Unit I: Concept of Health and Disease; Social & Psychological Aspects of Health; Nutrition and Health Indicators

1. Concept of Health and Disease

• Health (WHO Definition, 1948):
  “A state of complete physical, mental and social well‑being and not merely the absence of disease or infirmity.”

  • Key Points:

    • Holistic View: Goes beyond absence of illness to include mental and social dimensions.

    • Dynamic State: Health can vary over time and in different contexts.

• Disease:
  A deviation from normal structure or function of any body part or system, manifested by characteristic signs and symptoms.

  • Acute vs. Chronic:

    • Acute diseases (e.g., acute gastroenteritis) have rapid onset and short duration.

    • Chronic diseases (e.g., diabetes mellitus) persist over long periods and often require ongoing management.

2. Social Aspects of Health

• Social Determinants of Health:
  Conditions in which people are born, grow, live, work, and age that influence health outcomes.

  • Examples: Socioeconomic status, education, employment, social support networks, access to healthcare.

• Community and Health:

  • Role of Community Pharmacy:

    • First point of contact for health advice and minor ailments.

    • Promotes rational use of medicines and immunization services.

  • Health Promotion:

    • Organizing awareness camps on tobacco cessation, diabetes screening, blood donation drives.

3. Psychological Aspects of Health

• Mental Well‑being:
  The ability to cope with normal stresses of life, work productively, and contribute to community.

• Stress and Coping:

  • Stressors: Life events (e.g., exams, job loss) that challenge homeostasis.

  • Coping Mechanisms: Adaptive (exercise, social support) vs. maladaptive (substance abuse).

• Role of Pharmacist:

  • Identify signs of depression or anxiety in patients collecting long‑term medications.

  • Provide counseling or referral to mental health professionals.

4. Nutrition and Health Indicators

• Nutrition:
  The science of nutrients in food, how the body uses them, and the relationship between diet, health, and disease.

  • Macronutrients: Carbohydrates, proteins, fats—provide energy and structural components.

  • Micronutrients: Vitamins and minerals—regulate biochemical processes (e.g., vitamin D for calcium absorption).

• Key Health Indicators:

  • Anthropometric Measures:

    • Body Mass Index (BMI): weight (kg) ÷ height² (m²).

      • Underweight: < 18.5; Normal: 18.5–24.9; Overweight: 25–29.9; Obese: ≥ 30.

    • Waist‑Hip Ratio (WHR): indicator of fat distribution and cardiovascular risk.

  • Biochemical Indicators:

    • Hemoglobin Level: detects anemia (normal: Men 13–17 g/dL; Women 12–15 g/dL).

    • Serum Lipid Profile: total cholesterol, LDL, HDL, triglycerides—assess cardiovascular risk.

  • Clinical Indicators:

    • Blood Pressure: normal < 120/80 mm Hg; hypertension stages I & II.

    • Glycated Hemoglobin (HbA1c): long‑term glucose control in diabetics (target < 7%).

5. Relevance for B.Pharm Students

• Public Health Role: Understanding social and psychological dimensions enables pharmacists to tailor health education and interventions.

• Patient Counseling: Nutritional guidance (e.g., dietary modifications in dyslipidemia or diabetes) complements pharmacotherapy.

• Preventive Strategies: Early identification of risk factors (BMI, blood pressure) allows referral to preventive services, reducing disease burden.

Unit II: Preventive Healthcare, Immunization & Hygiene; Epidemiology—Types and Methods; Disease Transmission and Control

1. Preventive Healthcare

Preventive healthcare aims to avert the onset of disease or detect it early to reduce its impact.

• Levels of Prevention

  • Primary Prevention: Stops disease before it occurs.

    • Examples: Health education on smoking cessation; vaccination programs.

  • Secondary Prevention: Early detection and treatment to halt progression.

    • Examples: Blood pressure screening; Pap smear tests.

  • Tertiary Prevention: Reduces complications or disability from established disease.

    • Examples: Rehabilitation after stroke; diabetic foot care clinics.

• Role of the Pharmacist

  • Conduct blood‐pressure and blood‐glucose screening camps.

  • Counsel on lifestyle modifications (diet, exercise, smoking cessation).

  • Ensure availability and proper storage of vaccines and hygienic disposables.

2. Immunization & Hygiene

• Immunization

  • Active Immunization: Administration of antigenic material (vaccines) to stimulate body’s immune response.

    • Examples: DPT (diphtheria–pertussis–tetanus) vaccine; hepatitis B vaccine.

  • Passive Immunization: Transfer of pre‐formed antibodies.

    • Examples: Administration of anti‐snake venom; immunoglobulin for rabies exposure.

  • Cold Chain Maintenance: Ensuring vaccines are stored at recommended 2–8 °C from manufacture to administration.

• Personal and Community Hygiene

  • Personal Hygiene: Handwashing with soap and water, safe food handling, oral hygiene.

  • Environmental Hygiene: Safe disposal of biomedical waste; clean water supply; vector control (mosquito nets, insecticide spraying).

  • Pharmacy Practice:

    • Promote hand hygiene with alcohol‐based rubs.

    • Educate patients on correct disposal of sharps and expired medicines.

3. Epidemiology: Types of Studies

Epidemiology studies the distribution and determinants of health‐related states in populations.

• Descriptive Epidemiology

  • Purpose: Describe occurrence by person, place, and time.

  • Measures: Incidence (new cases/unit time), prevalence (existing cases/population).

  • Example: Mapping seasonal peaks of influenza in different regions.

• Analytical Epidemiology

  • Purpose: Identify causes or risk factors by comparing groups.

  • Study Designs: Case–control, cohort (as covered in Unit IV).

  • Measure of Association: Odds ratio (OR), relative risk (RR).

• Experimental Epidemiology

  • Purpose: Test preventive or therapeutic interventions in controlled settings (e.g., vaccine trials).

  • Design: Randomized controlled trials.

4. Methods of Epidemiological Investigation

• Surveillance

  • Continuous monitoring of disease incidence (e.g., National Measles Surveillance Programme).

  • Active Surveillance: Health workers actively seek cases (e.g., field visits).

  • Passive Surveillance: Routine reporting by healthcare facilities.

• Outbreak Investigation Steps

  1. Verify the Diagnosis: Confirm cases with clinical and laboratory criteria.

  2. Define & Identify Cases: Establish case definition and search for additional cases.

  3. Descriptive Analysis: Temporospatial mapping and epidemic curves.

  4. Generate & Test Hypotheses: Use case–control interviews or environmental sampling.

  5. Implement Control Measures: Vaccination drives, water chlorination, isolation of patients.

  6. Communicate Findings: Report to health authorities and publish recommendations.

5. Disease Transmission & Control

• Modes of Transmission

  • Direct: Person‐to‐person contact (e.g., respiratory droplets in influenza).

  • Indirect: Through an intermediate object or vector (e.g., contaminated water, mosquitoes in dengue).

• Chain of Infection

  1. Agent (pathogen)

  2. Reservoir (human, animal, environment)

  3. Portal of Exit (coughing, blood)

  4. Mode of Transmission (contact, airborne, vector)

  5. Portal of Entry (respiratory tract, broken skin)

  6. Susceptible Host (immunocompromised, unvaccinated)

• Control Strategies

  • Breaking the Chain:

    • Agent Control: Disinfection, antimicrobial stewardship.

    • Reservoir Control: Isolation of cases, rodent control.

    • Transmission Control: Barrier nursing, insecticide‐treated nets.

    • Host Protection: Vaccination, prophylactic drugs (e.g., antimalarials).

Relevance for B.Pharm Students:
Mastery of preventive strategies, immunization principles, and epidemiological methods empowers pharmacists to participate in public health campaigns, manage outbreaks effectively, and counsel communities on hygiene and disease prevention.

Unit III: National Health Programmes & Role of Pharmacists in Public Health

1. Overview of National Health Programmes

National health programmes are targeted initiatives launched by the government to control, reduce, or eliminate specific diseases and health challenges. They typically combine prevention, diagnosis, treatment, and surveillance.

2. National Malaria Control Programme

• Objective: Reduce malaria morbidity and mortality through early diagnosis and effective treatment.

• Key Components:

  1. Case Management: Free rapid diagnostic tests (RDTs) and artemisinin-based combination therapy (ACT).

  2. Vector Control: Distribution of insecticide‑treated bed nets (ITNs), indoor residual spraying (IRS).

  3. Surveillance: Reporting of all suspected and confirmed cases for timely response.

• Targets:

  • ≥ 90% reduction in incidence and mortality (relative to a baseline year).

  • Elimination in low‑burden areas by strengthening community health workers.

3. National Tuberculosis Elimination Programme (NTEP)

• Objective: “End TB” by 2025 through universal access to TB care and prevention.

• Key Strategies:

  1. Active Case Finding: Screening high‑risk groups (e.g., slum dwellers, diabetics).

  2. Directly Observed Treatment, Short‑Course (DOTS): Ensure adherence with supervised doses.

  3. Drug‑Resistant TB Management: Rapid molecular diagnostics (CB‑NAAT) and individualized regimens.

• Milestones:

  • 2020: ≥ 90% treatment success rate.

  • 2025: Reduce TB incidence by 50% from 2015 levels.

4. National AIDS Control Programme (NACP)

• Objective: Prevent new HIV infections, provide care and support to people living with HIV, and minimize impact.

• Key Phases:

  1. Preventive Interventions: Safe blood transfusion, condom promotion, harm reduction for injecting drug users.

  2. Testing & Counselling: Voluntary counselling and testing centres (VCTCs), provider‑initiated testing.

  3. Antiretroviral Therapy (ART): Free lifelong ART through government centres; “Test and Treat” policy.

  4. Support Services: Nutritional support, adherence counselling, and stigma reduction.

• Indicators:

  • ≥ 90% of PLHIV diagnosed, 90% of those on ART, 90% virally suppressed (“90‑90‑90” targets).

5. Other Key Programmes (Briefly)

• National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke (NPCDCS)

• Revised National Tuberculosis Control Programme (RNTCP) – now under NTEP

• Universal Immunization Programme (UIP)

6. Role of Pharmacists in Public Health

1. Medicine Supply & Management

   • Ensure uninterrupted availability of RDT kits, antimalarials, anti‑TB drugs, and ART.

   • Maintain proper cold chain for vaccines under UIP.

2. Patient Counseling & Adherence Support

   • Educate patients on dosage schedules, potential side effects, and importance of completing full courses (DOTS, ART).

   • Use motivational interviewing to improve adherence.

3. Health Education & Advocacy

   • Conduct community awareness sessions on malaria prevention (use of ITNs), TB symptoms, and HIV prevention.

   • Advocate for vaccination uptake and address vaccine hesitancy.

4. Adverse Event Monitoring

   • Report suspected ADRs from antimalarials, anti‑TB drugs, and ART to the pharmacovigilance programme.

   • Participate in active surveillance for drug resistance.

5. Participation in Surveys & Screening Camps

   • Organize or support blood‑sugar and blood‐pressure screening under NPCDCS.

   • Facilitate HIV testing drives and link reactive cases to care.

7. Relevance for B.Pharm Students

• Interdisciplinary Collaboration: Work with public health teams, NGOs, and local health authorities.

• Ethical Responsibility: Uphold confidentiality and non‑discrimination, especially in HIV/AIDS care.

• Continuous Learning: Stay updated on guidelines (e.g., WHO, NACO, NVBDCP) to ensure best practices in community pharmacy and public health settings.

Unit IV: Health Education & Communication; Disaster Management; Community Pharmacy Practices

1. Health Education and Communication

Health Education is a process of imparting information and skills to individuals or communities to improve health literacy and promote behavior change. Effective communication ensures that messages are understood and acted upon.

• Key Principles

  • Audience Analysis: Tailor content to age, education, culture, and language.

  • Clear Messaging: Use simple language, avoid medical jargon.

  • Interactive Methods: Encourage questions, demonstrations, and role‑plays.

• Channels & Tools

  • Print Media: Pamphlets, posters, billboards—use visuals and bullet points.

  • Mass Media: Radio, TV, social media—reach large audiences quickly.

  • Interpersonal: One‑on‑one counseling, group talks, workshops.

• Steps in Planning a Health Education Session

  1. Assess Needs: Identify knowledge gaps and misconceptions.

  2. Define Objectives: “By the end, 80% of participants will know three hand‑washing steps.”

  3. Develop Content & Materials: Flipcharts, videos, demonstration kits.

  4. Deliver & Facilitate: Use storytelling, Q&A, and real‑life examples.

  5. Evaluate: Pre‑/post‑tests, feedback forms, observation of behavior change.

2. Disaster Management

Pharmacists play a vital role before, during, and after disasters by ensuring medicine availability and advising on public health measures.

• Phases of Disaster Management

  1. Preparedness

     • Maintain emergency drug kits (e.g., ORS, analgesics, antibiotics).

     • Develop a communication plan with local health authorities.

  2. Response

     • Rapidly dispense essential medicines at relief camps.

     • Counsel on safe water purification, sanitation, and infection prevention.

  3. Recovery

     • Restock supply chains; assess cold‑chain integrity for vaccines.

     • Participate in mental health first aid and community rehabilitation.

  4. Mitigation

     • Educate communities on disaster‐proofing homes and medication storage.

     • Advocate for inclusion of essential medicines in local contingency plans.

3. Community Pharmacy Practices

Community pharmacies are frontline health‐care access points. Beyond dispensing, pharmacists engage in a range of preventive and promotional services.

• Essential Services

  • Medication Dispensing & Counseling: Verify prescriptions, explain dosage, warn about interactions.

  • Screening Services: Blood‐pressure, blood‐glucose, cholesterol checks.

  • Immunization: Administer vaccines (e.g., influenza, hepatitis B) where regulations permit.

  • Health Promotion: Run smoking‑cessation programs, weight‑loss clinics, and nutritional advice sessions.

• Good Pharmacy Practice (GPP) Standards

  • Maintain privacy and confidentiality during counseling.

  • Ensure proper storage (temperature, humidity) of all pharmaceuticals.

  • Keep accurate records of inventory, controlled substances, and patient profiles.

• Innovations in Community Pharmacy

  • Telepharmacy: Remote counseling and prescription verification via video calls.

  • Mobile Health (mHealth) Apps: Medication reminders, refill alerts, and drug information portals.

  • Point‑of‑Care Testing (POCT): Rapid tests for HbA1c, cholesterol, or infectious diseases.

4. Relevance for B.Pharm Students

• Communication Skills: Mastery of health‐education techniques enables you to influence community behavior positively.

• Emergency Preparedness: Understanding disaster management protocols prepares you to maintain continuity of care under crisis.

• Expanded Role: As pharmacists, you can evolve into “health hubs” providing screening, immunization, and telehealth—especially critical in underserved areas.

Unit V: Role of WHO, ICMR & Other Health Bodies; Environmental Health—Air, Water & Waste Management

1. Role of International & National Health Organizations

a. World Health Organization (WHO)

• Mandate: “The attainment by all peoples of the highest possible level of health.”

• Functions:

  • Setting global health norms and standards (e.g., International Pharmacopoeia).

  • Providing technical support to countries for disease control and health systems strengthening.

  • Coordinating international surveillance (e.g., Global Influenza Surveillance).

• Key Programs:

  • Expanded Programme on Immunization (EPI)—guides vaccine schedules.

  • Global Action Plan for AMR—combating antimicrobial resistance.

b. Indian Council of Medical Research (ICMR)

• Mandate: Apex body for formulation, coordination, and promotion of biomedical research in India.

• Functions:

  • Funding and conducting research on priority health issues (e.g., tuberculosis, leprosy, vector‑borne diseases).

  • Developing national guidelines (e.g., Standard Treatment Guidelines).

  • Operating a network of national institutes (e.g., National Institute of Virology).

c. Other Key Bodies

• Ministry of Health & Family Welfare (MoHFW): Policy formulation, implementation of national health programs.

• National Vector Borne Disease Control Programme (NVBDCP): Malaria, dengue, chikungunya control.

• National Accreditation Board for Hospitals & Healthcare Providers (NABH): Standards for quality in healthcare delivery.

• UNICEF, UNDP & World Bank: Technical and financial support for public health initiatives (maternal and child health, TB elimination).

2. Environmental Health: Overview

Environmental health examines how environmental factors affect human health and disease. As future pharmacists, understanding these links helps in community counseling and policy advocacy.

3. Air Quality Management

• Air Pollutants of Concern:

  • Particulate Matter (PM2.5 & PM10): Penetrate deep into lungs—linked to respiratory and cardiovascular diseases.

  • Gaseous Pollutants: NO₂, SO₂, CO, O₃—irritate airways and impair oxygen transport.

• Monitoring & Standards:

  • National Ambient Air Quality Standards (NAAQS) set permissible limits for each pollutant.

  • Air Quality Index (AQI): Translates complex data into a simple scale (Good to Severe).

• Control Measures:

  • Promoting clean fuel (LPG, CNG), emission controls on industries and vehicles.

  • Public education on reducing exposure (e.g., masks, air purifiers).

4. Water & Sanitation

• Waterborne Hazards:

  • Microbial Contaminants: Cholera, typhoid, hepatitis A—spread through fecal‐oral route.

  • Chemical Contaminants: Fluoride, arsenic, heavy metals—cause chronic health effects.

• Safe Water Provision:

  • Standards: Bureau of Indian Standards (IS 10500) for drinking water quality.

  • Treatment: Chlorination, filtration, UV disinfection.

• Sanitation Practices:

  • Solid & Liquid Waste Management:

    • Proper sewage systems, latrine construction under Swachh Bharat Mission.

    • Segregation, recycling, and safe disposal of municipal waste.

  • Pharmaceutical Waste:

    • Return‐to‐pharmacy programs for unused/expired medicines.

    • Incineration or encapsulation of cytotoxic and hazardous drugs per CPCB guidelines.

5. Solid Waste & Vector Control

• Municipal Solid Waste (MSW):

  • Composition: Organic (kitchen) and inorganic (plastics, metals).

  • Management Steps: Segregation at source; collection; transportation; processing (composting, recycling); disposal (landfills).

• Biomedical Waste (BMW):

  • Categories: Infectious, pathological, sharps, pharmaceutical, chemical.

  • Rules: BMW Management Rules, 2016—color‑coded bins and treatment (autoclaving, incineration).

• Vector Control:

  • Eliminating breeding sites (stagnant water).

  • Insecticide spraying and community awareness under NVBDCP.

6. Relevance for B.Pharm Students

• Advocacy: Counsel communities on pollution reduction, safe water practices, and proper pharmaceutical disposal.

• Collaboration: Engage with local health authorities, NGOs, and environmental agencies for public health campaigns.

• Research & Policy: Contribute to environmental health research (e.g., impact of air pollutants on drug efficacy) and policy formulation.