DR.MAHESH.V Post graduate, DEPT.

OF Community Medicine, KIMS HUBLI

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

 There is lot of confusion about DEFINITION ,
   


 Chronologically these terms present a


 These changing titles characterize ours as a


e. Have basic understandings & skills to deliver general medicine care & possess in depth knowledge of communicable and non communicable disease . social .principles of social & behavior sciences. range of skills .to the delivery of primary health care through out the life cycle of human beings (i. from child wood to old age) organ systems of human body but also the awareness of the civic.Cont…  Scope of this specialty is quite wide ranges from planning & provision of public health services .  It demands not only study of general medicine covering all the  Therefore community specialist has to acquire vast knowledge & . legal & economic organization of the society.

 Founder of epidemiology.  First distinguished epidemiologist. malaria.D. .  Syphilis (person to person transmission during sexual transmission). dysentery & cholera .  THOMAS SYDENHAM (1624-1689):  -D/D of scarlet fever .History and evolution of community medicine  Started around 1500A.  FRACASTORIUS(1483-1553):  “Theory Of Contagion” (transfer of infection via minute particles & explained cause of epidemics ).



SANITARY AWAKENING  In 1832 EDWIN CHADWICK investigated THE GREAT CHOLERA EPIDEMIC (gave report on sanitary conditions of labouring population ).  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.  It led to ENACTMENT OF PUBLIC HEALTH ACT OF 1848 in England.  This became the LAND MARK in the history of public health . .

sweeper roll call . line drawing – 1898 LONDON .Sanitary awakening  Department of street cleaning .

 4) organization of medical & nursing services for early diagnosis & prevention of disease .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.E.  5) development of social machinery to insure everyone a standard of living . .PUBLIC HEALTH:  C.

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. . To provide good health facilities to 80 percent ‘health for all’ by 2000 was pledged by members of WHO . 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.

 SOCIAL MEDICINE – Study of man as social being in his total environment .  FAMILY MEDICINE .  PREVENTIVE MEDICINE/COMMUNITY MEDICINE – Prevention of disease . .Family oriented medicine or health care centered on the family as unit .MODERN MEDICINE  CURATIVE MEDICINE – Removal Of Disease.

disability limitation and rehabilitation .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.

administration of medical services. psychological and genetic factors which have a bearing on the health of groups of individuals and individuals in these groups. almost with any subject in the extensive field of health and welfare. environmental. prevent disease and assist recovery of the sick. economical.SOCIAL MEDICINE  The study of the social. it is the study of man as a social being in his total environment. social medicine is concerned with a body of knowledge embodied in epidemiology and the study of the medical needs or medical care of society. . o In the broad sense. Thus it may be identified with care of patients. o But in the more restricted sense. o McKeon says “In contemporary usage social medicine has TWO meanings: ONE BROAD AND ILL-DEFINED and other MORE RESTRICTED BUT PRECISE. and at the same time with practical measures within the social field that may be taken to promote health. social medicine is an expression of the humanitarian tradition in medicine and people read into it any interpretation consistent with their aspirations and interests. prevention of disease. By derivation. cultural.

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. restoring the health of human communities rather than with the clinical care of individuals. From this definition.COMMUNITY MEDICINE A branch of medical practice that is concerned with promoting. and when necessary. An epidemiological understanding of community health problems  A management – oriented approach for these problems . maintaining.

.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 .

C. Partnership with the population served. Prime role of state in protecting & promoting the public’s health .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.

Emphasis on prevention. Identifying & dealing with proximal risk factors. F. Recognizing underlying socio-economic determinants of health and disease .Cont…. E. Multidisciplinary basis for action. D. G. .

occupational & political factors .  Set priorities and develop programs to meet the health needs of the population.  Develop skills in evaluating programs & in providing consultation to others involved in the planning. behavioral. educational.  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.  Implement programs taking in to account the socioeconomic. management or evaluation of health services .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. social & environmental factors that affect health .


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

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

� Cold chain.5  Non-communicable diseases. Dietary survey. Epidemiology and Demography Mathematical subjects . Survey methods. Communication skills. IMNCI.� Primary Health Care. Disaster management Descriptive subjects  Health education. Documentation Practical approach  Anthropometry.

national or international level 3. Practice of public health at local.WHERE DO COMMUNITY SPECIALISTS WORK? 1. Research . regional . 6. . 5. Community oriented clinical practice with an emphasis on health promotion & disease prevention. 4. provincial. Assessment and control of occupational & environmental health problems. Teaching . 2. Planning and administration of health services in institutions and government.


.  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. 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.


life styles(tobacco. sanitation. health etc. physical activity)etc.THEMES & SUBTHEMES  Reproductive & Child Health .vector borne diseases(malaria). air  Noncommunicable Diseases.  Environmental Health. borne (TB).focus on perinatal/ neonatal/preschool child/school health /infertility/reproductive tract diseases/ contraception. sexually transmitted (HIV/AIDS).  Communicable Diseases.air pollution.nutrition(obesity/under nutrition). occupational .

. Family medicine . nutrition etc. Malaria etc. Air pollution . ARI etc. Epidemiology Health management HIV. Family planning . theme & subtheme Subspecialty Theme Health promotion Non communicable diseases Communicable diseases Reproductive & child health Environmental health Subtheme Tobacco .. sanitation etc. TB ..Illustrated framework of subspecialty ..

CDC investigator  Pharmaco epidemiologist . Bio statistics  State health department.  Federal government .Data Management Director  Industry / Corporate .  Epidemiology  Local / State Health Department .CAREER OPPORTUNITIES.Director of Infectious / Chronic diseases  Industry/ Corporate – Outcomes researcher  Federal government.Director Of Clinical Trials.Program Evaluation Analyst.

 Health services administration:  Health Facilities – Hospital/Management Care Administrator  State Health Dept – Program Evaluation & Planning  Industry/ Corporate.Policy Analyst  Health education / Behavioral science:  Voluntary health agencies .consumer information director  Local health department.Health services Research Analyst  Federal government.Information Systems Manager  University.program planning & evaluation  Industry / Corporate – health promotion specialist  Behavior scientist .

Waste management specialist  State health department / Environmental Agency.Pollution control program director  Industry / Corporate – Industrial hygienist  Federal government – EPA researcher / Administrator . Health communications :  Communications specialist  Journalist  Occupational safety & Health :  Corporate medical director  Environmental health  Local health department / Environment Agency .

 Health Policy & Management :  Academic policy advisor  Legislative policy advisor  Management policy advisor  International & Global health:  Reproductive Health specialist  International Health Specialist  Tropical disease specialist .


Vaccines & Biologists .Protection of Human Environment Emergency & Humanitarian Action HUMAN RIGHTS .Reproductive Health & research women’s Health External Relations & Governing Bodies .Research Policy & Cooperation .Evidence For Health Policy .Nutrition for health & Development .CD research & development Non communicable Diseases & Mental Health Family & Community health Sustainable Development & Healthy Environments .Health in sustainable Development .CD surveillance & response .Budget & Management Reform Human Resources Services Financial Services Informative & Infrastructure Services Evidence & Information For Policy .Link to regional directors Special representatives of Director General Director General office Senior policy advisor Director General cabinet Communicable Diseases .Resource Mobilization External Cooperation & Partnerships Office Of Press & Public Relation Health & Technology & Pharmaceuticals .Child & adolescent health & development .Essential Drugs & Medicine Policy .Blood Safety & Clinical Technology General Management . prevention & eradication .Governing Bodies .CD control.Health Information Management & Dissemination Organization of Health Services Delivery .

seaports.g. Faculty in universities or schools for learning medicine  Active participation in various National programs e. UNICEF etc.. CSSM. ICDS. .. RCH etc. WHO.  Active participation in programs under supervision of  Hospital administrator  Family medicine physician  Office in charge of Quarantine / Isolation at airports. EPI. UIP. NACP.

One year · Diploma in Health Statistics (Also open to graduates with Mathematics or Statistics). .18 months · Diploma in Dietetics (Also open to BHSc degree holders).Two years · Master of Engineering and Public Health (open to degree holders in Civil engineering). All India Institute of Public Health And Hygiene            · MD (Social and Preventive Medicine)-Three years · DPH.One year · Diploma in Public Health Nursing-10 months · Certificate in Public Health Nursing-13 weeks.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).One year · Diploma in Health Education (also open to graduates in any discipline including Education).

 Ph. 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. D. .

Centre For Disease Control & Prevention  CPHR.Research opportunities  STAR.Indian Diabetes Education Association  WHO  UNICEF  CDC.Special Treatment & Research Programs  INN – Indian NCD Network  IDEA.Centre For Public Health Research .

Public health careers offer some thing for everyone.incorporates business & management skills. .includes a wide range of science skills.  Epidemiology & Biostatistics .involves skills required to develop community – wide prevention programs.  Health education .involve mathematics & biostatistics.includes an under standing of law.  Health administration .  Health policy .  Environmental health .making policy.

financing & evaluation of health programs)  Environment & occupational health. .  Application of primary . management. organization. secondary & tertiary preventive measures. distinctive aspects of preventive medicine include knowledge of and competence in.  Epidemiology & biostatistics  Administration (including planning.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 .  Application of the social & behavioral factors in health.

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

there is growing demand for experts in environmental health & industrial hygiene. 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.  Greater emphasis is also being placed on school health & the health of minority & disadvantaged populations.  Health services delivery systems are undergoing rapid change. Shortage of the community health specialists. but rather the broader and application of population.based prevention programs. HIV/AIDS.  Most experts agree that major advances in improvement of health over the next decades will not come from new medical findings or cures. TB & unplanned pregnancies . & an increased emphasis is being placed on behavioral change to prevent the risk of STD’s.  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. & child substance abuse. .  Public health research is focusing more on women’s health. As a result.


No.References :  Text book of PSM – Mahajan Gupta 2nd edition  Pfizer’s guide to Careers in Public Health  Future of academic community medicine in developing      countries. Future of community medicine . HOD department of community medicine. Text book of community medicine – Bhaskar Rao Foundations of preventive & social medicine – Dhaar & Robbani . by DR.journal of royal society of medicine. No. 2(2003-04 .2005-06).Willoughby Lathem MD IJCM vol 29. Rajesh kumar .2004-12) IJCM vol 30. 4(2004-10 .