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Dr Monika kalra
 INTRODUCTION
 DEFINITION
 CHANGING CONCEPT OF HEALTH
 SPECTRUM OF HEALTH
 CONCEPT OF CAUSATION
 CHANGING CONCEPTS IN PUBLIC HEALTH
 MILLENIUM DEVELOPMENT GOALS
 PRIMARY HEALTH CARE
 PUBLIC HEALTH IN INDIA
 CONCEPT OF PREVENTION
 CONCLUSION
 REFERENCES
 HEALTH IS COMMON THEME IN MOST
CULTURES.
 IN SOME CULTURE HEALTH AND
HARMONY ARE CONCIDERED
EQUIVALENT.
 HEALTH- ABSENCE OF DISEASE
 HARMONY- BEING AT PIECE WITH THE
SELF, THE COMMUNITY, GOD AND
COSMOS.
“HEALTH IS A STATE OF COMPLETE
PHYSICAL, MENTAL AND SOCIAL
WELLBEING AND NOT MERELY THE
ABSENCE OF DISEASE OR INFIRMITY”
WHO 1948
1. Biomedical concepts
2. Ecological concepts
3. Psychosocial concept
4. Holistic concept
1. Biomedical concept
 absence of disease
 inadequate to solve major health
problems (malnutrition, chronic
diseases, accidents)
2. Ecological concepts
 dynamic equilibrium between man
and his environment.
disease : maladjustment of the
human organism to environment.
3. Psychosocial concept
 health is influenced by social ,
psychological, cultural, economic and
political factors.
4. Holistic concept
all sectors of society have an
effect on health.
health implies a sound mind, in a
sound body, in a sound family, in a
sound environment.
POSITIVE HEALTH
BETTER HEALTH
FREEDOM FROM SICKNESS
UNRECOGNISED SICKNESS
MILD SICKNESS
SEVERE SICKNESS
DEATH
 EPIDEMIOLOGICAL TRIAD
 MULTIFACTORIAL CAUSATION
 NATURAL HISTORY OF DISEASE
 WEB OF CAUSATION
 RISK FACTOR & RISK GROUP
 SPECTRUM OF DISEASE
 ICEBERG OF DISEASE
AGENT HOST
 As an element or substance, animate or
inanimate, the presence (or  absence)
of it may initiate or perpetuate a disease
process.
 Nutritional agent: carbohydrate, vitamin,
fat, protein, mineral, water
 Chemical agent: polutan , drugs, Hg, Pb,
Ag, arsenicum.
 Physical agent: collision, traffic accident,
falling down, dust, climate (frost bite, heat
stroke)
Infectious agent
 Virus : dengue, morbili, varicella, hepatitis
 Bacteria : gram (+), gram (-) ; bacil, coccus,
acid fast resistence, anaerob, etc.
 Fungi : tinea capitis, tinea cruris, tinea pedis
 Protozoa : plasmodium, amoeba
 Metazoa : worm (ascaris , ancylostoma, etc.)
 A person or other living animal, that
affords subsistence or lodgment to an
infectious agent under natural condition
 Intrinsic factors that influence an
individual’s exposure, susceptibility, or
response to a causative agent
 As the aggregate of all the external
conditions and influence  affecting  the life
and development of an organism
1. Physical environment: geographic,
geology, climate
2. Biological environment: people, flora,
fauna, food population density
3. Socioeconomic: income, education,
culture, urbanization, economic growth,
poverty, fertility, etc.
 Given by pettenkofer of munich
 Modern disease could not be explained
by ‘single cause idea’
 Concept offers multiple approaches for
prevention of disease
 E.g.- coronary heart disease is caused by
excess fat intake, smoking, lack of
physical exercise and obesity.
It is the way in which a disease evolves
over time from the earliest stage of its
pre-pathogenesis phase to its
termination as recovery, disability or
death, in the absence of treatment or
prevention.
 PRE-PATHOGENIC PHASE OR
SUSCEPTIBILITY STAGE: PROCESS IN THE
ENVIRONMENT
 PATHOGENIC PHASE: PROCESS IN MAN
 Model Suggested by Macmahon and
Pugh.
 Applicable on chronic disease where
agent is unknown but is outcome of
interaction of multiple factors
 Removal of just 1 link is sufficient to
control disease
 Disease in a community may be compared with an
iceberg.
 Tip of iceberg  what the physician sees in the
community [clinical cases]
 The vast submerged  Hidden mass of disease portion of
iceberg
- latent
- Inapparent
- Presymptomatic
- undiagnosed
- carriers
 The water line  demarcation between apparent and
in apparent disease.
 Disease control phase
 Health promotion phase
 Social Engineering phase
 Health for all phase
 Disease control phase [1880-1920]
 aimed at the control of man’s
physical environment
 eg: Water supply ,sewage disposal,
etc
 improved the health of people due to
disease and death control
 Health promotion phase [1920-1960]
 mother and child health services
 school health services
 industrial health services
 mental health & rehabilitation services
2 movements were initiated
A. Basic health services – primary health
centers, sub-centers
B. Community development programme
 Social Engineering phase [1960 – 1980]
Social and behavioral aspects of
disease and health given priority
 acute illness problems were solved
”risk factors” as determinants of
diseases came into existence
 public health moved in to the
preventive and rehabilitation aspect.
 Health for all phase [1981 – 2000]
Members of WHO pledged “Health
for all by the year 2000”
The organized application of local,
state, national and international
resources permit all people to lead a
socially and economically productive
life
 Eradicate extreme poverty and hunger
 Achieve universal primary eduation
 Promote gender equality and empower
women
 Reduce child mortality
 Improve maternal health
 Combact HIV, Malaria and other disease.
 Ensure environmental sustainability
 Develop a global partnership for
development
 Primary health care is essential health care based
on practical, scientifically sound and socially
acceptable methods and technology made
universally accessible to individuals and families
in the community through their full participation
and at a cost that the community and country
can afford to maintain at every stage of their
development in the spirit of self reliance and self-
determination.” (Alma Ata Declaration, 1978)
1.Equitable distribution.
2.Community participation.
3.Intersectoral coordination.
4.Appropriate technology.
5. Focus on prevention
 Health services must be shared
equally by all people
irrespective of their ability to
pay.
 Rich or poor / rural or urban
must have access to health
services.
 80% percentage of people live
in rural areas & only 20% live in
the urban areas, but the
proportion of the health
services is grossly inversely
propotionate.ie, 80% of people
are catered by only 20% &
20% are catered by 80% of
health services.
 This has been termed as social
injustice.
 Primary Health Care aims to
readdress this imbalance by
shifting the centre of gravity of
the health care system from
cities to the rural areas, & bring
these services as near people’s
home as possible.
 Involvement of the individuals
& community in promotion of
their own health & welfare, is
an essential ingredient of
primary health care.
 There must be a continuing
effort to secure meaningful
involvement of the community
in planning, implementing &
maintenance of health
services, besides maximum
reliance on local resources
such as manpower, money &
materials.
 One approach – the VHG &
Trained Dais has been
successfully tried in India.
 They are selected by the local
community & trained locally in
the delivery of primary health
care to the community they
belong.
 By overcoming cultural &
communication barriers, they
provide primary health care in
ways that are acceptable to the
community.
 It is now considered that “Health
Guides” & “Trained Dais” are an
essential feature of primary
health care in India.
 These concepts are revolutionary.
They have been greatly influenced
by the experience in China where
community participation in the from
of “bare foot doctors” took place on
an unprecedented scale.
 There is an increasing
realization that HFA cannot be
provided by the health sector
alone.
 The declaration of Alma Ata
states that primary health care
involves in addition to health
sector, all related sectors &
aspects of national & community
development, in particular
agriculture, animal husbandry,
food, industry, education,
housing, public works,
communication & other sectors.
 To achieve such cooperation,
countries may have to review
their administrative system,
reallocate their resources &
introduce suitable legislation to
ensure that coordination can
take place.
 This requires a strong political will
to translate values into action.
 An important approach is
the inter sectoral approach.
 Appropriate technology has been defined
as “technology that is scientifically sound,
adaptable to local needs, & acceptable to
those who apply it & for those whom it is
used & that cab be maintained by the
people themselves in keeping with the
principles of self reliance with the resources
the community & country can afford”.
 The term appropriate is
emphasized because in some
countries luxurious hospitals
that are totally inappropriate to
the local needs, are built, which
absorb a major part of the
national health budget,
effectively blocking many
improvement in general health
services.
 This also implies use of costly
equipments, procedures &
techniques when cheaper,
scientifically valid &
acceptable ones are
available. (ORS packets over
house to house sand pipe
connections)
 1. Bhore Committee
 2. Mudaliar Committee
 3. Kartar Singh Committee
 4. Shrivastav Committee
 5. Rural Health Scheme
 at village level
(Village health guide scheme, training
local dais, Anganwadi workers),
 sub center level,
 PHC,
 CHC.
 Education concerning prevailing health
problems and the methods of preventing
and controlling them.
 Promotion of food supply and proper
nutrition.
 An adequate supply of safe water and
basic sanitation.
 “Sanitation generally refers to the
provision of facilities and services for the
safe disposal of human urine and feces.”
(WHO)
 Maternal and child health care,
including family planning.
 Maternal death is the death of a woman while
pregnant or within 42 days of termination of
pregnancy, irrespective of the duration and
site of the pregnancy, from any cause related
to or aggravated by the pregnancy or its
management but not from accidental or
incidental causes.
 The infant mortality rate (IMR) is the ratio of the
number of deaths among children less than
one year old during a given year to the
number of live births during the same year.
 Immunization against major infectious
diseases.
 Prevention and control of locally
endemic diseases.
 Appropriate treatment of common
diseases and injuries.
 Provision of essential drugs
 The goal of medicine is to promote, to
preserve, to restore health when it is
impaired & to minimize suffering &
distress.
 These goals are embodied in the word
“prevention”.
 The objective of preventive medicine
is to intercept or oppose the “cause”
& thereby the disease process.
 1. Primordial prevention.
 2. Primary prevention.
 3. Secondary prevention.
 4. Tertiary prevention.
 This primary prevention is purest in its
sense.
 It implies prevention of the
emergence or development of risk
factors in population groups in which
they have not yet appeared.
 This primary prevention is purest in
its sense.
 It implies prevention of the
emergence or development of risk
factors in population groups in
which they have not yet
appeared.
 Primary prevention can be
defined as “action taken
prior to the onset of
disease, which removes the
possibility that a disease will
occur”.
 It signifies intervention in the
pre pathogenesis phase of a
disease or health problem.
 Primary prevention may be
accomplished by measures
designed to promote general
health & well being, & quality
of life of people or by specific
protective measures.
 Secondary prevention can
be defined as “action which
halts the progress of a
disease at its incipient stage
& prevents complications”.
 The specific interventions are
early diagnosis & prompt
treatment.
 Secondary prevention attempts
to arrest the disease process,
restore health by seeking out
unrecognized disease & treating
it before irreversible pathological
changes have taken place &
reverse communicability of
infectious diseases.
 When disease process has
advanced beyond its early
stages, it is still possible to
accomplish prevention by
what might be called
“tertiary prevention”.
 It signifies intervention in the
late pathogenesis phase.
 Tertiary prevention can be
defined as “all measures
available to reduce or limit
impairments & disabilities,
minimize suffering caused by
existing departures from good
health & to promote the
 The main interventions
include disability limitation
& rehabilitation.
 Tertiary prevention extends
the concept of prevention
into fields of rehabilitation.
“So many people spend their health
gaining wealth, and then have to
spend their wealth to regain their
health.”
-Materi
“It is health that is real wealth, and
not pieces of gold and silver.”
-Gandhi
 1) SOBEN PETER: BOOK OF PREVENTIVE
AND COMMUNITY DENTISTRY
 2) S. S. HIREMATH: BOOK OF PUBLIC
HEALTH DENTISTRY
 3) K. PARK: PREVENTIVE AND SOCIAL
MEDICINE
Health

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Health

  • 2.  INTRODUCTION  DEFINITION  CHANGING CONCEPT OF HEALTH  SPECTRUM OF HEALTH  CONCEPT OF CAUSATION  CHANGING CONCEPTS IN PUBLIC HEALTH  MILLENIUM DEVELOPMENT GOALS
  • 3.  PRIMARY HEALTH CARE  PUBLIC HEALTH IN INDIA  CONCEPT OF PREVENTION  CONCLUSION  REFERENCES
  • 4.  HEALTH IS COMMON THEME IN MOST CULTURES.  IN SOME CULTURE HEALTH AND HARMONY ARE CONCIDERED EQUIVALENT.  HEALTH- ABSENCE OF DISEASE  HARMONY- BEING AT PIECE WITH THE SELF, THE COMMUNITY, GOD AND COSMOS.
  • 5. “HEALTH IS A STATE OF COMPLETE PHYSICAL, MENTAL AND SOCIAL WELLBEING AND NOT MERELY THE ABSENCE OF DISEASE OR INFIRMITY” WHO 1948
  • 6.
  • 7. 1. Biomedical concepts 2. Ecological concepts 3. Psychosocial concept 4. Holistic concept
  • 8. 1. Biomedical concept  absence of disease  inadequate to solve major health problems (malnutrition, chronic diseases, accidents)
  • 9. 2. Ecological concepts  dynamic equilibrium between man and his environment. disease : maladjustment of the human organism to environment.
  • 10. 3. Psychosocial concept  health is influenced by social , psychological, cultural, economic and political factors.
  • 11. 4. Holistic concept all sectors of society have an effect on health. health implies a sound mind, in a sound body, in a sound family, in a sound environment.
  • 12. POSITIVE HEALTH BETTER HEALTH FREEDOM FROM SICKNESS UNRECOGNISED SICKNESS MILD SICKNESS SEVERE SICKNESS DEATH
  • 13.  EPIDEMIOLOGICAL TRIAD  MULTIFACTORIAL CAUSATION  NATURAL HISTORY OF DISEASE  WEB OF CAUSATION  RISK FACTOR & RISK GROUP  SPECTRUM OF DISEASE  ICEBERG OF DISEASE
  • 15.  As an element or substance, animate or inanimate, the presence (or  absence) of it may initiate or perpetuate a disease process.  Nutritional agent: carbohydrate, vitamin, fat, protein, mineral, water  Chemical agent: polutan , drugs, Hg, Pb, Ag, arsenicum.  Physical agent: collision, traffic accident, falling down, dust, climate (frost bite, heat stroke)
  • 16. Infectious agent  Virus : dengue, morbili, varicella, hepatitis  Bacteria : gram (+), gram (-) ; bacil, coccus, acid fast resistence, anaerob, etc.  Fungi : tinea capitis, tinea cruris, tinea pedis  Protozoa : plasmodium, amoeba  Metazoa : worm (ascaris , ancylostoma, etc.)
  • 17.  A person or other living animal, that affords subsistence or lodgment to an infectious agent under natural condition  Intrinsic factors that influence an individual’s exposure, susceptibility, or response to a causative agent
  • 18.  As the aggregate of all the external conditions and influence  affecting  the life and development of an organism 1. Physical environment: geographic, geology, climate 2. Biological environment: people, flora, fauna, food population density 3. Socioeconomic: income, education, culture, urbanization, economic growth, poverty, fertility, etc.
  • 19.  Given by pettenkofer of munich  Modern disease could not be explained by ‘single cause idea’  Concept offers multiple approaches for prevention of disease  E.g.- coronary heart disease is caused by excess fat intake, smoking, lack of physical exercise and obesity.
  • 20. It is the way in which a disease evolves over time from the earliest stage of its pre-pathogenesis phase to its termination as recovery, disability or death, in the absence of treatment or prevention.
  • 21.  PRE-PATHOGENIC PHASE OR SUSCEPTIBILITY STAGE: PROCESS IN THE ENVIRONMENT  PATHOGENIC PHASE: PROCESS IN MAN
  • 22.  Model Suggested by Macmahon and Pugh.  Applicable on chronic disease where agent is unknown but is outcome of interaction of multiple factors  Removal of just 1 link is sufficient to control disease
  • 23.
  • 24.  Disease in a community may be compared with an iceberg.  Tip of iceberg  what the physician sees in the community [clinical cases]  The vast submerged  Hidden mass of disease portion of iceberg - latent - Inapparent - Presymptomatic - undiagnosed - carriers  The water line  demarcation between apparent and in apparent disease.
  • 25.  Disease control phase  Health promotion phase  Social Engineering phase  Health for all phase
  • 26.  Disease control phase [1880-1920]  aimed at the control of man’s physical environment  eg: Water supply ,sewage disposal, etc  improved the health of people due to disease and death control
  • 27.  Health promotion phase [1920-1960]  mother and child health services  school health services  industrial health services  mental health & rehabilitation services
  • 28. 2 movements were initiated A. Basic health services – primary health centers, sub-centers B. Community development programme
  • 29.  Social Engineering phase [1960 – 1980] Social and behavioral aspects of disease and health given priority  acute illness problems were solved ”risk factors” as determinants of diseases came into existence  public health moved in to the preventive and rehabilitation aspect.
  • 30.  Health for all phase [1981 – 2000] Members of WHO pledged “Health for all by the year 2000” The organized application of local, state, national and international resources permit all people to lead a socially and economically productive life
  • 31.  Eradicate extreme poverty and hunger  Achieve universal primary eduation  Promote gender equality and empower women  Reduce child mortality  Improve maternal health  Combact HIV, Malaria and other disease.  Ensure environmental sustainability  Develop a global partnership for development
  • 32.  Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self reliance and self- determination.” (Alma Ata Declaration, 1978)
  • 33.
  • 34. 1.Equitable distribution. 2.Community participation. 3.Intersectoral coordination. 4.Appropriate technology. 5. Focus on prevention
  • 35.  Health services must be shared equally by all people irrespective of their ability to pay.  Rich or poor / rural or urban must have access to health services.
  • 36.  80% percentage of people live in rural areas & only 20% live in the urban areas, but the proportion of the health services is grossly inversely propotionate.ie, 80% of people are catered by only 20% & 20% are catered by 80% of health services.
  • 37.  This has been termed as social injustice.  Primary Health Care aims to readdress this imbalance by shifting the centre of gravity of the health care system from cities to the rural areas, & bring these services as near people’s home as possible.
  • 38.  Involvement of the individuals & community in promotion of their own health & welfare, is an essential ingredient of primary health care.
  • 39.  There must be a continuing effort to secure meaningful involvement of the community in planning, implementing & maintenance of health services, besides maximum reliance on local resources such as manpower, money & materials.
  • 40.  One approach – the VHG & Trained Dais has been successfully tried in India.  They are selected by the local community & trained locally in the delivery of primary health care to the community they belong.
  • 41.  By overcoming cultural & communication barriers, they provide primary health care in ways that are acceptable to the community.  It is now considered that “Health Guides” & “Trained Dais” are an essential feature of primary health care in India.
  • 42.  These concepts are revolutionary. They have been greatly influenced by the experience in China where community participation in the from of “bare foot doctors” took place on an unprecedented scale.
  • 43.  There is an increasing realization that HFA cannot be provided by the health sector alone.
  • 44.  The declaration of Alma Ata states that primary health care involves in addition to health sector, all related sectors & aspects of national & community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communication & other sectors.
  • 45.  To achieve such cooperation, countries may have to review their administrative system, reallocate their resources & introduce suitable legislation to ensure that coordination can take place.  This requires a strong political will to translate values into action.
  • 46.  An important approach is the inter sectoral approach.
  • 47.  Appropriate technology has been defined as “technology that is scientifically sound, adaptable to local needs, & acceptable to those who apply it & for those whom it is used & that cab be maintained by the people themselves in keeping with the principles of self reliance with the resources the community & country can afford”.
  • 48.  The term appropriate is emphasized because in some countries luxurious hospitals that are totally inappropriate to the local needs, are built, which absorb a major part of the national health budget, effectively blocking many improvement in general health services.
  • 49.  This also implies use of costly equipments, procedures & techniques when cheaper, scientifically valid & acceptable ones are available. (ORS packets over house to house sand pipe connections)
  • 50.  1. Bhore Committee  2. Mudaliar Committee  3. Kartar Singh Committee  4. Shrivastav Committee  5. Rural Health Scheme
  • 51.  at village level (Village health guide scheme, training local dais, Anganwadi workers),  sub center level,  PHC,  CHC.
  • 52.
  • 53.  Education concerning prevailing health problems and the methods of preventing and controlling them.
  • 54.  Promotion of food supply and proper nutrition.
  • 55.  An adequate supply of safe water and basic sanitation.  “Sanitation generally refers to the provision of facilities and services for the safe disposal of human urine and feces.” (WHO)
  • 56.  Maternal and child health care, including family planning.
  • 57.  Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.  The infant mortality rate (IMR) is the ratio of the number of deaths among children less than one year old during a given year to the number of live births during the same year.
  • 58.  Immunization against major infectious diseases.
  • 59.  Prevention and control of locally endemic diseases.
  • 60.  Appropriate treatment of common diseases and injuries.
  • 61.  Provision of essential drugs
  • 62.
  • 63.  The goal of medicine is to promote, to preserve, to restore health when it is impaired & to minimize suffering & distress.  These goals are embodied in the word “prevention”.
  • 64.  The objective of preventive medicine is to intercept or oppose the “cause” & thereby the disease process.
  • 65.  1. Primordial prevention.  2. Primary prevention.  3. Secondary prevention.  4. Tertiary prevention.
  • 66.
  • 67.  This primary prevention is purest in its sense.  It implies prevention of the emergence or development of risk factors in population groups in which they have not yet appeared.
  • 68.  This primary prevention is purest in its sense.  It implies prevention of the emergence or development of risk factors in population groups in which they have not yet appeared.
  • 69.  Primary prevention can be defined as “action taken prior to the onset of disease, which removes the possibility that a disease will occur”.
  • 70.  It signifies intervention in the pre pathogenesis phase of a disease or health problem.  Primary prevention may be accomplished by measures designed to promote general health & well being, & quality of life of people or by specific protective measures.
  • 71.  Secondary prevention can be defined as “action which halts the progress of a disease at its incipient stage & prevents complications”.
  • 72.  The specific interventions are early diagnosis & prompt treatment.  Secondary prevention attempts to arrest the disease process, restore health by seeking out unrecognized disease & treating it before irreversible pathological changes have taken place & reverse communicability of infectious diseases.
  • 73.  When disease process has advanced beyond its early stages, it is still possible to accomplish prevention by what might be called “tertiary prevention”.
  • 74.  It signifies intervention in the late pathogenesis phase.  Tertiary prevention can be defined as “all measures available to reduce or limit impairments & disabilities, minimize suffering caused by existing departures from good health & to promote the
  • 75.  The main interventions include disability limitation & rehabilitation.  Tertiary prevention extends the concept of prevention into fields of rehabilitation.
  • 76. “So many people spend their health gaining wealth, and then have to spend their wealth to regain their health.” -Materi
  • 77. “It is health that is real wealth, and not pieces of gold and silver.” -Gandhi
  • 78.  1) SOBEN PETER: BOOK OF PREVENTIVE AND COMMUNITY DENTISTRY  2) S. S. HIREMATH: BOOK OF PUBLIC HEALTH DENTISTRY  3) K. PARK: PREVENTIVE AND SOCIAL MEDICINE