This document provides an overview of community medicine, public health, and preventive medicine. It discusses how community medicine differs from clinical medicine by focusing on populations rather than individuals. Key concepts covered include the importance of addressing issues like communicable diseases, malnutrition, and health trends through public health approaches. The document traces the history of medicine from ancient times to modern developments and changing approaches in public health.
2. Objectives
By the end of these lessons you will be
able to understand:-
â˘How Community Medicine is
different then Clinical Medicine
â˘Its evolution
⢠What is Community Medicine/
Public Health/ Preventive and Social
Medicine and
â˘Its basic Concepts
3. Importance of Preventive and Social
Medicine/ Public Health
What is common in:-
⢠Swine flu
⢠HIV
⢠Typhoid
⢠Malaria
⢠Malnutrition
⢠Cancer
⢠Addiction
4. Public health movements
⢠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 the sanitary
commission of Massachusetts)
5. Renewal of Interest in Prev. Prom.
And Protection of Health!!
Due to:-
⢠Continued Emergence and Resurgence of
Communicable Diseases and increase in Life-
Style Diseases
⢠Realization that investment in Clinical Care;
though necessary, bring diminishing results.
⢠Implementing Public Health Methods; may be
difficult, time-consuming but bring maximum
gains.
6. Clinical vs Preventive
Medicine Medicine
⢠Cater to individual patient
⢠Abstract, invisible
⢠Focus on cure of diseases
and immediate sufferings
⢠Bring immediate
gratification form patient;
his family and friends and
the community at large.
⢠Cater to Masses (community)
⢠concrete, visible
⢠Focus on promotion and
protection of health and
prevention of diseases
⢠Results are not easily
recognizable, measurable
and quantifiable!!
< 1% of national health budget is spent on public health
7. Contributions of Community Medicine
⢠A major driving force in furthering the
cause of human health and development!
⢠Simple Public Health measures like â
Safe Water Supply, Sanitary Excreta
Disposal, Vaccination and Vector control
measures has saved many more lives
than would have been saved by all the
dazzling advancement of curatives and
diagnostics put together.
8. Contributions of Community Medicine
⢠Smallpox Eradication
⢠Guinae worm Eradication
⢠Polio Eradication
⢠Elimination of Leprosy
⢠Elimination of Neonatal Tetanus
⢠Control of Maternal and Child Mortality and
Morbidity
⢠Control of IDD, Vit A deficiency, Iron Deficiency
and so onâŚ..
⢠Improved health planning (policies and system)
9. Medicine
Noted historian Henry Sigerist defined
medicine as:
âMedicine, by providing health and
preventing illness, endeavors to keep
individuals adjusted to their environment
as useful and contented members of
society; or by restoring health and
rehabilitating the former patient, it
endeavors to readjust individuals to their
environment.â
10. ContdâŚâŚ
From this definition, medicine has two
components â
⢠âThe Promotive and Preventiveâ component &
⢠âRestorative and Rehabilitativeâ component
⢠However there is no sacrosanct dividing line in
practice. A Public Health expert has to adopt
both the components with focus on public
⢠In broader sense Preventive medicine refers
to âLimiting the progression of disease â
at any stage of its courseâŚâŚâŚ..
11. ContdâŚâŚ..
⢠Initially, Preventive Medicine was identified
with âControl of Communicable Diseasesâ
⢠Subsequently, âEpidemiologyâ; an
important âKnow-how,â included prevention
of Non-Communicable diseases as well.
⢠With improvement in HE techniques
âCounseling and Behavior Change
Communicationâ techniques developed as its
tools too.
12. Preventive Medicine & Public health
The dividing line is hazy -
Preventive medicine is an overall science
while Public Health is an approach
When preventive efforts are focused on
population groups and utilizes the
approach of âorganized community
effortsâ it takes the shape of public health.
13. Public Health
⢠In public health problems are named
within the context of the community as
a whole.
⢠This help in establishing Priorities and
Rational use of resources for the benefit
of the health of the population as a
whole by âOrganized Community Effortâ
and âSystematic Social Actionâ
14. Public Health as defined by CEA Winslow
The science and art of preventing disease, prolonging life
and promoting physical health and efficiency; via:-
ď Organized community efforts for the sanitation of the ENV.
ď Control of community infections,
ď Education of individuals in principles of personal hygiene,
ď Organization of medical and nursing services for early
diagnosis and preventive treatment of disease and
ď Development of social machinery which will ensure to
every individual in the community, a standard of living
adequate for maintenance of health.
15. Preventive and Social Medicine
⢠Somewhere around the mid 20th century it
was realized that the art & science of
preventing disease and promoting health
should be taught as independent subject
in medical schools (till then it was taught
as hygiene with medicine).
⢠Rudolph Virchow et al emphasized the
role of social factors in disease causation
and thereby in its prevention. & helped in
origin of Preventive and Social Medicine
16. Preventive and Social Medicine
⢠The preventive medicine essentially
combine the social aspects of health &
disease in its theory, practice and teaching.
⢠Socialized Medicine: refers to the policy of
providing complete medical care
(preventive as well as curative), to all
members of the society (usually a nation)
as a Govt. commitment through public
funds.
17. History of Medicine:
Ancient Times
⢠Primitive Man attributed disease & sufferings to
the wrath of God- âSupernatural theory of disease;â
⢠Indian medicine:
5000BC- Ayurveda (âTridosa Theory) emerged from
âAtharvedâ
800BC- Atrey (Takshila); great Indian physician &
Teacher
200 AD- Charak (Court physician of king Kaniska);
wrote âCharak Samhitaâ descibing some 500
drugs;(Rauvolfia before Reserpine).
18. Indian MedicineâŚ..
Up to 400AD- Shushrut k/a âFather of Surgery,â
âShushrut Samhitaâ; included Surgery, Anatomy, Pathology,
Ophthalmology, Hygiene, medicine and Mid-Wifery
800AD- Charak & Shushrut Samhita translated in Arabic & Persian
languages.
Hygiene was upfront- âMohan zodaroâ
800BC-600AD- Golden Age of Indian Medicine
Set Back in Mughal period
10th Century AD- Unani & Tibb (originated in Greec), introduced
by Muslim Rulers
1810-1839AD- Homeopathy (originated in Germany),
19. Chinese Medicine: (2700 BC) oldest body of
Medical Knowledge
⢠Principle - âYangâ (Active Masculine Factor)
and âYinâ (negative Feminine Factor)-
balance= Good Health
⢠Tools were â hygiene, dietetics, hydrotherapy,
massages, immunization and drugs
⢠Integrated âTraditional Methodsâ with âModern
Techniquesâ
⢠Gave âBarefoot Doctorsâ & âAcupunctureâ
20. Egyptian Medicine: (âbest of all,â â Homer)
The Art of medicine was mingled with Religion
⢠Specialization prevailed- in âeye, tooth, head etc.â
⢠Principle - absorption of harmful substances from
intestine putrefy blood and formation of pus.
⢠Tools- Enema, Bloodletting and drugs
⢠Excelled in Public Health- Built public baths,
underground drains & planned cities.
⢠Knew association of plague with Rats, skull &
paralysis, worms, diabetes, rheumatism, polio &
smallpox Vaccination
⢠Recorded their work on âpapyrusâ
21. Greek Medicine:
460BC-136AD- civilizers of the ancient world
⢠Principle- âTheory of Humorâ matter is build up
of four elements- Earth (cold), Air(dry), Fire(hot)
and Water (moist); represented in body by four
humors- phlegm, yellow bile, blood & black bile.
The human body was assumed to have powers
of restoration of humoral equilibrium.
⢠Hygiea (PH) and Panacea (Curative)were two
daughters of Aesculapius (his staff; entwined by
a serpent continues to be the symbol of
medicine )
22. Greek MedicineâŚâŚ
⢠Hippocrates (460-370BC)- Challenged magic and
initiated âapplication of clinical methodsâ
⢠He studied & classified diseases based on
observation & reasoning; distinguished endemic
and epidemic diseases; (Epidemiologist seeking
causes).
⢠Taught us to think âWhy & How.â He studied
effect of climate, diet, clothing, water, habits of
eating & drinking on health.
⢠Established relation between âMan & his
Environmentâ
⢠Hippocratic Oath- set standards for âpracticing
medicineâ.
23. Roman Medicine:
⢠By 1st Century BC center of civilization shifted to
Rome. They built their Medicine on Greek medicine.
⢠Public health developed- they built fine roads,
sewers, aqueducts, drained marshes to combat
malaria and established Hospitals/ medical schools.
⢠Galen (130-205AD); - emphasized importance of
Preserving health; (since both in importance & in
time health precedes disease) & curing disease
⢠He said disease is due to three factors-
â Predisposing, Initiating, & Environmental Factors
⢠Europeans accepted his writings as Text Books
24. Middle Ages(500-1500AD)- âDark Ageâ
⢠Fall of Roman Empire lead to Abolition of Medical
Schools/ Hospitals
⢠Medicine reverted back to âmagic & superstitionâ
(T.B., Plague, Leprosy & Smallpox became
rampant)
⢠Arabs developed âUnani & Tibbâ with borrowed
knowledge from Greek & Roman.
⢠Abu Becr (Bagdad)865-925AD- also k/a âRazesâ
published book on child diseases, his book
differentiating smallpox & Measles !!
⢠Arabs were seeking âElixir of Life,â hence
Pharmaceutical chemistry developed.
⢠Built Hospitals with specialized departments.
25. After 1500AD- âAge of Revolutionsâ
⢠Fracastorius: Theory of âContagionâ ( transfer of
infection via minute invisible particles):-
Explained the cause of an Epidemic.
Recognized that Syphilis is transmitted via Sex.
⢠Vesalius- Anatomy & Ambroise Pare- Surgery.
⢠1540- united Co. of barber surgeons formed; later
became Royal College of Surgeons.
⢠1628- Harvey; discovery of circulation of blood
⢠1670- Leeuwenhoekâs microscope
⢠Morgagni; 1682-1771 founded pathologic Anatomy
⢠1796- Jennerâs vaccination against smallpox
26. ⢠18th Century; Industrial Revolution slums
⢠Edwin Chedwickâs (a lawyer) report on âthe
sanitary conditions of the labouring
population in Great Britainâ same time
Shuttak in America.
⢠19th Century; âGreat Sanitary
awakening.â
⢠Public health Act 1848- The State has a
direct responsibility for the Health of the
people.
27. ⢠Concept of Public Health emerged properly
with - Jhon Snowâs spot map for cholera deaths
& Willium Buddâs study on Typhoid fever leading to
source of infection even before causative organism
was identified.
⢠France, Spain, Australia, Germany, Italy, Belgium, &
the Scandinavian countries all developed Public
Health
⢠Developing Countries- slow growth of PH
⢠1945 â WHO, initiated Public Health movements
28. Germ Theory of Disease (1873):
⢠Louis Pasteur, (1860) showed presence of
bacteria in air.
⢠Robert Koch 1877- showed bacteria of Anthrax,
after that; many other were demonstrated-
gonococcus, typhoid, pneumococcus, TB,
Cholera, diphtheria & so on
Preventive Medicine:
James Lind; 1753 for scurvy, Edward Jenner;
1796 developed vaccine for smallpox. In later
part of 19th century many more vaccines
developed.
29. ⢠1898; Ross demonstrated that malaria
was transmitted by Anopheles, then
Walter Reed et al identified Aedes for
Yellow fever, thus control measures
became specific e.g. â blocking
transmission channels e.g. destruction of
vectors & its breeding places, quarantine.
⢠With development of Laboratory Methods
âEarly Diagnosis & treatmentâ was also
thought of as preventive measure.
30. ⢠Tissue culture of viruses- Anti Viral Vaccines;
eradication of Smallpox in 1977 (Somalia).
⢠Discoveries in the field of Nutrition- control of
deficiency diseases.
⢠Discovery of Synthetic Insecticides.
⢠Discovery of Sulpha Drugs, Anti malarials, ATT,
Anti Leprosy drugs.
⢠Development of Chemoprophylaxis and Mass
drug treatment strategies.
⢠Concept of Screening â Syphilis, TB etc
⢠Screening for âRisk Factorsâ& identification of
âHigh Risk Groupsâ
31. Changing Concepts in Public Health
⢠1880-1920 â Disease Control Phase
⢠1920- 1960 â Health Promotional Phase
⢠1960-1980 â Social Engineering Phase
⢠1981 - 2000 â Health for All Phase
⢠Preventive Medicine- âhealth
promotion, Disease Prevention, Disability
limitation & Rehabilitationâ
Editor's Notes
Last 2 decades of the 20th century witnessed renewal of interest in Public Health due to
If we had but the gift of second sight to transmute abstract figures into flesh and blood, so that as we walk along the street, we could say, âthat man would have been dead of typhoid feverâ, âthat woman would have succumbed to anaemia of pregnancyâ, âthat rosy infant would have been in its coffin because of diarrhoea and dehydrationâ, -then only would we have a faint conception of the silent victories of public health-----â.
even in USA, just about 1% of the nationâs total health spending 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.
In USA, the life expectancy 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 system, while the large majority of this gain has come from improvements in public health, broadly defined to include better housing, nutrition, sanitation, immunization and occupational safety
Rauvolfia or srpgandha - reserpine is an alkaloid first isolated from Rauvolfia serpentina and was widely used as antihypertensive drug. It had drastic psychological side effects and has been replaced by other drugs as first line anti hypertensive
Galen (130-205AD); - emphasized importance of Preserving health; & curing disease since both in importance & in time health precedes disease