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Population Perspective of RelationsPopulation Perspective of Relations
Individual
Family
Community, nation
Human population
All populations
Introduction To Community Medicine and Definitions of Terms
Introduction To Community Medicine and Definitions of Terms
Objectives:Objectives:
1. To understand the importance of the health of the nation through history and development of public health in developed countries comparing to developing countries.
2. You students should be capable to properly use, understand and describe different terminology.
Death rates from cholera, 1853-1854, according to water company supplying sub-districts of LondonDeath rates from cholera, 1853-1854, according to water company supplying sub-districts of London
Water companyPopulationIn 1851
Cholera deathsIn 1853-1854
Deaths per 100,000 living
Southwark and VauxhallBoth companiesLambeth
167,654
301,149 14,632
192
182 0
114
60 0
Source: J. Snow, on the Mode of Communication of Cholera (2nd ed). London: Churchill, 1855. Reproduced in Snow on Cholera. New York: Hafner, 1965
Death rates from cholera in London, 1853-1854, according to water company supplying actual houseDeath rates from cholera in London, 1853-1854, according to water company supplying actual house
Water company Number of houses
Deaths from cholera
Deaths per 10,1000
Southwark and VauxhallLambethRest of London
40,046
26,107256,423
1263
981422
315
37 59
Source: J. Snow, On the Mode of Communication of Cholera (2nd ed). London: Churchill, 1855. Reproduced in Snow on Cholera. New York: Hafner, 1965.
Chief causes of death in the US, 1900 and 1982source: USDHHS., Prevention’84/’85, �Washington, DC; public Health Service Office, 1985.
Chief causes of death in the US, 1900 and 1982source: USDHHS., Prevention’84/’85, �Washington, DC; public Health Service Office, 1985.
1900 % 1982 %Pneumonia/influenzaTuberculosisHeart diseaseStrokeDiarrhea/enteritisNephritisCancerAccidentsDiphtheriaOther
11.811.2 9.4 7.6 6.3 5.9 4.5 4.2 1.9 37.2
Heart diseaseCancerAccidentsStrokeChronic lung diseaseSuicidePneumonia/influenzaChronic liver diseaseDiabetes mellitusOther
34.423.9 6.6 6.5 2.9 2.1 2.0 1.9 1.718.0
1999 Disease or Injury 2020 Disease or Injury
Increasing burden of noncommunicable diseases and injurieschange in rank order of DALYs for the 15 leading causes
(baseline scenario)
1 Acute lower respiratory infections2.HIV/AIDS3.Perinatal conditions4.Diarrhoeal diseases5.Unipolar major depression6.Ischaemic heart disease7.Cerebrovascular disease8.Malaria9.Road traffic injuries10.Chronic obstructive pulmonary
disease11.Congenital abnormalities12.Tuberculosis13.Falls 14.Measles15.Anaemias
1. Ischaemic heart disease2. Unipolar major depression3. Road traffic injuries4. Cerebrovascular disease5 .Chronic obstructive pulmonary 6. Lower respiratory infections7. Tuberculosis8. War9. Diarrhoeal diseases10.HIV11.Perinatal conditions12.Violence 13.Congenital abnormalities14.Self-inflicted injuries15.Trachea, bronchus and lung
cancers
Community MedicineCommunity Medicine
Public health services
emphasizing preventive
medicine and epidemiology
for members of a given
community or region.
Scope of Community MedicineScope of Community Medicine Epidemiology Vital statistics School health Mental health Maternal and Child health (MCH) Environmental health Rural health Urban health Occupational health
Clinician versus community physician (GP, FP)Clinician versus community physician (GP, FP)
A clinician’s target is to diagnose and treat his patient
A community physician’s target is to manage health problem in a community (community diagnosis)
History of Public HealthHistory of Public Health1880-1920: Disease control phase1921-1960: Health promotional phase1961-1980: Social engineering phase1981-2000: Primary Health Care,
Health for All phase
Definition: ‘Health …’• ‘…is a state of complete physical, mental and
social well-being and not merely the absence of disease or infirmity’(WHO, 1948)
• ‘Health is only possible where resources are available to meet human needs and where the living and working environment is protected from life-threatening and health threatening pollutants, pathogens and physical hazards’(Who, 1992a)
Definition of HealthDefinition of Health50 y.o. immigrant F, with Ca breast, lives in a country with
no public access to free health services. Currently she lost her job because of offensive attitude and living on donations provided from neighbors.From the previous scenario we can say that the
definition of health is “ a state of well being that include the next parameters”
PhysicalMentalFinancialSocial Spiritual
Definition: ‘Environment’
• ‘…[All] that which is external to individual human host. [It] can be divided into physical, biological, social cultural any or all of which can influence health status in populations.’ (WHO, 1995)
Definition: ‘Environmental Health’Definition: ‘Environmental Health’‘…comprises those aspects of human health,
including quality of life, that are determined by physical, biological, social and psychosocial factors in the environment. It also, refers to the theory and practice of assessing, correcting, controlling, and preventing those factors in the environment that can potentially affect adversely the health of present and future generations’ (WHO, 1993a)
Population Perspective of RelationsPopulation Perspective of Relations
Individual
Family
Community, nation
Human population
All populations
Health and Environment Perspective of Relations Health and Environment Perspective of Relations
PersonalHealth
Family Health
Occupational Health
Public Health
Environmental health
EpidemiologyEpidemiology
The Study of the DISTRIBUTION
and DETERINIANTS of DISEASE
FREQUENCY in HUMAN
POPULATION (Mac Mahoon,
1970)