(1) Concepts of community health 17.01.2023.pptx

Concepts of Community Health Dr. Supun Wijesinghe MBBS MSc MD MPH MRSPH Consultant Community Physician Head / Family Health, Nutrition Communication & Behaviour Research Unit Health Promotion Bureau Ministry of Health Module: Community Development Module Objectives mentione...

Concepts of Community Health Dr. Supun Wijesinghe MBBS MSc MD MPH MRSPH Consultant Community Physician Head / Family Health, Nutrition Communication & Behaviour Research Unit Health Promotion Bureau Ministry of Health Module: Community Development Module Objectives mentioned in the curriculum 1. To describe health promotion concepts 2. To analyse the five Action Areas of health promotion 3. To appraise the role of community mobilizer 4. To create strategies for community mobilization Presentations Concepts related to community health Concepts in community diagnosis Community development and its approaches Community organization and its approaches Community participation theories for health development Volunteerism for community health development Formulate volunteer training programmes Participatory techniques Empowering the community in community development Outline Familiarize with basic terms- “Community”, “Health”, “Community Health”, and “Public Health”. Familiarize with the history related to evolution of the community health Identify the factors affecting for Community Health Identify the basic aims of the Community Health. Identify the few basic models of concept of health “Health”(සෞඛ්‍යය) “Health is a state of complete physical, mental and social well being and not merely the absence of disease or infirmity” (WHO, 1946). සෞඛ්‍යය යනු රෝග හෝ දුබලතා නොමැති වීම පමණක් නොව පූර්ණ කායික, මානසික සහ සමාජීය යහ පැවැත්මයි (ලෝක සෞඛ්‍යය සංවිධානය, 1946). 1. Questions What do you mean by a community? What are the main features and characteristics of a community?  Community (ප්‍රජාව) The word "community" is derived from Latin word communitas (meaning the same), which is in turn derived from communis, which means "common, public, shared by all or many" (encyclopedia). A community is a “group of people with a common characteristic or interest (such as norms, religion, values, or identity) living together within a larger society”. ප්‍රජාවක් යනු සමාජයක් තුළ ජීවත්වන, සම්මතයන්, ආගමික,සාරධර්ම හෝ අනන්‍යතාවයන් වැනි විශේෂිත පොදු ලක්ෂණ ඇති කණ්ඩායමකි. Dimensions of a community (ප්‍රජාවේ ප්‍රධාන මානයන්) Place (ස්ථානය) Population (ජනගහනය) Political system (දේශපාලන පද්ධතිය) Social organization (සමාජ සංවිධාන) Cultural system (සංස්කෘතික පද්ධතිය) Economic system (ආර්ථික පද්ධතිය)  Community health (ප්‍රජා සෞඛ්‍යය) Community health refers to the health status of the members of the community to the problems affecting their health and to the totally of health care provided to the community (World Health Organization,1971). ප්‍රජ සෞඛ්‍යය යන්නෙන් අදහස් කරන්නේ ප්‍රජාවේ සාමාජිකයින්ගේ සෞඛ්‍ය තත්ත්වය, ඔවුන්ගේ සෞඛ්‍යයට බලපාන ගැටළු සහ ප්‍රජාවට සපයනු ලබන සම්පූර්ණ සෞඛ්‍ය සේවාවයි (ලෝක සෞඛ්‍යය සංවිධානය,1971). Farther of Public Health  Public health (මහජන සෞඛ්‍යය) Public health is the art and science of preventing diseases, prolonging life, and promoting health through the organized effort of society (WHO,1988). මහජන සෞඛ්‍යය යනු සමාජයේ සංවිධානාත්මක උත්සාහයන් තුළින් රෝග වැළැක්වීම, ආයු කාලය දීර්ඝ කිරීම සහ සෞඛ්‍යය ප්‍රවර්ධනය කිරීමේ කලාව සහ විද්‍යාවයි (ලෝක සෞඛ්‍යය සංවිධානය,1988). But sometimes the terms of “Public health”, “Community Health”, “preventive health”, and the “social health” will be interchangeably used. නමුත්සමහර අවස්ථාවලදී“මහජන සෞඛ්‍යය”, “ප්‍රජා සෞඛ්‍යය”, “නිවාරණ සෞඛ්‍යය”, සහ “සමාජ සෞඛ්‍යය” යන පද එකම අදහසක්, අදහස්කිරීම සඳහා මාරුවෙමින්භාවිතා වේ.  Developmental stages in community health 1. Empirical health era (1800-1850) ) During this period diagnosis of diseases was made on empirical basis and also the given treatment was according to symptoms. This Era also called Symptoms- Oriented Era 2. Basic science era (1850-1900 ) This Period witness the invention of microscope, thermometer, BP apparatus and other tools for detection and measurement of disease. 3. Clinical science era (1900-1950) ) This era which witnessed the individual- centered or patient –centered approach for taking care of health and illness of the people. 4. Public health science era ( 1950-1975) In this period disease prevention oriented approach started (community centered approach , community side teachings) 5. Political health science era ( 1975-2000 AD) People – centered approach has been emphasized in this era , involvement of the leaders and community people for planning and implementation of health programs Factors affecting community health (ප්‍රජා සෞඛ්‍යයට බලපාන සාධක)  Social/cultural factors (සමාජ/සංස්කෘතික සාධක) Beliefs, traditions, and behaviours of the individuals and people Economy, politics, religion Socioeconomic status Social norms ways in which communities organize their resources community organization  Physical factors (භෞතික සාධක) Industrial development Community size Environment Geography Three basic aims of Community Health ප්‍රජා සෞඛ්‍යයේ මූලික අරමුණු Health promotion (සෞඛ්‍යය ප්‍රවර්ධනය කිරීම) Disease prevention (රෝග නිවාරණය) Management of factors affecting health (සෞඛ්‍යයට බලපාන සාධක කළමනාකරණය කිරීම) 2. Question What do you understand by heath promotion? What are the three main strategies of health promotion ? What are the five key action areas of Health promotion ?  Health promotion (සෞඛ්‍ය ප්‍රවර්ධනය) Health promotion is the “process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions” (WHO). සෞඛ්‍ය ප්‍රවර්ධනය යනු “මිනිසුන්ට ඔවුන්ගේ සෞඛ්‍යය පාලනය වැඩිදියුණු කිරීමට හැකියාව ලබා දී ඔවුන් සවිබල ගැන්වීමේ ක්‍ රියාවලියයි. එය පුද්ගල හැසිරීම් වලින් ඔබ්බට පුළුල් පරාසයක සමාජ සහ පාරිසරික මැදිහත්වීම් කරා ගමන් කරයි (ලෝක සෞඛ්‍යය සංවිධානය).  Health promotion ctd….. What are the three main strategies of health promotion Enabling Mediating Advocate What are the five key action areas of Health promotion Build healthy public policy Strengthen community action Develop personal skills Create supportive environment Reorient health services: Levels of disease prevention රෝග නිවාරණයේ/වැළැක්වීමේ මට්ටම් Primordial Prevention -It is applied when action is taken to remove even risk factors to develop Primary Prevention-All measures of prevention that are undertake before the onset of the disease Secondary Prevention -Action which halts the progress of a disease at its incipient stage and prevents complications Tertiary Prevention -All the measures available to reduce or limit impairments and disabilities, and to promote the patients’ adjustment to irremediable conditions 3. Question Can you explain the levels of prevention for DM ? Primordial Primary Secondary Tertiary  Levels of prevention for DM ? Primordial (No risk factors for DM) –Person who is maintaining good healthier lifestyle of avoiding sugary foods, doing exercises daily, avoiding from smoking and using alcohols etc. need to continue it as it is. Primary (Risk factors developed, still not developed the DM)– Person who is eating sugary foods, not doing exercises, obese or overweight ,smoking and using alcohols need to change his/her lifestyle into a healthier lifestyle. Secondary (developed the DM but not developed complications) - Comply on the treatment and regular clinic visits, need to modify the lifestyle etc. Tertiary (developed DM related complications) – Comply on the treatment and regular clinic visits to prevent further progression of complications. How can we achieve primary level prevention Safe drinking water Safe disposal of wase materials Maintaining general cleanliness Immunization of children Traffic control Good nutrition Health checkup and mass screenings Early diagnosis and mass treatment Health education 4. Question What do you understand by social determinants of health ? Management of factors affecting health (සෞඛ්‍යයට බලපාන සාධක) There are many factors affecting for health status of the community. These are called social determinants of health Health status of the community can change depend on the behaviour of these factors of social determinants of health  Models of concepts of health There are many different models for explain the concepts of health. It is easy to understand and describe using these models. Examples for such models, Holistic health model Host-agent-Environmental model (Leavell1965) Health belief modal (Rosenstock,1974, Modified by Stone 1991) 5. Questions How do you promote health in a community using HBM? (Suppose you need to promote the physical exercises in a community) Promote physical activities/regular exercises based Perceived on HBM….. susceptibility and Changed behaviour perceived severity Do regular ……we will get obese if exercise/Increase physical I do not exercise activity regularly. Perceived benefits and perceived barriers …….If we exercise our physical fitness will improve and we can maintain our BMI within the normal range, also Cues to action we will get shaped …advice from others, peer Self-efficacy body. But we face support, illness of a friend We are confident difficulty in finding or family member, in doing regular time to do exercises. information from media exercises ………….. Thank you