1st lecture mph

Introduction, Definitions &
General Concepts in Public Health &
Community Medicine
Prepared by: Associate Prof. Dr Farooqi
2020

11/11/2020 Kandahar University, faculty of Medicine, MPH Program 2

Content
BACKGROUND
DEFINITIONS & BASIC CONCEPTS
TOP 10 HITS OF THE LAST CENTURY
THREE CORE FUNCTIONS OF PUBLIC HEALTH
PUBLIC HEALTH –MAJOR DOMAINS
HEALTH IMPACT PYRAMID
CONTENT

BACKGROUND
֎The last two decades of the 20th century saw a renewal of the world
population’s interest in Public health, in Disease prevention,
Communicable and Chronic disease control, Health protection and
Health promotion.
֎ NOT THAT PUBLIC HEALTH IS A NEW CONCEPT; great public health
movements had already started in
۩ Mid-nineteenth century by Edwin Chadwick in UK (report on an
inquiry into the sanitary conditions of the labouring population in
great Britain, 1842) and
۩ Around the same time in USA in 1850 by Lemuel Shattuck (Report of the11/11/2020 Kandahar University, faculty of Medicine, MPH Program 4

Sir Edwin Chadwick KCB (24 January 1800 – 6 July 1890) was an
English social reformer who is noted for his work to reform the Poor
Laws and to improve sanitation and public health.
Lemuel Shattuck
Politician
His Report of the Sanitary Commission of Massachusetts in 1850 has been described as
a prophetic document in its anticipation of public health developments.

During the past 150 years, two factors have shaped the
modern public health system:
• First, the growth of scientific knowledge about sources
disease;
• Second, the growth of public acceptance of disease
public responsibility.

In developing countries not even ONE PERCENT of the total national budget is spent on public health; the
budget is spent on public health; the situation, even in the developed countries is no better.
• For example, even in USA, just about 1% of the nation’s total health spending's go towards public health.
spending's go towards public health.
• In 1992, when the average cost of medical treatment was $3,007 for each American, the amount spent on
public health was only $ 34 per person
Only would we have a faint conception of the silent victories of public health.

During the 20th century, many times more lives have been saved and diseases prevented by simple public health measures as
@ Safe Water Supply,
@ Vaccination And
@ Insect Vector- Control Measures,
For instance, as per a report, the life expectancy in USA increased from 45 years in beginning of 20th century to over 75 years
in the next 100 years and ONLY 5 OUT OF THESE 30 years increase can be attributed to the work of curative medical care
attributed to the work of curative medical care system, while most of this gain has come from improvements in public health,
come from improvements in public health, broadly defined to include.
۩ BETTER HOUSING,
۩ NUTRITION,
۩ SANITATION,
۩ IMMUNIZATION AND
۩ OCCUPATIONAL SAFETY.

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Public health Approach

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Definitions &
Basic Concepts

The science and art dealing with the maintenance of health and the prevention,
alleviation, or cure of disease.
“MEDICINE” as a discipline, has two clear components –
1. Promotive and preventive” component, which is mainly the scope of
(preventive medicine);
2. Restorative and Rehabilitative’ component, ( curative medicine).
• very often, a clinician may also adopt ways and means of primary and
medicine practitioner may very often focus on basic clinical care or
• Finally, public health, as a discipline, keeps a focus on both the components,
i.e. health promotive / preventive as well as restorative / rehabilitative,
Medicine

The problem Characteristic in the “absence of
disease” definition is that it focuses only on disease.
However, there is, in every disease, a long phase of
transition from actual health to the overt disease
process, “natural history of disease”. Hence, health is
something much more than the mere absence of
disease.
Health

World Health Organization 1946
Standard Reference Definition

1-Physical health- various
parameters related to the
anatomical, physiological,
genetic and biochemical makeup
of the person are within normal
normally.
Subdomains of Health

2-Mental Health- is the ability to LEARN and THINK clearly and
coherently.
A mentally healthy person is in peace with himself and with the
society.
- Able to Contribute advantageously to the society
- Able to tackle phases of stress without undergoing to
breakdown.Emotional health - is the ability of expressing emotions in the
appropriate way, for example to fear, to be happy, and to be
angry.
• Emotional health is related to mental health and includes feelings.
• It also means maintaining one’s own integrity in the presence of stressful
situation such as tension, depression and anxiety.

3- Social health-
is the ability to make and maintain Acceptable Interaction with
other people. e.g.
1. To celebrate during festivals;
2. To mourn when a close family member dies;
3. To create and maintain friendship and intimacy, etc.
- At peace with the other members of the community.
- Valuable member of society (contribute to its development)

4- Spiritual Health –
Spiritually has gradually come to be accepted in prevention of
diseases and promotion of health.
Spirituality means having faith in an external, supreme power
(God) who create and sustains the world.
Spirituality is not material in nature, but belongs to the realm of ideas,
beliefs, values and ethics that have arisen in the minds and conscience
of human beings.
Some people relate health with religion; for others it has to do
with personal values, beliefs, principles and ways of achieving
mental satisfaction, in which all are related to their spiritual
wellbeing.

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“Health is a state characterized by:
1. Anatomic, Physiologic And Psychological Integrity ,
2. Ability To Perform Personally Valued Family, Work And Community Roles,
3. Ability To Deal With Physical, Biological, Psychological And Social
Stressors,
4. A Feeling Of Well-being,
5. Freedom From the risk of disease and untimely death.
11/11/2020 Kandahar University, faculty of Medicine, MPH Program

The goals of medicine are:
- To PROMOTE health,
- To PRESERVE health, and
- To RESTORE health when it is impaired, and to
minimize suffering and distress.
These goals are embodied in the word
"PREVENTION".
CONCEPTS OF PREVENTION

S u c c e s s f u l p r e v e n t i o n d e p e n d s u p o n a
֎Knowledge Of Causation,
֎Dynamics Of Transmission,
֎Identification Of Risk Factors
֎Identification Risk Groups,
֎Availability Of Prophylactic Measures Or Early Detection
֎Availability Treatment Measures,
֎An Organization For Applying These Measures.
֎Continuous Evaluation Of Procedures Applied.
֎Development Of Procedures applied.

PREVENTIVE MEDICINE
The branch of medicine that deals with Promoting health and Preventing disease.
• The cardinal goal of preventive medicine is to AVOID THE OCCURRENCE OF DISEASE or
DISABILITIES.
• In a broader sense, preventive medicine refers to “limiting” the progression of disease at any
stage of its course (stage of susceptibility). For examples’
o When a clinician, using the approach of curative medicine, diagnosis and treats a
patient of pulmonary tuberculosis, she is practicing preventive medicine too, since
she is “preventing” the progress of the disease from the mild / uncomplicated phase
to one of complications and more disability.
o Similarly, when we “treat” a patient of BONE fracture, by closed reduction and
plaster cast, we are limiting the progress of a disease to a more severe form which
would have complications like malunion; thus we are practicing preventive
medicine (Preventing Disability).

PUBLIC HEALTH
• In public health, problems are Communal rather than occurring in series of
individuals. one in favor of solving problems for the benefit of the health of the
population.
• Over the years, the unique feature of public health has been acknowledged
to be
• “Organized Community Effort” and
• “Systematic Social Action”.

“The science and art of preventing disease,
prolonging life, and promoting health through the
organized efforts and informed choices of society,
organizations, public and private communities, and
individuals.”
—CEA Winslow
Public Health Defined
Photo: IF Fisher and EL Fisk
28
Charles-Edward Amory Winslow (February 4, 1877 – January 8, 1957) was an American
bacteriologist and public health expert

PREVENTIVE MEDICINE VERSUS PUBLIC HEALTH
The dividing line between Preventive Medicine and public health
is very thin. preventive medicine is an overall science while
public health is an approach which utilized the various principles
laid down in the science of preventive medicine.
When preventive medicines starts focusing on population groups rather
“organized community efforts” it would become public Health.
• Individualized preventive medicine, for instance, immunising an
otherwise healthy child,
• Clinical preventive medicine: clinical settings; for example,

PREVENTIVE MEDICINE VERSUS PUBLIC HEALTH…
• A doctor who educates her antenatal case about breast feeding or a doctor who takes a pap
smear from her patients who are attending a family planning clinic is practicing individualized or
clinical preventive medicine, but may be, not public health.
• On the other hand when the same doctor , working with either an NGO or governmental
agencies or community members in a village, organises a health education program about
breast feeding for expectant mothers, or organises a cervical cancer screening camp, the
approach becomes that of public health.

Social Medicine
The Study of the man in his social environment and study of social factors which
affecting health and diseases.
The branch of medicine that deals with the
- Cultural ,
- Economic ,
- Psychological and
- Social factors
among the individuals and communities which are associated with the development of the
disease process and application of this knowledge in preventing in mitigating the disease .

PREVENTIVE & SOCIAL MEDICINE
Beginning from somewhere around the mid 20th century it was realized that the art and science of preventing
disease and promoting health should be taught as an independent subject in the curricula of medical schools. tell then
most of the Medical College were conducting such training for graduate level students under the subject nomenclature of
Hygiene usually as a part of general Medicine curriculum it was also realized that preventive medicine should
essentially combine the social aspect of health and disease in theory ,practice and teaching. this led to the birth of
academic Department and specialty of preventive and social medicine (PSM) or
social and preventive medicine (SPM) . for many years, the standard nomenclature of the
discipline remained as PSM or SPM only, to be gradually replaced somewhere around the year 2000 by the name
“community medicine”.

COMMUNITY MEDICINE (HEALTH)
o Most recent term.
o As a discipline: a branch of medicine with deals with populations, in which doctors and their
populations, in which doctors and their Healthcare team Members
• Measure the health needs of these populations, both sick and healthy, and
• Administer the services too meets these needs, as well as
• Undertake teaching and research into populations health needs and their management.
o Usually delivered by an “institutional community base” which is usually either
• Academic department in medical college.
• Health care center.

POPULATION HEALTH
Population health is defined as:
- The distribution of health outcomes within a
population, the range of personal, social, economic
and environmental factors that influence the
distribution of these health outcomes, and the
policies and interventions that affect those factors.
- Thus , a Subset of Public Health.

Family medicine
Family medicine has been defined as "a 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 (from prevention
to rehabilitation).
The speciality of family practice is specially designed to deliver "primary
care"
Family practice physicians focus on
meeting the needs of the entire family.
The family doctor is uniquely trained to
care for the whole person throughout
his or her life, from birth to old age

TOP 10 HITS OF
THE LAST CENTURY
Public Health

1. VACCINE PREVENTABLE DISEASES
2. PREVENTION AND CONTROL OF INFECTIOUS
DISEASES
3. TOBACCO CONTROL
4. MATERNAL & INFANT HEALTH
5. MOTOR VEHICLE SAFETY
11/11/2020
Kandahar University, faculty of Medicine, MPH Program 39
6. CARDIOVASCULAR DISEASE PREVENTION
7. OCCUPATIONAL SAFETY
8. CANCER PREVENTION
9. Water Fluoridation
10. IMPROVED PUBLIC HEALTH/EMERGENCY
PREPAREDNESS

Three Core Functions of Public Health
Assessment
Assurance
Systematically collect, analyze, and
make available information on
healthy communities
Promote the use of a scientific
knowledge base in policy and
decision making
Ensure provision of services to
those in need
Institute of Medicine. The future of public health. Washington, DC: National Academies Press; 1988. 41
Policy
Development

ANALYTICAL
• EPIDEMIOLOGY
• STUDIES
• DATA COLLECTION
• ASSOCIATION/
• CAUSATION
• BIOSTATISTICS
BIOMEDICAL
• INFECTIOUS DISEASES
• CHRONIC DISEASES
• GENETIC DISEASES

PUBLIC HEALTH-MAJOR DOMAINS
SOCIAL/ BEHAVIORAL
• BEHAVIORAL HEALTH
• SMOKING, DRUGS, ALCOHOL
• NUTRITION
• HEALTH EDUCATION
• INJURY PREVENTION
• WORKPLACE SAFETY
• MATERNAL/CHILD HEALTH (Pre-
Conceptual Care)
ENVIRONMENTAL
• CLEAN, CLEAN,CLEAN
• CLEAN AIR
• CLEAN WATER
• CLEAN SOIL
• SOLID AND HAZARDOUS
WASTE
• SAFE FOOD/DRUGS
• POPULATION

PUBLIC HEALTH- MAJOR DOMAINS
MEDICAL CARE
• ACCESS/EQUITY
• COST
• QUALITY
• ETHICS
• REGULATION
A BRAVE NEW WORLD!
• BIOTERROISM
• NATURAL DISASTERS
• PANDEMICS
• BIOTECHNOLOGY
• GENOMICS/GM
• The Unknown!!!!!!

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