1

Introduction to
Community Medicine

INTRODUCTION
Community Medicine is that branch of medicine, which
deals with the study of provision of preventive, promotive,
curative, rehabilitative and evaluative services to the community at large, through an organized comprehensive health
care delivery system.
The goal is to identify the health problems and needs of
the defined population (community diagnosis) and to provide
the comprehensive health care (preventive, promotive,
curative and rehabilitative services) in an organized manner
followed by the evaluation of the services.
The term Community Medicine is only a new terminology. It is the successor of the terms Hygiene, Preventive
Medicine, Social Medicine and Public Heath.
Hygiene
This word is derived from Greek word Hygiea, the
Goddess of Health. Her disciples were called Hygienists,
who practiced Hygiene for health. Hygiea is represented as
a beautiful woman, holding in her hand a bowl from which
a serpent is drinking. In Geek mythology, the serpent testifies
the art of healing, which symbol is retained even today.
During ancient days, due to lack of knowledge about disease
causation and spread, Hygiene and cleanliness was the only
option for the promotion of health and prevention of disease.
Hygiene is defined as the Science of health and embraces
all factors contributing to healthful living. Hygiene continued
to be in prominence until further knowledge about disease
causation was acquired.
Later when Germ theory of disease causation came
to light, in 1840, the tern Public Health came into general
use, directed towards the maintenance and improvement of
the health of the people. In 1920, Prof. Winslow defined
Public Health as the science and art of preventing the

disease, prolonging life and promoting health and efficiency

through organized community efforts, such as control of
communicable disease, sanitation, health education, etc. so
as to enable every citizen to realize his birth-right of health
and longevity. Thus the importance of preventing the disease
was highlighted. The interventions were applied to healthy
persons so as to prolong life. Thus the scope was broadened.
The discoveries in microbiology in the turn of 18th
century became a turning point in the etiological concept of
disease. Possibility of disease prevention first came to focus
when James Lind, while traveling in a ship in 1748
conclusively showed that scurvy can be prevented by the
use of fresh citrus fruits. Cellen reported that he himself
drank milk inundate with mercury to prevent syphilis. But
the major thrust came with the discovery of small-pox
vaccine by Edward Jenner. Thus the concept of Preventive
medicine was developed as a branch of medicine distinct
from public health, based on etiology, applied to healthy
people for the control of infectious disease in the community.
Preventive Medicine
Leavell and Clark defined Preventive Medicine as the
science and art of preventing the disease, prolonging life
and promoting physical and mental health and efficiency.
Thus the scope of preventive medicine was broadened
from the general measures of health promotion (i.e. Hygiene)
to specific measures of disease prevention by immunization,
including both. Thus the term preventive medicine is
regarded as synonymous with public health.
Social Medicine
This term was first used by Jules Gurein, a French Physician
in 1848. However, it was during 1911, Alfred Grotjahn of

Community Medicine

Berlin who stressed that social factors play a dominant role

in health and disease.
Social medicine is defined as, the study of man as a
social being in his total environment, (Physical, Biological
and social environment). Thus social medicine became an
extension of preventive medicine.
Social medicine achieved academic respectability in
England, when John Ryle was appointed as first Professor
of Social Medicine at Oxford University in 1943, and
Professor Crew at Edinburgh. This subject consists of the
following components.
Social anatomy, Social physiology, Social pathology and
Social therapy.
Social Anatomy
Just like human anatomy deals with the structures of the
body, so also social anatomy deals with the structure of the
society, which consists of total population, their age and
sex-wise distribution, socio-economic classification, types
of housing, occupation, industries, temples, schools, etc.
The study of social anatomy gives a back-ground
information in understanding health and disease phenomena
in the community.
Social Physiology
Just like human physiology deals with the functions of the
body, so also social physiology deals with the functions of
the society. The various aspects of human physiology and
the corresponding aspects of social physiology are as follows.
Human physiology Social physiology
Respiration
Digestion
Excretion
Reproduction
Growth
Co-ordination

Air, ventilation, housing,

Nutrition and health
Disposal of refuse, sewage excreta, dead-bodies,
etc.
Family welfare services
Demography and population dynamics
Customs, habits, traditions, beliefs, cultural
practices, etc.

Social Pathology
Just like human pathology deals with the study of abnormal
structure of the body organs, so also social pathology deals
with the study of defects in the society such as strikes,
lock-outs, theft, murder, robbery, sexual assault, juvenile
delinquency, etc. and just like the extent of pathology is
studied by post-mortem studies so also the extent of social
pathology in the community is studied by social postmortem, which consists of morbidity and mortality (disease

and death) surveys. Such surveys also help us to understand

the social factors responsible for the prevalence of the disease
in the community (explained under Sociology).
Social Therapy
Just like medical therapy (treatment) consists of administration of drugs, so also social therapy consists of adoption
of social and political actions in the community. Social action
consists of giving health education to the community,
launching Immunization programme improvement of
sanitation, etc. so that the people become health conscious,
vaccine conscious, latrine conscious, water conscious, etc.
Political action consists of implementation of certain legal
measures for the health, safety and welfare of the people.
Examples for heath legislations are Medical Termination of
Pregnancy-Act (MTP-Act); Prevention of food Adulteration
Act (PFA-Act); Employees State Insurance Act (ESI-Act);
Indian Factories Act (IFA), etc.
COMMUNITY DIAGNOSIS
This consists of identification and quantification of health
problems, in terms of morbidity and mortality rates (disease
and death rates) and their influencing factors in a community.
This helps to prioritise the halth problems and implement
control measures. On the other hand, when a diagnosis is
made in an individual by the doctor based on signs and
symptoms it is called clinical diagnosis (Table 1.1).
Table 1.1: Differences between clinical
diagnosis and community diagnosis
Clinical diagnosis
1. Made by the Doctor.
(Physician)
2. Concerned with individual
case
3. Concerned with only sick
people
4. Doctor examines the patient
5. It is arrived at based on signs
and symptoms
6. It involves laboratory
investigations
7. Doctor decides the treatment
8. Treatment is the main aim
9. It involves follow-up of case
10. Doctor is interested in
technological advances

Community diagnosis
Made by the Epidemiologist
Concerned with a defined
population
Concerned with both sick and
healthy people
Epidemiologist conducts surveys
It is arrived at based on natural
history of disease
It involves epidemiological
investigations
Epidemiologist decides the plan
of action
Prevention and promotion is the
main aim.
It involves the evaluation of
programme
Epidemiologist is interested in
statistical values

Introduction to Community Medicine

Table 1.2: Differences between community medicine
and hospital medicine
Features
1. Service area

2. Operational
strategy

3. Organizational frame
work
4. Nature of
care

Community medicine

Hospital medicine

Provides health care

to the people of defined
geographic area
Both active and passive
operational strategies
are applied, i.e. both
providers and consumers are on the move
Consists of community
Health Centers, Primary
Health Centers and Subcenters
It is comprehensive
(i.e. preventive, promo-

Draws patients from ill

defined catchment area
Only passive operational
strategy is applied, i.e.
responsibility lies on the
patient to come to
hospital for treatment
Consists of a loose
conglomeration of
primary, secondary and
tertiary care hospitals.
Only curative care,
leading to freedom from

contd...
Features

Community medicine

tive, curative and rehabilitative)

5. Intersectoral Exits between the
co-ordination health department and
the health related
departments
6. Program
Promotes active participarticipation pation in the operation
of National health programs
7. Cost-benefit Gives high cost-benefit
analysis
ratios by involving
minimum expenditure
and yielding maximum
results

Hospital medicine
illness
Virtually no intersectoral
co-ordination exists

Has limited scope in the

participation of National
health programs
Gives poor cost-benefit
ratios by involving
maximum expenditure
and yielding minimum
benefits

contd...

Community Medicine and Hospital Medicine

There are two areas of work for the physician, viz. community medicine and hospital medicine. The differences are
given in Table 1.2.
With the emergence of non-communicable disease such
as hypertension, diabetes, cancer, accidents, etc. and due
to their multifactorial etiology, the concept of multifactorial
disease causation came into vogue. So measures like early
diagnosis, identification of risk-factors, limiting the
development of disability and rehabilitation of handicapped

persons were included in the subject. Thus the scope was

broadened from Hygiene to preventive and social medicine
and now to Community Medicine. Thus the concept of
Community Medicine came into vogue.
Whatever may be the terminology, the ultimate goal is
to prevent the disease, promote the health and to prolong
the life of the people. This is based upon the principle that
Prevention is Better than Cure. Not only prevention is
better than cure, but also it is Simpler than cure, Safer than
cure, Cheaper than cure and Easier than cure. This is a
Universal Truth.