Community Medicine - Answers from Park's Textbook

Q1. Methods of Health Communication

A. Individual Approach

1. Personal contact / consultation
2. Home visits
3. Personal letters

B. Group Approach

1. Lectures
2. Demonstrations
3. Discussion methods:
   • Group discussion
   • Panel discussion
   • Symposium
   • Workshop
   • Conferences
   • Seminars
   • Role play

C. Mass Approach

1. Television
2. Radio
3. Newspaper
4. Printed material
5. Direct mailing
6. Posters
7. Health museums and exhibitions
8. Folk methods
9. Internet

Any one or a combination of these methods can be used selectively at different times, depending upon objectives to be achieved, the behaviour to be influenced, and available funds.

• Park's Textbook of Preventive and Social Medicine, p. 968

Q2. Levels of Prevention of Disease (Imp. Q)

0. Primordial Prevention

• Directed at children before risk factors develop (e.g., preventing obesity, hypertension by discouraging harmful lifestyles in childhood - school-going children)
• Main intervention: individual and mass education
• Example: Discouraging smoking, unhealthy eating, sedentary lifestyle before these habits form

1. Primary Prevention

• Intervenes in the pre-pathogenesis phase
• Two WHO-recommended approaches:
  • (a) Population (mass) strategy - directed at whole population irrespective of individual risk
  • (b) High-risk strategy - directed at susceptible individuals

2. Secondary Prevention

• Specific interventions: early diagnosis (screening tests, case finding) and adequate treatment
• Largely the domain of clinical medicine

3. Tertiary Prevention

• Intervenes in the late pathogenesis phase
• Includes rehabilitation - psychosocial, vocational, and medical components

Note from your notebook: Health education is given BEFORE risk factors emerge (to school-going students) = Primordial Prevention

• Park's, p. 52-53

Q3. TFR - Total Fertility Rate

TFR = (5 × Σ ASFR from 15-19 to 45-49) / 1000

• It gives the approximate magnitude of "completed family size"
• TFR of 2.1 = Replacement level fertility - the ideal TFR to stabilize India's population (each couple replacing themselves + accounting for childhood mortality)
• TFR < 2.1 = Population decline; TFR > 2.1 = Population growth

• Park's, Chapter on Demography & Family Planning

Q4. Definition of Health

WHO Definition (1948)

"Health is a state of complete physical, mental and social well-being and not merely an absence of disease or infirmity."

• In recent years, amplified to include: ability to lead a "socially and economically productive life"

Operational Definition of Health (WHO Study Group)

• Broad sense: "A condition or quality of the human organism expressing the adequate functioning of the organism in given conditions, genetic or environmental"
• Narrow sense: (a) No obvious evidence of disease and person is functioning normally within normal limits for their age, sex, community; AND (b) several organs functioning adequately in themselves and in relation to each other (equilibrium/homeostasis)

New Philosophy of Health (key points):

• Health is a fundamental human right
• Health is intersectoral and integral part of development
• Health is central to quality of life
• Health is a worldwide social goal

• Park's, p. 1-2

Q5. Indicators of Disease

1. Mortality indicators - IMR, death rates, life expectancy
2. Morbidity indicators - incidence, prevalence rates
3. Disability rates
4. Nutritional status indicators
5. Health care delivery indicators
6. Utilization rates
7. Indicators of social and mental health
8. Environmental indicators
9. Socio-economic indicators
10. Health policy indicators
11. Indicators of quality of life
12. Other indicators

An indicator must be: valid, reliable, sensitive, specific, feasible, and relevant.

Q6. Disability Adjusted Life Years (DALY)

• Originally developed by Harvard University for the World Bank in 1990; WHO adopted it in 2000

DALY = YLL + YLD

• YLL (Years of Life Lost) = number of deaths at each age × expected remaining years of life (using global standard life expectancy)
• YLD (Years Lost to Disability) = number of incident cases × average duration of disease × severity weighting factor (0 = perfect health, 1 = dead)

• 1 DALY = 1 year of healthy life lost
• Japanese life expectancy is used as the standard for measuring premature death (longest life expectancy)
• WHO 1990 report: 5 out of 10 leading causes of disability were psychiatric conditions
• "Social weighting" is used - years as a young adult are valued more highly

• Park's, p. 74-75

• QALY (Quality-Adjusted Life Year): Each year in perfect health = 1.0, death = 0.0; used to assess value-for-money of medical interventions
• DFLE (Disability-Free Life Expectancy): Average years expected to live free of disability

Q7. Balanced Diet

• (a) Daily protein requirement should be met first = 10-15% of daily energy intake
• (b) Fat requirement limited to 15-30% of daily energy intake
• (c) Carbohydrates rich in natural fibre = remaining food energy (50-80%)
• Micronutrient requirements must also be met

• Park's, p. Nutrition chapter

Q8. Macronutrients & Micronutrients

(i) Macronutrients ("Proximate Principles")

(ii) Micronutrients

• Park's, Nutrition chapter

Q9. Iodine Deficiency Disorders & Salt Fortification

1 ppm = 1 mg/kg = 1 mg/L = 10⁻³ g/kg = mg/kg

1 ppm = 1/10⁶ = 10⁻⁶ (as a fraction) - but in nutrition context, ppm = mg/kg

• Iodized salt contains 30 ppm iodine at manufacturing level (30 mg iodine per kg salt)
• At consumer level: minimum 15 ppm

• 263 out of 325 surveyed districts are endemic (IDD prevalence >10%)

• 71 million persons suffer from goitre and other IDD

Q10. National Programme for Iodine Deficiency Disorders / NIDDCP

1. Iodized salt - universal salt iodization
2. Monitoring and surveillance - salt testing kits; monitoring iodated salt
3. Manpower training
4. Mass communication (IEC activities) - posters, pamphlets, interpersonal communication to promote consumption of iodized salt

• IEC activities to promote consumption of iodated salt by people
• Monitoring of iodated salt through salt testing kits

• Park's, p. 494 and Nutrition chapter