Health and Disease
Common Diseases in the
In the Caribbean
Four units
(1) Definitions and changing paradigms
(2) Common Diseases in the Caribbean
(3) Nutrition
(4) Genetic Diseases
1. Definitions
Health is a state of complete physical,
social and mental well-being and not just
the absence of disease or infirmity (WHO,
1978)
Health- A resource for everyday life
(Nutbeam, 1986)
Is health a state, an end in itself, or is it a
resource, a means to an end?
The second concept is more useful.
Disease - Pathological changes diagnosed
by symptoms and signs
Illness - The perception of a disease. So,
illness is what you feel, but disease is what
the doctor diagnoses.
Health Promotion the process of enabling
people to increase control over, and to
improve their health… Health promotion
affirms that you are in charge of your
health, not the doctor, not the health
services. Emphasizes prevention rather
than cure. It also requires (1) healthy public
policy (2) effective action from all the
stakeholders, including the family, the
education sector, the agricultural sector,
the media, the government and the
professional health sector (that is doctors,
nurses, hospitals etc).
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2.
Caribbean
Communicable – (also called infectious
diseases) passed on by contact or vector.
These could be caused by
parasites e.g. malaria,
bacteria – cholera, tuberculosis,
gastroenteritis, salmonella, STDs such
as syphilis.
viruses – flu, dengue Fever, yellow
fever, small pox, polio, human
immunodeficiency virus,
Non-communicable-Includes chronic or lifestyle
diseases- Diabetes mellitus, Hypertension,
Heart Disease, Cancer
Includes also
Genetic diseases: Sickle cell anaemia, Down's
syndrome, Cystic fibrosis
Causes of Death: Heart disease, strokes,
diabetes, cancer and injuries in that order.
100+ years ago infectious diseases were the
major killers, but first, improved sanitation and
chlorinated water, then antibiotics and
vaccinations, dramatically reduced their impact,
so that today, there are no infectious diseases
in the top five killers. Better scientific
understanding and laboratory practice also
played an important role.
Risk factors: It is necessary to speak about risk
factors rather than causes, because of the
complex interrelationships between the various
parameters which affect health. Risk implies
probability rather than certainty.
Three levels (1)Causes of death and ill-health-
heart disease, strokes, diabetes, cancer, injuries
(2) Major determinants- hypertension, diabetes,
obesity (3) Risk factors - habitual diet, physical
activity, tobacco use, alcohol, marijuana etc
(substance abuse).
Lifestyle factors: Substance abuse Alcohol,
tobacco, marijuana and hard drugs have had a
major social impact in the Caribbean.
Other lifestyle factors are sexual behaviour,
personal hygiene and sanitation, road use
behaviour, conflict resolution.
Finally health-seeking behaviours should be
embraced e.g. vaccination, cervical cancer
smears, hypertension checks, STD treatment.
HIV/AIDS
In 2009 some 240,000 people were living with
HIV in the Caribbean (70% in Haiti and DR)
With adult prevalence at 1.1% , the Caribbean is
the second most affected region in the world.
The number of new HIV positive cases appears
to be decreasing (1400 in 2007, 900 in 2009).
Transmission is mainly heterosexual, with 70%
of new infections in the 15-49 year age group.
The number of deaths due to AIDS also appears
to be decreasing (114 in 2007, 37 in 2009). The
falling death rate is linked to the use of
antiretroviral drugs. There is considerable effort
through the media to reduce the stigma,
discrimination and misinformation which, in
part, drive the epidemic.
3. Nutrition : Up to 40 years ago, the
main nutritional concern was energy -protein
malnutrition (EPM), that is, insufficiency of
total calories and particularly of protein. These
deficiencies have been corrected by the
increased consumption of animal protein and
fat, and a reduced consumption of fruits,
cereals and. vegetables. The result has been an
enormous increase in the incidence of chronic
diseases, especially diabetes, hypertension and
heart disease.
Iron deficiency anaemia remains a problem.
Growing popularity of 'fast foods' is a major
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nutritional problem, since these are high in fat,
animal protein and refined carbohydrates.
4. Genetic Diseases
These are defined as diseases in which there is a
defect in the gene or chromosomal make up of
the cell. Sickle cell anaemia is the most
common. Others discussed in the text are
Down’s syndrome, cystic fibrosis and
Huntington’s disease. Although they affect only
a small part of the population, understanding
how they are propagated is important.
Questions
1. Contemporary philosophy of health has
been quite focused on the problem of
determining the nature of the concepts of
health, illness and disease from a scientific
point of view. Some theorists claim and
argue that these concepts are value-free
and descriptive, while others claim that the
concept of health is essentially value-laden.
Discuss these two principal rival types of
theories and present reasoning by which we
could assess these theories.
2. The great medical success story of the 20th
century has been the effectiveness of
vaccinations and antibiotics in eliminating
or drastically reducing the incidence of
many diseases.
Discus why these technologies have not
worked on for all predominant ‘killer’
diseases?
3. What measures would be most effective in
curbing substance abuse, especially among
young people?
4. According to the World Bank, Non
Communicable Diseases or NCDs are linked
 to 7 out of every 10 deaths in the
Caribbean, which is above the average for
the rest of the world.
What aspect of malnutrition requires most
attention in the region (or in your neck of
the woods)? Is the concern over obesity
unwarranted? The loss due to chronic
diseases is very high, as measured in DALYs.
(Disability Adjusted Life Years). How can
this be reduced?

5. If only one parent has the sickle cell trait,

what chance does the child have of having
(a) the trait (b) the disease?

TUTORIAL 7 FOUN 1210 SEMESTER I 2017-18