DR.MAHESH.V Post graduate, DEPT.

OF Community Medicine, KIMS HUBLI

INTRODUCTION
Community medicine: It is a specialty of medicine concerned with disease prevention and health promotion among individuals, families, & communities.

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 .

 These changing titles characterize ours as a

YOUNG AND DYNAMIC DISCIPLINE EARNESTLY STRIVING TO UNRAVEL ITS TONE POTENTIALS .

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. from child wood to old age) organ systems of human body but also the awareness of the civic, social , legal & economic organization of the society. range of skills . Have basic understandings & skills to deliver general medicine care & possess in depth knowledge of communicable and non communicable disease ,principles of social & behavior sciences.

It demands not only study of general medicine covering all the

Therefore community specialist has to acquire vast knowledge &

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 sexual transmission).
Founder of epidemiology. THOMAS SYDENHAM (1624-1689): -D/D of scarlet fever , malaria, dysentery & cholera . First distinguished epidemiologist.

AESCULAPIUS 1200BC

HYGIEA

PANACEA

DEPARTMENT OF HYGIENE

DEPARTMENT OF MEDICINE

DEPARTMENT OF PUBLIC HEALTH(18341848)

PREVENTIVE ASPECT

CURATIVE ASPECT (1873)

DEPARTMENT OF SOCIAL MEDICINE(194 0-1948)

DEPARTMENT OF P&SM

DEPARTMENT OF COMMUNITY MEDICINE

SANITARY AWAKENING
In 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 as FATHER OF PUBLIC HEALTH.

Sanitary awakening
Department of street cleaning - sweeper roll call ,

line drawing 1898 LONDON

PUBLIC HEALTH:
C.E.A WINSLOW in 1920 defined public health as science of art of PREVENTING DISEASE PROLONGING LIFE & PROMOTING HEALTH & EFFICIENCY THROUGH ORGANIZED 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 .

CHANGING CONCEPTS IN PUBLIC HEALTH

A) DISEASE CONTROL PHASE (1880-1920)-

sanitary measures.

B) HEALTH PROMOTIONAL PHASE (1920-1960)-

personal health services.

C ) SOCIAL ENGINEERING PHASE (1960-1980): social & behavioral aspects of disease & health were given a new priority
Public health moved in to preventive & rehabilitative

aspects of disease & behavioral problems.

In this process goals of public health & community

health overlapped. So some readers preferred using community health

D) HEALTH FOR ALL PHASE (1981-2000): Only 20 percent of people in developing countries enjoyed good health facilities. To provide good health facilities to 80 percent health for all by 2000 was pledged by members of WHO .

MODERN MEDICINE
CURATIVE MEDICINE Removal Of Disease.
PREVENTIVE MEDICINE/COMMUNITY MEDICINE

Prevention of disease .
SOCIAL MEDICINE Study of man as social being

in his total environment .

FAMILY MEDICINE - Family oriented medicine or

health care centered on the family as unit .

PREVENTIVE MEDICINE:
It is the science and art of

Preventing disease Prolonging life and Promoting 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 limitation and rehabilitation

SOCIAL MEDICINE

The study of the social, economical, environmental, cultural, psychological and genetic factors which have a bearing on the health of groups of individuals and individuals in these groups; and at the same time with practical measures within the social field that may be taken to promote health, prevent disease and assist recovery of the sick.
By derivation, it is the study of man as a social being in his total environment.

McKeon says In contemporary usage social medicine has TWO meanings:

ONE BROAD AND ILL-DEFINED and other MORE RESTRICTED BUT PRECISE. o In the broad sense, social medicine is an expression of the humanitarian tradition in medicine and people read into it any interpretation consistent with their aspirations and interests. Thus it may be identified with care 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 body of knowledge embodied in epidemiology and the study of the medical needs or medical care of society.

COMMUNITY MEDICINE
A

branch of medical practice that is concerned with promoting, maintaining, and when necessary, restoring the health of human communities rather than with the clinical care 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

FAMILY MEDICINE
A field of specialization in medicine which is neither disease

nor organ oriented. It is family oriented medicine of health care centered on the family as a unit from first contact to the ongoing care of chronic problems (from prevention to rehabilitation.

Family practice is horizontal practice.

Distinction B/W curative medicine & preventive medicine

Curative medicine
Preventive medicine

Individual Disease Diagnosis and treatment

Populations Health Prevention and health promotion

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 & promoting

the publics health .

C. Partnership with the population served.

Cont.
D. Recognizing underlying socio-economic

determinants of health and disease . E. Emphasis on prevention. F. Identifying & dealing with proximal risk factors. G. Multidisciplinary basis for action.

What do community medicine specialists do?

Assess the health needs of the population by identifying appropriate information 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 statistical methods required to summarize & analyze the information.
Set priorities and develop programs to meet the health needs of the population. Implement programs taking in to account the socioeconomic, educational, occupational & political factors . Develop skills in evaluating programs & in providing consultation to others

involved in the planning, management or evaluation of health services

 Table I: Topics grouped by respondents in pile sort exercise and their reasons for grouping Respondent Groups of subjects as formed by respondents Reasons for grouping

1 Epidemiology, Non-communicable diseases, Anthropometry, Demography Academic relevance Immunization, Primary Health Care, Cold chain Subject of practical relevance Dietary survey, Health education, Disaster management, Survey methods, Documentation, Communication skills. 2 Primary Health Care, Epidemiology, Non-communicable diseases, Health education Related to Community health Cold chain, Demography, Anthropometry, Immunization, IMNCI Related to Maternal and Child Health

3 Functional and organizational relationship Non-communicable diseases Disaster management Communication skills Anthropometry, Epidemiology, Demography, Documentation, Survey methods, Dietary survey 4 Cold chain, Immunization Practical approaches Non-communicable disease & Disaster management Practical approach Primary Health Care, Health education, Survey methods, Dietary survey, Epidemiology, Demography, Documentation, Communication skills

5
Non-communicable diseases, Disaster management

Descriptive subjects Health education, IMNCI, Cold chain, Primary Health Care, Communication skills, Documentation Practical approach Anthropometry, Survey methods, Dietary survey, Epidemiology and Demography Mathematical subjects

WHERE DO COMMUNITY SPECIALISTS WORK?

1. 2.

Teaching ; Practice of public health at local, regional , provincial, national or international level

3.

Planning and administration of health services in institutions and government;

Community oriented clinical practice with an emphasis on health promotion & disease prevention; Assessment and control of occupational & environmental health problems; Research ;

4.

5.

6.

 As the scope of community medicine is vast it is not

possible for every community medicine specialist to have 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 essential pre-requisite for those institutions that have responsibilities of teaching and research in community medicine.
Therefore every specialist particularly in academic

positions should consider concentration on some aspects of subspecialties / themes of community medicine.

SUB SPECIALTIES OF COMMUNITY MEDICINE FOR TEACHING, RESEARCH & PRACTICE

There are 1. 2.

FOUR core subspecialties

FAMILY MEDICINE HEALTH MANAGEMENT

3.

HEALTH PROMOTION

4. EPIDEMIOLOGY

THEMES & SUBTHEMES

Reproductive & Child Health - focus on perinatal/

neonatal/preschool child/school health /infertility/reproductive tract diseases/ contraception. borne (TB), sexually transmitted (HIV/AIDS).

Communicable Diseases- vector borne diseases(malaria), air

Noncommunicable Diseases- nutrition(obesity/under

nutrition), life styles(tobacco, physical activity)etc. health etc.

Environmental Health- air pollution, sanitation, occupational

Illustrated framework of subspecialty , theme & subtheme

Subspecialty Theme
Health promotion Non communicable diseases Communicable diseases Reproductive & child health Environmental health

Subtheme
Tobacco , nutrition etc..

Epidemiology Health management

HIV, TB , Malaria etc.. Family planning , ARI etc.. Air pollution , sanitation etc..

Family medicine

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

 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

 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

 Health Policy & Management :

Academic policy advisor Legislative policy advisor

Management policy advisor

International & Global health:

Reproductive Health specialist International Health Specialist Tropical disease specialist

Link to regional directors

Special representatives of Director General

Director General office Senior 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

Sustainable Development & Healthy Environments .Health in sustainable Development .Nutrition for health & Development .Protection of Human Environment Emergency & Humanitarian Action HUMAN RIGHTS

.Child & adolescent health & development

.Reproductive Health & research womens Health

External Relations & Governing Bodies .Governing Bodies .Resource Mobilization External 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 Services Financial Services Informative & Infrastructure Services

Evidence & Information For Policy .Evidence For Health Policy

.Health Information Management & Dissemination

Organization of Health Services Delivery .Research Policy & Cooperation

 Faculty in universities or schools for learning medicine Active participation in various National programs e.g.

ICDS, EPI, UIP, CSSM, NACP, RCH etc.. WHO, UNICEF etc..

Active participation in programs under supervision of

Hospital administrator
Family medicine physician

Office in charge of Quarantine / Isolation at airports,

seaports.

 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 AH degrees holders)- Two years Master of Engineering and Public Health (open to degree holders in Civil engineering)- 18 months Diploma in Dietetics (Also open to BHSc degree holders)- One year Diploma in Health Education (also open to graduates in any discipline including Education)- One year Diploma in Health Statistics (Also open to graduates with Mathematics or Statistics)- One year Diploma in Public Health Nursing-10 months Certificate in Public Health Nursing-13 weeks.

 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.

Research opportunities
STAR- Special Treatment & Research Programs

INN Indian NCD Network

IDEA- Indian Diabetes Education Association WHO UNICEF CDC- Centre For Disease Control & Prevention CPHR- Centre For Public Health Research

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 & management

skills.

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 specialists over physicians from other disciplines

In addition to the knowledge of basic and clinical sciences and skills common to all physicians , distinctive aspects of preventive medicine include 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.

Yet
Perhaps never has there been more exciting time t0 pursue a career in public health.

why?

 Shortage of the community health specialists. Health services delivery systems are undergoing rapid change. Greater emphasis is being placed on health promotion and disease prevention as a means to reduce the costs of care by improving the health of our populations. Most experts agree that major advances in improvement of health over the next 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 communities as 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, & child substance abuse, & an increased emphasis is being placed on behavioral change 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.

References :
Text book of PSM Mahajan Gupta 2nd edition Pfizers guide to Careers in Public Health Future of academic community medicine in developing

countries- Willoughby Lathem MD IJCM vol 29, No. 4(2004-10 - 2004-12) IJCM vol 30, No. 2(2003-04 - 2005-06), by DR. Rajesh kumar , HOD department of community medicine. Future of community medicine - journal of royal society of medicine. Text book of community medicine Bhaskar Rao Foundations of preventive & social medicine Dhaar & Robbani

THANK YOU