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About Fundamentals of Public Health Core course 3 credit hours Evening: Mon & Tue 5 to 6:30 pm 1.5 hr session Morning: Fri 9am to 12 pm-3 hr session
Outline: : This course reviews the scope and historicalbackground of Public Health in developed and developingcountries, principles, development and organization ofhealth care system in Pakistan, primary health care,leadership in health care, health care economics, health
education and health information system, public healthemergencies and disease of public health importance, andpublic health surveillance.
Books: 1. Oxford textbook of Public Health 2. Public Health and Preventive Medicine by Maxcy-
Rosenau Last Dr Saadiyah Rao - School of Public Health, DUHS 1
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Dr Saadiyah RaoSenior LecturerSchool of Public HealthDow University of Health sciences
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Learning ObjectivesTo understand:
health
the definition of Public Health difference between public health professionals &
clinicians
services & function of Public Health
and to enlist achievements of Public Health
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Concept of Health The word health is derived from old English word hal:
sound, whole
Prior to the period of the Hippocrates (around 5BCE), health was perceived as a divine gift.
He theorized that what we currently regard as health.
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Concept of Health The word health means different things to different
people
The most widely quoted definition of health wascreated by WHO in 1946...... over half a century ago
health is a state ofcomplete physical, mental, socialwell being and not merely the absence of disease and
infirmity
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Concept of Health cont Conference of Health promotion: WHO, 1986, the
concept of health was amplified:
To reach a state ofcomplete physical, mental, socialwell being, an individual or group must be able toidentify aspirations, to satisfy needs, & to change orcope with environment. Health is a resource for
everyday living; it is a positive concept, emphasizingsocial & personal resources as well as physicalcapabilities
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Concept of Health cont More recently WHO has also indicated that health is
a cumulative state, to be promoted throughout life inorder to ensure that the full benefits are enjoyed inlater years
Good health is vital for maintaining an acceptablequality of life
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Concept of Health cont Critics argue that the WHO definition of health is
idealist, inflexible, and unrealistic, and that includingthe word complete in the definition makes it highly
unlikely that anyone would be healthy for a reasonableperiod of time Others have defined health as a dynamic condition of
the human organism that is multidimensional in
nature i.e physical, emotional, social, intellectual,spiritual and occupational, a resource for living andresults from persons interactions with and adaptationsto his/her environment.
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Concept of Health cont So, health can exist in varying degrees and is specific to each
individual and his or her situation
Example: a quadriplegic can be healthy in the sense that
his/her mental and social well being are high and physicalhealth is as good as it can be
Or this athlete?
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Concept of Health cont Several other generally accepted definitions of the
health: Saracchi in his paper The World Health Organization
needs to reconsider its definition of Health. BMJ 1997defines health as a condition of well being, free ofdisease or infirmity, and a basic and universal humanright
Bircher (Towards a dynamic definition of health and
disease. 2005) defines health as a dynamic state ofwell-being characterized by a physical and mentalpotential, which satisfies the demands of lifecommensurate with age, culture, and personalresponsibility.
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Concept of Health cont Health status is determined by interaction of five
domains:1-Genetic make up
2-Social circumstances such as education, employment,income, housing, crime
3-Enviornmental conditions where people live & work i.etoxic agents, microbes, structural hazards
4- Behavioural choices such as diet, physical activity,substance abuse
5-Availabilty of medical care
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Concept of Health cont Health fate of each of us is determined by factors not
acting in isolation but are interconnected
Gene expression can be determined by environmentalexposures & behavioural patterns
Nature & consequences of behavioural choices areaffected by social circumstances
Our genetic predispositions affect the health care weneed
And our social circumstances affects the health carewe receive
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Terms Community Health
Public Health
Population Health
These terms are used interchangeablyby bothlaypeople & professionals
Most people are referring to the collective health ofthose in society and actions/activities taken to obtainor maintain that health
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Community Health Refers to health status of a defined group of people &
the action, conditions to promote, protect andpreserve their health
Example:
People living in Essa nagri (slum area)
Punjabis living in London (ethnicity)
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Public Health Of the three terms Public Health is most inclusive C.E.A. Winslow, 1923 (pioneer in the development of this
discipline) characterized public health practice as the scienceand art of
disease prevention, prolonging life, and promoting health and well-being through organized community
effort for the sanitation of the environment, the control of communicable infections,
education of the individual in personal hygiene the organization of medical and nursing services for the early
diagnosis and prevention of disease the development of the social machinery to assure everyone a
standard of living adequate for the maintenance or improvement
of health. Dr Saadiyah Rao - School of Public Health, DUHS 15
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Public Health: More contemporary
definitions Report on Higher Education for Public Health 1976
efforts organized by society to protect, promote and
restore other peoples health. The programs, services &institutions involved emphasize the prevention ofdisease & health needs of the change with changingtechnology & social values but the goals remain thesame: to reduce the amount of disease, prematuredeath & disease-produced discomfort & disability
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Public Health: More contemporary
definitions The Institute of Medicine-USA(IOM) defined public
health in 1988in its landmark report the future ofpublic health as:
the fulfilment of societys interest in assuring theconditions in which people can be healthy andorganized community efforts aimed at the preventionof disease & promotion of health. What we, as asociety, do collectively to assure the conditions in
which people can be healthy. It links many disciplines& rests upon the scientific core of epidemiology
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Public Health: More contemporary
definitionsAcheson Report UK, Committee of Inquiry, 1988the
science and art of preventing disease, prolonging lifeand promoting health through the organized efforts ofsociety
The fundamental maxim of public health is that thehealth of the individual is best ensured by maintainingthe improving the heath of the community (DavidSatcher, Centers for Disease Control and Prevention,Emerging Infections: Getting Ahead of the Curve1995)
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The process of mobilizing local, state/provincial,national and international resources to assure theconditions in which all people can be healthy(Breslow/Detels, 1997)
Public health does not guarantee optimal health,but creates the conditions under which it can beachieved by society
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Public Health System Organizational framework of Public Health
encompasses activities undertaken within formalstructure of government and the associated efforts ofprivate & voluntary organizations and individuals,
Even with such formal definitions, public Healthactivities are still considered as efforts only originatingin federal, state and local governmental healthdepartments
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Population Health This term has emerged recently
It is similar to community health
Primary difference is the degree of organization oridentity of people
Refers to health status of people who are not organizedand have no identity as a group or locality and actions
& conditions to promote, protect and preserve theirhealth
Example: Men younger than 50years, adolescents,prisoners, white-collar workers
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Public health Vs Medical Care "Health care matters to all of us some of the time, public
health matters to all of us all of the time"(C. Everett Koop)
In medicine the patient is the individual; in public health,the patient is the community
Public health diagnoses the health of the communityusing public health sciences
Treatment of the community involves new policies andinterventions
Goal of medicine is cure; goal of public health isprevention of disease and disability
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Public health Vs Medical Care
Focus on individuals
Diagnosis & treatment
Clinical interventions
Well-established profession,standardized education &certification
Clinical sciences integral;social sciences less emphasized
Experimental studies withcontrol groups: RCTs.
Focus on populations
Prevention & healthpromotion
Environment & humanbehavior interventions
Diverse workforce, variableeducation & certifications
Social sciences integral;clinical sciences peripheralto education
Observational studies: casecontrol & cohort studies
Medicine Public HealthMedicine Public Health
Focus on individuals Focus on populations
Diagnosis & treatment Prevention & health promotion
Clinical interventions Environment & human behaviorinterventions
Well-established profession,
standardized education & certification
Diverse workforce, variable education &
certifications
Clinical sciences integral; socialsciences less emphasized
Social sciences integral; clinical sciencesperipheral to education
Experimental studies with controlrou s: RCTs Observational studies: case control &cohort studiesDr Saadiyah Rao - School of Public Health, DUHS 23
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Vision of Public HealthHealthy people in healthy Communities !
The Goal of Public HealthThe biologic, physical and mental well-being ofall members of the global society, regardless of
ethnicity, religion, gender, sexual orientation,country or political views. (Detels, 2003)
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Th S f P bli H lth
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The Scope of Public Health
Source: http://www.ewashtenaw.orgDr Saadiyah Rao - School of Public Health, DUHS 25
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The Scope of Public Health Infectious diseases Chronic diseases
Heart disease, metabolic disorders, cancer, etc. Mental health
Nutrition disorders Health of the vulnerable e.g. poor, children, women, elderly, etc.
Substance abusers: drugs, alcohol, tobacco
Accidents/violence/injuries Occupational health Environmental healthAccess to health care Quality of health careWar Dr Saadiyah Rao - School of Public Health, DUHS 26
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Five Public Health Responsibilitie1. Prevention of epidemics & spread of disease
2. Protection of people against environmental Hazards &prevention of injuries
3. Promotion & encouragement of healthy behavior changes
4. Quick response to the disaster & to assist the communities inrecovery phase
5. To assure quality, accessible, and affordable comprehensivehealth care services
http://www.health.ny.gov/press/reports/century/phc_terms.htm
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Public Health
Approach
Problem Response
Surveillance:Whatis the
problem?
Risk FactorIdentification:What is the
cause?
InterventionEvaluation:
Whatworks?
Implementation:How do you
do it?
Courtesy :Glyn G. CaldwellDr Saadiyah Rao - School of Public Health, DUHS 28
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Core public health functions Were outlined in the 1988 by Institute of Medicine report - The
Future of Public Health. In recent years there has been a growing sense that public
health as a profession, as a governmental activity, and as acommitment of society is neither clearly defined, adequatelysupported, nor fully understood. ..current capabilities foreffective public health action are inadequate.
So, Assessment Policy development Assurance
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How to achieve these function? Essential Public Health Services
The Core Public Health Functions Steering Committee
developed the framework for the Essential Services in1994.
The Essential Services provide a working definition ofpublic health and a guiding framework for the
responsibilities of local public health systems.
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10 Essential Services of Public Health
Public Health Functions Project, U.S. Dept. of Health and Human ServicesDr Saadiyah Rao - School of Public Health, DUHS 31
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Assessment
Monitor health status to identify community healthproblems
Diagnose and investigate health problems and healthhazards in the community
Research for new insights and innovative solutions to
health problems
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Policy Development
Inform, educate, and empower people about healthissues
Mobilize community partnerships to identify and solvehealth problems
Develop policies and plans that support individual and
community health efforts
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Assurance
Enforce laws and regulations that protect health andensure safety.
Link people to needed personal health services andassure the provision of health care
Assure a competent public health and personal health
care workforce Evaluate effectiveness, accessibility, and quality of
personal and population-based health services
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1.Monitor Health Status to Identify Community
Health Problems
Accurate, periodic assessment of the communitys healthstatus, including: Identification of health risks and determination of health
service needs.Attention to vital statistics and disparities Health status of groups that are at higher risk than the total
population Identifications of assets and resources
Utilization of methods and technology to interpret andcommunicate data
Population health registries
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2 .Diagnose and Investigate Health Problems
and Health Hazards in the Community Timely identification and investigation of health threats such
as disease outbreaks and patterns of infectious and chronicdiseases and injuries, environmental hazards
Active infectious disease epidemiology programsAvailability of diagnostic services, including laboratory
capacity of conducting rapid screening & high volume testing
Population-based screening, case finding, investigation, and
the scientific analysis of health problems Response plans to address major health threats
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3.Inform, Educate and Empower People about
Health Issues Health information, health education, and health promotion
activities designed to reduce health risk and promote betterhealth
Initiatives using health education and communication
sciences to: Build knowledge and shape attitudes Inform decision-making choice Develop skills and behaviors for healthy living
Health communication plans and activities such as mediaadvocacy and social marketing. Health education and health promotion program partnerships
with schools, faith communities, work sites, personal careproviders, and others to implement and reinforce health
promotion programs and messages.Dr Saadiyah Rao - School of Public Health, DUHS 37
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4.Mobilize Community Partnerships to Identify
and Solve Health Problems
Community development and identification of systempartners and stakeholders
Coalition development
Convening and facilitating partnerships among groups andassociations (including those not typically considered to behealth-related) in undertaking defined health improvement
projects, including preventive, screening, rehabilitation, andsupport programs.
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5.Develop Policies and Plans that Support
Individual and Community Health Efforts
Systematic health planning that relies on appropriate data,develops and tracks measurable health objectives, andestablishes strategies and actions to guide community health
improvement at the state and local levels. Development of legislation, codes, rules, regulations,
ordinances and other policies to enable performance of theEssential Public Health Services, supporting individual,
community, and state health efforts.
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6.Enforce Laws and Regulations that Protect
Health and Ensure Safety
The review, evaluation, and revision of laws and regulationsdesigned to protect health and safety to assure that theyreflect current scientific knowledge and best practices for
achieving compliance. Education of persons and entities obligated to obey or to
enforce laws and regulations designed to protect health andsafety in order to encourage compliance.
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Enforcement activities include, but not limited to theprotection of drinking water; enforcement of clean airstandards; regulation of care provided in health care facilities
and programs; re-inspection of workplaces following safetyviolations; review of new drug, biologic, and medical deviceapplications; enforcement of laws governing such as the seatbelt usage and childhood immunizations.
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7.Link People to Needed Personal Health
Services
Identifying personal health service needs of populations withlimited access, to a coordinated system of clinical care.
Assuring the linkage of people to appropriate personal healthservices through coordination of provider services and
development of interventions that address barriers to care(e.g., culturally and linguistically appropriate staff andmaterials, transportation services).
Partnership with public, private, and voluntary sectors to
provide populations with a coordinated system of healthcare.
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8.Assure a Competent Public and Personal
Health Care Workforce
Assessment of workforce (including volunteers and other laycommunity health workers) to meet community needs forpublic and personal health services.
Maintaining public health workforce standards, includingefficient processes for licensure/credentialing of professionaland incorporation of core public health competenciesneeded to provide the Essential Public Health Services intopersonnel systems.
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Education, training, development, and assessment of healthprofessional - including partners, volunteers and other laycommunity health workers - to meet statewide needs for
public and personal health services.
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9.Evaluate Effectiveness, Accessibility, and
Quality of Personal and Population-Based
Health Services
Assessing the accessibility and quality of services deliveredand the effectiveness of personal and population-based
programs provided. Evaluation answers
Are we doing things right?
Are we doing the right things?
Evaluation must be ongoing and should examine: Personal health services
Population based services
The public health systemDr Saadiyah Rao - School of Public Health, DUHS 45
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Evaluation should drive resource allocation and programimprovement
Evaluation and critical review of health program, based onanalyses of health status and service utilization data, areconducted to determine program effectiveness and to provideinformation necessary for allocating resources and reshapingprograms for improved efficiency, effectiveness, and quality
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10.Research for New Insights and Innovative
Solutions to Health Problems
Identification and monitoring of innovative solutions andcutting-edge research to advance public health
Linkages between public health practice and academic /research settings
Epidemiological studies, health policy analyses and healthsystems research.
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Achievements of Public
Health The dramatic achievements of Public Health in the
20th century have improved our quality of life:
an increase in life expectancy,
world wide reduction in infant and child mortality,
the elimination or reduction of many communicablediseases.
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Achievements of Public
HealthVaccination & Control of infectious diseases:Immunizations have virtually eliminated:Smallpox
DiphtheriaPertussisTetanus
PolioMeaslesRubella
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Achievements of Public
Health Motor-vehicle safety
Decreased death toll
Increased seat belt use
Vehicle safety improvements Traffic safety regulation
and enforcement Improved streets and highways
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Achievements of Public
Health Safer and healthier foods Safe and healthier foods are now common place
because of:
Hand washing Sanitation
Refrigeration
Pasteurization
Pest control Healthier animal care, feeding,
and processing
Improved food supply safety
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Achievements of Public
Health Safer workplaces
Mining safety
Industrial safety
Indoor air quality
Ergonomics
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Achievements of Public
Health Decline in deaths from coronary heart diseaseand stroke
The leading cause of death in the U.S. despite a 60%
decrease in death rates since 1950. Recognition of tobacco as a health hazard Smoking, once socially acceptable, is on the decline among U.S. adults.
% of population who smoke 196542.4% 199724.7%
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Achievements of Public
Health Healthier mothers and babies
Maternal mortality rates down 99%
Infant mortality rates down 90% Improved standards of living
Technological advances in medicine
Greater access to maternal and well-baby care
Family planning
Desired birth spacing and family size
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TaskApply the core functions i.e:Assessment
Policy developmentAssurance
to a public health problem
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References Foundations of community health. Jones & Bartlett
Bulletin of the World Health Organization: Re-defining Health Article: stn & Jakob. 2005;83:802
CDC National Public Health Performance StandardsProgram