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Community Public Health lec

Introduction
NOTES:
 Bringing medicine is not public health but educating the community is.
 Teaching them on what to do and what not to do is Public Health
 Public Health= Prevention
o Means to prevent disease attainment (Public health Interventions)
 Hand washing / Proper Sanitation
 Vaccination- important way to prevent disease
 Health promotion has successfully shifted the focus from behavioral change at the individual level to health-oriented
behavior
o Changes are largely confined to people of higher education and socioeconomic background than lower
socioeconomic groups.
 Critical factors that influence health = Consumption and communication, urbanization and environmental changes, public
health emergencies.
 It is also necessary to include the private sector when developing health promotion policies.

Health - State of complete physical, mental and social well-being and not merely the absence of
disease or infirmity.
Public Health -Science and art of preventing disease, prolonging life, promoting health and efficiency
through organized community effort for the sanitation of the environment,
control of communicable disease, the education of individual’s personal
hygiene. Discipline that addresses health at a population level.
Public Health - Is actually prevention, so disease would not occur.
Community Medicine/Health - Public health is also known as this.
Health Promotion - Process of enabling people to increase control over the determinants of health and
thereby improve their health. Strengthening individual skills and capabilities.
WHO, 1998 -^ is stated by them.
Health Promotion - A core function of public health and a cornerstone of primary health care.
Effective/cost effective -^ is this.
Ottawa Charter for Health Promotion - Health promotion came in to full force through this. They set out an agenda to pursue
health for all addressing the broad determinants of health such as shelter,
education, food and income.
1986 -^ during this year
Bangkok Charter - They urged all sectors and settings to invest in sustainable policies, actions and
infrastructure, to build capacity to promote health, etc. Also calls for
conscientious effort to sustain the effectiveness of health promotion.
Curative - To cure an already existing disease, not public health
Preventive - What public health circulates on. To prevent
Non-Communicable - No agent involved: hypertension, Diabetes, Cancer.
Communicable - There should always be an agent Example: Pulmonary tuberculosis (Mycobacterium
tuberculosis), Dengue, Influenza
Agents - Viral, Fungal, Parasitic, Bacterial

Fields in Public Health

(a.k.a Community MEDICINE; Community HEALTH)

1. Biostatistics and epidemiology - Responsible for interpreting the scientific data that is generated in Public Health
(Biostats). Epidemiology deals with the incidence, distribution, and possible
control of diseases and other factors relating to health.
2. Health Administration - People who work at registration under WHO and DOH
3. Environmental and Occupational Health.
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4. Environment - Factors in the environment that affect health
5. Occupational - Dangers and hazards in the workplace
6. Nutrition - For we are after the health of the community
7. Health Education and Promotion - Most of the time RNs are the ones who do health education and promotion
8. Microbiology and Parasitology - Tropical Medicine
Tropical Medicine - Diseases that are confined in the tropic regions found near or on the equator. \
Ex: Malaria, Dengue

Two divisions of Pathology:

Clinical Pathology - Concerned with the diagnosis of disease based on the laboratory analysis of bodily fluids
Anatomic Pathology - Biopsy, Autopsy, Histopathology

Environmental and Occupational Health

Global Warming - Are vectors affected by the increasing heat?

What do Public Health Professionals Do?

Evolution of Public Health

Late 19th Century - A package (educating) of sanitary and industrial safety measures.
Services (Environment)
- Assurance of safe water supply
- Sanitary disposal of waste
- Clearance of slums
- Improving the work environment and working conditions of industrial workers
Early 20th Century - Inclusion of measures for prevention of communicable disease.
Services (Self)
- Immunization: cholera, small pox, rabies, typhoid, anthrax, etc.
- Control of vectors and reservoirs of infection
1920 - Full spectrum of preventive and promotive services were incorporated. Primary health
centers and sub centers were constructed to provide the health service
mentioned.
Services (Education)
- Maternal and child health
- Family planning
- School health
- Nutrition Promotion
- Mental Health
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- Health Education
Early 1960s - Education of the public not to take risky lifestyle was included upon realization of the
role of risk factors.
1981 - Putting health care services in the hands of every person regardless of nationality, caste
and creed.

Synonyms/Terms in Public Health

- Hygiene
- Preventive Medicine
- Social Medicine
- Community Medicine
- Community Health

Roles of Medical Technologists in Public Health

- Health Programs/Project Field Coordinator
- Health Programs/Project Monitoring Officer
- “ “ Evaluation Officer
- Field Epidemiologist( Outbreak investigation; contact tracing, surveillance)
- Sanitation Inspector
- Quality Control/Assurance Officer for Pharmaceutical products, test kits/materials and other biological agents.
- Academician
- Researcher
- Clinical Lab Scientist in Public Health Lab
- Infection Control Center

Strategies/methods in public health promotion &

education
NOTES:
 Health workers implementing health education & promotion must make decisions on which method to use to bring about
change.

Practice of Health Promotion & Education is influenced by:

1. Stress on environmental vs. individual change
2. Stress on high risk individuals vs. whole population where risk is evened out
Factors to be considered in selecting strategies for Health Promotion and Education
1. Objective of the intervention
2. Characteristics and need of the target group
3. Resources to include human, financial & time
Strategies
Counseling - A process of helping people learn how to achieve personal growth, improve
interpersonal relationships, resolve problems, make decisions & change behavior.
Green & Morton, 1984 -^ this is according to them.
Reddy, 1987 - According to him, counseling is a set of techniques, skills and attitudes to help people
manage their own problems using their own resources.
Counseling is distinct from psychological therapy for:
o Generally, of short duration, frequently consisting of one or two appointments.
o It is highly situational rather than general & chronic
o The client is normal/rational neither neurotic nor dysfunctional
Three Phases of Counseling
1. Understanding -This leads to defining the problem.
2. Challenging - Leads to redefining the problem
3. Resourcing - Leads to managing the problem.
Group Discussion - A planned opportunity for participants to freely exchange ideas or opinions. Most
participatory in all group communication techniques. All members have the
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responsibility to share info.
During the Session, Members are Expected to:
o Speak to the subject
o Speak to the question
o Speak to one another
o Seek individual understanding & response
o Seek to affirm the other
o Seek to understand the other
o Seek dialogue, not monologue
o Have fun
Mass Media - A channel where large number of people are addressed. Includes print & electronic
media- newspaper, radio, tv, film, jingle, video, etc.
Target Group -They are expected to make little or no effort to receive the message.
Roles of Mass Media for HPE Program
- As educator
- As supporter
- As promoter
- As supplement
Influence of Mass Media on Societal Norms
- Reinforce existing patterns
- Create new shared convictions
- Can change existing norms
Social Marketing - The use of marketing principles & techniques to advance a social cause, idea or behavior.
Kotler & Zaltman, 1971 -^ they stated this.
Health Marketing - In public health perspective, this term is coined. Are health promotion programs
developed to satisfy and enhance consumer needs.
4 Ps in Marketing
Product - This is being sold
Social idea/practice, tangible object - The three types of products in social marketing
Social Idea - Can be the form of belief, attitude or value.
Belief - The perception held about a factual matter.
Attitude - Positive or negative evaluation
Value - Over all idea of what is right and wrong.
Social Practice - Occurrence of a single act. Altered pattern of behavior.
Tangible Object - Refers to the physical product that may accompany a campaign.
Price - Maybe monetary in nature. Also known as cost.
Time Cost - Would refer to amount of time it takes to obtain a product/service.
Opportunity Cost - Refer to benefits missed because of obtaining the service.
Place - The distribution channels used to make the product. Answers how & where the product
will be available to the target markets.
Accessible, secured and attractive - Qualities target consumers expect the place to be.
Promotion - Means by which the social product is promoted to the target adopters. Right people with
the right message at the right time. Posters/mascots/exhibits/tv/radio/ads/etc.
Folk Media - Channels for traditional messages that affirm values and worldview. Inform and
entertain or educate through literary & theatrical genres of religious or secular nature.
Traditional Media - Media of pre-electronic age.
Folk Media Examples
Balitao - Courtship debate in song & dance
Balagtasan - Like ^, is essentially a debate. Arguments are well structures in rhythmic cadence.
Zarsuela - A musical 3-act melodrama. Socially relevant play, satirizes social structures.
Magpamilya’y di Biro - A 45min musical comedy exploring the different facets of family planning.
Puppet Theater - Effective for a young target group
Proverbs (Kasabihan) - Poetic statements that comments about life, provides guidance for living.
Riddle - Problems and answers that uses literary techniques such as metaphors and rhythms.
Folk Media
- Folk Literature
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- Folk Songs
- Fold Performing Arts
- Folk Dances
Advantages of Using Folk Media
- Localized & intensive penetration of specific communities.
- There is a wide acceptance by the rural communities
- Balances the impersonal nature of mass media
- There exists a wide array of forms, structures and techniques
- Are familiar to the rural folks
Enter-Educate Approach - Entertain and educate system Should really be renamed to edu-tain 

5 Ps: Personal, popular, Pervasive, Persuasive, Profitable

Potential Stumbling Blocks
- More time for production
- More money
- Frustrations of creative people
Enter-educate methods
1. Commercial songs/videos
2. Radio and tv advertising
3. Telephone Hotlines
4. Service center network
Training - Prepares one to do certain job & is focused more on the acquisition of skills.
*Needs assessment  Goals and objectives  Plan or design  Implementation  Evaluation*
Nice to Learn Useful to Learn  Must Learn

EMERGING PUBLIC HEALTH CONCERNS

Obesity - A complex condition, affects psychological and social being of a person. Excessive
amount of fat.
1 Billion - Amount of adults who are overweight.
300 Mil, Clinically Obese - Is a major contributor to the global burden of chronic disease and disability.
Other Concerns: Bio-terrorism, International travel/migration/mobility, Porous borders, Weak surveillance systems.

Social Determinants of Health - Refer to both specific features of and pathways by which societal conditions affect
health and that potentially can be altered by informed action. The social
condition in which people live and work, reflecting their different positions in
hierarchies of power, prestige and resources.
** Tarlov, 1996 - The social characteristics in which living takes place.
Social Determinants
- Inequalities with/between countries
- Social classes; family patterns
- New patterns of consumption and communication
- Globalization
- Urbanization

Four Major Challenges Facing Health System

o Global health workforce crisis
o Lack of appropriate, timely evidence
o Lack of financial resources
o Stewardship challenge of implementing pro-equality health policies in a pluralistic environment.

Changing the Context of Public Health

o Communicable disease
o Emerging of new pandemics
o Non-communicable disease
o Global health threats e.g. environmental changes, bio-terrorism
o Scope of ph (control-leadership)
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Public Health Workforce (Health Professionals) Population-wide and inter-sectoral approach
 Composition/mic of different professionals -Health is prioritized within overall development and economic policies
o Roles/functions -Resource Mobilization
o Competencies - Private-public relationship
o Training

Philippine Health Care Delivery System

2 COMPONENTS
Public Sector - Can be in the city or municipality, includes health centers or barangay
health stations.
Department of Health (DOH) - National public sector
Local Government Unit (LGU) - Local public sector
Private Sectors - Clinics, hospitals, health insurance, med manufacture, vaccines, etc.

DEPARTMENT OF HEALTH HISTORY

Pre-Spanish and Spanish Period - Traditional health care, Dispensary of indigent patients of manila.
Before1898 -^ is in this year
Medicus Titulares -Provincial health workers. The medical doctors in the late 19th century.
Superior Board of Health and Charity, 1888 - This was established during the pre-Spanish and Spanish period.
June 23, 1898 - Creation of the Department of Public Works, Education and Hygiene.
E. Aguinaldo government -^ was created by
September 29, 1898 - Establishment of the Board of Health for the City of Manila
Gen. Order no.15 -^ General order that established the Board of Health “ .
July 1, 1901 - Creation of the Board of Health of Philippines Islands and Provincial
and municipal boards.
Act no. 157 - Act that established the Board of Health of Philippine Islands
Act no, 307 & 308 - Act that established the provincial and municipal boards
October 26, 1905 - Establishment of Bureau of Health
Act no. 1407 - Act that established the Bureau of Health
1912 - Establishment of the health fund for travel and salaries
Act no. 2156 - The act that established the health fund for travel and salaries
Fajardo Act - ^ this act is also known as?
1915 - Bureau of Health to Philippine Health Service “Semi-military system
of public health administration”
Act no. 2568 - Act that changed name of BOH to Philippine Health Service.
Aug 2, 1916 - Establishment of the act that includes the Public Health Law of 1917
Act 2711 - Act included the Public Health Law of 1917
1932 - Establishment of the Reorganization Act of 1932
Act no 4007 - The act that established the reorganization act of 1932
October 4, 1947 - There was a split of Department of Public Welfare and the Philippine
General Hospital to the office of the President; split between
curative and preventive services.
E.O. no 94 - Executive Order , reorganization of the Department of Health and
Public Welfare
Social welfare Administration - the Department of Public Welfare became this.
Bureau of Hospitals - Curative service
Bureau of Health - Preventive Service
Nursing Service Division -Was established during 1947.
January 1, 1951 - Conversion of Sanitary District to Rural Health Service
Rural Health Act of 1954 - The passage of this Health act happened in 1951
RA 1082 -^its republic act.
Different Services Provided by the Rural Health Service
- Maternal & Child health
- Environmental health
- Communicable disease control
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- Vital statistics
- Medical care
- Health Education
- Public health nursing
1970 - Conceptualization of the Restructured Health Care Delivery System.
(Primary, secondary and tertiary levels of care)
June 2, 1978 - Renaming of DOH to Ministry of Health during Martial Law
P.D 1937 -The Presidential Decree that renamed DOH to Ministry of Health
Sec. Gatmaitan - The first minister of health.
December 2, 1982 - The reorganization of the Ministry of Health as an integrated health
care delivery system.
E.O 851 - The executive order^
Integrated Provinicial Health Office - Through the creation of this, the ministry of health is an integrated
health care delivery system. This combines the public health
and hospital operations under the PHOs.
April 13, 1987 - Ministry of Health was back to Department of Health
E.O. 119 -^ the executive order
Cory Aquino - The president in charge of changing MOH to DOH.
October 10, 1991 - From provincial to local government (devolution/devolved health sector)
RA 7160 - RA that states that all structures, personnel and budgetary allocations
from the provincial health level down to the barangay were
devoted to the LGU to facilitate health service delivery.
Local Government Code -^ This is also known as this.
May 24, 1999 - Redirecting the Functions and Operations of the DOH
E.O 102 -^ its Executive Order
Pres. Joseph Estrada - The president to stablished the EO.
1999-2004 - Development of the Health Sector Reform Agenda.
2005 to present - Development of a plan to rationalize the bureaucracy in an attempt to
scale down including the DOH.

ROLES AD FUNCTION OF THE DEPARTNMENT OF HEALTH

Leadership in Health
Enabler and Capacity Builder
Administrator of Specific Services
- National policy & regulatory institution, leadership in formulation,
monitoring & evaluation of health policies, plans & programs.
Serve as advocate in health policies, plans and programs.
- Innovate new strategies in health. Ensures highest achievable
standards of quality health care.
- Manage selected national and sub-national facilities and hospitals
with modern facilities that shall serve as referral centers.
Direct service/Emergency response for health concerns.

Francisco Duque III, MD - Secretary of the Department of Health

Acute Lower RTI and Pneumonia - The Leading cause of morbidity in the Philippines.
Disease of the Heart - Leading cause of mortality in the Philippines.
Inter Local Health System - Espoused by DOH to ensure quality health care at the local level.
Inter Local Health Zone (ILHZ) -^Is clustered into this

Vision of DOH
The DOH is the leader, staunch advocate and model in promoting health for all in the Philippines
Mission of DOH
Guarantee equitable, sustainable and quality health for all Filipinos, especially the poor and shall lead the quest for excellence in
health.

Health Sector Reform Agenda (HSRA) - The goal of DOH.

For the last 50 years, these are still seen in the population:
- Persistence in large variations in health status across the population groups & geographic areas.
- IMR and MMR - ^ aims for the slowing down in reduction of these.
- Infectious Disease - There is a high burden of this
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- Chronic & degenerative disease - Rising burden of this
- Environmental & work related factors - Unattended emerging health risk from this
- Poor - The burden of disease is heaviest in this group.
Goals of Formula one for Health
1. Better health outcomes
2. More responsive health systems
3. Equitable health care financing
4 Elements of Strategy
1. Health financing
2. Health regulation
3. Health service delivery
4. Good governance

Objectives of the Local Health System

1. Establish local health systems for effective and efficient delivery of health care service
2. Upgrade health care management and service capabilities of local health facilities
3. Promote inter-LGU linkages & cost sharing schemes include local health care financing systems for better utilization of local
health resources.
4. Foster participation of the private sector, NGOs and communities in local health systems development
5. Ensure the quality of health service delivery at the local level.

Expected Achievement of the Inter-Local Health System

1. Universal Coverage of Health Insurance
2. Improved quality of hospital & RHU service
3. Effective referral system
4. Integrated planning
5. Appropriate health information system
6. Improved drug management.
7. Developed human resources
8. Effective leadership through inter-LGU corporation
9. Financially visible or self-sustaining hospitals
10. Integration of public health & curative hospital care
11. Strengthened cooperation between LGU & health sectors

Guiding Principles
1. Financial & Administrative autonomy of the provincial and municipal administrations
2. Strong political support
3. Strategic synergies and partnerships
4. Community participation
5. Equity of access to health services by the population, especially the poor.
6. Affordability of health services
7. Appropriateness of health programs
8. Decentralized management
9. Sustainability of health initiatives
10. Upholding of standards of quality health service

Composition of Inter-Local Health Zone

1. People
2. Boundaries
3. Health Facilities
4. Health Workers

Alma Ata Declaration of 1978

International Conference on Primary Health Care - Expressed the need for urgent action by all government/ health/
development workers and the world community to protect and
promote the health of all people of the world.
September 12,, 1978 -^ was held during this d ate
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Alma-Ata -^ was held here.

Ten parts of the Alma Ata Declaration

1. Definition of Health
2. Concern over inequality between countries
3. Health as a pre-requisite for economic progress of countries
4. People’s right to participate in planning and implementation of health services
5. State responsibility in provision of health care to all citizens
6. Reaffirmation of primary health care as an important strategy to organize health service
7. Components of primary health care
8. Align national policies and build political will to achieve primary health care
9. Cooperate between countries to achieve these goals
10. Health for all by 2000

Primary health care: Health for all

Declaration of Alma-Ata -Aimed to protect and promote the health of all people around the world
WHO-UNICEF - A conference of world health leaders
Almaty - Alma-ata is now known as this.
Kazakhstan - Is part of the USSR

Primary Health Care (PHC)
Primary Level of Health Care Services
Health Care Delivery system
Principles and Strategies of Primary Health Care
- This is an approach, provision of basic health care services to
everyone via acceptable, affordable and accessible health care.
- PHC is not synonymous with the delivery of this.
- PHC is a structure of this, serves as the first contact of an individual
to the health system.

Principle 1- Accessibility, Availability and Acceptability of Health Service.

Strategies
- Health Services must be delivered where the people are
- Use indigenous resident volunteer workers as health care providers with a ratio of 1 community health worker per
10-20 households
- Use of traditional (herbal) medicine together with the essential drugs

Principle 2: Provision of Quality Basic and Essential Health Service

Strategies
- Training design and curriculum based on community needs and priorities. Task analysis of community health
workers are competency based
- Attitudes, knowledge and skills are developed on promotive, preventive, curative and rehabilitative health care.
- Regular monitoring and periodic evaluation of CHW performances by the community and health staff.

Principle 3: Community Participation

Strategies
- Awareness building and consciousness- Raising on health and health related issues
- Planning, implementation, monitoring and evaluation done through small group meetings (10-20 household clusters)
- Selection of community health workers by the community.
- Community building and community organizing
- Formation of health committees
- Establishment of a Community Health Worker Organization at the parish or municipality level
- Mass health campaign and mobilization to combat health problems.

Principle 4: Self Reliance

Strategies
- Community generates support (cash/kind/labor) for the health program
- Use of local resources (human/financial/material)
- Training of community in leadership and management skills
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- Incorporation of income generating projects, cooperatives, small scale industries.
Principle 5: Recognition of Interrelationship between Health and Development
Strategies
- Convergence of health, food, nutrition/water, sanitation and population services
- Integration of PHC into national, regional, provincial, municipal, barangay development plans
- Coordination of activities with economic planning, education ,agriculture, industry, housing, public works,
communication and social services.
Principle 6: Social Mobilization
Strategies
- Establishment of an affective health referral
- Multi-sectoral and interdisciplinary linkages
- Information, education and communication support using multimedia
- Collaboration between government and non-government organizations
Principle 7: Decentralization
Strategies
- Re-allocation of budgetary resources
- Re-orientation of professionals on primary healthcare
- Advocacy of professionals on primary health care
- Advocacy for political will and support, from the national leadership down to the barangay levels

Essential Elements of Primary Healthcare

Education for Health
Locally Endemic Disease Control
Expanded Program on Immunization
Maternal and Child Health
Essential Drugs
Nutrition
Treatment of Communicable Disease
Safe Water and Sanitation