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A walk in the Park

This blog is dedicated to everyone who has struggled with Community Medicine. Through my posts I hope to simplify and demystify community medicine. The emphasis will be on clarifying concepts rather than providing ready-made answers to exam questions.

Feedback is crucial for the success of this endeavour, so you are encouraged to comment and criticize if you cannot understand something.

If you want a topic to be discussed sooner rather than later, please let me know via

Facebook: http://www.facebook.com/pages/Community-Medicine-for-ASSES/429533760433198  

[Alternatively, you may join the group communitymedicine4asses: 


Twitter: @DocRoopesh

In addition, you could take a short survey to help improve this blog:


A single example may not be able to explain 100% of a given topic, so multiple examples may be provided to explain different parts of a single concept.

If something doesn’t seem right:

a. Write to me about it (at communitymedicine4asses@yahoo.com), and

b. Cross check with another source (textbook, expert, etc.)

I hope that my exertions will make your experience with community medicine seem like a “Walk in the Park”

Note 1. Those who wish to contact me on facebook are requested to kindly send a personal message introducing themselves along with the request. This will help save time and effort of all concerned. Please do not expect me to visit your page to try and identify you/ your areas of work/ interest, etc. It is common courtesy to introduce oneself to another when interacting for the first time. I am merely requesting that the same civil courtesy be extended here, too. Henceforth, I may not accept any friend requests/ requests to join the group on facebook unless accompanied by a note of introduction (except when I already know the sender).  

Note 2. Please understand that this blog (and the corresponding facebook page/ group) is maintained in my spare time. I have a full time job, and am available to pursue these activities only after regular working hours (after 5 pm Indian Standard Time). However urgently you may wish to receive a response from me, I will be able to respond only upon returning home from work (I am offline the rest of the time).

Note 3. Please mind your language when interacting with me/ in the group linked to this blog. Rude/ offensive language will result in expulsion from both my friends list and the said group.

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A version of ICD-11 released (18 June 2018)

The World Health Organization (WHO) has released a version of the International Classification of Diseases, 11th version (ICD-11) on 18th June 2018.

Background Information:

The International Classification of Diseases (ICD) was developed as a means to ensure uniformity in recording of diseases for mortality and morbidity reports worldwide.

The first international classification edition, known as the International List of Causes of Death, was adopted by the International Statistical Institute in 1893.

WHO was entrusted with the ICD at its creation in 1948 and published the 6th version, ICD-6, that incorporated morbidity for the first time. The WHO Nomenclature Regulations, adopted in 1967, stipulated that Member States use the most current ICD revision for mortality and morbidity statistics. The ICD has been revised and published in a series of editions to reflect advances in health and medical science over time.

ICD-10 was endorsed in May 1990 by the Forty-third World Health Assembly. It is cited in more than 20,000 scientific articles and used by more than 100 countries around the world.

The decision to reboot the ICD for the 21st century was made in 2000 at the World Health Assembly. Until then, the ICD had been revised every decade or so (ICD-10 released in 1990). The reason for revising the code every decade or so is this: countries can apply to develop their own adaptations. They are not allowed to change the basic code, but they can add detail – essentially producing more granular versions tailored to their health systems and circumstances.

As WHO tweaks the ICD through the years to take into account new understandings of medicine, countries are expected to follow suit. Many do not, however. Every year, WHO takes slightly incompatible data from countries and makes them comparable. Over the years though, version control slips too far and several slightly varying versions appear all over the world. Thus, a new version becomes necessary to reset the system.

ICD-11, however, has been produced electronically and therefore should act more as a living document to which everyone has access. Its agility should ensure considerable longevity.

ICD is the foundation for the identification of health trends and statistics globally, and the international standard for reporting diseases and health conditions. It is the diagnostic classification standard for all clinical and research purposes. ICD defines the universe of diseases, disorders, injuries and other related health conditions, listed in a comprehensive, hierarchical fashion that allows for:

  • easy storage, retrieval and analysis of health information for evidenced-based decision-making;
  • sharing and comparing health information between hospitals, regions, settings and countries; and
  • data comparisons in the same location across different time periods.

Uses include

  • monitoring of the incidence and prevalence of diseases,
  • observing reimbursements and resource allocation trends,
  • keeping track of safety and quality guidelines, and
  • counting of deaths as well as diseases, injuries, symptoms, reasons for encounter, factors that influence health status, and external causes of disease.

Key Messages

On 18 June 2018, 18 years after the launch of ICD-10, WHO released a version of ICD-11 to allow Member States time to plan implementation. This is anticipating the presentation of ICD-11 to the World Health Assembly in 2019 for adoption by countries. Over a decade in the making, this version is a vast improvement on ICD-10.

ICD has been reviewed to accommodate for the needs of multiple use cases and users in recording, reporting, and analysis of health information. ICD-11 comes with:

  • Improved usability – more clinical detail with less training time
  • Updated scientific content
  • Enables coding of all clinical detail
  • Made eHealth ready for use in electronic environments
  • Linked to relevant other classifications and terminologies
  • Full multilingual support (translations and outputs) 


First, it has been updated for the 21st century and reflects critical advances in science and medicine.

Second,  it can now be well integrated with electronic health applications and information systems. This new version is fully electronic, significantly easier to implement which will lead to fewer mistakes, allows more detail to be recorded, all of which will make the tool much more accessible, particularly for low-resource settings.

A third, important feature is that ICD-11 has been produced through a transparent, collaborative manner, the scope of which is unprecedented in its history. An overriding motive in this revision was to make the ICD easier to use.

A critical point in engaging with the ICD is that inclusion or exclusion is not a judgement on the validity of a condition or the efficacy of treatment. Thus, the inclusion for the first time of traditional medicine is a way of recording epidemiological data about disorders described in ancient Chinese medicine, commonly used in China, Japan, Korea, and other parts of the world.

Example: Revisions in inclusions of sexual health conditions are sometimes made when medical evidence does not back up cultural assumptions. For instance, ICD-6 published in 1948 classified homosexuality as a mental disorder, under the assumption that this supposed deviation from the norm reflected a personality disorder; homosexuality was later removed from the ICD and other disease classification systems in the 1970s.

Useful Links:

Link to the WHO news release:


Link to the ICD-11 website:


Link to WHO video on ICD:


Link to Question & Answer video on Revision of ICD-11:

Link to Question and Answer video on Revision of ICD-11 (Mental health):

Link to Question and Answer on Revision of ICD-11 (Gender incongruence):