02. Health and measurements of health

• definition of health (biomedical model) 


  defined as the absence of disease or disability
• definition of disease(biomedical model)


  caused by an injury which may either be external or internal in origin
• external origin

  physical, chemical, or microbiological source
• internal origin


  vascular, immunologic, metabolic source
• Engel's Critique of Biomedicine


  A biochemical alteration does not translate directly into an illness. The appearance of illness results from the interaction of diverse causal factors, including those at the molecular, individual, and social levels. And the converse, psychological alterations may, under certain circumstances, manifest as illnesses or forms of suffering that constitute health problems, including, at times, biochemical correlates
• Engel's Critique of Biomedicine

  The presence of a biological derangement does not shed light on the meaning of the symptoms to the patient, nor does it necessarily infer the attitudes and skills that the clinician must have to gather information and process it well
• Engel's Critique of Biomedicine

  Psychosocial variables are more important determinants of susceptibility, severity, and course of illness than had been previously appreciated by those who maintain a biomedical view of illness
• Engel's Critique of Biomedicine

  Adopting a sick role is not necessarily associated with the presence of a biological derangement
• Engel's Critique of Biomedicine

  The success of the most biological of treatments is influenced by psychosocial factors, for example, the so-called placebo effect
• Engel's Critique of Biomedicine


  The patient-clinician relationship influences medical outcomes, even if only because of its influence on adherence to a chosen treatment
• Engel's Critique of Biomedicine

  Unlike inanimate subjects of scientific scrutiny, patients are profoundly influenced by the way in which they are studied, and the scientists engaged in the study are influenced by their subjects
• Engel's Critique of Biomedicine

  Biomedical model is dualistic – separates the body and the mind; body is more important
• Engel's Critique of Biomedicine

  Materialistic and reductionist orientation of medical thinking ; anything not objectively justified or explained at the level of cellular or molecular level is ignored or devalued
• Engel's Critique of Biomedicine

  Detached observer
• biopsychosocial model


  angle proposed to brought in biomedical and biopsychosocial models
• biopsychosocial model

  illness: defined in terms of human experience of "ill health"
• biopsychosocial model

  encompass both an objective and subjective reality in its definition
• disease


  should be diagnose and there is the irregularity in the body
• disease


  objective, biological concept, physiological condition, professionally defined
• illness


  subjective, psychosocial concept, personal perception, highly individualized depending on the state of mind and cultural beliefs as well as physiological and psychological stimuli
• illness-wellness continuum

  dr. john travis, 1972

  
• illness-wellness continuum

  individual state of health is of continual change ; person moves back and forth from illness to health ; health condition is rarely constant
• illness-wellness continuum

  individual experiences various states of health and illness
• we must continually adapt to health changes
• health (who definition)

  State of complete physical, mental and social well-being and not merely the absence of disease or infirmity
• Measures of Health

  Life expectancy, Mortality, Morbidity, Quality of life, Quality adjusted life year, Disability adjusted life year
• life expectancy


  Measures how many years, on average, a person is expected to live based on current age and sex-specific death rates
• life expectency


  most commonly used measure to aggregate the mortality data
• life expectancy (since 1936)

  canada - up to 80 years old
• life expectancy in the ph vs thailand vs world

  there is a time when our life expectancy was higher than thailand and the world but now, we are lower than them
• life expectancy


  females are expected to live longer than males
• life expectancy male vs female comparison factor

  health-seeking behavior of males are lower than females, nature of jobs of males are typically stressful than for females
• Mortality


  • Numbers and rates of deaths

  • Age-specific mortality rates

  • IMR (infant mortality rate)

  • MMR (maternal mortality ratio)

  • Pre-mature mortality
• imr (infant mortality rate)

  rate of death of young children (under the age of 1) per 1000 life birth (before their first birthday)
• high imr = poor conditions in the country
• imr rate


  helps in understanding the causes and extent of deaths of infants in a particular region
• mmr (maternal mortality ratio)

  no. of maternal deaths during a given time period per 100,000 life births during the same time period
• mmr

  kung napproteksyonan and supported ang mga birthing mothers
• pre-mature mortality (previous definition)

  measure the burden of tuberculosis
• pre-mature mortality


  potential years of lives lost before the age of 70 years old