NEW PARADIGM: CONCEPT OF HEALTH ILLNESSES AND DISEASE

Tatong Hariyanto, MD, MSPH

Dept of Public Health and Community Medicine

SESSION OBJECTIVES
Explain the concept of Health, illnesses and diseases Mention the impacts of difference in understanding of health, illmess and disease concepts between medical providers and laymen in the health care services Mention the impacts of Ice-berg phenomena on the development of disease transmission in the community Apply the comcept of Natural History of Diseases in understanding:
the development of common diseases in individuals and the community The work of the Doctors in defining the diagnosis of a disease in individuals
2

HEALTH
Health is a state of individual or communitys: physical, mental, spiritual, dan social wellbeing and not merely a condition of free from illness and injury, so that every individual can achieve his/her social and economic productivity (Health Law No 23 th 1992).
Physical, mental, spiritual dan social component of health are inter-related one to each other, and create a health conditions of individuals or community.

The Integration of the 4 components of health, create an interval scale of health states or levels of health ranges from low health level to a perfect health level.
3

COMPONENTS OF HEALTH AND THE LEVEL OF HEALTH

PERFECT STRUCTURE AND FUNCTIONS Perfect Health

STRUCTURAL & FUNCTIONAL DEFECTS

PHYSICAL MENTAL SOCIAL SPIRITUAL

Worst

LEVELS OF HEALTH
PERFECT HEALTH HEALTHY

Not as two sides . . . . . of a Coin

Health is a states of point on a scale, ranging of conditions from bad conditions to perfect health
5

ILLS

HANDYCAP DYING DEAD

Exercise - 01 :
Some one ask a health certificate from a doctor :
How the doctors do? What are the doctors constraints in determining ones health conditions ? What are the factors determine the difficulties ? How the doctor overcome the problems ? What are the best doctorsstatements written in the health certificate ?

INDIVIDUALS HEALTH CONDITIONS

DETERMINED BY :
The degree of deviation of ones physical, mental, spiritual and social structures and functions from their uniques normal states. The further the deviation from its normal states (positive or negative), mean that the health states will be poorer;

Health State: are a dynamic conditions (ever change from time to time) determined by the internal and external factors.
7

HEALTH CONDITION vs STRUCTURAL AND FUNCTIONAL DEVIATION

LEVELS OF HEALTH
SUBCLINICAL PHASE

POINT OF NO-RETURN

CLINICAL PHASE

Reversible CLINICAL HORIZON

Irreversible

Structural and Functional Deviation from normality

8 Notes : Subclinical phase create a condition of ICE-BERG PHENOMENA

Consequences
Since the doctors main jobs are analysing whether her/his patients are healthy or not, meaning that they must conclude the existing conditions of the patients body & mind structure and/or function deviate from normality. To be a skillfull doctors, the Medical Students must: Have a good knowledge and skills in examining the structure and functions of normal and abnormal individuals (physically, mentally and socially); Have a good knowledge and skills to stop the changing process of body structures and functions and then make it back to normal.
9

WHAT THE DOCTORS CANDIDATE MUST LEARN

1.
2.

3.
4. 5.

The normal body and mind structure and functions (anatomy, histology, physiology, biochemistry) Non-normal structure and functions (microbiology, parasitology, clinical pathology, anatomy pathology) Laboratory and clinical skills to practice medical profession (Clinical Pre internship or Clerkship) Management skills and knowledge of medical care services (Public Health) Intelectual skills and knowledge (Methodology, Science Projects)
10

Exercise - 02
If health conditions are timely changing, what are the social and medical impacts to the individuals? What are the impacts of timely changing conditions to the certificate of health? What are the impacts of ICE-BERG PHENOMENA upon the medical problems and transmission of diseases? What is the consequences of the concept of POINT OF NO-RETURN upon the doctors responsibility to their patients ?
11

ILLNESS VS DISEASES
ILLNESS Ones perception on the signs of the deviations / abnormality of biopsycho-socials structure or/and functions of their own or others Ex. Headache, Fever, pain, etc DISEASE Ones expectations upon causal factor/s that stimulate the structural and functional deviation of bio-psycho-social on their own or others Ex. HIV, Malaria, etc

12

HANDYCAP and DISABLE ?

A permanent or Temporary irreversible deviation of ones physical, mental, social and spiritual condition from his/her normality.
Mention some actual examples ? How many months of deviation, classi fied as irreversible?
13

Exercise - 03
If the patients perception of an illness or disease differs from their doctors, what will happen to the doctor-patients relationship ? Mention some examples of handicap or disorders that make a different perception between a patients and his/her doctors.
14

HOW DO WE MEASURE THE STRUCTURAL AND FUNCTIONAL DEVIATIONS FROM NORMALITY

Patients own or familys complaint If the abnormality founded : Measure the abnormality thru Physical Exam: The description of patients feeling of signs or symptoms; (taking history of diseases) Measure the functions and structure deviations of organs/systems using our sense organ objectively (Viewing/inspection, touching/palpation, tapping/percussion, hearing/auscultation). Measure the abnormality thru Lab. Exam
15

SIMPLE AND QUALITATIVE INDICATORS OF THE LEVELS OF HEALTH OF INDIVIDUALS

BEST Perfect health Fair health Sub clinical Clinical illness Handicapped / disable Dying Dead

WORST
16

Exercise - 04
How a doctor knows that his therapy improves the bio-psycho-social functions and structures of his/her patients? What the doctors should do, whenever he or she knows that his or her patients disorders have no change for a period of times? How the doctors compare the level of health of two or more individuals ?
17

What factors determine the extent of ones structural and functional changes?

INTERNAL FACTORS
Genetics, Immunity, phisical fitness Aging process, Psychological maturity

EXTERNAL FACTORS
Environmental Conditions: Physical Biological Socio - cultural
18

HOW DO THE DETERMINANT FACTORS STIMULATE THE DEVELOPMENT OF DISEASES

HUMAN BODY / MIND

External Factors

Internal factors
Yes

POSTULATE; NO DISEASE WITHOUT CAUSE

Negative effects? No

Body/mind Structure + Functions change to abnormal

HEALTHY
19

HOW DO THE DETERMINANT FACTORS STIMULATE THE DEVELOPMENT OF DISEASES

HEALTHY STATES
No mental, physical, and social Deviations,

NOT HEALTHY Structural and Functional Deviations, due to the influence of Int. & ext. factors

RECOVERY STATES Or CONVALESCENCE

Deviation toward normal; Permanent Deviation; Deviation toward infinity

20

HOW DO THE BODY + MIND CHANGES FROM NORMALITY

ABNORMAL

Clinical line

dead

Vital line
Asymptomatic

DESTRUCTIVE EFFECTS OF EXT / INT FACTORS

/ Sub-clinical

Structural + functional changes

Handicap

NORMAL

Healed

time
21

NATURAL HISTORY OF DISEASES

PRE PATOGENESIS PHASE PATOGENESIS PHASE CONVALESCENS PHASE DEAD

VITAL LIMIT
HANDYCAPPED

CLINICAL HORIZON
INT. & EXT. FACTORS

RECOVER

HEALTHY

UNHEALTHY

RECOVER
22

3 PHASES OF DISEASE PROCESSES

The Facts about Disease

Every disorder/diseases must be caused by at least one internal or external factors (mostly multifactors); The degree of the disorders, depend on the destructive power of the causal factors, and the protective power of the individuals body and mentality. There is always time lag (incubation period) between the exposure time of factors, and the development of sign or symptoms of diseases; The prevention of diseases, is actually a process to stop the worse development of diseases, as early as possible; to normalize the structural and functional deviation to achieve the highest social and economic productivity.
23

Exercise - 05
A male patient tells the doctors that he got gonorrhoea after having sexual contact with a prostitute the night before. Are you agree with the patients expectation? Mention your comment and rationals. In many occation, the doctors seems healthy, eventhough they have contacted with many common-cold patients in his/her medical practice. Can you mention the phenomena? Many people said that prevention of disease can only be done before getting diseases. Is that true of false? Can the treatment of a patient be classified as prevention of disease? Why?
24

GOOD LUCK !
25