NATURAL HISTORY

OF DISEASE

dr. Suryani Tawali, MPH

BASIC CONCEPTS

 The fields of preventive medicine and public health

share the goals of promoting general health, preventing
specific diseases, and applying the concepts and techniques
of epidemiology towards these goals.
 Preventive medicine seeks to enhance the lives of
individual by helping them improve their own health
 Public health attempts to promote health in
populations through the application of organized
community efforts
BASIC CONCEPTS
 Althought, they ( preventive medicine and public health)
are discussed somewhat separately.

 There should be a seamless continuum between:

 The practice of preventive medicine by physicians

and other health professionals

 The attempts of individuals and families their own

and neighbours’ health

 The efforts of government and voluntary agencies to

achieve the same health goals for populations
NATURAL HISTORY OF DISEASE

 Before a disease process begins (during

pre-disease/ pre-pathogenesis period).
An individual can be though as
possessing various factors that promote
or resist disease. These factors include
genetic makeup, demographic
characteristics (especially age),
environmental exposures, nutritional
history, social environment, immunologic
state, and behavioral patterns
NATURAL HISTORY OF DISEASE

 Over time, the sum of these and other factors

may cause a disease process to begin either
slowly (as is usually the case with infectious
diseases) or quickly (infectious diseases).
 If the disease-producing process is under way
but no symptoms of the disease have become
apparent, the disease is said to be in the
latent– stage (early pathogenesis). If the
underlying disease is detectable by a
reasonably safe and cost-effective means
during this stage, then screening may feasible.
NATURAL HISTORY OF DISEASE
(cont’d)

 In this sense, the latent stage may

represent a window of opportunity, during
which detection followed by treatment
provides better chance of cure or at least
effective treatment
 For some disease there is no window of
opportunity, because safe and effective
screening technology is not available.
NATURAL HISTORY OF DISEASE
(cont’d)
 When the disease is advanced enough to
produce clinical manifestations, it is said
to be in symptomatic/ manifest stage.
 Even in this stage, the earlier the
condition is diagnosed and treated, the
more likely the treatment effective to cure
the patient, or to prevent from serious
complication/ death. Or at least to
provide the opportunity for rehabilitation.
 The natural history of disease is its
normal course in the absent of
intervention. The central question for
studies of prevention (field studies/ trials)
and studies of treatment (clinical trials) is
whether the institution/body of a
particular preventive or treatment
measure will change the natural history
of the disease in a favorable direction.
 THE NATURAL HISTORY OF ANY DISEASE
OF MAN
Before man involved The course of the disease in man death

Interrelations of the various Chronic

state
AGENT Disability

illness
HOST
Defect
and Signs and
ENVIRONMENTAL CLINICAL HORIZON symptom
factors
Known or unknown
Tissue and
physiologic Immunity and
Bring AGENT and
changes resistance
HOST together
STIMULUS and AGENT
STIMULUS or BECOMES established and
AGENT becomes increases by multiplication or RECOVERY
Or Produce a increment
disease-provoking

STIMULUS Interactions of HOST HOST REACTION

in and SIMULUS
human Discernible
Early Advanced
HOST pathogenesis early lesions Convalescence
disease

PREPATHOGENESIS
PERIOD PERIOD OF PAT H O G E N E S I S