History of Medicine (Evolution of Community Medicine) Dr. Farooq Ahmad Assistant Professor Community Medicine Department Rawalpindi Medical College Rawalpindi - PowerPoint PPT Presentation

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History of Medicine (Evolution of Community Medicine) Dr. Farooq Ahmad Assistant Professor Community Medicine Department Rawalpindi Medical College Rawalpindi

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Title: History of Medicine (Evolution of Community Medicine) Dr. Farooq Ahmad Assistant Professor Community Medicine Department Rawalpindi Medical College Rawalpindi


1
History of Medicine (Evolution of Community
Medicine) Dr. Farooq Ahmad Assistant Professor
Community Medicine Department Rawalpindi Medical
College Rawalpindi
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,
    Chadwicks 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
  • Physical
  • Mental
  • Social
  • Spiritual
  • Emotional
  • Vocational
  • Others
  • Cultural
  • Socioeconomic
  • Environmental
  • Educational
  • Nutritional
  • Curative
  • Preventive

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

12
Concept of Wellbeing
  • Subjective component
  • Quality of Life (PQLI)
  • (IM, Life expt. _at_ 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. _at_ 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
  • Science and technology
  • Information and communication
  • Gender
  • Equality and social justice
  • Human rights
  • Biological
  • Behavioral
  • Environmental
  • Socioeconomic
  • Health system
  • Socio-cultural
  • Aging of the 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 of causation of disease
  • (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 acceptable level Total extirpation of disease agent
Objective To reduce morbidity mortality (no more PH problem) To uproot the disease
Area of operation In high incidence area Total coverage
Duration of operation Indefinite Time limited
Economic aspect Recurring Cheap
Case finding, Confirmation, Epidemiological investi. Not important Very Important
22
Examples of Risk Factors
Fatty diet, obesity Diabetes
Alcohol Cirrhosis of liver
Smoking, radiation Cancer
High cholesterol, obesity, type of personality Heart diseases
Smoking, high BP, high cholesterol Stroke
Alcohol, Ignorance about traffic signals Accident
23
Level of prevention
  1. Primordial Prevention
  2. Primary Prevention
  3. Secondary Prevention
  4. Tertiary Prevention

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

30
  • Thanks
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