2a21scope of Community

8/2/2019 2a21scope of Community

1/49

DR.MAHESH.V

Post graduate,

DEPT. OF Community Medicine,KIMS HUBLI


2/49

INTRODUCTION

Community medicine:

It is a specialty of medicineconcerned with disease preventionand health promotion amongindividuals, families, & communities.


3/49

Cont

There is lot of confusion about DEFINITION ,SCOPE , & CONTENTS OF PUBLIC HEALTH,PREVENTIVE MEDICINE,PREVENTIVE & SOCIAL MEDICINE &COMMUNITY MEDICINE

Chronologically these terms present a WORD PICTURE OF EVOLUTION OF

THE DISCIPLINE .


4/49

These changing titles characterize ours as a

YOUNG AND DYNAMIC DISCIPLINEEARNESTLY STRIVING TO UNRAVEL ITSTONE POTENTIALS .


5/49

Cont

Scope of this specialty is quite wide ranges from planning &provision of public health services , to the delivery of primary health care through out the life cycle of human beings (i.e. fromchild wood to old age)

It demands not only study of general medicine covering all theorgan systems of human body but also the awareness of the civic,social , legal & economic organization of the society.

Therefore community specialist has to acquire vast knowledge &range of skills . Have basic understandings & skills to delivergeneral medicine care & possess in depth knowledge of communicable and non communicable disease ,principles of social & behavior sciences.


6/49

History and evolution of community medicine

Started around 1500A.D.

FRACASTORIUS(1483-1553): Theory Of Contagion (transfer of infection via minute particles &explained cause of epidemics ). Syphilis (person to person transmission during sexualtransmission).

Founder of epidemiology.

THOMAS SYDENHAM(1624-1689): -D/D of scarlet fever , malaria, dysentery & cholera .

First distinguished epidemiologist.


7/49

AESCULAPIUS1200B C

HYGIEA

DEPARTMENT OF HYGIENE

DEPARTMENTOF PUBLIC

HEALTH(1834-1848)

DEPARTMENTOF SOCIAL

MEDICINE(1940-1948)

DEPARTMENTOF P&SM

DEPARTMENT OF COMMUNITY MEDICINE

PANACEA

DEPARTMENT OFMEDICINE

PREVENTIVE ASPECT

CURATIVE ASPECT (1873)


8/49


9/49

SANITARY AWAKENINGIn 1832 EDWIN CHADWICK investigated

THE GREAT CHOLERA EPIDEMIC(gave report on sanitary conditions of labouring population ).

This became the LAND MARK in the history of public health .

It led to ENACTMENT OF PUBLIC HEALTH ACT OF 1848 in England.

This gave rise to PUBLIC HEALTH

JOHN SNOW is known as FATHER OF PUBLIC HEALTH

CHOLERA is also often called asFATHER OF PUBLIC HEALTH.


10/49

Sanitary awakening

Department of street cleaning - sweeper roll call ,line drawing 1898 LONDON


11/49

PUBLIC HEALTH:C.E.A WINSLOW in 1920 defined public health as science of art of

PREVENTING DISEASE PROLONGING LIFE &PROMOTING HEALTH & EFFICIENCY THROUGHORGANIZED COMMUNITY EFFORT

FOR

1) the sanitation of environment

2) control of communicable disease

3) the education of the individual in personal hygiene.

4) organization of medical & nursing services for early diagnosis &prevention of disease .

5) development of social machinery to insure everyone a standard of living .


12/49

CHANGING CONCEPTS IN PUBLIC

HEALTH

A) DISEASE CONTROL PHASE (1880-1920 )-sanitary measures.

B) HEALTH PROMOTIONAL PHASE (1920-1960 )-personal health services.


13/49

C ) SOCIAL ENGINEERING PHASE(1960-1980):social & behavioral aspects of disease & health

were given a new priority

Public health moved in to preventive & rehabilitativeaspects of disease & behavioral problems.

In this process goals of public health & community health overlapped. So some readers preferred usingcommunity health

D) HEALTH FOR ALL PHASE (1981-2000):

Only 20 percent of people in developing countries enjoyedgood health facilities.

To provide good health facilities to 80 percent health forall by 2000 was pledged by members of WHO .


14/49

MODERN MEDICINE

CURATIVE MEDICINE Removal Of Disease.

PREVENTIVE MEDICINE/COMMUNITY MEDICINE Prevention of disease .

SOCIAL MEDICINE Study of man as social beingin his total environment .

FAMILY MEDICINE- Family oriented medicine orhealth care centered on the family as unit .


15/49

PREVENTIVE MEDICINE:It is the science and art of

Preventing diseaseProlonging life andPromoting health and efficiency groups of individuals and individuals within these groups,

THROUGH INTERCEPTION OF DISEASE PROCESSES

Customarily applied to healthy individuals

Actions affect large numbers or population

Modern Preventive Medicine:The science and art of health promotion, disability limitationand rehabilitation


16/49

SOCIAL MEDICINE

The study of the social, economical, environmental, cultural, psychological andgenetic factors which have a bearing on the health of groups of individuals andindividuals in these groups; and at the same time with practical measures within thesocial field that may be taken to promote health, prevent disease and assist recovery of thesick .

By derivation, it is the study of man as a social being in his total environment.

o McKeon says In contemporary usage social medicine has TWO meanings:

ONE BROAD AND ILL-DEFINED and other MORE RESTRICTED BUTPRECISE .

o In the broad sense , social medicine is an expression of thehumanitarian tradition in medicine and people read into it any interpretation

consistent with their aspirations and interests. Thus it may be identified withcare of patients, prevention of disease, administration of medical services;almost with any subject in the extensive field of health and welfare.

o But in the more restricted sense , social medicine is concerned with a bodyof knowledge embodied in epidemiology and the study of the medicalneeds or medical care of society.


17/49

COMMUNITY MEDICINE A branch of medical practice that is concerned withpromoting, maintaining, and when necessary, restoring thehealth of human communities rather than with the clinicalcare of individuals.

From this definition, it can be inferred that the practice of community

medicine requires: A defined consumer population/ community

A defined health care delivery system

A comprehensive and integrated health care service.

An epidemiological understanding of community health problems

A management oriented approach for these problems


18/49

FAMILY MEDICINE

A field of specialization in medicine which is neither diseasenor organ oriented. It is family oriented medicine of healthcare centered on the family as a unit from first contact tothe ongoing care of chronic problems (from prevention torehabilitation.

Family practice is horizontal practice.


19/49

Distinction B/W curative

medicine & preventive medicineCurative medicine Preventive medicine

Individual Populations

Disease Health

Diagnosis and treatment Prevention and health promotion


20/49

Modern interpretation of Winslow's definition

by Beaglehole & Bonita

They identified the following essential elements of modern public health .

A. Collective responsibility (public =people).

B. Prime role of state in protecting & promotingthe publics health .

C. Partnership with the population served.


21/49

Cont.

D. Recognizing underlying socio-economicdeterminants of health and disease .

E. Emphasis on prevention.

F. Identifying & dealing with proximal risk factors.

G. Multidisciplinary basis for action.


22/49

What do community medicine

specialists do? Assess the health needs of the population by identifying appropriateinformation or generating new information that recognizes the interactions of biological, behavioral, social & environmental factors that affect health .

Recognize the strengths and weakness in various measurements of health &characteristics of society & understand the principles of the statisticalmethods required to summarize & analyze the information .

Set priorities and develop programs to meet the health needs of thepopulation.

Implement programs taking in to account the socioeconomic, educational,occupational & political factors .

Develop skills in evaluating programs & in providing consultation to othersinvolved in the planning, management or evaluation of health services


23/49


24/49

Table I: Topics grouped by respondents in pile sort exercise and their reasons forgrouping

Respondent Groups of subjects as formed by respondents Reasons for grouping

1Epidemiology, Non-communicable diseases, Anthropometry, Demography

Academic relevanceImmunization, Primary Health Care, Cold chain

Subject of practical relevanceDietary survey, Health education, Disaster management, Survey methods,Documentation, Communication skills.

2

Primary Health Care, Epidemiology, Non-communicable diseases, Health educationRelated to Community health

Cold chain, Demography, Anthropometry, Immunization, IMNCIRelated to Maternal and Child Health


25/49

3Functional and organizational relationshipNon-communicable diseasesDisaster managementCommunication skills Anthropometry, Epidemiology, Demography,

Documentation, Survey methods, Dietary survey 4Cold chain, ImmunizationPractical approachesNon-communicable disease & Disaster management

Practical approach Primary Health Care, Health education, Survey methods,Dietary survey, Epidemiology, Demography,Documentation, Communication skills


26/49

5Non-communicable diseases, Disaster management

Descriptive subjectsHealth education, IMNCI, Cold chain, Primary Health Care, Communication skills, Documentation

Practical approach Anthropometry, Survey methods, Dietary survey,Epidemiology and Demography

Mathematical subjects


27/49

WHERE DO COMMUNITY

SPECIALISTS WORK?1. Teaching ;

2. Practice of public health at local, regional , provincial, national orinternational level

3. Planning and administration of health services in institutions andgovernment;

4. Community oriented clinical practice with an emphasis on healthpromotion & disease prevention;

5. Assessment and control of occupational & environmental healthproblems;

6. Research ;


28/49


29/49

As the scope of community medicine is vast it is notpossible for every community medicine specialist tohave in depth understanding of all aspects of community medicine specialty.

A multi-disciplinary team having sound knowledge

base on each aspect of the specialty is an essentialpre-requisite for those institutions that haveresponsibilities of teaching and research in community medicine.

Therefore every specialist particularly in academicpositions should consider concentration on someaspects of subspecialties / themes of community medicine.


30/49

SUB SPECIALTIES OF COMMUNITYMEDICINE FOR TEACHING, RESEARCH &

PRACTICE

There are FOUR core subspecialties

1. FAMILY MEDICINE

2. HEALTH MANAGEMENT

3. HEALTH PROMOTION

4. EPIDEMIOLOGY


31/49

THEMES & SUBTHEMESReproductive & Child Health - focus on perinatal/neonatal/preschool child/school health /infertility/reproductivetract diseases/ contraception.

Communicable Diseases - vector borne diseases(malaria), airborne (TB), sexually transmitted (HIV/AIDS).

Noncommunicable Diseases - nutrition(obesity/undernutrition), life styles(tobacco, physical activity)etc.

Environmental Health - air pollution, sanitation, occupationalhealth etc.


32/49

Illustrated framework of

subspecialty , theme & subthemeSubspecialty Theme SubthemeHealth promotion Non communicable

diseasesTobacco , nutrition etc..

Epidemiology Communicable diseases HIV, TB , Malaria etc..

Health management Reproductive & childhealth

Family planning , ARIetc..

Family medicine Environmental health Air pollution , sanitation

etc..


33/49

CAREER OPPORTUNITIES.Bio statistics State health department - Data Management Director

Industry / Corporate - Director Of Clinical Trials.

Federal government - Program Evaluation Analyst.

Epidemiology Local / State Health Department - Director of Infectious / Chronic diseases

Industry/ Corporate Outcomes researcher

Federal government - CDC investigator

Pharmaco epidemiologist


34/49

Health services administration:Health Facilities Hospital/Management Care Administrator

State Health Dept Program Evaluation & Planning

Industry/ Corporate - Information Systems Manager

University - Health services Research Analyst

Federal government - Policy Analyst

Health education / Behavioral science:

Voluntary health agencies - consumer information director

Local health department - program planning & evaluation

Industry / Corporate health promotion specialist

Behavior scientist


35/49

Health communications :

Communications specialist

Journalist

Occupational safety & Health :

Corporate medical director

Environmental health

Local health department / Environment Agency - Waste management specialist

State health department / Environmental Agency - Pollution control program director

Industry / Corporate Industrial hygienist

Federal government EPA researcher / Administrator


36/49

Health Policy & Management :

Academic policy advisor

Legislative policy advisor

Management policy advisor

International & Global health:

Reproductive Health specialistInternational Health Specialist

Tropical disease specialist


37/49


38/49

Link to regionaldirectors

Special representativesof Director General

Director General officeSenior policy advisor

Director General cabinet

Communicable Diseases

.CD surveillance & response.CD control, prevention & eradication.CD research & development

Non communicable Diseases & Mental Health

Family & Community health.Child & adolescent health & development

.Reproductive Health & research womens Health

Sustainable Development & Healthy Environments.Health in sustainable Development.Nutrition for heal th & Development.Protection of Human EnvironmentEmergency & Humanitarian Action

HUMAN RIGHTS

External Relations & Governing Bodies.Governing Bodies

.Resource MobilizationExternal Cooperation & Partnerships

Office Of Press & Public Relation

Health & Technology & Pharmaceuticals.Essential Drugs & Medicine Policy

.Vaccines & Biologists.Blood Safety & Clinical Technology

General Management.Budget & Management Reform

Human Resources ServicesFinancial Services

Informative & InfrastructureServices

Evidence & Information For Policy .Evidence For Health Policy

.Health Information Management &Dissemination

Organization of Health Services Delivery .Research Policy & Cooperation


39/49

Faculty in universities or schools for learning medicine

Active participation in various National programs e.g.ICDS, EPI, UIP, CSSM, NACP, RCH etc..

Active participation in programs under supervision of

WHO, UNICEF etc..Hospital administrator

Family medicine physician

Office in charge of Quarantine / Isolation at airports,seaports.


40/49

All India Institute of Public Health And Hygiene

MD (Social and Preventive Medicine)-Three years DPH- Two years Diploma in Maternity and Child Welfare-Two years Diploma in Industrial Health Two years Master of Veterinary Public Health (Open to MBBS and BVSc and AHdegrees holders)- Two years Master of Engineering and Public Health (open to degree holders inCivil engineering)- 18 months Diploma in Dietetics (Also open to BHSc degree holders)- One year Diploma in Health Education (also open to graduates in any disciplineincluding Education)- One year Diploma in Health Statistics (Also open to graduates withMathematics or Statistics)- One year Diploma in Public Health Nursing-10 months Certificate in Public Health Nursing-13 weeks.


41/49

Ph. D. in Health Services

Ph. D in Public Health

Master of healthcare Administration (MHA)

Master of Public Health (MPH)

M S in Clinical Research Administration Program.


42/49

Research opportunities

STAR - Special Treatment & Research ProgramsINN Indian NCD NetworkIDEA - Indian Diabetes Education Association WHOUNICEFCDC- Centre For Disease Control & PreventionCPHR - Centre For Public Health Research


43/49

Public health careers offer some

thing for everyone.Epidemiology & Biostatistics - involve mathematics & biostatistics.

Environmental health - includes a wide range of science skills .

Health administration - incorporates business & managementskills.

Health education - involves skills required to develop community wide prevention programs.

Health policy - includes an under standing of law- making policy.

Edge of community medicine


44/49

Edge of community medicinespecialists over physicians from

other disciplinesIn addition to the knowledge of basic and clinical sciences and skillscommon to all physicians , distinctive aspects of preventive medicineinclude knowledge of and competence in.

Epidemiology & biostatistics

Administration (including planning, organization, management, financing &evaluation of health programs)

Environment & occupational health.

Application of the social & behavioral factors in health.

Application of primary , secondary & tertiary preventive measures.


45/49

Yet

Perhaps never has there been moreexciting time

t0 pursue a career in public health .

why?


46/49

Shortage of the community health specialists.

Health services delivery systems are undergoing rapid change .Greater emphasis is being placed on health promotion and disease preventionas a means to reduce the costs of care by improving the health of ourpopulations.

Most experts agree that major advances in improvement of health over thenext decades will not come from new medical findings or cures ,but rather the broader and application of population- based prevention

programs.

As the public has become better informed about the effects of toxic wastes& pollutants on their health,Greater emphasis is being placed on assuring the safety of our communitiesas well as worker health & safety . As a result, there is growing demand for experts in environmental health &industrial hygiene.

Public health research is focusing more on womens health, & childsubstance abuse, & an increased emphasis is being placed on behavioralchange to prevent the risk of STDs, HIV/AIDS, TB & unplanned pregnancies .Greater emphasis is also being placed on school health & the health of minority & disadvantaged populations.


47/49


48/49

References :Text book of PSM Mahajan Gupta 2 nd editionPfizers guide to Careers in Public HealthFuture of academic community medicine in developing

countries- Willoughby Lathem MDIJCM vol 29, No. 4(2004-10 - 2004-12)IJCM vol 30, No. 2(2003-04 - 2005-06), by DR. Rajeshkumar , HOD department of community medicine.Future of community medicine - journal of royal society of

medicine.Text book of community medicine Bhaskar RaoFoundations of preventive & social medicine Dhaar &Robbani


49/49

THANK YOU

2a21scope of Community

Documents