UNIT 1 Concepts of Community Health and Community Health Nursing
PUBLIC HEALTH.
✅ 1. Definition of Public Health
Public Health is the science and art of preventing disease, prolonging life, and promoting health through organized efforts of society, organizations (public and private), communities, and individuals.
By C.E.A. Winslow (1920):
“Public health is the science and art of preventing disease, prolonging life and promoting health through the organized efforts of society.”
✅ 2. Objectives of Public Health
Prevention of diseases
Promotion of health
Prolongation of life
Environmental sanitation
Health education
Provision of medical and nursing care
✅ 3. Community Health Nursing – Definition
Community Health Nursing is a field of nursing that combines public health principles with nursing science to promote and protect the health of populations.
It focuses on health promotion, disease prevention, and health maintenance of individuals, families, and groups in a community setting.
✅ 4. Goals of Community Health Nursing
Improve the health status of the population.
Reduce health disparities.
Provide accessible, equitable, and affordable healthcare.
Promote self-care and independence.
Increase health awareness and literacy.
✅ 5. Principles of Community Health Nursing
Equity and social justice – Equal health services for all.
Preventive over curative – Focus on disease prevention.
Community participation – Involvement of people in planning and decision-making.
Intersectoral coordination – Cooperation with other departments (education, sanitation, etc.)
Evidence-based practice – Decisions based on scientific data.
✅ 6. Roles and Responsibilities of Community Health Nurse
Role
Description
Care Provider
Provide direct nursing care at home or clinics.
Educator
Educate community on hygiene, nutrition, family planning.
Counselor
Counsel individuals/families about health practices.
Advocate
Speak up for the health rights of the community.
Manager
Manage community health programs and field workers.
Researcher
Participate in surveys, data collection, and studies.
Secondary Prevention – Early diagnosis and treatment (e.g., screening)
Tertiary Prevention – Rehabilitation and disability limitation
✅ 8. Key Activities in Community Health Nursing
Home visits
Immunization programs
Maternal and child health services (ANC, PNC)
School health services
Health camps
Sanitation and safe water programs
Disease surveillance
Health education sessions
Referral services
✅ 9. Community Health Nursing Process
Assessment – Collect data on community health needs
Planning – Develop interventions
Implementation – Deliver nursing care/services
Evaluation – Measure outcomes and impact
✅ 10. Essential Skills of a Community Health Nurse
Communication and interpersonal skills
Observation and reporting
Health education and counseling
First aid and basic emergency care
Organization and coordination
Cultural sensitivity and empathy
✅ 11. Public Health Infrastructure in India
Sub-centre (SC) – First contact point
Primary Health Centre (PHC) – Referral from SC, has a Medical Officer
Community Health Centre (CHC) – For specialist services
District Hospital
Tertiary Hospitals/Medical Colleges
✅ 12. Community-Based National Programs in India
National Tuberculosis Elimination Program (NTEP)
National Leprosy Eradication Program (NLEP)
Universal Immunization Program (UIP)
Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A)
National Programme for Non-Communicable Diseases (NPCDCS)
✅ 13. Difference between Public Health Nursing and Community Health Nursing
Public Health Nursing
Community Health Nursing
Population-based
Family and individual focused
More preventive
Combination of curative and preventive
Macro-level planning
Micro-level interventions
Government policy emphasis
Service delivery emphasis
✅ 14. Current Trends in Community Health Nursing
Use of technology (telehealth, mHealth)
Focus on NCDs
Community-based rehabilitation
Mental health integration
Pandemic preparedness and response
Strengthening health education and digital health literacy
CONCEPT OF COMMUNITY HEALTH AND COMMUNITY HEALTH NURSING
✅ I. CONCEPT OF COMMUNITY
Community is a social group of people living in a specific geographic area, sharing common culture, values, norms, and often organized through a political or administrative structure.
🔹 Characteristics of a Community:
Geographical area (village, town, city)
Common interests/needs
Social interaction
Sense of belonging
Shared resources
Organized structure
✅ II. DEFINITION OF COMMUNITY HEALTH
Community Health is the art and science of maintaining, protecting, and improving the health of people in a community through organized efforts.
It emphasizes preventive, promotive, and rehabilitative aspects rather than just curative.
✅ III. OBJECTIVES OF COMMUNITY HEALTH
Promote and protect health
Prevent diseases and disabilities
Prolong life
Provide health education
Improve environmental sanitation
Encourage healthy behavior and lifestyle
Increase access to health services
✅ IV. COMPONENTS OF COMMUNITY HEALTH
Health promotion (education, awareness, lifestyle)
Community Health Nursing is a field of nursing that integrates nursing science with public health principles to promote and protect the health of populations in the community setting.
It deals with health promotion, disease prevention, and care of individuals, families, and groups in the community.
✅ VII. OBJECTIVES OF COMMUNITY HEALTH NURSING
Assess the health needs of the community.
Plan and implement nursing care for individuals, families, and groups.
Promote health and prevent diseases.
Provide health education to the community.
Encourage utilization of health services.
Develop community participation.
Support national health programs.
✅ VIII. PRINCIPLES OF COMMUNITY HEALTH NURSING
Care is based on needs of the community.
Focus on preventive and promotive services.
Equal and fair services to all.
Family and community-centered care.
Intersectoral collaboration with education, sanitation, etc.
Encourage self-care and community involvement.
✅ IX. FUNCTIONS OF COMMUNITY HEALTH NURSE
Area
Functions
Direct Care
Provide care during home visits, immunization, MCH services
Education
Health education on hygiene, nutrition, family planning
Assessment – Collect data on population health status.
Diagnosis – Identify health problems or risks.
Planning – Set goals and objectives.
Implementation – Deliver care, education, or services.
Evaluation – Measure outcomes and effectiveness.
✅ XII. IMPORTANCE OF COMMUNITY HEALTH NURSING
Helps in early disease detection.
Reduces healthcare costs by prevention.
Improves health status of underserved populations.
Increases community participation in health.
Strengthens the reach of health services in rural/remote areas.
Supports national and international health goals (e.g., SDGs).
✅ XIII. ROLE IN NATIONAL HEALTH PROGRAMS
Community health nurses play a vital role in programs like:
Universal Immunization Program (UIP)
Reproductive and Child Health (RCH)
National Tuberculosis Elimination Program (NTEP)
National Leprosy Eradication Program (NLEP)
Janani Suraksha Yojana (JSY)
Integrated Child Development Services (ICDS)
✅ XIV. CURRENT TRENDS IN COMMUNITY HEALTH NURSING
Digital health and telemedicine
Mobile health units
Community-based rehabilitation
Focus on non-communicable diseases (NCDs)
Health promotion through social media
Training of ASHAs, ANMs, community volunteers
PUBLIC HEALTH IN INDIA AND ITS EVOLUTION.
✅ I. Definition of Public Health
Public Health is the science and art of preventing disease, prolonging life, and promoting health through the organized efforts of society, public and private sectors, and individuals.
As per WHO: “Public health is all organized measures to prevent disease, promote health, and prolong life among the population as a whole.”
✅ II. ORIGIN AND EVOLUTION OF PUBLIC HEALTH IN INDIA
Public health in India has evolved over centuries, with key developments during ancient, colonial, and post-independence periods.
🔹 A. Ancient India (Before British Era)
Concepts of hygiene and sanitation mentioned in Ayurveda, Charaka Samhita, and Sushruta Samhita.
Emphasis on:
Clean water
Balanced diet
Personal hygiene
Yoga and mental well-being
Existence of hospitals during Maurya and Gupta periods.
🔹 B. British Period (1757 – 1947)
During colonial rule, public health infrastructure began to be established due to epidemic outbreaks and military needs.
🔸 Key Events:
Year
Event
1859
Civil Medical Department established
1869
Public Health Department established
1881
First All-India Census
1885
Local Self-Government Act (municipalities took public health responsibility)
1897
Epidemic Diseases Act (to control plague, still used today)
1904
Plague Commission established
1911
Birth and Death Registration made compulsory
1919
Montagu-Chelmsford Reforms: Health became a provincial subject
1946
Bhore Committee Report recommended universal health care
🔹 C. Post-Independence Era (After 1947)
India took major steps to build a public health system aimed at universal health care, disease control, and health promotion.
🔸 Important Developments:
Year
Event
1947
Independence of India
1948
India joined World Health Organization (WHO)
1951
Launch of First Five-Year Plan and National Family Planning Programme
1952
Establishment of Primary Health Centres (PHCs)
1963
National Smallpox Eradication Programme
1975
Integrated Child Development Services (ICDS)
1978
Alma Ata Declaration – India committed to “Health for All by 2000”
1983
First National Health Policy formulated
2000s
National Health Mission (NHM) launched (2005)
2017
Launch of National Health Policy 2017
2018
Launch of Ayushman Bharat – Health & Wellness Centres + PMJAY
✅ III. CURRENT PUBLIC HEALTH STRUCTURE IN INDIA
1. Rural Health Infrastructure (3-tier system):
Level
Facility
Population Coverage
1st
Sub-Centre (SC)
5,000 (3,000 in tribal areas)
2nd
Primary Health Centre (PHC)
30,000 (20,000 in tribal)
3rd
Community Health Centre (CHC)
1,20,000 (80,000 in tribal)
2. Urban Health Infrastructure:
Urban Primary Health Centres (UPHCs)
Urban Community Health Centres (UCHCs)
✅ IV. MAJOR PUBLIC HEALTH PROGRAMMES IN INDIA
Programme
Purpose
UIP (1985)
Universal Immunization Programme
RNTCP/NTEP
TB elimination
NACP
HIV/AIDS control
NLEP
Leprosy elimination
RCH
Reproductive and Child Health
POSHAN Abhiyaan
Nutrition and child development
PMJAY
Free secondary and tertiary care for the poor
AB-HWCs
Comprehensive primary healthcare at grassroots
✅ V. NATIONAL HEALTH POLICIES
Policy
Focus
1983
Primary healthcare, rural health services
2002
Private-public partnership, health financing
2017
Universal health coverage, digital health, NCD control
✅ VI. CURRENT CHALLENGES IN PUBLIC HEALTH IN INDIA
High burden of communicable and non-communicable diseases
Malnutrition in children and anemia in women
Lack of access in rural and remote areas
Shortage of health workforce
Environmental and occupational health risks
Inadequate health financing (<2.5% of GDP)
Rising lifestyle-related illnesses
Post-COVID mental health issues
✅ VII. ROLE OF PUBLIC HEALTH IN NATIONAL DEVELOPMENT
Reduces disease burden and mortality
Improves productivity and economic growth
Enhances quality of life
Promotes equity and access
Supports sustainable development goals (SDGs)
✅ VIII. FUTURE DIRECTIONS
Strengthening primary health care
Expanding Ayushman Bharat and HWCs
Digital Health Mission for e-records
Focus on preventive and promotive health
Training of healthcare professionals
Addressing climate change and health
SCOPE OF COMMUNITY HEALTH NURSING
✅ Definition Recap:
Community Health Nursing is a specialized field of nursing that integrates nursing and public health practices to promote and protect the health of populations, especially in a community setting (homes, schools, clinics, rural/urban areas).
✅ MEANING OF SCOPE
The scope of community health nursing means the range of roles, responsibilities, services, and areas in which community health nurses function to promote health, prevent disease, and ensure well-being of individuals, families, and communities.
✅ SCOPE OF COMMUNITY HEALTH NURSING – KEY AREAS
🔹 1. Family Health Care
Home visits
Health education
Care during pregnancy, childbirth, and postnatal period
Newborn and child care
Support for elderly and chronically ill family members
🔹 2. Maternal and Child Health (MCH)
Antenatal and postnatal care
Safe delivery support
Immunization
Growth monitoring
Nutritional counseling
Prevention of child mortality
🔹 3. School Health Nursing
Health screening of school children
First aid and basic treatment
Personal hygiene education
Counseling on nutrition, adolescence, reproductive health
Early detection of health problems (vision, hearing, mental health)
🔹 4. Occupational Health Nursing
Health care in industrial and workplace settings
Monitoring for occupational diseases
Ensuring safety standards (PPE, sanitation)
Health education and emergency care
🔹 5. Geriatric (Elderly) Nursing
Home-based care for aging population
Management of chronic diseases (BP, diabetes)
Fall prevention, diet, mobility assistance
Counseling and emotional support
🔹 6. Rehabilitation Nursing
Post-operative care at home
Support after stroke, injury, or surgery
Rehabilitation of disabled individuals
Coordination with physiotherapists, speech therapists
Use of IEC (Information, Education, Communication) materials
Community meetings, street plays, posters
Behavior change communication
🔹 12. Implementation of National Health Programs
Participation in programs like:
Universal Immunization Program (UIP)
Reproductive and Child Health (RCH)
National Tuberculosis Elimination Program (NTEP)
National Leprosy Eradication Program (NLEP)
Ayushman Bharat Health & Wellness Centres (HWCs)
🔹 13. Research and Data Collection
Community health surveys
Disease reporting and surveillance
Assessment of health needs
Evaluation of health programs
✅ SPECIAL AREAS IN MODERN COMMUNITY HEALTH NURSING
Digital Health (Telehealth)
Community Mental Health
Palliative Care at Home
Health Counseling in Remote Areas
Training ASHAs and community volunteers
REVIEW: CONCEPTS OF HEALTH & ILLNESS/DISEASE.
✅ I. CONCEPT OF HEALTH
According to WHO (1948): “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
🔹 Other Definitions:
Ottawa Charter for Health Promotion (1986):
“Health is a resource for everyday life, not the objective of living.”
✅ II. DIMENSIONS OF HEALTH
Health is a multidimensional concept. It includes:
Dimension
Description
Physical
Body functions properly, no disease
Mental
Positive thinking, emotional balance
Social
Ability to maintain good relationships
Spiritual
Sense of purpose, inner peace
Emotional
Coping with life stress and feelings
Vocational
Job satisfaction and productivity
Environmental
Safe, clean, and healthy surroundings
✅ III. DETERMINANTS OF HEALTH
Health is influenced by a combination of internal and external factors:
Factor
Examples
Biological
Age, sex, heredity
Environmental
Clean water, sanitation, pollution
Lifestyle
Diet, exercise, smoking, alcohol
Socioeconomic
Education, income, housing
Healthcare Services
Access, availability, quality of care
Cultural & Spiritual
Beliefs, practices, traditions
✅ IV. LEVELS OF HEALTH
Health is not just “healthy” or “sick.” It exists on a continuum:
Optimum Health – Full functioning and well-being.
Good Health – No symptoms or problems.
Average Health – Minor issues but manageable.
Poor Health – Frequent or chronic illnesses.
Illness/Disease – Diagnosed pathological state.
Death – End of life.
✅ V. CONCEPT OF ILLNESS
Illness is a subjective experience of feeling unwell. It refers to how an individual perceives and responds to a health condition.
🔹 Characteristics of Illness:
Personal experience
May not have a visible cause
Varies from person to person
Includes both physical and emotional discomfort
✅ VI. STAGES OF ILLNESS BEHAVIOR(By Suchman)
Stage
Description
1. Symptom Experience
Person notices symptoms
2. Assumption of Sick Role
Accepts illness and seeks rest/care
3. Medical Care Contact
Consults healthcare professional
4. Dependent Role
Accepts treatment and care
5. Recovery/ Rehabilitation
Returns to normal or adapted lifestyle
✅ VII. CONCEPT OF DISEASE
Disease is an objective, medically diagnosable condition with identifiable signs and symptoms.
🔹 Key Characteristics:
Biological or psychological dysfunction
Diagnosed by healthcare providers
Often measurable (e.g., blood tests, scans)
✅ VIII. DIFFERENCE BETWEEN ILLNESS AND DISEASE
Aspect
Illness
Disease
Definition
Subjective feeling of being unwell
Objective diagnosis of pathology
Nature
Personal, emotional experience
Biological, measurable condition
Diagnosis
May not always be diagnosed
Requires medical diagnosis
Treatment
May need rest/support
Needs clinical management
✅ IX. CLASSIFICATION OF DISEASES
By Cause:
Infectious: TB, Malaria, COVID-19
Non-infectious: Diabetes, Hypertension
By Duration:
Acute: Short duration (flu, cold)
Chronic: Long duration (asthma, arthritis)
By Mode of Transmission:
Communicable: Spread person to person
Non-communicable: Not spread (cancer)
By System Affected:
Respiratory, Gastrointestinal, Cardiovascular, etc.
✅ X. FACTORS AFFECTING ILLNESS BEHAVIOR
Education level
Cultural beliefs
Family support
Financial condition
Accessibility of health services
Past experiences
Health literacy
✅ XI. NURSING IMPLICATIONS
Community and clinical nurses should:
Understand cultural and emotional responses to illness
Educate patients and families
Promote health-seeking behavior
Encourage lifestyle modification
Provide physical and emotional support
✅ CONCLUSION
Understanding the concepts of health, illness, and disease helps nurses to:
Promote holistic health
Recognize early signs of illness
Educate individuals and communities
Provide patient-centered care
Reduce stigma and improve quality of life
DIMENSIONS OF HEALTH AND DISEASE –
✅ I. DIMENSIONS OF HEALTH
According to the World Health Organization (WHO), health is a multidimensional concept, not just the absence of disease, but a state of complete physical, mental, and social well-being.
Let’s explore the main and extended dimensions of health:
🔹 1. Physical Dimension
Refers to the normal functioning of the body and all organ systems.
A person is physically healthy if they:
Are free from diseases or disabilities
Have good energy levels
Can perform daily activities without fatigue
Indicators: BMI, pulse rate, BP, lab test reports, strength, immunity
🔹 2. Mental Dimension
Refers to emotional and psychological well-being.
A mentally healthy person:
Copes well with stress
Thinks clearly and logically
Has good self-esteem and decision-making ability
Examples: Ability to handle pressure, no depression/anxiety, positive thinking
🔹 3. Social Dimension
Refers to the ability to maintain satisfying interpersonal relationships and fulfill social roles.
A socially healthy person:
Has good communication skills
Adjusts in society
Maintains friendships and family relations
Examples: Participating in community work, cooperation with others
🔹 4. Emotional Dimension
Refers to the ability to recognize, express, and manage emotions such as joy, anger, fear, and sadness.
Includes emotional intelligence.
Examples: Coping with grief, controlling anger, being empathetic
🔹 5. Spiritual Dimension
Involves the search for meaning and purpose in life.
It is not limited to religious beliefs but includes inner peace, harmony, and moral values.
Examples: Faith, meditation, yoga, moral values, peace of mind
🔹 6. Vocational Dimension
Refers to job satisfaction and work-life balance.
A vocationally healthy person:
Finds purpose in work
Has good work relationships
Is productive and happy with their role
Examples: Career growth, satisfaction from nursing profession
🔹 7. Environmental Dimension
Refers to clean, safe, and supportive surroundings that contribute to good health.
Includes physical, biological, and social environment.
Examples: Clean water, safe housing, pollution-free air, safe community
✅ Summary Table: Dimensions of Health
Dimension
Key Features
Physical
Body fitness, absence of disease
Mental
Logical thinking, emotional balance
Social
Relationships, community engagement
Emotional
Emotional control and expression
Spiritual
Faith, inner peace, life purpose
Vocational
Job satisfaction, productivity
Environmental
Clean and safe surroundings
✅ II. DIMENSIONS OF DISEASE
While health has positive dimensions, disease also can be studied across different dimensions. Disease affects multiple aspects of a person’s life.
🔹 1. Biological Dimension
Involves structural or functional abnormalities in the body (organs, cells, tissues).
Examples:
Bacterial infection causing pneumonia
Diabetes due to insulin deficiency
🔹 2. Psychological (Mental/Emotional) Dimension
Disease affects emotional well-being or causes psychological disorders.
Examples:
Depression after chronic illness
Anxiety due to prolonged treatment
🔹 3. Social Dimension
Long-term illness may cause isolation, social stigma, discrimination, or job loss.
Examples:
Leprosy or HIV/AIDS stigma
Exclusion due to mental illness
🔹 4. Economic Dimension
Illness can lead to loss of income, high treatment costs, or poverty.
Examples:
Family burden due to cancer treatment
Loss of job due to disability
🔹 5. Cultural Dimension
Cultural beliefs and values affect how disease is perceived and treated.
Examples:
Belief that mental illness is due to evil spirits
Use of home remedies instead of medical care
DETERMINANTS OF HEALTH AND DISEASE –
✅ I. WHAT ARE DETERMINANTS?
Determinants are the factors that influence the health status of individuals or populations — they can either promote good health or contribute to disease and ill health.
They include both biological and environmental causes, as well as social, economic, behavioral, and political influences.
✅ II. DETERMINANTS OF HEALTH
WHO has grouped determinants into the following major categories:
🔹 1. Biological Determinants
These are internal to the individual and influence health from birth.
Examples
Heredity/genetics
Age and gender
Immunity and hormonal balance
Congenital conditions
Pregnancy and lactation
🔹 2. Behavioral/Lifestyle Determinants
These are personal habits and behaviors that affect health positively or negatively.
Positive Behaviors
Negative Behaviors
Healthy diet, exercise
Smoking, alcohol, drug abuse
Stress management
Physical inactivity
Safe sexual practices
Reckless driving
🔹 3. Environmental Determinants
Conditions in our surroundings (physical, chemical, biological, and social) affect health.
Examples
Clean air and water
Sanitation and waste disposal
Safe housing and roads
Noise and radiation exposure
Vector breeding sites (e.g., mosquitoes)
🔹 4. Socioeconomic Determinants
Social and economic status plays a major role in access to health and quality of life.
Examples
Education level
Employment and occupation
Income and poverty
Social support and community
Gender equality
🔹 5. Health Services Determinants
The quality and accessibility of healthcare services directly impact health.
Examples
Availability of health centers (PHC, CHC)
Immunization services
Trained health personnel (nurses, doctors)
Emergency care and ambulances
Health education and awareness programs
🔹 6. Political and Policy Determinants
Government actions and public health policies shape health systems and outcomes.
Examples
Health insurance schemes (e.g., Ayushman Bharat)
Laws on pollution, tobacco, alcohol
Regulation of drug prices
Public health campaigns and missions
🔹 7. Cultural Determinants
Health beliefs and practices rooted in culture influence health behaviors and decision-making.
Examples
Beliefs about illness and healing
Use of traditional/home remedies
Religious fasting
Attitudes towards vaccines or mental illness
✅ III. DETERMINANTS OF DISEASE
Just like health, disease also has multi-factorial causes. These determinants are risk factors that increase the likelihood of disease.
🔹 1. Agent Factors
Refers to the biological, chemical, or physical agents that cause disease.
Examples
Bacteria, viruses, parasites (TB, malaria)
Chemicals/toxins (poisoning)
Physical agents (heat, radiation, trauma)
🔹 2. Host Factors
Related to the individual’s resistance or vulnerability to disease.
Examples
Age, sex
Immunity
Genetic predisposition
Nutritional status
Lifestyle (smoking, alcohol use)
🔹 3. Environmental Factors
Influence disease transmission and exposure to risks.
Examples
Contaminated water (cholera)
Poor housing, overcrowding (TB)
Climate and sanitation
Vector breeding sites
🔹 4. Social Determinants of Disease
Examples
Poverty and unemployment
Illiteracy and ignorance
Poor access to health services
Stigma and discrimination (e.g., HIV)
✅ IV. INTERRELATIONSHIP – WEB OF CAUSATION
Disease is rarely caused by a single factor—it usually results from an interaction of multiple determinants, also known as the web of causation.
For example: Heart Disease = Genetics + Poor diet + Smoking + Stress + Lack of exercise
✅ V. IMPORTANCE FOR NURSES AND PUBLIC HEALTH WORKERS
Identifying risk factors and planning preventive strategies
Promoting health education on lifestyle modification
Improving access to health care in vulnerable communities
Advocating for policy changes that support public health
NATURAL HISTORY OF DISEASE
✅ I. DEFINITION
Natural History of Disease refers to the course of a disease from its onset (without medical intervention) to its final outcome — whether recovery, disability, or death.
It helps in understanding how diseases progress within an individual or a population over time, especially in the absence of treatment.
✅ II. IMPORTANCE OF STUDYING NATURAL HISTORY
To identify stages of disease and plan interventions
To develop preventive measures (primary, secondary, tertiary)
To design screening programs at the right time
To reduce complications and control epidemics
✅ III. STAGES OF NATURAL HISTORY OF DISEASE
It is broadly divided into two phases:
🔹 A. Pre-pathogenesis Phase
(Before disease agent enters the host) Focuses on risk factors and disease prevention.
Element
Description
Agent
Bacteria, virus, parasite, chemical, etc.
Host
Individual susceptible to disease
Environment
Factors that support transmission or exposure
🔸 At this stage, primary prevention (e.g., immunization, health education) is possible.
🔹 B. Pathogenesis Phase
(After the agent has entered the body and disease begins) Includes both clinical and subclinical phases.
➤ 1. Early Pathogenesis / Subclinical Stage
Disease process has started
No signs or symptoms yet
Disease can be detected only by screening tests
🟢 Example: Positive Mantoux test for TB before symptoms begin
🔸 Secondary prevention (e.g., early diagnosis and treatment) is effective here.
➤ 2. Clinical Stage
Appearance of signs and symptoms
Disease is now recognizable and diagnosable
If untreated, may lead to complications
🟢 Example: Cough, fever, night sweats in active pulmonary TB
➤ 3. Complication or Outcome Stage
Outcome may be:
Recovery
Disability
Death
🔸 Tertiary prevention (e.g., rehabilitation, supportive care) is applicable here.
✅ V. EXAMPLE: NATURAL HISTORY OF TUBERCULOSIS (TB)
Stage
Description
Pre-pathogenesis
Exposure to TB bacilli, malnutrition, crowded living
Subclinical
Latent TB infection (positive Mantoux)
Clinical
Cough, fever, weight loss, sputum positive
Complication/Outcome
Recovery with treatment, disability (lung damage), or death
✅ VI. LEVELS OF PREVENTION AND STAGES OF DISEASE
Level of Prevention
Applied at Which Stage
Example
Primary Prevention
Pre-pathogenesis
Vaccination, health education
Secondary Prevention
Early pathogenesis
Screening, early treatment
Tertiary Prevention
Late pathogenesis/outcome
Rehabilitation, physiotherapy
✅ VII. NURSING IMPLICATIONS
Community health nurses must:
Identify risk factors and educate during pre-pathogenesis
Encourage screening and early diagnosis
Ensure adherence to treatment
Provide rehabilitation and home care
LEVELS OF PREVENTION.
✅ I. DEFINITION
Prevention refers to actions taken to avoid the occurrence of disease, halt its progress, or minimize its impact on individuals and communities.
The concept of levels of prevention was introduced by Leavell and Clark in 1965.
There are four recognized levels of prevention:
Primordial prevention
Primary prevention
Secondary prevention
Tertiary prevention
Let’s focus on the main three levels: Primary, Secondary, and Tertiary.
✅ II. 1. PRIMARY PREVENTION
🔹 Definition:
Actions taken before the onset of disease to prevent its occurrence by eliminating risk factors or enhancing resistance.
🔹 Focus:
Health promotion
Specific protection
🔹 Examples:
Health Promotion
Specific Protection
Health education
Immunization
Personal hygiene
Use of mosquito nets
Physical exercise
Iron & folic acid tablets
Nutrition awareness
Chlorination of water
Anti-smoking campaigns
Safe sex practices (condoms)
🔹 Goal:
To keep people healthy and prevent disease before it starts.
✅ III. 2. SECONDARY PREVENTION
🔹 Definition:
Actions taken to detect a disease in its early stages and provide prompt treatment to halt its progression.
🔹 Focus:
Early diagnosis
Prompt and adequate treatment
🔹 Examples:
Screening for:
Breast cancer (mammography)
Hypertension (BP check)
Diabetes (blood sugar test)
TB (sputum test)
Early treatment of:
Tuberculosis
Pneumonia
Sexually transmitted infections
🔹 Goal:
To detect and treat disease early to prevent complications or spread.
✅ IV. 3. TERTIARY PREVENTION
🔹 Definition:
Actions taken after the disease has been diagnosed and treated, aiming to restore function, limit disability, and rehabilitate the individual.
🔹 Focus:
Disability limitation
Rehabilitation
🔹 Examples:
Physiotherapy after stroke
Rehabilitation of leprosy patients
Support for cancer survivors
Artificial limbs for amputees
Special education for mentally challenged children
Counseling for mental illness or substance abuse
🔹 Goal:
To reduce suffering, prevent disability, and improve quality of life.
✅ V. COMPARISON TABLE
Level
Stage of Disease
Focus
Target Group
Examples
Primary
Before onset
Prevent disease
Healthy population
Immunization, nutrition
Secondary
Early disease
Early detection & treatment
At-risk or suspected cases
Screening, early treatment
Tertiary
Established disease
Limit disability, restore function
Patients
Rehab, disability care
✅ VI. BONUS: PRIMORDIAL PREVENTION(Emerging Concept)
Preventing the development of risk factors themselves.
🔹 Examples:
Promoting healthy eating habits in children
Avoiding sedentary lifestyle in youth
Discouraging junk food advertisements
✅ VII. NURSING IMPLICATIONS
Nurses play a vital role in all levels of prevention:
Primary: Health education, immunization drives, nutrition counseling
Secondary: Conduct screening camps, assist in early diagnosis
Tertiary: Provide rehabilitation, emotional support, palliative care
✅ VIII. CONCLUSION
The levels of prevention provide a framework for planning public health and nursing interventions to:
Reduce disease burden
Improve early detection
Minimize disability
Enhance overall community well-being
HEALTH PROBLEMS (HEALTH PROFILE) OF INDIA.
✅ I. INTRODUCTION
India is a diverse country with vast differences in geography, socio-economic status, literacy, and healthcare access. As a result, it faces a triple burden of disease:
Communicable diseases
Non-communicable diseases
Nutritional and environmental health problems
✅ II. MAJOR HEALTH PROBLEMS IN INDIA
🔹 1. Communicable Diseases (Infectious diseases)
Despite progress, communicable diseases still pose a major threat.
Disease
Issues
Tuberculosis (TB)
High incidence, MDR-TB cases increasing
Malaria
Endemic in many states
Dengue, Chikungunya
Rising due to urbanization & poor sanitation
HIV/AIDS
Declining but still present in high-risk groups
Hepatitis B and C
Common in some regions
Diarrheal Diseases
Major cause of death in children under 5
Acute Respiratory Infections (ARIs)
High child morbidity
Leprosy
India has the highest number of leprosy cases globally
🔹 2. Non-Communicable Diseases (NCDs)
NCDs are responsible for over 60% of total deaths in India.
NCD
Details
Hypertension
1 in 4 adults affected
Diabetes
India is the diabetes capital of the world
Cardiovascular diseases
Leading cause of death
Cancer
Breast, cervical, oral cancers most common
Stroke
Increasing due to lifestyle changes
Mental Illness
Depression, anxiety, addiction underreported
Chronic respiratory diseases
Asthma, COPD due to pollution and smoking
🔹 3. Nutritional Problems
Issue
Details
Malnutrition in children
Wasting, stunting, underweight
Anemia in women
Especially pregnant and adolescent girls
Vitamin and mineral deficiencies
Vitamin A, D, Iodine
Obesity and Overnutrition
Growing problem in urban areas
Protein-Energy Malnutrition (PEM)
Kwashiorkor and Marasmus still reported
🔹 4. Maternal and Child Health Problems
Indicator
Current Challenges
Maternal Mortality Rate (MMR)
Improved but still high in rural/tribal areas
Infant Mortality Rate (IMR)
Due to preterm birth, infection, malnutrition
Low birth weight
Linked to poor maternal nutrition
High teenage pregnancy
Related to early marriage
🔹 5. Environmental and Occupational Health Problems
Problem
Impact
Air pollution
Major cause of respiratory diseases
Water pollution
Leads to diarrhea, cholera, hepatitis
Poor sanitation
Contributes to parasitic infections
Occupational diseases
Silicosis, asbestosis, pesticide poisoning
🔹 6. Population Explosion
India has over 1.4 billion people.
Leads to pressure on:
Health services
Housing
Employment
Education
Increases maternal and child health burden
🔹 7. Geriatric Health Problems
Issues
Details
Chronic illnesses
Diabetes, hypertension, arthritis
Mental health
Depression, loneliness, dementia
Neglect and abuse
Social isolation, elder neglect cases rising
🔹 8. Accidents and Injuries
Road traffic accidents: One of the leading causes of death in youth
Occupational injuries
Burns, falls, drowning, and poisoning
🔹 9. Mental Health Problems
Growing due to stress, unemployment, substance abuse
Suicide rate increasing among youth
Lack of mental health awareness and stigma
✅ III. HEALTH INDICATORS OF INDIA (Approximate)
Indicator
Latest Data (may vary slightly)
IMR (Infant Mortality Rate)
~28 per 1,000 live births
MMR (Maternal Mortality Ratio)
~97 per 100,000 live births
Life Expectancy
~70 years
Total Fertility Rate (TFR)
~2.0 (declining trend)
Under-5 Mortality Rate
~36 per 1,000
Malnutrition in under-5
~35% stunted
✅ IV. NATIONAL HEALTH PROGRAMS TO ADDRESS THESE PROBLEMS
National Health Mission (NHM)
Reproductive and Child Health (RCH)
Universal Immunization Program (UIP)
POSHAN Abhiyaan (Nutrition)
National TB Elimination Program (NTEP)
National Mental Health Program (NMHP)
National Programme for Prevention and Control of NCDs (NP-NCD)
Ayushman Bharat – PMJAY and Health & Wellness Centres