HISTORY OF PUBLIC HEALTH IN THE PHILLIPINES AND INTRODUCTION TO COMMUNITY AND PUBLIC

HEALTH

The student will be able to: • Trace the history of public health in the Philippines • Identify the different
programs and establishment built during the different socio-political periods

HISTORY OF PUBLIC HEALTH IN THE PHILIPPINES

History of Public health in the Philippines based on socio-political periods

1. Pre-American Occupation (up to 1898 ) 2. American Military Government (1898-1907) 3. Philippine

assembly (1907-1916) 4. The Jones law (1916-1936) 5. The Commonwealth (1936-1941) 6. Japanese
occupation ( 1941-1945) 7. Post World war II (1945-1972) 8. Post EDSA revolution (1986 to present Read
and understand the story

I.PRE-AMERICAN OCCUPATION - Public health works began at the old Franciscan Convent in Intramuros
where Fr. Juan Clemente put up a dispensary in 1577 for treating indigents in Manila. - This eventually
became the San Juan de Dios Hospital.

During Spanish time: 1. Creation of Board of vaccinators to prevent smallpox 2. Creation of board of
health 3. Construction of carried waterworks 4. First medical school in the Philippines- UST 5. School of
Midwifery 6. Public health laboratory 7. Forensic medicine

Hospitals before the Americans came to Philippines: 1. General hospitals a) San Juan de Dios Hospital b)
Chinese General hospital c) Hospicio de san Jose in Cavite d) Casa dela Caridad in Cebu e) Enfermeria de
Santa Cruz in Laguna

2. Contagious Hospitals a)San lazaro Hospital b)Hospital de palestina in Camarines Sur c)Hospital delos
Lesprosos in Cebu d)Hospital de Argencina in Manila for smallpox and cholera

3. Military hospital a) Hospital Militar de Manila b) Hospital Militar de Zamboanga

4. Naval Hospital a) Hospital dela Marie in Cebu b) Hospital de basilan

5. Other hospital/Asylums a) Hospicio de San Pascual Baylon in Manila b) Asylum of St. Vincent de Paul
in Manila for poor girls c) Hospital of San Jose for orphaned children and mentally ill

II. AMERICAN MILITARY GOVERNMENT - Control of epidemics such as cholera, smallpox and plague -
Fight against communicable diseases such as leprosy, diarrhea, malaria, beri-beri

Projects and activities a) Established a garbage crematory b) Approved the first sanitary ordinance and
rat control c) Amoebic dysenterycaused by contaminated water and unclean vegetables, and
malariaAnopheles minismus flavirostris was pointed out as vector.

d) Cholera vaccine was first tried e) Confirmed that plague in man comes from infected rat f) Opened a
leper colony in Culion g) Founded the manila Medical society and Philippine Island Medical Association
h) Opened the UP College of Medicine i) Established Bureau of Science
III. PHILIPPINE ASSEMBLY • New waterworks in Manila was inaugurated to control cholera • Nursing
school at Philippine Normal School • Hygiene and Physiology were included in curriculum of public
elementary school • Anti-TB campaign was started • Philippine Tuberculosis Society was organized

• Pasteur prophylaxis treatment against rabies was offered • Opening of the Philippine General Hospital
(PGH) • Use of anti-typhoid vaccine was initiated • Hypochlorite of lime was first used for treating the
water supply of Manila • Etiology of Amoebic dysentery was made clear • Dry vaccine against smallpox
was first used

IV. JONES LAW YEARS • Retrogression rather than progression in so far as the health was concern 1.
Increase CDR- death rate per 1000 person 2. Increase IMR-infant death per 1000 3. Increase Morbidity-
rate of incidence of disease • Increased deaths from smallpox, cholera, typhoid, malaria, beriberi and TB

• Re-organization happened (reorganized the health service and encouraged effective supervision) 1.
Study the cause and prevalence of typhoid fever 2. The composition, value and vitamin distribution of
many Philippine foods were studied. 3. Schick test was used to determine the causes of diphtheria 4.
Campaign against Hookworm was launched 5. Anti-dysentery vaccine was first tried 6. The roles of
seafood in transmission of cholera and the pollution of fishing sector to typhoid were studied

7. First training course for sanitary inspector was given 8. Women and Child labor was passed 9. The
mechanism of transmission of dengue fever through Aedes aegypti was studied 10. Construction of
Novaliches dam 11. Establishment of School of Hygiene and Public Health 12. National Research Council
of the Philippines was organized 13. BS in Education major in Health Education was opened in UP 14.
Philippine Public Health Association(PPHA) was organized

V. THE COMMONWEALTH PERIOD • Process of gaining and maintaining altitude (because the later years
under Jones Law was successful) • The epidemiology of life threatening diseases was studieddiphtheria,
yaws, dengue • Research in the field of health was promoted • UP school of Public health was
established to train public health leaders • Construction of Quezon institute for PTB patients

• Research and Control of TB, Malaria, leprosy and yaws • Development of Maternal and Child Health
(MCH) • 1939, creation of Department of Public Health and Welfare- Dr. Jose fabella as the first
secretary • 1940, Bureau of Census and Statistics was created to gather vital statistics • Inequitable
distribution of health services remained a problem • 80% of those who died were never given medical
attention.

VI. JAPANESE OCCUPATION • During this time, All public health activities were practically paralyzed THE
WORLD WAR II • After 5 years of Japanese occupation, public health tried to pick up the debris and rise
from the ruins • Survey: Increased incidence of TB, VD, malaria, leprosy and malnutrition. • General
sanitation has been reduced to level enough to constitute a national hazard • US congress passed an
emergency measures to control diseases: TB, VD, malaria. Leprosy, malnutrition • Immunization
program

VII. POST WORLD WAR II - The Philippine Independence 1. Completion for a research on
Dichlorodiphenyl trichlorothanel (DDT) saw dust as larvicide and DDT residual spraying of houses in the
control of malaria. 2. Construction of the National Chest Center-for control case registry for TB, mass
immunization with BCG 3. Industrial hygiene laboratory 4. Introduction of oneinfection method for
gonorrhea with penicillin 5. Creation of central Health laboratory in the Philippines
6. Creation of Institute of Nutrition under BRL, then it was transferred to National Institute of Science
and Technology and was renamed as Food and Nutrition Research Center, it was again renamed as FNRI
• Manila was selected as Headquarters for the WHO Western pacific Office. • Strengthening Health and
Dental services in rural areas • This is thru RHU program (per municipalities with 5,000-10,000
population) 1 Municipal Health Officer (MHO) 1 Public health Nurse (PHN) 1 Midwife 1 sanitary
Inspector

• Reorganization of DOH- creation of several offices 1. Dental health services 2. Malaria Education
services 3. Disease Intelligence Center 4. Food and Drug Administration 5. National Schistosomiasis
Control Commission 6. National Nutrition Program

• Initiation of programs with multilateral assistance 1. WHO and UNICEF assisted TB and BCG programs
2. TB control program as basic service of RHU 3. TB sputum case finding by microscopy 4. Serum and
vaccine production in Alabang 5. Expanded MCH and Mental Health Program 6. Training programs for
Midwives 7. Strengthened graduate health programs at the UP-CPH

• Development of family Planning Movement • Launching of programs in cooperation with private

sectors- top provide services to periphery ( indigents, minority groups) • Rizal Development project 1.
Restructuring of the DOH Rural Health Care Delivery System 2. Each barrio was provided with midwife 3.
For, the first time, dengue virus was isolated from typical H fever cases

VIII. MARTIAL LAW YEARS • Creation of National Economic Development Authority (NEDA) •
Department of health was renamed as Ministry of Health (MOH) • Accomplishment during this period:
1. Formulation of National Health Plan 2. Implementation of restructure Health care delivery system
(primary, secondary, tertiary) 3. Construction of tertiary hospitals (Philippine heart center, Lung center,
Kidney center,Lunsod ng kabataan) 4. Adaptation of the Primary Health Care 5. Promotive and
preventive rather than curative care 6. Philippines was the first country to implement PHC

7. Launching of Operation Timbang and Mothercraft 8. Nationwide program providing supplementary

food for infants and preschool children 9. Birth of integrated Provincial Health Office (IPHO) 10. Oral
rehydration Therapy for the National Control of Diarrheal Diseases 11. Community-based health
programs 12. Progress in Public Health research a. Nutrition council of the Philippines- to address
problems on malnutrition b. RITM- for infectious and tropical diseases c. PCHRD- mandated to lead,
direct and coordinate science and technology activities in health and nutrition.

IX. EDSA REVOLUTION • From Ministry of Health it was renamed again as Department of Health •
Increase in life expectancy slowed down • Morbidity and Mortality rates from preventable causes
stabilized at high rates • Declined in infant and child mortality decelerated • Increased incidence of
malnutrition • Declined practice of family planning

X. AQUINO ADMINISTRATION • 1987 constitution – more provision on health making comprehensive

health care available • Active participation of private sector and NGO • Major activities influencing
public health during this period 1. Milk code- EO51- required the marketing of breast milk substitute 2.
Universal child and mother immunization 3. International safe and motherhood initiative was launched
to reduced maternal mortality rate.

4. Act prohibiting discrimination against women (RA6725) 5. National Epidemic Surveillance System
(NESS)- this was made to track down the occurrence of 14 diseases with potential causing outbreaks. 6.
National drug policy and Generic Actensure the availability of safe, effective and affordable quality drugs
(RA6675) 7. Local government code- from national government to governors and mayors (RA7160) 8.
Organ Donation Act of 1991 (RA7170)Legalizing donation of all or body parts after death for specified
purpose.

XI. RAMOS ADMINISTRATION • “Health in the Hands of People” and “Lets DOH it”- by the Sec. Juan
Flavier • Continue to adopt PHC as a strategy • Memorable initiative during the leadership of Flavier: 1.
National Immunization Day – BCG, DPT, OPV, MMR 2. Mother and Friendly Hospital Initiative 3. This
strategy ensures the survival and health of children through breast feeding

4. Promotion of Philipine Traditional medicine- DOH and DOST 5. Hospital as Center of

Wellnesstransformed 45 government hospitals from disease places to centers of wellness 6. Yosi Kadiri-
Anti smoking campaign 7. Araw ng Sangkap pinoy- aimed to prevent vitamin A, iron and iodine
deficiency 8. Voluntary Blood Donation Program 9. Kung Sila’y Mahal mo Magplano- Family planning
program 10. Doctors to the Barrio

LAWS: 1. RA 7394- Consumer Act of the Philippines- an act providing penalties for manufacture,
distribution and sales of adulterated foods, drugs and cosmetics 2. RA 7610- Special protection of
Children against child abuse, exploitation and discrimination act 3. EO 39- which created the Philippines
National AIDS Council as a national policy and advisory body in the prevention and control of HIV-AIDS

4. RA 7432 - Senior Citizen’s Act - which grant benefits and special privileges in order to maximize the
contributions of senior citizen to nation building

5. RA 7719 - The National Blood services Act of 1994 which was passed to promote voluntary blood
donation

6. RA 8172 - An Act of Salt Iodization Nationwide- providing salt iodization nationwide approved in 1996
and renamed FIDEL _fortified for Iodine Elimination)

Reodica’s Seven Strategy Program 1. Expanded Program on Immunization (Oplan Alis Disease)- to
eliminate polio, measles and neonatal tetanus 2. Nutrition- vitamin A, iron and iodine utilization
(Araw ng Sangkap pinoy) 3. Family Planning 4. Tuberculosis prevention (Target, Stop TB) 5.
Environmental sanitation (TKO) 6. STD-AIDS awareness prevention 7. Healthy Lifestyle program

THANK YOU FOR LISTENING

HISTORY OF PUBLIC HEALTH IN THE PHILLIPINES AND INTRODUCTION TO COMMUNITY AND PUBLIC
HEALTH

Overview of Session

The students are introduced to Community and Public Health, its scope of services as well as its
development as a discipline in the Philippines, After the completion and review of the topic, the student
should be able to explain the meaning and significance of Public Health in the Philippines.

Objectives:

The student will be able to • Define Public health • Discuss the scope of the subject

PUBLIC HEALTH
• Ecological (environmental) in perspective(VIEWPOINT), multisectoral (division) in scope and
collaborative(2 WAY) in strategy

• It aims to improve the health of community through an organized community effort

• The science and art of preventing disease, prolonging life and promoting health through the organized
efforts and informed choices of society, organizations, public and private communities and individuals.

The 3 Core Functions of Public health

Assessment

Policy Development

Assurance

The Ten Essential Public health Services

Monitor health status to identify community health problems

Diagnose and investigate health problems and health hazards in the community

Inform, educate, and empower people about health issues

Mobilize community partnerships to identify and solve health problems

Develop policies and plans that support individual and community health efforts

6. Enforce laws and regulations that protect health and ensure safety 01

7. Link people to needed personal health services and assure the provision of health care when
otherwise unavailable 02

8. Assure a competent public health and personal healthcare workforce 03

9. Evaluate effectiveness, accessibility, and quality of personal and population based healthcare service
04

10. Research for new insights and innovative solutions to health problems 056 7 8 10 9
• It is concerned with threats to the overall health of a community based on population health analysis.

• Public health is typically divided into 3 fields:

CHARACTERISTICS OF PUBLIC HEALTH

1. It deals with preventive rather than curative aspects of health.

2. It deals with population levelrather than individual-level health issues.

What is community?

• It is a group of people with common characteristics or interests living together within a territory or
geographical (physical) boundary.

Community as Client World Views on Community : 1. Family, community and society 2. Contradictions /
Conflicts 3. Change

1. Family, Community and Society

A. Individual a. Patient- an individual who is sick. b. Client- an individual who is well/not sick. B. Family A.
Role/Relationship- Parents; Biparenting *Mother is expected to have the ABILITY to provide care and
usually takes the role of keeping the family well and healthy by combining: 1. Knowledge 2. Attitudes 3.
Skills C. Community - CHN serves up to this level only. - Everything that affects the individual affects the
family and eventually the community.

2.Contradictions / Conflicts

- People in the community are always in constant conflict and faced with contradictions:

1. Individual: intrapersonal conflicts (conflict within the person/personal conflicts) 2. Family: interfamilial
conflicts (conflict within the family/interpersonal conflicts) 3. Community: intercommunity (interfamilial
conflicts) 4. Society: intra-societal conflicts (intercommunity conflicts)

Stereotyping People tend to have negative perspectives. In the Philippines, negative regional
stereotyping is very common such as : a. Ilocanos: kuripot---(positive : call them resourceful) b.
Kapampangans: mayabang--(positive : maybe they are assertive/artistic) c. Bicolanos: malibog---(positive
: could be loving/warm hearted) d. Bisaya: aswang---(positive : they are mysterious/interesting people)
e. Mindanaoans: mamamatay tao (Muslims esp)---(positive : brave/courageous)

3. Change

-is inevitable because a community is a dynamic and is always changing * A CH worker should constantly
assess the community to come up with suitable interventions.

Community as Setting in CHN Practice

- Place where people under usual or normal conditions are found 1. Home- you render Family Health
Nursing 2. Workplace- you render Occupational Health Nursing 3. Schools- you render School Health
Nursing *Outside of purely curative institutions such as hospitals. *Are usually centers for wellness
where you do health promotion and disease prevention.
Health-Illness Continuum Models:

A. Dunn’s High-Level Wellness Grid B. Travis’ IllnessWellness Continuum

A.Dunn’s High-Level Wellness Grid: - describes a health grid in which a health axis and an environmental
axis intersect. - the grid demonstrates the interaction of the environment with the illness-wellness
continuum. - The axis extends from peak wellness to death, and the environment axis extends from very
favorable to very unfavorable. - The intersection of the two axes forms four quadrants of health and
wellness.

1. High-level wellness in a favorable environment : - Ex is a person who implements healthy lifestyle

behaviors and has the bio psychosocial, spiritual , and economic resources to support his lifestyle.

2. Emergent high-level wellness in an unfavorable environment : - Ex is a woman who has the knowledge
to implement healthy lifestyle practices but does not implement adequate self-care practices because of
family responsibilities, job demands, or other factors.

3. Protected poor health in a favorable environment : - Ex is an ill person whose needs are met by the
health care system and who has access to appropriate medications, diet, and health care instruction.

4. Poor health in an unfavorable environment: - Ex is a young child who is starving in a drought-stricken

country.

B. Travis’ Illness-Wellness Continuum: - Ranges from high-level wellness to premature death. - It

demonstrates two arrows pointing in opposite directions and joined at a neutral point.

- Movement to the right of the neutral point indicates increasing levels of health and well-being for an
individual achieved in three steps : 1. Awareness 2. Growth 3. Education

-In contrast, movement to the left of the neutral point indicates progressively decreasing levels of health
and premature death.

Variables influencing health status, beliefs and practices :

1. Internal variables - include those which are usually non-modifiable such as: a. Biologic dimension -
genetic makeup, sex, age, and developmental level all significant to a person’s health. b. Psychological
dimension - emotional factors which include mind-body interactions and self-concept. c. Cognitive
dimension - intellectual factors which include lifestyle choices and spiritual and religious beliefs.

2. External variables- the macrosystem which include: a. Environment - geographical locations

determine climate, and climate affects health; environmental hazards. b. Economics - standards of living
reflecting occupation, income and education is related to health, morbidity and mortality.

c. Family and cultural beliefs: - the family passes on life patterns of daily living and lifestyles to offsprings
(e.g. physical/emotional abuse or climate of open communication). - Culture and social interactions also
influence how a person perceives, experiences, and copes with health and illness.
d. Social support networks: - political/systems of governance; religion/church; mass media.

3. Agent-Host-Environment Model: also called the ecologic model by Leavell and Clark refers to the
interplay of agent(causative/etiologic factor), host (possessing intrinsic factors), and the environment
(extrinsic factors)

A. Etiologic Factors 1. Biological agents - virus, fungi, bacteria, helminthes, protozoa, ectoparasites 2.
Chemical elements: a. Carcinogens: - e.g. those contained in Pringles, Toblerone b. GMO:contained in
Nesvita c. Poisons: MSG d. Allergens e. Transfats

3. Nutritive elements : - excesses and or deficiencies e.g. marasmus & kwashiorkor 4. Mechanical factors
: - accidents 5. Physical : - as when one is struck (strike) by lightning 6. Psychological : - such as stress

B. Host: -Intrinsic factors include: 1. Exposure 2. Response (reaction)

C. Environment: -Extrinsic factors includes: 1. Natural boundaries 2. Biological environment 3. Socio-

economic (political boundary)

3. Health Belief Model: - refers to the relationship between a person’s belief and his behavior in health. -
It pertains to three components of an individual’s perception 1. Susceptibility to an illness 2. Seriousness
of an illness 3. Benefits of taking the action Example: In one HIV infection study

Commercial sex workers

Seafarer’s wives Nuns

Seriousness Yes Yes Yes

Susceptibility Unprotected penetrative sex a. Vaginal : 1:1000 chance b. Anal : male-male : 1:200 chance
male-female: family planning method c. Oral: Felatio : highest risk Cunnilingus: safest sex Analingus: no
HIV risk d. No recorded F-F HIV MOT

Unprotected penetrative sex

Care and support work a. occupational hazards-usually give nurturing care to the sick b. needle-sticks
c. splash accidents

Prevention: Abstinence(safe sex) Be faithful(mutual monogamy) Correct, consistent &continuous use of

condoms Do not penetrate (BCD : safer sex)

C and D B and C Universal precautions

4. Evolutionary-based Model: - states that illness and death sometimes serve an evolutionary function.
Elements considered in the theory are: 1. Life events -developmental variables and variables associated
with changes such as accidents/relocation. 2. Lifestyle determinants 3. Evolutionary viability within the
social context: - reflects the extent to which an individual functions to promote survival and well-being.

4. Control perceptions: - the extent to which a person can influence circumstances in life. 5. Viability
emotions: - affective reactions developed for life events or lifestyle determinants. 6. Health outcomes: -
physiological, behavioral and psychological status resulting from the interplay of those elements. 5.
Health Promotion Model - directed at increasing client’s well-being.
WHO definition (1978): - a state of complete physical, mental, and social well-being, not merely the
absence of disease or infirmity (sickness). - Health is a social phenomenon. - It is an outcome of
multicausal theories of health and disease. - It is an outcome or by-product of the interplay of societal
factors: a. Ecological 1. Biological 2. Physical b. Economic c. Political d. Socio-culture

What is Community Health? - A part of paramedical and medical intervention or approach which is
concerned with the health of the whole population. Its aims are : 1. Health promotion 2. Prevention of
disease 3. Management of factors affecting health

Public Health (definitions)

Major concepts of Public health: 1. Health promotion and disease prevention 2. People’s participation
towards self-reliance : active and full involvement with people in the decision-making process:
Assessment, planning, implementation, monitoring and evaluation.

Dr C E Winslow - The science and art of preventing disease, prolonging life, promoting health and
efficiency through organized community effort 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(long life).

Hanlon - It is dedicated to the common attainment of the highest level of physical, mental and social
wellbeing and longevity consistent with available knowledge and resources at a given time and place. - It
holds this goal as its contribution to the most effective total development and life on the individual and
this society. (Holistic)

Purdom

- It prioritizes the survival of human species, the prevention of conditions which lead to the destruction
or retardation of human function and potential in early years of life, the achievement of human
potential and prevention of the loss of productivity of young adults and those in the middle period of
life and the improvement of the quality of life especially in later years.

Nightingale

- The act of utilizing the environment of the patient to assist him in his recovery. - Any individual is
capable of reparative process.

Week 3

DEMOGRAPHY

Demography

- is the statistical study of human population. - It can be a very general science that can be applied to any
kind of dynamic human population, that is, one that changes over time or space.

- It encompasses the study of the size, structure and distribution of these population and spatial and/or
temporal changes in them in response to birth, migration, aging and death
Census - is the other common direct method of collecting demographic data. - is usually conducted by a
national government and attempts to enumerate every person in a country. - Analyses are conducted
after a census to estimate how much over or undercounting took place.

QUESTION?

1. Where will you go in case of error in census? 2. The keeper of the birth and death record in the
Philippines?

Census - is defined as an official and periodic enumeration of population. - During the census,
demographic, economic and social data are collected from a specified population group. - These data
are late collated, synthesized and made known to the public for purpose of determining and explaining
trends in terms of population changes and planning programs and services.

- Since the census asks for a complete enumeration of the population, it is usually a very expensive
undertaking. - It will require money to pool together people and other resources to complete the census
in a limited period of time. - Instead of a census, demographic information can still be collected from a
sample of a given population. - This is called a sample survey.

- Even if the obtained data come from a small number of people proportionate to the total population,
the results will always be generalized for the whole population.

- Registration systems such that collected by the civil registrar’s office deal with recording vital events in
the community. Vital events refer to births, deaths, marriage, divorces and the like.

- Censuses do more than just count people. - they typically collect information about families or
households, as well as about such individual characteristics as age, sex, marital status,
literacy/education, employment status and occupation, and geographical location. - they may also
collect data on migration (or place of birth or of previous residence), language, religion, nationality (or
ethnicity or race), and citizenship. - In countries in which the vital registration system may be
incomplete, the censuses are also used as a direct source of information about fertility and mortality;

There are two methods of data collection: direct and indirect.

1. Direct data come from vital statistics registries that track all births and deaths as well as certain
changes in legal status such as marriage, divorce, and migration.

2. Indirect methods of collecting data are required in countries where full data are not available, such as
is the case in much of the developing world.

- One of these techniques is the sister method, where survey researchers ask women how many of their
sisters have died or had children and at what age. - With these surveys, researchers can then indirectly
estimate birth or death rates for the entire population. - Other indirect methods include asking people
about siblings, parents, and children.

1. Crude birth rate - Refers to the annual number of live births per 1,000 people. 2. General fertility rate
- Refers to the annual number of live births per 1,000 women of childbearing age (often taken to be
from 15 to 49 years old, but sometimes from 15 to 44). 3. Age-specific fertility rates - Refers to the
annual number of live births per 1,000 women in particular age groups (usually age 15-19, 20-24 etc.)
4. Crude death rate, - Refers to the annual number of deaths per 1,000 people. 5. Infant mortality rate, -
Refers to the annual number of deaths of children less than 1 year old per 1,000 live births. 6. Life
expectancy - Refers to the number of years which an individual at a given age could expect to live at
present mortality levels.

7. Total fertility rate - Refers to the number of live births per woman completing her reproductive life, if
her childbearing at each age reflected current age-specific fertility rates 8. Replacement level fertility -
Refers the average number of children a woman must have in order to replace herself with a daughter in
the next generation. - For example the replacement level fertility in the US is 2.11. This means that 100
women will bear 211 children, 103 of which will be females. About 3% of the alive female infants are
expected to decease before they bear children, thus producing 100 women in the next generation. 9.
Gross reproduction rate - Refers to the number of daughters who would be born to a woman
completing her reproductive life at current age-specific fertility rates.

10. Net reproduction ratio - is the expected number of daughters, per newborn prospective mother,
who may or may not survive to and through the ages of childbearing. 11. Stable population - one that
has had constant crude birth and death rates for such long time that the percentage of people in every
age class remains constant, or equivalently, the population pyramid has an unchanging structure. 12.
Stationary population - one that is both stable and unchanging in size (the difference between crude
birth rate and crude death rate is zero). - A stable population does not necessarily remain fixed in size, it
can be expanding or shrinking

• Note that the crude death rate as defined above and applied to a whole population can give a
misleading impression. • For example, the number of deaths per 1,000 people can be higher for
developed nations than in lessdeveloped countries, despite standards of health being better in
developed countries.

- The fertility rates can also give a misleading impression that a population is growing faster than it in
fact. - For example, if a population has a total fertility rate of 4.0 but the sex ratio is 66/34 (twice as
many men as women), this population is actually growing at a slower natural increase rate than would a
population having a fertility rate of 3.0 and a sex ratio of 50/50. - This distortion is greatest in India and
Myanmar, and is present in China as well.

- Public workers determines the population size not because she simply wants to know how large or
small the population. - Knowing the population size of a place allows the PW to make comparisons
about population changes over time. - It also helps her rationalize the types of health programs or
intervention which are going to be provided for the community.

Populations can change through three processes: A.Fertility B.Mortality C.Migration

Fertility - involves the number of children that women have and is to be contrasted with fecundity.

Mortality - is the study of the causes, consequences, and measurement of processes affecting death to
members of the population.

Migration - refers to the movement of persons from an origin place to a destination place across some
pre-defined, political boundary - Migration researchers do not designate movements migrations' unless
they are somewhat permanent. - Thus demographers do not consider tourists and travelers to be
migrating. - While demographers who study migration typically do so through census data on place of
residence, indirect sources of data including tax forms and labor force surveys are also important

One method of measuring the population size is by determining the increase in the population resulting
from excess of births compared to deaths.

1. Natural increase - is simply the difference between the number of births and the number of death
occurring in a population in a specified period of time = number of births - Number of deaths (specified
year) (specified year)

2. Rate of Natural increase - is the difference between the Crude Birth Rate and the Crude Death rate
occurring in a population in a specified period of time = Crude Birth Rate - Crude Death Rate (specified
year) (specified year)

- The second method of measuring population size is to determine the increase in the population using
data obtained during two census periods. - This implies that the increase in the size of the population is
not merely attributed to excess in births but also the effect of migration.

1. Absolute increase per year Measures the number of people that are added to the population per
year. This is computed using the following formula:

Pt-Po =__________________

Where: Pt= Population size at a late time Po= Population size at an earlier time t= number of years
between time 0 and the time t

2. Relative increase Is the actual difference between the two census counts expressed in percent relative
to the population size made during an earlier census.

Pt- Po = ____________

Po

Where: Pt= population size at a later time Po= population size at an earlier time

Population Composition

- The composition of the population is commonly described in terms of its age and sex. - The PW utilizes
data on age and sex composition to decide who among the population groups merits attention in terms
of health services and programs

1. Sex composition To describe the sex composition of the population, the nurse computes for the sex
ratio. The sex ratio compares the number of males to the number of females in the population using the
formula below

Number of males = ____________________ x 1000

Number of females

The sex ratio represents the number of males for every 1000 females in the population.
2. Age composition There are two ways to describe the age composition of the population.

A. Median age divides the population into two equal parts. So, if the median age is said to be 19 years
old, it means half of the population belongs to 19 years and above, while the other half belongs to ages
below 19 years old. B. Dependency ratio compares the number of economically dependent with the
economically productive group in the population. The economically dependent are those who belong to
the 0-14 and 65 above age groups. Considered to be economically productive are those within the 15-64
age group. The dependency ratio represents the number of economically dependent for every 100
economically productive.

3. Age and Sex composition - The age and sex composition of the population can be described at the
same time using a population pyramid. - It is a graphical presentation of the age and sex composition of
the population.

RATES, RATIOS AND VITAL STATISTICS

Overview of Session - The students are introduced to the application of Biostatistics in Public health

Objectives - At the end of the session, the student should be able to define rates and ratios and compute
for the different health statistics as applied in Public health.

Rates and Ratios

• RATIO - also called a proportion is the quotient of two numbers - A good example is number of deaths
per population

• RATE - is a ratio involving a time period. - The count or measurement is observed over a period and
then divided by its base or population of observation.

Incidence Rate and Prevalence rate INCIDENCE RATE - measures the frequency of occurrence of the
phenomenon during a given period of time. - Deals only with NEW cases.

PREVALENCE RATE - measures the proportion of the population which exhibits a particular disease at a
particular time. - This can only be determined following a survey of the population concerned. - Deals
with total (old and new) number of cases

Concepts of Incidence • Also known as attack rate, case, sickness rate morbidity rate • It refers to newly
discovered cases of a particular disease • It answers the question “how frequent do cases of a particular
disease occur during a given period of time” • Used when dealing with a acute conditions and accidents

Concepts of Prevalence

• It refers to the newly discovered and old cases of a particular disease over a population • Used when
dealing with chronic conditions and disabilities • It answers the question “what proportion of the group
or population is actually ill with a particular disease at a point in time. • Usually determined by means of
survey

CBR and CDR

CRUDE BIRTH RATE (CBR) • This is rough of the fertility of the population • The rate is called crude for
the following reasons • Only live births are counted • The denominator is the total population which
includes children, old people and males • The rate is expressed in population unit of 1000 to make the
figures meaningful

CRUDES DEATH RATE (CDR) • This is a measure of the risk of dying from all causes in a population

MMR and IMR MATERNAL MORTALITY RATE (MMR) • Measure the risk of dying due to the process of
pregnancy, childbirth and puerperium. • It also measures the adequacy of maternal health services

INFANT MORTALITY RATE (IMR) • Measures the risk of dying due to infancy (under 1 year of age) •
deaths under 1 year of age/ number of live births x 1000

NMR,FDR and PNR NEONATAL MORTALITY RATE • Measures the risk of dying in the first four weeks of
life of the infant (newborn) • The number of children dying under 28 days of age divided by the number
of live births that year • (Number of infant death / number of life birth) X 1000

FETAL DEATH RATE • Measures the risk of dying before birth

PERI-NATAL MORTALITY RATE • The word means around the period of birth (a month or more before
births and one month after birth) • Measures the loss of life in later pregnancy and early infancy.

Fertility Rates

• Crude Birth rate = number of live births Mid year Population

• General Fertility Rate = Number of live births

X 1000

Midyear population of women 15-44 years of age X 1000

Mortality Rate

• Crude Death rate = number of death Mid year Population

• Specific Mortality rate = number of death in a specified group Midyear population of the same
specified group

X 1000

X 1000

Mortality Rate

• Cause-of-Death Rate number of deaths from a specified cause Midyear population

• Infant Mortality Rate Deaths under one year of age Number of live births

X 1000

X 1000

Mortality Rate
• Maternal Mortality rate=

number of deaths due to pregnancy, delivery and puerperium Number of live births

• Proportionate Mortality rate=

number of deaths from a particular cause Total Deaths

X 1000

X 100

Mortality Rate

• Swaroop’s Index= Number of deaths among those 50 years and over

Total Deaths

• Case Fatality rate= Number of Deaths from a specified cause Number of Cases of the same disease

X 100

X 100

Morbidity Rates

• Incidence Rate = number of new cases of disease developing from a period of time Population at risk
of developing the Disease

• Prevalence Rate= number of Old and new cases of a disease Population examined

X 100

X 100

Overview of the session

- The students are introduced to the concepts of Epidemiology and its application in Public Health.

Objectives: • At the end of the session, the students should be able to define epidemiology and
understand the different study designs as applied to public health.

EPIDEMIOLOGY

“Study the distribution and determinants of health related states and events in specified populations,
and the application of this study to the prevention and control of health problems”.

John M. Last, Dictionary of Epidemiology

C-E. A. Winslow, the great public health leader of the early 20th century, called epidemiology “the
diagnostic discipline of public health.”

EPIDEMIOLOGY

What is the Goal of epidemiology?

- The ultimate goal is to use this knowledge to control and prevent the spread of disease.

Uses of Epidemiology

1. Study the history of the health population and the rise and fall of diseases and changes in their
character. 2. Diagnose the health of the community and the condition of the people. 3. Study the work
of health services with a view of improving them. 4. Estimate the risk of diseases, accidents, detects and
the changes avoiding them. 5. Complete the clinical feature of chronic disease and describe their natural
history. 6. Search for cause of health and disease.

Health related States/events

• Definition of Health

• Health vs. Good Health –The absence or presence of a disease –Must be “clearly defined”

Disease Definitions

• Disease – State of physiological/biomedical dysfunction

• Illness – Subjective state/awareness of not being well

• Sickness – state of social dysfunction (the “sick role”)

• Impairment – Any loss of abnormality of structure or function

• Disability – Restriction or inability to perform in the manner considered normal of an individual

• Handicap – Disadvantage that limits or prevents the fulfillment of a social role

“Distribution”

Epidemic - an increase in the frequency (incidence) of a disease above the usual and expected rate,
which is called the endemic rate. - thus epidemiology count cases of a disease, and when they detect the
sign of epidemic, they ask who, when and where questions. • Who is getting the disease • Where and
when the disease is occurring • From this information, they can often make informed guesses as to why
it is occurring.

John Snow - father of modern epidemiology - Study about cholera - Snow would not have been
formulated his hypothesis without the data he gathered

Notifiable disease - surveillance made by the government before many people start dying.

The timely reporting of cases of notifiable disease allows public health authorities to detect an emerging
epidemic at an early stage.

A typical Epidemiologic InvestigationOutbreak of hepatitis

What? It is caused by virus that contaminates food or water Who, where and when

Who? Interviewed and asked question on what date did the first symptoms appear?(knowing the
hepatitis A virus has an incubation period of 30 days, it is possible to work back on the estimated date of
exposure)
The where question is the hardest: where did the victim obtain their food and water during the period
and what sources did they have in common?

Two main areas of investigation

1. Describes the distribution of health status in terms of age, gender, race, geography, and time. 2.
Patterns of disease distribution in terms of causal factor • In epidemiology of any disease or event, one
studies the factor which contribute to its causation and behaviorAGENT, HOST, ENVIRONMENT •
Epidemiology concept maintains that there can be no single cause of disease

THE AGENT FACTORS OF DISEASE

Agent - is any element, substance or force whether living or non-living thing; the presence or absence
can initiate or perpetuate a disease process.

Types of Agent:

1. This could be living or non-living things, physical or mechanical in nature such as extremes of
temperature, light electricity.

2. They could be chemicals- endogenous (within the body) or exogenous (poison)

Characteristics of Agent of disease 1. Inherent characteristics - physical feature, biological requirement,

chemical composition, resistance 2. Characteristic in relation to the environment - refers to the reservoir
and source of infection and modes of transmission. 3. Characteristic directly related to man a.Infectivity
b.Pathogenicity c.Virulence d.Antigenicity

Modes of Transmission 1. Direct transmission - immediate transfer of infectious agent a receptive portal
of entry 2. Indirect transmission a. Vehicle borne- contaminated inanimate objects or materials b.
Vector-borne- from other living organism (ex. Insects) c. Mechanical vector 3. Airborne- dissemination of
microbial aerosols to a suitable portal of entry usually the respiratory tract a. Droplet nuclei- usually
small residues which result from evaporation of fluid from droplets emitted by an infected host b. Dust

THE HOST FACTOR OF DISEASE

1.Age 2.Sex 3.Race 4.Habits, Customs, and religions 5.Exposure to agent 6.Defense mechanism of the
host

❖Humoral Defense ❖Cellular Defense

Immunity This is the total property of an individual to protect himself from an infectious agent

Two types of immunity ❖Non specific resistance- present at the time of birth or has developed during
maturation ❖Specific resistance- acquired as a result of prior exposure with a foreign substance

Two folds of specific resistance Active- what has been introduced to the individual is the antigen and the
body makes the antibody. ❖ Naturally acquired active immunity- when we get sick the infective agent
will gain entry to the body, act as stimulant for antibody formation because the organism acts as
antigen. The immunity is lifelong (ex. Measles, chicken pox, hepatitis A) ❖ Artificially acquired active
immunity- when the antigen has been deliberately introduce like injecting vaccines, they act as antigen
to stimulate antibody formation. It makes use of vaccine which is suspension of killed or living organism
(ex. MMR,OPV,BCG)

Passive- when what has been introduced to the body is already antibodies that provide immediate
protection against microorganisms. ❖ Naturally acquired passive immunityexhibited by the transfer of
antibodies from mother’s placenta to the fetus and transfer of antibodies from breast milk to the baby.
❖ Artificially acquired passive immunityinjection of artificially prepared substance like immune serum of
gamma globulin. These two are antibodies preparation (ex. Antitetanus antibodies, diphtheria antitoxin)

Two folds of specific resistance

THE ENVIRONMENTAL FACTORS OF DISEASE

Environment- sum total of an organism’s external surrounding conditions and influences that affect its
life and development • Physical Environment • climate- certain disease have seasonal distribution •
Geography and location • Biologic Environment- living environment of man consist of plants, animals
and fellow human beings. • Socio-economic environment

DISEASE CAUSATION

• The occurrence of disease follows biologic laws which apply to both communicable and non-
communicable diseases.

• Disease results from imbalance between the forces of the agent and host • The nature and extent of
imbalance depends on the nature and characteristics of host and agent • The characteristics of two are
influenced considerably the condition of the environment.

Incubation Period

- Time between exposure to infectious agent up to the time of appearance of the earliest signs and
symptoms

1. Clinical incubation period - the time between exposure to a pathogenic organism and the onset of
symptoms of a disease. 2. Biological Incubation Period - The time taken by the parasite to complete its
development in the definite host (from the time of entry of the infective larvae to the presence of
microfilariae) is called the Intrinsic incubation period (Biological incubation).

ISOLATION AND QUARANTINE

ISOLATION As applied to patient, separation for the period of communicability, of infected persons or
animals from others in such places and under such conditions as to prevent or limit the effect of the
direct or indirect transmission of the infectious agent from those infected to those who are susceptible
or who may spread the disease agent.

Categories of Isolation

1. Strict Isolation 2. Contact Isolation 3. Respiratory Isolation 4. Tuberculosis isolation (AFB isolation) 5.
Enteric Precautions 6. Drainage/secretion Precautions 7. Blood/body fluid Precautions

1. Strict isolation- this category is designed to prevent transmission of highly contagious or virulent
infectious that may spread by direct contact or droplet.
2. Contact isolation - for less highly transmissible or serious infections, for disease or conditions which
are spread primarily by close or direct contact.

3. Respiratory isolation - to prevent transmission of infectious diseases over short distance through the
air

4. Tuberculosis isolation (AFB isolation) - for patient with pulmonary tuberculosis who have a positive
sputum smear or chest x-rays which strongly suggest active tuberculosis

5. Enteric Precautions - for infectious transmitted by direct or indirect contact with feces purulent
material or drainage from an infected body site

7. Drainage/secretion Precautions - to prevent infections transmitted by direct or indirect contact with

purulent material or drainage from an infected body site.

8. Blood/body fluid Precautions - to prevent infections that are transmitted by direct or indirect contact
with infected blood or body fluids.

QUARANTINE - Restriction of the activities of a well persons or animals who have been exposed to a
case of communicable diseases during its period of communicability to prevent disease transmission
during incubation of infection should occur

Categories of Quarantine

1. Absolute or Complete Quarantine - Limitation of movement of those exposed to a communicable

disease for a period of time not longer than the longest usual incubation period of that disease.

2. Modified Quarantine - Selective, partial limitation of freedom of movements of contacts

THE DIFFERENT EPIDEMIOLOGIC STUDIES

1. Descriptive Study 2. Experimental Study

Analytical Study: - Ecological - Cross-sectional - Case-Control - Cohort

DESCRIPTIVE STUDY

EXPERIMENTAL STUDY

Randomized Control Trial - It is an epidemiological experimental study of a new preventative or

therapeutic regimen. - For this reason, it is commonly referred to as prophylactic trial, when testing the
effectiveness of a drug to prevent a disease, it is referred to as prophylactic trail. - Subject in a
population are randomly allocated to groups, usually called treatment and control groups, and the
results are assessed by comparing the outcome in the two or more groups.

EXPERIMENTAL STUDY

Field trials - It involves people who are disease free but presumed to be a risk. - Since the subjects are
disease- free and the purpose is to prevent the occurrence of diseases that may occur with relatively low
frequency, - field trials are often huge undertakings involving major logistics and financial
considerations.
EXPERIMENTAL STUDY

Community trials - In this form of experiment the treatment groups are the communities rather than
individuals. - This is particularly appropriate for diseases that have their origins in their social conditions,
which in turns can most easily be influenced by intervention directed at group behavior as well as at
individuals.

THE NATURAL HISTORY OF COMMUNICABLE DISEASE AND THE LEVELS OF DISEASE PREVENTION - The
natural history of diseases comprises the body of knowledge about the agent, host and environmental
factors relating to the disease process. - It includes the initial forces/factors which initiated the process
in the environment or elsewhere through the resulting changes which took place in man, until
continuing equilibrium is reached, or defect, disability, or death ensues.

Phases

1. Pre-pathogenesis - This is the phase before man is involved. Through the interaction of the agent, the
host and environmental factors, the agent finally reaches man. - It maybe said that everyone is in the
period of pre-pathogenesis of many diseases because agents are present in the environment where man
lives

2. Pathogenesis - This phases includes the successful invasion and establishment of the agent in the hos

- After a period of incubation, whereby the agent multiplies and develops, or get absorbed and fix in the
tissue, sufficient tissue or physiologic changes may have taken place to produce detectable evidence of
the disease process in man.

The process of infection: 1. Condition in the environment must be favorable to the agent or the agent
must be able to adapt in the environment 2. Suitable reservoirs must be present 3. A susceptible host
must be present 4. Satisfactory portal of entry into the host 5. Accessible portal of exit from the host 6.
Appropriate means of dissemination and transmission to a new host

COMMUNITY ORGANIZATION AND HEALTH/HEALTH PROGRAMS IN THE PHILIPPINES

Overview of Session

- The students are introduced to the concept of community health and the scope and focus of a
community health program. - The students are likewise introduced to the different health programs in
the Philippines that are being implemented by the Department of Health.

Objectives

- At the end of the session, the students shall be: 1. Able to understand the importance of the
availability and institutionalization of health programs in the reduction of mortality and morbidity rates
of common public health programs in the country.

COMMUNITY ORGANIZATION AND HEALTH/HEALTH PROGRAMS IN THE PHILIPPINES

- The science of preventing disease, prolonging life and promoting health and efficiency through
organize community effort. a. Environmental Sanitation b. Control of Community Infection c. Education
of the individual in principles of personal hygiene d. Organization of Medical and nursing services for
early diagnosis and preventive treatment of diseases e. Development of social machinery which will
ensure everyone as standard living adequate for maintenance of life

Two broad areas of preventive medicine 1. Public Health - includes programs and activities directed at
community level and will benefit everyone or individuals who are not currently under the care of
physician. 2. Risk Factor Evaluation - includes programs and activities directed at individuals who are
currently under the care of physician who evaluates them for high-risk factors that can cause disease,
educate them about good habits and screens them for appropriate conditions.

HEALTH

- A status of complete physical, mental and social well being and not merely the absence of disease or
infirmity regarded as person’s physical and psychological capacity to establish and maintain balance.

Aspects of Health 1. Physical Health - refers to condition which enables a person to maintain a strong
and healthy body. 2. Mental Health - refers to how a person thinks of himself, control his emotions and
adjust to environment. 3. Social Health - refers to ways a person feels, think and acts towards everybody
around him

Health or disease - is expressions of the success or failure of a person to respond adaptively to

environmental challenges.

◦ HEALTH - successful defense of the host against forces landing to disturb body equilibrium.

◦ DISEASE - failure of the body defense mechanism to cope with forces tending to disturb body
equilibrium.

Determinants of Health

1. Income and social status - higher income and social status are linked to better health 2. Education -
low education levels are linked with poor health, more stress and lower self confidence 3. Physical
environment - safe water and clean air, healthy workplace, safe houses, communities and roads all
contribute to good health. 4. Employment and working conditions - people in employment are healthier,
particularly those who have more control over their working conditions. 5. Social support networks -
greater support from families, friends and communities is linked to a better health

Determinants of Health

6. Culture - customs, traditions and the beliefs of the family and community all affect the health 7.
Genetics - inheritance plays a part in determining lifespan, healthiness and the likelihood of developing
certain illness. 8. Personal behavior and coping skills - balanced eating, keeping active, smoking, drinking
and how to deal with life’s stresses and challenges all affect health 9. Health services - access and use of
services that prevent and treat disease influence health 10. Gender - men and women suffer from
different types of diseases at different ages.

Primary Health Care (PHC) as an approach to delivery of health care services

WHO defines PHC as essential health care made universally accessible to individuals and families in the
community by means acceptable to them through their full participation and at a cost that the
community and country can afford at every stage of development.
Elements/ Components of PHC

1. Environmental sanitation 2. Control of communicable disease 3. Immunization 4. Health Education 5.

Family Planning 6. Adequate Food and Proper Nutrition 7. Provision of Medical Care and Emergency
Treatment 8. Treatment of Locally Endemic Diseases 9. Provision of Essential Drugs

Four Corners tones/ Pillars in PHC

1. Active community participation 2. Intra and intersectoral linkages 3. Use of appropriate technology 4.
Support mechanism made available

Levels of Health Care Referral System

Primary Level of Care

- It is health care provided by center physicians, public health nurse, rural midwives, barangay health
workers, traditional healers

Secondary level of care

- Given by physicians with basic health training. - It is usually given in health facilities privately owned or
government operated

Tertiary level of care

- Tertiary care is rendered by specialist in health facilities including medical centers as well as regional
and provincial hospitals and specialized hospitals. - Complicated cases and intensive care requires
tertiary care and all these can be provided by the tertiary care facility

Working together to help people help themselves, not merely to survive but also achieve the maximum
potential.

Concept of Community Health

Four priorities in Public Health

1. Survival of man 2.Prevention of condition which lead to destruction or retardation of human function
and potential in the years of life 3. Achievement of human potential and prevention of the loss of
productivity of young adults and those on the middle period of life 4. Improvement of the quality of life,
especially in the later years

STRUCTURE OF THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM

HEALTH RESOURCES

◦ Rural Health Unit (RHU) and their sub-centers ◦ Chest clinics, Malaria Eradication Units and
Schistosomiasis Control Unit ◦ Tuberculosis clinics and Hospitals of the PTBs ◦ Private Clinics ◦ Clinics run
by PMA ◦ Community Hospitals and Health services Centers run by Philippine Medical Care Commission
(PMCC) ◦ Voluntary Health Facilities run by religious and civic groups.

Three divisions of Health Care Delivery System

1. Government 2. Mixed Sectors 3. Private Sectors

GOVERNMENT

- The primary government agency in the field of health runs the bulk of the government health facilities
is the Department of Health

Responsibilities Of the DOH

◦ Ensuring access to basic health services to all Filipinos through the provision of quality health care ◦
Formulation and development of national health policies, guidelines, standards and manual operation
for health services and programs ◦ Issuance of rules and regulations, licenses and accreditation ◦
Promulgation of the national standards, goals, priorities and indicators ◦ Development of special health
programs and projects

HEALTH PROGRAMS

1. Adolescent and Youth Health and Development Program (AYHDP) - The program shall remain focus on
addressing the following health concerns regardless of their sex, race and socioeconomic background
Growth and Development concerns, Nutrition, Physical, Mental and emotional status Reproductive
health Sexuality , Reproductive Tract infection (STD, HIV/AIDS) Responsible parenthood, Maternal and
Child health, Communicable diseases, Diarrhea, DHF, Measles Malaria Mental Health Substance use and
abuse Intentional /nonintentional injuries Disability Mission: ◦ Ensure that all adolescent and youth have
access to quality health care services in an adolescent and youth friendly environment

2. Botika ng Barangay - Refers to a drug outlet manage by a legitimate community organization (CO/non-
government Organization (NGO) and/or Local Government Unit (LGU), with a trained operator and a
supervising pharmacist specifically established in accordance with Administrative Order No. 144 s. 2004.

3. Promotion of Breast-feeding program/ Mother and Baby Friendly Hospital Initiative (MBFHI) - The
Mother and Baby Friendly Hospital Initiative is the main strategy to transform all hospitals with
maternity and new born services into facilities which fully protect, promote, support breast feeding and
rooming-in practices

- To sustain this initiative, the field health personnel has to provide antenatal assistance and
breastfeeding counseling to pregnant and lactating mothers as well as to the breastfeeding support
groups in the community; there should also be continuous orientation and re-orientation/updates to
newly hired and old personnel, respectively, in support of this initiative.

4. Cancer Control Program - The Philippines Cancer Control Program, begun in 1988, is an integrated
approach utilizing primary, secondary and tertiary prevention in different regions of the country at both
hospital and community levels. - Six lead Cancers (lung, breast, liver, cervix, oral cavity, colon and
rectum) are discussed.

5. Diabetes Control Program - Diabetes is a serious chronic metabolic disease characterized by an

increase in blood sugar levels associated with long term damage and failure or organs functions,
especially the eyes, the kidneys, the nerves, the heart and blood vessels.

In diabetic, blood sugar reaches a dangerously high level which leads to complications ◦ Blindness ◦
Kidney failure ◦ Stroke ◦ Heart attack ◦ Wounds that would not heal ◦ Impotence What can you do to
control your blood sugar? 1. Diet therapy 2. Exercise 3. Control your weight 4. Quit smoking
6. Dengue Control Program - The thrust of the Dengue Control Program is directed towards community-
based prevention and control in endemic areas - Major strategy is advocacy and promotion, particularly
the Four O’clock Habit which was adopted by most LGUs. - This is a nationwide, continuous and
concerted effort to eliminate the breeding places of Aedes aegypti . - Other initiatives are dissemination
of IEC materials and tri-media coverage

7. Dental Health Program - Comprehensive Dental Health program aims to improve the quality of life of
the people through the attainment of the highest possible oral health. - Its objective is to prevent and
control dental diseases and conditions like dental carries and periodontal diseases thus reducing their
prevalence. - To attain orally fit children, the program focuses on the following package of activities: oral
examination and prophylaxis; sodium fluoride mouth rinsing; supervise tooth brushing drill: fit and
fissure sealant application; a-traumatic restorative treatment.

8. Emerging Disease Control Program - Emerging infectious disease are newly identified and previously
unknown infection which cause public health problems either locally or internationally. - These include
diseases whose incidence in humans have increased within the past two decades or threaten to increase
in the near future

9. Environmental Health - Environmental health is concerned with preventing illness through managing
the environment and by changing people’s behavior to reduce exposure to biological and non-biological
agents of disease and injury. - It is concerned primarily with effects of the environment to the health of
the people.

Goals: ◦ Reduction of environmental and occupational related diseases, disabilities and deaths through
health promotion and mitigation of hazards and risks in the environment and workplaces.

10. Expanded program on Immunization - The expanded program on immunization is one of the DOH
programs that has already been institutionalized and adopted by all LGUs in the region. - Its objective is
to reduce infant mortality and morbidity through decreasing the prevalence of six (6) immunizable
diseases (TB, diphtheria, pertussis, tetanus, polio and measles.

11. Family Planning - The program is anchored on the following basic principles 1. Responsible
Parenthood which means that each family has the right and duty to determine the desired number of
children they might have and when they might have them 2. Respect for life 3. Birth spacing refers to
interval between pregnancies

Mission - The DOH in partnership with LGUs, NGOs, the private sectors and communities ensures the
availability of FP information and services to men and women who need them

Objectives General: - To help couples, individuals achieve their desired family size within the context of
responsible parenthood and improve their reproductive health

12. Food and Waterborne Diseases Prevention and Control Program - The food and Waterborne
Diseases Prevention and Control Program (FWBDPCP) established in 1997 but became fully operational
in 1997 but became fully operational in year 2000 with the provision of a budget amounting to PHP
551,000.00 - The program focuses on Cholera, typhoid fever, hepatitis A and other food borne emerging
diseases (e.g. Paragonimus)
13. Knock out Tigdas - The Knock-out tigdas is s strategy to reduce the number or pool of children at risk
of getting measles, or being susceptible to measles and achieve 95% measles circulation in all
communities in 2008.

14. Leprosy Control program - Leprosy Control program envisions eliminating Leprosy as a human
disease by 2020 and is committed to eliminate leprosy as a public health problem by attaining a national
prevalence rate (PR) of less than 1 per 10,000 populations by year 2000

15. Malaria Control Program ◦ 58 of 80 provinces: malaria endemic ◦ Population at risk: 12 M ◦ 22

provinces: maintain malaria-free* status ◦ 2– 4 outbreaks per year * malaria-free: absence of indigenous
malaria case

16. National Filariasis Elimination Program Mission: ◦ Universal access to quality health services Program
Objectives: ◦ General Objectives: To reduce the Prevalence Rate to <1/1000 population ◦ Specific
Objectives 1. To established the endemicity of municipalities at the end of two years 2. To perform Mass
Treatment in established endemic municipalities for at least four years. 3. To continue surveillance of
established endemic areas five years after Mass treatment.

17. National Mental Health Program - It aims at integrating mental health within the total health system,
initially within the DOH system, and local health system. - Within the DOH, it has initiated and sustained
the integration process within the hospital and public health systems, both at the central and regional
level. - Furthermore, it aims at ensuring equity in the availability, accessibility, appropriateness and
affordability of mental health and psychiatric services in the country.

18. Newborn screening - Newborn Screening (NBS) is a simple procedure to find out if your baby has a
congenital metabolic disorder that may lead to mental retardation and even death if left untreated.

19. Occupational Health Program Vision/Mission Statement ◦ Health for all occupations in partnership
with the workers, employers, local government authorities and other sectors in promoting self-
sustaining programs and improvement of workers’ health and working environment. ◦ Program
Objective and Targets: To promote and protect the health and well being of the working population thru
improved health, better working conditions and workers’ environment

20. Health development Program for Older Persons - The Program intends to promote and improve the
quality of life of older persons through the establishments and provision of basic health services for
older persons, formulation of policies and guidelines pertaining to older persons, provision of
information and health education to the public, dedicated to older person and, the conduct of basic and
applied researches.

21. Pinoy MD Program “Gusto Kong Maging Doktor”

- A Medical scholarship Grant for Indigenous People, Local Health Workers, Barangay Health workers,
Department of Health employees or their children. - This is a joint program of the Department of Health
(DOH), Philippine Charity Sweepstakes Office (PCSO), and several State Universities and Medical Schools

22. Prevention of Blindness Program ◦ To eliminate all avoidable blindness by preventing and controlling
diseases through the development of human resource, infrastructure, and appropriate technology
23. Schistosomiasis Control Program - Goal of the National Schistosomiasis control program is to
eliminate Schistosomiasis as a public health problem (Prevalence of 1% and below)

24. National TB Control Program - In 1196, WHO introduced the Directly Observed Treatment Short
Course (DOTS) to ensure completion of treatment - The DOTS strategy depends on five elements for its
success: - Microscope, Medicines, Monitoring, DOT and Political Commitment - If any of these elements
are missing, our ability to consistency cure TB patients slips through our fingers.

25. Republic Act 7719 is otherwise known as “Blood Services Act of 1994” The main Objectives are: - To
promote and encourage voluntary blood donation by the citizenry and to instill public consciousness of
the principle that blood donation is a humanitarian act - To provide, adequate, safe, affordable and
equitable distribution of supply of blood and blood products

MIXED SECTORS

◦ PTS - Philippine Tuberculosis society ◦ PCS - Philippine Cancer Society ◦ PNRC - Philippine National Red
Cross ◦ PMHA - Philippine Mental Health Association ◦ PHA - Philippine Heart Association

1. Socialized Medicine - funded by general taxation, emphasis on prevention 2. Compulsory Health

insurance - law requires people to subscribe to health insurance plan, usually government
sponsored; covers only curative and rehabilitative medicine; preventive services provided by
government agencies 3. Voluntary Health insurance - government only encourages people to
subscribe to health insurance 4. Free Enterprise- people have to take care of their medical
needs.