1Introduction to Community Medicine INTRODUCTION 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 to identify the health problems and needs of the defined population (community diagnosis) and to provide the comprehensive health care (preventive, promotive, curative and rehabilitative services) in an organized manner followed by the evaluation of the services. The term Community Medicine is only a new terminology. It is the successor of the terms Hygiene, Preventive Medicine, Social Medicine and Public Heath. Hygiene This word is derived from Greek word “Hygiea”, the Goddess of Health. Her disciples were called Hygienists, who practiced Hygiene for health. Hygiea is represented as a beautiful woman, holding in her hand a bowl from which a serpent is drinking. In Geek mythology, the serpent testifies the art of healing, which symbol is retained even today. During ancient days, due to lack of knowledge about disease causation and spread, Hygiene and cleanliness was the only option for the promotion of health and prevention of disease. Hygiene is defined as “the Science of health and embraces all factors contributing to healthful living”. Hygiene continued to be in prominence until further knowledge about disease causation was acquired. Later when “Germ theory of disease causation” came to light, in 1840, the tern “Public Health” came into general use, directed towards the maintenance and improvement of the health of the people. In 1920, Prof. Winslow defined Public Health as “the science and art of preventing the disease, prolonging life and promoting health and efficiency through organized community efforts, such as control of communicable disease, sanitation, health education, etc. so as to enable every citizen to realize his birth-right of health and longevity”. Thus the importance of preventing the disease was highlighted. The interventions were applied to healthy persons so as to prolong life. Thus the scope was broadened. The discoveries in microbiology in the turn of 18th century became a turning point in the etiological concept of disease. Possibility of disease prevention first came to focus when James Lind, while traveling in a ship in 1748 conclusively showed that scurvy can be prevented by the use of fresh citrus fruits. Cellen reported that he himself drank milk inundate with mercury to prevent syphilis. But the major thrust came with the discovery of small-pox vaccine by Edward Jenner. Thus the concept of Preventive medicine was developed as a branch of medicine distinct from public health, based on etiology, applied to ‘healthy’ people for the control of infectious disease in the community. Preventive Medicine Leavell and Clark defined Preventive Medicine as “the science and art of preventing the disease, prolonging life and promoting physical and mental health and efficiency”. Thus the scope of preventive medicine was broadened from the general measures of health promotion (i.e. Hygiene) to specific measures of disease prevention by immunization, including both. Thus the term preventive medicine is regarded as synonymous with public health. Social Medicine This term was first used by Jules Gurein, a French Physician in 1848. However, it was during 1911, Alfred Grotjahn of Doctor examines the patient 5. Biological and social environment). sexual assault. Family welfare services Demography and population dynamics Customs. It involves laboratory investigations 7. and Professor Crew at Edinburgh. This subject consists of the following components.1). robbery. Employees’ State Insurance Act (ESI-Act). launching Immunization programme improvement of sanitation. socio-economic classification. when John Ryle was appointed as first Professor of Social Medicine at Oxford University in 1943. It is arrived at based on signs and symptoms 6. beliefs. so also social pathology deals with the study of defects in the society such as strikes. Social pathology and Social therapy. their age and sex-wise distribution. This helps to prioritise the halth problems and implement control measures. etc. COMMUNITY DIAGNOSIS This consists of identification and quantification of health problems. Treatment is the main aim 9. Social Anatomy Just like human anatomy deals with the structures of the body. which consists of morbidity and mortality (disease and death) surveys. Social action consists of giving health education to the community. ventilation.4 Community Medicine Berlin who stressed that social factors play a dominant role in health and disease. (Physician) 2. cultural practices. Concerned with only sick people 4. housing. Social Therapy Just like medical therapy (treatment) consists of administration of drugs. Prevention of food Adulteration Act (PFA-Act). when a diagnosis is made in an individual by the doctor based on signs and symptoms it is called “clinical diagnosis” (Table 1. On the other hand. etc.1: Differences between clinical diagnosis and community diagnosis Clinical diagnosis 1. etc. safety and welfare of the people. Human physiology Social physiology Respiration Digestion Excretion Reproduction Growth Co-ordination Air. sewage excreta. so that the people become health conscious. Social anatomy. traditions. water conscious. temples. vaccine conscious. “the study of man as a social being in his total environment”. occupation. lock-outs. Table 1. Political action consists of implementation of certain legal measures for the health. Social physiology. schools. Thus social medicine became an extension of preventive medicine. Doctor is interested in technological advances Community diagnosis Made by the Epidemiologist Concerned with a defined population Concerned with both sick and healthy people Epidemiologist conducts surveys It is arrived at based on natural history of disease It involves epidemiological investigations Epidemiologist decides the plan of action Prevention and promotion is the main aim. Made by the Doctor. so also social therapy consists of adoption of social and political actions in the community. The various aspects of human physiology and the corresponding aspects of social physiology are as follows. Concerned with individual case 3. and just like the extent of pathology is studied by post-mortem studies so also the extent of social pathology in the community is studied by social postmortem. so also social anatomy deals with the structure of the society. industries. which consists of total population. etc. Doctor decides the treatment 8. murder. theft. Examples for heath legislations are Medical Termination of Pregnancy-Act (MTP-Act). (Physical. types of housing. The study of social anatomy gives a back-ground information in understanding health and disease phenomena in the community. in terms of morbidity and mortality rates (disease and death rates) and their influencing factors in a community. Social Pathology Just like human pathology deals with the study of abnormal structure of the body organs. It involves the evaluation of programme Epidemiologist is interested in statistical values . juvenile delinquency. etc. etc. dead-bodies. Social medicine is defined as. Indian Factories Act (IFA). latrine conscious. so also social physiology deals with the functions of the society. Social Physiology Just like human physiology deals with the functions of the body. Nutrition and health Disposal of refuse. habits. etc. It involves follow-up of case 10. Social medicine achieved academic respectability in England. Such surveys also help us to understand the social factors responsible for the prevalence of the disease in the community (explained under “Sociology”). i. the concept of “multifactorial disease causation” came into vogue. This is a Universal Truth. Nature of care Community medicine Hospital medicine Provides health care to the people of defined geographic area Both active and passive operational strategies are applied. cancer. secondary and tertiary care hospitals. etc. diabetes. promote the health and to prolong the life of the people.. i. Service area 2. leading to freedom from 5 contd.Introduction to Community Medicine Table 1. So measures like early diagnosis.e. viz. Only curative care. community medicine and hospital medicine. Cost-benefit Gives high cost-benefit analysis ratios by involving minimum expenditure and yielding maximum results Hospital medicine illness Virtually no intersectoral co-ordination exists Has limited scope in the participation of National health programs Gives poor cost-benefit ratios by involving maximum expenditure and yielding minimum benefits contd.2. . identification of risk-factors. Cheaper than cure and Easier than cure. but also it is Simpler than cure. Thus the concept of Community Medicine came into vogue. With the emergence of non-communicable disease such as hypertension. Operational strategy 3. and due to their multifactorial etiology. both providers and consumers are on the move Consists of community Health Centers. preventive.e. Whatever may be the terminology. Primary Health Centers and Subcenters It is comprehensive (i. the ultimate goal is to prevent the disease.. Organizational frame work 4.. promo- Draws patients from ill defined catchment area Only passive operational strategy is applied.. Program Promotes active participarticipation pation in the operation of National health programs 7. Community Medicine and Hospital Medicine There are two areas of work for the physician. limiting the development of disability and rehabilitation of handicapped persons were included in the subject. Thus the scope was broadened from Hygiene to preventive and social medicine and now to Community Medicine. Safer than cure.2: Differences between community medicine and hospital medicine Features 1.e. Features Community medicine tive. Not only prevention is better than cure. accidents. curative and rehabilitative) 5. The differences are given in Table 1. responsibility lies on the patient to come to hospital for treatment Consists of a loose conglomeration of primary. This is based upon the principle that “Prevention is Better than Cure”. Intersectoral Exits between the co-ordination health department and the health related departments 6.
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