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ObjectivesObjectives
To understand the importance of parameters measuring healthy conditions; social, cultural and economical.
You students should also be capable to understand the role of human genetics, food and nutrition, infectious agents, environment and education in health status.
Health is a state of complete Physical, Mental, and Social well-being and not merely the absence of disease or infirmity.
WHO, 1948
The Metaphysical Context of the Universe
The Secular Dimensions of Health
Physical Mental
Social
Determinants of HealthDeterminants of Health
the complex inter-relationships of genetics social environmentphysical environmentbehaviorhealth/illness services
that determine the level of health and sense of well-being in an individual
GeneticsGenetics
Body Size Special Abilities Disease Resistance Disease Susceptibility Genetic Diseases General Robustness
Physical EnvironmentPhysical Environment
Macro-environmentFood and WaterAir Pollution
Micro-environmentHomeWorkplace
Social EnvironmentSocial Environment
Religion Race/Gender Socioeconomic Status Education Occupation Family Composition
Socioeconomic Status, Socioeconomic Status, Income and HealthIncome and Health
Socioeconomic StatusAs GDP increases, the health of a nation
increases In times of economic hardship, the
incidence of disease increases
Health CareHealth Care
Quality Availability “Health has improved NOT because of
steps taken while we are ill, but because we are ill less often.”
Thomas McKeown, 1978
Primary PreventionPrimary Prevention
Measures taken to prevent the disease from occurring such as:healthy lifestyle habits Immunizations
Secondary PreventionSecondary Prevention
Measures undertaken to facilitate early detectionScreeningsDiagnostic tests
Tertiary PreventionTertiary Prevention
Measures to minimize complications or exacerbation of injury or disease.Rehabilitation TherapyPatient counseling
Rising Life Expectancy Rising Life Expectancy
Source: United Nations (U.N.) Population Division, Demographic Indicators, 1950-2050 (The 1996 Revision) (U.N., New York, 1996).
Prevention and ReligionPrevention and Religion
Washing Hands Hands should be washed when one
touches something polluted or unclean; likewise, before or after eating.The Prophet, Peace Be Upon Him, said:
“Whoever sleeps and his hands are not clean from fat and thereby gets harmed should blame no one but himself”
“The Prophet, Peace Be Upon Him, used to wash his hands before eating”
Historical Examples of Global Historical Examples of Global Prevention ActivitiesPrevention Activities
*Model for acute infectious agents
AHECSOUTHCAROLINA
Vaccinationavailable
Streptomycinintroduced
Koch identifiedtuberclebacillus
Death rate for Tuberculosis, 1860-1960, United States, Source: US Bureau of the Census, Historical Statistics of the United States; Colonial Times to 1970 (Washington, D.C: Government Printing Office, 1975), Part 1 pp58,63. Note: Data between 1860 and 1900 for Massachusetts only.
The Sanitary Revolution and The Sanitary Revolution and the Ascendancy of Public the Ascendancy of Public
HealthHealthThe sanitary revolution produced the greatest
transformation in the pattern of disease that the world had known since nomadic hunter-gatherers settled in permanent villages, and
ultimately developed modern urban industrial communities
Death Rates for Measles in Children Under Age Death Rates for Measles in Children Under Age
15, England and Wales, 1850-197015, England and Wales, 1850-1970
Source: Thomas McKeown, The Modern Rise of Population (Academic Press, San Francisco, 1976), pp. 93, 96.
Epidemiologic Transition, MexicoEpidemiologic Transition, MexicoDecline in Communicable, Rise of NCDsDecline in Communicable, Rise of NCDs
1
10
100
1000
1932 1952 1972
Diarrhea
Malaria
TB
Typhoid
CHD
CA
Example of successful prevention Example of successful prevention program in Cubaprogram in Cuba : : VACCINATION VACCINATION
PROGRAM RESULTPROGRAM RESULT
POLIO ELIMINATED SINCE 1962DIPHTHERIA ELIMINATED SINCE 1969NEWBORN TETANUS ELIMINATED SINCE 1972CONGENITAL RUBELLA ELIMINATED SINCE 1989MENINGITIS POST MUMPS ELIMINATED SINCE 1989MEASLES ELIMINATED SINCE 1993
WHOOPING COUGH TRANSMISSION INTERRUPTED SINCE 1994RUBELLA TRANSMISSION INTERRUPTED SINCE 1995MUMPS TRANSMISSION INTERRUPTED SINCE 1995
MORBIDITY
MENINGOCOCCICAL DISEASE REDUCTION 93%TYPHOID FEVER REDUCTION 75%B HEPATITIS REDUCTION 52%
IntroductionIntroduction
Cervical cancer is the 2nd most common cancer among women globally
Higher cervical cancer mortality in developing countries due to lack of effective screening programs
Estimated impact of AIDS on under-5 child Estimated impact of AIDS on under-5 child mortality ratesmortality rates – – Selected African countries, 2010Selected African countries, 2010
Source: US Bureau of the Census
250
200
150
100
50
0
per 1000 live births with AIDS
Botswana Kenya Malawi Tanzania Zambia Zimbabwe
without AIDS
NZ
FRANSPN
USSR
CHN
SING
HK
USAAUST
CAN
FIN
ITY
SCOT
750
500
250
0
Death Rates for Coronary Heart Disease by Country Men Ages 35-74, 1970 and 1993 (Rate/100,000)
JPN
““Genes load the gun.Genes load the gun.Lifestyle pulls the trigger”Lifestyle pulls the trigger”
Dr. Elliot Joslin
Lifestyle Factors
What is the future of prevention?What is the future of prevention?
Globalization of Prevention
Networking of people in prevention
Sharing of data, knowledge and wisdom