Slides on health and disease by dr. rajan bikram rayamajhi


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Slides on health and disease by dr. rajan bikram rayamajhi for medical students

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Slides on health and disease by dr. rajan bikram rayamajhi

  1. 1. CONCEPTONHEALTH & DISEASEDr. Rajan Bikram RayamajhiDepartment of Community MedicineB. P. Koirala Institute of Health SciencesDharan, Nepal 1
  2. 2. Changing ConceptBiomedical ConceptIt is based on Germ Theory of Disease .[ Human body: a Machine , Disease: Breakdown of Machine ]Limitation : minimized role of environment , psychology ,social structure , culture in determining health.2
  3. 3. Ecological ConceptHealth is viewed as dynamic equilibriumbetween human & environment .(imperfect human versus imperfect environment)It depends on human adaptability to naturalenvironment3
  4. 4. Psychosocial ConceptHealth is influenced by Social , Psychological ,Cultural , Economic & Political factors.Health is both biological and social phenomenon.Holistic conceptIt’s a unified or multidimensional and includes allthe concept.It implies sound mind, in a sound body, in a soundfamily, in sound environment.It emphasis on the promotion and protection ofhealth.4
  5. 5. Definition of HealthA state of complete physical, mental & socialwellbeing & not merely an absence of diseaseor infirmity that enables an individual to leadsocially & economically productive life.(WHO Definition of Health)Infirmity – weakness/ illness over a longperiod.5
  6. 6. Definition of Health by WHO is Idealistic butnot Realistic.Operational Definition:Condition or Quality of the human organismexpressing the adequate functioning of theorganism in given conditions genetic orenvironmental”6
  7. 7. Health : No obvious evidence of disease. Personfunctioning normally. Several organs functioning adequately inequilibrium.7
  8. 8. New Philosophy of HealthFundamental Human Right , an essence ofproductive life & an Integral part ofDevelopment. Intersectoral Central to the concept of quality of lifeInvolves Individuals, State & InternationalResponsibility, a world-wide Social goal.8
  9. 9. Dimensions of Health9
  10. 10. Dimensions of HealthPhysical Dimension Perfect functioning of body. Every cell / organ functioning at an optimumcapacity & in perfect harmony with rest of thebody.Mental DimensionA state of balance between the Individual andsurrounding world, Harmony between oneself andothers.10
  11. 11.  Social DimensionQuantity & Quality of an Individual’sInterpersonal ties and extent of involvement withCommunity , Degree of social functioning.Spiritual Dimension• Individual striving for meaning in Life , commitmentto some higher being.• It also includes ethics, integrity, principles andpurposes in life.11
  12. 12. Emotional DimensionRefers to feeling.Mental is related to knowing and cognition.Vocational Dimension :Work is fully adapted to human goals, capacities &limitations, it often plays role in promoting health.Goal achievement and self realization at work are a source ofsatisfaction and enhanced self esteem.Others: Philosophical, Cultural, Environmental,Nutritional, Educational, Socio- Economic, Curative,Preventive.Various “non medical” dimensions have to be considered tomake an individual lead healthy life 12
  13. 13. Positive HealthPerfect functioning of body and mind[Depends also upon Economic, Cultural, Social factors operating in community]Health is a Relative ConceptPositive health is a mirage as everything in life issubject to change.‘Dubos’: Concept of perfect positive health can’t come in realitybecause man will never be so perfectly adapted to hisenvironment that his life will not involve struggles, failures andsufferings. 13
  14. 14. Concept of Well BeingIt has objective and subjective components.1) Standard of LivingStandard of Living [ WHO ]1) Income : Per capita GNP 2) Occupation 3) HousingStandard 4) Nutrition 5) Sanitation6) Health 7) Education, 8) RecreationRefers to the usual scale of our expenditure, the goods we consume and the services we enjoy.14
  15. 15. 2) Level of LivingLevel of Living [ UN ]All of the above except Sanitation plus Clothing ,Human Right & Social SecurityHealth impairment lowers level of living15
  16. 16. 3) Quality of Life :A composite measure of physical, mental and socialwellbeing as perceived by each individual or groupof individuals.For ex: Happiness /gratification experienced in life concerned withhealth, marriage , family work, financial situation, educationalopportunities, self esteem, creativity, belongingness, trust in others.Individual’s own subjective evaluation16
  17. 17. Human Development Index (HDI)A composite index combining indicators representing3 dimensionsLongevity : life expectancy at birthKnowledge: adult literacy rate and mean years ofschoolingIncomeIncome is only means to human development , not an end17
  18. 18. Physical Quality of Life Index (PQLI)1. Infant Mortality2. Life Expectancy at age One3. LiteracyTheme: Money is not everythingOil rich countries of Middle East Asia have high per capita incomeand Low PQLIBUTSri Lanka , Kerala of India have low per capita income and highPQLI 18
  19. 19. Human Poverty Index: measures deprivation in 3 basicdimensions1) Probability of dying before 40 years2) Adult Illiteracy Rate3) Percentage of underweight children.4) Percentage of population not using improved water sourceGender Empowerment Measure (GEM)Gender related Development Index(GDI)Kerala – High female literacy played key role in improvinghealth situation19
  20. 20. Determinants of Health20
  21. 21. Concept of DiseaseoA condition where body or any of its part has its functions disrupted orderanged.( Oxford Dictionary)oMal-adjustment of human organism to the environment. (Ecology)oAny deviation from normal functioning(complete physical & mentalwell being)oIt has many shades (spectrum of disease) ranging from inapparent(subclinical) cases to severe manifested illnessoFinal outcome of disease – Recovery , Disability, and Death.21
  22. 22. Disease:Disease:Physiological/Psychologicaldysfunction; a condition that isdiagnosed by physician Illness:Illness:Subjective state of the person whofeels aware of not being well. Sickness:Sickness:State of social dysfunction, i.e., arole that the individuals assumeswhen ill (“sickness role”)22
  23. 23. Concept of CausationBefore Louis Pasteur (1822 -1895 AD)Supernatural theory of disease,Theory of humorMiasmatic theory – disease due to noxious airTheory of spontaneous generation .Discoveries of microbes:(Germ theory of disease)GonococcusTyphoid bacillusPneumococcusVibrio CholeraTubercle Bacillus23
  24. 24. Epidemiological Triad24
  25. 25. o Not everyone exposed to germs develop disease -other factors relating to host & environment equallyimportant in determining whether disease will occuror not25
  26. 26. Agent Factorso Biological agents:Viruses, Bacteria, Protozoao Nutrient agents:Proteins, Fats, Vitaminso Physical agents:Heats, Cold, Pressureo Chemical agents:Dust, Gases, Insecticideso Mechanical agents:Forces, Crushing, Tearingo Absence or insufficiency or excess of a necessary tohealth:Hormones (Insulin) 26
  27. 27. o Social agents:Poverty, Smoking, Abuse of Drugso HOST Factors (Intrinsic)o Demographic:o : Age, Sex, Ethnicityo Social & economic factors:Income, Education, Occupation, Stresso Lifestyle factors:Living Habits, Physical Exercise, Smoking, Nutrition27
  28. 28. Environmental Factors (Extrinsic)• Physical environment: air, water, heat, noise,climate, soil• Biological environment: insects, rodents, dogs• Psychosocial environment: culture, beliefs habits,attitudes, education, health services• Events like loss of close ones, loss of employment,sudden exposure to stressful conditions anxiety,depression, frustration - psychosomatic disorderDuodenal ulcer, HTN, mental disorder28
  29. 29. Disease/HealthRelated EventsRisk factorsHeart Disease Smoking , High BP, Obesity , Lack of Exercise,High Serum CholesterolCancer Smoking, Alcohol, Radiation, EnvironmentalPollutionVehicle Accidents High Speed, Poor Road Quality, Vehicle Design,Alcohol UseReference: Park’s textbook of Preventive & Social Medicine29
  30. 30. Risk Factoro For many disease “agent” unidentified example –cancer , peptic ulcer , coronary heart disease.o Etiology discussed in terms of Risk factors.o Attribute/exposure significantly associated withdevelopment of Disease.o Some can be modified by intervention, reducingthe possibility of disease occurrence 30
  31. 31. Web of CausationoMulti factorial causationLung cancer : Genetic predisposition, Smokinghabit (No. of cig./day, Different forms of Tobacco) ,Environmental FactorsChronic disease: Outcome of Interaction of multiplefactors31
  32. 32. Sometimes removal of just only one link/chain sufficient to control the diseaseprovided that the link is important32
  33. 33. Natural history of disease :The way in which a disease evolves over time fromearliest stage of its pre-pathogenesis phase to itstermination as recovery, disability or death, inthe absence of treatment or prevention.33
  34. 34. Natural history of disease34
  35. 35. 35