HEALTH AND ILLNESS

Assoc. Prof. Petko Salchev, MD, PhD

Our concepts for health and illness, life and death evolve through the ages, beginning with the secret of birth and death, our place in the surrounding world, life and health as individual values and health care as a social value, legal right and aim.

HEALTH AND ILLNESS

Stages in the development of the concept for health and illness

Empirical-sensory knowledge Humoral concept Mechanical-systemic concept Biomedical (etiological) concept Ecological concept Psycho-social concept Holistic concept Socio-medical concept

Empirical-sensory knowledge

It is typical of man’s first attempts to understand himself and the surrounding world.

Human life and death, as well as health and illness have been dependant on supernatural powers, which could be pacified by magic and the rituals of shamans and medicine men

Humoral concept

In the course of development of the humoral concept of health and illness, the latter is seen as „disturbance in the balance of „humors” in the human body - Paracelsus (1493-1541)

The „humors” in the human body are blood (sanguis), phlegm (phlegma), bile (cholera) and melancholy (melancholia) – black bile

Mechanistic-systemic concept

Related to the development of knowledge of the human body structure and the discovery of part of the physiologic processes

Sees human body as a machine, disease as a a failure of this machine. Main objective of medicine is the repair of this machine.

Biomedical (etiological) concept

Founded on the development of the microbial theory of disease

The development of this concept is based on the understanding that every disease occurs as a result of the presence of a certain agent in the host

Model: agent – host – environment

(etiological)

agent hostMode of

transmission

Enhanced model: agent – host – environment (etiological-

pathogenic)

Developed to define more correctly the three components in view of the achievements of medical science and epidemiology, both in the fields of communicable and chronic diseases.

– Factors related to host and influencing health or disease are: age, gender, genetic factors, psychological factors, life style, education, social status, occupation, culture, etc..

– Factors related to causative agent may be defined as : biological, genetic, nutritional, chemical, physical, mechanic, etc.

– Factors of the environment are defined as: physicochemical – air, water, geographic location, altitude, dust, etc.; генетични; socio-economic; political and others.

Enhanced model: agent – host – environment (etiological-

pathogenic)

agent hostMode of

transmission

Factors:Gender, age, genetic, psychological, lifestyle

Factors:physicochemical, genetic, socio-economic

Factors:Biological, genetic,

nutritional, chemical, mechanical

Psychosocial concept

Development of the psychosocial sciences and theories for the influence of psychological factors on health and illness

Ecological concept for health

Dating back to the middle of the ХХ century, it is based on the hypothesis, that health represents a dynamic equilibrium between man and his environment

„Health means … a continuous adaptation to environment with the purpose of achieving optimal functioning” (Dubos,R., 1965).

Holistic concept

Health according to this concept is described as a singular or multi-aspect process, including human wellbeing in the context of his/her environment

„Health is a way of existence, permitting the imperfect human to achieve satisfaction and not so painful existence, faring in the also imperfect world.” (Dubos, R., 1968).

Socio-medical concept

In order for health and illness be understood in light of this concept, we need to answer the following questions:

– Where does health (respectively illness) start and end?– Is health (illness) a condition of the organism or a process?– Is health (illness) a feature of the organism or just an

expression of the influence of various factors?– How is health measured?– What is health as a social category – a value, right or a

goal?– Can health serve to measure vitality, wellbeing?

Model of health – socio-medical concept

health diseasebirth death

life

chronification

Permanent disability (invalidity)

Unknown factor

Known factor

treatment

rehabilitation

Promotion

Primary prophylaxis

Secondary prophylaxis

Tertiary prophylaxis

Vit

al p

roce

sses

Hea

lth

act

ivit

ies

diagnostics

Vital processes

Birth is a „complete push out or taking out from the mother’s body of the product of conception, regardless of the pregnancy duration, which demonstrates signs of life, breathing, heart beat, umbilical cord pulse or clear movement of skeletal muscles” (WHO, ICD-X).

Illness is a dynamic process, which passes through the stages of onset, course, treatment and recuperation.

Disease is the period through which the process of illness evolves and correlates to the disturbance of one or more vital, social and psychological functions of the organism.

Death is an established fact of a final and irreversible stopping of signs of life, due to the interruption of vital functions of one or more organs or systems.

Definitions of health

Based on the previous questions eight types of definitions for health can be formulated : Health as a state Health as a feature Health as a process Health as a social category (value, purpose) Health as a human right Health as a total of statistical features Health as a measure of vitality (quality of life) Health as an integral category

Health as a condition or process

Health can be defined as a state only in a brief (and measurable) moment, but in its essence it is a continuous process of change in different conditions (but not just a sum of them).

Hence, the answer to the question whether health represents a process or a state is – health is a process of constant change of states, influenced by extrinsic and intrinsic to the organism factors and aimed at maintaining the integrity of the individual and achieving optimal balance.

Health as a human right.Constitution of Bulgaria

„Art. 52. (1) Citizens have the right to health insurance, guaranteeing them accessible medical care and free use of medical services under conditions and order, stipulated by law.

(2) Health care for citizens is funded by the state budget, employers, personal and collective insurance payments and other sources under conditions and order, stipulated by law.

(3) The state promotes citizens health and encourages the development of sport and tourism.

(4) No single person can be subjected unwillingly to treatment and sanitary measures, except for the cases foreseen in law.

(5) The state exercises control over all treatment facilities, as well as the production of medications, bioactive substances and medical equipment and over trade with them.”

Health as a combination of statistical features

Can health be measured?

How can it be assessed and validated?

When is a certain man healthy or ill and what are the indicators for this?

Health is a multi-aspect category

Assessment of the health status in a given moment is based on the heuristic thinking of the physician and analysis of data incoming from anamnesis, status, measured through various technologies indicators – laboratory, microbiologic, pathogenic, imaging diagnostics, as well as correlation of these data with the influence of environment factors.

Health is a multi-aspect category, functioning in certain intervals with unsettled borders, providing optimal functioning of the organism, where various other factors are read, related to the biological, social or psychic essence of man.

Example: distribution of diastolic and systolic blood pressure

norm

norm

mm Hg

20 120 140 240200 220160 180100806040

diastolic systolic

count

Example: assessment of individual health status

Leading present complaints; Personal data:age, gender, ethnicity, education, family status; Occupational anamnesis; Family anamnesis; Personal anamnesis; Functional status; Risk factors: family predisposition, high blood pressure, diabetes, smoking, alcoholism,

sedentary life, fats rich diet, occupational stress, etc.; Present diseases; Physical examination; Differential diagnosis; Other medical problems; Tests: lab, imaging, ECG, etc.; Working diagnosis; Treatment and its effect; Final diagnosis; Other medical problems and treatment consequences; Condition follow-up; Long term health care – plan.

Health as a measure of vitality

Health is the main measure of vitality and objective in itself, but this objective has its dimensions and the most fundamental of them is quality of life.

„Quality of life” is a state of life as a result of the combined effect of all factors, which define health, happiness е (including physical comfort and satisfactory knowledge), education, social and intellectual achievements, freedom of action, justice and freedom of speech.”

Health as an integral category

”Health is a state of complete physical, mental and social well-being and not merely

the absence of disease or infirmity.”

(WHO - 7 April,1948)

Integral model of health

person

health

Definition of health

„Health is a complex multidimensional category with triple structure of harmonious unity between biological, psychological and social features, developing as a continuous process in time and space under the influence of factors (determinants) of the environment, as well as the intrinsic for the individual, reflecting the integral qualities of the individual in the community, expressed and measured through the achieved quality of life.” (Salchev)

Leading determinants of health

Factors related to way of life and life style

Genetic factors (hereditary)

Environmental factors

Strength of association in % of different factors with health

100 %0 %

Genome – 10%

Health service – 10 %

Lifestyle – 20%

Physicochemical environmental factors – 10%

Socio-economic factors – 50%