Basics & brief foundation notes on Community medicine and public health

1. Concepts of Community Medicine ,
Public Health,
Positive Health and Well being.
Guided by ,
Dr Abhishek Joshi
Associate Professor,
Dept of Community medicine
DMIMS , Wardha
Presented by ,
Dr K Himabindu Reddy
JR1 ,
Dept of Community medicine
DMIMS , Wardha

2. Community Medicine

3. Concepts of
Community
medicine &
Public Health
 The dichotomy of medicine into two major branches namely curative medicine, and
public health/preventive medicine was clear by the end of 19th century.
 After 1900, with the control of acute infectious diseases, diseases such as cancer,
diabetes, cardiovascular disease, mental illness and accidents came into
prominence .
 These diseases could not be explained on the basis of the Germ theory of
disease. The germ theory of disease gave place to a newer concept of disease -
“Multifactorial causation"
 Other factors in the aetiology of diseases, namely social, economic, genetic,
environmental and psychological factors which are equally important came to focus.
Most of these factors are linked to man's lifestyle and behaviour .
 It was realized that every disease has deep rooted social causes and was not
simply a result of an infectious agent.
 For example, Tubercle bacilli infection;

4. Concepts
of Community
medicine
& Public
Health
 1923, Dr. Francis Peabody, commented that specialization in medicine had already reached
its apex & that modern medicine had fragmented the health care delivery system a lot.
 He called for a rapid return of the general physician (family physician) who would give
comprehensive and personalized care.
 The emergence of Family and Community Medicine represents a counterforce to the
direction which medical science has taken during the past 20 years or so.
 The field of specialization of family and community medicine is neither an organ system nor
a disease syndrome, but rather a designation of social categories namely family and
community.
 Family and community medicine overlap and strengthen each other.
 Community medicine as a discipline, is defined as that branch of medicine, which
addresses certain selected aspects of health promotion, disease prevention, health
restoration (by curative steps) and rehabilitation of the former patients, in the community.

5. Concepts of
Community m
edicine &
Public
Health
 Beginning from somewhere around the mid 20th century, it was realized that the art and
science of preventive disease and promoting health should be taught as an
independent subject in the curricula of medical schools.
 The considered decision was that preventive medicine should essentially combine the
social aspects of health and disease in its theory, practice and teaching.
 This led to the birth of academic departments and the specialty of Preventive & Social
Medicine (PSM) or Social & Preventive Medicine (SPM).
 Community medicine is the successor of what was previously known as public health,
community health, preventive and social medicine.
 All these share common ground, i.e., prevention of disease and promotion of health.

6. Community
Medicine
 Community medicine, as an approach, has borrowed heavily from the concepts, methods
and approaches of its two elder sisters, viz. public health and preventive medicine.
 Community medicine is one pathway for representing an institution’s commitment to
improving health of its immediate (or adopted) community - generally a medical college,
hospital or a clinical department serve as the base.
 The health task is to define the health problems, propose solutions, maintain surveillance,
evaluate progress and monitor the use of resources.
 The approaches employed range from tools of epidemiology to the social skills, necessary
for involvement with the community.
 Central to the approach of community medicine, whether in academia or in practice, is the
promise that the main factors that determine a community’s health are to be found within
the community itself - in its social, cultural or biological features, or in its environment -
natural and man made.

7. Community
Medicine
 Professor Winslow defined Public health as ‘the science and art of preventing the disease,
prolonging life and promoting health and efficiency through organized community efforts,
such as control of communicable disease, sanitation, health education, etc. so as to
enable every citizen to realize his birth-right of health and longevity’.
 Leavell and Clark defined Preventive medicine as ‘the science and art of preventing the
disease, prolonging life and promoting physical and mental health and efficiency’.
 Social medicine is defined as, ‘The study of man as a social being in his total environment’
(Physical, biological and social environment).
 The Faculty of Community Medicine of the Royal College of Physicians has defined
Community medicine as "that speciality which deals with populations."
 It 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"

8. Features Community Medicine General Medicine
Service area
Provides health care to the people of defined geographic
area
Draws patients from ill-defined catchment area
Operational strategy
Both active and passive operational strategies are applied,
i.e. both providers and consumers are on the move
Only passive operational strategy is applied, i.e.
responsibility lies on the patient to come to
hospital for treatment
Organizational
framework
community health centers, primary health centers and
subcenters
primary, secondary and tertiary care hospitals.
Nature of care
It is comprehensive (i.e. preventive, promotive, curative
and rehabilitative)
Only curative care
Intersectoral
coordination
Exits between the health department and the health related
departments
Virtually no intersectoral coordination exists
Program
participation
Promotes active participation in the operation of National
health programs
Has limited scope in the participation of
National health programs
Cost-benefit analysis
Gives high cost-benefit ratios by involving minimum
expenditure and yielding maximum results
Gives poor cost-benefit ratios by involving
maximum expenditure and yielding minimum
benefits

9. Public Health

10. Public Health
 Public Health, and Community Medicine contain many overlapping ideas.
 The unique feature of public health has been acknowledged to be “Organized Community
Effort” and “Systematic Social Action”
 The classical definition of public health : “ The science and art of preventing disease,
prolonging life and promoting physical health and efficiency through organized community
efforts for the sanitation of the environment, the control of community infections, the
education of the individual in principles of personal hygiene, the organization of medical
and nursing services for the early diagnosis and preventive treatment of diseases and the
development of social machinery which will ensure to every individual, in the community, a
standard of living adequate for maintenance of health”.
 “A health problem becomes a public health responsibility if, or when, it is of such character
or extent as to be amenable to solution only through systematized social action” .

11. Public Health
 Core Principles Underlying Public health Practice:
 ● The emphasis on collective responsibility for health.
 ● An envisaged major role of the state in protecting and
 promoting the public’s health.
 ● A focus on whole populations and not on individuals.
 ● An emphasis on prevention, especially primary prevention,
 while not losing track of the importance of curative medicine also.
 Readiness to undertake partnership with populations being served.
 A concern for underlying socio-economic determinants of health and
disease as well as more proximal determinants, such as health care.
 ● A multi-disciplinary basis; the readiness to work, in a team, with
different and diverging disciplines concerned with human health and
development.
 ● Attitude to incorporate qualitative and quantitative methods, as
appropriate, in the area of work.

12. Differences

13. Diffrences
 The dividing line between preventive medicine and public health is
actually a very thin & hazy one.
 Preventive medicine is an overall science, public health is an approach
within this science.
 Community medicine / Preventive and social medicine : the common
denominator here is “medicine”. Community medicine is a subdivision of
the overall discipline of medicine. Its based in medical profession ,
cornerned with role of social factors in etiology of disease & explores
need for government action in areas of disease prevention and medical
care.
 The concept of Public health on the other hand, is of major governmental
and social activity . Its multidisciplinary and extends to many aspects of
the society . the key word is “health”, not the discipline of medicine .

14. Differences
 When preventive medicine starts focusing on population groups rather than
individuals and utilises the approach of ‘organised community efforts” it takes
the shape of public health.
 Eg : a doctor who educates her ante-natal case about breast feeding or a
doctor who takes a pap smear from her patients who are attending a family
planning clinic is actually practicing individualized or clinical preventive
medicine, but, may be, not public health.
 On the other hand when the government or even a Non Governmental
Organization (NGO) working with community members in a village, organises
a health education program in breast feeding for expectant mothers, or
organises a cervical cancer screening camp, the approach becomes that of
public health.

15. Positive Health &
Well Being

16. Positive
Health &
Well Being
• The state of Positive health implies the notion of "perfect
functioning" of the body and mind.
• 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
• psycho logically, as a state in which the individual feels
a sense of perfect well-being and of mastery over his
environment, and
• socially, as a state in which the individual's capacities
for participation in the social system are optimal .

17. Positive Health
& Well Being
 Positive health can be considered as the highest
standard of health.
 It’s the highest level on the Spectrum of health ,
wherein death is the lowest level.
 The spectral concept of health emphasizes that the
health of an individual is not static; it is a dynamic
phenomenon and a process of continuous change.
 The transition of health from one level to other level
is gradual, & attempt to attain the state of positive
health indicates the improvement in the quality of life.
Positive Health
Better Health
Freedom from sickness
Unrecognized Sickness
Death
Mild – Severe Disease

18. Well Being
 Well Being is a concept introduced in the WHO definition of health.
 Objective component & Subjective component
 Objective component relates to' Standard of living’, or 'Level of Living
' which includes educational level, income, occupational status,
standard of housing, nutrition, sanitation, dress and other comforts of
modern living.
 Standard of living primarily depends on GNP (Gross National
Product) , includes the gross income generated within the country as
well as the net income received from abroad.
 Level of living consists of nine components: health, food
consumption, education, occupation and working conditions, housing,
social security, clothing, recreation and leisure, and human rights.
WHO (1948) in the preamble to its constitution, states :
"Health is a state of complete physical, mental and social well-being and not merely an
absence of disease or infirmity"

19. Well Being
 Subjective component :- Quality of Life .
 The quality of life can be evaluated by a composite index called
‘physical quality of life index’ (PQLI) which consolidates 3 indicators viz
 •Infant mortality rate,
 • Life expectancy at age one
 •Literacy.
The composite index is calculated by averaging the three indicators,
giving equal weight to each of them. The resulting PQLI thus also is
scaled 0 to 100.
 This indicator PQLI is used for national and international comparison of
human well-being.
 PQLI does not depend upon per capita GNP, unlike standard of living,
showing thereby that ‘money is not everything.

20. REFERENCES
 Park, K., 2018. Parks Textbook Of Preventive In Social Medicine. 24th ed.
P47 - 51 Jabalpur: Banarsidas Bhanot Publishers.
 Rajvir Balwar , 2009. Textbook of Public Health and Community Medicine.
1st ed. P. 23 -25 Pune: Armed Forces Medical College and WHO
(collaboration).
 Kadri, a., 2019. IAPSM's textbook of community medicine. [S.L.]: Jaypee
brothers medical p. 143 – 147.
 Krishnan A. Community medicine in India—which way forward?. Indian
journal of community medicine: official publication of Indian Association
of Preventive & Social Medicine. 2016 Jan;41(1):5.
 https://online.ahu.edu/blog/understanding-the-difference-between-
public-health-and-community-health/
 Journal of Public Health Policy/
www.jstor.org/1985_Article_TheDistinctionBetweenPublicHealth

21. Human
Development
Index
HDI is defined as "a composite index focusing on three basic dimensions of
human development :
Dimension
Indicator
Dimension
indices
A long ,
healthy life
Knowledge A decent standard
of living
Life expectancy at birth
Expected yrs of
schooling
Mean yrs of
schooling GNI per capita
Life expectancy index Education Index GNI Index
Human Development
Index [HDI]

22. Human
Development
Index
 HDI on the other hand , is an indicator of Overall development. It is
claimed as standard means of measuring human development according
to UNDP.
 The HDI is a more comprehensive measure than per capita income. It
provides a more comprehensive picture of human life than income does.
 The HDI values range between 0 to 1.
 The HDI value for a country shows the distance that it has already
travelled towards maximum possible value [to 1] & allows for international
comparison.
 An index of below 0.5 indicates poor development, while an index of 0.8
and above indicates good development of a country.

23. Human
Development
Index
 STEPS TO ESTIMATE THE HUMAN DEVELOPMENT INDEX
 Step 1. Creating the dimension indices
 Minimum and maximum values (goalposts) are set in order to transform the indicators
into indices between 0 and 1.
 Dimension index = Maximum value - Minimum value
 Step 2. Aggregating the subindices to produce the Human Development Index
 The HDI is the geometric mean of the three dimension indices.
 I life
1/3 x I eductaion
1/3 x I income
1/3
 HDI classification for the year 2015 are relative – based on quartiles of HDI distribution
across 188 countries , denoted as* Very high, * High *Medium & * Low.
 Norway , Australia & Switzerland are at the top of HDI ranking . Niger and
African republic , are at the bottom . India comes in the medium human development
category , ranking at 131.


24. THANK YOU