Community Medicine for 4th Year Medical Students

Department of Community, Environmental and Occupational Medicine

• The department's vision is to have "Healthy People in Healthy Communities"
• The mission is to preserve, promote, and improve the health and well-being of populations, communities, and individuals
• The department prepares graduates to address the multifaceted health needs of their community and fosters collaborations among public health and the health professions in education, research, and service

Preface

• Health is a complex issue that is difficult to achieve and has variable definitions and broad scope
• Public health is concerned with promotion, prevention, and restoration of the health of the community individuals
• Collaboration between governmental and non-governmental organizations is necessary to achieve the goal of healthy community through planned systematic activities

Book Objectives

• The department's book is designed to provide medical students with essential information about the main concepts and important aspects of public health
• The book covers health promotion, prevention, early detection, and reduction of disabilities and premature deaths in the entire population
• The book integrates a wide array of intellectual disciplines, including vital statistics, demography, epidemiology, biostatistics, and more

Target Audience

• The book is intended specifically for 4th year medical students, although many professional workers, trainers, and students of public health will find it beneficial and interesting

Acknowledgments

• The authors acknowledge the help received from staff members and colleagues at the department of Community, Environmental and Occupational Medicine for their dedicated effort throughout the initiation, development, and revision of this book
• The authors express their gratitude to previous chairpersons of the department for their cumulative effort and leadership that led to this product

Department Staff

• The department staff includes professors, emeritus professors, assistant professors, lecturers, assistant lecturers, demonstrators, and reviewers who have contributed to the development of the book### Introduction to Community Medicine

• Community medicine is the delivery of health services to individuals and families, while public health includes the delivery of community medicine services, surveillance of diseases, environmental protection, epidemiology, public education, and information services.

Definitions

• Public health is "the art and science of promoting health, preventing diseases, and increasing the span of healthy life through organized efforts of society."
• Community is a group of individuals sharing an identity, culture, and operates through common institutions and organizations.
• Preventive medicine is the science and art of application of the different levels of prevention at the population, community, and individual levels.
• Clinical medicine is concerned with diagnosing illness, treating disease, promoting health, and relieving pain and distress in individual patients.

Comparison between Clinical Medicine and Community Medicine

• Clinical medicine: patient care, information based on complaint, history, and related factors, targets diseased persons, uses lab tests and x-rays for diagnosis, and focuses on available therapy.
• Community medicine: health improvement, information based on morbidity and mortality, targets healthy and diseased persons, uses epidemiological studies for diagnosis, and focuses on health-related services.

Successful Preventive Strategies

• Smallpox vaccination with a good surveillance system eradicated the disease globally.
• Modification of behavior controlled AIDS.
• Screening for early detection of breast cancer was effective.
• National programs of Hepatitis C Virus screening and treatment of positive cases, and non-communicable diseases screening (obesity, hypertension, and diabetes mellitus) were successful.

Working within the Community

• To work effectively within a community, one should define the boundaries of the community based on geographic, demographic, and administrative data.
• Important factors to consider include population characteristics, economic activities, social background, educational levels, culture, and traditions, environmental sanitation problems, existing community development projects, and governmental and non-governmental organizations serving the community.

Roles of Public Health

• The 10 roles of public health include monitoring health status to identify and solve community health problems.### Diagnose and Investigate Health Problems

• Diagnose and investigate health problems and health hazards in the community

• Inform, educate, and empower people about health issues

• Mobilize community partnerships to identify and solve health problems

• Develop policies and plans that support individual and community health efforts

• Enforce laws and regulations that protect health and ensure safety

• Link people to needed personal health services and assure the provision of health care when otherwise unavailable

• Assure a competent public and personal healthcare workforce

• Evaluate effectiveness, accessibility, and quality of personal and population-based health services

• Research for new insights and innovative solutions to health problems

Epidemiology

• Epidemiology is the study of the distribution, dynamics, and determinants of health-related states and events in a defined population and the application of this study to the control of health problems
• Distribution includes a description of the disease frequency by person, time, and place
• Dynamics means the interaction between different factors in transmission of diseases
• Determinants are factors that determine the probability of occurrence of disease (i.e., risk factors)

Uses of Epidemiology

• Study the etiology of diseases and identify diseases’ risk factors
• Syndrome identification and describing the natural history of a disease
• Identify the factors or conditions that can be modified to prevent the occurrence or spread of the disease
• Identify the health needs of the community
• Measure trends of diseases (i.e., change of disease pattern by time)

Important Definitions in Epidemiology

• Health: a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity
• Infection: the entry and multiplication of an infectious agent inside the body
• Endemic: the constant presence of a disease within a given geographical area or population group
• Epidemic: the occurrence of a disease in the community in excess number of cases more than expected
• Outbreak: the term used when the epidemic occurs in a small confined area
• Pandemic: an epidemic affecting more than one country
• Zoonoses: an infectious disease transmitted from vertebrate animals to man

Etiology of Diseases

• The epidemiologic triad: the interaction between the agent, host, and environmental factors
• Agent factors: biological, physical, chemical, or nutritive agents
• Host factors: intrinsic (non-modifiable: age, sex, ethnic group, race, etc.) and extrinsic (modifiable: occupation, education, marital status, diet habits, etc.)
• Environmental factors: physical, biological, and socio-cultural

Natural History of Diseases

• The course of a disease over time, unaffected by treatment
• The role of community medicine is applied throughout the whole health spectrum of individuals
• The stages of disease: positive health, susceptibility, pre-pathogenesis, manifest disease, disability, and death

Levels of Prevention

• Primary prevention: actions taken prior to the onset of disease, which remove the possibility that a disease will occur
• Secondary prevention: actions taken at an early stage of the disease that prevent its progress and prevent complications
• Tertiary prevention: actions that reduce or limit impairments and disabilities, and rehabilitation

Demography

• Demography is the statistical study of human populations
• Importance of demography: public health focuses on the health of the population, and demography helps to study its dynamics

Methods of Data Collection in Demography

• Census: a national survey for systematically acquiring and recording information about the members of a given population
• Census approaches: de facto (enumeration of individuals as where they are found during the census day) and de jure (enumeration of individuals as where they usually reside)