History of community medicine

Medicine in antiquity

Dubos said the ancient medicine was mother of science medicine was concieved in sympathy and borned 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

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 samhita incude medicine, pathology, ophthalmology , bebside manners, fractures , excised tumor etc Vaghbhatt

Introduction

Public health is a modern concept, although it has roots in antiquity. From time immemorial man has been interested in trying 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 and medical history is an aspect of history of culture
Ancient medicine was the mother of sciences and played 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

Introduction

What is Public health? the science and the art of preventing disease, promoting health and prolonging life through the organized efforts and informed choices of society, organizations, public and private, communities and individuals.

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PHASES IN DEVELOPMENT OF PUBLIC HEALTH

Disease 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

PHASES IN DEVELOPMENT OF PUBLIC HEALTH

Health promotion phase (1920 -1960) --- provision of personal services; maternal & child health, school health, industrial health, etc --provision of basic health services , building prymary health centers ---community development programmes

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 rich and poor countries 1981 WHO declaration for health for all by 2000

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

community
a neighbourhood or a collection of people in similar geographical circumstances a group of people who share the same stakes and common interests such as trade unions, those who are mobilized around a given activity, or the users of health services. those employed in a workplace, the population of a nation, or a civil society

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

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) as well as management of diseases through organized efforts

Community medicine
The field concerned with the study of health and disease in the population of a defined community or group Its goal is identification of the heath problems and needs of the community and to plan implement and evaluate interventions It involves provision of health care at the community level with their full participation

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 and clinical servises provided by physician and nurses but in a defined community

Modern public health

Multidiscilpinary Multisectoral Evidence based Equity oriented

Community diagnosis
This is process of collection and collation and analysis of health data and indices in a community for the purpose of understanding the health status of the community on general or specific issues It is an important concern of community health The unit of interest is the community

Community diagnosis

first task to define health and disease burden in a given community is to define the target community. This can be a country, province, district, or state more defined geographical region, such as an urban inner city, or a socially defined group such as poor communities, women in the reproductive age range, pregnant mothers, infants, young adults, or the elderly

Health indicators

The definition of indicators is a prerequisite for the development of an effective information system in community diagnosis. Indicators have to reflect the kind of decisions which will be needed to estimate the burden of illness and the strategies for control

The main health indicators are expressed in terms of crude age-adjusted or age-specific mortality rates ( infant mortality rates, mortality for children under 5, MMR), disease-specific morbidity rates, and life expectancy at birth. other indicators have been developed. potential years of life lost, quality-adjusted life years gained, disability-adjusted life years, healthy life years lost, and disabilities and quality of life index

Characteristics of community diagnosis

ability to address important problems amenable to practical control ability to identify most of the target health events adequacy in reflecting changes in distribution of events over time, place, and person having a clearly defined population, data collection, data flow, analysis, interpretation, and feedback orientation towards appropriate action being participatory, uncomplicated, sensitive, timely, and inexpensive.

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

Routine reporting system

Birth and death registration Hospital morbidity and mortality records At risk register Disease registers e.g. cancer register

Limitation of routine reporting:

measuring utilization of services versus health needs Affected by poor utilization (awareness, poverty etc Multiple presentation Depends on natural history of diseases

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: active surveillance, passive surveillance, and sentinel surveillance.

The role of surveillance

to monitor secular and long-term trends of diseases and public health issues to provide early warning for disease outbreaks to evaluate prevention and control programmes

Active surveillance

to detect without delay the introduction of change in incidence of a specific disease agent to alert pubic health officials early about an impending epidemic to assess the extent of the risk of transmission of a particular disease to estimate and monitor the effectiveness of control activities. active surveillance is usually disease specific

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 passive surveillance system include the use of standardized case definitions and a standardized reporting system.

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

screening
Detection of diseases among apparently healthy individuals using a rapid tool The objective of a screening programme is to detect health problems at an early stage

Survey and special studies

The objective of a special survey is to gain insight into the nature and extent of a problem in a defined community Surveys and special studies can answer a particular question relevant to a community when routine systems cannot yield adequate information for action

Contact tracing

Contact tracing is particularly useful when information from routine systems and surveillance suggests the need for a clarification of the pattern of the spread of disease

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

Vital registration and census

Vital registration relies on the requirement by law to report health events including birth and death. These figures can be obtained from the national statistical offices Many countries also have periodic censuses every 10 years.

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

CONCLUSION

DESPITE THE ATTRACTION IN THE FIELDS OF CLINICAL MEDICINE THE COMMUNITY PHYSICIAN WILL REMAIN THE CUSTODIAN OF THE PEOPLES HEALTH FOR HE ALONE REALISES THAT ULTIMATE POWER MUST RESIDE WITH THE PEOPLE