2.

Concept of Health & Diseases

1- Health
Definition (PSM-SE)
Health is a state of Physical, Mental &Social wellbeing &not merely an absence of disease or infirmity
(Ability to lead a Socially & Economlcally productivelife)

1.1- Dimensions of Health

(Dimensionless-VC NE PSM SEE]
1. Physical dimension
State in which every Cell &Organ is functioning at optimum capacity &in perfect harmony with the rest of the
body
2. Mental dimension
Mental health has been defined a state of balance between the individual &the surrounding world
3. Social dimension
- Quantity &quality of an individual's interpersonal ties &involvement with the community
4. Spiritual dimension
Refers to that part of the individual which strives for meaning& purpose in life
5. Emotional dimension
- Relates to feeling
6. Vocational dimension
-
Work often plays an important role in promoting both physical &mental health
7. Cultural dimension
8. Economical dimension
9. Environmental dimension
10. Nutritional dimension

1.2- Determinants of health

(Determlne- GH SE AGELESS BB]
1. Biological
Diseases are known to be of genetic origin e.g., chromosomal anomalies, diabetes
2. Behovioral
Lifestyles &Personal habits
Cultural 8& Behavioral pattern
Developed countries- Obesity, drug addiction
i. Developing countries- Lack of sanitation, poor nutrition
3. Environment
i. Internal environment-tissue, organ &organ system &their harmonious functioning within the system
External environment-all that which is external to the individual
4. Socio economic
i. Economic status- Purchasing power
Education- Especialy female education
iii. Occupation
State of being employed promotes health
Loss of work can cause psychological &social damage
S. Healith system
Health &family welfare services
Personal &community services
Immunization of children
Provision of safe water
6. Ageing
Increased prevalence of chronic diseases &disabilities
7. Gender
Women's health

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 2. Concept of Health &Diseases

Dimesons tHealt
Dimensonlea VC NE PSM SEE....

Dtrnensionlesa Dimensiona o Heauth

V- Vocational dimension
C- Cutmal dimenion
N - Nutitonal divension
E- EnwinoNmrtal dionon
P- Fhysical climension
S-Soial dinanbion
M- Mental dinension
Spiital dimension
E -Emotonal dimansion
E - Economical dimension

Detoninanta of tHeah
te
Detomine GqH SE Agdene BB....
Detominc - Deteminanta o Health
G-Gende
H- Heoh Sytem
Soio ecoomic GH
E-EnwioNmental
Agaca- Ageing
BBolagcad
8-Behawioal
pis

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 2. Concept of Health & Diseases

2- Spectrum of Health
Health of an individual is not static, it's a dynamlc phenomenon &a
pectum o Heath
process of continuous change
Lowest point on health spectrum is death &Highest point corresponds O Pobitlwe Healtd
to positive health Beter Heait
Health slckness spectrum
1. Posltlve health
2. Better health
3. Freedom from sickness
4. Unrecognized sickness
S. Mild sickness
6. Severe sickness
O S e Gldenea?
7. Death

3- Indicators of Health aaath

Heolth Indicators ore used for megsuring health stotusof community
Ideal indicator should be Valid, Reliable, Sensitive, Specific, Feasible &
Relevant
1. Mortality indicators
Life expectancy ls apositive mortalityindicator
" Years of potentiat tife lost(YPLL) sa mortaliy Indicotor
$ Age stondardized death rote s best to compare the vital stotisticsof Mowbidity
countrieS
Crude death rate Dibabii
CDR= Total deaths x 1000 Nututona
Midyear population EwisNonment
Number of deaths per thousand population per year
Health Pog
Age specific death rate A HeothCaôu Delivo
ASDR =Total number of denths ocCurringin aspecificare group x1000 uizaton
Midyear population of the same age group 9)Soial and martal Hmt
Infant mortality rate
IMR= Total Infant death x1000
Socioecoromic
Total live birth
Most unhversaly gcgpted Lndicgtor of health status of whole population &their socio-econNomk conditions
Best Indicator for avollobilitY, utillizotion &eifetiveness ofhealth services

v. Child mortality rate

CMR = Total death of1-4years x 1000
Midyear population of 1-4 years

Under 5proportionate mortality rate- Proportion of total death occuring in the under 5age group
vi. Adult mortallty rate- Probability of dying between the age of 15 to 60 years per 1000 population
vi Maternal (puerperal) mortality rate- Maternal deaths among women of reproductive age group

vlli. Dlsease specific mnortality rate- Mortality rates computed for specific disease
DSMR =death from a specific disease x1000
Midyear population

Proportional mortallty rate

Measure ofestimating the burden ofa diseasein acommunity
PMR =deathfrom specific diseasex1000
Total deaths

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 2. Concept of Health &Diseases

Case fatality rate

CFR= Total no. of death due to specific disease x 100
Total no. ofcases due to that specfic disease
Represents killing power of the diseose or virulence ofthe organism
It's a proportlon
Always expressed in percentage
CFR =1-Survival rate
CFR of
Rables- 100%
Yellow fever- 80%
Japanese encephalitis-35%
Chlcken pox-<1
Umitation -Tlme Interval is not specified so usefulness is limited for chronic disease
(l.e., typicaly used in acute infections)
2. Morbidity indicators
Incldence rate
Prevalence rate
Attendance at OPD
iv. Admission at IPD
V Duration of hospltal stay
vi. Notification rates

3. Disability indicators
Event type Indicotors
a. Days of restricted activities
Bed dlsobility days
C. Work loss days
Person type indicators
Umitation of mobility- Confined to house
imitation of actiýity- Limitation to perform baslc activitles
" DALY Disobility Adlusted Life Years
Numbers of years lost due to disability
One DALYE one year of heokhy life lost
Mea_ure burden of diseose &eifectlveness of intervention
Meosures morbldity &disabiliy
Itepresses years lostto premature death &years lved with disabllty
DALY =YLm"YLD
o Years of Lost fe-VLLa Number of deathsx Expected remalning years of life
Years Lost to DigabifityYLD =Number of cases due to Injuyyx Average duratlon of the disease xWelghting factor
(welghting factor reflects severity of the disease)
YPLL- Years of Potential ife Lost
Years of Potentlal Lfe Lost through premature death
Years of potentlal lifle lostsemortalltindcater
" DFLE- Disablity Free Ufe Expectancy (Active life expectancy)
Average number of years an individual ls expected to llve free of disabllty
Also known gs Sullivan'sIndexSullivan's Index life expectancy-duratlon of disablity
Posltlve
Dlr edlcetorfor heolth &wellbelng olsocdeb

4 HALE- Heolth Adlusted Life ExpectancY

" It not only includes life expectengyat birth but also an adjustment for time spent, In poor health
HALE Is replaced by DALE (Disability Adjusted Life Expectancy)
* QALY-Quality Adjusted Life Years- Number of quality years that would be added by Intervention

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 2. Concept of Health & Diseases

Dlbabiluky Indlcatoo

ODALY Dibabled ce
(Dibabilg Aayuatad
ollout libNomal e that ia
ODFLE g n o k Uved
(bbabl Fnee Total C
Li Expeckane)
HALE Total ie tat i
eath Adfusted +
Nona e t DibableÀ U

QALY yeans Ueaddacl due to inheet +Added lije

4. Nutritional status indicator

Anthropometric measures of preschool children (Weight, Height, MUAC)
Prevalence of LBW
S. Environmental indicators
Indicators of Noise pollution
ii. Indicators of Air pollution - SO, Soiling index, Coefficient of haze etc
iii.
Indicators of Water pollution-Total suspended solids, Concentration of chlorides,nitrogen, phosphorus etc.
6 Health policy indicators- Proportion of GNP spent on health services
7. Health care delivery indicators
Doctor - Population ratio
Doctor- Nurse ratio
Population- Health centre ratio
Population - Bed ratio
8. Utilization rates
Proportion of infants who are fully immunized
Proportion of pregnant women who received antenatal care
Percent of population using contraceptives Bocio Econome Indiaton Heaih
Bed occupancy rote Houe Bya**
V. Averoge length ofstoy
Bed turnover Rotio -Amount of time that the bedsat O Houing
hospital are unoccupied until next patient is admitted
Negative value- Indicates over occupancy or scarcity of Famity Bonal
beds or over utilization of services
b Positive value- indicates vacant beds or underutilization
of services
Slight positive value- indicates optimum utilizotion gf
services
9. Social &mental health Indicators
Suicide UhEmployment levd
Homicide To PaiaA NAHE K a .
Juvenile delinquency
Battered baby syndrome
GNP po Copla
10. Socio economic indicators
Housing
Fomlly slze E
H. LIteracy rote
v. Unenployment level
GNP per capita
Calorie availability per capita To Dqonaone h
vil Growth rate
vii. Dependency ratio

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 2. Concept of Health & Diseases

4-Concepts of Health

1. Biomedical / Biological Concept of Health

Healthy is being free from disease
Bosed on qerm theorof disease
Umitation
- Minlmal role of environmental, social, psychological &cultural determinants of health

2. Ecological concept of health

Equilibrium with human &environment

3. Psychological concept of health

Social, cultural, economlc &political harmony

4. Holistic concept of health- (we follow it today)

Sound mind, healthy body, strong family &harmony with environment

S. Concept of Positive Heatth

Perfect functioning of body &mind
Conceptualize heath- biologically, psychologicaly &socially
Depends on economic, sociol &culturol factors
Positive heolth remains a miroge due to constgnt chonge

6. Concept of Well Being

Individuals wellbeing have an Objective &Subjective component
Objective component
Standard of living
Refers to scale of- Our Expenditure, Goods we consume &Services we enjoy
Includes
Income &occupatlon
Housing, sonitotion& nutrtion
Provislon gleducotionol& heath services
Depends on per caplta GNP
Level of living
Indudes 9 components
Subjective component
Quality of life
Physical, mental &social wellbeing as perceved by happlness, satistaction &
ytification, that is concerned with flnanclal situatlon, educational opportunities,
reativity, belongingness &trust in others
PQUhwbletlive cemonent of auallty oflule

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 2. Concept of Health & Diseases

5- PQLI- Physical Quality Life Index

Includes
1 Infont mortolity (IMR)
2. LIfe eNpectangy ot the age of one Yeor
3. Literasy

Scale- 0to 100

0-worst performance
100- best performance
India- 6S
Measures the resut of social, economlc & political policies
PQU sa subiective component ofquality oflife

6- HDI-Human Developmental lndex

Incdudes
1. ife expectongy ot birth
2. Meon yeors of schooling&Expected years of schoollng
3. GNI(Gross Notional lncomel per coplta

Calculation of each dimension Index = actual value-minimum value

maximum value-minimum value

HDI is ageometit mean of 3-dimension indlices =Viure)x i(education) xVi(ncome)

Dimensions Indicator Minimum value Maximum valve

Healh Lfe expectangy ot blrth (years) 20 83.2

Education Mean years of schooling 13.2
Expected years of schooling 20.6

Standard of living Real GNI per capita (US$ per annum) 163 108211

Yaue-onges between 0to1

HD- Indla -0.67 (Rank 132/ 189 counties)
HDI rankdng
- Top Australla, Switzerand
Medlum-Indlg
Bottom-Central Afrcan Republlc, Niger
Lvlng stondardhcompared ln derent countdes by HDI
HDLmeasures gchlevements In boskdmenslons olhuman develogment
-HDI- now used improvised HDI Is known as Inequality-adjusted HDI
Human Poverty Index (HPI) Is complimentary to HDI

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 2. Concept of Health & Diseases

PQLI(Prysea Quy e Tnde)

PaLL
P Penla ’ 1year
LBe expectang a 1yeanoage

Lie expecoyat age %1gn Lpnt Motaity

"Sau- 1o0 o to loo

Sixty Fve-65-’ 65 (pTrdla
'Sujectve Componert %

HDI(Huron Dovdopmetal Thdes) Arpits

Huron Ke Baxop hoe ke Liye soo

Phi

Phon

Paisa KomeraGNI per capita

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 2. Concept of Health &Diseases

7-Multi-dimensional Poverty Index (MPI)

International measure of acute poverty covering over 100 developing countries
Uses 3 dimenslons (& 10 indicators)
Dimensions
1. Health
Nutrition
II. Child mortality
2. Education(knowledqel
Years of schooling
School attendance
3. Standard oflving
Cooking fuel
Sanitatlon- sanitatlon facility
Drinking water
Electricity
Housing- housing material for roof, walls &floors
VI. Assets -radio TV telephone, computer, refrigerator, bike car etc
Range-0<MPI <+1
MPI India 0.121
Interpretation
1. 20-33.3 %-vulnerable to poverty (lndia, 27.5%- poor population)
2. >33 %-poverty
3. >s0 %-severe poverty
MPI h¡s reploced HDI (Human PovertyIndex]

7.1 Human Poverty Index (HPI)

HPI meosures deprivation of Bosic dimensions In countn
Takes into account
School dropout rate &lliteracy rate
NO sofe water &NO Sgnitotion
Under-Weiqht for Age
honces of NOT SUNYNÍnatI 40vears of as
HPL-1 HPI- 2
For Developing countrles For Developed countries
Adult literacy rate Gross enrolment ratio In school
NO safe water & NO sanitation Living bekow poverty line
Under-Weight for Age children Social excluston &long-term Unemployment
Probabilsyofdeoth within 40 vears Probobilityof death within 60 veors

HPL- Hhman Povewy ThAex

to NO SHoO
Pori NAHE Psoo
NO Syate and Ganitalon)
to

to
40 Kepenie max g

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 2. Concept of Health & Diseases

8- Kuppuswamy Scale
Scale of Socio-Economic Status (SES) of Urban families
3components
1. Educotionstatus of Head of family
2. Occupation status of Heod of family
3. Total per capita family Income (per month)

Education Education Occupation Occupation Total per capita family Income Income
(head of family) SCore (head of family) SCore (per month) sCore

Professional 7 Professional 10 Rs, 47348 &above 12

degree
Graduate Semi professional Rs. 23674 - 47347 10
Intermediate/ 5 Clerical / Shop / 5 Rs. 17756-23673 6
Diploma Farm
High school 4 Skilled worker 4 Rs. 11837-17755 4
Middle school 3 Semiskilled 3 Rs. 7102-11836 3
worker
|Primary school 2 Unskilled worker Rs. 2391-7102 2
iliterate 1
Unemployed 1 Less than 2390 1

Education
Professional degree- MBBS, BE, Ph.D.
Graduate- B.A, B.SC., B.Com.
Intermediate/ diploma - at least cdass 12th pass
High school- at least class 10th pass
Middle school- at least class 8th pass
vi. Primary school- any level of literacy below zth class
v. lliterate- person above 7 years of age who cannot read &write
Occupation
i. Professional -Requires decision making & organizational abilities
-
Dotors, Engineers, Advocates, Architects, Managers, Principals
i. Semiprofessional - Routine nature of job which requires post high school education
commission agents, research assistants
Clerical/shop/ farm -Some training in arithmetic along with reading &writing is required
clerks,shopkeepers, farm owners
iy. Skilled workers-Long training &practice is required
electrician, plumber, mechanic, carpenter
V. Semiskited workers - Some tràining is required
factory worker, library attendant
Unskilled worker - Noeducation or training is required
laborer, watchman, peon, servant
Unemployed-not employed
5ocioecoNerorri Stalu Scale
Income
Kuppusvan Tiane Tota For Gaptha Farnl reaTe
Per capita family Income Total income of the family
Total number of family members
PhEdcion Educasthn Staliu Haad o the Faie
Socio-Economic Status/ Class
LSKaam apaon Stabua Head o c Pornig
Total score Socio-economic dass
26-29 Upper class Edaallon Ouupatin o ad Fam
16-25 Upper middie Totol P

11-15 Lower mlddle

5-10 Upper lower
Below 5 Lower class

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 2. Concept of Health &Diseases

9-Ottawa Charter for Health Promotion

LAS
MEOUATs

ONALTHY
Health promotion logo
Circle with 3 wings
Incorporates 5 key action areas &3 basic strategies

3 Basic strategies
1. Advocate
2. Enable
3. Mediate

S key action areas (Puble's SkilledAction- Reorients Environment]

Public health policy
2. Personalskills development
3. Strengthen community oction forhealth
4. Reorientotion of health services
5. Supportive environment for health

Otada Chorter
Key Acson aeas
SeRbico skiued ation’ Reoiets Ensinonmet

Pubslics -Pabieteath Poley

Giied -Teuonal Buua deelopmett
'Acuor-Stmengthen Cormmunt ocion
to Heas

'Recxierts Reoveaion
Heasn boue
"EnmonmertSuppottve
teash.

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 2. Concept of Health & Diseases

10 - Epidemiological Triad

Agert At

Time
Time

opulotion Bosawoual
Cuituxal
Host Enwionmert and its
Chamacteri aticá and EcooacaL
Host Ewionmert elementA
Aduprctd Mode of
Epdenologa TFuod Epitenlog a Thiangle Epdenlajl Tringke

Useful in showing the interoction &interdependence

of
1. Aqent
2 Host
3. Environment
&Time

1. Agent
Substance living or nonliving whose presence or absence of which may nitiate a disease process
Cause of a disease
Biological agents- Viruses, bacteria, fungi, protozoa
Nutrient agents- Protein, fats, carbohydrate, vitamins, minerals
Physical agents- Heat, cold, humidity, presure, radiation, electricity, sound
iv. Chemical agents
a. Endogenous -produced inside the body
eg, serum bilirubin (aundice), uric acid (Gout)
Exogenous -arising outside the body
e.g., allergens, fumes, dust, gases, metals
V Mechanieal ngents- Mechanical forces like crushing &friction
vi. Social ngents-Poverty, smoking, alcohol, drug abuse

2 Host
- Person that harbors the disease
. Demographic characteristics -Age, Sex, Ethnicity
i. Biological characterlstics -Genetic makeup, immunity
Social characterlstics -Socioeconomic status, occupation
iv Lifestyle factors- Fitness, Nutritional habits, physical exercise, behavioral patterns

3 Environment
Suroundings that allow disease transmission
Biological, social, cutural &physical
All that which is external to the individual host, living or non-living with which he is in constant interaction
Physical environment- Air, water, soil, radiation
Biological environment- Microbial agents, animals, plants
Psychological environment- Culture, customs, beliefs

& Time
Incubation period
how long a person is infected

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 2. Concept of Health & Diseases

11 - Natural History of Disease

Natural history of disease signifies the woy in which odiseose evolves gver otÉme frÍm the eartiest stoge to its
termingtion gs recovery, disability or death, in the absence of treatment or prevention
Natural history of disease is best established by cohort studies/ longitudina! study
Consists of two phases -
1. Prepathogenesis (.e., the process in environment)
2. Pathogenesis (i.e., the process in man)
1. Prepathogenesis phase
Refers to period, preliminaryto the onset of diseose in mon,
The dise0se aqent has not yet entered man, but the foctors which fovor lts interaction with the human
host are olready exitinginthe Environment
Interaction of agent, host && environment(epidemiological triad) determine not ony the onset of disease
process in man but also the distribution of disease in the community
Primary level of prevention is possible
2 Pathogenesis phase
Begins with the entry of diseose ogentinthe Susceptible Host
Disease agent multiplies &induces physiologikcal changes
Final outcome of the disease may be recovery, disability or death
Host can aso become aclinicat case, subclinical coseor carrier
Secondary &Tertiarylevel of prevention are possible
Screening of diseose moyimprove proqnosis &
increase survival!
Early pathogenesis phase
o This phase in chronic disease is referred to as Presyrnptomatlc Phase
Late pathogenesis phase
o By the time, Signs &Symptom appears the disease is already well advanced into the late
pathogenesis phase

Natnal Histoy Disaae

Pxe-Tathogenai phae Pathogenais phase
Dibeabe
Poce Agent Host
Eany Pthogenets hanc Late tanca
(Prebenptomasc phas)
Kecov

Agert ertena Agert Hast Signs Ting

Enon mut Hast Trteracnon and
Dabliyg|
Death

Leveb
Bteuartion Poravetion Secondag Texb
Reu ention ertion

Modeso Health pecike

1ntereionmornor pactuclon Eany
DAn
Treatment Diolbilitu Reocilitabiov
Limitaton

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 2. Concept of Health &Diseases

12 - Levels of prevention & Modes of intervention

4 Levels of Prevention

1. Primordial prevention
prevention of theemnergence ofrisk factors In population In which they have not vet øpPEOred
it is primary prevention in purest sense
Best level of prevention for Non-Communicable Diseases
Mode of intervention

Education
Examples
Childhood obesity prevention through educotion
Education on maintenance of normal body welght, preservatlon oflife style, primitive
nutritional habits for prevention of myocardial inforction
Educotion on benefits of salt restriction for prevention of CAD
2. Primary prevention
Action taken prior to the onset of disease
Intervention done in prepathogenesis phase of disease
Based on elimination of risk factors
Removes the possibility that a disease will ever occur
Mode of intervention
Health promotion
a. Health educotion
o Through heath care providers, community leaders, decision makers
o Exomple-Marriage counseling, Concer educotion
b. Environmental modification
oExomple- Provision of safe woter (potable sofe woter suppl), installation of sanitarylatrines.
insecticidal spray&rodents' control &improvement of housing
c. Nutritlonal intervention
o Food fortificotion, nutritional education, chiid feeding program
o Erample -high fiber diet to prevent obesity, ietary sat reductlon, paosteurization of milk
d. ifestyle &behavioral chonges
o Changing habits &behavior of the patients
o Exomple-Control oftobacco, exerclse promotion, welght reduction

Specific protection
Approaches
Mass strategy- for whole population
High risk strategy- for individuals at risk
Examples
Prospective screening isa Primarylevel of prevention
o Screening of immiqrants, HIV screening among sex workers
Immunization/ vaccines
ChemoprophyBaxis/ Vitamin Aprophyloxis
Contraceptives /useof condoms
lodization of solt
Defluorination of water
Protection against occupational hazards &accidents(helmets/seatbelts)
Desks provided with table top to prevent neck problem
National iron plus initiatives, mosquito bed nets
Radiation protection
Wearing of qoggles byy welders
Primary prevention for dental carles-fluoridation& dental heoth education

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3. Secondary prevention
Action taken to halt the progress of a disease at its Inciplent stoge &prevents complications
Intervention done in Early pathogenesis phase
More expenslve &less effective than primary prevention
Target qroup in secondary prevention is potients
Eorly diognosis &treatment isthe bestlevel of preventlon for breast cancer
Modes of intervention
Earty diagnosis
" Screening test- Preseriptive screening is aSecondary level of prevention
papsmear, self-breast examinaotion, monitoring of BP
Diagnostic tests- sputum smear for AFB, Peripheral smear for MP
Treatment- DOTS, MDT
Mass treatment
Used when 1 clinical case of active disease can give at least 5 latent cases in a community
Used in control of-Yaws, Pinta, Trachoma, Filaria
Variants- total mass treatment, juvenile mass treatment, selective mass treatment
Examples of secondary prevention
o National health programs,contact tracing of STIS, Case finding for malaria, Health sereentng for diabetes
4. Tertiary prevention
Action taken to limit the impairment &disabilities
Intervention done in Late pathogenesis phase of disease
Modes of Interventions
Disability limitation
" Prevents transition of disease from impatrment to handicap
Example- Spectacles for refroctory error Physiotherapy in poliomyelitis, resting limb in neutrol positionin
polio (helps to prevent overstretching of paralyzed muscles, thereby limits further disability)

Disease Impairment Disability Handicap

Disease- Any abnormal condition of an organism that impairs function
b. Impairment- Any loss of anatomical structure or physiological function
o Example- loss of foot, defective vision
Disability- (Because of impairment) Any restriction or inability to perform an activity in a range
consldered normal for a human being
Example- Unable to walk
d. Handicap-A Disadvantages fora given individuals resulting from an impairment or disabilitythat
limits/ prevents fulfllment of a role considered normal for that individual
Examples
Accident disease
Loss of foot impairment
Cannot walk disobility
Unemployed handicap

Rehabilitation
Combined &coordinated use of medical, social, educational &vocational measure for training &
retraining of individual to the highest possible level of functional ability
Types
a. Medical rehabilitation- Restoration of function
b. Vocational rehabilitation- Restoration of capacity to earn livelihood
C.
Social rehabilitation- Restoration of family &social relation
d. Psychological rehabilitation- Restoration of personal dignity &confidence
Examples- Establishing schools for blind, Gradededexercises in polio, Reconstructive surgery in leprosy,
Crutches in poliomyelitis

Quaternary prevention- preventing general public with over diagnosis of disease due to medical literature reviews

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 2. Concept of Health & Diseases

Levelo o Brevenion and Modes Intewetion

Dibabius Modes a Irtewuon

Leves Broerton Rek Foton|Diease
Pimordial Breuenion Abbut educotion
To puuert emergee
Riok Facdon
Health Bomotion and
Primany Prevotion Precert |Abet Speciti pNotectior
To Preuetemegene
Disnse
Seconday tnevetion Preat Preset Abbet Eoy Diagnobia and
T9reato

To pryant Pnogn
Dibsase into Disabilt
Tectiooy etionPresent Present PBresent Disabilitg Limtaton
and Rebabilittior
To Linnt Dizabiky

Dibease Impaimert ’ Dlbabilty + Hondeap

Disaoze
! ! !

Accidert

Tnpotman
"Ahotomy-Lo oAnatomial
Sbucune
"Phy bioogy -Lose oPhgaio
Los Fost legical fyanctton
Diaputa
Inabiuy to ppmactulks
ndhtonsideted. omal ta
Tnability to Walk

ttandiap
herents individual po
butjuing hi nole In Souehy
Unemp

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 2. Concept of Health & Diseases

13 - Web of Causation
(Makdi ke Web mne Mohan ka Pug]
Suggested by MocMohon &Pugh
Ideally suited in the study of chronic disease, where disease agent is often not known &it's the outcome of interoction
between muttiplefoctors (Biological, Environmental, Immunological, Nutritional, Genetic, Soclal /Spictuo) [BEINGSS]
Web of causation considers all the predisposing foctors &their interrelationship with each other
Someties
Helps to waYs to interrupt the rskof transmission
removal of just one link may be sufficient to control disease

Web q Causanon (Myocandal Ttpmcron)

Ageing 6t Loce o Phupia Alundanee
Grnoki

ernoHon
Distuonnce

nonge tn Hapotensin Obeit ‘CotecoamineA

Aueal sal

Comona Atheotclo

LA Maocandia Tpnaian

14- lceberg Phenomenon

According to this concept, disease in a community may be compared with an iceberg
1 Floating tip
Represents what the physiclan sees in the community L.e.,
lceberg phenomenon
clinicalcgEs diognosed cose Floating tip "Clinical cases
Exomple- PEM "Diagnosed cases
Cinician s concerned with tip of the iceberg
Diagnostic test is done for tip of iceberg
2 Submerged portion Watedine
Represents the hidden portion of disease, ie., latent coses,
inapparent cases, prSYmptomatis çoS yndiggnosed çoses
&corriers in the community
Eoldemioloaist ls concened wth hidden portion gf iceberg
Submerged OLatentcases
Screening test s dong or hidden portion ofthe kebera
porton lnapparent
3 Waterline cases
Represents demarcation between gpparent& Ingpporent Pre symptomatic
diseose cases
Undiacgnosed
lceberg phenomenon used in cases
Hypertension, Diabetes, Anemla, Malnutrition, Mental
llness &Obesity Carmers
Invenro, HepotitisALPolle, Rubella, Mumps, JE,
Diphthera

lceberg phenomenon is NOT shown by (lceberg Me NO Kutta &Tota)

Megskes, Rgbles, Tetan

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 2. Concept of Health &Diseases

15 - Monitoring
Definition- Continuous oversight of activitles to ensure that they are proceeding according to plan
Example- monitoring of air polution, water quality, & nutritional status
Monitoring can be carried out by-Technicians
Obiectvetson angtysis of routine meosurement, atmed ot detecting changes in envtronment
16- Surveillance
Definition- Continuous scrutiny offactors that determine occurreNCe &distribution of disease
Examples -Epidemiological surveillance, Demographic surveillance, Nutritional surveillance, Sentinel suveitlance
Surveillance is carried out by - Professionals
Objectives
Health plonning
Control of disease
pato on new &changing trends
To provide timely warnings
Types
1. Active Surveillance
Health worker actively goes to house every fortnight to detect cases &collect data
Done In NVBDCP
2. Passive Surveillance
Data is itself reported to health system passively
Done in most of National Health Programs
3. Sentinel Surveillance
Helps in identifying missing cases &supplementing notified cases
Done in NACP

16.1 - Difference between Active & Passive Surveillance

Active Surveillance Passive Surveillance
Data is actively collected 1. Data is passtvely reported
2. Heath system staff actively goes to the patients to 2 Data is itself reported to health system passively
gather data
3 Example- health worker goes house to house to detect 3. Example- patients coming to PHC, CHC, private
fever cases & collect blood slides practitioners etc.
Mostly used when disease is targetedfor Elimination or Mostly used when disease is targeted for Control
Eradication
Includes mainly NVBDCP & NLEP 5. Includes most of the National Health Programs in India
6. More expensive 6. Less expensive
7. Diseases- poliomyelitis, leprosy, neonatal tetanus Diseases Diphtherla, Hepatitis B, mumps

16.2- Sentinelsurveillance
Definition-It'sa studyof disease rotes In gspecific population to estimate trends in larger population
Objective
ldentihdng the missing cases &therebysupplementing the notified coses
ldentifving new told cases
Estimates disease prevalence
- Iue morbldity is measured by sentinel survellance
Sentinel system- Involves limted network of carefully selected reporting sites
- Network of hospitals used to collect data on varlous diseases &their causative agents
- Health practitioners are also used to monitor trends of a disease in a specific population
Minimlzes reporting blas
Uses
When a high-quality data is needed about a particular disease that cannot be obtained through a passive system
- Data collected can be used to ldentify trends or outbreaks &to monitor the burden of a disease in a community
Done for-HIVinNational AIDS Control Program (STD clinics &ANC cllnics aere sentinel sites)

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 2. Concept of Health &Diseases

17- Difference between Monitoring &Surveillance

Monitoring Surveillance
Continuous oversight of actlvitiesto ensure that they 1. Continuous scrutiny of the factors that determine the
are proceeding according to plan occurrence & distribution of disease
Can be done by Technlcians Done by Professlonals
3. One time actlvity Continuous cycle
4. Stops once disease is eliminated or eradicated 4. Continues even after disease is eliminated /eradicated
Smaller concept Broader concept
6. No feedback present 6. Feedback present
7. No inbuilt action component present 7 Inbuilt action component present
Example- monitoring of alr polution, water pollution, Example- demographic suveillance, nutritional
noise pollution surveillance, sentinel
surveillance

18- InternationaiClassification of Disease (1CD)

Produced by WHO
Tnternational standard diagnostit classification for morbidity & mortality data In world
Used gso base in heath fields for epidemiological &heath management purposes
ICD Is revised every 10 years
It aligns with GLASS (Global Antimicrobial resistance System)
WHO references classifications
ICD- Intermatlonal classification of Diseases
ICFDH- international classification of functioning disability &health
ICHI- international classification of health interventions

ICD 10 (Unternationol Classificotion of Disease, 10h revislon/edition)

came in- 1 January 1993 ICD-11
PooraChectcaon of Daes or
Coding systemin 10h revision is alhonumerica! y t y S c

Arranged in- 22 chopters &3volumes

ICD 11 ((nternational Classification of Diseose, 11h revision/edition)
June 2018 (will tome in full effect from January 2022)
Numerical-Arabic
3 volumes
1. Volume 1-Tabular list
2. Volume 2- Reference guide
3. Volume 3- Alphabetical index
4-character category with 2 subcategorles Organization
1 charecter corresponds to chapter name
26 chapters with V, X
Chapter 6& mental, behavioral or neurodevelopmental disorders
Chapter 21- symptoms, signs or clinical findings, not elsewhere classified
Chapter 26- traditional medicine conditions- module
V" supplementary section for functioning assessment
X- extension codes
Ycategory-residual çategory with other specified diseases
Zcategory- residual category with other unspecified diseases
New chapters (Sleep Sex BITE]
Sleep wake disorders
Condition related to Sexual health (contains gender incongruence, earlier included in mental health)
Disease of Blood &blood forming organs
Iv. Dlsorders of lmmune system
Traditional medicine
vi. Extenslon codes

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 2. Concept of Health &Diseases

19- Public Health

Definitlon
Science &art of preventing disease, prolonging life &promoting health through organized community efforts
fncludes
Health education to the individuals
Personal hygiene
Sanitation of the environment
Control of communicable disease
Early diagnosls &treatment
Public heath in
Developed country- controlof Non-Communicable Diseases
Developing country- control of Communicable Diseases

20- Community Diagnosis

Definition
Identification &quantification of health problems in a community in terms of mortality &morbidity
Describing pattern of disease in a community, in terms of factors which influence thls pattern
Based on -collection &interpretation of data such as
Age &sex distribution of population
Vital statistics such as birth rate &death rate
Incidence & prevalence of disease in an area
Objectlve
Identification of health needs &health problems of the community
* Community treatment
Health education
Health legislation
Control of specific diseases
Immunization
Improvement of water supplies

21- Patient's care

Inpotient
Wdurotlon ofobservatlon care of a potent is expected to be 24 hours or more
Outpatient
-

patient recetving care in hospital/ clinic/ at emergency care &where patient is released within 23 hours
Observation status patient
active treatment is required to determine of, if patient requires hospitalization or discharge the same day
Urgent care patient
patient who requires stabilization due to emergency situation
Domiciliary core
personalservices rendered bydoctors to petents In hespltol, nursing home &ot home

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