This topic is a part of Social and Preventive Pharmacy subject of Final year B. Pharm. This PPT will help students to clear their concept related to health and disease.

1. UNIT 1: CONCEPT OF HEALTH AND
DISEASE
1
By Prof. Varsha N. Tambe
K. K. Wagh college of pharmacy, Nashik

2. WHAT IS HEALTH ?
⮚ “A state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity”
(World Health Organisation, 1948)
⮚ “The extent to which an individual or group is able to realize aspirations and
satisfy needs and to change or cope with the environment.”
(World Health Organisation, 1984)
2

3. CONCEPT OF HEALTH
3
Concept of
health
Biomedical
concept
Ecological
concept
Psychosocial
concept
Holistic
concept

4. 1. Biomedical concept
⮚ Traditionally, health has been viewed as an “absence of disease” and if one has
free from disease, then the person was considered healthy. This concept, known as
the “biomedical concept” has the basis in the ‘germ theory of disease’.
⮚ The medical profession viewed the human body as a machine, disease as a
consequence of the breakdown of the machine and one of the doctor’s task as
repair of the machine.
4
Microorganism Enters Human body Cause Illness/ Disease

5. CRITICISM OF BIOMEDICAL CONCEPT :
⮚ According to biomedical concept, one factor ,i.e. Germ is responsible for illness,
but other factors which contribute to the illness are not considered.
⮚ But it has been seen that some of the health problems such as accidents,
nutritional deficiency disorders, mental disorders, disease due to environment
pollution also occur. Even germs also get an opportunity to multiply and thereby
cause disease, it get appropriate environment inside the body to grow.
5

6. 2. ECOLOGICAL CONCEPT :
⮚ Form ecological point of view; health is viewed as a dynamic equilibrium
between human being and environment, and disease a maladjustment of the
human organism to environment.
⮚ According to Dubos “Health implies the relative absence of pain and discomfort
and a continuous adaptation and adjustment to the environment to ensure optimal
function.”
⮚ The ecologist put forward an attractive hypothesis which viewed health as a
dynamic equilibrium between man and his environment.
⮚ Disease a maladjustment of the human organism to environment.
⮚ The ecological concept raises two issues, Imperfect man and Imperfect
environment.
⮚ So in the view of ecologists health problems occur due to environmental pollution
or mans maladjustment or imperfect man environment.
6

7. CRITICISM OF ECOLOGICAL CONCEPT :
⮚ Ecologists have considered the external environment of human beings ,but
internal environment is also responsible for disease.
⮚ E.g : Genetic inheritance, Hemophilia and Mental retardation
7

8. 3. Psychosocial concepts:
⮚ Health is not only a biomedical phenomenon, but one which is influenced by
social, psychological, cultural, economic and political factors of the people
concerned.
Psychosocially healthy people
⮚ Feel good about themselves
⮚ Feel comfortable with other people
⮚ Control tension and anxiety
⮚ Are able to meet the demands of life
⮚ Curb hate and guilt
⮚ Maintain a positive outlook
⮚ Value diversity
⮚ Appreciate and respect nature
⮚ Enrich the lives of others
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9. � Mental Health: The Thinking You
� “Thinking” or “rational” part of psychosocial health
� Mentally healthy people tend to respond to life’s
� challenges constructively.
� Irrational thinking may indicate poor mental health.
Emotional Health: The Feeling You
� The “feeling” or subjective side of psychosocial health
� that includes emotional reactions to life
� Emotions are intensified feelings and complex patterns:
� Love, hate, frustration, anxiety, and joy
9

10. Social Health: Interactions with Others
� Aspect of psychosocial health that includes interactions
� with others, ability to use social supports, and ability to
� adapt to various situations
� Social bonds
� Social support
Spiritual Health: An Inner Quest for Well-Being
� A belief in a unifying force that gives purpose or
� meaning to life
� A sense of belonging
� A feeling of connection to other people, to nature, or a
� god or other higher power
10

11. Factors Influencing Psychosocial Health
The Family
� Dysfunctional families
� Children raised in dysfunctional families may have a
� harder time adapting to life and run an increased risk of
� psychosocial problems.
The Macro Environment
� Drugs, neighborhood, crime, threats to safety, injury,
� school failure, unemployment, financial problems, and
� natural disasters also play a role in increased risk of
� psychosocial problems.
11

12. Self-Efficacy and Self-Esteem
� Self-Efficacy
• Belief in one’s ability to perform a task successfully
� Self-Esteem
• Sense of self-respect or self-worth
Personality
� In general, people who possess the following personality traits healthy:
� Extroversion
� Agreeableness
� Openness to experience
� Emotional stability
� Conscientiousness
� Resiliency
12

13. Characteristics of Psychosocially Healthy and Unhealthy
People
13

14. 4. Holistic concept:
⮚ The holistic model is a synthesis of all the above concepts.
⮚ It recognized the stronger of social, economic, political and environmental
influences on health.
⮚ The holistic approach implies that all sectors of society have an effect on health
in particular, agriculture, animal husbandry, food, industry, education, housing,
public works, communications and other sectors.
⮚ The emphasis is on the promotion and protection of health.
14

15. Dimensions of health
15
Dimensions of
health
Physical
health
Mental
health
Social
Health
Spiritual
health
Emotional
health
Vocational
health

16. 1. Physical Dimensions
⮚ Physical health means perfect functioning of the body in which each organ is
working in harmony with the maximum capacity.
⮚ Physical health is achieved by the exercise, healthy diet, adequate rest and sleep
and no smoking or alcohol intake.
⮚ To maintain proper physical health there is need for taking safety precautions,
and regular follow up with the health care providers.
⮚ Signs of physical health :
- A good complexion.
- A clean skin.
- Bright eyes.
- Not too fatty.
- A sweet breath.
- A good appetite.
- Sound sleep.
- Regular activities of bowels and bladder.
16

17. Evaluation of Physical Health
⮚ Self assessment of overall health.
⮚ Inquiry about ill health and risk factors.
⮚ Inquiry in to medications.
⮚ Standardized questionnaire for cardiovascular and respiratory diseases.
⮚ Clinical examinations.
⮚ Nutritional and dietary history.
⮚ Biochemical and laboratory investigations.
17

18. 2. Mental dimensions
� Mental health is a state of balance between body and mind .
� Earlier the body and mind were considered two separate entities
� But these are interrelated as physical illness can result mental illness and vice
versa.
� How mental illness influence physical health has been shown in fig;
18
Mental illness
Depression
Poor nutrition intake
Poor hygiene
Decreased immune
system
Prone to infection
Physical illness

19. Characteristics of mentally healthy person
⮚ Mentally healthy person will be capable of making personal and social
adjustment.
⮚ Mentally healthy person is free from internal conflicts.
⮚ He faces problems and tries to solve them intelligently.
⮚ He has good self control balances rationally and emotionally.
⮚ He knows him self his needs problems and goals.
⮚ He has strong sense of self esteem.
⮚ He serches for identity.
⮚ He lives a well balanced life means able to maintain the balance between work
rest and recreation.
19

20. 3. Social Dimensions
⮚ An individual is socially healthy if he is able to maintain harmonious relationship
with other members of society in which he lives.
⮚ Social health rooted in “positive material environment” and “positive human
environment” which is concerned with the social network of the individual.
⮚ The social dimensions of health includes;
- Communication
- Intimacy
- Respect
- Equality
- Social functioning
20

21. 4. Spiritual Dimensions
⮚ Spirituality means in touch with deeper self and exploration the purpose of life, as
people believe in some force that transcend physiology and psychology of human
beings.
⮚ It includes love , charity, purpose , principles , ethics, intigrity,hope of life.
⮚ Meditations ,prayers, or spiritual gatherings are organized to maintain spiritual
health.
21

22. 5. Emotional Dimensions
⮚ Emotional health is closely related to the mental health and is considered as an
important element of health.
⮚ Mental and emotional aspects of health are now viewed as two separate entities
for human life.
⮚ Cognition is related to the mental health whereas emotional health is related to
the feelings of a person.
⮚ Emotional health includes ;
• An emotionally healthy person has a positive thinking and is capable of coping
and adjusting self.
• An emotionally healthy person participates in all the activities which are related to
personal growth and his self esteem.
• Emotionally well people have the ability to express feelings freely and manage
feelings effectively.
• They are also aware of and accept a wide range of feelings in themselves and
others.
22

23. 6. Vocational Dimension
⮚ The choice of profession, job satisfaction, career ambitions and personal
performance are all important components of this dimension.
⮚ To be occupationally well, a person is ultimately doing exactly with what they
want to do in life and are comfortable with their future plans.
⮚ Vocational dimension of health can be assesed by ;
• Assessing the satisfaction level at job ,
• Facilities attached to the job ,
• Behaviour of the management and administrator and of colleagues at job.
23

24. 7. Other dimensions
A few other dimensions also suggested such as ;
⮚ Cultural dimensions
⮚ Socio-economic dimensions
⮚ Environmental dimensions
⮚ Educational dimensions
⮚ Nutritional dimensions
⮚ Preventive dimensions
24

25. A MODEL OF HEALTH
Exposure to risk factors
Body resistance
Poor Health
Genetic vulnerability
Disease condition
Manifestation
Disability Death
25

26. FACTORS INFLUNCING HEALTH AND WELL BEING
26
Social and economic factors (40%)
Health behavior (30%)
Physical environment (10%)
Clinical care (10%)
Genes and biology(10%)

27. SOCIO-ECONOMIC CONDITIONS
⮚ It consist of education, occupation and income.
⮚ The world map of illiteracy closely coincides with the maps of poverty,
malnutrition, ill health, high infant and child mortality rates.
⮚ The very state of being employed in productive work promotes health, because the
unemployed usually show a higher incidence of ill-health and deaths.
⮚ There can be no doubt that economic progress has positive impact factor in
reducing morbidity, increasing life expectancy and improving the quality of life.
27

28. Health behaviour
⮚ Behavioural pattern and life long habits
⮚ e.g. smoking and alcohol consumption, food habit, personal hygiene, rest and
physical exercise, bowel and sleeping patterns, sexual behavior.
Clinical care
⮚ Health and family welfare services cover a wide spectrum of personal and
community services for treatment of diseases, prevention of disease and
promotion of health.
⮚ The purpose of health services is to improve the health status of population.
⮚ For example, immunization of children can influence the incidence/prevalence of
particular disease.
⮚ Provision of safe water can prevent mortality and morbidity from water-borne
diseases.
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29. Physical environment
⮚ Biological: disease producing agent (e.g. bacteria, virus, fungi), intermediate host
(e.g. mosquito, sand fly), vector (e.g. house fly), reservoir (e.g. pig in JE).
⮚ Physical: Air, water, light, noise, soil, climate, altitude, rad iation housing, waste
etc.
⮚ Psychosocial: psychological make up of individual and structure and functioning
of society. E.g. habit, beliefs, culture, custom, religion etc.
Genes and biology
⮚ The health of an individual partly depends on the genetic constitutions.
⮚ A number of diseases e.g. chromosomal anomalies, inborn error of metabolism,
mental retardation and some types of diabetes are some extent due to genetic
origin.
29

30. PUBLIC HEALTH
Comprehensive definition of Public health (Charles-Edward Amory Winslow, 1920 ):
“The science and art of preventing disease, prolonging life, and promoting health and
efficiency through organized community effort for:
• The sanitation of the environment
• The control of communicable infections
• The education of the individual in personal hygiene
• The organization of medical and nursing services for the preventive treatment of
disease, and
• The development of the social machinery to ensure everyone a standard of living
adequate for maintenance of health
So, organizing these benefits as to enable every citizen to realize his birth right of health
and longevity
30

31. Public health
⮚ “The process of mobilizing and engaging local, state, national, and international
resources to assure the conditions in which people can be healthy”
(The Oxford Textbook of Public Health)
⮚ Public health is population based.
⮚ Emphasizes collective responsibility for health, its protection and disease
prevention.
⮚ Recognizes key role of the state, link to the concern for the underline socio
economic and wider determinants of health as well as disease.
31

32. Public health
Public health may be conceptualized as –
⮚ “Analyzing the health of a population and the threats it faces is the basis for
public health.”
⮚ Science of protecting the safety and improving the health of communities through
education, policy making and research for disease and injury prevention.
32

33. PUBLIC HEALTH SYSTEM
PUBLIC
HEALTH
SYSTEM
Community
Health care
delivery
system
Employers
and business
The media
Academia
Governmental
public health
infrastructure
33

34. Public Health Approach
Public Health Model Versus Medical Model
34

35. Public Health Approach
35
Public Health Model
Population
Disease Prevention
Health Promotion
Interventions
- Environment
- Human behavior
Medical Model
• Individual
• Diagnosis
• Treatment
• Intervention
• - Medical care

36. Public Health Model
Define the problem
Identify risk and
protective factors
Develop and test
prevention strategies
Assure widespread
adoption
36

37. PUBLIC HEALTH VS HEALTH CARE
Public health Health care
1. Population focus 1. Individual patient focus
2. Public health ethic 2. Personal service ethic
3. Prevention or public health
emphasis
3. Diagnosis and treatment emphasis
4. Joint laboratory and field
involvement
4. Joint laboratory and patient
involvement
5. Clinical sciences peripheral to
professional training
5. Clinical sciences essential to
professional training
6. Public sector basis 6. Private sector basis
37

38. Components of Public health
⮚ Public health is an interdisciplinary field.
It includes,
⮚ Epidemiology
⮚ Biostatistics
⮚ Management of health services
⮚ Environmental health
⮚ Community health
⮚ Behavioral health,
⮚ Health economics
⮚ Public policy
⮚ Mental health
⮚ Occupational safety
⮚ Gender issues in health and
⮚ Sexual and reproductive health.
38

39. Dimensions of public health
Dimensions of
public health
Health
education
Health
promotion
Health
protection
Disease
prevention
Early
diagnosis
and
Treatment
Disability
limitation
and
Rehabilitati
on
39

40. Dimensions of public health
1. Health education
Health education is a process which informs, motivate and helps people to adopt and maintain
healthy practices and lifestyles; advocates environmental changes as needed to faciliate this
goal and conduct professional training and research to the same end.
(The national conference on preventive medicine USA)
Health education stages
40
Awareness Interest Evaluation Trial
Adoption

41. 2. Health promotion
⮚ Health promotion is the process of enabling people to increase control over disease
and to improve their health.
⮚ It moved beyond the focus on individual behavior towards the wide range of social
and environmental interventions.
⮚ Health promotion = health education × healthy public policy.
(Tones and Tilford, 1994)
⮚ It is not directed against any particular disease but is intended to strengthen the host
through a variety of approaches(interventions):
- Health Education
- Environmental Modifications
- Nutritional Interventions Lifestyle and Behavioral
chgange,.
41

42. 3. Health Protection
⮚ Health protection is the branch of public health concerned with policies and practice
to improve the prevention and control of disease and other environmental threats
to the health of the population.
⮚ Some of the currently available interventions aimed at specific protection are:
- Immunization
- Use of specific Nutrients
- Chemoprophylaxis
- Protection against Occupational Hazards
- Avoidance of Allergens
- Control of specific hazards in general environment
- Control of Consumer Product Quality & Safety
4. Disease prevention
⮚ Disease prevention covers measures not only to prevent the occurrence of disease
such as risk factor education, but also to arrest its progress and reduce its
consequences once established.
42

43. Levels of Prevention
43

44. 5. Early diagnosis and treatment
44

45. ⮚ Though not as effective and economical as ‘Primary Prevention’, early detection
and treatment are the main interventions of disease control, besides being
critically important in reducing the high morbidity and mortality in certain
diseases like hypertension, cancer cervix, and breast cancer.
⮚ The earlier the disease is diagnosed and treated the better it is from the point of
view of prognosis and preventing the occurrence of further cases (secondary
cases) or any long term disability.
45
5. Early diagnosis and treatment

46. 6. Disability limitation
⮚ “Any loss or abnormality of psychological, physiological or anatomical structure
or function.”
⮚ “ Any restriction or lack of ability to perform an activity in the manner
considered normal for the human being.”
⮚ “A disadvantage that limits or prevents the fulfillment of a role in the
community.”
46
Disease
Impairment
Disability
Handicap

47. Impairment
Loss or abnormality of psychological, physiological/anatomical structure or function.
Disability
Any restriction or lack of ability to perform an activity in a manner considered
normal for one’s age, sex, etc
Handicap
Any disadvantage that prevents one from fulfilling his role considerednormal.
47

48. 7. Rehabilitation
⮚ Rehabilitation is “the combined and coordinated use of medical, social, educational,
and vocational measures for training and retraining the individual to the highest
possible level of functional ability.”
⮚ Salutogenesis is amedical approach focusing on factors that support human health and
well-being, rather than on factors that cause disease(pathogenesis).
48

49. Areas of concern in rehabilitation :
⮚ Medical Rehabilitation
⮚ Vocational Rehabilitation
⮚ Social Rehabilitation
⮚ Psychological Rehabilitation
49

50. Public health activities
⮚ Prevents epidemics
⮚ Protects the environment, workplaces, housing, food, and water
⮚ Monitors health status of population
⮚ Mobilizes community action
⮚ Responds to disasters
⮚ Assures quality, accessibility, and accountability of medical care
⮚ Reaches out to link high-risk and hard-to-reach people to needed services
⮚ Researches to develop new insights and innovative solutions
⮚ Leads the development of sound health policy and planning
50

51. Differentiation among Public health, Community medicine, social
medicine and Preventive medicine
⮚ GREAT deal of confusion exists with regard to the meaning of the terms "public
health," "community medicine," "social medicine," and "preventive medicine." The
terms are often used interchangeably, a practice which adds to the confusion.
⮚ Two basic concepts are at issue: public health on the one hand, and
community/social/preventive medicine on the other. The latter three terms have
different historical roots, but reflect a more or less identical orientation.
⮚ The key word: community, social and preventive medicine are considered to be, a
subdivision of the overall discipline. The common denominator of all three of these
terms is "medicine." Indeed, they constitute a very minor subdivision of medicine.
⮚ The concept of public health, on the other hand, is that of a major governmental and
social activity, multidisciplinary in nature, and extending into almost all aspects of
society. Here the key word is "health," not "medicine“.
51

52. 52

53. 53

54. Preventive Medicine
⮚ The term "preventive medicine" stems in USA from a period when public health
was almost exclusively concerned with the prevention of infectious diseases either
by preventing the occurrence of a disease or by halting a disease and averting
resulting complications after its onset and was dominated by the medical
profession.
Social Medicine
⮚ "Social medicine" is a product of France, Germany, Belgium and other European
countries.
⮚ Firmly based in the medical profession, it reflected a concern with the role of
social factors in the etiology of disease, and the need for government action in the
areas of disease prevention and medical care.
54

55. Community medicine
⮚ "Community medicine" became prevalent in the United States as a substitute for
"social medicine," since the latter term sounds too much like "socialism.”
⮚ WHO defined community medicine as a system of delivery of comprehensive
health care to the people by health team to improve the health of the community
through the promotive, preventive and curative health services.
55

56. 56

57. 57

58. Evaluation of Public health
⮚ Public health is as old as the man itself.
⮚ In primitive time ,since the knowledge was limited, man attributed disease to the
wrath of gods, the invasion of body by evil spirits and the malevolent influence of
stars and planets.
Primitive medicine (6000BC)
It was based on
⮚ Supernatural theory of disease
⮚ Disease and human sufferings
& calamities were attributed to the wrath of god
⮚ Influence of evil spirits, stars & planets
58

59. Christian Era
⮚ After the fall of Rome, Christian faith entered the world
⮚ Implicit faith on Christ was the only method of treatment of disease
⮚ Christ was the supreme healer, the savior of body & soul
⮚ Because of this the enquiry into the diseases became unnecessary & even
culpable.
⮚ A doctor curing patients by rational methods was considered to be committing sin
& using medicine was seemed to be lack of faith in God.
⮚ The scientific medicine suffered greatly & was fully dormant.
⮚ All classes of people were treated alike.
59

60. Christian medicine and public health
⮚ Crowding, poor nutrition and sanitation, lack of water sources and drainage,
unpaved streets, keeping of animals in towns, and lack of organized waste
disposal created conditions for widespread infectious diseases
⮚ All these were threat for the public health
⮚ Although physicians provided services for those able to pay but medical
knowledge was a mix of pragmatism, mysticism and sheer lack of scientific
knowledge.
Quarantine
⮚ The practice of separating people with disease from the healthy population is an
ancient one.
⮚ By the 7th century, China had a well-established policy of detaining sailors and
foreign travellers suffering from plague.
⮚ The term “quarantine” dates back to the late 14th century
60

61. Plague and quarantine
⮚ From the 14th century, European doctors visiting plague victims wore –
protective clothing
– mask and
– a beak containing strong-smelling herbs.
61

62. Small pox and immunization
⮚ Smallpox is one of the oldest known human diseases.
⮚ There are evidences that during the 18th century, Smallpox killed every seventh
child born in Russia, and every 10th child born in France and Sweden
⮚ Edward Jenner’s experiment in 1796 brought hope that the disease could be
controlled. He carried out the first vaccination with cowpox virus in 1796.
62

63. Dawn of scientific medicine
⮚ Following 1500 AD
⮚ Fracastorius envisaged the transfer of infection via minute invisible particles and
explained the cause of epidemics(Theory of contagion)
⮚ He became the founder of epidemiology.
⮚ Sydenhem made differential diagnosis of scarlet fever, malaria, dysentery,
cholera.
⮚ He is also regarded as the first distinguished epidemiologist.
Sanitary awakening
⮚ A milestone in the history of public health is great Sanitary awakening which took
place in England in mid-nineteenth century and gradually spread to other
countries.
⮚ Industrial revolution of the 18th century sparked off numerous problems, i.e.
creation of slums, overcrowding with all its ill effects.
63

64. Rise of public health
⮚ Great cholera epidemic of 1832 led the birth of public health in England around
1940.
⮚ John Snow, studied the epidemiology of cholera in London from 1848 to 1854
and established the role of polluted drinking water in its spread.
⮚ The great cholera epidemic of 1832 drew attention of the people and govt. on
urgent need to improve public health led to enactment of the Public Health Act of
1848, in England.
⮚ A comprehensive piece of legislation was brought into force in England, the
Public Health Act of 1875, for the control of man’s physical environment.
⮚ By the beginning of 20th century, the broad foundation of public health are clean
water, clean surroundings ,wholesome condition of houses, control of offensive
trades etc., were laid in all the countries of the western world.
64

65. The Nineteenth century: The great sanitary awakening
� In the era of unplanned industrialization in nineteenth century, "The great sanitary
awakening"—the identification of filth as both a cause of disease and a vehicle of
transmission, and the ensuing embrace of cleanliness—was a central component
of nineteenth-century social reforms and advancement in public health.
65

66. PUBLIC HEALTH
⮚ Term Public Health came in to general use around 1840’s
⮚ It arise from need to protect the public from the spread of communicable diseases
⮚ In1848 the Public Health Act in England crystallized the efforts organized by the
society to protect, promote & restore the public health
⮚ C.E.A. Winslow (1920) gave definition of public health: “the science & art of
preventing disease, prolonging life & promoting health & efficiency through
organized community efforts” • This summarizes the philosophy of public health,
which remains largely true even today
66

67. ⮚ Illness came to be seen as an indicator of poor social and environmental conditions,
as well as poor moral and spiritual conditions.
⮚ Cleanliness was embraced as a path both to physical and moral health.
⮚ Disease control shifted from reacting to intermittent outbreaks to continuing
measures for prevention.
⮚ With sanitation, public health became a societal goal and protecting health became
a public activity.
The Development of Public Activities in Health
⮚ Edwin Chadwick, a London lawyer (1838), is one of the most recognized names in
the sanitary reform movement.
⮚ Under Chadwick's authority, a commission conducted studies of the life and health
of the London working class in 1838 and that of the entire country in 1842.
⮚ The report of these studies, ‘General Report on the Sanitary Conditions’, was a
document of the appalling conditions in which masses of the working people were
compelled to live, and die, in the industrial towns and rural areas of UK.
⮚ Chadwick documented that the average age at death for the gentry was 36 years; for
the tradesmen, 22 years; and for the laborers, only 16 years.
67

68. ⮚ To remedy the situation, Chadwick proposed what came to be known as the
"sanitary idea."
⮚ His remedy was based on the assumption that diseases are caused by foul air from
the decomposition of waste.
⮚ To remove disease, therefore, it was necessary to build a drainage network to
remove sewage and waste.
⮚ Further, Chadwick proposed that a national board of health, local boards in each
district, and district medical officers be appointed to accomplish this goal.
⮚ Chadwick's report eventually was adopted in the Public Health Act, of 1848 in
UK, and subsequently American Public Health Act 1872, which both promoted
sanitation and engineering as means of controlling disease.
68

69. Birth of preventive medicine
⮚ Preventive medicine really dates back to the 18th century.
⮚ It developed as a branch of medicine distinct from Public Health.
⮚ Preventive Medicine got a firm foundation after the discovery of causative
agents of disease and establishment of the Germ Theory of disease.
⮚ Modern Preventive Medicine: defined as… “ the art and science of health
promotion, disease prevention, disability limitation and rehabilitation”
69

70. Modern medicine
70
Curative medicine
Public health/
Preventive
medicine

71. PUBLIC HEALTH ETHICS
⮚ Beneficence
⮚ Non-maleficence
⮚ Autonomy
⮚ Social justice
⮚ Truth-telling
Beneficence
Beneficence refers to actions or rules aimed at benefiting others.
Non-maleficence
The concept of non-maleficence is embodied by the phrase, "first, do no harm," or the
Latin, ‘primum non nocere’. “Non-Maleficence” requires an intention to avoid
needless harm or injury that can arise through acts of commission or omission. In
common language, it can be considered “negligence” if you impose a careless or
unreasonable risk of harm upon another.
71

72. Autonomy
⮚ The principle of autonomy, views the rights of an individual to self determination.
⮚ This is rooted in society's respect for individuals' ability to make informed
decisions about personal matters with freedom.
Social distance
⮚ Social justice is a concept of fair and just relations between the individual and
society. Social justice assigns rights and duties in the institutions of society, which
enables people to receive the basic benefits and cooperation.
Truth-telling
⮚ Truth-telling, or veracity, can be defined as the avoidance of lying, deception,
misrepresentation, and non-disclosure in interactions with patients or relevant to
patient care
72

73. Changing concepts in Public Health
Disease
control phase
(1880-1920)
Health
promotion
phase (1920-
1960)
Social
engineering
phase
(1960-1980)
Health for all
phase
(1980
onwards)
73

74. Disease control phase
⮚ 1880-1920
⮚ Sanitary legislation and sanitary reforms
⮚ Less available technical knowledge
⮚ Aimed at the control of man’s physical environment(water supply, sewage
disposal) and not at the control of any specific disease.
⮚ Improvement in the the health of people due to disease and death control
74

75. Health promotion phase
⮚ 1920-1960
⮚ In addition to disease control activities one more goal was added to public health
i.e. health promotion of the individuals.
⮚ It was initiated as personal health services such as
- Introduction of mother and child health services
- School health services
- Industrial health services
- Rehabilitation services
Two great movements were initiated for human development:
a) Provision of basic health services through the medium of PHCs and sub-centers
b) community development programme to promote village development through
active participation of whole community.
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76. Social engineering phase
⮚ 1960-1980
⮚ Change in pattern of disease
⮚ Public health entered in new phase called “social engineering phase.”
⮚ It moved towards preventive and rehabilitative aspects of chronic diseases and
behavioural problems.
Health for all phase
⮚ 1981-2000 AD
⮚ Health gap between rich and poor, within and between countries
⮚ Health for all phase include provision of health care to all by reducing the
inequalities within and between the population so that individual will lead a
socially and economically productive life.
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77. Modern public health
⮚ With the adoption of health for all (1978), a new concept of public health became
evident worldwide, which may be defined as “ the organised application of local,
state, national and international resources to achieve health for all, i.e. attainment
by all the people of the world by the year 2000 of a level of health that will permit
them to lead a socially and economically productive life.”
⮚ During 20th century the dramatic increase in average span of life is credited to
public health achievements such as vaccination programs, control of infectious
diseases, better safety policy such as motor vehicle and worker safety, improved
family bplanning, emphasis on safe drinking water.
⮚ Now the focus is shifting more towards chronic diseases such as cancer, AIDS,
Diabetes and heart diseases.
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78. 78

79. ⮚ Surveillance is the continuous, systematic collection, analysis and interpretation of
health related data needed for the planning, implementation, and evaluation of
public health practice.
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80. Three core functions of Public healthhealth
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Assessment
Policy development
Assurance
Systematically collect, analyze, and
make available information on
population at risk to identify health
problems and priorities
Promote the use of a scientific
knowledge base in policy and
decision making to solve problems.
Ensure provision of services to those
in need

81. Core functions of public health
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82. CONCEPT OF PREVENTION
⮚ Primordial prevention
⮚ Primary prevention
⮚ Secondary prevention
⮚ Tertiary Prevention
Primordial Prevention :
⮚ Prevention from Risk Factors.
⮚ Prevention of emergence or development of Risk Factors.
⮚ Discouraging harmful life styles.
⮚ Encouraging or promoting healthy eating habits
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83. Primary Prevention:
⮚ Pre-pathogenesis Phase of a disease.
⮚ Action taken prior to the onset of the disease
⮚ Immunization & Chemo-prophylaxis
Secondary Prevention:
⮚ Halt the progress of a disease at its incipient phase.
⮚ Early diagnosis & Adequate medical treatment.
Tertiary Prevention:
⮚ Intervention in the late Pathogenesis Phase.
⮚ Reduce impairments, minimize disabilities & suffering
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84. Concept of control
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Disease control Elimination Eradication
Monitoring Surveillance

85. 1. Disease control
The term disease control refers ongoing operation aimed at reducing:
⮚ The incidence of disease.
⮚ The duration of disease and the consequently the risk of transmission.
⮚ The effect of infection including physical and psychological complication.
⮚ The financial burden to the community.
⮚ In disease control, the disease agent is permitted to persist in the community at
a level where it ceases to be a public health problem according to the tolerance
of local community.
⮚ For example Malaria control programme. Disease control activities focus on
primary prevention.
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86. 2. Elimination
⮚ Reduction of case transmission to a predetermined very low level or interruption
in transmission.
⮚ E.g. measles, polio, leprosy from the large geographic region or area.
3. Eradication
⮚ Termination of all transmission of infection by extermination of the infectious
agent through surveillance and containment. “All or none phenomenon”.
⮚ E.g. Small pox
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87. 4. Monitoring
⮚ Defined as “the performance and analysis of routine measurement aimed at
detecting changes in the environment or health status of population.”
⮚ e.g. growth monitoring of child, Monitoring of air pollution, monitoring of water
quality etc.
5. Surveillance
⮚ Defined as “the continuous scrutiny of the factors that determine the occurrence
and distribution of disease and other conditions of ill health.”
⮚ E.g. Poliomyelitis surveillance programme of WHO.
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88. Social causes of disease and social problems of sick
Major risk factors for chronic disease
⮚ Drug addiction
⮚ Smoking
⮚ Sexually transmitted disease
⮚ Poor diet
⮚ Stress
⮚ High alcohol consumption
⮚ Poor hygiene
⮚ Injuries
⮚ Sedentary lifestyle
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89. Social problems and their behavioural component
Social problems Behavioral component
Population explosion High fertility, early marriage, Non-
acceptance of contraceptive.
Adverse sex-ratio or falling child
sex ratio
Female feticide, Infanticide, Gender bias
Smoking and tobacco and alcohol
abuse
Habit of smoking in the family or peer
group, social acceptability, seen as a social
status
Accidents and suicides Rash driving, disobeying traffic rules,
driving under influence of alcohol, drugs or
stress
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90. Social problems and their behavioural component
HIV AIDS and STDS Pre and extra marital sex, unproted sex
with multiple sexual partners
Mental disorder and behavioural
problems in children
Broken families, problem families,
Adjustment disorder, inability to cope
with stress
Insanitary environment Open field defecation, non-acceptance
of latrine, poor personal hygiene
Leprosy and tuberculosis Social stigma, Fear of loosing job, low
or non-utilization of treatment facilities,
fatalistic attitudes
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91. THANK YOU
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