Introduction to

Community
Health

Prepared By:- Ms. Anjali Patel

 Introduction
• Community: The word 'community' has
its origin from Latin word 'communis’.
Com: Together
Munis: Serve
• The word community is used in many
different ways in a wide variety of
situations and therefore many
definitions have come up.
• The WHO expert committee on
community health nursing (1974) in
their report agreed on the following
definition.
 Definition
1. Community:
“Community may be
defined as a group of individual
living together in a some what
localized area under the some general
regulations and have common
interest, function, needs and
organization”
-According to WHO
2. Community Health:
“Refers to the
healthy status of the member of the
community to solve the problems
affecting their health and to the totality
of a health care provided for the
community'.
- According to
WHO
3. Health:
"Health is a state of
complete physical, mental and social
well being and not merely an absence
of disease or infirmity".
-According to
WHO
4. Community Health Nursing:
“It is a synthesis
of nursing and public health practice
applied to promoting and preserving
the health of the people.”
-American Nursing Association
(ANA)
 Concept Of Health
• Good health is the fundamental right of
every human being.
• Internal and external growth of a person
is not possible without good health.
• Good health is essential to lead a quality
and successful life.
• Beyond being a personal responsibility,
health is a national and international
responsibility.
• Health is the common theme in most
cultures.
• All communities have their concepts of
health as part of their culture.
• Among definitions still used, the oldest
is that health is the 'absence of disease.
• But concept of health is not perceived
by the same way by all members of a
community.
• Hence, the concept of health is as
follows:
Biomedica Ecological
l concept concept

Psychosoc Holistic
ial concept concept
1. Biomedical concept:
• Traditionally, health has been viewed
as an 'absence of disease and if one
was free from disease, then the
person was considered healthy.
• This concept known as the
biomedical concept.
2. Ecological concept:
• According to this concept, health as a
dynamic equilibrium between man
and his environment, and disease a
maladjustment of the human
organism to environment.
• According to one ecologist, 'Health
implies the relative absence of pain
and discomfort and a continuous
adaptation and adjustment to the
environment to ensure optimal
function'. This was defined by Dubos.
3. Psychosocial concept:
• According to this concept, health is
not only a biomedical phenomenon
but one which is influenced by social,
psychological, culture, economic and
political factors of the people
concerned.
• These factors must be taken into
consideration in defining and
measuring health. Thus, health is both
biological and social phenomenon.
4. Holistic concept:
• This holistic concept of is a synthesis
of all above concepts.
• It recognizes the strength of social,
economic, political, and environmental
influences on health the holistic
approach implies that all sectors of
society have an effect on health.
Dimensions Of Health

• Health is multidimensional. There are

mainly three concepts - Physical, mental
and social, Many people maybe
included such as spiritual, emotional,
vocational and political dimensions.
 Physical

Others Mental

Dimensions
Vocatio of health Social
nal

Emotio Spiritua
nal l
1. Physical dimension: The state of
physical health implies the nation of
"perfect functioning of the body.
• It conceptualizes health biologically
as a state in which every cell and
every organ is functioning at
optimum capacity and in perfect
harmony with the rest of the body.
2. Mental dimension: Mental health is
not mere absence of mental illness,
Good mental health is ability to
responds to the many varied
experiences of life with flexibility and
sense of purpose.
3. Social dimension: Social well-being
implies harm only and integration
within the individual between each
individual and other member of
society and between individuals and
world in which they live.
• The social dimension includes level of
social skills one possess, social
functioning and ability to see oneself
as a member of larger society
4. Spiritual dimension: Spiritual health
in this context refers to that part of
individual which reaches out and
strives for meaning and purpose of
life.
• The dimensions includes integrity,
principles and ethics, the purpose in
life, commitment to some higher being
and belief in concept that are not
subject to 'state-of-the-art' explanation.
5. Emotional dimension: Traditionally,
the mental and emotional dimension
have been considered one but mental
health can be seen as 'knowing' or
'cognition' while emotional health
relates to 'feeling'.
6. Vocational dimension: It is new
dimension.
• It is part of human existence.
• When work is fully adapted to human
goals, capacities and limitations, work
often plays a role in promoting
physical and mental health.
7. Others: It includes:
• Philosophical dimension
• Cultural dimension
• Socioeconomic dimension
• Environmental dimension
• Educational dimension
• Nutritional dimension
• Curative dimension
• Prevention dimension
 Health Determinants
• There are many factors which affect the
health of individuals and communities in
a combined form.
• The circumstances and environment of
an individual determine whether or not
he/she is healthy.
• The factors influencing the health (either
in a better way or worse) are known as
the determinants of health.
• The World Health Organization has
identified the following 12 determinants
of health:
1. Income and Social Status: As the
income and social hierarchy increases,
the health of an individual improves.
• Living conditions like safe housing
and ability to buy good food are
determined by high income.
• Those individuals having prosperous
and an equitable distribution of wealth
are considered the healthiest
populations.
2. Employment: Poor health arises due to
unemployment, underemployment, and
working under stressed conditions.
• Individuals are comparatively healthy
if they can control their work
conditions and have relatively few
stress- related job demands.
• Such individuals also live longer in
comparison to those who have
stressful or riskier work and activities.
3. Education: Health of an individual is
also determined by the education
level. Education also increases
opportunities for income and job
security, and provides with a sense of
control over life circumstances
(prime health influencing factors).
• Poor health, more stress, and lower
self-confidence often result due to
low education levels.
4. Social Environments: Values and
norms of a society also affect an
individual's health and well-being in
different ways.
• Social stability diversity recognition,
safety, good working relationships, and
cohesive communities also establish a
supportive society that reduces or
avoids the potential risks to good
health.
• It has also been revealed that an
individual's health and well-being is
negatively affected by the low
availability of emotional support and
low social participation.
5. Physical Environments: Air and water
quality are the physical factors in the
natural environment which put their
impact on health.
• Housing, workplace safety, and road
design are the factors in the human-
built environment which also show
important influences.
6. Healthy Child Development: The
effect of pre-natal and early childhood
experiences has a very powerful
impact on health, well-being, coping
skills, and competence.
• Children born in families having low
income have low birth weights, eat
less nutritious food, and have more
difficulty in school in comparison to
those born in families having a high
income.
7. Personal Health Practices and
Coping Skills: Health is greatly
influenced by eating a balanced diet,
being active, smoking, drinking, and
the way of dealing with life's stresses
and challenges.
8. Health Services: Health is also
influenced when an individual make
use of the services provided for
preventing and treating diseases.
9. Social Support Networks: A better
health results from support provided
by families, friends, and communities.
• Responding effectively to stress
conditions, and having family and
friend support provides a caring and
supportive relationship that acts as a
buffer against health problems..
10.Biology and Genetic Endowment:
Inheritance determines lifespan,
healthiness, and probability of
developing certain illnesses.
11.Gender: Men and women at different
ages suffer from different types of
diseases.
12.Culture: It is defined as all the ways
of life including arts, beliefs, and
institutions of a population passed
down from generation to generation.
• Culture includes codes of manners,
dresses, languages, religions, rituals,
norms of behaviour (law and
morality), and systems of belief and
art.
• Health is influenced by customs and
traditions, and beliefs of family and
community.
 Indicators of Health
• Definition: In WHO's guidelines for
health program evaluation, health
indicators are defined as 'Variables,
which helps to measure changes."
Purpose of Indicators:

• To measure the health status of a

community
• To compare the health status of one
country with that of another
• To assess health care needs
• To allocate the scare resources and
• To monitor and evaluate the health
services, activities and programs .
• Indicators help to measure the extent to
which the objectives and targets of a
programare being attained.
 Characteristics of
Indicators:
• The indicators should be valid
• The indicators should be reliable
• The indicators should be sensitive
• The indicators should be specific
• The indicators should be feasible
• The indicators should be relevant.
1. Mortality Indicators
• Crude death rate
• Expectation of life
• Infant mortality
• Child mortality rate
• Under five proportionate mortality rate
• Maternal mortality rate
• Disease specific mortality
• Proportional mortality rate
2. Morbidity Indicators

• Morbidity indicators are used to

supplement mortality data to describe
the health status of a population because
mortality indicators do not reveal the
burden of ill health in a community, e.g.
Mental illness and rheumatoid arthritis.
• For assessing ill health status in the
community, the following morbidity
rates are used.
• Incidence and prevalence
• Notification rates
• Attendance rates at out patient
departments, health centers
• Admission, readmission and discharges
rates
• Duration stay in hospital
• Spells of sickness or absence from work
or school.
3. Disability Indicators
• It includes incidence and prevalence of
cases who are not able to perform full
range of activities because of some
inherited or acquired problems.
• These include sickness, absentism rates
at work and schools; prevalence of
blindness, deafness and dumbness,
prevalence of paralytic poliomyelitis,
limited mobility and limited activities,
mental and social handicaps, etc.
4. Nutritional Status Indicators

• This is another positive health indicator.

These include measurements of weight,
mid- arm circumference and height
(anthropometric measurements) of
children under five, measurement of
height and weight of school children and
prevalence of low birth weight. Le.
weight less than 2.5 kg.
5. Social and Mental Health
Indicators
• It includes drug abuse, child abuse and
neglect, women abuse, child
delinquency, suicide and homicide, road
traffic accidents.
Primary Health Care
Introduction

• Primary Health Care (PHC) is a basic

health care facility that should be
designed to be easily accessible by and
acceptable to the individuals.
• Community should have full
involvement and the cost should be
affordable to the community and
country.
• PHCs are based on an approach to
health beyond the traditional healthcare
system that focuses on social equality
regarding the health.
• PHC has some fundamental elements
and aims that are adapted to cater better
health services for all.
• PHC does not focus on a single disease,
but provides whole-person care for
health requirements during whole life.
• It makes sure that an individual gets
complete care, including prevention of
disease, its treatment, rehabilitation and
palliative care as per the requirement of
that individual.
 Essential Elements of
Primary Health Care
• PHC has the following 8 elements:
1. E-Education concerning the prevailing
health problems and the methods of
identifying, preventing and controlling
them.
2. L-Locally endemic disease prevention
and control.
3. E-Expanded programme of
immunisation against major infectious
diseases,
4. M-Maternal and child healthcare,
including family planning.
5. E-Essential drugs arrangement.
6. N-Nutritional food supplement, an
adequate supply of safe and basic
nutrition.
7. T- Treatment of communicable and
non-communicable disease and -
promotion of mental h
8. S-Safe water and sanitation.
 Principles of Primary
Health Care
• The above-mentioned elements of PHC
are based on the basic health objectives
that should be formulated in national
policies to launch and sustain PHC as
part of a comprehensive health system
and coordination with other sectors.
Following are the principles of PHC:
1. Equity/Equitable Distribution: The
first key principle in primary health
care strategy is equity or equitable
distribution of health services. Health
services must be shared equally by all
people, irrespective of their ability to
pay and all (rich or poor, urban or
rural) must have access to health
services.
2. Community Participation: The
involvement of individuals, families,
and communities in promotion of their
own health and welfare is an essential
ingredient of primary health care. PHC
coverage cannot be achieved without
the involvement of community in
planning, implementation and
maintenance of health services.
3. Intersectoral Coordination:
Declaration of Alma-Ata states that
PHC involves in addition to the
health sector all related sectors and
aspects of national and community
development, in particular education,
agriculture, animal husbandry, food,
industry, education, housing, public
works and communication. To
achieve cooperation, planning at
country level is required to involve
all sectors.
4. Appropriate Technology: Technology
that is scientifically sound, adaptable
to the local needs, and acceptable to
those who apply it and those for whom
it is used and can be maintained by the
people themselves with the resources
of the community and country can
afford.
 Levels of Primary
Health Care
1. Health Promotion: These are the
services and activities designed to
maintain and improve health status.
They have 5 strategies, which include
building health public policy,
strengthening community action,
creating supportive environment,
developing personal skills, and
reorienting health services.
2. Disease and Injury Prevention:
This level includes the services
designed for preventing illness that
helps to reduce the risk of disease and
injury. Prevention strategies for
clients, family, and community may
include clinical, behavioural, and
environmental.
3. Diagnosis and Treatment: This level
refers to healthcare activities that focus
on the individual rather than the family
or community. The main intention is to
recognise and treat the clients existing
health problem.
4. Rehabilitative Care: Restoration of
an individual to the complete physical,
mental, social, and vocational
functioning from a physical or mental
illness, injury, or chemical addition is
known as rehabilitation. The services
in home, outpatient, or in institution
comprise of OT, PT, and speech
therapist.
5. Supportive Care: This level states the
requirements of the chronic health to patients of
different age groups. These are the patients or
clients having long term chronic condition or
those with progressive illness or disease that may
become severe. The two aspects of support care
are palliative and respite care. Different services
at this level comprise of health, personal, and
social services to patients who have disability, or
to those who are incapable of working
independently or those who have terminal
disease.
 Role of Nurse in
Primary Health Care
1. Patient Care: The nurse performs
different clinical activities and
relationships with patients.
2. Organiser: The nurse plays varying
roles in organisational aspects of
patient care, e.g., recall systems,
reminders, feedback of patient results,
and follow-up of specialist
appointment; and systems supporting
patient care, e.g., stocking
medications, cleaning and sterilising
instruments, managing contaminated
waste.
3. Quality Controller: The nurse
manages the certification process and
other quality and risk management
activities like infection control and the
safe disposal of sharps.
4. Problem Solver: The nurse helps in
resolving the issues that arise on daily
basis, like addressing patient
emergencies, lessening triage stress for
receptionists, resolving issues using
practice software systems, brokering
between staff to avoid arguments and
finding information.
5. Educator of Practice Staff and : The
nurse educates about wound care,
accreditation standards and MBS items
to others within the practice and helps
in providing important information.
6. Agent of Connectivity: The nurse is a
good communicating agent. They
communicate between different
healthcare providers within the
workplace, and between patients and
clinicians.
 Millennium
Development
Goals (MDGS)
• The United Nations General Assembly
has set Millennium Development Goals
which include 8 goals signed under the
United Nations Millennium Declaration
in September 2000.
• All the 191 UN member states have
agreed to achieve these MDGs by the
year 2015.
• According to the United Nations
Millennium Declaration, world leaders
commit to combat poverty, hunger,
disease, illiteracy, environmental
degradation, and discrimination against
women.
• The MDGs are adopted in this
Declaration and have specific targets
and indicators.
• Eight Millennium Development Goals
1. To eradicate extreme poverty and
hunger,
2. To achieve univers
3. To promote gender equality and
empower women,
4. To reduce child mortality,
5. To improve maternal health,
6. To combat HIV/AIDS, malaria, and
other diseases,
7. To ensure environmental sustainability,
and
8. To develop a global partnership for
development.
• MDGs are inter-dependent as they
influence health, and health influences
all the MDGs.
• For example, better health promotes
better learning among children and
efficient earning among adults.
• Similarly, gender equality is essential to
achieve better health, reduce poverty,
hunger and environmental degradation.
 Promotion And
Maintenance of Health
• Health promotion and maintenance
services support patients to maintain
their health, prevent diseases and
injuries, detect diseases in early stage,
and promote healthier lifestyles.
• These services generally include active
involvement of patients and cannot be
performed only by the healthcare
providers.
• These services are based on the
assumption that if patients adopt healthy
lifestyles, they are less prone to
lifestyle-related diseases (e.g., heart
attacks, lung cancers, and certain
infections).
• Health promotion also covers other
health dimensions, such as detection of
warning signs indicating the presence of
a disease in early stages.
• Early detection of many diseases
requires minimum treatment at very less
cost with increased positive results.
• An example of early detection includes
diagnosis of breast cancer by self-
examination and mammography.
• Both the methods of diagnosis help to
detect breast cancer in its early stages,
thus increase the chances of successful
treatment.
• Health promotion is categorised into
three main types, namely health
education, disease prevention, and
health protection.
Health Education
• The whole idea of health promotion and
maintenance is based on health
education, which includes activities to
provide adequate, accurate and
reflective information and knowledge to
recipients.
• Health education empowers the
recipients to take their own rational
decisions.
• To provide health education, a top down
approach is not followed; instead
information is provided as per the
requirements of the recipients, with
providers and recipients learning from
each other.
Disease Prevention
• Disease prevention is a process of
reducing the risk of occurrence of a
disease, illness, injuries, disability,
handicap or some other unwanted
actions.
• Disease prevention basically includes
three levels, i.e., primary, secondary and
tertiary, which may include healthy
lifestyle, immunization, health
screening, maternal and child health,
rehabilitation programmes, and
sexuality education.
• Some counseling programs are also
conducted for disease prevention that
can be done on face-to-face basis or
through mass media.
Health Protection
• Health protection includes regulations,
policies, or voluntary practices that are
mainly adopted to improve the living
and working environment and to prevent
bad health.
• For example, the new ordinance has
proposed for total ban on smoking in
restaurants and most indoor public
places so that rate of heart disease and
lung cancer can be reduced in the
population.
• Similarly, essential use of automobile
seat belt ensures protection of
passengers from road accidents and
injuries.
• Policy has been made for compulsory
labeling of food items so that consumers
become enable to make healthy and
rational choices regarding their food.
• Thus, health promotion includes all the
life aspects.
Thank You!
 PRINCIPLES OF
COMMUNITY HEALTH
NURSING

DR. MAHESWARI JAIKUMAR.

maheswarijaikumar2103@gmail.com
• Community
Health Nursing
(CHN) is a vital
part of Public
Health and
there are 12
principles the
govern CHN.
COMMUNITY NEEDS
1. The recognized
need of individuals,
families &
communities provid
es the basis for CHN
practice.
• Its primary purpose is to further
apply public health
measures within the
framework of the total CHN
effort.
UNDERSTANDING
2. Knowledge and understanding
of the objectives and policies
of the agency facilitates goal
achievement.
• The mission statement commits
Community Health Nurses to
positively actualize their
service to this end.
FAMILY A UNIT
3. CHN considers the family as the
unit of service. Its level of
functioning is influenced by
the degree to which it can deal
with its own problems.
• Therefore the family is an
effective and available channel
for the most of the CHN efforts.
RESPECT VALUES &
CUSTOMS
4. Respect for the
values, customs &
beliefs of the clients
contribute to the
effectiveness of
care to the client.
• CHN services must be available
sustainable and affordable to all
regardless of race, creed, color or
socio-economic status.
INTEGRATING EDUCATION
& COUNSELLING
• 5. CHN integrats
health
education and
counseling as
vital parts of
functions.
• These encourage and support
community efforts in the
discussion of issues to improve
the people’s health.
COLLABORATIVE WORK
6. Collaborative work
relationships with the co-
workers and members of the
health team facilitates
accomplishments of goals.
• Each member is helped to see
how his/her work benefits the
whole enterprise.
CONTINUOUS EVALUATION
7. Periodic and continuing
evaluation provides the
means for assessing the
degree to which CHN goals and
objectives are being attained.
• Clients are involved in the
appraisal of their health program
through consultations,
observations and accurate
recording.
8. Continuing staff
education program &
quality services to
client and are essential
to upgrade and
maintain sound
nursing practices in
their setting.
• Professional interest and needs
of Community Health Nurses are
considered in planning staff
development programs of the
agency.
LOCAL RESOURCES
9. Utilization of indigenous and
existing community resources
maximizes the success of the
efforts of the Community
Health Nurses.
• The use of local available
ailments & linkages with existing
community resources, both
public and private, increase the
awareness of what care they
need what are entitled.
COMMUNITY PARTICIPATION
10. Active participation of the
individual, family and
community in planning and
making decisions for their
health care needs, determine,
to a large extent, the success
of the CHN programs.
• Organized community groups are
encouraged to participate in the
activities that will meet
community needs and interests.
SUPERVISION OF SERVICES
11. Supervision of nursing
services by qualified by CHN
personnel provides guidance
and direction to the work to
be done.
• Potentials of employees for
effective and efficient work are
developed.
RECORDING & REPORTING
12. Accurate recording and
reporting serve as the basis
for evaluation of the progress
of planned programs and
activities and as a guide for
the future actions.
• Maintenance of accurate records
is a vital responsibility of
community as these are utilized
in studies and researches and as
legal documents.
THANK YOU