First MBBS Lecture

1.  Concept of health and disease
 Natural history of disease
 Concept of prevention and control
 Health indicators (morbidity and mortality)

2. CONCEPT OF PUBLIC HEALTH
Dr. Kharde Anup
Assistant Professor
Dept. of Community Medicine

4. Concept of Public Health
 18th century is a era of Industrial Revolution;
 Results in health problems; slums, overcrowding, accumulation of filth,
tuberculosis, industrial and social problems.
 In 1842, among laborers mean life expectancy of was 44 in London
 Frequent outbreak of Cholera worsen the situation
 Great cholera epidemic of England; led Edwin Chadwik to investigate
determinants of poor health; gave report “The Sanitary Conditions of Laboring
population in Great Britain”

5.  Focus shifted to improve housing and working conditions
 Anti-filth crusade; filth recognized as man’s greatest enemy.
 The Great Sanitary Awakening which leads to enactment of the Public Health
Act of 1848 in England
 New thinking initiated “ state has a direct responsibility for the health of the
people”

6.  Lemule Shattuck, published report on the health conditions in Massachusetts;
(Report of the sanitary commission of the Massachusetts) stirred the
conscience of American people to the improvement of public health
 Leads to Rise of PublicHealth...............

7. Comprehensive definition of Public health
(Charles – Edward Amory Winslow, 1920)
 The Science And Art Of Preventing Disease, Prolonging Life, And Promoting Health And
Efficiency Through Organized Community…..
 effort for:
 The sanitation of the environment
 The control of communicable infections
 The education of the individual in personal hygiene
 The organization of medical and nursing services for the early diagnosis and preventive
treatment of disease, and
 The development of the social machinery to ensure everyone standard of living adequate for
maintenance of health
 So, organizing these benefits as to enable every citizen to realize his birth right of health and
longevity.

8.  Nearly all governments Developed or Developing countries; Recognized ..
 Continue investment in clinical care diminished return;
 Gain can be maximized by Health Promotion & disease prevention among population at large
Increase
Decrease
Clinical Care
Public Health

9.  Handicap of public and preventive health; its achievements are difficulty to recognize
(measures)
 The doctor who cures a patient has achieved a real, recognizable benefit and the patient, as
well as her near ones and even the community members, are all grateful

10. ----”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,
“that man would have been dead of typhoid fever”, “that woman would
have succumbed to anaemia of pregnancy”, “that rosy infant would have
been in its coffin because of diarrhoea and dehydration”, -then only would
we have a faint conception of the silent victories of public health-----“.
Because of this
“silence” that accounts, in large part,
for the lack of attention paid to public health
by those who are in a position to mobilize
community opinion or take public decisions.

11. “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
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” Bunker JP. Improving
Health : Measuring effects of medical care. Milbank quarterly 1994; 72 : 225 - 58.