The Dimensions Of Public Health

It would be useful to explore the concepts contained in the four terms that are commonly used to describe different aspects of public health (Fig. 1.1):

preventive medicine;

■ social medicine;

■ community health;

■ community medicine.

Preventive medicine

Prevention is better than cure is one of the prime messages of public health. It differentiates public health from the clinical disciplines that are primarily involved with the care of the sick, whilst public health emphasizes the avoidance of illness. Prevention was initially construed narrowly in terms of protective measures like vaccination and improved nutrition that target only healthy people with the aim of preventing the onset of disease. This concept was extended to cover the early diagnosis and treatment of sick persons with the aim of preventing advanced diseases and in the case of communicable diseases, in preventing the spread within the community. A further extension of the definition covers the treatment of sick individuals aimed at reversing damage and restoring function. This concept led to the classification of prevention into three levels later to be differentiated into five stages (Table 1.1).

Social medicine

'The poor die young'

The rise of social medicine coincided with increasing realization of the links between social status

Figure 1.1: The dimensions of public health.

and the health of individuals and communities. Statistical analyses of mortality and morbidity data show strong correlation between the social stratification in society and the pattern of health and disease. At one end of the scale, the affluent educated privileged groups, including professional persons, senior managers, employers, enjoy significantly better health than the poor, deprived, illiterate and unemployed. Numerous studies in many countries confirm this association and point to the need for social interventions to complement biomedical tools in improving the health of the deprived sections of the community. The objective of social medicine is to identify the social determinants of health and disease in the community and to devise mechanisms for alleviating suffering and ill health through social policies and actions. Social medicine is based on certain fundamental assumptions:

■ Health as a birthright. Everyone has the right to enjoy the highest possible level of health.

■ The responsibility of the state. It is the duty of governments to ensure that the people have the basic elements that would enable families and individuals to maintain good health and that they have access to good quality health care.

■ Development and health are inter-related. Good health promotes development, and development promotes health.

■ Education promotes health. The-StroHg association between health and level of edubaîîon isf particularly marked with regard to women's ed nation. It affects their health status, anc behaviour as well as that of their children.

■ Social factors ha\>e a profound influence on health. Culture, behaviour, social organization.

THE DIMENSIONS OF PUBLIC HEALTH

Table 1.1: Two classifications of preventive medicine

Three levels of prevention

Five stages of prevention

PRIMARY

■ Target population: entire population with special attention to healthy individuals

■ Objective: prevent onset of illness

■ Methods: education, immunization, nutrition, sanitation, etc.

1 General health promotion

■ Target population: entire population with special attention to healthy individuals

■ Objective: prevent onset of illness

■ Methods: education, nutrition, sanitation, life style changes, etc.

2 Specific prophylaxis

■ Target population: entire population with special attention to healthy individuals

■ Objective: prevent onset of specific diseases

■ Methods: education, immunization, nutritional supplement (vitamin A, iodine), chemoprophylaxis (e.g. against malaria)

SECONDARY

■ Target population: sick individuals

■ Objective: early diagnosis and treatment to prevent further damage to the individual and in cases of infectious diseases, spread to the community

■ Methods: screening of high risk groups e.g. Pap smears, sputum examination forTB; monitoring of vulnerable groups - children, pregnant women

3 Early diagnosis and treatment

■ Target population: sick individuals

■ Objective: early diagnosis and treatment to prevent further damage to the individual and in cases of infectious diseases, spread to the community

■ Methods: screening of high risk groups e.g. Pap smears, sputum examination forTB, blood test for HIV; monitoring of vulnerable groups - children, pregnant women

TERTIARY

■ Target population: sick patients

■ Objective: reduce damage from disease and restore function

■ Method: clinical care and rehabilitation

4 limiting damage

■ Target population: sick patients

■ Objective: limit damage from disease

■ Methods: skilled clinical care and social support to limit physical and social damage from the disease

5 Rehabilitation

■ Target population: convalescent patients

■ Objective: restore function and capability

■ Methods: physical and social rehabilitation

allocation of family resources, healthcare seeking behaviour, etc.

■ Health begins at home. Many of the interventions required for promoting health in developing countries begin at home through changes in individual behaviour and lifestyle, in families and in households.

■ Poverty is a major underlying cause of ill health (Table 1.2).

The overall goal is to achieve equity in health. As noted in the Declaration at Alma Ata (p. 304):

'The existing gross inequality in the health status of the people particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable and is, therefore, of common concern to all countries'.

Alma Ata Declaration, WHO (1978)

Health and human behaviour

Human behaviour is an important dimension of social medicine. The link between health and human behaviour is a major area of interest in public health with medical anthropologists ajjd sociologists providing specific professional expertise. The link between lifestyle and health is gaining more, attention as chronic diseases in :ens .ml> dominate the epidemiological pattern. The risk factors associated with cancers, cardiovascuJai diseases, diabetes and other chronic disease:, relate

Table 1.2: Comparing some health indicators of the poor versus the non-poor in selected countries. Source: WHO (1999)

Table 1.2: Comparing some health indicators of the poor versus the non-poor in selected countries. Source: WHO (1999)

*Poverty is defined as income per capita less than or equal to $1 per day in dollars adjusted for purchasing power.

to such lifestyle choices as the use of tobacco and alcohol, diet, nutrition and exercise. The pandemic of HIV/AIDS has highlighted the health importance of sexual behaviour, making sex literally a matter of life and death: life in its reproductive function and death in its association with the risk of acquiring deadly diseases.

interventions vary from environmental sanitation including vector control to personal health care, immunization, health education and such like. It includes an important diagnostic element - 'community diagnosis' - aimed at surveying and monitoring community health needs and assessing the impact of interventions.

Access to and utilization of health services

Behavioural scientists are also interested in healthcare seeking behaviour of individuals and families ranging from the self-treatment at home, to consultations with traditional or orthodox medical practitioners.

Information about beliefs, attitudes and behaviour provides the rational basis for developing programmes of health education for individuals and communities. Social medicine emphasizes the relationship between social factors and health status. It draws attention to the need for a multidiscip-linary approach to health with deep involvement of social and behavioural scientists, economists, ethicists and political scientists.

Community health

Community health deals with the services that aim at protecting the health of the community. The

Community medicine

This usually refers to services that are provided at the community level and is now often encompassed in the new term primary care. Community physicians, nurses and other health-care personnel are involved in providing care at clinics, health centres and in people's homes.

Modern public health

The modern concept of public health includes all these elements - preventive medicine, social medicine, community medicine, community health. Important features of modern pub lie health iuclftcfc the following characteristic featytfo^fi-is?.

■ multidisciplinary;

■ multisectoral;

■ equity-oriented.

KEY PUBLIC HEALTH FUNCTIONS

MULTIDISCIPLINARY

Although medical practitioners constitute a vital segment of the public health practitioners, the contributions from other health-related disciplines are absolutely essential for achieving the goals of public health. Thus, the public health team would include, as required, doctors, nurses, midwives, dentists and pharmacists; anthropologists, economists and other social scientists; philosophers, ethicists and other experts on moral sciences, as well as educationists, communications experts and managers. It is noteworthy that at the peak of its achievements, the late James Grant, a lawyer by profession, led UNICEF. Leadership in public health has to be earned from demonstrated ability and performance and not granted as a matter of course to the individual with a medical degree.

MULTISECTORAL

The health sector has two distinct roles. It is primarily responsible for planning and delivering health services. It also has an important leadership function in mobilizing intersectoral action. It should work with other ministries: with public works on water and sanitation; with education on the health of school children and health promotion; with transport on the control of road traffic accidents; and with agriculture on food security, nutrition, use of pesticides and the control of zoonotic infections.

The Complete Compendium Of Everything Related To Health And Wellness

The Complete Compendium Of Everything Related To Health And Wellness

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Responses

  • irmina
    What are the public health dimensions?
    6 months ago
  • Hanno
    What are public health dimension?
    6 months ago

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