Concept_of_Public_health community medicine .pptx

Public health concepts

1. Concept of Public Health

2. Index Rise of Public health Germ theory of disease Birth of P reventive Medicine Health for all Primary health care Millennium developmental goals Sustainable developmental goals Changing Concepts of Health Dimensions of Health

3. Med in pre historic times based on superstition, religion, magic etc The priest, the herbalist, magician & medical men-tried to cure diseases & give relief to sick There were errors, false theories, misinformation & wrong interpretations

4. Rise of Public health P ublic health concept enunciated the principle ‘ State responsible for the health of its people ’. Cholera- called the "father of public health ". E pidemiologist , John Snow, studied cholera established the role of polluted drinking water in its spread. William Budd, another pioneer, by careful observations of an outbreak of typhoid fever concluded that the spread was by drinking water. Then came the demand from people for clean water and control of man's physical environment . This early phase of public health is often called the " disease control phase ".

5. Broad foundations of public health – Clean water, Clean surroundings, Wholesome condition of houses, Control of offensive trades Public health made rapid strides in western world, but slow progress in developing countries such as India

6. Germ theory of disease Louis Pasteur demonstrated presence of bacteria in air & Robert Koch showed that anthrax was caused by a bacteria. The discoveries of Pasteur and Koch confirmed the germ theory of disease . Microbe after microbe was discovered in quick succession – G onococcus T yphoid bacillus P neumococcus T ubercle bacillus C holera vibrio D iphtheria bacillus and so on. All attention was focused on microbes and their role in disease causation . The germ theory of disease came to the forefront, supplanting the earlier theories of disease causation.

7. Biomedical concept of Health “ Biomedical concept " has the basis in the "germ theory of disease“ Human body-machine , disease- consequence of the breakdown of the machine & one of the doctor's task- repair of the machine. Criticism against this concept- it has minimized the role of environmental, social, psychological and cultural determinants of health . Biomedical model-found inadequate to solve some of the major health problems (e.g., mal nut, ch diseases, accidents, drug abuse, mental illness, environmental pollution, population explosion) Biomedical concept of health was inadequate.

8. Ecological concept In it- health-dynamic equilibrium bet man and his environment & disease a maladjustment of man & environment. Human , ecological and cultural adaptations do determine not only the occurrence of disease but also the availability of food and the population explosion. The ecological concept raises two issues, imperfect man and imperfect environment. History argues strongly that improvement in human adaptation to natural environments can lead to longer life expectancies and a better quality of life - even in the absence of modern health delivery services.

9. Psychosocial concept Health not only a biomedical phenomenon, but one which is influenced by social, psychological, cultural, economic and political factors of the people. Thus health is both a biological and social phenomenon. Holistic concept It is a synthesis of all the above concepts. It recognizes the strength of social, economic, political and environmental influences on health. Holistic view corresponds to ancients that health implies a sound mind, in a sound body, in a sound family, in a sound environment . The holistic approach implies that all sectors of society have an effect on health. The emphasis is on the promotion and protection of health.

10. The dichotomy of medicine into two major branches C urative medicine, and Public health/Preventive M edicine With control of Ac infectious diseases, the so-called modern diseases such as Cancer , DM, CVD, mental illness and accidents came into prominence and have become the leading causes of death. These diseases could not be explained on the basis of the germ theory of disease . Realization -there are other causes in the etiology of diseases, namely Social , Economical, Genetic, Environmental and Psychological factors Most of these factors linked to man's lifestyle and behavior. The germ theory of disease gave place to a newer concept of disease - “ Multifactorial causation ".

11. Curative medicine Its primary objective -removal of disease from the patient (rather than from the mass). It employs various modalities to accomplish this objective (dx techniques, treatment) Tools of dx have become refined, sophisticated & numerous treatment options more specific & potent . Curative medicine, over the years, has accumulated a vast body of scientific knowledge, technical skills, medicaments and machinery – Tremendous growth of specialization due to advances in medical technology

12. Some specialities have emerged, based on clearly defined skills such as Surgery , Radiology , and Anaesthesia ; S ome based on parts of the body such as ENT , Ophthalmology Cardiology , Gynaecology S ome based on particular age or sex groups such as Paediatrics , Geriatrics and Obstetrics .

13. Preventive medicine It developed as a branch of medicine distinct from public health. James Lind, a surgeon advocated the intake of fresh fruit & vegetables (↑ Vit C) for the prevention of scurvy. Edward Jenner discovered vaccination against smallpox. These two discoveries marked the beginning of a new era of disease prevention by specific measures Preventive medicine got a firm foundation only after the discovery of causative agents of disease.

14. The latter part of the 19th century was marked by such discoveries in preventive medicine as Pasteur's anti-rabies treatment, cholera vaccine, diphtheria antitoxin, anti-typhoid vaccine, antiseptics & disinfectants etc.

15. Preventive medicine Applied to "healthy" people, customarily by actions affecting large numbers or populations. Its primary objective is prevention of disease and promotion of health . The eradication of smallpox is one of the greatest triumphs of preventive medicine. Preventive medicine did not confine itself to vaccination and quarantine. New strategies developed for sp def - nutritional blindness and IDD. Role of V it , minerals, proteins and more recently dietary fibers emphasize the nutrition component of preventive medicine.

16. Preventive medicine currently facing problem of " population explosion " in developing countries Population overgrowth causing social, economic, political and environmental problems. Prevention of a problem that demands a mass attack, if its benefits are to accrue in the present and succeeding generations. Screening for disease among apparently healthy people has remained an important part. Screening for "risk-factors" of disease and identification of "high-risk groups ". The emergence of preventive paediatrics , geriatrics and preventive cardiology reflect newer trends in the scope of preventive medicine

17. Disease Transmission Modes of disease transmission. Disease Mode of transmission Malaria Anopheles mosquito Yellow fever Aedes mosquito African sleeping sickness Tsetse fly

18. It became possible to control disease by specific measures such as quarantine, water purification, pasteurization of milk, protection of foods, proper disposal of sewage, destruction of insects and disinfection. In its early years, preventive medicine was equated with the control of infectious diseases.

19. Discovery of synthetic insecticides such as Dicholoro diphenyl tricholoroethane (DDT), Hexacholoro cyclo hexane (HCH), malathion and others. brought about fundamental changes in strategy for control of vector borne diseases (malaria , leishmaniasis , plague, rickettsial diseases) The discovery of sulpha drugs, anti- malarials , antibiotics, anti-tubercular and anti-leprosy drugs have all enriched preventive medicine. Chemoprophylaxis and mass drug Rx- imp tools of preventive medicine .

20. Three levels of prevention are P rimary , intended to prevent disease among healthy people; Secondary, in whom the disease has already developed; and T ertiary , to reduce the prevalence of chronic disability consequent to disease . Modern preventive medicine has been defined as “Art and science of health promotion, disease prevention, disability limitation and rehabilitation ". In sum, preventive medicine is a kind of anticipatory medicine.

21. Health for all - Objective The 30th World Health Assembly resolved in May 1977, that “Main social target of govts and WHO in the coming decades should be the attainment by all citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life ." This culminated in the international objective of HEALTH FOR ALL by the year 2000 as the social goal of all governments.

22. The G oal of Health for All A ttainment by all peoples of the highest possible level of health. Minimum , all people in all countries should have a level of health that allows them to be economically & socially productive. Health is to be brought within the reach of every one in a given community. Removal of obstacles to health – Elimination of malnutrition. ignorance, disease, contaminated water supply, unhygienic housing, etc.

23. Primary health care The existing gross inequality in the health status of people particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable. WHO goal of Health for All proclaimed primary health care to achieve HFA. PHC- new approach to health care. which integrates at the community level. PHC -available to all at the 1 st level of health care- based on principles of equity, wider coverage, individual and community involvement and intersectoral coordination. PHC integrates promotive, preventive and curative services- also an integral part of the country's plan for socio-economic development.

24. Deprofessionalization of medicine Laymen have come to play a prominent role in the delivery of health care. Physician still holds his unique position in the field of health care in general, the participation of a new cadre of health workers Community health workers, Anganwadi workers, Multipurpose workers (M/F) ASHA They now comprise part of the " health teams ". The medical man can no longer restrict himself to his traditional role as diagnoser of ailments, prescriber of pills and potions. He has acquired new roles - being an educator, case-finder, preventer, counsellor and an agent of social change.

25. Millennium Development Goals MDG in September 2000, representatives from 189 countries met at the Millennium Summit in New York to adopt the UN Millennium Declaration. The leaders made specific commitments in seven areas : Peace, Security and disarmament; Development and poverty eradication: Protecting our common environment, Human rights, Democracy and good governance; Protecting the vulnerable; Meeting the special needs of africa ; and Strengthening the united nations.

26. The MDG, place health at the heart of development represent commitments to ↓ Poverty and hunger, and Tackle ill-health, Gender inequality, Lack of education, Access to clean water; and Environmental degradation. Thus three of the eight goals are directly health related and all of other goals have important indirect effects on health.

27. Sustainable Development Goals SDGs, the 2030 Agenda integrates all three dimensions of sustainable development (economic, social and environmental) around the themes of 5p’s people , planet , prosperity , peace and partnership . The SDGs recognize that eradicating poverty and inequality, creating economic growth and preserving the planet are inextricably linked, not only to each other, but also to population health.

28. Health is centrally positioned within the 2030 Agenda, with one comprehensive goal - SDG 3 : " Ensure healthy lives and promote well-being for all at all ages“ SDG 3 includes 13 targets covering all major health priorites .

29. What is health? Acc to WHO " Health is a state of complete physical, mental and social well-being and not merely an absence of disease or infirmity“ Concept of health is broad and positive in its implications; it sets out the standard, the standard of "positive" health. It symbolizes the aspirations of people and represents an overall objective or goal towards which nations should strive .

30. New philosophy of H ealth: - Health is a fundamental human right - Health is the essence of productive life - Health is intersectoral - Health is an integral part of development - Health is central to the concept of quality of life - Health involves individuals, state and international responsibility - Health and its maintenance is a major social investment - Health is a worldwide social goal .

31. Dimensions of Health Health is multidimensional. The WHO three specific dimensions – Physical, Mental and Social. Although these dimensions function and interact with one another, each has its own nature .

32. Physical Dimensions The state of physical health implies the notion of 'perfect functioning " of the body. The signs of physical health in an individual are: a good complexion, a clean skin, bright eyes, a good appetite, sound sleep, regular activity of bowels & bladder and coordinated bodily movements. All the organs of the body are of unexceptional size & function normally; all the special senses are intact; the resting pulse rate, blood pressure and exercise tolerance are all within the range of "normality'' for the individual's age and sex . In the young and growing individual there is a steady gain in weight and in the future this weight remains more or less constant at a point about 5 lbs (2.3 kg) more or less than the individual's weight at the age of 25 years. This state of normality has fairly wide limits. These limits are set by observation of a large number normal people who are free from evident disease.

33. Evaluation of physical health Modern medicine has evolved tools and techniques which may be used in various combinations for the assessment of physical health. They include : self assessment of overall health inquiry into symptoms of ill-health and risk factors inquiry into levels of activity (degree of fitness) nutrition and dietary assessment, and clinical examination biochemical and laboratory investigations . At the community level , assessed by death rate, infant mortality rate and Quality of life.

34. Mental Dimension Mental health is not mere absence of mental illness. Good mental health is the ability to respond to the many varied experiences of life with flexibility and a sense of purpose . Defined as "a state of Balance between the individual and the surrounding world, a state of harmony between oneself and others, a coexistence between the realities of the self and that of other people and that of the environment ". Some decades ago, the mind and body were considered independent entities. However, researchers have discovered that psychological factors can induce all kinds of illness, not simply mental ones. They include conditions such as essential hypertension. peptic ulcer and bronchial asthma.

35. we do not have precise tools to assess the state of mental health unlike physical health. Psychologists have mentioned the following characteristics as attributes of a mentally healthy person: a . Mentally healthy person is free from internal conflicts . b . he/she is well-adjusted, i.e., he is able to get along well with others. He accepts criticism and is not easily upset. c . he/she searches for identity. d . he/she has a strong sense of self-esteem. e . he/she knows himself: his needs, problems and goals (this is known as self-actualization). f . he/she has good self-control-balances rationality and emotionality. g . he/she faces problems and tries to solve them intelligently, i.e., coping with stress and anxiety .

36. Social Dimension Social well-being implies harmony and integration within the individual, between each individual and other members of society. It has been defined as the "quantity and quality of an individual's interpersonal ties and the extent of involvement with the community ''. In general, social health takes into account that every individual is part of a family and of wider community F ocuses on social and economic conditions and well-being of the "whole person" Social health is rooted in "positive material environment" ( focussing on financial and residential matters), and "positive human environment" which is concerned with the social network of the individual.