Explain the Iceberg Metaphor of Diseases

Diseases may be mild or even ‘silent’—one of the many explanations for undiagnosed
disease in the community. This phenomenon is described by the metaphor of the iceberg of
disease. The iceberg phenomenon describe a situation in which a large percentage of a problem
is subclinical, unreported, or otherwise hidden from view. Thus, only the "tip of the iceberg" is
apparent to the epidemiologist.
In most diseases, as with the iceberg, the larger presence lurks unseen, unmeasured and
easily forgotten. In the model seen above, the “seen” part of the iceberg can be categorized to
two: Diagnosed & Controlled and Diagnosed & Uncontrolled. The submerged part of the
iceberg, on other hand consists of the following: Undiagnosed or wrongly diagnosed disease;
Risk factors for disease; and Free of risk factors.
Undiagnosed diseases and wrongly diagnosed diseases are the submerged category
described as unidentified cases of disease which are not treated due to its unknown nature and an
inaccurate assessment of a patient’s condition that sometimes lead to wrong treatment,
respectively. The second submerged level, Risk Factors for Disease, involve people that have
high chance of acquiring a said disease. Free of Risk Factors, on the other hand, involve people
who have low chances of acquiring the disease.
Screening attempts to uncover the iceberg of disease. . Screening is the use of tests to
help diagnose diseases (or their precursor conditions) in an earlier phase of their natural history
or at the less severe end of the spectrum than is achieved in routine clinical practice. The
screening methods used per category of the iceberg from the top are as follows: nil, except
vigilance; review; opportunistic or population screening; screening or health education; and
protection of current status.