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Introduction to elements of Public Health


Introduction to elements of Public Health First meeting on the topic: 9th June 2007 Public Health Public health is the science of protecting and improving the health ... – PowerPoint PPT presentation

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Title: Introduction to elements of Public Health

Introduction to elements of Public Health
  • First meeting on the topic 9th June 2007

Public Health
  • Public health is the science of protecting and
    improving the health of the communities through
    education, promotion of healthy lifestyles and
    research for diseases and injury prevention. Thus
    the focus is on entire populations rather than on
  • Poor public health takes economic tolls in
    various ways prevention better than cure

Public Health
  • Achievements of modern public health improved
    quality of life.
  • Attributed to vaccination programs, control of
    infectious diseases, better safety policies,
    improved family planning, fluoridation of
    drinking water and programs to decrease heart
    diseases and stroke.
  • Vast discrepancy between Developing and Developed
    countries poverty being the main factor. Now
    the focus in developed countries is shifting
    towards chronic diseases such as cancer, AIDS,
    diabetes and heart diseases but infectious
    diseases continue to haunt developing countries.
  • India has focused mainly on curative care and
    immunizations while public health services has
    been neglected

Public Health in Independent India
  • Many problems reported in Monica Das Guptas
  • In Independent India the capacity to prevent
    outbreaks has reduced.
  • the focus was more developing heavy industry
    rather than health and education.
  • Public health is the responsibility of the state
    in India, but is not adequately funded
  • Public health regulations are in place but often

Yet Future Trends are Encouraging
  • Financing is available through large programs
    Rural health mission, National sanitation mission
    and employment guaranteed scheme.
  • Institutions are being built at local and
    national level. Panchayati Raj Act emphasizes on
    building local government and delegates health
    activities to them.
  • A new thrust to build an institution like the US
    Center of disease control (adapted in China and
    EU). It recognizes that public health systems
    have to be coordinated and supported by a federal
  • India has an exceptional capacity to deliver
    services (ex Elections, Censuses)

Burden of disease in India
Burden of disease in India
  • Measuring the Impact of disease
  • - DALYS disability adjusted life years
  • - Impact of diseases in India
  • How to proceed further (as a group)
  • - Disease specific, group specific, work
  • - Anoop to lead subsequent discussion on
    infant diseases and intervention
  • Education as means of help in public health
  • - suggested by Manas, eg. Indradhanush

Burden of disease in India by DALYS
  • Non-communicable diseases
  • Cardiovascular diseases (31)
  • Mental illnesses (26)
  • Cancer (10)
  • Communicable diseases
  • Acute respiratory infections (ARI, e.g.
    pneumonia) (18)
  • Perinatal illnesses (around childbirth) (17)
  • Diarrhoea (16)
  • Tuberculosis (6)
  • HIV (4)
  • Malaria (3)

Post-meeting notes
  • Need for affordable technological advances
  • Key point is to speed up diagnosis and subsequent
  • List of useful sites posted on webpage

Neonatal mortality reduction
Neonatal mortality reduction
  • Status of infant and perinatal issues in rural
  • Different kinds of traditional beliefs
  • Efforts led by Abhay Bang, Gadchiroli dist
  • - Village health workers educating the
    households about safe procedures
  • - Issues regarding traditional practices
  • Role of father in neonatal care, etc.

Other issues discussed
  • Helping make the perinatal period safer using
    simple household tools/remedies
  • Eg Anoops demo of preparing disinfectant bleach
    using lime juice and baking soda
  • Monitor maternal and baby health regularly
  • Simple tool possible design of paper tapes for
    measuring size of mothers abdomen to estimate
    weight of baby.

Malnutrition in India
Malnutrition in India - statistics
  • Malnutrition consists of both protein-energy
    malnutrition (underweight etc.) and micronutrient
  • Cause of half of all child deaths, and more than
    half of deaths due to major diseases (malaria,
    diarrhea, pneumonia, measles) in India.
  • Prevalence of underweight children is highest in
    the world, double of sub-Saharan Africa.
  • More than a third of undernourished kids of the
    world live in India.
  • More prevalent in rural areas, among girls,
    backward classes and poorer income groups.

Indias solution - ICDS (Integrated Child
Development Services)
  • World's largest early child development program
  • Uses a multi-sectoral approach of provising
    healthcare as well as pre-school education to
    children and mothers.
  • Supplementary feeding, immunization, health
    checkups, health and nutrition education to adult
    women, micronutrient supplements, pre-school
    education, growth monitoring.
  • Anganwadi centers led by anganwadi workers in
    every administrative block
  • By 2004 6lakhs AWC workers covered 33M children
    and 6M women
  • Very prevalent (covers 90 of administrative
    blocks in the country) but effectiveness is under
  • We studied various success stories of anganwadi
    centers and measures on how they can be improved.

Malaria Cycle
Parasite in RBCs
Distribution of Malaria
Sachs Malaney, Nature 2002
Malaria in India
Dr VP Sharma http//
  • Preventing mosquito breeding
  • Indoor spraying of insecticide
  • Insecticide-treated bednets
  • Larva-eating fish
  • No vaccine available

Water Supply, Sanitation, and Public Health in
  • Source Field Survey on water supply, sanitation
    and associated health impacts in urban poor
    communities- a case from Mumbai City, India.
  • S. Kumar Karan H. Harada, Water Science
    Technology, 2002

Mumbai Background
  • Largest metropolitan area in India, 5th largest
    in the world
  • Population 20 million
  • About half of the population lives in slums-
    urban poor

Water Supply and Sanitation
  • Govt. provides 3 billion liters/day
  • Only 65 of the requirement is met
  • Urban Poor
  • Get 1/3rd the supply compared to the rest (45
    liters per capita per day)
  • US- 260 liters/c.d. household consumption
  • 90 of city and 40-50 of suburbs have sewerage
  • But most urban poor do not have access to it
  • Less than 1/3rd the requirement for public
    toilets is met
  • 90 waste water (2.2 billion l/d) is collected
  • 0.1 billion is treated
  • 1 billion to oceans
  • Rest in creeks/waterways

Impact on Health
  • 35-45 families in slums, gt50 among pavement
    dwellers have at least one person ill
  • Water-related diseases (diarrhea, malaria,
    typhoid, etc.) account for 26-32 of all diseases
  • Children share 2/3rd of all disease burden

(Short duration) (Chronic)
Incidence of Water Borne Diseases
  • Higher incidence of water and sanitation related
    disease in slum and pavement dweller areas
  • Environmental problems include location near
    polluted sites, lack of sanitation, poor personal
    hygiene, poverty, lack of environmental education
  • Pavement dwellers suffer the most
  • Problem lies in huge slum population, 10
  • Provide safe and adequate water and sanitation

Technological ways to make water cleaner - to
prevent water-borne diseases
  • Statistics, WHO 1b people do not have easy
    access to clean water.
  • Before the goal of providing clean drinking water
    to everyone materializes
  • local or household treatment of water may
    protect people from disease.

Common methods of water purification
  • Disinfection using chlorine
  • Boiling
  • Flocculation (e.g. alum)
  • Filtration
  • Solar/UV treatment.

Group discussed about
  • Techniques of different methods.
  • Socio-economic obstacles on their implementation
  • Cost and availability
  • Ignorance and lack of belief in the benefits of
    water treatment
  • More important concerns than purity of drinking