Preventive Medicine

Shuai Zhi

Email: zhishuai@nbu.edu.cn
1.Environmental Health

2.Occupational Health

3.Food nutrition and health

20% Assignment, 20% Attendance, and 60% Final exam.

 What is Health?

Lay Point of view: Persons are healthy when they are doing their activities with no
apparent symptoms of disease in them. The New oxford Dictionary of English
describes health as ‘the state of being free from illness or injury’.

Professional points of view: From this point, health is defined as a measure of the
state of the physical bodily organs, and the ability of the body as a whole to function.
It refers to freedom from medically defined diseases.

WHO definition: The world Health Organization (WHO) described health in1948, in
the preamble to its constitution, as “A state of complete physical, mental, and social
well-being and not merely the absence of disease or infirmity”.
 WHO definition of Health

Physical health- is concerned with anatomical integrity and physiological

functioning of the body. It means the ability to perform routine tasks without any
physical restriction. E.g., Physical fitness is needed to walk from place to place.

Mental Health- is the ability to learn and think clearly and coherently. E.g., a person
who is not mentally fit (retarded) could not learn something new at a pace in which
an ordinary normal person learns.

Social health- is the ability to make and maintain acceptable interaction with other
people. E.g. to celebrate during festivals; to mourn when a close family member
dies; to create and maintain friendship and intimacy, etc.
 Determinants of health

Health or ill health is the result of a combination of different factors. There are
different perspectives in expressing the determinants of health of an
individual or a community.

A. Human Biology

B. Environment

C. Life style (Behavior)

D. Health care organization

A. Human Biology

Every Human being is made of genes. In addition, there are factors,

which are genetically transmitted from parents to offspring. As a
result, there is a chance of transferring defective trait. The modern
medicine does not have a significant role in these cases.

Genetic Counseling: For instance during marriage parents could

be made aware of their genetic component in order to
overcome some risks that could arise.
B. Environment

is all that which is external to the individual human host. Those

are factors outside the human body. Environmental factors that
could influence health include:

1. Life support, food, water, air etc.

2. Physical factors, climate, Rain fall

3. Biological factors: microorganisms, toxins, biological

waste

4. Psycho-social and economic e.g. Crowding, income

level, access to health care

5. Chemical factors: industrial wastes, agricultural wastes,

air pollution, etc
C. Life style (Behavior)

is an action that has a specific frequency, duration, and purpose,

whether conscious or unconscious. It is associated with practice. It is
what we do and how we act.

Recently life style by itself received an increased amount of attention

as a major determinant of health. Life style of individuals affects their
health directly or indirectly.

For example:
Cigarette smoking
Unsafe sexual practice
Eating contaminated food
D. Health care organization

Health care organizations in terms of their resource in human power,

equipment, money and so on determine the health of people.

It is concerned with

a. Availability of health service

People living in areas where there is no access to health service are
affected by health problems and have lower health status than those with
accessible health services.

b. Scarcity of health services

leads to inefficient health service and resulting in poor quality of health
status of people.

c. Acceptability of the service by the community

Accessibility : in terms of physical distance, finance etc
 Other Determinants of health

1. Physical Determinants -The physical factors affecting the health of a

community include: the geography (e.g. high land versus low land), the
environment (e.g. manmade or natural catastrophes) and the industrial
development (e.g. pollution occupational hazards)

2. Socio – cultural determinants – The socio- cultural factors affecting the

health of a community include the beliefs, traditions, and social customs in
the community. It also involves the economy, politics and religion in the
community.

3. Community organization - Community organization include the

community size, arrangement and distribution of resources (“relations of
productions’)

4. Behavioral determinants- The behavioral determinants affecting health

include individual behavior and life style affecting the health of an individual
and the community. E.g. smoking, alcoholism and promiscuity.
 What is Public Health?
The science and 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 service for the early diagnosis and

prevention 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.

American Public Health Leader, Charles Edward Amory Winslow

 What is Public Health?

The science and art of preventing disease, prolonging life and

promoting health through the organized efforts and informed
choices of society, organizations, public and private,
communities and individuals.
-WHO

Public health has many sub-fields, but typically includes

preventive medicine, epidemiology, medical statistics and health
services etc.
 Historical Development of Public Health
(1) Ancient societies (before 500 B.C.)

The Hemudu Culture (5000 B.C. to 4500 B.C.) was a Neolithic culture (新
石器文化) that flourished just south of the Hangzhou Bay in Ningbo, China.
In the remains of the Hemudu Culture, a number of plants are found which
are effective in preventing and curing some kinds of diseases. Also
discovered in the ruins are ancient wells, which ensured good quality
drinking water. India's ancient water drain system and bathrooms (2000
B.C) .
Hemudu

Ningbo
University
(2) Classical cultures (500 B.C.–A.D. 500)

During this period,

v Greeks were active in the practice of community sanitation. Personal

hygiene, fitness, nutrition, sanitation, municipal doctors, occupational
health; Hippocrates – clinical and epidemic observation and
environmental health. （founder of Western Medicine）

v Romans improved upon Greek engineering in the building of

aqueducts （渡槽） to protect water supplies. They also perform
sanitation, municipal planning, and sanitation services, public baths,
municipal doctors, military and occupational health.
Whoever wishes to investigate medicine properly,

should proceed thus: in the first place to consider the

seasons of the year; Then the winds, the hot and the

cold; We must also consider the qualities of the water;

and the mode in which the inhabitants live, whether

they are fond of drinking and eating to excess, and

given to indolence, or are fond of exercise and labor,

and not given to excess in eating and drinking.

(2) Classical cultures (500 B.C.–A.D. 500)

During this period,

v Greeks were active in the practice of community sanitation. Personal

hygiene, fitness, nutrition, sanitation, municipal doctors, occupational
health; Hippocrates – clinical and epidemic observation and
environmental health. （founder of Western Medicine）

v Romans improved upon Greek engineering in the building of

aqueducts （渡槽） to protect water supplies. They also perform
sanitation, municipal planning, and sanitation services, public baths,
municipal doctors, military and occupational health.
Picture of aqueduct
(3) Middle Ages (A.D. 500 –1500)

The Middle Ages was devastated by the Black Death (鼠疫) in

England (1348-1350) which killed nearly one third of the
population of England.

The underlying cause of many of the Middle Ages health

problems and illnesses was due to the lack of sanitation,
especially in large towns or cities such as London.

The pathogen responsible for Black Death was the Yersinia

pestis bacterium
Oriental rat flea

The Black Death is thought to have originated in the dry plains of Central Asia, where it
then travelled along the Silk Road, reaching Crimea by 1343 (it was spread by armies of
Genghis Khan). From there, it was most likely carried by Oriental rat fleas living on the
black rats that were regular passengers on merchant ships, spreading throughout the
Mediterranean and Europe.

The world pandemic kills 60 million in fourteenth century, 1/3 to 1/2 of the population of
Europe.
(3) Middle Ages (A.D. 500 –1500)

During the Middle Ages, a number of first steps in public

health were made: attempts to cope with the unsanitary

conditions of the cities and, by means of quarantine, to limit

the spread of disease; the establishment of hospitals; and

provision of medical care and social assistance.

(4) Renaissance and exploration (1500 –1700)

Among the early pioneers in public health medicine was John

Graunt, who in 1662 published book of statistics, called
“Natural and Political Observations on the London Bills of
Mortality”, which gave numbers for deaths and sometimes
suggested their causes.

The Bills of Mortality were the vital statistics about the

citizens of London collected over a 70-year period. the
numbers might be inaccurate, but a start was made in
epidemiology.
(5) The eighteenth century
Dr. Edward Jenner’s discovery of vaccine. In 1796, he successfully
demonstrated the process of vaccination as a protection against
smallpox (天花). Disease can be prevented !!!

Edward Jenner giving smallpox vaccine to a child

Smallpox was an infectious disease caused by either of two virus variants,

Variola major and Variola minor
Yet when Lady Mary Wortley Montagu deliberately infected her own daughter

with a tiny dose of smallpox – successfully inoculating the three-year-old child in

1721 – her ideas were dismissed and she was denounced by 18th-century society

as an “ignorant woman” .

Wortley Montagu, a smallpox survivor with a disfigured face, took the risky

decision to inoculate her daughter by making tiny cuts on her daughter’s skin and

rubbing in a small amount of pus from a live smallpox sore.

This gave the child, known as “young Mary”, a very mild dose of the disease,

Willett said. “Normally, with smallpox, you might have several thousand spots on

your body. An inoculated child would probably have about 30 spots and then a

few days later they’d be absolutely fine again, running around and having fun.”
smallpox face scars
(6)The nineteenth century

The 19th century brought tremendous advances in the

understanding of public health.

Discoveries of pathogenic bacteria by Louis Pasteur in France

and Robert Koch in Germany in the late 1870s, the science of
microbiology was born. Which provided public health workers
with the tools to study and understand epidemic phenomena.

In India, in 1897, Ronald Ross identified mosquito as the vector

of malaria.
(6)The nineteenth century

John Snow: waterborne cholera in London: the Broad Street Pump.

Robert Koch discovers anthrax bacillus， tubercle bacillus.
Neisser discovers gonococcus organism.
Louis Pasteur vaccinates against anthrax(Bacillus anthracis).
Typhoid bacillus discovered (Laveran)
Leprosy organism (Mycobacterium leprae, Hansen)
Malaria organism (parasites in the genus Plasmodium, Laveran)
(6)The nineteenth century
John Snow: waterborne cholera in London:
the Broad Street Pump.
(6)The nineteenth century

John Snow: waterborne cholera in London: the Broad Street Pump.

Robert Koch discovers anthrax bacillus.
Neisser discovers gonococcus organism.
Louis Pasteur vaccinates against anthrax.
Typhoid bacillus discovered (Laveran)
leprosy organism (Hansen， Mycobacterium leprae )
Malaria organism (Laveran)
(7) The twentieth century to present

★ From Individual to population

★ From acute infectious diseases to chronic diseases:

cancer, diabetes, cardiovascular diseases, alcoholism and
drug addiction, etc.

★ From prevent disease (vaccine) to promote health and

extend life expectancy
(7) The twentieth century to present

1928 Alexander Fleming discovers penicillin

1946 World Health Organization founded

1979 WHO declares eradication of smallpox achieved

1998 WHO Health for All in the Twenty-first Century adopted

 Public Health Agencies

Most countries have their own government public health agencies,

sometimes known as ministries of health, to respond to domestic health
issues.

National Health Committee of the People's Republic of China

Hospitals---hospital infection control department

Central CDC (Beijing)
Provincial CDC (Hang Zhou)
City CDC (Ningbo)
Health For All is a programming goal of the World
Health Organization (WHO),

It is the basis for the WHO’s primary health care

strategy to promote health, human dignity, and
enhanced Quality of Life.
Goals of Health for All: !!!

To attain health security for all

To achieve global health equity (very difficult)
To increase healthy life expectancy
To ensure access for all to essential health care of
good quality.
 What is Health

① Layman point of view:

The state of being free from illness or injury.

② Professional points of view: Health is the general

condition of a person's mind and body, usually meaning
to be free from illness, injury or pain.

③ WHO view: WHO defined health as “a state of

complete physical, mental, and social well-being and
not merely the absence of disease or infirmity”.
Measurement of Health

Life expectancy is defined as the average number of years of life

remaining at a given age.

Healthy life expectancy attempts to combine mortality and morbidity

into one index. The index reflects the number of years of life remaining
that are expected to be free of serious disease.

Activity of daily living (ADL) index measures a person's ability

measure the
independently to bathe, dress, toilet, transfer, feed, and control their
ability of
bladder and bowels.
patients to
perform their
Instrumental activities of daily living (IADL) scale include shopping,
daily activities
housekeeping, handling finances, and taking responsibility in
administering medications.
While ADLs are very fundamental, IADLs refer to more complex activities often

involving more thinking and organizational skills that help a senior live and

function independently.