Page 146 - Prioridades en salud y salud intercultural

Duncan Pedersen
146
ric disease and intentional injuries,
together represent 10.5 % of the
total number of DALYs (Disabil-
ity-Adjusted Life Years) lost world-
wide, making it the single most
important cause of disease and
disability, when compared with
other worldwide prevalent causes,
such as diarrhoea (7.3 %); cancer
(5.8 %); or malaria (2.6 %). The
figures for neuro-psychiatric condi-
tions may even under-represent the
magnitude of the problem, since
many of the “newly” emerged pat-
terns of social and behaviour-related
problems, such as street violence,
women battering, child sexual
abuse, substance abuse and smok-
ing, among others, are somewhat
“hidden” under the conventional
classification of disease categories
and causes of death. Mental health
problems such as major depres-
sion, has also been underestimated
by traditional approaches that take
into account mortality and morbid-
ity rates and not disability. Major
depression is the leading cause of
disability in Canada and elsewhere,
where it accounts for more than
one in every ten years of life lived
with disability worldwide. The pre-
dominance of these conditions is by
no means restricted to established
market economies, although their
burden is higher in these countries
and affects disproportionately more
women than men(12,13).
5. There is no single paradigm to
explain the role of psychosocial,
environmental and biological fac-
tors in mental illness. However,
current research provides strong
evidence that most if not all mental
disorders are bio-psychosocial and
− regardless of the psychological
and/or physiological processes in-
volved − the quality of the person’s
social environment influences the
onset, course and outcome of men-
tal illness(12). Although the links
between social and biological de-
terminants and ill-health are still
poorly understood, there is increas-
ing recognition that mental health
and well-being are largely –but not
exclusively– related to the broader
context of the political economy,
the social milieu and the local re-
sources available for managing and
coping with illness and disability.
Recent epidemiological evidence
has shown that the oversimpli-