Concepts of Community Health

Introduction

• Health is a dynamic concept

• In order to protect, promote, and restore the health of individuals and
populations, an integrated discipline of public health or community health
came into existence.
• Public health has achieved success in terms of improvement of various
morbidity and mortality indicators
• However, a lot needs to be achieved and mid-level health care providers
(MLHPs) can play an important role in this regard
 Objectives
At the end of the session participants will be able to:
• Define health
• Differentiate between illness, sickness and disease
• Describe various dimensions of health
• Enumerate determinants of health
• Draw epidemiological triad with the help of example
• Describe the natural history of disease
• Enumerate and apply the levels of disease prevention in control of diseases
 Public Health
• ‘Public Health’ : Organized community efforts aimed at prevention of disease
and promotion of health.

Control
communicable
infection
Improved
access to safe Improved
water and environment
sanitation

Public health
Development
of the social Improvement
machinery for hygiene
health through
maintenance Organization of education
medical and
nursing services
for prevention
of disease
 Evolution of Public Health In India

Harappa 1400 1000 18th

culture B.C. A.D. century

Planned cities with

Ayurveda and Legislative measures
drainage and Unani system of
Siddha systems of for disease control
practices of medicine
medicine and prevention
sanitation
 Evolution of Public Health in India contd..

Community
Bhore 1st five-
development
committee year plan 2005 2013
program
(1943) (1950)
(1952)

Survey existing Budget allocation for

health conditions to national health
recommended program Developing rural National Rural
RMNCH+A
integration of areas Health Mission
preventive and National malaria
curative services control program
CONCEPTS OF HEALTH AND
ILLNESS
 Health, Illness, Sickness and Disease
Health
“State of complete physical, mental and
social well-being and not merely an
absence of disease or infirmity”
Sickness
“Socially and culturally held conceptions of
health conditions, which in turn influence
how the patient reacts”
Illness
“Subjective sense of feeling unwell; it does
not define a specific pathology, but refers
to a person’s subjective experience of it,
such as discomfort, tiredness, or general
malaise”
Disease
“Physiological or psychological
dysfunction. In other words, disease
implies a focus on pathological processes
that may or may not produce symptoms
and that result in a patient’s illness”
 Spectrum of health

1) Mortality–prevention of health
2) Serious morbidity– the prevention and control of conditions that
produce disability or chronic illness
3) Minor morbidity– the handling of lesser illnesses (in terms of death
and disability), environmental conditions that create inconveniences
and nuisances, and
4) Positive health– the attainment of a full sense of personal vigor and
mental well-being, as well as constructive relationships with others in
an environment that promotes longevity and happiness
 Dimensions of health

Environment

Social Physical

Occupational Health Emotional

Financial Intellectual

Spiritual
 Physical health

• State of the body its compositions, development, functions, and

maintenance.
• Optimum physical abilities of all his body parts being intact and working in
coordination

Avoid
Healthy Adequate Regular Physical
Exercise harmful
eating sleep check-ups Health
habits
Emotional health: Ability to accept and cope with our own and others
feelings.
Characteristics:
• Adjusting mind-set
• Not getting agitated easily
• Freedom from internal conflicts
• Looks for his personal identity
• Strong self esteem
• Knows his limitations and capabilities
• Not carried away by unnecessary emotions
• Ability to cope up
 Intellectual Health
• Cognitive ability to develop skills
and knowledge to enhance one’s
life
• It encourages creative,
stimulating mental activities and
improves our decision-making
ability
Spiritual Health
• Personal beliefs and values
• Attained by seeking one’s values,
rights, and responsibilities, ethics,
and code of living and it is the
capacity to love, have compassion
for others, forgiveness, joy, and
fulfillment
 Occupational Environmental
Social Health Financial health
health Health
• Recognize personal • One’s contribution • Focuses on one’s • Learning and
satisfaction and to environment attitude toward contributing to the
enrichment in one’s and community money and a health of the planet
life through work • Deals with commitment to and a sustainable
• The choice of setting goals for lifestyle
supportive social
future needs,
profession, job network,
developing good
satisfaction, career contributing to
money habits and
ambitions, and society, and valuing
effectively
personal cultural diversity
performance • How well a person
components of
mixes and interacts
occupational
with others
wellness
 Determinants of health

Health of an individual is a complex subject influenced by a variety of factors

which may lead to either a healthy outcome to promote health or an
unhealthy outcome to have deleterious effects on health.
 Determinants of health
• Some diseases are common in younger age group while some
Age chronic diseases are predominant in older age groups

• Women are considered to be biologically stronger than men.

Gender • Diseases differ according the gender

• The traits transferred from parents during conception as genetic

Genetics configuration are permanent

• Members of non-white racial and ethnic groups tend to experience

Race, ethnicity more ill health and disease than their white counterparts

• Indirect impact on health (good educational background have

Literacy status better ways and means of living improving their health standard)
 Nutrition • Scientifically and extensively linked to disease

• External environment: Physical and biological agents

Environment • Internal environment: Own anatomical body parts and
physiological activities

Socio-economic • Daily needs of life and access to health depends upon income
status

Socio-cultural • Health behavior of person is also influenced by his socio-

conditions cultural environment

Health care • Good healthcare system has positive influence on health of

system/ services people
CONCEPT OF CAUSATION
OF DISEASE
 Theories of diseases

Supernatural theory Contagion theory Germ theory

Diseases are caused

Diseases are spread Every human disease is
because by evil spirits,
through “bad air” or to caused due to a
wrath of gods,
various forms of close specific microbe or
punishment for evil
contacts with diseased “germ” which is specific
deeds during previous
person for that disease
births etc

In 19th century bacteria was discovered by Robert Koch and Louis

Pasteur.
 Epidemiological Triad Theory

Characteristics of the Characteristics of

t
“agents” which cause human being like age,

Ho
en
Ag

st
the disease gender, ethnicity

Environment

Characteristics of the
environment in which
human being is living
 Epidemiological Triad Theory
Moment equilibrium is disturbed
Equilibrium is maintained between
(change in any one or more of the
the various agent, host and
agent, host and environment factors)
environmental factors, the person
departure from state of health
stays healthy.
occurs

Host Health Agent

Agent

Host Environment

Balance Disturbed balance

 Web theory of disease causation
• To explain the causation of non-communicable diseases in particular, theory
of web of causation was postulated
• Various factors related the disease, are like an interacting web of spider
• Each factor has its own relative importance in causing the final departure
from the state of health, as well as interacts with others, modifying the
effect of each other
 Natural history of disease
• Complete course of a disease from the time a human host is exposed to the
disease agent in an environment to its final outcome is termed the natural
history of disease
• It has two phases:

Pathogenesis phase: This

The pre-pathogenesis period phase begins with the entry of
refers to period before the the disease “agent” in the
onset of disease in man susceptible human host
 Levels of prevention

Primordial Primary Secondary Tertiary

Prevention Prevention Prevention Prevention

• It is applied when • All measures of • “Action which • “All the measures

action is taken to prevention that halts the progress available to
remove even risk are undertake of a disease at its reduce or limit
factors to before the onset incipient stage impairments and
develop of the disease, so and prevents disabilities, and
that the disease complications” to promote the
never occurs patients’
adjustment to
irremediable
conditions”
 Disability limitation

• Pathological process and it’s manifestations indicate a departure from

Disease
the state of perfect health

• Actual loss or damage of a part of body anatomy or an aberration of the

Impairment
physiological functions that occurs consequent to a disease

• Inability to carry out certain functions or activities which are otherwise

Disability
expected for that age / sex, as a result of the impairment

• Final disadvantage, which occurs consequent to an impairment or

Handicap disability, which limits the fulfillment of the role a person is required to
play in life

Disability limitation: The prevention of complications of a disease before irreversible

changes set in would limit disability
 Rehabilitation
When a defect or disability has already occurred, tertiary prevention can be
instituted to restore as much functions as is possible

Medical rehabilitation

Emotional and
Vocational
Psychological Rehabilitation
rehabilitation
rehabilitation

Social rehabilitation
 Roles and responsibilities of
midlevel health providers (MLHP)

• A midlevel health provider is defined as a health provider:

who is trained, authorized and regulated to work autonomously

who receives pre-service training at higher education institution for at least a

total of 2–3 years

whose scope of practice include being able to diagnose, manage and treat
illness, disease and impairments, as well as engage in preventive and promotive
care
 Job responsibilities
• Implement National Programmes
• Administration and management at Health and Wellness Centers
• Health education and encourage awareness about Family Planning, Maternal
and Child- Health, and Non-Communicable Diseases
• Preventive, Promotive and curative care
• Identification of Danger Signs and Referral after pre-referral stabilization
• Implement Biomedical waste disposal guidelines and Infection Control
policies
• Supervision of health workers for Maternal and Child Health, Family
Planning and Nutrition related services
 Responsibilities of Health Worker (Female):
• Maternal and child health
• Family planning
• Medical termination of pregnancy
• Nutrition
• Immunization
• Implementation of communicable disease control programme
• Recording of vital events
• Treatment of minor ailments
• Maintaining all records
• Coordination with other team members
 Responsibilities of Health Worker (Male)

• Record keeping
• National Health Programmes
• Assisting health worker female (HW-F)
• Ensure environmental sanitation
• Rest functions same as HW (F)
 Check your progress

• Name any three sources of vitamin A

• What you will measure during Anthropometric assessment of nutrition?
• Explain the principles of Nutritional education
• What is the daily recommendation for fruits and vegetables for
pregnant woman?
• How can we increase the bioavailability of iron in pulses?

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THANK YOU