3. Population Perspective of Relations Individual Family Community, nation Human population All populations

4. Introduction To Community Medicine and Definitions of Terms

5. Objectives: 1. To understand the importance of the health of the nation through history and development of public health in developed countries comparing to developing countries. 2. You students should be capable to properly use, understand and describe different terminology.

6. Death rates from cholera, 1853-1854, according to water company supplying sub-districts of London Water company Population In 1851 Cholera deaths In 1853-1854 Deaths per 100,000 living Southwark and Vauxhall Both companies Lambeth 167,654 301,149 14,632 192 182 0 114 60 0 Source: J. Snow, on the Mode of Communication of Cholera (2 nd ed). London: Churchill, 1855. Reproduced in Snow on Cholera. New York: Hafner, 1965

7. Death rates from cholera in London, 1853-1854, according to water company supplying actual house Water companyNumber of houses Deaths from cholera Deaths per 10,1000 Southwark and Vauxhall Lambeth Rest of London 40,046 26,107 256,423 1263 98 1422 315 37 59 Source: J. Snow, On the Mode of Communication of Cholera (2 nd ed). London: Churchill, 1855. Reproduced in Snow on Cholera. New York: Hafner, 1965.

8. Chief causes of death in the US, 1900 and 1982 source: USDHHS., Prevention’84/’85, ًWashington, DC; public Health Service Office, 1985. 1900%1982% Pneumonia/influenza Tuberculosis Heart disease Stroke Diarrhea/enteritis Nephritis Cancer Accidents Diphtheria Other 11.8 11.2 9.4 7.6 6.3 5.9 4.5 4.2 1.9 37.2 Heart disease Cancer Accidents Stroke Chronic lung disease Suicide Pneumonia/influenza Chronic liver disease Diabetes mellitus Other 34.4 23.9 6.6 6.5 2.9 2.1 2.0 1.9 1.7 18.0

9. 1999 Disease or Injury2020 Disease or Injury Increasing burden of noncommunicable diseases and injuries change in rank order of DALYs for the 15 leading causes (baseline scenario) 1 Acute lower respiratory infections 2.HIV/AIDS 3.Perinatal conditions 4.Diarrhoeal diseases 5.Unipolar major depression 6.Ischaemic heart disease 7.Cerebrovascular disease 8.Malaria 9.Road traffic injuries 10.Chronic obstructive pulmonary disease 11.Congenital abnormalities 12.Tuberculosis 13.Falls 14.Measles 15.Anaemias 1. Ischaemic heart disease 2. Unipolar major depression 3. Road traffic injuries 4. Cerebrovascular disease 5.Chronic obstructive pulmonary 6. Lower respiratory infections 7. Tuberculosis 8. War 9. Diarrhoeal diseases 10.HIV 11.Perinatal conditions 12.Violence 13.Congenital abnormalities 14.Self-inflicted injuries 15.Trachea, bronchus and lung cancers

10. Community Medicine Public health services emphasizing preventive medicine and epidemiology for members of a given community or region.

11. Scope of Community Medicine  Epidemiology  Vital statistics  School health  Mental health  Maternal and Child health (MCH)  Environmental health  Rural health  Urban health  Occupational health

12. Medicine includes  Curative and  Preventive Medicine

13. Clinician versus community physician (GP, FP)  A clinician’s target is to diagnose and treat his patient  A community physician’s target is to manage health problem in a community (community diagnosis)

14. History of Public Health  1880-1920: Disease control phase  1921-1960: Health promotional phase  1961-1980: Social engineering phase  1981-2000: Primary Health Care, Health for All phase

15. Definition: ‘Health …’ ‘… is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’(WHO, 1948) ‘Health is only possible where resources are available to meet human needs and where the living and working environment is protected from life-threatening and health threatening pollutants, pathogens and physical hazards’(Who, 1992a)

16. Definition of Health 50 y.o. immigrant F, with Ca breast, lives in a country with no public access to free health services. Currently she lost her job because of offensive attitude and living on donations provided from neighbors. From the previous scenario we can say that the definition of health is “ a state of well being that include the next parameters”  Physical  Mental  Financial  Social  Spiritual

17. Definition: ‘Environment’ ‘…[All] that which is external to individual human host. [It] can be divided into physical, biological, social cultural any or all of which can influence health status in populations.’ (WHO, 1995)

18. Definition: ‘Environmental Health’  ‘… comprises those aspects of human health, including quality of life, that are determined by physical, biological, social and psychosocial factors in the environment. It also, refers to the theory and practice of assessing, correcting, controlling, and preventing those factors in the environment that can potentially affect adversely the health of present and future generations ’ (WHO, 1993a)

19. Population Perspective of Relations Individual Family Community, nation Human population All populations

20. Health and Environment Perspective of Relations Personal Health Family Health Occupational Health Public Health Environmental health

21. Epidemiology The Study of the DISTRIBUTION and DETERINIANTS of DISEASE FREQUENCY in HUMAN POPULATION (Mac Mahoon, 1970)

24. Objectives: 1. To understand the importance of the health of the nation through history and development of public health in developed countries comparing to developing countries. 2. You students should be capable to properly use, understand and describe different terminology.