Understanding Health and Illness

Health and Illness

• Presented by Dr. Kristen Smith, Community Health and Psychiatry (2016/2017)

Outline

• Health revised definitions of illness
• How does one become ill
• Causes of illness/disease
• Disease classification
• Stages and effects of illness

Health Revised

• The World Health Organization (WHO) defines health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.
• The biopsychosocial model of health includes psychological, sociological, and biological factors relating to health and illness,

Terminologies

• Disease: Disturbance of structure or function of the body, due to lack of adaptation of the organism to its environment.
• Morbidity: Condition of being diseased.
• Morbidity Rate: The proportion of disease to health in a community.
• Mortality: Condition or quality of being subject to death.
• Epidemiology: Study of the patterns of health and disease for control and prevention.
• Susceptibility: The degree of resistance the potential host has against the pathogen.
• Etiologic Agent: An agent that produces injury or disease (e.g. Streptococcus, Staphylococcus).
• Virulence: Relative power or degree of pathogenicity of the invading microorganism, able to produce poisons that repel or destroy phagocytes.
• Symptomatology: Study of symptoms.
• Symptom: Any disorder experienced by the patient indicative of a disease.
• Sign: An objective symptom or evidence made apparent by examination.
• Syndrome: A set of symptoms that commonly occur together, characterizing a disease.
• Pathology: The branch of medicine dealing with the cause, nature, and treatment of disease.
• Diagnosis: Determining the nature of a disease.
• Complication: A condition that occurs during or after an illness.
• Prognosis: Prediction of the course of a disease, with good indicating recovery and poor indicating morbidity or mortality.
• Recovery: Restoration to the pre-illness state.

Illness Definitions

• Illness and sickness are generally synonyms for "disease."
• "Illness" refers specifically to a patient’s personal experience of their disease.
• Illness is a personal or subjective state of feeling unhealthy or unwell and may or may not be related to disease.
• Illness diminishes physical, emotional, intellectual, social, developmental, or spiritual functioning.

How Does One Become Ill? Causation

• Models are theoretical ways of understanding a concept.
• Models provide ways of approaching complex concepts like health and illness.
• Models are used to understand the relationship between these concepts and the client's attitudes toward health and health practices.

Models of Health & Illness

• Agent-Host-Environment
• Health Belief Model
• Health/Illness Continuum
• Health Promotion Model
• High-Level Wellness Model

Agent-Host-Environment (The Epidemiological Triad)

• Host is the man.
• Agents are specific causative factors, like P. falciparum.
• Environment facilitates the interaction of host and agent.
• Areas with stagnant water are breeding grounds.
• Sometimes a vector like Anopheles mosquito is involved.

Models of Causation

• Chain of Infection includes:
  • Infectious agent
  • Reservoir
  • Portal of exit
  • Mode of transmission
  • Portal of entry
  • Susceptible host
• Web of Causation de-emphasizes the disease agent and allows for multifactorial causes.

Health - Illness Continuum

• Depicts pre-mature death to high-level wellness, along with disability, symptoms, and signs under the "treatment paradigm."
• Wellness paradigm involves awareness, education, and growth.

High-Level Wellness Model

• Consists of a wellness grid involving:
  • Environmental Axis
  • Health Axis

Health Belief Model

• It is built on the premise that:
  • Disease prevention and curing treatment will eventually be successful.
  • Health is highly valued.
• Both premises need to be present in the model to be relevant in explaining health behavior.

Health Promotion Model

• Primary usage in nursing.
• Describes major components and behaviors influencing health promotion.
• Emphasizes increased well-being rather than avoidance of disease.
• The model has three components: individual characteristics and experiences, behavior-specific cognition and affect, and behavioral outcome.

What Causes Illness/ Disease?

• A number of factors contribute that may be one or many, and these may include:
  • Risk factors.
  • Health determinants.

Risk Factors for Disease

• Genetic and Physiological Factors: Heredity or genetic predisposition to specific illness
• Age: Age either increases or decreases susceptibility to certain illnesses.
  • The risk of heart disease increases with age in both sexes.
  • The risk of birth defects and pregnancy complications increase in women bearing children after age 35.
• Environment: The physical environment in which a person works or lives.
• Lifestyle: Activities, habits, and practices and behaviors have positive or negative effects on health.
  • Stress can be a risk factor if severe/prolonged, or the person is unable to cope.

Disease Classification

• According to aetiological factors
• According to duration of onset
• Other classification of disease

According to Aetiology Factors

• Hereditary: Due to a defect in the genes of one or other parent which is transmitted to the offspring.
• Congenital: Due to a defect in the development, hereditary factors, or prenatal infection; present at birth (e.g. cleft lip, cleft palate)
• Metabolic: Due to disturbances or abnormality in the intricate processes of metabolism.
• Deficiency: Results from inadequate intake of absorption of essential dietary factors.
• Traumatic: Due to injury.
• Allergic: Due to abnormal response of the body to chemical or protein substances.
• Neoplastic: Due to abnormal or uncontrolled growth of cells.
• Idiopathic: Cause is unknown
• Degenerative: Results from degenerative changes that occur in tissue and organs.
• Iatrogenic: Results from the treatment of a disease.

According to Duration or Onset

• Acute Disease:
  • Usually has a short duration and is severe.
  • Intense signs and symptoms appear abruptly and subside after a relatively short period.
  • A person may return to a normal level of functioning.
• Chronic Illness:
  • Characterized by slow onset.
  • Persists longer than 6 months and affects functioning.
  • The client fluctuates between maximal functioning and serious relapses that may be life threatening.
  • Characterized by remission.
    • Period during which the disease is controlled symptoms are not obvious.
  • Characterized by exacerbation.
    • The disease becomes more active again at a future time, recurrence of pronounced symptoms.

Other Classification of Disease

• Organic: Results from changes in the normal structure.
• Functional: No anatomical changes are observed to account for the symptoms.
• Occupational: Results from factors associated with the patient’s occupation
• Epidemic: A large number of individuals in a community are attacked at the same time.
• Endemic: Persistently present in a community.
• Pandemic: Extremely widespread epidemic diseases involving an entire country or continent.
• Sporadic: A disease in which only occasional cases occur.
• Familial: Occurs in several individuals of the same family (e.g., hypertension, cancer).
• Venereal: Usually acquired through sexual relation (HIV/AIDS, gonorrhea).

Stages of Illness

• Symptom Experience
  • Transition stage in which symptoms are experienced.
  • The person believes that something is wrong
  • Includes physical, cognitive, and emotional aspects
• Assumption of Sick Role: Acceptance of the illness, seeking advice/support to discontinue the activities.
• Medical Care Contact: Seeking advice to health professionals.
  • Validation of real illness, explanation of symptoms, reassurance, prediction of outcome
• Dependent Patient Role: The person becomes a client dependent on the health professional for help.
  • The client may then reject or agree to suggestions and also regress to an earlier behavioral stage.

Effects of Illness

• Reduction in privacy.
• Reduction in autonomy.
• Financial burden.
• Change in life-style.
• Effect on family and significant others.

Family Factors That Determine the Extent of the Effects of Illness

• The member of the family who is ill.
• The seriousness and length of the illness.
• Cultural and social customs the family follows.
• Occurrence of the family
• Role changes.
• Tasks reassignments and increase demands on time.
• Increase stress due to anxiety about the outcome of the illness
• Financial problems
• Loneliness resulting from separation and pending loss.
• Change in social customs.