RIFT VALLEY UNIVERSITY

DEPARTMENT OF GENERAL PUBLIC HEALTH

Assignment on introduction to public health

NAME: - KEDIR DAYU HAMDA

Id number: - new

Date: - January 05,2021

 Part I
1. CROSS BOARDER DISEASES OF PANDEMIC MAGNITUDE, AND BIOTERRORISM

Virulent pandemics have been devastating to many different societies and the three largest
pandemics with the greatest impact on human history include the Plague, Smallpox, and Spanish
Influenza. The Plague or ‘Black Death’ of the 14th century was estimated to have killed close to
50 million people. Repeated Smallpox outbreaks and epidemics have been recorded many times
until the 1800s killing tens of millions of people. The Spanish flu pandemic of 1918–1919
emerged killing an estimated 50 million people.
Humans are still being assailed by infectious disease threats. In the past five years alone, several
pathogens were seen in North America for the first time – West Nile virus, monkey pox virus,
low pathogenic avian flu in commercial bird farms, mad cow disease and Severe Acute
Respiratory Syndrome (SARS).
Example.
The Japanese religious group Aum Shinrikyo recruited university educated members and
conducted several acts of biological terrorism before its infamous use of the chemical agent
(sarin) in Tokyo subways in March 1995. At the time the cult was a group of well-coordinated
and well-funded individuals with religious chapters in many other countries, and each sect could
potentially have developed or deployed biological weapons to fulfill their cult’s end of the world
prophecy.

Another extremely disquieting category of threat emerged in the United States in 2001 with the
deliberate release of anthrax, an infectious but no transmissible biological agent signaling the use
of Weaponized bacteria and viruses as weapons of mass destruction by inducing a pandemic.
With increasing awareness of bioterrorism threats and the next pandemic predicted by experts,
several researchers have called for stricter controls over biotechnology experimentation that
provide dual-use
information and technologies, dissemination of bioinformatics data and regulation of researchers
as a way to manage infectious disease risks.4 Such a frontend approach for risk management is
largely unworkable for a number of reasons: the number of public and private laboratories,
medical institutions and research facilities that use various biochemical and molecular tools
globally; the availability of scientific literature available in print; the availability and ease of
dissemination of scientific data using the
Internet; and the pervasiveness of medical equipment and techniques. Risk issue management of
natural or induced pandemics requires a different approach.
 2. TWO MAJORS 21ST CENTURY PUBLIC HEALTH CHALLENGES

A. Inequalities in health pose the challenge supreme over all others to public health
professionals in developed countries.
E.g., The “Black Report”, the product of the committee set up by the UK Government in the late
1970s to investigate health inequalities in UK, was published in 1980. It opened the eyes of a
generation to the extent of the health gap between the health experienced by the more prosperous
in developed countries and that of the more deprived parts of such populations. This is
demonstrated by very marked differences in life expectancy of those living in prosperous parts of
our cities as compared with that of those living in more deprived areas. In London it has been
shown that life expectancy falls steadily, tube station by tube station, as one travels eastward on
the District Line from the West End; similar findings have been demonstrated in many other
cities; Molony and Duncan (2) have described analogous findings in Glasgow, where a traveller
on the suburban train line service between Jordanhill, in the West End, and Bridgeton in the East
End, would pass through a two year reduction in life expectancy between each adjacent stations
where the trains stop along the line.
Since the “Black Report” there have been many similar studies in various European countries,
including the UK (1, 3, 4). Actually, Syme and Berkman (5) had published similar findings in
the USA as early as the 1970s, but it seems that these reports were considered so shocking at that
time, and outside the bounds of appropriate scientific enquiry, that they were almost hidden
away, and treated almost as “samizdat literature” (as described by Marmot (6)). However,
Marmot himself and his colleagues have thrown considerable light on health inequalities through
their reports on the social determinants of health (7, 8, 9), which include the main aetiological
factors responsible for health inequalities. Meanwhile, Pick and Wilkinson (10) have shown us
that, in countries where the gap between rich and poor is narrow (such as in Sweden or Japan),
the health status of everyone (including the rich) is superior to that of everyone in countries
where the gap between rich and poor is much wider (such as in USA and UK). On the other
side of the Atlantic, Deaton has written a very readable account of many of the issues concerning
health, wealth and inequality, including a useful historical overview of the subject.
Marmot has provided (6) many potential entry points at which public health workers might
obtain entry into these problems, bringing public health skills and approaches to bear on at least
limited aspects of them. Molony and Duncan have described the health inequalities situation in
Scotland, and how this is being addressed there. However, such activity in reality can provide
little more than tinkering around the edges of the matter; inequalities of health and the social
determinants responsible for these are the outcome of the economic system prevalent in the
developed world, and ultimately the solutions can only really be economic ones. Such evidence
as there is indicates that health inequalities were much narrower in all western countries when
Keynesian economics reigned supreme, from 1945 to 1975, and then they began to widen, and
have continued to do so, as neoliberal economic policies replaced Keynesian ones (12). There
are some signs, both in North America and in Europe, that neoliberal policies are being
questioned ever more severely; maybe we are entering an era when economics ministers may
prove to be more responsive than in recent history to the health needs of the more deprived parts
of the populations of developed countries.

B. The other major challenge to public health consists of nutrition, and the major policy areas now
inevitably associated with it.
E.g., In UK most major health problems are caused either by over-nutrition and obesity or by
malnutrition. Hogler and colleagues. Remind us of the need to continue to address
malnutrition, including in developed countries, while Xiaohui Hou demonstrates the
importance of addressing, in particular, maternal and child under-nutrition in developing
countries. Birt has described the extent to which in Europe there is almost a mismatch
between the food grown and produced (agricultural policy) and the types of food most
needed by European populations for their healthy nutrition, and Pushkarev has described how
the EU, through reform of the Common Agricultural Policy, should build public health
nutrition into this. Meanwhile, over the last 30 years there has been an increasing awareness
of the environmental threats posed by modern farming practices. These are numerous, but
have become especially visible now we are aware that farming contributes more global
warming gases to the atmosphere than does any other industry (18), with dairy and beef
production being the cause of most of this. It is therefore interesting to observe that, while a
nutrition-friendly food policy in both Europe, North America, and Australia, etc., would
necessitate a reduction in beef and dairy production and consumption, with increased
production and consumption of fruit and vegetables, such policy movement would also be
consistent with environmental protection and reduction in global warming gas production.
Accordingly, it is at last becoming recognized that we need to develop policies for
sustainable healthy nutrition, to incorporate together agricultural and food industry policy,
public health nutrition policy, and policy for environmental sustainability. O`Flaherty and
Guzman (21) have described how there are lessons to be learned from other public health
successes, such as in the case of tobacco; they also describe how much there is to do to
encourage the food industry to comply with objectives to provide our populations with much
healthier food products than are many of those they sell currently, especially in the context of
any meaningful attempts to address seriously the world`s obesity epidemic.
Health inequalities and the social determinants of health, and sustainable healthy nutrition,
both provide major challenges to the manner in which developed societies and countries are
organized. It remains to be seen whether the advocates promoting both sustainable healthy
nutrition and policies designed to address the social determinants of health can obtain
sufficient prominence amongst all political priorities so as to effect the genuine changes in
public policy which are needed, if these public health challenges are at last to be met
effectively. If this is not achieved, this can only indicate the relative ineffectiveness of
public health in the twenty first century.
 3. VARIOUS OCCUPATIONS, PROFESSIONS, AND CAREERS CONTRIBUTED TO
CARRYING OUT PUBLIC HEALTH’S CORE FUNCTIONS AND ESSENTIALS

Essential Public Health Functions

In 1994, the Public Health Functions Steering Committee in the United States suggested that the
mission of public health should be to “promote physical and mental health and prevent disease,
injury and disability”. In 2000, the US “Healthy People 2010” report established two overarching
goals: to increase quality and years of healthy life, and to eliminate health disparities.

The Government of British Columbia believes that public health has the following fundamental
tasks: -

To improve the overall health and well-being of the population;

To prevent diseases, injuries, or disabilities that may shorten life or impair health, well-
being and quality of life; and

to reduce inequalities in health between different groups and communities in society (this
task cuts across the other tasks.) by utilizing multiple strategies drawn from one or more
of the essential functions of public health, as appropriate. They are delivered either to the
population as a whole or to selected populations, often in key life settings such as homes,
schools, workplaces, health care settings, and neighborhoods.

Core programs are long-term programs, representing the minimum level of public health services
that health authorities would provide in a renewed and modern public health system. Each
program will have clear goals, measurable objectives, and an evidentiary base that shows it can,
indeed, improve people’s health and prevent disease, disability, and/or injury. Programs will also
be supported through the identification of best practices and national and international
benchmarks.

Core programs in British Columbia will be targeted to one of four broad categories. These are
not mutually exclusive, and there will be overlap:
Health Improvement Programs: intended to improve overall health and well-being;
they are capable of preventing a wide range of acute and chronic diseases and disability,
as well as injuries.
Disease, Injury and Disability Prevention Programs: intended to prevent specific
health problems that make, or might make, a significant contribution to the burden of
disease.
Environmental Health Programs: intended to protect people from environmental
hazards, whether caused by natural or human activity, in the built and natural
environments.
 Health Emergency Management Programs: intended to coordinate available resources
to deal with emergencies effectively, thereby saving lives and avoiding injury.

Figure1: Core Programs and Province-wide Initiatives

This is illustrated in Figure 1, which shows that

the prevention of chronic disease, for example,
involves more than just the delivery of public
health core programs. A province-wide chronic Population health
disease prevention initiative, shown as a wedge
crossing the entire spectrum of population and
public health action, must extend beyond the Health Services
realm of public health core programs in chronic
Chronic
disease prevention, to involve partners in the
disease Core Programs
rest of the health care system and in the wider In Public
society beyond that contributes to the Prevention Health
population health promotion movement,
including, where appropriate, the private sector. Population health promotion
An example of a province-wide initiative is the `
BC Healthy Living Alliance, which is focused
on chronic disease prevention and population
health improvement, and includes the Ministry
of Health Services, the health authorities, and
many other stakeholders outside of the health
system.

4. MODERNIZATION AND ITS EFFECT IN HEALTH

The processes of modernization and development have health implications, both positive and
negative. Negative health impacts of modernization include increased poverty as extended family
support and traditional knowledge are lost, poor nutrition due to deterioration in the quantity and
quality of land deteriorates, health consequences of increased high density living in city slums,
increased sexually transmitted infections (STIs) and risk-taking Behavior, disintegration of
families, and increased alcohol use as young men lose their traditional roles (Ramin, 2009).
Positive impacts include greater access to private and public health facilities, improved access to
tests and drugs, and improved knowledge of and access to preventative care such as
immunizations. A study by D. A. K. Singh et al. (2013) in Uganda, it appears that both
modernization and development have impacted health positively and negatively. Key themes
distilled from interviews included that modernization has led to the breakdown of families;

Chronic
Disease
Prevention
Initiative
increased maternal responsibility for children; diminished land and economic resources; and an erosion
of cultural Values and practices that had previously provided stability.

5. PRIMARY HEALTH CARE

Is essential health care based on practical, scientifically sound and socially acceptable methods
and technology made universally accessible to individuals and families in the community
through their full participation and at a cost that the community and country can afford to
maintain at every stage of their development in the spirit of self-reliance and self-determination.
Why primary health care? stop the unacceptable gross inequality in the health to status of
people particularly between the developed and the developing countries as well as within the
countries.
Principles of Primary Health Care
social equity;
nationwide coverage;
self-reliance;
intersectoral coordination;
Peoples involvement in the planning of health programs in pursuit of common health
goals. and implementation
Elements of Primary Health Care

A. education concerning prevailing health problems and the methods of preventing and
controlling them:
E.g., Health education, Group discussions and Demonstrations
B. promotion of food supply and proper nutrition:
• Food safety
• Equal distribution (Fair price shop)
• Proper nutrition (Mid-day meal programs & School health services)
C. adequate supply of safe water and basic sanitation:
• Government should provide a potable safe drinking water and basic sanitary facilities.
• The Aim is every house should have a latrine, avoid open air defecation.
D. maternal and child health care, including family planning:
• From Antenatal period to child birth care should be taken by the Gov.as well as individual.
• A separate family clinic should be run by the Gov. and also NGO’s for promotion of mothers’
health and infants & child health and also spacing of the children
E. immunization against major infectious diseases
• To prevent vaccine preventable diseases.
• E.g., Measles,
• Polio
 • Hep. B

F. prevention and control of locally endemic diseases;

• To prevent and control local endemic diseases like malaria, diarrhea, worm infestations etc.
G. appropriate treatment of common diseases and injuries
• For example—
• RTA (Minor injuries)
•Tetanus
• Anti-diarrheal treatment
• Anti-malarial treatment
• Dog bite
H. provision of essential drugs
Examples: Birth control pills
• Nutrition supplements

6. DEVELOPING SCHOOL HEALTH PROGRAMS DURING COVID -19 ERA

A comprehensive school health program is an integrated set of planned, sequential, school-

affiliated strategies, activities, and services designed to promote the optimal physical, emotional,
Social, and educational development of students. The program involves and is supportive of
families and is determined by the local community, based on community needs, resources,
standards, and requirements. It is coordinated by multidisciplinary team and is accountable to the
community for program quality and effectiveness.
Schools have direct contact with 56 million students for at least 6 hours a day during the most
critical years of their social, physical, and intellectual development.1,2 School health programs
can reduce the prevalence of health risk behaviors among youth and have a positive effect on
academic performance.

Each school day provides students the opportunity to learn the importance of behaviors and skills
needed to engage in a healthy lifestyle. It is easier and more effective to develop healthy
behaviors during childhood than to change unhealthy behaviors during adulthood.4 Schools can
contribute directly to a student’s ability to successfully practice behaviors that promote health
and well-being.

E.g., Public health measures implemented in schools across Canada have been adjusted over time
in response to COVID-19 activity. Risk assessments should be considered when decisions need
to be made about opening or closing schools and how to function as safely as possible for those
that are open.
Knowing the risks associated with COVID-19 in the school setting will help administrators to
consider potential mitigation strategies. An important consideration is the extent of local
community COVID-19 transmission, as this influences the likelihood of COVID-19 introduction
into the school setting. The proportion of individuals who visit the school from outside of the
community also influences the risk of COVID-19 introduction and spread. PHAs should be
consulted for information about local COVID-19 transmission.
Measures used in the school setting to mitigate risks of COVID-19 transmission can include both
personal preventive practices taken by individuals to protect themselves and others, as well as
community-based measures implemented by Parents, municipalities, Indigenous community
leadership, school boards or individual schools to protect the school and surrounding community.

The modified hierarchy of controls provides a useful approach and helps inform the list of risk
mitigation measures provided in this guidance. Risk mitigation measures that are most protective
involve physically separating people from each other through physical distancing and physical
barriers. Less protective measures rely on individuals consistently following personal preventive
practices such as respiratory etiquette, hand hygiene, and wearing non-medical masks. Given that
physical distancing is not always possible in schools, it will be important to "layer" multiple
measures to reduce the risk of COVID-19 spread in schools. While some risk mitigation
measures, such as the practice and promotion of personal preventive practices, should
consistently take place, other measures should be proportionate with the risk in the school and
community. Schools should consult with their Local Public Health Authorities (PHAs) for
information about local COVID-19 transmission.

For mitigation measures specific to employees (for example, staff and volunteers in child/youth
settings), such as the use of personal protective equipment, the Risk mitigation tool for
workplaces/businesses operating during the COVID-19 pandemic is available and should be
considered in addition to relevant guidance from Occupational Health & Safety advice. In some
cases, staff or teachers (such as occasional / supply teachers) work in multiple settings. It will be
important for school administrators to consult with their PHAs in advance to conduct a risk
assessment and to identify potential mitigation measures/ policies based on their community
needs, relevant P/T guidance, and local epidemiology. Consideration should be given to
encourage teachers and staff to wear face masks and eye protection (such as face shields).
Part п Article Summary

Occupational Health and Safety Organization in Expanding

Economies: The Case of Southern Africa
Data Source: 2015 Icahn School of Medicine at Mount Sinai.
(http://creativecommons.org/licenses/by-nc-nd/4.0/ )

Globally, access to occupational health and safety (OHS) by workers has remained at very low
levels. The objective of this study was to review the organization of occupational health in
expanding economies in southern Africa, namely, Zimbabwe, South Africa, Botswana, and
Zambia. However, little published literature exists on this subject, particularly in Zimbabwe,
Zambia, and Botswana. A literature review and country systems inquiry on the organization of
OHS services in the 4 countries was carried out. Because of the infancy and underdevelopment
of OHS in southern Africa, literature on the status of this topic is limited.
In the 4 countries under review, OHS services are a function shared either wholly or partially by
3 ministries, namely Health, Labor, and Mining. Other ministries, such as Environment and
Agriculture, carry small fragments of OHS function. The 4 countries are at different stages of
OHS legislative frameworks that guide the practice of health and safety in the workplace.
Inadequacies in human resource capital and expertise in occupational health and safety are noted
major constraints in the implementation and compliance to health and safety initiatives in the
work place. South Africa has a more mature system than Zimbabwe, Zambia, and Botswana.
Lack of specialized training in occupational health services, such as occupational medicine
specialization for physicians, has been a major drawback in Zimbabwe, Zambia, and Botswana.
The full adoption and success of OHS systems in Southern Africa remains constrained. Training
and education in OSH, especially in occupational medicine, will enhance the development and
maturation of occupational health in southern Africa. Capacitating primary health services with
basic occupational health knowledge would be invaluable in bridging the current skills deficit.
Introducing short courses and foundational tracks in occupational medicine for general medical
practitioners would be invaluable.
Ethiopia is an agrarian country that is industrializing rapidly with a focus on construction,
manufacturing, mining, and road infrastructure. An estimated work force of about two million is
currently engaged in the public and private sectors according to Analysis and Needs Assessment
of OSH in Ethiopia.
Although there is a severe scarcity of peer-reviewed literature related to workplace problems,
exposures and their impact on workplace health and safety in Ethiopia is the same to above
article i.e., the study in Southern Africa. Limited adequately skilled manpower is available. The
internal infrastructural capacity is weak and cannot help to identify and assess hazards in the
workplace. Monitoring system and laboratory investigation is limited despite the presence of
favorable policy and regulatory frameworks. Addressing these gaps is of immediate concern.

Since I am working currently in one of the federal public organization, I got the chance to visit
plenty federal organizations and their OSH status. there are so many gaps and complains related
to occupational safety and health i.e., lack of basic OSH training for workers, shortage in
personal protective equipment (PPE) provision, inadequate water supply and other non-
conformities in the premises.
In Ethiopia Labor and Social Affairs (MOLSA) is the state organ that regulates workers’ safety
and health in work places, both private and state owned. MOLSA and its regional networks have
an organizational structure lined to the periphery.
Ethiopia is one among the many countries from around the world that have adopted ILO
Convention No 155 of 1981 in 1991 which resulted in two major regulations: Labor
Proclamation No. 1156/2019 and Labor Proclamation No. 1064/2017 on public civil servants.
The national level policy on Occupational Safety and Health (OSH) has been developed and
approved (July 2014) by the Central government.so in order to improve these problems the
central government should enforce the above legislatives; organizations have to assign
experienced occupational safety professionals, form safety committee, include OSH works in
strategic plan as well as annual plan and allocate sufficient budget for the works. Finally, all
stakeholders should monitor and evaluate the progress at all levels as soon as possible.