This condition is a disability. Disability is an umbrella term, covering impairments, activity limitations, and participation restrictions. An impairment is a problem in body function or structure; in this case, the amputation of the left leg. Due to the impairment (amputation), there is an activity limitation, which is the inability to walk without support. This activity limitation results in a disability - reduced ability to perform daily activities.

1. Concept of health and
disease
Dr. Aruna

2. Primitive medicine
 Born out of necessity
 Wrath of God, entry of evil spirits
 Supernatural theory of disease
 Medicine: appeasing Gods by prayers,
rituals and sacrifices, driving out evil
spirits
 Superstition
 Still prevalent
 Traditional healers

3. Indian medicine
 Ayurveda: knowledge of life
 5000BC
 Dhanvantri: Hindu God oof medicine
 Atharvaveda
 Charaka samita: treaty on medicine
 Susrutha: father of Indian surgery
 Thridosha theory
 Greek theory: four humors

4.  Other medical systems not of Indian
origin
 Unani Tibb,
 Homeopathy : Samuel Hahnemann
 Chinese medicine: yang & Yin,
Pioneers of immunisation, bare foot
doctors, accupunture
 Egyptian medicine: Edwin smith
papyrus, Ebers papyrus; 2000 BC old
 Mesopotamian medicine: code of
Hammurabi

5. Greek medicine
 Father of medicine: Hippocrates
 Application of clinical methods in
medicine
 Epidemiologist: differentiated epidemic
from endemic
 Book: Air, water and places
 Roman medicine: Galen

6. Revival of medicine
 Paracelsus: Swiss doctor
 Fracastorius: theory of contagion,
founder of epidemiology
 Vasalius : dissection of human body
 Ambroise pare: father of surgery
 Thomas Snedenham: true clinical
methods
 Harvey : circulation of blood
 Leeuwenhoek: microscope

7. Sanitary awakening
 Mid 19th century
 Filth, Infectious diseases,
overcrowding
 Edwin Chadwick: The sanitary
conditions of labouring population in
Great Britan
 New thinking: state has a great
responsibility in health of the people

8. Pasteur
 Identify the public health
important discovery by
the given person.
a) Developed small pox
vaccine
b) Developed vaccine for
rabies
c) Demonstrated link
between cholera and
contaminated water
source
d) Described social
medicine

9.  Identify the public health
important discovery by the
given person.
a) Developed small pox
vaccine
b) Developed vaccine for
rabies
c) Demonstrated link
between cholera and
contaminated water
source

10. Louis pasteur
 Development of live vaccine
 Developed vaccine for anthrax and
rabies
 Introduced technique of sterilisation
 Disproved the theory of spontaneous
generation
 Coined the term vaccine
 Established the different growth needs
of different bacteria

11.  Identify the person related to
preventive medicine
a) Louis pasteur
b) Edward jenner
c) James lind
d) John snow

12.  Identify the person related to
preventive medicine
a) Louis pasteur
b) Edward jenner
c) James lind
d) John snow

13. James lind
 Demonstrated the prevention of
scurvy by intake of fresh fruits

15. Edward jenner
 Vaccination
 Small pox vaccine

16. John snow

17.  Father of public health ?

19.  Presence of Bacteria in air: Louis
pasteur
 Disproved the theory of spontaneous
generation
 Robert Koch: Anthrax caused by
bacteria
 Shift to scientific knowledge

20. Modern medicine
 Curative medicine
 Preventive medicine
 Social medicine
Phases :
 Disease control phase
 Health promotional phase
 Social engineering phase
 Health for all phase

21. Socialized medicine
 Medical service and education provided by
state and regulated by professional
 Eliminates competition
 Social equity
 Universal coverage
 Free medical care supported by state

22.  ‘Yoga’ would be best described as a
form of
a) Physiotherapy
b) Preventive medicine
c) Emergency medicine
d) Caloric usurper

23.  Health implies the relative absence
of pain and discomfort and a
continuous adaptation and
adjustment to the environment to
ensure optimal function is a
 A) Piomedical concept
 B) Ecological concept
 C) Psychological concept
 D) Holistic concept

24.  Health implies the relative absence
of pain and discomfort and a
continuous adaptation and
adjustment to the environment to
ensure optimal function is a
 A) biomedical concept
 B) Ecological concept
 C) psychological concept
 D) holistic concept

25. Concept of heath
 Biomedical concept: absence of
disease
 Ecological concept : adjustment to
enviroinment
 Psychological concept: social, cultural,
economical, psychological influence
 Holistic : all above concepts

26. Definition of health
 Health is a state of complete physical,
mental and social well being and not
merely the absence of disease or
infirmity

27. Dimensions of health
 Physical dimension:
 Perfect functioning of the body
 All levels within the range of normality
for the given age and sex
 Clinical assessment, nutritional status,
biochemical & lab investigations
 Indicators : death rate, infant mortality
rate, expectation of life

28.  Mental dimension:
 Psychological factors influence health
 Assessment: questionnaires by
trained interviewers
 Social dimension:
 ties & involvement with society
 Root : positive material environment &
positive human environment

29.  Spiritual dimension:
 Something transcending physiology
and psychology
 Emotional dimension: feeling
 Vocational dimension: work related
 Others: cultural, socioeconomic,
environmental educational, nutritional,
curative, preventive dimensions

30.  Biomedical concept of health is based
on
a) Germ theory of disease
b) Absence of pain
c) A sound mind in sound body in a
sound family in a sound environment
d) none

31. Ans: a

32. Positive health
 Perfect functioning of body and mind
 Biologically
 Psychologically
 Socially
 Remain a mirage because everything
in our life is subject to change

33. Concept of well being
 Objective: standard of living
 Subjective: quality of life

34. Standard of living
 Income & occupation
 Standards of housing, sanitation &
nutrition
 Level of provision of health,
educational, recreational and other
services
 Depends on per capita GNP

35. LEVEL OF LIVING
Nine components
 Health
 Food consumption
 Education
 occupation & working conditions
 Housing
 Social security
 Clothing
 Recreation & leisure
 Human rights

36.  Most important factor?

37. Physical quality of life index
 PQLI
 Consolidation of three
 Literacy rate
 Infant mortality rate
 Life expectancy at age one
 Range : 0 to 100
 India : 65

38. HDI
 Life expectancy at age one: 20 years
 Mean years of schooling: 0 years
 Gross national income: 100 $
 Maximum values are highest observed
in time series
 HDI India for 2010 is 0.547 (medium),
rank130

39.  In HDI calculation, minimum value for
life expectancy used is
a) 10
b) 20
c) 30
d) 40

40.  In HDI calculation, minimum value for
life expectancy used is
a) 10
b) 20
c) 30
d) 40

41. HPI
 Measures deprivations in the basic
measurements of human development
 Complementary to HDI
 Indication of standard of living
 HPI of India is 31.3%

42. Determinants of health
 Mortality indicators:
 Crude death rate
 Expectation of life
 Age specific death rate
 IMR
 Years of potential years lost

43.  Morbidity indicators: incidence,
prevalence
 Disability rates:
Event type indicators: number of days
of restricted activity, bed disability
days
Person type indicators: limitation of
mobility, activity

44. Sullivan’s index
 Expectation of life free of disability
 = life expectancy – duration of bed
disability
 Direct indicator of health & well being
 Most advanced

45.  Not true about disability adjusted life
years is:
a) Used in health impact assessment
b) Used to measure the impact of non fatal
disabling conditions
c) One DALY is equal to one year of
healthy life lost
d) Japanese life expectancy statistics used
as a standard

46.  Not true about disability adjusted life
years is:
a) Used in health impact assesment
b) Used to measure the impact of non fatal
disabling conditions
c) One DALY is equal to one year of
healthy life lost
d) Japanese life expectancy statistics used
as a standard

47. DALY
 Developed by Harvard university for
world bank
 Measure of burden of disease in a
population and effectiveness of
interventions
 Impact of both fatal and non fatal
disease conditions
 Psychiatric and neurological conditions
are major contributors

48. HALY
 Measures healthy life expectancy
 Based on Life expectancy at birth
 Adjustment for life spent in poor health
 Equivalent number of years in full
health that a newborn can expect to
live based on current rates of ill health
and mortality


49. QALY
 Measure of disease burden both
quality and quantity
 Number of years added by
intervention
 Half a year lived in perfect health= 0.5
QALY

50. DFLE
 Average number of years an individual
is expected to live free of disability if
current pattern of mortality and
disability continue to apply

51.  Nutritional status indicators
 Health care delivery indicators
 Utilization rates: proportion of children
fully immunized, bed occupancy rate
 Indicators of social & mental health
 Environmental indicators

52.  Socio economic indicators
 Health policy indicators
 Indicators of quality of life
 Social indicators
 Best needs indicators: calorie
consumption, access to water,life
expectancy, deaths due to disease,
illiteracy, doctors and nurses per
population

53. Declaration of Alma ata
Primary health care includes
 Education about prevailing health
problems &methods of preventing &
controlling them
 Promotion of food supply & proper
nutrition
 Adequate supply of safe water & basic
sanitation
 Maternal & child health care, including
family planning

54.  Immunization against infectious
diseases
 Prevention & control of endemic
diseases
 Appropriate treatment of common
diseases & injuries
 Provision of essential drugs

55. Health promotion
 First international conference held on
Nov 1986
 Ottawa charter for health promotion
 HP through investment & action has a
marked impact of determinants of
health
 Ultimate goal is to increase life
expectancy
 Jakarta declaration on health
promotion:
 HP in 21st century

56.  5 key actions in HP
1. Build healthy public policy
2. Create supportive environment for
health
3. Strengthen community action for
health
4. Develop personal skills
5. Reorient health services

57. CONCEPT OF
CAUSATION

58. Germ theory of disease
 Disease agent  man disease
 One to one relationship

59. Epidemiological triad
 Not everyone exposed to agent gets
the disease
Time
Environment
Agent Host

60. Multi-factorial causation
 Pettenkofer of Munich proposed this
concept in 19th century
 NCD’s & modern day epidemics not
explained by single cause model
 Multiple risk factor of disease
 Lead to advanced model of triangel of
epidemiology

61. Epidemiological triad- advanced
model
Time
Causative factors
Group of
population & thier
characterestics
Environment behaviour,
culture physiological
factors ecological
elements

62.  Advanced model of triangle of
epidemiology does not include
a) Agent
b) Group of population and their
characteristic
c) Environment behaviour, culture,
physiological determinants,
ecological elements
d) Time

63.  Advanced model of triangle of
epidemiology does not include
a) Agent
b) Group of population and their
characteristic
c) Environment behaviour, culture,
physiological determinants,
ecological elements
d) Time

64. Advanced model
Includes all factors of communicable
disease model
 Causative factors
 Group of population and their
characteristic
 Environment behaviour, culture,
physiological determinants,
ecological elements
 Time

65.  Which is not true in web of causation?
a) Suggested by Macmohan and Pugh
b) Ideally suited in studying chronic disease
c) This model shows the variety of possible
interventions for a single disease
d) Web of causation implies that disease
cannot be controlled unless all the
multiple chains of causation are removed

66.  Which is not true in web of causation?
a) Suggested by Macmohan and Pugh
b) Ideally suited in studying chronic
disease
c) This model shows the variety of
possible interventions for a single
disease
d) Web of causation implies that disease
cannot be controlled unless all the
multiple chains of causation are

67. Web of causation

68.  Web of causation first suggested by
Macmohan and Pugh.
 Chronic disease
 All predisposing factors and their
complex relationship
 Can find variety of possible
interventions for a disease
 Removal or elimination of just only one
chain may be sufficient
 Relative risk : relative importance of

69. Ice berg of disease

70.  Water line : demarcation between
apparent and inapparent disease
 Screening ?
 Clinician’s fallacy?
 important diseases: Rubella, Polio,
Mumps, JE, influenza, diptheria
hepatitis A & B

71.  Not exhibited by?

72.  Rabies, tetanus & measles

73. Natural history of disease
 Disease : complex interaction between
man, an agent and the environment
 Best established by cohort studies
 Pre pathogenesis phase:
epidemiological triad
 interaction

74. Pathogenesis phase
 Agent factors:
1. Biological agents: infectivity,
pathogenicity, virulence
2. Nutrient agents
3. Physical agents
4. Chemical agents: endogenous,
exogenous
5. Mechanical agents
6. Absence or insufficiency or excess of a
factor necessary to health
7. Social agents

75.  Host factors(intrinsic):
 Demographic characteristics
 Biological characteristics
 Social & economical characteristics
 Life style factors

76.  Environmental factors (extrinsic)
 Physical
 Biological
 Psychosocial

77. Concepts of control
 Incidence
 Duration
 Clinical effects and complications
 Financial burden to community

78. Control :
 Dec transmission to such low levels so
that it is no longer considered to be a
public health problem
 Decrease incidence
 Decrease duration
 Decrease social & financial impact of
disease

79.  Elimination :
 Interruption of transmission of a
disease in a localises geographical
area
 0 case rate for 3 years

80.  Disease eliminated from India:
 Guinea worm : 2000 ( 0 case rate)
 Leprosy : 2005 (< 1/ 10 k )
 Yaws : 2006 (0 case rate)
 Polio : 2014 ( 0 case rate), last case (13
jan,2011)
 Maternal (0 case rate) & neonatal
tetanus (<1/10K lb) : 2015

81.  Disease on verge of elimination in
India:
 Measles
 Trachoma
 Kalazar
 Lymphatic filariasis

82. Eradication :
 Cessation of all transmission &
extermination of disease agent
 Disease eradicated till date:
 Small pox: 8th may 1980
 Polio virus type 2

83.  Amputation of left leg after road
traffic accident has been done in a
35 year old male. He cannot walk
without support. Currently this
condition is a
a) Disease
b) Impairment
c) Disability
d) Unemployed

84.  Amputation of left leg after road
traffic accident has been done in a
35 year old male. He cannot walk
without support. Currently this
condition is a
a) Disease
b) Impairment
c) Disability
d) Unemployed

85. Consequence of disease
 Sequence of events leading to
disability
 Disease-> impairment->disability-
>handicap
Example:
 Accident-> disease
 Loss of foot -> impairment
 Cannot walk -> disability
 Unemployed -> handicap

86. Prevention
Primordial prevention
 Emergence of risk factors
 Education
 Best level for NCD’s

87.  Primary prevention :
 Action taken prior to onset of disease
 Risk factors present
 Modes of intervention: health
education, environmental modification,
nutritional , life style, behavioural
 Specific protection: immunization,
supplementation, chemoprophylaxis,
contraception, control for pollution,
occupational exposure prevention

88.  Secondary prevention :
 After onset of disease
 Halts the progress
 Mode: early diagnosis & treatment
 Screening
 National health programms
 TB, leprosy , STD’s etc.,

89. Tertiary prevention:
 Disease has advanced
 Modes :
Disability limitation :
 Prevents impairment from becoming
handicap
 Physiotherapy for paralysed limb
Rehabilitation
 Training of disabled person to highest
possible level of functional ability

90. Health indicators
Characteristics:
 Valid
 Reliable
 Sensitive
 Specific
 Feasible
 Relevant

91.  Health service as a determinant of
health; not true is
a) Covers personal and community
services for treatment
b) Purpose is to improve health status of
population
c) There strong correlation between
medical density and expectation of life
at birth
d) Health services essential for social and
economical development

92.  Health service as a determinant of
health; not true is
a) Covers personal and community
services for treatment
b) Purpose is to improve health status of
population
c) There strong correlation between
medical density and expectation of life
at birth
d) Health services essential for social and
economical development

93. Health services
 Wide spectrum
 Improve health status of population
 Equitably distribution
 Essential for social and economic
development
 Strong correlation between GNP and
expectation of life at birth but no
significant correlation between medical
density and life expectancy

94.  High risk sexual behaviour is classified
in which chapter of ICD classification
a) 19
b) 20
c) 21
d) 22

95.  High risk sexual behaviour is classified
in which chapter of ICD classification
a) 19
b) 20
c) 21
d) 22

96. ICD
 10th revision (revised every 10 years)
 Produced by WHO
 21 chapters
 3 volumes
 21st chapter includes factors
influencing health status and contact
with health services: alcohol,
tobacco,drug use lack of physical
exercise, inappropriate eating habits,
high risk sexual behaviour

97.  1 – infectious diseases
 2 - neoplasms
 3 – blood & neoplasms
 4 – endocrine, nutritional & metabolic
disorders
 5 - Mental & behavioural disorders
 6 – CNS
 7 – eye
 8 – ear & mastoid
 9- CVS
 10- RS

98.  11- Digestive system
 12- skin & subcutaneos tissue
 13 – muskuloskeletal system
 14- genito urinary system
 15 – pregnancy, child birth & peurperium
 16 – perinatal period
 17 – congenital malformation & genitic
disorder
 18- clinical & lab findings not included
elsewr
 19- injury, poisoning & consequences of
external causes

99. Social medicine
 Introduced by Jules Guerin in 1848
 In 1911, Alfred grotjahn – stressed the
importance of social factors as
determinants of health & disease
 Social medicine: study of man as a
social being in his total environment
 All factors including use of health
services
 Medicine + social sciences

100.  Concerned with health of group of
individuals with a view to create,
promote , preserve & maintain
optimum health
 Unit of study : community
 Tools: epidemiology & biostatistics
 Social therapy : social & political
actions for betterment of conditions of
life
 Displaced y newer term ‘community
medicine’ : administrative &

101. Community diagnosis
 Based on collection & interpretation of
relevant data
 Age & sex distribution
 Vital statistics
 Incidence & prevalence of important diseases
 + social & economical factors
 Focus: identification of basic health needs &
health problems of the community & needs
felt by community
 Priority listed for community treatment

102. Community treatment
 Health action: health needs+
resources available+ wishes of the
people
 Improvement of water supplies,
immunization, health education,
control of specific diseases, health
legislation
 3 levels: individuals, family, community

103.  Characteristics:
 Must effectively utilize all the available
resources
 Must coordinate the efforts of all other
agencies in the community :
intersectoral co-ordination
 Must encourage the full participation
of community
Principles of primary health care