Dr Siham Gritly 1

2 Community medicineConcept of health and disease

Prepared by; Dr. Siham Gritly

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Concept of health

• Biomedical Concept- “absence of disease”• Limitation- it has minimized the role of

environmental, social, psychological & cultural determinants 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.

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

• Holistic Concept – biomedical + ecological + psychosocial concept.

• Holistic concept implies that, all sectors of society have an effect on health

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Definitions of Health

• Oxford dictionary; soundness of body or mind; that condition in which its functions are duly (accordingly) and efficiently discharged

• Webster's Dictionary; 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.”

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WHO Definition of health

• In 1948, in its constitution, the World Health Organization (WHO) defined health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity".

• In more recent years, this statement has been modified to include the ability to lead a "socially and economically productive life."

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new philosophy of health stated that

• -health is fundamental human right• -health is the essence of productive life and not the

result of ever increasing expenditure on medical care• -health is inter-sectoral • -health is an integral part of development• -health is central to the concept of quality of life• -health involves individual, state and international

responsibility• -health is the major social investment Physical

component

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Dimensions of health

• Health is multidimensional,

• Physical, mental, social, spiritual, emotional, vocational…..

• all health dimensions function and interact with one another, but each has its own nature.

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WHO specified specific dimensions, those are;

• *physical dimension; perfect function of the body and its systems

• *mental dimension; mental health defined as "a state of balance between individual and its surrounding"

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• *social dimension; concern with social well-being of the society. It is the interaction of individual to each other and between individuals to the communities.

• It is defined as "quantity and quality of an individual's interpersonal ties and the extend of involvement within the community".

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• Other dimensions such as;• *spiritual dimension; it is intangible

something• *emotional dimension; emotional relates to

feeling • *vocational dimension; or work dimension

which has very critical and important role in promoting physical and mental performance.

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Concept of social well-being

• Social wellbeing of an individual as suggested by psychologists have objective and subjective components;

• -the objective components relates to the term standard of living or level of living.

• The subjective is related the quality of life

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Standard of living

• Refers to the goods we consume and the service we enjoy.

• Standard of living as defined by WHO: “Income & occupation, standard of housing, sanitation and nutrition, the level of provision of health, educational, recreational and other services.

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Level of living• Level of living or standard of living as proposed by the

United Nation is that it consist of nine components • Health, • Food consumption, • Education, • Occupation and working condition• Housing,• Social security• Clothing• Recreation and leisure (freedom)• Human right

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Quality of life

• Quality of life defined by WHO as;• "the condition of life resulting from the

combination of the effect of complete range of factors such as those determining health, happiness, education, social and intellectual attainment, freedom of action, justice and freedom of expression.

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• factors such as• determining health, • happiness, • education, • social and intellectual attainment,• freedom of action,• justice and freedom of expression.

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• Another definition of quality of life is that.• "a composite measure of physical, mental and

social wellbeing as perceived by each individual or by group of individual, that is to say, happiness, satisfaction and gratification as it is experience in such life concerns as health, marriage, family work, financial situation, educational opportunities, self esteem, creativity, belongingness and trust in others."

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Physical Quality of Life Index PQLI

• The Physical Quality of Life Index (PQLI) is an attempt to measure the quality of life or well-being of a country. The value is the average of three statistics: basic literacy rate, infant mortality, and life expectancy at age one, all equally weighted on a 0 to 100 scale.

• 1-Infant mortality• 2-Life expectancy at age one and • 3-Literacy• Scale 0 to 100 = worst to best

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Steps to Calculate Physical Quality of Life:

• 1) Find percentage of the population that is literate (literacy rate).

• 2) Find the infant mortality rate. (out of 1000 births) INDEXED Infant Mortality Rate = (166 - infant mortality) × 0.625

• 3) Find the Life Expectancy. INDEXED Life Expectancy = (Life expectancy - 42) × 2.7

• 4) Physical Quality of Life = • (Literacy Rate + INDEXED Infant Mortality Rate +

INDEXED Life Expectancy) over 3

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Human Development Index (HDI)

• A tool developed by the United Nations to measure and rank countries' levels of social and economic development based on four criteria:

• 1-Life expectancy at birth,• 2-mean years of schooling,• 3-expected years of schooling • 4-gross national income per capita. • The HDI makes it possible to track changes in

development levels over time and to compare development levels in different countries.

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• Combines indicators representing 3 dimensions• Longevity – Life expectancy at birth• Knowledge – adult literacy rate & mean year of

schooling.• Income – real (Gross Domestic Product) GDP

Per Capita in Purchasing Power• Index = (Actual value) – (Minimum Value)• (Maximum value) – (Minimum Value)

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• The monetary value of all the finished goods and services produced within a country's borders in a specific time period, though GDP is usually calculated on an annual basis.

• GDP is commonly used as an indicator of the economic health of a country, as well as country's standard of living.

• It includes all of private and public consumption, government outlays, investments and exports less imports that occur within a defined area.

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Human Poverty Index

• The Human Poverty Index (HPI) was an indication of the standard of living in a country, developed by the United Nations (UN)) and was first reported as part of the Human Development Report in 1997.

• The HPI concentrates on the deprivation in the three essential elements of human life already reflected in the HDI:

• Longevity, • Knowledge • Standard of living.

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• The HPI is derived separately for developing countries and a group of select high-income countries to;

• better reflect socio-economic differences• and the widely different measures of

deprivation in the two groups

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Spectrum of health

• There is no cut of point among health and disease

• The lowest point on the health-disease spectrum is death and a highest point is positive health

• Positive health describes a state beyond the simple absence of disease.

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Positive health predicts increased longevity, decreased health costs, better mental health in aging, and better prognosis when illness strikes

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The determinants of health

• There are some factors, which affect health, or factors contributing to health;

• *biological determinants, such as genetic in origin.

• *behavioral and socio-cultural factors, such as lifestyle (the way of living), behavioral, attitudes.

• *environmental factors, such as water, climate air and others

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• Environment; classified as• internal environment• External environment

• Aging and gender

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• *socio-economic conditions, such as economical status of the individual or society additional to educational, occupational, or political systems

• *provision of health services, mainly in developing countries where lack of proper health care services contribute negatively to the health of the communities

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The determinants of healthالمحددات

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references

• Park's Textbook of Preventive and Social Medicine 21 Edition, by K. PARK