Centre for Community Medicine,
All India Institute of Medical Sciences,
New Delhi, INDIA
Concepts in Public Health:
A Case Study of Diarrhea
Dr Baridalyne N, Dr Kapil Yadav, Dr Palnivel C
Prof. Chandrakant S Pandav
1
Babita, Age – 2 years
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
3
Causes of death among children
under five years of age in India
4
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.
5
What were the factors that led to Babita’s death?
6
What were the factors that led to Babita’s death?
Many siblings
No family support
Poor hygiene
No transport
Lack of care
No medical
facility
Wrong
Cultural beliefs
& practices
Diarrhea
Dehydration
Female child
Poverty
Malnutrition
< 2 yrs old
Illiteracy
7
Web of Causation
8
No family support
Many siblings
Wrong
Cultural beliefs
And practices
Lack of care
Female child
Poor hygiene
No medical
facility
Diarrhea
Dehydration
No transport
Malnutrition
Low socio
economic status
Illiteracy
9
Was the death preventable?
YES
No family support
Wrong Cultural
Beliefs & practices
Many siblings
Lack of care
Female child
Poor hygiene
No transport
No medical
facility
Diarrhea
Dehydration
Malnutrition
Poverty
Illiteracy
11
No family support
Wrong Cultural
Beliefs & practices
Many siblings
Lack of care
Female child
Poor hygiene
No medical
facility
Diarrhea
Dehydration
Poverty
Malnutrition
Illiteracy
THROUGH THE
THE HEALTH
SYSTEM
THROUGH
HEALTH
SYSTEM
12
No family support
Faulty advice
Many siblings
Lack of care
No medical
facility
Poor hygiene
No transport
No medical
facility
Diarrhea
Dehydration
Poverty
Malnutrition
Illiteracy
OUTSIDE THE HEALTH SYSTEM
13
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,
14
– Stems from the multi-factorial causation of disease
Traditional Bio-Medical Concept
VIBRIO
E. COLI (Entero
Pathogenic)
CHOLERA
E. COLI
(Entero
Toxigenic)
SHIGELLA
DIARRHEAL
DISEASES
CRYPTOSPORIDIUM
ROTA
VIRUS
CAMPYLOBACTER
SALMONELLA
15
Socio- Epidemiological Concept
& ILLITERACY
16
Politico- Developmental Concept
& ILLITERACY
17
Public health trains
you to have a
“Holistic Approach”
to Health and Disease
19
20
Clinical Vs Public Health
Variables
Clinical Medicine
Public health
UNIT OF STUDY
• Individual
• Population
TARGET GROUP
• Patient – with
disease
• Diseased/NonDiseased
VIEWPOINT OF
HEALTH SYSTEM
TYPE OF CARE
SERVICE PROVIDERS
BENEFITS
•Passive process
• Active process
• Focus on curative
• Comprehensive care
• Provided by
private sector
• Provided by
PUBLIC/private sector
• Short term benefits
• Obvious benefit
• Long term benefits
• Not obvious
In Public Health – Good work means no epidemics
21
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
22
23
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)
24
-Health Survey & Development Committee
, Government of India
Critical appraisal
Yes
Can’t tell No
Do you believe the
results?
Can the results be
applied to the local
population?
Do the results of this
study fit with other
available evidence?
Thank You
25/59