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Concepts of Community Health
Introduction
• Health is a dynamic concept
• In order to protect, promote, and restore the health of individuals and
populations, an integrated discipline of public health or community health
came into existence.
• Public health has achieved success in terms of improvement of various
morbidity and mortality indicators
• However, a lot needs to be achieved and mid-level health care providers
(MLHPs) can play an important role in this regard
Objectives
At the end of the session participants will be able to:
• Define health
• Differentiate between illness, sickness and disease
• Describe various dimensions of health
• Enumerate determinants of health
• Draw epidemiological triad with the help of example
• Describe the natural history of disease
• Enumerate and apply the levels of disease prevention in control of
diseases
Public Health
• ‘Public Health’ : Organized community efforts aimed at prevention of
disease and promotion of health.
Public health
Control
communicable
infection
Improved
environment
Improvement
hygiene
through
education
Organization of
medical and
nursing services
for prevention
of disease
Development of
the social
machinery for
health
maintenance
Improved
access to safe
water and
sanitation
Evolution of Public Health In India
Harappa
culture
Planned cities with
drainage and
practices of
sanitation
Ayurveda and
Siddha systems of
medicine
1400
B.C.
1000
A.D.
Unani system of
medicine
Legislative
measures for
disease control
and prevention
18th
century
Bhore
committee
(1943)
Survey existing
health conditions
to recommended
integration of
preventive and
curative services
Budget allocation
for national health
program
National malaria
control program
Developing rural
areas
National Rural
Health Mission
1st five-
year plan
(1950)
Community
development
program
(1952)
2005
RMNCH+A
2013
Evolution of Public Health in India contd..
CONCEPTS OF HEALTH AND
ILLNESS
Health, Illness, Sickness and Disease
“State of complete physical, mental and
social well-being and not merely an
absence of disease or infirmity”
“Socially and culturally held conceptions
of health conditions, which in turn
influence how the patient reacts”
“Subjective sense of feeling unwell; it
does not define a specific pathology, but
refers to a person’s subjective experience
of it, such as discomfort, tiredness, or
general malaise”
“Physiological or psychological
dysfunction. In other words, disease
implies a focus on pathological processes
that may or may not produce symptoms
and that result in a patient’s illness”
Sickness Disease
Health Illness
Spectrum of health
1) Mortality–prevention of health
2) Serious morbidity– the prevention and control of conditions that
produce disability or chronic illness
3) Minor morbidity– the handling of lesser illnesses (in terms of death
and disability), environmental conditions that create inconveniences
and nuisances, and
4) Positive health– the attainment of a full sense of personal vigor and
mental well-being, as well as constructive relationships with others in
an environment that promotes longevity and happiness
Dimensions of health
Health
Environment
Physical
Emotional
Intellectual
Spiritual
Financial
Occupational
Social
Physical health
• State of the body its compositions, development, functions, and
maintenance.
• Optimum physical abilities of all his body parts being intact and working in
coordination
Healthy
eating
Exercise
Adequate
sleep
Regular
check-
ups
Avoid
harmful
habits
Physical
Health
Emotional health: Ability to accept and cope with our own and others
feelings.
• Adjusting mind-set
• Not getting agitated easily
• Freedom from internal conflicts
• Looks for his personal identity
• Strong self esteem
• Knows his limitations and capabilities
• Not carried away by unnecessary emotions
• Ability to cope up
Characteristics:
Spiritual Health
Intellectual Health
• Personal beliefs and values
• Attained by seeking one’s values,
rights, and responsibilities, ethics,
and code of living and it is the
capacity to love, have compassion
for others, forgiveness, joy, and
fulfillment
• Cognitive ability to develop skills
and knowledge to enhance
one’s life
• It encourages creative,
stimulating mental activities and
improves our decision-making
ability
Occupational
health
• Recognize
personal
satisfaction and
enrichment in
one’s life through
work
• The choice of
profession, job
satisfaction, career
ambitions, and
personal
performance
components of
occupational
wellness
Social Health
• One’s contribution
to environment and
community
• Deals with
supportive social
network,
contributing to
society, and
valuing cultural
diversity
• How well a person
mixes and
interacts with
others
Financial health
• Focuses on one’s
attitude toward
money and a
commitment to
setting goals for
future needs,
developing good
money habits and
effectively
Environmental
Health
• Learning and
contributing to the
health of the planet
and a sustainable
lifestyle
Determinants of health
Health of an individual is a complex subject influenced by a variety of
factors which may lead to either a healthy outcome to promote health or an
unhealthy outcome to have deleterious effects on health.
Determinants of health
• Some diseases are common in younger age group while some
chronic diseases are predominant in older age groups
Age
• Women are considered to be biologically stronger than men.
• Diseases differ according the gender
Gender
• The traits transferred from parents during conception as genetic
configuration are permanent
Genetics
• Members of non-white racial and ethnic groups tend to experience
more ill health and disease than their white counterparts
Race, ethnicity
• Indirect impact on health (good educational background have
better ways and means of living improving their health standard)
Literacy status
• Scientifically and extensively linked to disease
Nutrition
• External environment: Physical and biological agents
• Internal environment: Own anatomical body parts and
physiological activities
Environment
• Daily needs of life and access to health depends upon income
Socio-economic
status
• Health behavior of person is also influenced by his socio-
cultural environment
Socio-cultural
conditions
• Good healthcare system has positive influence on health of
people
Health care
system/
services
CONCEPT OF CAUSATION
OF DISEASE
Theories of diseases
Diseases are caused
because by evil
spirits, wrath of gods,
punishment for evil
deeds during previous
births etc
Every human disease
is caused due to a
specific microbe or
“germ” which is
specific for that
disease
Diseases are spread
through “bad air” or to
various forms of close
contacts with diseased
person
In 19th century bacteria was discovered by Robert Koch and
Louis Pasteur.
Supernatural theory Contagion theory Germ theory
Epidemiological Triad Theory
Characteristics of the
“agents” which cause
the disease
Environment
Characteristics of
human being like age,
gender, ethnicity
Characteristics of the
environment in which
human being is living
Epidemiological Triad Theory
Equilibrium is maintained between
the various agent, host and
environmental factors, the person
stays healthy.
Host Agent
Moment equilibrium is disturbed
(change in any one or more of the
agent, host and environment factors)
departure from state of health occurs
Agent
Host Environment
Health
Balance Disturbed balance
Web theory of disease causation
• To explain the causation of non-communicable diseases in particular,
theory of web of causation was postulated
• Various factors related the disease, are like an interacting web of spider
• Each factor has its own relative importance in causing the final departure
from the state of health, as well as interacts with others, modifying the
effect of each other
Natural history of disease
• Complete course of a disease from the time a human host is exposed to the
disease agent in an environment to its final outcome is termed the natural
history of disease
• It has two phases:
The pre-pathogenesis period
refers to period before the
onset of disease in man
Pathogenesis phase: This
phase begins with the entry of
the disease “agent” in the
susceptible human host
1. concepts of community health
Levels of prevention
Primordial
Prevention
• It is applied when
action is taken to
remove even risk
factors to
develop
Primary
Prevention
• All measures of
prevention that
are undertake
before the onset
of the disease,
so that the
disease never
occurs
Secondary
Prevention
• “Action which
halts the
progress of a
disease at its
incipient stage
and prevents
complications”
Tertiary
Prevention
• “All the measures
available to
reduce or limit
impairments and
disabilities, and
to promote the
patients’
adjustment to
irremediable
conditions”
• Pathological process and it’s manifestations indicate a departure from
the state of perfect health
Disease
• Actual loss or damage of a part of body anatomy or an aberration of
the physiological functions that occurs consequent to a disease
Impairment
• Inability to carry out certain functions or activities which are otherwise
expected for that age / sex, as a result of the impairment
Disability
• Final disadvantage, which occurs consequent to an impairment or
disability, which limits the fulfillment of the role a person is required to
play in life
Handicap
Disability limitation
Disability limitation: The prevention of complications of a disease before
irreversible changes set in would limit disability
Rehabilitation
Medical rehabilitation
Vocational
rehabilitation
Social rehabilitation
Emotional and
Psychological
rehabilitation
Rehabilitation
When a defect or disability has already occurred, tertiary prevention can be
instituted to restore as much functions as is possible
Roles and responsibilities of
midlevel health providers (MLHP)
• A midlevel health provider is defined as a health provider:
who is trained, authorized and regulated to work autonomously
who receives pre-service training at higher education institution for at least a
total of 2–3 years
whose scope of practice include being able to diagnose, manage and treat
illness, disease and impairments, as well as engage in preventive and
promotive care
Job responsibilities
• Implement National Programmes
• Administration and management at Health and Wellness Centers
• Health education and encourage awareness about Family Planning,
Maternal and Child- Health, and Non-Communicable Diseases
• Preventive, Promotive and curative care
• Identification of Danger Signs and Referral after pre-referral stabilization
• Implement Biomedical waste disposal guidelines and Infection Control
policies
• Supervision of health workers for Maternal and Child Health, Family
Planning and Nutrition related services
Responsibilities of Health Worker (Female):
• Maternal and child health
• Family planning
• Medical termination of pregnancy
• Nutrition
• Immunization
• Implementation of communicable disease control programme
• Recording of vital events
• Treatment of minor ailments
• Maintaining all records
• Coordination with other team members
Responsibilities of Health Worker (Male)
• Record keeping
• National Health Programmes
• Assisting health worker female (HW-F)
• Ensure environmental sanitation
• Rest functions same as HW (F)
Check your progress
• Name any three sources of vitamin A
• What you will measure during Anthropometric assessment of nutrition?
• Explain the principles of Nutritional education
• What is the daily recommendation for fruits and vegetables for
pregnant woman?
• How can we increase the bioavailability of iron in pulses?
32
THANK YOU

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1. concepts of community health

  • 2. Introduction • Health is a dynamic concept • In order to protect, promote, and restore the health of individuals and populations, an integrated discipline of public health or community health came into existence. • Public health has achieved success in terms of improvement of various morbidity and mortality indicators • However, a lot needs to be achieved and mid-level health care providers (MLHPs) can play an important role in this regard
  • 3. Objectives At the end of the session participants will be able to: • Define health • Differentiate between illness, sickness and disease • Describe various dimensions of health • Enumerate determinants of health • Draw epidemiological triad with the help of example • Describe the natural history of disease • Enumerate and apply the levels of disease prevention in control of diseases
  • 4. Public Health • ‘Public Health’ : Organized community efforts aimed at prevention of disease and promotion of health. Public health Control communicable infection Improved environment Improvement hygiene through education Organization of medical and nursing services for prevention of disease Development of the social machinery for health maintenance Improved access to safe water and sanitation
  • 5. Evolution of Public Health In India Harappa culture Planned cities with drainage and practices of sanitation Ayurveda and Siddha systems of medicine 1400 B.C. 1000 A.D. Unani system of medicine Legislative measures for disease control and prevention 18th century
  • 6. Bhore committee (1943) Survey existing health conditions to recommended integration of preventive and curative services Budget allocation for national health program National malaria control program Developing rural areas National Rural Health Mission 1st five- year plan (1950) Community development program (1952) 2005 RMNCH+A 2013 Evolution of Public Health in India contd..
  • 7. CONCEPTS OF HEALTH AND ILLNESS
  • 8. Health, Illness, Sickness and Disease “State of complete physical, mental and social well-being and not merely an absence of disease or infirmity” “Socially and culturally held conceptions of health conditions, which in turn influence how the patient reacts” “Subjective sense of feeling unwell; it does not define a specific pathology, but refers to a person’s subjective experience of it, such as discomfort, tiredness, or general malaise” “Physiological or psychological dysfunction. In other words, disease implies a focus on pathological processes that may or may not produce symptoms and that result in a patient’s illness” Sickness Disease Health Illness
  • 9. Spectrum of health 1) Mortality–prevention of health 2) Serious morbidity– the prevention and control of conditions that produce disability or chronic illness 3) Minor morbidity– the handling of lesser illnesses (in terms of death and disability), environmental conditions that create inconveniences and nuisances, and 4) Positive health– the attainment of a full sense of personal vigor and mental well-being, as well as constructive relationships with others in an environment that promotes longevity and happiness
  • 11. Physical health • State of the body its compositions, development, functions, and maintenance. • Optimum physical abilities of all his body parts being intact and working in coordination Healthy eating Exercise Adequate sleep Regular check- ups Avoid harmful habits Physical Health
  • 12. Emotional health: Ability to accept and cope with our own and others feelings. • Adjusting mind-set • Not getting agitated easily • Freedom from internal conflicts • Looks for his personal identity • Strong self esteem • Knows his limitations and capabilities • Not carried away by unnecessary emotions • Ability to cope up Characteristics:
  • 13. Spiritual Health Intellectual Health • Personal beliefs and values • Attained by seeking one’s values, rights, and responsibilities, ethics, and code of living and it is the capacity to love, have compassion for others, forgiveness, joy, and fulfillment • Cognitive ability to develop skills and knowledge to enhance one’s life • It encourages creative, stimulating mental activities and improves our decision-making ability
  • 14. Occupational health • Recognize personal satisfaction and enrichment in one’s life through work • The choice of profession, job satisfaction, career ambitions, and personal performance components of occupational wellness Social Health • One’s contribution to environment and community • Deals with supportive social network, contributing to society, and valuing cultural diversity • How well a person mixes and interacts with others Financial health • Focuses on one’s attitude toward money and a commitment to setting goals for future needs, developing good money habits and effectively Environmental Health • Learning and contributing to the health of the planet and a sustainable lifestyle
  • 15. Determinants of health Health of an individual is a complex subject influenced by a variety of factors which may lead to either a healthy outcome to promote health or an unhealthy outcome to have deleterious effects on health.
  • 16. Determinants of health • Some diseases are common in younger age group while some chronic diseases are predominant in older age groups Age • Women are considered to be biologically stronger than men. • Diseases differ according the gender Gender • The traits transferred from parents during conception as genetic configuration are permanent Genetics • Members of non-white racial and ethnic groups tend to experience more ill health and disease than their white counterparts Race, ethnicity • Indirect impact on health (good educational background have better ways and means of living improving their health standard) Literacy status
  • 17. • Scientifically and extensively linked to disease Nutrition • External environment: Physical and biological agents • Internal environment: Own anatomical body parts and physiological activities Environment • Daily needs of life and access to health depends upon income Socio-economic status • Health behavior of person is also influenced by his socio- cultural environment Socio-cultural conditions • Good healthcare system has positive influence on health of people Health care system/ services
  • 19. Theories of diseases Diseases are caused because by evil spirits, wrath of gods, punishment for evil deeds during previous births etc Every human disease is caused due to a specific microbe or “germ” which is specific for that disease Diseases are spread through “bad air” or to various forms of close contacts with diseased person In 19th century bacteria was discovered by Robert Koch and Louis Pasteur. Supernatural theory Contagion theory Germ theory
  • 20. Epidemiological Triad Theory Characteristics of the “agents” which cause the disease Environment Characteristics of human being like age, gender, ethnicity Characteristics of the environment in which human being is living
  • 21. Epidemiological Triad Theory Equilibrium is maintained between the various agent, host and environmental factors, the person stays healthy. Host Agent Moment equilibrium is disturbed (change in any one or more of the agent, host and environment factors) departure from state of health occurs Agent Host Environment Health Balance Disturbed balance
  • 22. Web theory of disease causation • To explain the causation of non-communicable diseases in particular, theory of web of causation was postulated • Various factors related the disease, are like an interacting web of spider • Each factor has its own relative importance in causing the final departure from the state of health, as well as interacts with others, modifying the effect of each other
  • 23. Natural history of disease • Complete course of a disease from the time a human host is exposed to the disease agent in an environment to its final outcome is termed the natural history of disease • It has two phases: The pre-pathogenesis period refers to period before the onset of disease in man Pathogenesis phase: This phase begins with the entry of the disease “agent” in the susceptible human host
  • 25. Levels of prevention Primordial Prevention • It is applied when action is taken to remove even risk factors to develop Primary Prevention • All measures of prevention that are undertake before the onset of the disease, so that the disease never occurs Secondary Prevention • “Action which halts the progress of a disease at its incipient stage and prevents complications” Tertiary Prevention • “All the measures available to reduce or limit impairments and disabilities, and to promote the patients’ adjustment to irremediable conditions”
  • 26. • Pathological process and it’s manifestations indicate a departure from the state of perfect health Disease • Actual loss or damage of a part of body anatomy or an aberration of the physiological functions that occurs consequent to a disease Impairment • Inability to carry out certain functions or activities which are otherwise expected for that age / sex, as a result of the impairment Disability • Final disadvantage, which occurs consequent to an impairment or disability, which limits the fulfillment of the role a person is required to play in life Handicap Disability limitation Disability limitation: The prevention of complications of a disease before irreversible changes set in would limit disability
  • 27. Rehabilitation Medical rehabilitation Vocational rehabilitation Social rehabilitation Emotional and Psychological rehabilitation Rehabilitation When a defect or disability has already occurred, tertiary prevention can be instituted to restore as much functions as is possible
  • 28. Roles and responsibilities of midlevel health providers (MLHP) • A midlevel health provider is defined as a health provider: who is trained, authorized and regulated to work autonomously who receives pre-service training at higher education institution for at least a total of 2–3 years whose scope of practice include being able to diagnose, manage and treat illness, disease and impairments, as well as engage in preventive and promotive care
  • 29. Job responsibilities • Implement National Programmes • Administration and management at Health and Wellness Centers • Health education and encourage awareness about Family Planning, Maternal and Child- Health, and Non-Communicable Diseases • Preventive, Promotive and curative care • Identification of Danger Signs and Referral after pre-referral stabilization • Implement Biomedical waste disposal guidelines and Infection Control policies • Supervision of health workers for Maternal and Child Health, Family Planning and Nutrition related services
  • 30. Responsibilities of Health Worker (Female): • Maternal and child health • Family planning • Medical termination of pregnancy • Nutrition • Immunization • Implementation of communicable disease control programme • Recording of vital events • Treatment of minor ailments • Maintaining all records • Coordination with other team members
  • 31. Responsibilities of Health Worker (Male) • Record keeping • National Health Programmes • Assisting health worker female (HW-F) • Ensure environmental sanitation • Rest functions same as HW (F)
  • 32. Check your progress • Name any three sources of vitamin A • What you will measure during Anthropometric assessment of nutrition? • Explain the principles of Nutritional education • What is the daily recommendation for fruits and vegetables for pregnant woman? • How can we increase the bioavailability of iron in pulses? 32