Contemporary definitions of health, concept of disease doc. PhDr. Kateřina Ivanová, Ph.D. PhDr. Miloslav Klugar, Ph.D. Department of Social Medicine and Health care Policy Social risks Try to indicate specific examples of risks: economic enviromental merit demographic political Social risks Sociology specifies these social risk: economic – different living standards and poverty (especially women povely), discrimination and social exclusion, unemployment and kind of work environmental - globalization, environmental threats, social stress, traffic problems, genetic experiments merit – social inequality, excessive consumerism, emotional burnout, relativity of values demographic – aging population, protection of life political - non-functioning institutions, terrorism, etc. (cp. Bourieu, Giddens, Tofflerovi, Bauman, Beck, Lorenz, Habermas, Riesman et al.) Health What is health? Health Manifestation of living organism Has dynamics and interactions with the environment Multidimensional and very complex Difficult definable Individual and community level Reflects an external conditions Social and working relationships Availability and quality of health services Freedom of the individual Biological predisposition Definitions of Health • 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.“ Definitions of Health The definition is derived from bio-psycho-social health model of George L. Engel (1977), who suggested it as an alternative to biomedical model, whose limits are reflected in case of chronic and psychiatric diseases. However, the definition is criticized for its generality, particularly it is not clear what is meant by well-being; health dynamics and spiritual human health are not captured and the definition has a lack of motivational character (Křivohlavý, 2003). Definitions of Health • New definition of health recognizes the inextricable links between an individual and her/his environment - it is known as „socio-ecological“ definition. • Health is 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.“ Definitions of Health • Health encompass social and political concerns and the relationship of individuals to the environment in which they live. • From this perspective, health is not just the responsibility of the traditional „health“ sector, but of all the sectors, institutions, and organizations that may influence the well-being of individuals and communities. Approaches to Health Approaches to Health • Psychology = perceive health from the perspective of individual situation interpretation • Biomedicine = demonstrates the examined person´s disease from medical perspective, because only the absent state of disease is considered a health • Sociology = social construct that varies in different social groups and its main aim is to fulfill social roles • Anthropology (physical) = examines health during human phylogeny and ontogeny • Anthropology (clinical) = studies the ill individuals´ deviation of physical features from the standard • Anthropology (cultural and social) = determines the cultural and social impact on the perception of human health and disease Theology = examines person´s ability to come to terms in a healthy way with something that transcends him; study the integration of human thinking when accepting the meaning of life and human destiny Philosophy (ethics) = includes moral aspirations of a man and his ability to accept ethical decisions, then also competence to reflect ethically on their own thoughts and acts and the impact on the life satisfaction associated with health. Economics = verifies the value of health as a fundamental prerequisite of the manpower, thus of the gross domestic product. Ecology = perceives health as a consequence of the external environment impact Health as a Concept Human being and his/her health Global concept Psychology system Biophysical System Internal nerves blood bones Emotion External etc. meal cloths etc. anger live Intelligence thought understanding Social System Economy etc. etc. Ethics etc. General concept Religion etc. Simple concept Individual experiences Examining influences on Health The most important health benefits in history, by Thomas McKeown (England and Wales): • Behavioural changes – family restriction • Environmental changes - improvement of nutrition and healthier environment • Health Care changes – preventive and therapeutic measures Determinants of Health (HORIZONTAL CONCEPT FROM LALONDE IN WHO) Human Biology The Environment Health care Organization Health Status Lifestyles, Behaviours and Risk Factors Determinants of Health (HORIZONTAL CONCEPT FROM LALONDE IN WHO) Human Biology The Environment Health care Organization Lifestyles, Behaviours and Risk Factors 10 - 15% 20 – 25% 10 – 15% 50 – 60% Health Status Disease • What is disease? Disease • • • • Term is the central concept of contemporary medicine as a deviation from the norm observable signs (symptoms) are quantifiable associated with incapacity of work • Pointed to Parsons´definition of heatlh: either one is healthy and perform their social role, or is sick and is exempt from them (Parsons, 1981). Definitions of Disease? • Disease – morbus (lat.), nosos, pathos (gre.) • Injury – health failure, usually caused by oneoff or short-acting harm of organism • Defect – physical or mental defect, usually permanent in nature (congenital, acquired effect of disease or injury) DISEASE, ILLNESS, SICKNESS • Disease • Professionally defined physiological or psychological dysfunction • Illness • Subjective state of the individuals who feels aware of not being well • Sickness • State of social dysfunction based on professional-social arrangement Factors and Disease Processes • • • Etiology = summary of findings about disease causes. Pathogenesis = rational interpretation of the internal mechanism that leads from health to disease. Etiopathogenesis of disease is often mentioned because both processes are closely related (and often confused). Monocausality = a disease caused by a specific reason Multicausality = a disease caused by a number of reasons, evident in chronic civilization diseases Disease and its terms • Syndrome = complex of symptoms that occure together • Nosology = branch of medicine dealing with disease classification and context • International Statistical Classification of Diseases and Related Health Problems (ICD) - (revisions in 2003) divides diseases and related health problems, and is used to indicate the cause of the disease, cause of death, etc. Approaches to Disease 1) Biomedical Disease Model the reference system of medicine – disease • corresponds to the natural scientific approach and perceives the disease primarily as a biological disorder or also as the failure or inadequacy of human adaptive mechanisms in response to stimuli from its environment • Etiological Disease Triangle (Biomedical Model) The onset of the disease is determined by condition and impact of three factors: a) disease initiator (specific agent) - produces disease not only by its presence but also by its absence (avitaminosis) b) human - demographic characteristics, physiological states, immunological experience, genetic predisposition, lifestyle c) external environment – including natural and social aspects; in terms of disease origin probability are defined risk factors or characteristics and risk persons. Approaches to Disease 2. Psychological • • Disease Model the reference system of person – rather illness according to Špatenková (2000) includes these parts: Sensitive – problems perception, pain Emotional – fear, anxiety, hope Volitional - efforts to resist disease, the decision to see a doctor Informative - knowledge of disease and its treatment The behavior of people in disease is influenced by different factors such as age, gender, mental stability, personality, but also the confidence in physicians and other healthcare professionals and willingness to cooperate (called compliance). Approaches to Disease 3. Sociological Disease Model • the reference system of disease causing – sickness • consider the onset of the disease as a change of social situation for both society and an individual To define (find) disease, to determine what is composed of, and decide what is needed for its termination, this is an assignment of physician. Via the physician society can then check the stability of the social system. Health vs. Disease • Borders between health and disease are not always easily measurable. • According to Žáček are disease and health concepts that can not be separated from the human being in his integrity of life, composed of physical condition, social functions and roles, attitudes and behaviors, feelings and emotions. Control questions Define health and disease. What is ICD? Name the main factors of Etiological Triangle (Biomedical Model) What is syndrome? Explain the concept of monocausality. How sociology approaches to disease? Questions?