The document provides an overview of concepts related to community health and the role of mid-level health care providers. It defines key terms like health, illness, sickness and disease. It describes the various dimensions of health and determinants of health. It explains the epidemiological triad theory of disease causation and the natural history of disease. It outlines the levels of disease prevention and discusses the roles and responsibilities of mid-level health providers in areas like implementing national health programs, preventive care, identification of danger signs, and record keeping.

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

10. Dimensions of health
Health
Environment
Physical
Emotional
Intellectual
Spiritual
Financial
Occupational
Social

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

18. CONCEPT OF CAUSATION
OF DISEASE

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?
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33. THANK YOU