Concept of Community

Medicine
Dr. Fouzia Yesmin
Associate Professor
Community Medicine
 Introduction
• From time immemorial man has been interested in trying to
control disease.
• The medicine man, priest, herbalist and magician all
undertook in various ways to cure man’s disease and/or bring
relief to the sick.
• Medical knowledge has been derived to a great degree from
the intuitive and observational propositions and cumulative
experiences.
• In the course of evolution, which proceeded by stages with
advances and halts medicine has drawn richly from the
traditional cultures, of which it is a part and later from
biological and natural sciences and more recently from social
and behavioural sciences.
History of Primitive Medicine
• It has been truly said that medicine was conceived in
sympathy and out of necessity; that the first doctor
was the first man and the first woman was the first
nurse
• Since the knowledge was limited, the primitive man
attributed disease and in fact all human suffering
and calamities to the wrath of gods, the invasion of
body by “evil spirit” and malevolent influence of
stars and planets.
• The concept of disease in which the ancient man
believed is known as “supernatural theory of
disease”.
 Indian Medicine
• The medical system truly Indian in origin are the
Ayurveda and the Siddha system.
• Ayurveda is practised throughout India but Siddha
system in Tamil speaking areas of South India.
• Ayurveda implies the “knowledge of life” can be
traced back to the Vedic times, about 5000 BC.
• The celebrated authorities in Ayurvedic medicine
were Atreya, charaka, Susruta ana Vaghbhatt.
• In Ayurveda, disease is explained as a disturbance in
the equilibrium of the three humors – vata (wind),
pitta (gall) and kapha (mucus).
Indian Medicine (cont… )
• Hygiene was given an important place in ancient
Indian medicine.
• The golden age of Indian medicine was between
800 BC and 600 AD.
• Unani-Tibb system of medicine was introduced
in India by the Muslim rulers about the 10th
century AD.
• The Indian systems of medicine including Unani-
Tibb and Homeopathyare very much alive in
India today.
Chinese Medicine
• It claims to be the world’s first organized body of
medical knowledge dating back to 2700 BC.
• It was based on two principles- the yang (active
masculine principle) and the yin (negative faminine
principle).
• The balance of the two opposing forces meant good
health.
• The Chinese system of “bare foot doctors” and
acupuncture have attracted worldwide attention in
recent years.
Egyptian Medicine
• In Egyptian times, the art of medicine was mingled
with religion. Egyptian physicians were co-equals of
priest, trained in school within the temples,
• Egyptian Medicine reached its peak in the days of
Imhotep (2800 BC) who was famous as a statesman,
architect and builder of the step pyramid and
physician.
• Specialization prevailed in Egyptian times.
• The best known medical manuscripts belonging to
the Egyptian times are the Edwin Smith papyrus
(3000-2500) and Ebers papyrus (1150 BC).
Mesopotamian Medicine
• This civilization is contemporary to ancient Egyptian
civilization.
• The basic concepts of medicine were religion and taught
and practised by herb, knife and spell doctors.
• Hammurabi, a great king of Babylon who lived around
2000 BC formulated a set of drastic laws known as the
code of Hammurabi that governed the conduct oh the
physicians and provided for health practices.
• While the code of Hammurabi reflected a high degree of
social organization, the medicine of his time was devoid of
any scientific foundation.
Greek Medicine
• The classic period of Greek Medicine was the year of
460-136 BC.
• Aesculapius was the early leader of Greek medicine.
• He bore 2 daughters –Hygiea and Panacea. Hygiea was
worshiped as goddess of health and Panacea as goddess
of medicine.
• By far the greatest physician in Greek medicine was
Hippocrates (460-370 BC) who is often called the
“Father of Medicine”. He challenged the tradition of
magic in medicine and initiated a radically new
approach to medicine.
 Roman Medicine
• The Romans borrowed their medicine largely from
the Greeks whom the conquered.
• The Romans were more practical minded people
than the Greeks with a keen sense of sanitation.
• Public health was borne in Rome with the
development of baths, sewers and aqueduct.
• They made fine roads throughout their empire,
brought pure water to all their cities through
aqueduct, combat malaria and established hospitals.
• An outstanding figure among Roman medical
teacher was Galen (130-205 AD).
Middle Ages
• The period between 500-1500 AD is generally known
as middle ages.
• With the fall of the Roman empire, the medical schools
established in Roman times also disappeared.
• Europe was ravaged by diseases and pestilence:
plague, small pox, leprosy and tuberculosis.
• The practice of medicine reverted back to primitive
medicine dominated by superstition and dogma. The
medieval period is therefore called “the dark ages of
medicine”.
 Middle Ages (cont…)
• When Europe was passing through dark ages, the
Arabs stole a march over the rest of the civilization.
• They translated the Graeco-Roman medical
literature into Arabic and helped preserved the
ancient knowledge.
• They developed Unani system of medicine and
founded schools of medicine and hospitals in
Bagdad, Damascus, Cairo and other muslim
capitals.
• Leaders in Arabic medicine were the Persians, Abu
Becr (865-925) and Ibne Sina (980-1037).
Dawn of Scientific Medicine
• The revival of medicine encompasses the period from
1453-1600 AD.
• Paracelsus (1493-1541) helped turn medicine towards
rational research.
• Fracastorius (1483-1553), an Italian physician
enunciated the “theory of contagion”.
• Andreas Vasalius (1514-1564) did lot of dissection on
the human body and his great work Fabrica became the
classic text in medical education.
• Ambroise Pare (1510-1590) earned the title, “father
of surgery”.
 Cont….
• John Hunter (1728-1793) taught the science of
surgery.
• Thomas Sydenham (1624-1689) set the example of
true clinical method.
• Some exciting discoveries of the 17th and 18th centuries
were:
Harvey’s discovery of the circulation of blood (1628).
Leeuwenhoek’s microscope (1670).
Pathological anatomy founded a new branch of medical
science
Sanitary Awakening
• The industrial revolution of 18th century sparked
off numerous problems including creation of
slums, overcrowding with all its ill effects,
accumulation of filth in cities and towns, high
sickness and death rates, infectious diseases,
industrial and social problems.
• The great cholera epidemic of 1832 led Edwin
Chadwick, a lawyer in England to investigate the
health of the inhabitants of the large town with a
view to improve the condition under which they
lived.
Sanitary Awakening (cont…)
• Chadwick’s report on “the sanitary condition of
the labouring population in Great Britain” is a
landmark in the history of Public Health.
• It set London and other cities slowly on the way
to improve housing and working conditions.
• Filth was recognized as man’s greatest enemy
and with that an anti filth crusade the “great
sanitary awakening” began.
• This eventually led to the enactment of the
Public Health Act.
 Rise of Public Health
• Cholera which is often called the “father of public
health” appeared time and again in the western world
during the 19th century.
• John Snow, an English epidemiologist studied the
epidemiology of cholera in London from 1848 to 1854
and established the role of polluted drinking water in
the spread of cholera.
• William Budd also concluded that the spread of typhoid
fever was by drinking water.
• Then came the demand from people for clean water.
Germ Theory of Disease
• In 1860, Louis Pasteur demonstrated presence
of bacteria in air and in1873 advanced the “germ
theory of disease”.
• In 1877, Robert Koch showed that anthrax was
caused by a bacteria. These discoveries
confirmed the germ theory of disease.
• All attention was focused on microbes and their
role in disease causation. The germ theory of
disease came to the forefront supplanting the
earlier theories of disease causation.
Definitions

• Community Medicine – A system of delivery of

comprehensive health care by a health team in order to
improve the health of the community.
• Comprehensive Health Care – provision of integrated
preventive, promotive, curative and rehabilitative care to
the people from womb to tomb.
• Community Health – a EURO symposium in 1966
defined it as including all the personal health and
environmental services in any human community
irrespective of weather such services were public or
private ones.
Health Team
• A group of persons who share a common health goal
and common objectives, determined by community
needs and toward the achievement of which each
member of the team contributes in accordance with
her/his competence and skills and respecting the
functions of the other.
• The team must have a leader.
• The group is composed of health professionals and
auxiliaries and is guided and supervised by a team
leader.
Health Team (cont…)
• An auxiliary worker has been defined as one
who has less than full qualifications in a
particular field and is supervised by a
professional worker.
• For proper functioning it is important for each
team member to have specific job description
and the channel of communication.
• The line of authority should be clearly
understood by the team members.
• The health team concept is widely applied in
PHC approach.
Definition (cont….)
• Preventive Medicine – Not only is the organized
activities of the community to prevent
occurrence as well as progression of disease
and disability, mental and physical but also the
timely application of all means to promote the
health of individuals and of the community as a
whole including prophylaxis, health education
and similar work done by a good doctor in
looking after individuals and families.
Definition (cont….)
• Family Medicine – A field of specialization in
medicine which is neither disease nor organ
oriented. It is family oriented medicine or health
care centred on the family as the unit- from first
contact to the ongoing care of chronic problems
(from preventive to rehabilitation).
• Social Medicine – Is the study of man as a social
being in his total environment. It is concerned
with all the factors affecting the distribution of
health and ill-health in population including the
health services.
 Definition (cont….)
• Population Medicine – Is referred to as hygiene, public
health, preventive medicine, social medicine or community
medicine. All these share a common ground in their
concern for promotion of health and prevention of
diseases. Each has originated at a different time and each
has introduced a new direction or emphasis.
• Hygiene – the word is derived from Hygeia, the goddess of
health in Greek mythology. Hygiene is defined as the
science of health and embraces all factors which contribute
to healthful living.
Definition (cont….)
• Public Health – in 1920 C.E.A. Winslow, former professor of Yale
University gave the oft-quoted definition of public health. The WHO
expert committee on Public Health Administration adapting
Winslow’s earlier definition as defined it as “the science and art of
preventing disease, prolonging life and promoting health and
efficiency through organized community efforts for the sanitation of
environment, the control of communicable infections, education of
individual in personal hygiene, the organization of medical and
nursing services for early diagnosis and prevention of disease and the
development of social machinery to ensure every individual a
standard of living adequate for the maintenance of health, so
organizing these benefits as to enable every citizen to realize his
birthright of health and longevity”.
Changing Concepts of Public Health

• Disease control phase (1880-1920)

• Health promotional phase (1920-1960)
• Social engineering phase (1960-1980)
• Health for All phase (1980-2000 AD)
Disease Control Phase (1880-
1920)
• Largely a matter of sanitary legislation and sanitary
reforms.
• Aimed at the control of mans physical environment
eg. water supply, sewage disposal, etc.
• Measures were not aimed at the control of any
specific disease due to lack of technical knowledge.
• However these measures vastly improved the health
of the people.
Health Promotional Phase
(1920-1960)
• The concept of 'health promotion' began to take
place.
• It was initiated as personal health services such as
mother and child health services, school health
services, industrial health services, mental health
and rehabilitation services.
• Public health nursing was a direct offshoot of this
concept.
• Since the state has assumed direct responsibility for
the health of the individual, two great movements
were initiated for human development.
Health Promotional Phase
(cont….)
• 'Basic health services' through the medium of
primary health centers and sub-centers for rural
and urban areas.
• Community development programme through
the active participation and initiative of the whole
community
Social Engineering Phase
(1960-1980)
• With the advances of preventive medicine and
practice of public health, the pattern of disease
began to change.
• Many of the acute illness problems have been
brought under control.
• New health problems in the form of chronic diseases
began to emerge.
• These problems could not be tackled by the
traditional approaches.
Social Engineering Phase (cont.)

• The concept of 'risk factors' as the determinants of

the diseases came into existence.
• They brought new challenges to public health which
needed more orientation towards social objectives.
• Social and behavioural aspects of disease and health
were given a new priority.
Health for All Phase (1981-
2000)
• Despite advances in medicine, the glaring contrast in
health situation of the developed and developing
countries came into a sharper focus.
• The global conscience was stirred leading to a new
awakening that health gap between rich and poor within
countries and between countries should be narrowed
and ultimately eliminated.
• Against this background, in 1981, the members of WHO
pledged themselves to an ambitious target to produce
"Health For All" by the year 2000.
Community
• Community is a social group determined by
geographical boundaries and/or common
values and interest. Its members know and
interact with each other. It functions within a
particular social structure and exhibits and
creates certain norms, values and social
institutions. The individual belongs to the
broader society through his family and
community.
Characteristics of a community

• The community is a contiguous geographical

area.
• It is composed of people living together.
• People co-operate to satisfy basic needs.
• There are common organizations, eg. markets,
schools, stores, banks, hospitals.
 Difference Between Community
Medicine and Clinical Medicine
Community Medicine Clinical Medicine

A system of delivery of comprehensive Clinical medicine only deals with

health care to the people by a health treatment of an individual.
team in order to improve the health of
the community.
It encompasses preventive, promotive,
curative and rehabilitative health care.

Treatment is given as a part of Preventive care is not usually given.

prevention.
It is concerned with defined population It is only concerned with patients.
or population at risk.
It is field oriented. It is hospital oriented.
 Cont….
Community Medicine Clinical Medicine

Skill is required to control epidemic. Skill is needed for management of

medical and surgical emergencies.
Team work with health related Team work is not always essential.
personnel is essential.
It depend on relevant data collection Diagnosis is based on clinical
and analysis manifestation and investigation.
Investigators go to the community to Patients go to the doctor for treatment.
identify the problem.
Monitoring facility is poor but Follow up of patient is easy and strong.
surveillance is present to control
disease.
Thank You