CONCEPT OF DESEASE

Concept Of Disease
Definitions.
A condition in which body health is impaired ( Webster )

A departure from a state of health or an alteration of the human

body interrupting the performance of vital functions (Oxford
English Dictionary)

Ecological point of view : Maladjustment of the human organism

to the environment.

Sociological point of view: A social phenomenon with respect to

cultural forces prevalent in the society.
 Defining Disease
Disease;
• It is a condition in which body health is impaired
• Person may or may not know that he is suffering
from disease
• Departure from state of physiological to
psychological well being
 Defining Disease
Illness;
• It is a subjective state in which one or more
functions of body are so much disturbed that the
effected individual can not meet the natural
requirements of every day life
• A subjective state
• Person is aware of his state of being unwell
Sickness;
• State of social dysfunction (sickness role)
 Concept Of Causation
Objectives of studying concept of causation

• Knowing factors which are responsible

• Quantifying and prioritizing them

• Formulating approaches for prevention / control

 Concept Of Causation.
 Previously up to time of Louis Pasteur e.g. supernatural theory

 Germ theory of disease

 Epidemiological Triad

 Multi factorial Theory

 Web of Causation
 1. Germ Theory Of Disease

• Microbes as sole cause of disease

• Presented by Kock
• One sided view of disease
• One is to One relationship
• Disease model
disease agent _____man _______disease
[Link] Triad

Environment

Agent Host
 CAUSATIVE FACTORS

• Agent:
Substance living or non living, or a force, tangible or
intangible, excessive presence or relative lack of which any
initiate or perpetuate or disease process.
 Agents
• Physical
Heat e.g. heat stroke
Cold e.g. frost bite
Noise e.g. deafness
Radiation e.g. cancers
Moisture e.g. fungal infection
light

• Chemical:
Endogenous e.g. hormones , cholesterol , uric acid etc.
Exogenous e.g dst, smoke
 Agents
• Nutritional
Proteins, fats, CHO, minerals , vitamins

• Biological
Viruses, Bacteria ,Fungi, Protozoa , Helminthic etc.

• Mechanical
 Host Factors
• Age
• Sex
• Race
• Heredity
• Marital Stats
• Immunization
• Nutritional status
• Occupation
• Life style
• Socioeconomic status
 Host Types
• Obligatory Host:
Only one host e.g. man in measles

• Definite Host:
In which sexual cycle of agent is completed
e.g. Mosquitos for malarial parasite

• Indefinite Host:
In which asexual cycle of agent is completed

• Transport Host:
Host is only carrier e.g. Cyclops in guinea worm
 Environmental Factors (Extrinsic)
1. Physical environment
2. Biological environment
3. Psychosocial environment
 3. Multifactorial Causation
• Non communicable diseases cannot be explained on the basis
of germ theory or Epidemiological triad, nor they can be
prevented by the traditional methods of isolation,
immunization or improvement in sanitation

• Concept of multifactorial causation or web of causation

model was developed

• Multiple Risk Factors for IHD e.g. Age, smoking,

hyperlipidemia, DM , sedentary life style, obesity,
stress……….
 4. Web Of Causation
• It considers all the predisposing factors and their complex
relation ship with each other

• It does not imply that disease can not be controlled unless all
the cases or chain of causation are controlled or removed

• Some time removal of just one link or chain may be sufficient

to control the disease provide that link is sufficiently
important in pathogenic phase
Web Of Causation of Myocardial Infarction

Changes in life style Stress

Abundance of food
Smoking Emotional
disturbances
Lack of Aging and other
physical factors
exercise
Obesity hypertension
Hyperlipidaemia Increased catacholamines
thrombotic tendency
Changes in walls of arteries

Coronary atherosclerosis

Coronary occlusion

Myocardial ischaemia

Myocardial infarction
 Natural History Of Disease
• Definition:
Evolution or course of disease in absence of any intervention
from the earliest stage to its termination as……
recovery , chronicity, disability or death.

• Best explained by cohort studies

• Each disease has its own unique natural history

 Phase Of Natural History Of Disease
1. Pre – pathogenesis phase

2. Pathogenesis phase
 Pre – Pathogenesis Phase
• Definition: Period preliminary to the onset of disease

• No interaction between Agent Host Environment

• “Man exposed to risk of disease

• We all are in pre pathogenesis phase of many diseases both

communicable and non communicable.
 Pre – Pathogenesis Phase
Causative factors
• Agent
• Host
• environment
Pre – Pathogenesis Phase
Pre – Pathogenesis Phase

Agent Host

Environment
 Pathogenesis Phase

• Agent , Host, and Environment interact with each other

• Entry of disease agent > Multiplies > Incubation period >

Early pathogenic phase > Late pathogenic phase

• Final out come may be recovery, disability or death

• Host’s Reaction To Disease Agent

o Clinical or subclinical
o Typical or Atypical
o Carrier case with or without having developed disease e.g.
polio and Diphtheria
 Factors Modifying Pathogenesis Phase

• Host’s immunity
• Immunization status
• Chemotherapy / treatment
• environment
Phase of Disease Levels of Prevention Modes Of
Intervention

Pre pathogenic Phase Primordial Health Promotion

Primary Specific Protection

Early Pathogenic Secondary Early Diagnosis &

Phase Treatment

Late Pathogenic Tertiary Disability protection

Phase
Rehabilitation
 RISK FACTORS

• Causative e.g Smoking for lung cancer

• Contributory: e.g. Mal nutrition leading to infection
• Modifiable: Obesity
• Non modifiable : Age
 RISK FACTORS

Disease Risk factors

Heart disease Smoking, high blood pressure, elevated serum cholesterol, diabetes,
obesity, lack of exercise, type A personality
Cancer Smoking, alcohol, solar radiation, ionizing radiation, work – site hazards,
environmental pollution, medications, infectious agents, dietary factors
Stroke High blood pressure, elevated cholesterol, smoking

Motor vehicle accidents Alcohol, non – use of seat belts, speed, automobile design, roadway
design
Diabetes Obesity, diet

Cirrhosis of liver Alcohol

 RISK GROUPS

• “Those in need”

• Called “Risk approach”

• Helps to define priorities

• For example used by WHO for MCH services

 Ice Berg Phenomenon
• Disease in the community can be compared with ice
berg

• The floating tip of the ice berg represents what

physician sees in the community i.e. Clinical Cases

• The vast submerged portion of the ice berg

represents the hidden mass of disease

• The hidden cases may be Latent, subclinical ,

carriers pre symptomatic, un diagnosed cases in the
community
 ICE – BERG OF DISEASE

• Ice – berg phenomenon

 ICE – BERG OF DISEASE

• Ice – berg phenomenon

 ICE – BERG OF DISEASE

•
 ICE – BERG OF DISEASE

• Ice – berg phenomenon

 Ice Berg Phenomenon
• Examples are disease like Hypertension , DM, anaemia,
mental illness, AIDS, Hepatitis B & C

• The hidden portion constitutes an important and

undiagnosed reservoir of disease

• The detection of these cases is a challenge for

preventive medicine

• The best measure for there detection is through

Screening
THANK YOU