1. Fundamental Causes of Ill-Health
Aim
What is Health?
Articulate the root causes of disease
=>Biomedical, Lifestyle & Social
Views of health & healthcare access
a. Health as a privilege
b. Health as a human right
My goal for this portion of the lecture is to discuss the fundamental cause of morbidity and mortality and articulate at least 2 competing perspectives on healthcare access and utilization.

2. “What is Health?”
Health: a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
(WHO, 1948)
Disease: a biomedically-defined affliction which can be scientifically verified as a malfunction of body organs or systems.
Illness: an individual’s subjective sense of being unwell.

3. Biomedical Determinants Life Style Determinants Social Determinants
ROOT CAUSES OF DISEASE
Biomedical Determinants
Life Style Determinants
Social Determinants

4. Summary Table for Discussion
Biomedical
Lifestyle
Social
Focus
Health promotion Objective
Level of Intervention
Mode of Intervention
Strength
Limitation

5. I. Biomedical Determinants
Centerpiece: role of biological agents- bacteria, viruses and microbes in human disease.
HIV infection => AIDS,
M. tuberculi infection => TB
Plasmodium sp = > Malaria
Health Promotion Objectives:
Identify microbes and toxins responsible for disease
Understand How microbes cause disease
Eliminate disease using strategies tailored to each pathogen in affected individuals.

6. Biomedical Tips for Good Health
When sick go to the doctor
Follow medical advise and obtain required screening and diagnostic work-up
When you are given medicines to treat your disease – take them as instructed.
Perform the necessary follow-up with your Doctor or health care professional.

7. Limitations of the Biomedical Perspective
…..Does not address disease in its societal context or from the population perspective.

8. II. Behavioral or Life-Style Determinants of Health
Focus: Role of human behaviors/factors in health promotion and ill health
Smoking => cancer
No exercise => obesity
Health Promotion Objectives
Identify human factors important for health
Educate persons/individuals at Risk
Prevent disease

9. Assumptions of the Life Style Framework
Individuals in the society have a choice.
Individuals can be provided incentives to make salutary or healthful choices
Primarily effected through education
With the right information most individuals have the capacity to make the changes necessary to improve their health.

10. And So…. The emphasis for disease prevention is on the individual.
Educational awareness is at the corner stone of effective disease prevention in the life-style framework.
The fact that even among the poor, individuals with higher education experience better health provides evidence in support of the notion that education not only confers the benefit of power, but is a powerful contributor to good health and well-being.

11. Important Contribution of the Life Style / Biomedical Perspective
Ascribes power and agency to the individual
Encourages individuals to be proactive about their health by putting them in the driver seat for change.

12. Ten Tips For Better Health - Donaldson, 1999
1. Don't smoke. If you can, stop. If you can't, cut down.
2. Follow a balanced diet with plenty of fruit and vegetables.
3. Keep physically active.
4. Manage stress by, for example, talking things through and making time to relax.
5. If you drink alcohol, do so in moderation.
6. Cover up in the sun, and protect children from sunburn.
7. Practise safer sex.
8. Take up cancer screening opportunities.
9. Be safe on the roads: follow the Highway Code.
10. Learn the First Aid ABC : airways, breathing, circulation.

13. Limitations of the Life Style Framework
Makes some strong assumptions:
Most people have a choice
Most people have the knowledge and wherewithal to be display constructive and effective health agency.
Could encourage blame for individuals or groups deemed to make irresponsible choices – victim blaming & poor bashing
Both the lifestyle & biomedical frameworks lack emphasis on a public policy agenda.

14. Social Determinants of Disease
Focus: factors outside the health care system, the individual and their choices significantly affect health.
Income, social status, social support networks, education, employment and working conditions, physical environments, social environments, healthy child development, health services, gender and culture.
Health Promotion Objective: Policy Change
Level of Intervention: Structural Change
Advantage: Shape fundamental risk level of populations => McKewon Thesis
Disadvantage: Very difficult in practice

15. McKeown Thesis
The enormous increase in population and dramatic increase in health experienced by humans in the past 200 years owe more to changes broad economic & social conditions than to specific medical advances or public health initiatives.
Centralizes Social/Economic Changes
Minimizes the role of Human Agency.

16. Alternative Views
It is likely not an all or none contribution for socioeconomic vs. human agency.
Fundamental Social Causes Approach:
When a population develops the wherewithal to avoid disease & death, individuals’ ability to benefit from that wherewithal is shaped by resources of knowledge, power, prestige, & beneficial social connections.

17. The importance of knowledge, Power, prestige, & Enabling Social Networks
Individuals who command more of the above resources are able to gain a health advantage. These individuals are can benefit more from the fruits of human agency to a greater extent than those less endowed => HEALTH DISPARITY.
“The most fundamental resource in modern economy is knowledge and, accordingly, the most important process is learning”
The new philosophy of global health will include information sharing- one of the most important means to improve health globally.
Global health is a knowledge organization, with multiple different disciplines tied together by lines of communication to attack global problems. New achievements in the field of information technology are helping to exchange information rapidly and at minimal cost. The Internet revolution allows us to effectively share global health research information across the globe. Palm pilots, iPods, cell phones, and other technologies hold a great potential to improve information delivery to remote regions.
If knowledgeable about global health, medical students could play a major role in sharing public health and medical information and improving health around the world.
Visit the Supercourse lecture “Knowledge access and sharing. An overview of access models.” at

18. Education is the most powerful weapon which you can use to change the world.
Nelson Mandela
It is critical to take our scientific knowledge and to translate this into the global community. The new information systems are a million times more powerful than they were but 40 years ago. Combining prevention, research, education, and IT creates a powerful prevention stew, perhaps the most powerful for nourishing global health.
Visit the Supercourse lecture “The role of peer reviewed journals in providing information for doctors and patients” at