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Concepts, Determinants and promotion of health and Disease


Title: Concepts, Determinants and promotion of health Author: katerina Last modified by: Ivanov Created Date: 12/7/2011 7:27:33 AM Document presentation format – PowerPoint PPT presentation

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Title: Concepts, Determinants and promotion of health and Disease

Concepts, Determinants and promotion of health
and Disease
  • Katerina Ivanová
  • Department of Social Medicine and Health care

Contemporary Definitions of Health basic
  • Health is multidimensional it is not only merely
    the presence or absence of disease, but also has
    social, psychological and cultural determinants
    and consequences.
  • The WHO defined Health as A complete state of
    physical, mental and social well-being and not
    merely absence of illness.

Contemporary Definitions of Health New
  • New definition of health recognizes the
    inextricable links between and individual and
    her/his environment. It is known as
    socio-ecological definition.
  • Health defined as The ability to identify and
    realize aspirations, to satisfy needs, and to
    change or cope with environment. Health is
    therefore a resource for everyday life, not the
    objective of living. Health is a positive concept
    emphasizing social and personal resources.

Contemporary Definitions of Health as the
integrity of the body
  • Health encompass social and political concerns
    and the relationship of individuals to the
    environment in which they day live.
  • From this perspective, health is not just the
    responsibility of the traditional health
    sector, but all sectors, institutions, and
    organizations that may influence the well-being
    of individuals and communities.

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Population health
  • Individual health human
    being and his/her health
  • Population health is
    variously defined as the study of the
    determinants of health and disease, health
    status, health gradient, and the degree to which
    health care affects the health of the community
  • The population health is the focus of prevention
    and health promotion.

Traditional model of prevention
  • Traditionally, there have been three approaches
    to disease prevention
  • Primary prevention is aimed at preventing
    disease before it occurs, thereby reducing the
    incidence of disease (immunization programs,
    dietary recommendations, avoidance of taking up
    smoking, the use of seat belts and other)
  • Secondary prevention involves the early
    detection of disease in an asymptomatic period
    before it progresses, and the treatment which may
    occur as a result of screening.
  • Tertiary prevention attempts to reduce
    complications by treatment and rehabilitation,
    which are carried out primarily by the existing
    health care systém.

Definition of Health Promotion
  • This new definition of health provides the
    foundation for the developing concept of health
  • Term of health promotion first time defined in
    Ottawa Charter resolution form First
    International Conference on health promotion,
    held in Ottawa in 1986.
  • According to this Charter health promotion is
    The process of enabling people to increase
    control over, and to improve, their health.

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Disease, Illness, sickness
  • Disease - refers to abnormal medically defined
    changes in the structure or functioning of the
    human body.
  • Illness refers to the individuals experience
    or subjective perception of lack of physical
    and/or mental well-being
  • Sickness refers about consequences to function
    normally in social roles

Systematic taxonomy of diseases
  • WHO defines three concepts which refer to
    distinct and important dimensions of human
    experience in the context of disease
  • Impairment refers to changes in the
    individuals body (any loss or abnormality of
    psychological, physiological or anatomical
    structure of function)
  • Disability refers about changes in what the
    individual can and cannot do
  • Handicap - refers about changes in their
    relationship with physical and social environment

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Epidemiological triangle of disease
  • Epidemiological triangle is based on the theory
    names Doctrine of Specific Etiology the idea
    that each disease has a single and specific
  • The epidemiological triangle portrays the
    interaction between agent, host and environment.
  • Agent may be chemical (lead), biological
    (bacteria), physical (violence)
  • Host factors may be genetic or acquired and
    influence susceptibility to disease
  • Environmental factors may be biologic, social
    or physical and affect exposure and susceptibility

Epidemiological triangle of disease
  • From an epidemiologic point of view, such an
    agent as the necessary but not sufficient
    cause, since suitable conditions, with respect to
    the host and the environment, must be present for
    disease develop.
  • What is mean?
  • That we must known determinants of health and
    disease - determinants are based on the Health
    Field Concept (from Marc Lalondes documents
    names A New Perspective on the Health of
    Canadians 1974).

Determinants of Health Health Field elements
from Lalonde document names Health Field Concept
Human Biology (H B) a)
  • H B encompasses those aspects of health (both
    mental and physical) which are determined by the
    organic structure and physiological functioning
    of the human body
  • The genetic make up of the individual determines
    the likelihood of inherited disorders and the
    predisposition to later acquired diseases.
  • The individuals constitution is also a
    determinant of susceptibility to risk factors
    arising form certain lifestyles and environments.

Human Biology (H B) B)
  • Changes in the human body due to maturation and
    aging are also important factors that can
    interact with the other three Health Field
    elements in determining the individuals state of
  • The H B elements has many facets, only a few of
    which are adequately understood.
  • The medical and allied sciences have made great
    progress in understanding the complex process of
    the human body and mind, but much remains to be

The environment a)
  • The Physical Environment (P E)
  • The factors include
  • the quality of air, water and soil
  • the safety of food, drugs, and other products
    which human consume or exposed to
  • the physical handling and disposal of waste
  • the control of excessive noise.
  • Directly affects of P E by exposure to
    potentially hazardous agents (chemicals or
    radiation)and etc.
  • Indirectly affects of P E by global warming,
    redundant hunt of animals, etc.

The environment B1)
  • The Social Environment (PS E)
  • In the Scottish city of Glasgow, people living in
    the most deprived districts have life expectancy
    12 years porter than those living in the most
    affluent (NHS Health Scotland, 2004). In some
    American cities, the differences are even
    greater. Among countries, too, the differences in
    the life expectancy are large, even within
    Europe. Life expectancy form men in Russia are
    58, 4 years less than in Sweden and Iceland (WHO
    2005). To understand the cause of differences
    such as these and, more importantly, to do
    something about them, requires a focus social
    determinants of health.(Social Determinant of
    Health - Marmot and Wilkinson)

The environment B2)
  • Main social determinants of health
  • Social organization, stress, and health
  • Early life
  • The life course, the social gradient, and health
  • Health and labour market, unemployment,
    non-employment, job insecurity
  • Health and psychosocial environment at work
  • Transport and health
  • Social support and social cohesion
  • Food is a political issue

The environment B3)
  • Main social determinants of health
  • Poverty, social exclusion, and minorities
  • Social patterning of individual health
    behaviours the case of cigarette smoking
  • The social determination of ethnic/racial
    inequalities in health
  • The social determinants of health in older age
  • Neighbourhoods, housing, and health
  • Social determinants, sexual behaviour, and sexual
  • Ourselves and others for better or worse
    social vulnerability and inequality

Social determinants and The health gradient a)
  • British statistics have shown, for as a long as
    one has cared top look, that health follows a
    social gradient the higher the social position,
    the better health. I became aware of this
    gradient only when I started to analyse data from
    the first Whitehall study of British civil
    servants (Marmot et. al, 1978).
  • There had been a curious disjunction between the
    factor of the social gradient and the infection
    diseases that major killer in developer
    countries, coronary heart diseases, affected most
    those of high status.

Social determinants and The health gradient B)
  • The view appeared to be that there were diseases
    of the rich (heart disease and cancer) diseases
    of the poor. Mortality for all causes reflected a
    balance of the two. We now know that this is
    inaccurate on two counts.
  • First, in rich countries, most diseases affect
    people of low position more than those of higher.
    In those senses, the diseases of affluence are
    few breast cancer has been a notable exception
    to the pattern of low social position, high risk.
  • Second, it is not only the poor who suffer. The
    Whitehall studies showed that in civil servants
    who are not poor, the low employment grade, the
    higher and the risk of most cause of death.

Social determinants and The health gradient C)
  • This social gradient in health is a remarkably
    widespread phenomenon (Marmot, 2004).
  • Source
  • MARMOT, Michael, WILKINSON, Richard, G., Social
    Determinants of Health. 2nd ed. London Oxford
    University Press, 2008. ISBN 978-0-19-856859-5
  • What is mean?
  • That social gradient has a big influence to
    health gradient!!!!????!!!!!

Lifestyle and behaviours
  • Lifestyle consist of aspects of individuals
    behaviour and surroundings over which they may
    exercise control, althought recognition of the
    importance of the social and physical
    environmental context in this concept is
  • Healthy lifestyle comprise patterns of
    health-related behaviour, values and attitudes
    adapted by groups of individuals in response to
    their social, cultural and economic environment.

Risk continuum
  • A useful conceptualization of the health effects
    of a lifestyle factor it that of the degree of
    risk posed by the health-related behaviour.
    Figure shows the risk continuum which is derived
    from alcohol consumption

Health care organization (HCO)
  • The HCO is what traditionally defined as the
    health care system. In includes medical and
    dental practice, nursing, hospitals, chronic care
    facilities, rehabilitation, drugs, public health
    services, and health services provided by allied
    health professionals such as chiropractic,
    podiatric and optometric services.

1st Question for you Determinants of Health
Health Field elements from Lalonde document
Health Field Concept
2ndQuestion for you Determinants of Health
Health Field elements from Lalonde document
Health Field Concept