Community PharmacyCommunity The community means a group of people living together in a specified geographical area may or may not have the same cultural region or social background. According to Webster Dictionary, community is a body of people having common organization or interest of living in the same place under the same laws. In other word, a community is a network of a human relationship. It is the major functioning unit of a society. It is the place where our home is located, children are educated, sick people are treated and individuals basic needs and desires are meet.Community Health It refers to the healthy status of the member of the community to solve the problems affecting their health and to the totality of a health care provided for the community. The term “community health” has represented the term public health preventing medicine or self-medication in some countries. It is because of the changing nature | of the public health, which has now entered an area of individual responsibility and voluntary co-operation. Community health is defined more broadly and encompasses the entire gamut of community efforts for maintaining protecting, improving the health of the people. In some instances, community health is used as a synonym for environmental health and is also used to refer community health care. Modern community health seeks to bring together all the available health services (e.g., medical care, mother and child health care (MCH), family planning services, environmental sanitation, laboratory services, disease control program, health education) within the reach of the people and also prepare the people who need the services receptive to thus services.Public Health The term “public health” has lost its original meaning, although the term is still widely used. In 1923, public health was defined by CEA Winslow, a former professor of public health at Yale University as follows: Public health is the science and arts of 1, Preventive disease. 2. Prolonging life. 3. Promoting health and efficiency through organized community efforts for- i. the sanitation of the environment. ii, the control of communicable diseases. iii. the education of the individual in personal hygiene. iv. the organization of medical and nursing services for the early diagnosis and preventive treatment of disease. vy. the development of the social machinery to ensure everyone a standard of living adequate for the maintenance of health. So, organizing these benefits as to enable every citizen to realize this birth right of a health and longevity.The concept of public health is different today to what it was 80 years ago. From the control of physical environment and communicable disease, public health has moved to the preventive, therapeutic and rehabilitative aspect of chronic disease and behavioral disorders which are currently the major health problems in the developing countries. The current emphasis in the field of health is also on the application of modern management techniques for improving the efficiency of health care delivery system. So, a recent definition of public health, which meets the criteria of modern public health, is as follows. Public health is the planning carrying out an evolution of health measures and system services that both maintain and improve the health of a population group and prevent and control diseases within that population group.Difference; Public & Community Health Public Health Community Health Public health is the science & arts Community health refers to the of preventive disease, prolonging healthy status of the member of life and promoting health & the community to solve the problems efficiency through organised affecting their health community efforts. & to the totality of a health care provided for the community. Itis a part of community health. It covers all the aspect of public health preventive disease & social medicine.Public Health In practice, public health components are community water supply, proper sweage, disposal, good housing etc. Its main objects are to control physical, environmental and communicable disease. Community participation is not needed. Community Health Community health components are curative, preventive, promotive & rehabilitative services. Its main objects are to promote physical, mental, social wellbeing of the people. Community participation is essential.a Community Health & Public Health Community health differ from public health in the following way: Tle) ees ancy 2. Itisa part of community 2, It covers all the aspect of health. public health preventive disease and social medicine.Health and Its Dimensions The World Health Organization (WHO) in 1948 provide the widely accepted definition of health as follows: Health is a state of complete physical, mental and social well being and not merely an absence of disease or infirmity so that each citizen can live a socially and economically productive life. To this has recently been added, the aspect of spiritual well being. Dimensions of a health: There are four major dimensions of a health included in the WHO definition of a health. 1. Physical Health, 2. Mental Health 3. Social Health 4. Spiritual Health Besides these, many more can be sited e.g., -Emotional - Vocational - Philosophical §- Cultural - Socio-economical - Environmental - Political ~ Educational -Nutritional - Curative — - PreventivePhysical Health Physical health conceptualizes ae biology as a state in which every cell and every organ is functioning at optimum capacity and in perfect harmony with the rest of the body. The sign of physical health in an individual are as follows. -Good complexation -Clear skin. - Bright eyes. - Lustrous hair with a body. ~ Well cloth with flesh. - Not too fat. ~ Sweet breath. - Good appetite. - Sound sleep. - Regular activity of bowels and bladder. - Smooth, easy coordinated bodily movement. - All the body organs are of unexceptional size and function normally. ~ All the special senses are intact. The resting pulse rate, blood pressure and exercise tolerance are within the normal for the age and sex of the patient.Mental Health Mental health has been defined more recently as a state of balance between an individual and the surrounding world, a state of harmony between the individual and his or her community in which he or she lives and a co- existence based on the realities between the individual and that of other people, on regarding to his or her physical, social, economical and spiritual environment. A mentally healthy person should have the following characteristics: * Free from internal conflicts, not at war with himself. * Optimum adjustment with family and community i.e., able to get alone well with others can accept criticism and not easily upset *# Awareness of one’s identity. # Adequate sense of self- esteem * Capacity to self-actualize. *# Adequate self-control. * Faces problem and tries to solve them intelligently that is copying with stress and anxiety.Social & Spiritual Health Social Health: This is based on the concept that a human being can not achieve in isolation to his or her full potential in any aspect of his or her life including health. He or she is a member of a family which again is a component of a community and society at large. Thus, health has a component of social well being. In fact, development of health both at individual and community levels is dependent on many social factors. Social health is concerned with positive material environment which is related to financial, economical and residential matter. In general, the concept of social health connotes such abilities as those of making friendships that are satisfying and lasting of assuming responsibilities in accordance with one’s capacities of finding satisfaction, success and happiness in accomplishments of everyday tasks, of living effectively with others and showing socially considerate behavior. Spiritual Health: It refers to that part of the individual which reaches out and strikes for meaning and purpose of life. It is the intangible something that goes beyong physiology and psychology. Spiritual health includes integrating principles and ethics, the purpose in life, commitment to some higher being and believe in concept that are not subject to ordinary reasoning.Determinants of Health The factors which influence the health are collectively known as determinants of health that lie both within the individual and externally in the society in which he or she lives. These factors interact and thus interaction may be health promoting or deleterious. Determinants of health can be classified as- A. Human biology B. Environment. C. Life style. D. Socio-economic status. E. Health and family welfare services. Human biology: The mental and physical traits of every human being are to some extent determined by the nature of his genes at the moment and conception. The genetic endowment of man can not be alter after conception. A number of diseases are now known to be of genetic origin, ¢.g., mental retardation, some types of epilepsy etc. Therefore, the state of health depends partly on the genetic constitution of man. Thus, from the genetic standpoint, health may be defined as the state of the individual which is based upon the absence from genetic constitution of such gene as corresponds to character that take the form of serious defects and derangement and to the absence of any aberrations in respect of the total amount of chromosome material in the karyotype or stated in positive term from the presence in genetic constitution of the gene that corresponds to the normal characterization and to the presence of a normal karyotype.Environmental Factors Environment is classified as internal and extemal. Internal Environment: The internal environment of man attains to each and every component part, every tissue organ and organ system and their harmonious functioning within the system. The health status of a man is the outcome of a continual adjustment and readjustment between the internal and external environments. External Environment: The external or macro-environment consists of those things to which man is exposed after conception. It is defined as all that which is external to the individual human host. It can be further subdivided into physical, biological and psychological components, any or all of which can affect the health of man and his susceptibility to illness. Physical environment that has bearing on health: Air, Soil, Climate, Heat radiation, Cold. Water, Refuse, Excreta, Ionizing radiation, Clothing, Housing, Food. Biological environment that has bearing on health: Man, Animal, Insect, Plant, Microbes, Birds. Psychological environment that has bearing on health: Custom, Habit, Believe, Religion, Moral, Education, Occupation, Community life. Some epidemiologist have described environmental factors as follows: I. Macro-environment (General Environment): Water supply, Air, Food, Housing, Insect, Rodents. IL Micro-environment (Personal Environment): Habit (Smoking or Drinking), Occupation, Culture.Life Style or Personal Hygiene life style” is the way people live, that reflect a whole range of social values, attitude ies. It is composed of cultural and behavioral patterns and life long personal habits (e.g,, smoking, alcoholism) that have developed through processes of socialization. Life style are learnt through social interaction with parents, friends and siblings and through school and mass media. The term “personal hygiene” includes all those personal factors which influence the health and well being of an individual. The primary factors for good personal hygiene are- # Care of body regarding bathing and washing, # Care of clothing, # Care of teeth, # Care of hair, # Care of feet and nail, # Care of posture, # Cultivating good habits regarding eating, diet, exercise, sleep, smoking and drinking and mental attitude towards life. Any disruption of these activities may impair health e.g., bad oral hygiene predisposes to pyorthoea and caries of teeth; dirty skin predisposes to scabies, eczema, dermatitis and fungal infection; lack of sleep leads to lack of concentration, mental depression and inability to perform work with enthusiasm; dirty nails may harbour ova of intestinal parasites; dirty hair may lead to louse infection. Excessive smoking is positively harmful and is implicated in the aetiology of chronic bronchitis and lung cancer. In the developing countries like Bangladesh, traditional life style shaped by poverty, ignorance and superstition leading to lack of nutrition, adequate housing and sanitation, poor water supply, lack of personal hygiene etc. is one of the major causes of diseases and death,Socio-economic Status (1) For the majority of the World’s people, health status is determined primarily by their level and socio-economic development e.g., per capita GNP (Gross National Product), education, nutrition, employment, housing, the political system of the country etc. Those of major importance are- 1, Economic Statue: Economic statue of a community determines it’s purchasing power, standard of living, quality of life and family size as well as the adequacy of health services, all of which directly influence the pattern of disease and health status. Thus, a community with a high per capita GNP is likely to have a better health status than one with a low GNP. On the other hand, affluence may be an indirect predisposing factor for health hazard. a) The hazards of poverty: Most of the infections and nutritional deficiency diseases, common in developing countries are really disease of poverty. Poverty disposes to high maternal, child and infant mortality rates. Poverty also predisposes to crime, violence, drug abuse, depression, alcoholism and other forms of deviant behaviours. b) The hazards of affluence: Affluence may be indirect predisposing factor for diseases such as coronary disease, heart disease, diabetes, obesity, cancer etc. 2. Education: A second major factor influencing health status is education especially female education. The world map of illiteracy closely co-inside with the map of poverty, malnutrition, ill health, high infant and child mortality rates. Studies indicate that education compensates the effect of poverty on health irrespective of the availability of health facilities.Socio-economic Status (2) 2. Education: A second major factor influencing health status is education especially female education. The world map of illiteracy closely co-inside with the map of poverty, malnutrition, ill health, high infant and child mortality rates. Studies indicate that education compensates the effect of poverty on health irrespective of the availability of health facilities. 3. Occupation: The state of being employed in production work promotes health because the unemployed usually show a higher incidence of ill health and death. For many loss of work, may mean loss of income and status. It can cause psychological and social damage. 4. Political System: A health is also related to the country’s political system. In the absence of strong political commitment in most developing countries like Bangladesh allocation for a health development is probably the lowest as a health is not seriously consider as a development sector. Due to political expediency and a major chunk of the development budget is allocated to so called economic development sectors. The percentage of GNP spent on health is a quantitative indicator of political commitment. Currently, the allocation for health development is around 1% of GNP in Bangladesh while minimum allocation to the health sector should be at least 5% of GNP according to WHO.Health and Family Welfare Services The term “health and family welfare services” cover a wide spectrum of personal and community services for treatment of disease, prevention of illness and promotion of health. The purpose of health services is to improve the health status of population, e.g., immunization of children can influence the incidence or prevalence of particular diseases. Provision of safe water can prevent mortality and morbidity from water bound diseases. The care of pregnant woman and children would contribute to the reduction of maternal and child morbidity and mortality. To be effective, the health services must reach the social periphery, equitably distributed, accessible at a cost of the country and community can afford and socially acceptable. All these are ingredients of primary health care which is seen as the way to better health. To major factors would determine the success or failure of the health service system, to adequately improve health status. 1. whether it is a balanced service in terms of promotive, preventive, curative and rehabilitative components in the socio-economic context of the people. 2. whether the service is equitably distributed, accessible at a cost, the country and the community can afford and socially acceptable to fulfill their needs.HEALTH CARE OF COMMUNITYHealth Care & Health System Health Care: It is defined as the multitude of services rendered to individuals, families or communities by the agents of a health services or professions for the purpose of promoting, maintaining, monitoring or restoring health. Such services might be staffed organized, administered and financed in every imaginable way. But they all have one thing in common, people are being served i.e., diagnosed health cured, educated and rehabilitated by health personnel. The term medical care is not synonymous with the health care. It refers chiefly ' to those personal services that are provided directly by physicians or rendered as the result physician’s instructions. It ranges from domiciliary care to residence hospital care. Medical care is a sub-set of health care system. Health System: The health is intended to deliver health services. In other words, it constitutes the management sector and involves organizational matters ¢.g., - planning. ~ determining priorities. - mobilizing and allocating resources. - translating policy into services. - evaluation and health education.Levels of Health Care Health services are usually organized at three levels, each level supported by a higher level to which the patient is referred. These levels are: A. Primary Health Care: It is also called grass root level. This is the first level of contact of individuals, the family and the community with the national health system when essential health care (primary health care) is provided. In majority of prevailing health complain and problems can be satisfactorily dealt with at this level. This level of care is closest to the people. This level of care is most effective within the context of the area's needs and limitations because of providing by the primary health centre and other sub center within the community participation. e.g., the Thana Health Complex and their union sub centers constitute this level of care in Bangladesh. B. Secondary Health Care (Intermediate level): At this level, more complex problems are dealt with. This care comprises essentially curative services and is provided by the district hospital and community health centre. This level serves as a first referral level in the health system. This level is assigned to provide some specialist services particularly in internal medicine, general surgery, obstetrics, gynecology and pediatrics. C. Tertiary Health Care (Central level): This level offers super specialist care. This care is provided by the regional or central level institutions. This institutions provide not only highly specialized care but also planning and managerial skills and teaching for specialized staff, viz medical college hospital and other specialized hospital; cancer hospital, eye hospital, mental disease hospital. In addition, the tertiary level supports and complement the action carried out at the primary level.Primary Health Care (PHC) The concept of primary health care was adopted at an international conference in 1978 at Alma Ata (former USSR, presently in the independent state of Kazakhstan) which was jointly sponsored and organized by WHO and UNICEF. In its declaration, popularly known as the Alma Ata declaration. The international conference defined the primary health care as follows. Essential health care based on practical scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self determination. It forms an integral part both the countries health system and overall social and economic development of the country. PHC is the point of entry for the individual to the national health system. PHC is also defined as first contact care where a majority of personal health services can be provided.Elements of PHC Although specific services provided will vary in different countries and communities, the Alma Ata declaration has outline eight essential components of PHC. . Education concerning prevailing health problems and the methods of preventing & controlling them. . Promotion of food supply and proper nutrition. . An adequate supply of safe water and basic sanitation. . Maternal and child health care, including family planning. . Immunization against major infectious diseases. . Prevention and control of locally endemic diseases. . Appropriate treatment of common diseases and injuries. . Provision of essential drugs. E= Education, L= Locally endemic diseases, E= Extended Immunization Programme, M= Maternal and child health care, E= Essential drugs, N= Nutrition & food supply, T= Treatment of common diseases, S= Sanitation and safe water supply.Principles of PHC The PHC approach its based on principles of social equity national wide coverage, self reliance, inter-sectorial co-ordination and people's involvement in the planning and implementation of the health programme in persuit of common health goals. This approach has been described as health by the people and placing people's hand. So, PHC is based on four principles. 1. Equitable distribution. _3. Inter-sectorial co-ordination. 2. Community participation. 4. Appropriate technology. 1. Equitable distribution: The first key principle in the PHC strategy is equity or equitable distribution of health services i.e., health services must be shared equally by all people irrespective of their ability to pay and all (rich or poor, urban or rural) must have access to health services. At present, health services are mainly concentrated in the major towns and cities resulting an inequality of care to the people in rural areas. The worst hit are the needy and vulnerable groups of the population in rural areas and urban slums. This has been termed as social injustice. PHC aims to redress this imbalance by shifting the centre of gravity of the health care system from cities to the rural areas and bring thus services as near people's home as possible.2. Community participation: The involvement of individuals, families and communities (social workers, health personnel, school teachers, religious, political and local leaders) in promotion of their own health and welfare is an essential ingredient of PHC. Thus, the community should participate in the planning implementation and maintenance of health services. 3. Inter-sectorial co-ordination: There are an increasing realization of the fact that the components of PHC can not be provided by the health sector alone. So, PHC should involve in addition to the health sector, all related sectors and aspects of national and community development; in particularly, agriculture, animal husbandry, food, industry, education, housing, public works, communication and other sectors. To achieve such co-operation, countries may have to review their administrative system, reallocated their resources and introduce suitable legislation to ensure that co-ordination can take place. This requires strong political will to translate values into action.4. Appropriate Technology: Appropriate technology has been defined as the technology that is scientifically sound, adaptable to local needs and acceptable to those, who apply it and those for whom it is used and that can be maintained by the people themselves, in keeping with the principle of self-reliance with the resources, the community and country can afford. This applies to using sophisticated technology and medicine in appropriate way against relevant health problems. Thus, it facilitates proper way of treatment, minimizes complication and ensure proper recovery. e.g., domiciliary treatment of T.B. instead of sanitorium of treatment; oral rehydration therapy in cholera and other diarrhoeal disease, bifurcated needle for vaccination etc.