Introduction - Community Medicine Concept of Hygeine, Public health, Preventive & Social Medicine and Community diagnosis.. Difference between Clinician and Epidemiologist..

1. CommunityMedicine-
Let’sThinkBeyondtheDisease
-DrJatinChhaya
Assistantprofessor
CommunityMedicineDepartment
SBKSMedicalCollege,Vadodara

2. LearningObjectives
• Concept of Hygiene, Public health, Preventive
Medicine,SocialMedicine&CommunityMedicine
• Roles & Responsibilities of Community Physician
andClinicalPhysician

3. Background..
• 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.
• Goal: 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).
• The term community medicine is only a new terminology.
• It is the successor of the terms hygiene, preventive medicine, social
medicine and public heath.

4. HYGEINE.. • Greek word ‘Hygiea’, the Goddess of
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.
• Later, when ‘Germ theory of disease
causation’ came to light, in 1840, the term,
‘Public Health’ came into general use,
directed towards the maintenance and
improvement of the health of the people

5. PUBLICHEALTH..
In 1920, Professor 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.
Thus, the importance of preventing
the disease
was highlighted.

6. 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.
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.
PUBLICHEALTH..

7. PREVENTIVEMEDICINE..
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 broaden 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.

8. SOCIALMEDICINE..
This term was first used by Jules Gurein, a French physician in
1848. However, it was during 1911, Alfred Grotjahn of Berlin
who stressed that social factors play a dominant role in health and
disease.
Social medicine is defined as, ‘The study of man as a social being
in his total environment’ (Physical, biological and social
environment)
Thus, social medicine became an extension of preventive
medicine

9. ACADEMICRESPECTABILITYOFSOCIALMEDICINE..
Social medicine achieved academic respectability in England, when
John Ryle was appointed as the first Professor of social medicine at
Oxford University in 1943
This subject consists of the following components: Social anatomy,
Social physiology, Social pathology and Social therapy.
• Social Anatomy: Just like human anatomy, deals with the structures
of the body, so also social anatomy deals with the structure of the
society, which consists of total population, their age and sex-wise
distribution, socioeconomic classification, types of housing,
occupation, industries, temples, schools, etc.
– The study of social anatomy gives a background information in
understanding health and disease phenomena in the community.

10. • Social Physiology: Just like human physiology deals with the
functions of the body, so also social physiology deals with the
functions of the society.

11. • Social Pathology: Just like human pathology, deals with the study of
abnormal structure of the body organs, the social pathology also
deals with the study of defects in the society such as strikes, lock-
outs, theft, murder, robbery, sexual assault, juvenile delinquency,
etc.
• Social Therapy: Just like medical therapy (treatment) consists of
administration of drugs, so also social therapy consists of adoption
of social and political actions in the community.
– Social action: Health education to the community, launching
immunization program, improvement of sanitation, etc.
– Political action: Implementation of certain legal measures for the
health, safety and welfare of the people. Examples: Medical
Termination of Pregnancy-Act (MTP-Act); Prevention of food
Adulteration Act (PFA-Act); Employees’ State Insurance Act
(ESI-Act); Indian Factories Act (IFA), etc.

12. COMMUNITYDIAGNOSIS..
Clinical diagnosis: When a diagnosis is made in an individual by
the doctor based on signs and symptoms.
Just like, Community Diagnosis consists of identification and
quantification of health problems, in terms of morbidity and
mortality rates (disease and death rates) and their influencing
factors in a community.
This helps to prioritise the health problems and implement
control measures.

13. Twoareasofworkforthephysician,viz.communitymedicineand
hospitalmedicine..
Features Clinical Medicine Community Medicine
Made by Made by the doctor (Physician) Made by the epidemiologist
Concern Concerned with individual case Concerned with a defined population
Focus Concerned with only sick people
Concerned with both sick and healthy
people
Method to reach
conclusion
Doctor examines the patient Epidemiologist conducts surveys
Interest in
It is arrived at based on signs and
symptoms
It is arrived at based on natural history
of disease
Diagnosis It involves laboratory investigations
It involves epidemiological
investigations
Treatment Doctor decides the treatment
Epidemiologist decides the plan of
action
Aim Treatment is the main aim
Prevention and promotion is the main
aim.
Follow-up It involves follow-up of case It involves the evaluation of program
Equipment
interest
Doctor is interested in technological
advances
Epidemiologist is interested in
statistical values

14. DifferencesbetweenCommunitymedicineandHospitalmedicine..
Features Community Medicine Hospital Medicine
Service area
Provides health care to the people
of defined geographic area
Draws patients from ill-defined
catchment area
Operational strategy
Both active and passive
operational strategies
Only passive operational strategy
is applied, i.e. responsibility lies
on the patient to come to hospital
Organizational
framework
Consists of community health
centres, primary health centres and
subcenters
Consists of a loose
conglomeration of primary,
secondary and tertiary care
hospitals.
Nature of care
It is comprehensive (i.e.
preventive, promotive, curative
and rehabilitative)
Only curative care, leading to
freedom from illness
Intersectoral
coordination
Exits between the health
department and the health related
departments
Virtually no intersectoral
coordination exists
Cost-benefit
analysis
Gives high cost-benefit ratios by
involving minimum expenditure
and yielding maximum results
Gives poor cost-benefit ratios by
involving maximum expenditure
and yielding minimum benefits

15. Summary..
• Thus, the scope was broadened from hygiene to
preventive and social medicine and now to
community medicine.
• Whatever may be the terminology, the ultimate goal
is to prevent the disease, promote the health and to
prolong the life of the people.
• This is based upon the principle that ‘Prevention is
better than cure’.
• Not only prevention is better than cure, but also it is
simpler than cure, safer than cure, cheaper than cure
and easier than cure. This is a universal truth.

16. Thank you..