This document provides an overview of community medicine, including its goals, concepts, and differences from clinical medicine. The three main goals of community medicine are primary prevention to prevent disease occurrence, secondary prevention for early disease detection and control, and tertiary prevention dealing with complications. Community medicine focuses on populations rather than individuals, uses epidemiological studies and statistics, and aims to promote health and prevent disease through public health programs. Key factors that determine health are both personal factors like genetics and behaviors, as well as environmental factors including the physical, biological, and social environment.

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CHAPTER I
GOALS OF COMMUNITY MEDICINE CURRICULUM
1- Development of an honorable physician and researcher capable of providing
international standards of medical care that follow medical ethics.
2- Prepare a community oriented physician capable of anticipating and
responding to community health needs according to the policy, regulation
and guidelines of the Ministry of Health.
3- Develop a graduate who can apply the knowledge and skills learned and is
able to be leader in motivating the community served.
CONCEPT OF COMMUNITY MEDICINE
Objectives:
- Define health and list the spectrum of health.
- Compare between clinical and community medicine
- Describe health determining factors.
Health:
It is defined by world health organization (WHO) in 1948 as “A state of
complete physical, mental and social wellbeing and not merely absence of
diseases or infirmity”. As evident from the previous definition, health does
not mean the absence of disease but it has a broader sense which includes
more care; starting from promoting health to preventing the occurrence of
diseases to treating the disease and controlling complications to finally
caring of the handicaps.
Health is a resource for everyday life, it is not the objective of living.
Positive health concept includes social and personal resources as well as
physical capabilities. Blaxter, in 1990, defined health as "it is the absence
of illness, the ability to cope with everyday activities, self control, will
power and sense of wellbeing satisfaction". From these definitions we
conclude that the Pre-requisites for health are peace, shelter, education,
food, income, stable eco-system, sustainable resources, social justice,
equity and safe environment.
The spectrum of health is divided into stages in a descending ladder:
- 100 % perfect health (can not be maintained lifelong)
- Positive Health: as defined by WHO
- Negative Health: beginning of pathological changes
- Clinical Disease: apparent sign and symptoms
- Complications: of diseases
- Death

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Diseaseorill health:
Disease is the deviation from the normal status of health i.e. it is the
presence of symptoms, signs and/or abnormal laboratory readings that
denotes the presence of physiological or pathological abnormality.
Medicine:
Medicine is the branch of science of improving health and curing disease.
Medicine has two main components: 1-Preventive and 2- Curative
Community Medicine:
It is the branch of preventive medicine, which deals with populations or
groups of individuals living in a community rather than with individual
patients. Community medicine (or Public health) can be defined as the art
of promoting health of all people living together in a common environment,
preventing and controlling illness between them and rehabilitating the
disabled individuals. It is the science teaching how to keep the whole
community healthy.
At each stage of health spectrum, community health programs have a role :
1. At the stage of positive health  promotion programs are
done through premarital examination, genetic counseling,
antenatal care, adequate nutrition, sanitary clean environment,
health consciousness, recreation, physical exercise and
relaxation. Regulations, laws and policy adopted by the
community for health protection. The aim of these programs is
to add more health to healthy individuals, to increase
immunity, to add higher quality to life years. This stage (of
course) costs more and is applied in developed countries.
2. At the stage of negative health  primary prevention programs
through immunization, health education, increased health
services, strengthening law and legislations and international
measures for prevention of diseases. The aim at this stage is to
prevent the occurrence of specific health problem.
3. At the stage of clinical diseases  secondary prevention to
control the spread of diseases mainly by case finding through
screening tests, pre-employment examination, outpatient
clinics, or at school clinic and in military service. The aim of
this stage is early detection of susceptible individuals and sub
clinical cases to treat them earlier, to prevent complications and
to prevent spread of disease to other healthy persons.
Secondaryprevention also acts on contacts of diseased persons
to protect them from being ill.
4. At the stage of complications  tertiary prevention for
rehabilitation of handicapped by finding suitable jobs and

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training, physical exercise, special aids for hearing or vision loss,
moving chairs. The aim is to benefit from the remaining
capabilities and to help the handicap to be an active member in
the community and to be independent.
To summarize, the goals of Community Medicine are:
1- Primary prevention: or health promotion is to prevent the
occurrence of disease or health hazard.
2- Secondary prevention: for early detection of disease and control
of cases and contacts to prevent spread of disease and its
complications in the community.
3- Tertiary prevention: dealing with complicated and handicapped
cases.
The following table summarizes the differences between clinical medicine
and community medicine:
Items Community medicine Clinical medicine
Target To prevent diseases To cure diseases
Customer Population or all community.
Healthy or diseased.
Individual patient.
Diseased only.
Methods of
diagnosis
Community based studies, surveys
vital indices, demographic studies,
statistics, epidemiology research
Complaint, Clinical exam. &
laboratory investigations
Management Community health programs for
promotion, prevention and control
of health hazards and
rehabilitation of disabled.
Treatment of diseases and
complications.
Branches Epidemiology, environmental
health, health management,
statistics, health services, nutrition
Internal medicine, surgery,
pediatrics, ENT, gynecology
ophthalmology.
Specialty Family medicine, occupational
medicine physician, statistician
epidemiologist. Health care
manager.
Pediatrician, gynecologist,
internal medicine physician,
surgeons. Cardiologist.
Determinants of health
Factors affecting health and disease:
(1) Personal factors (2) Environmental factors
Each individual is born with genetic inheritance (or predisposition) to
certain diseases, which can be affected by environmental factors to be
apparent clinically. The interaction between the genetic predisposition and
the environmental factors results either in occurrence of disease or

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immunity against it. Some races are immune against certain diseases
(genetically) while other races are susceptible, the environment plays
important role in the second group.
To assure health for all the community members, efforts should be
directed to both personal and environmental factors.
(1) Personal or Host factors:
Host factors can be grouped in the following categories:
1. Characteristics that can not be changed such as age, sex, race,
genetic configuration and inherited immunity.
2. Characteristics that can be modified or changed because they are
related to personal activities such as work, religion, culture, habits,
marital status, level of education and health consciousness.
Social and economic conditions: income, prestige, social position in
the community, relations to relatives and colleagues.
-Age : Reflects many biological, social and behavioral factors. Very young
and very old persons suffer from defects in immunity so they are easily
infected by bacteria or viruses. Atherosclerosis affects adults over 45 years,
most of tumors occur in old age etc..
- Sex: Variation in disease frequency in relation to sex may be due to
biological, social or behavioral attitudes between males and females.
Women are less likely to suffer from myocardial disease (ostrogen
protection) and cancer lung (mostly non-smokers) but they are more liable
to osteoporosis (hormonal), gall stones and cancer breast than men.
- Occupation: exposure in work place to certain hazards as dust
(pneumoconiosis) cause many problems in the lung such as fibrosis,
malignancy. Doctors are exposed to infections from their patients. Farmers
are exposed to insecticides and butchers are exposed to diseases affecting
animals.
- Marital Status: In general, mortality and morbidity rates are higher
among unmarried compared to married.
- Socio-economic Status: Living conditions, life style and the economic
status have a profound impact on occurrence of health hazards, for example
tuberculosis and rheumatic fever are related to unsanitary housing
conditions. Coronary heart diseases affect high standard businessmen.
Diseases of malnutrition and infections are common in poor classes while
atherosclerosis, diabetes and hypertension are common in high classes.
High standard of living means living in sanitary house, eating sanitary

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nutritious foods, seeking advice of highly specialized (expensive) doctors,
buying all prescribed drugs etc.
(2) Environmental factors:
Environment includes all the living and non-living elements in our
surroundings that can affect health. It consists of three major components:
1- Physical environment: air, water, soil and climate. Pollution in air
or water causes many diseases as asthma, allergy and toxicity.
Severe increase of temperature causes heat cramps, heat retention
and death.
2- Biological environment: plants, animals and micro-organisms.
Bacteria, viruses causing communicable diseases as tuberculosis,
measles and cholera. There are diseases that can be transmitted from
animals to man as brucellosis, rabies and tetanus.
3- Social environment: culture, beliefs, customs, laws, education,
income, use of health care services, housing, health behavior etc. it is
entirely man-made. Bad cultural and wrong beliefs as: wrapping
infants in many cloths predisposes to rickets. Stopping breast feeding
in diarrhea is wrong belief leading to deterioration of child health.
Treatment of diseases by magic is wrong belief, smoking is bad
unhealthy habit.
Use of health services for vaccination and early detection of diseases
are good behaviors that can prevent illness or complications.
Compulsory use of car seat belt and helmets for accident prevention
is an example for health protection by law.
In the following chapters we will discuss:
1. The effect of different environmental factors on health in order to
know how to prevent these hazards and live healthy.
(Environment and health).
2. The composition, characteristics and distribution of the
community members to know the magnitude of different health
problems they suffer from. These information help in planning of
preventive measures on scientific base. (Demography & vital
statistics).
3. The basic information on management of health systems and the
available health services offered in Egypt for each group of
population. (Health management, Health systems and services
for different population groups in Egypt).
4. Methods of communication with people in order to change their
wrong knowledge and behavior through health education.

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(Communication & health behavior).
5. Basic rules in healthy nutrition, how to detect and solve
nutritional health problems. (Nutrition in health & disease).
6. Study different scientific research methodology to know what is
the best method to apply in medical research to reach your aim.
(Research methodology).
7. Use of statistics in the medical field and research studies in order
to find objective scientific answers for relations between disease
and risk, compare between groups affected by disease and
control group etc.(Medical statistics).
8. Study some selected disease (communicable and non
communicable) in details to know why they occur, when and
who will be affected,. This will help in knowing how to prevent
diseases and thus keep people healthy. (Epidemiology of
diseases).
Community Medicine cares with both the environment and individuals
for achieving best levels of health.
Man Environment
1- Chemical
2- Physical
3- Radiation
4- Biological
5- Social
6- Law
7- Economic
8- Health services
Age
Race
Genetic map
Habits
Literacy
Health
behavior
Culture
Religion
Marital state
Wealth
1- Perfect health
2- +ve health
3- Diseased
4- Complicated
5- Death