Concepts of Health & Disease

Lecture Objectives:
At the end of the lecture the students are expected to 1- To Define the terms : Health Disease Illness/ sickness 2- To know the general factors affecting health status 3- To know the general factors affecting illness perception and illness behavior 4- To know the relation between and magnitude of illness and disease 5- To know the different indicators used to measure Quality of Life and Wellbeing

Concept of Health
Health is a common theme in almost all countries absence of disease Health = harmony = being in peace with self, community, god and cosmos body equilibrium with humors

Historical background
Health was neglected after WW1 in the League of Nation, added later. Same happened after WW2 in the United Nation Charter. Later W.H.O was for established and constitution approved in 1948 . 1977 The 30th World Health Assembly the attainment by all citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life HFA/2000 ( Health For All by Year 2000) 1979 UN Health is an Integral part of the Socio- economic Development plans

Definition of disease, illness, and sickness

The Oxford English Dictionary defines disease as a condition of the body or some part or organ of the body in which its functions are disrupted or deranged. From an ecological point of view, disease is defined as a maladjustment of the human organism to the environment.

The WHO has defined health but not disease.

Defining Health:
1- The WHO Definition Health is the complete of status of physical, mental and social wellbeing and not only the absence of disease or infirmity A Healthy Person is leading a socially and economically active live"

2- Health is the presence of a positive capacity to lead energetic satisfying and productive life.

3 -Ecological definition: health is a state of optimal physical, mental and social adaptation to ones environment.

Health is a relative, not an absolute concept-always involves many levels or degrees

Changing Concepts of Health

1- Biomedical : health is the absence of disease- Germ theory of disease. Minimized the role of : Environmental, Social, Psychological, Economic, Cultural and other determinants. Germ theory could not solve : Nutritional, Chronic diseases, Accidents, Substance abuse, Psychological diseases, pollution, population explosion and other health non communicable health problems.

Changing Concepts of Health

2- Ecological Concept: Health is an Dynamic Equilibrium between Man and his Environment. Imbalance results in Disease. ( Imperfect man and Imperfect Environment) ** Adaptation of Man to his Environment leads to better health and longer life expectancy even in the absence of Modern health services.

Changing Concepts of Health

3-Psychosocial concept: Biomedical ( Biological) in addition to: Psychological, Social, Cultural , Economic, Political factors 4-Holistic concept: Include all the factors of the other concepts in addition to all human activities such education, communication, agriculture, industry, housing , recreation etc Emphasis on Promotion and Protection of Health

Definition of disease, illness, and sickness

Disease, illness, and sickness are not synonymous. The term disease literally means without ease, the opposite of easewhen something is wrong with bodily function.( Professional definition based on a pathological process- OBJECTIVE) Illness refers to the individuals perceptions and behavior in response to being ill ( loss of function , not feeling well- SUBJECTIVE) Sickness refers to a state of social dysfunction.( from disease or illness)

Definition of disease, illness, and sickness

Disease is a physiological/psychological dysfunction defined professionally Illness is a subjective state of the person who feels aware of not being well Sickness is a state of social dysfunction based on professional and social agreement

Sick Role
( If a person is diagnosed as patient by a health professional (Disease) or considered ill by family or community ( Illness )- is labeled as SICK such person has TWO RIGHTS associated with TWO DUTIES RIGHTS : 1- exempt from usual responsibilities. 2- not expected to take care or get well by himself DUTIES : 1 -should want to get well 2- should seek expert advice and make effort to get well

Health-sickness spectrum

There are degrees or levels of health as there are degrees or severity of illness.
positive health better health freedom from sickness unrecognized sickness mild sickness severe sickness death

SPECTRUM OF ILLNESS EPISODES

Out of 1000 adults at risk IN PERIOD OF 2 4 WEEKS : - 750 report a sickness episode ( ILLNESS ) - 250 of them consult health professionals ( the other 500 persons took other actions Enumerate other actions ) - 9 of the 250 persons are admitted to general hospitals - 5 of them referred to a specialized hospital - 1 of them admitted in the Intensive Care Unit

General factors affecting health and illness

Physical health means perfect functioning of the body. All the organs of the body are of average size and function normally; all the special senses are intact; the resting pulse rate, BP and exercise tolerance are all within the range of normality for the individuals age and sex.
Genetic make-up, age, developmental level, race and sex are all part of an individuals physical dimension Ex: A young woman who has a family history of breast cancer and diabetes and therefore is at higher risk to develop these conditions.

1- Physical dimension:

General factors affecting health and illness

Defined as the state of balance between the individual and the surrounding world, a state of harmony between oneself and others.
Psychological factors can induce all kinds of illness, not simply mental ones(give examples). Long term stress affects the body systems; conversely, calm and relaxation can actually change the body response to illness.

2-Mental dimension

General factors affecting health and illness

Mental dimension (cont.)
The following characteristics are attributes of a mentally healthy person: a) he is free from internal conflicts, b) he accepts criticism, c) he searches for identity, d) he has a strong sense of self-esteem, e) he knows himself, f) he has a good self-control, g) he faces problems and tries to solve them.

General factors affecting health and illness

Social well-being implies harmony and integration within the individual, between each individual and other members of the society and between individuals and the world in which they live.
Health practices and beliefs are strongly influenced by a persons economic level, life style, family and culture. Low-income groups are less likely to seek health care to prevent or treat illness; high-income groups are more prone to stress-related habits and illness

3-Social and economic dimensions

General factors affecting health and illness

It includes principles and ethics, the purpose in life, religious beliefs and values; all are important components of the way the person behaves in health and illness.

4-Spiritual dimension

When work is fully adapted to human goals, work often plays a role in promoting both physical and mental health. The importance of this dimension is exposed when individuals suddenly lose their jobs or retire.

5-Vocational dimension

Environmental, educational, nutritional..

6-Other dimensions

Summary of factors affecting health status ( ENVIRONMENT)

1-INTERNAL ENVIRONMENT : hereditary, congenital personal behavior - acquired risk factors :smoking , eating , driving habits attitudes, values

2-EXTERNAL ENVIRONMENT : More important than internal environment 2.1PHYSICAL , geographical , place, man made housing , transportation, communication, work environment, pollution 2.2.BIOLOGICAL , living agents microorganisms, macro organisms, animals, plants 2.3-SOCIO/ECONOMIC , education, income, health services availability, accessibility, utilization. This is the most important environment.( Many Dimensions are included : Social, Psychological, Spiritual, Emotional, Vocational , Cultural, Philosophical, Environmental, Nutritional , Curative and Preventive Services)

Stages of illness behavior

STAGE 1: SYMPTOM EXPERIENCE The person is aware that "something is wrong". A person usually recognizes change such as pain, a rash or a limitation in functioning but does not suspect a specific diagnosis.

Stages of illness behavior

STAGE 2 : ASSUMPTION OF THE SICK ROLE If symptoms persist and become severe, clients assume the sick role. At this point the illness becomes a social phenomenon, and sick people seek confirmation from their families and social groups that they are indeed ill and that they be excused from normal duties and role expectations.

Stages of illness behavior

STAGE 3: MEDICAL CARE CONTACT If symptoms persist despite the home remedies, become severe, or require emergency care, the person is motivated to seek professional health services.

Stages of illness behavior

STAGE 4 : DEPENDENT CLIENT ROLE The client depends on health care professionals for the relief of symptoms. The client accepts care, sympathy and protection. A client can adopt the dependent role in a health care institution, at home, or in a community setting. The client must also adjust to the disruption of a daily schedule.

STAGE 5 : RECOVERY AND REHABILITATION This stage can be full recovery . In the case of chronic illness, the final stage may involve in an adjustment to a prolonged reduction in health and functioning.

New philosophy of Health

*Fundamental right *Interesctorial *Integral part of Development *Central to Quality of Life *Involves Individuals, Families, Communities Local, National and International responsibilities *Social Investment *World wide Social Goal.

Concept of Wellbeing
1*Standard of Living ( Expenditure, Consumed goods, Services enjoyed, Educational level, Employment status, Food, Dress, Housing, Recreational activities and Facilities 2*Level of Living : used by UN consists of Nine components :Health, Food consumption, Education, Occupation and working conditions, Housing, Social security, Clothing, Recreation , Leisure and Human Rights. Health is the Most Important of All of them

Concept of Wellbeing
3*-Quality of Life : Subjective Component of Wellbeing. Perception by the individual or a group of individuals . Level of Living is based on Objective Criteria , Quality of Life is based on the Person own Subjective evaluation of these criteria in form of levels of happiness , Satisfaction etc..

Physical Quality of Life Index PQLI

One Composite Index consisting of : 1-Infant Mortality Rate IMR 2-Life Expectancy at age ONE 3-Literacy rate Each is given Equal Weight . The Total Score is 100 which is the Best performance and 0 the Worst performance

Human Development Index HDI

One Composite Index Range from 0 1 Minimum to Maximum . consisting of : 1-Life Expectancy at age Birth- (Minimum 25 Maximum 85 years) 2-Knowledge (Adult Literacy and Mean Years of Schooling ) Minimum 0% Maximum 100 %)( 3- Income ( Real Gross Domestic Product GDP per capita ).(Minimum US$100 , Maximum US$40000 )

New Concepts
Gender- Related Development Index (GDI) Gender Empowerment Measure (GEM) They reflect gender inequalities human development or economic and political opportunities.

Human Poverty Index HPI

HDI measures average ACHIEVEMENTS in basic dimensions of human development HPI measures DEPRIVATION in those dimensions

Thank you

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