History of Medicine(Evolution of Community Medicine)
Evolution of Community Medicine(History of Medicine)Stages seen in the history of medicine:• Stone age• 5000 BC: Indian medicine• 2700 BC: Chinese medicine (system of barefoot doctor, System of acupuncture)• 2000 BC: Egyptian medicine (manuscript of papyrus) Continued…..
Evolution of Community Medicine(History of Medicine)Stages seen in the history of medicine:• 2000 BC: Mesopotamian medicine (Babylonian code of hammurabi)• 460 BC: Greek medicine (Hygiea daughter of Aescuapius, Hippocrates oath)• 130 AD: Roman medicine (Galen)• Up to 800 AD: Dark ages of medicine Continued…..
Evolution of Community Medicine(History of Medicine)Stages seen in the history of medicine:• 900 AD: Arabic medicine (Rhazes, Avicenna)• 1500 AD: Revival period (theory of contagion blood circulation by Harvey, vaccination by Jenner)• 1800: Sanitary awakening• 1850: Rise of public health (epidemic of cholera by John Snow, typhoid by William, Chadwick’s sanitary reforms) Continued…..
Evolution of Community Medicine(History of Medicine)Stages seen in the history of medicine:• 1860: Germ theory (anthrax by Robert Koch)• 1880: Typhoid & pneumonia 1882 TB• 1883: Birth of preventive medicine (ARV)• 1883: Cholera vaccine, 1892 dipth antitoxin• 1898: Malaria transmission by Ross Continued…..
Evolution of Community Medicine(History of Medicine)Stages seen in the history of medicine:• 1900: Multifactorial causation of disease• 1911: Social medicine• 1920: Disease control• 1960: Health promotion• 1981: HFA
WHO Definition of HealthHealth is a state of complete physical,mental and social well-being and not merelyan absence of disease or infirmityand ability to lead socially and economically productive lifeOperational definition: A condition or quality of human organism expressing the adequate functioning of the organism in giving condition, genetic or environmental
Concept of Wellbeing• Objective component 1. Standard of living 2. Level of living• Subjective component • Quality of Life (PQLI) (IM, Life expt. @ 1, Literacy.) • Human development Index (Life expt. @ 0, Knowledge, Income)
Concept of Wellbeing• Subjective component • Quality of Life (PQLI) (IM, Life expt. @ 1, Literacy.) The condition of life resulting from combination of the factors such as those determining health happiness education social and intellectual attainments freedom of action, justice and freedom of expression • Human development Index (Life expt. @ 0, Knowledge, Income)
Determinants of health1. Biological / Hereditary2. Behavioral & Socio-cultural Lifestyle3. Environmental4. Socioeconomic conditions5. Health and family welfare services6. Aging of the population7. Gender8. Others…..
Determinants of health1. Biological 8. Science and2. Behavioral technology3. Environmental 9. Information and communication4. Socioeconomic 10. Gender5. Health system 11. Equality and social6. Socio-cultural justice7. Aging of the 12. Human rights population
Responsibility of Health1. Individual responsibility2. Community responsibility3. State responsibility4. International responsibility
Indicators of health(Valid Reliable Sensitive Specific) 1. Mortality indicators 2. Morbidity indicators 3. Disability indicators 4. Nutritional Status indicators 5. Health care delivery indicators 6. Utilization rate 7. Indicators of social and mental health 8. Environmental indicators 9. Socioeconomic indicators 10. Health policy indicators 11. Indicators of quality of life 12. Others……….
Health Indicators Valid, reliable, sensitive and relevant indicators which determine health development are called health indicators:• Mortality Indicators: Death rate, Life span, IMR, Child mortality rate, MMR, Case fatality rate, proportion mortality rate.• Morbidity Indicators: Disease rate (incidence, prevalence)• Disability Indicators: Hospitalization, loss of work, sullivan index DALYs• Nutritional Indicators: Anthropometric values, LBW• Utilization Indicators: Fully immunized, bed turn out…• Socioeconomic Indicators: Per capita income. Family size.
Mortality indicators1. Crude death rate2. Expectancy of life3. Infant mortality rate4. Child Mortality rate5. Under 5 proportionate mortality rate6. Maternal mortality7. Disease specific mortality8. Proportionate mortality rate
Concept of diseaseIt is departure from state of health interrupting in normalfunction of the body
Concept of disease• Theories (Germ theory, Epidemiological Triad, Multifactorial causation, web of causation)• Natural History of disease (Prepathogenesis – pathogenesis) (Agent Host Environment)• Risk Factors• Iceberg Phenomena• Monitoring the performance & analysis of routine measurements aimed at detecting changes in the environment or health status of population• Surveillance The continuous scrutiny of the factors that determines the occurrence and distribution of disease and other conditions of ill health• Sentinel Surveillance• Prevention and Control
Difference between Control & Eradication Control EradicationDefinition To reduce incidence to Total extirpation of acceptable level disease agentObjective To reduce morbidity & To uproot the disease mortality (no more PH problem)Area of operation In high incidence area Total coverageDuration of operation Indefinite Time limitedEconomic aspect Recurring CheapCase finding, Not important Very ImportantConfirmation,Epidemiological investi.
Examples of Risk FactorsFatty diet, obesity DiabetesAlcohol Cirrhosis of liverSmoking, radiation CancerHigh cholesterol, obesity, type Heart diseasesof personalitySmoking, high BP, high StrokecholesterolAlcohol, Ignorance about Accidenttraffic signals
Natural history of disease Interrelation of Agent , Host and Reaction of the host to the stimulus Environmental Factor Production of stimulus Early Discernible Advance Convalescenc pathogenesis early lesions disease e Pre-pathogenesis period Period of Pathogenesis Health Promotion Specific protection Early diagnosis & Disability Rehabilitation prompt treatment limitation•Health Education •Use of specific •Case finding measures •Adequate •Provision of•Good standard of immunization individual & mass treatment to hospital &nutrition adjusted to •Attention to personal •Screening surveys arrest the community facilitiesdevelopmental phases hygiene disease for retaining & •Selective examinationsof life process and to education for •Use of environmental objectives prevent further maximum use of•Attention of personality sanitation To cure & preventdevelopment complications remaining •Protection against disease process capacities•Provision of adequate occupational hazards To prevent the spread ofhousing recreation & •Provision of •Education of public •Protection from a communicable diseases & industry theagreeable working accidents facilities to limit To prevent complications rehabilitatedcond. disability and •Use of specific & sequel •As full employment•Marriage counseling nutrients to prevent To shorten period of as possibleang sex education death •Protection of disability •Selective•Genetics carcinogens placement•Periodic selective •Avoidance of allergensexamination •Work therapy in hospitals •Use of shelter
Modes of Intervention Intervention is an attempt to intervene or interrupt the usual sequence in the development of disease in a man.1. Health Promotion: It is a process of enabling people to increase control over & to improve health – Health education – Environmental health – Nutritional intervention – Lifestyle changes – Behavior changes
Modes of Intervention2. Specific Protection: It is a process to totally avoid disease or illness – Immunization – Nutritional supplement – Chemoprophylaxis – Immunoprophylaxis – Protective device in industry – Protective device against carcinogen – Protective device against allergens
Modes of Intervention3. Early diagnosis and prompt treatment It is a process of early detection of transformation from physiological to pathological state Early diagnosis and prompt treatment of: • Ca breast • Ca cervix • TB • Leprosy
Modes of Intervention4. Disability Limitation It is a process involving interaction to prevent disability e.g. – Disability limitation in nerve damage in leprosy – Physiotherapy in polio lameness. Impairment Disability Handicap
Modes of Intervention5. Rehabilitation It is a combine & co-ordinate use of medical, social, economical, vocational and psychological measure to make an individual or community function normally – Medical rehabilitation – Social rehabilitation – Economic rehabilitation – Vocational rehabilitation – Psychological rehabilitation