Course Tittle:
 Community health nursing
Community & Public Health
 Pre-requisites: AnaPhy, PH 51, PH 52
 Course Tittle: Community & Public Health
 Units: 5 (3 lecture/ 54 hours/ 2 labs. 108 hours)
 Course Description: It deals with the study of the
foundations of community health that includes
human ecology, demography and epidemiology. It
emphasizes the promotion of community, public and
environmental health.
The following competencies:
1. Establishes collaborative relationships with
community members, health team and related
sectors.
2. Demonstrate knowledge based on the health
status of the individual
3. Provides sound decision making in the care of the
individuals, families, groups considering their
beliefs and values.
4. Develop health education based on assessed and
anticipated needs
5.Adheres to organizational policies and procedures,
local and national
6. Displays positive attitude towards change and
criticism.
7. Chooses appropriate information technology to
facilitate communication
8. Demonstrate functions as to professional
standards
Learning Outcomes: organizer, effective
communicator, care provider, health educator &
community-minded.
COURSE INTENDED LEARNING OUTCOME
- Chapter I.
 Demonstrate familiarity on the Ambisyon Natin
2040, the University VMGO, and College goals and
objectives, Course policies, Grading system, course
requirements.
 Define health and community.  the health-oriented needs of the people.
 Discuss the focus of PH
 List the three levels of prevention.  surrounding populations by focusing health
 Explain the difference among community health
nursing, public health nursing and community-based
nursing.
 Cite the distinguishing features of community
health.
 Discuss public health practice in terms of public
health core functions.
 Compare the different fields of community health
practice.
 Apply the competency standards of health practice
in the Philippines in the community.
 Discuss community health nursing interventions
based on the intervention wheel.
 Outline the historical development of public health
and public health nursing in the Philippines.
KEY TERMS
 Aggregates
 Community health
 Developmental service
 Disease prevention
 Faith community nursing
 Health
 Health promotion
 Home health care
 Hospice care
 population
 population
 Population focused nursing
 Prepayment mechanisms
 Primary prevention
 Public health
 Public health nursing
 Secondary prevention
 Tertiary prevention
Introduction:
 Philippine’s health indicators remained markedly
below the health indicators of many other countries.
 Leading causes of Morbidity;
- Mostly Infectious, preventable diseases
 Leading causes of Mortality:
- Mixture of infectious disease and NC lifestyle
diseases such as: Heart and vascular conditions and
malignant neoplasms.
 These data reflect the general living conditions in
the country as well as the severe disproportion of
funding for preventive services and social and
economic opportunities.
 Health status of the population varies markedly
across areas of the country and among groups.
 Ex. Economically disadvantaged and many cultural
and ethnic groups have poorer overall health status
compared with Filipinos who belong to the upper
socioeconomic classes.
MAJOR ROLES OF HEALTH WORKERS
 Create a health care delivery system that will meet
 Preserve the health of the community and
promotion and health maintenance of individuals,
families and groups of the community.
 Identification of populations at risk rather than with
an episodic response to patient demand.
MISSION OF PUBLIC HEALTH
 Is SOCIAL JUSTICE that entitles all people to basic
necessities, such as adequate income and health
protection and accepts collective burden to make
possible.
 Public health with its egalitarian tradition and vision
conflicts with the predominant model of market
justice that only entitles people to what they have
gained through individual rights, collective action
and obligations are minimal. The tendency of the
economically able private health sector to focus on
high-level technology and curative medical services
within the market justice system has stiffed the
evolution of a health system designed to protect and
preserve the health of the population. There is a need
for an ethnic of social justice, for it is society’s
 responsibilities, rather than the individuals to meet
the basic needs of all people.
 Thus, there is a need for public funding of
prevention effort to enhance the health of our
people. Because of the rising prevalence of chronic
lifestyle diseases, the Philippine Health policy
advocates changes in personal behaviors that might
predispose individuals to chronic disease or
accident. This policy promotes exercise, healthy
eating, tobacco cessation, and moderate
consumption of alcohol. However, simply
encouraging the individual to overcome the effects
of unhealthy activities lessens the focus on collective
behaviors necessary to change the determinants of
health stemming from such factors as air water
pollution, workplace hazards, and unequal access to
health care. Because living arrangements,
work/school environment, and other socio-cultural
constraints affect health and well-being public policy
must address societal and environmental changes,
that will positively influence the health of the entire
population.
DIFFERENTIATE HEALTH AND
COMMUNITY.
HEALTH (def. is evolving)
 The state of complete physical, mental and social
well-being and not merely the absence of disease or
infirmity WHO, 1947
 A dynamic state or condition which is
multidimensional in nature and results from the
adaptation to his/her environment.
 Basic human right/Birthright of every Filipino.
Health- optimum level of functioning of an
individual.
 Health therefore seen as resource for everyday life
not the objective of living. It is positive concept
emphasizing social and personal resources and
physical capabilities
Saylor (2004)
 WHO definition considers several dimensions of
health:
1. physical – structure and functions
2. social, role, mental emotional and intellectual
3. general perceptions of health status
 HEALTH- state of well-being in which the person is
able to use purposeful, adaptive responses and
processes physically, mentally, emotionally,
spiritually, and socially. MURRAY (2009).
 HEALTH- Actualization of inherent and acquired
human potential through goal directed behavior,
competent self-care, and satisfying relationship with
others. (Pender’s 2006)
 HEALTH-a state of person that is characterized by
soundness or wholeness of develop human structures
and bodily and mental functioning (Orem 2001).
 Standardizing the conceptualization of health:
 Commonalities involve description of “goal-
directed” or “purposeful” actions, processes,
responses, or behaviors possessing, “soundness”,
wholeness and or well-being
 HEALTH- adaptation and environment and present
the environment as static and requiring human
adaptation, rather than as changing and enabling
human modification.
 Health workers favored DUNN’s (1961) classic
concept of wellness, in which family, community,
society and environment are interrelated and have an
impact on health
 From this viewpoint, illness, health is fluid and
changing. Consequently, within a social
environment, the state of health depends on the
goals, potentials and performance of individuals,
families, communities and societies.
 Public health often looks at the "big picture" and
society as a whole.
 Community health tends to look at a particular
population or community and targets a program or
intervention to their specific needs.
 Public health is typically divided into
epidemiology, biostatistics and health services,
environmental, social, behavioral, and occupational
health and other important subfields.
 It deals with preventive rather than curative aspects
of health.
 It deals with population level-rather than
individual-level health issues.
 Public Health- to promote health and quality of life
by preventing and controlling disease, injury, and
disability.”  Centers for Disease Control and
Prevention Mission Statement
 Public health" and "community health" are often
used interchangeably and tend to go hand in hand.  
 Public Health & Community Health
 However, the goals are NEARLY IDENTICAL:
- To prevent disease, illness and injury while
improving quality of life.
PUBLIC HEALTH VS. PREVENTIVE
MEDICINES
 Preventive Medicines is the science and art of
preventing disease, prolonging life and promoting
physical health, mental and efficiency for:
 *Group and communities by organized mass action
for public health
 *Individual and families by private patient care for
medical and dental health in order to intercept the
Natural History of the disease at any stage of
development.
DEFINITION OF COMMUNITY
 Focused on geographical boundaries, combined with
social attributes of people. But on the later part of
the decade this definition become secondary
characteristics definition of Community.
 A collection of people who interact with one another
and whose common interests or characteristics form
the basis for a sense of unity or belonging. (Allender
2009)
 A group of people who share something in common
and interact with one another, who may exhibit a
commitment with one another and may share
common interests, who interact with each other and
who functions collectively within a defined social
structure to address common concerns (Clark 2008)
 A locality-based entity, composed of systems of
formal organizations reflecting society’s institutions,
informal groups and aggregates (Shaster and
Geoppinger 2008)
 (Maurer and Smith 2009) identified FOUR defining
attributes/characteristics of community
1. people
2. place
3. interaction
4. common characteristics, interests or goals
By combining concept and ideas:
Community is seen as a group or collection of
locally-based individuals, interacting in social units
and sharing common interests, characteristics,
values, and or goals
MAURER AND SMITH (2009)
 Two main Types of Communities:
1. Geographical
2. Phenomenological
 Geographical communities are most traditionally
recognized or imagined when considering the term
community. Are defined or formed by both natural
and man-made boundaries and include barangays,
municipalities, cities, provinces, regions and nations.
 Other commonly recognized are congressional
districts and neighborhoods.
 Also called Territorial communities.
 Phenomenological Communities
 Refer to relational, interactive groups, in which the
place or setting is more abstract, and people share a
group perspective or identity based on culture,
values, history, interests, and goals:
 Examples:
 Schools, colleges and universities, churches and
mosques, various groups or organizations.
 These communities may also be described as
Functional Communities
Phenomenological Communities are:
 A community of solution.
 A collection of people who form a group specifically
to address a common need or concern.
 Ex: The GAWAD KALINGA, whose members aim
to alleviate poverty by community development, and
a group of indigenous people who lobby against
environmental degradation of their ancestral land.
 These groups or social units work together to realize
a level of potential ‘health” and to address identified
actual and potential health threats and health needs.
POPULATION AND AGGREGATE ARE
RELATED TERMS
 POPULATION
 Used to denote a group of people having
common personal or environmental
characteristics. (Maurer and Smith 2009)
 All people.
 AGGREGATES
 Are subgroups or subpopulations that have some
common characteristics or concerns (Clark
2008).
 These common characteristics or concerns may
make the members vulnerable to similar health
problems.
 Ex. Pregnancy, menopause
 Depending on the situation, needs and practice,
parameters, community health nursing
interventions may be directed toward:
 A community (e.g residents of a small town)
 A population (e.g all elders in a rural region) or
an aggregate (e.g pregnant teens within school
district)
CLASSIFICATION OF COMMUNITIES
 URBAN- developed and civilized, based on
geographical conditions, a big city or town, are often
busy and crowded.
 RURAL- are often farmlands, few businesses,
building, people
 RURBAN- combination
PUBLIC HEALTH KEY TERMS
 CLINICAL CARE: prevention, treatment and
management of illness and the prevention of mental
and physical well-being through the services offered
by medical and allied health professions, also known
as health care.
 DETERMINANT: factor that contributes on the
generation of a trait
 EPIDEMIC OR OUTREAK: epidemic;
occurrence in a community or region of cases of an
illness, specific health-related behavior, or other
health-related event clearly in excess of normal
expectancy. Both terms are used interchangeably,
however, epidemic usually refers to a larger
geographic distribution of illness or health-related
events.
 HEALTH OUTCOME: result of a medical
condition that directly affects the length or quality of
a person’s life.
DETERMINANTS OF HEALTH AND
DISEASES
 The health status of the community is associated
with a number of factors such as:
1. health care access,
2. economic conditions,
3. Social issues
4. Environmental issues
5. Cultural practices.
 It is essential to understand and recognize the
interactions of the factors that lead to disease, death
and disability.
DETERMINANTS OF HEALTH AND
DISEASES
 Determinants and how they affect health:
 Income and social status- higher income and social
status are linked to better health. The greater the gap
between the richest and poorest people the greater
the differences in health.
 Education- low education levels are linked with
poor health more stress and lower self-confidence
 Physical Environment- safe water and clean air,
health workplaces, safe houses, communities and
road all contribute to good health.
 Employment and working conditions-people in
employment are healthier particularly those who
have control over their working conditions.
 Social support networks- greater support from
families, friends and communities is linked to better
health.
 Culture- customs and traditions and the beliefs of
the family and community all affects health.
 Genetics- inheritance plays a part in determining
lifespan, healthiness and the likelihood of
developing illnesses.
 Personal behavior/lifestyle- and coping skills-
balanced eating, keeping active, smoking, drinking,
and how we deal with life’s stresses and challenges
affect health.
 Health services- access and use of services that
prevent and treat disease influences health.
 Gender- men and women suffer from different types
of diseases at different ages.
 In the Philippines, this is evident in the leading
causes of death during the past six decade.
 Indeed, the individual’s biology and behaviors
influence health through their interaction with each
other and with the individual’s social and physical
environments.
 In addition, policies and intervention can improve
health by targeting detrimental or harmful factors
related to individuals and their environment.
 McGinnis and Foege (1993) described “actual
causes of death” in US.
 Smoking, diet, activity patterns and alcohol
 Related to individual lifestyle choices strongly
influenced by population-focused policy efforts
and education.
 Ex. Prevalence of micronutrient deficiencies in
vulnerable groups have led to population-based
measures to address the issue such as food
fortification.
 Community and health workers should understand
and appreciate that health and illness are influenced
by a web of factors, some that can be change:
- E.g individual behavior such as tobacco use, diet,
activity)
 And factors that cannot change: (e. genetics, age,
gender)
 Other factors (physical and social environment) will
require changes that may need to be accomplished
from a policy perspective.
 Health workers must work with policy makers and
community leaders to identify patterns of disease
and death and to advocate for activities and policies
that promote health at the individual, family, and
community level.
FACTORS THAT AFFECT THE HEALTH OF
THE COMMUNITY
- PHYSICAL FACTORS
 Geography
 A community health problem can be directly
influenced by its altitude, latitude and climate
 In tropical countries where warm, humid
temperatures and rain prevail throughout the year,
parasitic and infectious diseases are a leading
community health problem
 Environment
 With an increase in population and continuous
depletion of non-renewable natural resources, the
future generation will most likely live in less
desirable environment
 Community size
 The larger the community, the greater its range of
health problems and the greatest its number of health
resources
 For example, larger communities have more health
professionals and better health facilities than smaller
communities. These resources are often needed
because communicable diseases can spread more
quickly and environmental problems are often more
severe
 Industrial development
 Provides a community with added resources for
community health programs but it may bring with it
environmental pollution and occupational injuries
and illnesses.
- SOCIAL AND CULTURAL FACTORS
 Social Factors:
 For example, people who live in urban communities,
where life is fast paced, experience higher rates of
stress-related illnesses rather than who live in rural
communities
 On the other hand, those in rural areas may not have
access to the same quality or selection of health care
that is available to those who live in urban
communities
 Cultural Factors:
 Beliefs, Traditions, and Prejudices
 The traditions of specific ethic groups can influence
the types of food, restaurants, retail outlets, and
services available in a community.
 Prejudices of one specific ethnic or racial group
against another can result in acts of violence or
norms.
 Economy:
 Both national and local economies can affect the
health of a community through reductions in health
and social services
 Employers usually find it increasingly difficult to
provide health benefits for their employees as their
income drops. Those who are unemployed and
underemployed face poverty and deteriorating health
 Politics:
 Those who happen to be in political office can
improve or jeopardize the health of their community
by the decisions
 e. Laws and ordinances) they make.
 Religion:
 For example, some religious communities limit the
type of medical treatment their members may
receive. Some do not permit immunizations; others
do not permit their members to be treated by
physicians.
 Social Norms:
  Cigarette smoking is a good example. During the
1940’s, 1950’s and 1960’s. it was socially acceptable
to smoke in most settings. Now in the 21’s century,
it has become socially unacceptable to smoke.
 Socio-economic status
 There is a strong correlation between SES and health
status-individuals in lower SES groups, regardless of
other characteristics, have poorer health status.
- COMMUNITY ORGANIZING
 Is a process through which communities are helped
to identify common problems or goals mobilize
resources, and in other ways develop and implement
strategies for reaching their goals they may have
collectively set?
- INDIVIDUAL BEHAVIORS (HERD IMMUNITY)
 The behavior of the individual community members
contributes to the health of the entire community
 E.g 2009 H1N1 flu pandemic is health issue
DIMENSIONS OF HEALTH
 Wood (1980) and Patrick (1982) defined health in
terms of eclectic sets of characteristics
 Death (mortality)
 Diseases (pathology)
 Impairment (anatomical loss, structural abnormality)
 Functional limitation (restriction in function)
 Discomfort (restriction in activity)
 Disability (lack of ability)
 Handicap (disadvantages, loss of opportunities,
social deprivation and dissatisfaction))
INDICATORS OF HEALTH AND ILLNESS
 National Health Situations 2019
A. Philippines population- 108,116,615
B. Global population- 7,577,130,400
C. Life expectancy(years)
i. Female- 72.6
ii. Male-66.2
iii. Average-69.3
D. Fertility Rate- 2.555/woman
E. Growth Rate- 64%
F. Infant Mortality Rate- 15.16/1000 LB
G. Maternal Mortality Rate- 121/100,00 LB
H. Crude Birth Rate- 20.27/1000 pop.
I. Crude Death Rate- 5.92/1000 pop.
J. 10 Leading Causes Morbidity
1. Acute RI
2.Acute Lower Tract & Pneumonia
3. Bronchitis
4. HPN
5. Acute watery disease
6. Influenza
7. UTI
8. TB Respiratory
9. Injuries
10. Diseases of the Heart
K. 10 Leading Causes of Mortality
1. Diseases of the heart
2. Diseases of the vascular system
3. Malignant Neoplasms
4. Pneumonia
5. Accidents
6. Tuberculosis all forms
7. Chronic Lower respiratory diseases
8. Diabetes Mellitus
9. Nephritis, Nephrotic syndrome & Measles
10.Certain Conditions originating in the perinatal
period
 Life Span- it is the probable number of years
remaining in life of an individual or class or persons
determined statistically, affected by such factors as
heredity, physical conditions, nutrition and
occupation.
 Life Expectancy-it is the longest period over the life
of any organisms or species may extend according to
the available biological knowledge concerning it. It is
the longevity of any individual.
Uses variety of health indicators to measure the
health of the community are:
 Health providers
 Policy makers
 Community health workers
Providers of mortality, morbidity and other
health related status
 National Epidemiology Center of the DOH
 National Health Statistics Office
 Local Health Centers/ Offices/Department
 Local health centers/offices departments are
responsible for collecting morbidity and mortality data
and forwarding the information to the higher-level
health facility, such as the Provincial Health Office.
 Health workers should ask many questions:
 What are the leading causes of death and disease
among various groups served?
 How do infant mortality rates and maternal
mortality rates in this community compare with
national and regional rates?
 What are the most serious CD threats?
 What are the most common environmental risk?
 The health workers may identify areas for further
investigation and intervention through an
understanding of health disease and mortality
patterns.
 Example:
 Health workers learns that the incidence rate of
severe acute diarrhea in the community is higher
than the national average.
Solution: Working with school officials, parents
and students to address the problem.
 High rate of chronic lung diseases in an industrial
facility, they should work with company
management, employees and health officials to
identify potential harmful sources.
Solution: Participate in investigative efforts to
determine what is precipitating the increased
diseases rate work to remedy the identified threats
or risk.
DEFINITION AND FOCUS OF
PUBLIC HEALTH AND COMMUNITY
HEALTH
 Who is known for the classic definition of Public
Health?
 In 1923, C.E.A. Winslow (Charles-Edward Amory
Winslow (1877-1957)
 Defined public health as the science and art of:
1. Preventing disease.
2. Prolonging life.
3. Promoting health and efficiency through
community organized efforts for the:
1. Sanitation of the environment.
2. Control of communicable diseases.
3. Education of the individual in personal
hygiene.
4. Organization of medical and nursing
services for the early diagnosis and preventive
treatment of disease.
5. Development of the social machinery to
ensure everyone a standard of living adequate
for the maintenance of health.
 More Contemporary Definitions (C.E. Winslow)
- "The organized application of resources to achieve
the greatest health for the greatest number"
(Brotherton, 1967)
 A KEY Phrase in the definition of Public Health by
CEW is “through organized community effort”.
 The term Public Health connotes organized,
legislated, and tax-supported efforts that serve all
people through health departments or related
governmental agencies. Its purpose is to improve
the health of the public by promoting healthy
lifestyles, preventing disease and injury, and
protecting the health of communities.
 Three Core Functions of Public Health
Assessment
 What are the health problems of a population or
individual?
 Regular collection, analysis, and information
sharing about health conditions, risks and
resources in a community
Policy Development
 Collectively deciding which actions or
interventions are most appropriate for the problems
identified.
 Use of information gathered during assessment to
develop local and state health policies and to direct
resources toward those policies.
Assurance
 The necessary interventions will be put into place,
assuring conditions in which people can be healthy.
 Focuses on the authority of necessary health
services throughout the community. It includes
maintaining the ability of both public health
agencies and private to provide and manage day-
to-day operations and having the capacity to
respond to critical situations and emergencies.
PUBLIC HEALTH SYSTEM ACTIVITIES
1. Health promotion
2. Disease prevention
3. Treatment Rehabilitation/sequelae
UNIQUE FEATURES OF PUBLIC HEALTH
 Social Justice Philosophy Expanding Agenda
 Inherently Political Nature
 Grounded in Science Link with Government
 Uncommon Culture Focus on Prevention
PUBLIC HEALTH
 A Science- consists of systematic steps to follow
or has chronological order to achieve/reach goals.
 An Art –it deals different types of management/
managing.
RESOURCES IN HEALTH ADMINISTRATION
1. people- human resources
 Very hard to manage!
 Reasons: differ in perception, idiosyncrasies,
practices
2. Fund, money, fiscal logistic
3. Infrastructure/physical resources
HEALTH CARE MANAGERS VS.
ADMINISTRATORS
 Health care manager:
 better than Administrator
 Focus on output & outcome
 Entire unit will realize their goals.
 Administrator: Better only in the delivery of
services, protocols
SUMMARY:
 Public Health:
1. Services were developed to address the health needs
of communities.
2. Has developed a world view of health.
3. Focuses on populations rather than individuals.
 How Does Public Health Differ from Health Care?
SELF-HELP ASSESSMENT:
1. What has been your personal awareness of public
health?
2. What are current public health issues in your
community?
3. Make a Case Study of the implementation of the
public health programs in your own community.
ESSENTIAL PUBLIC HEALTH FUNCTIONS
1. Health situation monitoring and analysis
2. Epidemiological surveillance disease prevention and
control
3. Development of policies and planning in public
health
4. Strategic management of health systems and
services for population health gain
5. Regulation and enforcement to protect public health
6. Human resources development and planning in
public health
7. Health promotion, social participation, and
empowerment
8. Ensuring the quality of personal and population-
based health service
9. Research development and implementation of
innovative public health solutions.
UNIQUE FEATURES OF PUBLIC HEALTH
 Inherently Politically Nature
 Expanding Agenda
 Link with government
 Grounded in Science
 Focus on prevention
 Social justice Philosophy
 Uncommon Culture
PUBLIC HEALTH ACHIEVEMENTS (1900-
1999)
 Vaccination
 Safe workplaces
 Safe and healthier foods
 Motor vehicle safety
 Control of infectious diseases
 Family Planning
 Decline in deaths from heart disease and stroke
 Recognition of tobacco use as a health hazard
 Healthier mothers and babies
 Fluoridation of drinking water
 Public Health Achievements (2001-2010)
PUBLIC HEALTH ACHIEVEMENTS (2001-
2010)
 Vaccine preventable diseases
 Prevention and control of infectious diseases
 Tobacco control
 Maternal and Child health
 Motor vehicle safety
 Cardiovascular disease prevention
 Occupational safety
 Cancer prevention
 Childhood lead poisoning prevention
PREVENTIVE APPROCH TO HEALTH
Health Promotion Levels of Prevention
 Medical Care which focuses on disease management
and cure.
 Public Health focus on health promotion and disease
prevention
 Health promotion activities enhances resources
directed at improving well-being.
 Disease Prevention activities protect people from
disease and the effect of disease.
PUBLIC HEALTH APPROACH
 Implement interventions to improve the health of the
population.
 Monitor those interventions to assess their
effectiveness
 Define the health problems
 Identify the risks factors associated with the problem
 Develop and test community-level interventions to
control or prevent the cause of the problem
 Discuss the three levels of prevention. 
THREE LEVELS OF PREVENTION
(CLARK 1958)
Level I
Primary Prevention
Ex. Immunization
Level 2
Secondary Prevention s
Ex. Screening of STD’s
Level 3
Tertiary Prevention
Ex. Teaching Insulin administration in the home
PRIMARY PREVENTION
 Relates to activities directed at preventing a
problem before it occurs altering susceptibility or
reducing exposure for susceptible individuals.
 Two Elements of Primary Prevention:
1. General health promotion
2. Specific protection
- Health promotion efforts enhance resiliency and
protective factors and target essential well populations
EXAMPLES OF PRIMARY PREVENTION
 Promotion of good nutrition
 Provision of adequate shelter
 Encouraging regular exercise
 Eliminate risk factors through immunization &Water
purification
 Eliminate risk factors
SECONDARY PREVENTION
 Refers to early detection and prompt intervention
during the period of early disease pathogenesis.
 Pathogenesis- development of a disease.
 It is implemented after a problem has begun but
before signs and symptoms appear and target those
population who are risk factors.
- Examples;
 Mammography, Blood pressure screening, newborn
screening and mass sputum examination for PTB-
(pulmonary tuberculosis).
TERTIARY PREVENTION
 Targets populations that have experienced disease or
injury and focuses on limitation of disability and
rehabilitation;
 AIMs:
1. reduce the effects of disease and injury
2. to restore individuals to their optimal level
of functioning
 EXAMPLES OF TERTIARY PREVENTION
1. Teaching how to perform insulin injection
techniques and disease mgt. To a patient with
diabetes
2. Referring a patient with spinal cord injury for
occupational and physical therapy.
3. Leading a support group for cancer patients who
have undergone cancer treatment, such as surgery, Definition of Levels of Prevention
chemotherapy and/or radiation therapy Client Serve

Primary (health Secondary Tertiary

 SELF ASSESSMENT promotion and (early (limitation of
 Situation: Concerning malnutrition among young specific diagnosis disability and
children in a community: prevention) and rehabilitation)
treatment)
 Applying levels of prevention:
 Give at least 3 interventions:
Community Fluoride water Organized Alcoholics
 Primary= and supplementation screening Anonymous
 Secondary= population programs and others
 Tertiary= (aggregate Environmental for self-help
of people sanitation communities groups
sharing
 Answers: Interventions Concerning Malnutrition space over
Removal of (e.g health Mental health
 Educate pregnant women on the benefits of BF environmental fairs) VDRL services for
time within
hazards screening
 (Primary prevention) a social
Military
system, marriage
 Conduct periodic Operation Timbang license veterans
population
 (Secondary prevention) groups or applications
Shelter and
 Provide nutrition education to mothers of children aggregates relocation
with severe malnutrition with centers for the
 (Tertiary prevention) fire, typhoon
or earthquake
victims

Definition of Levels of Prevention

Client Serve
Primary Secondary Tertiary
(health (early (limitation of
Examples of Levels of prevention and Clients serve in the Community promotion diagnosis disability and
and and rehabilitation)
Definition of Levels of Prevention treatment)
specific
Definition Levels of Prevention Client Serve prevention)
of Client Primary Secondary Tertiary
Serve (health (early (limitation of
Primary Secondary Tertiary Emergency
promotion diagnosis disability and
(health (early (limitation of medical services
and specific and rehabilitation)
promotion diagnosis and disability and prevention) treatment)
and specific treatment) rehabilitation) Community
prevention) Individual Dietary HIV testing Teaching new
mental health
teaching Screening for clients with
services by
during cervical diabetes how
chronically
pregnancy cancer to administer
Group or Mother’s Vision Dietary mentally ill.
immunization insulin
aggregate class on screening of instructions Exercise
Home care
(interacting Breastfeeding first-grade and therapy
services after
for
people class monitoring stroke
Education for chronically ill
with a for family
drug abuse Mass sputum Family (two Education or Dental Skin care for
common with
prevention examination or more counseling examinations incontinent
purpose/s overweight individuals, regarding Diabetes patients,
for high in a low- members,
school income bound by smoking, screening for mental
Group kinship, law, dental care, family at risk health
neighborhood counseling to or living or nutrition counseling or
Hearing tests grade school arrangement Adequate referral for
at the center children with and with housing family in crisis
asthma, common (e.g., Grieving
for elderly
Exercise emotional or
program for ties and experiencing
diabetic at a obligations) a marital
center for the conflict)
elderly
Public Health Interventions and definitions
Keller et al (2004)
Public Health DEFINITION Community Helps community to identify common problems or
Interventions Organizing goals, mobilize resources and develop and
implement strategies for realizing the goals they
collectively have set.
Surveillance Describe and monitor health events through ongoing
and systematic collections, analysis, and
interpretation of health data for the purpose
planning, implementing and evaluating Public DEFINITION
Health
Public health interventions. Intervention
s

Disease and Systematically gathers and analyses data regarding

other health threats to the health of the populations, ascertains Advocacy Pleads someone’s cause or acts on someone’s
event the source of the threat, identifies causes and others behalf, with a focus on developing the community,
intervention at risk and determines control measures. system, and individual or family ‘s capacity to
plead their own cause or act on their own behalf.

Outreach Locates population of interest or population at risk

and provides information about the nature of the Social Utilizes commercial marketing principles and
concern, what can be done about it, and how marketing technologies for programs designed to influence
services can be obtained. the knowledge, attitudes, values beliefs, behaviors,
and practices of the population of interest

Screening Identifies individuals with unrecognized health risks

Policy Places health issues on decision maker’s agenda s,
factors asymptomatic disease conditions.
developmen acquires a plan of resolution, and determines
t and needed resources, resulting in laws, rules,
enforcement regulations, ordinances and policies. Policy
enforcement compels others to comply with laws,
Public Health DEFINITION
rules, regulations, ordinances, and policies
Interventions

Case Finding Locates individuals and families with identified risk

THINKING UPSTREAM: EXAMINING THE
factors that connects them with resources
ROOT CAUSES OF POOR HEALTH
Referral and Assists individuals, families, groups, organizations
Follow-up and/or communities to identify and access
ROOT CAUSES OF POOR HEALTH
necessary resources to prevent or resolve  Inequities Distribution of Resources
problems or concerns. *A threat to the common good
*A challenge for community and public health
Case Optimizes self-care capabilities of individuals and practitioners.
managemen families and the capacity of systems and  Factors that contribute to wide variations in health:
t communities to coordinate and provide services. 1. education
2. income
Delegated Are direct care task, that a public health 3. occupations
functions practitioner carries out under the authority of a
4. lack of health insurance-key factor
health care practitioner as allowed by law.

 (ADAPTED FROM A STORY TOLD Y IRVING

Health Communicates facts, ideas, and skills that change
Teaching knowledge, attitudes, values beliefs, behavior, and
ZOLA AS CITED IN MCKINLAY JB 2008).
practices of individuals, families, systems and/or A CASE FOR REFOCUSING UPSTREAM THE
communities. POLITICAL ECONOMY OF ILLNESS.

 Questions: On a case for refocusing upstream the

Public DEFINITION political economy of illness.
Health  What is description of the story?
Intervention
s  What imagery used in the story?
 In real situation. What are the necessary things
Counseling Establishes an interpersonal relationship with a
failed to recognize by the health care providers?
community, a system, and a family or individual,
with the intention of increasing or enhancing their  Answers:
capacity for self-care and coping
 The description of the frustrations in medical
practice.
Consultatio Seeks information and generates optional solutions  Used the imagery of a swiftly flowing river to represent illne
n to perceived problems or issues through interactive
problem solving with a community system, and
family or individual.

Collaboratio Commits two or more persons or an organization to

n achieve a common goal through enhancing the
capacity of one or more of the members to promote
and protect health

Coalition Promotes and develops alliances among

building organizations or constituencies for a common
purpose
  In this analogy, doctors are so busy rescuing victims
from the river that they fail to look upstream to see
who is pushing patients into the perilous waters.
There are many things that could cause a patient to
fall (get pushed) into the water of illness such as:
 Tobacco company products
 Companies that profit selling products high in
saturated fats
 Alcoholic beverages industry
 The beauty industry
 Exposure to environmental toxins or
 Occupationally induced illnesses
 Manufacturers of illnesses are what push clients into
the river.
 “Health providers should refocus their efforts
toward preventive and upstream activities-
examining the root causes of poor health”
 address health from a preventive versus curative
focus.
 critically examine the relative weight of their
activities toward illness response versus the
prevention of illness.
 examine the origin of disease, identify social,
political, environmental and economic factors that
often lead to poor health.
 provides affirmation of their daily efforts to prevent
disease in population at risk in schools, worksites
and clinics throughout their local communities and
in the larger world
BRIEF HISTORY/ EVOLUTION 0F PUBLIC
HEALTH
1. Philippines
2. Global
 Levels of Clientele in the Community
 Community Health Nursing
 Community Based Nursing
 Public Health Nursing
PUBLIC HEALTH INTERVENTION (1990’S)
(REVISED)THE INTERVENTION WHEEL
(KELLER2004)
 Recognized Framework for Community Health
Nursing Practice
 It contains THREE IMPORTANT ELEMENTS:
1. POPULATION
2. THREE LEVELS PRACTICE
I. COMMUNITY
II. SYSTEMS
III. INDIVIDUAL/FAMILY
3. IDENTIFIES & DEFINES 17 PUBLIC
HEALTH INTERVENTIONS
 These interventions are actions taken on behalf of
the communities, systems, individuals and families
to improve or protect the health status.
PUBLIC HEALTH INTERVENTION
(1990’S)
(REVISED)THE INTERVENTION WHEEL
(KELLER2004)
 SURVEILLANCE- describes and monitors health
events through ongoing and systematic collection,
analysis, and interpretation of health data for the
purpose of planning, implementing, and evaluating
PHI.
 DISEASE AND OTHER HEALTH EVENT
INVESTIGATION- Systematically gathers and
analyzes data regarding threats to the health
populations, ascertains the source of the threats to
the health of populations, ascertains the source of the
threat, identifies cases and others at risk, and
determines control measures
 OUTREACH- locates population of interest or
population at risk and provides information about
the nature of the concern, what can be done about it ,
and how services can be obtained.
 SCREENING- identifies individuals with
unrecognized health factors or asymptomatic
diseases factors.
 CASE FINDING- locates individuals and families
with identified risks factors and connects them with
resources.
 REFERRAL AND FOLLOW-UP- assists
individuals, families, groups, organizations, and/or
communities to identify and access necessary
resources to prevent or resolve problems and
concern.
 CASE MANAGEMENT- optimizes, self-care
capabilities of the individuals, and families and the
capacity of systems and communities to coordinate
and provide services.
 DELEGATED FUNCTIONS- are direct care tasks
that a PHW carries unless the authority of health
care practitioner as allowed.
 HEALTH TEACHING- communicates facts, ideas,
and skills that change knowledge, attitudes, values,
beliefs and practices of individuals, families,
systems, and/or communities.
 COUNSELLING- establishes an interpersonal
relationship with a community, a system, and a
family or individual, with the intention of increasing
or enhancing their capacity to self-care and coping.
 CONSULTATION- Seeks information and
generates optional solutions to perceived problems
or issues through interactive problem solving with a
community system.
 COLLABORATION- commits two or more
persons or an organization to achieve a common
goal through enhancing the capacity of one or more
of the members to promote and protect health.
 COALITION BUILDING- promotes and develops
alliances among organizations or constituencies for a
common purpose.
 COMMUNITY ORGANIZING- helps community
groups to identify common problems to goals,
mobilize resources, and develop and implement
strategies to realizing the goals they collectively
have set.
 ADVOCACY- pleads someone’s cause or acts or
someone’s behalf, with a focus on developing the
community, system, and individual or family’s
capacity to plead their own cause or act on their own
behalf.
 SOCIAL MARKETING- Utilizes social marketing
principles and technologies for programs, designed
 to influence the knowledge, attitudes, values, beliefs,
behaviors, and practices of the population of interest.
 POLICY DEVELOPMENT- Place health issues on
decision makers’ agendas, acquires a plan of
resolution, and determines needed resources,
resulting in laws, rules and regulations, ordinances,
and policies. Policy enforcement compels others to
comply with laws, rules, regulations, ordinances and
policies.