Health,disease, illness

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ทญ.จิตรวรี จิตตังสมบู รณ์
ทญ.ปวีณา คุณนาเมือง
Health
• whole
• WHO 1948
• “state of complete physical, social and mental
well-being, and not merely the absence of
disease or infirmity”
Illness
• Marinker (1975)
• a feeling, an experience of unhealth which is entirely
personal, interior to the person of the patient.
• Often it accompanies disease but disease maybe
undeclared.
• Sometimes illness exists where no disease can be
found

J Med Ethics: medical humanities 2000;26:9-17

Sickness
• Marinker (1975)
• external and public mode of unhealth.
• Social role, a status, a negotiated positioned in
the world

J Med Ethics: medical humanities 2000;26:9-17

Disease
• Dis-ease
• Marinker (1975)
• pathological process,most often physical as in throat
infection, or cancer of the bronchus
• sometimes undetermined in origin, as in
schizophrenia
• Deviation from a biological norm.

Munchausen’s syndrome
• healing relationship J Med Ethics: medical humanities 2000;26:9-17
Disease
R. M. Hare,1986
• We have to commit ourselves to there being a
cause, ascertainable in principle, of the same
sort as the causes of diseases whose aetiology we
do understand
Boyd ,2000
• Diagnosis of Munchausen’s syndrome and
committing themselves to hope that someday
they will be able to understand “mentally ill”
J Med Ethics: medical humanities 2000;26:9-17
Biostatistical theory
Christopher Boorse
• “a disease is a type of internal state which is either an
impairment of normal functional ability “
• If they, given a statistically normal environment, make at
least their statistically normal contribution to the
survival of A or to the survival of the species which A
belongs
• Naturalism (Objectivism)
• scientific, value-free basis

Nordenfelt L ,Medicine, health care and philosophy 2007;10:5-10.

Khushf G Medicine, health care and philosophy2007;10:19-27
Holistic theory of health
• Lennart Nordenfelt
• A is completely healthy if , and only if,A has the ability,
given standard circumferences, to reach all his or her
vital goals
• A has a disease, and if only if, A has at least one organ
which is involves in such a state or process as tends to
reduce the health of A.
• Normativism (Constructivism)
• sociohistorically conditioned notions of human welfare ,
not just survival and reproduction
Nordenfelt L ,Medicine, health care and philosophy 2007;10:5-10.
Khushf G Medicine, health care and philosophy2007;10:19-27
• Naturalism  Normativism
• Medical model  Socioenvironmental model
Medical model
• Mind-body dualism
• The body is isolated from the person
• Pateint ‘s subjective experiences of health and
illness are ignored
• To treat oral cavity which is located within the
body but not connected to the person

Locker D. concepts of oral health, disease and the quality of life; 1997.
Socioenvironmental model
• Health is not the absence of disease but optimal
functioning and social and psychological well-
being
• Concern with disease  concern with health
• Disease prevention  health promotion
• Patient : body  person

Locker D. concepts of oral health, disease and the quality of life; 1997.
Model of disease

1◦ Prevention 3◦ Prevention
2◦ Prevention

Epidemiology kept simple An introduction to traditional and modern epidemiology; 2003

Disease prevention
Primary prevention
• stage of susceptibility
• Prevent disease from occurring
Secondary prevention
• subclinical stage
• delay emergence of disease or reduce its severity once it emerges
Tertiary prevention
• clinical stage of disease
• prevent or minimize the progression of disease or the sequelae
• Preventing disability

Epidemiology kept simple An introduction to traditional and modern epidemiology; 2003

Disease prevention & health promotion
• Reducing environmental exposure over with the
individual had little personal control

• Individual responsibility for health can be fully

effective only if society ensure access to
necessary education and professional services
• (Health promotion)

Breslow L. JAMA1999;281(11):1030-3.
Disease prevention & health promotion
• People are living longer
• More hopeful of minimizing disease and
impairment during their lifetime
• Not only to avoid being sick but to expand the
potential of living
• enhancing people’s capacities for living

Breslow L. JAMA1999;281(11):1030-3.
Disease prevention & health promotion

prevention promotion
Disease Health

Negative thinking Positive thinking

Breslow L. JAMA1999;281(11):1030-3.
Caries prevalence
• จากผลการสำรวจทันตสุขภาพแห่งชาติของ
ประเทศไทยตามตัวชวี้ ด ั หลักขององค์กรอนามัยโลกใน
เด็กอายุ 5-6 ปี พบว่าค่าร ้อยละผู ้ปราศจากฟั นผุตงั ้ แต่ปี
พ.ศ. 2527, 2532, 2537, 2543-2544, 2549-2550
เท่ากับ 25.6, 17.2, 14.7, 12.5 และ 19.36 ตามลำดับ
• สภาวะโรคฟั นผุในเด็กอายุ 3 ปี จากการสำรวจระดับ
ประเทศตัง้ แต่ปีพ.ศ. 2532, 2537, 2543-44 และ
2549-50 โดยสำรวจจากความชุกของโรคเป็ นภาพรวม
ทัง้ ประเทศมีคา่ เท่ากับ 66.5, 61.7, 65.7 และ 61.37
ตามลำดับ

http://dental.anamai.moph.go.th/index2.php.
Caries etiology

http://www.aap.org/oralhealth/cme/page15.htm
http://www1.umn.edu/dental/courses/dent_5501/dntcar2.htm
http://www.dentalofficemag.com/display_article/284037/55/none/none/Feat/Treating-
Caries-Chemically:-Fact-or-Fiction
http://www.biomedcentral.com/content/figures/1472-6831-6-S1-S8-1-l.jpg
Dental caries management

• The past : extension for prevention

• Now : Prevention
Prevention of caries
• Caries risk assessment
• Fluoride
• Diet
• Sealant
• Remineralization
Diagnosis of caries
• Clinical methods
• Radiographic methods
• Other technology-based detection methods
Treatment of caries
• Restorative material
http://www.piedmontpediatricdentistry.com/_media/images/caries-2.jpg
Thank you