catacholamine Changes in walls of arteries
thrombotic activity
Coronory atherosclerosis
Coronary occlusion
Myocardial Infarction

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

34. Spectrum of disease Disease in many Forms.. Acute Chronic/insidious
Carrier

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

36. 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.

37. References
WHO. Tech. Report Series 137. WHO
WHO.Constitution Of World Health Organization
WHO. Role of Health sector in Food and Nutrition. Tech. Report Series 137. Geneva
IGNOU. Concepts in Nursing. Available online at:
WHO. Ageing and Health. A health promotion approach for developing countries. WHO, Regional Office for the Western Pacific United Nations Avenue.Manila, Philippines;
Ghai OP, Gupta P. Essential Preventive Medicine. Vikas Publishing House Pvt Ltd. India;1999:23,
Park K. Park’s textbook of preventive and social medicine. 20th edition, Banarsidas Bhanot publishers, Jabalpur, India

38. Thank you………