Community health

Community medicine’s prime concern is to prevent disease. Community health responsibilities include: controlling housing standards and population density; the disposal of domestic and industrial waste; the maintainance of public hygiene; health screening; the elimination of sources of disease and infection, for instance, by vermin control or by neutralization (or drainage) of malarial swamps; and defining acceptable standards of burial. They can also extend to the provision of training and research facilities; the establishment and staffing of hospitals and clinics; the provision of medical emergency services; and the arrangement of financial support for sick people.

Water supply and sanitation

People everywhere need a constant supply of clean water for drinking, cooking, and washing, and also facilities for the removal of sewage waste. The latter must never contaminate the former, otherwise epidemics such as dysentery, typhoid, and cholera can result.

Water is collected from natural sources and stored in reservoirs. It is then purified and distributed for public usage. In some countries, one or two parts of fluoride per million are added to water, to help prevent tooth decay. Constant checks are carried out at all stages to see that no contamination occurs.

An adequate public and domestic water supply enables the sewage system to use waste water to transport the sewage from its source (washrooms) to sewage treatment works. This ensures that the transport is relatively swift and enables the system to be enclosed, which greatly reduces the spread of diseases, especially those such as food poisoning and dysentery, which are transmitted from feces to food by flies.

Milk is sterilized or pasteurized to kill bacteria such as these streptococci, which were photographed in a stained sample of untreated milk.

Vaccination programs

Children, adults, and animals are vaccinated against disease according to the principle established by a British doctor, Edward Jenner, in 1796. He discovered that people who had been given cowpox were protected against smallpox; this is because the cowpox virus, which causes a mild disease, stimulates production of antibodies that are effective against the smallpox virus. Babies are vaccinated against poliomyelitis, tetanus, diphtheria, measles, mumps, hepatitis B, and hemophyllus. Susceptible children are screened for tuberculosis. Vaccination against typhoid, cholera, and yellow fever is also required for people of all ages who are traveling in areas where they may contract these diseases. Smallpox vaccination has effectively eradicated the disease, so vaccination is no longer required.

Baby clinics are a valuable aspect of community health because they allow primary care physicians to regularly monitor the progress of growing infants. Any disorders are diagnosed and treated promptly. Parents are also given advice about hygiene, growth and development, and vaccinations.

Hygienic food processing

Hygienic controls are introduced at all stages of food production, from breeding and growing, to slaughtering and harvesting, to preparation and packing, to transporting and storing, and to selling, cooking, and serving. Such controls are obligatory in many countries, particularly where the food is being produced for storage and wholesale national or international marketing.

To prevent the spread of tuberculosis and brucellosis through dairy products, milk is pasteurized by being heated to 161° F. (72° C). This process kills most bacteria in the milk and improves its storage qualities without affecting its taste.

Cattle are vaccinated against brucellosis and tuberculosis, and meat is inspected for infections such as tapeworm after animals have been slaughtered in accredited slaughterhouses. Tuberculosis of the bone and brain tissue of cattle, which was common 50 years ago, is now rarely encountered in developed countries, as a result of scrupulous agricultural controls. Similar controls are applied to all other animals used as sources of food.

Food-processing factories, hotels, and restaurants are regularly inspected for the presence of vermin such as rats, mice, and cockroaches, and for evidence that adequate standards of hygiene are maintained in all parts of the operation where food might be contaminated. Stringent controls are also imposed to ensure that imported foods are fit for human consumption.

Malaria is spread by mosquitoes, so the disease can be prevented by destroying these carriers. The life cycle of a mosquito has three aquatic stages. Fish introduced to the breeding grounds reduce the population of mosquito eggs, larvae, and pupae. Alternatively, pupae can be killed by a thin layer of oil on the water surface, which prevents them from breathing.

Food additives

During manufacture, processed foods may be enriched with substances that benefit health, particularly vitamins and minerals, which are sometimes destroyed in the commercial preparation of such foods. Iron and other minerals are added to bread and cereal foods, and glucose is sometimes added to drinks and candies. Some foods contain extra bran to provide roughage, which helps prevent bowel disease.

Health screening

In many countries, schoolchildren are tested for tuberculosis susceptibility. Chest radiography which may be provided by companies, schools, or local health authorities is available if necessary to check for disorders such as tuberculosis, lung cancer, chronic chest infection, and other conditions. Regular health checks and education programs are also instituted wherever possible, often under the direction of international bodies such as the World Health Organization.

Women, particularly in developed countries, are advised to have regular cervical smear tests, called Pap tests, and to examine their breasts for lumps. Both these examinations increase the chances for cancer being detected at the earliest opportunity, when it can be treated more effectively.
Mothers are encouraged to take their babies and children to clinics or to their doctor’s office, where their development, weight, and rate of growth are noted against a chart of normal development. Their feeding programs are discussed and dietary advice is given where necessary. Nursing mothers are advised to continue breastfeeding as long as possible. In some countries, however, the need to return to work and the availability of artificial milks has encouraged many mothers to stop breastfeeding too soon. Consequently, their babies fail to acquire natural immunity to certain diseases and also suffer from illness caused by contamination of the artificial food. An important aspect of health education is the identification and correction of such harmful trends.

Safe sewage disposal is fundamental to community health. In primitive communities, sewage may be disposed of by using it as a fertilizer or by throwing it into a river. In an urban community, however, sewage can also be a serious source of disease if it is not properly treated.