basic concept of disease

8/13/2019 Basic Concept of Disease

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BASIC CONCEPT OF DISEASE

Joko Mulyanto

Department of Publ ic Heal th & Community Medic ine

Jenderal Soedirman Sch ool o f Medic ine


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OUTLINE

The concept of health and disease

Natural history of disease

Determinants of health and disease


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Definition of Health

"a state of complete physical, mental, and socialwell-being and not merely the absence ofdisease or infirmity.(WHO, 1948).

"a state characterized by anatomical,physiological, and psychological integrity; abilityto perform personally valued family, work, andcommunity roles; ability to deal with physical,biological, psychological, and social stress; a

feeling of well-being; and freedom from the riskof disease and untimely death"(Stokes, Noren,and Shindell, 1982).


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Problems with the concept of health

Abstract and vague

Difficult to be measured.

Health is more dynamic state ratherthan static condition.

Encompass many dimensions.


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More approaches to the concept of

health

Ecological approach

The extent to which an individual ora group is able to realize aspirations

and satisfy needs and to change orcope with the environment. (Last,2000).

The equilibrium among humans andother living things that share theearth (harmony).


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Dimensions of Health

Physical, mental, social.

Absence of disease, illness, pain.

Reserve for coping with stress andillness

Functional ability to allow task to be

performed

Positive well-being

Conformity to expected norms.


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Concept of Disease

The boundary between health and

disease is fuzzy

Subjective and objective perception.

Sociological perspective


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Objective Perception of Disease

The impaired, endangered, lost of

individual and populations health.

Based on empirical and

experimental evidence specially in

modern medicine.

The deviation from the normal

distribution.

Judged by well-trained physician.


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Sociological Perspective

The concept of disease, illness, and

sickness.

Disease related to biomedical aspect,

diagnosed by physician, usually believedlocated in specific organ or system,

curable through specific treatment.

Illness is the personal experience of the

person who acknowledges that he or shedoes not feel well.


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Contd

Sickness refers to the social actions

taken by a person as a result of

illness or disease, such as taking

medication, visiting the doctor.

Patient feel illness, act sickness,

physician diagnose and treat

disease.


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Final Thoughts about Health &

Disease Concept

The concept of health and disease iscomplex, dynamic, and often unclear.

Many dimensions of health.

Positive Health. Clear and operable definition is need to

measure health.

There is no single-best indicator to

measure health. Health and disease are socially and

culturally mediated.


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Natural History of Disease

The progress of a disease process

in an individual over time, in the

absence of intervention.

Begin with accumulation of factors

causing disease.

End with recovery, disability, or

death.


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Contd


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Stages of Natural History of Disease

Susceptibility

Risk factor (modified, unmodified),exposure of agent.

Sub-clinicalIn apparent pathological changes,incubation / latency period (detectable).

Clinical

Sign and symptom, physiological andanatomical disorder. Clinicalmanifestation and disease spectrum.


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Contd

Recovery & Disability

Limitation of daily activity;

- Physical or mental functional

disorder.

- Temporary or permanent

- Short or long term.


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Factors Influencing Disease

Spectrum (Infectious Disease)

Infectivity

% person exposed become infected

Pathogenicity

% person infected develop clinical

disease

Virulence% person with clinical disease

become severely ill or death


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The Importance of Natural History of

Disease

Basis of disease prevention


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Determinant of Health and Disease

Epidemiological Triangle / Triad

Conceptual cause and component

pies.

Biomedical model

Force field & well-being paradigm of

health

Health field model

Social model of health


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Epidemiologic Triangle


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Contd

Traditional model of infectious diseasecausation.

External agent

microorganism, physical chemical agent.

Susceptibility of hostintrinsic factor; age, sex, behavior,genetic, SES.

Environmental

extrinsic factor, affect agent & facilitateexposure. Physical, Biological,Socioeconomic.

C t l d t


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Conceptual cause and component

pies


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Contd

Specially for non infectious disease.

Multi-factorial causes.

Sufficient cause

Necessary cause


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Biomedical Model

Traditional view

Separate body and mind

The determinant is the provision of

healthcare Disease or illness appear when body fail

to function due to many causes.

Health is no presence of somatic sign &symptom, and the absence of disease.


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Health Paradigm (Blum, Lalonde)

Heredity

Environmental

Lifestyle

Medical care


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Health Field Model (Evans &

Stoddard)

Expanded model of health paradigm

9 components: social environment,

physical environment, genetic

endowment, individual response,healthcare, health & function,

disease, well-being, prosperity

Dynamic interrelationship

Population health


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Contd


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Social Model of Health (Dahlgren &

Whitehead)

Multiple determinants

Five layers

Nested each other, not as separate

entities.


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Contd


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T H A N K Y O U

djokomoeljanto2007

basic concept of disease

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