Concept of Community Medicine, Community & Community

7/31/2019 Concept of Community Medicine, Community & Community

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History of community

medicine


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Medicine in antiquity

Dubos said the ancient medicine was mother of

science

medicine was concieved in sympathy andborned out of necessity

First doctor was man and first nurse was female

Disease due to wrath of God , evil spirit,influence of stars -- supernatuaral theory


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Indian medicine

Ayurveda and siddh

dhanvantari god of Hindu medicine born by churning of

occean during war

Atharvaveda developed to ayurveda

Atreya first great Indian physician in bhuddist time

Charaka chraka samhita mention 500 drugs

Susruta father of Indian surgery , wrote susruta samhitaincude medicine, pathology, ophthalmology , bebside

manners, fractures , excised tumor etc

Vaghbhatt


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Introduction

Public health is a modern concept, although it has

roots in antiquity.

From time immemorial man has been interested intrying to control disease.

The medicine man, the priest, the herbalist and

magician, all undertook in various way to prevent and

cure disease.

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Evolution of Medicine

Every culture had developed a system of medicine andmedical history is an aspect of history of culture

Ancient medicine was the mother of sciences andplayed a large role in the integration of early culture

Medicine improved as civilization and development

evolved

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Theories of diseases

Supernatural theory of diseases

Theory of humors

Theory of contagion

Miasmic theory

Theory of spontaneous generation Germ theory of disease

Concept of multifactoral causation


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Introduction

What is Public health?

the science and the art of preventing disease,

promoting health and prolonging life through theorganized efforts and informed choices of society,

organizations, public and private, communities and

individuals.

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PHASES IN DEVELOPMENT OF

PUBLIC HEALTHDisease control phase (1880 1920)-Sanitary legislation & sanitary reforms

-control of mans physical environment

Health promotion phase (1920-1960)-provision of personal health services ; maternal & child

health, school health, industrial health, mental health, etc

-provision of primary health centers and sub centers

-inauguration of community development programmes


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PHASES IN DEVELOPMENT OF

PUBLIC HEALTH

Health promotion phase (1920 -1960)--- provision of

personal services; maternal & childhealth, school health, industrial health,

etc --

-provision of basic health services ,

building prymary health centers

---community development

programmes


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Phases ctnd

Social engineering phase (1960 -1980) ---priority shift to social and behavioural aspect of

diseases ---

emergence of concept of risk factors ---preventive & rehabilitative aspect of chronic

diseases

Health for all phase (1981 -2000 AD)

---Attempt to correct imballance between richand poor countries

1981 WHO declaration for health for all by

2000


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where we are

Primary health care

1978 Alma Ata declaration of WHO

The Millennium Development Goal

Sept 2000 millennium summit in New York

Health a developmental issue


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community

a community can encompass several

interpretations such as a village,

subdistrict, district, province, or nation. This can be a country, province, district, or

state

A community is not a static entity

a socially defined group, such as poor

communities


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Community medicine

While medicine evolve along individual

lines over the ages it has also evolve

along community lines Man has understood the importance of

collective living in the aetiology (interaction

leading to communicability of diseases) aswell as management of diseases through

organized efforts


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Community health/

medicine Community health deals with all the servises that

is aimed at protecting the health of the community

Preventive

Promotive

Curative

Rehabiltative

Community medicine looks at the medical andclinical servises provided by physician and nursesbut in a defined community


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Modern public health

Multidiscilpinary

Multisectoral

Evidence based

Equity oriented


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Community diagnosis

This is process of collection and collation

and analysis of health data and indices in

a community for the purpose ofunderstanding the health status of the

community on general or specific issues

It is an important concern of communityhealth

The unit of interest is the community


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Community diagnosis

first task to define health and disease burdenin a given community is to define the targetcommunity.

This can be a country, province, district, orstate

more defined geographical region, such asan urban inner city, or a socially definedgroup

such as poor communities, women in thereproductive age range, pregnant mothers,infants, young adults, or the elderly


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Health indicators

The definition of indicators is a pre-

requisite for the development of an

effective information system in communitydiagnosis. Indicators have to reflect the

kind of decisions which will be needed to

estimate the burden of illness and thestrategies for control


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The main health indicators are expressed interms of crude age-adjusted or age-specific

mortality rates ( infant mortality rates,mortality for children under 5, MMR),disease-specific morbidity rates, and lifeexpectancy at birth.

other indicators have been developed.potential years of life lost, quality-adjusted lifeyears gained, disability-adjusted life years,healthy life years lost, and disabilities and

quality of life index


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Characteristics of community

diagnosis ability to address important problemsamenable to practical control

ability to identify most of the target healthevents

adequacy in reflecting changes in distributionof events over time, place, and person

having a clearly defined population, datacollection, data flow, analysis, interpretation,

and feedback orientation towards appropriate action

being participatory, uncomplicated, sensitive,timely, and inexpensive.


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Sources of information for community

diagnosis

Routine reporting from health facilities Surveillance including active, passive, and

sentinel surveillance

Screening Special surveys

Rapid surveys

Contact tracing Vital registration

A combination of several methods


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Routine reporting system

Birth and death registration

Hospital morbidity and mortality records

At risk register

Disease registers e.g. cancer register


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Surveillance

a tool for community diagnosis of diseases

which have the potential to become an

epidemic Three types of surveillance can be used to

diagnose the nature and extent of a health

problem in a community: activesurveillance, passive surveillance, and

sentinel surveillance.


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Active surveillance

to detect without delay the introduction ofchange in incidence of a specific diseaseagent

to alert pubic health officials early about animpending epidemic

to assess the extent of the risk oftransmission of a particular disease

to estimate and monitor the effectiveness ofcontrol activities.

active surveillance is usually disease specific


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Passive surveillance

useful for monitoring long-term secular trends

but is relatively insensitive to tracking

epidemics. Most countries have a passive surveillance

system.

The key components of a passivesurveillance system include the use of

standardized case definitions and a

standardized reporting system.


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Sentinel surveillance

sentinel surveillance system is used to

identify rapidly changing health problems

in a country or community the objective is to track an approximate

pattern or trend of the situation on which to

base interventions


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screening

Detection of diseases among apparently

healthy individuals using a rapid tool

The objective of a screening programme isto detect health problems at an early stage


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Contact tracing

Contact tracing is particularly useful when

information from routine systems and

surveillance suggests the need for aclarification of the pattern of the spread of

disease


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Purpose of contact tracing

Confirm diagnosis and find causes

Behaviour risk estimates

Estimate magnitude of problems Identify possible control measures

Identify where/to whom to apply control

measures Recommend control measures


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A bi ti f l th d


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A combination of several methods: an

example

All academic disciplines for community

diagnosis have both strengths and

weaknesses. To solve a public health problem

adequately requires inputs from several

disciplines and approaches


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CONCLUSION

DESPITE THE ATTRACTION IN THE

FIELDS OF CLINICAL MEDICINE THE

COMMUNITY PHYSICIAN WILL REMAINTHE CUSTODIAN OF THE PEOPLES

HEALTH FOR HE ALONE REALISES

THAT ULTIMATE POWER MUSTRESIDE WITH THE PEOPLE

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Concept of Community Medicine, Community & Community