Health care of community chapter indetail spm and important questions from with answers

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Reading File

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Here is the complete, exam-oriented coverage of the Health Care of Community chapter from Park's Textbook of Preventive and Social Medicine (SPM), with important questions and answers.

HEALTH CARE OF COMMUNITY - SPM (Park's Textbook)

1. HEALTH CARE - Definition and Characteristics

Definition: Health care is "a multitude of services rendered to individuals, families or communities by the agents of the health services or professions, for the purpose of promoting, maintaining, monitoring or restoring health."

Health care includes medical care, but medical care is only a subset of the health care system. Medical care refers chiefly to personal services provided directly by or on instructions of a physician.

Characteristics of Health Care (7 A's + F)

Feature	Meaning
Appropriateness	Whether the service is needed at all in relation to essential human needs and policies
Comprehensiveness	Optimum mix of preventive, curative, and promotional services
Adequacy	Service is proportionate to the requirement
Availability	Ratio between population and health facility (e.g., doctor-population ratio)
Accessibility	Geographic, economic, or cultural accessibility
Affordability	Cost within the means of individual and state
Feasibility	Operational efficiency, logistic support, manpower, and material resources

2. HEALTH SYSTEM

Definition: "The human and material resources that a nation or community deploys to preserve, protect, and restore health and to minimize suffering caused by disease and injury, and the corresponding administrative and organizational arrangements."

Components include: concepts (health and disease), ideas (equity, coverage, effectiveness, efficiency, impact), objects (hospitals, drugs, equipment), and people (patients, providers, policymakers).

3. LEVELS OF HEALTH CARE

Health services are organized at three levels, each supported by a higher level with referral:

(a) Primary Health Care

First level of contact between individual and health system
Provides "essential" health care
Majority of health problems are managed here
Closest to the people
In India: provided by Primary Health Centres (PHCs) and sub-centres with community participation

(b) Secondary Health Care

Deals with more complex problems
Comprises essentially curative services
Provided by district hospitals and community health centres (CHCs)
Serves as the first referral level

(c) Tertiary Health Care

Offers super-specialist care
Provided by regional/central level institutions
Provides highly specialized care, planning, managerial skills, and teaching
Supports and complements primary level actions

4. FAMILY AND COMMUNITY MEDICINE

Dr. Francis Peabody (Harvard, 1923) called for return of the general physician for comprehensive, personalized care
Millis Commission Report and Willard Committee Report (1966, USA) made similar recommendations
American Academy of Family Physicians (formerly General Practice, renamed 1971) - placed emphasis on family-oriented health care
Family medicine is "family-oriented medicine or health care centred on the family as the unit - from first contact to the ongoing care of chronic problems (from prevention to rehabilitation)"

Community Medicine is defined by the Faculty of Community Medicine of the Royal College of Physicians 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 engaged in research and teaching."

5. HEALTH CARE REVOLUTION & PRIMARY HEALTH CARE (PHC)

Background

Recognition that health services did not cover the whole population
High proportion in rural areas had no access to health services
Services favoured only the privileged few and urban dwellers
Health care revolution demanded: a shift from curative to preventive, and hospital-based to community-based care

Alma-Ata Declaration (1978)

The concept of Primary Health Care came into the spotlight in 1978 following the International Conference at Alma-Ata, USSR.

Definition of PHC:

"Essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-determination."

Principles of PHC:

Social equity
Nation-wide coverage
Self-reliance
Intersectoral coordination
People's involvement in planning and implementation

PHC has been described as "Health by the people" and "placing people's health in people's hands."

8 Elements of PHC (Alma-Ata Declaration)

Education about prevailing health problems and their prevention/control
Promotion of food supply and proper nutrition
Adequate supply of safe water and basic sanitation
Maternal and child health care, including family planning
Immunization against infectious diseases
Prevention and control of endemic diseases
Appropriate treatment of common diseases and injuries
Provision of essential drugs

Mnemonic: SEMI PANE or WIPE MEAD

6. HEALTH PROMOTION

First International Conference on Health Promotion: Ottawa, November 1986 - resulted in the Ottawa Charter for Health Promotion
Built on progress from Alma-Ata Declaration and WHO intersectoral action debates
Fourth conference: Jakarta Declaration (July 1997) - reaffirmed health promotion

7. HEALTH TEAM CONCEPT

An auxiliary worker is one with "less than full professional qualifications in a particular field and is supervised by a professional worker"
WHO no longer uses the term "paramedical" for health professions allied with medicine
Modern medicine is a joint effort: physicians, nurses, social workers, health assistants, ASHA, and others
Definition of Health Team: "A group of persons who share a common health goal and common objectives, determined by community members, and who work together to achieve them."
The team must have a leader; the auxiliary is an essential member

8. HOSPITALS AND COMMUNITY

WHO Definition of Hospital (1963): "A residential establishment which provides short-term and long-term medical care consisting of observational, diagnostic, therapeutic and rehabilitative services for persons suffering or suspected to be suffering from a disease or injury and for parturients."

Criticism of hospitals:

Exist in "splendid isolation" - called an "ivory tower of disease"
Absorb 50-80% of health budget
Not people-oriented; procedures are inflexible
Overlook cultural aspects of illness
Treatment is expensive; resistant to change

Role in PHC (Post Alma-Ata):

Hospitals must be part of a social and medical system providing complete care
"The right patient should receive the right care at the right time in the right place at the right cost" - Dr. Rene Sand
Primary health care cannot work without effective hospital support for referred patients

9. COMMUNITY HEALTH

Replaced terms: public health, preventive medicine, social medicine in some countries
EURO Symposium (1966): "All the personal health and environmental services in any human community, irrespective of whether such services were public or private ones"
A WHO Expert Committee (1973) noted the term is ambiguous without further qualification

10. SOCIAL MEDICINE

Term first introduced by Jules Guerin, French physician, 1848
Revived in 1911 by Alfred Grotjahn of Berlin - stressed social factors as determinants of health
Defined as: "The study of man as a social being in his total environment"
Professor Crew of Edinburgh stated: "Social medicine stands upon two pillars, medicine and sociology... The laboratory is the whole community; the tools are epidemiology and biostatistics; and social therapy consists of social and political action."
John Ryle - first professor of social medicine at Oxford
Todd Report (1968) first referred to "community medicine" instead of social medicine

IMPORTANT EXAM QUESTIONS AND ANSWERS

Q1. Define Primary Health Care. State its 8 elements as per Alma-Ata Declaration.

A: PHC is "essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-determination." (Alma-Ata, 1978)

The 8 elements are: (1) Health education, (2) Nutrition, (3) Safe water and sanitation, (4) MCH including family planning, (5) Immunization, (6) Prevention/control of endemic diseases, (7) Treatment of common diseases and injuries, (8) Provision of essential drugs.

Q2. Enumerate the characteristics of health care (7 A's).

A: (i) Appropriateness, (ii) Comprehensiveness, (iii) Adequacy, (iv) Availability, (v) Accessibility, (vi) Affordability, (vii) Feasibility.

Q3. Define Health Care and Health System. How do they differ?

A: Health care is a multitude of services rendered to individuals/families/communities for promoting, maintaining, monitoring, or restoring health. A health system is the human and material resources a nation deploys to preserve, protect, and restore health, plus the administrative and organizational arrangements. Health care is the service delivered; health system is the structure that delivers it.

Q4. What are the three levels of health care? Give Indian examples.

A: (a) Primary - PHCs and sub-centres; (b) Secondary - District hospitals and CHCs (first referral level); (c) Tertiary - Regional/central institutions (super-specialist care).

Q5. What is the significance of the Alma-Ata Conference (1978)?

A: It was an international conference in Alma-Ata, USSR that defined and popularized the concept of Primary Health Care. It accepted PHC as the key to achieving "Health for All by 2000 AD." It emphasized social equity, nation-wide coverage, intersectoral coordination, people's involvement, and self-reliance. India, as a signatory, pledged to provide PHC.

Q6. What are the principles on which the PHC approach is based?

A: (1) Social equity, (2) Nation-wide coverage, (3) Self-reliance, (4) Intersectoral coordination, (5) People's involvement in planning and implementation.

Q7. Define Community Medicine.

A: Community medicine is "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." (Faculty of Community Medicine, Royal College of Physicians, UK)

Q8. What is the Ottawa Charter? When was it proclaimed?

A: The Ottawa Charter for Health Promotion was proclaimed at the First International Conference on Health Promotion held in Ottawa in November 1986. It arose in response to growing expectation for a new public health movement and was built on the Alma-Ata Declaration. It has been a source of guidance and inspiration for health promotion since that time.

Q9. What is the role of hospitals in relation to primary health care?

A: Hospitals cannot work in isolation; they must be part of a social and medical system providing complete health care. PHC cannot work without effective hospital support to deal with referred patients. The role of the hospital is being redefined as a "community health-oriented institution" with responsibilities in preventive medicine and health promotion, not only disease-oriented care.

Q10. What is the Health Team concept? Define a health team.

A: The health team concept recognizes that modern medicine is a joint effort of many groups - physicians, nurses, social workers, health assistants, ASHA, and others. A health team is "a group of persons who share a common health goal and common objectives, determined by community members, and who work together to achieve them." An auxiliary worker is an essential member. The team must have a leader who evaluates team members and stimulates their potentialities.

Q11. Who coined the term "Social Medicine"? Define it.

A: The term was first introduced by Jules Guerin, a French physician, in 1848. It was revived in 1911 by Alfred Grotjahn. By derivation it is "the study of man as a social being in his total environment." Its two pillars are medicine and sociology; tools are epidemiology and biostatistics.

Q12. What criticism is levelled against hospitals in relation to the community?

A: Hospitals (i) exist in isolation ("ivory tower of disease"), (ii) absorb 50-80% of health budget, (iii) are not people-oriented, (iv) procedures are inflexible, (v) overlook cultural aspects of illness, (vi) treatment is expensive, and (vii) are resistant to change.

Q13. Short note: Jakarta Declaration

A: The Jakarta Declaration on Health Promotion was the fourth international conference on health promotion, held in July 1997. It offered a new vision and focus for health promotion into the 21st century. It reaffirmed the importance of health promotion and identified new priorities for health promotion in the 21st century. It emphasized that health promotion requires participation from all sectors, including private sector.

Q14. What obstacles exist to implementation of PHC in India?

A: (1) Shortage of health manpower, (2) Entrenchment of a curative culture within the existing health system, (3) High concentration of health services and health personnel in urban areas.

Source: Park's Textbook of Preventive and Social Medicine, 25th edition (ISBN 9789382219163), Chapter on Health Care of Community.

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