HEALTH, HISTORY AND SOCIETY

Part 1. Health, Disease and Society

1. Health, normality and disease

2. Dimensions of disease

3. Social dominant diseases and epidemiologic patterns

4. Health transition, demographic transition, transition of risks

5. Health and globalisation

6. Health determinants and public health strategies

7. The origins of public health

8. Health and the State: health care systems. Historical origins and present models

9. International organisations and health

10. Health and social inequalities

11. The world health situation and trends

1. Health, normality and disease

World Health Organisation (WHO): WHO is the directing and coordinating authority for
health within the United Nations system. It is responsible for providing leadership on global
health matters, shaping the health research agenda, setting norms and standards, articulating
evidence-based policy options, providing technical support to countries and monitoring and
assessing health trends.

Health has three dimensions:

 Biological
 Psychological
 Social

Health can be defined as: “The state of perfect physic, psychological and social well-
being”.
 It has two dimensions:

 Individual
 Collective

Normality: statistic pattern

Health and Disease: are processes resulting from the relation between human/living
beings and environment (physical, cultural, social).

Differences between illness and disease

Illness and disease both cause the same feelings of discomfort, pain or unease in people.
However, an illness is more of a subjective feeling. This means that there is really no
identifiable reason behind the condition. Of course, if the condition behind the illness is
identified, it is more often referred to as a disease. However, in more generalized terms, we
can define an illness as a state where the person has feelings of pain or discomfort that does
not have an identifiable reason.

A disease refers to a condition where the body or the parts of the body of a person does
not work properly. There is usually a pathological reason behind the condition.

2. Dimensions of disease
Health is not only the lack of disease. When we talk about health or healthy life means
other factors like smoking or drinking.

-Biological dimensions

-Psychological dimensions

The process of going from a healthy way to an illness id due to the fact of the change on
the homeostasis. It is necessary for the correct function of the organism. In a psychological
way is utopian. We not depend on the external conditions; instead we depend on our internal
medium. The place where our constants have limits, if you go to its borders is when you die.
Homeostasis can`t be apply in general, it is specific for each specimen. From a biological
prospective defined which is being health and is characterized by specific aspects.

In a social way everyone develops a role in society. This social role can be affected by the
disease; you acquire the role of patient, changing your initial role. It is the social consequence,
affects the private and public roles of the society.
 “Disease is a pretext of the body to die” [A. Bioy Casares]

A way to avoid life. In you are in a stress situation or a depression body can suffer an
illness, a way to draw attention.

1. The perception of feeling sick is a perception of the individual different between the
different cultures or community. You read what is going on according to the patters of what is
going on.

2. Biological dimension: There are two different characteristics that can be refere to the
detection of an illnes

 Signs:
 Symptoms

Though signs and symptoms describe the same conditions, these two are different in many
characteristics. While signs are what a doctor sees, symptoms are what a patient experiences.
A symptom can be defined as one of the characters of a disease. Meanwhile, sign is the
definite indication of a specific disease. Signs are the physical manifestation of injury, illness or
disease, symptoms can be described as what a patient experiences about the injury, illness or
disease.

Shaped by family and community environment

When one person decides that has an illness can make several options:

Options:

 Conservation of the everyday life

 Assuming the role of patient/sick person. Then you can chose different
alternative options, it is your decision:
o Self-treatment
o Official medicine: delegation of the responsibility to an expert.
o Others: wait until you return to your previous state.

Diseases affect humans.

That has biographic consequences: personal, social and occupational. They depend on
the decisions that you make.
 3. Social dominant diseases and epidemiologic patterns
In a society point of view the way how the different disease appear and affect to the
different types societies are different. There is some characteristics implicated on it like the
geography.

One of the most important medical problems in Valencia are problems associated with
risk factors that affects different diseases like cancer, psychological diseases such depressions
even degenerative diseases.

Social dominant diseases

There are not the same problems in every part of the world. There are specific
predominance of diseases in specific areas. Are the diseases relevant in each society. The fact
of beein relevant is assignee depending on the amough of people that suffers it. The two
factos that affect are severity and predominance.

Social dominant diseases are those characterizing a society, social group, territory
(urban, rural…).

Criteria to define a social disease:

 Statistics: factors to determinate to describe the dominance of a disease.

o Incidence: number of new cases that appear every year.
o Prevalence: The amount of people that is affected. Number of
people that suffers by the number of people.
o Morbidity: amount of people that suffers the disease.
o Mortality: amount of people who die suffering the disease

 Medical and therapeutic

 Psycho-social:
o Moral: disease associate to underdevelopment can have a
negative connotation.
o Fears: by the fact that the disease don’t have a cure.
o Culture: not all societies have the same concept and conception of
the disease. That can be seen along the centuries.

The construction of a social disease is produced by the huge attention of the media,
politicians and people in general. Also by the three factors mentioned.

  Social dominant diseases determine:

 Demographic patterns: internal structure of the population (global, per group

of age, sex, level of income, etc.)
 Epidemiologic patterns: distribution of types of disease at any population.
 4. Health transition, demographic transition, transition of risks

a) Great acute infectious-contagious epidemics/plagues

The epidemics and plagues constitute a short of epidemiological patters and are not the
same depending on time and place. You will find different epidemiological patters around the
world.
For example moments where some plagues affected most were: from the Antiquity until
the end of the 19th century in Western, industrialised countries. There are also present in poor
countries in present times. We can highlight periods like wars or between wars.
The epidemiological patters are acute, appear and disappear in a short period of time,
and provoke high rates of mortality. Lots of people die because of this diseases.
Main social diseases: pest, yellow fever, small pox, cholera…
They can be characterised by big catastrophe. However, they can be characterised also
by several conditions. Living in a rural area or in an urban area can characterise a new stage for
the diseases mentioned, the degeneration of this places can rise the danger of suffering this
diseases.

b) Chronic infectious-contagious diseases

Chronic from an illness means that has a long duration on time.
Closely linked to development of industrialisation and defiencient public health facilities.
Main social diseases: tuberculosis, malaria, typhoid fever, diphtery, venereal diseases...).
These diseases produce a high social mortality. Nowadays in the idea of modernity it
can’t be accepted this high mortality.

c) Health transition, demographic transition, transition of riscs

Inter-war Period- 1st half of the 20th c.

Main features:
 Decrease of global mortality
 Decrease of infant and child mortality
 Increase of living expectancy
 Improvement of hygienic and working conditions

Consequences

 new epidemiological pattern

 demographic changes
 aging of the population

d) Non infectious-contagious diseases and accidents

TRANSITIONS from an old pattern to a new pattern

 Appear after the industrialized societies 1945-1980. By this time appeared the
protection of the state, introduction of the welfare state, important for people that can’t
afford the sanitary assistance. Problems of nutrition wars progressively disappear, the patter
change to chronic non infection diseases. The problems associated to bacteria were mostly
overcome.

The main diseases are during these years were: cancer, heart attacks, brain vascular
accidents, traffic accidents, industrial accidents…

Now these type of disease are important, however we have developed to a new patter
where viruses and a few other infectious diseases have the main importance

e) Globalization and new health problems (+1980)

After 1980 appears the Spanish flu (Spain was the first country that reported cases). It
was one of the first pandemic diseases produced by a virus. It produce a big catastrophe all
over the world, we have to mention that the social and political conditions improve it virulence
(Second world post-war).

It produces a new concept of illness. Something that happens in an underdeveloped

place of the world can affect in other developed countries.

We have nowadays the thought of medicine can solve all the health problems, but not
all this problems can easily solves.

Main problems are relates with: new epidemic diseases (virus) and new health
problems (toxicomanies, anorexia…).

Re-emergency:

 The previously controlled diseases came back

 Crisis in the systems of health. After the destruction of wars affected in
the systems of health of many developed countries. There was a discussion
in the 80s and 90s about the sustainability of a system of health with
public funds, based in the concept that every citizen has the right of a
healthy care. In the begging of the development of medicine the cost was
lower but along years of development this cost increased until arriving to
an unsustainable point. Then appeared a new ideological patters.
 Neo-liberalism. “The state can’t assume the big growing cost of the
society” appear a new ideology that defend the privacy of the health
system.
The factors that have people arrive to this conclusion are:
- Technology (development of the systems make more expensive
medicine)
- Demand of the people and industry (pharmacology)
- Growing of the societies
Produced a crisis of health care universality.
 Population movements and inequalities
 - Emigrants: increase the possibility of bringing diseases of other
places of the world.
 Climatic and ecologic change... Increases the possibility of suffer the
diseases that southern countries suffers.

5. Health and globalisation

Factors:

 Market globalization and financial de-regulation: the things that we consume are not
produced around the place they are sold. This market globalization has followed this
own direction without any regulation. Are more important the profits.
 Mass media, social networks and global communication
 Migration and people transfer
 Multinational technologies (medicines, devices, prostheses, biological products, cell
technologies...)

Consequences

It has a good sense for economy but there aren’t everything advantages in social fields
like:

 Crisis of international organisations: countries try to have their own organisation. The
international organisations tended to fail.
 Non sustainable development: environment destruction and ecological crisis
 Crisis in the productive and energetic pattern
 Increase of inequalities
 Emergency and re-emergency of diseases
New threats, new risks, new opportunities.

6. Health determinants and public health strategies

Conditioning factors of the State of heath

 Life style (individual): each person has his own life style that affect himself and
is chosen freely.
 Living condition (social, professional group): depends on if you live in a upper
class, in a medial class...
 Living pattern (society): there are different patterns between the Western ,
Mediterranean, the Eastern... For example the diet that we have is different or
the time table.

In order to improve this conditions there a few strategies:

Public health strategies:

  Health promotion: promotion a healthy lifestyle. Say people what is better for
them. Improve the level of health.
 Prevention: giving information to avoid some of the risk factors that can
produce a disease.
 Cure Rehabilitation: while the other two can be used in all the conditioning
factors of the State of Health this one can only affect to the life style. It is
individual action because the one that is cure is the one that is damage.

7. The origins of Public Health

a. Health and liberal reforms in the 19th century

 France: “Déclaration des Droits de l’Home”

 Comité de Salubrité (1790) Louis René Villermé
 United Kingdom: Edwin Chadwick Sanitary Movement
 William Far: Vital Statistics (1839)
 McCulloch: A Statistical Account of the British Empire (1842)
 Germany: medizinische Polizei (Johann Peter Franck)
 Rudolf Virchow: Die Medizinische Reform (1848)
o Max von Pettenkofer: Über die Wert der Gesundheit für eine Stadt (1873)
 Spain: Mateo Seoane, Consideraciones generales de estadística médica (1837); Boletín
de Estadística Demográfica-Sanitaria de la Península e Islas Adyacentes (1879)

 Krankenkassen, Poor Laws, International Sanitary Conferences

b. The International Sanitary Movement

Ideology: public health is wealth

 During the first decades of the 19th century and the Inter-war Period (1914-1945)
powerful health administration stimulated by Rockefeller Foundation, Office
Internationale d'Hygiène Publique, Health Organisation of the League of Nations
and International Sanitary Conferences ...
National Instituts of Hygiene, Public Health Schools
 Public health administration (central/periphery) & experts
 Health care organisation: dispensaries, campaigns, laboratory technologies applied
to public health, centres of hygiene...
I only happened in certain areas of the world.

c. Social reformism ans providential state

Comissión de Reformas Sociales liberal reformism

 Survey (1884) la cuestión obrera

 Origins of the so-called Providencial State (estado providencial) Institutions that
foment this idea:
Instituto for the Social Reforms (1903)
Instituto Nacional de Previsión (1920)
Ministry of Work and Social Prevision
Conference of Social Insurances (1917)
1920 - 1935: compulsory social insurance, retirement, working insurance,
accidents...
 Opposition of conservatives & Catholic Church

d. Sanitary transition and public health policies 1875-1945

A – Sanitary facilities (urban and then rural): pipes, housing, control of water supplies,
management of waste and filth…
At the starting of the century appeared a big difference between rural and urban places.
In rural they remained living in a traditional way, in the urban places they developed and
growth being designed more hygienic and providing more hygienically facilities.

B – Health care and welfare systems

C – Municipal preventive policies, new bacteriology: vital statistics, epidemiologic

records, sanitary campaigns, vaccines, sera, antibiotics…

(Pueden preguntar cómo surgió la sanidad pública y que factores lo impulsaron)

B. Dimensions of the health transition

- Decrease of big bacterial epidemics and pandemics (plague,

cholera, yellow fever, smallpox...)
- Demographic increase
- Decrease of global mortality, children and infant mortality
- Increase of life expectancy
- Predominance of infectious, chronic diseases such as tuberculosis, malaria,
syphilis, etc. Some associated with the lack of hygiene and facilities (typhus)
- First viral epidemic outbreaks (influenza, 1918).

In every moment of the transition are equal important all the aspects that affect the
society (social, demographics, sanitary, economical, ect.). There is no sufficient the medicine to
develop this change.

C) The transition of risks

Associated with rural/urban life, industrialization, changes in life style, changes in

nutrition, migrations, working conditions, economic crisis…
Risks are changing all the time depending in all the factors that we are mentioning.
8. Health and the State: health care systems
Historical origins

We have three different periods, is important to distinguish them:

 1900: liberal patterns + initiatives from providencial state resulting from

industrialization and trade:
Krankenkassen, Zestvo, Igualas, Societé de Socors Mutus...
 1900-1929: Health Insurances regulated by the State
Seguro Obligatorio de Enfermedad (SOE) = persistance and widening
previous experiences
 1929-1945: Health Organisation of the League of Nations
National Instituts and Public Health School
 After 1945: diversification:
-Eastern Euprope Socialist countries : URSS + satellit countries = financed by State

- Europeus: Wellfare State based mainly on health care (mix financial system)
- USA: private insurances: State excluded