Public Health 2


PUBLIC HEALTH AND PREVENTIVE MEDICINE

 

Health is Wealth. There’s lots of people in this world who spend so much time watching their health that they haven’t the time to enjoy it.

The History of Public Health and Preventive medicine are noticed in India since long time. The laws of Manu wrote about Public Health and Hygiene. The Indus Valley civilization clearly described how the water systems were protected. But unfortunately none in the world are talking about India’s old civilization and the glory of our ancestors.

In the Modern History Italians, Greeks and Persians are also followed Public Health and Sanitation.

In USA, Charles-Edward Amory Winslow (4 February 1877 – 8 January 1957) was an American bacteriologist and public health expert who  founded the Yale Department of Public Health in the year 1915 within the Yale Medical School, and he was professor and chairman of the Department until he retired in 1945. (The Department became the Yale School of Public Health after accreditation was introduced in 1947.)  During a time dominated by discoveries in bacteriology, he emphasized a broader perspective on causation, adopting a more holistic perspective. The department under his direction was a catalyst for health reform in Connecticut.  He was the first director of Yale’s J.B. Pierce Laboratory, serving from 1932 to 1957. Winslow was also instrumental in founding the Yale School of Nursing.

Public Health is the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals. Public health is concerned with threats to the overall health of a community based on population health analysis. The population in question can be as small as a handful of people   or as large as all the inhabitants of several continents. There are two distinct characteristics of public health. One it deals with preventive rather than curative aspects of health and the second one it deals with population rather than individuals. The subfields of Public Health are Environmental, social, behavioral, , Communicable diseases, Health related Hygiene, preventive Medicine, Preventive Cardiology, occupational health etc.etc  also included in the public Health.

The focus of public health is based on fives P’s to partner, provide, protect,  promote  and prevent Health hazard.  Intervention is to prevent rather than treat a disease through surveillance of cases and the promotion of healthy behaviors. In addition to these activities, in many cases treating a disease may be vital to preventing it in others, such as during an outbreak of an infectious disease.  Hand washing,  vaccination,  programs and distribution of condoms are  few examples of public health prevention measures.

Disease surveillance is an epidemiological practice by which the spread of disease is monitored in order to establish patterns of progression. The main role of disease surveillance is to predict, observe, and minimize the harm caused by outbreak, epidemic, and pandemic, situations, as well as increase our knowledge as to what factors might contribute to such circumstances.

A key part of modern disease surveillance is the practice of disease case reporting.

The important study methods and components of Public Health are Epidemiology, the study of factors affecting the health and illness of populations, and serves as the foundation and  interventions made in the interest of public health and preventive medicine It is considered a cornerstone methodology of public health research. It is also highly regarded as evidence based medicine.  Evidence-based medicine (EBM) aims to apply the best available evidence gained from the scientific method to medical decision making.   It seeks to assess the quality of evidence of the risks and benefits of treatments (including lack of treatment). How should one can take evidence?, by applying bio-statistical  and survey procedures.

Biostatistics (a combination of the words biology and statistics; sometimes referred to as biometry or biometrics) is the application of statistics to a wide range of topics in the health care. The science of biostatistics encompasses the design of biological experiments, especially in medicine.

Health Services or Health care is the treatment and management of illnesses of the elderly/or any age group in the population , and the preservation of health through services offered by the medical, dental,  and alternative medicine (Ayurveda, Unani, Homeopathy, Naturopathy etc).

Health care embraces all the goods and services designed to promote health, including preventive, curative and palliative interventions, whether directed to individuals or to populations

Before understanding more about this vast subject of public Health one should know about Preventive Medicine and Hygiene are two of many  different entities of the health care but they are the prime components  of Public Health. Both Public Health and Preventive care are like hand and Glove.

The following brief Information  may help  to understand more about Public health.  By knowing the interlaced items like preventive medicine{primary prevention ( avoid disease, by health education& health promotion ), secondary prevention (early detection and prevent spread /progress of disease) and tertiary prevention}, Hygiene, Change in life style, and wellness may have health benefits to the population.

Preventive medicine or preventive care refers to measures taken to prevent diseases (or injuries) rather than curing them or treating their symptoms, Simple example is hand wash and Immunization. Prevention is better than cure is the old slogan but the new saying is Prevention is the Best cure.

When preventive medicine is applied to a whole population, it includes things like extensive work in public health, pest and insect control, vaccinations, food safety, and improvements in hygiene for water supplies, homes, and individuals. As can be seen by looking at this wide variety of topics covered by preventive medicine, a number of specialties are incorporated into successful preventive medicine programs. In developing nations, doctors who specialize in preventive medicine are focused on improving hygiene and living conditions to prevent outbreaks, and on vaccinating and educating the population. In the West, preventive medicine includes extensive research and development, monitoring of food supplies, and well trained epidemiology teams who track down an outbreak at its source when one emerges.

When practiced on an individual basis, preventive medicine involves looking at the body as a whole, rather than at the individual parts of the body. Many Eastern disciplines already view the body this way, and practitioners of traditional Chinese medicine and other similar disciplines work with their patients to keep the body balanced, happy, and healthy. Measures to treat the body as a whole include herbal regimens, massage, psychotherapy, and dietary changes. The West has slowly accepted the value of preventive medicine for individuals, especially with rising obesity rates, and many doctors are starting to incorporate whole body therapy into their practice.

Preventive medicine has a long history all over the world, dating back for centuries to the time when people first realized that unclean water made them sick, and that living conditions needed to be more hygienic to prevent illness. Steps made in the field were small, but important, until the twentieth century, when numerous governments founded disease prevention centers such as the Centers for Disease Control and Prevention in the United States. These scientific establishments began to set firm guidelines designed to minimize the transmission of disease, improve hygiene, and enable rapid responses to major outbreaks.

Preventive medicine, is a medical discipline which focuses on preventing diseases and promoting a general state of health and well being. Preventive medicine  is considered to be a board specialty, meaning that physicians can focus on preventive medicine while they get their medical degree, and use the skills they learn in school to reduce the outbreak of disease epidemics, improve public health, and increase the general quality of life for individuals all over the world. In the West, preventive medicine is practiced as an arm of public health, and is applied to the whole population, while in Eastern medicine, many doctors practice individual preventive medicine. Individual Western doctors are sometimes criticized for not practicing preventive medicine on a patient by patient basis, because insurance companies often feel that it is too expensive and time consuming, and will not compensate doctors for preventive measures.  As the cost of Health care is sky rocketing in USA many Hospitals are now focusing to adopt Preventive measures by using alternate medicine as well as Life style change.

Preventive care may include examinations and screening tests tailored to an individual’s age, health, and family history. For example, a person with a family history of diabetes, Hypertension, Cardiac problems and certain cancers  would begin screening at an earlier age and more frequently than those with no family history. Apart from the screening it is advisable to the local Institutions and NGO’s to do epidemiological  research towards finding ways to prevent diseases.

This presentation is not completed with out discussing Hygiene, Vaccination and Life style change and wellness centers which are the back bone for preventive care.

Hygiene is simply called  cleanliness, though we simply call it cleanliness the procedures adopted  and maintained in various Hygienic conditions vary and having lengthy procedures(Dental and Industrial Hygiene).

The term hygiene is derived from Hygeia, the Greek goddess of health, cleanliness and sanitation. Hygiene refers to the set of practices associated with the preservation of health and healthy living. Hygiene is a concept related to medicine, as well as to personal and professional care practices related to most aspects of living, although it is most often associated with cleanliness and preventative measures. In medicine, hygiene practices are employed to reduce the incidence and spreading of disease. Hygiene is also the name of the science that deals with the promotion and preservation of health, also called hygienics. Hygiene practices vary widely, and what is considered acceptable in one culture might not be acceptable in another.

Hygiene is in different forms, they are personal hygiene, dental hygiene, surgical hygiene, industrial hygiene etc. etc. It is practically impossible to write all the Hygiene methods in this article, however interesting and important items are given.

Personal hygiene is the first step to good grooming and good health. Elementary cleanliness is common knowledge. Neglect causes problems that you may not even be aware of. Many people with bad breath are blissfully unaware of it. Some problems may not be your fault at all, but improving standards of hygiene will control these conditions. Dandruff is a case in point. More often than you know, good looks are the result of careful and continuous grooming. Washing one’s hands, a form of hygiene, is the most effective overall way to prevent the spread of  infectious diseases .

 

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Hand wash is the key for Hygiene, where 40% to 50%  communicable disease are prevented.

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Astronaut taking a hot bath in the crew quarters of the Orbital Workshop (OWS) of the Skylab space station cluster in Earth orbit. In deploying the shower facility the shower curtain is pulled up from the floor and attached to the ceiling. The water comes through a push-button shower head attached to a flexible hose. Water is drawn off by a vacuum system. This shows the importance of personal Hygiene. Every external part of the body demands a basic amount of attention on a regular basis

Dental Hygiene:

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This is the important part of the day to day Hygiene. Recent studies showed the link between dental Hygiene and Heart problems.  Could the health of your teeth and gums affect your heart? It seems like it couldn’t be possible, but more and more doctors are convinced that there is a relationship between poor dental hygiene and heart disease. It is suggested that inflamed, bleeding gums allow bacteria in the mouth to enter the bloodstream and cause problems in the heart. Once in the blood, the bacteria attach themselves to fatty plaques that are responsible for Coronary Heart Disease (CHD). These plaques are the ones that will clot together, hasten atherosclerosis (hardening of the arteries), and cause heart attacks or strokes. So proper flossing and brushing of your teeth may have an added purpose – that of protecting your heart.

Healthy gums are firm, light pink, and very elastic. If you have reddened or inflamed gum tissue, or bleeding gums after brushing or after you eat hard foods, or your gums are sensitive to the touch, or bad breath especially when you first get up in the morning – seek professional-dental help. Gum disease if left to go to long will develop toxins which spread the infection and begin to dissolve the gum and bone tissue causing the teeth to loosen and eventually to fall out.

It is believed that anaerobic bacteria are the culprits in destroying gums and the underlying bone. If the infection is not stopped before the bacteria travel into the blood system, then the heart may become infected. These bacteria have been found clumped together in the fatty plaque found in heart arteries.

This can be explained by the third stage of atherosclerosis which is an inflammatory response of the immune system. The body’s own defensive system reacts against the invading bacteria. The arteries constrict complicating blood flow and increasing the risk of blood clots which may lead to a heart attack. So it seems possible that invading bacteria could encourage CHD.

Other heart illnesses such as infective endocarditis (a serious infection of the lining of the heart) can occur. The symptoms of this disease are: always tired, constant or near constant headaches, a mild fever that can last for months, night sweats and cold chills, and possibly dark lines may develop under the fingernails.

Gum disease if left unchecked can also cause problems in other parts of the body. So it is important to have dental exams every six months.  The following measures may help to enhance dental Hygiene

• Brush your teeth twice a day. Bad brushing technique can actually make gum disease worse. It’s best to make a circular motion with your toothbrush, which helps the bristles clear out any debris in the gaps between the teeth and gums.
• Floss at least once a day. Ask your dentist to show you how to floss properly if you have any doubts on how to do it.

• If your dentist recommends it – use antiseptic mouthwash and toothpaste.

• Get regular checkups and cleanings every six months. Some people may need to make them more frequently – ask your dentist.

• Eat healthy foods – a good balanced diet with adequate vitamins and nutrients will build up your immune system. In this way your body can fight off infection and heal better.

• Stop smoking – the American Academy of Periodontology points out that smoking may be one of the most significant risk factors for gum disease.

In summary the feeling in the medical community is that it is very possible that the bacteria causing gum disease do in fact infect the heart system, since the same bacteria have been found clumped together in the fatty plaque found in the heart arteries. In any case, the proper care of your teeth and gums (and your smile) are simple things to do. And if what the dentists and medical researchers think does prove to be true, your heart will be that much better off for your efforts.

Another important topic of Hygiene is the Industrial hygiene(IH), This is poorly developed in the Indian Industry. IH  is defined as the recognition, evaluation, and control of workplace hazards. Its origins are based on limiting personal exposures to chemicals, and have evolved to address the control of most other workplace hazards including over-exposure to noise, heat, vibration, and repetitive motion.

Occupational exposure to chemicals is still considered one of the most wide spread hazards in industry. The use of engineering controls is the preferred method of limiting these exposures. Dilution and capture ventilation are two important methods to control occupational exposure. The design and position of hoods and vents, and amount of air infiltration can substantially change exposure conditions. Material Safety Data Sheets and other documentation provide a basis for predicting adverse effects, disposal needs, and fire and ignition concerns. Information about several chemicals or groups of chemicals can be found in Reference Data Sheets written by Meridian Engineering & Technology staff members and consultants. Some of these data sheets also include specific topics in the fields of safety or environmental engineering.

Sampling and monitoring equipment is available to quantify exposures to contaminants, noise, radiation, and heat. Correct sampling strategy and interpretation are essential elements of an industrial hygiene survey. Confined spaces, ventilation changes, the performance of collection systems, and pressure relief valves are all items of concern for exposure evaluation.
often requires both an understanding of the limitations of the equipment, and the expected exposure parameters as determined by an industrial hygiene evaluation. Engineering controls are considered the preferred method of control, but personal protective equipment plays an important role for health, safety, and rescue, especially when using confined space entry The selection of appropriate personal protective equipment for exposure control procedures. The potential for misuse or misapplication of these devices should be evaluated.

The Occupational Safety and Health Administration, the American Conference of Governmental Industrial Hygienists, and the National Institute of Occupational Safety and Health are three organizations which establish many of the rules governing allowable workplace exposures. Permissible exposure limits for noise, chemicals, heat, and other workplace stressors have been established and often include safety factors.

Another aspect of Public Health improvement and is the Life style change and wellness for Healthy living which is directly proportional to preventive medicine. Life style change not only prevent the disease but Many disease will be altered by changing the life style.

Modifying or eliminating long-held habits over years to change. They may be of eating or physical activity and maintaining the new habits over months and years for the better health. More than ever before, we hear this word  of wellness in the news,  in conversation and even at work. The role of Wellness centers have become pervasive in recent years to prevent certain diseases. The types of services offered will vary from center to center depending on the center’s mission and philosophies.
Interestingly, there is no universally-accepted definition of wellness. There is, however, a set of common characteristics seen in most thoughtful attempts at a definition of wellness. We generally see a reference to a state of well-being, which is vague, to say the least. Also frequently seen is a state of acceptance or satisfaction with our present condition.

Health assessment is true to its name. It checks you and your lifestyle assessing it to the risk of Silent Killer diseases – Diabetes, Heart Diseases & Respiratory Diseases. Health Assessment is designed to give you an idea how your current lifestyle may be affecting your health and well-being. The reports generated after completing the assessment tell you your personal risk for diseases such as Diabetes, Hypertension and Cardiovascular diseases. It provides you with an insight of what these diseases are and how they affect your body. It also provides you with health behavior targets one should set for himself or herself to reduce the risk and improve your overall health.  This Health Assessment should be done  at least twice a year to keep a close tab on the current Health and Lifestyle. This also encourage the person to use these reports as a starting point for conversations with your health professional, family members, or other health and well-being partner about changes that  might make in lifestyle habits to improve the over all health.

Lifestyle Health Assessment is conducted in a very simple process. Our

The following seven tests may be useful.

  • ECG (Electrocardiogram)
  • Blood Pressure
  • Random Blood Glucose (We suggest that you do not eat or drink anything except water, 2 hours before your scheduled test for more accurate results)
  • SpO2 (To check the Blood Oxygen Level)
  • Spirometry (To check the Lung Function)
  • Total Cholesterol (To identify the risk of developing Heart Disease)
  • Triglyceride (To identify the risk of developing Heart Disease)

Life style change is more needed for the Older Population as the aging process may be reduced by keeping fitness programs. You can change  simply by changing how you think, feel and act now. Geriatrics experts say. Staying healthy, fit and active are the keys to successful aging. Here  We simply characterized normal aging. Now we are seeing that people can age successfully in good health well into old age. Disease and disability are not inevitable consequences of aging. That is good news not only for individuals but also for communities and society in general. In the last two decades, census figures have shown that the world’s vital statistics are changing. In the U.S., the proportion of older adults went from roughly four percent in 1900 to 13 percent today, and will increase to more than 20 percent by 2030.

In the recently ended Diabetes Prevention Program study, sponsored by NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and NIA with additional support by several other institutions, scientists found that moderate diet and exercise successfully delayed and possibly prevented participants from developing type 2 diabetes. About 16 million people in the United States have diabetes , which is the main cause of kidney failure, limb amputations and new-onset blindness in adults, as well as a major cause of heart disease and stroke. Type 2 diabetes accounts for up to 95 percent of all diabetes cases. The most interesting aspect of the study in terms of aging was that diet and exercise worked better in those participants ages 60 and older. The study  noted that lifestyle changes prevented the disease at better rates than did the oral diabetes drug metformin, which was also tested during the program. Life style change Is not only for exercise but it also includes the diet what you are eating. “The food what you eat You are” Many foods what we are eating in the present world are contaminated at the stage of growing. As a result the over all health of the population is at Risk. The air we breath, the water we drink, and the food we eat are fully polluted and contaminated. In order to correct the health hazards caused by the above one should bring awareness in the Public. Therefore Health education and health promotion are more important and the policy makers in the health sector must focus by changing the law and over all health reforms must be done.

 

Every person, whether or not he or she has diabetes, has a certain amount of glycosylization present. Because of more sugar in their blood, people with diabetes have a greater amount of glycosylization present. A low result on the glycated hemoglobin test is a good result. If your test is in the good control category, you can be satisfied that your diabetes management plan is working well. If results are in the marginal category, some fine tuning of your treatment plan may be needed. A poor result can be improved. This test gives you valuable feedback on how well you are controlling your diabetes. It can also let you know when to work on improving your diabetes management.

It’s important for you to remember that normal values for the glycated hemoglobin test may vary from laboratory to laboratory, because different laboratories use different procedures to perform the measurement. Be sure to ask for the “normal” range for that particular lab. It’s best to have the tests done by the same laboratory so you can compare the results from one test to the next to note the progress you are making. Your physician will help you determine your goal range for glycated hemoglobin. If you are Type I or Type II diabetic, you should be having this test every 90 days; there is no reason that you should not. If your physician is not running the glycated hemoglobin test on you every 90 days ask him why.

Vaccines:

Edward Jenner in (1749-1823 ). Louis Pasteur (1822-1895)furthered the concept through his pioneering work in microbiology. Vaccination (Latin: vacca—cow) is so named because the first vaccine was derived from a virus affecting cows—the relatively benign cowpox virus

The vaccines developed over the first two hundred years since Jenner’s lifetime have accomplished striking reductions of infection and disease wherever applied. Pasteur’s early approaches to vaccine development, attenuation and inactivation, are even now the two poles of vaccine technology. Today, purification of microbial elements, genetic engineering and improved knowledge of immune protection allow direct creation of attenuated mutants, expression of vaccine proteins in live vectors, purification and even synthesis of microbial antigens, and induction of a variety of immune responses through manipulation of DNA, RNA, proteins and polysaccharides. Both noninfectious and infectious diseases are now within the realm of vaccinology. The profusion of new vaccines enables new populations to be targeted for vaccination, and requires the development of routes of administration additional to injection. With all this come new problems in the production, regulation and distribution of vaccines.

Vaccine is the Best Preventive Measure which protect against disease by inducing immunity  are widely and routinely administered around the world based on the common-sense principle that it is better to keep people from falling ill than to treat them once they are ill. Vaccination is considered to be one of the most cost-effective health interventions. Through vaccination one dreaded disease, Smallpox, was eradicated and poliomyelitis has been eliminated from most countries in the world. It is estimated that over 2.5 million deaths are averted through vaccination every year. Vaccination have an advantage in that they can be delivered with very high coverage even in the most underserved areas, thereby preventing disease, disability and death in these marginalized populations.

A number of new vaccines with major potential for controlling infectious diseases have just been licensed or are at advanced stages of development. Among the illnesses targeted are rotavirus diarrhoea, pneumococcal disease, and cervical cancer (as caused by human papillomavirus), which together kill more than a million people each year, most of them in developing countries. In addition to these efforts against diseases of global importance, progress is being made on a vaccine for the regional menace posed by meningococcal meningitis sero-group A, which causes frequent epidemics and high rates of death and disability in African countries south of the Sahara.

These advanced candidate vaccines are the focus of the information provided below. However, it should be noted that continuing, intensive efforts are under way to develop effective vaccines for AIDS, malaria, tuberculosis, dengue, leishmaniasis, and enteric diseases, among others and to adapt new technologies to improved formulation and delivery. The current situation of a number of new vaccines is described below:

Rotavirus

Acute diarrhoea is responsible for nearly 1.9 million deaths per year in children under age five. Rotavirus is responsible for as much as one fourth of these casualties, almost all of which occur in developing countries.

Human papillomavirus (HPV), Pneumococcal disease, Meningococcal meningitis A (Men A)

The WHO Initiative for Vaccine Research was established in 2001 to streamline the various vaccine research and development projects being carried out by different departments of WHO (including the Special Program for Research and Training in Tropical Diseases: TDR) and UNAIDS. IVR is an international team of scientists, managers, and technical experts whose task is to facilitate the development of vaccines against infectious diseases of major public health importance, to improve existing immunization technologies, and to ensure that these advances are made available to the people who need them the most. IVR will achieve these objectives using a three-pronged approach:

Indian companies are poor in manufacturing Vaccines. Now under the PPP and with foreign collaboration fewer Indian companies are emerging in to this business. Once started this will help the middle class and poor population to save their lives.

Before concluding this topic a word about WHO:

One should not forget the role of World Health Organization (WHO) and its services in the field of public Health. It is a specialized agency of the United Nations (UN) that acts as a coordinating authority on international public health. Established on 7 April 1948, and headquartered in Geneva, Switzerland.

 

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The World Health Organization is the lead agency for coordinating global response to major diseases. The WHO maintains Web sites for a number of diseases, and has active teams in many countries where these diseases occur.

Present and future Challenges in Public health:

Prevention of obesity, diabetes, hypertension, Pollution related Lung diseases, Mold related fungal disease are the immediate challenge for the Indian community.

Geriatric care for the aging senior citizens is another discipline where an immediate attention is required.

Inspite of many Public Health measures ,the neglected part of maternal mortality and child mortality are unacceptably high, therefore promotion of women and child health. Nutrition and  education to the rural population is a must.

Conclusion :  Threats to public health are generally known and manageable. Some public health emergencies, however, such as outbreaks of H1N1, Avian Flue, AIDS, dengue and other infectious diseases, could have been prevented or better controlled if the health systems concerned had been stronger and better prepared. Global public health security depends on all countries being well-equipped to detect, investigate, communicate and contain events that threaten public health security whenever and wherever they occur. However, some countries, mostly in sub-Saharan Africa and South-East Asia, are struggling to provide even basic health security to their populations because they lack resources, or because their health infrastructure has collapsed as a consequence of under-investment, shortages of trained health workers, conflicts and wars, or a previous natural disaster. These constraints pose significant challenges to all countries, WHO, and its partners in global public health security.

No single country  however capable, wealthy or technologically advanced can alone prevent, detect and respond to all public health threats. Global cooperation, collaboration and investment are necessary to ensure a safer future. This involves not only cooperation between different countries but also between different sectors of society such as governments, industry, public and private financiers, academia, international organizations and civil society, all of whom have responsibilities for building a global public health security.