Health and Disease

The World Health Organization (WHO) defines health as being a state of complete physical,
mental and social well-being and not merely the absence of disease or infirmity. OR Health can
be defined as a person's physical, mental and social condition.

A disease is anything that impairs the normal functioning of the body. OR Disease is
a disorder or malfunction of the mind or body, which destroys good health.

Categories of disease

There are nine main categories of disease but some diseases are more difficult to classify and fit
into more than one of them.

1. Physical disease

These diseases involve temporary or permanent damage to the body and include all the other
categories except mental disease where there is no sign of physical damage to the brain. An
example would be leprosy.

2. Infectious disease

Pathogens are organisms living in or on our bodies, causing disease. Infectious diseases are
caused by pathogens such as viruses, bacteria, fungi, protoctists, worms and insects, which can
be transmitted from person to person. This may be via normal social contact - for
example, chicken pox, or via food and water, sexual contact or an animal bite.

Carriers are people who can transmit the pathogen but do not have the disease symptoms.

Non-infectious diseases

These are all diseases, which are not caused by pathogens and cannot be passed on by physical
contact. An example would be sickle cell anaemia.

3. Deficiency diseases

These are nutritional diseases caused by an inadequate or unbalanced diet. One or more essential
nutrient is missing or in short supply - for example, a shortage of Vitamin C causes scurvy.

4. Inherited diseases

These diseases are caused by genes and can therefore be passed from parent to child. They are
also sometimes called genetic diseases or disorders.
In Britain, the most common inherited disease is cystic fibrosis, which is characterised by a
build-up of sticky mucus. This makes breathing difficult and can act as a breeding ground for
bacteria, so sufferers need daily physiotherapy to remove the mucus.

It is caused by a recessive faulty allele and so parents may be carriers for the disease without
having any symptoms. As yet, genetic diseases may be treated but not cured because we cannot
replace the faulty gene (gene therapy).

The Human Genome Project involves scientists in many countries and began in 1990.

It aims to:

 Determine the sequence of the bases throughout all the DNA in human cells.

 Identify the estimated 1000, 000 genes formed by the bases.

 Find the location of the genes on the 23 human chromosomes.

 Store all this information for research.

 Consider the ethical, legal and social issues arising from this information.

The findings have already had a major impact, such as the devising of diagnostic tests to see if
parents are carriers for a particular disease. In the future, drugs that act against the faulty gene
causing a disease may be developed, which will have fewer side effects and be more effective.

The replacement of faulty genes or gene therapy may become commonplace.

Many people are concerned about the implications of genetic testing. In many cases there may be
no treatment for a disease that we can test for. There are also risks of discrimination by
employers, insurance companies and others if they discover an individual has a positive test for a
faulty gene.

5. Degenerative diseases

These diseases are characterised by a gradual loss of function, in one or several organs or tissues.
In old age, this is often the result of the failure of the bodies repair mechanisms - for example,
loss of mobility due to worn joints.

However, degenerative diseases can strike in ones youth or middle age. They may be the result
of poor nutrition in childhood or due to the immune system attacking the bodies, own cells.

There are three main categories:

 Diseases of skeletal, muscular and nervous tissues - for example, osteoarthritis.

 Cardiovascular diseases of the circulatory system - for example, coronary heart disease.
  Cancers.

6. Mental disorders

These disorders affect a person's mind, but may be accompanied by physical

symptoms. Emotions, thoughts, memories and personal and social behaviour can be affected.

Some mental diseases are caused by degeneration of brain tissue - for example, Alzheimer's - a
progressive deterioration in memory is followed by a general decline in all mental faculties
(dementia). Other mental disorders seem to be accompanied by changes in the blood flow to the
brain - for example, Schizophrenia.

7. Social diseases

This is a very wide category that can include almost all infectious diseases and multifactorial
diseases, which are influenced by people's living conditions and their personal behaviour. For
example, deficiency diseases may be the result of lack of choice of food, due to shortage of
money ( Obesity, scurvy, diabetes, cardiovascular ect.)

8. Self-inflicted diseases

These diseases are caused by damage to a person's health by their own decisions and behaviour.
Included in this category would be the choice to smoke or misusing drugs, sunbathing or eating
a high fat diet.

Deliberate self-harm, such as attempted suicide, could also be placed here although it is often an
indication of poor mental health.

9. Degenerative disease

These are diseases that result from the gradual loss of function of some part of the body. Many
are associated with ageing such as Alzheimer’s. Others can afflict younger people, such as
muscular dystrophy, in which muscle function is lost and multiple sclerosis in which nerve axons
lose their myelin sheaths and fail to work correctly.

Terms used to describe diseases

An infectious disease, which is always present in a population, is called endemic.

An epidemic occurs when a disease suddenly spreads rapidly and affects many people. If a
disease spreads over a continent or even the world it will be termed pandemic.

Health Statistics

Epidemiology is the study of patterns of diseases and the factors affecting its spread. Incidence,
prevalence and mortality for a disease may be determined. Collecting information on the
distribution of disease helps to identify the underlying causes and if it turns out to be infectious,
may point to how it is transmitted.

Other causes such as the links between smoking and lung cancer may also be determined. The
data on morbidity (numbers ill) and mortality (numbers who have died) for a disease when
expressed in certain ways enables comparisons across cities or countries to be made.

Statistics can be used to monitor the effectiveness of health provisions by both governments and
the WHO.

Global patterns of disease

Data collected by WHO shows that in developing countries, the main cause of death is infectious
diseases, while in developed countries, very few deaths are caused by pathogens.

The reasons for this is that the incidence of infectious disease is low in developed countries due
to vaccination, good standards of hygiene and nutrition, and the availability of antibiotics if they
do contract one.

Although globally health is improving, there are still many poor people in the world and poverty
is responsible for the highest death rates in some countries. In the richer countries, degenerative
diseases are the biggest killers. This is mainly due to lifestyles that put people at risk of heart
disease and cancers.

Smoking and Disease

Tobacco companies do not declare the ingredients in cigarettes, but upon analysis, they contain
over 4000 different chemicals, many of which are toxic.

There are three main ingredients, which damage the gaseous exchange system or the
cardiovascular system.

Chemicals found in cigarettes

1. Tar

This is a mixture of aromatic substances, which settles on the airway linings and stimulates
changes that may lead to obstructive lung disease and lung cancer.

2. Carbon monoxide

This gas diffuses across the alveoli into the blood and onto the red blood cells, combining with
haemoglobin to form carboxyhaemoglobin. This stops the haemoglobin from becoming fully
saturated and so it carries 5-10% less oxygen.
This places a strain on the heart as the heart muscle receives less oxygen and carbon monoxide
can damage directly, the linings of arteries.

3. Nicotine

This drug is absorbed readily into the blood and stimulates the nervous system to reduce the
diameter of arterioles and the adrenal glands to release adrenaline. This increases heart rate and
blood pressure and decreases the blood supply to the extremities - for example, the hands and
feet.

Another effect is that platelets become stickier which, can lead to an increased risk of blood
clots forming.

Lung disease

1. Chronic bronchitis

Tar stimulates goblet cells and mucus glands to enlarge, producing more mucus. It destroys
the cilia inhibiting the cleaning of the airways and mucus (containing dirt, bacteria and viruses)
builds up blocking the smallest bronchioles.

A smoker's cough is the attempt to move the mucus but it damages the epithelia resulting in scar
tissue, which narrows the airways and makes breathing difficult.

Infections like pneumonia may further inflame the linings resulting in a very severe cough and
large quantities of phlegm.

2. Emphysema

Due to constant infection, phagocytes are attracted to the lungs where they release elastase - an
enzyme that breaks down the elastin in the alveoli walls, to enable them to reach the surface
where the bacteria are. Without adequate elastin, the alveoli cannot stretch, so they recoil and
many burst.

Large air spaces appear, reducing the surface area for gas exchange and making sufferers breath
more rapidly. As it progresses, patients become breathless and wheezy - they may need a
constant supply of oxygen to stay alive.

3 .Chronic obstructive pulmonary disease

This very disabling disease is the result of chronic bronchitis and emphysema occurring together.
Troublesome breathlessness often only occurs once half of the lung tissue has been destroyed,
which can only rarely be reversed. Britain has the highest death rate from this disease in the
world.
4. Lung cancer

Tar contains carcinogens, which react with the DNA in epithelial cells and
cause mutations, which can lead to tumours.

Although it takes twenty to thirty years to develop, most growth of the tumour occurs prior to
any symptoms, which include coughing up blood due to tissue damage. Once discovered, it's
usually well advanced and requires surgery to remove it, followed up by chemotherapy or
radiotherapy.

Links Between Smoking and Disease

These can be put into two groups:

Epidemiological evidence looks for patterns in the diseases, which smokers suffer from. It only
shows an association and not a causal link.

Experimental evidence attempts to prove a causal link.

Chronic obstructive pulmonary disease is very rare in non-smokers and 90% of deaths from it
can be attributed to smoking. 98% of people with emphysema smoke and 20% of smokers suffer
from it. Deaths from pneumonia and influenza are twice as high among smokers.

Lung cancer is eighteen times more likely in smokers and one third of all cancer deaths can be
attributed to smoking. 25% of smokers die from lung cancer and the risks are higher if they
inhale, start young, smoke a large number of cigarettes a day and smoke over a long period of
time.

The risks of developing lung cancer fall as soon as smoking stops but it takes ten years for the
risks to fall to that of a non-smoker.

Experimental evidence includes the development of tumours in animals exposed to smoke and
the identification of carcinogens in tar. Both lung cancer and chronic obstructive lung disease
have been observed in dogs and tar has caused cancerous growths in the skin of mice.

The cardiovascular system

Cardiovascular diseases are degenerative diseases of the heart and circulatory system. They are
responsible for 50% of deaths in developed countries and are multifactorial - smoking being one
risk factor.
Atherosclerosis

This is caused by a build-up of fatty material in artery walls, which reduces the flow of blood
and therefore oxygen to the tissues. An atheroma is a build up of cholesterol, fibres, dead muscle
cells and platelets and is more likely to develop upon damage to the artery wall by high blood
pressure, carbon monoxide or nicotine.

Blood clots (thrombosis) become more likely and if one develops in the coronary artery a heart
attack may be the result, while if it occurs in an artery supplying the brain, a stroke may result.

Coronary heart disease

This is a disease of the coronary arteries, which branch from the aorta, to supply the heart
muscle. If atherosclerosis, of these vessels occurs, then the heart has to work harder and blood
pressure rises. This makes it difficult for the heart to receive the extra nutrients and oxygen it
requires during exercise.

Three forms exist:

 Angina is severe chest pains upon exercising caused by a shortage of blood to the heart
muscle but causes no death of heart tissue and stops upon resting.

 Heart attacks occur upon the blocking of a moderate branch of the coronary artery by a
blood clot and cause starvation and death of heart tissue.

 Heart failure is when the coronary artery starts to block up and results in a gradual
weakening of the heart.

Stroke

These occur if an artery in the brain bursts and blood leaks into the brain tissue or when an artery
supplying the brain becomes blocked. The brain tissue becomes starved of oxygen and dies.
Strokes can be fatal or very mild and may affect speech, memory and control of the body.

Links between smoking and cardiovascular disease

Smoking increases the concentration of blood cholesterol, which is a risk factor, so smokers
increase the risk of having heart disease or a stroke. The risks of developing the disease increases
with age and men are more at risk than women.

Being overweight increases the risk as does eating a diet high in saturated fat and salt. Diets with
more antioxidants (vitamins) and soluble fibre decrease the risk as does taking regular exercise.
Having diabetes raises the risks and high alcohol intake is another contributory factor.

This is a disease associated with affluence and is avoidable by a change in lifestyle.

Treatments involve:

 Drugs to lower blood pressure, decrease risks of clots, reduce retention of fluids and
decrease blood cholesterol.

 Coronary by-pass surgery involves the use of blood vessels from - for example, a leg to
replace a diseased vessel and carry blood from the aorta to a place beyond the blockage.

 Heart transplants are very expensive and it is difficult to obtain matching tissue from
donors.

Better than treatment is obviously prevention. This can be achieved via education
highlighting the risk factors and by screening for those most at risk. Unfortunately, bad eating
and smoking are hard habits to kick.

Acquired immune deficiency syndrome

This disease is caused by the human immunodeficiency virus (HIV). HIV is a ball of protein and
lipid around a core containing RNA and the enzyme reverse transcriptase, which is required once
the virus has entered the cell. The enzyme makes a DNA version of the virus’s RNA. The
infected cell then follows the code on the DNA to make new viruses. The virus essentially
hijacks the human cell’s protein-making machinery.

HIV infects a type of blood cell called a T- lymphocyte specifically ones with CD4 receptors in
their plasma membrane.

Life cycle of HIV

1. Transmission- Virus particles are carried from the body fluid of one person to the body of
another.

2. Infection- Virus protein binds to receptors and the virus enters a T-lymphocyte. Viral RNA is
release.

3. Reverse transcription- A DNA copy is made of the viral RNA using reverse transcriptase
enzyme.

4. Integration- The DNA copy is inserted into a chromosome using the viral integrase enzyme.

5. Years later the lymphocyte divides normally, still with the viral DNA in a chromosome, but
the cell remains normal( latent virus).

6. Transcription- Viral protein direct mRNA synthesis.

7. Translation- Viral proteins are synthesized.

8. Assembly and maturation- Viral particles are assembled and become infective.

9. Release- HIV particles are rreleased from the cell by budding. The cell the lyses (burst).

Incubation period of HIV

Incubation period is the period between the infection of an individual by a pathogen and the
manifestation of the illness or disease.

The HIV incubation period can be wildly different in each individual. There are a variety of
factors that influence the progression from infection to symptom appearance, but genetics
appears to play a strong factor. Just as some people seem to have increased protection against
flus and colds thanks to strong genes, the incubation period may last longer in those with a
naturally strong genetic code. Those with weakened immune systems may have a shorter
incubation period. Some research also suggests that children born with HIV have an extremely
short incubation period. Therefore, the incubation period can be from 3 months to 10 years.

The main ways HIV is passed on:

1. during sexual intercourse

2. sharing hypodermic needles

3. blood transfusion

4. from mother to child during birth or by breast feeding

Symptoms and signs

persistent tiredness and weight loss, night sweats, persistent diarrhea, blurred vision ,white
spots on the tongue or mouth, dry cough and shortness of breath, persistent fever or swollen
glands.

Diabtes Mellitus

It is an illness in which the bold glucose control mechanism has partly or completely broken
down.

Types

1. Type 1/ insulin dependent- it begins at an early stage of the individual life. The pancreas is
incapable of secreting enough insulin, so that the blood glucose levels may soar after a
carbohydrate containing meal.
2. Type 2 / non- insulin dependent – it occurs later in life. The pancreas does secrete insulin, but
the liver and other target organ do not respond to it adequately.

Type 2 diabetes is most likely to develop in people with excessively high body weight, especially
those with a BMI above 27.

Factors that increase Type 2 diabetes

Being over weight, being over 45, being physical inactive, having a close relative with diabetes,
being of Asian or African descent, having high blood pressure or coronary artery disease,
prenatal malnutrition and having low level of HDL (high-density lipoprotein) cholesterol in the
blood.

Cancer

It is a disease in which the normal control of cell division breaks down. The timing of mitosis is
controlled by a number of different genes within a cell. If these genes are altered, then the cell
may begin to divide uncontrollably. These continuously dividing cells may eventually from a
lump, called a tumour.

Types of Tumour

1. Benign – the tumour growns and stays in one place. The growth rate is extremely slow. This
types of tumour can become cancerous if it invades tissue around it or spread around the body.

2. Malignant- this type of tumour is metastasis. In this case, the cells break away and start
producing more tumours elsewhere in the body.

Causes of Cancer

Gene and Lifestyle

In our body are regulatory and repressor genes.

Regulatory genes called proto-oncogenes can mutate to form slightly different ones called
oncogenes. Oncogenes can cause cancer, because they allow the cell to divide uncontrollably,
over and over again.

Repressor genes normally inhibit cell division, however, they can mutate so that they lose their
function, which once again allows uncontrollable division to take place.

Lifestyle

Due to our lifestyle we are consuming chemical that are carcinogenic by direct means, in our
food, or from the immediate environment.