Concepts in Public Health: A Case Study of Diarrhea

Centre for Community Medicine,Centre for Community Medicine,All India Institute of Medical Sciences, All India Institute of Medical Sciences,

New Delhi, INDIANew Delhi, INDIA

Dr Baridalyne N, Dr Kapil Yadav, Dr Palnivel CDr Baridalyne N, Dr Kapil Yadav, Dr Palnivel CProf. Chandrakant S Pandav 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

4Source- 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?

No family support Many siblings

No transport Poor hygiene

Diarrhea Dehydration

WrongCultural beliefs

& practices

No medical facility

Lack of care

Illiteracy Poverty

Female child < 2 yrs old

7

Malnutrition

Web of Causation

8

No family support

Many siblings

No transport

Poor hygiene

Diarrhea Dehydration

WrongCultural beliefs And practices

No medical facility

Lack of care

Illiteracy Low socio

economic status 9

Female child

Malnutrition

YES

Was the death preventable?

No family support

Many siblings

No transport

Poor hygiene

Diarrhea Dehydration

Poverty

No medical facility

Lack of care

Illiteracy 11

Wrong Cultural Beliefs & practices

Female child

Malnutrition

No family support

Many siblings

Poor hygiene

Diarrhea Dehydration

Wrong Cultural Beliefs & practices

Poverty

No medical facility

Lack of care

Illiteracy

THROUGH THE HEALTH SYSTEMTHROUGH THE HEALTH SYSTEM 12

Female child

Malnutrition

No family support

Many siblings

No transport

Poor hygiene

Diarrhea Dehydration

Faulty advice

Poverty

No medical facility

Lack of care

Illiteracy

OUTSIDE THE HEALTH SYSTEM 13

No medical facility

Malnutrition

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

14

15

Traditional Bio-Medical Concept

DIARRHEAL DISEASES

VIBRIO CHOLERA

E. COLI (Entero Pathogenic)

SHIGELLAE. COLI (Entero

Toxigenic)

ROTA VIRUS

CAMPYLOBACTER SALMONELLA

CRYPTO-SPORIDIUM

Socio- Epidemiological Concept

16

& ILLITERACY

Politico- Developmental Concept

17

& ILLITERACY

Public health trains you to have a “Holistic Approach”

to Health and Disease

19

20

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Clinical Vs Public Health

VariablesVariables Clinical Medicine Public health

UNIT OF STUDYUNIT OF STUDY • Individual • Population

TARGET GROUPTARGET GROUP• Patient – with disease

• Diseased/Non- Diseased

VIEWPOINT OF VIEWPOINT OF

HEALTH SYSTEMHEALTH SYSTEM

•Passive process• Active process

TYPE OF CARETYPE OF CARE • Focus on curative• Comprehensive care

SERVICE SERVICE

PROVIDERSPROVIDERS

• Provided by private sector

• Provided by PUBLIC/private sector

BENEFITSBENEFITS

• Short term benefits• Obvious benefit

• Long term benefits • Not obvious

In Public Health – Good work means no epidemics

22

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

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”.

24-BHORE COMMITTEE REPORT (1946)-Health Survey & Development Committee , Government of India

Critical appraisal

25/59

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 YouThank You