HW215: Models of Health & Wellness Unit 5: Community-based Models of Health & Wellness

Unit 5 Learning Outcomes Recognize the ways in which the practice of medicine continues to evolve due to a change in focus from treating diseases to emphasizing achieving and maintaining health. Recognize the role social context plays in individual and community health and wellness. Assess the relationship between hospital-based services to community verses the traditional role of hospitals in the care continuum. Assess the value in using community-based models to improve health outcomes.

Seminar 5 Overview Components of a community-based health and wellness model. Community health in Bhopal, India.

What is Community-based Health? Prevention Focused Population Based Not limited to medical care settings Community leaders Social Networks Mass Communication Education of general population Multiple interventions

Why community-based health? Idea is to create change at the individual, group, organization and societal levels. Some historical ingredients leading to a community based health approach: ER / Hospital Based Cost Effectiveness of Prevention Multi-Level Determinants of Health Movement toward prevention / health promotion away from treatment.

Health Promotion “Health promotion is the process of enabling people to increase control over their health and its determinants, and thereby improve their health. It is a core function of public health and contributes to the work of tackling communicable and noncommunicable diseases and other threats to health.” World Health Organization (2005)

Environmental Toxins Earth Flag (public domain image), Retrieved 3/23/10 from

Bhopal Gas Disaster December 3, 1984 Methyl Isocyanate -Used in the manufacture of pesticides -Major route of exposure is through the lungs -Pulmonary edema (fluid in the lungs), injury to lungs and death -Eye/skin irritant, can cause severe eye damage Source: Centers for Disease Control and Prevention, Agency for Toxic Substances and Disease Registry. Methyl Isocyanate. Retrieved on 3/22/10 from

Bhopal Gas Disaster December 3, 1984 Initial Deaths = 3,000 (official) Initial Deaths = 7,000-8,000 (unofficial) Total Deaths to Date => 15,000 Number Affected = 600,000 Source: BBC News (2009). Bhopal marks devastating gas leak. Retrieved 3/22/10 from

Bhopal Gas Disaster International Medical Commission on Bhopal (December 1996) Recommendations include: Reorganization of the health system to establish a network of community-based clinics. Expand gas-related disease categories to include brain and psychological injury. Health data collected should be communicated to the population. Victims have a right of access to their medical records. Victim organizations should be adequately represented in national and state commissions. Criteria for compensation should include medical and social damage to victims. Allocation of resources for economic and social rehabilitation of people and communities. Thorough examination of the impact of waste buried at the site. Source: The International Medical Commission on Bhopal: Findings & Recommendations (n.d.). Retrieved on 3/22/10 from

Bhopal Gas Disaster Why does community-based health care work in Bhopal?

Bhopal Gas Disaster Why does community-based health care work in Bhopal? Door-to-door outreach Understanding of specific community Hospitals as referral centers; services provided in the community sites

Bhopal Gas Disaster What is the primary model used in Bhopal to treat symptoms of illness and disease?

Bhopal Gas Disaster What is the primary model used in Bhopal to treat symptoms of illness and disease? Hospitals as referral centers; services provided in the community

Bhopal Gas Disaster What are the social implications of Bhopal’s health problems?

Bhopal Gas Disaster What are the social implications of Bhopal’s health problems? Attention and resources were not focused on needs. Community participation in planning, health education, surveillance and research was not encouraged.

Bhopal Gas Disaster What are the barriers to implementing a community-based health model in Bhopal?

Bhopal Gas Disaster What were the barriers to implementing a community-based health model in Bhopal? Closed communication/Secrecy Lack of continuity of care Lack of understanding of the scope of the problem

Community-based Health & Wellness Can you think of examples of community- based health and wellness programs where you live?

Unit 5 Seminar Wrap-Up Questions?

References BBC News (2009). Bhopal marks devastating gas leak. Retrieved 3/22/10 from Centers for Disease Control and Prevention, Agency for Toxic Substances and Disease Registry. Methyl Isocyanate. Retrieved on 3/22/10 from Earth Flag (public domain image), Retrieved 3/23/10 from Merzel, C. and D’Afflitti, J. (2003). Reconsidering community-based health promotion: Promise, performance, and potential. American Journal of Public Health, 93(4): World Health Organization (2005). The Bangkok Charter for Health Promotion in a Globalized World. Retrieved on 3/22/10 from