BASIC CONCEPT OF DISEASE

Joko Mulyanto Department of Public Health & Community Medicine Jenderal Soedirman School of Medicine

OUTLINE
The concept of health and disease Natural history of disease Determinants of health and disease

Definition of Health
"a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. (WHO, 1948). "a state characterized by anatomical, physiological, and psychological integrity; ability to perform personally valued family, work, and community roles; ability to deal with physical, biological, psychological, and social stress; a feeling of well-being; and freedom from the risk of disease and untimely death" (Stokes, Noren, and Shindell, 1982).

Problems with the concept of health

Abstract and vague Difficult to be measured. Health is more dynamic state rather than static condition. Encompass many dimensions.

More approaches to the concept of health

Ecological approach The extent to which an individual or a group is able to realize aspirations and satisfy needs and to change or cope with the environment. (Last, 2000). The equilibrium among humans and other living things that share the earth (harmony).

Dimensions of Health
Physical, mental, social. Absence of disease, illness, pain. Reserve for coping with stress and illness Functional ability to allow task to be performed Positive well-being Conformity to expected norms.

Concept of Disease
The boundary between health and disease is fuzzy Subjective and objective perception. Sociological perspective

Objective Perception of Disease

The impaired, endangered, lost of individual and populations health. Based on empirical and experimental evidence specially in modern medicine. The deviation from the normal distribution. Judged by well-trained physician.

Sociological Perspective
The concept of disease, illness, and sickness. Disease related to biomedical aspect, diagnosed by physician, usually believed located in specific organ or system, curable through specific treatment. Illness is the personal experience of the person who acknowledges that he or she does not feel well.

Contd
Sickness refers to the social actions taken by a person as a result of illness or disease, such as taking medication, visiting the doctor. Patient feel illness, act sickness, physician diagnose and treat disease.

Final Thoughts about Health & Disease Concept

The concept of health and disease is complex, dynamic, and often unclear. Many dimensions of health. Positive Health. Clear and operable definition is need to measure health. There is no single-best indicator to measure health. Health and disease are socially and culturally mediated.

Natural History of Disease

The progress of a disease process in an individual over time, in the absence of intervention. Begin with accumulation of factors causing disease. End with recovery, disability, or death.

Contd

Stages of Natural History of Disease

Susceptibility Risk factor (modified, unmodified), exposure of agent. Sub-clinical In apparent pathological changes, incubation / latency period (detectable). Clinical Sign and symptom, physiological and anatomical disorder. Clinical manifestation and disease spectrum.

Contd
Recovery & Disability Limitation of daily activity; - Physical or mental functional disorder. - Temporary or permanent - Short or long term.

Factors Influencing Disease Spectrum (Infectious Disease)

Infectivity % person exposed become infected Pathogenicity % person infected develop clinical disease Virulence % person with clinical disease become severely ill or death

The Importance of Natural History of Disease

Basis of disease prevention

Determinant of Health and Disease

Epidemiological Triangle / Triad Conceptual cause and component pies. Biomedical model Force field & well-being paradigm of health Health field model Social model of health

Epidemiologic Triangle

Contd
Traditional model of infectious disease causation. External agent microorganism, physical chemical agent. Susceptibility of host intrinsic factor; age, sex, behavior, genetic, SES. Environmental extrinsic factor, affect agent & facilitate exposure. Physical, Biological, Socioeconomic.

Conceptual cause and component pies

Contd
Specially for non infectious disease. Multi-factorial causes. Sufficient cause Necessary cause

Biomedical Model
Traditional view Separate body and mind The determinant is the provision of healthcare Disease or illness appear when body fail to function due to many causes. Health is no presence of somatic sign & symptom, and the absence of disease.

Health Paradigm (Blum, Lalonde)

Heredity Environmental Lifestyle Medical care

Health Field Model (Evans & Stoddard)

Expanded model of health paradigm 9 components: social environment, physical environment, genetic endowment, individual response, healthcare, health & function, disease, well-being, prosperity Dynamic interrelationship Population health

Contd

Social Model of Health (Dahlgren & Whitehead)

Multiple determinants Five layers Nested each other, not as separate entities.

Contd

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