INTRODUCTION TO PUBLIC HEALTH

Dr.Madhuniranjanswamy M S
LEARNING OUTCOMES
At the end of the lecture, the student should be able to

• Describe the different concepts and phases of public health

• Discuss the history of public health and concepts of causation
Health
• ‘Health is a state of complete physical, mental and social well being
and not merely an absence of disease or infirmity’’.

‘WHO’
PUBLIC HEALTH

• The science and art of preventing disease, prolonging life and

promoting health and efficiency through organized community effort.

-Winslow 1920
DENTAL PUBLIC HEALTH

• The science and art of preventing oral disease, prolonging life and
promoting health and efficiency through organized community effort
and informed choices, society, organistaion, public and private
,individual and community.

-Downer et all 1994

Essential public health functions includes:
• Protection of the environment
• Health education
• Health legislation, and health regulations
• Prevention and control of communicable diseases
• Care for special groups as mothers,children, and workers in certain hazardous
occupations
• Assessment of health needs, plans and supports the provision of health care
services to the population
 Community Health / Community Medicine:

• Is the application of the principles of public health to communities.

• A community is a group of individuals sharing an identity, culture, and

operates through common institutions and organizations.

• A health Center in a rural or an urban area is responsible for the health of the
community they serve within their catchment area.
HISTORY OF PUBLIC HEALTH
First phase
MIASMA THEORY OF DISEASE

• Explained the spread of cholera in London and Paris

• Death was believed to be caused by miasma (pollution ≈Greek) was

considered to be a poisonous vapour or mist filled withparticles from
decomposed waste and matter (miasmata).

• Disease was said to be preventable by basic hygiene

GERM THEORY OF DISEASE
Dr.JohnSnow-science of Epidemiology
• Proposes that microorganisms are the cause of many diseases
• Source of the 1854 Cholera epidemic in the Soho neighborhood of London
was traced
• Statistical analysis showed that drinking water was the vessel of
transmission of the disease
• Cases occurred in homes which was supplied by the Broad street pump at
the centre of outbreak
• Then came the demand from people for clean water
• At that time, Thames was both a source of drinking water and
the depository for sewage.
• A legislation was brought into force in England, the Public
Health Act of 1875 for the control of man's physical
environment
• Sir John Simon (1816-1904) the first medical officer
of health in London, built up a system of public health
in England which became admiration for the rest of
world

• Early phase of public health (1880-1920) was known

as “ Disease Control Phase”
Second phase

• Edward Jenner

• The theory of immunization

• He inserted pus taken from cowpox pustule into an incision on the

boy’s arm.

• Inoculated an 8 old boy with cowpox pox virus and subsequently

observed that he was resistant and immune to small pox .
KOCHS’S POSTULATES

• Demonstrated that anthrax was caused by the bacterium bacillus

ANTHRACIS.

• Useful in determining and assessing the cause of the disease by

microorganisms.
Third phase

• Shifted focus away from public health towards concentration of

medical treatment and services delivery in hospital

• This phase also saw the disappearance given towards infectious

diseases which was addressed in the early 20th century
Fourth phase

• With growing awareness of the limitation of medical therapy to tackle

the chronic diseases and spiraling the cost of health care.
Changing concepts in public health
A. Disease control phase (1880-1920 )

• Public health during 19th century was largely a matter of Sanitary

legislation and Sanitary reforms aimed at control of man’s physical
environment . Eg :water supply, sewage disposal

• These measures were not aimed at control of any specific disease

• However these measures vastly improved the health of people due to

disease & death control.
B. Health promotional phase (1920-1960):

• At the beginning of 20th century, a new concept , “Health Promotion”

began to shape

• In addition to disease control activities, one more goal was added to

public health i.e. health promotion of individuals.

• It was initiated as personal health services, school health services,

industrial health services, mental health & rehabilitation services
C. Social engineering phase(1960-1980):

• With advances the pattern of disease began to change in developed world a new
health problems in the form of chronic disease began to emerge. e.g. Cancer,
Diabetes, Cardiovascular disease, alcoholism etc..

• A new concept, concept of “Risk Factors” came into existence.

• These problems brought new challenges to public health and it entered into a new
phase in 1960, described as “social engineering phase”

• The social & behavioral aspects of disease & health were given a new priority

• thus public health moved into preventive & rehabilitative aspects of chronic
disease & behavioral problems
D. Health for All phase (1981 -2000 AD):

• People in the developed countries,& the elite of developing countries,

enjoy all determinants of good health

• Adequate income, nutrition, education, sanitation, safe drinking water

and comprehensive health care

• In contrast, only 10 to 20 percent of developing countries enjoy ready

access to health services of any kind
• Death claims 60-250 of every 1000 live births within first year of life
& Life expectancy is 30% lower than in developed countries

• Therefore it was conceded that remaining 80% too have an equal

claim to health care.

• In 1984, the members of WHO pledged themselves an ambitious target

to provide health for all by the year 2000

i.e. attainment of level of health that will permit all people to lead
socially & economically productive life.
Changing Concepts of health
• Biomedical concept
• Ecological concept
• Psychosocial concept
• Holistic concept
Biomedical concept
• Has the basis in the ‘ germ theory of disease’

• Human body as a machine, disease as a consequence of the breakdown

of the machine and doctors task as repair of the machine

• Criticism – has minimized the role of environmental, social,

psychological and cultural determinants of health
Ecological concept
• Here health is viewed as dynamic equilibrium between man and his
environment and disease a maladjustment of the human organism to
environment
• Dubos defined health saying – health implies the relative absence of pain and
discomfort and a continuous adaptation and adjustment to the environment to
ensure optimal function
• History argues strongly that improvement in human adaptation to natural
environments can lead to longer life expectancies and better quality of life –
even in the absence of modern health delivery services
Psychosocial concepts

• 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 it is both biological and social phenomenon

Holistic concept

• Synthesis of all the above concepts

• Unified of multidimensional process involving the wellbeing of the

whole person in the context of his environment

• Implies all sectors of the society have an effect on health

• The emphasis is on the promotion and protection of health

Concepts Of Causation
• EPIDEMIOLOGICAL TRIAD
• NATURAL HISTORY OF DISEASE
• WEB OF CAUSATION
• RISK FACTORS AND RISK GROUPS
• MULTIFACTORIAL CAUSATION
• SPECTRUM OF DISEASE
• ICEBERG OF DISEASE
Epidemiological triad
AGENT
• Living or biological agents (Eg: Bacteria, virus, Fungi)

• Non Living or inanimate

a) Nutrient agents (Protein, fat)

b) Chemical agents (Arsenic, Lead)

1) Internal (Urea, Ketone Bodies)

2) External (Temperature, pressure)

HOST
Demographic characteristics :
• Age, Gender, Ethnicity
• Biological characteristics:
• Genetic, background, physiologic and biochemical characteristics,
immune status, nutritional status
• Socioeconomic characteristics:
• Social class, religion, education, marital status
• Life Style:
• Living habits, food habits etc
ENVIRONMENT
• Source or reservoir for the agents of disease

• Helps in the transmission of agents to the host, bringing about the

contact and interaction

• Can be favorable and unfavorable to man and environment

Two types
1. Internal
2. External Micro or Macro Environment
• Physical Eg. solid, liquids and gases

• Biological

• Social
Concepts of disease
Disease –

• A condition in which body health is impaired, a departure from a state

of health, an alteration of the human body interrupting the
performance of vital functions

– webster
NATURAL HISTORY OF DISEASE
• Model signifies the way in which a disease evolves over time from period
of its earliest stage to its termination as recovery or death.

Two phases

Period of pre-pathogenesis

• The process is in the environment.

• The disease agent has not yet entered man, but the factors, which favour its
interaction with the human host are present in the environment
2. Period of pathogenesis
• The process in man, begins with the entry of the
• Disease agent into the human host.
• Outcome: Recovery/Disability/Death
Web of causation
Mac mohan & Pugh – Epidemiological principles and methods

• Ideally suited for chronic diseases – interaction of multiple factors

• Considers all predisposing factors of any type & their complex inter
relationship with each other.

• Sometimes removal or elimination of just one link or chain is

sufficient to control disease, provided that link is imp in pathogenic
process
Risk Factors And Risk Groups
• An attribute or exposure that is significantly associated with the
development of disease

• A determinant that can be modified by intervention, thereby reducing

the possibility of occurrence of disease or other specified outcomes.

• Risk groups are those who are exposed to risk factors.

Multifactorial Causation
Pettenkofer of Munich (1819-1901)

• Other factors in the etiology of disease (social, economic, culture,

genetic, psychological) are also equally important

• This de-emphasizes the concept of disease agent & stress on

multiplicity of interaction between host and environment.
Spectrum Of Disease
• It is a graphic representation of the variations in the manifestation of
disease

• The sequence of events that occur in the human host from the time of
contact with the etiologic agent up to the point of the ultimate outcome

• Extends from subclinical to the fatal, progression and can be halted by

preventive measures
Iceberg Phenomenon

• Floating tip – what physician sees in community – clinical cases

• Vast submerged portion – hidden mass of disease – latent,

presymptomatic & undiagnosed or carrier cases

• Water line – demarcation between apparent and in apparent cases