Introduction to community medicine
Prof. Miluda Rajab Elhamadi
CM 341-2021
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.
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.
Conceptual evolution of public health:
Phase I Phase II Phase III Phase IV
•Disease •Health
control •Social •Health
promotion for all
phase engineering
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.
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.
4) Health for all phase (HFA) (1980-2000):
There was a health gap between rich and poor within countries and between
countries and should be narrowed and finally eliminated.
The Bridging the gap between poor & rich is mainly achieved through primary
health care ( PHC).
The essential principle of HFA is the concept of “equity in health”, that is, all
people should have an opportunity to enjoy good health.
-Health for all in 21st century:
- Elimination & eradication of diseases
- Universal health coverage (UHC)
Preventive medicine:
Two discoveries in Britain; the use of fresh fruit and vegetables for the
prevention of scurvy (by James Lind in 1753) 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.
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)
Difference between clinical medicine and community medicine:
Clinical medicine Community medicine
Objective Patient care Health improvement
Concern with 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
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