Adobe Systems
Abanoub Riad. Health and Disease. Public Health I. October 2020
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Health and Disease
Public Health I

Adobe Systems
Abanoub Riad. Health and Disease. Public Health I. October 2020
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Dr. Abanoub RIAD, DDS
Doctor of Dental Surgery (2016)
Research Fellow at Czech National Center of Evidence-based Healthcare and Knowledge Translation
(CEBHC-KT)
Doctoral Candidate of Hygiene, Preventive Medicine, and Epidemiology (MED-MUNI)
Doctoral Candidate of Clinical Psychology (FSS-MUNI)
abanoub.riad@med.muni.cz
Office Consultation (Upon Request)
Public Health I

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Abanoub Riad. Health and Disease. Public Health I. October 2020
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Seminar Outline
I. Definition of Health
II. Theory of Disease
III. Global Burden of Disease
BREAK
IV. Measuring Disease Frequency
V. Mortality

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How do you define “Health”?
Health is a state of complete physical, mental and social well-being and not merely the absence of
disease or infirmity.
Constitution of WHO as adopted by the International Health Conference, New York; signed on 22 July
1946
The definition has not been amended since 1948

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Abanoub Riad. Health and Disease. Public Health I. October 2020
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Exercise 1
Model of World Health Organization (MWHO)
You have been commissioned to represent your country at the 74th World Health Assembly (WHA) in
Geneva, Switzerland ∼ May 2021. The agenda of Committee A highlights the definition of “Health” at
WHO’s constitution for revision. What will be your critiques for the current definition?

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Abanoub Riad. Health and Disease. Public Health I. October 2020
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Huber Machteld, Knottnerus J André, Green Lawrence, Horst Henriëtte van der, Jadad Alejandro
R, Kromhout Daan et al. How should we define health? BMJ 2011; 343 :d4163
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How should we define health?
1. Medicalization of society
2. Incompliance with current demographics & disease burden
3. Operationalization of definition
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Abanoub Riad. Health and Disease. Public Health I. October 2020
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Natural History of Disease
Source: Centers for Disease Control and Prevention. Principles of epidemiology, 2nd ed. Atlanta:
U.S. Department of Health and Human Services;1992.
PREDISEASE
LATENT
SYMPTOMATIC
Primary Prevention
secondary Prevention
tertiary Prevention

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How disease occurs?
Supernatural Theories
1.Demonic Theory
2.Punitive Theory
Philosophical Theories
1.Humoral Theory
2.Miasmatic Theory
3.Contagion Theory
Scientific Theories
1.Germ Theory
2.Epidemiological Triad
3.Epidemiological Tetrad
4.Wheel Theory
5.Web of Causation

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Abanoub Riad. Health and Disease. Public Health I. October 2020
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Exercise 2
BEINGS Model of Disease
BEINGS concept postulates that human diseases and its consequences are caused by a complex
interplay of nine different factors. By coining the first letters of these factors the theory is
called BEINGS theory. Explain the nine domains of BEINGS model with explanatory examples for each
domain. (Homework Assignment 1)
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How do we classify diseases?
POPULATION
Age (e.g. Pediatric, Geriatric)
Gender (e.g. Gynecologic, Productive)
Race
Occupation
TARGET
Organ-specific (e.g. Liver, Kidney, Brain)
System-specific (e.g. Respiratory, Cardiovascular)
TRANSMISSION
Communicable (Infectious) Diseases
Non-Communicable (Chronic) Diseases
Tissue-specific (Mucosal)
Syndromic

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Abanoub Riad. Health and Disease. Public Health I. October 2020
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Global Burden of Disease (GBD)
Since 1990 (350 diseases, 195 countries, +3600 researchers)
The largest study for diseases distribution and their impact.
Quantifying mortality, and morbidity.
Symbol of coordinated “global health” efforts.
http://www.healthdata.org/gbd
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Exercise 3
Global Burden of Disease
1.Go to: https://vizhub.healthdata.org/gbd-compare/
2.Click “Compare” – then “By Year”
3.Select “1990” for “Top Chare Settings”
4.What happened in the last 30 years?
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Exercise 3
Global Burden of Disease

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BREAK

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Disease Frequency
Population at Risk
Ratio vs. Rate
Incidence vs. Prevalence

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Ratio
A ratio is the relative magnitude of two quantities or a comparison of any two values.
It is calculated by dividing one interval- or ratio-scale variable by the other.
The numerator and denominator need not be related.

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Gender
Female / Male

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Population / Clinics

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Case-to-death Ratio (Case-fatality ratio)
https://www.who.int/news-room/commentaries/detail/estimating-mortality-from-covid-19

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Abanoub Riad. Health and Disease. Public Health I. October 2020
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Rate
•In epidemiology, a rate is a measure of the frequency with which an event occurs in a defined
population over a specified period of time.
•Because rates put disease frequency in the perspective of the size of the population, rates are
particularly useful for comparing disease frequency in different locations, at different times, or
among different groups of persons with potentially different sized populations; that is, a rate is
a measure of risk.
Incidence Rate
Attack Rate
Incidence Proportion

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Ratio Vs. Rate
https://www.cdc.gov/csels/dsepd/ss1978/lesson3/section1.html

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Incidence
The incidence of disease represents the rate of occurrence of new cases arising in a given period
in a specified population
Prevalence
Prevalence is the frequency of existing cases in a defined population at a given point in time.

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Exercise 4
Prostate Cancer
Black men in the United States have a substantially higher incidence of prostate cancer than U.S.
white men. Let’s say there’s a variant of the androgen receptor gene that’s more common in black
than white men in the United States — 50 % versus 30 % — that is also associated with a doubling of
incidence of prostate cancer in American men of either race.
What would be the relative incidence of prostate cancer, black versus white American men, if the
genetic marker were the sole risk factor for this disease that differed between the two races?

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Exercise 4
Prostate Cancer in the U.S.

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Exercise 4
Suicide of Physicians
The rate of suicide among American physicians, relative to the corresponding rate in the population
as a whole, varies by gender. Among men, the rate in physicians is 1.5 times higher, whereas among
women the corresponding relative rate is 3.0. It turns out that the rate of suicide in American
male and female physicians is identical.
For American men and women in general, what is the relative rate of suicide in men compared to
women?

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Abanoub Riad. Health and Disease. Public Health I. October 2020
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Exercise 4
Suicide of Physicians

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Exercise 4
Guillain-Barré syndrome
A population-based case-control study of Guillain-Barré syndrome (a neurological disease) conducted
in 1992–1994 in 4 states estimated the risk of this disease to be 1.7 times greater among adults
who had received influenza vaccine in the prior 6 weeks than those who had not. Th e investigators
also estimated that the added risk of Guillain-Barré syndrome associated with the receipt of
influenza vaccine was about one per million persons during the first 6 weeks after vaccination.
From these data, can you calculate the 6-week incidence among adults in the 4-state population who
did not receive the vaccine? If yes, what is that incidence? If no, why not? (Homework Assignment
2)

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Exercise 4
Stomach Cancer
The incidence of stomach cancer in country X is 8.0 per 100,000 per year. The incidence rate in
nearby country Y, with a similar age-sex-race composition as country X, is 10.0. You are concerned
with explaining this difference. You know that 5% of people in country Y drink tea containing
suspected carcinogen A, whereas nobody in country X drinks this tea.
In order for this to be the sole explanation of the difference in the incidence rates of stomach
cancer between the two countries, how strongly must carcinogen-A-tea drinking be associated with
stomach cancer? (Homework Assignment 2)

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Mortality
•Crude Mortality
•Age-specific vs. Age-standardized Mortality
•Proportionate Mortality
•Infant Mortality
•Maternal Mortality
•Adult Mortality
•Life Expectancy

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Proportionate Mortality
•Occasionally the mortality in a population is described by using proportionate mortality, which is
actually a ratio: the number of deaths from a given cause per 100 or 1000 total deaths in the same
period. Proportionate mortality does not express the risk of members of a population contracting or
dying from a disease.
•Unless the crude or age-group-specific mortality rates are known, it may not be clear whether a
difference between groups relates to variations in the numerators or the denominators.
•Example: Proportionate mortality rates for cancer would be much greater in high-income countries
with many old people than in low- and middle-income countries with few old people, even if the
actual lifetime risk of cancer is the same.

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Age-standardized Rate
Age-adjusted rate

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Infant Mortality
Child Mortality
Rate
Rate
•The child mortality rate (under-5 mortality rate) is based on deaths of children aged 1–4 years,
and is frequently used as a basic health indicator.
•Injuries, malnutrition and infectious diseases are common causes of death in this age group.
•The under-5 mortality rate describes the probability (expressed per 1000 live births) of a child
dying before reaching 5 years of age.

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Maternal Mortality
Adult Mortality
Rate
Rate
Life Expectancy
is defined as the average number of years an individual of a given age is expected to live if
current mortality rates continue.

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Life Expectancy
https://www.populationpyramid.net

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Life Expectancy
in Japan
https://www.populationpyramid.net

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Exercise 5
Homicide Death Rate
In 2001, a total of 15,555 homicide deaths occurred among males and 4,753 homicide deaths occurred
among females. The estimated 2001 midyear populations for males and females were 139,813,000 and
144,984,000, respectively.
1.Calculate the homicide-related death rates for males and for females.
2.What type(s) of mortality rates did you calculate in Question 1?
3.Calculate the ratio of homicide-mortality rates for males compared to females.
4.Interpret the rate you calculated in Question 3 as if you were presenting information to a
policymaker.

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Exercise 5
Homicide Death Rate

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Abanoub Riad. Health and Disease. Public Health I. October 2020
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abanoub.riad@med.muni.cz
Office Consultation (Upon Request)
Public Health I
THANK YOU