Community and Public Health: Yesterday, Today, and Tomorrow

Community and Public Health: Yesterday, Today, and Tomorrow

Outline

  • Health & Community
  • Public/Community/Population/Global Health
  • Health of a Community
  • History of Community and Public Health
  • Achievements

Health

  • Definition: Health can mean different things to different people.
  • Dynamic State: It is a dynamic state or condition of the human organism that is multidimensional in nature.
  • Resource for Living: Health is viewed as a resource for living.
  • Interactions with Environment: Health results from an individual’s interactions with and adaptations to his or her environment.
  • Influencing Factors: Major factors affecting health include:
    • Genetics
    • Social circumstances
    • Environmental conditions
    • Behavioral choices
    • Medical care

Community

  • Definition: A community consists of individuals who share a common characteristic, which may include geography, race/ethnicity, age, etc.
  • Characteristics of Community:
    • Membership: Individuals belong to the community.
    • Common Symbol Systems: Shared languages or signs that convey meaning.
    • Shared Values and Norms: Common beliefs and behaviors that unite the community.
    • Mutual Influence: Members influence one another and foster relationships.
    • Shared Needs and Commitment: Recognition of common needs and commitment to address them.
    • Shared Emotional Connection: Bonds that encourage community cohesion.

Definitions

  • Public Health: Refers to the actions that society takes collectively to ensure conditions that allow people to be healthy.
  • Community Health: Focuses on the health status of a defined group of people and the actions taken to promote, protect, and preserve their health.
  • Population Health: Relates to the health outcomes of a group of individuals and the distribution of outcomes within that group.
  • Global Health: Encompasses health problems, issues, and concerns that transcend national boundaries.

Difference Between Personal Health Activities and Community/Public Health Activities

  • Health Activities:
    • Personal Health Activities: Involves individual actions and decision-making affecting one's health and the health of immediate family or friends.
    • Community/Public Health Activities: Aimed at protecting or improving the health of a population or community.

Factors Affecting the Health of the Community

Physical Factors

  • Geography: For example, tropical countries often have increased rates of parasitic and infectious diseases.
  • Environment: The quality of the natural environment is closely linked to its stewardship.
  • Built Environment: The design, construction, and management of human-made surroundings significantly impact health.
  • Community Size: Larger communities tend to have a greater range of health problems.
  • Industrial Development: Adds resources for community health programs.

Social and Cultural Factors

  • Beliefs, Traditions, and Prejudices: Specific beliefs about issues (like exercise and smoking) can influence healthcare policies.
  • Economy: A poor economy may lead to decreased charitable contributions, thereby reducing available resources for assistance.
  • Politics: Variations in government involvement in healthcare can impact community health (Democratic vs. Republican policies).
  • Religion: Religious beliefs can limit types of medical treatment received by community members.
  • Social Norms: For instance, smoking rates have shifted dramatically from 51% and 34% in 1965 to 19% and 15% presently.
  • Socioeconomic Status (SES): Impacting education, employment, and income; lower SES correlates with poorer health status.

Community Organizing

  • Definition: Community organizing is a process through which communities identify common problems or goals, mobilize resources, and develop strategies to achieve their collectively set goals.

Individual Behavior

  • Impact on Community Health: Individual behaviors of community members influence the overall health of the community.
  • Examples: Specific examples can illustrate the relationship between individual behaviors and community health outcomes.

History of Community and Public Health

Early Civilizations

  • Ancient Societies (before 500 BCE):
    • Notable practices included sewage disposal, written medical prescriptions, laws governing medicine, and guidelines for sanitation.
  • Classical Cultures (500 BCE – 500 CE):
    • Contributed to sanitation, aqueduct building, and construction regulations.
  • Middle Ages (500 – 1500 CE):
    • Characterized by health issues tied to spiritual beliefs; response to health problems included plague, leper houses, and various epidemics.
  • Renaissance and Exploration (1500 – 1700 CE):
    • Shift in thinking; diseases attributed to environmental factors rather than spirituality, leading to better description of symptoms and causes.

Eighteenth Century

  • Characteristics: Marked by industrial growth, urban overcrowding, and inadequate water supplies; sanitation was significantly lacking.
  • Key Developments:
    • In 1796, Dr. Jenner demonstrated the process of vaccination against smallpox.
    • The average age at death was reported as 29 years.
    • The first census was taken in 1790.

Nineteenth Century

  • Modern Era of Public Health (1850):
    • Initiated by Lemuel Shattuck's health report for Massachusetts, introducing health boards and sanitary measures.
    • The 1854 cholera epidemic highlighted the significance of epidemiology, famously studied by John Snow.
    • The concept of spontaneous generation was disproven, giving rise to the germ theory of disease.

Twentieth Century

  • Public Health Landscape: Life expectancy was under 50 years, with communicable diseases as leading causes of death.
  • Health Challenges: Issues included vitamin deficiencies and inadequate prenatal and postnatal care, leading to high rates of maternal and child mortality.
  • Key Periods:
    • Health Resources Development Period (1900-1960): Included social engineering and health promotion efforts.

Health Resources Development Period (1900-1960)

  • Class Disparities: Increase in differences between upper and lower classes, urban population growing from 19% in 1860 to 45% by 1910.
  • Innovative Organizations: Established the American Cancer Society, nursing programs, schools of public health, and the National Cancer Institute.
  • Legislative Milestones: Social Security Act of 1935 provided support for state health departments.
  • Medical Advancements: Notable advancements included antibiotic penicillin, DDT development, and the polio vaccine.
  • Sociopolitical Events: Impact of Eisenhower’s heart attack.

Period of Social Engineering (1960-1973)

  • Federal Involvement: Increased federal government involvement in healthcare delivery.
  • Key Programs: Introduction of Medicare for older adults and Medicaid for low-income individuals.
  • Financial Impact: Influx of federal dollars contributed to rising healthcare costs.

Period of Health Promotion (1974-present)

  • Health Risks Identification: Recognition that lifestyle choices contribute to premature death.
  • Publications and Initiatives: Establishment of the Healthy People framework, leading to Healthy People 2020 objectives and the MAP-IT model (Mobilize, Assess, Plan, Implement, Track).

Twenty-First Century

  • Challenges in U.S. Public Health: Issues include healthcare delivery, environmental problems, lifestyle diseases, ongoing spread of communicable diseases, substance abuse, health disparities, and preparedness for disasters.
  • International Comparisons:
    • In low- to middle-income countries, five of the ten leading death causes are infectious diseases.
    • In high-income countries, nine out of ten leading death causes relate to non-communicable diseases.
    • Problems such as poor sanitation and unsafe drinking water remain critical, with one in five childhood deaths attributed to water-related diseases.
    • Hunger reflects a continued concern, with a 27% reduction worldwide since 2000, despite 795 million people suffering from chronic undernourishment.

Twenty-First Century Global Health Achievements

  • Improvements Observed:
    • Significant reductions in child mortality and vaccine-preventable deaths.
    • Increased access to safe water and sanitation facilities.
    • Effective malaria prevention and control strategies implemented.
    • Successful initiatives for HIV/AIDS prevention and tuberculosis control.
    • Improved management of neglected tropical diseases.
    • Advancements in tobacco control and global road safety initiatives.
    • Enhanced global public health preparedness and response mechanisms.