BS Public Health Notes 9.2.22 & 16.2.22

Public Health & Prevention
Definitions and Concepts

Outline
• Some definitions
– Preventive Medicine
– Community Medicine
– Public Health
• Concepts of:
– Disease Prevention
– Levels of Prevention
– Control, Eradication & Elimination of Disease
• Associated Sciences
 Prevention
Action to reduce or eliminate the onset, causes, complications

or recurrence of disease
 Preventive Medicine
The science & art of preventing disease, prolonging life &

promoting physical & mental health & efficiency
 Social Medicine
The study of man in his total environment, -- physical,

biological, & socio-economic
• Personal Health Services: Personal oriented services, directed to care of

person e.g. maternal and child health, occupational health, school health
services.
• Impersonal Health Services: Community oriented health services which
indirectly influence the health of persons e.g. safe water supply, safe
excreta disposal, vector control
• Comprehensive Health Care: Delivery of personal and impersonal health

services to the community for prevention of disease, cure of illness,
prevention of disability, economic insecurity and dependency associated
with illness
• Principles of comprehensive care (4-As)
• Availability
• Acceptability
• Accessibility
• Affordability
Community Medicine is a branch of medicine which deals with the preventive,

promotive and curative services, through organized community efforts.
Public Health
Public Health is the science and art of preventing disease, prolonging life, and
promoting health through organized efforts of society (WHO 1988)
Community Medicine VS Public Health
• Terms used Interchangeably
– UK: CM
– US: PH
Public health incorporates the interdisciplinary approaches of community health,

epidemiology, biostatistics, environmental health, health economics, occupational
health, public policy & health planning/ management
Pioneers in Public Health
Edwin Chadwich”
o Public Health Act (1848)
“John Snow”
o Cause of Cholera out breaks
“Louis Pasteur”
o Germ theory of Disease (1873)
Public Health Systems
• All public and private entities that contribute to the delivery of public
health services within a jurisdiction
• This concept ensures that all entities’ contributions to the health and well-
being of the community are recognized in assessing the provision of public
health services
Medical Model
• Etiology: causes and the development of disorder
• Diagnosis: identifying the symptoms and signs and distinguishing one

disease from the other
• Treatment: treating the disorder in a clinic/ hospital
• Prognosis: forecasting about the disorder, as to how it will progress
Public health: distinct from medicine …
• Primary focus on populations
• Public service ethics, extension of concerns for the individual
• Emphasis on disease prevention and health promotion for the community

• Biological/life sciences central, with a focus on major threats to the health
of the populations
• Research moves between laboratory and the field
• Social and public policy disciplines an integral part of public health

education
• Employs interventions aimed at human behavior, lifestyle, environment,

and medical care – coercive role of state
Sequence for the Control of Public Health Problem
1. The awareness that the problem exists
2. The understanding of what causes the problem
3. The capability to deal with the problem
4. A sense of values that the problem matters
5. The political will to control the problem
6. Public health model Scope involves defining problem, identifying cause,

developing and testing prevention strategies, and assuring widespread
adoption and implementation.
Tools of Public Health
• Major Tools
Epidemiology
Biostatistics
• Other Tools
Social Sciences like: Sociology, Economics, Management, Psychology

etc
Basic Biological sciences
Clinical Sciences
• PUBLIC HEALTH: Range of Required Acquaintance
Public Health emphasizes multi-disciplinary approach, seeking guidance from

diverse branches of knowledge, including inter alia :
Physical Sciences Social Sciences Arts
Management,
Biology, Ecology, Sociology,
Chemistry, Physics, Philosophy, Law,
Anthropology, History
Psychology, Statistics, Political Science,
Information Economics, Mass
Technology Communication
Associated Sciences
 Administrative Medicine
• Sub-specialty of CM: aims to improve health status of population through

practice of evidence based medicine and health service management.
Evidence Based Public Health (EBPH)
• Process of decision making based on a synthesis of the best available

evidence, applicable theoretical models, professional experience and
knowledge of the specific population
• The development, implementation and evaluation of effective programs

and policies in Public Health through application of principles of scientific
reasoning, including systemic use of data and information systems and
appropriate use of program planning models.
Prevention, Control, Eradication & Elimination
Prevention
• Actions aimed at eradicating, eliminating or minimizing the impact of

disease and disability, or if none of these are feasible, retarding the
progress of the disease and disability.
Levels of Prevention
1. Primordial prevention
2. Primary prevention
3. Secondary prevention
4. Tertiary prevention
Primordial Prevention
 Consists of actions and measures that inhibit the emergence of risk factors
in the form of environmental, economic, social, and behavioral conditions
and cultural patterns of living etc.
Example:
Discouraging children from adopting harmful lifestyles to avoid hypertension,

obesity etc
Primordial Prevention
Primary Prevention
• Actions taken prior to the onset of disease, which removes the possibility
that the disease will ever occur
• It signifies intervention in the pre-pathogenesis phase of a disease or health

problem
• Primary prevention may be accomplished by measures of “Health
promotion” and “Specific Protection”
Intervention for Primary Prevention
Primary prevention
Achieved by
Health promotion Specific protection
Immunization and seroproph

Health education
chemoprophylaxis
Use of specific nutrients or
Environmental modifications
Protection against occupati
Nutritional interventions Safety of drugs and foods
Life style and behavioral changes Control of environmental ha
e.g. air pollution
Secondary Prevention
• Action which halts the progress of a disease at its incipient stage and
prevents complications
• The specific interventions are:

I
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– early diagnosis (e.g. screening tests, and case finding programs) and
– adequate treatment
SCREENING
Screening test
Intervention for Secondary Prevention
Screening is carried out in the hope that earlier diagnosis and subsequent
treatment.
1. Done on apparently healthy individuals

2. Applied to groups
3. Results are arbitrary and final
4. Based on one criteria and cut-off
5. Less accurate
6. Less expensive
7. Not a basis for treatment
8. Initiative comes from investigator
Common Screening Tests
• Hb A1c/ Fasting blood glucose for diabetes
• Blood pressure for hypertension
• Pap smear for cervical cancer
• Mammography for breast cancer
• PSA for prostate cancer
• Procto / colonoscopy for Colon Cancer
Quarantine is defined as the limitation of freedom of movement of such,
persons or domestic animals exposed to communicable diseases for a period of
time as to prevent effective contact with those not so exposed
Tertiary Prevention
• All measures available to reduce or limit impairments and disabilities, and

to promote the patients’ adjustment to irremediable conditions when the
disease process has advanced beyond its early stages
• It is used when the disease process has advanced beyond its early
stages
Intervention for Tertiary Prevention

Disease Control
Ongoing operations aimed at reducing:
– The incidence of disease
– The duration of disease and consequently the risk of transmission
– The effects of infection, including both the physical and psychosocial

complications
– The financial burden to the community
 TB, AIDS, Hepatitis Control Programs
Disease Eradication
• Eradication literally means to "tear out by roots“
“Termination of all transmission of infection by extermination of the infectious

agent through surveillance and containment”
• Eradication is an absolute process, an "all or none" phenomenon, restricted

to termination of an infection from the whole world
• Implies that disease will no longer occur in a population
• To-date, only one disease has been eradicated, smallpox
Disease Elimination
• An intermediate goal between control and eradication
• Interruption of transmission of disease, as for example, elimination of

malaria, measles and diphtheria from large geographic regions or areas
• Regional elimination is now seen as an important precursor of eradication
VERTICAL PROGRAM
• A single program of health services for community

• Expanded Program of Immunization (EPI)
• The staff of this service is only concerned with the immunization proje
• National Program for PHC & FP (Population Welfare Dept).
• MNCH Program
• EPI
• Nutrition
• Malaria Control
• Dengue Control
• TB/DOTS
• AIDS Control
• Hepatitis Control
The End

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Public Health & Prevention

Definitions and Concepts

– Control, Eradication & Elimination of Disease

Action to reduce or eliminate the onset, causes, complications

The science & art of preventing disease, prolonging life &

The study of man in his total environment, -- physical,

• Personal Health Services: Personal oriented services, directed to care of

• Comprehensive Health Care: Delivery of personal and impersonal health

• Principles of comprehensive care (4-As)

Community Medicine is a branch of medicine which deals with the preventive,

Community Medicine VS Public Health

• Terms used Interchangeably

Public health incorporates the interdisciplinary approaches of community health,

o Public Health Act (1848)

o Cause of Cholera out breaks

o Germ theory of Disease (1873)

Public Health Systems

• Etiology: causes and the development of disorder

• Diagnosis: identifying the symptoms and signs and distinguishing one

• Treatment: treating the disorder in a clinic/ hospital

• Prognosis: forecasting about the disorder, as to how it will progress

Public health: distinct from medicine …

• Primary focus on populations

• Public service ethics, extension of concerns for the individual

• Emphasis on disease prevention and health promotion for the community

• Research moves between laboratory and the field

• Social and public policy disciplines an integral part of public health

• Employs interventions aimed at human behavior, lifestyle, environment,

Sequence for the Control of Public Health Problem

1. The awareness that the problem exists

2. The understanding of what causes the problem

3. The capability to deal with the problem

4. A sense of values that the problem matters

5. The political will to control the problem

6. Public health model Scope involves defining problem, identifying cause,

Social Sciences like: Sociology, Economics, Management, Psychology

Basic Biological sciences

• PUBLIC HEALTH: Range of Required Acquaintance

Public Health emphasizes multi-disciplinary approach, seeking guidance from

Physical Sciences Social Sciences Arts

• Sub-specialty of CM: aims to improve health status of population through

• Process of decision making based on a synthesis of the best available

• The development, implementation and evaluation of effective programs

Prevention, Control, Eradication & Elimination

• Actions aimed at eradicating, eliminating or minimizing the impact of

Discouraging children from adopting harmful lifestyles to avoid hypertension,

• It signifies intervention in the pre-pathogenesis phase of a disease or health

Intervention for Primary Prevention

Health promotion Specific protection

Immunization and seroproph

• The specific interventions are:

1. Done on apparently healthy individuals

• All measures available to reduce or limit impairments and disabilities, and

Intervention for Tertiary Prevention

Ongoing operations aimed at reducing:

– The incidence of disease

– The duration of disease and consequently the risk of transmission

– The effects of infection, including both the physical and psychosocial

– The financial burden to the community

 TB, AIDS, Hepatitis Control Programs