4 Humor in Greek medicine in west Greek prayed 4 Humor in west same as 3 Humor in India.
Because of the popularity of knowledge it is transmitted to Persian.
Amputation – removal of the part of the body completely.
MANU
‘Laws of Manu’ he is a controversial person. He spoke about personal hygine, how to lead a life with dignity and respect.
Harappa and Mohanjudaro:-
· Sanitation
· Water supply
· Engineering
Golden Age of medicine – 800 BC – 400 AD shrustha
Buddist empire – Due to invasion there was a set back. In bhuddist period due to “Ahimsa” surgery was effected progress deteriorated. Then came the professional
PREVENTIVE AND SOCIAL MEDICINE
Prevents the disease 18th century.
1. James Lind – Navel Surgeon
Scurvy – deficiency of vit C. 1753
Adviced in take fresh fruits & vegetables.
2. Edward Jenner : 1776 – Small pon – vaccination marked the beginning of preventure medicine.
SOCIAL MEDICINE:-
Neumann & Vinchow – said medicine is a social science – (1848)
Germ theory – Louis Pasteur – Vaccination for – he said disease is spread through Robies bacteria present in air. Till them disease was caused by fate, sin, supernatural power.
ROBERT KOCH:- Amthran – caused by bacteria. After this Germ theory was popular. People concentrated on Germs. Social medicine was popular only in 19th century.
Cholra Di Ptheria anti (toxin) – harmful on poison – Anti typhoid
This period where the above medicine was discovered in bacteriology was called as golden period.
P.M. aims at promotion of good health. Yellow fever is called by Aids – Mosquito – Malaria.
End of 19th century medicine was divided into 2 parts
1. Curative 2. preventive
1. Curative medicine – curing the disease treatment - Rx
Social, economic, environment factor was taken into consider. Early people believed only on Germ theory but now people thought of various other psychological factors-
Multi factorial causation – “Pettern Kofer” belong to Munich 1st person who worked on multifactorial causation.
It was not much popular because most of them concentrated on bacteriology.
H2O – purification
Food – covered, hygienic, sewage – life style and behavior – importance was given of individual.
Epidemiologists – worked on multifactorial causation
Epidemic – particular geographical area people are effected
Epidemiologist gave the term
· Risk factor – Eg: AIDS
· High risk factor – people who are more vulnerable to disease. Eg: diabetes.
DDT:- ‘Vector Borne’ disease
HCH – ATT – Anti turbo circle treatment
20th century in preventive medicine
“scruning and Diagnosis” – lab test
1930’s – Blood test to identify cyphilis (STD)
X ray to identify Tuberculosis.
Through lab test we can come to know in which phase we are suffering.
Levels of prevention
1. Primary – Take care to see to it that disease is not effected.
2. Secondary – Awareness – I am already effected by disease and can be cured.
3. Tertiary:- Final stage several physical, psychological of disease problems. How best: can modify the family surrounding, collegue.
SCIENTIFIC ADVANCES
Preventive medicine occupies the place of medicine
Definition for “MODERN PREVENTIVE MEDICINE”
“Is the art & science of health promotion, disease prevention, disability, limitation and rehabilitation”.
SOCIAL MEDICINE
European specialist
· Nevmann Virchow – said medicine as a social science. Popularity was on Germ theory.
· 1911 Alfred Grotjahn (Berlin) Reviewed the important of S.M. He called it as “Social Pathology”.
· Geographical pathology – population – other names of social medicine.
1912 - Important of SM was spreading.
1912 , Rene Sand founded an association called Belgian social medicine association.
· JOHN Ryle :- He spread the concept of SM in England. He set up “ A Chain” – Oxford 1942.
All the disease is associated with social consequence, social reason, social therapy is also needed.
Social Medicine – “Treating as indi as a social being in his total environment with the fours on health of the community as a whole”.
Prof. Crew believes S.M. stands on 2 pillars
1. Medicine
2. sociology
Professor Mc. Keown:- SM has 2 meaning
1. Broad & ill defined
2. Restricted & precise
1. Case of patients which include Health & welfare
- prevention of disease
- administration of medical service
2. Body of knowledge embodied in epcomediology of medical care of society.
SM is not a branch of medicine. It is only a new orientation given to the medical knowledge in the society.
CONCEPT OF HEALTH:-
· “Absence of disease” early people believed
· Humor’s – dosha – Ancient Indians & Greek Diseased caused by in equilibrium in these dosha.
· ‘Health’ was equated to ‘Harmony’ - Harmony – being at peace with the self, the community, God and the cosmos.
· Modern medicine more stress is given to the research of disease & not health.
· End of world war I – Convenannt of league of Nations in this health was not included. Later at last the world came “World Health” was included end of the IInd world war. “Charter of the omitted nation” was prepared. Health was not included on mentioned.
· Till 1945 health had not got proper mention any where.
· In 1945 – united nation conference at San Francisco Health was included as a “ad hoe” [kind of temporary]
· In last few decades there was a re awakening that “Health’ as a fundamental right and world wide social goal.
· 1977 30th world health assembly took major decision and said “the main target of government and WHO in the coming years should be” attainment by all citizens the world by the year 2000 of a level of health that will permit them to lead a socially & economically productivity life.
In brief it is health for all
Health is considered as an integral part (and quality life should be achieved by everyone) of the socio-economic growth of the country.
Wealth, power, security, knowledge – first priority.
Changing concept of health
1. Bio-medical concept:- It is based on the Germ theory of disease.
According to this human body is a machine.
Disease:- is consequences of breakdown in the machine.
Doctor is repairer of machine. It is one of the very initial concept. It doesn’t give a complete picture. It ignores the role of environment and socio-cultural aspects, psychological economic aspects.
Ecological Concept:-
It believe that health is dynamic equilibrium between man & his environment and disease a mal-adjustment of the human organism to environment.
Imperfect – imperfect
Man – Environment.
According to DUBOS:-
Health implies the relative absence of pain and dis comfort, and a continuous adoption and adjustment with the environment to ensure optimal functioning.
3. Psychological concept:-
4. Holistic concept:-
All the above put together all the good aspects.
DIMENSIONS OF HEALTH
1. Physical
2. Mental
3. Social
4. Spiritual
5. Emotional
6. Vocational
7. Others.
1. Physical:- All the tissue on cell of the body. (each & every).
Healthy person (Indicators)
1. Good completion
2. Clear skin
3. Bright eyes
4. Lustrous hair
5. body well clothed with firm flesh
6. Not too fat
7. Sweet breath
8. Good apetite
9. Sound sleep
10. regular activity of bowel & bladder
11. Co-ordinated bodily movements
12. All senses are intact
13. Resting pulse rate
14. Blood pressure & excise tolerance with in the range of normality for individual age and sex.
2. Mental dimension :- Absence mental illness doesn’t mean.
Definition Mental dimension:-
A state of balance between the indi and the surrounding would, a state of harmony between are self and others, a co-existence between the realities of the self and that of other people and that of the environment.
Indicators of mental health:
· 1. Free from interval conflict (he shouldn’t be war with himself)
· 2. Being well adjusted and being able to get along with others. “No man is perfect”.
· 3. Accepting criticism without getting upset easily.
· 4. The one who searches for identity. Unique – something which is mine.
· 5. person who has a strong self- esteem (not condem yourself)
· 6. knowing oneself need strength, limitation. (Self actualization) – indicators of sound mental health.
· 7. Good self control (Balance between rational & emotional).
DIMENSION OF HEALTH
Objectivity: as it is mental dimension can’t be learn objectively.
Subjectivity:- Mental health has more subjectivity (Agreement)
Social Dimension:- Indi and family relationship towards society (variation in biochemical – we end up doing something. That is the result of my emotions) Paronoia –
Delusion – Thought disorder (suspecting)
Dehesion of reference :- Eg. I think your talking about me.
Delusion of persecution:- Afraid of themselves that something might happen to me.
Erotomanic delusion:- Start interpreting somebody is loving me.
Social dimension:- Good meaningful, purposeful relationship with the society. Anything that is nowal in me includes social dimension.
Inclusive of all social aspects in me more the is relatively more good is my social health.
Vibes – Indicature of energy (-ve energy, +ve energy) relationship with the family, widen society. Utilizing all the social skills.
Spiritual Dimension:- “Looking into Self”
· Principle that we have in one life.
· Values
· Ethics
Emotional Dimension:-
Emotional & mental dimension was treated as same in earlier days.
The meaning was closely related – mental – knowing (tend to know about various aspects).
Emotional feeling for health to be in good male we need both.
Vocational Dimension:- May be a source of income. Anything to be with ‘work’ incapable of doing work will effect the health.
Other Dimension:-
· Philosophical dimension.
· Socio economic dimension
· Cultural dimension
· Preventure dimension
· Curative dimension
Other dimension concentrate on “non-medical” majority of dimension are non-medical.
WHO definition :- “Not only mere absence of disease but perfect functioning of psychological, physical, social state of mind and well being”.
POSITIVE HEALTH.:-
Perfect functioning of both body & mind not only absence of disease.
3 Essential Components based on WHO definition.
1. Biological component:-
2. Psychological aspect:- ability of an idni to understand our self & also adjust to external environment.
3. Social aspect:- In the larger community how will the adjust with other at the optimum level .
4. Spiritual aspects:- Health is not a standard term it is a relative term (vary according to life style) our health depends on our culture, socio, economic spiritual.
Well –being:-
1. Objective well being:- which aspect that is measurable. Eg. Standard of living level of living (UN documentation) It is a alternative.
9 Compounds according to U.N. documents (assessed).
1. Health
2. Food consumption
3. Eduction
4. Occupation & working condition
5. Housing
6. Social security
7. Clothing
8. Recreation & hisure
9. Human rights.
WHO Definition for std of living:-
“Income and occupation”, standards of housing sanitation and nutrition, the level of provision of health, education, recreational & other services may all be used individually as measures of socio-economic states and collection as an inden of the standard of living”.
2. Subjective well being:-
Quality of life:-
DETERMINANTS OF HEALTH
Genes determine completion, height, weight etc.,
1. Heridity:- Mental retaldation, Some types of diabetes, chromsonal anomalys.
2. Environment:-(Micro environment speaker about personal habits).
a. Internal [functioning within the body ] respiratory
b. External [Macro environment] [outside the body – physical, social & biological] food, environment. (All things external is called human )
Hippocrates is the 1st person to speak about the relationship between health & environment next Pettern Koffer- Association between environment & disease.
Life Style:- “The way live”
Life style is developed through nowalisation on social interaction within the social sphere.
Socio Economic condition:- Economic status , education, occupation, political system. Eg. Education also determine the health of a person [economic status, Education, Occupation, Pol. System].
Health Services:
Improving the health status of the people. Eg. Immunization, Providing safe drinking water. Peripheries – outer area.
Others:
· Creating policies and programs . Policy play main role in health.
INDICATIORS OF HEALTH
12 indicators was identify.
1. Martality Indicators:- Life expectancy disease, CDR crude death rate. (No. of deaths per 1000 population in one year in a particular country)
a. CDR, crude death rate
b. expectation of life
c. infant mortality rate
d. child mortality rate
e. under- 5 proportionate mortality rate
f. maternal (puerperal) mortality rate.
g. disease specific mortality.
h. proportional Mortality rate.
Life expect any varies at birth, IMR 1 year, CMR 5 year.
Below 1 year per 1000 per year in one country – IMR
1 -5 year per 1000 per year in one country – CMR.
Under -5 proportionate MR – Below 5 years MR.
Matrinal MR:- Death of mother during their reproductive age in 1000 per year per country.
More DR health condition.
Disease specific MR:- Cordio vascular disease communicable, or road accidents, HIV death occurs due to disease but not natural per 1000.
Proportional MR:- particular part HIV, CVD – percentage of the disease and death occur per 1000. Burden of the disease on particular community.
Morbidity Indicators:-
Morbid – which is not healthy or illness
a. incidence & prevalence.
b. notification rates.
c. attendance rate at out patient departments, health centres etc.,
d. A discussion, re-admission and discharge rates.
e. Duration of sickness or absence foam work.
Notification Rates:- Reporting or notifying of disease. Morbidity rates can be identify.
OPD:- Registration of cases in OPD & weather spells of sickness: Duration of sickness.
Disability Rates:-
Event type
Personal type
1. Event type indicators:- No. of days of restricted activities.
· Bed disability days.
· Work loss days.
2. Person type disability:-
· Limitation of mobility (unable to move from place to place)
· Limitation of activity.
ADL – activity of daily living.
Sullivan’s Index:- Life expectancy:- No. of years of disability. Eg: 60-3 = 57.
DALY – Disability Adjusted Life Years.
Measures which tells about the burden of disability among the indi.
Nutritional state indicators – This is a positive health indicators 3 important measures.
1. Anthropometric measurements-pre-school children ht, nt, mid aim.
2. measurement of night and sometimes lot and other thing at the time of entry puto school.
3. Prevalance of low birth weight.
5. Health care delivery:-
1. Doctor population ratio
2. doctor nurse ratio
3. Population bed ratio
4. Population per health centre or sub centres.
5. Population per traditional birth attendant.
6. Utilization Rates:-
1. proportion of infants who are fully immunized.
2. proportion of pregnant women who receive anti natal care or have their deliveries supervised by trained birth attendants.
3. Percentage of population using various methods. Of family planning.
4. Bed occupying rate (how many people daily are utilizing beds in hospital).
5. Average length of stay.
6. Bed turnover ratio (no. of discharges)
7. Social and Mental Health Indicator:- Indicators of social mental pathology Eg: suicide, homicide, voile crime.
8. Environmental Indicators:- Those aspects of environment necessary for + & -ve health. Eg: drinking water, weather, drainage, air pollution.
9. Socio Economic Indicators
a. Rate of population increase
b. Per capita GNP (Gross Net Product)
c. Level of unemployment
d. Dependency ratio
e. Literacy rates especially female literacy rates.
f. Family size
g. Housing: the no. of persons per room
h. Per capita “Colories” availability.
Dependency Ratio:- People who are not engage in economic activity – children below 15 years and old age.
10. Health Policy Indicators:-
Allocation of available resources equally.
· Proportion of GNP spent on health services.
· Proportion of GNP spent on health related activities (including water supply, sanitation, housing & nutrition & country development)
· Proportion of total health resources devoted to primary health care.
11. Quality of life health indicators.
12. Other indicators
1. Social 2. Basic needs 3. Health for all
· Population increase
· Family formulation, families & households.
· Learning & educational services
· Earning activities.
· Distribution of income consumption & accumulation.
· Social security and welfare services
· Housing and its environment
· Public order and safety
· Time use.
· Lea sure & culture
· Social stratification
2. Basic needs:- food, shelter & clothing
3. Health for all:-
· This is the definition of WHO
· Health policy indicators
· Socio-economic indicators of health
· Indicators of provision for health care
· Health status indicators
Health and development
Health Development
1960’s – developing countries people gave more importance to “modern public health measures”. No much important is given to health status 1973-77- There was considerable rethinking about the health development. Major changes took place in economic theories role of human being was underestimated non-economic activities was given important in order to understand the health status.
Health development is the process of continuous progressive improvement of the health it also of a population
Health & development are mutually inter-related with one anothetr Health is the result of development and vice versa.
Health development is the result of recent policy thinking Developing the health status of people is the responsibility of the government . it is the right of each person to participate is developmental activities of health.
Development : Social, Economic. The result is Health & development. Each concept contribute to the health.
CONCEPT OF PREVENTION, LEVELS OF PREVENTION
Prevention:- Promote and preserve health & restore.
1. knowledge of causation
2. dynamics of transmission.
3. identification of risk factors and risk group.
4. availability of early detection and treatment measures
5. an organization for applying these measures to appropriate persons and groups.
6. continuous evaluation of and development of procedures applied.
Levels
1. Primordial prevention
2. Primary prevention
3. Secondary prevention
4. Tertiary prevention
1. Primordial Prevention:- Purest of primary prevention. It comes or starts in early childhood days. Eg: obesity, hypertension .
2. Primary Prevention:- An acceptable level of health which will enable indi to lead a socially and economically acceptable life. Primary prevention is the action taken prior to the onset of disease, which remove the possibility that a disease will ever occur.
WHO has given 2 important strategy
· Population strategy:- directed to whole population irrespective of indi level.
· High risk population:-
2. Secondary Prevention:- In an action which halts the program of a disease at its incipient stage and prevents complications aimed at
· Clinical intervention
· Government progs implemented are secondary prevention.
3. Tertiary Prevention:- It is all measures available to reduce or limit impairment and disability, minimize referring caused by existing departments from good health and to promote the patients adjustment to irremediable conditions.
Tertiary Prevention leads to rehabilitation:
1. Medical rehabilitation
2. Social rehabilitation
3. Psychological rehabilitation
4. Vocational rehabilitation
MODELD OF INTERVENTION
5 important models of intervention
1. Health promotion
2. Specific protection
3. Early diagnosis & treatment
4. Disability limitation
5. Rehabilitation
Primary Prevention
1. Health promotion :
· Health education
· Environmental modification
· Nutritional intervention.
· Life style and behavioral modification.
Health Promotion: It is a process of enabling people to increase control over and to improve health. According to WHO Health education: The intension to all people of the benefits of medical, psychological, & related knowledge is essential for the fullest attainment of health.
1. General public – Health provides.
2. Patient
3. Community leaders
4. Priority groups.
2. Environmental modification:-
· Provision of safe drinking
· Taking care of insects & rodent
· Sanitary facility
· Proper housing
· Water & food facility.
It is non-clinical in nature
3. Nutritional intervention
· Food distribution
· Nutritional improvement of vulnerable groups
· Child feeding programs
· Nutritional education
4. Life style and behavioral modification:-
· Food habits, physical exercise
· Personal hygiene
SPECIFICATION PROTECTION:-
a. Immunisation
b. Use of specific nutrients
c. Chemoprophylaxis:- Temporary relief medicine.
d. Protection against occupational hazards.
· Bagarso ses of lungs: Sugarcane factory
· Silicoses: gold mine
· Byssinosis: Cotton industry
e. Protection against accidents
f. Protection of carcinogens (cancer
g. Avoidance of allergens
h. Control of specific hazards in general environment
i. Control of consumer products quality and safety of foods drugs and cosmetics.
Health Protection:- The provision of conditions for normal mental & physical functioning of the human being individually and in groups. It includes the promotion of health, prevention of sickness and curative & restorative medicines in all its aspects.
EARLY DIAGNOSIS & TREATMENT – SECONDARY PREVENTION
According to WHO:- The detections of disturbances of homeostatic and compensatory mechanism while/ bio chemical , morphological and functional changes / are still reversible.
(Balance between body chemists) Man-treatment:- Disease Trachoma, Malaria.
DISABILITY LIMITATION:- Tertiary Prevention
Impairment:- Any con or abnamality of psychological, physiological or anatomical structure or function.
Disability: Any restriction or lack of ability to perform an activity in the manner on within the range considered normal for a human being.
Handicap:- A disadvantage for a given indi resulting from an impairment on a disability that limits or prevents the fulfillment of a role that is normal (depending on age, sex, & social & cultural factors) for that inid.
Disease – impairment – Disability – Handicap
Accident – loss of foot- can’t walk-unemployed.
REHABILITATION:- Tertiary prevention
1. Restoration
2. Vocational rehabilitation
3. Social rehabilitation (Restoration of social relation)
4. Psychological rehabilitation (Increasing on regain his dignity to function as other person)
Hygiene:- Greek word – Hygeia represent the Goddess of health.
Serpend – indicates the art of healing
Definition “ It is the science of health and embarrass all factor which contribute to health full living”.
PUBLIC HEALTH:
Public health, in its present form, is a combination of scientific disciplines (Eg: epidemiology, biostatistics, laboratory sciences, social sciences, and demography) and skills and strategies (Eg: epidemiological investigation, planning and management, intervention surveillance and evaluation) that are directed to the maintenance and improvement of the health of people.
Generally it was used in. It came in existence in England in 1848.
3. Community health:-
Euro symposium 1966. All the personal health and environment services in any human community irrespective of whether such services were public a private once.
4. Community Medicine:-
It is a very recent origin it is much more advance than others concept.
Epidemiology:- “Study of distribution and upon population study determinants of disease frequency among men”.
2. types of determinants:
1. Descriptive epidemiology
2. Analytical epidemiology