Learning Objectives:

• Define health and public health in a pharmacy-practice perspective

• Understand health as a basic human right and its role in the
development of a community and society as a whole
Introduction to Public Health • Describe the core functions of public health.
Danielle T. Matuguinas, RPh
• Analyze the similarities and differences of public health approach
Jeritz George A. Orbigo, RPh from clinical health approach

PHARMACY DEPARTMENT
SAN PEDRO COLLEGE

DOES A PHARMACIST HAVE A FUNCTION IN PUBLIC HEALTH?

The pharmacist's role is expanding beyond the traditional product-oriented
functions of dispensing and distributing medicines and health supplies. J he
pharmacist's services of today include more patient-oriented, administrative
Public health is "the science and art of preventing disease, prolonging and public health functions. There are many functions of public health that
life, and promoting health through the organized efforts and can benefit from pharmacists' unique expertise that may include
informed choices of society, organizations, public and private pharmacotherapy, access to care, and prevention services.1-5 Apart from
communities, and individuals." - CEA Winslow dispensing medicine, pharmacists have proven to be an accessible resource
for health and medication information. The pharmacist's centralized
• THE SCIENCE OF PREVENTION placement in the community and clinical expertise are invaluable. The
reexamination and integration of public health practice into pharmacological
• THE ROLE OF RESEARCH AND DISCOVERY training and pharmaceutical care is essential. The encouragement of cross-
training will also maximize resources and aid in addressing the work force
needs within the fields of pharmacy and public health.

PHARMACY DEPARTMENT PHARMACY DEPARTMENT

SAN PEDRO COLLEGE SAN PEDRO COLLEGE

~
Public Health Key Terms
Knowledge Check
clinical care: prevention, treatment, and management of illness and the Fill in the blank with the correct answer.
preservation of mental and physical well-being through the services offered
by medical and allied health professions; also known as health care.
A. groups of people B. individuals
determinant: factor that contributes to the generation of a trait.

epidemic or outbreak: occurrence in a community or region of cases of an

illness, specific health-related behavior, or other health-related event clearly Public health aims to provide groups of people
in excess of normal expectancy. Both terms are used interchangeably; with the right to be healthy and live in conditions
however, epidemic usually refers to a larger geographic distribution of illness
or health-related events.
that support health.

health outcome: result of a medical condition that directly affects the

length or quality of a person's life. ~ - -~ - ~ - - ~
PHARMACY DEPARTMENT Stedman TL, ed. Stedman' s medical dictionary. 28 th ed. Baltimore, MD: Lippincott, Williams, and Wilkins; 2006.
Farlex, Inc. The free dictionary. Huntingdon Valley, PA: Farlex, Inc.; 2014. Available at: http://www.thefreedictionary.com/.
PHARMACY DEPARTMENT
SAN PEDRO COLLEGE SAN PEDRO COLLEGE
6
5
 HEALTH AS A HUMAN RIGHT:
~ Knowledge Check THE DECLARATION OF ALMA ATA
Fill in the blank with the correct answer. □ The Alma-Ata Declaration of 1978 emerged as a major milestone of the twentieth
century in the field of public health, and it identified primary health care as the key
A. pandemic B. intervention to the attainment of the goal of Health for All.
C. epidemic or outbreak D. prevention □ was adopted at the International Conference on Primary Health Care, Almaty,
Kazakhstan, 6-12 September 1978.
A(n) epidemic or outbreak is a disease □ It expressed the need for urgent action by all governments, all health and
occurrence among a population that is in development workers, and the world community to protect and promote ttile health
excess of what is expected for a given time of all people.
and place.

PHARMACY DEPARTMENT PHARMACY DEPARTMENT

SAN PEDRO COLLEGE SAN PEDRO COLLEGE
7

HEALTH AS A HUMAN RIGHT: HEALTH AS A HUMAN RIGHT:

THE DECLARATION OF ALMA ATA
The following are excerpts from the Declaration:
□ The Conference strongly reaffirms that health, which is a state of complete physical,
mental, and social well-being, and not merely the absence of disease or infirmity, is a
fundamental human right and that the attainment of the highest possible level of
health is a most important world-wide social goal whose realization requires the
action of many other social and economic sectors in addition to the health sector.
□ The existing gross inequality in the health status of the people, particularly between
developed and developing countries as well as within countries, is politically, socially,
and economically unacceptable and is, therefore, of common concern to all
countries.
□ The people have a right and duty to participate individually and collectively in the
~.......lanning and implementation of their health care.
THE DECLARATION OF ALMA ATA
□ 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.
□ An acceptable level of health for all the people of the world by the year 2000 can be
attained through a fuller and better use of the world's resources, a considerable part
of which is now spent on armaments and military conflicts.

PHARMACY DEPARTMENT PHARMACY DEPARTMENT

SAN PEDRO COLLEGE SAN PEDRO COLLEGE

Three Core Functions of Public Health

Core Functions
Systematically collect, analyze,
and Essential Services Assessment )
and make available information
of Public Health on healthy communities

Policy Promote the use of a scientific

) knowledge base in policy and
decision making

Assurance )
Ensure provision of services to
those in need

PHARMACY DEPARTMENT PHARMACY DEPARTMENT

SAN PEDRO COLLEGE SAN PEDRO COLLEGE
11 Institute of Medicine. The future of public health. Washington, DC: National Academies Press; 1988. 12
 Ten Essential Public Health Services
l. Monitor Health
2. Diagnose and Investigate
3. Inform, Educate, Empower
4. Mobilize Community Partnership
5. Develop Policies
6. Enforce Laws
7. Link to/Provide Care
8. Assure a Competent Workforce
9. Evaluate
l 0. Research
PHARMACY DEPARTMENT
SAN PEDRO COLLEGE
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Resources and Additional Reading
• Institute of Medicine. The future of public health. Washington , DC: The National Academies Press; 1988.
. Institute of Medicine. The future of the public's health in the 2ist century. Washington, DC: The National Academies Press; 2002.
• Institute of Medicine. Who will keep the public healthy? Workshop summary. Washington , DC: The National Academies Press; 2003.
• Pearl R. Tobacco smoking and longevity. Science l 938;87:216-7.
• Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, June 19-
July 22, 1946.
• Federal Communications Commission. Texting while driving. http://www.fcc.gov/guides/texting-while-driving.
• UNAIDS. UNAIDS World AIDS Day Report, 2012. http://www.unaids.org/en/media/unaids/contentassets/
documents/epidemiology/20l2/gr2012/JC2434_WorldAIDSday_results_en.pdf.
• Skelton A. Introduction to public health science and practice." Presented at the CDC Steven M. Teutsch Prevention Effectiveness
Fellowship Orientation, August 15, 2012.
• US Department of Health, Education, and Welfare. Smoking and health. Washington , DC: public health Service; 1964.
http://profiles.nlm.nih.gov/ps/access/NNBBMQ.pdf.
· Winslow CEA. The untilled field of public health. Mod Med 1920;2: 183-91.
• World Health Organization (WHO). World report on violence and health. Geneva: WHO; 2002.
://www.who.int/violence_injury_prevention/violence/world_report/en/.
-:;:.:..::~1r7ai
PHARMACY DEPARTMENT
SAN PEDRO COLLEGE
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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 selfreliance and self-determination. It forms an integral part both of the country's
health system, of which it is the central function and main focus, and of the overall social
and economic development of the community. It is the first level of contact of individuals,
the family and community with the national health system bringing health care as close as
possible to where people live and work, and constitutes the first element of a continuing
health care process.
VII
Primary health care:
1. reflects and evolves from the economic conditions and sociocultural and political
characteristics of the country and its communities and is based on the application
of the relevant results of social, biomedical and health services research and
public health experience;
2. addresses the main health problems in the community, providing promotive,
preventive, curative and rehabilitative services accordingly;
3. includes at least: education concerning prevailing health problems and the
methods of preventing and controlling them; promotion of food supply and proper
nutrition; an adequate supply of safe water and basic sanitation; maternal and
child health care, including family planning; immunization against the major
infectious diseases; prevention and control of locally endemic diseases;
appropriate treatment of common diseases and injuries; and provision of essential
drugs;
4. involves, in addition to the health sector, all related sectors and aspects of national
and community development, in particular agriculture, animal husbandry, food,
industry, education, housing, public works, communications and other sectors;
and demands the coordinated efforts of all those sectors;
5. requires and promotes maximum community and individual self-reliance and
participation in the planning, organization, operation and control of primary
health care, making fullest use of local, national and other available resources;
and to this end develops through appropriate education the ability of communities
to participate;
6. should be sustained by integrated, functional and mutually supportive referral
systems, leading to the progressive improvement of comprehensive health care for
all, and giving priority to those most in need;
7. relies, at local and referral levels, on health workers, including physicians, nurses,
midwives, auxiliaries and community workers as applicable, as well as traditional
Resources and Additional Reading
• American public health Association (APHA). The Prevention and public health Fund: a critical investment in our nation's physical and
fiscal health. APHA Center for Health Policy Issue Brief. Washington, DC: APHA; 2012. http://www.apha.org/NR/rdonlyres/8FA 1377 4-
AA47-43F2-838B- l B0757D 111 C6/0/ APHA_PrevFundBrief_June2012.pdf.
• California Department of public health. TabaccoFreeCA. http://www.Tobaccofreeca.org.
. Centers for Disease Control and Prevention. Key facts about seasonal flu vaccine. http://www.cdc.gov/flu/protect/keyfacts.htm.
• Centers for Disease Control and Prevention. Overweight and obesity. http://www.cdc.gov/obesity/index.html.
• Centers for Disease Control and Prevention. Social determinants of health. http://www.cdc.gov/socialdeterminants/FAQ.html.
• Centers for Medicare and Medicaid Services. National health expenditure projections: 2008-2018. http://www.cms.gov/Research-
Statistics-Data-a nd-Syste ms/Statistics-Trends-a nd-Reports/N atio no IHea Ith Expend Data/ down loads/ proj2008. pdf.
• Dean H. Introduction to public health, epidemiology, and surveillance. Presented at the CDC Science Ambassador Program, July 16,
2012.
• Frieden, TR. Framework for public health action: the health impact pyramid. Am J public health 20 l O; l 00:590-5.
· Kindig D, Stoddart G. What is population health? Am J public health. 2003;93:380-3.
• Institute of Medicine. For the public's health: investing in a healthier future. Washington, DC: National Academies Press; 2012.
• Institute of Medicine. Primary care and public health: exploring integration to improve population health. Washington, DC: The
National Academies Press; 2012.
PHARMACY DEPARTMENT
SAN PEDRO COLLEGE
15
Declaration of Alma-Ata
International Conference on Primary Health Care, Alma-Ata, USSR, 6-12
September 1978
The International Conference on Primary Health Care, meeting in Alma-Ata this twelfth
day of September in the year Nineteen hundred and seventy-eight, expressing the need
for urgent action by all governments, all health and development workers, and the world
community to protect and promote the health of all the people of the world, hereby makes
the following
Declaration:
I
The Conference strongly reaffirms that health, which is a state of complete physical,
mental and social wellbeing, and not merely the absence of disease or infirmity, is a
fundamental human right and that the attainment of the highest possible level of health is
a most important world-wide social goal whose realization requires the action of many
other social and economic sectors in addition to the health sector.
II
The existing gross inequality in the health status of the people particularly between
developed and developing countries as well as within countries is politically, socially and
economically unacceptable and is, therefore, of common concern to all countries.
III
Economic and social development, based on a New International Economic Order, is of
basic importance to the fullest attainment of health for all and to the reduction of the gap
between the health status of the developing and developed countries. The promotion and
protection of the health of the people is essential to sustained economic and social
development and contributes to a better quality of life and to world peace. IV The people
have the right and duty to participate individually and collectively in the planning and
implementation of their health care.
V
Governments have a responsibility for the health of their people which can be fulfilled
only by the provision of adequate health and social measures. A main social target of
governments, international organizations and the whole world community in the coming
decades should be the attainment by all peoples of the world by the year 2000 of a level
of health that will permit them to lead a socially and economically productive life.
Primary health care is the key to attaining this target as part of development in the spirit
of social justice.
VI
Primary health care is essential health care based on practical, scientifically sound and
socially acceptable methods and technology made universally accessible to individuals
practitioners as needed, suitably trained socially and technically to work as a
health team and to respond to the expressed health needs of the community.
VIII
All governments should formulate national policies, strategies and plans of action to
launch and sustain primary health care as part of a comprehensive national health system
and in coordination with other sectors. To this end, it will be necessary to exercise
political will, to mobilize the country's resources and to use available external resources
rationally.
IX
All countries should cooperate in a spirit of partnership and service to ensure primary
health care for all people since the attainment of health by people in any one country
directly concerns and benefits every other country. In this context the joint
WHO/UNICEF report on primary health care constitutes a solid basis for the further
development and operation of primary health care throughout the world.
X
An acceptable level of health for all the people of the world by the year 2000 can be
attained through a fuller and better use of the world's resources, a considerable part of
which is now spent on armaments and military conflicts. A genuine policy of
independence, peace, detente and disarmament could and should release additional
resources that could well be devoted to peaceful aims and in particular to the acceleration
of social and economic development of which primary health care, as an essential part,
should be allotted its proper share.
The International Conference on Primary Health Care calls for urgent and effective
national and international action to develop and implement primary health care
throughout the world and particularly in developing countries in a spirit of technical
cooperation and in keeping with a New International Economic Order. It urges
governments, WHO and UNICEF, and other international organizations, as well as
multilateral and bilateral agencies, nongovernmental organizations, funding agencies, all
health workers and the whole world community to support national and international
commitment to primary health care and to channel increased technical and financial
support to it, particularly in developing countries. The Conference calls on all the
aforementioned to collaborate in introducing, developing and maintaining primary health
care in accordance with the spirit and content of this Declaration.
 GOALS

The Health System We Aspire For

FINANCIAL BETTER HEALTH

PROTECTION
Filipinos, especially the
poor, marginalized, and
vulnerable are
protected from high
cost of health care
OUTCOMES
Filipinos attain the Filipinos feel
best possible health respected, valued, and
outcomes with no empowered in all of
disparity their interaction with
the health system
2

VALUES
During the last 30 years of Health Sector Reform, we have
undertaken key structural reforms and continuously built on
The Health System We Aspire For programs that take us a step closer to our aspiration.

Milestones

~ (l)
EQUITABLE & INCLUSIVE TRANSPARENT &
Devolution Use of Generic~ Milk Code PhilHealth (1995)
TO ALL ACCOUNTABLE
DOH
•
(fe~
0 DOH resources to
promote local
Fiscal autonomy
for government
Good Governance
Programs
Funding
for UHC
USES RESOURCES PROVIDES HIGH health system hospitals (ISO, IMC, PGS)
EFFICIENTLY QUALITY SERVICES development

Persistent Inequities in Health Outcomes Restrictive and Impoverishing Healthcare Costs

Tiisin ko na
••• lang ito ..

2000
Every year, around A Filipino child born to the
2000 mothers die due poorest family is 3 times
to pregnancy-related more likely to not reach his
complications. sth birthday, compared to
one born to the richest
family.
Three out of 10
children are Every year, 1.5 million Filipinos forego or delay Php 4,000/month
stunted· families are pushed to care due to prohibitive healthcare expenses
poverty due to health and unpredictable user considered
care expenditures fees or co-payments catastrophic for single
income families
5 6
 Poor quality and undignified care synonymous
with public clinics and hospitals

ALL FOR HEALTH

TOWARDS
Long wait times
Limited autonomy
to choose provider
Less than hygienic restrooms,
lacking amenities HEALTH FOR ALL
Lahat Para sa Kalusugan!
<) Tungo sa Kalusugan Para sa Lahat
Privacy and confidentiality Poor record-keeping Overcrowding &
taken lightly under-provision of care
7

• UNIVERSAL HEALTH
COVERAGE

• STRENGTHEN
IMPLEMENTATION OF
RPRH LAW

Investing in People • WAR AGAINST ;21,

DRUGS 3 Guarantees ALL LIFE STAGES &
TRIPLE BURDEN OF
DISEASE

• ADDITIONAL
Protection Against FUNDS FROM
Instability PAGCOR

A C H I E V E

Guarantee 1: All Life Stages & Triple Burden of Disease

Pregnant Newborn Infant Child Adolescent Adults Elderly

GUARANTEE #1 - ., - - -
First 1000 days I Reproductive and sexual health I maternal, newborn,
ALL LIFE STAGES & and child health I exclusive breastfeeding I food & micronutrient
TRIPLE BURDEN OF DISEASE supplementation I Immunization I Adolescent health I Geriatric Health
Services for Both the Well & the Sick I Health screening, promotion & information

COMMUNICABLE
• t) DISEASES
Guarantee 1: All Life Stages & Triple Burden of Disease
- -
COMMUNICABLE GUARANTEE #2
•
t) DISEASES
SERVICE DELIVERY NETWORK
Functional Network of Health Facilities
• HIV/Al DS, TB, Malaria • Cancer, Diabetes, Heart • Injuries
• Diseases for Elimination Disease and their Risk • Substance abuse
• Dengue, Lepto, Factors - obesity, • Mental Illness
Ebola, Zika smoking, diet, • Pandemics, Travel Medicine
sedentary lifestyle • Health consequences of
• Malnutrition climate change/ disaster

13

Guarantee 2: Services are delivered

by networks that are

GUARANTEE #3

UNIVERSAL
COMPLIANT WITH HEALTH INSURANCE
CLINICAL PRACTICE Financial Freedom when Accessing Services
GUIDELINES

AVAILABLE 24/7 &

911 EVEN DURING
DISASTERS

Guarantee 3: Services are financed predominantly by PhilHealth Our Strategy

• 100% of Filipinos are members A Advance quality, health promotion and primary care
• Formal sector premium paid through payroll
• Non-formal sector premium paid through tax C Cover all Filipinos against health-related financial risk
subsidy
H Harness the power of strategic HRH development
• No balance billing for the poor/basic
accommodation & Fixed co-payment I Invest in eHealth and data for decision-making
for non-basic accommodation
E Enforce standards, accountability and transparency

• Expand benefits to cover comprehensive Value all clients and patients, especially the poor,
range of services V marginalized, and vulnerable
• Contracting networks of providers within Elicit multi-sectoral and multi-stakeholder support for
SDNs E health .•
II Advance quality, health promotion and primary care
1. Conduct annual health visits for all poor families and
special populations (NHTS, IP, PWD, Senior Citizens)
2. Develop an explicit list of primary care entitlements that
will become the basis for licensing and contracting
arrangements
Transform select DOH hospitals into mega-hospitals with
capabilities for multi-specialty training and teaching and
reference laboratory
4. Support LGUs in advancing pro-health resolutions or
ordinances (e.g. city-wide smoke-free or speed limit
ordinances)
5. Establish expert bodies for health promotion and
surveillance and response
m Harness the power of strategic HRH development
1. Revise health professions curriculum to be more
primary care-oriented and responsive to local and
global needs
2. Streamline HRH compensation package to
incentivize service in high-risk or GIDA areas
3. Update frontline staffing complement standards
from profession-based to competency-based
4. Make available fully-funded scholarships for HRH
hailing from GIDA areas or IP groups
5. Formulate mechanisms for mandatory return of
service schemes for all heath graduates
II Enforce standards, accountability and transparency
l. Publish health information that can
trigger better performance and
accountability
2. Set up dedicated performance
monitoring unit to track
performance or progress of reforms
II Cover all Filipinos against health-related financial risk
1. Raise more revenues for health, e.g. impose health-
promoting taxes, increase NHIP premium rates, improve
premium collection efficiency.
2. Align GSIS, MAP, PCSO, PAGCOR and minimize overlaps with
Phil Health
3. Expand PhilHealth benefits to cover outpatient diagnostics,
medicines, blood and blood products aided by health
technology assessment
4. Update costing of current PhilHealth case rates to ensure that
it covers full cost of care and link payment to service quality
5. Enhance and enforce PhilHealth contracting policies for
better viability and sustainability
II Invest in eHealth and data for decision-making
1. Mandate the use of electronic medical records in all health
facilities
2. Make online submission of clinical, drug dispensing,
administrative and financial records a prerequisite for
registration, licensing and contracting
3. Commission nationwide surveys, streamline information
systems, and support efforts to improve local civil
registration and vital statistics
4. Automate major business processes and invest in ware-
housing and business intelligence tools
5. Facilitate ease of access of researchers to available data
V
Value all clients and patients, especially the poor,
marginalized, and vulnerable
1. Prioritize the poorest 20 million Filipinos in all health
programs and support them in non-direct health
expenditures
2. Make all health entitlements simple, explicit and
widely published to facilitate understanding, &
generate demand
3. Set up participation and redress mechanisms
4. Reduce turnaround time and improve transparency
of processes at all DOH health facilities
5. Eliminate queuing, guarantee decent
accommodation and clean restrooms in all
government hospitals
II Elicit multi-sectoral and multi-stakeholder support for health
ATTAIN HEALTH-
RELATED SDGs

1. Harness and align the private sector in planning

supply side investments
2.

3.
Work with other national government agencies to
address social determinants of health
Make health impact assessment and public health
.. ALL LIFE STAGES &
TRIPLE BURDEN OF
DISEASE

management plan a prerequisite for initiating

large-scale, high-risk infrastructure projects ACHIEVE
4. Collaborate with CSOs and other stakeholders on
budget development, monitoring and evaluation

Public Health - Definition

World Health Organization (WHO)
"Public Health is defined as the art
and science of preventing disease~ c,)_ _ _ _
Differentiation of Public prolonging life and promoting
health through the organized
efforts of society"
Health from Clinical Health

PHARMACY DEPARTMENT
SAN PEDRO COLLEGE

Clinical Health - Definition Public vs Clinical Health

USLegal Inc. Public Health Clinical Health

"Clinical health service means a

Primary focus on populations Primary focus on individual
single diagnostic~ therapeutic~
rehabilitative~ preventive or
palliative procedure or a series of Public service ethic: Personal service ethic:
As an extension of concerns for the individual In the context of social responsibilities
such procedures that may be
separately identified for billing and
Emphasis on disease prevention and health promotion Emphasis on disease diagnosis, treatment, and care
accounting purposes." for the whole community for the individual patient

PHARMACY DEPARTMENT PHARMACY DEPARTMENT

SAN PEDRO COLLEGE SAN PEDRO COLLEGE
Public vs Clinical Health Public vs Clinical Health
Public Health Clinical Health Public Health Clinical Health

Lines of specialization organized
• analytical method (epidemiology, toxicology)
• setting and population (occupational health,
global health)
• substantive health problem (environmental
health, nutrition)
Lines of specialization organized
• organ system (cardiology, neurology)
• patient group (obstetrics, pediatrics)
• etiology and pathophysiology (infectious
disease, oncology)
• technical skill (radiology, surgery)
Population sciences and quantitative disciplines Numerical sciences increasing in prominence, though
essential features of analysis and training still a relatively minor part of training
Social and public policy disciplines an integral part of Social sciences tend to be an elective part of medical
public health education education

Public health paradigm employs a spectrum of

Life sciences central, with a prime focus on major
threats to the health of populations; research moves
between laboratory and field
Biological sciences central, stimulated by needs of Medical paradigm places predominant emphasis on
interventions aimed at the environment, human
patients; research moves between laboratory and medical care
behavior and lifestyle, and medical care
bedside

PHARMACY DEPARTMENT PHARMACY DEPARTMENT

SAN PEDRO COLLEGE SAN PEDRO COLLEGE

Department of Health (DOH) Programs Department of Health (DOH) Programs

Public Health Clinical Health
• Adolescent Health and Development Program • Emergency Services • Ophthalmology

• Blood Donation Program • Anesthesia • Orthopedics

• Dental • Pathology
• Barangay Nutrition Scholar (BNS) Program
• Dermatology • Pediatrics
• Child Health and Development Strategic Plan Year 2001-2004
• Family Medicine • Radiology
• Dengue Prevention and Control Program • Internal Medicine • Surgery
• Emerging and Re-emerging Infectious Disease Program • Obstetrics and Gynecology • Urology
• ENT-HNS

PHARMACY DEPARTMENT PHARMACY DEPARTMENT

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