((Foundations of Medicine))
Concept of Health and Disease:
Health is not mainly an issue of doctors, social scientists and
hospitals, it is an issue of social justice. Health is a fundamental human
right and a world-wide social goal. Modern medicine is often accused for its
preoccupation with the study of disease and neglect of the study of health.
An understanding of health is the basis of all health care. A
brief account for the changing concepts of health is given below:
I- Biomedical Concept: Health has been viewed as
an absence of disease and if one is free from disease, then the person is
considered healthy.
The
concept has minimized the role of the environment, social, psychological, and
cultural determinants of health.
II- Ecological
Concept: Health is a
dynamic equilibrium between man and his environment, and disease is a
maladjustment of human to environment.
Human ecological and cultural adaptation do determine not only
the occurrence of disease but also the availability of food and the population
explosion.
III- Psychosocial
Concept: Health is
influenced by social, psychological, cultural, economic, and political factors
of the people concerned.
IV- Holistic Concept: This model is a synthesis of all the
above concepts, This approach implies that all sectors of society have an
effect on health and the emphasis is on the promotion of health.
Definitions of Health:
Health is one of those terms which most of people find it
difficult to define, although they are confident of its meaning.
Therefore, many definitions of health are offered from time to
time including the following:
I- The condition of being sound in the body, mind especially freedom
from physical disease or pain.
II- A state of relative equilibrium of body form and function which
results from its successful dynamic adjustment to forces tending to disturb it.
III- A state of equilibrium between humans and the physical,
biological, and social environment compatible with full functional activity.
The
ideal definition for health of WHO* is:
The
health is the state of complete physical, mental, and social well-being and it
does not merely mean the absence of disease or infirmity.
The Environment:
The total environment of human beings includes all the living and
non-living elements in their surroundings. It consists of three major
components: physical, biological, and social. The relationship of human beings
to their environment is reciprocal in that the environment has a profound
influence on them and they in turn make extensive alterations to the
environment to meet their needs and desires.
Physical Environment:
This refers to the non-living part of the environment – air,
soil, water, minerals – and climatic factors such as temperature and humidity.
The physical environment is extremely variable: deserts, cold dry or humid
plateaux, marshlands, high mountains or tropical rainforest.
Climatic factors such as temperature and humidity have a direct
effect on humans, their comfort and their physical performance. The physical
environment also exerts an indirect effect by determining the distribution of
organisms in the biological environment: plants and animals which provide food,
clothing and shelter; animals which compete with humans for food; and parasites
and their vectors which produce and transmit disease.
Humans alter the natural characteristics of the physical
environment, sometimes on a small scale but often on a very large scale: from
building a hut and digging a small canal to irrigate a vegetable garden to the
building of large cities, draining of swamps, irrigating arid zones, damming
rivers and creating large artificial lakes.
On the global scale, there is increasing concern that human
activities are steadily leading to a significant rise in the earth s temperature
with forecasts of dire results.
Biological Environment:
All the living things in an area – plants, animals, and
microorganisms – constitute the biological environment. They are dependent on
each other and ultimately, on their physical environment. Thus, nitrogen-fixing
organisms convert atmospheric nitrogen into the nitrates that are essential for
plant life. Plants trap energy from the sun by photosynthesis. A mammal may
obtain its nourishment by feeding on plants (herbivore) or on other
animals (carnivore) or both (omnivore). Under natural conditions,
there is a balanced relationship between the growth and the size of the
population of a particular species, on the one hand, and its sources of food
and prevalence of competitors and predators, on the other hand.
Humans deliberately manipulate the biological environment by
cultivating useful plants to provide food, clothing and shelter, and raising
farm animals for their meat, milk, leather, wool, and other useful products.
They hunt and kill wild animals, and destroy insects which transmit disease or
which compete with them for food.
In many parts of the tropics, insects, snails and other vectors
of disease abound and thrive. This is partly because the natural environment
favors their survival but also because, In some of these areas, relatively
little has been done to control these agents.
Social Environment:
This is the part if the environment that is entirely made by
humans. In essence, it represents the situation of human beings as members of society:
family groups, village or urban communities, culture including beliefs and
attitudes, the organization of society – politics and governments, laws and the
judicial system, the educational system, transport and communication and social
services including health care.
The characteristics of
Five-Stars doctors are:
1- Community leader.
2- Care provider.
3- Communicator.
4- Decision-maker.
5- Member in the team.