INTERNSHIP 1: PUBLIC HEALTH DOMAIN 1

UNDERSTANDING HEALTH NEEDS AND PUBLIC HEALTH INTERVENTION DESIGN

4TH YEAR | 1ST SEM

As a Public Health Pharmacist it's important to first Public health does not just deal with the
appreciate the larger field of Public health. individual level but it also tries to deal with the
The environment we work in : Explaining the spread of community level (population).
coronavirus with an Iceberg Analogy ● It is understanding health needs and intervening
To help understand the spread of coronavirus in a to improve the health of the population. -Walley
population, think of an iceberg. The tip of the 2012
iceberg, above the water, represents everyone *Public health pharmacists work with society and
who has symptoms and has been diagnosed. the community, not just on the individual level.
Symptomatic cases make up about 20% of the The bigger the population, the more levels of
total of the infections.And the other 80% of public health.
infections? These exist "below the water." They
include individuals who have been sick, but not Who is involved in Public Health?
sick enough to be tested.As well as people who 1. Department of Health (DOH)
are asymptomatic, meaning they have not 2. World Health organization (WHO)
exhibited symptoms.The number of people who 3. World Bank
are infected is actually much higher than the
number of people who test positive-and all those Population Level
people can spread the virus to others. Even ● Global
without symptoms, staying home and practicing ○ WHO - “drivers/enablers” Different offices
social distancing ensures people "below the and levels.
water" won't spread the disease. HQ: Geneva, Switzerland
*Takeaways: In the recent or still current issue of ● National
the Covid-19 pandemic the concern is not just the ● Local
symptomatic cases or the 20% of an iceberg or
population but what we actually concern about is Nature of Organization
the rest of the population as well as the 80%. ● Public
This is what public health does, it handles the ● Private
whole iceberg or the whole population. Public - They have regional and country offices.
Health is also called “population health” because Regionally, the Philippines is part of the western
it studies the health of the population. pacific region office being handled by WHO
located at UN avenue in Manila.
What is Public Health? - National counterpart is the WHO country office
● The science and art of preventing disease, here in the Philippines and they have an office
prolonging life, and promoting health through located inside the DOH in Manila.
the organized efforts and informed choices of - World Bank also works globally, they give grants,
society, organizations, public and private loans, financial aid to organizations either public
communities and individuals. -Winslow, 1920 or private to pursue developmental goals.
*Most public health interventions are preventative - At the National level, there are also private and
rather than curative, more mitigating instead of public practices. Most well known public
addressing when you are already in the advanced organization is the DOH. The Philippine country
stage. The goal of public health is to make sure office for WHO provides assistance to the DOH as
that you are healthy and also to ensure life is well as LGUs, etc.
prolonged and the disease to no longer progress.
 UNDERSTANDING HEALTH NEEDS AND PUBLIC HEALTH INTERVENTION DESIGN

- Private Public Practices: Private healthcare ■ Then, it tries to understand

establishments such as the pharmaceutical additional layers, such as the
industry, have medicine access and corporate factors that contribute or
social responsibility programs. influence the increasing
- Local Level: through public health programs of prevalence of the disease.
the LGUs and project based programs of ■ Tha main tools in trying to
non-government organizations. understand things from a public
Secretary of Health: Teodoro J. Herbosa health point of view: statistics
Director General of FDA: Dr. Samuel Zacate and epidemiology.
○ GBD Visualizer/GBD Compare:
What is done in public health and what are the ■ Developed by the Institute for
problems that we are expected to solve? Health Metrics and Evaluation
It's the whole iceberg, health problems of the community by the University of
that you are handling Washington.
■ It gives you a visual on what
3 fundamental concepts in public health: disease causes the most burden
1. Burden of Disease (DALYs/Death) on a particular
2. Bundled concept of epidemiologic and population.
demographic transitions ■ In 2019, lifestyle
3. Determinants of Health related/non-communicable
diseases caused the most
Burden of Disease deaths followed by
● GDB (Global Burden of Disease) compared by communicable disease, and
IHME (Institute for Health Metrics and Evaluation.) injuries.
○ It answers the question: which diseases ■ Public Health Pharmacists must
cause the most illness/death in a learn to prioritize which
population? diseases to address first since
○ Clinician-patient relationship: where the resources are limited.
health professionals try to find and ■ 1990 vs 2019 (Burden of
understand the complaint of the patient Disease):
in order to address the issue of the ● General Trend for
patient. They ask themselves: what is Infectious
wrong? And they answer questions by (Communicable)
conducting a history and examination Diseases: Decrease
(e.g. knowing the signs and symptoms, ● General Trend for
and conducting laboratory tests) in order Lifestyle-related
to make a diagnosis, gauge the severity disease
of the disease and address it by (Non-communicable
providing therapy. disease): Increase
○ In contrast, in Public Health we are ● General Trend for
trying to learn facts about a disease Injuries: Increase
since it deals with the population.
■ Public Health aims to answer
the question: how prevalent is
Demographic transition Epidemiologic Transition
this disease in the community or
population level?
 UNDERSTANDING HEALTH NEEDS AND PUBLIC HEALTH INTERVENTION DESIGN

● Deaths due to Injuries were also higher because

With more older people in the population,
of more people are in the transport sector (mobile
communicable/infectious diseases become less common
and driving), road safety is a public health issue
and there are more non-communicable/chronic diseases.
● Mental health awareness
● There was a change in the pattern of disease - Mental Disorders are becoming prevalent
between 1990 and 2019. but are better handled right now
● With socioeconomic development including because of advance technology and
urbanization, better housing and water supply, better awareness
and increasing access to clean and purified water. ● Unfortunately from 1990-2019 there is an
● With urbanization, more people are becoming a increase in deaths due to injuries.
part of the productive workforce and we are living Determinants of Health
in bigger cities and in smaller spaces. - The different factors that shape the health of
● With socioeconomic development, we have more individuals and communities
access to better education and better health - Helps in analyzing particular problems seen right
services as compared to before. now and how to use/formulate solutions to
● All of these have an effect on the pattern of address those public health problems
disease. This change in environment has an effect - Diseases can be caused by many factors, we
the pattern of disease such as a reduction of traditionally try to explain it for example Covid-19
infectious diseases (i.e. decrease rates of diarrhea is caused by Coronavirus, Dengue is acquired from
due to better water supply) a bite of mosquito infected with the dengue virus,
○ Couples also have less children; since type 1 diabetes occurs when the pancreas has
parents are becoming more productive– difficulty in producing insulin presenting
that means they are part of the difficulties in regulating blood sugar. But in
workforce. This may also be brought determinants of health we tend to focus more on
about by better awareness and access to the holistic view, we come to understand that
family planning. getting a disease not only has direct causes but
● Moreso, there are changes in the pattern of also indirect or underlying causes=determinants
disease because we are living in an environment of health.
where mobility has changed which can affect - From macro to micro=have a contribution to the
lifestyle. progression of disease
● In terms of demography, there are declining birth - A disease not only cause by a virus but also the
and death rates. environment, where you live, income level and
● Pattern of the disease in the community and state of relationships
population shifts to having more chronic - Provides a holistic approach in providing different
diseases/non communicable diseases such
solutions in trying to address a disease
diabetes, hypertension, high cholesterol.
● Changes in mortality and patterns of diseases is
called epidemiologic transition.
● In the earlier graphs the 1990 and 2019 graphs
have significant difference

● Communicable / infectious diseases

- Consistent deaths
● Non-communicable diseases
- Lifestyle related diseases
 UNDERSTANDING HEALTH NEEDS AND PUBLIC HEALTH INTERVENTION DESIGN

- Holistic approach: easier accessibility for 1992 - HepB (infants)

healthcare services 2010 - Pentavalent vaccine and MMR (infants)
- Public health intervention during COVID-19 2012 - Rotavirus (infants, selected regions)
pandemic = “AYUDA” giving a direct income was a 2013 - PCV (infants), IPV (infants), MR and Td (school
means to people to minimize the risk factors of children)
getting a disease 2015 - HPV (selected provinces, females 9-10 years old)
2017 - Dengue (3 regions, children 9-10 years;
ADDRESSING PUBLIC HEALTH ISSUES suspended)
1. Public health interventions 2019 - JEV (endemic regions, aged 9 months to 5 years
- Actions that aim to improve health
- Any strategies that were trying to do to TB Free Philippines
employ our action to address a particular
issue
- Examples: immunization, lifestyle related
interventions, condom promotion (to
reduce HIV)
- Public health tries to deal with the
palliative aspect of addressing or
tentative aspect of a disease to prevent
progression of it
- Providing medicines
- Any action that tries to address a disease
2. Public health programmes
- The systematic implementation of DOH (2020) Updates Philippines STrategic TB Elimination
interventions to control disease Plan 2020-2023
- Does not only target one aspect, we try
to address the many aspects of acquiring
a disease “Sometimes I write down tasks after I’ve done them, just
- Example: a program trying to address to get the satisfaction of crossing them off my list.”
STDs will ideally have components such
as sexual education, condom provision,
reducing blood borne transmission with
screening, early diagnosis through
services and voluntary counseling and
testing, for advance stages = usage of
antiretrovirals
3. Public health pharmacy
- A public health programme dealing with
access to safe, effective and affordable
medicines

SPECIFIC EXAMPLES
Evolution of EPI in the Philippines (Ulep and Uy, 2021)
1976 - Philippine EPI launched
1979 - BCG, DPT, OPV, TT (infants and mothers)
1982 - Anti-measles vaccine (infants)