In community medicine, there are four basic concepts that must be understood well. It was health paradigm, concept of epidemiology, mandala of health, and theory of Blum.
Health paradigm is a view that health is a need. Health paradigm is effective as efforts to prevent people for getting a disease. We know that prevention is more important than cure. To prevent disease, people should consider that health is a need and it is very important. This paradigm can change behavior of the people; so can reduce the risk to be sick. So a healthy person must own health paradigm before they get sick.
The concept of epidemiology is also called H-E-A concept. Incidence of a disease represents a unique combination of several factors: agent, host, and environment. As an illustration, disease can develop because there is dangerous disease agents that attack vulnerable-host in a supportive environment. The emergence of a disease is never caused by one factor but by several factors that form a mesh (epidemiologic web).
First is agent. Agents may be chemicals (toxins, poisons), biological (microorganism), food (deficiency of vitamin, deficiency or excess of a substances), vehicle pollution or radiation. An agent doesn’t always cause clinical symptoms, but it’s influenced by several factors: dose, type (for example, Hemophilus influenzae type B), and interaction with host. Agents must be able to enter the host.
Second is host. Host is influenced by two factors: biological and social. Biological factors include genetic, race, ethnicity, gender, and age. These biological factors can’t be changed. Age is the most important factor that determines what types of disease that can be suffered by someone. Social factors include marital status, lifestyle, diet, residence and travel.
Third is environment. Environmental factors include physical, biological and social. Physical factors include climate (temperature, humidity), region (rural or urban), and pollution (water, air). Biologic factors are environmental conditions that inhibit the transmission of disease. For example, there was no malaria disease in Kathmandu, Nepal because mosquito as vector of malaria cannot reach the mount area. Social factors, including political, social, cultural and economic circumstances of society. For example, Tuberculosis usually found on the lowest economic strata in society.
Mandala of health is a systemic method that should be owned by physicians in treating patients. A patient is not only looked from his/her physical condition, but also mind and spiritual. Then the doctor must look at the condition of his family, lifestyle, behavior, culture and biosphere. Thus, patients are looked as a holistic. It’s not only can overcome disease effectively, but also can eliminate risk factors for getting that sickness again.
Blum describes multifactor theory to determine a person’s health status. According to Blum, a person’s health status is determined by four factors: behavior (behavioral), heredity (genetic/heredity), environment (environment), and health services (health care). The fourth factor is a risk factor for why a person can be had a disease. In solving health problems, physicians should consider and evaluate these factors. These four basic concepts are useful for physicians to adopt a holistic approach to family physicians in managing patients.[primz]
1. Lecture note.
2. Cassens, Brett J.1992. Preventive medicine and public health.Harwal Publishing.
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