Community Preventive Medicine

Generality
Zhuhong (Judy)

Self-introduction
Room 402,
Department
of
Epidemiology
Biostatistics,
School of Public Health,
Tianjin Medical University

E-mail: zhuhong@tmu.edu.cn
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and

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 Feb

27rd----------Apr 24th
Little quiz 30%
Final exam 70%

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The main contents of

community preventive medicine
Generality

(1w)
Social factors (1w)
Community health service (1w)
Community mental health (2w)
Environmental health (2w)
Occupational health (2w)
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Community Preventive Medicine

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The five-star doctor WHO

Care provider
Decision-maker
Communicator
Community leader
Manager

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The

concept of the five-star

doctor is proposed as an ideal
profile of a doctor possessing a mix
of aptitudes to carry out the range of
services that health settings must
deliver
to meet the requirements of
relevance, quality, cost-effectiveness
and equity in health.

Learning objectives

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The definition of community preventive

medicine
The transformation of medical model
The definition of health and disease
The definition of primary, secondary,
tertiary prevention

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. Definition of community preventive medicine

It is the branch of medicine concerned with
assessing needs and trends of health and
disease in population and providing health
care services, which include health education
disease prevention, health care, treatment,
rehabilitation, and birth control for people
living locally.

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Preventive Med

Clinical Med

Clinical Med v.s. Preventive Med

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Community medicine realized the

expansion
from

treatment only to prevention,

from inside hospital to outside hospital,
from
physical service to psychological
service.
from technical service to social service.

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The goal of community health care

Protect
Promote
Preserve

best health status in

community residents

medical

care service + other social services

(i.e. social medicine, public health medicine)
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Questions
Why

could people have diseases?

what is medicine?
What can be done by medicine?

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. Medical Model
1.concept
Medical Model is the scientific view about the
phenomena of health and disease, is the highly
generalized, abstract concept and thought
expressed the total characteristic of the
medicine, and is the basic standpoint to guide
medical practice.
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Theory and practice have effect on each other

What is what can be done

medicine
by medicine
View method
guides
Theory

practice
produces

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2. Historical Main Medical Model

1 Spiritualism medical model
2 Nature philosophical medical model
3 Biomedical model
4 bio-psycho-social model

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(1) Spiritualism medical model

view

God and spirits bestowed the human's life and

health, and their punishment and condemnation
were diseases and disasters.
method

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To beg God and pray for his bless and

forgiveness to protect health and treat diseases.
To use natural effective plants and minerals for
medical treatment.
To banish the ghosts who caused plague.
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(2) Nature philosophical medical model

ancient

Greek medicine, Chinese medicine

Health

and disease are connected with the

natural environment and social
environment.

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Ancient Greece
view
Western medicine originator Hippocrates
thought that person's health, disease and
character depended on the mixture of these four
body fluids (mucus, blood, black bile and yellow
bile).
method
A doctor's job was only to maintain
natural essentiality of man's body.

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Hippocrates (460-377 BC)

Epidemic
Epidemic
On Airs, Waters and Places

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Ancient China
Yin-Yang

and Five Elements theories

endogenous happiness, anger, sadness, worries,

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sorrow, fear, shock

exogenous wind, cold, summer-heat, dampness,
dryness, fire
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15th century
European

Renaissance Industrial Revolution

pushed the advancement of natural science and
experimental science,
medicine
and medical model developed
increasingly.

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Boom of Life science

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Germ theory
Physiology
Anatomy
Histology
Embryology
Pathology
Immunology
Genetics
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Molecular Biology

Achievements under bio-medical model

Three big issues

in surgery
ache
Infection
Blood loss

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Astonishing achievement in biomedicine

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surgery(ache, infection and blood loss) ;

discovery of many microorganism and the
development of vaccination and chemical
therapy;
The incidence and the death rate of acute and
chronic infectious disease fell down:
Smallpox, plague, cholera, etc;
The life expectancy has increased from 30
40 years old to 60 70 years old in 50 years.
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(3) Biomedical model

in

any of disease we can find measurable

morphological and chemical changes on
organ, cell or molecule and make sure of
the biological, physical and chemical
special causes; and therapeutic means
can be found.

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(4) bio-psycho-social medical model

Background
1 Conversion of disease spectrum
2 Health requirement rise
3 Medical socialization
4 The internal integrate and exterior
development in the medical science.
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bio-psycho-social Model
biomedical

model should gradually turn into biopsycho-social medical model.

Engel 1977
an internal medicine professor
in Rochester University

Engel

Model
The health is the high level coordination between
inside and outside system.

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we must put up the three-dimensional point of

view to understand the issue of health and disease
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Human beings are not only the

biological ones, but also social ones.

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 NOTE:

The medical mode has

continuously changed and transferred
along with the development of medical
science and the demands of human
health.

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. Definition of health and disease

(WHO)
Health

is a perfect state of body,

psychology and society, but does not just
mean having no disease or weakness.

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. Definition of health and disease

(WHO)
health

and disease are relative.

It

can be regarded as a continuous

process.
Good health exists on one end, while death
on the other end. Each person has a
position at a place between the two ends,
and the position will change with the pass
of time.
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How to prevent diseases ?

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three levels of prevention

Primary
Lifestyle

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Secondary

Tertiary

Screening

Self-manage

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1. primary prevention

It is activities designed to prevent disease from

occurring in the first place, i.e., to reduce the
incidence of disease.
Example:

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preventing environmental exposures

improving human resistance to disease
Health education to diminish harmful behaviors

successful primary prevention helps avoid the

suffering, cost and burden of disease, so it is the
most cost-effective form of health care.
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2. Secondary Prevention

it is the intervention designed to reduce the

progress of a disease in asymptomatic individuals
prior to development of clinical manifestations.
i.e.three-early prevention:

applied to those diseases

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early finding, early diagnosing, early treating.

has a significant latency period
occurs commonly,
hyperlipidemia, hypertension, breast and prostate cancer.
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2. Secondary Prevention
Examples

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the Pap smear for detecting early cervical

cancer,
routine mammography for early breast cancer,
periodic determination of blood pressure and
cholesterol,
screening for high blood-lead levels in persons
with high occupational exposure.
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3. Tertiary Prevention
it

is the intervention designed to reduce

the limitations of disability from disease
in symptomatic individuals after
development of clinical manifestations
of disease, i.e. restore to highest
function, minimize the negative effects
of disease, and prevent disease-related
complications.
.

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3. Tertiary Prevention
Examples

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eliminating allergens from asthmatic

patients;
routine screening for and management
of early renal, eye, and foot problems
among diabetics;
physical exercises to regain function in
stroke patients.

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Example: PREVENTION OF DIABETES

Primary

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Prevention: Preventing occurance

the reduction of obesity
physical activity
Stop smoking, restrict drinking
balanced Diet
psychological health

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Secondary Prevention: Early Detection of

Diabetes Through Screening

early

identification of diabetes through

routine test of blood sugar to prevent or
delay the progression of the disease.

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Tertiary Prevention: Preventing or Delaying

the Complications of Diabetes
control

of blood sugar and blood pressure

microvascular and macrovascular complications;

treatment of hyperlipidemia
macrovascular disease;
regular

foot \ eye examinations and treatment

amputations and progression of retinopathy.

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Consider the following situations:

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Ms. Leonard is a 72 year-old woman with chronic bronchitis who is a

cigarette smoker. Her medication is ipratropium bromide. Her
primary prevention needs include:
A. Reviewing appropriate use of her medications 3
1
B. Receiving an annual influenza immunization
C. Obtaining pulmonary function measurement 3/2
D. Periodic sigmoidoscopy
2
Ms. Giordano is a 68 year-old woman with hypertension who resides
alone in a private home. Her secondary prevention needs include:
1
A. Administration of influenza vaccine
2
B. Annual mammography
1
C. Discussion of home safety to minimize fall risks
3
D. Avoiding or minimizing damage in target organs of hypertension
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Questions
What

is community preventive medicine?

What is the modern medical model?
The four main medical model
Give an example to explain what are
primary/secondary/tertiary prevention.

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