Introduction to community medicine

Dr. Meluda Rajab AlHamadi

Associated Prof. Community medicine .

Community medicine is the successor of what has been previously known as

public health, preventive medicine, social medicine and community health.

Public health:
The birth of public health occurred in England around 1840. Several reformers
notably Edwin Chadwick (1800-1890) focused the attention of the people and
government on the need for sanitary reforms and to improve public health. A
movement known as the “Great Sanitary Awakening” started in England, which
led to the enactment(‫ ) تشريع‬of Public Health Act of 1848 in England . It began in
England and spread to the other parts of the world.
The torch was already lit by Chadwick, but the man who was actually
responsible for sanitary reforms was Sir John Simon (1814-1904), the first
medical officer of health of London and built up a system of public health in
England.

Definition of public health:

In 1920, Winslow, an eminent pioneer of public health in the United States,
defined public health as follows:
“Public health is the Science and Art of (1) preventing disease, (2) prolonging
life and (3) promoting health and efficiency through organized community
effort for:
1- Sanitation of the environment
2- Control of communicable diseases
3- Education of the individual in personal hygiene
4-Organization of medical services for the early diagnosis and treatment of
disease,
5-To insure for everyone a standard of living adequate for the maintenance of
health.

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Conceptual evolution of public health:

Phase I Phase II Phase III Phase IV

•Disease
•Health
control •Social •Health
promotion
phase engineering for all
phase
phase phase

1)Disease control phase (1880-1920):

Sanitary legislation & reform to control of physical environment ( water supply
& sewage disposal).
These measures were not aimed at the control of any specific disease but to
improve the health of people.

2) Health promotion phase (1920-1960):

Health promotion of people was initiated as personal health services such as
maternal child health care, School health services, industrial health services, and
mental health and rehabilitation services.
The state had assumed direct responsibility for the health of the individuals and
there are two movements were initiated for human development :
a- Provision of health services.
b- Active participation of the whole community.

3) Social engineering phase (1960-1980):

- with advances of preventive medicine , many acute diseases are under control,
and new health problems in the form of chronic disease began to emerge such as
cancer, CVD, alcoholism & drug addiction . (NCD’s emerging (risk factors)
- Social & behavioral aspects of disease and health were given a new priority.

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4) Health for all phase (HFA) (1980-2000):
The global conscience was stirred leading to a new awaking that the health gap
between rich and poor within countries and between countries should be
narrowed and finally eliminated.
The essential principle of HFA is the concept of “equity in health”, that is, all
people should have an opportunity to enjoy good health.
The World Health Assembly, in May 1977, decided that the main social goal of
governments and WHO in the coming years should be the “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”. This goal has come to be
popularly known as “Health for All by the year 2000” (HFA).
-Global HFA targets (up to 2020): Targets related to health policies and systems
needed to improved health outcomes and access to care.
-Health for all in 21st century:
- Elimination & eradication of diseases

Preventive medicine:
Two discoveries in Britain; the use of fresh fruit and vegetables for the
prevention of scurvy (by James Lind in1753) and vaccination against smallpox
in 1796 (by Edward Jenner) , marked the beginning of a new era, the era of
disease prevention by specific measures.
Discoveries in the field of nutrition, chemotherapy, antibiotics, insecticides,
hormones have all enriched preventive medicine.

Definition of preventive medicine :

Preventive medicine is “the science and art of preventing disease, prolonging
life and promoting physical and mental health and efficiency”.
In preventive medicine, the focus of attention is on the individual ( healthy) ,
whereas in public health the focus is on groups of individuals who form the
community.
Modern preventive medicine is concerned not only with the prevention of acute
communicable diseases, but also prevention of chronic non-communicable
diseases such as coronary heart disease, cancer, mental illness, and accidents.

Social Medicine:
It is defined as the study of the man as a social being in his total environment. It
stands on two pillars ( ‫) دعامة‬: medicine and sociology.

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The concept of social medicine is based upon realization of the following facts:

1- Suffering of man is not due to pathogens alone. It can be partly considered

to be due to social causes (social etiology).
2-The consequences of disease are not only physical (pathological alterations
due to pathogens) but also social (social pathology).
3-Comprehensive therapeutics has to include social remedies in addition to
medical care (social medicine or therapy).
4-Social services are often needed alone or with medical care services.

Community medicine:
It is the successor of what has been previously known as public health,
preventive medicine, social medicine and community health.
In England 1968 ( Todd commission forcibly recommended that every
medical school in England should have a department of community
medicine.
Definition of Community medicine :
-It is branch of medicine which deals with preventive, promotive, and
curative services through organized community effort.
- It is the field concerned with the study of health and disease in population
or group of individuals living in a community rather than individual
patients".

Main goals of Community Medicine:

 To identify the health problems and needs of defined populations
(community diagnosis)
 To plan & implement measures (community health care services)
 To evaluate extent of effectiveness ( health care evaluation)

Importance of studying community medicine :

Knowledge about human health & disease is sum of the contributions of a large
number of disciplines , classified as:
-Basic sciences (e.g., physiology, biochemistry, microbiology) are primarily
sites in laboratories.
-Clinical act ivies are carried out in hospitals
- Population (Community ) medicine in Community

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Tuberculosis provides a good illustration of three different approaches to the
same disease.
Basic sciences: concerned with tubercle bacilli
Clinical : treatment of tuberculosis in the individual
Community M : prevention & control of TB in the community
To answer the question why is important to study community medicine there are
some points to be understanded:
1- Treatment of patient:
A doctor’s aim should be to treat a patient not a disease.
The doctor has to know more than clinical medicine , he has to know the
preventive , social, and environmental aspects of disease.

2- Social equity:
Resources for health care are limited .
This resources must be equitably distributed among the people .
Who should get priority when it comes to providing free medical care
through the country health system. One who needs sophisticated cardiac care
or thousands of unimmunized , malnourished children and pregnant women
who have no access to simple technology as growth chart, ORS, vaccination,
ANC, etc.
Only a through principles of community medicine can provide answers to
such dilemmas.

3- Health services planning:

The needs of the many should take precedence over those of the few.
What are the health needs of population?
Do we know whether health is a priority for the most people ?
What are the reasons which prevent them from seeking health care?
Answers by community medicine.

4- Doctor’s responsibility:
To whom is a doctor responsible?
Only to those come to clinic or also to those who need his services but cannot
come to clinic?

5- Patient’s queries:
Some questions like :
-What is the chance that I get lung cancer since I smoke 20 cigarettes a day?

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 -I suffering from TB , can I breast feed my child?
Answers for these questions are possible if one is familiar with natural
history of disease, it’s etiology and risk factors and their interactions.

6- Interaction with patients:

Knowledge of community dynamics, community skills and cultural factors
related to health improves the doctor –patient relationship.

7- Health team leadership:

Health practice is a team effort and the doctor is the team leader.
The varied knowledge encompassed within community medicine will make
the doctor a strong team leader and able health administrator .

Clinical medicine Community medicine

Objective Patient care Health improvement
Disease in individual Disease pattern in
Population
Unit of concern Case or cases Population , population at
Risk (healthy and sick)
Diagnosis D/D Community diagnosis &
Priority setting
Investigation Lab. Exam., x- rays, etc Studies & surveys
Resources Available therapy Health and health related
services
Management Treatment Health programme
Evaluation Follow-up of patient Assessment of health

‫مع تمنياتي للجميع بالنجاح‬

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