INTRODUCTION TO COMMUNITY MEDICINE

•         Specialty which deals with populations and comprises those doctors who try to measure the needs of the population, both sick and well, who plan and administer services to meet those needs, and those who are engaged in research and teaching in the field (Faculty of Community Medicine of the Royal College of Physicians)

HEALTH

•         Health is a state of complete physical, mental and social wellbeing and not merely an absence of disease or infirmity

HISTORICAL BACKGROUND

•         Ancient Era of Medicine (5000 BC to 1500 AD)

•         Dawn of Scientific Medicine (1500 to 1900 AD)

•         Modern Medicine (1900 to 2000 AD)

•         Medical Revolution

•         Health Care Revolution

ANCIENT ERA OF MEDICINE
(5000 BC to 1500 AD)

•         Primitive Medicine

•         Indian Medicine

•         Chinese Medicine

•         Egyptian Medicine

•         Greek Medicine

•         Roman Medicine

•         Middle Ages

PRIMITIVE MEDICINE

•         Evil Spirits

•         Traditional Healers

INDIAN MEDICINE

•         Ayurveda and the Siddha System

–        Knowledge of Life

•         Hygiene – Mohenjo-daro and Harappa

•         Unani Tibb System – 10th Century AD

•         Homeopathy – Early 19th Century

•         Treatment of disease by the use of drug

CHINESE MEDICINE

•         Concept of early preventive medicine

•         Pioneers of immunization

•         Practiced vaccination – smallpox

•         The great doctor is one who treats not someone who is already ill but someone not yet ill

EGYPTIAN MEDICINE

•         One of the oldest civilization – 2000 BC

•         Art of medicine mingled with religion

•         Concept of Specialization

•         Pulse – “the speech of the heart”

•         Built planned cities, public baths and underground drains – further excelled in  public health

GREEK MEDICINE

•         Classical period : 460 – 136 BC

•         Thinking begun as “Why” and “How”

•         Healers (Curative Medicine)

•         Hygienists (Preventive Medicine)

•         Hippocrates (460 – 370 BC) – “Father of Medicine”

•         Epidemiologist – Climate, Water, Clothing, Diet, Habits (eating & drinking)

•         Relationship b/w man and environment – indicators of public health

ROMAN MEDICINE

•         Romans had keen “Sense of Sanitation”

•         Development of Baths, Sewers and aqueducts (public health born in Rome)

•         Pure water supply

•         Drainage of marshes

•         Establishment of hospitals

•         Galen (130 – 205 BC)

–         Factors responsible for Disease

–         Modern Concept

MIDDLE AGES
(500 – 1500 AD)

Dark Ages of Medicine

RISE OF ARABIC MEDICINE

•         Graeco-Roman medical literature translated into Arabic

•         Unani System of Medicine

•         Founded schools of Medicine and hospitals

•         Abu Becr (865 – 925 AD) – (Rhazes)

•         Ibn Sina   (980 – 1037 AD) – (Avicenna)

•         Greatest contribution in Pharmacology

•         Golden Age of Arabic Medicine 800 – 1300 AD

•         Established Chains of Hospitals

DAWN OF SCIENTIFIC MEDICINE
(1500 to 1900 AD)

•         Revival of Medicine

•         Sanitary Awakening

•         Rise of Public Health

•         Germ Theory of Disease

•         Birth of Preventive Medicine

REVIVAL OF MEDICINE

•         1453 – 1600 AD – Age of Individual Scientific Endeavour

•         Paracelsus – turned medicine towards Rational Research

•         Fracastorius (1453 – 1553 AD) Theory of Contagion

•         1540- Royal College of Surgeons

•         17th and 18th Centuries – Discoveries

–        Harvey’s – Circulation of Blood (1628)

–        Leeuwenhoek’s – Microscope (1670)

–        Jenner’s – Vaccination (Smallpox) (1796)

SANITARY AWAKENING
(1830 – 1880 AD)

•         Great Sanitary Awakening – Mid nineteenth in England

•         Era of Public Health

•         Problems of 18 Century

–        Creation of Slums, overcrowding, accumulation of filth, high sickness and death rates, infectious disease

–        Average age – 44 yrs

–        Frequent health problems

•         Cholera Epidemic of 1832

•         Edwin Chadwick (1800 – 1890 AD) Report

–        The Sanitary Conditions of the Labouring Population

–        Landmark in the history of public health

–        Emphasized the need to improve public health

•         Improvement in housing & working conditions

•         Anti Filth Crusade – Great Sanitary Awakening

•         Public Health Act of 1848 – England

•         State has a direct responsible for the health of the people

RISE OF PUBLIC HEALTH

•         Cholera – Father of public health

•         John Snow- Polluted drinking water- Cholera

•         William Budd- Spread of Typhoid by dirty water

•         Demand from people for clean water

•         Public Health Act of 1875

•         Sanitary reforms

•         Early phase of public health (1880 – 1920)

–        Disease Control Phase

•         General cleanliness, garbage & refuse disposal

THEORIES – CAUSATION OF DISEASE

•         Supernatural theory of disease

•         Theory of humors

•         Theory of spontaneous generation

•         Louis Pasteur (1822 – 1895) – Germ Theory of Disease (1877)

•         Robert Koch (1843 – 1910) – Anthrax

•         Golden age of bacteriology

•         Gonococcus in 1847

•         Tubercle Bacillus in 1882

•         Vibrio Cholera in 1883

BIRTH OF PREVENTIVE MEDICINE

Era of Disease Prevention by Specific Measures

18th Century

•         James Lind (1716 – 1794) – fresh fruit and vegetables for prevention of scurvy

•         Edward Jenner – Vaccination against smallpox in 1796

19th Century

•         Discoveries in preventive medicine – Pasteur’s anti-rabies (1883), Cholera Vaccine (1892), Diphtheria antitoxin (1894)

•         Modes of disease transmission :–

–        1896 African sleeping sickness by tsetse fly

–        1898 Ross – Malaria by Anopheles Mosquitos

•         Disease prevention by blocking the channels of transmission

MODERN MEDICINE
(1900 to 2000 AD)

•         Curative Medicine

•         Preventive Medicine

•         Social Medicine

•         Concepts in Public Health

CURATIVE MEDICINE

•         Modern Medicine -100 years old

–        Removal of Disease (Prime Objective)

•         Allopathic Medicine – Treatment of disease by the use of a drug which produces a reaction that itself neutralizes the disease

•         Tremendous growth of specialization

•         Specialities :Surgery, Radiology, Anaesthesia etc

•         Subspecialities :Neonatology, Paediatric Surgery etc

•         Raised the standards of medical care

•         Escalated the cost of medical care

PREVENTIVE MEDICINE

•         Applied to “healthy” people – large populations

•         Primary objective – prevention of disease and promotion of health

•         Vaccines & Antisera – Decline in diphtheria, tetanus, typhoid fever & eradication of smallpox

•         Nutrition e.g. Nutritional blindness, iodine deficiency, role of vitamins, minerals, protein and other nutrients

•         Synthetic Insecticides e.g. DDT, control of vector borne disease (malaria & leishmaniasis)

•         Drugs – Sulpha drugs, anti malarial, antibiotics, chemoprophylaxis etc

•         Improved control of infectious diseases

•         People are now living for longer years

•         Concepts of Disease Eradication

•         Screening for Risk Factors

•         Early detection of Cancers, Diabetes, Rheumatism and cardiovascular diseases “Diseases of Civilization”

•         MODERN PREVENTIVE MEDICINE

•         Art and science of health promotion, disease prevention, disability limitation and rehabilitation

•         It emplies a more personal encounter between the individual and health professionals than public health

•         MODERN PREVENTIVE MEDICINE

•         Importance of social factors in the aetiology of disease

•         Emerged as part of modern medicine

•         Primarily a European Speciality

•         Disease has social causes, social  consequences and social therapy

•         Focuses health of community as a whole

•       MEDICAL REVOLUTION

•         State of the Art Medicine

•         Failure of Medicine

•         Social Control of Medicine

•         Family and Community Medicine

•

•         STATE OF THE ART MEDICINE

•         Modern Medicine – Marvellous Discoveries

•         Uncovering of genetic code

•         Prenatal diagnosis of sex / genetic diseases

•         Cloning

•         Organ transplant

•         FAILURE OF MEDICINE

•         Increased medical costs has not come increased benefits in terms of health !

•         Threat posed by certain major diseases such as malaria, leprosy, Leishmaniasis either has not lessened or has actually increased

•         Life expectancy has remained low (developing countries)

•         No equity in the distribution of health services

•         Increasing concern about the cost

•         Efficacy of modern medicine is fundamentally questionable

•         SOCIAL CONTROL OF MEDICINE

•         Charitable and voluntary agencies

•         Socialization of medicine

•         Provision of medical service and professional education by state

•         Programme regulated by health professionals

•         Health by the People

•         FAMILY MEDICINE

•         Field of specialization in medicine which is neither disease nor organ oriented. It is family oriented medicine or health care centred on the family as the unit (from first contact to the ongoing care of chronic problems i.e from prevention to rehabilitation)

•         When family medicine is applied to the care of patients and their families, it becomes the speciality of family practice

•         COMMUNITY MEDICINE

•         Successor of public health, community health, preventive and social medicine

•         All have common grounds i.e. prevention of disease and promotion of health

•         “That speciality which deals with population and comprises those doctors who try to measure the needs of the population, both sick and well, who plan and administer services to meet those needs, and those who are engaged in research and teaching in the field (The faculty of Community Medicine of the Royal College Physicians)

•         HEALTH CARE REVOLUTION

•         Health for All

•         Primary Health Care

•         Deprofessionalization of Medicine

•         The Millennium Development Goals

•         HEALTH FOR ALL

•         Health for all by year 2000

•         Attainment by all peoples of the highest possible level of health

•         Health is to be brought within the reach of everyone in a given community

•         PRIMARY HEALTH CARE

•         Joint WHO – UNICEF international conference in 1978 at Alma Ata (USSR)

•         Revolutionary approach to health care

•         Primary health care – new approach to health care, integrates, all the factors required for improving the health status of population

•         Essential health care – (Eight elements)

•         DEEPROFESSIONALIZATION OF MEDICINE

•         Health workers

•         Health team

•         MILLENNIUM DEVELOPMENT GOALS

•         In 2000 representative from 189 countries

•          Specific commitments in seven area

•         Target – 2015

•         Goals in area of development & poverty eradication – Millennium Development Goals

•         CONCEPTS IN PUBLIC HEALTH

•         Disease Control Phase (1880 – 1920)

•         Health Promotional Phases (1920 – 1960)

•         Social Engineering Phase (1960 – 1980)

•         Health for All Phase (1981 – 2000)

•         IMPORTANT TERMINOLOGIES/
DEFINITIONS

•         COMMUNITY MEDICINE

•         The field concerned with the study of health and disease in the population of a defined community or group.

•         Its goal is to identify the health problems and needs of defined populations (community diagnosis) and to plan, implement and evaluate the extent to which health measures effectively met these needs

•         RELATED TERMS

•         Community Medicine means different things in different countries and may include/ substitute fol:

•         Public Health

•         Preventive Medicine

•         Social Medicine

•         Community Health

•         PUBLIC HEALTH

•         The science and art of preventing disease, prolonging life and promoting health and efficiency

•         through

•         ORGANIZED COMMUNITY EFFORTS

•         for

•         The sanitation of the environment

•         The control of infections (Winslow – 1920)

•         The education of the individual in personal hygiene

•         The organization of medical and nursing service for early diagnosis and preventive treatment of disease

•         The development of social machinery to ensure every individual has a standard of living adequate for the maintenance of health

•         PREVENTIVE MEDICINE

•         Preventive medicine is the science and art of preventing disease, prolonging life and promoting physical and mental health and efficiency

•         Besides communicable diseases, it is concerned with environmental, social, economic and more general aspects of the prevention of the disease

•         COMPREHESIVE HEALTH CARE

•         It is the delivery of personal and impersonal health services to the community for prevention of disease, cure of illness, prevention of disability, economic insecurity and dependency associated with illness

•         PERSONAL HEALTH SERVICES

•         These are health services that are directly directed for the care of the person e.g. Maternal and Child Health Care, Occupational Health Services and School Health Services

•         IMPERSONAL HEALTH SERVICES

•         These are community health services that indirectly influence the health of the person e.g. Safe Water Supply, Safe Excreta Disposal and Vector Control Measures

•         VERTICAL PROGRAMME

•         It is a single programme of health services for the community e.g. expanded programme of immunization (EPI). The staff of this programme is concerned only with the immunization project

•         HORIZONTAL PROGRAMME

•         It is a health service delivery programme, which covers the two dimensions of health, personal and community health. Most often the vertical programmes are merged into existing health project