BASIC CONCEPT OF DISEASE

Joko Mulyanto
Department of Public Health & Community Medicine
Jenderal Soedirman School of Medicine

OUTLINE
The concept of health and disease
Determinants of health and disease

Definition of Health
"a state of complete physical, mental, and social
well-being and not merely the absence of
disease or infirmity. (WHO, 1948).
"a state characterized by anatomical,
physiological, and psychological integrity; ability
to perform personally valued family, work, and
community roles; ability to deal with physical,
biological, psychological, and social stress; a
feeling of well-being; and freedom from the risk
of disease and untimely death" (Stokes, Noren,
and Shindell, 1982).

Problems with the concept of health

Abstract and vague
Difficult to be measured.
Health is more dynamic state rather
than static condition.
Encompass many dimensions.

More approaches to the concept of

health
Ecological approach
The extent to which an individual or
a group is able to realize aspirations
and satisfy needs and to change or
cope with the environment. (Last,
2000).
The equilibrium among humans and
other living things that share the
earth (harmony).

Dimensions of Health
Physical, mental, social.
Absence of disease, illness, pain.
Reserve for coping with stress and
illness
Functional ability to allow task to be
performed
Positive well-being
Conformity to expected norms.

Concept of Disease
The boundary between health and
disease is fuzzy
Subjective and objective perception.
Sociological perspective

Objective Perception of Disease

The impaired, endangered, lost of
individual and populations health.
Based on empirical and
experimental evidence specially in
modern medicine.
The deviation from the normal
distribution.
Judged by well-trained physician.

Sociological Perspective
The concept of disease, illness, and
sickness.
Disease related to biomedical aspect,
diagnosed by physician, usually believed
located in specific organ or system,
curable through specific treatment.
Illness is the personal experience of the
person who acknowledges that he or she
does not feel well.

Contd
Sickness refers to the social actions
taken by a person as a result of
illness or disease, such as taking
medication, visiting the doctor.
Patient feel illness, act sickness,
physician diagnose and treat
disease.

Final Thoughts about Health &

Disease Concept
The concept of health and disease is
complex, dynamic, and often unclear.
Many dimensions of health.
Positive Health.
Clear and operable definition is need to
measure health.
There is no single-best indicator to
measure health.
Health and disease are socially and
culturally mediated.

Determinant of Health and Disease

Epidemiological Triangle / Triad
Conceptual cause and component
pies.
Biomedical model
Force field & well-being paradigm of
health
Health field model
Social model of health

Epidemiologic Triangle

Contd
Traditional model of infectious disease
causation.
External agent
microorganism, physical chemical agent.
Susceptibility of host
intrinsic factor; age, sex, behavior,
genetic, SES.
Environmental
extrinsic factor, affect agent & facilitate
exposure. Physical, Biological,
Socioeconomic.

Conceptual cause and component

pies

Contd

Specially for non infectious disease.

Multi-factorial causes.
Sufficient cause
Necessary cause

Biomedical Model
Traditional view
Separate body and mind
The determinant is the provision of
healthcare
Disease or illness appear when body fail
to function due to many causes.
Health is no presence of somatic sign &
symptom, and the absence of disease.

Health Paradigm (Blum, Lalonde)

Heredity
Environmental
Lifestyle
Medical care

Health Field Model (Evans &

Stoddard)
Expanded model of health paradigm
9 components: social environment,
physical environment, genetic
endowment, individual response,
healthcare, health & function,
disease, well-being, prosperity
Dynamic interrelationship
Population health

Contd

Social Model of Health (Dahlgren &

Whitehead)
Multiple determinants
Five layers
Nested each other, not as separate
entities.

Contd

THANK YOU
djokomoeljanto2007