Spectrum of Heath

Manish ChaudharyBPH( IOM,TU)MPH(BPKIHS)

Spectrum of health

Spectrum of Health

• Health fluctuates within a range of optimum well-being to various level of dysfunction

• Spectral concept of health emphasizes that the health of an individual is not static; it is a dynamic phenomenon and a process of continuous change, subject to frequent subtle variations

• Health is a state not to be attained once and for all, but ever to be renewed

Spectrum of Disease

Fatal illness

Severe illness

Mild illness

Clinicl infection

Sub- clinical Infection

death

disease

Natural history of disease

The word natural history of disease is the key concept in epidemiology.

It signifies the way in which a disease evolves over time from the earliest stage of its pre-pathogenesis phase to its termination as its recovery, disability or death, in the absence of treatment or prevention.

Natural history of disease

Susceptiblehost

TIME

Incubation period

Death

Recovery

Exposure Onset

Latent Infectious Non-infectious

Infection

No infection

Clinical disease

• Natural history of disease consist of two phases-

– Pre-pathogenesis phase (i.e. the process in environment)

– Pathogenesis phase (i.e. the process in man)

PHASES

Prepathogenesis Pathogenesis

Pre-pathogenesis phase

the process in environment

• Refers to the period preliminary to the onset of disease in man.

• The disease agent has not yet entered man but the factors which favour the onset are already existing in the environment.

Causative factors of disease

• Three factors referred as epidemiological triad- agent, host and environment.

• Operating in combination, these factors causes not only single case to epidemics, but also the distribution of disease in community.

Pathogenesis phase

• Begins with the entry of the disease “agent” in the susceptible host.

• The disease progresses through incubation period,early and late pathogenesis.

• Final outcome- recovery, death, disability.

• The infection in the host may be clinical, sub-clinical; typical or atypical or the host may become carrier with or without having developed disease. (e.g. diphtheria, poliomyelitis)

……………………

• Natural history of disease is not necessarily the same in all individuals

Iceberg phenomena of Disease

According to this concept , disease in the community may be compared with an iceberg.

The floating tip of iceberg represents what the physician sees in the community i.e. clinical cases. The vast submerged portion of the iceberg represents the hidden mass of disease ie latent , inappareant , presymptomatic and undiagnosed cases and carriers in the community. The waterline represents the demarcation between apparent and inapparant disease.

In some diseases (e.g. hypertension, diabetes, anaemia, malnutrition, mental illness) the unknown morbidity far exceeds the known morbidity. The hidden part of the iceberg thus constitutes an important undiagnosed reservoir of infection or disease in a community and its detection and control is a challenge to modern techniques in preventive medicine.

Determinates of Health

• All those factors that exert an influence on the health of an individuals and populations

• •Presents a conceptual framework within which to understand the multiple determinants that shape patterns of disease and well-being in populations

• •Provides a basis for evaluating where and how public health can intervene most effectively to improve health, particularly for vulnerable groups

Determinants of Health

Determinants of Health

• Biological Determinantsage, gender, genes

• Life Stylediet and nutrition, smoking, alcohol, physical activity

• PsychologicalSelf esteem, level of control, coping, stress, depression, anger

• Environment determinantair, water, soil quality, built environment, housing, work place, transport system

• Socioeconomic determinantsIncome, education, employment

• Community and social contextSocial network, community connectedness, social capital

• Culture and EthnicityBelifef, attitude, norms, values

Determinants of Health• Global Forces

World economics, markets and trades, environmental conditions eg global warming, natural and man made disasters

• Government PoliciesEconomic welfare, housing, taxation, local, regional and national priorities, public safety initiatives

• Access to services

Primary, secondary and tertiary health care , social services, transport, housing, employment services, recreation

• The relationship between the determinants and actual level of health is complex. Because health determinants are inter-related and interdependent, outcomes of one determinant will influence and produce other outcomes.

• For example, low income can result in lower levels of education, which influence where people live, their social contacts, their behaviours, lifestyle and overall health status.

• Outcomes are also cumulative. Individuals or groups who experience low income, low educational attainment, lack of control, lack of social supports and inadequate coping skills have a poorer health status than those with fewer health risks.

Thank you