BY

K.SAGAR
ASSO PROFESSOR

CONCEPTS IN HEALTH
 CONCEPT OF CONTROL

 Aimed at reducing:
 the incidence of disease
 the duration of disease, and consequently
the risk of transmission
 the effects of infection
 the financial burden to the community
 Disease elimination

 The term "elimination" is used to describe

interruption of transmission of disease.
 EG: elimination of measles, polio ,Diphtheria
 Disease eradication

 Eradication literally means to "tear out by roots".

 Eradication of disease implies termination of all
transmission of infection by extermination of the
infectious agent.
 cessation of infection and disease from the whole
world .
 Today, smallpox is the only disease that has been
eradicated.
 candidates for global eradication within the
foreseeable future: polio, measles and dracunculiasis
 Monitoring

 "the performance and analysis of routine

measurements aimed at detecting changes in
the environment or health status of
population" .
 EG: monitoring of air pollution, water quality,
growth and nutritional status,
 on-going measurement of performance of a
health service or a health professional, or of
the extent to Which patients comply with or
adhere to advice from health professionals.
 Monitoring

 In management, monitoring refers to "the

continuous oversight of activities to ensure
that they are proceeding according to plan.
 It keeps track of achievements, staff
movements and utilization, supplies and
equipment, and the money spent in
relation to the resources available so that if
anything goes wrong, immediate corrective
measures can be taken"
 surveillance

 watch over with great attention, authority

and often with suspicion .
 surveillance is defined as "the continuous
scrutiny of the factors that determine the
occurrence and distribution of disease and
other conditions of ill-health" .
 epidemiological surveillance ,
 demographic surveillance,
 nutritional surveillance.
 USES OF SURVEILLANCE

 to provide information about new and changing

trends in the health status of a population. eg:
morbidity, mortality, nutritional status or other
indicators and environmental hazards, that may
affect health .
 to provide feed-back which may be expected to
modify the policy and the system itself and lead to
redefinition of objectives.
 provide timely warning of public health
disasters so that interventions can be mobilized.
 DIFFERENCES

 Monitoring requires careful planning and the

use of standardized procedures and methods
of data collection, and can then be carried
out over extended periods of time by
technicians and automated instrumentation.

 Surveillance requires professional analysis

and sophisticated judgment of data leading
to recommendations for control activities.
 sentinel surveillance

 A method for identifying the missing cases and

thereby supplementing the notified cases is
required. This is known as "sentinel surveillance."
 estimate the disease prevalence in the total
population.
 reporting biases are minimized
 feed-back of information
 sentinel sites could be developed into a
notification system for providing more detailed
information.
 CONCEPTS OF PREVENTION

 LEVELS OF PREVENTION:
 Primordial prevention
 Primary prevention:
 a. Population (mass) strategy
 b. high risk strategy
 Secondary prevention
 Tertiary prevention
 MODES OF INTERVENTION

 "intervention" can be defined as any

attempt to intervene (OR ) interrupt the
usual sequence in the development of
disease In man
 MODES OF INTERVENTION

 1. Health promotion
 2. Specific protection
 3. Early diagnosis and treatment
 4. Disability limitation
 5. Rehabilitation
 Health promotion

 health education
 environmental modifications
 nutritional interventions
 lifestyle and behavioral changes
Disability limitation

 Accident.............. Disease (or disorder)

 Loss of foot ........ Impairment (extrinsic or
intrinsic)
 Cannot walk ........ Disability (objectified)
 Unemployed ....... Handicap (socialized)
CHANGING PATTERN OF DISEASE
Developed countries
 Infectious diseases
 CHD, cancer accident
 Chronic non communicable diseases
 Mental disorders (Alzheimer's disease)
 Social Pathology due to alcohol & drug abuse.
 Environmental health problems connected
with toxic, carcinogenic & mutagenic material
in the external environment
CHANGING PATTERN OF DISEASE
Developing countries
 infectious, parasitic & respiratory diseases,
malnutrition, Diarrhoeal diseases, tuberculosis,
filariasis, viral hepatitis,dysentry
 On the other hand, increase in the "new" health
problems such as coronary heart disease,
hypertension, cancer, diabetes and accidents.
 pneumoconiosis
 The emerging picture is a mixture of the old and
"modern" diseases.
Factors which play a role in
the changing patterns
 changing lifestyles
 living standards,
 demographic factors,
 urbanization and industrialization,
 medical interventions,
 genetic defects,
 Technology , ecology
 Emphasize on forward looking solutions
Population medicine

 Hygiene
 Social medicine
 Preventive medicine
 Community medicine
 Public health
 Hygeia, the goddess of Greek mythology.

 Hygeine “the art of science of health and

embraces all factors which contribute to
healthful living.
Public health

 Terms like preventive medicine,

social medicine and community medicine are
used as synonyms for public health
Preventive medicine

 applied to "healthy" people.

 It scored several successes in the prevention
of communicable diseases based on:
 immunization.
 health promotion, specific protection
 Early diagnosis & prompt treatment,
 prevention of disability
Preventive medicine

 screening for disease, population control,

environmental control
 genetic counseling
 prevention of chronic diseases.
 control of coronary heart disease,
 hypertension and cancer
 preventive pediatrics,
 preventive geriatrics
 preventive cardiology
 In this the Goals of preventive medicine &
public health have become identical, i.e.,
Health for All.
 primary, secondary and tertiary
levels of prevention
 The cornerstone of preventive
medicine is ''primary prevention”.
Social medicine

 "social medicine" was first introduced by Jules

Guerin a French physician in 1848.
 In 1911, the concept of social medicine was
revived by Alfred Grotjahn of Berlin who
stressed the importance of social factors as
determinants of health and disease.
 These ideas of social medicine spread
throughout Europe and England after the
First World War.
 "Social medicine” stands upon two pillars,
medicine & sociology.
 The laboratory to practice social medicine is
the whole community;
 the tools for diagnosing community ills
are epidemiology and biostatistics;
 Social therapy does not consist in
administration of drugs but social and
political action for the betterment of
conditions of life of man.
 Terms such as social anatomy, social
physiology, social pathology.
 In 1968, the Report of the Royal Commission
on Medical Education (Todd Report) for the
first time referred to "community medicine"
instead of social medicine
Community medicine

 It is a practice which focuses on the health

needs of community as a whole.
 aims to change the health of the
community by intervention both at
individual and group level.
 epidemiology, biostatistics
Functions of a physician

 provide promotive,
 preventive,
 curative,
 rehabilitative
 emergency care services appropriate to
meet the main health problems in the
community, with special attention to
vulnerable groups.
Functions of a physician

 The care of the individual

 The care of community
 As a teacher
Community diagnosis

 The community diagnosis may be defined as

the disease in a community
described in terms of the important
factors which influence this
pattern.
Community diagnosis

 the age and sex distribution of a

population;
 the distribution of population by social
groups;
 Vital statistical rates such as the birth rate,
death rate
 the incidence and prevalence of the disease
Community diagnosis

 Community health action or interventions:

 improvement of water supplies,
 immunization,
 control of specific diseases
 health legislation
Community health action or interventions. Action
taken at three levels:
 At individual,
 At family and
 At the level of the community