01.health and health determinants

8/2/2019 01.Health and Health Determinants

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HEALTH AND HEALTH DETERMINANTSHEALTH AND HEALTH DETERMINANTS

PUBLIC HEALTH AND COMMUNITYPUBLIC HEALTH AND COMMUNITYHEALTHHEALTH

Sonia Fernndez Balbuena

Course 2011/12


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HEALTHHEALTH


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CLASSIC CONCEPTCLASSIC CONCEPT

Absence of illness

Subjective concept hard to define

Not very useful


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WHOWHO

1946: A state of complete physical,social and mental well-being, and notmerely the absence of disease or

infirmityStrengths: positive definition and includes

all the dimensions of human lifeWeakness: wellness health (utopic)

Static and subjective


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WYLLIE (1970)WYLLIE (1970)

Health is the perfect, continuingadjustment of an organism to its

environment.

Disease: would be an imperfect,

continuing adjustment


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TERRYS (1980)TERRYS (1980)

State of physical, mental and social well-being and ability to function, and not merelythe absence of illness or infirmity

Subjective: Feeling well

Objective: Ability to function

Objective and dynamic (health degrees)


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TERRYS (1980)TERRYS (1980)

HEALTH DEGREESHEALTH DEGREES

+++ ++ + ++++++

Health Illness

Feeling

well

Feeling ill

Ability to function


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SALLERAS (1985)SALLERAS (1985)

Health

High levelof physical,mental and

social well-being andability tofunction

Prematuredeath

Defense and health

promotion and disease

prevention

Health gain Loss of healh

Health restoration

Signs Symptons Disability

Neutral zone

Community activities

Education

Economic policy


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DETERMINANTSDETERMINANTS

The range of personal, social, economic andenvironmental factors which determine the healthstatusof individuals or populations.

Lalonde Health Factors (1974):1. Genetic and biological factors2. Behavioural and attitudinal factors (lifestyle

factors)

3. Environmental factors (economic, social,cultural and physical factors)

4. The organization of health care systems


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LALONDE (LALONDE (weightsweights))


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PUBLIC EXPENDITUREPUBLIC EXPENDITURE


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TARLOV (1999)Genes and biology

Social/societalcharacteristics

and ecologyMedical care

Health

behaviours

Relative influence of the five major determinant categories of populationhealth: rou h a roximations


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ORAL HEALTH EXAMPLE:ORAL HEALTH EXAMPLE:

TOOTH DECAYTOOTH DECAY

Biological factors: age, individualdisease resistance

Environmental: source of fluorideavailable for large groups of population

Lifestyle: sugar diet, oral hygiene

Dental care


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PUBLIC HEALTHPUBLIC HEALTH

protect, foment and promote the welfare ofthe population when is healthy

and to restore and re-establish their healthwhen it is lost and,

if necessary, to rehabilitate and reintegrate

the sick, integrated into his social,professional and cultural media.

Organized community effort aimed to:


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Responsibility of governments, who organizes the

activities to improve the health of the population.

Some are carried out by health services (prevention

and restoration of health) but some have no direct

relation to health services:

-Education

-Employment and wage policy-Construction of affordable housing

-Roads

-Social Security ...


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PUBLIC HEALTH ACTIONSPUBLIC HEALTH ACTIONS

Restoration of healthIll person

Disease prevention and healthprotection

Threat Health promotion

Healthy

Recovery/ death/ chronicity

Risk factor (prevention)

Enviromental (protection)

Maintain and expand the

welfare state


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PREVENTIONPREVENTION

Any measure that reduces thelikelihood of a disease, or stops it, or

slow its progression

Prevention can be:

Primary

Secundary

Tertiary


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PREVENTIONPREVENTION Primary

Before the disease to appearVaccination/ improve workplace

SecondaryIntervene in presymptomatic phase

Cancer screening/ tooth decay screening

TertiaryReduce complications, cure, rehabilitate ...

Usual health care


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diseas

e.

h

ealth

Vulnerables Diagnosis-earlyIntervention

Rehabilitation

Clinical Medicine:

90% resources

PRIMARY SECONDARY TERTIARY

PREVENTIONPREVENTION


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TBC EVOLUTIONTBC EVOLUTION

Koch

ChemoterapyBCG

4.000

3.000

2.000

1.000

1838

1880

1950

196

0

Why this decline occurs?Cases

per millionpopulation

Evolution of tuberculosis in 150 years


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CHRONIC DISEASESCHRONIC DISEASESIt is not characterized by a unique syndrome or symptom

It is a process nor a state

ACUTIZATION

HEALING

CONVALESCENCE

RECOVERYAFTER-EFFECTS

DISABILITY

ADAPTATION

HIGH INFLUENCE OF ENVIRONMENTAL FACTORS


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PUBLIC HEALTH is a complex discipline that extracts

knowledge of a variety of sciences, specially:

-Demography -Food technology

-Statistics -Education

-Microbiology -Communication

-Immunology -Clinical Medicine

-Epidemiology


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COMMUNITY HEALTH

Responsibility and participation of thecommunity to contribute for a better level of

health for all its members.

The community (citizens) participates

actively to improve their health

It is essential the health information and

education of the community


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HEALTH INEQUITIESHEALTH INEQUITIES1992: The people from Harlem has a lower life expectancy than

people from Bangladesh (F. J. Martin Santos)

STRUCTURAL FACTORS:- Education

- Occupation- Income- Habitat- Environment

LIFESTYLE FACTORS:- Nutrition

- Drugs- Medicines- Sexual behavior- Exercise

- StressHEALTH SERVICES FACTORS

- Availability and accessibility (cost..)- Priority Vs Preventive care

- Evaluation and effective control


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DISEASES AND INEQUITIESDISEASES AND INEQUITIES

Less incomeStigma

Decreased economic ability andinfluence for decisions affecting

the community

Deficiencies

- Nutritional- Educational

Personaland social malfunction

DISEASE

PREVENTIONRECOVERY


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INEQUITIESdisINEQUALITIESINEQUITIESdisINEQUALITIES

NO

Individual and free choices?

YES NO

Acceptable inequality Acceptable inequality

Could the circumstances been modified/ controlledby humans?

Determinants of differencesin health

Inacceptable inequalityInequity

YES


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INEQUITIESINEQUITIES

A difference in health that is

systematic,

socially produced (modifiable)

and unfair

S i h N ti l H lth


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Spanish National Health

System (SNS)

3 administrativelevels

1. Central

2. Regional3. Health area


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NHS (SNS)

1. CentralMinistry of Health (Ministerio de Sanidad yConsumo):

Establishes general criteria for healthcoordination.

2. RegionalEach region manages their own healthcare services since 2004.


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3. Health Area Basic structures of the health system

Each Autonomic community establishestheir health areas considering : population,

socioeconomic and geographic factors,

transport

There is one general hospital at least for

each health area

NHS (SNS)


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HEALTH CARE LEVELSHEALTH CARE LEVELS1-Primary Health care:

The health areas are divided in basic health zones with aPrimary Healthcare Center for each zone.

The primary health care professionals are general

practitioners, paediatricians, nurses and social workers.

2-Specialized Health care:

Satisfy the welfare needs related with more complex healthproblems.

There are specialized centers and hospitals


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PRIMARY HEALTH CAREPRIMARY HEALTH CARE

Covers a broad range of health and preventative

services, including health education, counseling,

disease prevention and screening.

It is essential health care made accessible at acost a country and community can afford, with

methods that are practical, scientifically sound and

socially acceptable.


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QUESTIONSQUESTIONS

Make groups to work the following questions.

Each group must have at least one copy ofthe notes

What is the contribution from CommunityHealth Into Public Health?

Why disease can cause inequality?In which case you could say that inequality is

acceptable?

01.health and health determinants

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