Concepts of

UNIT 1 CONCEPTS OF COMMUNITY Community

Health
HEALTH
Structure
1. Introduction
2. Objectives
3. Public Health in India and its Evolution
4. Concepts of Health and Illness
2. Dimensions of Health
3. Determinants of Health
5. Concept of Causation of Disease
6. Natural History of Disease
7. Levels of Prevention
1. Primary Prevention
2. Secondary Prevention
3. Tertiary Prevention
7. Roles and Responsibilities of Mid Level Healthcare Providers (MLHP)
8. Let Us Sum up
9. Model Answers
10. References

11. INTRODUCTION
Health is a dynamic concept, which every human being desires to achieve.
While health refers to positive end of spectrum; illness, sickness and disease
symbolise the negative side of the spectrum. In order to protect, promote, and
restore the health of individuals and populations, an integrated discipline of
public health or community health came into existence. Public health has
evolved in India since independence and we have achieved success in terms of
improvement of various morbidity and mortality indicators. However, a lot
needs to be achieved and mid level health care providers (MLHP) can play an
important role in this regard. In this unit we shall discuss about basic concepts
of health and disease with brief description about role of MLHP.

12. OBJECTIVES
After completing this unit, you should be able to:
 define health and differentiate between illness, sickness and disease;
 describe various dimensions of health and enumerate determinants of
health;
 draw epidemiological triad with the help of example;
 describe the natural history of disease; and
 enumerate and apply the levels of disease prevention in control of
diseases.
7
Introduction to Public
Health and Epidemilogy 1.1 PUBLIC HEALTH IN INDIAAND ITS
EVOLUTION
‘Public Health’ is defined as organised community efforts aimed at prevention
of disease and promotion of health. In other words, it is the science and art of
preventing disease, prolonging life and promoting health and efficiency
through organised community efforts. The organised community efforts that
promote health and prolong life are:
 control of communicable infection,
 improved environment– access to safe water and sanitation,
 personal hygiene improvement through education,
 organisation of medical and nursing services for the early diagnosis and
preventive treatment of disease,
 development of the social machinery to ensure everyone a standard of
living adequate for the maintenance of health.
Public health incorporates the inter-disciplinary approaches of epidemiology,
biostatistics and health services. Environmental health, community health,
behavioural health and occupational health are other important subfields.
Public health in India dates back to ancient times. Excavations in the Indus
valley (Harappa culture) show evidence of planned cities, with drainage and
practices of environmental sanitation. Ayurveda and Siddha systems of
medicine came into existence in 1400 B.C. Medical education was introduced
in the ancient universities of Taxila and Nalanda during the post-vedic period.
The Greek system of medicine known as Unani was introduced by Muslims
when they entered India around 1000 A.D. Another phase in evolution of
public health came when British empire conquered India by middle of 18 th
century. Many legislative measures for disease control and prevention were
taken during this time. Quarantine act (1825), the Births and Deaths
Registration Act (1873), Vaccination act (1880), Factories act (1881), Local
self-government act (1885), Epidemic disease act (1897), and the Madras
Public Health Act (1939) were promulgated and passed.
Just before independence, Bhore committee was constituted in 1943 to survey
the existing health conditions and organisations. The committee recommended
integration of preventive and curative services at all levels and also
emphasised the social orientation of medical practice. The report formed the
basis of health planning in India. The constitution of India came into force in
1950 and first five-year plan began with allocated budget for launch of
national health programme. The community development programme was
launched in 1952 with the aim of overall development of rural areas. The
National Malaria Control programme was started in first five-year plan.
Important public health institutes like Central Health Education Bureau
(CHEB) in Delhi and the Central Leprosy Teaching and Training Institute in
Chennai were also started during this time.
India has evolved a lot since the time of independence. Over the past six and
half decades public health infrastructure and services have expanded,
particularly after the inception of National Rural Health Mission (NRHM) in
2005. The progress has been further accelerated with combining of rural and
urban components as National Health Mission in 2013 and launch of
RMNCH+A strategy (Reproductive Maternal Neonatal Child Health plus
8 Adolescence) that stress on provision of continuum of care through every
phase of life.
Financial health focuses on one’s attitude toward money and a commitment to Concepts of Community
Health
setting goals for future needs, developing good money habits and effectively
using tools to manage financial resources. In order to be financially healthy,
one does not need to be wealthy; however, one must sensibly manage money.
While financial well-being is not often considered when discussing health, it
can be a significant source of stress which can have major effects on the other
dimensions.
Social Health encourages contributing to one’s environment and community. It
emphasises the interdependence between others and nature. It deals with
having a supportive social network, contributing to society, and valuing cultural
diversity. It can also be defined as the “quantity and quality of an individual’s
interpersonal ties and extent of his involvement with the community”. How
well a person mixes and interacts with others in family, society, community
and world and considers him as a part of these, is witnessed as social
dimension of his health.
Environmental Health is learning and contributing to the health of the planet
and a sustainable lifestyle. The key to human health largely lies in his
external environment. Much of human being’s ill health can be traced to
adverse environmental factors such as water pollution, soil pollution, air
pollution, poor housing conditions, presence of animal reservoirs and insect
vectors of diseases. Thus, it is pertinent to control all the factors that exert
deleterious effect on the health.
Check Your Progress 1
1. Define Health according to WHO.
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2. Draw the Health Septrum.

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3. Enumerate any 3 dimensions of health.

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1.3.2 Determinants of Health

Health of an individual is a complex subject influenced by a variety of factors
which may lead to either a healthy outcome to promote health or an unhealthy
outcome to have deleterious effects on health. Since these factors are largely
responsible to determine health of a person, they are termed the determinants
of health. The main determinants of health are:
1) Age: There is close relationship of diseased status with age. While some
diseases are common in younger age group, chronic diseases such as
hypertension, diabetes, osteoarthritis are predominant in older age groups.
Age is also an important factor in determining the prognosis of diseases.
11
Introduction to Public 2) Gender: Women are considered to be biologically stronger than men.
Health and Epidemilogy
Consequently, the life expectancy of women is relatively more than men.
Further, some diseases differ according the gender. While oral cancers are
more common among men, breast cancer and cervical cancer affect large
number of women. Similarly, inguinal hernias have gender predisposition
towards males. Due to the gender differences in pattern of a distribution of
a particular disease, you as a Midlevel Health Provider (MLHP) should
keep in mind while dealing with gender.
3) Genetics: The traits transferred from parents during conception as genetic
configuration are permanent and remain unaltered till end of the life. His
physique, intelligence, temperament and response to diseases agents
usually resembles in many respects to either of his parents or
grandparents. Many diseases in humans like chromosomal anomalies,
errors of metabolism, mental retardation, diabetes etc. are known to be of
genetic origin.
4) Race, ethnicity: Members of non-white racial and ethnic groups tend to
experience more ill health and disease than their white counterparts.
5) Literacy status: Literacy and education status of the people also have an
indirect impact on health as these are interrelated with occupation,
economic and hygiene standards. People with good educational
background have an understanding to practice better ways and means of
living improving their health standard.
6) Nutrition: Diet has been scientifically and extensively linked to disease.
The relation between high fat diet and coronary heart disease is well
established. Similarly, under-nutrition predisposes the person to multitude
of infections. Thus, the health of a community depends both on the
adequate availability of safe food and the intelligent consumption of it.
7) Environment: A person is fully dependent on external environment for
his body needs in day to day life, but its adverse conditions are
responsible for a very large number of health related problems and
diseases. All the diseases caused by physical and biological agents are the
result of adverse conditions of the external environment. Internal
environment of a person is comprised of his own anatomical body parts
and physiological activities which comes under internal medicine.
8) Socio-economic status: Economic status of the country, community and of
an average individual has an impact on the purchasing power and thus
affects the living standard of a person. Daily needs of nutrition, education,
housing, clothing and standard of life are all dependent on per capita
income. Further, access to health services, are also largely dependent upon
the income. Certain diseases such as lifestyle disorders have been found to
be associated among the group belonging to higher socio-economic status
while infectious diseases such as tuberculosis, leprosy are considered to be
diseases of poor.
9) Socio-cultural conditions: Culture is a learned behaviour which has been
socially acquired. A person learns and develops the qualities to interact
with others in the society in his early developmental stage. On interaction
with a person, one can easily think of the culture and a society which he
belongs to. These are all behavioural traits displayed by him during
interaction. Development of such qualities is mostly by learning from
12 prevailing behavioural and socio-cultural conditions in the society. The
health behaviour of person is also influenced by his socio-cultural
environment.
10) Health care system/services: Care of people provided through effective Concepts of Community
Health
system of medical and health care services creates a positive influence on
health of the people. Infant mortality rate, maternal mortality rate and
expectation of life at birth are affected by the kind of health services
available in the state or country.
11) Other factors: The development of newer technologies of information
and communication offer tremendous opportunities in providing an easy
and instant access to medical information. Other determinants include
adoption of policies in the economic and social fields that would assist in
raising the standards of living and hence indirectly affecting the health.

Check Your Progress 2

i) List 5 determinants of health.
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ii) What do you understand by socio-economic determinants of health?
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iii) How literacy status affects health?
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1.4 CONCEPT OF CAUSATION OF DISEASE

Let us now read concept of causation of disease.
Since disease has always been a constant accompaniment of human, right from
the pre-historic times onwards, he has been trying to find out the causes of
disease. The various theories prevalent in different civilisations were:
 Supernatural causes like being possessed by evil spirits, wrath of gods,
punishment for evil deeds during previous births etc. cause diseases.
 Contagion theory: Diseases are spread through “bad air” or to various
forms of close contacts with diseased person.
 Germ theory: In 19th century, bacteria was discovered as a cause of human
disease by Robert Koch and Louis Pasteur. It was believed that every
human disease to a specific microbe or “germ”, to the extent that the germ
theory of the human disease emphasised that each and every human
disease has to be caused by a microbe or germ, which is specific for that
disease and one must be able to isolate the microbe from the diseased
human being. This was the central philosophy of the famous Koch’s
postulates, formulated by Robert Koch (now also known as Henle-Koch
postulates).
However, with turn of the century, it was being realised that germ theory could
not fully explain the causation of disease. It was being considered that there
were other factors that played the role in accentuation or attenuating the effect
of “germ” or “agent” in causation of disease. This formed the basis for
Epidemiological Triad theory. 13
Introduction to Public Epidemiological Triad Theory
Health and Epidemilogy
Complex interactions among people, their characteristics and the environment
influence health. It, thus, involves a state of interaction between self and
environment. This theory, known as Epidemiological triad theory
hypothesizes that there are 3 important determinants of state of health or
disease in human being namely: agent factors-related to various
characteristics of the “agents” which cause the disease; host factors which
relate to various characteristics of human being like age, gender, ethnicity etc.;
environmental factors which describe the various characteristics of the
environment in which human being is living. As per the theory, as long as a
state of fine balance or equilibrium is maintained between the various agent,
host and environmental factors, the person stays in a state of health. On the
other hand, the moment this fine balance is disturbed due to change in any one
or more of the agent, host and environment related factors, a departure from
the state of health occurs as shown in Fig. 1.3 (A.B.C).
AGENT (A)

ENVIRON-
HOST (H)
MENT
(E)
Fig. 1.3(A): Epidemiological Triad

H A

Fig. 1.3(B): Balance

(A)

(H) (E)
Fig. 1.3(C): Disturbed balance

14 Fig. 1.3: (A) (B) (C) Epidemiological Triad

Difficulties come up when an attempt is made to explain the causation of non Concepts of Community
Health
communicable diseases like Ischemic Heart Disease (IHD) or road accidents on
the basis of epidemiological triad. For example, no single agent can be
ascribed for road accidents, there is complex interaction of numerous
causative factors such as lack of driving experience, intake of alcohol while
driving, not wearing of seat belts, poor implementation of legislation.
Therefore, for explaining the causation of non-communicable diseases in
particular, theory of web of causation was postulated. Various factors related
the disease, are like an interacting web of spider. Each factor has its own
relative importance in causing the final departure from the state of health, as
well as interacts with others, modifying the effect of each other.

1.5 NATURAL HISTORY OF DISEASE

Complete course of a disease from the time a human host is exposed to the
disease agent in an environment to its final outcome is termed the natural
history of disease. Let us take an example of a common disease like hepatitis
A. After the infecting organism enters our body by way of food or drinks, there
is an incubation period of about 28 days, after which we have clinical
manifestations in the form of fever, malaise, anorexia, nausea and abdominal
discomfort, followed by dark urine and jaundice. Most of the individuals
recover by the third week, though variable feeling of weakness may persist for
a longer time. However, some patients may develop complications in the third
week in the form of relapsing hepatitis, cholestatic hepatitis and fulminant
hepatitis.
It is known that hepatitis A is caused by a virus belonging to picornavirus
family. Some may not be infected due to their immune status (previous
exposure to infection or already received immunisation against hepatitis A).
Therefore, another factor to be considered in development of human diseases is,
besides the organism (agent), the human being himself too. Now, there is yet
another factor which needs to be considered also. There should be water or
food which should be contaminated with the faeces of a patient of hepatitis A.
Hence, the third thing, besides the microbial organism and the human being,
which determines the disease, is the “environment”. Despite the presence of
these three factors, some may get the disease or may not get the disease. We
would therefore agree that the mere presence of agent, host and environment
is not enough to cause the disease. As long as the agent, host and environment
are in a state of equilibrium disease will not be initiated; the process of human
disease would be initiated only if there is an appropriate interaction and a loss
in equilibrium, between the agent, host and environment. For example, if we
become malnourished due to an attack of severe measles or take on to heavy
alcoholism, or become poor and hence forced to consume contaminated food
or water, or are exposed to a very heavy dose of infection (for example,
drinking raw water in a flood like situation), we would become “susceptible”
to developing hepatitis. As shown in the Fig. 1.4, natural history of disease has
two phases: pre-pathogenesis (i.e., the process in the environment) and
pathogenesis (i.e., the process in man). The pre-pathogenesis period refers to
period before the onset of disease in man. The causative agent of disease, has
not yet entered man, but the factors (i.e. environmental factors) that are
favourable for its interaction with the human host are already existent in the
environment. However it must be remembered that mere presence of agent,
15
host and environmental factors in this phase is not sufficient to start the
disease. What is required is an INTERACTION between these factors. (Fig
1.5).
Introduction to Public Healt h
and Epidemilogy

Fig. 1.4: Natural history of disease and level of prevention

Pathogenesis phase: This phase begins with the entry of the disease “agent” in
the susceptible human host. In case of infectious diseases, the disease agent
multiplies and induces physiological changes. The disease progresses through
period of incubation to early and late pathogenesis. The final outcome may
vary between recovery, diability or death depending upon the interventions
undertaken. In chronic diseases, the early pathogenesis phase is referred to as
pre-symptomatic phase as there is no manifestation of disease. The clinical
stage begins when recognisable signs or symptoms appear and by this time, the
disease is already advanced to late pathogenesis phase.

AGENT HOST

ENVIRONMENT

Fig. 1.5: Interaction of Agent, Host and Environment

1.6 LEVELS OF PREVENTION

Prevention and control of diseases is an important concept in preventive
medicine. Knowledge about natural history of a disease helps in applying the
preventive principles in its prevention and control. It further helps in reducing
the burden and morbidity or mortality arising out of the disease occurrence. In
general, there are three major levels of prevention, depending on the phase of
16 the natural history
of the disease. Before these three levels of prevention, primodial prevention is Concepts of Community
Health
applied when action is taken to remove even risk factors to develop for
example school children are educated not to smoke as smoking is risk factor
for many disease.

1.6.1 Primary Prevention

All measures of prevention that are undertaken before the onset of the disease,
so that the disease never occurs. Primary prevention involves:
 Health promotion: All steps undertaken to improve the level of general
health and well-being so that conditions for initiation of disease process
are prevented is defined as health promotion. e.g. Cessation of smoking,
personal hygiene, attempts to remove hazards, such as insect-breeding sites
or polluted waters, by environmental control would also promote health.
 Specific protection: These include measures to prevent the initiation of
specific diseases or a group of diseases. e.g. Vaccination, food fortification
(e.g. iodine fortification of salt).

2. Secondary Prevention
It is defined as “action which halts the progress of a disease at its incipient
stage and prevents complications.”
The specific interventions are: early diagnosis (e.g. screening tests, and case
finding) and adequate treatment.

3. Tertiary Prevention
It is defined as “all the measures available to reduce or limit impairments and
disabilities, and to promote the patients’ adjustment to irremediable
conditions.”
 Disability limitation:The prevention of complications of a disease before
irreversible changes set in would limit disability. For example, careful
attention to skin care daily, particularly of the feet of a diabetic patient,
would prevent the development of ulcers and subsequent gangrene of the
feet. Careful avoidance of injury from cuts, burns, and scalds to the part of
the body with sensory loss, particularly the hands and feet, of leprosy
patients could also avoid the loss of fingers and toes consequent to injury.
Disease turns into a handicap as follows:
 Disease: This is a pathological process and it’s manifestations which
indicate a departure from the state of perfect health.
 Impairment: This is the actual loss or damage of a part of body
anatomy or an aberration of the physiological functions that occurs
consequent to a disease.
 Disability: This is defined as the inability to carry out certain
functions or activities which are otherwise expected for that age / sex,
as a result of the impairment.
 Handicap: This is the final disadvantage in life which occurs
consequent to an impairment or disability, which limits the fulfilment
of the role a person is required to play in life.
 Rehabilitation: When a defect or disability has already occurred, tertiary
prevention can be instituted to restore as much functions as is possible. For 17
Introduction to Public example, residual paralysis from poliomyelitis can be overcome by the use
Health and Epidemilogy
of callipers or other devices. Individuals with mild refractive errors can
have these corrected with lenses, while the partially deaf can be
rehabilitated with hearing aids. Rehabilitation is undertaken at four
dimensions:
 Medical rehabilitation: This is done through medical / surgical
procedures to restore the anatomy, anatomical functions and
physiological functions to as near normal as possible.
 Vocational rehabilitation: This includes steps involving training and
education so as to enable the person to earn a livelihood.
 Social rehabilitation: This involves steps for restoration of the family
and social relationships.
 Emotional and Psychological rehabilitation: This involves steps to
restore the confidence and personal dignity.

Check Your Progress 3

1) Explain state of Health.
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2) Explain State of occurance of Disease

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3) Incubations of Hepatitis A is ..................................................................

4) List Clinical manifestations of Hepatitis A.

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1.7 ROLES AND RESPONSIBILITIES OF MID

LEVEL HEALTHCARE PROVIDERS (MLHP)
A mid level healthcare provider is defined as a health provider
a) Who is trained, authorised and regulated to work autonomously
b) Who receives pre-service training at higher education institution for atleast
a total of 2–3 years and
c) Whose scope of practice includes (but is not restricted to) being able to
diagnose, manage and treat illness, disease and impairments (including
perform surgery, where appropriately trained), as well as engage in
preventive and promotive care.
Trained and competent human resources (CHR) are essential for an effective
health care delivery system. There is a pressing need to strengthen health sub
centres to provide Comprehensive Primary Care including for NCDs. Global
18 evidence suggests that suitably trained (3–4 years duration) service providers
can provide considerable primary care. As one of the measures to increase the Concepts of Community
Health
availability of such appropriately qualified HR, especially in rural and remote
areas, on 13th November 2013, the Cabinet approved the introduction of a
3&1/2 year Bachelor of Science in Community Health (BSc CH) Course in
India. However, the uptake for this course has been slow and if some
Universities were to start the course, the first batch of professionals will be
available for recruitment only by the end of the fourth year. On the other
hand, qualified Ayurveda doctors and B.Sc./GNM qualified nurses are
available in the system, who could be trained in public health & primary care
through suitably designed ‘Bridge Programmes in Community Health’. Such
qualified human resource may function as Mid Level Health Care Providers
and called ‘Community Health Officers (CHOs)’ and posted at health Sub
Centres; which could be developed as ‘Health & Wellness Centres’.
The BSc (CH) Curriculum is the benchmark for developing this bridge course
and these MLHPs will be primarily deployed at Health & Wellness Centres (or
Sub Centres). You would possess the necessary knowledge and competencies
to deliver comprehensive primary care services and implement public health
programmes.
Job Responsibilities: The trained MLHPs would broadly be expected to carry
out public health functions, ambulatory care, management and leadership at
the Health & Wellness Centres (H&WCs). You would be expected to:
a) Implement National Programmes
b) Administration and management at Health and Wellness Centres (or Sub-
centres)
c) Health education and encourage awareness about Family Planning,
Maternal and Child Health, and Non-Communicable Diseases
d) Preventive, promotive and curative care
e) Identification of Danger Signs and Referral after pre-referral stabilisation
f) Implement Biomedical waste disposal guidelines and Infection Control
policies
g) Supervision of health workers for Maternal and Child Health, Family
Planning and Nutrition related services.

In other words, MLHP are those health cadres often, but not always, linked to
traditional health professions, who have received less training and have a more
restricted scope of practice than professionals. In India, MLHP have been
regarded as “auxillaries” and have been bestowed with following worker’s
responsibilities:
1) Health Worker (Female):
a) Maternal and child health: Register and provide care to pregnant
women, ensure that each women comes for at least 4 antenatal visits,
get basic laboratory investigations done for her, refer women with
‘high risk’ pregnancy, make atleast 2 postnatal visits, assess the
growth and development of infant and provide immunisation.
b) Family planning: Maintaining eligible couple register, motivate 19
couples for family planning services, distribute conventional
and oral
Introduction to Public contraceptives to the couples, motivate couples who have completed
Health and Epidemilogy
family for permanent methods of sterilisation, organise health
education for the same.
c) Medical termination of pregnancy: Identify women requiring medical
termination of pregnancy and refer them to approved institutions,
educate women about harmful effects of septic abortion and acquaint
them about safe abortion services in the community.
d) Nutrition: Identify cases of malnutrition and refer them to primary care
facility, distribute iron folic acid to women and children, work in
collaboration with anganwadi workers, provide vitamin A
supplementation to all children below 6 years.
e) Immunisation: Immunise pregnant women with tetanus toxoid and
children below 5 years with all vaccines under universal immunisation
programme.
f) Implementation of communicable disease control programme in her
area
g) Recording of vital events
h) Treatment of minor ailments: Treat minor ailments and provide first aid
in case of emergencies and disasters.
i) Maintaining all records of her health facility pertaining to MCH
services, immunisation and family planning.
j) Coordination with other team members like ASHA (Accredited Social
Health Activist) and anganwadi workers, medical officer, etc.

2) Health Worker (Male):

a) Record keeping
b) National health programmes:
i) National vector borne disease control programme: Active
surveillance, collect blood smears, assist in spraying operations,
assist in administration of radical treatment, provide health
education.
ii) National leprosy elimination programme: Identify cases and refer
to health facility with doctor, maintain records of patients and
ensure they are taking treatment, health education.
iii) Revised national tuberculosis control programme: : Identify cases
and refer to health facility with doctor, maintain records of patients
and ensure they are taking treatment, health education.
iv) Assisting health worker female (HW-F) in MCH, immunisation
and family planning services.
v) Ensure environmental sanitation.
vi) Rest of the functions same as HW (F).
1.8 LET US SUM UP
In this unit we have discussed various aspects of health.
Health is defined as a state of complete physical, mental, and social well-being
and not merely the absence of disease or infirmity.
20
Health is not static. It ranges from complete well-being to uneasiness, disease, Concepts of Community
Health
disability and death.
Pursuit of optimal health includes physical, emotional, intellectual, spiritual,
occupational, financial, social, and environmental dimensions.
Health of an individual is a complex subject influenced by a variety of factors
known as determinants of health.
Disease is the state where a body is not at ease, means it is not comfortable.
Illness refers to the subjective sense of feeling unwell. Sickness refers to
socially and culturally held conceptions of health conditions
Complex interactions among people, their characteristics and the environment
influence health.
Complete course of a disease from the time a human host is exposed to the
disease agent in an environment to its final outcome is termed the natural
history of disease. Concept of interactions between agent, bost and
environment is also death.
We also planned three major levels of prevention, depending on the phase of
the natural history of the disease.

1.9 MODEL ANSWERS

Check Your Progress 1
1) World Health Organization (WHO) defines health as “state of complete
physical, mental and social well-being and not merely an absence of
disease or infirmity”.
2) Refer Fig. 1.1 A, B
3) Three dimension of health are physical, emotional and intellectual.
Check Your Progress 2
i) Genetics, socio-cultural, environment, gender, nutrition
ii) World Health Organization (WHO) describes social determinants of health
as the “the conditions in which people are born, grow, live, work and age”.
iii) Literacy and education status of the people also have an indirect impact
on health as these are interrelated with occupation, economic and hygiene
standards. People with good educational background have an under
standing to practice better ways and means of living improving their
health standard.
Check Your Progress 3
1) As long as agent, host and environment are in a state of balance with each
other the person stays in a state of health.
2) When agent, host and environment are not in fine balance or balance is
disturbed due to change in any one or more of the agent, host and
environment related factors disease occus.
3) Incubation period of Hepatits A is 28 days.
4) Fever, Malaise, anorexia, nausea, abdominal discomfort. 21
Introduction to Public
Usual Time
Health and Epidemilogy of Diagnosis

Pathologic Onset of
Exposure Changes Symptoms

Stage of Stage of Stage of Stage of Recovery,

Susceptibility Subclinical Disease Clinical Disease Disability of Death

Primordial Primary Secondary Tertiary

Prevention Prevention Prevention
Prevention

1.10 REFERENCES
1) C. E. A. Winslow, “The Untilled Fields of Public Health,” Science, N.S. 51
(1920), p. 23.
2) Kishore J. The Dictionary of Public Health. 3rd ed. Century Publications:
New Delhi; 2014.
3) Park K. Park’s Textbook of Preventive and Social Medicine. 23rd ed.
Jabalpur. Bhanot Publishers; 2015.
4) Chapter 1. Public health system in India: An introduction and evolution
[Internet] 2007 [Accessed on 2016, Sept 5]. Available from: http://
shodhganga.inflibnet.ac.in/bitstream/10603/8917/7/07_chapter%201.pdf
5) Roy BN, Saha I. Mahajan & Gupta Textbook of Preventive and Social
Medicine. 4th ed. New Delhi: Jaypee Brothers Medical Publishers; 2013.
6) WHO. The First Ten Years of the World Health Organization. Geneva:
WHO, 1968.
7) AFMC Primer on Population Health. Part 1-Theory: Thinking about
health. Chapter 1: Concepts of health and disease [Internet] 2014
[Accessed on 2016, Sept 5]. Available from:
http://phprimer.afmc.ca/Part1-TheoryThinking
AboutHealth/Chapter1ConceptsOfHealthAndIllness/IllnessSickness and
Disease.
8) AJPHNH. A Broadened Spectrum of Health and Illness. Am J Public
Health Nations Health. 1961;51(5):762.
9) WHO. Ottawa Charter for Health Promotion: First International
Conference on Health Promotion. Geneva: WHO;1986.
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