concept of health & disease health equities & inequities levels of prevention

1. Prof. Dr. Mona Aboserea
Prof of Public health
Zagazig University

2. Contents
 Community def
 Stages of development of the
concept of health
 Definition of health
 Assessment of individual
health status
 Health equality
 Health disparities &
unequalities
 Health indicators
 Health determinants
 Dimensions of health
 Concept of disease
 Distinction between
disease, illness, &
sickness
 Standard of living
 Quality of life
 Responsibility for
health
 Levels of prevention
2

3. Community
A group of people with a shared
identity: living in a particular
geographic area, having some level of
social interaction, sharing a sense of
belonging or having common political
or social responsibilities
Urban & rural communities

4. Question
 Define community and compare between urban
versus rural communities? With illustration of
commonest problems in both areas?
4

5. Stages in the development of the concept
for health and illness
 Supernatural power
 Humoral concept ‫المزاجية‬ ‫الحالة‬
 Mechanical-systemic concept
 Biomedical (etiological) concept
 Ecological concept
 Psycho-social concept
 Holistic concept
 Socio-medical concept

6. Supernatural power ‫خارقة‬ ‫قوة‬
Human life and death, as well as health and
illness have been dependant on supernatural
powers, magic and the rituals ‫طقوس‬ of
shamans‫السحرة‬

7. 7

8. Humoral concept ‫المزاجية‬ ‫الحالة‬
Disturbance in the balance of
‘humors” in the human body -
The ‘humors” in the human body are
affected by the colored fluids as
blood, phlegm and bile

9. Mechanistic concept
Related to the development of knowledge
of the human body structure and the
discovery of part of the physiologic
processes
Sees human body as a machine, disease as a
failure of this machine. The main objective
of medicine is the repair of this machine.

10. BIOMEDICAL CONCEPT
Traditionally, health has been viewed
as an “absence of disease”, and if one
was free from disease, then the person
was considered healthy.
This concept has the basis in the “germ
theory of disease”.
10

11. ECOLOGICAL CONCEPT
 health is viewed as a dynamic equilibrium between
human being and environment, and disease a
maladjustment of the human organism to
environment.
 The ecological concept raises two issues, viz.
imperfect man and imperfect environment.
11

12. PSYCHOSOCIAL CONCEPT
“health is not only biomedical
phenomenon, but is influenced by social,
psychological, cultural, economic and
political factors of the people concerned.”
12

13. HOLISTIC CONCEPT
This concept is the synthesis of all the
previous concepts.
It recognizes the strength of social,
economic, political and environmental
influences on health.
It described health as a multi dimensional
process involving the wellbeing of whole
person in context of his environment .
13

14. Integral model of health
person
health

15. Epidemiological model:
host -- agent– environment
 Factors related to host and influencing health
or disease are: age, gender, genetic factors,
psychological factors, life style, education,
social status, occupation, culture, etc..
 Factors related to causative agent may be
defined as : biological, genetic, nutritional,
chemical, physical, mechanic, etc.
 Factors of the environment are defined as:
physicochemical – air, water, geographic
location, altitude, dust, etc.; socio-economic;
political and others.

16. ‫الشكل‬ ‫هذا‬ ‫في‬ ‫يلخص‬ ‫ممكن‬
Enhanced model:
agent – host – environment (etiological-pathogenic)
agent hostMode of
transmission
Factors:
Gender, age, genetic,
psychological, lifestyle
Factors:
physicochemical, genetic, socio-economic
Factors:
Biological, genetic,
nutritional, chemical,
mechanical

17. Model of socio-medical concept
health diseasebirth death
life
chronification
Permanent disability (invalidity)
Unknown factor
Known factor
treatment
rehabilitation
Promotion
Primary prophylaxis Secondary
prophylaxis
Tertiary prophylaxis
VitalprocessesHealthactivities
diagnostics

18. Definitions of health
Based on the previous eight types of definitions for health
can be formulated :
Health as a state ‫حالة‬
Health as a feature ‫خاصية‬
Health as a process ‫عملية‬
Health as a social category (value, purpose) ‫اجتماعية‬ ‫فئة‬
Health as a human right ‫انساني‬ ‫حق‬
Health as a total of statistical features ‫خصائص‬ ‫اجمالي‬
‫احصائية‬
Health as a measure of vitality (quality of life) ‫مقياس‬
‫للحيوية‬
Health as an integral category ‫متكاملة‬ ‫فئة‬

19. DEFINITIONS OF HEALTH
 “Health is a state of complete physical, mental,
social well-being and not merely the absence of
disease or infirmity.” WHO
‫ال‬ ‫واالجتماعية‬ ‫والعقلية‬ ‫الجسدية‬ ‫الرفاهية‬ ‫من‬ ‫حالة‬ ‫هي‬ ‫الصحة‬‫كاملة‬
‫العجز‬ ‫أو‬ ‫المرض‬ ‫غياب‬ ‫مجرد‬ ‫وليس‬."
 In recent years, this definition has been amplified
to include “the ability to lead socially and
economically productive life”.
19

20. DEFINITIONS OF HEALTH
 WHO refers health as situation that may exist in
some individuals but not in everyone all the
time, it is not usually observed in a groups of
human beings and in communities. Nobody is
qualified as completely healthy, i.e., perfect
biological, psychological and social
functioning all the time.
 That is, if we accept the WHO definition, we are
all sick.
20

21. NEW PHILOSOPHY OF
HEALTH
Health is a fundamental human right.
Health is essence ‫جوهر‬of productive life.
Health is inter- sectoral.
Health is integral part of development.
Health is central to quality of life.
Health involves individuals, state and international
responsibility.
Health and its maintenance is major social
investment.
Health is world-wide social goal.
21

22. Health as a condition or process
 Health can be defined as a state only in a brief
(and measurable) moment, but in its essence it
is a continuous process of change in different
conditions (but not just a sum of them).
 Health is a process of constant change of states,
influenced by extrinsic and intrinsic factors and
aimed at maintaining the integrity of the
individual and achieving optimal balance.

23. Health Equity
•Health equity is the fair distribution of
health determinants, outcomes, and
resources within and between segments
of the population, regardless of social
standard
•The opportunity for everyone to attain his or
her full health potential

24. 24

25. 25

26. Inequity versus inequality
Health inequity: unjust differences in
health between persons of different
social groups; a normative concept
Health inequality: observable health
differences between subgroups within a
population; can be measured and
monitored
Handbook on Health Inequality Monitoring26 |

27. 27

28. What are the differences between
health inequalities & health
disparities???
28

29. Health as a combination of statistical
features
 Can health be measured?
 How can it be assessed and validated?
 When it is sure to say that an individual is
healthy or ill ? What are the indicators for this?

30. Assessment of individual health status
Personal data:age, gender, ethnicity, education,
family status;
Occupational history;
Family history;
Personal history;
Functional status;
Risk factors: family predisposition, high blood
pressure, diabetes, smoking, alcoholism,
sedentary life, fats rich diet, occupational
stress, etc.;
Present diseases; complaints

31. Physical examination;
Differential diagnosis;
Other medical problems;
Tests: lab, imaging, ECG. etc.
Provisional diagnosis;
Treatment and its effect;
Final diagnosis;
Other medical problems and treatment
consequences;
Condition follow-up;
Long term health care – plan.
34

32. INDICATORS OF HEALTH
‫الصحة‬ ‫معايير‬
Health Indicator: A variable which helps
to measure health changes directly or
indirectly (WHO,1981).
The health indicators measure the health
status of an individual and a
community.
35

33. Indicators of
health
Morbidity Mortality Disability
Sullivan’s
index
HALE DALY
36

34. INDICATORS OF HEALTH
 Mortality Indicators: Crude Death rate, Life
Expectancy, Infant mortality rate, Child
mortality rate, Under five mortality rate,
Maternal mortality ratio, Disease specific
mortality, proportional mortality rate etc.
 Morbidity Indicators: Incidence and
prevalence rate, disease notification rate,
attendance rate, Admission, readmission and
discharge rate, duration of stay in hospital and
spells of sickness or absence from work or
school. 37

35. INDICATORS OF HEALTH
Disability Indicators: Sullivan's index, HALE
(Health Adjusted Life Expectancy), DALY
(Disability Adjusted Life Year).
 Sullivan's index is an expectation of life free from
disability.
HALE is the equivalent number of years in full
health that a newborn can expected to live based on
the current rates of ill health and mortality.
DALY expresses the years of life lost to premature
death and years lived with disability adjusted for the
severity of disability. 38

36. INDICATORS OF HEALTH
 Nutritional Status Indicators: Anthropometric
measurement of preschool children, Prevalence of
low birth weight …….etc.
 Health Care Delivery Indicators: Doctor-
population ratio, Bed-nurse ratio, Population-bed
ratio, Population per health facility ……etc.
 Utilization Rates: immunization coverage, ANC
coverage, % of Hospital Deliveries, Contraceptives
prevalence rate, Bed occupancy rate, average
length of stay in hospital and bed turnover rate
……..etc.
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37. INDICATORS OF HEALTH
 Indicators of social and mental health: Rates of
suicides, homicides, violence, crimes, drug abuse,
smoking and alcohol consumption ……etc.
 Environmental indicators: proportion of population
having access to safe drinking water and improved
sanitation facility, level of air pollution, water
pollution, noise pollution ……etc.
 Socio Economic Indicators: rate of population
increase, Per capita income, Dependency ratio, Level
of unemployment, literacy rate, family size…… etc.
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38. INDICATORS OF HEALTH
 Health policy Indicators: proportion of growth
national product (GNP) spent on health
services, proportion of GNP spent on health
related activities …..etc. and proportion of
total health resources devoted to primary health
care.
 Indicators of Quality of Life
41

39. Health Impact Assessment
(HIA)
A combination of
procedures, methods and
tools by which a policy,
programme or project
may be judged as to its
potential effects on the
health of a population,
and the distribution of
those effects within the
population

40. WHAT ARE THE HEALTH
DETERMINANTS?
43

41. Determinant factors of health
‫للصحة‬ ‫المحددة‬ ‫العوامل‬ ‫او‬ ‫الصحة‬ ‫محددات‬
Factors related to way of life and life
style
Genetic factors (hereditary)
Environmental factors

42. Strength of association in % of different
determinants of health
100 %0 %
Genome – 10%
Health service – 10 %
Lifestyle – 20%
Physicochemical environmental factors – 10%
Socio-economic factors – 50%

43. Communities
Individuals
Families
Societies
46
DETERMINANTS OF HEALTH

44. DIMENSIONS OF HEALTH
‫الصحة‬ ‫أبعاد‬
Health is multidimensional.
World Health Organization (1984) explained
health in four dimensional perspectives:
physical, mental, social and spiritual.
Besides these many more may be cited, e.g.
emotional, vocational, political,
philosophical, cultural, socioeconomic,
environmental, educational, nutritional,
curative and preventive.. 47

45. PHYSICAL DIMENSION
 Physical dimension views heath from
physiological perspective.
 Physical health can be assessed at community
level by the measurement of morbidity and
mortality rates.
48

46. MENTAL DIMENSION
 Ability to think clearly and coherently. This
deals with sound socialization in communities.
 Mental health is a state of balance between the
individual and the surrounding world, a state of
harmony between oneself and others,
coexistence between the relatives of the self
and that of other people and that of the
environment.
 Mental health is not merely an absence of
mental illness.
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47. SOCIAL DIMENSION
It refers to the ability to make and maintain
relationships with other people or
communities.
It states that harmony and integration within and
between each individuals and other members of
the society.
Social dimension of health includes the level
of social skills one possesses, social functioning
and the ability to see oneself as a member of a
larger society.
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48. SPIRITUAL DIMENSION
 Spiritual health is connected with religious
beliefs and practices. It also deals with personal
creeds ‫الشخصية‬ ‫,العقائد‬ principles of behavior and
ways of achieving peace of mind and being at
peace with oneself.
 It is intangible “something” that transcends ‫تسمو‬
physiology and psychology.
 It includes integrity, principle and ethics, the
purpose of life, commitment to some higher
being, belief in the concepts that are not subject
to “state of art” explanation.
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49. CONCEPT OF DISEASE
 Webster defines disease as “a condition in
which body health is impaired, a departure from
a state of health, an alteration of the human body
interrupting the performance of vital functions”.
 The oxford English Dictionary defines disease
as “ a condition of the body or some part or
organ of the body in which its functions are
disturbed or deranged ‫.”خلل‬
52

50. CONCEPT OF DISEASE
 From ecological point of view, disease is
defined as “a maladjustment of the human
organism to the environment.”
 The simplest definition is that disease is just
the opposite of health: i.e. any deviation from
normal functioning or state of complete
physical or mental well-being.
53

51. Distinction between Disease,
Illness and Sickness
 Disease is a physiological/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 being ill
(sickness role).
54

52. Quiz
 Explain the difference between disease,
illness, & sickness?????????
55

53. CONCEPT OF WELLBEING
 Wellbeing of an individual or group of
individuals have objective (standard of living)
and subjective (quality of life) components.
56

54. STANDARD OF LIVING
‫المعيشي‬ ‫المستوى‬
 Income and occupation, standards of
housing, sanitation and nutrition, the level
of provision of health, educational,
recreational and other services all be used
individually as measures of
socioeconomic status, and collectively as
an index of the standard of living.
SES
57

55. LEVEL OF LIVING
It consists of nine objective components:
food consumption, education, occupation,
working conditions, housing, social
security, clothing, recreation and leisure
human rights.
58
Level of
living
Health

56. Quiz
What are the variables on which we could
classify SES in Egypt?????????????
59

57. QUALITY OF LIFE
A composite subjective measure of
physical, mental and social wellbeing as
perceived by each individual or by group of
individuals
e.g. happiness, satisfaction and gratification
as it is expressed in such life concerns as
health, marriage, family work, financial
situation, educational opportunities, self-
esteem ‫الذات‬ ‫,احترام‬ creativity,
belongingness ‫,االنتماء‬ and trust in others.
60

58. RESPONSIBILITY FOR HEALTH
Individual responsibility: self care for
maintaining his own health, adoption of
healthy life style
Community responsibility: health care for
the people to the health care by the people.
State responsibility: constitutional
rights. ‫دستورية‬ ‫حقوق‬
International responsibility:
Health for All through PHC.
61

59. Levels of prevention
62

60. PREVENTION OF DISEASES
 Primordial prevention
 Primary prevention
 Secondary prevention
 Tertiary Prevention
63

61. 64
Levels of
Prevention:

62. Prevention by intervention
 Intervention is any attempt to intervene or interrupt
the usual sequence in the development of disease.
Five modes of intervention corresponding to the
natural history of any disease are:
Health Promotion ‫ترقية‬-‫الصحة‬ ‫تعزيز‬
Specific Protection
Early Diagnosis and Treatment
Disability Limitation
Rehabilitation
65

63. LEVELS OF PREVENTION
I-Primordial Prevention: health promotion
Prevention of emergence or development of
Risk Factors.
Prevention from Risk Factors.
Discouraging harmful life styles.
Encouraging or promoting healthy eating
habits (to prevent obesity in childhood) .
Not focused to specific disease
66

64. LEVELS OF PREVENTION
II-Primary Prevention:
 Action taken prior to the onset of the disease
 Pre-pathogenesis Phase of a certain disease.
68

65. SPECIFIC PROTECTION
 Immunization
 Use of specific Nutrients
 Chemoprophylaxis
 Protection against Occupational Hazards
 Avoidance of Allergens
 Control of specific hazards in general
environment
 Control of Consumer Product Quality & Safety
69

66. LEVELS OF PREVENTION
III-Secondary Prevention:
 Halt the progress of a disease at its incipient
phase ‫اولية‬ ‫.مرحلة‬
 Early diagnosis & Adequate medical
treatment.
70

67. Secondary prevention = CONTROL
DISEASE CONTROL: aimed at
reducing:
The incidence of disease.
The duration of disease and the
consequently the risk of transmission.
Physical and psychological
complication.
The financial burden to the community.
71

68. CONCEPT OF CONTROL
ELIMINATION: Reduction of case
transmission to a predetermined very low level or
interruption in transmission. E.g. measles, polio,
leprosy from the large geographic region or area.
ERADICATION: Termination of all
transmission of infection by extermination of the
infectious agent through surveillance and
containment. “All or none phenomenon”. E.g.
Small pox
72

69. CONCEPT OF CONTROL
 MONITORING: Defined as “the performance
and analysis of routine measurement aimed at
detecting changes in the environment or health
status of population.” e.g. growth monitoring of
child, Monitoring of air pollution, monitoring of
water quality……. etc.
 SURVEILLANCE: Defined as “the continuous
analysis of the factors that determine the
occurrence and distribution of disease and other
conditions of ill health.” e.g. Poliomyelitis
surveillance programme of WHO.
73

70. IV-Tertiary Prevention:
 Intervention in the late Pathogenesis Phase.
 Reduce impairments, minimize disabilities &
suffering.
74

71. DISABILITY LIMITATIONS
The Objective is to prevent or halt the transition
of the disease process from impairment to
handicap.
 Sequence of events leading to disability &
handicap:
Disease → Impairment → Disability→
Handicap
75

72. 76

73. DISABILITY LIMITATIONS
Impairment: Loss or abnormality of
psychological, physiological/
anatomical structure or function.
Disability: Any restriction or lack of ability to
perform an activity in a manner considered
normal for one’s age, sex, etc.
Handicap: Any disadvantage that prevents one
from fulfilling his role considered normal.
77

74. REHABILITATION
Rehabilitation has been defined as the
‘combined and coordinated use of medical,
social, educational and vocational measures for
training and retraining the individual to the
highest possible level of functional ability”
Areas of concern in rehabilitation:
 Medical Rehabilitation
 Occupational Rehabilitation
 Social Rehabilitation
 Psychological Rehabilitation
78

75. Quiz
 Distinguish between different levels of
prevention. Illustrate with
example???????????????/
79

76. Alternative ten tips for better
health
1. Don't be poor. If you can, stop. If you can't, try not to
be poor for long.
2. Don't live in a deprived area, if you do move.
3. Be able to afford to own a car.
4. Don't work in a stressful, low paid manual job.
5. Don't live in damp, low quality housing or be homeless.
6. Be able to afford to go on an annual holiday.
7. Don’t be a lone parent.
8. Claim all benefits to which you are entitled.
9. Don't live next to a busy major road or near a polluting
factory.
10. Use education to improve your socio-economic
position.

77. Finally we have finished the lecture
81
Best Wishes
Thank you