Community Medicine PDF

Community Medicine Dr. ESRA ABDEEN MBBS , MSc of Global Health, Senior Registrar Community Medicine SMSB , CPHQ COURSE OUTLINES : INTRODUCTION TO COMMUNITY MEDICINE COMMUNITY DIAGNOSIS HEALTH CONCEPT CONCEPT OF DISEASE HEALTH IN...

Community Medicine Dr. ESRA ABDEEN MBBS , MSc of Global Health, Senior Registrar Community Medicine SMSB , CPHQ COURSE OUTLINES : INTRODUCTION TO COMMUNITY MEDICINE COMMUNITY DIAGNOSIS HEALTH CONCEPT CONCEPT OF DISEASE HEALTH INDICATORS PREVENTION AND CONTROL COURSE OUTLINES: EPIDEMIOLOGY EPIDEMIOLOGY TRAID MEASURMENT OF HEALTH AND DISEASE COMUNICABLE AND NON COMUNICABLE DISEASES. DAY ONE OUTLINES: INTRODUCTION TO COMMUNITY MEDICINE. COMMUNITY DIAGNOSIS. CONCEPT OF HEALTH. HEALTH DIMENSHIONS. CONCEPT OF DISEASE. HEALTH DETERMINANTS. INTRODUCTION TO COMMUNITY MEDICINE Community medicine is that branch of medicine, which deals with the study of provision of preventive, promotive, curative, rehabilitative and evaluative services to the community at large, through an organized comprehensive health care delivery system. The goal is: 1.to identify the health problems and needs of the defined population. 2.To provide the comprehensive health care (preventive, promotive, curative and rehabilitative services) in an organized manner followed by the evaluation of the services. Differences between community medicine and hospital medicine Service Area Community Medicine Hospital Medicine Operational strategy Provides health care to the Draws patients from ill-defined people of defined geographic catchment area. area Organizational framework Both active and passive Only passive operational operational strategies are strategy is applied, i.e. applied, i.e. both providers and responsibility lies on the patient consumers are on the move to come to hospital for treatment Nature of care It is comprehensive (i.e. Only curative care, leading to preventive, promotive, curative freedom from illness and rehabilitative) Intersectoral coordination Exits between the health Virtually no intersectoral department and the health coordination exists related department COMMUNITY DIAGNOSIS This consists of identification and quantification of health problems, in terms of morbidity and mortality rates (disease and death rates) and their influencing factors in a community. This helps to prioritize the health problems and implement control measures. Difference between clinical and community diagnosis Clinical diagnosis Community diagnosis Made by the doctor (Physician) Made by the epidemiologist Concerned with individual case Concerned with a defined population Concerned with only sick people Concerned with both sick and healthy people Doctor examines the patient Epidemiologist conducts surveys It is arrived at based on signs and symptoms It is arrived at based on natural history of disease It involves laboratory It involves epidemiological investigations Doctor decides the treatment Epidemiologist decides the plan of action Treatment is the main aim Prevention and promotion is the main aim. It involves follow-up of case It involves the evaluation of program Doctor is interested in technological advances Epidemiologist is interested in statistical values CONCEPT OF HEALTH AND DISEASE CONCEPT OF HEALTH Health is defined (by WHO) as ‘A state of complete physical, mental and social well-being of an individual and not merely an absence of disease or infirmity’ (infirmity = weakness, feebleness, opposite of firmness). As per the definition, health is three dimensional: the physical, the mental and the social. Nonmedical dimensions are: spiritual, emotional, vocational and political dimensions PHYSICAL DIMENSION A person is said to be physically healthy, when all the organs and systems in the body are functioning perfectly at their optimum capacity. The signs of physical health are a clean skin, bright eyes, a good appetite, sound sleep, regular activity of bowel and bladder and coordinated bodily movements , All the systems function normally. The physical health can be assessed by the history of having taken treatment or hospitalization for any illness, thorough clinical examination , biochemical and laboratory investigations. MENTAL DIMENSION A person is said to be mentally healthy, when he/she is having a perfect state of balance with the surrounding world, having harmonious relation with others. the memory, learning capacity are normal. Not having any internal conflicts, accepts criticism sportively, has got good self-control emotionally. The mental health of an individual can be assessed by his behavior, and attitude. SOCIAL DIMENSION An individual is said to be socially healthy, when he is accepted, respected and loved by all in the family, by his friends, relatives, neighborers, colleagues and others. SPIRITUAL DIMENSION This is a holistic dimension. A person is said to be spiritually healthy, when he possesses ‘Sound mind in a sound body’ EMOTIONAL DIMENSION This is difficult to differentiate from mental health. However, a person is said to be emotionally healthy, when he does not loose temper or does not develop tension and has self-control. VOCATIONAL DIMENSION An individual is said to be healthy vocationally, when he is capable of earning sufficiently to lead the life successfully. DEFINITION OF DISEASE Disease is a condition of the body or some part or organ of the body in which its functions are disrupted. Oxford dictionary Disease = No ease (opposite of health) TYPES OF DISEASES Congenital: a person is born with the disease Acquired: 1. Communicable or infectious 2. Non communicable or non infectious DEFINITION OF HEALTH DETERMINANTS Any factors combine together to affect the health of individuals and communities. Whether people are healthy or not, is determined by their circumstances and environment. The factors which determine the health of an individual are many : ❑Genetics (biological)factors ❑Environmental factors ❑Life style (way of living) ❑Socioeconomic conditions: Education Occupation Income ❑Health services  AGING OF THE POPULATION GENDER OTHERS GENETICS The health of the human beings is to some extent is determines by the genetics constitution that take place at the time of conception. If the constitution of the gene is defective , it result in certain diseases which transmitted by hereditary such as sickle cell disease. Its permanent ,No treatment and can prevented by” Genetic counseling” before marriage. ENVIRONMENTAL FACTORS ❖Internal environment constituted by various organs and systems of the body. ❖ External environment: Physical such as: air , water and soil Biological such as :plants and animals Social environment such as: culture, beliefs and traditions LIFE STYLE Health behavior Includes cultural patterns and habits such as smoking ,alcoholism, multiple sexual partners. Many diseases have shown a strong association e.g AIDS, coronary heart diseases, obesity Socioeconomic conditions: A.EDUCATION It has been observed that illiteracy is associated with increased morbidity and mortality. Specially the female literacy level is very important Socioeconomic conditions: B.OCCUPATION It has been observed that morbidity and mortality is more among the unemployed than the employed persons. Unemployment problems itself causes psychological and social damage. On the other hand ,there are many occupations which affect the health of the workers. Socioeconomic conditions: C.INCOME This is the most important key factor which determines the standard of living, quality of life and thus the health status of the individual and community at large. Diseases of the poor socioeconomic status are malnutrition, tuberculosis and worm infestation Diseases of high socioeconomic status are obesity , HTN, DM HEALTH SERVICES The availability of health care services such as immunization services, nutritional services not only prevent the diseases but also promote the health and prolongs the life of the people ❑ ageing of the population: By 2020, world will have more than one billion people aged 60 years & over. More than 2/3 of them living in developing countries. A major concern of rapid population aging is the increased prevalence of chronic diseases and disabilities. ❑Gender ❑Others(Information and communication, science and technology, human rights and equity and social justice.