unit 1 part 1: introduction to public health

what is health?, history, determinants, core functions, essentials, economic impact

Health

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

* Exposure to risk factors
* Genetic Vulnerability
* Ability of the body to resist infections

model of health

40%

**Factors influencing Health & Well-being**:

Social and Economic Factors

30%

**Factors influencing Health & Well-being**:

Health Behaviors

10%

**Factors influencing Health & Well-being**:

* Clinical Care
* Physical Environment
* Genes and Biology

Public health

Measures directed to __group of people__ (not individuals) to **promote, protect and preserve health**

**Analyzing the health** of a population and the **threats** it faces

**Public health**:

**basis** for public health

education, policy making and research for disease and injury prevention

**Public health**:

**Science of protecting the safety and improving the health of communities** through ___

group of people

**Public health**:

Aims toward a ___

**Collective** health

**Public health**:

focus; Not directed at the individual level

**Charles-Edward Amory Winslow**, 1920

**Public health**:

The science and art of **preventing disease, prolonging life, and promoting health and efficiency** through __organized community__

sanitation

**Public health**: *Charles-Edward Amory Winslow*

The ___ of the environment

communicable infections

**Public health**: *Charles-Edward Amory Winslow*

The control of ___

personal hygiene

**Public health**: *Charles-Edward Amory Winslow*

The education of the individual in ___

medical and nursing services

**Public health**: *Charles-Edward Amory Winslow*

The organization of ___ for the **early diagnosis and preventive treatment** of disease

social machinery/structures

**Public health**: *Charles-Edward Amory Winslow*

The development of the ___ to ensure everyone a **standard of living** __adequate for maintenance of health__ So, organizing these benefits as to **enable** every citizen to realize his **birth right of health and longevity**

clinicians

**Public health Specialist & Clinician**:

* **treat** diseases and injuries of **one** patient at a time
* treated **individually**

Public health

**Public health Specialist & Clinician**:

* **prevent** disease and injury
* treated **collectively**

communities and populations

**Public health Specialist**:

Public health researchers, practitioners and educators work with ___

causes of disease and disability

**Public health Specialist**:

identify the ___, and they implement large scale solutions.

microbiologists

**Public health Specialist**:

find a vaccine

behavioral scientists

**Public health Specialist**:

discourage populations from smoking

Environmental health scientists

**Public health Specialist**:

foods prevent cancer

health policy analysts

**Public health Specialist**:

evaluate health insurance programs and make recommendations

epidemiologists

**Public health Specialist**:

identify trends in health and illness

prevention

**Public health Specialist**:

**approach** is always geared towards ___

Public health

* **population** based
* **collective responsibility** for health, its **protection and disease prevention**
* Recognizes the **key role of the state**, linked to a **concern for the underlying socio-economic and wider determinants of health**, as well as disease
* Emphasis on **partnerships** with all those that contribute to the health of the population

state

**primary agency** responsible to ensure public health

Public health

**Public health Approach**:

* **Population** focus
* **Public health** ethic
* **Prevention** or public health emphasis
* Joint laboratory and **field** involvement
* Clinical sciences **peripheral** to professional training
* **Public** sector basis

Health Care

**Public health Approach**:

* **Individual** patient focus
* **Personal service** ethic
* **Diagnosis and treatment** emphasis
* Joint laboratory and **patient** involvement
* Clinical sciences **essential** to professional training
* **Private** sector basis

* Epidemiology
* Biostatistics
* Biomedical Sciences
* Social and behavioral Science
* Environmental Science
* Public Policy

**Public health Approach**: *Components & Its Sciences*

* Public health is an interdisciplinary field

1. **Define** the health **problem**.
2. **Identify the risk factors** associated with the problem
3. **Develop and test community-level intervention** to __control and prevent__ the cause of the problem.
4. **Implement intervention** to __improve the health__ of the population.
5. **Monitor those interventions** to assess their __effectiveness__

**Public health Approach**: *Prevention & Intervention*

5-step process

Prevention

**Public health Approach**: *Prevention & Intervention*

main task is to **develop intervention** designed **to prevent specific problems** through an assessment process initiated by a public health agency or through community

**Primary** prevention

**Public health Approach**: *Prevention & Intervention: 3 levels*

**prevents** illness or injury __from occurring at all.__

**Secondary** prevention

**Public health Approach**: *Prevention & Intervention: 3 levels*

seeks to **minimize the severity** of the illness or the **damage** due to an injury-causing event once the event has occurred

**Tertiary** prevention

**Public health Approach**: *Prevention & Intervention: 3 levels*

**seeks to minimize disability** by __providing medical care and rehabilitation__

Intervention

**Public health Approach**: *Prevention & Intervention:*

an **act** performed for, with or on behalf of a person or population whose purpose is to **assess, improve, maintain, promote or modify** health, functioning or health conditions

common tool

**Public health Approach**: *Prevention & Intervention: International Classification of Health Interventions (ICHI)*

Being developed to provide a ___ for **reporting and analyzing health interventions** for statistical purposes

common tool

**International Classification of Health Interventions (ICHI):** *Prevention & Intervention*

Being developed to provide a ___for reporting and analyzing health interventions for statistical purposes

patient

**Public health Approach**: *Prevention & Intervention:*

In **clinical care**, the laboratory works with

field

**Public health Approach**: *Prevention & Intervention:*

In **public health**, the laboratory works in

Public Health and Terrorism

* Many events globally disturbed the **sense of complacency**
* **Groups of individuals** who not only wanted to **cause harm** to people at home but who **has the resources and the will to succeed in that goal** forced us to think about how to prevent similar events in the future
* PH was concerned not only with **coordinating emergency medical care, but also ensuring the safety of clean up workers**
* Natural disasters must be dealt with

Prevention of **violent attacks**

**Role of Public Health in Terrorism:**

primarily a **responsibility of law enforcement**

**controlling** the damage

**Role of Public Health in Terrorism:**

public health plays a big role in ___

secondary and tertiary prevention

**Role of Public Health in Terrorism:**

Primary prevention may be __out of the domain of PH__, but ___ are very much a part of public health’s mission.

well-designed plans

**Role of Public Health in Terrorism:**

**Success** at these services depend on having ___

* **Social** Medicine
* **Community Health**
* **Community** Medicine
* **Preventive** Medicine

Public Health consists of ___

The great 19th Century Sanitary Awakening

**Rise of Public Health:**

era of unplanned industrialization

The identification of **filth** as both a **cause of disease and a vehicle of transmission** and ensuing **embrace of cleanliness**

**Rise of Public Health:** *19th Century*

central component of 19th century social reforms and advancement in public health.

Illness

**Rise of Public Health:** *19th Century*

indicator of **poor social environmental conditions** as well as **poor moral and spiritual conditions**

Cleanliness

**Rise of Public Health:** *19th Century*

embraced as a **path** both to __physical and moral health__

Disease control

**Rise of Public Health:** *19th Century*

shifted from **reacting** to __intermittent outbreaks__ to __continuing measures__ for **prevention**

societal goal

**Rise of Public Health:** *19th Century*

With sanitation, **public health** became a ___

public activity

**Rise of Public Health:** *19th Century*

With sanitation, **protecting health** became a ___

Edwin Chadwick

**Development of Public Activities in Health:**

a London lawyer (1838), is one of the most recognized names in the sanitary reform movement

General Report on the Sanitary Conditions

**Development of Public Activities in Health:** *Edwin Chadwick*

a **document** of the appalling conditions in which masses of the working people were **compelled to live, and die**, in the industrial towns and rural areas of the UK

36 years

**Development of Public Activities in Health:** *Edwin Chadwick*

average age of death: **gentry**

22 years

**Development of Public Activities in Health:** *Edwin Chadwick*

average age of death: **tradesmen**

16 years

**Development of Public Activities in Health:** *Edwin Chadwick*

average age of death: **laborers**

**Disease Control** Phase

**Changing Concept of Public Health:**

* 1880-1920
* **Sanitary legislation** and **reforms**
* **Less** available **technical knowledge**
* Aimed at the **control of man’s physical environment** (water supply sewage disposal) & not at the control of any specific disease
* **Improvement** in the health of people due to **disease and death and control**

**Health Promotion** Phase

**Changing Concept of Public Health:**

* 1920-1960
* In addition to disease control activities
* It was initiated as personal health services
* movement for human development

* Introduction of **mother & child** health services
* **Industrial** health services
* **Mental** health services
* **Rehabilitation** services

**Changing Concept of Public Health:** *Health Promotion Phase*

personal health services

Provision of basic health services

**Changing Concept of Public Health:** *Health Promotion Phase*

human development: media, of PHCs and sb-centers

Community development programme

**Changing Concept of Public Health:** *Health Promotion Phase*

human development: promote village development through **active participation** of the whole community.

**Social Engineering** Phase

**Changing Concept of Public Health:**

* 1960-1980
* **Golden Era** of Public Health
* Change in pattern of disease
* It moved towards **preventive and rehabilitative aspects** of chronic disease and behavioral problems

**Health for All** Phase

**Changing Concept of Public Health:**

* 1981-2000 AD
* **Health gap** between rich and poor, within & between countries
* Provision of health care to all by **reducing the inequalities** within & between the population so that __individuals will lead a socially and economically productive life__.

Millennium Development Goals (MDGs)

**Changing Concept of Public Health:** *Health for All Phase*

* very lofty goals established by many countries including the UN
* reach these by the year 2000
* changed to SDGs

Modern Public Health

“the organized application of **local, state, national, international resources to achieve health for all**, i.e. attainment by all the people of the world by the year 2000 of a level of health that will permit them to **lead a socially and economically productive life**”

dramatic **increase** in average span of life

**Modern Public Health:**

credited to __public health achievements__ such as **vaccination programs, control of infectious diseases, better safety policy** such as motor vehicle and worker safety, **improved reproductive health**, emphasis on **safe drinking water**

chronic diseases

**Modern Public Health:**

focus is shifting more towards

**epidemic** in scale

**Shifting Focus of Public Health:**

control of infectious diseases

**endemicity** of diseases

**Shifting Focus of Public Health:**

prevention

surveillance

**Shifting Focus of Public Health:**

**continuous , systematic collection, analysis and interpretation of health-related data** needed for the __planning, implementation, and evaluation of public health practice__

Cholera

* **fatal intestinal disease**
* rampant during the early **1800’s in London**
* caused **death to tens of thousands of people** in the area
* commonly thought to be caused by **bad air from rotting organic matter**

John Snow

* traced the **source of the cholera** outbreak
* father of **modern epidemiology**
* Pioneer of **spot maps** and other epidemiological principles

The Broad Street Pump

**John Snow, Cholera:** *Risk Factor Identification*

people who had cholera would often **take their water supply from a particular water pump**

* **STOP EXPOSURE** to the entire contaminated water supply in the area
* Cholera was **water contaminated** with sewage

**John Snow, Cholera:**

Intervention Evaluation

* Broad Street Pump to supply water was **sealed** forever

**John Snow, Cholera:**

Implementation

Greek and Roman civilisations **sanitation measures and practices**

**History of Public Health:**

* **500 B.C.E**

Black Death

**History of Public Health:**

* **1346 – 1352**
* claimed **one-third of Europe’s population**

Yersinia pestis

**History of Public Health:** *Black Death*

* thought to be an **epidemic of bubonic plague**, a bacterial disease caused by

weapon of war

**History of Public Health:** *Black Death*

* used as a ___ during the **siege of Kaffa**

**Inoculation** brought to Britain by Lady Mary Wortley **Montagu**

**History of Public Health:**

* **Early 1700s**
* **Earliest** proponent of **vaccination**
* if one is **exposed to a weak form** of a disease, one would be immune from it

get scabs from wounds of smallpox

**History of Public Health:** *Inoculation*

* Montagu would ___ and __inoculate herself and herself and her daughter__

**Vaccination** by Edward **Jenner**

**History of Public Health:**

* **1798**
* **inoculation of cowpox pustules**
* women who work as milkmaids seldom have smallpox
* used cowpox as a vaccine against smallpox and tested it on a child

Latin word “***vacca***”

**Edward Jenner**:

word vaccination comes from cowpox

**Chadwick: dirty conditions** that the poorest members of the society were living in.

**History of Public Health:**

* **1830s**
* main cause of illness was ___

**invest** in infrastructures

**Edwin Chadwick:**

urged government to ___ related to sanitary conditions

**Public Health Act** of 1848

**History of Public Health:**

* **1848**

development of the first vaccine in the Philippines

**Public Health Act of 1848:**

* blood of the **last child** was used for

carabaos

**Public Health Act of 1848:** *Philippine vaccines*

* used to produce vaccines

John Snow

**History of Public Health:**

* **1854**
* innovated several key **epidemiologic methods** that remain valid and in use today
* **mapped the disease pattern** of the cholera epidemic in London

William **Farr**: quantitative study of **morbidity and mortality**

**History of Public Health:**

* **1807 – 1883**
* establish the **field of medical statistics**

census

**William Farr:**

* pioneer the use of ___

Louis **Pasteur**: discovery of **artificial immunity**

**History of Public Health:**

* 1870s
* rabies, anthrax, cholera

pasteurization

**Louis Pasteur:**

* sanitary conditions of milk

Compiler of Abstracts at the General Register Office of England and Wales

**Notable Events in Public Health:** *William Farr*

* registered births, marriages, and deaths

Robert Koch

**Notable Events in Public Health:**

* verified that the **human disease was caused by a specific living disease**
* first to determine that certain **diseases** are caused by **microorganism infection**

*Bacillus anthracis*

**Notable Events in Public Health:** *Robert Koch*

cause of **anthrax**

Vibrio cholerae

**Notable Events in Public Health:** *Robert Koch*

cause of **cholera**