Transcript Concepts, Determinants and promotion of health

07/12/2011
PROMOTION OF HEALTH AND
DISEASE
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Kateřina Ivanová
Department of Social Medicine and Health care
Policy
3rd year of English speaking programme
CONCEPTS, DETERMINANTS AND
CONTEMPORARY DEFINITIONS OF HEALTH
– BASIC DEFINITION:
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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.“
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CONTEMPORARY DEFINITIONS OF HEALTH
– NEW DEFINITION:
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New definition of health recognizes the
inextricable links between and individual and
her/his environment. It is known as „socioecological“ 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.“
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CONTEMPORARY DEFINITIONS OF HEALTH
AS THE INTEGRITY OF THE BODY:
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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

human being and
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Individual health
his/her health
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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.
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TRADITIONAL MODEL OF PREVENTION

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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.
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DEFINITION OF HEALTH PROMOTION
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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.

to this Charter health
promotion is: „The process of enabling
people to increase control over, and to
improve, their health.“
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 According
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DISEASE, ILLNESS, SICKNESS
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- 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
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 Disease
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SYSTEMATIC TAXONOMY OF DISEASES
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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
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EPIDEMIOLOGICAL TRIANGLE OF DISEASE
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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
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EPIDEMIOLOGICAL TRIANGLE OF DISEASE
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

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).
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 What
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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.
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DETERMINANTS OF HEALTH – HEALTH FIELD
LALONDE DOCUMENT
NAMES HEALTH FIELD CONCEPT
ELEMENTS FROM
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HUMAN BIOLOGY (H B) – A)
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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 susceptibility to risk factors
arising form certain lifestyles and environments.
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HUMAN BIOLOGY (H B) – B)
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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.
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THE ENVIRONMENT A)
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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.
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The Physical Environment (P E)
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THE ENVIRONMENT B1)
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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)
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The Social Environment (PS E)
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THE ENVIRONMENT B2)
1.
3.
4.
5.
6.
7.
8.
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2.
Social organization, stress, and health
Early life
The life course, the social gradient, and health
Health and labour market, unemployment, nonemployment, job insecurity
Health and psychosocial environment at work
Transport and health
Social support and social cohesion
Food is a political issue
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Main social determinants of health:
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THE ENVIRONMENT B3)
9.
11.
12.
13.
14.
15.
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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
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Main social determinants of health:
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SOCIAL DETERMINANTS AND THE HEALTH
GRADIENT A)
(Marmot et. al, 1978).
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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.
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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
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SOCIAL DETERMINANTS AND THE HEALTH
GRADIENT B)
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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.
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SOCIAL DETERMINANTS AND THE HEALTH
GRADIENT C)
This social gradient in health is a remarkably
widespread phenomenon (Marmot, 2004).
 What
is mean?
That social gradient has a big influence to
health gradient!!!!????!!!!!
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Source:
MARMOT, Michael, WILKINSON, Richard, G., Social
Determinants of Health. 2nd ed. London: Oxford
University Press, 2008. ISBN 978-0-19-856859-5
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LIFESTYLE AND BEHAVIOURS
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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 healthrelated behaviour, values and attitudes adapted
by groups of individuals in response to their
social, cultural and economic environment.
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RISK CONTINUUM
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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:
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HEALTH CARE ORGANIZATION (HCO)
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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.
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1ST QUESTION FOR YOU: DETERMINANTS OF
HEALTH – HEALTH FIELD ELEMENTS FROM LALONDE DOCUMENT
HEALTH FIELD CONCEPT
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10 – 15%
50 – 60%
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10 - 15%
20 – 25%
Health Status
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2NDQUESTION FOR YOU: DETERMINANTS OF
HEALTH – HEALTH FIELD ELEMENTS FROM LALONDE DOCUMENT
HEALTH FIELD CONCEPT
Health care
Organization
Lifestyles,
behaviours and
Risk Factors
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The
Environment
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Human
Biology
Health Status
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