2. • Community health is a major field of study within the medical and clinical
sciences which focuses on the maintenance, protection, and improvement
of the health status of POPULATION GROUPS AND COMMUNITIES.
• It is a distinct field of study that may be taught within a separate school
of public health or environmental health.
• The WHO defines community health as:
• “Environmental, social, and economic resources to sustain emotional and
physical well being among people in ways that advance their aspirations
and satisfy their needs in their unique environment”.
• Medical interventions that occur in communities can be classified as three
categories: primary care, secondary care, and tertiary care.
• Each category focuses on a different level and approach towards the
community or population group.
3. • Primary healthcare programs aim to reduce risk factors and increase
health promotion and prevention.
• Secondary healthcare is related to "hospital care" where acute care is
administered in a hospital department setting.
• Tertiary healthcare refers to highly specialized care usually involving
disease or disability management.
• The success of community health programmes relies upon the transfer of
information from health professionals to the general public using one-
to-one or one to many communication (mass communication).
• The latest shift is towards health marketing .
6. I. Primary Healthcare
• Primary healthcare is provided by health professionals, specifically the ones a
patient sees first that may refer them to secondary or tertiary care.
• Primary care refers to the work of health professionals who act as a first point of
consultation for all patients within the health care system.
• Such a professional would usually be a primary care physician, such as a general
practitioner or family physician.
• Another professional would be a licensed independent practitioner such as
a physiotherapist, or a non-physician primary care provider such as a physician
assistant or nurse practitioner.
• Depending on the locality, health system organization the patient may see
another health care professional first, such as a pharmacist or nurse.
• Depending on the nature of the health condition, patients may be referred for
secondary or tertiary care.
• Primary care is often used as the term for the health care services that play a
role in the local community.
7. • Primary care involves the widest scope of health care, including all ages of
patients, patients of all socioeconomic and geographic origins, patients
seeking to maintain optimal health, and patients with all types of acute and
chronic physical, mental and social health issues, including multiple chronic
diseases.
• Primary prevention refers to the early avoidance and identification of risk
factors that may lead to certain diseases and disabilities.
• Community focused efforts including immunizations, classroom teaching, and
awareness campaigns are all good examples of how primary prevention
techniques are utilized by communities to change certain health behaviors.
• Prevention programs, if carefully designed and drafted, can effectively prevent
problems that children and adolescents face as they grow up
• This finding also applies to all groups and classes of people.
8. • Common chronic illnesses usually treated in primary care may include,
for
example, hypertension, diabetes, asthma, COPD, depression and anxiety,
back pain, arthritis or thyroid dysfunction.
• Primary care also includes many basic maternal and child health care
services, such as family planning services and vaccinations.
• In the context of global population aging, with increasing numbers of
older adults at greater risk of chronic non-communicable diseases,
rapidly increasing demand for primary care services is expected in both
developed and developing countries.
• The World Health Organization attributes the provision of essential
primary care as an integral component of an inclusive primary health
care strategy.
9. II. Secondary healthcare
• Secondary care includes acute care, necessary treatment for a short period of
time for a brief but serious illness, injury, or other health condition. This care
is often found in a hospital emergency department.
• Secondary care also includes skilled attendance during childbirth, intensive
care, and medical imaging services.
• The term "secondary care" is sometimes used synonymously with "hospital
care".
• However, many secondary care providers, such as psychiatrists, clinical
psychologists, occupational therapists, most dental
specialties or physiotherapists, do not necessarily work in hospitals.
• Some primary care services are delivered within hospitals.
• Depending on the organization and policies of the national health system,
patients may be required to see a primary care provider for a referral before
they can access secondary care.
• In countries that operate under a mixed market health care system,
10. • This restriction may be imposed under the terms of the payment
agreements in private or group health insurance plans.
• In other cases, medical specialists may see patients without a referral,
and patients may decide whether self-referral is preferred.
• In other countries patient self-referral to a medical specialist for
secondary care is rare as prior referral from another physician (either a
primary care physician or another specialist) is considered necessary,
regardless of whether the funding is from private insurance
schemes or national health insurance.
• Allied health professionals, such as physical therapists, respiratory
therapists, occupational therapists, speech therapists, and dietitians, also
generally work in secondary care, accessed through either patient self-
referral or through physician referral.
11. III. Tertiary healthcare
• Tertiary care is specialized consultative health care, usually
for inpatients and on referral from a primary or secondary health
professional, in a facility that has personnel and facilities for
advanced medical investigation and treatment, such as a tertiary referral
hospital.
• Examples of tertiary care services
are cancer management, neurosurgery, cardiac surgery, plastic surgery,
treatment for severe burns, advanced neonatology services, palliative, and
other complex medical and surgical interventions.
12. IV. Quaternary care
• The term quaternary care is sometimes used as an extension of tertiary
care in reference to advanced levels of medicine which are
highly specialized and not widely accessed.
• Experimental medicine and some types of
uncommon diagnostic or surgical procedures are considered quaternary
care.
• These services are usually only offered in a limited number of regional or
national health care centers.
13. Home and Community Care
• Many types of health care interventions are delivered outside of health
facilities.
• They include the services of professionals in residential and community
settings in support of self-care, home care, long-term care, assisted living,
treatment for substance use disorders among other types of health and
social care services.
• Community rehabilitation services can assist with mobility and
independence after the loss of limbs or loss of function. This can
include prostheses, orthotics, or wheelchairs.
• Many countries, especially in the west, are dealing with aging populations,
so one of the priorities of the health care system is to help seniors live full,
independent lives in the comfort of their own homes.
• There is an entire section of health care geared to providing seniors with
help in day-to-day activities at home such as transportation to and from
doctor's appointments along with many other activities that are essential for
their health and well-being.
14. Measuring Community Health
• Community health is generally measured by geographical information
systems and demographic data.
• Geographic information systems (GIS) can be used to define sub-communities
when neighborhood location data is not enough.
• Traditionally community health has been measured using sampling data which
was then compared to well-known data sets, like the National Health Interview
Survey or National Health and Nutrition Examination Survey.
• With technological development, information systems could store more data
for small scale communities, cities, and towns; as opposed to census data that
only generalizes information about small populations based on the overall
population.
• GIS can give more precise information of community resources, even at
neighborhood levels.
•
15. • The ease of use of GIS, advances in multilevel statistics, and spatial
analysis methods makes it easier for researchers to procure and generate
data related to the built environment.
• Social media can also play a big role in health information analytics.
• Studies have found social media being capable of influencing people to
change their unhealthy behaviors and encourage interventions capable of
improving health status.
• Social media statistics combined with geographical information systems
(GIS) may provide researchers with a more complete image of community
standards for health and well being.
16. Health care in
India
• Primary Level: Primary healthcare is the first level of contact between the
healthcare institution and the patient.
• It includes Sub-centres and Primary Health centre.
• Sub Centre – It is the most peripheral and the first contact point between
the patient and the healthcare facility. It has three employees
1. The Health worker male
2. The Health worker female
3. A Voluntary worker
The Government of India’s Ministry of Health and Family welfare, is
responsible in providing the 100% fund for the Sub-centres.
17. • Primary Health Centres – It is the first point of contact between the village
community and the Doctor.
• It has a strength of at least 15 people, including a Medical officer, a
medical health assistant.
• The Medical officer is considered as the leader of the team or Primary
Health centre.
• Each Primary Health Centre acts as a referral point for 6 Sub-centres.
• And they have a bed strength of four to six beds.
18. • Secondary Level: The secondary level is the first referral level where
the patient is referred, depending upon the seriousness of the issue.
• It includes the Community Health Centre.
• Community Health Centre – Here, the staff strength is 30, including 4
specialist doctors, there should be a Physician, a Surgeon, a
Gynaecologist and a Paediatrician.
• Three new posts have been created under the NRHM program. They
are Ophthalmic Surgeon, Anaesthetist and Public Health Program
Manager.
• Each Community Health Centre acts as a referral point for 4 Primary
Health Centre.
19. Tertiary Level: The tertiary level is the second referral level
• It is a specialized consultative care is provided usually on referral from
primary and secondary medical care.
• Specialised Intensive Care Units, advanced diagnostic support services
and specialized medical personnel on the key features of tertiary health
care.
• In India, under public health system, tertiary care service is provided by
medical colleges and advanced medical research institutes.
