I N T R OD U C TI ON T O H E A L T H

Health is the level of functional or metabolic efficiency of a living being.

In humans, it is the general condition of a person's mind, body and spirit, usually meaning to
be free from illness, injury or pain.
When the body is threatened or suffers an injury its response may involve functional that the
body can mount will determine between adaptation and maladaptation.

D E F I N I T I ON O F H E A L TH
The term health has been defined in a variety of ways.

Health is a state of complete physical, mental and social well being and not merely the
absence of disease or infirmity” - W H O

Health is a state of dynamic balance of an individual’s ability to perform personally valued

roles and responsibilities, to deal and cope with physical, biological, psychological and
social stresses and challenges thought the life while continuing to maintain sense of well
being” - According to I C N

D E T E R M I N A NT S OF H E A L T H

 HUMAN BIOLOGY
 ENVIRONMENT
 LIFESTYLE
 H E A L T H AND H E A L T H A L L I E D RESOURCES

 HUMAN BIOLOGY
 Genetic inheritance and physiological factors - Physiological factors involve
the physical functions of the body. Certain physical condition such as being
pregnant or overweight place an increased risk of stress on physiological
system increasing susceptibility to illness in that area.
 Hereditry or genetic predisposition to specific illness is a major physical risk factors. Eg.
A family history of diabetes mellitus is at risk of developing disease later in life. Other
genetic risk factor include family history of cancer,heart disease or mental illness.
 Age –Age increases or decreases susceptibility to get illness. Eg:An infant
born prematurely and neonates are more susceptible to infection. The risk of heart
increases with age for both sex.

 ENVIRONMENT
 Micro-environment -Refers to immediate environment or personal environment usually
include home environment, occupational environment, socio-cultural environment.
 Macro-environment -External environment which is outside the home environment.
 Physical environment-It includes housing; building structures and wide variety of
physical substances which directly or indirectly regulate body mechanism and affect
heath.
 Social environment-It includes other people and social institutions, socio-cultural
events, religious beliefs, moral and ethical values and social rules and regulations
pertaining to living in the society. The individuals develop certain practices which will
have positive and negative impact on heath.
  Biological environment-It is comprised of plant and animal kingdom which help in
maintaining the ecosystem and thereby heath of people.

 LIFE STYLE

L i f e style refers to the people’s ways of living which is reflective of their knowledge,
attitude and practices. It is composite of daily living activities, behavioural and cultural
practices including customs and traditions. e.g.-unhygienic practices, nutritional
deficiencies, smoking, alcoholism etc .

 H E A L T H AND H E A L T H AL L I E D RESOURCES
 Socio-economic conditions-It includes economic status, education, occupation and
living standard.
 Political system-It has a very strong role in promotion of people in the country. The
heath care delivery system is determined by the political system through there is
constitutional control.
 Heath related services-It includes education, food and agriculture, industry, rural and
urban development, social welfare and manpower development, communication and
broadcasting and transportation etc.

P A T H O - P H Y S I O L OG Y A N D P S Y C H O D Y N A M IC S O F D I S E A S E C AU S A T I O N

Disease

Disease is just the opposite of the health “Disease is a condition in which body health is
impaired, a departure from the state of health, an alteration of human body interrupting the
performance of vital functions” Webster.

The Oxf ord English Dictionary defines decease as, "a condition of the body or some part or
organ of the body in which its functions are disrupted or deranged.”

Pathophysiology

It is the physiology of altered health. The term combines pathology and physiology.
Pathology deals with the study of structural and functional changes and ph ysiology deals with
the functions of the human body.

Psychodynamics

 It is a systematized study and theory of the psychological forces that underlie human
behaviour, emphasizing the interplay between conscious & unconscious motivation.
 It is defined as human behaviour, either external or internal which can lead to its state
of health or disease.
 The original concept of psychodynamics was developed by “Sigmund Freud”.
Psychodynamics also known as dynamic psychology.It is the study of the
interrelationship of various part of mind, personality or psyche in relation to mental,
emotional or motivational forces.

C ON C E P T O F D I S E A S E C A U SA T I ON -

Includes theories of disease causation,pathogenesis and iceberg phenomenon.

Theories of disease causation:

 Old theories
 Germ theory of disease 
Biomedical model
 Theory of multifactorial causation 
Epidemiological triad
 Lazaru’s theories of stress response
 Wolff’s theory of stress, organ maladaptation and disease
 Holmes and Rahe’s theory of life change and the onset of il lness

 OLD THEORY
 Old Theories- T i l l the end of 18th century, various theories were in vogue, e.g.
supernatural theory of disease (e.g. curse of God; an evil eye).
 The Ayurveda considers that the disease is due to imbalance of the “tridoshas.” These
are Vata (air), pitta (bile) and kapha (mucus).
The Chinese medicine believes that the disease is caused due to imbalance of male
principle (yang) and female principle (yin).

 GERM THEORY
 The discoveries in microbiology became a turning point in the etiological concept of
disease.
 Louis Pasteur(1860) demonstrate the presence of bacteria in the air.
 Robert Koch (1877) showed the anthrax was caused by bacteria.
 These theories of Pasteur and Koch confirmed the germ theory of disease
 Thus the emphasis has shifted from empirical causes (like bad air as cause in
malaria)of the old theories to microbes of Germ theory.
 But now, it is recognized that a disease is rarely caused by a single agent alone, but
depends upon a number of contributory factors.

 BIOMEDICAL MODEL
 This model explains disease as a result of malfunctioning organs or cells .e.g. diabetes is
caused by malfunctioning of pancreas.
 But the drawback with it is that it focuses on cause and effect relationships, tends to
ignore the psychosocial component of the disease.

 THEORY OF MULTIFACTORAL CAUSATION

 This theory of multifactorial causation was put forth by Pettenkofer Munich (1819-
1901).
 Disease is not caused by an organism but predisposed by many factors contributing to its
occurrence, specially “modern diseases” of civilization
 These predisposing factors are:-social, economic, cultural, genetic, psychological
factors, etc.(including poverty, illiteracy, ignorance, poor living condition, over-crowed)
 This theory de-emphasizes the “Germ theory” (or single cause idea).
It is now known that most of these factors are so much linked to life-style and human
behavior, that they are considered as “Risk-factors”, in the web of causation of the
disease.

 WEB OF CAUSATION
 It was suggested b y M A C M A H O N and P U G H .
  This model is ideally suited in study of chronic diseases where disease agent is not
known but is outcome of interaction of multiple factors.
 It considers all predisposing factors of any type and there interrelationship with each
other. E.g Myocardial infarction.

 EPIDEMIOLOGICAL TRIAD
Environment which are equally important to determine whether or not disease will occur
in the exposed host. This demanded a broader concept of disease that synthesized the
basic factors of agent, host and environment.

 LAZARU’S THEORIES OF STRESS RESPONSE

According to him, in the process of coping , the individual shapes as well as responds to
a demand or stress which can have an impact on the client’s resistance to disease

 WOLFF’S T H E O R Y O F STRESS, ORGAN MALADAPTATION AND DISEASE

He studied people’s responses to chronic stressors, like a frustrating job or an unhappy
home life. He believed that a person’s total life situation, profoundly affects a person’s
susceptibility to disease

 HOLMES AND RAHE’S THEORY O F LIFE CHANGE AND THE ONSET O F

ILLNESS
 They explored the relationship between the amount if change in a person’s life and
subsequent illness.
 They discovered that the higher a person’s life change score, the greater the likelihood
that an illness would develop

PATHOGENIES O F TH E DISEASE

 Prepathogenesis phase 
Pathogenesis phase

 P R E P A T H O G E N ES I S P H A S E
 This phase refers to the period before the onset of disease. During this phase, interaction is
taking place among the three components of epidemiological triad namely agent, host and
environmen t, each representing the angle of triangle respectively.

 A s long as there is equilibrium among these three interacting factors, so long the person will
be healthy. Once the equilibrium is disturbed, disease process starts. In other words,
potentially we are all in pre-pathogenesis phases of many diseases, both communicable and
non-communicable.

Agent factor

 Physical agent-heat, cold, radiation, humidity

 Chemical agent-endogenous:urea, uric acid, calcium oxalate
 Exogenous:dust, allergens, gas
 Biological agent-viruses, bacteria etc
 Mechanical agent-friction, injury, accidents
Nutritional agent
 Host factor

 Age
 Sex
 Ethnicity
 Occupation 
Literacy rate
 Income
 Marital status
 Nutritional status
 Lifestyle factor

Environment factor

 Physical environment-air,water,soil,food
 Biological environment-plants,animals,insects, microbes
 Socio-cultural environment-death or divorce of parents, loss of employment, etc.

 PATHOGENESIS PHASE
 The pathogenesis phase begins with the entry of the disease "agent" in the susceptible
human host.
 The further events in the pathogenesis phase are clear-cut in infectious diseases, i.e.,
the disease agent multiplies and induces tissue and physiological changes, the disease
progresses through a period of incubation and later through early and late
pathogenesis.
 The final outcome of the disease ma y be recovery, disability or death.
 The pathogenesis phase may be modified by intervention measures such as
immunization and chemotherapy.
 The infection may be clinical or sub clinical, and when the sub clinical, the person
will not have a recognizable signs and symptoms but may spread the disease agent to
others, acting as a “carrier”, as in typhoid, diphtheria.
 When the person develops clinical signs and symptoms, he is called as a “clinical
case”.

ICEBERG PHENOMENON

 To this disease can be closely related with an iceberg. The floating tip of iceberg
represents what physician sees in the community i.e clinical cases.
 The vast submerge portion of the iceberg represents the hidden mass of disease i.e
latent, unapparent, presymptomatic and undiagnosed cases and carrier in the
community. The waterline represents the demarcation between apparent and
unapparent diseases.

Role of nurse in prevention of disease

 Participation in early diagnosis and treatment.
 Notification of certain specific diseases
 Identification of source of infection and method of spread
 Health education of people in general