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1. Health – definitions, aspects and models of health
Definitions of health
– state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO – 1948)
Dimensions of Health: provide a realistic approach and include the following aspects:
– Physical: mechanistic function of body
– Mental: ability to think and make judgements
– Social: the ability to make and maintain relationships with others
– Emotional: recognise emotions such as fear, joy, grief and anger
– Spiritual: ability to put into practice moral, religious & beliefs to achieve peace of mind – Sexual: acceptance and ability to achieve a satisfactory expression of one’s sexuality – Societal: the basic infrastructure necessary for health, e.g. shelter, peace, food, income, a certain degree of integration or division within society
– Environmental: physical environment includes housing, transport, sanitation, availability of clean water , pollution control
Environmental Model – Based on analyses of ecosystems and environmental risks to health such as socioeconomic risks to health, level of education and various environmental factors. It includes quality of air and water, living conditions, exposure to harmful substances, SES and social relationships.
Holistic Model – Encompasses the physiological, mental, emotional, social, spiritual and environmental aspects of individuals and communities. Each person has the capability and the responsibility for optimizing his/her sense of wellbeing, practicing self-healing, creating feelings and conditions that help prevent diseases and promote health.
2. Determinants of health. Main groups and impact. Social Determinants of health
four general groups of health determinants
– genetic and biological factors 18-22%
– determine individual predisposition to hereditary and degenerative diseases – Examples include chromosomal diseases, mental retardation, blood hypertension, ischemic heart disease and neoplasms – breast and colorectal cancer and mental disorders
– lifestyle factors 49-53%
– smoking, alcohol, drugs, physical activity, diet, psychological stress – Related Diseases include Coronary Heart Disease (CHD), Stroke, Diabetes, Chronic Respiratory Disease, Obesity and Chronic Liver Diseases
– environmental factors 17-20%
– unfavourable factors of the environment: air, water, soil, chemical factors, work
– socio-economic factors: income, social status, education, employment, housing and living conditions, social support (immigrants, homeless,
unemployed and refugees)
– healthcare services 8-10%
– quality, accessibility, timeliness
– Effectiveness of preventive interventions; coverage with immunization programmes; coverage with family planning programmes, contraceptive use; effectiveness of the screening programmes; organisation and efficiency of health services for pregnant, women and children, for chronically ill patients, for elderly, etc.
The Health Iceberg
– Visible above the waterline – the state of health we are concerned with; – Just below the surface are the known risk factors for this health issue; – What sets up these risk factors? Lifestyles.
– what creates these life styles ?
– the psycho-socio-cultural environment.
Socio-economic status and Health:
– There is a very strong correlation between socio-economic status and health. – There is a continual gradient, from the top to the bottom of the socioeconomic ladder, relating status to health – the “SES Gradient”.
– Lower socioeconomic status – linked to: chronic stress, heart disease, ulcers, type 2 diabetes, rheumatoid arthritis, certain types of cancer, and premature aging, etc.
Social Class and Health:
Social class classification:
– indicates the way of life and living standards experienced by groups of different social class;
– It correlates with other aspects of social position such as income, housing, education, working and living environments.
– Social class differences in health (the “social class gradient in health”;) – People from lower social classes experience more sickness and ill health; – Marmot’s “Whitehall studies” of British civil servants document the existence of a health gradient by civil service rank:
– Those living in lower income areas were much more likely to develop coronary heart disease than those in well-off neighbourhoods.
– These effects remained strong even after controlling for tobacco use, level of physical activity, presence of hypertension or diabetes, level of cholesterol and BMI
The Inverse Care Law: “The availability of good medical care tends to vary inversely with the need of the population served” (Tudor Hart 1971).
In areas with most sickness and death (greatest health needs), general practitioners have more work, larger lists, less hospital support, and inherit more clinically ineffective traditions of consultation, than in the healthiest areas; and hospital doctors shoulder heavier case-loads with less staff and equipment, more obsolete buildings, and suffer recurrent crises in the availability of beds and replacement staff
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