INTRODUCTION TO COMMUNITY AND PUBLIC HEALTH

WHAT IS HEALTH?
 HEALTH is a “state of complete physical, mental, and social wellbeing and
not merely the absence of disease.” (WHO, 1948)

PUBLIC HEALTH
 “The science & art of preventing disease, prolonging life, & promoting health
through the organized efforts & informed choices of society, organizations,
public & private communities, & individuals.” — CEA Winslow

COMMUNITY HEALTH
 “Community Health refers to the health status of a defined group of people
and the actions and conditions, both private and public (governmental), to
promote, protect, and preserve their health”. (McKenzie et al., 2005)

PERSONAL HEALTH
 ability to take charge of your health by making conscious decisions to
 be healthy
 physical wellbeing of an individual
 emotional, intellect, social, economical, and spiritual wellness.

The Mission of Public Health

 “Fulfilling society’s interest in assuring conditions in which people can be
healthy.”—Institute of Medicine
 “Public health aims to provide maximum benefit for the largest number of
people.”—WHO

Public Health Key Terms

Clinical Care:
 prevention, treatment, and management of illness and the preservation of
mental and physical well-being through the services offered by medical and
allied health professions.
Determinant:
 factor that contributes to the generation of a trait.
Epidemic or Outbreak:
 occurrence in a community or region of cases of an illness, specific health-
related behavior, or other health-related event clearly in excess of normal
expectancy.
Health Outcome:
 result of a medical condition that directly affects the length or quality of a
person’s life.

HISTORY OF PUBLIC HEALTH

 500 BCE - Greeks and Romans practiced community sanitation measures

 1840’s - The Public Health Act of 1848 was established in the United
Kingdom

 1970 - The Environmental Protection Agency was founded

Pandemics
 Influenza - 500 million infected worldwide in 1918
 Polio - Vaccine introduced in 1955; eradication initiative launched in 1988
 HIV - 34 million living with HIV worldwide; 20% decline in new infections
since 2001

Preparedness for Disaster Response

 Biologic Warfare - Plague used as a weapon of war during the Siege of
Kaffa

 September 2001 - Public health surveillance conducted after the 9/11

attacks

 Hurricane Katrina - Emergency services, public health surveillance, and

disease treatment provided
Prevention Through Policy
 Book of Leviticus - The world’s first written health code

 Tobacco Laws - Laws banning smoking in public places

 Obesity - Food labeling and promotion of physical activity

A PUBLIC HEALTH APPROACH

Public Health Core Sciences

 A Public Health Approach:
CHOLERA
 a fatal intestinal disease rampant during the early 1800s in London,
causing thousands of deaths in the area

John Snow
 best known for his work tracing the source of the cholera outbreak
 father of modern epidemiology

Epidemiology — What is the Problem?

 Cluster of Cholera Cases, London — 1854

Risk Factor Identification — What Is the Cause?

 Cluster of Cholera Cases and Pump Site Locations

Intervention Evaluation — What Works?

Through continuous research, Snow understood what interventions were required
to …
 stop exposure to the contaminated water supply on a larger scale, and
 stop exposure to the entire supply of contaminated water in the area

Implementation — How Do You Do It?

 John Snow’s research convinced the British government that the source of
cholera was water contaminated with sewage.


PUBLIC HEALTH: CORE FUNTIONS AND ESSENTIAL SERVICES

Core Functions of Public Health

1. ASSESSMENT
 Systematically collect, analyze, & make available information on
healthy communities

2. POLICY DEVELOPMENT
 Promote the use of a scientific knowledge base in policy and
decision making

3. ASSURANCE
 Ensure provision of services to those in need

TEN ESSENTIAL PUBLIC HEALTH SERVICES

Stakeholder Roles in Public Health

Non-governmental Organization Examples

Health Care as a Partner in Public Health

Other Partners in Public Health

  MEDIA
 Vehicle for public discourse
 Health education, promotion & communication
 Social media as catalyst

 EMPLOYERS AND BUSINESSES

 Employer-sponsored health insurance programs
 Wellness initiatives & benefits
 Healthy workplaces & communities

 GOVERNMENT AGENCIES
 City planning
 Education
 Health in all policies

 ACADEMIA
 Education
 Training
 Research
 Public Service

DETERMINING & INFLUENCING THE PUBLIC’S HEALTH

HEALTH IMPACT PYRAMID
HEALTH IMPACT PYRAMID

PUBLIC HEALTH CORE SCIENCES

 COMMUNITY AND PUBLIC
HEALTH

DIMENSIONS OF HEALTH
 These 5 dimensions of
health provide a full picture
of health.
 They are linked; problems
in one area can impact the
other.

1. PHYSICAL HEALTH
 The bodily aspect of
health.
 It refers to the more traditional definitions of health as the absence of
disease and injury.
 Affects other dimensions of health.

2. MENTAL HEALTH
 The cognitive aspect of health.
 It refers to the person’s ability to use their brain and think.
 Focuses on the functioning of the brain.
 Includes many mental health issues (Alzheimer’s & dementia).
 Mental healthcare affects the other dimensions of health.

3. EMOTIONAL HEALTH
 Pertains to a person’s mood or general emotional state.
 ability to recognize and express feelings adequately.
 It relates to self-esteem & the ability to control emotions & maintain a
realistic perspective on situations.

MENTAL HEALTH VS EMOTIONAL HEALTH

 4. SPIRITUAL HEALTH
 relates to our sense of overall purpose in life.
 Others find this purpose from a belief or faith system; some create
their own purpose.
 Having a purpose to life can also help people to maintain a proper
perspective on life and overcome adversity.
"The two most important days in your life are the day you are born and the day you
find out why." – Mark Twain

5. SOCIAL HEALTH

 refers to our ability to make and maintain meaningful relationships with

others.
 It also includes behaving appropriately within them and maintaining
socially acceptable standards.
 Family relationships impact a person’s life the most.

LEVELS OF PREVENTION
1. PRIMARY prevention
 prevents the onset of illness or injury before the disease process
begins.

2. SECONDARY prevention
 measures that lead to early diagnosis and prompt treatment of an
illness or injury to prevent more severe problems developing.

3. TERTIARY prevention
 aimed at rehabilitation following significant illness.
 retrain, re-educate and rehabilitate people who have already
developed an impairment or disability.

ETHICAL VALUES OF PUBLIC HEALTH

For Public Health Practitioners & Organizations

A. Professionalism and Trust.

 promote competence, honesty, & accuracy
  ensure that our work is not unduly influenced by secondary interests.
 transparent & honest about disclosing conflicting interests &
influences.
B. Health and Safety.
 essential conditions for human thriving.
 We have an ethical responsibility to prevent, minimize, and mitigate
health harms.
 Promote and protect public safety, health, and well-being.
C. Health Justice and Equity.
 to use our knowledge, skills, experience, & influence to promote
equitable distribution of benefits and opportunities for health,
regardless of relative position in social hierarchies.
D. Interdependence and Solidarity.
 foster positive relationships among individuals, societies, &
environments in ways that protect & promote the thriving of humans,
communities, animals, & ecologies.
E. Human Rights and Civil Liberties.
 observe social & cultural conditions of respect for personal autonomy,
self-determination, privacy, and the absence of domination.
F. Inclusivity and Engagement.
 be transparent
 be accountable to the public at large
 to include & engage diverse publics, communities, or stakeholders in
decision making.

LEVELS OF CLIENTELE
1. COMMUNITY
• A group of people sharing common geographic boundaries and common
values and interests.
2. POPULATION GROUP
• A group of people sharing common characteristic and development stage
and common exposure to environmental factors, thus resulting in common
health problems.
3. FAMILY
 • A number of persons joined together by bonds of marriage, blood or
adaptation.
• Two or more persons who are joined together by bonds of sharing and
emotional closeness and who identify themselves as being part of the
family.
4. INDIVIDUAL

LEVELS OF HEALTH CARE

REFERRAL SYSTEM IN THE PHILIPPINES

LEVELS OF HEALTH CARE

1. PRIMARY LEVEL OF CARE

 Primary health facility
 usually the first contact between the community members & the
other levels of health facility
 Health care provided by:
• center physicians
• public health nurses
• rural health midwives
• barangay health workers
• traditional healers
• others at the barangay health stations and rural health units

2. SECONDARY LEVEL OF CARE

 Health facilities either private owned or government operated
(infirmaries, municipal, & district hospitals & out-patient departments
of provincial hospitals)
 Capable of performing minor surgeries, simple laboratory
examinations
 Given by physician with basic health training
 Referral center for the primary health facilities

3. TERTIARY LEVEL OF CARE

  Rendered by specialists in health facilities including medical centers
(regional & provincial hospitals, and specialized hospitals)
 Referral center for the secondary care facilities.
 Complicated cases & intensive care

LEVELS OF HEALTH CARE

According to Increasing Complexity of According to the Type of Service

the
Services Provided
TYPE SERVICE TYPE EXAMPLE
PRIMARY Health promotion, Health promotion Information
preventive Care Illness prevention Dissemination
continuing care for
common health
problems, attention to
psychological and social
care, referrals
SECONDARY Surgery, Medical services Diagnosis and Screening
by treatment
specialists
TERTIARY Advanced, specialized, Rehabilitation PT / OT
diagnostic,
therapeutic &
rehabilitative care