Personal care medicine: Social health

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“Health is not just the absence of disease, but a state of complete physical, mental and social well-being”. This is a well-recognized definition of health as given by the World Health Organization (WHO).

As this definition clearly states, the social contexts of health and disease or “social health” also form important aspects of health. These are the conditions in which we live, learn, work and age i.e. the conditions of day-to-day life, which in turn are influenced by the political, social and economic systems of the country. How a person gets along with other people and how do people talk about a person behind his back is also social health.

These social determinants of health are equally important or perhaps even more important in influencing the health and well-being of an individual. For this reason, they have also been called “the causes of the causes”.

The WHO has identified 10 social determinants of health:

1. Social gradient
2. Stress
3. Early life
4. Social exclusion
5. Work
6. Unemployment
7. Social support
8. Addiction
9. Food
10. Transport

Social gradient is measured by variables such as income, education, housing or occupation.

Education inculcates healthy behaviors. Housing determines better access to healthy foods and health services. Conflicts, gender inequality are also important social determinant of health as they may also influence availability and access to health services.

Food- and water-borne diseases are due to lack of access to safe food and clean drinking water and poor sanitation. These are more often than not the consequence of poverty or low income, which is associated with poor housing, overcrowding and poor sanitation. So, you may treat that one episode of diarrhea but, the patient who lives in areas of poor housing and sanitation may come back to you with recurrent episodes of diarrheal diseases.

Air pollution is a major environmental risk to health. NCDs, such as cardiovascular diseases including stroke, chronic respiratory diseases and cancers have been linked to outdoor air pollution. Exposure to biomass smoke, or indoor air pollution, is a major risk factor for COPD.

A patient who is struggling to meet his daily needs may not be amenable to advice about lifestyle modifications – quitting smoking, physical activity/exercise, healthy food. These will not be a priority for him.

Social isolation and loneliness will only further aggravate the condition in a patient of depression.

Persons whom we come in contact with daily, be it family or friends, also influence healthy behaviors. If your family and friends exercise regularly, it is more than likely that you will also pick up this healthy habit. But remember, bad habits are also catching, for example, alcoholism, substance abuse, smoking, etc.

A research published in the May 22, 2008 issue of the New England Journal of Medicine had shown that when one person quits smoking, than others are likely to follow. One person quitting can cause a ripple effect, making others more likely to kick the habit.

• If your spouse stops smoking, you’re 67% less likely to continue smoking.
• If your friend kicks the habit, it’s about 36% less likely that you’ll be smoking.
• When a sibling gives up cigarettes, your risk of smoking decreases by 25%.
• Risk of smoking drops by 34% if a coworker in a small office quits smoking.
So, have positive influences around you. Keep the company or “sangat” of good people to spend time with. Adi Shankaracharya has described Sangat as the main force for living a spiritual life.

India is facing the double burden of infectious diseases and non communicable diseases, undernutrition and overnutrition (overweight and obesity). This is a reflection of the health inequities in the country.

Therefore, achieving the desired health outcomes is not just dependent on treating the disease alone. Addressing the social determinants of health is equally important, first to achieve the desired results and then to sustain them. A healthy person is more productive and contributes to the growth and development of society.

The concept of “One Health” recognizes that the health of people, animals and the environment are connected. Many diseases in humans or zoonoses are spread from animals.

Treat the person in totality and not just the disease.

As Sir William Osler said, “The good physician treats the disease; the great physician treats the patient who has the disease.”

Dr KK Aggarwal
National President IMA & HCFI

Recipient of Padma Shri, Dr BC Roy National Award,Vishwa Hindi Samman, National Science Communication Award & FICCI Health Care Personality of the Year Award
Vice President Confederation of Medical Associations of Asia and Oceania (CMAAO)
Past Honorary Secretary General IMA
Past Senior National Vice President IMA
President Heart Care Foundation of India
Gold Medalist Nagpur University
Limca Book of Record Holder in CPR 10
Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre
Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand
Editor in Chief IJCP Group of Publications & eMedinewS
Member Ethics Committee Medical Council of India (2013-14)
Chairman Ethics Committee Delhi Medical Council (2009-15)
Elected Member Delhi Medical Council (2004-2009)
Chairman IMSA Delhi Chapter (March 10- March 13)
Director IMA AKN Sinha Institute (08-09)
Finance Secretary IMA (07-08)
Chairman IMAAMS (06-07)
President Delhi Medical Association (05-06)

Heat exhaustion and heat stroke should be differentiated promptly

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Most parts of the country are experiencing high temperatures. With the ongoing heat wave, cases of heat–related disorders are also bound to increase. Heat cramps, heat exhaustion and heat stroke are the three forms of heat-related disorders that occur with prolonged exposure to heat and differ in their severity. Hence, it is important to differentiate between the three conditions.

Clinically, both heat exhaustion and heat stroke may manifest as fever, dehydration and other symptoms such as headache, thirst, malaise, nausea or vomiting, rapid pulse etc. The main difference between heat exhaustion and heat stroke is the presence of sweat in the former and absence in the latter.’

Normally, the axillae will always be wet even if a person has severe dehydration. If the axillae are dry and the person has high fever, this invariably means that the person has progressed from heat exhaustion to heat stroke and this should be treated as a medical emergency.

In heat exhaustion, the core temperature is between 37°C and 40°C. While in heat stroke, the core temperature is very high, > 400C and needs to be lowered within minutes and not hours. Rapid reduction in body temperature can be accomplished by cool or tepid bathing preferably using damp sponges. Submersion should be avoided so that body heat loss by evaporation can occur. Cooling blankets should also be avoided.

The absence of sweating, dry armpit, non-passage of urine for 8 hours or presence of high grade fever in summer seasonare ‘red flags’ and medical attention should be sought immediately.

Heat cramps are muscle spasms in the arms, legs, or abdomen that result from loss of large amount of salt and water through exercise. The treatment is replacing fluid and salt orally.

Dr KK Aggarwal
National President IMA & HCFI

BE FAST: A modified assessment tool to identify stroke

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‘Time is brain’. A patient with suspected stroke or ‘brain attack’ should therefore be shifted to hospital at the earliest and given a clot dissolving therapy. Jeffrey L. Saver reported in the journal Stroke that “every minute in which a large vessel ischemic stroke is untreated, the average patient loses 1.9 million neurons, 13.8 billion synapses, and 12 km (7 miles) of axonal fibers. And, each hour in which treatment fails to occur, the brain loses as many neurons as it does in almost 3.6 years of normal aging” (Stroke. 2006;36:263-6).

The American Stroke Association recommends the mnemonic FAST to recall the signs of stroke and quickly identify victims of stroke; “F” stands for Face drooping; “A” stands for arm weakness i.e. inability to raise arms high, “S” stands for Speech difficulty – slurring of speech and “T” stands for Time – time to call for emergency medical help.

A new research has devised a modified version of this simple prehospital stroke assessment tool, ‘BE FAST’ for early identification of patients with occlusion of large vessel, which was presented at the American Stroke Association’s International Stroke Conference 2017, which concludes in Houston, USA today (AHA News, February 22, 2017).

The acronym ‘BE FAST’ evaluates:

• Balance/coordination
• Eye deviation
• Facial weakness
• Arm/leg weakness
• Slurred speech/sensory deficits
• Time of onset

Researchers examined 455 ischemic stroke patient charts from July 2014 to June 2015, using information about patients’ symptoms and physical findings. The sensitivity i.e. positively recognizes a large vessel occlusion, for the ‘BE FAST’ score was found to be 83%.

Stroke is an emergency and getting timely help and treatment is extremely important. Hence, it is very important to act fast to identify these patients. Early treatment improves the chances of recovery.

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