Nama :Noura masry

Health is a state of complete physical, mental and social well-being and not merely
the absence of disease or infirmity.

The enjoyment of the highest attainable standard of health is one of the fundamental
rights of every human being without distinction of race, religion, political belief,
economic or social condition.

The health of all peoples is fundamental to the attainment of peace and security and
is dependent on the fullest co-operation of individuals and States.

2(Dimensions of Health )

There are five (5) dimensions of health: physical, mental, emotional, spiritual, and
social. These five (5) dimensions of health provide a full picture of health as a change
in any dimension affects the others. This interrelationship between the dimensions of

health is one o f the key aspects that you

need to understand for Preliminary PDHPE.

Physical

health continuum

Health Continuum
The physical dimension of health refers to the bodily aspect of health. It refers to the
more traditional definitions of health as the absence of disease and injury. Physical
health ranges in quality along a continuum where a combination of diseases such as
cancer, diabetes, cardiovascular disease or hypertension are at one end and a
person who is at optimum physical condition (think health not fitness) is at the other.

Physical health can affect the other dimensions of health as a decline in physical
health can result in a decline in other forms of health. E.g. a person who suddenly
gets the flu is often isolated socially as to not infect others, struggles to focus in order
to study or learn anything new, and may feel sad as a result of their isolation.

Mental

Mental health refers to the cognitive aspect of health. Often mental health is linked to
or includes emotional health, I want to distinguish the two. Mental health is more the
functioning of the brain, while emotional health refers to the a persons mood often
connected to their hormones. Mental health then includes many mental health issues
such as Alzheimers and dementia. It refers to the persons ability to use their brain
and think. This may be to solve problems or to recall information, but the focus is on
the cognitive aspect of the person.

Mental healthcare affect the other dimensions of health. An increase in mental health
can come as a result of increased physical activity, and good mental health can then
lead to an increase in self esteem as mental performance improves. Greater self
esteem then leads to more confidence in social situations and can lead one to ask
the larger questions about life leading to increased spiritual health.

Emotional

Emotional health is about the persons mood or general emotional state. It is our
ability to recognise and express feelings adequately. It relates to you self esteem as
well as your ability control your emotions to maintain a realistic perspective on
situations. The relationship between emotional and mental health is clear and as
such some illnesses relate to both, such as: depression and anxiety.

Emotional health affects the other dimensions of health as a person with a good self
esteem is more confident in social settings, makes friends quickly and often performs
better in physical activity.
 Spiritual

Spiritual health relates to our sense of overall purpose in life. People often find this
purpose from a belief or faith system, while others create their own purpose. A
person who has purpose to life is said to be healthier than those who don’t see a
purpose to life.

Spiritual health will very easily affect emotional and mental health as having a
purpose in life can help you to apply yourself to achieving goals. Having a purpose to
life can also help people to maintain a proper perspective on life and overcome
adversity. Often people who are spiritual meet together regularly around their spiritual
purpose, which helps to improve their social health.

Social

The social dimension of health refers to our ability to make and maintain meaningful
relationships with others. Good social health includes not only having relationships
but behaving appropriately within them and maintaining socially acceptable
standards. The basic social unit of relationship is the family, and these relationships
impact a persons life the most. Other key relationships are close friends, social
networks, teachers, and youth leaders.

Multifactorial causation of disease

1. SPEAKER:- Dr.KUMAR HIMANSHU PGT-1ST YEAR DEPT. OF COMMUNITY

MEDICINE K.M.C.H,KATIHAR

2. For long time man was grouping in darkness about the causation of diseases,
Several theory of diseases were advanced from time to time to Explain disease
causation such as:- Supernatural theory Theory of humors by Greek and Indians
Theory of contagion The miasmatic theory Theory of spontaneous generation etc
INTRODUCTION

3. The breakthrough came in 1860,when French bacteriologist Louis Pasteur

demonstrated the presence of bacteria in air. In 1873 he advanced theory of
Spontaneous generation .. Later Robert Koch discovered anthrax caused by bacteria
and GOLDEN ERA of Bacteriology begun with discovery of microbe after microbe..
Gonnococus in 1879 Typhoid bacillus,Pneumococci in 1880 Tubercle bacillus in
1882 Cholera in 1883 Diptheria in 1884 and so on… Louis Pasteur Germ Theory
of Disease
 4. All attention was focused on microbes and their role in disease causation, and
disease model accordingly is :- DISEASE AGENT MAN DISEASE In 1878 Robert
Koch summarized his experiments on the etiology of wound infection,By inoculating
animals with material from various sources, he produced six types of infection, each
caused by a specific microorganism. He then transferred these infections by
inoculation through several kinds of animals, reproducing the original six types.
Robert Koch

5. In that study, he observed differences in pathogenicity for different species of

hosts and demonstrated that the animal body is an excellent apparatus for the
cultivation of bacteria. These theories of Pasteur and Koch confirmed the germ
theories of disease. Later, Robert Koch has given Koch Postulates

6. Koch’s postulates, are: A specific microorganism is always associated with a

given disease. The microorganism can be isolated from the diseased animal and
grown in pure culture in the laboratory. The cultured microbe will cause disease
when transferred to a healthy animal. The same type of microorganism can be
isolated from the newly infected animal.

7. The Germ theory has many limitation , It was unable to explain Why only some
people suffer from the disease after exposure to microorganism and not all,as with
exposure to tubercle bacilli. Why some people do not suffer from the disease even
through they harbor the pathogen in the body. As in carrier state This lead to demand
of a broader concept of disease causation that synthesized the basic factors of
Agent, Host and Environment.

8. The limitation of germ theory led to the concept of “Epidemiological or Ecological

Triad”. According to the theory of Epidemiological triad everyone exposed to disease
agent did not contract the disease, This means it is not only the causative agent that
is responsible for disease. But there are another Factors also related to Man and
Environment which contributes to disease.

9. ENVIORNMENT AGENT HOST

10. BIOLOGICAL MECHANICHAL NUTRITIONAL PHYSICAL/CHEMICAL AGENT

11. GENETIC MAKEUP AGE/SEX LITERACY INCOME LIFE STYLE IMMUNITY

HOST

12. PHYSICAL BIOLOGICAL PSYCHOLOGICAL CUSTOMS ENVIRONMENT

13. According to this model of Epidemiological triad disease occurs when the
equilibrium between agent, host and environment is disturbed. This model explains
that some persons do not suffer from the disease even through they harbor the
pathogens because an equilibrium is established between the causative agent and
the host.

14. Epidemiological triad theory is not applicable for non infectious and chronic
diseases like Coronary artery diseaes,Mental illness etc,because these disease has
many causes and multiple factors. This led us to think for the Multiple Factors behind
a disease causation.
 15. The theory of Multifactorial Causation of Disease was first proposed by Galen in
130-150 AD In 1819-1901 ,this theory was again put forward by Peten Kofer of
Germany, but this was overshadowed by germ theory at that time. Galen said the
factors are:- Predisposing Exciting and Environmental Multifactorial Causation
of Disease

16. THESE PREDISPOSING FACTORS ARE:- SOCIAL ECONOMICAL

CULTURAL PSYCHOLOGICAL FACTORS (Including poverty,illiteracy,Ignorance,
poor living condtion Overcrowding etc)

17. TUBERCULOSIS IS NOT MERELY DUE TO TUBERCLE BACILLI… Factors

such as - • Poverty , • Overcrowding and • Malnutrition Contribute to occurrence of
tuberculosis

18. Now it is recognized that a disease is not only caused by an organism but also
predisposed by many factors contributing to its occurrence . For example:- “Modern
Diseases” of civilization like –lung cancer,diabetes,coronary heart disease and
mental illness etc has several contributing factors behind for there occurrence.

19. It is now known that diseases such as Coronary heart disease and cancer are
due to multiple factors. For Example- Excess of fat (saturated) intake, Smoking ,lack
of physical exercise and obesity are involved in the Pathogenesis of Coronary Heart
Disease Most of these factors are linked to Lifestyle and human behavior.

20. Causative Factors Group or Popullations and their Charcteristics

Enviornment,Behaviour, Culture, Physiological Factors, Ecological Elements TIME

21. WEB OF CAUSATION This model of disease causation was suggested by

Macmahon and Pugh in their book: Epidemiology :Principles and Methods This
model is ideally suited in the study of chronic disease, where the disease agent is
often not known ,but is the outcome of interaction of multiple factors…

22. The “web of causation” considered all the predisposing factors of any type and
their complex inter relationship with each other The figure illustrates the
complexities of a casual web of myocardial infarction which is by no means
complete)

23. The basic tenet of epidemiology is to study the clusters of cause and
combinations of effects and how they relate to each other casual web provides a
model which shows variety of possible interventions that could be taken to reduce the
occurrence of disease. The Multifactorial theory helps us to understand the various
associated causative factors,prioritize and plan measures to control the disease
CONCLUSION

Why is herd immunity important?

Herd immunity occurs when a large portion of a community (the herd) becomes
immune to a disease. The spread of disease from person to person becomes unlikely
when herd immunity is achieved. As a result, the whole community becomes
protected — not just those who are immune.
 Often, a percentage of the population must be capable of getting a disease in order
for it to spread. This is called a threshold proportion. If the proportion of the
population that is immune to the disease is greater than this threshold, the spread of
the disease will decline. This is known as the herd immunity threshold.

What percentage of a community needs to be immune in order to achieve herd

immunity? It varies from disease to disease. The more contagious a disease is, the
greater the proportion of the population that needs to be immune to the disease to
stop its spread. For example, the measles is a highly contagious illness. It's
estimated that 94% of the population must be immune to interrupt the chain of
transmission.

How is herd immunity achieved?

Herd immunity can be reached when enough people in the population have
recovered from a disease and have developed protective antibodies against future
infection. However, experts now believe it'll likely be difficult to achieve herd immunity
for COVID-19.

Getting COVID-19 offers some natural protection or immunity from reinfection with
the virus that causes COVID-19. It's estimated that getting COVID-19 and COVID-19
vaccination both result in a low risk of another infection with a similar variant for at
least six months.

But because reinfection is possible and COVID-19 can cause severe medical
complications, it's recommended that people who have already had COVID-19 get a
COVID-19 vaccine. In addition, COVID-19 vaccination might offer better protection
than getting sick with COVID-19. A recent study showed that unvaccinated people
who already had COVID-19 are more than twice as likely as fully vaccinated people
to be reinfected with COVID-19.

Recent research also suggests that people who got COVID-19 in 2020 and then
received mRNA vaccines produce very high levels of antibodies that are likely
effective against current and, possibly, future variants. Some scientists call this
hybrid immunity. Further research is needed.

Thank you