Health and Disease: Concepts, Determinants, Prevention, and Statistics

Posted on Dec 6, 2024 in Medicine & Health

1) Concept of Health and Disease

The concept of health has been changing over time. Long defined in negative terms (health = no disease), it is currently used as defined by the WHO in 1946: “Health is a state of complete physical, mental and social well-being.” This definition is subjective and utopian, and many institutions disagreed with it. Its drawback is that it measures health as an absolute state and does not admit different degrees. The concept of health varies by country and historical stage. Health has two aspects:

  • Subjective: Feeling good or bad, depending on the individual.
  • Objective: Measurable, the body’s ability to function.

Since 1946, WHO has adapted its definition of health, making it a dynamic concept that allows for appropriate health programs in different countries and eras.

2) Determinants of Health

Many factors influence an individual’s health status, most changing over their lifespan:

  • Lifestyle: Behaviors chosen by the individual, such as diet, sports, health habits, substance use, work, etc.
  • Environment: Influences health through climate, bacteria, waste, radiation, etc.
  • Health System: Coverage determines access to disease prevention and treatment.
  • Genetics: The unmodifiable factor, characteristics transmitted through DNA that predispose to disease, aging, etc.

3) Health Indicators

Factors within a community that allow us to assess individual health.

HEALTH:

General:

  • Life expectancy
  • Mortality rate
  • Nutritional status
  • Natality

Specific:

  • Certain diseases
  • Number of cases of each disease
  • Number of unwanted pregnancies/abortions

ECONOMIC:

Housing conditions:

  • Water
  • Light
  • Heating/Cooling
  • Sewerage

Food:

Health expenditure:

  • Vaccines
  • Hospitalization

SOCIAL:

  • Illiteracy
  • Unemployment
  • Delinquency
  • Expenditure on social services

THEME 2: The Concept of Prevention

INTRODUCTION

NATURAL HISTORY OF DISEASE

LEVELS OF PREVENTION

LEVELS OF IMPLEMENTATION OF SAFEGUARDS

INTRODUCTION:

Health practice was always oriented to diagnosis and treatment. Disease prevention was not discussed until the 1970s when campaigns were initiated to treat diseases before they developed.

NATURAL HISTORY OF DISEASE:

The evolution of disease, especially if untreated. Each disease is divided into three periods:

  • Prepathogenic Period
  • Pathogenic Period
  • Period of Results

PREPATHOGENIC PERIOD:

The disease has not yet manifested. We are constantly exposed to factors that promote or determine disease appearance (environmental, genetic, social, habits, etc.). The sum of several factors determines a specific disease.

PATHOGENIC PERIOD:

Divided into two phases:

  • Presymptomatic: Changes have occurred in the body, but there are no symptoms.
  • Clinical disease: Changes in organs and tissues are sufficient to show signs and symptoms.

PERIOD OF RESULTS:

Possible outcomes: healing, patient death, or chronic sequelae.

LEVELS OF PREVENTION:

Three levels of prevention:

  • Primary: Actions taken before the disease starts, during the prepathogenic period, aiming to reduce the possibility of disease development. Two types:
    Specific: Directed at specific diseases, e.g., fluoride, vaccines, condoms.
    Nonspecific: General disease prevention, e.g., healthy diet, exercise.
  • Secondary: Early diagnosis of the disease. Acting when primary prevention did not exist or failed. Once the disease has begun, the only prevention is interrupting the process as soon as possible.
  • Tertiary: Treatment of the disease, limiting damage, preventing progression, or rehabilitating the patient.

Prevention: Any action that reduces the probability of disease occurrence or stops its progression.

LEVELS OF IMPLEMENTATION OF SAFEGUARDS:

A) Government Action:

  • Wide: Providing general means to prevent pathologies (diet, sports, etc.).
  • Restricted: Limited to a population or a particular disease.

B) Patient-Healthcare Relationship (patient-dentist/hygienist):

Practitioner interacts directly with the individual. The message is clearer. Preventive level is more advisable for dental hygienists, with a favorable cost/benefit ratio.

C) Individual Action: Actions taken by each individual in their daily lives.

ITEM 3: Health Education

OBJECTIVES:

  • Informing the public about health/illness and how individuals can improve and protect their health.
  • Motivating people to change their habits.
  • Teaching people to acquire knowledge and skills to adopt and maintain healthy habits and lifestyles.
  • Proposing environmental changes to provide favorable living conditions.

FIELDS OF ACTION:

All individuals, healthy and sick, should receive health education. Two main groups: young people and adults. Young people are reached through schools, adults through advertising and media. Young people have not yet adopted habits, making health education cost-effective. Adults require habit changes. The health system reaches sick people. Changing adult habits is also necessary to prevent diseases.

METHODS:

Direct (Bidirectional)

– Dialogue

– Health Interview

– Lecture/Class

Indirect (Unidirectional)

– Visual

– Sound

– Audiovisual

Direct: Direct contact between the educator and the population receiving the information.

“Dialogue: Interviews with high-risk groups to address questions and provide personalized advice.”

Health-Interview: Health educator interacts individually with the patient to understand needs and habits and provide solutions.

-Lecture/Class: Direct method for large groups, allowing a single teacher to address many, with the possibility of organizing engaging sessions.

Indirect: No direct contact between the educator and the receiver, more economical but less personalized.

-Visual: Clear, quick-to-read materials (posters, leaflets, etc.). Newsletters are more expensive but more personalized.

-Sound: Radio reaches many people, regardless of reading ability.

Audiovisual: TV, Movies, Series, Internet, advertising, infomercials, etc.

ITEM 4: Measures of Statistics

Incidence / Prevalence:

  • Prevalence: Proportion of individuals in a population suffering from a disease over a period of time. Prevalence = number of people affected / total individuals.
  • Incidence: Number of new cases of a disease in a population during a period of time. Incidence = number of new cases / total individuals.
    Two types of incidence:
  • Cumulative Incidence: Proportion of healthy individuals who develop the disease over time. Probability/risk of contracting a disease.
  • Incidence rate: Number of new cases over a period divided by the sum of individual observation times.

High incidence and low prevalence indicate many new cases and quick recovery (or death). High prevalence and low incidence indicate chronic diseases.

HEALTH INDICATORS IN STATISTICS:

They are attempting to measure variables in qualitative or quantitative events in order to support collective actions and evaluate achievements. WHO defines health as indicators of variables used to measure changes, so that a valid indicator must meet a number of characteristics:

  • Validity: Be able to measure what we really want to evaluate.

  • Reliability: In a repeated measurements by different observers should result in similar values of the indicator.

  • Sensitivity: To be able to capture the changes quickly, which is sensitive to change.

  • Specificity: Let us very specific securities, reflects only changes in particular situations.

For a reliable indicator of health has to come from a rigorous and reliable source, the main sources from which we can obtain accurate information in a civil records are populations, census data, community surveillance. Health indicators are useful to evaluate four major points of health:

  • Health policy basically is measured by knowing the proportion of funds that allocates a country to its health (% of budget) within the health budget can also evaluate the money that goes to various community resources (doctors, hospital beds, prevention , etc …)

  • Socio-economic: It is important to assess the rate of population growth, illiteracy, food availability, indicators of housing conditions (water, electricity, computers, etc. ..)

  • Health care benefits: will be assessed;

    – Provision of care / medical.

    – Accessibility of the population to these services.

  • Health status of the population:

    – Birth (simple): This measures the number of births and the maternal health / child after birth.

    – Mortality (simple): A single value, tells of the death toll there in a country.

    – Morbidity (simple): Measures the involvement of people of different diseases and the extent and impact of each disease.

    – Quality of life (composite): It’s pretty subjective, and the rest of the indicators are simple, the quality of life of a population is based on composite indicators. Used terms such as “The functional capacity of the people”, “life expectancy” and “The level of adaptation of the individual to the environment.”

Among the health indicators, when we use to evaluate a program, we can find epidemiological indicators and operational indicators:

  • Epidemiological indicators: Used to assess the magnitude and importance of a given situation will always be referred to the population from which to calculate a period of time and geography. It is useful to measure the impact and effects of health programs, comparing the results before and after implementing the program (measured results).

  • Operational Indicators: Measure the work performed, either the quantity or quality, measure the amount of activities based on the goals, are typical in developing countries, (measuring the number of actions taken.)