Download - 7-12-2009 Basic Concept of Disease
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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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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
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