Unit 1

THE CONCEPT OF HEALTH

VARIOUS CONCEPTS OF HEALTH

a) Biomedical- The biomedical concept of health defines health as freedom

from disease, pain, or defect, making the normal human condition "healthy”.
The model's focus on the physical processes (for example, pathology,
biochemistry and physiology of a disease) does not take into account the role
of social factors or individual subjectivity.

As per this concept the human body can be compared to a machine, disease
is a breakdown and doctor’s job is to repair the machine.

Limitation: Its focuses on purely biological factors and excludes

psychological, environmental, and social influences.

b) Ecological- Health is a dynamic equilibrium between man & his

environment and disease is the result maladjustment of the human
organisms to the environment.

The concept supports the need for clean air, safe water, ozone layer in the
atmosphere, etc. to protect us from exposure to unhealthy factors.

c) Psychosocial- Health is not only a biomedical phenomenon, but also

influenced by social psychological, cultural, economic factors of the people
concerned.

d) Holistic

1.1. DEFINITION OF HEALTH

Health is a dynamic condition resulting from a body's constant adjustment

and adaptation in response to stresses and changes in the environment for
maintaining an inner equilibrium called homeostasis. The World Health
Organization (WHO) defined health in its broader sense in its 1948
constitution as "a state of complete physical, mental, and social well-
being and not merely the absence of disease or infirmity”. It is also the
ability to lead a socially and economically productive life.

The WHO’s definition was subject to controversy as critics claim it to be void

of operational value. So an operational definition was also adopted, which
states health as “a condition or quality of human organism expressing
the adequate functioning of the organism in given conditions, genetic
or environmental”. It means:
  that there is no obvious evidence of disease and that the person is
functioning normally, conforming within the normal limits of variation
to the standards of health criteria generally accepted for ones age,
gender, community and geographic region.
 that the various organs of the body are functioning adequately in
themselves and in relation to one another, which implies a kind of
equilibrium or homeostasis.
 a condition relatively stable but changes as humans adapt to internal
and external stimuli.

Most Recent Concept

 Health is a fundamental human right.

 Health is the essence of a productive life
 It is inter-sectoral.
 It is an integral part of development.
 Health is central to concept of quality of life.
 Health involves individuals, state and international responsibilities.
 Health and its maintenance is a major social investment.
 It is a worldwide social goal.

1.2. DETERMINANTS OF HEALTH

The range of personal, social, economic, and environmental factors that

influence health status are known as determinants of health. Generally, the
context in which an individual lives is of great importance for both his
health status and quality of his life. It is increasingly recognized that health
is maintained and improved not only through the advancement and
application of health science, but also through the efforts and intelligent
lifestyle choices of the individual and society. According to the World Health
Organization, the main determinants of health include the social and
economic environment, the physical environment, and the person's
individual characteristics and behaviours.

The determinants of health are defined as those predisposing factors,

which influence the health of an individual or a particular community.
They can be broadly classified into three. They are:

1. Host Factors (Intrinsic Factors)

The host predisposing factors are those found within the human
individual. The host is the 'soil' and disease agent is the 'seed'. The host
predisposing factors include:

 Age, sex, ethnicity, biological characteristics such as genetic factors,

blood groups etc.
  Socio-economic factors such as status, education, occupation, stress
etc
 Life style such as personality traits, drugs, alcohol, smoking,
behaviour patterns.

2. Environmental Factors (Extrinsic Factors)

The extrinsic determinants are those factors which exist external to

individual human host. They may be living or non-living and with which the
being is in constant interaction.

The environment of man can be divided into three components- physical,

biological and psychological.

3. Risk Factors

Health Risk Factors are defined as attributes, characteristics or exposures

that increase the likelihood of a person developing a disease or health
disorder.

These factors are often:

 suggestive- the presence of a risk factor does not imply that the
disease will occur, and in its absence disease will not occur.
 Causative- e.g. smoking for CA lung
 Contributory- e.g. lack of physical exercise for CHD
 Predictive- e.g. illiteracy for prenatal mortality

These can also be classified as behavioural and biomedical risk factors.

 Behavioural risk factors are those that individuals have the most
ability to modify. e.g. Tobacco smoking, excessive alcohol
consumption, inadequate fruit and vegetable consumption,
insufficient physical activity etc.
 Biomedical risk factors are bodily states that are often influenced by
behavioural risk factors. e.g. Obesity, High BP, Dyslipidaemia,
Impaired fasting glucose etc.

suggestive

Causative
DETERMINANTS OF HEALTH Age, sex, ethnicity,
genetic factors, blood
Contributory
groups
Physical
Predictive
HEALTH Socio-economic
Biological
factors
Behavioural
INTRINSIC
RISK FACTOR
EXTRINSIC Psychological
Life style
Biomedical
1.3. EPIDEMIOLOGICAL TRIAD

Epidemiology

The word “epidemiology” comes from the Greek words epi, meaning “on” or
“upon”, demos, meaning “people”, and logos, meaning “the study of”. In
other words, the word epidemiology has its roots in the study of what befalls
a population

So, it is defined as “the study of the distribution and determinants of

health-related states or events (including disease), and the application
of this study to the control of diseases and other health problems”.

Various methods can be used to carry out epidemiological investigations:

surveillance and descriptive studies can be used to study distribution;
analytical studies are used to study determinants.

Epidemiological Triad (Triangle)

The Epidemiologic Triangle is a model of infectious disease. It helps to

understand infectious diseases and how they spread.
The triad consists of three corners known as vertices- Agent, Host and
Environment. These three factors interact in a variety of ways that result in
various states of health in an individual or a community.

HOST

DISEASE

AGENT ENVIRONMENT

Agent- Microbe that causes disease- the ‘what’ of the Triangle

In infectious disease models, the term "agent" originally referred to the entity
or micro-organism (e.g. virus, bacterium) capable of causing the disease. As
a general rule, the agent must be present for the disease to occur. However,
the mere presence of the agent is not always sufficient for the disease to
occur.

As the scope of epidemiology has expanded, the concept of "agent" has also
grown to include chemical and physical components. This model works well
with infectious diseases and accidents/injuries and most non-infectious
diseases.

Host- organism harbouring the disease (the “who” of the Triangle)

"Host" refers to the organism (e.g. human) capable of being infected by a

specific agent. There are intrinsic factors that influence an individual's
exposure, susceptibility or response to a causative agent. These factors
include socio-economic status, lifestyle, behaviours, and psychological
characteristics etc.

Environment- those external factors that cause or allow disease

transmission (the “where” of the Triangle)

The environment is all that is external to the host. Environmental factors

are extrinsic factors that affect the agent and the opportunity for exposure.
They can be physical factors (e.g. climate), biological factors (e.g. insects) or
socio-economic factors (e.g. sanitation, access to health services).
An outbreak or an epidemic exists when there are more cases of a particular
disease than expected in a given area, or among a specific group of people,
over a particular period of time. The mission of an epidemiologist is to break
at least one of the sides of the Triad, disrupting the connection between the
environment, the host, and the agent, and stopping the continuation of
disease.

Example of Sexual Transmission of HIV infection in a community

-Host Genetics
-Stage of Infection
-Antiretroviral Therapy
-Reproductive tract infections
-Cervical ectopy
HOST -Contraception
-Menstruation and pregnancy

-Social norms
- Average rate of sex partner
-HIV subtype (A, B, C, D, E) change
-Phenotypic differences -Local prevalence or probability
-Genotypic differences of exposure
-Antiretroviral drug -Social and economic
resistance determinants or risk behaviour
AGENT ENVIRONMENT

How the triad interacts

The interaction of the agent, host and environmental factors determines an

individual's state of health at a given point. Picture in your mind a teeter-
totter in a children's playground, with the agent at one end of the board, the
host at the other end and the environmental factors as the base or fulcrum.
This is the epidemiologic triad.

AGENTS- biological, HUMAN HOST-Age,

nutrient chemical, sex, race, genetics,
physical, mechanical personality
At Equilibrium

LEVER
ENVIRONMENT-physical, social, economic,
biological

FULCRUM
When the system is in balance (known as the equilibrium state), health
prevails. Change in any of the factors could lead to a change in equilibrium,
causing disease.

Imbalance Scenarios

Intervention

The "Epidemiologic Triad" of infectious disease summarizes the factors that

influence an infection, and the measures you might take to combat the
infection.
1.4. CAUSES OF DISEASES

Disease

A disease is a particular abnormal condition that affects a part(s) or all of an

organism and that consists of a disorder of a structure or function. Disease
is often construed as a medical condition associated with specific symptoms
and signs. The study of disease is called pathology, which includes the
study of cause.

It may be caused by external factors such as pathogens or by internal

dysfunctions, particularly of the immune system, such as an
immunodeficiency, or by hypersensitivity, including allergies and
autoimmunity.

In humans, disease is often used more broadly to refer to any condition that
causes pain, dysfunction, distress, social problems, or death to the person
afflicted, or similar problems for those in contact with the person. In this
broader sense, it sometimes includes injuries, disabilities, disorders,
syndromes, infections, isolated symptoms, deviant behaviours, and atypical
variations of structure and function, while in other contexts and for other
purposes these may be considered distinguishable categories. Diseases can
affect people not only physically, but also emotionally, as contracting and
living with a disease can alter the affected person's perspective on life.

Death due to disease is called death by natural causes.

There are four main types of disease: infectious diseases, deficiency

diseases, genetic diseases (both hereditary and non-hereditary), and
physiological diseases. Diseases can also be classified as communicable and
non-communicable.

The deadliest diseases in humans are coronary artery disease (blood flow
obstruction), followed by cerebro-vascular disease and lower respiratory
infections.

Causes

Only some diseases such as influenza are contagious and commonly

believed infectious. The micro-organisms that cause these diseases are
known as pathogens and include varieties of bacteria, viruses, protozoa and
fungi. Infectious diseases can be transmitted, e.g. by hand-to-mouth contact
with infectious material on surfaces, by bites of insects or other carriers of
the disease, and from contaminated water or food (often via faecal
contamination), etc. In addition, there are sexually transmitted diseases. In
some cases, microorganisms that are not readily spread from person to
person play a role, while other diseases can be prevented or ameliorated
with appropriate nutrition or other lifestyle changes.

Some diseases, such as most (but not all) forms of cancer, heart disease,
and mental disorders, are non-infectious diseases. Many non-infectious
diseases have a partly or completely genetic basis (see genetic disorder) and
may thus be transmitted from one generation to another.

Social determinants of health are the social conditions in which people live
that determine their health. Illnesses are generally related to social,
economic, political, and environmental circumstances. Social determinants
of health have been recognized by several health organizations such as the
Public Health Agency of Canada and the World Health Organization to
greatly influence collective and personal well-being. The World Health
Organization's Social Determinants Council also recognizes Social
determinants of health in poverty.

Types of causes

1. Airborne- An airborne disease is any disease that is caused by pathogens

and transmitted through the air.
2. Food borne- Food borne illness or food poisoning is any illness resulting
from the consumption of food contaminated with pathogenic bacteria,
toxins, viruses, prions or parasites.

3. Infectious- Infectious diseases, also known as transmissible diseases or

communicable diseases, comprise clinically evident illness (i.e.,
characteristic medical signs or symptoms of disease) resulting from the
infection, presence and growth of pathogenic biological agents in an
individual host organism. Included in this category are contagious diseases
– an infection, such as influenza or the common cold, that commonly
spreads from one person to another – and communicable diseases – an
disease that can spread from one person to another, but does not
necessarily spread through everyday contact.

4. Lifestyle- A lifestyle disease is any disease that appears to increase in

frequency as countries become more industrialized and people live longer,
especially if the risk factors include behavioural choices like a sedentary
lifestyle or a diet high in unhealthy foods such as refined carbohydrates,
trans fats, or alcoholic beverages.

5. Non-communicable- A non-communicable disease is a medical condition

or disease that is non-transmissible. Non-communicable diseases cannot be
spread directly from one person to another. Heart disease and cancer are
examples of non-communicable diseases in humans.

Five Causes of Diseases

The five causes of diseases are adaptation, injury, cellular death, neoplasia
and aging.

Adaptation- When some kind of an injurious agent comes into the

environment of a cell, the cell tries to adapt to that agent and that can cause
altered cell biology.

Injury- If there is an injurious agent, the cell tries to adapt with it, and it
does certain things to try to adapt, and at a certain point, it can no longer
adapt, and the cell becomes injured.

Cellular death- The cell tries to adapt, it gets injured, and if that injurious
agent stays around for long enough, that can cause the cells to die.

Neoplasia- Neoplasia is new, uncontrolled growth of cells that is not under

physiologic control. When there’s something that causes the cell to
uncontrollably divide. (cancer).

Aging- The cells get older, and as they get older, certain things happen that
cause the cell’s biology to be altered.
1.5. METHODS OF TRANSMISSION

Understanding how infectious pathogens spread is critical to preventing

infectious disease. Many pathogens require a living host to survive, while
others may be able to persist in a dormant state outside of a living host. But
having infected one host, all pathogens must also have a mechanism of
transfer from one host to another or they will die when their host dies.
Pathogens often have elaborate adaptations to exploit host biology, behavior,
and ecology to live in and move between hosts. Hosts have evolved defenses
against pathogens, but because their rates of evolution are typically slower
than their pathogens (because their generation times are longer), hosts are
usually at an evolutionary disadvantage.

Reservoirs and Carriers

For pathogens to persist over long periods of time they require reservoirs
where they normally reside. Reservoirs can be living organisms or nonliving
sites. Nonliving reservoirs can include soil and water in the environment.
These may naturally harbor the organism because it may grow in that
environment. These environments may also become contaminated with
pathogens in human feces, pathogens shed by intermediate hosts, or
pathogens contained in the remains of intermediate hosts.

Pathogens may have mechanisms of dormancy or resilience that allow them

to survive (but typically not to reproduce) for varying periods of time in
nonliving environments. For example, Clostridium tetani survives in the soil
and in the presence of oxygen as a resistant endospore. Although many
viruses are soon destroyed once in contact with air, water, or other non-
physiological conditions, certain types are capable of persisting outside of a
living cell for varying amounts of time. For example, a study that looked at
the ability of influenza viruses to infect a cell culture after varying amounts
of time on a banknote showed survival times from 48 hours to 17 days,
depending on how they were deposited on the banknote.[1] On the other
hand, cold-causing rhinoviruses are somewhat fragile, typically surviving
less than a day outside of physiological fluids.

A human acting as a reservoir of a pathogen may or may not be capable of

transmitting the pathogen, depending on the stage of infection and the
pathogen. To help prevent the spread of disease among school children, the
CDC has developed guidelines based on the risk of transmission during the
course of the disease. For example, children with chickenpox are considered
contagious for five days from the start of the rash, whereas children with
most gastrointestinal illnesses should be kept home for 24 hours after the
symptoms disappear.
An individual capable of transmitting a pathogen without displaying
symptoms is referred to as a carrier. A passive carrier is contaminated with
the pathogen and can mechanically transmit it to another host; however, a
passive carrier is not infected. For example, a health-care professional who
fails to wash his hands after seeing a patient harboring an infectious agent
could become a passive carrier, transmitting the pathogen to another
patient who becomes infected.

By contrast, an active carrier is an infected individual who can transmit the

disease to others. An active carrier may or may not exhibit signs or
symptoms of infection. For example, active carriers may transmit the
disease during the incubation period (before they show signs and symptoms)
or the period of convalescence (after symptoms have subsided). Active
carriers who do not present signs or symptoms of disease despite infection
are called asymptomatic carriers. Pathogens such as hepatitis B virus,
herpes simplex virus, and HIV are frequently transmitted by asymptomatic
carriers. Mary Mallon, better known as Typhoid Mary, is a famous historical
example of an asymptomatic carrier. An Irish immigrant, Mallon worked as
a cook for households in and around New York City between 1900 and
1915. In each household, the residents developed typhoid fever (caused by
Salmonella typhi) a few weeks after Mallon started working. Later
investigations determined that Mallon was responsible for at least 122 cases
of typhoid fever, five of which were fatal.

A pathogen may have more than one living reservoir. In zoonotic diseases,
animals act as reservoirs of human disease and transmit the infectious
agent to humans through direct or indirect contact. In some cases, the
disease also affects the animal, but in other cases the animal is
asymptomatic.

In parasitic infections, the parasite’s preferred host is called the definitive

host. In parasites with complex life cycles, the definitive host is the host in
which the parasite reaches sexual maturity. Some parasites may also infect
one or more intermediate hosts in which the parasite goes through several
immature life cycle stages or reproduces asexually.

Transmission

Regardless of the reservoir, transmission must occur for an infection to

spread. First, transmission from the reservoir to the individual must occur.
Then, the individual must transmit the infectious agent to other susceptible
individuals, either directly or indirectly. Pathogenic microorganisms employ
diverse transmission mechanisms.

Contact Transmission
Contact transmission includes direct contact or indirect contact.

Person-to-person transmission is a form of direct contact transmission. Here

the agent is transmitted by physical contact between two individuals
through actions such as touching, kissing, sexual intercourse, or droplet
sprays. Direct contact can be categorized as vertical, horizontal, or droplet
transmission. Vertical direct contact transmission occurs when pathogens
are transmitted from mother to child during pregnancy, birth, or
breastfeeding. Other kinds of direct contact transmission are called
horizontal direct contact transmission. Often, contact between mucous
membranes is required for entry of the pathogen into the new host, although
skin-to-skin contact can lead to mucous membrane contact if the new host
subsequently touches a mucous membrane. Contact transmission may also
be site-specific; for example, some diseases can be transmitted by sexual
contact but not by other forms of contact.

When an individual coughs or sneezes, small droplets of mucus that may

contain pathogens are ejected. This leads to direct droplet transmission,
which refers to droplet transmission of a pathogen to a new host over
distances of one meter or less. A wide variety of diseases are transmitted by
droplets, including influenza and many forms of pneumonia. Transmission
over distances greater than one meter is called airborne transmission.

Indirect contact transmission involves inanimate objects called fomites that

become contaminated by pathogens from an infected individual or reservoir
(Figure 2). For example, an individual with the common cold may sneeze,
causing droplets to land on a fomite such as a tablecloth or carpet, or the
individual may wipe her nose and then transfer mucus to a fomite such as a
doorknob or towel. Transmission occurs indirectly when a new susceptible
host later touches the fomite and transfers the contaminated material to a
susceptible portal of entry. Fomites can also include objects used in clinical
settings that are not properly sterilized, such as syringes, needles, catheters,
and surgical equipment. Pathogens transmitted indirectly via such fomites
are a major cause of healthcare-associated infections

Vehicle Transmission

The term vehicle transmission refers to the transmission of pathogens

through vehicles such as water, food, and air. Water contamination through
poor sanitation methods leads to waterborne transmission of disease.
Waterborne disease remains a serious problem in many regions throughout
the world. The World Health Organization (WHO) estimates that
contaminated drinking water is responsible for more than 500,000 deaths
each year. Similarly, food contaminated through poor handling or storage
can lead to food borne transmission of disease
Dust and fine particles known as aerosols, which can float in the air, can
carry pathogens and facilitate the airborne transmission of disease. For
example, dust particles are the dominant mode of transmission of
hantavirus to humans. Hantavirus is found in mouse feces, urine, and
saliva, but when these substances dry, they can disintegrate into fine
particles that can become airborne when disturbed; inhalation of these
particles can lead to a serious and sometimes fatal respiratory infection.

Although droplet transmission over short distances is considered contact

transmission as discussed above, longer distance transmission of droplets
through the air is considered vehicle transmission. Unlike larger particles
that drop quickly out of the air column, fine mucus droplets produced by
coughs or sneezes can remain suspended for long periods of time, traveling
considerable distances. In certain conditions, droplets desiccate quickly to
produce a droplet nucleus that is capable of transmitting pathogens; air
temperature and humidity can have an impact on effectiveness of airborne
transmission.

Tuberculosis is often transmitted via airborne transmission when the

causative agent, Mycobacterium tuberculosis, is released in small particles
with coughs. Because tuberculosis requires as few as 10 microbes to initiate
a new infection, patients with tuberculosis must be treated in rooms
equipped with special ventilation, and anyone entering the room should
wear a mask.

Vector Transmission

Diseases can also be transmitted by a mechanical or biological vector, an

animal (typically an arthropod) that carries the disease from one host to
another. Mechanical transmission is facilitated by a mechanical vector, an
animal that carries a pathogen from one host to another without being
infected itself. For example, a fly may land on faecal matter and later
transmit bacteria from the faeces to food that it lands on; a human eating
the food may then become infected by the bacteria, resulting in a case of
diarrhoea or dysentery

Biological transmission occurs when the pathogen reproduces within a

biological vector that transmits the pathogen from one host to another
(Figure 4). Arthropods are the main vectors responsible for biological
transmission (Table 1). Most arthropod vectors transmit the pathogen by
biting the host, creating a wound that serves as a portal of entry. The
pathogen may go through part of its reproductive cycle in the gut or salivary
glands of the arthropod to facilitate its transmission through the bite. For
example, hemipterans (called “kissing bugs” or “assassin bugs”) transmit
Chagas disease to humans by defecating when they bite, after which the
human scratches or rubs the infected feces into a mucous membrane or
break in the skin.

Biological insect vectors include mosquitoes, which transmit malaria and

other diseases, and lice, which transmit typhus. Other arthropod vectors
can include arachnids, primarily ticks, which transmit Lyme disease and
other diseases, and mites, which transmit scrub typhus and rickettsial pox.
Biological transmission, because it involves survival and reproduction within
a parasitized vector, complicates the biology of the pathogen and its
transmission. There are also important non-arthropod vectors of disease,
including mammals and birds. Various species of mammals can transmit
rabies to humans, usually by means of a bite that transmits the rabies
virus. Chickens and other domestic poultry can transmit avian influenza to
humans through direct or indirect contact with avian influenza virus A shed
in the birds’ saliva, mucous, and faeces.

ACUTE AND CHRONIC DISEASES

The conditions we develop are often categorized as either chronic or acute.

Acute illnesses generally develop suddenly and last a short time, often only
a few days or weeks.

Chronic conditions develop slowly and may worsen over an extended period
of time—months to years.

But of course, the differences are more than just that.

Causes

Acute conditions are often caused by a virus or an infection, but can also be
caused by an injury resulting from a fall or an automobile accident, or by
the misuse of drugs or medications.

Chronic conditions are often caused by unhealthy behaviours that increase

the risk of disease—poor nutrition, inadequate physical activity, overuse of
alcohol, or smoking. Social, emotional, environmental, and genetic factors
also play a role. As people age, they are more likely to develop one or more
chronic conditions.

Symptoms and treatment

Acute diseases come on rapidly, and are accompanied by distinct symptoms

that require urgent or short-term care, and get better once they are treated.
For example, a broken bone that might result from a fall must be treated by
a doctor and will heal in time. Sometimes, an acute illness, such as the
common cold, will just go away on its own. Most people with acute illnesses
will soon recover.

Chronic conditions are slower to develop, may progress over time, and may
have any number of warning signs or no signs at all. Common chronic
conditions are arthritis, Alzheimer’s disease, diabetes, heart disease, high
blood pressure, and chronic kidney disease. Unlike acute conditions,
chronic health conditions cannot be cured—only controlled. Controlling (or
managing) the symptoms of a chronic condition can often be done by
creating a health care plan in partnership with your physician—the plan
may include taking medication, healthy eating, physical or occupational
therapy, exercise, or complementary treatments, such as acupuncture or
meditation. Frequently, chronic conditions can be prevented by practicing
healthy lifestyle behaviours, such as staying physically active; maintaining a
healthy weight and nutritional status; limiting sun exposure; and refraining
from drugs, smoking, and excessive alcohol use.

Examples of acute and chronic conditions

Acute conditions

 Asthma attack

 Broken bone

 Bronchitis

 Burn

 Common cold

 Flu

 Heart attack

 Pneumonia

 Respiratory infection

 Strep throat

Chronic conditions

 Alzheimer’s disease

 Arthritis

 Chronic obstructive pulmonary disease (COPD)

  Depression

 Diabetes

 Heart disease

 High blood pressure

 High cholesterol

 Obesity

 Osteoporosis

 Stroke

Acute vs. Chronic

An acute condition is one where symptoms appear suddenly and worsen

rapidly, while a chronic condition is one that develops gradually and
worsens over an extended period of time.

Acute pain tells your body you’ve been hurt — say, when you fall, stub a toe,
burn your finger, etc. The pain appears suddenly, peaks as a signal to your
body to heal the injury, and wanes as it heals. Similarly, acute illnesses like
flu or common cold afflict a person suddenly, worsen over a short period,
and then disappear.

Chronic pain, on the other hand creeps up on you gradually, and by the
time you feel its presence, you realize it has been there for a while. It lasts
for weeks, even months beyond the expected recovery; till you feel the pain
itself is a disease and becomes a part of you. Back pain that lasts for
months and worsens over time is a good example of chronic pain.

Comparison chart
Acute Chronic
A chronic condition is a human health
An acute disease is condition or disease that is persistent or
a disease with a otherwise long-lasting in its effects. The
Definition
rapid onset and/or term chronic is usually applied when the
a short course. course of the disease lasts for more than
three months.
Appearance Sudden Usually gradual
of
 Comparison chart
Acute Chronic
symptoms
Short; a few days to Extended period of time; usually six weeks
Duration
a week or two. or more, often months or years.
Starts suddenly as a Develops gradually out of habitual diet,
Nature of
reaction to an injury posture or other condition. Continues
Pain
or something else. beyond expected period of recovery.
Breaking a bone,
Osteoporosis, asthma, frequent migraines,
burn, strep throat,
Examples consistent back pain, heart disease, kidney
flu, asthma attack,
disease.
heartburn.
Diagnosis

A condition is typically only diagnosed as chronic when symptoms have

been present for at least three months, especially in the case of acute or
chronic pain.

Frequency

Acute illnesses are far more common than chronic illnesses. An acute
condition can be as simple as a stubbed toe, or as serious as a heart attack.
They are simply illnesses or injuries that occur and end relatively quickly.

1.6. THE SICK ROLE, THE PATIENT, CARER AND SOCIETY

Definition of Sick Role Theory

Sick role theory, as described by researcher Talcott Parsons in 1951, is a

way of explaining the particular rights and responsibilities of those who are
ill. Since those who are diagnosed with a medical condition cannot always
fulfill the same duties that a person in good health can, society adapts to
this situation and allows for a reasonable amount of deviation from
behaviour that would be viewed as typical of a well person.

Parsons saw the sick role as a form of deviance, or going against societal
expectations, because an ill person has different patterns of behaviour than
the norm. He argued that people are generally expected to be productive
members of society. However, if an ill person is not able to carry out his or
her usual duties, such as work at a job, go to school or care for family
members, this deviance from the usual is positively sanctioned, or approved
by the community or authority figures. For instance, if you don't show up
for school, teachers and administrators will see this as deviant, but if it is
because you are sick in bed, they will allow your absence.

For the deviance to be sanctioned, a medical expert, such as a doctor, must

certify that a person is actually ill, a process that legitimates their illness.
Legitimization is proof that the person is truly sick and in need of a more
lenient set of expectations. This is the equivalent of a doctor's note that you
could take to school to prove that you didn't simply skip classes to go to the
movies.

Parsons describes two rights and two responsibilities that an ill person has:

Rights:

 The patient has a right not to be blamed for his illness and
 The sick person is exempt from normal social roles.

Obligations:

 The patient has the responsibility to make getting well a priority and
 The sick person should seek technically competent help and cooperate
with the medical professional.

These rights and responsibilities may be in effect only during a certain

period while a person is ill and so may be temporary. The specifics of these
expectations will vary depending on the seriousness of an illness and how
much the condition interferes with everyday life.

PATIENT

A patient is any recipient of health care services. The patient is most often ill
or injured and in need of treatment by a physician, advanced practice
registered nurse, physiotherapist, physician assistant, psychologist, dentist,
podiatrist, or other health care provider.

The word patient originally meant 'one who suffers'. This English noun
comes from the Latin word patiens, the present participle of the deponent
verb, patior, meaning 'I am suffering,' and akin to the Greek verb πάσχειν (=
paskhein, to suffer) and its cognate noun πάθος (= pathos).

Outpatients and inpatients

An outpatient (or out-patient) is a patient who is hospitalized for less than

24 hours. Even if the patient will not be formally admitted with a note as an
outpatient, they are still registered, and the provider will usually give a note
explaining the reason for the service, procedure, scan, or surgery, which
should include the names and titles and IDs of the participating personnel,
the patient's name and date of birth and ID and signature of informed
consent, estimated pre- and post-service time for a history and exam (before
and after), any anaesthesia or medications needed, and estimated time of
discharge absent any (further) complications. Treatment provided in this
fashion is called ambulatory care. Sometimes surgery is performed without
the need for a formal hospital admission or an overnight stay. This is called
outpatient surgery. Outpatient surgery has many benefits, including
reducing the amount of medication prescribed and using the physician's or
surgeon's time more efficiently. More procedures are now being performed in
a surgeon's office, termed office-based surgery, rather than in a hospital-
based operating room. Outpatient surgery is suited best for healthy patients
undergoing minor or intermediate procedures (limited urologic,
ophthalmologic, or ear, nose, and throat procedures and procedures
involving the extremities).

An inpatient (or in-patient), on the other hand, is "admitted" to the hospital

and stays overnight or for an indeterminate time, usually several days or
weeks, though in some extreme cases, such as with coma or persistent
vegetative state patients, stay in hospitals for years, sometimes until death.
Treatment provided in this fashion is called inpatient care. The admission to
the hospital involves the production of an admission note. The leaving of the
hospital is officially termed discharge, and involves a corresponding
discharge note.

Day patient

A day patient or (day-patient) is a patient who is using the full range of

services of a hospital or clinic but is not expected to stay the night. The term
was originally used by psychiatric hospital services using of this patient type
to care for people needing support to make the transition from in-patient to
out-patient care. However, the term is now also heavily used for people
attending hospitals for day surgery.

CARER OR CARE-GIVER

A carer is anyone who cares, paid or unpaid, for a person who due to illness,
disability, a mental health problem or an addiction cannot cope without
their support.

Typical duties of a caregiver might include taking care of someone who has a
chronic illness or disease; managing medications or talking to doctors and
nurses on someone's behalf; helping to bathe or dress someone who is frail
or disabled; or taking care of household chores, meals, or bills for someone
who cannot do these things alone.
With an increasingly aging population in all developed societies, the role of
caregiver has been increasingly recognized as an important one, both
functionally and economically. Many organizations which provide support
for persons with disabilities have developed various forms of support for
carers as well.

Role of Carer

The roles and responsibilities of carers vary as much as the people they
support. The duties of a carer can include:

Practical tasks such as, tidying the house, doing washing, ironing, paying
the bills, cooking meals, shopping

Personal care including, dressing, washing, lifting, giving medication or

collecting prescriptions, attending doctors’ appointments

Emotional support such as providing a listening ear, giving support and

advice, giving reassurance

This is a small sample of the extensive list of tasks that carers may
undertake.

QUESTIONNAIRE

1. WHO definition of health (2 marks; 20 words)

2. Transmission of HIV- AIDS

3. Determinants of health

4. Epidemiologic Triad

5. Holistic Health

6. Homeostasis

7. Treatment, Cure and Healing

(5 marks; 100 words)

8. Theory of Humours in Health

9. Who declared “Health for all by 2000” in 1981- Why did if fail?

***

HOLISTIC HEALTH
Holistic Health is actually an approach to life. Rather than focusing on
illness or specific parts of the body, this ancient approach to health
considers the whole person and how he or she interacts with his or her
environment. It emphasizes the connection of mind, body, and spirit. The
goal is to achieve maximum well-being, where everything is functioning the
very best that is possible. With Holistic Health people accept responsibility
for their own level of well-being, and everyday choices are used to take
charge of one’s own health.

How Holistic Health Developed

Ancient healing traditions, as far back as 5,000 years ago in India and
China, stressed living a healthy way of life in harmony with nature. Socrates
(4th century BC) warned against treating only one part of the body “for the
part can never be well unless the whole is well.” Although the term holism
was introduced by Jan Christian Smuts in 1926 as a way of viewing living
things as “entities greater than and different from the sum of their parts,” it
wasn’t until the 1970s that holistic became a common adjective in our
modern vocabulary.

Holistic concepts fell temporarily out of favour in Western societies during

the 20th century. Scientific medical advances had created a dramatic shift
in the concept of health. Germs were identified as outside sources causing
disease. Gaining health became a process of killing microscopic invaders
with synthesized drugs. People believed that they could get away with
unhealthy lifestyle choices, and modern medicine would “fix” them as
problems developed.

However, for some conditions medical cures have proven more harmful than
the disease. In addition, many chronic conditions do not respond to
scientific medical treatments. In looking for other options, people are
turning back to the holistic approach to health and healing. The Holistic
Health lifestyle is regaining popularity each year, as the holistic principles
offer practical options to meet the growing desire for enjoying a high level of
vitality and well-being.

The Basic Principles of Holistic Health

Holistic Health is based on the law of nature that a whole is made up of

interdependent parts. The earth is made up of systems, such as air, land,
water, plants and animals. If life is to be sustained, they cannot be
separated, for what is happening to one is also felt by all of the other
systems. In the same way, an individual is a whole made up of
interdependent parts, which are the physical, mental, emotional, and
spiritual. When one part is not working at its best, it impacts all of the other
parts of that person. Furthermore, this whole person, including all of the
parts, is constantly interacting with everything in the surrounding
environment. For example, when an individual is anxious about a history
exam or a job interview, his or her nervousness may result in a physical
reaction–such as a headache or a stomach ache. When people suppress
anger at a parent or a boss over a long period of time, they often develop a
serious illness–such as migraine headaches, emphysema, or even arthritis.

The principles of Holistic Health state that health is more than just not
being sick. A common explanation is to view wellness as a continuum along
a line. The line represents all possible degrees of health. The far left end of
the line represents premature death. On the far right end is the highest
possible level of wellness or maximum well-being. The centre point of the
line represents a lack of apparent disease. This places all levels of illness on
the left half of the wellness continuum. The right half shows that even when
no illness seems to be present, there is still a lot of room for improvement.

Holistic Health is an ongoing process. As a lifestyle, it includes a personal

commitment to be moving toward the right end of the wellness continuum.
No matter what their current status of health, people can improve their level
of well-being. Even when there are temporary setbacks, movement is always
headed toward wellness.

The U.S. Centres for Disease Control and Prevention report that the key
factors influencing an individual’s state of health have not changed
significantly over the past 20 years. Quality of medical care is only 10%.
Heredity accounts for 18% and environment is 19%. Everyday lifestyle
choices are 53%. The decisions people make about their life and habits are,
therefore, by far the largest factor in determining their state of wellness.

The most obvious choices people make each day is what they “consume”–
both physically and mentally. The cells in a person’s body are constantly
being replaced. New cells are built from what is available. Harmful
substances or lack of needed building blocks in the body can result in
imperfect cells, unable to do what is required to keep that person healthy.
Similarly, on the non-physical level, a person’s mental attitudes are “built”
from what they see and hear.

The majority of illnesses and premature death can be traced back to lifestyle
choices. There are the well-known dangers connected with drugs, alcohol,
nicotine, and unprotected sexual activity. Less recognized is the impact of
excesses in things like sugar, caffeine, and negative attitudes. Combined
with deficiencies in exercise, nutritious foods, and self-esteem, these
gradually accumulate harmful effects. With time they diminish the quality of
the “environment” within that human being, and can set the stage for illness
to take hold. Quality of life, now and in the future, is actually being
determined by a multitude of seemingly unimportant choices made every
day.

How Holistic Health Is Practiced

While preventing illness is important, Holistic Health focuses on reaching

higher levels of wellness. The right half of the wellness continuum invites
people to constantly explore which everyday actions work for them and
discovering what is appropriate to move them toward maximum well-being.
People are motivated by how good it feels to have lots of energy and
enthusiasm for life, knowing that what they are doing that day will allow
them to continue to feel this great for years to come.

When disease and chronic conditions do occur, the Holistic Health

principles can also be applied. The term is usually changed to holistic
medicine, and additional factors are added. The healthcare professionals
using the holistic approach work in partnership with their patients. They
recommend treatments that support the body’s natural healing system and
consider the whole person and the whole situation.

A holistic approach to healing goes beyond just eliminating symptoms. For

example, taking an aspirin for a headache would be like disconnecting the
oil light on the dash of a car when it flashes. The irritation is eliminated, but
the real problem still exists. In holistic medicine, a symptom is considered a
message that something needs attention. So, the symptom is used as a
guide to look below the surface for the root cause. Then what really needs
attention can be addressed.

The Benefits of Holistic Health

Holistic Health supports reaching higher levels of wellness as well as

preventing illness. People enjoy the vitality and well-being that results from
their positive lifestyle changes, and are motivated to continue this process
throughout their lives.

***