Konsep sehat dan sakit

Yusuf Alam Romadhon

 Dimension and Determinants of Health

• Health is difficult to define but easier to understand.

• To many of us it may mean absence of disease or
infirmity and to many it may mean sound body and
sound mind and sound function of the body.
 Health definitions
• To an anatomist
Healthy body means it should confirm to normal
anatomical structures.

• To a physiologist
Health means normal body functions
 Health definition
• To a biochemist
It means normal biochemical levels / values

• To a pathologist
It means normal cellular make up.
 Health definition
• To a geneticist
It means correct existence of genetic potential

• Similarly to a clinician it means no abnormality in

structure and function of the body. When a clinician fails
to detect anything abnormal by his clinical wisdom and
laboratory tests he labels a person no abnormality
detected (NAD).
 Health Definition
• To a psychiatrist

It means well adjusted and a balanced personality

Any comprehensive
definition?
 Definitions of Health States
• Health: a state of complete physical, mental, and social
well being, not merely the absence of disease (WHO)
• Illness: the unique response of a person to a disease
• Disease: any physiological disfunction in an individu or
organism due to specific causality
• Wellness: an active state, oriented toward maximizing the
potential of the individual
 Physical Health
• It means adequate body weight, height and circumference as
per age and sex with acceptable level of vision, hearing,
locomotion or movements, acceptable levels of pulse rate,
blood pressure, respiratory rate, chest circumference, head
circumference, waist hip ratio.
 It means The body structure and functions
confirming to laid down standards within the
range of normal development and functions of
all the systems.
 Mental health
The positive dimension of mental health is stressed in
WHO’s definition of health as contained in its constitution.
Mental health is defined “as a state of well
being in which the individual realized his
or her own abilities, can cope with
normal stresses of life, can work
productively and fruitfully and is able to
make a contribution to his or her
community”.
 A mentally normal person has the ability to
mix up with others, he/she makes friendship,
behaves in a balanced manner, keeps himself
tidy and observes adequate personal hygiene,
well oriented to time, place and person and
environments and he is unduly not suspicious of
others.
 Mental health cont..
He is cheerful and happy and enjoys life with a purpose
and he thinks positively and has normal development
and contributes fully and is useful and productive to
society and nation.
 Social wellbeing
• It is the third dimension of health
• It means ability of a person to adjust with others in
his/her social life, at home, at work place and with
people. Individu interact with individu and they
inter-relate and inter depend on each other and pay
their effective role in accordance with a situation.
 Essentially social wellbeing includes inter-relation and
interaction of human beings.
Social wellbeing is a composite function of income level,
literacy, occupation and working conditions marital
harmony, institution of a family, social groups and have
good cultural and behavioral patterns of the society.
Social wellbeing can be measured on
scale by taking in to consideration of
indicators like income, literacy and
occupation (as discussed under socio
economic status of family).
 Determinants of health
Heredity

Environment Health services

 Promotive,
 Physical, social,
biological and man-
Health preventive,
curative,
made rehabilitative

Behavior
 Actions
 Habits
 Reactions
 Belief,
attitudes
 Practices
(Lifestyles)
 Environment
The environment is considered to be the most important
determinant and input of health.
 Human made environment
• Health is influenced in the man made environment or
artificial environment too.
• It included items like housing, transport, industries and
communication.
 Health services

Availability, accessibility, affordability

and acceptability of health services are
considered an important determinant /
input to health.
 Health indicators
It is some what easier to defined health for an individual.
But to define “community health” it is some what more
difficult. “Community health” parameters are different
from health parameters of an individual.
“Community health” can be measured through
indicators of economics, (gross national product
gross national income and per capita income), life
expectancy, under five mortality, infant mortality,
literacy level, composite index of human
development, maternal mortality etc.
A community is healthy when it enjoys sound health
where disease and death rate is acceptably low, it is not
threatened with bad environments and its economy is
sound and the health resources are available, practices
are sound and based on scientific evidences.
• Its literacy levels are high and demographically it has
balanced sex ratio and people live long, quality of life is
good and human development index is high.
 A village is said to be healthy if it has: safe
sources of improved water supply, safe method of
waste water disposal, paved streets, disposal of
garbage refuse and animal excreta by manure pits,
people use sanitary latrines, female literacy is
high, girls enrolment is universal, deliveries are
conducted by trained persons, birth rate and death
rate are within acceptable limits, immunization
coverage is high and housing condition is good.
Health is a fundamental human right. The
attainment of highest possible level of health is
the most important world wide social goal.
 What is Disease

The meaning of “Disease” is “without ease”

(uneasiness)

Either a Physiological /Psychological dysfunction

 Illness
Not only presence of disease but involvement of individual's
perceptions and behavior in response to disease are included.
Disease is very subjective.

Sickness
includes a state of social dysfunction too. i.e. The role, an individual
assumes when ill.
 The environment related to disease
This refers not only to the environment the man lives. Various
environmental factors are categorized as follows.
 1. Physical Environment
Physical aspects of environment

• Air, water, light, heat, radiation, gravity, pressure, and chemical

agents etc.

• man tries a great deal to control these factors.

 2. Biological Environment
Certain diseases do not occur in some areas because agents or
vectors can not exist in that environment due to biological
reasons.
 Biological environment includes
Infectious agents of diseases, reservoirs of infective agents,
vectors that transmit diseases, plants and animals.
 3. Social Environment

The social factors relevant to health include

socio-economic status, social customs,
traditional believes, etc.
 Natural History of Disease
• Refers to the course of a disease over a period of time, unaffected
by treatment.
Disease occurrence is usually insidious. Chronic
diseases evolve over a long period and have their
own progression. The history and time period that it
spread is different from disease to disease. Most
of the diseases pass through the
following pattern.
 1. Stage of susceptibility
Risk factors that favors the occurrence of a disease are operating in this
stage.

Host factors : Age, sex, race, family history, nutritional status

Environmental Factors: Exposure to infectious agents, (infections)

obesity, (HT, DM, coronary artery diseases)

During this stage the person remains free of clinical diseases

 2. Stage of pre-symptomatic disease

Three important factors i.e.. Host, agent and environment interact to

initiate pathogenic changes that is adequate to cause a disease.

Still the disease does not clinically manifest.

 3. Stage of clinical disease
In this stage, the particular signs and symptoms
develop. During this stage a disease can be sub
classified in to its own severity grades.
 E.g. Cancers
Stage
I. Localized
II. Local Lymph nodes are involved

III. Involvement of other organs within the same region

IV. Distant metastases

 4. Stage of terminations
Disease terminates and follow the following trend

1.Spontaneous resolution –No sequels

2.Settles down but with some sequels.

3.Result in death of the patient.

 5. Stage of sequels
Disease may extinct but aftermath remains
may be an impairment is left.

Disability

Handicap
 Sequence of events
Disease Impairment Disability Handicap

Impairment
“Any loss or abnormality of psychological,
physiological or anatomical structure or function”.

e.g. Loss of foot, defective vision, mental retardation.

Impairment will be

 visible or invisible

 temporary or permanent

 progressive or regressive
Disability

“Any restriction or lack of ability to perform an

activity in the manner or within or within the range
considered normal for a human being”.
Handicap

Definite disadvantages for a given individual

resulting from an impairment or a disability that
limits or prevents the fulfillment of a role that is
normal for him/her depending on his/her age,
sex, social and cultural factors or for that
individual.

e.g. Accident Disease

Loss of foot Impairment
Cannot walk Disability
Unemployed Handicap
Terima Kasih