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Concepts in Public Health: A Case Study of Diarrhea. Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, INDIA. Dr Baridalyne N, Dr Kapil Yadav, Dr Palnivel C Prof. Chandrakant S Pandav . Babita, Age – 2 years. The Story……………. . Baby girl aged 2 yrs
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Concepts in Public Health: A Case Study of Diarrhea Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, INDIA Dr Baridalyne N, Dr Kapil Yadav, Dr Palnivel C Prof. Chandrakant S Pandav
The Story……………. • Baby girl aged 2 yrs • Large family -5 siblings • Diarrhea & Dehydration • Grandmother told not to feed child during diarrhea • No health facility in village • Couldn’t go in the night –had to look after other children & drunken husband • Mother walks to nearby hospital-10 kms away! • Unfortunately the girl child dies
Causes of death among children under five years of age in India Source- WHO- India: Mortality Country Fact Sheet 2006
Burden of Diarrheal Diseases in India • 9.1% of all deaths below 6 years¹ • 158,209 diarrheal deaths per year¹ • 2 week prevalence- 12.2% in children < 3 years² • 10.5 episodes per child per year ³ 1- National Commission on Macroeconomics and Health, 2005. 2- National Family Health Survey 3 (2005-06) 3- Bhattacharya SK, 2003. NMJI, 16 (S 2): 15-19.
What were the factors that led to Babita’s death? Many siblings No family support No transport Poor hygiene Lack of care No medical facility Wrong Cultural beliefs & practices Diarrhea Dehydration Malnutrition Female child < 2 yrs old Illiteracy Poverty
No family support Wrong Cultural beliefs And practices Many siblings Lack of care Female child Poor hygiene No transport Diarrhea Dehydration No medical facility Malnutrition Low socio economic status Illiteracy
No family support Wrong Cultural Beliefs & practices Many siblings Lack of care Female child Poor hygiene No transport Diarrhea Dehydration No medical facility Malnutrition Poverty Illiteracy
No family support Wrong Cultural Beliefs & practices Many siblings Lack of care Female child Poor hygiene Diarrhea Dehydration Malnutrition No medical facility Poverty Illiteracy THROUGH THE HEALTH SYSTEM THROUGH THE HEALTH SYSTEM
No family support Faulty advice Many siblings Lack of care No medical facility Poor hygiene No transport Diarrhea Dehydration Malnutrition No medical facility Illiteracy Poverty OUTSIDE THE HEALTH SYSTEM
Concepts of disease causation • Traditional Bio-medical concept • Disease caused due to the presence of causative agents • Basis in Germ theory of disease • Socio- Epidemiological Concept • Causative agents alone may/may not be sufficient for disease occurrence • Social factors important in the disease causation & progression • Politico- Developmental Concept • Comprehensive approach, puts health in the context of various politico- developmental situations • Effects of government policies & outfalls of development on disease occurrence, • Stems from the multi-factorial causation of disease
Traditional Bio-Medical Concept VIBRIO CHOLERA E. COLI (Entero Pathogenic) SHIGELLA E. COLI (Entero Toxigenic) DIARRHEAL DISEASES CRYPTO-SPORIDIUM ROTA VIRUS CAMPYLOBACTER SALMONELLA
Socio- Epidemiological Concept & ILLITERACY
Politico- Developmental Concept & ILLITERACY
Public health trains you to have a “Holistic Approach” to Health and Disease
Clinical Vs Public Health In Public Health – Good work means no epidemics
Axioms of Public Health • Prevention is better than cure • Best should not be the enemy of good • Good for many rather than best for few • Primary health care is NOT primitive care
Bhore Committee • “The physician of tomorrow, • who will naturally be concerned • with the promotion of the new era of social medicine- • will be scientist and social worker, • ready to cooperate in team work,, • in close touch with the people he serves, • a friend and leader, • he directs all his efforts towards the prevention of disease, and • becomes a therapist where prevention has broken down, • the social physician, • Protecting the people, and • Guiding them to a healthier and happier life”. • BHORE COMMITTEE REPORT (1946) • Health Survey & Development Committee , Government of India
Critical appraisal Thank You