Concept3 of health and disease

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Health For All:

Health For All Attainment by all the people of the world, by the year 2000, of a level of health that will permit them to lead a socially and economically productive life.

Primary Health Care:

Primary Health Care “Essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self determination.” International conference in Alma-Ata, USSR 1978.

Primary Health Care includes at least-:

Primary Health Care includes at least- Education about prevailing health problems and methods of preventing and controlling them, Promotion of food supply and proper nutrition, An adequate supply of safe water and basic sanitation, Maternal and child health care, including Family Planning, Immunization against infectious diseases. Prevention and control of endemic diseases, Appropriate treatment of common diseases and injuries; and Provision of essential drugs.

Concept of Disease 104#:

Concept of Disease 104# Disease – without ease Any deviation from normal functioning or state of complete physical, mental or social well being. Health and disease are mutually exclusive.

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Spectrum of Health Positive Health Better Health Freedom from Sickness (Carrier State) Unrecognized Sickness (SUBCLINICAL DISEASE) Mild Sickness Severe Sickness Death (OR DISABILITY)

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Disease is a Physiological or Psychological dysfunction- Illness is a subjective state of the person who feels aware of not being well Sickness is a state of social dysfunction, i.e. a role that the individual assumes when ill (sickness role)

Concept of Causation:

Concept of Causation First scientific theory was- GERM THEORY OF DISEASE (2#) One to one relationship between causal agent and disease

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Not everyone exposed to Tuberculosis agent ( mycobacterium tuberculosis ) gets the disease. Optimal interaction of Agent, host and environment is required There are other factors relating to the host and environment which are equally important to determine whether or not disease will occur in the exposed host. All diseases studied under these three factors of agent, host and environment.

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Epidemiological Triad (4#) Agent Host- Malnourishment Environment- poverty, over-crowding

Multifactorial Causation (4#):

Multifactorial Causation (4#) Modern diseases of civilization, e.g. lung cancer, coronary heart disease, mental illness, etc. could not be explained on the basis of germ theory And could not be prevented by traditional method of isolation, immunization or improvement in sanitation. Other factors are required, e.g. social, economic, cultural, genetic & psychological. Even microbial diseases like TB, leprosy, etc. require other factors.

New model of disease causation:

New model of disease causation Multifactorial causation – many factors are required. Web of causation – many factors are related to each other. Risk factors for myocardial infarction- [SNQ] Excess fat intake Obesity Hyperlipidaemia Coronary atherosclerosis Lack of physical exercise Smoking Stress Hypertension

Multiple approaches for prevention & control:

Multiple approaches for prevention & control Multiple risk factors gives multiple levels of control at the levels of risk factors Web of Causation-considers all the predisposing factors of any type and their complex inter-relations. Reducing each risk factor has additive effect in controlling disease.

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Natural History of Disease Interaction of Epidemiological Triad Beginning of Disease Process Termination as Recovery, Disability or Death.

Before man is involved:

Before man is involved Triad interaction – many factors Level of Prevention – Primary Prevention 1. Health Promotion- Nutrition, rest, exercise 2. Specific Protection- immunization, diet, etc.

After man is involved:

After man is involved Preclinical & before the physician is consulted Screening in healthy person- e.g. Carcinoma of Breast by mammogram Tissue and physiologic changes occur during this time. Level of prevention- Secondary 3. Early Diagnosis – AIDS, leprosy, TB / Koch’s 4. Treatment – most infectious disease progress like this. Early lesions after physician is consulted also get treated. Clinical horizon is crossed and signs and symptoms appear.

Late Stage:

Late Stage Late stage of disease leads to chronic stage or death It can also lead to recovery with or without disability, e.g. Poliomyelitis Levels of Prevention- 5. Disability Limitation 6. Rehabilitation – Productive work

Pathogenesis Phase:

Pathogenesis Phase Begins with the entry of disease agent in susceptible human host Disease progresses through a Period of Incubation. May be modified by interventions like immunization & Chemotherapy. Rabies May become a carrier with or without clinical stage of disease, e.g. Diphtheria, Poliomyelitis. In chronic diseases symptoms appear in the late pathogenesis stage (coronary heart disease, cancer, hypertension)

Agent Factors:

Agent Factors A substance living or nonliving, or a force tangible or intangible, the excess presence or relative lack of which may initiate or perpetuate a disease process.

Types of Agents:

Types of Agents 1. Biological Agent 2. Nutrients 3. Physical 4. Chemical 5. Mechanical 6. Social 7. Factors or structure needed to health

Host Factors (Intrinsic):

Host Factors (Intrinsic) Human host is soil, agent is the seed 1. Demographic characteristics -age, sex, ethnicity 2. Biological Characteristics- Genetic factors Biochemical Levels- e.g. cholesterol Immunological factors Physiological functions- blood pressure 3. Socio-economic characteristics- Socio-economic status Education Occupation Stress

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4. Life style factor Personality traits Smoking Physical Exercise, etc.

Environmental Factors (Extrinsic):

Environmental Factors (Extrinsic) External living and nonliving things & situations with which the host is in constant interaction. Physical Biological Psychosocial Economic

Physical Environment:

Physical Environment Air, water, soil, housing, climate Heat, light, noise, debris, Radiation, electromagnetic energy

Biological Environment:

Biological Environment Animals and plants Disease producing Agents Reservoir of infection Intermediate hosts Vectors

Psychosocial Environment:

Psychosocial Environment Cultural values, customs Habits, beliefs, attitudes, Morals, religion, education, Life styles, Health services Social & Political Organizations

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Beneficial social behavior, like community participation, should be restored where it has disappeared due to social change. Medical cause of lung cancer may be chemical substance, but psychosocial cause is behavior of smoking. Man has to be viewed in his total environment.

Risk Factor:

Risk Factor Disease agent is still unidentified for many diseases like – coronary heart disease, cancer, peptic ulcer, mental illness, etc. So aetiology is discussed in terms of risk factors.

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Risk factor is an attribute or exposure that is significantly associated with the development of a disease. The determinant can be modified by intervention, thereby reducing the possibility of occurrence of disease. Absolute proof of cause & effect between a risk factor and a disease is usually lacking.

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Risk factor is observable or identifiable prior to the event they predict. Risk factors may be truly causative, e.g. smoking for lung cancer OR Merely contributory to the undesired outcome, e.g. physical exercise for coronary heart disease, OR Predictive only in statistical sense- e.g. illiteracy for perinatal mortality.

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A. Modifiable risk factors- can be modified, e.g. smoking, hypertension, elevated serum cholesterol, physical activity, obesity, etc. B. Non-modifiable or immutable risk factors- cannot be modified Age, race, sex, family history, genetic factors, etc. NOT subject to change Act as a SIGNAL for alerting the health professional

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Risk factors indicates the need for promotive & preventive health care where whole community is at risk, e.g. presence of malaria, air pollution, substandard housing, poor water supply, etc. Studies are carried out in population groups – where certain diseases occur more frequently than other groups.

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Risk factor for heart disease- Smoking High blood pressure High serum cholesterol Diabetes Obesity Lack of exercise Type A personality, etc.

Risk Group identification:

Risk Group identification Those at higher risk are targeted for spending money / resources as better result is obtained. Various National Programs. Risk Approach- Something for all, but more for those in need, in proportion to the need.

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Since Resources are scarce, we cannot fulfill all the needs. So we have to identify those at risk, it is imperative to identify those at risk. It helps to define priorities to prevent disease in so far as we are able to remove or minimize risk.

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