Concepts, Determinants and promotion of health and Disease

1. Concepts, Determinants and promotion of healthand Disease 3rd year of English speaking programme Kateřina Ivanová Department of Social Medicine and Health care Policy

2. Contemporary Definitions of Health – basic definition: • 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 andnot merely absence of illness.“ 3rd year of English speaking programme

3. Contemporary Definitions of Health – New definition: • 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.“ 3rd year of English speaking programme

4. 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. 3rd year of English speaking programme

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6. 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. 3rd year of English speaking programme

7. 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. 3rd year of English speaking programme

8. Definition of Health Promotion • This „new“ definition of health provides the foundation for the developing concept of „health promotion“. • 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.“ 3rd year of English speaking programme

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10. Disease, Illness, sickness • Disease - refers to abnormal medically defined changes in the structure or functioning of the human body. • Illness – refers to the individual´s experience or subjective perception of lack of physical and/or mental well-being • Sickness – refers about consequences to function normally in social roles 3rd year of English speaking programme

11. 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 individual´s 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 3rd year of English speaking programme

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13. 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 cause. • 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 3rd year of English speaking programme

14. Epidemiological triangle of disease 3rd year of English speaking programme

15. 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 Lalonde´s documents names A New Perspective on the Health of Canadians – 1974). 3rd year of English speaking programme

16. Determinants of Health – Health Field elementsfrom Lalonde document names Health Field Concept 3rd year of English speaking programme

17. 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 individual´s constitution is also a determinant of susceptibilityto risk factors arising form certain lifestyles and environments. 3rd year of English speaking programme

18. 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 individual´s state of health. • 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 elucidated. 3rd year of English speaking programme

19. 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. 3rd year of English speaking programme

20. 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) 3rd year of English speaking programme

21. 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 3rd year of English speaking programme

22. 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 health • Ourselves and others – for better or worse: social vulnerability and inequality 3rd year of English speaking programme

23. 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. 3rd year of English speaking programme

24. 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. 3rd year of English speaking programme

25. 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!!!!????!!!!! 3rd year of English speaking programme

26. 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 increasing. • 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. 3rd year of English speaking programme

27. 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: 3rd year of English speaking programme

28. 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. 3rd year of English speaking programme

29. 10 - 15% 20 – 25% 10 – 15% 50 – 60% Health Status 1stQuestion for you: Determinants of Health – Health Field elementsfrom Lalonde document Health Field Concept 3rd year of English speaking programme

30. Human Biology The Environment Health care Organization Lifestyles, behaviours and Risk Factors Health Status 2ndQuestion for you: Determinants of Health – Health Field elementsfrom Lalonde document Health Field Concept 3rd year of English speaking programme