Introduction to community health.pptx

Definition, scope, dimension, role

1. Introduction to Community Health Prepared By:- Ms. Anjali Patel

2. Introduction Community: The word 'community' has its origin from Latin word ' communis ’. Com: Together Munis : Serve The word community is used in many different ways in a wide variety of situations and therefore many definitions have come up.

3. The WHO expert committee on community health nursing (1974) in their report agreed on the following definition.

4. Definition Community: “Community may be defined as a group of individual living together in a some what localized area under the some general regulations and have common interest, function, needs and organization” -According to WHO

5. Community Health: “Refers to the healthy status of the member of the community to solve the problems affecting their health and to the totality of a health care provided for the community'. - According to WHO

6. Health: "Health is a state of complete physical, mental and social well being and not merely an absence of disease or infirmity". -According to WHO

7. Community Health Nursing: “It is a synthesis of nursing and public health practice applied to promoting and preserving the health of the people.” -American Nursing Association (ANA)

8. Concept Of Health Good health is the fundamental right of every human being. Internal and external growth of a person is not possible without good health. Good health is essential to lead a quality and successful life. Beyond being a personal responsibility, health is a national and international responsibility.

9. Health is the common theme in most cultures. All communities have their concepts of health as part of their culture. Among definitions still used, the oldest is that health is the 'absence of disease. But concept of health is not perceived by the same way by all members of a community. Hence, the concept of health is as follows:

10. Biomedical concept: Traditionally, health has been viewed as an 'absence of disease and if one was free from disease, then the person was considered healthy. This concept known as the biomedical concept.

11. Ecological concept: According to this concept, health as a dynamic equilibrium between man and his environment, and disease a maladjustment of the human organism to environment.

12. According to one ecologist, 'Health implies the relative absence of pain and discomfort and a continuous adaptation and adjustment to the environment to ensure optimal function'. This was defined by Dubos.

13. Psychosocial concept: According to this concept, health is not only a biomedical phenomenon but one which is influenced by social, psychological, culture, economic and political factors of the people concerned.

14. These factors must be taken into consideration in defining and measuring health. Thus, health is both biological and social phenomenon.

15. Holistic concept: This holistic concept of is a synthesis of all above concepts. It recognizes the strength of social, economic, political, and environmental influences on health the holistic approach implies that all sectors of society have an effect on health.

16. Dimensions Of Health Health is multidimensional. There are mainly three concepts - Physical, mental and social, Many people maybe included such as spiritual, emotional, vocational and political dimensions.

17. Physical dimension: The state of physical health implies the nation of "perfect functioning of the body. It conceptualizes health biologically as a state in which every cell and every organ is functioning at optimum capacity and in perfect harmony with the rest of the body.

18. Mental dimension: Mental health is not mere absence of mental illness, Good mental health is ability to responds to the many varied experiences of life with flexibility and sense of purpose.

19. Social dimension: Social well-being implies harm only and integration within the individual between each individual and other member of society and between individuals and world in which they live. The social dimension includes level of social skills one possess, social functioning and ability to see oneself as a member of larger society

20. Spiritual dimension: Spiritual health in this context refers to that part of individual which reaches out and strives for meaning and purpose of life. The dimensions includes integrity, principles and ethics, the purpose in life, commitment to some higher being and belief in concept that are not subject to 'state-of-the-art' explanation.

21. Emotional dimension: Traditionally, the mental and emotional dimension have been considered one but mental health can be seen as 'knowing' or 'cognition' while emotional health relates to 'feeling'.

22. Vocational dimension: It is new dimension. It is part of human existence. When work is fully adapted to human goals, capacities and limitations, work often plays a role in promoting physical and mental health.

23. Others: It includes: Philosophical dimension Cultural dimension Socioeconomic dimension Environmental dimension Educational dimension Nutritional dimension Curative dimension Prevention dimension

24. Health Determinants There are many factors which affect the health of individuals and communities in a combined form. The circumstances and environment of an individual determine whether or not he/she is healthy.

25. The factors influencing the health (either in a better way or worse) are known as the determinants of health. The World Health Organization has identified the following 12 determinants of health:

26. Income and Social Status: As the income and social hierarchy increases, the health of an individual improves. Living conditions like safe housing and ability to buy good food are determined by high income. Those individuals having prosperous and an equitable distribution of wealth are considered the healthiest populations.

27. Employment: Poor health arises due to unemployment, underemployment, and working under stressed conditions. Individuals are comparatively healthy if they can control their work conditions and have relatively few stress- related job demands. Such individuals also live longer in comparison to those who have stressful or riskier work and activities.

28. Education: Health of an individual is also determined by the education level. Education also increases opportunities for income and job security, and provides with a sense of control over life circumstances (prime health influencing factors). Poor health, more stress, and lower self-confidence often result due to low education levels.

29. Social Environments: Values and norms of a society also affect an individual's health and well-being in different ways. Social stability diversity recognition, safety, good working relationships, and cohesive communities also establish a supportive society that reduces or avoids the potential risks to good health.

30. It has also been revealed that an individual's health and well-being is negatively affected by the low availability of emotional support and low social participation.

31. Physical Environments: Air and water quality are the physical factors in the natural environment which put their impact on health. Housing, workplace safety, and road design are the factors in the human-built environment which also show important influences.

32. Healthy Child Development: The effect of pre-natal and early childhood experiences has a very powerful impact on health, well-being, coping skills, and competence. Children born in families having low income have low birth weights, eat less nutritious food, and have more difficulty in school in comparison to those born in families having a high income.

33. Personal Health Practices and Coping Skills: Health is greatly influenced by eating a balanced diet, being active, smoking, drinking, and the way of dealing with life's stresses and challenges.

34. Health Services: Health is also influenced when an individual make use of the services provided for preventing and treating diseases.

35. Social Support Networks: A better health results from support provided by families, friends, and communities. Responding effectively to stress conditions, and having family and friend support provides a caring and supportive relationship that acts as a buffer against health problems..

36. Biology and Genetic Endowment: Inheritance determines lifespan, healthiness, and probability of developing certain illnesses.

37. Gender: Men and women at different ages suffer from different types of diseases.

38. Culture: It is defined as all the ways of life including arts, beliefs, and institutions of a population passed down from generation to generation. Culture includes codes of manners, dresses, languages, religions, rituals, norms of behaviour (law and morality), and systems of belief and art. Health is influenced by customs and traditions, and beliefs of family and community.

39. Indicators of Health Definition: In WHO's guidelines for health program evaluation, health indicators are defined as 'Variables, which helps to measure changes."

40. Purpose of Indicators: To measure the health status of a community To compare the health status of one country with that of another To assess health care needs To allocate the scare resources and

41. To monitor and evaluate the health services, activities and programs . Indicators help to measure the extent to which the objectives and targets of a programare being attained.

42. The indicators should be valid The indicators should be reliable The indicators should be sensitive The indicators should be specific The indicators should be feasible The indicators should be relevant. Characteristics of Indicators:

43. Crude death rate Expectation of life Infant mortality Child mortality rate Under five proportionate mortality rate Maternal mortality rate Disease specific mortality Proportional mortality rate 1. Mortality Indicators

44. Morbidity indicators are used to supplement mortality data to describe the health status of a population because mortality indicators do not reveal the burden of ill health in a community, e.g. Mental illness and rheumatoid arthritis. 2. Morbidity Indicators

45. For assessing ill health status in the community, the following morbidity rates are used. Incidence and prevalence Notification rates Attendance rates at out patient departments, health centers Admission, readmission and discharges rates Duration stay in hospital Spells of sickness or absence from work or school.

46. It includes incidence and prevalence of cases who are not able to perform full range of activities because of some inherited or acquired problems. These include sickness, absentism rates at work and schools; prevalence of blindness, deafness and dumbness, prevalence of paralytic poliomyelitis, limited mobility and limited activities, mental and social handicaps, etc. Disability Indicators

47. This is another positive health indicator. These include measurements of weight, mid- arm circumference and height (anthropometric measurements) of children under five, measurement of height and weight of school children and prevalence of low birth weight. Le. weight less than 2.5 kg. Nutritional Status Indicators

48. It includes drug abuse, child abuse and neglect, women abuse, child delinquency, suicide and homicide, road traffic accidents. Social and Mental Health Indicators

49. Introduction Primary Health Care (PHC) is a basic health care facility that should be designed to be easily accessible by and acceptable to the individuals. Primary Health Care

50. Community should have full involvement and the cost should be affordable to the community and country. PHCs are based on an approach to health beyond the traditional healthcare system that focuses on social equality regarding the health. PHC has some fundamental elements and aims that are adapted to cater better health services for all.

51. PHC does not focus on a single disease, but provides whole-person care for health requirements during whole life. It makes sure that an individual gets complete care, including prevention of disease, its treatment, rehabilitation and palliative care as per the requirement of that individual.

52. PHC has the following 8 elements: E- Education concerning the prevailing health problems and the methods of identifying, preventing and controlling them. L- Locally endemic disease prevention and control. Essential Elements of Primary Health Care

53. E- Expanded programme of immunisation against major infectious diseases, M- Maternal and child healthcare, including family planning. E- Essential drugs arrangement.

54. N- Nutritional food supplement, an adequate supply of safe and basic nutrition. T- Treatment of communicable and non-communicable disease and -promotion of mental h S- Safe water and sanitation.

55. The above-mentioned elements of PHC are based on the basic health objectives that should be formulated in national policies to launch and sustain PHC as part of a comprehensive health system and coordination with other sectors. Following are the principles of PHC: Principles of Primary Health Care

56. Equity/Equitable Distribution: The first key principle in primary health care strategy is equity or equitable distribution of health services. Health services must be shared equally by all people, irrespective of their ability to pay and all (rich or poor, urban or rural) must have access to health services.

57. Community Participation: The involvement of individuals, families, and communities in promotion of their own health and welfare is an essential ingredient of primary health care. PHC coverage cannot be achieved without the involvement of community in planning, implementation and maintenance of health services.

58. Intersectoral Coordination: Declaration of Alma-Ata states that PHC involves in addition to the health sector all related sectors and aspects of national and community development, in particular education, agriculture, animal husbandry, food, industry, education, housing, public works and communication. To achieve cooperation, planning at country level is required to involve all sectors.

59. Appropriate Technology: Technology that is scientifically sound, adaptable to the local needs, and acceptable to those who apply it and those for whom it is used and can be maintained by the people themselves with the resources of the community and country can afford.

60. Levels of Primary Health Care Health Promotion: These are the services and activities designed to maintain and improve health status. They have 5 strategies, which include building health public policy, strengthening community action, creating supportive environment, developing personal skills, and reorienting health services.

61. Disease and Injury Prevention: This level includes the services designed for preventing illness that helps to reduce the risk of disease and injury. Prevention strategies for clients, family, and community may include clinical, behavioural , and environmental.

62. Diagnosis and Treatment: This level refers to healthcare activities that focus on the individual rather than the family or community. The main intention is to recognise and treat the clients existing health problem.

63. Rehabilitative Care: Restoration of an individual to the complete physical, mental, social, and vocational functioning from a physical or mental illness, injury, or chemical addition is known as rehabilitation. The services in home, outpatient, or in institution comprise of OT, PT, and speech therapist.

64. Supportive Care: This level states the requirements of the chronic health to patients of different age groups. These are the patients or clients having long term chronic condition or those with progressive illness or disease that may become severe. The two aspects of support care are palliative and respite care. Different services at this level comprise of health, personal, and social services to patients who have disability, or to those who are incapable of working independently or those who have terminal disease.

65. Role of Nurse in Primary Health Care Patient Care: The nurse performs different clinical activities and relationships with patients.

66. Organiser : The nurse plays varying roles in organisational aspects of patient care, e.g., recall systems, reminders, feedback of patient results, and follow-up of specialist appointment; and systems supporting patient care, e.g., stocking medications, cleaning and sterilising instruments, managing contaminated waste.

67. Quality Controller: The nurse manages the certification process and other quality and risk management activities like infection control and the safe disposal of sharps.

68. Problem Solver: The nurse helps in resolving the issues that arise on daily basis, like addressing patient emergencies, lessening triage stress for receptionists, resolving issues using practice software systems, brokering between staff to avoid arguments and finding information.

69. Educator of Practice Staff and : The nurse educates about wound care, accreditation standards and MBS items to others within the practice and helps in providing important information.

70. Agent of Connectivity: The nurse is a good communicating agent. They communicate between different healthcare providers within the workplace, and between patients and clinicians.

71. Millennium Development Goals (MDGS)

72. The United Nations General Assembly has set Millennium Development Goals which include 8 goals signed under the United Nations Millennium Declaration in September 2000. All the 191 UN member states have agreed to achieve these MDGs by the year 2015.

73. According to the United Nations Millennium Declaration, world leaders commit to combat poverty, hunger, disease, illiteracy, environmental degradation, and discrimination against women. The MDGs are adopted in this Declaration and have specific targets and indicators.

74. Eight Millennium Development Goals To eradicate extreme poverty and hunger, To achieve univers To promote gender equality and empower women, To reduce child mortality,

75. To improve maternal health, To combat HIV/AIDS, malaria, and other diseases, To ensure environmental sustainability, and To develop a global partnership for development.

76. MDGs are inter-dependent as they influence health, and health influences all the MDGs. For example, better health promotes better learning among children and efficient earning among adults. Similarly, gender equality is essential to achieve better health, reduce poverty, hunger and environmental degradation.

77. Promotion And Maintenance of Health Health promotion and maintenance services support patients to maintain their health, prevent diseases and injuries, detect diseases in early stage, and promote healthier lifestyles.

78. These services generally include active involvement of patients and cannot be performed only by the healthcare providers. These services are based on the assumption that if patients adopt healthy lifestyles, they are less prone to lifestyle-related diseases (e.g., heart attacks, lung cancers, and certain infections).

79. Health promotion also covers other health dimensions, such as detection of warning signs indicating the presence of a disease in early stages. Early detection of many diseases requires minimum treatment at very less cost with increased positive results.

80. An example of early detection includes diagnosis of breast cancer by self-examination and mammography. Both the methods of diagnosis help to detect breast cancer in its early stages, thus increase the chances of successful treatment.

81. Health promotion is categorised into three main types, namely health education, disease prevention, and health protection.

82. Health Education The whole idea of health promotion and maintenance is based on health education, which includes activities to provide adequate, accurate and reflective information and knowledge to recipients. Health education empowers the recipients to take their own rational decisions.

83. To provide health education, a top down approach is not followed; instead information is provided as per the requirements of the recipients, with providers and recipients learning from each other.

84. Disease Prevention Disease prevention is a process of reducing the risk of occurrence of a disease, illness, injuries, disability, handicap or some other unwanted actions.

85. Disease prevention basically includes three levels, i.e., primary, secondary and tertiary, which may include healthy lifestyle, immunization, health screening, maternal and child health, rehabilitation programmes, and sexuality education. Some counseling programs are also conducted for disease prevention that can be done on face-to-face basis or through mass media.

86. Health Protection Health protection includes regulations, policies, or voluntary practices that are mainly adopted to improve the living and working environment and to prevent bad health.

87. For example, the new ordinance has proposed for total ban on smoking in restaurants and most indoor public places so that rate of heart disease and lung cancer can be reduced in the population.

88. Similarly, essential use of automobile seat belt ensures protection of passengers from road accidents and injuries. Policy has been made for compulsory labeling of food items so that consumers become enable to make healthy and rational choices regarding their food. Thus, health promotion includes all the life aspects.

89. Thank You!