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Introduction to elements of Public Health
First meeting on the topic: 9 th
June 2007
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P ublic HealthP ublic health is the science of protecting and improvingthe health of the communities through education,promotion of healthy lifestyles and research for diseases
and injury prevention . Thus the focus is on entirepopulations rather than on individuals.
P oor public health takes economic tolls in various ways:
prevention better than cure
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P ublic Health
Achievements of modern public health improved qualityof life. Attributed to vaccination programs, control of infectious
diseases, better safety policies, improved family planning,fluoridation of drinking water and programs to decrease heartdiseases and stroke.
Vast discrepancy between Developing and Developed countries poverty being the main factor. Now the focus indeveloped countries is shifting towards chronic diseases such
as cancer, AIDS, diabetes and heart diseases but infectiousdiseases continue to haunt developing countries.
India has focused mainly on curative care and immunizationswhile public health services has been neglected
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P ublic Health in Independent
India Many problems reported in Monica Das Guptas paper. In Independent India the capacity to prevent outbreaks
has reduced. the focus was more developing heavy industry rather
than health and education.
Public health is the responsibility of the state in India, butis not adequately funded
P ublic health regulations are in place but oftenneglected.
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Y et Future Trends are
Encouraging Financing is available through large programs Rural healthmission, National sanitation mission and employmentguaranteed scheme.
Institutions are being built at local and national level.P anchayati Raj Act emphasizes on building local governmentand delegates health activities to them.
A new thrust to build an institution like the US Center of disease control (adapted in China and EU). It recognizes thatpublic health systems have to be coordinated and supportedby a federal authority.
India has an exceptional capacity to deliver services (ex:Elections, Censuses)
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Burden of disease in India
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B urden of disease in India
Measuring the Impact of disease- DALY S disability adjusted life years- Impact of diseases in India
How to proceed further (as a group)- Disease specific, group specific, work specific- Anoop to lead subsequent discussion on infant diseases and intervention
Education as means of help in public health- suggested by Manas, eg. Indradhanush magazine
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B urden of disease in India by DAL Y S
Non-communicable diseases: Cardiovascular diseases (31%) Mental illnesses (26%) Cancer (10%)
Communicable diseases: Acute respiratory infections (ARI, e.g. pneumonia) (18%) P erinatal illnesses (around childbirth) (17%) Diarrhoea (16%)
Tuberculosis (6%) HIV (4%) Malaria (3%)
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P ost-meeting notes
Need for affordable technologicaladvances
Key point is to speed up diagnosis andsubsequent treatment
List of useful sites posted on webpage
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Neonatal mortality reduction
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Neonatal mortality reduction
Status of infant and perinatal issues inrural India
Different kinds of traditional beliefs Efforts led by Abhay B ang, Gadchiroli
dist :- Village health workers educating the householdsabout safe procedures- Issues regarding traditional practices
Role of father in neonatal care, etc.
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O ther issues discussed
Helping make the perinatal period safer using simple household tools/remedies
Eg: Anoops demo of preparing disinfectantbleach using lime juice and baking soda
Monitor maternal and baby healthregularly Simple tool: possible design of paper tapes
for measuring size of mothers abdomen toestimate weight of baby.
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Malnutrition in India
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M alnutrition in India- statistics
Malnutrition consists of both protein-energy malnutrition (underweightetc.) and micronutrient deficiencies.
Cause of half of all child deaths, and more than half of deaths due tomajor diseases (malaria, diarrhea, pneumonia, measles) in India.
P revalence of underweight children is highest in the world , doubleof sub-Saharan Africa.
More than a third of undernourished kids of the world live in India.
More prevalent in rural areas, among girls, backward classes andpoorer income groups.
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Indias solution - ICDS (Integrated
Child Development Services) World's largest early child development program Uses a multi-sectoral approach of provising healthcare as well as pre-
school education to children and mothers.
Supplementary feeding, immunization, health checkups, health and nutritioneducation to adult women, micronutrient supplements, pre-school
education, growth monitoring.
Anganwadi centers led by anganwadi workers in every administrative blockB y 2004 6lakhs AWC workers covered 33M children and 6M women
Very prevalent (covers 90% of administrative blocks in the country) buteffectiveness is under debate.
We studied various success stories of anganwadi centers and measures onhow they can be improved.
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Malaria
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P arasite in R B Cs
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Malaria in India
Dr VP Sharma: http://www.pitt.edu/~super1/lecture/lec17341/001.htm
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Interventions
P reventing mosquito breeding Indoor spraying of insecticide Insecticide-treated bednets Larva-eating fish No vaccine available
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Water Supply, Sanitation, andP ublic Health in Mumbai
Source: Field Survey on water supply, sanitation and associated health impacts in
urban poor communities- a case from Mumbai City, India.S. Kumar Karan & H. Harada, Water Science & Technology, 2002
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Mumbai: B ackground
Largest metropolitan area inIndia, 5 th largest in the world
P opulation: ~20 million
About half of the populationlives in slums- urban poor
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Water Supply and Sanitation Govt. provides 3 billion liters/day
O nly 65% of the requirement is met Urban P oor
Get 1/3 rd the supply compared to the rest (45 liters per capita per
day) US- ~260 liters/c.d. household consumption
90% of city and 40-50% of suburbs have seweragesystems
B
ut most urban poor do not have access to it Less than 1/3 rd the requirement for public toilets is met 90% waste water (2.2 billion l/d) is collected
0.1 billion is treated 1 billion to oceans Rest in creeks/waterways
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Impact on Health 35-45% families in slums, >50% among pavement dwellers have at
least one person ill Water-related diseases (diarrhea, malaria, typhoid, etc.) account for
26-32% of all diseases
Children share 2/3 rd of all disease burden
( Short duration)(C hronic)
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Incidence of Water B orne
Diseases
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Conclusions
Higher incidence of water and sanitation related diseasein slum and pavement dweller areas
Environmental problems include location near pollutedsites, lack of sanitation, poor personal hygiene, poverty,
lack of environmental education
P avement dwellers suffer the most
P roblem lies in huge slum population, ~ 10 million
P rovide safe and adequate water and sanitation facilities
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T echnological ways to make water cleaner
- to prevent water-borne diseases
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B ackground
S tatistics , WH O : ~1b people do not have easyaccess to clean water.
B efore the goal of providing clean drinking water toeveryone materializes
local or household treatment of water may protectpeople from disease.
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Common methods of water purification
Disinfection using chlorineB oiling
Flocculation (e.g. alum) Filtration Solar/UV treatment.
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Group discussed about Techniques of different methods.
Socio-economic obstacles on their implementation Cost and availability Ignorance and lack of belief in the benefits of water
treatment
More important concerns than purity of drinking water