GRADUATE SCHOOL

MASTER IN NURSING



NRS 211
Nursing Concepts IV
Advanced Community Health Nursing


CONCEPTS OF PUBLIC HEALTH




Submitted by:

Arnold L. De Guzman Jr. RN
MN Student


Submitted to:

Mr. Dean Michael D. Songco, RN, MAN
Professor




June 2014

DEFINITIONS & CONCEPTS

HEALTH
The World Health Organization defines health as a state of complete physical, mental, and
social well-being, not merely the absence of disease or infirmity.

PUBLIC HEALTH
The classic definition of public health comes from Dr. C. E. Winslow. He defines public
health as the science and art of preventing diseases, prolonging life, promoting health and
efficiency through organized community effort for the sanitation of the environment, control of
communicable diseases, the education of individuals in personal hygiene, the organization of
medical and nursing services for the early diagnosis and preventive treatment of disease, and
the development of the social machinery to ensure everyone a standard of living adequate for
the maintenance of health, so organizing these benefits as to enable every citizen to realize his
birthright of health and longevity.

On the other hand, WHO defined public health as the art of applying science in the
context of politics so as to reduce inequalities in health while ensuring the best health for the
greatest number. It points to the fact that public health is a core element of government
attempts to improve and promote the health and welfare of their citizens.

HISTORY OF PUBLIC HEALTH FROM ITS EARLY BEGINNINGS TO PRESENT

The history of public health nursing in the Philippines is embedded in the history of the
Department of Health which was first established as the Department of Public Works,
Education, and Hygiene in 1898.

Since then, various laws were enacted to organize and establish the various structures
and activities of the health agency covering the entire country. The following milestones marked
the events when the nurses and nursing were particularly mentioned in the historical accounts.

1912
The Fajardo Act (Act No. 2156) created Sanitary Divisions. The President
of Sanitary Division took charge of two or three municipalities. Where
there were no physicians available, male nurses were assigned to perform
the duties of the President, Sanitary Division.
1914
School nursing was rendered by a nurse employed by the Bureau of
Health in Tacloban, Leyte. In the same year, Reorganization Act No. 2462
created the Office of General Inspection. The Office of District Nursing
was organized under this office. It was headed by a lady physician, Dr.
Rosario Pastor who was also a nurse. This Office was created due to
increasing demands for nurses to work outside the hospital, and the need
for direction, supervision and guidance of public health nurse.
1916-1918
Ms. Perlita Clark took charge of the public health nursing work. Her staff
was composed of one American nurse supervisor, one American dietitian,
36 Filipino nurses working in the provinces and one nurse and one
dietitian assigned in two Sanitary Divisions.
1917
Four graduate nurses paid by the City of Manila were employed to work in
the City Schools. Provinces that could afford to carry out school health
services were encouraged to employ a district nurse.
1918 The office of Ms. Clark was abolished due to lack of funds.
1919
The first Filipino nurse supervisor under the Bureau of Health, Miss
Carmen del Rosario was appointed. She succeeded Ms. Mabel Dabbs.
She had a staff of 84 public health nurses assigned in five health stations.
1923
Two government Schools of Nursing were established: Zamboanga
General Hospital School of Nursing in Mindanao and Baguio General
Hospital in Northern Luzon. In later years, four more government Schools
of Nursing were established.
1928
The first convention of nurses was held followed by yearly conventions
until the advent of World War II.
1930
The Section of Public Health Nursing was converted into Section of
Nursing due to pressing need for guidance not only in public nursing
service but also in hospital nursing and nursing education.
1941
When World War II broke out, public health nurses in Manila were
assigned to devastated areas to attend to the sick and the wounded.
October 7,
1947
Executive Order No. 94 reorganized government offices and created the
Division of Nursing under the Office of the Secretary of Health.

1948
The first training center of the Bureau of Health was organized in
cooperation with the Pasay City Health Department. Physicians and
nurses undergoing pre-service and in-service training in public health/
public health nursing as well as nursing students on affiliation were
assigned to the above training center.
1950 The Rural Health Demonstration and Training Center ( RHDTC) was
established by the Department of Health. It was used as a laboratory for
the field experience of graduate and basic students in medicine, nursing,
health education, nutrition and social work.
1953
Philippine Congress approved Republic Act No. 1082 or the Rural Health
Law. It created the first 81 Rural Health units. Each unit had a physician, a
public health nurse, midwife, a sanitary inspector and a clerk driver.
1957
Republic Act 1891 was approved amending Sections 2, 3, 4, 7, & 8 of
R.A. 1082 Strengthening Health and Dental Service in the rural Areas
and Providing Funds thereto. This resulted in additional number of
positions fro health workers including public health nurses and midwives.
1958 1965
Republic Act 977 passed by Congress in 1954 was implemented. This
abolished the Division of Nursing. However, it created nursing positions at
different levels in the health organization.
The Reorganization Act with implementing details embodied in Executive
Order 288, series 1959 de-cetralized and integrated health services. It
created 8 Regional Health Offices in the country, which were later
increased to 11 and eventually 17.
The reorganization of 1959 also merged two Bureaus in the Department if
Health. The Bureau of Health was merged with the Bureaus of Hospitals
to form the Bureau of Health and Medical Services.
1967
In the bureau of Disease Control, Mrs. Zenaida Panlilio Nisce was
appointed as Nursing Program Supervisor and served as consultant on
the nursing aspects of the 5 special diseases: TB, Leprosy, Venereal
Disease, Cancer, Filiariasis; and, Mental Health. She was involved in
program planning, monitoring, evaluation and research.
1975
As a result of the restructuring of the health care delivery system based on
findings of the Operations Research (WHO assisted) conducted in the
province of Rizal in the early 70s, the functions of the health team
members were redefined. The roles of the public health nurse and the
midwife were expanded. Two thousand midwives were recruited and
trained to serve in the rural areas.
1976 1986
The Nursing Consultant and Nursing Program Supervisor of the Office of
the Secretary of Health were involved in the Rural Health Practice
Program which required medical and nursing graduates to serve for two
months in the rural areas of the country before their licenses could be
issued by the Professional Regulation Commission. When the number of
nursing graduates reached over 12,000 per year, the program was
stopped. By then, the objectives of the program that health services be
made available in the rural areas of the country and that the young
medical and nursing graduates develop a liking for working in these
remote underserved areas were partially attained.
1987 1989
Executive Order No. 119 reorganized the Department of Health and
created several offices and services within the Department of Health.
1990-1992 Aside from the usual services for mothers and children, involvement of
nurses in the following programs has emerged: Expanded Program on
Immunization, Control of Diarrheal Diseases and control of Acute
Respiratory Infections.
January 1999
Department Order No. 29 designated Mrs. Nelia F. Hizon, Nurse IV, then
President of the National League of Philippine Government Nurses, as
Nursing Adviser. She was detailed at the Office of Public Health Service.
As Nursing Adviser, matters affecting nurses and nursing are referred to
her
May 24, 1999
Executive Order No. 102 was signed by President Joseph Ejercito
Estrada, redirecting the functions and operations of the Department of
Health. Based on this Executive Order, most of the nursing positions at
the Central Office were either transferred or devolved to other offices and
services
2005 2006
The development of the Rationalization Plan to streamline bureaucracy
further was stated and is in the last stages of finalization.

CORE BUSINESS OF PUBLIC HEALTH

1. Disease Control
2. Injury Prevention
3. Health Protection
4. Healthy public policy including those in relation to environmental hazards such as in the
workplace, housing, food, water, etc.
5. Promotion of health and equitable health gain.

The core business of public health cannot be achieved without the proper delivery Of
essential public health functions which Yach described as a set of fundamental activities that
address the determinants of health, protect a populations health and treat disease. These
public health functions represent public goods, and in this respect governments would need to
ensure the provision of these essential functions, but would not necessarily have to implement
and finance them. They prevent and manage the major contributors to the burden of disease by
using effective technical, legislative, administrative and behavior-modifying interventions or
deterrents, and thereby provide an approach for intersectoral action for health. This approach
stresses the importance of numerous different public health partners. Moreover, the need for
flexible, competent state institutions to oversee these cost-effective initiatives suggests that the
institutional capacity of states must be reinforced.

The following are the essential public health functions:
1. Health situation monitoring and analysis
2. Epidemiological surveillance/disease prevention and control
3. Development of policies and planning in public health
4. Strategic management of health systems and services for population health gain
5. Regulation and enforcement to protect public health
6. Human resources development and planning in public health
7. Health promotion, social participation and empowerment
8. Ensuring the quality of personal and population based health services
9. Research, development and implementation of innovative public health solutions

For these public health functions to be adequately delivered, a well-defined, coordinated public
health system or infrastructure must be put in place. Governments need to ensure these
essential functions are provided, but do not necessarily have to implement or finance them
themselves. Implementation may be achieved through other governmental agencies, community
and non-governmental organizations or the private sector, among others.


PUBLIC HEALTH PROGRAMS / INTERVENTIONS

Public health programs are sets of interventions put together to operationalize policies
and standards directed towards the prevention of certain public health problems. Strategies and
activities used are based on scientific evidences and has shown to be effective.

Family Health Programs
1. Infant and Young child feeding
2. Newborn Screening
3. EPI ( Expanded Program on Immunization
4. Maternal-child Health/ Safe Motherhood and Family Planning
5. Child Injury Prevention
6. Integrated Management of Childhood Illness

Non-Communicable Disease Prevention and Control Program
1. National Healthy Lifestyle Program
2. Drug Dependence/ Substance Abuse Control
3. Mental Health Program
4. Prevention of Blindness
5. Oral Health Programs

Communicable Disease Prevention and Control Program
1. National Tuberculosis Control Program
2. Leprosy Control Program
3. Schistosomiasis Control Program
4. Filiriasis Control Program
5. Malaria Control Program
6. Rabies Control Program
7. Dengue Control Program
8. STD snd HIV/AIDS Control Program

Environmental Health and Sanitation
1. Water Supply Sanitation Program
2. Food Sanitation Program
3. Hospital Waste Management Program
ECONOMICS IN PUBLIC HEALTH

Health economics is a branch of economics concerned with issues related to efficiency,
effectiveness, value and behavior in the production and consumption of health and health care.
In broad terms, health economists study the functioning of the health care systems as well as
health-affecting behaviors such as smoking.

The scope of health economics is neatly encapsulated by Alan Williams' "plumbing diagram"
dividing the discipline into eight distinct topics:
What influences health? (other than health care)
What is health and what is its value
The demand for health care
The supply of health care
Micro-economic evaluation at treatment level
Market equilibrium
Evaluation at whole system level; and,
Planning, budgeting and monitoring mechanisms.