A Textbook of Community Medicine/History of Community Medicine
Community Medicine is a new branch of medicine. It is often considered synonymous with Preventive and Social Medicine(PSM), Public Health, and Community Health. All these share common ground, i.e., prevention of disease and promotion of health. In short, Community Medicine provides comprehensive health services ranging from preventive, promotive, curative to rehabilitative services. The importance of the speciality of Community Medicine has been very well recognised and emphasized repeatedly from grass root to international levels, not only in health sector but in other related sectors too. The scope of medicine has expanded during the last few decades to include not only health problems of individuals, but those of communities as well. If we want to achieve Health For All, Community Medicine will definitely be the key factor during the next millennium.
Evolution and Development
A branch of medicine that is concerned with the health of the members of a community, municipality, or region. The emphasis in community medicine is on the early diagnosis of disease, the recognition of environmental and occupational hazards to good health, and the prevention of disease in the community The industrial revolution of the 18th century while bringing affluence also brought new problems - slums, accumulation of refuse and human excreta, overcrowding and a variety of social problems. Frequent outbreaks of cholera added to the woes Chadwick’s report on ‘The Sanitary Conditions of Labouring Population (1842)’ focussed the attention of the people and Government on the urgent need to improve public health. Filth and garbage were recognised as man’s greatest enemies and it lead to great sanitary awakening bringing Public Health Act of 1848 in England, in acceptance of the principle that the state is responsible for the health of the people. The act was made more comprehensive in 1875 when Public Health Act 1875 was enacted. The public health movement in USA followed closely the English pattern. The organised professional body, American Public Health Association was formed in 1872.
Public Health is defined as the process of mobilising local, state, national and international resources to solve the major health problems affecting communities and to achieve Health For All by 2000 AD.
While Public Health made rapid strides in the western world, its progress has been slow in the developing countries where the main health problems continue to be those faced by the western world 100 years ago. The establishment of the World Health Organisation (WHO) providing a Health Charter for all people provided a great help to the public health movement in these countries.
Many different disciplines contributed to the growth of Public Health; physicians diagnosed diseases; sanitary engineers built water and sewerage systems; epidemiologists traced the sources of disease outbreaks and their modes of transmission; vital statisticians provided quantitative measures of births and deaths; lawyers wrote sanitary codes and regulations; public health nurses provided care and advice to the sick in their home; sanitary inspectors visited factories and markets to enforce compliance with public health ordinances; and administrators tried to organise everyone within the limits of the health departments budgets. Public Health thus involved Economics, Sociology, Psychology, Law, Statistics, and Engineering as well as biological and clinical sciences. Soon another important and emerging branch of medicine i.e., Microbiology became an integral part of Public Health. Public Health during the 19th Century was around sanitary regulations and the same underwent changes.
Community Medicine developed as a branch of medicine distinct from Public Health. By definition, Community medicine is applied to ‘healthy’ people, customarily by actions affecting large numbers or populations. Its primary objective is prevention of disease and promotion of health. The development of laboratory methods for the early detection of disease was a further advance.
Community Medicine has been defined as that speciality which deals with populations, and comprises those doctors who try to measure the needs of the population, both sick and well, who plan and administer services to meet those needs, and those who are engaged in research and teaching in the field.
Decades old concept of health care approach has experienced a dramatic change. Today health is not merely an absence of disease; it is related to quality of life instead. Health is considered a means of productivity. Thus health development is essential to socio-economic development as a whole. Since health is an integral part of development, all sectors of society have an effect on health. Scope of medicine has extended from individual to community. Study of health and disease in population is replacing study of disease in man. Germ theory of disease gave place to newer concepts - multi-factorial causation. Social and behavioural aspects of the disease have been accorded a new priority. Contemporary medicine is no longer solely an art and science for the diagnosis and treatment of diseases. It is also the science for the prevention of disease and promotion of health. Today technical sophistication of modern medicine is not an answer to everyday common ailments of the vast poor in the country. Appropriate technology and cheaper interventions like Oral Rehydration Solution (ORS), immunisation, etc., are increasingly being applied as life saving measures and for disease prevention in community health care. Physicians’ role is no longer confined to diagnosing and treating those who come to the clinic. He is also responsible for those who need his service but can not come to the clinic. Health of the people is not only the concern of health care providers. It is the responsibility of the community also to identify and solve their own health problems through their active participation.
All these changes in concept and ideas of health and health care system are embodied in community health care. The spate of new ideas and concepts, for example, increasing importance given to social justice and equity, recognition of crucial role of community participation called for the new approaches to make medicine in the service of humanity more effective.
In 1978, the UN's Alma-Ata Declaration of Health for All by 2000 specified that Primary Health Care approaches are the means of achieving their goal of Health For All by 2000 AD. The Primary Health Care approach stressed that “essential health care should be made universally accessible to individuals and acceptable to them, through their full participation and at a cost the community and the country can afford”.