Ecologic models and levels of disease prevention

1.Ecologic models
Concept of multiple causation depicted in the following models: a. The Epidemiologic triangle b. The Web of causation c. The Wheel

The Epidemiologic triangle

TIME

Agent

Host

Environment

About the model

Agent- biological, chemical, physical, Environment- physical, social, economic, biologic Host characteristics- age, sex, race, genetic factors, personality TIME: accounts for incubation periods, duration and severity of illness

Interpretation of the model

The amount of disease in the community results from the interaction of the three components. If any of the components change, sufficient to affect the steady state, there would be changes in one of the following: a) a change in the frequency of diseases in the community b) a change in the pattern of disease with respect to the characteristics of person, place, or time

b.The Web of causation Features of the model Usefulness to the study of disease causation Interpretation of the model How the model compares with the other two models? How does the model illustrates multifactorial nature of disease?

c.The Wheel Features of the model Usefulness to the study of disease causation Interpretation of the model How the model compares with the other two models? How does the model illustrates multifactorial nature of disease?

Summary
Understanding disease and its causation does not hinge on a single cause. Many factors may influence the development of disease in addition to the direct cause. The investigation of cause is usually a complex exercise that involves both the identification of the characteristics of susceptible individuals and the types of exposures to external agents that are necessary for the diseases to occur. Ecological models illustrate ways in which more than one factor must be present for disease to develop in a host.

2. Levels of disease prevention

Primordial prevention
Health promotion Target lifestyle factors with high disease risk Target groups where risks are not yet high

Primary Prevention
Health promotion Health education Nutrition

Secondary Prevention
Early diagnosis Screening Case finding Arrest of disease process

Tertiary prevention
Treatment Rehabilitation

Personal development
Education Housing Recreation

Prompt treatment

Specific protection

Immunization
Personal hygiene Environmental controls Protection from occupational hazards and accidents

Framework for levels of prevention

Onset of disease (after exposure)

Healthy state

Preclinical disease

Clinical disease

Disease outcome