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Introduction to

Health and
Disease
By:
Dr Anania Arjuna
Rahul Bhaskar
Definition
• The condition of being sound in body,
mind or spirit, especially freedom from
physical disease or pain.
WHO definition

• Health is a state of complete physical,


mental and social wellbeing and not
merely an absence of disease or infirmity.
Operational definition
• A condition or quality of the human
organism expressing the adequate
functioning of the organism in given
condition, genetic or environment
– No obvious evidence of disease.
– The several organs of the body are
functioning adequately in themselves and in
relation to one another.
New philosophy of health
• Fundamental human right.
• Intersectoral
• Integral part of development
• Central to concept of quality of life
• Involves Individuals state and international
responsibility.
• A major social investment.
• World wide social goal
Physical dimension
• Every cell and every organ is functioning
at optimum capacity and in perfect
harmony with the rest of the body.
• Signs of good physical health ???
Evaluation of physical health
• Self assessment of overall health
• Inquiry into
– symptoms of ill health and risk factors
– Medication
– Medical services
– Nutrition and dietary
• Standardized questionnaires
– Cardio vascular disease
– Respiratory disease
Mental dimension
• A state of balance between the individual
and the surrounding world,
• a state of harmony b/w oneself and other,
• a coexistence b/w the realities of the self
and that of other people and that of
environment
Characteristics to mental health
• Free form internal conflicts
• Well adjusted.
• Accepts criticism and is not easily upset
• Searches for identity
• Strong sense of self-esteem
• Knows himself
• Good self control balance, rationally and
emotionally
• Faces problems and tries to solve them.
Social dimension
• Harmony and integration within the
individual, b/w each individual and other
members of society and b/w individuals
and the world in which they live.
• Well being of the whole person
• Positive material environment
• Positive human environment
Spiritual health
• The part of the individual which reaches
out and strives for meaning and purpose in
life.
• Includes integrity, principles and ethics,
the purpose in life, commitment to some
higher being and belief in concepts that
are not subject to “state of the art”
explanation.
Emotional health
• Mental health – knowing
• Emotional health - feeling
Vocational dimension
• Vocational health is one's attitude about
work and career.  This dimension involves
preparing for and participating in work that
provides personal satisfaction and life
enrichment.  This includes continued
development of occupational skills, finding
balance between work and leisure
activities, participating in paid and
volunteer activities, and finding
challenging work. 
Determinants of health
• Combination of genetic and environmental
factors.
Factors:
• Biological
• Behavioral and socio-cultural
• Environment
• Socio economic
• Health services
• Aging of population
• Gender
Biological determinants
• Genetic make- up
– Chromosomal abnormalities
– Error in metabolism
– Mental retardation
– Some type of diabetes

• Can be used for betterment.


• Positive health
From genetic point of view, health is defined as

• State of the individual which is based upon the


absence from the genetic consttution of such
genees as correspond to characters that take
the form of serious defects and derangement
and to the absence of any aberation in respect
of total amt of chromosome material in the
karyotype or stated in positive terms, from the
presence of genetic constitution of genes that
correspond to the normal characterization and
the presence of normal karyotype.
Behavioral and socio-cultural
determinant
• Life style
– (cultural, behavioral patterns and life long personal
habits)
• Learnt through social interaction.
• Developed countries risk: CVD, obesity, lung
cancer, drug addiction
• Developing countries risk: lack of sanitation,
poor nutrition, personal hygiene, custom and
cultural patterns.

• Beneficial lifestyle ?????


Environment
• Internal
• External
– Physical, biological or psychological factors
• Micro or domestic or personal environment
(lifestyle)
• Occupational, socio-economic and moral
environment.
Socio-economic condition
• Economic
– Determines purchasing power, standard of living,
quality of life, family size etc.
• Educational
– Especially female education. Eg Kerala (1999) female
edcation 87.86% others 54.16%, infant mortality, 14,
others 71
• Occupational (productive work)
• Political
– Implementation of health technologies are not
technical, but political
– Expenses only 3% per capita GNP at 5%
Health services
• Primary health care
– Immunization
– Safe water provision
– Care of pregnant women and children
– Cost of health care
– Quality of health care
• Aging of population
– By 2020, MT one billion people- age 60

• Gender
– Men vs Women
– Violence, aging, life style
Disease
• A condition in which body health is impaired, a
departure from state of health, an alteration if the
human body interrupting the performance of vital
function.
• A condition of body or some part or organ of the
body in which its function are disrupted or
deranged. – Oxford
• A maladjustment of the human organism to the
environment – ecological view
• Social phenomenon occurring in all societies –
sociological view
• Any deviation from normal functioning or
state of complete physical or mental well
being.
• No criteria for disease ????
• WHO ????
– Acute (food poisioning)
– Insidious (mental illness, RA)
– Carrier state (typhoid fever)
– Organism with MT one clinical manifestation
(Streptococcus)
– Same disease by MT one organism (diarrhea)
– Couse – short or prolonged
• Disease – physioligical/ psychological
dysfunction
• Illness – subjective state of a person who
feel aware of not being well
• Sickness – state of social dysfunction, i.e
the role that the individual assumes when
ill. (sickness role)
• Victim of disease without feeling it ????
• Disease classification
• ICD-10
– Vol I-
• report of international conference
• Classifiscatin
• Special tubulation list of mortality
• Definition and nomenclature regulaiton
– Vol2 –
• Instruction manual
– Vol 3
• index
• The coding system
• Chapter List
• I A00-B99Certain infectious and parasitic diseases
• II C00-D48Neoplasms
• III D50-D89Diseases of the blood and blood-forming
organs and certain disorders involving the immune
mechanism
• IV E00-E90Endocrine, nutritional and metabolic diseases
• V F00-F99Mental and behavioural disorders
• VI G00-G99Diseases of the nervous system
• VII H00-H59Diseases of the eye and adnexa
• VIII H60-H95Diseases of the ear and mastoid process
• IX I00-I99Diseases of the circulatory system
• X J00-J99Diseases of the respiratory system
• XI K00-K93Diseases of the digestive system
• XII L00-L99Diseases of the skin and subcutaneous
tissue
• XIII M00-M99Diseases of the musculoskeletal system
and connective tissue
• XIV N00-N99Diseases of the genitourinary system
• XV O00-O99Pregnancy, childbirth and the puerperium
• XVI P00-P96Certain conditions originating in the perinatal
period
• XVII Q00-Q99Congenital malformations, deformations
and chromosomal abnormalities
• XVIII R00-R99Symptoms, signs and abnormal clinical
and laboratory findings, not elsewhere classified
• XIX S00-T98Injury, poisoning and certain other
consequences of external causes
• XX V01-Y98External causes of morbidity and mortality
• XXI Z00-Z99Factors influencing health status and contact
with health services
• XXII U00-U99Codes for special purposes
The determinants of health
• the social and economic environment,
• the physical environment, and
• the person’s individual characteristics and
behaviours.
The determinants of health
• Introduction
• Evidence base of health determinants
• Transport
• Food and Agriculture
• Housing
• Waste
• Energy
• Industry
• Urbanisation
Introduction
• Income and social status - higher income and
social status are linked to better health. The
greater the gap between the richest and poorest
people, the greater the differences in health.
• Education – low education levels are linked with
poor health, more stress and lower self-
confidence.
• Physical environment – safe water and clean air,
healthy workplaces, safe houses, communities
and roads all contribute to good health.
Employment and working conditions – people in
employment are healthier, particularly those who
have more control over their working conditions
Determinants contd…

• Social support networks – greater support from


families, friends and communities is linked to
better health. Culture - customs and traditions,
and the beliefs of the family and community all
affect health.
• Genetics - inheritance plays a part in
determining lifespan, healthiness and the
likelihood of developing certain illnesses.
Personal behaviour and coping skills – balanced
eating, keeping active, smoking, drinking, and
how we deal with life’s stresses and challenges
all affect health.
• Health services - access and use of services
that prevent and treat disease influences health
• Gender - Men and women suffer from different
types of diseases at different ages.
Transport
• Accidents between motor vehicles, bicycles and
pedestrians (particularly children and young
people).
• Pollution from burning fossil fuels such as
particulates and ozone.
• Noise from transportation.
• Psychosocial effects such as severance of
communities by large roads and the restriction of
children’s movement.
• Climate change due to CO2 emission
• Loss of land
• Improved physical activity from cycling or
walking
• Increased access to employment, shops
and support services
• Recreational uses of road spaces
• Contributes to economic development
• Vector borne diseases
Food and agriculture
• Tobacco farming and its impact on heart
disease, stroke, certain cancers and chronic
respiratory disease. Including passive smoking
and impact of foetal development. Pesticide
policies on tobacco crops require consideration.
• Changes in land use, soil quality, choice of crop,
use of agricultural labour and occupational
health.
• Mechanisation of work previously done by hand,
and plantation agriculture.
• Fisheries – biotoxins, pollution, chemical use, wastewater,
processing, and occupational health
• Forestry – vector borne diseases, occupational health, and food
security.
• Livestock use – vector borne diseases, drug residues, animal feed,
waste, and food security.
• Sustainable farming including chemical and energy use, biodiversity,
organic production methods, and diversity of foods produced.
• Fertiliser use – nitrate levels in food, pollution of waterways, re-use
of agricultural waste.
• Water – irrigation use and its impact on river/water-table levels and
production outputs.
• Pesticide usage and veterinary drugs– legal requirements, best
practice, consumer issues.
• Food packaging, preservation and safety, and avoidance of long
storage and travel.
Access to, and distribution of food
• Household food security – appropriate food
being available, with adequate access and being
affordable (location of markets, supermarkets
and closure of small suppliers creating food
deserts in cities).
• Food supplies, including national and regional
food security, and regional production.
• National food security – able to provide
adequate nutrition within a country without
relying heavily on imported products
• Cold-chain reliability – the safety of transporting
products that deteriorate microbiologically in the
heat.
Dietary patterns, diversity of food
available and home production,
• Fruit and vegetable consumption on reduced stroke,
heart disease and risk of certain cancers,
• Total, saturated and polyunsaturated fat, carbohydrates
and sugars consumption on obesity, heart disease,
stroke and other vascular diseases.
• Alcohol consumption and impact on social effects related
to behaviour (traffic accidents, work/home accidents,
violence, social relations, unwanted pregnancy and
STDs), and toxic effects (all-cause mortality, alcoholism,
certain cancers, liver cirrhosis, psychosis, poisoning,
gastritis, stroke, foetal alcohol syndrome and others).
• Micronutrients such as iron, vitamin A, zinc and iodine
and their impact on deficiency syndromes.
Food safety and foodborne
illness hazzards
• Microorganisms such as salmonella, campylobacter, E.
coli O157, listeria, cholera.
• Viruses such as hepatitis A, and parasites such as
trichomonosis in pigs and cattle.
• Naturally occuring toxins such as mycotoxins, marine
biotoxins and glycosides.
• Unconventional agents such as the agent causing bovine
spongiform encephalopathy (BSE, or "mad cow
disease"),
• Persistant organic pollutants such as dioxins and PCBs.
Metals such as lead and mercury.
• New foods developed from biotechnology such as crops
modified to resist pests, changes in animal husbandry,
antibiotic use and new food additives.
Housing
• Improvements in housing and improved mental
health and general health
• The possibility of improved housing leading to
rent rises, impacting negatively on health.
• Movement of original tenants after housing
improvement and therefore not benefiting from
the improvements.
• Housing tenure, outdoor temperature, indoor air
quality, dampness, housing design, rent
subsidies, relocation, allergens and dust mites,
home accident prevention, and fire prevention.
• Homelessness.
Waste
• the transmission of agents of infectious disease
from human and animal excreta (sanitation,
hygiene and water-related);
• exposure to toxic chemicals in human and
animal excreta; and in industrial wastes
discharged into the environment;
• environmental degradation, direct and indirect
impacts on health;
• exposure to radioactive wastes;
• exposure to health-care wastes;
• exposure to solid wastes and involvement in
informal waste recycling; and
• breeding of disease vectors.
Energy
• Fossil fuels
• Biomass fuels
• Hydropower and their impact on vector borne diseases,
and pollution
• Electricity generation and transmission
• Nuclear power
• Other energy sources
• Occupational health effects of energy workers
• Impacts on ecosystems, agriculture, forests, fisheries
and building materials
• Noise
• Visual impact
• Global warming
Industry
• Asbestos and man made fibres
• Basic chemicals
• Cement, glass and ceramics
• Electronicds
• Iron and steel
• Manufacture of rubber and plastic products
• Metal products
• Mining
• Pesticides, paints and pharmaceuticals
• Petroleum products
• Pulp and paer
• Service industries
• Textiles and leather
• Wood and furniture.
Urbanization
• Urban housing problems
• City environment and non-communicable
diseases
• Communicable diseases
• Road trauma
• Psychosocial disorders
• Sustainable urban development
• Urban wastes
• Health services

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