Concepts of health disease and Prevention

Under the able guidance of :

Dr.Rashmi thakral
Submitted by: Annu verma 610 Anshit panwar 611

Concept of Health
Health is a common theme in almost all countries absence of disease Health = harmony = being in peace with self, community, god and cosmos body equilibrium with humors

Definition of disease, illness, and sickness

The Oxford English Dictionary defines disease as a condition of the body or some part or organ of the body in which its functions are disrupted or deranged. From an ecological point of view, disease is defined as a maladjustment of the human organism to the environment. The WHO has defined health but not disease.

Defining Health:
1- The WHO Definition Health is the complete of status of physical, mental and social wellbeing and not only the absence of disease or infirmity A Healthy Person is leading a socially and economically active live" 2- Health is the presence of a positive capacity to lead energetic satisfying and productive life. 3 -Ecological definition: health is a state of optimal physical, mental and social adaptation to ones environment. Health is a relative, not an absolute concept-always involves many levels or degrees

Definition of disease, illness, and sickness

Disease, illness, and sickness are not synonymous. The term disease literally means without ease, the opposite of easewhen something is wrong with bodily function.( Professional definition based on a pathological process- OBJECTIVE) Illness refers to the individuals perceptions and behavior in response to being ill ( loss of function , not feeling well- SUBJECTIVE) Sickness refers to a state of social dysfunction.( from disease or illness)

Health-sickness spectrum
There are degrees or levels of health as there are degrees or severity of illness.
positive health better health freedom from sickness unrecognized sickness mild sickness severe sickness death

factors affecting health status ( ENVIORNMENT)

1-INTERNAL ENVIRONMENT : hereditary, congenital personal behavior - acquired risk factors :smoking , eating , driving habits attitudes, values 2-EXTERNAL ENVIRONMENT : More important than internal environment 2.1PHYSICAL , geographical , place, man made housing , transportation, communication, work environment, pollution 2.2.BIOLOGICAL , living agents microorganisms, macro organisms, animals, plants 2.3-SOCIO/ECONOMIC , education, income, health services availability, accessibility, utilization. This is the most important environment.( Many Dimensions are included : Social, Psychological, Spiritual, Emotional, Vocational , Cultural, Philosophical, Environmental, Nutritional , Curative and Preventive Services)

The goals of medicine are to promote health, to preserve health, to restore health when it is impaired, and to minimize suffering and distress. These goals are embodied in the word "prevention"

Prevention; Definition and Concept

Actions aimed at eradicating, eliminating or minimizing the impact of disease and disability, or if none of these are feasible, retarding the progress of the disease and disability. The concept of prevention is best defined in the context of levels, traditionally called primary, secondary and tertiary prevention. A fourth level, called primordial prevention, was later added.

Determinants of Prevention
Successful prevention depends upon:
a knowledge of causation, dynamics of transmission, identification of risk factors and risk groups, availability of prophylactic or early detection and treatment measures, an organization for applying these measures to appropriate persons or groups, and continuous evaluation of and development of procedures applied

Preventable Causes of Disease

BEINGS
Biological factors and Behavioral Factors Environmental factors Immunologic factors Nutritional factors Genetic factors Services, Social factors, and Spiritual factors
[JF Jekel, Epidemiology, Biostatistics, and Preventive Medicine, 1996]

Levels of prevention
Primordial prevention

Primary prevention

Secondary prevention

Tertiary prevention

Primordial prevention
Primordial prevention consists of actions and measures that inhibit the emergence of risk factors in the form of environmental, economic, social, and behavioral conditions and cultural patterns of living etc.

Primary prevention
Primary prevention can be defined as the action taken prior to the onset of disease, which removes the possibility that the disease will ever occur. It signifies intervention in the prepathogenesis phase of a disease or health problem. Primary prevention may be accomplished by measures of Health promotion and specific protection

Primary prevention

Achieved by

Health promotion
Health education Environmental modifications Nutritional interventions Life style and behavioral changes

Specific protection
Immunization and seroprophylaxis chemoprophylaxis Use of specific nutrients or supplementations

Protection against occupational hazards

Safety of drugs and foods Control of environmental hazards, e.g. air pollution

Approaches for Primary Prevention

The WHO has recommended the following approaches for the primary prevention of chronic diseases where the risk factors are established:
a. Population (mass) strategy b. High -risk strategy

Secondary prevention
It is defined as action which halts the progress of a disease at its incipient stage and prevents complications. The specific interventions are: early diagnosis (e.g. screening tests, and case finding programs.) and adequate treatment. Secondary prevention attempts to arrest the disease process, restore health by seeking out unrecognized disease and treating it before irreversible pathological changes take place, and reverse communicability of infectious diseases. It thus protects others from in the community from acquiring the infection and thus provide at once secondary prevention for the infected ones and primary prevention for their potential contacts.

Early diagnosis and treatment

WHO Expert Committee in 1973 defined early detection of health disorders as the detection of disturbances of homoeostatic and compensatory mechanism while biochemical, morphological and functional changes are still reversible. The earlier the disease is diagnosed, and treated the better it is for prognosis of the case and in the prevention of the occurrence of other secondary cases.

Tertiary prevention
It is used when the disease process has advanced beyond its early stages. It is defined as all the measures available to reduce or limit impairments and disabilities, and to promote the patients adjustment to irremediable conditions. Intervention that should be accomplished in the stage of tertiary prevention are disability limitation, and rehabilitation.

Disability limitation
disease

impairment

disability

handicap

Rehabilitation
Rehabilitation is the combined and coordinated use of medical, social, educational, and vocational measures for training and retraining the individual to the highest possible level of functional ability.

Rehabilitation

Medical rehabilitation

Vocational rehabilitation

Social rehabilitation

Psychological rehabilitation

Strategy for Prevention

Identify Populations at High Disease Risk
(based on demography / family history, host factors..)

Modify Existing Intervention Programs

Evaluate Intervention Programs

Assess Exposure

Apply Population-Based Intervention Programs

Conduct Research on Mechanisms

(including the study of genetic susceptibility)

Epidemiology Division

Control
Concept of control: The term disease control describes ongoing operations aimed at reducing:
The incidence of disease The duration of disease and consequently the risk of transmission The effects of infection, including both the physical and psychosocial complications The financial burden to the community.

Control activities focus on primary prevention or secondary prevention, but most programs combine both.
control

elimination

eradication

Disease Elimination
Between control and eradication, an intermediate goal has been described, called "regional elimination" The term "elimination" is used to describe interruption of transmission of disease, as for example, elimination of measles, polio and diphtheria from large geographic regions or areas Regional elimination is now seen as an important precursor of eradication

Disease Eradication
Eradication literally means to "tear out by roots".

It is the process of Termination of all transmission of infection by extermination of the infectious agent through surveillance and containment. Eradication is an absolute process, an "all or none" phenomenon, restricted to termination of an infection from the whole world. It implies that disease will no longer occur in a population.
To-date, only one disease has been eradicated, that is smallpox.

Monitoring
Monitoring is "the performance and analysis of routine measurements aimed at detecting changes in the environment or health status of population" (Thus we have monitoring of air pollution, water quality, growth and nutritional status, etc). It also refers to on -going measurement of performance of a health service or a health professional, or of the extent to which patients comply with or adhere to advice from health professionals.

Surveillance
surveillance means to watch over with great attention, authority and often with suspicion According to another, surveillance is defined as "the continuous scrutiny (inspection) of the factors that determine the occurrence and distribution of disease and other conditions of ill-health"

Control of infectious diseases (the 4 Cs

Control

Cases
Diagnosis

Contacts

Carriers

Community

notification isolation
disinfection treatment follow up release

standard strict protective

observation

detection

Epidemiological Investigation & containment

Evaluation of control
Evaluation is the process by which results are compared with the intended objectives, or more simply the assessment of how well a program is performing. Evaluation should always be considered during the planning and implementation stages of a program or activity. Evaluation may be crucial in identifying the health benefits derived (impact on morbidity, mortality, sequelae, patient satisfaction). Evaluation can be useful inidentifying performance difficulties. Evaluation studies may also be carried out to generate information for other purposes, e.g., to attract attention to a problem, extension of control activities, training and patient management, etc.

To summarize
The goals of medicine are to promote health, to preserve health, to restore health when it is impaired, and to minimize suffering and distress. These goals are embodied in the word "prevention" Successful prevention depends upon a knowledge of causation, dynamics of transmission, identification of risk factors and risk groups, availability of prophylactic or early detection and treatment measures, an organization for applying these measures to appropriate persons or groups, and continuous evaluation of and development of procedures applied The objective of preventive medicine is to intercept or oppose the "cause" and thereby the disease process. This epidemiological concept permits the inclusion of treatment as one of the modes of intervention

Thank You