Determinants of health

MARGARET Hannah

Determinants of health
Health is multi-factorial These factors are both with in individual and externally in the society. What man is and the diseases he has fallen victim is to due to genetics and the environment. These factors interact; interactions may be health promoting or not.

Determinants of health
There are as many determinants but these are the most important;
Heredity Environment Life style Socio-economic conditions Health and family welfare services Others

Heredity
The physical and mental traits of every human; to some extent is determined by genes. Genetic make up is unique and cannot be altered after conception. A number of diseases are genetic in nature List all the genetic diseases

Environment i
Hippocrates were the 1st to relate disease and environment. There are two types of environment; 1. Internal
Pertains to the each and every component part, every tissue, organ, system and their harmonious functioning. (the domain of internal medicine).

2. External or the macro environment

Include all the those things man is exposed to. May be divided into physical, biological and psychosocial components.

Environment ii
It is established that environment has a direct impact on the physical, mental and social wellbeing of those living in it. The environmental factors include;
1. 2. 3. 4. 5. 6. Housing Water supply Waste management Psychosocial stress Family structure Economic support systems

Life styles
It is composed of cultural and behavioral patterns and life long habits. Life style are learnt through social interaction with parents, peer groups, friends, siblings and mass media.

Life style some times is health promoting or health inhibiting

Give examples of life styles that are health inhibiting. Give examples of life styles that are health promoting.

Socio-economic conditions i
Health status is determined by their level of their development per capita GNP, education, nutrition, employment, housing, political system, e.t.c

1. Economic status
I. GNP is the mostly used measure of economic performance. II. Economic progress; a major factor In reducing morbidity, mortality, increasing life expectancy and improving the quality of life. III. It determines the purchasing power, standard of living, quality of life, family size, pattern of diseases and deviant behaviour in the community. IV. Important factor in seeking health care.

Socio-economic conditions ii
2. Education

Is a factor influencing health; especially females.

The world map of illiteracy closely coincides the maps of poverty, malnutrition, ill health, high infant, child and maternal mortality rates. Education compensates the effects of poverty on health irrespective of the availability of health facilities (study in India). In the state of Kerala where Fe literacy 86.9%, IMR=12 compared to Fe literacy 39.4%; and IMR = 71%;

Socio-economic conditions
3. Occupation

State of being employed in productive work promotes health. The unemployed show higher incidence of ill health and death.
For many loss of work may mean loss of income, status and may cause psychosocial and social damage.

Socio-economic conditions iii

4. Political system

Health is always related to the political system.

Often obstacles to implementation of health technologies are not technical but rather political. Decisions concerning resource allocation, man power policy, choice of technology and the degree to which health services are made available and accessible to different segment of society are examples of a political system.

Health services
Health and family welfare cover a wide spectrum of personal and community services for treatment of diseases, prevention of illness and promotion of health. The purpose of health services is to improve the health status of populations. The services include and are not limited to; immunization, ANC, provision of safe water etc To be effective the services must reach the peripheral, equitably, distributed, accessible at an affordable cost by the country and community PHC.

Other factors
Derived from systems outside formal health care systems; Food, Agriculture Development Social welfare Industry

Concepts of disease causation

Margaret Hannah

Concepts of disease causation

There are many concepts of disease causation; 1. Germ theory (single cause idea or one to one) relationship between causal agent and disease. 2. Agent man disease

3. Epidemiologic or disease triad 4. Ice berg concept. 5. Herd immunity concept.

Concepts of disease causation

5. Multi-factorial causation; realization that single cause was over an oversimplication; there are other factors in the cause of disease which are equally important.

Some diseases have multiple causes e.g. TB is merely due to the tubercle bacilli; poverty, poor housing, over population, overcrowding, other infections, malnutrition. Coronary heart disease and cancer. 6. Web of causation

Epidemiologic or disease triad

Different disease are common in different places and at different times. To understand this we need to consider the;
1. The living organism of disease (Agent; toxic/infectious) 2. The people they infect (Host) 3. The surrounding where they live (Environment)

The agents need a suitable environment in which the grow, multiply, able to spread. If they dont succeed in doing this they die out

The disease traid

Environment

Disease

Agent

Host

The disease triad

Disease is a result of complex interactions (imbalance) between the agent, host and environment. The components of this interaction differ depending upon circumstances of each group of affected populations. Recognizing the different components of this triad is important because they are the source of opportunities to reduce disease at multiple points in the transmission cycle. A common mistake is to focus on only one aspect of the triad for disease control or prevention and to overlook the others.

The disease triad

Illustration of the triad

The hosts are affected by their environment; for example they may live in hot and wet climate but people can change the environment by draining swamps, changing the vegetation and adding competing hosts.

Similarly, the environment can affect the agent, e.g the altitude and temperature.
When the balance between the 3 is constant, there will be a fairly steady number of people falling sick all the time. When this happens the disease is said to be endemic.

Illustration of the triad

If the balance is shifted in favour of the organism, e.g. Many non immune, there will be large number of cases in a short time and this is said to be an epidemic.

When all the non immune have been diseased, the number of the new cases will decline. If the balance is shifted against the agent the disease will be controlled and the number of cases will go down.

The host factors

While many people may be exposed, a few of them are likely to be infected. Human diseases are not randomly distributed in populations but rather, their distribution is influenced by a number of factors.

Examples include but are not limited to;

1. Innate resistance (e.g. gastric barrier, mucocilliary transport mechanism) 2. Previous exposure 3. Passive immune status (neonates)

Host factors
4. Age

5. Sex Gender
6. Behavior (e.g. mutual grooming, dominance, ) 7. Production status (e.g., lactating vs. non-lactating) 8. Reproductive status (e.g., pregnant vs. non-pregnant, sterile vs. intact) 9. Genetics

Host factors
Age is a very important because the risk of many diseases change widely over a persons life time. Neonates are very susceptible to many enteric and respiratory infections but resistance increases as the person grows.
As immunity decreases in advanced age susceptibility increases.

The agent factors

1. Dose (infective dose, concentration of organism in the infectious material). 2. Environmental hardiness (the ability of agent to survive in the environment).

3. Virulence (microbial): ability to cause disease

4. Infectivity (microbial): ability to establish infection 5. Toxicity (poisons): ability to cause toxicity.

The environmental factors

1. 2. 3. 4. 5. 6. 7. Population density Peron movement between population. Housing (e.g. ventilation, sanitation) Animal stocking density Environmental conditions (e.g. temperature, humidity, wind velocity, precipitation) Nutrition (protein, energy and macro and micro mineral adequacy) Animal movement between groups

The environmental factors

Many infectious agents are susceptible to the ultraviolet (UV) in direct sunlight and desiccation. Others survive for longer periods.

These factors interact in complex ways that are often under control of man. Example : increased population
may lead to increased microbial load in the environment, a roof prevent exposure of microbes from UV, poor ventilation- increase humidity-increased survival of organisms- increase exposure and infects more people.

Assignment
Based on the epidemiologic triad of disease causation, briefly explain why malaria is a common infection in South Sudan.