Host : A person/ living animal that affords lodgment to agents of diseases under natural conditions. Demographic characteristics: age, sex ethnicity, etc. Biological characteristics: Genetic, Biochemical levels of blood, Physiological functions: BP, etc. Lifestyle characteristics: personality traits, living habits

Environment : All (living or non-living) that is external to the individual human host in which he is in constant interaction Physical: Air, water, soil, housing, Climate, etc. Biological: Insects, rodents, animals, plants, other human beings Psychosocial: Cultural values, habits, beliefs, attitudes, moral, social interaction, etc.

Risk factors: An attribute or exposure that is significantly associated with the development of the disease Ex. Ht. Disease: Smoking, high BP, elevated serum cholesterol, diabetes, obesity, lack of exercise

Risk factors: 1) Additive or synergestic (multiplicative) - smoking and aniline in the production of bladder cancer : additive -smoking and high BP in heart disease: synergistic 2) May be: a) Contributory – lack of physical exercise in heart disease OR b) Predictive (in statistical sense) – illiteracy in perinatal mortality

Risk factors: 3) May be: a) Modifiable – smoking, BP,obesity, physical fitness OR b) Non-modifiable – age, sex, family history, genetic factors 4) May be: a) Individual – age, sex, smoking OR b) Community – air pollution, water pollution, lack of basic sanitation, etc.

Spectrum of disease - Subclinical infection (inapparent) -Unrecognized sickness - Mild -Moderate - Severe - Death Disease -Graphic representations of variations in the manifestations of diseases -Spectrum of disease is best seen in diseases such as syphilis, leprosy

Iceberg of diseases ( Iceberg phenomenon)

1) Disease in a community may be compared to an iceberg 2) Floating tip of iceberg- what the physician sees - clinical cases with illness 3) Submerged portion represents the hidden mass of diseases – latent, inapparent, presymptomatic, undiagnosed, indignant

Iceberg of diseases ( Iceberg phenomenon) 4) Varies from disease to disease ; submerged portion greatest in non-communicable diseases – HPT, DM 5) Submerged portion – constitutes reservoir of infection 6) Major challenge is to detect the undiagnosed portion

Determinants Of Health Dr. Adinegara Bin Lutfi Abas

Health - absence of disease Disease -impairment of human body affecting vital functions

Determinants Of Health : Heredity Environment Lifestyle Socio-economic conditions Health and family welfare services

Heredity The genetic transmission of characteristics from parent to offspring The physical and mental traits of human being are determined by genes from conception Diseases of genetic origin: - chromosomal anomalies, errors of metabolism, mental retardation, etc.

Health from genetic stand-point “State of individual based upon absence of defects of genes and absence of any abnormality in respect to total amount of chromosome in karyotype.”

Environment All that is external to the individual human host.

Environment Physical Biological Psychosocial 1.Housing 2.Water supply 3.Waste treatment 4.Workplace conditions - lighting - ventilation - humidity 1.Domestic / wild animals 2.Vectors in propagation of diseases - mosquitoes, flies, rodents 3. Bacteria/ virus/ protozoa/ etc. Stress - workload - relationship with peers, family

Lifestyle “The way people live” Composed of cultural and behavioural patterns and personal habits (eg. Smoking, alcoholism) Lifestyle diseases – coronary heart disease, obesity, drug addiction, etc. However, take note of positive lifestyle factors: - exercise, adequate nutrition, etc.

The Healthy Lifestyle Campaign of the Ministry of Health was launched in Cardiovascular Diseases (1991) AIDS (1992) Food Hygiene (1993) Promotion of Environmental Health (2002).

Socio-economic conditions 1) Economic status 2) Education 3) Occupation 4) Other factors- political system

1) Economic status Per capita GNP most widely accepted measure of economic performance Determines purchasing power, standard of living, quality of life, family size, pattern of disease and deviant behaviour Strong correlation between GNP and life expectancy Affluence associated with obesity, CHD, diabetes

2) Education- Illiteracy coincides with poverty, malnutrition, ill- health, high infant and child mortality rates 3) Occupation – The unemployed shows a higher incidence of ill- health and death 4) Political system- Percentage of GNP spent on health (WHO recommends a minimum of 5%)

Health and family welfare services Purpose is to increase health status of population Include - immunization of children - provision of safe water supply - care of antenatal mothers and children - food quality control

An effective health service: 1) Must reach the social periphery 2) Equitably distributed 3) Accessible at a cost the country and the community can afford However there is NO correlation between medical density and life expectancy