Population Perspective of RelationsPopulation Perspective of Relations

Individual

Family

Community, nation

Human population

All populations

Introduction To Community Medicine and Definitions of Terms

Introduction To Community Medicine and Definitions of Terms

Objectives:Objectives:

1. To understand the importance of the health of the nation through history and development of public health in developed countries comparing to developing countries.

2. You students should be capable to properly use, understand and describe different terminology.

Death rates from cholera, 1853-1854, according to water company supplying sub-districts of LondonDeath rates from cholera, 1853-1854, according to water company supplying sub-districts of London

Water companyPopulationIn 1851

Cholera deathsIn 1853-1854

Deaths per 100,000 living

Southwark and VauxhallBoth companiesLambeth

167,654

301,149 14,632

192

182 0

114

60 0

Source: J. Snow, on the Mode of Communication of Cholera (2nd ed). London: Churchill, 1855. Reproduced in Snow on Cholera. New York: Hafner, 1965

Death rates from cholera in London, 1853-1854, according to water company supplying actual houseDeath rates from cholera in London, 1853-1854, according to water company supplying actual house

Water company Number of houses

Deaths from cholera

Deaths per 10,1000

Southwark and VauxhallLambethRest of London

40,046

26,107256,423

1263

981422

315

37 59

Source: J. Snow, On the Mode of Communication of Cholera (2nd ed). London: Churchill, 1855. Reproduced in Snow on Cholera. New York: Hafner, 1965.

Chief causes of death in the US, 1900 and 1982source: USDHHS., Prevention’84/’85, �Washington, DC; public Health Service Office, 1985.

Chief causes of death in the US, 1900 and 1982source: USDHHS., Prevention’84/’85, �Washington, DC; public Health Service Office, 1985.

1900 % 1982 %Pneumonia/influenzaTuberculosisHeart diseaseStrokeDiarrhea/enteritisNephritisCancerAccidentsDiphtheriaOther

11.811.2 9.4 7.6 6.3 5.9 4.5 4.2 1.9 37.2

Heart diseaseCancerAccidentsStrokeChronic lung diseaseSuicidePneumonia/influenzaChronic liver diseaseDiabetes mellitusOther

34.423.9 6.6 6.5 2.9 2.1 2.0 1.9 1.718.0

1999 Disease or Injury 2020 Disease or Injury

Increasing burden of noncommunicable diseases and injurieschange in rank order of DALYs for the 15 leading causes

(baseline scenario)

1 Acute lower respiratory infections2.HIV/AIDS3.Perinatal conditions4.Diarrhoeal diseases5.Unipolar major depression6.Ischaemic heart disease7.Cerebrovascular disease8.Malaria9.Road traffic injuries10.Chronic obstructive pulmonary

disease11.Congenital abnormalities12.Tuberculosis13.Falls 14.Measles15.Anaemias

1. Ischaemic heart disease2. Unipolar major depression3. Road traffic injuries4. Cerebrovascular disease5 .Chronic obstructive pulmonary 6. Lower respiratory infections7. Tuberculosis8. War9. Diarrhoeal diseases10.HIV11.Perinatal conditions12.Violence 13.Congenital abnormalities14.Self-inflicted injuries15.Trachea, bronchus and lung

cancers

Community MedicineCommunity Medicine

Public health services

emphasizing preventive

medicine and epidemiology

for members of a given

community or region.

Scope of Community MedicineScope of Community Medicine Epidemiology Vital statistics School health Mental health Maternal and Child health (MCH) Environmental health Rural health Urban health Occupational health

Medicine includesMedicine includes

Curative andPreventive Medicine

Clinician versus community physician (GP, FP)Clinician versus community physician (GP, FP)

A clinician’s target is to diagnose and treat his patient

A community physician’s target is to manage health problem in a community (community diagnosis)

History of Public HealthHistory of Public Health1880-1920: Disease control phase1921-1960: Health promotional phase1961-1980: Social engineering phase1981-2000: Primary Health Care,

Health for All phase

Definition: ‘Health …’• ‘…is a state of complete physical, mental and

social well-being and not merely the absence of disease or infirmity’(WHO, 1948)

• ‘Health is only possible where resources are available to meet human needs and where the living and working environment is protected from life-threatening and health threatening pollutants, pathogens and physical hazards’(Who, 1992a)

Definition of HealthDefinition of Health50 y.o. immigrant F, with Ca breast, lives in a country with

no public access to free health services. Currently she lost her job because of offensive attitude and living on donations provided from neighbors.From the previous scenario we can say that the

definition of health is “ a state of well being that include the next parameters”

PhysicalMentalFinancialSocial Spiritual

Definition: ‘Environment’

• ‘…[All] that which is external to individual human host. [It] can be divided into physical, biological, social cultural any or all of which can influence health status in populations.’ (WHO, 1995)

Definition: ‘Environmental Health’Definition: ‘Environmental Health’‘…comprises those aspects of human health,

including quality of life, that are determined by physical, biological, social and psychosocial factors in the environment. It also, refers to the theory and practice of assessing, correcting, controlling, and preventing those factors in the environment that can potentially affect adversely the health of present and future generations’ (WHO, 1993a)

Population Perspective of RelationsPopulation Perspective of Relations

Individual

Family

Community, nation

Human population

All populations

Health and Environment Perspective of Relations Health and Environment Perspective of Relations

PersonalHealth

Family Health

Occupational Health

Public Health

Environmental health

EpidemiologyEpidemiology

The Study of the DISTRIBUTION

and DETERINIANTS of DISEASE

FREQUENCY in HUMAN

POPULATION (Mac Mahoon,

1970)

Objectives:Objectives:

1. To understand the importance of the health of the nation through history and development of public health in developed countries comparing to developing countries.

2. You students should be capable to properly use, understand and describe different terminology.