1. Spectrum of Heath Manish Chaudhary BPH( IOM,TU) MPH(BPKIHS)

2. Spectrum of health

3. Spectrum of Health Health fluctuates within a range of optimum well-being to various level of dysfunction Spectral concept of health emphasizes that the health of an individual is not static; it is a dynamic phenomenon and a process of continuous change, subject to frequent subtle variations Health is a state not to be attained once and for all, but ever to be renewed

4. Spectrum of Disease Fatal illness Severe illness Mild illness Clinicl infection Sub- clinical Infection death disease

5. Natural history of disease The word natural history of disease is the key concept in epidemiology. It signifies the way in which a disease evolves over time from the earliest stage of its pre-pathogenesis phase to its termination as its recovery, disability or death, in the absence of treatment or prevention.

6. Natural history of disease Susceptible host TIME Incubation period Death Recovery Exposure Onset Latent Infectious Non-infectious Infection No infection Clinical disease

7. Natural history of disease consist of two phases- – Pre-pathogenesis phase (i.e. the process in environment) – Pathogenesis phase (i.e. the process in man)

8. PHASES Prepathogenesis Pathogenesis

9. Pre-pathogenesis phase the process in environment Refers to the period preliminary to the onset of disease in man. The disease agent has not yet entered man but the factors which favour the onset are already existing in the environment.

10. Causative factors of disease Three factors referred as epidemiological triad- agent, host and environment. Operating in combination, these factors causes not only single case to epidemics, but also the distribution of disease in community.

11. Pathogenesis phase Begins with the entry of the disease “agent” in the susceptible host. The disease progresses through incubation period,early and late pathogenesis. Final outcome- recovery, death, disability.

12. The infection in the host may be clinical, sub- clinical; typical or atypical or the host may become carrier with or without having developed disease. (e.g. d iphtheria, poliomyelitis)

14. …………………… Natural history of disease is not necessarily the same in all individuals

15. Iceberg phenomena of Disease According to this concept, disease in the community may be compared with an iceberg.

16. The floating tip of iceberg represents what the physician sees in the community i.e. clinical cases. The vast submerged portion of the iceberg represents the hidden mass of disease ie latent, inappareant, presymptomatic and undiagnosed cases and carriers in the community. The waterline represents the demarcation between apparent and inapparant disease.

17. In some diseases (e.g. hypertension, diabetes, anaemia, malnutrition, mental illness) the unknown morbidity far exceeds the known morbidity. The hidden part of the iceberg thus constitutes an important undiagnosed reservoir of infection or disease in a community and its detection and control is a challenge to modern techniques in preventive medicine.

18. Determinates of Health All those factors that exert an influence on the health of an individuals and populations Presents a conceptual framework within which to understand the multiple determinants that shape patterns of disease and well-being in populations Provides a basis for evaluating where and how public health can intervene most effectively to improve health, particularly for vulnerable groups

19. Determinants of Health

22. Biological Determinants age, gender, genes Life Style diet and nutrition, smoking, alcohol, physical activity Psychological Self esteem, level of control, coping, stress, depression, anger Environment determinant air, water, soil quality, built environment, housing, work place, transport system Socioeconomic determinants Income, education, employment Community and social context Social network, community connectedness, social capital Culture and Ethnicity Belifef, attitude, norms, values

23. Determinants of Health Global Forces World economics, markets and trades, environmental conditions eg global warming, natural and man made disasters Government Policies Economic welfare, housing, taxation, local, regional and national priorities, public safety initiatives Access to services Primary, secondary and tertiary health care, social services, transport, housing, employment services, recreation

24. The relationship between the determinants and actual level of health is complex. Because health determinants are inter-related and interdependent, outcomes of one determinant will influence and produce other outcomes. For example, low income can result in lower levels of education, which influence where people live, their social contacts, their behaviours, lifestyle and overall health status. Outcomes are also cumulative. Individuals or groups who experience low income, low educational attainment, lack of control, lack of social supports and inadequate coping skills have a poorer health status than those with fewer health risks.

26. Thank you