1. By Hatim Jaber MD MPH JBCM PhD 20-09-2017
Faculty of Medicine Introduction to Community Medicine Course ( ) Disease and factors affecting occurrence of disease Dimensions and Determinants of Health By
Hatim Jaber
MD MPH JBCM PhD

2. Presentation outline Last lecture feedback Health and Disease
Time
Last lecture feedback
08:00 to 08:10
Health and Disease
08:10 to 08:20
Factors affecting the occurrence of disease
08:20 to 08:40
Dimensions of health
08:40 to 09:00
Determinants of health
09:00 to 09:15

4. WHO Definition
“Health is a state of complete physical, mental and social wellbeing and not merely an absence of disease or infirmity.”
now added
“the ability to lead a socially and economically productive life.”
The concept of health as defined by WHO is broad and positive in its implications; it sets out the standards, the standard of “positive” health.

5. CONCEPT OF WELLBEING Standard of Living
As per WHO, “Income and occupation, standards of housing, sanitation and nutrition, the level of provision of health, educational, recreational and other service and collectively as an index of the ‘standard of living’.”
Level of Living
As per United Nations documents “level of living” consists of nine components: health, food consumption, education, occupation and working conditions, housing, social security, clothing, recreation and leisure, and human rights.

6. “germ theory of the disease.”
Traditionally health has been considered as an absence of the diseases and if someone was free from disease, then that person was considered healthy.
This concept is known as biomedical concept, and it has a basis on the
“germ theory of the disease.”

7. Holistic concept Social Health Political economic Health protection
Health promotion
Health
Environmental
Political
Holistic concept

8. SPECTRUM OF HEALTH Positive health Better health Freedom from sickness
Unrecognised sickness
Mild sickness
Severe sickness
Death

9. Health-Illness Continuum
Measure person’s perceived level of wellness
Health and illness/disease opposite ends of a health continuum
Move back and forth within this continuum day by day
Wide ranges of health or illness
Copyright 2008 by Pearson Education, Inc. 9

10. Illness and Disease Illness
Is a highly personal state in which the person's physical, emotional, intellectual, social, developmental, or spiritual functioning is thought to be diminished.
Illness is usually associated with disease but may occur independently of it.
Illness is a highly personal state in which the person feels unhealthy or ill.

11. Concept of Disease
“A condition in which body function is impaired, departure from a state of health, an alteration of the human body interrupting the performance of the vital functions.” - Webster.
Oxford English Dictionary – the condition of body or some part of organ of body in which its functions are disrupted or deranged.
Ecologically – ‘a maladjustment of human organism to the environment’
Simplest definition – ‘opposite to Health’.

12. Disease
Disease can be described as an alteration in body functions resulting in a reduction of capacities or shortening of the normal life span.

13. Some terms..
Disease- biological concept. Means physiological/psychological dysfunction
Illness –socio-pathological concept. Means - subjective feeling of not being well.
Sickness – Biological concept of social dysfunction.

14. Concept of Disease مرادفات كلمة مَرَض :
مرادفات كلمة مَرَض :
آفَة , إصَابَة , إِعَاقَة , إِعْتِلال , بَلاَء , تَوَعُّك , داء , دَاء , دَنَف , سَقَم , سُقْم , شَكْوًى , ضَنًى , ضُرّ , عاهَة , عَيْب , عِلَّة , نَقْص , هُزَال , وَبَاء , وَبَلة , وَصَب , وَصَم , وَعْكَة ، سَقَام , سُقْم

15. There are many ways to classify illness and disease:
Acute illness is typically characterized by severe symptoms of relatively short duration.
A chronic illness is one that lasts for an extended period, usually 6 months or longer, and often for person's life.
Severe Illness, Moderate illness………..

16. Suchman describes five stages of illness:
Stage 1 symptoms experiences.
Stage 2 assumption of the sick role confirmation from family and friends.
Stage 3 medical care contact.
Stage 4 dependent client role.
Stage 5 recovery or rehabilitation.

17. The Health-Sickness spectrum

18. HEALTH AND ILLNESS

19. Impact of Illness On the Client Behavioral and emotional changes
Loss of autonomy
Self-concept and body image changes
Lifestyle changes
On the Family
Depends on:
Member of the family who is ill
Seriousness and length of the illness
Cultural and social customs the family follows 19

20. Impact of Illness: Family Changes
Role changes
Task reassignments
Increased demands on time
Anxiety about outcomes
Conflict about unaccustomed responsibilities
Financial problems
Loneliness as a result of separation and pending loss
Change in social customs 20

21. Natural History of Disease
Period of prepathogenesis
Period of pathogenesis

22. Subclinical Case: ICEBERG PHENONMENON
Example: Cholera , Polio, hypertension, malnutrition etc.

23. The causation of a disease is called its etiology.

24. Historical Theories for causation of disease
“Supernatural causes”& Karma
Theory of humors (humor means fluid)
The miasmatic (وبالي (theory of disease
Theory of contagion
Germ theory
Epidemiological Triad
Multi-factorial causation
Web of causation
………Supernatural to multi-factorial causes…
Environment
Agent
Host

25. Factors affecting occurrence of disease
Host Factors: 1- Heredity and genetic
2-Age and sex
3- Health Status
4- Immunity
5- physiological state; pregnancy..
6- Life style
7- Socio-economic
Environmental Factors: physical, biological, social/cultural,
Causative agent: biological, nutritional, chemical, physical, mechanical, metabolic, genetic, functional
Risk factors

27. DIMENSIONS OF HEALTH
Health is multidimensional and are interrelated, each has its own nature
Physical Dimension
“Perfect functioning” of the body.
It conceptualizes health biologically as a state in which every cell and every organ are functioning at optimum capacity and in perfect harmony with the rest of the body.
Mental Dimension
Ability to respond to many varied experiences of life with flexibility and a sense of purpose.
Mental health has been defined as “a state of balance between the individual and the surrounding world, a state of harmony between oneself and others

28. Social Dimension
Harmony and integration with the individual, between each individual and other members of society, and between individuals and the world in which they live.
“quantity and quality of an individual’s interpersonal ties and the extent of involvement with the community.”
Spiritual Dimension
Spiritual health refers to “something” that transcends physiology and psychology.

29. Vocational Dimension Emotional Dimension
Relates to “feeling.” it reflects emotional aspects of humanness.
Vocational Dimension
Work often plays a role in promoting both physical and mental health.
Physical work is usually associated with an improvement in physical capacity, while goal achievement and self-realization in work are a source of contentment and enhanced self-esteem.
Others
A few other dimensions have also been suggested such as philosophical dimension, cultural dimension, socioeconomic dimension, environmental dimension, educational dimension, nutritional dimension, and so on.

30. Dimensions of Wellness
Copyright 2008 by Pearson Education, Inc. 30

31. 1. Physical.
The ability to carry out daily tasks, achieve fitness (e.g. pulmonary, cardiovascular, gastrointestinal), maintain adequate nutrition and proper body fat, avoid abusing drugs and alcohol or using tobacco products, and generally to practice positive lifestyle habits.

32. 2. Social.
The ability to interact successfully with people and within the environment
3. Emotional.
The ability to manage stress and to express emotions appropriately, Emotional wellness involves the ability to recognize, accept, and express feelings.

33. 4. Intellectual. 5. Spiritual.
The ability to learn and use information effectively for personal, family, and career development
5. Spiritual.
The belief in some force (nature, science, religion, or a higher power) that serves to unite human beings and provide meaning and purpose of life

34. 6. Occupational.
The ability to achieve a balance between work and leisure time, A person's beliefs about education, employment, and home influence personal satisfaction and relationships with others.

35. 7. Environmental.
The ability to promote health measures that improve the standard of living and quality of life in the community

36. DETERMINANTS OF HEALTH
Biological
Behavioral & sociocultural condition
Other factor
Health
Environment
Gender
Socioeconomic
Aging
Health services

38. Biological Determinants
Physical and mental traits of every human being are to some extent determined by the nature of his genes at the moment of conception.
Behavioral and Sociocultural Conditions
Health requires promotion of healthy lifestyle. Modern health problems especially in the developed countries and in developing countries are mainly due to changes in lifestyles. Healthy lifestyle includes adequate nutrition, enough sleep, sufficient physical activity etc.
Environment
Environment has a direct impact on the physical, mental and social wellbeing of those living in it. Environmental factors range from housing, water supply, psychosocial stress and family structure

39. Socioeconomic Conditions
● Economic status: Economic situation in a country is an important factor in morbidity, increasing life expectancy and improving quality of life, family size and pattern of disease
● Education: Illiteracy correlates with poverty, malnutrition, ill health, high infant and child mortality rates.
● Occupation: Productive work provides satisfaction, promotes health and improves quality of life.
● Political system: timely decisions concerning, resource allocation, choice of technology etc

40. Environmental Determinants
Biochemical effects (lead paint, diesel fumes.)
Often overlooked rural-based pollutants
New interest in the effects of the “Built Environment”: the use, layout & design of a community’s physical structures
Urban: high crime and traffic
Suburban: pedestrian “unfriendly”
Rural: ?

41. Gender Aging of the Population Health Services
To be effective, the health services must reach the masses, equitably distributed, accessible at a cost the country and community can afford and social acceptable.
Aging of the Population
A major concern of rapidly aging population is increased prevalence of chronic diseases and disabilities that deserve special attention.
Gender
Women’s health is gaining importance in areas such as nutrition, health consequences of violence, aging, lifestyle related conditions and the occupational environment.
There is an increased awareness among policy makers of women’s health issues, and encourages their inclusion in all development as a priority.

42. Physical Activity
Blacks less likely to engage in physical activity than Whites.
Men 30% more likely than women.
Married individuals 19% less likely than single individuals.

43. Social Determinants Gender Race Marital status
Physical abilities (also biological)
Education

44. “The Big Sort” Social and geographic segregation
People have migrated to socially isolated areas.
Divided by race, income, social perspectives.
Possible adverse health effects?

45. Economic Determinants
Intersection between social (e.g. job) and economic (income) determinants is fuzzy.
Concept of “social class” is less accepted here.
Social status is more than income, though income is an important determinant.
“Status Syndrome” (Marmot)

46. Effects of Disparities
Complex relationship between determinants and outcomes.
Some “determinants” are likely outcomes of others.
Parental income associated with educational attainment and health of child. Low education associated with high tobacco use. Tobacco use associated with…..

47. Social effects of Disparities
Discrimination?
Stress?
Low self-esteem?
High-risk behaviors ??

48. Biological Determinants
Genes: much to learn
Immunities or disposition
Varying estimates of “nature”- effect on longevity.
Age

49. Behavioral Determinants
Tobacco
Nutrition and Physical Activity
Alcohol
Violence
What is the origin or cause of behavior?

50. Premature mortality by Income

51. Parent Education and Children’s Health

52. US Mortality by Age
(per 100,000)
Source: National Center for Health Statistics,CDC: 2005

54. Cigarette Smoking by Education

55. Physical Activity/Nutrition
Source: USDA, 2006

56. U.S. Mortality by Gender
(per 100,000)
Source: National Center for Health Statistics, CDC, 2005

57. U.S. Mortality by Race
(per 100,000)
National Center for Health Statistics, CDC, 2005

58. Social Determinant: Education
Source: National Health interview Survey, Robert Wood Johnson Foundation, 2008

59. Education and Mortality

60. Parent Education and Children’s Health

62. Premature mortality by Income

64. Indicators of Health