Community Health - the concept

Community Health - the concept:

Community is a small or large group in which people share no particular interest but the basic condition of life it‐self. The basic criterion of community is that all of one’s social relationship may be found within it . Community health, a field of public health, is a discipline which concerns itself with the study and improvement of the health characteristics of biological communities. While the term community can be broadly defined, community health tends to focus on geographical areas rather than people with shared characteristics. The health characteristics of a community are often examined using geographic information system (GIS) software and public health datasets. Some projects, such as Info Share or GEOPROJ combine GIS with existing datasets, allowing the general public to examine the characteristics of any given community in participating countries. Well‐being is influenced by a wide array of socio‐demographic characteristics, relevant variables range from the proportion of residents of a given age group to the overall life expectancy of the community. Medical interventions aimed at improving the health of a community range from improving access to medical care to public health communications campaigns. Recent research efforts have focused on how the built environment and socio‐economic status affect health. Success of community health programmes relies upon the transfer of information from health professionals to the general public using one‐to‐one or one to many communication (Mass communication). The latest shift is towards Health marketing.

Scope of Community health:

Community health may be studied within three broad categories:

Primary healthcare: Primary healthcare refers to interventions that focus on the individual or family such as hand‐washing, immunization, circumcision. Traditionally, a population health approach has been a public health focus. More recently. However, the Primary Health Care Strategy set a new direction for primary health care, which traditionally provided treatment services focusing on individuals, not communities or populations. Primary health care services are now to focus on better public health for a population and actively work to reduce health inequalities between different groups. There is now a clearer interface between public health and primary health care and a closer alignment in their overarching priorities. Primary care is often used as the term for the health care services which play a role in the local community. It can be provided in different settings, such as Urgent care centers which provide services to patients same day with appointment or walk‐in bases.

Primary care involves the widest scope of health care, including all ages of patients, patients of all socioeconomic and geographic origins, patients seeking to maintain optimal health, and patients with all manner of acute and chronic physical, mental and social health issues, including multiple chronic diseases. Consequently, a primary care practitioner must possess a wide breadth of knowledge in many areas. Continuity is a key characteristic of primary care, as patients usually prefer to consult the same practitioner for routine check‐ups and preventive care, health education, and every time they require an initial consultation about a new health problem. The International Classification of Primary Care (ICPC) is a standardized tool for understanding and analyzing information on interventions in primary care by the reason for the patient visit.

Common chronic illnesses usually treated in primary care may include, for example: hypertension, diabetes, asthma, COPD, depression and anxiety, back pain, arthritis or thyroid dysfunction. Primary care also includes many basic maternal and child health care services, such as family planning services and vaccinations. In the United States, the 2013 National Health Interview Survey found that skin disorders (42.7%), osteoarthritis and joint disorders (33.6%), back problems (23.9%), disorders of lipid metabolism (22.4%), and upper respiratory tract disease (22.1%, excluding asthma) were the most common reasons for accessing a physician.

In context of global population aging, with increasing numbers of older adults at greater risk of chronic non‐communicable diseases, rapidly increasing demand for primary care services is expected around the world, in both developed and developing countries. The World Health Organization attributes the provision of essential primary care as an integral component of an inclusive primary health care strategy.

Secondary healthcare:  Secondary healthcare refers to those activities which focus on the environment such as draining puddles of water near the house, clearing bushes and spraying insecticides to control vectors like mosquitoes. It includes acute care: necessary treatment for a short period of time for a brief but serious illness, injury or other health condition, such as in a hospital emergency department. It also includes skilled attendance during childbirth, intensive care, and medical imaging services.

The "secondary care" is sometimes used synonymously with "hospital care". However many secondary care providers do not necessarily work in hospitals, such as psychiatrists, clinical psychologists, occupational therapists or physiotherapists (physiotherapists are also primary care providers and a referral is not required to see a physiotherapist), and some primary care services are delivered within hospitals. Depending on the organization and policies of the national health system, patients may be required to see a primary care provider for a referral before they can access secondary care. For example in the United States, which operates under a mixed market health care system, some physicians might voluntarily limit their practice to secondary care by requiring patients to see a primary care provider first, or this restriction may be imposed under the terms of the payment agreements in private or group health insurance plans. In other cases medical specialists may see patients without a referral, and patients may decide whether self‐referral is preferred.

Allied health professionals, such as physical therapists, respiratory therapists, occupational therapists, speech therapists, and dietitians, also generally work in secondary care, accessed through either patient self‐referral or through physician referral.

Tertiary healthcare: Tertiary healthcare refers to those interventions that take place in a hospital setting such as intravenous rehydration or surgery. Tertiary care is specialized consultative health care, usually for inpatients and on referral from a primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment, such as a tertiary referral hospital.

Examples of tertiary care services are cancer management, neurosurgery, cardiac surgery, plastic surgery, treatment for severe burns, advanced neonatology services, palliative, and other complex medical and surgical interventions.

As per census 2001, India is a country of 102.70 crores of people, out of whom majority (around 73%) lives in rural areas. There is a terrific imbalance between the availability of natural and capital resources Vis‐a‐ Vis the required amount of these resources for all round growth and development of  this population. Therefore, this enormity of population leads to sustenance of poverty and ill‐health, which results into the falling standard of living for quite substantial proportion of people. This sort of situation is unacceptable as it defeats our national developmental goals. Hence, the need for population controls.

To achieve this avowed objective as well as execution of various national health programmes, a vast health infrastructure in the shape of Community Health Centers (CHCs)( 30 bedded hospital on each 80‐120 thousand population ), Primary Health Centers (PHCs) (on each 20‐30 thousand population ) and Sub‐Centers (SCs)( on each 3‐5 thousand population) has been created. In September 2004, a network of 3,222 CHCs, 23, 109 PHCs and 1, 42,655 Sub‐ Centers had been functioning in the rural and semi‐ urban areas of the country (GOI, 2006, 456).

Community Health Center is staffed with a Medical Specialist, a child specialist, a gynecologists, a surgeon and a lady doctor along with around 25 other paramedical and support staff. A Primary Health Centre (PHC) is staffed with a medical officer, a pharmacist, a staff nurse, block extension educator/ health educator, lab technician, one male and one female health worker and 4‐5 other support staff. At the Sub‐Center level, a team of health workers (one male and one female) is stationed at the village itself. The overall administrative responsibility of running these centers rests with the MO of the PHC/CHC.

Some related concepts:

Population health:

Population health has been defined as "the health outcomes of a group of individuals, including the distribution of such outcomes within the group". It is an approach to health that aims to improve the health of an entire human population. This concept does not refer to animal or plant populations. A priority considered important in achieving this aim is to reduce health inequities or disparities among different population group due to the social determinants of health, SDOH. The SDOH include all the factors: social, environmental, cultural and physical the different populations are born into, grow up and function with throughout their lifetimes which potentially have a measurable impact on the health of human populations. The Population Health concept represents a change in the focus from the individual‐level, characteristic of most mainstream medicine. It also seeks to complement the classic efforts of public health agencies by addressing a broader range of factors shown to impact the health of different populations. The World Health Organization's Commission on Social Determinants of Health, reported in 2008, that the SDOH factors were responsible for the bulk of diseases and injuries and these were the major causes of health inequities in all countries. In the US, SDOH were estimated to account for 70% of avoidable mortality.

From a population health perspective, health has been defined not simply as a state free from disease but as "the capacity of people to adapt to, respond to, or control life's challenges and changes".

The World Health Organization (WHO) defined health in its broader sense in 1946 as "a state of complete physical, mental, and social well‐being and not merely the absence of disease or infirmity."

population health as an approach:

Public health takes a population health approach, which places a greater emphasis on community health including:

·              The population as a whole

·              The role of the community

·              Health promotion and preventative care, and

·              The need to involve a range of professionals

Population Health: the determinants of health :

A population health approach also takes into account all factors that determine a Person’s health and wellbeing, and it plan how these factors can be addressed. These factors are called the determinants of health and include:

·              Peace, shelter and food

·              Education and sufficient income

·              A stable eco‐system

·              Sustainable resource use

·              Social justice and equity, etc

Healthy People 2020:

Healthy People 2020 is a web site sponsored by the US Department of Health and Human Services, representing the cumulative effort of 34 years of interest by the Surgeon General's office and others. It identifies 42 topics considered Social determinants of health and approximately 1200 specific goals considered to improve population health. It provides links to the current research available for selected topics and identifies and supports the need for community involvement considered essential to address these problems realistically.

The human role of economic inequality:

Recently, human role has been encouraged by the influence of population growth. There has been increasing interest from epidemiologists on the subject of economic inequality and its relation to the health of populations. There is a very robust correlation between socioeconomic status and health. This correlation suggests that it is not only the poor who tend to be sick when everyone else is healthy, heart disease, ulcers, type 2 diabetes, rheumatoid arthritis, certain types of cancer, and premature aging. Despite the reality of the SES Gradient, there is debate as to its cause. A number of researchers (A. Leigh, C. Jencks, A. Clarkwest—see also Russell Sage working papers) see a definite link between economic status and mortality due to the greater economic resources of the better‐off, but they find little correlation due to social status differences. Other researchers such as Richard G. Wilkinson, J. Lynch, and G.A. Kaplan have found that socioeconomic status strongly affects health even when controlling for economic resources and access to health care. Most famous for linking social status with health are the Whitehall studies—a series of studies conducted on civil servants in London. The studies found that, despite the fact that all civil servants in England have the same access to health care, there was a strong correlation between social status and health. The studies found that this relationship stayed strong even when controlling for health‐affecting habits such as exercise, smoking and drinking. Furthermore, it has been noted that no amount of medical attention will help decrease the likelihood of someone getting type 1 diabetes or rheumatoid arthritis—yet both are more common among populations with lower socioeconomic status. Lastly, it has been found that amongst the wealthiest quarter of countries on earth (a set stretching from Luxembourg to Slovakia) there is no relation between a country's wealth and general population health, suggesting that past a certain level, absolute levels of wealth have little impact on population health, but relative levels within a country do. The concept of psychosocial stress attempts to explain how psychosocial phenomenon such as status and social stratification can lead to the many diseases associated with the SES gradient. Higher levels of economic inequality tend to intensify social hierarchies and generally degrade the quality of social relations—leading to greater levels of stress and stress related diseases. Richard Wilkinson found this to be true not only for the poorest members of society, but also for the wealthiest. Economic inequality is bad for everyone's health. Inequality does not only affect the health of human populations. David H. Abbott at the Wisconsin National Primate Research Center found that among many primate species, less egalitarian social structures correlated with higher levels of stress hormones among socially subordinate individuals. Research by Robert Sapolsky of Stanford University provides similar findings.