BASIC CONCEPTS
OF
COMMUNITY
MEDICINE
Learning objectives:
1) To understand the meaning of health & disease.
2) To define Community Medicine.
3) To understand the levels of prevention.
4)To recognize the levels & the determinants of health.
HEALTH
WHO defined health in 1984 as "a state of complete
physical, mental, social & spiritual well-being and not
merely the absence of disease or infirmity.
Health doesn't mean absence of diseases but it has a broader
concept.
Physical
Mental
Social
Spiritual
HEALTH
If you feel that all these aspects are well then you are
enjoying perfect health!!
• Every cell & • Sound • keeping air, • Job should be safe
organ in the body relationships with housing & water for health
is functioning at friends, family & • Comprises aspects
clean.
optimum the community as of wellness that
capacity & in • Safe food & safe help achieve a
a whole. waste disposal.
harmony with the balance between
rest of other work & leisure.
organs.
Physical Social Environmental Occupational
health health health
health
• Maintaining harmonious
• Express emotions relationships with • Ability to recognize
in a positive, ALLAH & other living reality & cope with
things the demands of daily
nondestructive way life.
• Having spiritual direction
& purpose. • Sound thinking,
taking decision, self
• Living according to one’s
esteem & dealing with
ethics, morals, & values.
Emotional conflicts.
health Spiritual Mental
health health
Spectrum of health (Levels of health)
Ideal health
(100% health)
Good health (+ve health)
Negative health
(Pre clinical) Apparent disease
(Clinical illness)
Complications
Death
Perfect health
• 100% health in all the 7 aspects
• Very difficult to be attained in real life.
Good health (+ve health)
• One may enjoy good health without complete 7 aspects.
• Health is a dynamic process (ups and downs within the 7 aspects).
Negative health (Pre-clinical)
• There is a pathological changes but no symptoms.
• The individual looks healthy but he is unable to restore the body to its normal
function (disease can be detected by proper clinical exam. or by lab).
Apparent disease (Clinical illness)
• The individual develops symptoms & signs.
Complications
• Failure or breakdown of body organs & functions “permanent or transient”.
Death
• End result of breakdown of health
New philosophy of Health
Fundamental Essence of
Inter-sectoral.
human right. productive life.
Involves
Integral part of Central to individuals, state
development. quality of life. & international
responsibility.
Major social World-wide
investment. social goal.
Disease
Disease: Any deviation from the normal health
state that is manifested by a characteristic set of
symptoms & signs and whose etiology, pathology,
and prognosis may be known or unknown.
WHO defined Community Medicine or Public Health as:
the art and science of promoting health, preventing disease
and prolonging life through organized governmental and
community efforts.
All efforts are directed to the whole community rather than
individual patients.
Community: is a group of individuals sharing an
identity, culture, and operates through common
institutions and organizations.
Public health is a combination of scientific
disciplines (e.g. epidemiology, biostatistics, social
sciences & demography) and skills (epidemiological
investigations, management, planning, surveillance
& evaluation) that are directed to maintenance &
improvement of people’s health.
Scientific
disciplines
Skills
Community Medicine deals with:
Prevention of health
Control spread of
problems before its Sanitation of communicable
occurrence e.g. environment diseases
hazard identification
Ensure availability
Plan & implement of methods for early
Health education suitable medical diagnosis of diseases
services for all areas to ensure good
prognosis.
Legislations & laws
that protect the
community against
environmental
hazards
The role of community medicine in various conditions of
human life
Health in the SDG era
The 3rd goal of the 17 goals of Sustainable development
goals “SDGs” announced internationally at 2016 was to
“ensure healthy lives and promote well-being for all at all
ages”
By promoting good health at all ages, the benefits of
development extend across generations.
Investments in 1ry health care can promote health across
all social groups & reduce health inequities within and
between countries.
Improving performance of health systems by enhancing
financial & human resources, appropriate use of
technology,community empowerment and good
governance will advance this agenda.
• Health promotion of healthy people via preventing emergence or
development of risk factors (not focused to a specific disease).
Encouraging healthy life styles as good nutrition, physical exercise,
sanitary environment.
1ry • Specific prevention also for healthy people but against specific diseases by
using vaccines and chemoprophylaxis
• Early detection & treatment of cases
• Disease occurred & the aim is to prevent spread to others who is at
2ry risk and to treat patients to prevent complications.
• Care with complicated & disabled cases
• Rehabilitation: to help handicapped benefit from their capabilities
3ry to live independently
Medicine
Medicine: is a branch of science concerned with prevention
of diseases & the maintenance of good health, diagnosis of
diseases and treatment.
It has 2 main branches: 1- Preventive 2- Curative
Preventive
Curative
Items Community medicine Clinical medicine
Objective To prevent diseases To cure diseases
Customers Population or all community Individual patients
(healthy and diseased) (diseased only)
Tools of Epidemiological & Statistical History, clinical exam,
diagnosis studies & investigations.
Management Community health programs Medical/surgical
treatment
Evaluation Assessment of health programs Follow up of patients
& health status of a community
by calculation of rates.
Branches Epidemiology, statistics, Pediatrics,
nutrition, health services & gynecology, general
management medicine, surgery
Non-modifiable Modifiable
• Genetics • Behavioral &
• Gender Sociocultural
• Age • Socio-economic
• Health services
• Physical environment
• Social support networks
Non-modifiable determinants
• State of health depends on the genetic constitution of man.
• There are multiple diseases known to be of genetic disorders like
Genetics chromosomal anomalies, errors of metabolism, mental retardation.
• Men and women suffer from different types of diseases at different
ages.
• Recently, focused actions are taken towards women’s health covering
Gender nutrition, reproductive health, consequences of violence and ageing.
• Some diseases are more common in certain ages than others.
• Also, rapid population ageing leads to increased prevalence of
Age chronic diseases & disabilities that deserves special attention.
These factors can not be modified or prevented.
Everyone is borne with certain genetic pattern, being male
or female and passes through different ages till death.
Prevention of these factors is impossible (except for
genetics there may be modification in the coming years)
Modifiable determinants
Behavioral & Socio-cultural factors
• Life style “cultural, behavioral pattern and lifelong personal habits developed through socialization”.
• Health requires adoption of healthy lifestyles like adequate nutrition, enough sleep, physical activity.
Socio-economic factors
• Income & social status: The greater the gap between the richest & poorest people, the greater the
differences in health.
• Education: Education can compensates the effects of poverty on health irrespective of the availability
of health services.
• Occupation: being employed in productive work promotes health.
• Political system: It can shape the community health services “resource allocation, manpower policy,
choice of technology °ree to which health services are made accessible and available to different
segments of the society.”
Health services
• Access & use of services that prevent and treat disease influences health.
Physical environment
• Safe water & clean air, healthy workplaces, safe houses, communities and roads all contribute to good
health.
Social support networks
• Greater support from families, friends and communities is linked to better health. Culture - customs and
traditions, and the beliefs of the family and community all affect health.
The following model summarizes the main determinants of health
according to their spheres of influence, starting from those at the
individual level and moving through to those in the wider society.
Strength of association of different determinants on health
Physico-
chemical
environmental
factors
Health services 10% Genome
10% 10%
Life style
20% Socio-economic
factors
50%
