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Premium member Presentation Transcript PowerPoint Presentation: 1 Good AfternoonPublic health : P ublic health DR AJAY TYAGI JR COMMUNITY MEDICINE PGIMS ROHTAK-124001 2“The science & art of preventing disease, prolonging life & promoting health through organized efforts of the society” Acheson (1988) : “The science & art of preventing disease, prolonging life & promoting health through organized efforts of the society” Acheson (1988) 3PowerPoint Presentation: Contents Introduction Prehistoric Public Health Primitive medicine(after 6000 BC) Middle Ages (500-1500 AD) Dawn of Scientific Medicine Rise of Public Health Modern Public Health Evolution of Health System in India Health care Revolution Great Public Health Achievements of Century Important International Agencies 4: Public health is as old as the man itself. In primitive time ,since the knowledge was limited , man attributed disease to the wrath of gods, the invasion of body by evil spirits and the malevolent influence of stars and planets. Introduction 5PowerPoint Presentation: There was nomadic existence of men Magic and spells were prevalent Sanitation of camp sites was there but it was due to mythical reasons Prehistoric public health 6: It was based on Supernatural theory of disease Disease and human sufferings & calamities were attributed to the wrath of god Influence of evil spirits, stars & planets Primitive medicine (6000BC) 7PowerPoint Presentation: Types Indian medicine Chinese medicine Mesopotamian medicine Egyptian medicine Greek medicine Roman medicine Primitive medicine 8PowerPoint Presentation: Ayurveda: m eans knowledge of life Has been practiced in India for more than 5000 years INDIAN MEDICINE 9PowerPoint Presentation: Hindu god of medicine born as a result of churning of oceans during tug of war between gods & demons Lord of healing in A yurveda Father of Indian science of medicine and Ayurveda DHANVANTRI 10PowerPoint Presentation: Great physicians of ancient India : Charak & Shushruta ‘CHARAK SAMHITA’ & ‘SUSHRUTA SAMHITA ’ are their great contributions. Great physicians 11PowerPoint Presentation: Ayurveda emphasizes on Importance of hygiene Modification of diet Important source of medical relief to rural population even today Ayurveda & PH 12PowerPoint Presentation: Lothal ( Mohanjodaro ) Sanitation and drainage systemPowerPoint Presentation: Mohanjodaro toiletPowerPoint Presentation: First organized body of medical knowledge dating back to 2700 BC Based on two principles Yin & Yang Yin : Negative feminine principle Yang: Active masculine principle Chinese medicine 15: Hypothesis Yin and Yang 16Chinese medicine ….: Chinese medicine …. Pioneer of Immunization Barefoot doctors which is the basis of recent concept of community participation Acupuncture Cultivation of plants & use of herbs Acupuncture 17PowerPoint Presentation: Cradle of civilization Cradle of magic & necromancy Demons were considered as causes of diseases Concept of ‘herb doctors’, ‘knife doctors’ & ‘ spell doctors’ Mesopotamian medicine (4000BC) 18PowerPoint Presentation: Babylonian Code of Hammurabi (2000BC) High degree of social organization Governed the conduct of physicians & health practices Penalties for harmful therapy Influence on Public health 19PowerPoint Presentation: Physiotherapy, tramping on patient’s body and counter-irritant mixtures were common therapeutic measures Importance of worms, insects & other parasites in pathology of diseases depicted in their paintings Egyptian Medicine 20Egyptian Medicine….: Egyptian Medicine…. Circumcision was started in 4000 B.C. Meanwhile they started realizing importance of hygiene & sanitation 21PowerPoint Presentation: Mummification was a special custom in Egypt. All viscera had to be removed except the heart & kidney The brain had to be removed through the nostrils Egyptian Medicine…. 22PowerPoint Presentation: Well-established community systems: Public baths Drains collecting rain water Importance of hygiene & clean dwellings Punishment for artificial abortions Care of infants Use of Knife & cautery Value of mosquito nets Association of plague with rats Public bath Egyptian Medicine…. 23PowerPoint Presentation: Hippocrates Greek Medicine (460-136 BC ) 24PowerPoint Presentation: Greek Medicine (460-136 BC ) Hippocratic oath 25PowerPoint Presentation: Greeks created rational medicine Many Greek cities realized the importance of doctors Created posts of city medical officers. Polyclinics were started Taxes were collected for this from the public Greek Medicine (460-136 BC ) 26PowerPoint Presentation: Appointed health officers were to advise the Govt on Epidemics Like other Greek pioneers of science, the doctors were prone to think that much more could be discovered by mere reflection and argument than by practice and experiment Greek Medicine (460-136 BC) 27PowerPoint Presentation: Aesculapius (1200 BC) An early leader in Greek medicine Had two daughters : H ygiea & Panacea Hygiea : goddess of health (preventive medicine) Panacea: goddess of medicine (curative medicine ) 28PowerPoint Presentation: Aesculapius Hygeia (Preventive medicine) Panacea (clinical medicine) 29PowerPoint Presentation: Greeks emphasized the value of exercise, a nutritious diet, and clean air in healing the body. Disease prognosis and case histories were introduced in the 5th century, and medical schools were established. Greek Influence on PH 30PowerPoint Presentation: Romans borrowed their medicine from Greeks whom they had conquered They were more practical The first doctor to come to Rome was Arcagathus who arrived from Greece. ROMAN Medicine(300 BC) 31PowerPoint Presentation: Public health was born in Rome They developed drained marshes for Malaria control Development of public baths, sewers: mark of cleanliness & hygiene Establishment of hospitals Roman medicine & PH 32PowerPoint Presentation: Sanitary awareness A Roman health officer stated on sanitary aspects “My office concerns not only the usefulness of such a system, but also the very health & safety of Rome” Sewers & Rain water drains Roman medicine & PH 33PowerPoint Presentation: The Romans also had knowledge of harmful effects of many common materials. Asbestos and lead were two products causing potential problems that were documented as having ill effects from extended exposure Roman medicine & PH 34PowerPoint Presentation: Dark Ages of Medicine: medicine reverted back to primitive medicine dominated by superstition & dogma Following the sacking of Rome in fifth century, Roman empire disappeared as an organized entity Later conquered by Muslims, there was continuity of Greek and Roman teachings in health Middle ages (500-1500AD) 35PowerPoint Presentation: When Europe was passing through dark ages, Arabians translated Graeco -Roman medical literature into A rabic They developed Unani system of medicine Schools of medicine & hospitals in Baghdad, Cairo were established by them Unani medicine 36PowerPoint Presentation: This is one of the indigenous system of medicine nowadays Unani medicine Unani medicine 37PowerPoint Presentation: After the fall of Rome, Christian faith entered the world Implicit faith on Christ was the only method of treatment of disease Christ was the supreme healer, the savior of body & soul CHRISTIAN ERA 38PowerPoint Presentation: Because of this the enquiry into the diseases became unnecessary & even culpable. A doctor curing patients by rational methods was considered to be committing sin & using medicine was seemed to be lack of faith in God. The scientific medicine suffered greatly & was fully dormant. All classes of people were treated alike . CHRISTIAN ERA 39PowerPoint Presentation: Founded by St . Benedict in 529 AD & took care of the sick Monasteries with well developed sanitary facilities were located on major travel routes and provided hospices for travelers Sole centers of learning and for medical care They emphasized the tradition of care of the sick and the poor as a charitable duty Monastery 40PowerPoint Presentation: These institutions provided efforts to cope with epidemic and endemic diseases Most physicians were monks guided by church doctrine and ethics Medical scholarship was based primarily on the teachings of Galen Monastery 41PowerPoint Presentation: Crowding, poor nutrition and sanitation, lack of water sources and drainage, unpaved streets, keeping of animals in towns, and lack of organized waste disposal created conditions for widespread infectious diseases All these were threat for the public health Although physicians provided services for those able to pay but medical knowledge was a mix of pragmatism, mysticism and sheer lack of scientific knowledge Christian medicine & PH 42PowerPoint Presentation: The practice of separating people with disease from the healthy population is an ancient one. By the 7th century, China had a well-established policy of detaining sailors and foreign travellers suffering from plague. The term “quarantine” dates back to the late 14th century Q uarantine 43PowerPoint Presentation: From the 14th century, European doctors visiting plague victims wore protective clothing mask and a beak containing strong-smelling herbs. Plague and quarantine 44PowerPoint Presentation: Smallpox is one of the oldest known human diseases . There are evidences that during the 18th century, Smallpox killed every seventh child born in Russia, and every 10th child born in France and Sweden Smallpox & Immunization 45Edward Jenner’s experiment in 1796 brought hope that the disease could be controlled. He carried out the first vaccination with cowpox virus in 1796 : Edward Jenner’s experiment in 1796 brought hope that the disease could be controlled. He carried out the first vaccination with cowpox virus in 1796 46 Smallpox & ImmunizationPowerPoint Presentation: Following 1500 AD Fracastorius envisaged the transfer of infection via minute invisible particles and explained the cause of epidemics(Theory of contagion) He became the founder of epidemiology. Sydenhem made differential diagnosis of scarlet fever, malaria, dysentery ,cholera. He is also regarded as the first distinguished epidemiologist. Dawn of scientific medicine 47PowerPoint Presentation: A milestone in the history of public health is great Sanitary awakening which took place in E ngland in mid-nineteenth century and gradually spread to other countries. Industrial revolution of the 18 th century sparked of numerous problems, i.e. creation of slums, overcrowding with all its ill effects. Sanitary awakening 48PowerPoint Presentation: Great cholera epidemic of 1832 led the birth of public health in England around 1940. John Snow, studied the epidemiology of cholera in London from 1848 to 1854 and established the role of polluted drinking water in its spread . The great cholera epidemic of 1832 drew attention of the people and govt. on urgent need to improve public health……led to enactment of the Public Health A ct of 1848 , in England. Rise of Public health 49PowerPoint Presentation: A comprehensive piece of legislation was brought into force in England, the Public H ealth A ct of 1875 , for the control of man’s physical environment. By the beginning of 20 th century, the broad foundation of public health …..clean water, clean surroundings ,wholesome condition of houses, control of offensive trades etc., were laid in all the countries of the western world. Rise of Public health 50PowerPoint Presentation: Preventive medicine really dates back to the 18 th century. It developed as a branch of medicine distinct from Public H ealth. P reventive M edicine got a firm foundation after the discovery of causative agents of disease and establishment of the Germ T heory of disease. Birth of preventive medicine 51PowerPoint Presentation: Modern P reventive Medicine: defined as… “ the art and science of health promotion, disease prevention, disability limitation and rehabilitation” Birth of preventive medicine 52PowerPoint Presentation: C urative M edicine Public H ealth / P reventive Medicine Modern medicine 53PowerPoint Presentation: Term Public H ealth came in to general use around 1840’s It arose from need to protect the public from the spread of communicable diseases In1848 the Public H ealth A ct in England crystallized the efforts organized by the society to protect, promote & restore the public health Public health 54PowerPoint Presentation: C.E.A. Winslow (1920) gave definition of public health: “the science & art of preventing disease, prolonging life & promoting health & efficiency through organized community efforts” This summarizes the philosophy of public health, which remains largely true even today Public health 55PowerPoint Presentation: WHO expert committee on public health administration adapted the Winslow’s definition & defined it as, “the science & art of preventing disease, prolonging life & promoting health & efficiency through organized community efforts for sanitation of the environment, control of the communicable infections, the education of the individual in personal hygiene, organization of medical & nursing services for early diagnosis & preventive treatment of the disease, & the development of the social machinery to ensure for every individual a standard of living adequate for maintenance of health, so organizing these benefits as to enable every citizen to realize his birth right of the health & longevity” Public health 56PowerPoint Presentation: Disease control phase (1880-1920) Health promotional phase (1920-1960) Social engineering phase (1960-1980) Health for All phase (1981-2000AD) Changing concepts in PH 57PowerPoint Presentation: 1880-1920 Sanitary legislation and sanitary reforms Less available technical knowledge Aimed at the control of man’s physical environment (water supply, sewage disposal) & not at the control of any specific disease Improvement in the health of people due to disease and death control Disease control phase 58PowerPoint Presentation: (1920-1960) In addition to disease control activities one more goal was added to public health i.e. health promotion of the individuals It was initiated as personal health services such as Introduction of Mother & Child health services School health services Industrial health services Mental health Rehabilitation services Health promotional phase 59PowerPoint Presentation: Two great movements were initiated for human development : a) provision of basic health services through the medium of PHCs & Sub-centers b) community development programme to promote village development through active participation of whole community Health promotional phase 60PowerPoint Presentation: 1960-1980 Change in pattern of disease Public Health entered in new phase called “social engineering phase ” It moved towards preventive & rehabilitative aspects of chronic diseases & behavioral problems Social engineering phase 61PowerPoint Presentation: Goals of public health & preventive medicine which had already considered overlapping became identical, namely prevention of disease, promotion of health & prolongation of life Social engineering phase 62PowerPoint Presentation: 1981-2000 AD Health gap between rich & poor, within & between countries Health for all phase I nclude provision of health care to all by reducing the inequalities within & between the population so that individual will lead a socially & economically productive life Health for all phase 63PowerPoint Presentation: WHO adopts Health for All by 2000AD (1977 ) Alma Ata declaration : primary health care (1978) Health for all phase 64PowerPoint Presentation: Stated ” The main social goal of Governments and the WHO in the coming decades should be the attainment , by all the citizens of the world (by the year 2000) of a level of health that will permit them to lead a socially and economically productive life (or) Health for All by 2000A.D (HFA 2000 )”. This was a revolutionary statement , because it stated the desired outcome . World Health Assembly 1977 65PowerPoint Presentation: In September, 1978, a Joint WHO-UNICEF International conference was held at Alma Ata , in the then USSR . The Alma Ata declaration reaffirmed that the goal was HEALTH FOR ALL and the way to get there was through PRIMARY HEALTH CARE. PHC was not just a package of services, or a level of care or an 8 point programme. It was a philosophy that placed people’s health in people’s h and . Alma Ata conference 1978 66PowerPoint Presentation: “ Essential Health care, made universally accessible to individuals and families in the community through their full participation and acceptable to them and at a cost that the community and the country can afford “ Primary Health Care As Per Alma Ata Declaration 67: Community participation Equitable distribution Appropriate technology Inter- sectoral coordination Principal of PHC 68PowerPoint Presentation: Health education Food supply and nutrition Safe water and basic sanitation Maternal & child care including Family Planning Immunization Prevention and control of locally endemic diseases. Appropriate treatment of common illnesses and injuries . Provision of Essential drugs Elements of PHC 69PowerPoint Presentation: With the adoption of Health for All (1978 ), a new concept of Public H ealth became evident worldwide, which may be defined as…. “the organized application of local, state, national & international resources to achieve health for all, i.e. attainment by all the people of the world by the year 2000 of a level of health that will permit them to lead a socially & economically productive life” 70 Modern Public HealthPowerPoint Presentation: During 20th century the dramatic increase in average span of life is credited to public health achievements such as vaccination programs, control of infectious diseases , better safety policy such as motor vehicle and worker safety, improved family planning, emphasis on safe drinking water. Now the focus is shifting more towards chronic diseases such as cancer, AIDS, diabetes and heart diseases Modern Public Health 71PowerPoint Presentation: Evolution of Health systems in India 72PowerPoint Presentation: NRHM-2005 NHP-2002 NPP-2000 RCH-1996 UIP-1985 NHP-1983 Alma Ata-1978 (HFA) Small pox eradicated-July 5, 1975 NFPP-1952 India Joins WHO-1948 HSDC-1946 Mile stones 73PowerPoint Presentation: 1946- the Health Survey and Development Committee was constituted with Sir Joseph Bhore as Chairman. recommended: Integration of preventive and curative services Development of primary health centres Changes in medical education which includes three months training in preventive & social medicine Health Committees 74PowerPoint Presentation: 1959-62: Mudaliar committee Health Survey And Planning Committee Health services restructuring 1963: Chadah committee Malaria 1964 : Mukherjee committee Family planning 1964-67 : Jungalwalla committee Integration of Health Services Health Committees 75PowerPoint Presentation: 1972-73: Kartar Singh committee MPW scheme 1974-75: Shrivastav committee Medical Education & Support Man-Power Health Committees 76PowerPoint Presentation: 1952- A start was made to setup primary health centres to provide integrated, promotive , preventive, curative and rehabilitative services to entire rural population , as an integral component of wider Community Development Programme. 1952 - India was the first country to launch a national programme emphasizing family planning to stabilize the population at a level consistent with the requirement of national economy. 1952- A move to set up P HCs 77PowerPoint Presentation: 1970s- The political changes that took place impelled the Central Government to implement the vision of Sokhey Committee of having one Community Health Worker for every 1000 people to entrust ‘people’s health on people's hand'. India has come quite close to Alma Ata Declaration on Primary Health Care . During 1970s 78PowerPoint Presentation: The ICDS(Integrated child Development Services ) scheme began in selected Community Development blocks in 1975. Two major evaluations of the scheme were conducted in 1978 & 1982. The positive results of these evaluation led the government to accelerate the expansion of ICDS scheme through out the country in 1982. 1975-ICDS 79PowerPoint Presentation: Formed in 1983, keeping in view the national commitment to the goal of Health for All by 2000 . To keep up with the changes in the health sector, National Population Policy-2002 was evolved OBJECTIVE: achieve an acceptable standard of good health amongst the general population APPROACH: decentralized public health system by establishing new infrastructure in the existing institutions, equitable access, and importance to preventive & first line curative initiatives. National Health policy 80PowerPoint Presentation: 1985- The Universal Immunization Programme (UIP) was launched to provide universal c overage of infants and pregnant women with immunization against identified vaccine preventable diseases . 1985-UIP 81PowerPoint Presentation: From the year 1992-93, the UIP has been strengthened and expanded into the Child Survival and Safe Motherhood (CSSM) Project. It involved sustaining the high immunization coverage level under UIP , and augmenting activities under Oral Rehydration Therapy, prophylaxis for control of blindness in children and control of acute respiratory infections. 1992-93 CSSM 82PowerPoint Presentation: In 1997, Reproductive and Child Health programme was launched which incorporated child health maternal health family planning treatment and control of reproductive tract infections adolescent health 1997-RCH 83PowerPoint Presentation: RCH Phase-2 (2005-2010) aims at sector wide outcome oriented program based approach with emphasis on decentralization monitoring and supervision 2005-2010 RCH Phase 2 84PowerPoint Presentation: The National Rural Health Mission (2005-2012) April 12 th 2005 major undertaking by the present United Progressive Alliance Government to honour its commitments under common minimal programme A dopted key guidelines given in National Health Policy 2002 e.g . equity, decentralization, involving Panchayati Raj Institutions (PRIs) and local bodies in owning primary health care management, strengthening primary health care institutions and suggestions for generating alternate source of financing . NRHM 85PowerPoint Presentation: The NRHM subsumes key national programmes , namely, Reproductive and Child Health-2 , National Disease Control Programmes and IDSP . The mission covers the entire country, with special focus on 18 states, which have relatively poor infrastructure NRHM 86PowerPoint Presentation: 87PowerPoint Presentation: NFHS - 1 in 1992-93 NFHS - 2 in 1998-99 NFHS - 3 in 2005-06 NFHS surveys are conducted under the stewardship of MOHFW IIPS is the nodal agency for the National Family Health Surveys National Family Health Survey 88PowerPoint Presentation: All 29 states are covered Slum and non-slum areas of eight cities, i.e. Chennai, Delhi, Hyderabad , Indore, Kolkata, Meerut , Mumbai, Nagpur Interviews were conducted with Women age 15-49 Men age 15-54 National Family Health Survey 89PowerPoint Presentation: Health for all. Primary health care. Deprofessionalization of medicine i.e. medical man beside clinician plays the role of educator, preventer, counsellor etc. MDGs Health care revolution 90PowerPoint Presentation: 1996–2004 Ebola - Congo haemorrhagic fever Influenza H5N1 Hantavirus Lassa fever Monkey pox Selected emerging and re-emerging infectious diseases 91PowerPoint Presentation: Creutzfeld – Jakob disease Rift Valley fever SARS coronavirus Venezuelan equine encephalomyelitis Yellow fever West Nile fever Selected emerging and re-emerging infectious diseases 92PowerPoint Presentation: Cryptosporidiosis Leptospirosis Lyme borreliosis Escherichia coli O157 Multidrug-resistant Salmonella Plague Selected emerging and re-emerging infectious diseases 93PowerPoint Presentation: Vaccination Safer workplaces Control of infectious diseases Decline in deaths from coronary heart disease and stroke Motor vehicle safety Great Public Health Achievements of This Century 94PowerPoint Presentation: Safer, healthier food Healthier mothers and babies Family planning Safe drinking water Recognition of tobacco as a hazard Improved sanitation Great Public Health Achievements of This Century 95PowerPoint Presentation: CARE- Co-operative for Assistance And Relief Everywhere UNICEF – United Nation International Children Emergency Fund WHO – World Health O rganization WORLD BANK GOARN- Global Outbreak A lert and Response N etwork International agencies o f public health importance 96PowerPoint Presentation: UNDP- United Nations Development Programme FAO – Food and Agriculture Organization UNFPA - United Nation Fund for Population Activities. Global fund to fight AIDS, TB, Malaria Bill and Melinda Gates Foundation International agencies o f public health importance 97PowerPoint Presentation: USAID :United States Agency for International Development SIDA: Swedish International Development Agency DANIDA: Danish International Development Agency GAVI: The Global Alliance for Vaccines and Immunization INTERNATIONAL RED CROSS International agencies o f public health importance 98: “At present each and every activity directly or indirectly is related to public health” 99PowerPoint Presentation: "It is my aspiration that health finally will be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan 100PowerPoint Presentation: www.who.int.in International digest of health legislation, WHO Park K. Textbook of Preventive & Social Medicine, 20 th edition, chp 1, p 1-10 Anderson C L. Community Health, p 3-16 http://en.wikipedia.org/wiki/Public_health http://www.abpischools.org.uk/res/coResourceImport/resources04/history/timeline.cfm http:// www.enotes.com/public-health-ncyclopedia/history-public-health References 101PowerPoint Presentation: THANK YOU Thank You 102 You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.