Disease Prevention and Control

Concepts of Health & Disease, Natural History of Disease, Principles of

Disease Prevention & Control
June 30, 2015 Dr. Paredes

OBJECTIVES Preventive Medicine

At the end of the lecture, the 1st year medical student will be able - The science and art of prolonging life, promoting and
to: maintaining health, and preventing the occurrence of
1. Define basic concepts in preventive medicine, health and diseases (improving the health of groups of people)
disease - Epidemiology = basic science of Preventive Medicine
2. Differentiate community medicine from clinical medicine
practice Social Medicine
3. Explain the natural history of a disease - Studies man as a social being in his total environment
4. Define the factors contributing to disease occurrence including societal factors that may influence health
5. Explain the various concepts of disease causation outcome
6. Explain the basic principles behind prevention and control - Concerned also with the health of groups of individuals
of disease - Integrates preventive, curative, and even palliative
approach in order to achieve holistic management
OUTLINE - Conforms to the biopsychosocial model:
I. Definitions Biological factors (genetics, environmental
II. Preventive Medicine factors)
A. Historical Accounts Psychological factors (affective, cognitive,
III. Epidemiology behavioral dimensions)
IV. Public Health Social factors (social systems, social support,
A. Concerns of Public Health quality and access to health care)
B. Modern Public Health
C. 10 Essential Public Health Services Community Medicine
V. Community Medicine - Focuses on health and diseases within a population of
A. Community Medicine vs. Clinical Medicine a defined community or group
VI. Health - Common Concern: promotion of health and prevention
A. Health Measurements of illness
B. Health and Disease Ecologic Concept
C. Ecologic Concept Premises Family Medicine
VII. Disease - A medical specialty concerned with the comprehensive
A. Models of Disease and continuing health care for the individuals, the
B. Natural History of Disease family, and the community
C. Determinants of Disease - Not limited by age, sex, organ system, or disease entity
D. Interventions - Considered a specialty
VIII. Principles of Disease Control
IX. Summary II. PREVENTIVE MEDICINE

I. DEFINITIONS - The science and the art of promoting and maintaining

health, prolonging life and preventing the occurrence of
Clinical and Curative Medicine diseases
- Clinical diagnosis of disease, pathophysiology, - Applicable to the individual, family and the community
therapeutic management
- Concerned with the sick individual A. Historical Accounts
- Main Objective: Medical treatment of the sick Time Event
Disease was considered wrath of gods
1000 BC
Social and Preventive Medicine (witchcraft, demons, astral influence)
- Health statistics, public health education, Egyptian account of medicine
2600 BC
epidemiology, environmental health Imphotep = King Zosers physician
- Primarily concerned with a group of individuals (i.e., Miasma Theory
family, community) bad air (polluted water, wastes and other
- Main Objective: Prevention and control of disease, 1700s environmental factors
promotion and maintenance of health Micro-organisms discovery (Van
Leeuwenhoek)
1800s Germ Theory
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 Linked microbes with diseases - CORE FUNCTIONS: Assessment, Policy
Epidemic investigation (John Snow) Development, Assurance of quality for health services
Variola vaccine development (Jenner)
1875 Public Health Act (England) C. 10 Essential Public Health Services
Shift of focus from communicable to non- 1. Monitor health status
19th Century 2. Diagnose and investigate health problems,
communicable disease
Modern public health hazards
Focuses on chronic diseases, intervention 3. Inform, educate, empower people about health
20th century issues
programs for population vs. individual patient
care 4. Mobilize community partnerships
Re-emerging diseases, new diseases (AIDS, 5. Develop policies and plans
21st century 6. Enforce regulations that protect health and ensure
SARS, H1N1)
safety
III. EPIDEMIOLOGY 7. Assure provision of health care
8. Assure competent health care teams
9. Evaluate services: Efficiency, Acceptability,
- Basic Science in preventive medicine
Quality (EAQ)
- It refers to the study that deals with patterns of disease
10. Research for new and innovative solutions to
occurrence, injury, disabilities and their determinants
health problems
among populations or groups of people
- Quantitative, applied science, systematic & orderly
V. COMMUNITY MEDICINE
methods

IV. PUBLIC HEALTH - Concepts, methods and approaches adopted from

preventive medicine and public health
- The art and science of preventing disease, prolonging
- Branch of medicine focused on the health of
life and promoting physical health and efficiency
populations and communities
through organized community effort and systematic
- Deals with promotion of health and prevention of ill-
social action
health through early detection, planning and
- A social movement for the promotion and protection of
administration of services, research and health
the communitys health
education
- Central to its approach is its concern for the social,
A. Concerns of Public Health
cultural, environmental and biological features that
1. Sanitation of the environment
influence the health of the community
2. Control of community infections
3. Health, personal hygiene education
Differentiation of Community Medicine vs Clinical Medicine
4. Early diagnosis and treatment of diseases
5. Adequate standard of living all for the COMMUNITY CLINICAL
maintenance of healthy communities MEDICINE MEDICINE
Focus of Community or groups Individual Patients
19th Century Shift
attention of people
- The process of mobilizing local, national, international
Disease Epidemiologic tools Medical History, PE,
government and private resources, to solve major Approaches e.g. indices, rates, and Laboratory Exam
health problems affecting populations or communities Employed ratios (morbidity rates,
- Public Health Team = consists of sanitary engineers, mortality rates;
epidemiologists, nurses, administrators and other frequency of
health care providers occurrence of a
disease); surveys
B. Modern Public Health Interventions Health program plans Medical, surgical,
Prospective outlook palliative treatment
- A coalition of professions united by their shared
(seek out whos sick to Reactive outlook
missions, their focus on disease prevention and health prevent spreading;
promotion, their approach prospective in contrast to maintaining health)
the reactive focus of therapeutic medicine, and their Outcome Evaluation studies, Follow up clinic visits
common science, epidemiology monitoring
- MISSION: The fulfillment of societys interest in
assuring conditions in which people can be healthy
- SUBSTANCE: Organized community efforts aimed at
the prevention of disease and promotion of health
- ORGANIZATIONAL FRAMEWORK: Includes
activities undertaken by the government & the private,
voluntary organizations & individuals
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 VI. HEALTH C. Ecologic Concept Premises
- Absence of disease, no impediments to an individuals - Interaction between the host and the disease agent
functioning or survival - Host and disease agents interaction is influenced by
- Soundness of body; that condition in which its functions environmental factors
are duly and efficiently charged - Equilibrium or balance among these three forces
- State of complete physical, mental, social well-being should be attained
and not merely the absence of disease or infirmity Health results from a dynamic process of attaining
Modern Look equilibrium of these 3 forces. Imbalance results to disease.
- Quality of life
- Productivity of people DISEASE
- Health as an essential aspect of socioeconomic HOST
AGENT
development FACTORS
- Shift of health concern from individual health (patient FACTORS
care) to community health

A. Health Measurements
Traditional Indices of Health
1. Morbidity
Prevalence Rate
Incidence Rate ENVIRONMENTAL
2. Mortality FACTORS
Crude death rate
Cause specific death rate
Case fatality rate
Proportionate mortality rate VII. DISEASE
Human Development Index
- An international measure of development
- Imbalance between the forces found in the host,
- Includes life expectancy, education & standard of
disease agent and the environment
living measures that quantify the options
- Failure of the adaptive mechanisms of an organism to
available to society
counteract adequately the stimuli and stresses to which
Quality of Life Index
it is subjected, resulting in disturbance in function or
- Quantify a nations livability for its average
structure of any part, organ or system of the body
inhabitant (health, education, wealth, democracy,
peace & environment)
A. Models of Disease
Happy Planet Index
1. MULTIPLE CAUSATION OR MULTIFACTORIAL
- Uses ecological footprint and other standards of
ETIOLOGY
well-being
- The occurrence of disease is attributed to more
Physical Quality of Life Index
than one factor
- Based on basic literacy, infant mortality and life
o Intrinsic factors host factors influencing
expectancy
susceptibility
Ecological Footprint
o Extrinsic factors biologic, social, physical
- Measures the land and water needed by human
factors in the environment that are relevant to
population to produce their resource
health
requirements and to absorb its carbon dioxide
2. EPIDEMIOLOGIC TRIANGLE
emissions
HOST
B. Health and Disease Ecologic Concept
- Considers the total complex interrelationships
among living organisms: HOST, DISEASE
AGENT, ENVIRONMENT
AGENT ENVIRONMENT

HOST DISEASE Each of these components must be analyzed for

comprehension and prediction of disease patterns.

ENVIRONMENT

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 3. Wheel Model of Man-Environment Interactions keeping environment clean, maintaining
equilibrium)
Various measures aimed at:
o Promotion of general health and well
being
o Maintenance of healthy practices
o Intercepting factors before they involve
the human host directly
General Health Promotive Measures
o Health education
o Proper nutrition
o Healthy habits, personality development
o Adequate housing & environment
B. Natural History of Disease o Personal hygiene
- Life story of a disease starting from without or within Specific Protective Measures
the individual, resulting in changes in body form and o Prophylaxis: Immunization and
functions, and ending either in recovery or death Chemoprophylaxis
Stages: o Water, food, and milk sanitation
1. Pre-pathogenesis/Pre-disease - Happens in the o Proper waste disposal
environment; Disease agent havent entered the host o Vector & vermin control
yet; interaction of host and disease agent, together with o Risk factor control & prevention
the relationship of host and environment 2. Secondary Prevention (during Pathogenesis
Host Disease Agent Environment interaction stage)
2. Pathogenesis happens when balance is altered Objectives:
Subclinical and clinical changes o To recognize the disease process at its
a. Subclinical/Latent Stage no apparent earliest stage to prevent its dissemination
manifesations yet to other hosts
**Clinical Horizon: divides apparent from inapparent o To start treatment early in order to
stage of disease prevent disease progression and its
b. Prodrome nonspecific manifestations sequelae or prolonged disability
c. Frank Illness when organisms have entered the o To prevent its dissemination to other
indicative organ (e.g., in hepatitis liver) hosts
d. Chronic/Complicated Stage Early diagnosis and prompt treatment
3. Outcome o Case findings
Recovery o Surveillance of contacts
Disability o Medical, surgical and other interventions
Death o Adequate care for the sick
Disability limitation institution of continued
C. Determinants of Disease care & treatment in order to prevent further
1. HOST Factors - Age, gender, race, ethnic group, progression, complications and sequelae of
occupation, education, marital status, family the disease
history, socioeconomic group 3. Tertiary Prevention (during Outcome stage)
2. AGENT Factors Infectious agents: virulence, Objectives:
infectivity, mode of transmission, immunogenicity, o Application of rehabilitative measures in
physical, chemical, nutrient factors order to maximize the use of the
3. ENVIRONMENTAL Factors Socio-cultural remaining functions
factors, physical & biologic environment: fauna o To pave the way for the individuals return
and flora to a useful place in the society
Measures (rehabilitation):
D. Interventions (applied at various stages) o Physical rehabilitation
1. Primary Prevention (during Pre-pathogenesis o Psychosocial rehabilitation
stage) o Occupational rehabilitation
Objective:
o To prevent the initiation or onset of
diseases
o Maintain health healthy practices,
lifestyle and habits = Primordial
intervention (keeping person healthy,
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 VIII. PRINCIPLES OF DISEASE CONTROL

SUITABLE ENVIRONMENT

SOURCE OF DA >>> SUSCEPTIBLE HOST

INTERRUPT TRANSMISSION!!!
Basic Principles of Disease & Prevention Control
1. Increase host resistance
2. Eliminate disease agent
3. Modify environment
Make this unsuitable for biologic disease agents
existence
Interrupt transmission of disease agents from a
source to a susceptible host
Allow healthful living of hosts
Availability and accessibility of resources for
health

IX. DISEASE

1. Prevention is a basic concept that has evolved with the

progress of the science of medicine and technology
2. Modern outlook concern for the health and quality of
life (QOL) of communities or populations vs. reactive
patient care
3. Role of environmental, host & disease agent factors
4. Health promotion and maintenance, prevent onset and
progression of disease
5. Need for rehabilitation

PREVENTION IS THE KEY TO HEALTHY POPULATIONS

REFFERENCES:
Dr. Paredes PowerPoint presentation
Recordings
2011 Transcriptions

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