Depart. of Comm. Med
.
General Epidemiology
Lec.1
د.يوسف
ِ◌ ِ◌
Al-Kindy College of
Medicine
١
Introduction to Community Medicine or, Preventive
Medicine & Public Health
Community Medicine:
Is
the science that concerns with the promotion of health,
prevention, control, and management of diseases, disabilities, and other health
problems in the community.
It is the branch of medicine that deals with community rather than individual.
Public Health:
Is the combination of sciences, skills, and beliefs directed toward
maintenance and improvement of health of all people through collective or social
actions.
The mission of Public Health is to assure conditions in which people can live healthy.
Its efforts are organized by comprehensive activities of society. The society must
balance illness care with wellness care in order achieve definition of health
"Complete physical, mental and social wellbeing and not merely the absence of
disease or infirmity-WHO 1948". Then add spiritual, and in recent years the
statement is amplified to include the ability to lead a socially and economically
productive life.
Aims of Preventive Medicine Specialty
1.
Promote and preserve health and longevity in individuals and community by
adoption of healthy life style and health education.
2.
Prevent and limit diseases, injuries, and other ill health effects.
3.
Enhance quality of health care system and assure that all populations have access
to appropriate and cost effective care.
4.
Use epidemiology to assess and monitor the health of communities and
populations at high risk to identify health problems.
Prevention:
Is the anticipatory action taken to reduce the possibility of an event or
condition occurring or developing, or to minimize the damage that may result from
the event or condition if it does occur.
Prevention may take place at any point along the spectrum of the disease, from the
prevention of the disease or injury to the prevention of impairment, disability or
dependency.
Disease or injury Î Impairment Î Disability Î dependence
Ï Ï Ï
Primary prevention Secondary prevention Tertiary prevention
Depart. of Comm. Med
.
General Epidemiology
Lec.1
د.يوسف
ِ◌ ِ◌
Al-Kindy College of
Medicine
٢
Three categories of disease prevention:
1- Primordial prevention: (Acting on risk factor) consists of actions and measures that
inhibit the emergence of risk factors in the form of environmental, economic, social,
and behavioral conditions and cultural patterns of living etc.
2- Primary prevention: (Acting before disease occurrence) Activities designed to
prevent onset of disease. We act before the development of the sign and symptoms
of the disease. Ex: Immunization, ban on smoking, speed limit, seat belts.
3- Secondary prevention: (Acting after disease occurrence) Early identification of
health problems to reduce the risk of progression or transmission. Ex: Early
diagnosis of HT, DM, cervical CA, breast CA, STD.
4- Tertiary prevention: (Acting after complications occurrence) Focused on
rehabilitation to reduce the impairment. Ex: Learning to walk after stroke, adjusting
diet and life style after MI, learning to live with DM.
So, prevention is any intervention that seeks to reduce or eliminate diagnosable
conditions and may be applied at individual level, as in immunization, or the community
level, as in the chlorination of the water supply.
History of public Health
"An ounce of prevention is worth than a pound of cure"
Henry De Bracton, 1240
In many ways, Public Health is largely a modern concept, although it has roots in
antiquity. The value of primary prevention was known to man kind for many centuries.
Unfortunately, even today its benefits are not always recognized due to preoccupation
with high tech modern medicine.
Early in human civilization, it was recognized that polluted water and lack of proper
waste disposal may spread vector-born disease. By Roman times, it was well understood
that proper diversion of human waste was a necessary tenet of public health in urban area.
The practice of vaccination did not become prevalent until the 1820s, following the work
of Edward Jenner. The science of epidemiology was found by John Snow's identification
of polluted public water as the cause of an 1854 cholera outbreak in London.
Microorganisms were first identified in1880s by the germ theory of Robert Koch and
Louis Pasteur and the production of artificial vaccines revolutionized the study of
infectious diseases and introduced the modern era of public health.
Public Health has become an important specialty in developed countries in the early of
19
th
century. The development of public health policies and programs required intersectral
collaboration to understand the cause and prevention of diseases.
Depart. of Comm. Med
.
General Epidemiology
Lec.1
د.يوسف
ِ◌ ِ◌
Al-Kindy College of
Medicine
٣
Medicine is one of the most ancient professions that evolved over time and developed
further by different civilization. Until the 18
th
century all the doctors were general medical
practitioners who treat all people from all diseases. The 20
th
century has witnessed a real
revolution of medicine and considered as the era of specialization in medicine.
The 4 major medical specialties of ''curative medicine'': General Medicine, General
Surgery, Pediatrics, and gynecology & Obstetrics have paved the way for more and more
specialties later on. The Preventive (Community) Medicine have stand hand by hand with
other specialties concentrating more on preventive aspects and act as bridge between
practice of medicine and Public Health.
Family Medicine as specialty was recognized in Europe and America in the 1950s.
Although it is new and modern specialty, some may see it as the father of all medical
specialties as it resembles the general medical practitioner. The benefits of incorporating
prevention into medical practice have become increasingly apparent over the past 30-40
years, as many serious diseases have decline in incidence following the introduction of
effective clinical preventive services: Ex: Poliomyelitis which occur in regular epidemic
waves (over 18300 cases in 1954), have become rare in the USA as well as many other
countries as a results of childhood vaccination. Other Ex: Rubella epidemics occurred
regularly in the USA every 6-9 years (in 1964 caused 12 million rubella infections, 11000
fetal losses and about 20000 infants born with congenital rubella syndrome. But now
rubella is very rare since 1969 when the vaccine first became available.
Evidence Based Medicine (EBM) was first described in 1992. It was hailed as a new
approach to teaching medicine and was once describe as "revolution" in the medical
practice. EBM is defined as the conscientious, explicit, and judicious use of current best
available evidence in making decision about the care of the patients. The practice of EBM
calls for the integration of individual clinical expertise with the best available external
evidence from systemic researches.
Preventive Medicine sciences:
Include a set of biological, epidemiological,
statistical, social, and economical sciences and practices intended to measure, protect, and
promote health on a population level. It provides an exciting opportunity for physicians
who are interesting in developing and intermingling skills in clinical and preventive health
services to promote health and reduce the risks of disease, disability, and death in
individual and population.
Issues of Preventive Medicine
1. General Epidemiology & biostatistics: Measures the occurrence and
distribution of diseases in population.
2. Primary Health Care, Includes:
Health education.
Maternal and child health care including family planning.
Mental health.
Depart. of Comm. Med
.
General Epidemiology
Lec.1
د.يوسف
ِ◌ ِ◌
Al-Kindy College of
Medicine
٤
Accidents and injuries.
Geriatric Health
3. Nutritional Health Nutritional Disorders.
4. Environmental &Occupational Health.
5. Health Services Administration.
6. Infectious Diseases.
7. Non-Communicable Diseases e.g. HT, DM.
Public Health Problems
1. In Developing Countries:
Infectious diseases e.g. TB, malaria….etc.
Malnutrition.
Poor health education.
Limit access to health services.
((Problems associated with poverty and overcrowding))
2. In Developed Countries:
Chronic diseases e.g. IHD, HT, DM…etc.
Over nutrition and obesity.
Violence and drug addiction.
Sexually transmitted diseases (STD)
Environmental pollution e.g. air pollution, ozone layer depletion…etc.
((Problems associated with industrialization, affluence, aging,
violence, and medical intervention))