the content briefs out about community health nursing basic knowledge, information about PHC and prevention of diseases there by promoting the health of individuals especially in the community

2. Community and community health nursing
Are the integral parts of society, focus on these two
will help us to bring optimal health in the country.

3. Definition
A community is a group of people living together in a
particular geographical area or having the same
culture/subculture or are associated to each other on the
basis of education, occupation etc.
Community is a social system, where interaction among
individuals occur. It is composed of subsystems such as
socio- cultural, political, educational, environmental and
religious.

4. Definition
Community health is defined in a broader way of
community organized effort for maintaining, protecting,
and improving the health of the people. It involves
motivating individuals and families to change patterns
of behaviours and to take such action,including seeking
of medical care,as would enable them to achieve
optimum health.

5.  Community health refers to the health status of the
members of the community, to the problems
affecting their health, and to the totality of health
care provided to the community.
WHO

6. Definition
Community health nursing is a synthesis of nursing and
public health practice applied for promoting and
preserving the health of people.
- ANA(1980)

7. Definition
It is a service rendered by professional nurse with the
Community, Groups, Families, and Individuals at home,
in health centers, clinics, schools, place of work for the
promotion of health, prevention of illness, care of the
sick at home and rehabilitation.

8. Health is perceived in different ways giving rise to
various concepts of health. Health has evolved over
the centuries as a concept from an individual concern
to a worldwide social goal.
Biomedical Concept
• Health means “absence of disease.”
• It was felt that human body is a machine and disease is an
outcome of the breakdown of the machine, and one of the
doctor’s tasks was to repair the machine.
• Developments in medical and social sciences led to the
conclusion that the biomedical concept of health was
inadequate.

9. Ecological Concept
Ecologists viewed health as a dynamic equilibrium
between man and his environment, and disease – a
maladjustment of the human organism to environment.

10. Psychosocial Concept
Advances in social sciences showed that health is not only a biomedical
phenomenon, but one which is influenced by social, psychological,
cultural, economic and political factors of the people concerned. Thus
health is both a biological and social phenomenon.
Holistic Concept
Holistic concept recognizes the strength of social, economic, political
and environmental influences on health.
It has been variously described as multidimensional process involving
the wellbeing of the person as a whole
The emphasis is on the promotion and protection of health.

11.  Health is multidimensional and are interrelated, each has its
own nature
Physical Dimension
 “Perfect functioning” of the body.
 It conceptualizes health biologically as a state in which every
cell and every organ are functioning at optimum capacity and
in perfect harmony with the rest of the body.
Mental Dimension
 Ability to respond to many varied experiences of life with
flexibility and a sense of purpose.
 Mental health has been defined as “a state of balance
between the individual and the surrounding world, a state of
harmony between oneself and others

12. Social Dimension
Harmony and integration with the individual, between each
individual and other members of society, and between
individuals and the world in which they live.
“quantity and quality of an individual’s interpersonal ties
and the extent of involvement with the community.”
Spiritual Dimension
Spiritual health refers to “something” that transcends
physiology and psychology.

13. Emotional Dimension
Relates to “feeling.” it reflects emotional aspects of humanness.
Vocational Dimension
Work often plays a role in promoting both physical and mental
health.
Physical work is usually associated with an improvement in physical
capacity, while goal achievement and self-realization in work are a
source of contentment and enhanced self-esteem.
Others
A few other dimensions have also been suggested such as
philosophical dimension, cultural dimension, socio economic
dimension, environmental dimension, educational dimension,
nutritional dimension, and so on.

14.  Indicators should be valid, reliable and objective, sensitive,
specific, feasible and relevant.
 The indicators are:
1. Morbidity indicators
2. Disability rates
3. Nutritional status indicators
4. Health care delivery indicators
5. Utilization rates
6. Indicators of social and mental health
7. Environmental indicators
8. Socioeconomic indicators
9. Health policy indicators
10. Indicators of quality of life
11. Other indicators

15. Mortality Indicators
Mortality indicators represent the traditional measures of health
status:
● Crude death rate: It is defined as the number of deaths per 1000
population per year in a given community.
● Expectation of life: “the average number of years that will be lived”
An increase in the expectation of life is regarded, inferentially, as an
improvement in health status. It can be considered as a positive health
indicator. It is a global health indicator.
● Infant mortality rate: It is the ratio of deaths under 1 year of age in a
given year to the total number of live births in the same year; usually
expressed as a rate per 1000 live births.
It is one of the most universally accepted indicators of health status.

16. Child mortality rate: It is defined as the number of deaths at ages
1-4 years in a given year, per 1000 children.
It is related to insufficient nutrition, low coverage by
immunization, etc.
Under-5 proportionate mortality rate: It is the proportion of total
deaths occurring in the under-5 age group. This rate can be used
to reflect both infant and child mortality rates.
Maternal mortality rate: Maternal mortality accounts to the
greatest proportion of deaths among women of reproductive age.
Disease-specific mortality rate: Mortality rates can be computed
for specific diseases.

17. Morbidity Indicators
Morbidity indicators supplement mortality data to describe
the health status of a population.
Morbidity rates are incidence and prevalence, notification
rates, attendance rates at outpatient departments, health
centres, admission, readmission and discharge rates, duration
of stay in hospital, and spells of sickness or absence from
work or school etc.

18. Disability Rates
Disability rates related to illness and injury supplement
mortality and morbidity indicators.
The commonly used disability rates are:
(i)event-type indicators:
(ii)person-type indicators.

19. Sullivan’s index: It is calculated by subtracting from the
life expectancy the probable duration of bed disability and
inability to perform major activities.
HALE (Health adjusted life expectancy): HALE is
based on life expectancy at birth but includes an adjustment
for time spent in poor health.
DALY (Disability – adjusted life year):DALY is a
measure of the burden of disease in a defined population and
the effectiveness of the interventions.

20. Nutritional Status Indicators
Nutritional status is a positive health indicator.
It consists of anthropometric measurements of preschool
children (e.g., weight and height, mid-arm circumference),
heights and weights of children at school entry and
prevalence of low birth weight (less than 2.5 kg).
Health Care Delivery Indicators
Frequently used indicators of health care delivery are
doctor-population ratio, doctor-nurse ratio, population bed
ratio, population per health/sub centre and population per
traditional birth attendant.

21. Utilization Rates
Proportion of people in need of a service who actually
receive it in a given period, usually a year.
Utilization rates give some indication of the care needed by a
population, and therefore, the health status of the population
such as immunization, deliveries supervised by a trained birth
attendant, methods of family planning etc.

22. Indicators of Social and Mental Health
Indirect measures
These include acts of violence and other crime, road
traffic accidents, juvenile delinquency, alcohol and drug
abuse, smoking etc.
Environmental Indicators
Environmental indicators reflect the quality of physical
and biological environment in which diseases occur and in
which the people live.
They include indicators relating to pollution of air and
water radiation, solid wastes, noise, exposure to toxic
substances in food or drink.

23. Socioeconomic Indicators
indirect indicators of health.
These include rate of population increase, level of
unemployment, dependency ratio, literacy rates,
especially female literacy rates, family size, etc.
Health Policy Indicators
The most important indicator of political commitment is
“allocation of adequate resources.”
The relevant indicators are proportion of gross national
product (GNP) spent on health services, proportion of
GNP spent on health-related activities and proportion of
total health resources devoted to primary health care.

24. Biological Determinants
Physical and mental traits of every human being are to some
extent determined by the nature of his genes at the moment of
conception.
Behavioral and Sociocultural Conditions
Health requires promotion of healthy lifestyle. Modern health
problems especially in the developed countries and in developing
countries are mainly due to changes in lifestyles. Healthy
lifestyle includes adequate nutrition, enough sleep, sufficient
physical activity etc.
Environment
Environment has a direct impact on the physical, mental and
social wellbeing of those living in it.

25.  Environmental factors range from housing, water supply,
psychosocial stress and family structure
Socioeconomic Conditions
● Economic status: Economic situation in a country is an
important factor in morbidity, increasing life expectancy
and improving quality of life, family size and pattern of
disease
● Education: Illiteracy correlates with poverty, malnutrition,
ill health, high infant and child mortality rates.
● Occupation: Productive work provides satisfaction,
promotes health and improves quality of life.
● Political system: timely decisions concerning, resource
allocation, choice of technology etc

26. Health Services
To be effective, the health services must reach the masses,
equitably distributed, accessible at a cost the country and
community can afford and social acceptable.
Aging of the Population
A major concern of rapidly aging population is increased
prevalence of chronic diseases and disabilities that deserve
special attention.
Gender
Women’s health is gaining importance in areas such as
nutrition, health consequences of violence, aging, lifestyle
related conditions and the occupational environment.
There is an increased awareness among policy makers of
women’s health issues, and encourages their inclusion in all
development as a priority.

27. HISTORICAL DEVELOPMENT
OF COMMUNITY HEALTH IN
INDIAAND ITS PRESENT
CONCEPT

28. HISTORICAL DEVELOPMENT OF COMMUNITY HEALTH IN INDIA
AND ITS PRESENT CONCEPT
ANCIENT
PERIOD
PRE
INDEPENDENCE
PERIOD
POST
INDEPENDENCE
PERIOD

29.  VEDIC PERIOD:
• Ayurveda and Siddha Systems of medicine came into
existence which
suggested development of comprehensive concept of
health.
• Ayurveda practiced throughout the India but the
Siddha system is
practiced in Tamilnadu.

30. • Atreya (about 800 b.c) is acknowledged as the
first great Indian physician and teacher.
• He lived in the ancient university of takshashila.

31. • Charaka compiled his famous treatise on medicine,
the “charaka samhita”.
• He explained about 500 drugs.
• He was a first physician to explain the concept of
digestion, metabolism, immunity, genetics and drugs.

32. • Father of Indian surgery
• Written “shusruta samhita”
• Performed so many surgeries in ancient India
eg. Amputation, tumor extraction, hernia repair and
plastic surgery etc.
• British physicians learned rhinoplasty from Indian
surgeons.

33. • King Ashoka and other Buddhist kings
established Ayurveda hospitals and schools of
medicine in India.
• King Ashoka patronized Ayurveda as state
medicine.

34. NALANDA UNIVERSITY TAKSHASHILA UNIVERSITY

35. • Introduced unani system of medicine.
• Ayurveda started to decline.
• Exchange of thoughts and experience between the Hindu,
Arab, Persians, Greek and Jewish scholars.

36. • Homeopathy was introduced by Samuel
Hahnemann during 1810-1839.
• India claims to have the largest number of
practitioners of homeopathy medicine in the world.

37. • 1664 : EAST INDIA COMPANY STARTED HOSPITAL
FOR SOLDIERS IN A HOUSE AT FORT. ST. GEORGE,
MADRAS.

38. • The first real development of modern public health in
India took place in 1859 when the administration of India
was taken over from east India company by the crown.
• British soldiers were died because of poor sanitation
conditions.

39. 1859:• A Royal Commission was appointed in India to
investigate the causes of unhealthy conditions prevailing in
British Army stationed in India .
• This commission recommended that there was a need in
each presidency to protect the water supply, construction of
drains and prevention of epidemics in civil population.

40. • Florence nightingale studied the public health conditions
in India and suggested the preventive measures for it.
• She suggested the measures for the welfare of the army.
• She suggested the system of nursing for hospitals in India.
• She motivated to start the nursing training schools in
India

41. • First nursing training school started in govt. General
hospital, madras.
• Separate clinical facilities for wounded soldiers in st.
George fort.
• During 1874 – 90 the christian mission hospitals in india
started training courses for nurses.
• The roman catholic nuns served as nurses in many
govt.Hospitals in india as well as in hospitals run by
religious orders.

42. • During 1874 – 90 the Christian Mission Hospitals in India
started training courses for nurses.
• The Roman Catholic Nuns served as nurses in many Govt.
Hospitals in India as well as in Hospitals run by religious
orders.

43. • 1881– First Indian Factories Act was passed and First
All India Census was taken.
• 1885– Local self Government Act was passed.
• 1888– Government directed that local bodies should be
responsible for sanitation.
• 1930- At Calcutta ,an All India Institute of Hygiene and
Public Health was established with aid from the
Rockefeller.

44. • 1931- A Maternal Child Welfare Bureau was established
by IRC Society.
• 1935-All the health activities in the country were grouped
as under the control of
(a)Central (b)Central cum provincial (c) Provincial
government
• 1937– A Central Advisory Board of health was set up.
• 1939– Madras Public Health Act was passed.
– Rural Health Training Centre at Singur near
Calcutta(Rockefeller Foundation)
• 1940– The Drugs Act was passed.

45. 1939:• Tuberculosis association of India is started to control
the tuberculosis burden in the country.
• Nursing colleges established in c.m.c Vellore and
RAK college in Delhi to provide degree in nursing.
1943– A health survey and development committee (Bhore
Committee) was appointed under the chairman of sir. Joseph
Bhore.
1946– Bhore Committees report was submitted.
- Indian nursing council is started to set the nursing
standard in india.

46. • The national government took up the responsibility of
improving health of people with the Bhore committee’s
report.
• Ministry of health was established at Central and State
level.
1948:– India joined as a member of WHO.
– ESI Act was passed
– Environment Hygiene Committee was published.
1950:– Planning Commission was set up in India.
– Central Food Technological Institute was established.

47. • 1951- First Five Year Plan began.
- BCG Vaccination program was launched.
-Central Drug Research Institute was opened at Lucknow.
• 1952- Central council of health was statutorily constituted
with Union minister of health as chairman and health
Minister of states as members.
• 1953:- Model Public Health Act Committee was appointed.
-National Malaria Control Program was initiated.
- National Smallpox Eradication Program was started.
-Family Planning Program began, Family Planning
Research and Program was set up.

48. 1954:-Contributory Health Services Scheme was initiated in Delhi.
-Central Social Welfare board was setup
-National water supply and sanitation scheme was inaugurated.
National Leprosy Control Program as started.
- VDRL antigen production was setup.
-Food Adulteration Act was passed.
1955:-National Filiria Control Programme was started.
- Central Research Centre and Central Leprosy Training was
established in TN.
-National TB Survey Commenced.
1956
-Second Five Year plan began.
- Central Health education bureau was established.
-Director of Family Planning was established.
Chemotherapy centre started at Madras

49. • 1958- NMCP was changed to NMEP.
• 1959- Mudaliar Committee was appointed.
-Rajasthan was first state to introduce Panchayat Raj
-National TB Institute at Bangalore was established.
• 1960-School Health Committee was formed.
• 1961-3rd Five Year Plan was launched.
• 1962-Central Family Planning Institute was established
in New Delhi.
-National Smallpox eradication Program, National
Goitre Control
-Program, National School Health Program and
district TB control program was established.

50. • 1963-Applied Nutrition Program started.
-NICD established.
-National Trachoma control program was
started.
• 1965 -IUCD was introduced
-Direct BCG vaccination program without
tuberculin tests was introduced.

51.  In May 1977, World Health Assembly decided that the main social
goal of governments in the coming years should be the “attainment
by all the people of the world by the year 2000 AD of a level of
health that will permit them to lead a socially and economically
productive life.
 ” This goal has come to be popularly known as “Health for all by the
year 2000.”
 There was a growing concern about the low levels of health status of
the majority of the world’s population, especially the rural poor
 the gross disparities in health between the rich and poor, urban and
rural population, both between and within countries. The important
principle in this concept is “equity in health”, which means all

52.  The concept of primary health care came into limelight
in 1978 following an international conference in Alma
Ata, erstwhile USSR. It has been defined as:
 “Essential health care based on practical, scientifically
sound and socially acceptable methods and technology
made universally accessible to individuals and families
in the community through their full participation and at
a cost that the community and the country can afford to
maintain at every stage of their development in the spirit
of self-determination.”

53.  Declaration of Alma Ata stated that primary health care
includes at least:
● Education about prevailing health problems and methods of
preventing and controlling them
● Promotion of food supply and proper nutrition
● An adequate supply of safe water and basic sanitation
● maternal and child health care, including family planning
● Immunization against infectious diseases
● Prevention and control of endemic diseases
● Appropriate treatment of common diseases and injuries
● Provision of essential drugs.

54.  On September 2000, member states of the United Nations
Organization made a historic declaration that by 2015
they would meet the ‘millennium development goals’:
● Eradicate extreme poverty and hunger
● Achieve universal primary education
● Promote gender equality and empower women
● Reduce child mortality
● Improve maternal health
● Combat HIV/AIDS
● Malaria and other diseases
● Develop global partnership for development.

55. Health promotion is any combination of educational,
economical, organizational and environmental support for
behaviors and conditions of living conductive to health.
It includes-behavior and lifestyle modification
-preventive health services
-health protection directed environment
-health policies
-economic and regulatory measures

57. Organize
Communicate
Assess
plan
Act
Evaluate
Maintenance of
health