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Outline
• Determinants of health
• The health field concept
• Ecological perspectives of health
• Models and theories of disease causation
_Agent Host Environment Interactions
– The Nineteen century models
– The Twenty century models

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 Determinants Of Health
Health or illness is the result of the combination
of different factors.
disease can not be caused by a single factor and
requires
Primary or Necessary factor- a disease can not
occur with out the factor being present
Risk factors/ secondary factors
A number of models and theories has been
developed to explain the determinants of health.

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 The Health Field Concept
According to the Health field concept there
are four major determinants of health

Human biology

Environment

Life style or behavior

Health care organizations

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 Human biology
 Every human being is made of genes

 Some factors are genetically transmitted from parents to

offspring's as a result of defective gene transmission.

 The modern medicine has no input to prevent and

control such cases.

 Currently genetic counseling and genetic engineering

are the suggested solutions.

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 Environment
It is every thing external to the individual or
human host, and include those factors outside
the human body.

These factors include-Food, water, air, climate,

microorganisms, toxins, wastes, crowding,
economic levels, agricultural and industrial
wastes, air pollution…
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 Life style or behavior
 Behavior is an action that has a specific frequency,
duration and purpose whether it is conscious or
unconscious.

 It is what we do and how we act.

 Life style has a significant effect in determining the

health of an individual

E.g. cigarette smoking, dietary habit (sweet, fatty,

cholesterol), unsafe sexual practice…
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 Health care organizations
Health care organizations in terms of their
resources in human power, equipments,
infrastructures, different facilities determine the
health of people
Availability and accessibility of health services

Acceptability of health services

Quality of health services

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 Ecological Perspective of Health
This is another perspective that state the
health of a community is determined by
Socio cultural factors,

Physical determinants,

Community organizations and

Behavioral determinants
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 Physical
determinants

Socio Community
cultural Behavioral
factors
Health Determinants

Community
organizations

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Physical determinants includes
• Geographical factors- High land vs low land.

• Climatic factors, environmental catastrophes both

man made and natural pollutions associated with
industrial developments

Socio cultural factors includes

• beliefs, traditions, social customs, economy,

politics and religion
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 Ecological con…
Community organization includes
• population size, distribution of resources

Behavioral determinants includes

• Individual behaviors and life styles affecting the
health of individuals and the community

E.g. smoking, alcoholism, promiscuity,….

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 Models and Theories: Disease Causation

A model is a representation of a system that

specifies different components and the
relationship among different variables to
determine or effect an outcome.
The health of a community or individual
health is the outcome of interest.
The models here after describe different
factors interrelationship to determine the
health of community or individuals.

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 The of disease
causation.
 Is called “The Epidemiologic Triad” or “ The
Epidemiologic Triangle”.
 It has three components
Agent
Susceptible host
An environment brings the host and the agent together

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Agent
 An infectious micro organism like- virus, bacteria,
parasite or other microbe, cigarette tar, chemicals,
toxins, carcinogens

 They differ in their infectivity, virulence,

Pathogenecity, immunogenicity, antibiotic resistance

 They differ in their size, shape, strain, chemical

character, ability to produce toxins

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 Host:
– Host is the individual.
– Host factors influence exposure, susceptibility or
response to a causative agent.
– Host factors include: age, sex, race, socioeconomic
status, behaviors…
 Environment:
– Are extrinsic factors which affect the agent and the
opportunity for exposure.
– Include: climate, crowding, sanitation, availability of
health service, air pollution, contamination, animal
contact, water composition

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Each of the efforts to improve the health of
the community in the 19th century are based
on the following theories and concepts
Contagion Theory
Supernatural Theory
Personal Behavior Theory
Miasma Theory

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 Contagion Theory
The concept is “illness is contagious”

The measures used at that time were to keep sick

people away from healthy people

Where the concept of Quarantine is derived.

Isolation of infected households and fumigation

or washing of the bedding and clothing's of the
sick.
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Problems faced on contagion theory

There were so many occasions where people

were sick regardless of isolation from human
contact

most of the care takers of the sick were remained

healthy

These above points let the concept to be under

question?
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 Supernatural Theory
In these theory, supernatural forces are
believed to result sickness or illness.

Disease prevention measures based on this

theory were important to religious people.

The important perception is that disease is a

punishment for transgression of God’s laws.

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 Personal Behavior Theory
This theory is based on the belief that, disease is
resulted from wrong personal behavior

In this concept, people caused their disease by

living in unhealthy ways.

Hence improper diet, lack of exercise, poor

hygiene, emotional tensions

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 Miasma Theory
The cause of a disease is argued as it is the odor
of decaying organic materials.

The concept is totally deviated from the above

three notions.

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 The development in sound research methods and
undertakings are now the basic grounds to develop any
theory or model.

 The twenty century theories include

The germ theory

The life style theory

The environmental theory

The multi casual theory

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 Germ Theory
• The notion is “ Micro organisms cause disease
and it is possible to control disease using
antibiotics and vaccines.” “A single disease has a
single etiology”

• Currently this theory is the basic theory that

overtook other explanations of disease causation.

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 Life Style Theory
 “Unhealthy life styles are causes for disease”
This hypothesis categorize stress, lack of exercise,
alcoholism, smoking, improper nutrition are
causes of most chronic diseases.
This theory contradicts with the germ theory that
“a single disease has a single etiology.”
Instead it emphasize on the interrelatedness of
many factors in disease causality.

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 Environmental Theory
“ significant number of chronic disease are
caused by toxins in the environment.”
This theory relays on disease prevention , instead
of medical treatments or personal hygiene,
demands change in industrial productions.
The basic lines are
Occupational hazard, Environmental pollution, toxics
in air, water and soil, even foods, and radio activity
Synthetic additives to foods, “organic foods” ,
industrial products
Critic: threshold level
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 Multi Casual Theory
It is also called the “The web of causation”
The theory emphasizes as
 “There are multiple factors for a cause of a
single disease entity.”
Widely accepted.
Critic: incapable of directing to an effective
preventive strategy.

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 Thank You

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