It's a clinical Medicine topic

1. COMMUNITY
HEALTH
W R I T T E N B Y M I C H A E L M U T I S YA
M S C P U B L I C H E A LT H , B S C P H - J K U AT, C L I - M E D & S U R G ( K M T C –
N R B )

2. INTRODUCTION TO COMMUNITY
HEALTH
• Due to interrelationships of this topic, lesson 1and 2 are going to to be combined.
• What to learn in this lesson:
• Defination of terms on community health
• Types of communities
• Preventive
• Curative
• Promotive
• Rehabilitative health

3. INTRODUCTION TO COMMUNITY HEALTH
DEFINATION OF TERMS IN COMMUNITY HEALTH
Health: is a state of complete physical,mental and social well being and not merely
the absence of disease or infirmity.
Environment: All that is external to individual . It is divided into physical, biological
and social cultural
Environmental health: ……comprises of all those aspects of human health including
quality of life, that are determined by physical,biological social factors in the environment .
Public health: is the science and art of preventing diseases ,prolonging life and promoting
mental and physical health and efficiency through organized community efforts for the
sanitation

4. COMMUNITY HEALTH
Is apart of health care that is concerned with the health of the whole population and
prevention of diseases through community participation.It involves:
Establishing the health status of the community
Planning for community services
Managing and utilizing health facilities
Community health care focus is in the population and how specific social determinants of
health and disease influence well being.
Community health emphasizes how well the community can be mobilized and and
empowered to improve on the conditions within their homes, behavior, social cultural
interaction , effective use of resources so as to achieve the best possible level of well
being.

5. DEFINITION OF TERMS ….CONT
The term community health also refers to :
Population medicine
Social medicine
Community medicine
Preventive medicine
• Research has shown that prevention of diseases, health
promotion and effective rehabilitation has far reaching
positive effects in health and social economic activities.

6. COMMUNITY
• Is a group of people (a large or small group) living in certain geographical area working
together for a common goal. It shares the same resources water,climate, and
geographical conditions health services administration and leadership.
• They also share the same disadvantages such as shortages, risks, and dangers.
• Community is made up of the following:
Individual
Family
Community

7. INDIVIDUALS
• Each individual you is different and unique. Each has got a mixture of characteristics of
which some they share with others and some of which are part of a particular culture.
• Culture is all those things which people learn, share and pass on later to generation
• One of essential things is language for it is the means by which people communicate with
one another.
• Thus as a health worker, you must be able to communicate with indivinduals in the
community where you work and acquire some knowledge of the language they speak.
• It is also important to be able to show respect and understanding for other people and
their culture as well as knowing their local practices like greetings.
• In some communities, they may follow their traditional believes, others may be both sided
consulting modern medicine at the dispensary and traditional and faith healers so that
they can get rid of what is the real cause of the disease.
• For that reason, as a health worker, you ought to understand the human behavior and the
factors that influence their behavior.

8. TYPES OF COMMUNITIES

9. FAMILY
• Is a group of two or more persons, who share emotional bonds and materials things,
usually live in the same house hold, are related by blood, marriage or adoption and
sexual relationship is socially approved by the parents.
• The family is very important social group in community health. It provides love,
security, and a sense of belonging for Indivinduals from the time they are born.
• Many of the people characteristics are influenced by the family. A child learns from the
family what behavior is acceptable in the community and the language its parents
speak.
• Families have a strong influence on what each other member does.
• Often, there is an important figure in the family who makes the decisions or whose
opinions are highly valued. Thus the opinion of the people in he family may be more
important to a person than the opinion of the health worker
• This ultimately has got an important effects on health behavior and the use of health
services.

10. TYPES OF FAMILIES
• There are different types of families in a community. Look at each in turn.
1.The Nuclear Family
• This consists of a husband and a wife with or without children. This type of family
brings forth children (family of procreation). Children born in this family consider it to be
the family of their origin.
2. The Extended Family
• This is also called a joint extended family. This family includes members of nuclear
families and other relatives, aunts, uncles, cousins, nephews and grandparents.
3. Single Parent Family
• This is formed when one parent brings up children alone either because of divorce,
separation, death or desertion of their spouse.
4.The Blended Family
• This type of family is formed when husband and wife bring into the new marriage
unrelated children from their previous marriages.

11. FUNCTIONS OF A FAMILY
• The family has many important functions, these include:
i. Bringing about a sense of togetherness and a balance between individual and
shared (mutual) action by each family member; nurturance and trust; stability and
integrity of the group; interdependence and the ability to meet demands for survival
and development
ii. Socializing its members into the larger community
iii. Teaching respect for individual members and their property. This includes respect for
differences among the family members and others
iv. Teaching tolerance, fairness and a sense of right or wrong among its members and
others
v. Caring for its members and developing a sense of trust between and among its
members
vi. Providing an environment for learning and internalising individual and gender roles
and responsibilities

12. FACTORS AFFECTING FAMILY HEALTH
• The health of a family can be influenced by both internal and external factors:
• Internal factors:
Family size
Structure
Type of members
Relationships
Biological characteristics and values
 External factors are:
Family locality
Climate and terrain
Water supply and air
Biological environment : insects, rodents,
Housing

13. FUNCTIONS OF COMMUNITY HEALTH
Having seen the different components that make up a community, now look at the
functions of the community.
• The functions of a community include:
i. Transmitting and sharing information, ideas and beliefs.
ii. Educating its children about their culture (socialising) and welcoming newcomers
into the group’s culture (acculturation)
iii. Producing and distributing services and goods
iv. Providing companionship and support to individual members and smaller groups
v. Sharing and utilising space for living, schools, health facilities, fields, roads etc.
vi. Protecting individual and group rights and welfare

14. CHARACTERISTICS OF A GOOD
COMMUNITY
i. Safe healthy environment relatively free from natural and man-made hazards
ii. Community members value hygiene
iii. Clean water
iv. Nutritious food
v. Available and utilization of health facilities
vi. Available and accessibility of suitable educational,social and recreational facilities
vii. Gainful occupation
viii. There is sound communication structure
ix. Communal and participatory approach when tackling community problem

15. PROBLEMS AFFECTING THE HEALTH OF
A COMMUNITY
I. Unsanitary environment
II. Overcrowding
III. Poverty
IV. Unclean and inadequate water
supply
V. Lack of nutritious food
VI. Unsafe environment
VII. Epidemic and endemic disease
VIII. Unstable family life
IX. Illiteracy and ignorance
X. Poor leadership and lack of
participation
XI. Adverse weather conditions
XII. Poor infrastructure
XIII. Political instability

16. LEVELS OF COMMUNITY ACTIVITY
i. The people can provide health workers with resources (Money, men, material),
logistics, and shaping the plan [ SUPPORT]
ii. They can Utopias and and join the health service [ PARTICIPATION]
iii. They can be more than mere consumers , i.e. They can take part in planning and
evaluation of service [ INVOLVEMENT]

17. AIMS OF COMMUNITY HEALTH
• Community health aims to achieve the following
i. Improved sanitation in the environment
ii. Prioritisation of the community’s needs
iii. Control of communicable diseases
iv. Health education to promote healthy behaviour and practices
v. Early diagnosis and prevention of disease
vi. Disease surveillance
vii. Case/contact tracing and treatment
viii. Empowerment of all individuals to realize their rights and responsibilities for the
attainment of good health for all.

18. GOALS OF COMMUNITY HEALTH
The main goals of community health are to:
i. Identify community health problems and needs
ii. Plan ways of meeting community health needs
iii. Implement activities geared towards meeting the community health needs
iv. Evaluate the impact of community health services/activities

19. BENEFITS OF COMMUNITY HEALTH
A successful community health programme is one in which the community and health
care providers collaborate to achieve the following benefits:
i. Increased life expectancy (life span) of every individual
ii. Decreased mortality rates particularly of mothers and children
iii. Decreased morbidity rates from all causes
iv. An increase in the total well being (physical, mental and social) of every individual
v. An increase in the quality of life for all people
vi. Overall social and economic development of the population
vii. Equitable distribution of resources
viii. Having looked at the aims, goals, and benefits of community health, you will now
explore the activities which you are expected to undertake in community health, also
referred to as the scope of community health.

20. COMMUNITY HEALTH ACTIVITIES
i. Community health assessment and diagnosis
ii. Information, education and communication
iii. Environmental sanitation and supply of adequate clean wholesome water
iv. Food hygiene and household food security
v. Personal hygiene
vi. Vector and pest control
vii. Control of communicable diseases
viii. Provision of prenatal services to pregnant women
ix. Provision of family planning services
x. Provision of child health/welfare services for children under five years old

21. COMMUNITY HEALTH ACTIVITIES
[CONT]
i. Provision of school health services
ii. Home visiting and home-based nursing care
iii. Occupational/industrial health
iv. Care of the disabled, the elderly, the disadvantaged, the chronically ill
v. Inter-sectoral collaboration
vi. Health education, counseling, and the training of other health workers

22. PRINCIPLES OF COMMUNITY HEALTH
• Before you explore the principles of community health, first look at the definition of
the word ‘principle’. A principle can be defined as: A basic belief, theory, or rule
that has a major influence on the way in which something is done.
• Principles are the basic ideas of conduct or rules of action. Principles of
Community Health (Alma Ata Declaration - WHO 1978)
i. Availability of health care for all people and at a cost they can afford
ii. Promotive and preventive aspects of health care
iii. Integration of curative and preventive services
iv. Active participation of individuals and communities in the planning and provision
of care
v. Development of maximum potential for self-care
vi. Utilisation of all levels and types of community manpower
vii. Inter-sectoral approach

23. LESSON 2

24. EPIDEMIOLOGICAL TRIAD
• The triad describes the relationship between various factors that cause disease and
how they interact to determine disease occurrence. The factors, namely agent and
host, interact in the environment to cause disease in humans. The natural
progression of a disease is influenced by the following factors:
i. The causative agent(s)
ii. The susceptible host
iii. The environment
iv. The vector(s) in some diseases

25. EPIDEMIOLOGICAL TRIAD

26. EPIDEMIOLOGICAL TRIAD [1]
1.The agent is the harmful etiological factor that causes health problems. The
etiological factor (agent) may cause disease either by its presence or by its absence. The
causative agent may be a substance, living or non-living, excessively present or lacking,
tangible or non-tangible.
2. Physical Agents
• These include mechanical forces such as friction, extreme heat, cold, humidity,
pressure, sound, radiation, electricity, etc.
3. Biological Agents
• Living organisms, such as bacteria, fungi, chlamydia, rickettsiae, protozoa, viruses,
mycoplasma, helminths.
4. Chemical Agents
• Endogenous chemical agents are those which are made by the body as a result of
abnormal metabolism, for example urea (uremia), serum bilirubin (jaundice), ketones
(ketosis, keto- acidosis), uric acid (gout), calcium carbonate(renal stones), etc.

27. EPIDEMIOLOGICAL TRIAD [2]
Exogenous chemical agents : arise from outside the body, for example allergens,
meals, fumes, gases, insecticides, etc. Exogenous chemical agents may enter into the
body tissues through inhalation, ingestion or inoculation.
Genetic Agents :Transmitted from parent to child through genes.
Nutrient Agents :Excessive or deficient intake of nutrients. This results in malnutrition
related diseases such as the most common Protein Energy Malnutrition (PEM), for
example kwashiorkor and marusmus. Other examples include iron deficiency anaemia

28. EPIDEMIOLOGICAL TRIAD [3]
Excessive or Relative Lack
• Endocrine disorders, for example diabetes mellitus (lack of insulin),
thyrotoxicosis (excess thyroid hormone).
• Immunodeficiency (HIV infection, some drugs). The human or animal that
comes into contact with and is affected by the agent is the host. Some factors
within the host determine its interaction with the agent.
• Age: Some diseases are more common in certain age groups:
Childhood: measles, whooping cough, chickenpox.
 Adulthood: diabetes mellitus, cardiovascular diseases.
 Old age: pneumonia, cancers and arteriosclerosis.

29. EPIDEMIOLOGICAL TRIAD[4]
• Lifestyle : Lifestyle choices such as: dietary habits, smoking, alcohol consumption,
substance abuse, casual sexual intercourse.
• Nutrition : Nutritional status is a major factor where food is either of inadequate
quantity, quality or both.
• Tradition : Tradition (culture, custom): food beliefs, child- rearing practices, rituals (for
example female genital mutilation).

30. EPIDEMIOLOGICAL TRIAD[5]
• Mobility: International and local travel, which may expose
• an individual to new diseases.
• Immune Status : Lack of previous exposure to a disease, lack of vaccination, or poor
natural immunity (immune deficiency). All these are referred to as intrinsic factors.

31. EPIDEMIOLOGICAL TRIAD [7]
• Biological: This includes all the living things in and around where humans live.
The living things include animals, plants and micro-organisms.
• Social and Economic:This is the human society in which every human being
lives. Men and women live among others in groups in which there are shared
values, customs, habits, beliefs, attitude and culture. Conflicts among human
beings lead to tension which may cause mental and behavioural disorders.
• Examples of social economic factors include; Housing, water, lighting, sanitation,
area of residence, food, education, occupation, working environment and health
care among others.

32. LESSON 3

33. PREVENTION
• Is the art and science of health promotion, diseases prevention, disability

35. LEVELS OF PREVENTION
• Diseases evolve over time and the pathological changes become less reversible as the
disease process continues.
• There are three stages in the development of a disease, namely, healthy, sub- clinical or
pre-symptomatic, and clinical. It is obvious that the best sort of prevention is that applied
before the person becomes ill.
• A three-level model for intervention, based on the stages of the disease, was developed
by Level and Clark (1965). The three levels of the model are:
i. Primary prevention of disease
ii. Secondary prevention of disease
iii. Tertiary prevention of disease

36. 1. PRIMARY PREVENTION
This is the actual prevention of a disease. Primary prevention is carried out before the
disease or dysfunction has occurred in the body. It is directed at decreasing the risks of
acquiring the disease.
Primary prevention methods applied to people and the environment include: health
education; environmental sanitation; supply of clean safe water; adequate
nutrition; rest; sleep; recreation; personal hygiene; good working conditions;
good housing; regular medical checkups; screening for disease; genetic
screening and counseling; immunization against specific disease; avoidance of
home, traffic, and industrial accidents.
Remember:
Prevention is better than cure.

37. 2. SECONDARY PREVENTION
• Secondary prevention aims at diagnosing a disease early and treating it even before
the symptoms have appeared.
• This is the second stage of disease which is called sub-clinical or pre-symptomatic.
The main goal is to cure the disease completely in its early stages or slow down its
progression, in order to prevent the development of complication and disability.
• This kind of prevention often requires screening, to find the people who have the
illness but don't know they have it.

38. WHAT HAPPENS IN SECONDARY PREVENTION
• Activities of Secondary Prevention
i. Screening tests to detect early the pre- symptomatic physiological and
anatomical indicators of disease, for example pap smear, random blood sugar
test,.
ii. Case finding and case-tracing.
iii. Screening surveys and examinations.
iv. Mass treatment and campaigns.
v. Adequate treatment of disease.
vi. Follow-up of treated patients at special clinics and at their homes.
Remember:
• Secondary prevention detects disease early by screening and starts treatment
promptly

39. 3. TERTIARY PREVENTION
• This means diagnosing and treating people who are already sick with a disease, in
order to reduce suffering, cure the disease, and prevent disability.
• Hence, aim is to: reduce or limit impairment and disability, minimize suffering caused
by existing disease, promote the patients adjustment to irremediable condition
• If a permanent disability such as blindness or paralysis remains, then special
rehabilitation services may be necessary. Most of the curative work that goes on in the
outpatient and inpatient departments occurs at this stage of disease.

40. CURATIVE
• In this stage, a susceptible person develops clinical illness. The disease causing
organism make the individual to start feeling unwell. Thus, he goes to seek medical
consultation.
• The susceptible host may be given medication like analgesics, antibiotics or
chemotherapy and after taking them, he gets cured. So, the aim of curative is to cure
a disease.
• Additionally, the person may be done laboratory and radiology investigations and be
treated according to the outcome of the results and subsequently get cured and his
health be restored back to normal.
• That's curative

41. PROMOTIVE [1]
• Health Promotion is the process of helping people to adopt healthier patterns of
behaviour.
• Terminology: the term Health Education is still used, but some people feel it implies
only one part of this process – the giving of information and motivation. The term
Health Promotion, which has come from the AIDS field, is commonly fashionable.
Information, Education and Communication (IEC) is used in the Family Planning field.
The newest name is BCC – Behavioural Change and Communication.
• Classic Health Education describes the kind of short talks to groups of mothers which
are given so often in PHC, about nutrition or preventing diarrhoea or whatever. Often
these talks are, top-down and one-way – examples of the "empty bottles" approach
that sees people as empty bottles, which only need to be filled up with scientific
knowledge for them to change behaviour.

42. PROMOTIVE [2]
• Now, workers focus on Behaviour Change; this can only happen if and when the individual
gets the right skills. Take for example a young girl at risk of sexual exploitation and HIV
infection. Good health BCC might help her to learn how to say “No”, might point her to other
ways to earn a living and support her six orphan brothers and sisters. This is done after the
girl and the Educator analysis why she might make certain choices rather than others.
• So the approach is to provide some new information and motivation for change; it might start
by considering sessions on FP or Malaria in an MCH Clinic and conclude that:
• • The information is directed at mothers, but cannot help If husbands or mothers-in-law make
decisions; These people must be offered an information session as well, and at a good time.
• • Health education may be used where community mobilisation is a better way to go – if
malaria is the problem, a community can reduce infection with weed-clearing and smoke.
Means and materials are also important – for malaria control, they need medicines, mosquito
nets and the money to buy them. Perhaps a cash crop?

43. HEALTH PROMOTION INCLUDES THE
FOLLOWING
• Health education
• Environmental modification (reducing air pollution, safe water , sanitary latrines, control
of insects, and improving housings
• Engineering lifestyle ( anti smoking campaign, condom promotion,etc
• Genetic and marriage counseling so as to prevent congenital diseases
• Increasing the standard of living ( the income, education, and occupational status)
• Health legislation I.e. forming rigid standards of health care

44. SPECIFIC PROTECTION
• This are measures which target particular disease:
i. Immunization
ii. Nutrient supplementation (vitamin A , iodine)
iii. Protection against occupational hazard ( masks, PPE)
iv. Avoiding allergens
v. Quality control of consumer products

45. DISABILITY LIMITATION

46. REHABILITATIVE
• Rehabilitation is to restore to a condition of good health, ability to work. It assists a
person in recovering from a deteriorating condition.
• The people to be rehabilitated are:
i. Drug and substance abuse addicts
ii. Persons with disabilities like amputation,
iii. Persons with mental and psychiatric disorders
iv. Persons with chronic disease conditions like leprosy

47. REASONS FOR REHABILITATION
i. Prevention for loss of function
ii. Slowing the rate of loss of functions
iii. Improvement or restoration of function
iv. Compensation for lost functions
v. Maintenance of current function

48. TYPES OF HANDICAPS
• Physical :- poliomyelitis
• Mental:- autism
• Social:- orphans
REHABILITATION:
There is combined use of:
i. Medical, social,educational and vocational measures
ii. For training and retraining the disabled person
iii. To the highest level of rehabilitation

49. FOUR DIMENSIONS OF REHABILITATION
1) Medical : if possible restoration of function (physiotherapy/gadgets etc)
2) Vocational:- restoration of the capacity to earn a livelihood (training and creating
jobs)
3) Social: re- introduction into family and society as a whole involving everyone to
maintain the same relationship with this person
4) Psychic: restoration of self confidence and self esteem.