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

Obat pencegahan bertujuan untuk meningkatkan

kehidupan individu dengan membantu mereka
meningkatkan kesehatan mereka sendiri
Kesehatan masyarakat upaya untuk meningkatkan
kesehatan pada populasi melalui penerapan upaya
masyarakat terorganisi

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

(contd)
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

(contd)
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

death

The course of the disease in man

Interrelations of the various

Chronic
state

AGENT

Disability
illness

HOST

Defect

and
ENVIRONMENTAL
factors

CLINICAL HORIZON

Known or unknown

Tissue and
physiologic
changes

Bring AGENT and

HOST together
STIMULUS or
AGENT becomes
Or Produce a
disease-provoking

STIMULUS

Immunity and
resistance

STIMULUS and AGENT

BECOMES established and
increases by multiplication or
increment

Interactions of HOST
and SIMULUS

in
human
HOST
PREPATHOGENESIS
PERIOD

Signs and
symptom

HOST REACTION
Discernible

Early
pathogenesis

PERIOD

RECOVERY

early lesions

OF

Advanced
disease

PAT H O G E N E S I S

Convalescence