Introduction to Public Health and

Community Medicine (Hx o PH)

By
Prof. M.C. Asuzu
 PUBLIC HEALTH 1

.. Is the science and the art of preventing disease,

prolonging life, and promoting physical health and
efficiency through organized community efforts for the
sanitation of the environment, the control of
community infections, the education of the individual in
principles of personal hygiene, the organization of
medical and nursing services for the early diagnosis and
preventive treatment of disease, and the development of
the social machinery which will ensure to every
individual in the community a standard of living
adequate for the maintenance of health
C.E.A Winslow, 1923.
Public health is not a concrete intellectual discipline,
but a filed of social activities - C.EAW
 PUBLIC HEALTH 2

is the protection and improvement of the health of the

public through community action, primarily by government
agencies. It includes four major areas:
(1)the promotion of positive health and vitality (primordial
prevention and /or health promotion) and
(2)The prevention of infectious and non-infectious disease as
well as injuries (primary prevention). The others are
(3)The organization and provision of services for the early
diagnosis and prompt treatment of illness (efficient public
medical and health services by the government and/or by
the people)
(4)4 the rehabilitation of sick and disabled persons to their
highest possible level of function in spite of the disability
(tertiary prevention).
Funk and Wagnalls Encyclopedia, 1984
 Historical Milestones
Nursing, midwifery and medicine as the original, primary and
fundamental health professions; then apothecary/alchemy
Origin in antiquity and the eschatological and Homo sapient
foundations; the medical and religious ministration mix
Healthy and unhealthy relations and inter-mixing with religious
ministration till separation with religious ministration.
-Witchcraft and wizardry on the negative side
-Sacrifices, prayers and atonement on the positive side
-Divination on the ?indeterminate/neutral side
Many modern health practices as not medical in origins
- Jewish ritual cleanliness practices
- Egyptian embalmment practices
- Greek aesthetics, dietary and sporting practices
- Roman sports and sewerage systems
 Birth and Development of Scientific Medicine and Public
Health
Hippocrates and Scientific medicine; ethics as link with religion
Trans-Mediterranean trade, epidemics, Middle Ages and birth of
public health in enlightened, humanitarian legalism; before that in
missionary hospices, etc.; government (public) hospitals 1751 (Penn)
Public health still under the cloud of the miasmatic concept of disease
causation: Venice and the Quarantine laws of 1374; Marseilles, 1383.
Persisting by-products of the mixture of health and religious
ministration as well as the miasmatic culture- venereal diseases,
malaria, etc
The original germ theory of disease causation and its limited
recognition - Fracastorius, etc
 Public Health to Community Medicine and Health

The original public health

The development of social medicine, preventive medicine,
psm, community medicine and community health (nursing
and medicine) over time- Bernadino Ramazzini, James
Lind, John Howard, Robert Peel, Edwin Chadwick, John
Snow, WH Duncan, John Simon, Lemuel Shattuck,
Thomas Legg, etc
The office of the Medical Officer of Health and the
Community (Zonal or District) Nurse, school health nurse
and doctor, occupational health nurse and physician, etc
The Health Inspector or sanitarian and the continuing
public health legalism.
Modern proper Public Health and Community Medicine and Health

Distinction, continuum and overlap of public health , social

medicine, preventive medicine, preventive and social
medicine, community health and community medicine; the
2 public healths disciplinary and that of the PH Services.
Public Health as dovetailed completely into community
health at the district level and variously at the 20 and 30
health care levels; CH & CM as part of PH & vice versa.
Proper definition and understanding of modern public
health services both as the organized clinical as well as
specialist public/community health and medical services
The organization of the public health systems in view of
the danger of error-inducing (specialist) clinical medicine
and vertical public health (both money and power sucking
or inducing)
 Understanding the Sociology of Medicine and allied Health
Professions
The difference between medical sociology, the sociology
of medicine and of social (and rehabilitative) medicine
Contribution to the sociology of medicine from society and
of/by medical practitioners
Similar and contrasting sociology of nursing, midwifery
and vertical public health practices
[Sociology of apothecary/pharmacy, laboratory science
and technology, physiotherapy, etc]. Alchemy and
apothecary vs midwifery and witchcraft, etc.
Curbing the problems posed by the unhelpful aspects of
the sociology of these profession - proper education and
organization of the health services, health management
training and leadership.
 Functions of a Medical Officer of Health

MOH functions at all levels of the health care system

Organization and function of the public district health
systems, with examples
The legal/statutory functions of the MOH and the Health
inspector (EHO) in it.
The clinical functions and the community nurse/midwife in
it
The social and management functions
The counselor/advisor functions
Other issues; epidemiologists function, annual report, etc.
 Lessons on the Hx.and Dev. of PH, sociology of medicine,
and of public health from WHOs first 4 decades

The 4 paradigms in WHOs approaches to HFA till 1980

vertical programmes, rural/district health system
development, basic health services and then primary health
care
The Riga conference and its 4 main conclusions: meaning
of HFA, practice point of PHC and the rest of the health
system (the PHC-support system), PHC as the permanent
approach to HFA.
PHC as the permanent approach to HFA
The continuing undermining of PHC by medicine and
public health
Local abuses of CH, CM, PHC.
 Overview of Hx, Dev, Contents and Concepts (Principles) of
CH/M and PHC
PHC as resulting finally from the BHSS paradigm.
PHC as modern HM approach to CH/CM/HFA, the latest paradigm.
The minimum content, more limited content, and universal contents
The concepts and/or principles and the radical difference this
makes political will; orientation & re-orientation of HC personnel
& institutions to PHC; intra-sectoral and inter-sectoral integration &
collaboration; comm. Mob & involvement up to self-ownership and
self-reliance; appropriate technology; new mgt methods including
new cadres of health workers as the case may be.
Vertical programmes abuse, new health workers abuse, and other
abuses of PHC - contrast world-wide models of good function
Ideal PHC systems world wide
Quo vadis?
 HX of PH in NIGERIA
Pre-colonization M/HS and the 1st Nig Drs
William Broughton Davies & James Africanus
Horton; & Nathaniel King as 1st to practice here.
The colonial times; govt., missionary, training
schools, legislations, development plan and unitary
health services, proper medical school,
regionalization and after.
The Independence era: 2nd Development plan, war
time and immediate post-war (RRR) health services,
3rd NDP, 4th NDP, Rolling plans, Nat. Hlth. Policy,
Nat. Popn. Policy, Ransome-Kuti and Nigerias PHC
the pros and the con!
 CONTRIBUTIONS TO PUBLIC HEALTH &
COMMUNITY MEDICINE IN NIGERIA.
Public Health of the public health services: Lord Mcgregor of
the Mcgregor Canal, Sir Samuel Manuwa as Nigerias first
DMS/CMA to Govt.; Prof. Adeoye Lambo (comm psych &
DDG WHO; Prof. Lucas (int med to psm to 1st Dir TDR/WHO;
Prof. Olikoye Ransome-kuti (frm paed to ch to PH/BHSS&PHC;
Prof. TO Ogunlesi as 1st Dir, Ibarapa Programme; etc.
Public Health & Community Medicine: Dr I Ladipo Oluwole
as 1st indigenous MOH; Prof. Oladele Ajose as 1st Nig/Afr Prof
of PSM/CM; Dr. MP Otolorin as last Nig DMS/MATG; Dr GO
Sofoluwe & C/OHS; etc.
Other Nigerian Doctors: Dr Sapara & Sopona; etc.
 THE SUB-SPECIALTIES IN PH/CM-H
(i.e., areas of field practice or concentration)
The basic sciences: epidemiology; biostatistics
The major practices areas: health management
(especially as MOHs); environmental health; family
health; (vertical) disease control programmes.
The other areas: health education; occupational health;
public health nutrition; rehabilitative & social medicine;
international (& port) health
The emerging disciplines: mental health; dental health;
nature and bio-diversity conservation.
(?primary/community eye care/health)
AREAS OF BASIC THEORETICAL TRAINING
USEFUL/NEEDED FOR PH/CM-H
(but obviously not specialties of disciplinary CH!)
History of medicine & public health (esp @ PG)
Primary health care (as modern health management
approach to all of PH/CH/CM)
Medical sociology
Demography
Bioethics, medical ethics and research ethics
At PG level: the sociology of medicine and the other
health professions; ergonomics; social, clinical &
industrial psychology.
THANK YOU