CHAPTER 1: HEALTH COMMUNITY

Terminologies:

Community
- boundaries and/or common values A social group determined by geographic and interests. It functions within a
particular social structure and exhibits and create norms, values and social institutions
- a collection of people who interact with one another ad whose common interests or characteristics form the basis for a
sense of unity or belonging (Allender et. Al)
- a group of people who share something in common and interact with one another, who exhibit a commitment with
another ad may share a geographic boundary (Lundy and Janes)

Population
- used to denote a group of people having common personal or environmental characteristics. Refers to the people in the
community

Aggregates

- subgroups or sub-populations that have some common characteristics or concerns

- Example: group of elderly women; group of people undergoing treatment for Diabetes

Attributes of Community:
A. People
B. Place
C. Interaction
D. Common characteristics, interests or goals

Components:
l Environment – physical, social-cultured, educational and employment milieu
l Population behavior and lifestyle – self-responsibility, self-care competency
l Human biology – genetic characteristics of a community/population
l Systems of health care – prevention, promotion, cure and rehabilitation

Two main types of communities:

1. Geopolitical communities - formed by both natural and man-made boundaries (barangays, municipalities, cities,
provinces, regions, nations). This is also called as “territorial communities”

Classifications:
ü Rural – usually small and occupation of the people is usually farming, fishing and food-gathering. It consists of simple
folk characterized by primary group relation, well-knit and having a high degree of group feeling. People assume agric
ü Urban – high density, a social heterogeneous population and a complex structure, non-agricultural occupations,
something different from an area characterized by complex interpersonal social relations. People assume industrial-type of
works

2. Phenomenological communities - refers to relational or interactive groups; setting is more abstract and people share a
common perspective, identity, culture etc. (schools, churches). This is also called “functional communities”

Five Functions of a Community

1. Production, distribution, and consumption of goods and services
- These are the means by which the community provides for the economic needs of its members.
2. Socialization
- processes and ways on how the residents interact with the members of the community
3. Social control
- The way in which order is maintained in a community. Laws are enforced by the police; public health regulations are
implemented to protect people from certain diseases
4. Social inter-participation
- Refers to community activities that are designed to meet people’s needs for companionship.
5. Mutual support
- Refers to its ability to provide resources at a time of illness or disaster

Characteristics of a Healthy Community

Healthy communities or at least the idea and principles of living in a healthy community is a trend whose popularity has
been steadily increasing.

Factors that foster optimum level of community functioning:

1. Access to quality education
l Education and health go hand in hand. Those who pursue a higher level of education have longer lifespans and often
experience a higher quality of life than their peers. Having a school that reinforces health education is a powerful tool for
a parent to have when they are trying to raise their children to be mindful of their food choices and activity levels.
2. The community naturally blends into its environment
l It’s also very important for a healthy community to be part of its natural environment. Being part of the natural
surroundings also offers benefits of a less concrete nature, by allowing residents a chance to feel closer to nature.
3. Health care and preventive health services
l It should be taken as a given that healthy communities have access to quality health care facilities.
4. Access to healthy food
l Access to healthy food is also very important for any health-conscious community. It allows residents to make dietary
choices thus making them healthier.
5. Fitness and wellness opportunities
l Fitness and wellness opportunities are often foundational amenities for a health minded community. It’s important that
residents not need to venture far to get daily exercise. Wellness doesn’t just mean exercise, though – it also means access
to like-minded individuals who will provide support and even motivation.

Elements of Community:
1. Promotion of healthful living: ü Immunizations
a. Individual level: ü Information about STD
ü Smoking cessation
ü Reduction of alcohol c. Group level
ü Drug abuse ü Occupational safety and health
ü Exercise and fitness ü Accidental injury may be considered
ü Stress management
d. Community level:
b. Family level: ü Toxic agent control
ü Family planning ü Flouridation of water
ü Pregnancy and infant care ü Infectious agent control

2. Prevention of Health Problems:

l Health protection activities are highly varied. They may include the prevention of nutritional deficiencies, accidents at
work and at home, communicable diseases, CVDs, cancers, pollution, etc.

3. Remedial Care for Health Problems:

l Community health nurses provide direct and indirect services to individuals with chronic health problems.
l A variety of health care services provide direct services, such as home visits for assessment and monitoring of health
problems, dietary planning, administration of injections, personal care, home-making services, and information about
equipment resources (bath seats, wheel chairs, canes, walkers, syringes, etc.)
Ø Indirect services
 - Focus on assisting people with health problems to obtain treatment.
- Example: a community health nurse may assist a person to get a physician’s appointment after eliciting data
about an elevated BP, a persistent cough or vaginal bleeding
Ø In other instances, the nurse may refer an individual or family to other agencies that provide information and/or
therapy such as:
1. A family therapy and counseling program
2. A self-help group or association
3. A chemical dependency counseling and treatment center

4. Rehabilitation
l Services that focus on reducing disability and/or restoring function are provided at the individual, family and
community level.
l At the individual level, a community health nurse in conjunction with other allied health workers may assist disabled
people regain some degree of lost function, prevent further disability, and develop new skills that enable them to assume
an appropriate vocation or degree of independence.

5. Evaluation:
l Essential component of community health practices
l Aims:
-Determine effectiveness of current activities
-Determine needs
-Develop improved services.

6. Research
l Provide the means to identify problems and examine improved methods of providing health services
Investigates:
u Patterns of illness and health
u Possible causes and means of preventing specific problems
u Deficiencies in services
u Effectiveness of treatment programs such as weight reduction, stress management, substance abuse programs
u The effect of societal and environmental changes on existing services
u Utilization of existing health services

FACTORS THAT AFFECT COMMUNITY 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 workplaces, 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 better health
6. Culture - Customs and traditions, and the beliefs of the family and community all affect health
7. Genetics - Inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain illnesses
8. Personal Behavior and coping skills - Balanced eating, keeping active, smoking, drinking and how we deal with life’s
stresses and challenges all affect health.
9. Health services - Access and use of service that prevent and treat disease influence health
10. Gender - Men and women suffer from different types of diseases at different ages.

CHAPTER II: HEALTH STATISTICS AND EPIDEMIOLOGY

Terminologies:

l Statistics
- refers to a systematic approach of obtaining, organizing and analyzing numerical facts so that conclusion may be drawn
from them
l Vital Statistics
- refers to the systematic study of vital events such as births, illnesses, marriages, divorce, separation and deaths
l Epidemiology
- study of occurrences and distribution of diseases as well as the distribution and determinants of health states or events in
specified population, and the application of this study to the control of health problems

A. Vital Statistics

Statistics on disease and death indicate the health status of the community and the success or failure of the health activities
and programs that were implemented. 

Table 1. Recording of Statistics

Philippine Statistics Agency Local Civil Registry

Population and Characteristics Births and Death statistics

 l  Age

l  Sex

l  Distribution

Use of Vital Statistics

l indices of the health and illness status of a community

l Serves as bases for planning, implementing, monitoring and evaluating community health nursing programs and
services

Sources of data
l Population census
l Registration of vital data
l Health surveys
l Studies and researches

Rate
Definition: Shows the relationship between a vital event and those persons exposed to the occurrence of said event,
within a given area and during a specified unit of time. It is evident that the persons experiencing the event must come
from the total population exposed to the risk of the same event

Ratio
Definition: Used to describe the relationship between 2 numerical quantities or measures of events without taking
particular considerations to the time or place. These quantities need not necessarily represent the same entities, although
the unit of measure must be the same for both numerator and denominator of the ratio

Crude or General rates

Definition: Refers to total living population. It must be presumed that the total population was exposed to the risk of
occurrence of the event

Specific rate
Definition: The relationship is for a specific population class or group. It limits the occurrence of the event to the portion
of the population definitely exposed to it

Midyear population
Definition: Refers to the estimated population as of July 1 of a specified year

Crude birth rate

- a measure of one characteristic of the natural growth or increase in population

total no. of live births registered in a given year

CBR = ---------------------------------------------------------------- x 1000
Estimated population as of July 1 o the same year

Crude death rate

- a measure of one mortality from all causes which may result in a decrease of population

total no. of deaths registered in a given calendar year

CDR = --------------------------------------------------------------------- x 1000
Estimated population as of July 1 o the same year

Infant Mortality rate

- measures the risk of dying during the first year of life. It is a good index of the general health condition of a community
since it reflects the changes in the environment and medical condition of a community.

total no. of deaths under 1 year of age registered in a given year

IMR = ----------------------------------------------------------------------------------- x 1000
total no. of live births registered of the same year

General fertility rate

- measure of one characteristic of natural growth compared to the fertility age group

total no. of live births registered in a given year

GFR = ------------------------------------------------------------------ x 1000
total population of fertility age group

Specific Death rate

- Describes more accurately the risk of exposure of certain classes or groups to particular diseases.

Deaths in a specific class or group registered in a year

SDR = -------------------------------------------------------------------------- x 100,000
estimated population as of July 1 in same specified class / group of said year

Age specific death rate

No. Of death in a particular age group registered in a given calendar year

ASDR = ----------------------------------------------------------------------------------------- x 100,000
Estimated population as of July 1 in same age group of the same year

Sex specific death rate

No. of deaths of a certain sex in a given year

SSDR = -------------------------------------------------------------------------------- x 100,000
estimated population as of July 1 (same sex for the same year)
Cause Specific Death rate

No. of deaths from a specific cause in a given year

CSDR = ------------------------------------------------------ x 100,000
estimated population as of July 1 of the same year

Fetal death rate

- Measures pregnancy wastage. Death of the product of conception occurs prior to its complete expulsion, irrespective of
duration of pregnancy

Total no of fetal deaths in a given year

FDR = ----------------------------------------------------- x 1000
total no. of live births in the same year

Neonatal death rate

-Measures the risk of dying the 1st month of life. May serves as an index of the effects of prenatal care and obstetrical
management on the newborn

No. of Deaths under 28 days of age in a given yr.

NDR = --------------------------------------------------------------------x 1000
total no. of live births in the same year
Neonatal death rate
-Measures the risk of dying the 1st month of life. May serves as an index of the effects of prenatal care and obstetrical
management on the newborn

No. of Deaths under 28 days of age in a given yr.

NDR = --------------------------------------------------------------------x 1000
total no. of live births in the same year

Maternal Mortality Rate

-Measures the risk of dying from causes related to pregnancy, childbirth and puerperium. An index of the obstetrical care
needed and received by the women in a community

No. of deaths from maternal causes registered for a given year

MMR = ----------------------------------------------------------------------------------- x 1000
Total no. of live births registered of the same year

Swaroops Index
-Measures the risk of dying for 50 years old and above

No. of Deaths of 50 yrs. Old and above

SI = ----------------------------------------------------------------- x 100
estimated population as of July 1 of the same year

Proportionate Mortality Rate

- Shows the numerical relationship between deaths from a cause, age etc.

No. of registered deaths from a specific cause

PMR = ------------------------------------------------------------------ x 100
no. of registered deaths from all causes

Case Fatality Ratio

- Index of a killing power of the disease. It is influenced by incomplete reporting and poor morbidity data

No. of registered deaths from a specific disease for a given year

CFR = ---------------------------------------------------------------------------------- x 100
No. of registered cases from specific disease

Incidence Rate
- Measures the frequency of occurrence of the phenomenon during a given period of time. Deals only with new cases

No. of new cases of a particular disease in a specified time

IDR = ---------------------------------------------------------------------------- X 100,000
Sum of person - time at risk
Attack Rate
- A more accurate measure of the risk of exposure. Useful in epidemiological investigation

No. of persons acquiring the disease in a given year

AR = -------------------------------------------------------------------------- X 100
No. of exposed to same disease in same year

Prevalence Rate
- Measures the proportion of the population which exhibits a particular diseases at a particular time. This can only be
determined following a survey of the population concerned, deals with total (new and old) number of cases

No. of new and old cases of a certain disease at a given time

PR = ------------------------------------------------------------------------------- x 100
Total no. of persons examined at the same given time

Factors affecting Prevalence

Increased by Decreased by
Longer duration of the disease Shorter duration of the disease
Prolongation of life of patients without cure High case-fatality rate from disease
Increase in new cases (increase in incidence) Decrease in new cases
In-migration of cases In-migration of healthy people
Out-migration of healthy people Out-migration of cases
In-migration of susceptible people Improved cure rates of cases
Improved diagnostics facilities (better reporting)  

Proportionate Mortality (Death Ratios)

- shows the numerical relationship between deaths from all causes (or group of causes), age (or group of age) and the total
number of deaths from all causes in all ages taken together

No. of registered deaths from specific cause or age for a given calendar year
PM = ------------------------------------------------------------------------------------------------- x 100
Number of registered deaths from all causes, all ages in same year

Presentation of Data
ü Line or curved graphs - shows peaks, valleys and seasonal trends. Also used to show the trends of birth and death rates
over a period of time
ü Bar graphs - each bar represents or expresses a quantity in terms of rates or percentages of a particular observation like
causes of illness and deaths
ü Area Diagram (Pie Charts) - shows the relative importance of parts to the whole

Functions of the Nurse:

ü Collects data
ü Tabulates data
ü Analyzes and interprets data
ü Evaluates data
ü Recommends redirection and/or strengthening specific areas of heath programs as needed
Epidemiology
-backbone of the prevention of diseases

2 Main Areas of Investigation

1. Definition, study of distribution of disease
- describes the distribution of health status in terms of age, gender, race, geography and time
2. Search for the determinants (causes) of the disease and its observed distributions
- involves explanations of the patterns of disease distribution in terms of casual factors.

Uses of Epidemiology
To study the history of the health populations and the rise and fall of disease and changes in their character
To diagnose the health of the community and the community and the condition of people; to measure the distribution and
dimension of illness in terms of incidence, prevalence, disability and mortality
To study the working of health services with a view of improving them
To estimate the risks of disease, accident, defect and the chances of avoiding them
To identify syndromes by describing the distribution and association of clinical phenomena in the population
To complete the clinical picture of chronic disease and describe their natural history
To search for causes of health and disease by comparing the experience of groups that are clearly defined by their
composition, inheritance, experience, behavior and environments

Epidemiologic Triangle
l Host - any organism that harbors and provides nourishment for another organism
l Agent - intrinsic property of microorganisms to survive and multiply in the environment
l Environment - sum total of all external condition and influences that affects the development of an organism which can
be biological, social and

3 Components of the Environment:

1. Physical environment: consists of the inanimate surroundings such as the geophysical conditions of the climate
2. Biological environment: makes up the living things around us
3. Socio-economic: level of economic development of the community; presence of social disruptions

Disease Distribution
Variables: TIME, PERSON and PLACE

l Time: refers both to the period during which the cases of the disease being studied were exposed to the source of
infection and the period during which the illness occurred.
Ex: Epidemic period, Year, Period of Consecutive years
l Persons: refers to the characteristics of the individual who were exposed and who contacted the infection or the disease
in question
Ex: Age, Sex and Occupation
l Place: refers to the features, factor or conditions which existed in or described the environment in which the disease
occurred.

Patterns of Occurrence and Distribution

l Sporadic: intermittent occurrence of a few isolated and unrelated cases in a given locality; “on and off”, “seasonal”
Example: Rabies
l Endemic: continuous occurrence throughout a period of time, of the usual number of cases in a given locality.
Example: schistosomiasis is endemic in Leyte and Samar
l Epidemic: occurrence is of unusually large number of cases in a relatively short period of time. There is a
disproportionate relationship between the number of cases and the period of occurrence; “outbreak”
Example: Dengue outbreak during rainy season; Measles outbreak
l Pandemic: simultaneous occurrence of epidemic of the same disease in several countries; “International Perspective”
Example: HIV/AIDS; Covid-19
Outline of Plan for Epidemiological Investigation
1. Establish fact of presence of epidemic
n Verify diagnosis: do clinical and laboratory studies to confirm the data
n Reporting
n Is there an unusual prevalence of the disease

2. Establish time and space relationship of the disease

n Are the cases limited to or concentrated in any particular geographical subdivision of the affected community
n Relation of cases by days of onset of the first known cases

3. Relations to characteristic of the group of community

n Relation of cases to age groups, sex, color, occupation, school, attendance, past immunization etc.
n Relation of sanitary facilities, especially water supply, sewerage disposal, general sanitation of homes, and relation to
animal or insects vector
n Relation to milk and food supply
n Relation of cases to other cases and known carriers if any

4. Correlation of all data obtained

n Summarize data clearly with the aid of such tables and charts are necessary to give a clear picture of the situation
n Build up the case for the final conclusion carefully utilizing all the evidence available
n Establish the source of the epidemic and the manner of the spread, if possible
n Make suggestions as to the control, if disease is still present in community and as to prevention of future outbreaks

Outline on the Operational Procedure during a Disease Outbreak

1.Organization of Team
l Coordination of personnel
l Orientation/ demonstration on the methodology to be employed
l Checklist on the team’s paraphernalia
l Pooling of data and resource-record keeping

2. Epidemiological Investigation
l Active case finding
l Carriers and contact control
l Surveillance

3. Collection of laboratory specimens

l Rectal swabbing
l Food sampling
l Other that are relevant to disease

4. Treatment of Patients and contacts

l Analgesics and antipyretics
l Antibiotics
l Parenteral fluids
l Supportive drugs
l Emergency drugs
l Isolation of patients- “cordon sanitaire”
l Boiling and disinfection of fomites
l Conduction of patient to hospitals

5. Immunization campaign
l Type of vaccine
l Dosage, schedule, technique
l Areas to be covered
l Target population
l Consolidation and evaluation of data

6. Environmental Sanitation (during the survey)

l Water
l Toilets and surroundings
l Garbage disposal
l Insect and vermin control
l Food sanitation

7. Health education
l Individual approach
l Community approach and meetings
l Schools PTA, church and other congregations

8. Involvement of other agencies

9. Reporting
l Telegraphic report
l written

Functions of the Epidemiology Nurse

l Implement public health surveillance
l Monitor local health personnel conducting disease surveillance
l Conduct and/or assist other health personnel in outbreak investigation
l Assist in the conduct of rapid surveys and surveillance during disasters
l Assist in the conduct of surveys, program evaluations and other epidemiologic studies
l Assist in the conduct of training course in epidemiology
l Assist the epidemiologist in preparing the annual report and financial plan
l Responsible for inventory and maintenance of epidemiology and surveillance unit (ESU) equipment

Specific Roles of Nurses during Epidemiological Investigations:

l Maintains surveillance of the occurrence of notifiable diseases
l Coordinates with other members of the health team during a disease outbreak
l Participates in case finding and collection of laboratory specimens
l Isolates cases of CD
l Functions of the Nurse in Epidemiology
l Renders nursing care teaches and supervises giving of care
l Performs and teach household members methods concurrent and terminal disinfection
l Give health teaching to prevent further spread of disease to individuals and families
l Follow-up cases and contacts
l Organize, coordinate and conduct community health education campaign/ meetings
l Refer cases when necessary
l Coordinates with other concerned community agencies
l Accomplishes and keep records and reports and submits to proper office/ agency

Pertinent Laws
RA 3753 – Civil Registry Law
RA 3573 – Law on Reporting of Notifiable Disease
PD 651 - Requiring the Registration of Births and Deaths in the Philippines which occurred from January 1, 1974 and
thereafter