L1: INTRODUCTION TO COMMUNITY AND PUBLIC HEALTH

For CPH (Week 1)

hale, sound, and whole

Health is derived from the word “Hal” which means ___,___,___

1. Health

2. 1946

3. holistic concept

• A state of complete physical, mental, and social well - being and not merely the absence of disease and infirmity 

• Most widely accepted definition of health and was set out in the preamble to the constitution of the WHO in (2)

• WHO encouraged a (3) of health

1. support

2. wider society

3. meaning and purpose

Health (Definition)

• A resource for everyday life, not the object of living, and is a positive concept emphasizing social and personal resources as well as physical capabilities - WHO, 1989

• WHO made a clarification from their first definition of health. Health is now a resource to (1) and individuals function in a (2) rather than an end in itself

• A healthful lifestyle provides the means to lead a full life with (3)

1. financial health

2. Spiritual

Health (Definition)

A dynamic state or condition of the human organism that is multidimensional (i.e., physical, emotional, social intellectual, spiritual and occupational) in nature, a resource for living, and results from a person’s interactions with and adaptations to his or her environment.

• This also includes (1). All new added examples also contribute to overall health. Medical experts have linked this to lower stress levels and improve mental and physical well-being.

• (2) is also included because those with good spiritual health may feel a sense of calm and purpose that fuels good mental health. 

Health Equity

The absence of systematic disparities in health between and within social groups that have different levels of underlying social advantages or disadvantages - that is, different positions in a social hierarchy

Community 

A geographic area with specific boundaries

Community and Public Health

• A collective body of individuals identified by common characteristics such as geography, interests, experiences, concerns, or values

1. membership 

2. common symbol systems 

3. shared values and norms 

4. mutual influence 

5. needs and commitment

6. emotional connection

Elements of Community 

• Communities are characterized by the following elements:

• (1)

  • A sense of identity and belonging. It is very common for communities to form among those who share a common sense of identity.

  • Ex. Alumni group

• (2)

  • Ex. similar language, rituals, or ceremonies

• (3)

  • Communities usually operate based on agreed rules and expectation

  • Ex. cleanliness, participation, respect

• (4)

  • Community members have influence and are influenced by each other

• shared (5) to meeting them 

• shared (6)

  • Ex. the members may share a common history, experiences, and mutual support

Public Health system

- it is every organization, every sector, and every person working together to protect and improve the health of the population.

Community Health

• Health status of a defined group of people and the actions and conditions to promote, protect, and preserve their health

• The health status of the people of Dasmariñas, Cavite, and the private and public actions taken to promote, protect, and preserve the health of these people would constitute community health

Population Health

Health outcomes of a group of individuals, including the distribution of such outcomes within the group

Group of individuals: whether by age, gender, income, marital status, etc.

Global Health

health problems, issues, and concerns that transcend national boundaries, may be influenced by circumstances or experiences in other countries, and are best addressed by cooperative actions and solutions

Prior to 2000 b.c.e

History of Public Health

Part 1: Years Before 1700s

Ancient Civilizations (Before 500 B.C.E)

Archeological findings provide evidence of sewage disposal and written medical prescriptions.

Circa 1900 b.c.e [mesopotamia]

History of Public Health

Part 1: Years Before 1700s

Ancient Civilizations (Before 500 B.C.E)

• Perhaps the earliest written record of public health was the Code of Hammurabi; included laws for physicians and health practices

  • Penalties for malpractice is also included in the code of hammurabi

Circa 1500 b.c.e

History of Public Health

Part 1: Years Before 1700s

Ancient Civilizations (Before 500 B.C.E)

• Bible's Book of Leviticus written; includes guidelines for personal cleanliness and sanitation. See Leviticus 15:11-18

  • Leviticus 15:11-18 – describes how to handle bodily fluids and how to stay clean which was essentially an early infection control measure

code of hammurabi

• The _______ indicates that physicians were merited by the public __ ?, they were to be rewarded with adequate fees, carefully prescribed and regulated by the law.

• If a surgeon damages a patient's eye, his hands could be cut off

The Greeks

History of Public Health

Part 1: Years Before 1700s

Classical Cultures (500 B.C.E)

• They believed that a strong body meant a strong mind which is why physical fitness was a major part of their culture

• men participated in games of strength and skill and swam in public facilities.

• involved in practice of community sanitation;

• involved in obtaining water from sources far away and not just local wells.

The Romans

History of Public Health

Part 1: Years Before 1700s

Classical Cultures (500 B.C.E)

• Improved community sanitation of Greeks; built aqueducts to transport water from miles away; built sewer systems;

  • Aqueducts gave them access to clean drinking water

  • Sewer systems helped remove waste water which reduced the contamination and disease

• created regulation for building construction, refuse removal, and street cleaning and repair

  • They created some of the earliest sanitation and urban planning policies

• created hospitals as infirmaries for slaves.

  • Established the first form of hospital especially for slaves and soldiers

The Christians

History of Public Health

Part 1: Years Before 1700s

Classical Cultures (500 B.C.E)

• Created hospitals as benevolent charitable organizations

  • These hospitals were safe places for the sick, poor, and abandoned. For them, caring for the sick is a moral duty so the hospitals became centers of compassion which provided food, shelter, and basic care

Fall of Roman Empire 476 C.E

History of Public Health

Part 1: Years Before 1700s

Classical Cultures (500 B.C.E)

• Most public health activities ceased

• Marked a major set back in public health because the people reverted back to unsanitary living conditions and without roman engineering and governance, diseases soon spread quickly and wildely

spiritual era of public health.

History of Public Health

Part 1: Years Before 1700s

The Dark Ages (500 C.E-1000 C.E)

Growing revulsion for Roman materialism and a growth of spirituality.

Health problems were considered to have both spiritual causes and spiritual solutions, a time referred to as the _______.

The Black Death (543-1348)

History of Public Health

Part 1: Years Before 1700s

The Dark Ages (500 C.E-1000 C.E)

Notable Epidemics:

• ________

  • Swept across Europe and killed about ⅓ of the population. It was so terrifying that people didn't even understand how it spread. Some blamed the air, alignment of planets, or divine punishment

• Leprosy (1200)

History of Public Health

Part 1: Years Before 1700s

The Dark Ages (500 C.E-1000 C.E)

Notable Epidemics:

• ______

• Caused skin lesions and nerve damage. During this time, people with this disease were shunned from society and moved to a different communities called Leper Colonies

Syphilis (1492)

History of Public Health

Part 1: Years Before 1700s

The Dark Ages (500 C.E-1000 C.E)

Notable Epidemics:

• _____

  • With limited understanding of sexually transmitted infections, people did not know how to prevent or cure the disease so it became another wide spread epidemic

Renaissance & Exploration (1500-1700)

• Rebirth of thinking about the nature of the world and humankind.

  • Revived curiosity, science, art and philosophy. People started questioning all beliefs and started studying the world through observation and experimentation

• Belief that disease was caused by environmental, not spiritual, factors.

• Observation of illness led to more accurate descriptions of symptoms and outcomes of diseases.

  • first recognition of whooping cough, typhus, scarlet fever, and malaria as distinct and separate diseases.

John Graunt

Renaissance & Exploration (1500-1700)

• 1662: _____ published the Observations on the Bills of Mortality, the beginning of vital statistics.

15%

Renaissance & Exploration (1500-1700)

• Epidemics (e.g., smallpox, malaria, and plague) still rampant.

  • plague epidemic killed 68,596 (____ of the population) in London in 1665.

1. Columbus

2. Hispaniola's indigenous inhabitants

Renaissance & Exploration (1500-1700)

• Explorers, conquerors, and merchants and their crews spread disease to colonists and indigenous people throughout the New World.

• (1) built his first town on the nearby island of Hispaniola. Lacking immunity to Old World pathogens carried by the Spanish, (2) fell victim to terrible plagues of smallpox, influenza, and other viruses.

18th Century

History of Public Health

Part 2: 1700 Onwards

• Characterized by industrial growth

  • Despite the beginnings of recognition of the nature of disease, living conditions were hardly conducive to good health.

• Many jobs were unsafe or involved working in unhealthy environments, such as textile factories and coal mines.

Edward Jenner

History of Public Health

Part 2: 1700 Onwards

18th Century

1796: _______ introduces smallpox vaccine.

1. Predominance of Miasmas

2. Bacteriological period of public health

3. Modern era of public health

History of Public Health

Part 2: 1700 Onwards

19th Century

• (1) Theory

• (2) - the period of 1875-1900, during which the causes of many bacterial diseases were discovered

• (3)- the era of public health that began in 1850 and continues today.

1. London

2. Dr. John Snow

3. Germ Theory of Diseases

4. Robert Koch

5. yellow fever

6. 1875-1900

7. Bacteriological Era of Public Health

History of Public Health

Part 2: 1700 Onwards

19th Century: The 1854 Cholera Endemic

• Struck (1)

• (2)studied the epidemic and hypothesized that the disease was being caused by the drinking water from the Broad Street Pump

• 1862: Louis Pasteur introduces (3) - DEATH BLOW OF THE THEORY OF SPONTANEOUS GENERATION

• 1876: (4) demonstrates the anthrax bacillus

• 1900: Reed declares that mosquitoes are the source of (5).

• (6)- Bacteriological period of Public Health

• 19th Century: Beginnings of (7)

1. April 7, 1948

2. 1959

3. 1980

20th Century

• 1945-1948: Foundation of WHO through the UN diplomats

  • (1): Constitution of WHO came into force, basis of World Health Day

• (2) - WHO Global Smallpox Eradication Program

  • (3) - Smallpox declared to be eradicated

1. R.A. No. 8423-TAMA of 1997- PITAHC

2. BANTAYLUBS/BABYPLANTS

History of Public Health

Part 3: Public Health in the Philippines

Pre-Spanish Era (Before 1545)

• Ancient Filipinos regarded health as a harmonious relationship with the environment, both natural and supernatural. (1)

• Use of medicinal plants to cure various ailments - (2)

1. FEMALE ANOPHELES MOSQUITOES

2. babaylan

History of Public Health

Part 3: Public Health in the Philippines

Pre-Spanish Era (Before 1545)

• Malaria has been present in the Philippines for centuries - (1)

• Ailments were believed to be caused by disharmony with the spiritual world, and restoring health meant appeasing the gods through rituals.

  • At the center of these rituals was the (2), mediator between the physical and spiritual worlds.

1. igasud

2. Pepita of San Ignacio

History of Public Health

Part 3: Public Health in the Philippines

Pre-Spanish Era (Before 1545)

• One of the most prized medicinal plants is the (1) from the mountain regions of the Visayas. Its seed when chewed is an antidote for poison.

  • renamed (2) by Spanish missionaries.

1. San Lazaro Church and Hospital

History of Public Health

Part 3: Public Health in the Philippines

Spanish Era (1565 - 1898)

• Spaniards attempt to westernize the practices of our ancestors.

• The (1) represents early medical healthcare in the Spanish era. Juan Clemente

1. Hospital Real

2. Miguel Lopez de Legazpi

3. King Philip II

4. Hospital de Naturales - SAN LAZARO

History of Public Health

Part 3: Public Health in the Philippines

Spanish Era (1565 - 1898)

(1)

• The very first hospital in the Philippines

• Established in Cebu in 1565 by (2) as approved by (3)

• Relocated in Manila when the seat of power transferred there.

• exclusively for Spanish soldiers and sailors

• destroyed during an earthquake on June 3, 1863 

• (4) (1578 by Fray Clemente)

• 1603 - Was destroyed by fire (following Fray Clemente's death).

• A new location was chosen for the reconstruction of the facility, a development that led to the establishment of one of the oldest medical institutions in the country, the Hospital de San Lazaro

1. Hospital de San Lazaro - SAN LAZARO HOSPITAL

2. Dilao (Paco)

3. Juan Nino de Tabora

4. Chine Pirate Chen Ch'e Kung

5. Miguel de Loarca

6. UST Faculty of Medicine and Pharmacy

History of Public Health

Part 3: Public Health in the Philippines

Spanish Era (1565 - 1898)

(1)

• Site : (2)

• The name was given after the hospital undertook the care of 150 lepers sent to the Philippines by the Japanese emperor Iemitsu in 1632 at the time of Governor-General (3).

• Demolished in 1662 when the city was under the threat of invasion by the (4)

• 1582 - (5) reported that inhabitants of Cebu were afflicted by itchy lesions and a certain “bubas.”

  • Accounts say this “bubas” came from Bohol when raiders from Maluku infected the natives.

• Introduction of safe water supply in the 1690s

  • The water taken from various water sources are stored in bamboo poles

• 1871 - (6) was established.

  • First medical school in the Philippines

1. Spanish Era: Smallpox - Beri-beri/Thiamine(b1) Deficiency

2. 1574 Smallpox Epidemic

3. Dr. Francisco de Balmis

4. King Carlos IV

History of Public Health

Part 3: Public Health in the Philippines

Spanish Era (1565 - 1898)

(1)

• (2) - first recorded epidemic in the country

• 1789 - a vessel from China traveling to the locos region was believed to be the probable source of an epidemic that soon spread to Manila and its neighboring provinces

• April 15, 1805 - (3) - smallpox vaccine expedition as ordered by (4)

Bureau of Public Health - Gen. Order 15

History of Public Health

Part 3: Public Health in the Philippines

American Era (1898 - 1918)

_______

• Part of Aguinaldo's government

1. Board of Health for City of Manila

2. Frank Bourns

3. Guy Edie

History of Public Health

Part 3: Public Health in the Philippines

American Era (1898 - 1918)

• Replaced by the (1) upon the takeover of the Americans

  • Headed by Dr. (2)

• 1899 - Appointment of Dr. (3) as the first Commissioner of the Board of Health

1. Philippine Islands

2. Insular Board of Health

3. UP College of Medicine and Surgery

4. Leper Law

5. Smallpox

6. 25 million

History of Public Health

Part 3: Public Health in the Philippines

American Era (1898 - 1918)

• 1901 - Board of Health for (1)

  • Became (2)

• 1902 - 1905: Cholera epidemic claimed 200,222 lives.

  • 66,000 were children

• 1905 - establishment of (3) using John Hopkins University as their model

• 1907 - enactment of the (4)

• 1917 - Mass Vaccination for (5)

  • (6) Filipinos were given the vaccine

1. Philippine Health Services

2. Jones Law by Woodrow Wilson

History of Public Health

Part 3: Public Health in the Philippines

American Era (1898 - 1918) towards Filipinization of Health Services

• 1915 - Bureau of Health reorganized and renamed as (1)

• 1916 - enactment of (2)

  • PHS came under the supervision of the Department of Public instruction

Dr. Vicente de Jesus

History of Public Health

Part 3: Public Health in the Philippines

American Era (1898 - 1918) towards Filipinization of Health Services

(1)

• 1914 - appointed as the first Filipino Assistant Director of Philippine Health Services; Became the Director in 1919

• Started the Filipinization of Health Services

Warren Harding

History of Public Health

Part 3: Public Health in the Philippines

American Era (1898 - 1918) towards Filipinization of Health Services

1921 - (1) becomes the US president

• Immediate investigation and evaluation of the conditions in the Philippines headed by Leonard wood and William Forbes

• noted the lack of hospitals and dispensaries and the loss of "zeal and vigor" among the health personnel.

• Focused on health education targeting young children and their mothers

• Required school children to undergo health examination once a year 

1. Theodore Roosevelt Jr.

2. Bureau of Health

History of Public Health

Part 3: Public Health in the Philippines

American Era (1898 - 1918) towards Filipinization of Health Services

• 1932 - (1). becomes Gov. Gen

• 1933 - Reverted PHS to (2)

1. Jose Fabella

2. Secretary of Health and Public Welfare

3. water-borne diseases

History of Public Health

Part 3: Public Health in the Philippines

American Era (1898 - 1918) towards Filipinization of Health Services

• 1934 - Dr. (1) is appointed as commissioner of Public Health and Welfare and soon as the first (2)

  • During this period, incidence of (3) significantly decreased due to the construction of a modern water filtration plant in Manila that supplied safe quality water:

1. Manuel L. Quezon

2. PHS, Office of Public Welfare Commissioner, and Tuberculosis Commission

History of Public Health

Part 3: Public Health in the Philippines

American Era (1898 - 1918) towards Filipinization of Health Services

• 1935 - Start of PH Commonwealth ((1))

• 1939 - Department of Health and Public Welfare

  • Combination of (2)

1. Jose P. Laurel

2. Claro M. Recto

3. Dr. Eusebio Aguilar

4. malaria, TB, and severe malnutrition

History of Public Health

Part 3: Public Health in the Philippines

Japanese Occupation (1942 - 1945)

• October 14, 1943 - inauguration of Japanese-sponsored republic with (1) as President

  • (2) - Commissioner of Education, Health, and Public Welfare

  • (3) - Director of Health

• Increased incidence of (3)

• About 5,000 segregated lepers escaped in search for food

1. Sergio Osmena

History of Public Health

Part 3: Public Health in the Philippines

Second Commonwealth (1945 - 1946)

• February 27, 1945: reconstitution of commonwealth with (1) as President

1. October 4, 1947

2. President Manuel Roxas

History of Public Health

Part 3: Public Health in the Philippines

The Department of Health

• (1) : Establishment of DOH

  • Executive Order No, 94 by (2)

  • separation of the country's health and public welfare offices

1. health, quarantine, hospitals

2. Elpidio Quirino

3. 288

4. Rural Health Act of 1954

History of Public Health

Part 3: Public Health in the Philippines

The Department of Health

• Dr. Antonio C. Villarama as appointed Secretary.

• Had three distinct units - (1)

• Reorganized in 1958 under Pres. (2) through Executive Order (3) - reorganization

• Decentralization of power into Eight Regional Offices

• (4) transformed the puericulture centres to RHUs and health centres, a national network of public health facilities at the community level was organized in all cities and municipalities.

1. Martial Law (1970s)

2. FDA - RA 3720 

History of Public Health

Part 3: Public Health in the Philippines

The Department of Health

(1)

• Transformed into Ministry of Health

• Primary health-care approach was adopted as a national policy in the late 1970s following the Alma Ata Declaration

• 1950 - WHO Regional for Western Pacific

• 1963- (2)

1. People Power Revolution of 1986

2. EO 119

3. Dr. Alfredo Bengzon

4. RA 7305

5. RA 7875

6. Fidel V. Ramos

7. PhilHealth

8. RA 11223

History of Public Health

Part 3: Public Health in the Philippines

The Department of Health

• (1) - Aquino Administration

  • (2) - revert Ministry of Health to DOH

  • (3) as the Secretary of Health

• 1992 - Magna Carta for Public Health Workers ((4))

• 1995 - National Health Insurance Act ((5))

  • Signed by (6)

  • Established (7)

•  2019 - Universal Health Care Act ((8)) 

1. EO 366

2. Pres. Arrayo

3. 18 bureaus and services

4. 17 regional health offices

5. Local Government Level

6. City Health System

The Department of Health - Structure

• 2004 (1) by (2) - basis of structure

• National Government Level

  • The DOH acts as the national lead agency in health

  • The DOH central office consists of (3)

  • DOH has (4), one for each of the 17 administrative regions of the country.

• (5)

  • Municipal Health System

    • Rural Health Units, Barangay Health Stations

• (6)

  • Health Centers, BHS, City Hospitals, Medical Centers

1. The Alma Ata Declaration

2. Dr. Jesus Azurin

3. World Health Organization Sasakawa Health

(1) (September 6-12, 1978)

• Major milestone of the twentieth century in the field of public health, and it identified primary health care as the key to the attainment of the goal of Health for All

• (2) launched the nationwide implementation of the Primary Health Care approach, which made him the first (3) Prize recipient.

1. Aedes spp. A. aegypti

2. M. tuberculosis

Current Challenges

• COVID-19

• Dengue - (1)

• HIV - AIDS

• Tuberculosis - (2)

• Improving Health Care in Remote Areas

Host, Agent, Environment

The Epidemiologic Triangle consists of…