1. History of Medicine
(Evolution of Community Medicine)

2. Evolution of Community Medicine
(History of Medicine)
Stages seen in the history of medicine:
• Stone age
• 5000 BC: Indian medicine
• 2700 BC: Chinese medicine (system of
barefoot doctor, System of acupuncture)
• 2000 BC: Egyptian medicine (manuscript
of papyrus)
Continued…..

3. Evolution of Community Medicine
(History of Medicine)
Stages seen in the history of medicine:
• 2000 BC: Mesopotamian medicine
(Babylonian code of hammurabi)
• 460 BC: Greek medicine (Hygiea daughter
of Aescuapius, Hippocrates oath)
• 130 AD: Roman medicine (Galen)
• Up to 800 AD: Dark ages of medicine
Continued…..

4. Evolution of Community Medicine
(History of Medicine)
Stages seen in the history of medicine:
• 900 AD: Arabic medicine (Rhazes, Avicenna)
• 1500 AD: Revival period (theory of contagion
blood circulation by Harvey,
vaccination by Jenner)
• 1800: Sanitary awakening
• 1850: Rise of public health (epidemic of
cholera by John Snow, typhoid by
William, Chadwick’s sanitary reforms)
Continued…..

5. Evolution of Community Medicine
(History of Medicine)
Stages seen in the history of medicine:
• 1860: Germ theory (anthrax by Robert
Koch)
• 1880: Typhoid & pneumonia 1882 TB
• 1883: Birth of preventive medicine (ARV)
• 1883: Cholera vaccine, 1892 dipth
antitoxin
• 1898: Malaria transmission by Ross
Continued…..

6. Evolution of Community Medicine
(History of Medicine)
Stages seen in the history of medicine:
• 1900: Multifactorial causation of disease
• 1911: Social medicine
• 1920: Disease control
• 1960: Health promotion
• 1981: HFA

7. Concept of Health

8. Concept of Health
• Biomedical concept
• Ecological concept
• Psychological concept
• Holistic concept

9. WHO Definition of Health
Health is a state of complete physical,
mental and social well-being and not merely
an absence of disease or infirmity
and ability to lead socially and economically productive life
Operational definition:
A condition or quality of human organism expressing the adequate
functioning of the organism in giving condition, genetic or environmental

10. Dimensions of health
1. Physical 6. Vocational
2. Mental 7. Others:
1. Cultural
3. Social 2. Socioeconomic
4. Spiritual 3. Environmental
4. Educational
5. Emotional 5. Nutritional
6. Curative
7. Preventive

11. Concept of Wellbeing
• Objective component
1. Standard of living
2. Level of living
• Subjective component
• Quality of Life (PQLI)
(IM, Life expt. @ 1, Literacy.)
• Human development Index
(Life expt. @ 0, Knowledge, Income)

12. Concept of Wellbeing
• Subjective component
• Quality of Life (PQLI)
(IM, Life expt. @ 1, Literacy.)
The condition of life resulting from combination of the factors
such as those determining health happiness education social
and intellectual attainments freedom of action, justice and
freedom of expression
• Human development Index
(Life expt. @ 0, Knowledge, Income)

13. Determinants of health
1. Biological / Hereditary
2. Behavioral & Socio-cultural Lifestyle
3. Environmental
4. Socioeconomic conditions
5. Health and family welfare services
6. Aging of the population
7. Gender
8. Others…..

14. Determinants of health
1. Biological 8. Science and
2. Behavioral technology
3. Environmental 9. Information and
communication
4. Socioeconomic
10. Gender
5. Health system
11. Equality and social
6. Socio-cultural justice
7. Aging of the 12. Human rights
population

15. Responsibility of Health
1. Individual responsibility
2. Community responsibility
3. State responsibility
4. International responsibility

16. Indicators of health
(Valid Reliable Sensitive Specific)
1. Mortality indicators
2. Morbidity indicators
3. Disability indicators
4. Nutritional Status indicators
5. Health care delivery indicators
6. Utilization rate
7. Indicators of social and mental health
8. Environmental indicators
9. Socioeconomic indicators
10. Health policy indicators
11. Indicators of quality of life
12. Others……….

17. Health Indicators
Valid, reliable, sensitive and relevant indicators which
determine health development are called health
indicators:
• Mortality Indicators: Death rate, Life span, IMR, Child mortality rate,
MMR, Case fatality rate, proportion mortality rate.
• Morbidity Indicators: Disease rate (incidence, prevalence)
• Disability Indicators: Hospitalization, loss of work, sullivan index DALYs
• Nutritional Indicators: Anthropometric values, LBW
• Utilization Indicators: Fully immunized, bed turn out…
• Socioeconomic Indicators: Per capita income. Family size.

18. Mortality indicators
1. Crude death rate
2. Expectancy of life
3. Infant mortality rate
4. Child Mortality rate
5. Under 5 proportionate mortality rate
6. Maternal mortality
7. Disease specific mortality
8. Proportionate mortality rate

19. Concept of disease
It is departure from state of health interrupting in normal
function of the body

20. Concept of disease
• Theories (Germ theory, Epidemiological Triad, Multifactorial causation, web of causation)
• Natural History of disease
(Prepathogenesis – pathogenesis) (Agent Host Environment)
• Risk Factors
• Iceberg Phenomena
• Monitoring the performance & analysis of routine measurements aimed at
detecting changes in the environment or health status of population
• Surveillance The continuous scrutiny of the factors that determines the
occurrence and distribution of disease and other conditions of ill health
• Sentinel Surveillance
• Prevention and Control

21. Difference between
Control & Eradication
Control Eradication
Definition To reduce incidence to Total extirpation of
acceptable level disease agent
Objective To reduce morbidity & To uproot the disease
mortality (no more PH problem)
Area of operation In high incidence area Total coverage
Duration of operation Indefinite Time limited
Economic aspect Recurring Cheap
Case finding, Not important Very Important
Confirmation,
Epidemiological investi.

22. Examples of Risk Factors
Fatty diet, obesity Diabetes
Alcohol Cirrhosis of liver
Smoking, radiation Cancer
High cholesterol, obesity, type Heart diseases
of personality
Smoking, high BP, high Stroke
cholesterol
Alcohol, Ignorance about Accident
traffic signals

23. LEVEL OF
PREVENTION
1. Primordial Prevention
2. Primary Prevention
3. Secondary Prevention
4. Tertiary Prevention

24. Natural history of disease
Interrelation of Agent , Host and Reaction of the host to the stimulus
Environmental Factor
Production of stimulus Early Discernible Advance Convalescenc
pathogenesis early lesions disease e
Pre-pathogenesis period Period of Pathogenesis
Health Promotion Specific protection Early diagnosis & Disability Rehabilitation
prompt treatment limitation
•Health Education •Use of specific •Case finding measures •Adequate •Provision of
•Good standard of immunization individual & mass treatment to hospital &
nutrition adjusted to •Attention to personal •Screening surveys arrest the community facilities
developmental phases hygiene disease for retaining &
•Selective examinations
of life process and to education for
•Use of environmental objectives
prevent further maximum use of
•Attention of personality sanitation To cure & prevent
development complications remaining
•Protection against disease process
capacities
•Provision of adequate occupational hazards To prevent the spread of
housing recreation & •Provision of •Education of public
•Protection from a communicable diseases
& industry the
agreeable working accidents facilities to limit
To prevent complications rehabilitated
cond. disability and
•Use of specific & sequel
•As full employment
•Marriage counseling nutrients to prevent
To shorten period of as possible
ang sex education death
•Protection of disability
•Selective
•Genetics carcinogens
placement
•Periodic selective •Avoidance of allergens
examination •Work therapy in
hospitals
•Use of shelter

25. Modes of Intervention
Intervention is an attempt to intervene or interrupt the usual
sequence in the development of disease in a man.
1. Health Promotion:
It is a process of enabling people to increase control
over & to improve health
– Health education
– Environmental health
– Nutritional intervention
– Lifestyle changes
– Behavior changes

26. Modes of Intervention
2. Specific Protection:
It is a process to totally avoid disease or illness
– Immunization
– Nutritional supplement
– Chemoprophylaxis
– Immunoprophylaxis
– Protective device in industry
– Protective device against carcinogen
– Protective device against allergens

27. Modes of Intervention
3. Early diagnosis and prompt
treatment
It is a process of early detection of transformation from physiological to
pathological state
Early diagnosis and prompt treatment of:
• Ca breast
• Ca cervix
• TB
• Leprosy

28. Modes of Intervention
4. Disability Limitation
It is a process involving interaction to
prevent disability e.g.
– Disability limitation in nerve damage in
leprosy
– Physiotherapy in polio lameness.
Impairment Disability Handicap

29. Modes of Intervention
5. Rehabilitation
It is a combine & co-ordinate use of medical, social,
economical, vocational and psychological measure to
make an individual or community function normally
– Medical rehabilitation
– Social rehabilitation
– Economic rehabilitation
– Vocational rehabilitation
– Psychological rehabilitation