Concept4 of health and disease

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Spectrum of disease:

Spectrum of disease It is difficult to determine where one state of health or disease begins and where other ends. It is like the spectrum of health from death to positive health.

Iceberg of disease:

Iceberg of disease Disease in a community may be compared to an iceberg. Floating tip of the iceberg represents what the physician sees in the community as clinical cases. Vast submerged portion represents the hidden mass of the cases, i.e. latent, inapparent, presymptomatic, undiagnosed cases and carriers. The waterline represents the demarcation between apparent and inapparent disease.

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In some diseases the hidden morbidity far exceeds the known morbidity, e.g. hypertension, diabetes, anaemia, malnutrition, mental illness, etc. The hidden part is the undiagnosed reservoir of infection or disease in community, and its detection and control is a challenge to modern techniques in preventive medicine. New techniques of SCREENING have to be developed to find such cases.

Concepts of CONTROL:

Concepts of CONTROL Disease control describes the ongoing operations aimed at reducing – The incidence of disease The duration of disease and thus, the risk of transmission The effects of infection, both physical and psychosocial complications The financial burden to the community.

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Control activities focus on Primary and Secondary Prevention. In disease control the disease agent is permitted to persist in the community at a level where it ceases to be a public health problem. E.g. Malaria Control.

Disease Elimination:

Disease Elimination Is used to describe the interruption of transmission of disease. E.g. measles, polio & Diphtheria from large geographic regions. This could be a step to disease eradication.

Disease Eradication:

Disease Eradication Extermination of the infectious Agent totally. Means cessation of infection and disease from the whole world. To date only small pox has been eradicated from the world.

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Eradication not easy as there are – Hidden foci of infection Unrecognized methods of transmission Resistance of vector or organism, All of these flare up when the agent host environment equilibrium is disturbed. Failure to understand this has led to disappointment in the eradication programs mounted against malaria, yaws, plague, kala-azar, & yellow fever.

Monitoring & Surveillance:

Monitoring & Surveillance Monitoring is the performance and analysis of routine measurements aimed at detecting changes in the environment or health status of population. E.g monitoring of air pollution, water quality, growth and nutritional status, etc. In management monitoring refers to The continuous oversight of activities to ensure that they are proceeding according to plan.


Surveillance The continuous scrutiny of the factors that determine the occurrence and distribution of disease and other conditions of ill health.

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The main objectives of surveillance are- To provide information about new and changing trends in the health status of a population. To provide feed back which may be expected to modify the policy and the system itself and lead to redefinition of objectives and Provide timely warning of public health disaster so that interventions can be mobilized.

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Monitoring requires careful planning and use of standardized procedures and methods of data collection and can then be carried out over extended period of time by technicians and automated instrumentation. Surveillance, in contrast, requires professional analysis and sophisticated judgment of data leading to recommendation for control activities.

Sentinel Surveillance:

Sentinel Surveillance A method of identifying missing cases and thereby supplementing the notified cases is known as sentinel surveillance. The sentinel data is extrapolated to the entire population to estimate the disease prevalence in the total population.

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The objective of preventive medicine is to intercept or oppose the cause and thereby the disease process. If we know the natural history of disease sometimes just removal of just one cause can prevent the disease.

Levels of Prevention:

Levels of Prevention A. Primordial Prevention B. Primary Prevention C. Secondary Prevention D. Tertiary Prevention

Primordial Prevention:

Primordial Prevention Prevention of emergence or development of risk factors in countries or population groups in which they have not yet appeared. Efforts are directed towards discouraging children from adopting harmful life styles. Main intervention is through individual and mass education.

Primary Prevention:

Primary Prevention Action taken prior to the onset of disease, which removes the possibility that a disease will occur. Action taken in prepathogenesis phase of the disease or health problem (eg. Low birth weight) Also by treating the disease the spread of the disease is stopped. By promoting general health, well being & quality of life AND specific protection Two strategies are used- Population / mass strategy High risk strategy

Population Strategy:

Population Strategy It is directed at the whole population, e.g. Reduction of average blood pressure or serum cholesterol reduces incidence of incidence of cardiovascular disease. This approach is directed towards socioeconomic, behavioural & lifestyle changes.

High Risk Strategy:

High Risk Strategy This requires detection of individuals at high risk by optimum use of clinical methods The safety and low cost of primary prevention justifies its wider application.

Secondary Prevention:

Secondary Prevention Action that halts the progress of a disease at its incipient stage and prevents complications Early Diagnosis- by screening tests, case finding programmes, etc. Adequate treatment- before irreversible pathological changes have taken place. By treating the disease the spread of disease is also prevented. Patient has already suffered from disease and loss of productivity.

Tertiary Prevention:

Tertiary Prevention All measures available to limit impairments and disabilities, minimise suffering (Disability Limitation), and to promote the patient’s adjustment to irremediable conditions (Rehabilitation). Rehabilitation has psychosocial, vocational and medical components.

Modes of Intervention:

Modes of Intervention Any attempt intervene or interrupt the usual sequence in the development of disease in man. Health Promotion Specific Protection Early diagnosis & Treatment Disability Limitation Rehabilitation.

Health Promotion:

Health Promotion Is intended to strengthen the host through a variety of approaches – Health Education Environmental modification Nutritional Intervention Lifestyle and Behavioural Changes

1. Health Education:

1. Health Education It is one of the most cost effective intervention, the target for this are – General public Patients Priority groups Health providers Community leaders and Decision makers

2. Environmental Modification:

2. Environmental Modification Provision of safe drinking water Installation of Sanitary Latrines Control of insects & Rodents Improvement of housing Nonclinical and do not require Physician

Nutritional Intervention:

Nutritional Intervention Child Feeding Programs Food Fortifications Nutrition Education

Lifestyle & Behaviour changes:

Lifestyle & Behaviour changes First identify the target group or at risk individual Then direct appropriate message to them. Lot needs to be done in modification of lifestyle and behaviour. E.g. smoking, etc.

Specific Protection:

Specific Protection Immunization Use of specific nutrient Chemoprophylaxis Protection from carcinogens Avoidance of allergens Air pollution, noise Consumer product quality control Safety of food, drugs, cosmetics, etc.

Early Diagnosis & Treatment:

Early Diagnosis & Treatment Earlier the disease is diagnosed and treated better it is in terms of preventing disability, It also reduces the number of secondary infection in infectious diseases And in chronic diseases it will reduce the morbidity & mortality, e.g. essential hypertension, carcinoma cervix, carcinoma breast, etc.

Disability Limitation:

Disability Limitation When the patient reports late in Pathogenesis phase, the mode of intervention is disability limitation. Impairment – Any loss or abnormality of psychological, physiological or anatomical structure or function. E.g. loss of foot, defective vision, or mental retardation.

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Disability- Inability to carry out certain because of impairment is called disability. Handicap- a disadvantage for a given individual, resulting from an impairment or a disability, that limits or prevents the fulfilment of a role that is normal for that individual. E.g. loss of foot in accident – disease; loss of foot – impairment; cannot walk – disability; Unemployment – handicap.

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Impairment has a large medical component; but at later stage of disability and handicap there is large social and environmental component.


Rehabilitation The combined use of medical, social, educational & vocational measures for training and retraining the individual to the highest possible level of functional ability, to integrate them in the mainstream of the community life. Medical R- restoration of function; Vocational R- restoration of the capacity to earn a livelihood Social R. – restoration of family & social relationships Psychological R.- restoration of personal dignity and confidence.

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Purpose of Rehabilitation is to Make productive people out of non-productive people .

Changing pattern of disease:

Changing pattern of disease In 1900 leading causes of death were Pneumonia, tuberculosis and diarrhoea; In 2004 they are Heart disease, cancer and cerebrovascular disease. Communicable diseases have declined and Chronic noncommunicable diseases have taken their place as leading causes of death.

Public Health:

Public Health The science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community efforts.

Community Medicine:

Community Medicine It includes what was previously known as public health, preventive medicine, social medicine and community health. The field concerned with the study of health and disease in the population of a defined community or group. Its goal is to identify the health problems and needs of defined population and to plan, implement and evaluate the extent to which health measures effectively meet these needs.

Community Diagnosis:

Community Diagnosis Diagnosis of problems in the community in an integrated manner. Listing the problems & especially identifying the FELT NEED of the community. Coordinating with other sectors to identify the problem

Community Treatment:

Community Treatment By COMMUNITY PARTICIPATION and coordinating with other sectors (INTERSECORAL COORDINATION) in an integrated approach to find the solutions. E.g. water supply, immunization, health education, control of specific diseases. It must utilize all the available resources from all agencies and community. Priority is given to FELT NEEDS.

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