AN INTRODUCTION TO COMMUNITY MEDICINE

The specialty which deals with population.
Comprises those doctors who try to measure the needs of sick and healthy.
Who plan and administer the services to meet the needs.
Who are engaged in research & teaching in the field.

1. AN INTRODUCTION TO COMMUNITY MEDICINE AB RAJAR. ASSOCIATE PROFESSOR COMMUNITY HEALTH SCIENCES.

2. DEFINITIONS: The specialty which deals with population . Comprises those doctors who try to measure the needs of sick and healthy. Who plan and administer the services to meet the needs. Who are engaged in research & teaching in the field.

3. INTRODUCTION: The community medicine is the field concerned with the study of health and disease in the population of a defined community or group. COMMUNITY: “A large number of individuals, living together in a defined geographical area and having common interests, goals and ways of life”. MEDICINE: “The branch of science that deals with diagnosis, treatment and maintenance of health is called medicine.”

4. Community Medicine may be defined as: “ The art and science of application of technical knowledge and skills to the delivery of healthcare to a given community, designed in collaboration with related professions as well as human and social sciences on the one hand, and community on the other.” Community medicine is the field concerned with the study of health and disease in the defined community or group. Its goal is to identify the health problems and needs of people (community diagnosis) and to plan, implement and evaluate the effectiveness of health care system. WHO has suggested that every country should have its own definition of Community Medicine.

5. Community Medicine Successor of the terms ----- Hygiene --Public Health – Preventive Medicine – Social Medicine – Community Health(1992) All share common ground i.e., prevention of diseases & promotion of Health

6. Hygiene Greek word “Hygeia” Goddess of health Hygeia represents woman holding bowl in hand & Serpent drinking from bowl. Serpent testifies the art of healing. Term hygiene was first used by “Galen”.

7. Public health:( By Winslow in 1920 ) Winslow defined as: “The science and art of preventing disease , prolonging life and promoting health through organized community efforts ”. Efforts are -control of infection . -Sanitation. -Health education. -Provision of health care service

8. Public Health ( By Winslow in 1920 ) Deals with maintenance & improvement of sanitation, cleanliness and personal hygiene. Largely matter of sanitation- like: P roper disposal of waste, P rovision of safe water, S afe food, a nd over-all safe environment.

9. Preventive medicine. “The art and science of health promotion , disease prevention , disability limitation and rehabilitation ”. Prevention  includes : Primary prevention Secondary prevention Tertiary prevention

10. Curative Medicine “ A vast body of scientific knowledge, technical skills, medicaments and machinery that not merely treat the disease but preserves life in a highly organized way ”.

11. Social Medicine “The Study of man as a social being in his total environment – It focuses on the health of the community as a whole.”

12. Social Hygiene “The science of prevention and treatment of sexually transmitted diseases (STDs) including social rehabilitation”

13. Sociology Scientific study of the nature and growth of society and social behavior of people.

14. Anthropology Science of human beings, specially the beginnings,development,customs and beliefs. It may be: Physical anthropology: Biological growth, genetic heritage, human adaptability and human evaluation. Cultural Anthropology: Cultural charactership,gender,marriage,class,ethinicity,religion,political system, socialization etc. Archeology: Prehistory & early history of culture & society, techniques to detect,unreath,date and analyze the material remnants of the past. Linguistic Anthropology: Study of the history of languages and dialects.

15. Medical Anthropology Study of the social and cultural elements of health and illness; and people’s efforts to solve these problems.

16. Culture Peoples way of living or social inheritance which includes values,norms,customs,tradition,institutions and artifacts ( work of art) that are passed from one generation to another generation by way of learning alone.

17. Society This is the learning process of people to develop their human potentials and attain the traditional and customary patterns of their culture. Institution of society: Family Education Economy Politics Religion.

18. Family A basic social unit which includes the parents and their children, regarded as a group, whether living jointly or not.

19. Status A position in society; may be ascribed or achieved. Caste: A closed shape of social grouping in which the status is established by birth & is lifelong. Class: An open type of stratification, which is based largely on the economic status. Ethnicity : A category of people who as a result of their shared culture heritage. Race: A socially distinct category of people because they share genetically transmitted physical characteristics.

20. Gender and Sex The word “sex” determines the biological differences, whereas “gender", establishes variations in the social roles and relations between males and females.

21. Medical Care Services of physician/doctor to a sick person and includes in it the provision of medications.

22. Health Care The services delivered by healthcare providers to people or communities. The aim is to: To promote,protect,maintain or restore health.

23. Integrated Health Care “Bringing together all types of health services to the community, preventive and curative”.

24. Vertical Program “A single program of health services for community. For example, Expanded Program on Immunization (EPI ). The staff of this service is only concerned with the immunization project.”

25. Horizontal Program “A health service delivery program which covers the two dimensions of health, personal and community health. Most often the vertical programs are merged into existing health facilities in which case it becomes a horizontal program. In principle the concept is that of integration.”

26. COMPREHENSIVE HEALTH CARE It refers to the “provision of personal and impersonal health services to the community for the prevention of disease, cure of illness, prevent disability and economic insecurity and dependency associated with illness.”

27. COMPREHENSIVE HEALTH CARE PERSONAL HEALTH SERVICES Directly affecting health of individual. E.g. Provision of mother and child health services. School health services. Occupational health services . IMPERSONAL HEALTH SERVICES Indirectly affecting health of individual. E.g. Water supply. Sanitation. Drainage. Housing. Vector control .

28. P hysician (Medical Practioner,Doctor) “Professional person qualified by education and authorized by the law to practice.”

29. Social Physician

30. DISEASE : It is a physiological/psychological dysfunction . It is a condition in which body health is impaired. This is an objective pathology of the body, such as an infection. ILLNESS : A condition in which the equilibrium of the body is distrubed.The subjective sense; the individual does not feel well & can not function as usual. 30 IMPORTANT DEFINITIONS

31. FOLK ILLNESS: Syndromes from which members of a particular group claim to suffer;& for which their culture provide their etiology, a diagnosis, preventive measures,& regimens of healing. SICKNESS : It is a state of social dysfuntion.It is the condition of those who are socially recognized as unwell. 31 IMPORTANT DEFINITIONS

32. Life style The collection of habits,practice,norms and customs that are affected changed,encouraged,or inhibited by the life long course of socialization. These norms & habits may contain use of substance,e.g. A lcohol, T obacco, T ea, and coffee, E ating habits,exercise,etc

33. Health Beliefs People’s thoughts,passion,approach and attitude regarding health and disease, which generally affect their health behavior. Health beliefs can be positively or negatively influence a person’s health.

34. GOALS To identify the health problems and needs of defined population. To identify means by which these needs should be met. To evaluate the extent to which health services effectively meet these needs.

35. GOALS OF MODERN MEDICINE Focus shift from treatment of sick. Prevention of diseases. Promotion of health. Quality of life improvement for individuals and groups.

36. The following are included in the study of community medicine: Knowledge regarding Study of : Population to be served Demography Patterns of Health and disease Epidemiology Collection, compilation and analysis of data Biostatistics Behavioral factors and their effect on Health Behavioral sciences Control and prevention of diseases Preventive Medicine The food people eat Nutrition Environmental factors and their effects on Health Environmental Health Delivery of Health Care Health Administration and Planning

37. FIVE STAR DOCTOR

38. ACHIEVEMENTS OF PREVENTIVE MEDICINE The early triumph of preventive medicine were in the field of bacterial vaccines and anti-sera at the turn of the century. Hence declines to place in morbidity and mortality from diphtheria,tetunus,typhoid fever and others. In 1955-60 eradication of smallpox from entire world. The field didn't confines itself to vaccinations and quarantine but discoveries in the field of nutrition have added a dimension to combat against specific deficiencies, like nutritional blindness and iodine deficiency disorders. Another glorious chapter in the history is the discovery of insecticide such as DDT,HCH,Malathion and others.

39. ACHIEVEMENTS OF PREVENTIVE MEDICINE The discovery of sulpha -drugs, antimalarial drugs,antibiotics,anti tubercular, and anti-leprosy drugs have all enriched the preventive medicine. An other notable development in the 20 th century is the development of “SCREENING", for the diagnosis of diseases in its pre-symptomatic stages. An off shoot of screening is screening for “Risk factors", of disease and identification of “High risk groups" , an important place in the detection of cancer,diabetes,rhumatisim and cardiovascular diseases, so called “Diseases of civilization ”. The emergence of preventive medical pediatrics, geriatrics and preventive cardiology reflect newer trends in the scope of preventive medicine.

40. DIFFERENCE B/W CLINICAL & COMMUNITY MEDICINE CLINICAL MEDICINE COMMUNITY MEDICINE Aim To shorten the morbidity and prevent mortality in ill or diseased person To reduce the un necessary morbidity and premature mortality in whole population. Objectives To cure the patient of diseased To improve the health status of a community. Information required Clinical history, physical examination,labortory tests. Population data, health problems, disease pattern,avialability of health services. diagnosis Differential diagnosis and probable diagnosis. Community diagnosis. Action plan Treatment and rehabilitation. Community health programme .

41. CORE CONTENTS

42. The complete course of community medicine is according to laid down syllabus listed by PMDC.

43. CORE CONTENTS Concept of health and disease. Introduction to public health and health system in Pakistan. Epidemiology, screening and infectious disease control. Non-communicable diseases. Bio-statistic and HMIS. Demography and population dynamics. Food and nutrition. Reproductive and child health. School health services.

44. CORE CONTENTS (Conti…) Environmental health. Occupational health. Parasitic diseases-prevention and control. Zoonotic diseases. Arthropod of public health importance. Mental health. Behavioral sciences. Health education and promotion. Disaster management. Medical ethics.

45. Concept of Health & Disease ƒ Definition of health (Dimensions, physical, mental, social and spiritual). Spectrum of health ƒ Determinants of health. Responsibility for health ƒ Indicators of health Concept of disease. Concept of causation (all theories including ecological triad, agent, host & environmental factors). Spectrum of disease. Iceberg phenomenon. ƒ Natural history of disease. Levels of prevention. Disease elimination and eradication. Disease surveillance.

46. Introduction to Public Health and Health Systems in Pakistan Background and Concepts: Definitions and concepts in Public Health Development of Public Health in Pakistan. Economics and Health. Health Policy and planning in Pakistan. “ Health for all”, background, concepts and progress. “Primary Health Care”: Concepts and progress. The National Disease Control programmes ; policies, strategies and operations.

47. Epidemiology and disease control General epidemiology and research methodology. ƒ Background and concepts, uses, basic measurements in epidemiology ( morbidity, mortality, disability and fatality). ƒ Epidemiological methods ( descriptive , analytic and experimental). ƒ E pidemiological transition. Association and causation. ƒ Investigation of an outbreak or an epidemic. Screening for disease. Community diagnosis. Research and survey methodology. Introduction to qualitative research methodology.

48. Prevention and control of Infectious diseases Definitions to differentiate between: ƒ Infection, contamination , pollution, infestation ƒ Infectious disease, communicable disease, contagious disease Host, Immune and susceptible persons Sporadic, Endemic, Epidemic, Pandemic Epizootic, Exotic, Zoonosis Contact, fomites, Carriers, Insect Vectors , Reservoir of infection ƒ Incubation period, Infective period, Generation time ƒ Cross infection, Nosocomial infection, Opportunistic infections, Iatrogenic ( Physician induced) disorders ƒ Surveillance, Eradication, Elimination.

49. Dynamics of infectious disease Transmission Reservoir and source of infection, Escape of organism, Mode of transmission, Entry into the body, Susceptible host, Immunity (different types of Immunity and immunization)

50. Dynamics of infectious disease Transmission

51. Control of infection Controlling the reservoir-notification , early diagnosis treatment, isolation, quarantine , disinfections. Interruption of transmission . The susceptible host (active & passive immunization, Combined Chemoprophylaxis, Non-specific measures). Health advice to travelers. National case management guide lines.

52. Epidemiology, control and prevention of infectious diseases of Public Health importance Diseases transmitted through inhalation Diseases transmitted through faeco -oral route Arthropod borne diseases. Diseases of animals conveyed to man. Diseases due to direct contact

53. Epidemiology, control and prevention of non-infectious diseases of Public Health importance . Hypertension, Coronary heart disease. Cancers, Injuries Diabetes mellitus Obesity Rheumatic fever and heart disease.

54. Biostatistics Concepts and uses Data and its types Rates, ratios and proportion. Crude, specific and standardized rates. Collection and registration of vital events in Pakistan Sources of health related statistics Measures of central tendency , (Mean, Median, Mode), Measures of dispersion (Range, Standard deviation, Standard error) Normal curve Methods of data presentation (tables, graphs & diagrams)

55. Demography and Population dynamics Concept, demographic principles and demographic processes Census, definition, methodology, types. Determinants of fertility, mortality Population pyramid, and its interpretation. Demographic transition, demographic trap and its public health importance. Demographic and social implication of high population growth. Social mobilization Urbanization

56. Food and Nutrition Concepts (nutrition, nutrient, food, diet). Food groups and their functions. Role of fiber in diet. Balanced diet. Malnutrition at all stages of life its types causes and prevention. Common nutritional problem of public health importance and their prevention and control. Dietary requirements of normal human being at different stages of life. Food hygiene, pasteurization, fortification, additives & adulteration and preservation Food poisoning Assessment of nutritional status of a community.

57. Reproductive and child health Safe mother hood, and its components. (ante-natal , post-natal, family planning & emergency obstetric care ). Maternal mortality, causes and prevention. Infant care: growth and development . Breast feeding, Common causes of morbidity and mortality, their prevention. And control. Child care: health promotion strategies. Common ailments , home accidents, C hild mortality prevention . Strategic approaches of integrated management of childhood illness (IMCI). Adolescent health Reproductive tract infections: G uidelines for management of STD’s.

58. Health of school age children Role of teachers and role of doctor in maintenance of health Procedures for determining health S tatus of school age children. Common health problems of school children

59. Environmental Health Sciences. Air: Composition of air. Causes of Air pollution. Purification of Air. Diseases caused by impurities in air and their prevention. Water: Sources of Water. Daily water requirement. Water pollution its causes and prevention. Purification of Water. Water quality Standards. Diseases due to polluted water . Waste disposal: Contents , H azards and safety measures for solid and liquid; D omestic , industrial and hospital waste.

60. Environmental Health Sciences(Cont..) Climate: Climate and weather. Global environmental concerns Green house effect, depletion of ozone layer, acid rains. Effect of extremes of temperature, humidity, atmospheric pressure on human health and their prevention . Radiation: Sources , types, causes , hazards and prevention . Healthful housing. Urban and rural slums. Refugee camps and hostels. Noise : Definition , causes, acceptance level, hazards and control.

61. Occupational Health Concepts, of occupational health, occupational medicine and occupational hygiene. Ergonomics and its importance. Occupational hazards. Principles of control. General principles of occupational disease prevention. Organization of occupational health services.

62. Arthropods and their public health importance Common arthropod borne diseases Control of arthropods of medical importance. Insecticides and their public health importance

63. Prevention and control of parasitic diseases of public health importance

64. Behavioral Sciences and lifestyle Concept, attitudes, health and illness behavior. Drug abuse, addiction and smoking Child abuse and child labour Role of physical exercise in health and disease.

65. Information, Education and Communication (IEC) Concept. Aims and objectives Approaches used in public health Contents, principles and stages of health education Communication methods, barriers and skills in health education Planning, organizing and evaluating a health education programe Social marketing

66. Disaster Definition, classification, ( natural disasters like earthquake, floods. Epidemic of communicable diseases , man made disasters. Accidents, thermo nuclear warfare , causes and prevention), Magnitude and effects of disaster and public health consequences Disaster: preparedness and management

67. Medical Ethics Background concepts and components National recommended guidelines.

68. PRACTICAL AND COMMUNITY BASED TRAINING Student should have practical experience in: Q uestionnaire development, D ata collection , C ompilation , P resentation , A nalysis A nd report writing.

69. Field visits Visit to BHU and RHC ƒVisit to an NGO Visit to a primary school to asses the nutritional status of school children Visit to MCH/Reproductive Health Centre to observe the organization, and function of the center and to demonstrate counseling skills in one of the following: Nutritional counseling for children, pregnant and lactating women. ƒ Antenatal Care ƒ Family planning services ƒ Immunization, other

70. Skills development lab Water purification at domestic level. Contraceptives Vaccination including the cold chain Oral rehydration solution

71. THANKS FOR YOUR ATTENTION