Host :

1. Host : • A person/ living animal that affords lodgment to agents of diseases under natural conditions. Lifestyle characteristics: personality traits, living habits Demographic characteristics: age, sex ethnicity, etc. Biological characteristics: Genetic, Biochemical levels of blood, Physiological functions: BP, etc.

2. Environment : • All (living or non-living) that is external to the individual human host in which he is in constant interaction Psychosocial: Cultural values, habits, beliefs, attitudes, moral, social interaction, etc. Physical: Air, water, soil, housing, Climate, etc. Biological: Insects, rodents, animals, plants, other human beings

3. Risk factors: • An attribute or exposure that is significantly associated with the development of the disease • Ex. Ht. Disease: Smoking, high BP, elevated serum cholesterol, diabetes, obesity, lack of exercise

4. Risk factors: • 1) Additive or synergestic (multiplicative) • - smoking and aniline in the production of bladder cancer : additive • -smoking and high BP in heart disease: synergistic • 2) May be: • a) Contributory – lack of physical exercise in heart disease OR • b) Predictive (in statistical sense) – illiteracy in perinatal mortality

5. Risk factors: • 3) May be: • a) Modifiable – smoking, BP,obesity, physical fitness OR • b) Non-modifiable – age, sex, family history, genetic factors • 4) May be: • a) Individual – age, sex, smoking OR • b) Community – air pollution, water pollution, lack of basic sanitation, etc.

6. Spectrum of disease • Graphic representations of variations in the manifestations of diseases • Spectrum of disease is best seen in diseases such as syphilis, leprosy Disease • Subclinical infection (inapparent) • Unrecognized sickness • Mild • Moderate • Severe • Death

8. Iceberg of diseases ( Iceberg phenomenon)

9. Iceberg of diseases ( Iceberg phenomenon) • 1) Disease in a community may be compared to an iceberg • 2) Floating tip of iceberg- what the physician sees • - clinical cases with illness • 3) Submerged portion represents the hidden mass of diseases – latent, inapparent, presymptomatic, undiagnosed, indignant

10. Iceberg of diseases ( Iceberg phenomenon) • 4) Varies from disease to disease ; submerged portion greatest in non-communicable diseases – HPT, DM • 5) Submerged portion – constitutes reservoir of infection • 6) Major challenge is to detect the undiagnosed portion

11. Determinants Of Health Dr. Adinegara Bin Lutfi Abas

12. Health - absence of disease • Disease • impairment of • human body • affecting • vital • functions

13. Determinants Of Health : Health and family welfare services Heredity Socio-economic conditions Environment Lifestyle

14. Heredity • The genetic transmission of characteristics from parent to offspring • The physical and mental traits of human being are determined by genes from conception • Diseases of genetic origin: • - chromosomal anomalies, errors of metabolism, mental retardation, etc.

15. Health from genetic stand-point • “State of individual based upon absence of defects of genes and absence of any abnormality in respect to total amount of chromosome in karyotype.”

16. Environment • All that is external to the individual human host.

17. Environment Physical Psychosocial Biological • Housing • Water supply • Waste treatment • Workplace conditions • - lighting • - ventilation • - humidity Stress - workload - relationship with peers, family • Domestic / wild animals • Vectors in propagation • of diseases • - mosquitoes, flies, rodents • 3. Bacteria/ virus/ protozoa/ etc.

18. Lifestyle • “The way people live” • Composed of cultural and behavioural patterns and personal habits (eg. Smoking, alcoholism) • Lifestyle diseases – coronary heart disease, obesity, drug addiction, etc. • However, take note of positive lifestyle factors: • - exercise, adequate nutrition, etc.

19. The Healthy Lifestyle Campaign of the Ministry of Health was launched in 1991.  • Cardiovascular Diseases (1991) • AIDS (1992) • Food Hygiene (1993) • Promotion of Environmental Health (2002).

20. Socio-economic conditions • 1) Economic status • 2) Education • 3) Occupation • 4) Other factors- political system

21. 1) Economic status • Per capita GNP most widely accepted measure of economic performance • Determines purchasing power, standard of living, quality of life, family size, pattern of disease and deviant behaviour • Strong correlation between GNP and life expectancy • Affluence associated with obesity, CHD, diabetes

23. 2) Education- • Illiteracy coincides with poverty, malnutrition, ill-health, high infant and child mortality rates • 3) Occupation – • The unemployed shows a higher incidence of ill-health and death • 4) Political system- • Percentage of GNP spent on health (WHO recommends a minimum of 5%)

28. Health and family welfare services • Purpose is to increase health status of population • Include • - immunization of children • - provision of safe water supply • - care of antenatal mothers and children • - food quality control

29. An effective health service: • 1) Must reach the social periphery • 2) Equitably distributed • 3) Accessible at a cost the country and the community can afford • However there is NO correlation between medical density and life expectancy