Centre for Community Medicine,

All India Institute of Medical Sciences,

New Delhi, INDIA

Concepts in Public Health:

A Case Study of Diarrhea
Dr Baridalyne N, Dr Kapil Yadav, Dr Palnivel C
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

4
Source- 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?

Many siblings No family support

Poor hygiene No transport

Lack of care No medical

facility
Wrong
Cultural beliefs Diarrhea
& practices Malnutrition
Dehydration

Female child < 2 yrs old

Poverty Illiteracy 7
Web of Causation

8
 No family support Wrong
Cultural beliefs
Many siblings And practices
Lack of care
Female child
Poor hygiene

No medical Diarrhea No transport

facility Dehydration

Malnutrition

Low socio
Illiteracy
economic status 9
Was the death preventable?

YES
 No family support
Wrong Cultural
Many siblings Beliefs & practices
Lack of care

Female child
Poor hygiene

No transport
Diarrhea
Dehydration
No medical
Malnutrition
facility

Poverty Illiteracy
11
 No family support
Wrong Cultural
Many siblings Beliefs & practices
Lack of care
Female child
Poor hygiene

Diarrhea
Dehydration Malnutrition
No medical
facility
Poverty Illiteracy

THROUGH
THROUGH THE HEALTH
THE HEALTH SYSTEM SYSTEM 12
 No family support
Faulty advice
Many siblings
Lack of care
No medical
Poor hygiene facility

No transport
Diarrhea
No medical Dehydration Malnutrition
facility
Poverty Illiteracy

OUTSIDE THE HEALTH SYSTEM 13

 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
 Traditional Bio-Medical Concept
VIBRIO E. COLI (Entero
CHOLERA Pathogenic)

E. COLI
(Entero SHIGELLA
Toxigenic)

DIARRHEAL
DISEASES
CRYPTO-
SPORIDIUM
ROTA
VIRUS

CAMPYLOBACTER SALMONELLA
15
Socio- Epidemiological Concept
& ILLITERACY

16
Politico- Developmental Concept

& ILLITERACY

17
 Public health trains
you to have a
“Holistic Approach”
to Health and Disease
19
20
 Clinical Vs Public Health
Variables Clinical Medicine Public health

UNIT OF STUDY • Individual • Population

• Patient – with • Diseased/Non-

TARGET GROUP
disease Diseased
VIEWPOINT OF •Passive process
• Active process
HEALTH SYSTEM

TYPE OF CARE • Focus on curative • Comprehensive care

• Provided by • Provided by
SERVICE PROVIDERS
private sector PUBLIC/private sector

• Short term benefits • Long term benefits

BENEFITS
• Obvious benefit • Not obvious

In Public Health – Good work means no epidemics 21

 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

22
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”.

-BHORE COMMITTEE REPORT (1946)

24
-Health Survey & Development Committee
, Government of India
 Critical appraisal

Yes Can’t tell No

Do you believe the
results?
Can the results be
applied to the local
population?

Do the results of this

Thank You
study fit with other
available evidence?

25/59