1. CONCEPT OF DISEASE 1. ‘A condition body or some part or organ of body in which its function disrupted or deranged’ 2. ‘Any deviation from normal functioning or state of physical &mental wellbeing ‘

2. Concept of causation of disease Germ theory : Agent→Man→Disease Epidemiological triad : Agent, Host, Environment triad Multifactorial causation: No s of factors interact with each other

3. EPIDEMIOLOGICAL TRIAD Environment Agent Host

4. MULTIFACTORIAL CAUSATION A NOs OF FACTORS INTERACT EACH OTHER AND CAUSES A DISEASE A number of factors operate in the causation of disease. (eg. in non-communicable diseases) Relative importance of each factor can be quantified and arranged in order of priority sequence. These factors are suggestive and not absolute proof of as causative agents Analytical epidemiological study used to identify risk factors

5. NOs OF FACTORS INTERACT EACH OTHER & CAUSES A DISEASE *Change in Life style (Excess food intake, Sedentary)  *Obesity *Smoking *Stress ↓ ↓ ↓ *Hyperlipidaemia→*Hypertension  *Aging ↓ ↓ *Atherosclerosis → *Coronary artery occlusion ↓ *Myocardial infarction

6. RISK FACTORS AN ATTRIBUTE OR EXPOSURE THAT IS SIGNIFICANTLY ASSOCIATED WITH DEVELOPMENT OF A DISEASE Suggestive and not necessarily a absolute proof of disease Must be identified prior to occurrence of a disease

7. Type of Risk factors Modifiable–eg. smoking, hypertension, high cholesterol, lack of exercise in CHD etc Non modifiable-age, sex, race, genetic factor etc.

8. RISK GROUP AND ITS IMPORTANCE Presence of RF in an individual/group make them more vulnerable to certain disease Can be identified by certain defined criteria & more attention can be paid to them (Risk approach)—“Something for all, but more for those in need- in proportion of need”

9. SURVEILLANCE ” is on going systematic collection, analysis, interpretation of health data essential to planning, implementation and evaluation of public health practices, closely integrated with the timely dissemination of these information to control and prevent health problem.”

10. PURPOSE OFSURVEILLANCE Provide information on new or changing trend in health status, mortality etc. Timely warning on public health disasters / epidemic Feedback to modify policy or action Help to plan and set programme priority and to evaluate P.H progm.

11. MONITORING Performance and analysis of routine measurements aimed at detecting changes in the environment or health status of popn. It is an ongoing measurement of performance It is part of surveillance In monitoring data collection and analysis can be carried out by technician and instrumentation In surveillance data require analysis and judgment by professionals Monitoring + Action = Surveillance

12. HEALTH &DEVELOPMENT Health is an integral part of development Health and its maintenance is a major social investment It is wider social goal Health is essential for S.E. development and vice versa Economic development alone is not sufficient for improving health& quality of life

13. COMPARISON OF KERALA & ALL INDIA HEALTH SITUATION Health indicatorsKeralaAll India Death rate/1000 (1990)6.49.0 IMR(1999) 14 70 AnnualGrowth rate%(2001) 0.91.93 L E at birth(1993)66.5 61.5 Literacy rate 90.9265.38 FemaleLiteracy rate (2001)87.854.16 Per capita income(‘98-‘99)1775614712