We have heard the word ‘health’ used quite frequently all around us. We use it ourselves as well, when we say things like ‘my grandmother’s health is not good’. Our teachers use it when they scold us saying ‘this is not a healthy attitude’. What does the word ‘health’ mean?
If we think about it, we realise that it always implies the idea of ‘being well’. We can think of this well-being as effective functioning. For our grandmothers, being able to go out to the market or to visit neighbours is ‘being well’, and not being able to do such things is ‘poor health’. Being interested in following the teaching in the classroom so that we can understand the world is called a ‘healthy attitude’; while not being interested is called the opposite. ‘Health’ is therefore a state of being well enough to function well physically, mentally and socially.
If health means a state of physical, mental and social well-being, it cannot be something that each one of us can achieve entirely on our own. The health of all organisms will depend on their surroundings or their environment. The environment includes the physical environment. So, for example, health is at risk in a cyclone in many ways.
But even more importantly, human beings live in societies. Our social environment, therefore, is an important factor in our individual health. We live in villages, towns or cities. In such places, even our physical environment is decided by our social environment.
Consider what would happen if no agency is ensuring that garbage is collected and disposed. What would happen if no one takes responsibility for clearing the drains and ensuring that water does not collect in the streets or open spaces?
So, if there is a great deal of garbage thrown in our streets, or if there is open drainwater lying stagnant around where we live, the possibility of poor health increases. Therefore, public cleanliness is important for individual health.
If this is what we mean by ‘health’, what do we mean by ‘disease’?
The word is actually self-explanatory – we can think of it as ‘disease’ – disturbed ease. Disease, in other words, literally means being uncomfortable. However, the word is used in a more limited meaning. We talk of disease when we can find a specific and particular cause for discomfort. This does not mean that we have to know the absolute final cause; we can say that someone is suffering from diarrhoea without knowing exactly what has caused the loose motions.
We can now easily see that it is possible to be in poor health without actually suffering from a particular disease. Simply not being diseased is not the same as being healthy. ‘Good health’ for a dancer may mean being able to stretch his body into difficult but graceful positions. On the other hand, good health for a musician may mean having enough breathing capacity in his/her lungs to control the notes from his/her flute. To have the opportunity to realise the unique potential in all of us is also necessary for real health.
So, we can be in poor health without there being a simple cause in the form of an identifiable disease. This is the reason why, when we think about health, we think about societies and communities. On the other hand, when we think about disease, we think about individual sufferers.
What does disease look like?
Let us now think a little more about diseases. In the first place, how do we know that there is a disease? In other words, how do we know that there is something wrong with the body? There are many tissues in the body, these tissues make up physiological systems or organ systems that carry out body functions. Each of the organ systems has specific organs as its parts, and it has particular functions. So, the digestive system has the stomach and intestines, and it helps to digest food taken in from outside the body. The musculoskeletal system, which is made up of bones and muscles, holds the body parts together and helps the body move.
When there is a disease, either the functioning or the appearance of one or more systems of the body will change for the worse. These changes give rise to symptoms and signs of disease. Symptoms of disease are the things we feel as being ‘wrong’. So we have a headache, we have cough, we have loose motions, we have a wound with pus; these are all symptoms. These indicate that there may be a disease, but they don’t indicate what the disease is. For example, a headache may mean just examination stress or, very rarely, it may mean meningitis, or any one of a dozen different diseases.
Signs of disease are what physicians will look for on the basis of the symptoms. Signs will give a little more definite indication of the presence of a particular disease. Physicians will also get laboratory tests done to pinpoint the disease further.
The manifestations of disease will be different depending on a number of factors. One of the most obvious factors that determine how we perceive the disease is its duration. Some diseases last for only very short periods of time, and these are called acute diseases. We all know from experience that the common cold lasts only a few days. Other ailments can last for a long time, even as much as a lifetime, and are called chronic diseases. An example is the infection causing elephantiasis, which is very common in some parts of India.
As we can imagine, acute and chronic diseases have different effects on our health. Any disease that causes poor functioning of some part of the body will affect our general health as well. This is because all functions of the body are necessary for general health. But an acute disease, which is over very soon, will not have time to cause major effects on general health, while a chronic disease will do so.
As an example, think about a cough and cold, which all of us have from time to time. Most of us get better and become well within a week or so. And there are no bad effects on our health. We do not lose weight, we do not become short of breath, we do not feel tired all the time because of a few days of cough and cold. But if we get infected with a chronic disease such as tuberculosis of the lungs, then being ill over the years does make us lose weight and feel tired all the time.
We may not go to school for a few days if we have an acute disease. But a chronic disease will make it difficult for us to follow what is being taught in school and reduce our ability to learn. In other words, we are likely to have prolonged general poor health if we have a chronic disease. Chronic diseases therefore, have very drastic long-term effects on people’s health as compared to acute diseases.
What causes disease? When we think about causes of diseases, we must remember that there are many levels of such causes. Let us look at an example. If there is a baby suffering from loose motions, we can say that the cause of the loose motions is an infection with a virus. So the immediate cause of the disease is a virus.
But the next question is – where did the virus come from? Suppose we find that the virus came through unclean drinking water. But many babies must have had this unclean drinking water. So, why is it that one baby developed loose motions when the other babies did not?
One reason might be that this baby is not healthy. As a result, it might be more likely to have disease when exposed to risk, whereas healthier babies would not. Why is the baby not healthy? Perhaps because it is not well nourished and does not get enough food. So, lack of good nourishment becomes a second level cause of the disease the baby is suffering from. Further, why is the baby not well nourished? Perhaps because it is from a household which is poor.
It is also possible that the baby has some genetic difference that makes it more likely to suffer from loose motions when exposed to such a virus. Without the virus, the genetic difference or the poor nourishment alone would not lead to loose motions. But they do become contributory causes of the disease.
Why was there no clean drinking water for the baby? Perhaps because the public services are poor where the baby’s family lives. So, poverty or lack of public services become third-level causes of the baby’s disease.
It will now be obvious that all diseases will have immediate causes and contributory causes. Also, most diseases will have many causes, rather than one single cause.
As we have seen, it is important to keep public health and community health factors in mind when we think about causes of diseases. We can take that approach a little further. It is useful to think of the immediate causes of disease as belonging to two distinct types. One group of causes is the infectious agents, mostly microbes or micro-organisms. Diseases where microbes are the immediate causes are called infectious diseases. This is because the microbes can spread in the community, and the diseases they cause will spread with them.
On the other hand, there are also diseases that are not caused by infectious agents. Their causes vary, but they are not external causes like microbes that can spread in the community. Instead, these are mostly internal, non-infectious causes.
For example, some cancers are caused by genetic abnormalities. High blood pressure can be caused by excessive weight and lack of exercise. You can think of many other diseases where the immediate causes will not be infectious.
The ways in which diseases spread, and the ways in which they can be treated and prevented at the community level would be different for different diseases. This would depend a lot on whether the immediate causes are infectious or non-infectious.
For many years, everybody used to think that peptic ulcers, which cause acidity– related pain and bleeding in the stomach and duodenum, were because of lifestyle reasons. Everybody thought that a stressful life led to a lot of acid secretion in the stomach, and eventually caused peptic ulcers.
Then two Australians made a discovery that a bacterium, Helicobacter pylori, was responsible for peptic ulcers. Robin Warren
(born 1937), a pathologist from Perth, Australia, saw these small curved bacteria in the lower part of the stomach in many patients. He noticed that signs of inflammation were always present around these bacteria. Barry Marshall (born 1951), a young clinical fellow, became interested in Warren’s findings and succeeded in cultivating the bacteria from these sources.
In treatment studies, Marshall and Warren showed that patients could be cured of peptic ulcer only when the bacteria were killed off from the stomach. Thanks to this pioneering discovery by Marshall and Warren, peptic ulcer disease is no longer a chronic, frequently disabling condition, but a disease that can be cured by a short period of treatment with antibiotics.
Health is a state of physical, mental and social well-being.
The health of an individual is dependent on his/her physical surroundings and his/her economic status.
Diseases are classified as acute or chronic, depending on their duration.
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