unit 1 part 1: introduction to public health

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