LECTURE # 1

CONCEPTS OF
HEALTH, PUBLIC
HEALTH AND
PRIMARY HEALTH
CARE
DR. SHOMIK MARUF
 OBJECTIVES OF THE LECTURE

• By the end of this lecture, you will be able to:

• Conceptualize
• Health & its Dimensions
• Determinants of health with importance

• Public health
• Objectives of Public Health.
• Health care & Primary health care.
• Elements and importance of Primary Health care.
 CONCEPT OF HEALTH

• People define health from their own POV.

What’s yours???
 CONCEPT OF HEALTH

• According to WHO(1948)“ Health is a state of complete

physical, mental and social wellbeing and not merely an
absence of disease or infirmity”

• The ability to lead a socially and economically Productive

life.
 CONCEPT OF HEALTH

• Biomedical Concept
• Ecological Concept
• Psychosocial Concept
• Holistic Concept
 Health is multidimensional, e.g.
• Physical Dimension

DIMENSIONS • Mental dimension

OF HEALTH • Social Dimension
• Spiritual Dimension
• Emotional Dimension etc.
 PHYSICAL DIMENSION

Physical Dimension: perfect functioning of the body

A physically healthy person may be conceived as one---
(a) who has a normal anatomical profile.
(b) who has a normal physiological profile
(c) who has a normal biochemical profile
(d) who possesses a normal nutritional profile
PHYSICAL DIMENSION

Normal anatomical profile:

(a) Skin, mucous membrane, eyes,
nose, ears, hair, teeth, gums,
complexion, trunk, extremities, frame
and posture etc. are all normal.
(b) Whose body organs are normal in
size, shape and structure.
 • Normal Physiological Profile:
• (a) Vital parameters-(e.g., pulse,
respiration, BP & temperature) are
normal

PHYSICAL • (b) Sleep, appetite, energy output,

work efficiency & bowel movement
DIMENSION
• © Sensation like touch, taste, hearing
are normal
• (d) Processes like respiration,
excretion, reproduction &
metabolism are normal
 PHYSICAL HEALTH
• Normal biochemical profile:
a. Blood, serum, plasma , CSF, urine, stool are biochemically
normal.
b. Level of nutrients, hormones, enzymes, electrolytes etc.
fall within the normal range.
• Normal nutritional profile:
a. Height, Weight, body circumference at various levels fall
within the normal range by age and sex.
b. Weight for age, Height for age and weight for height
estimation during infancy and childhood have fallen
within expected levels.
 MENTAL DIMENSION
Mental Dimension: a state of balance between the
individual and the surrounding world.

Criteria of a mentally healthy person:

• Is free from internal conflict
• Is well adjusted
• Has a strong sense of self-esteem
• Knows himself/herself, his/her needs, problems and
goals
• Knows his/her strength and weakness
• Has good self-control
• Faces problems and tries to solve them intelligently
OTHER DIMENSIONS OF
HEALTH

Emotional Dimension: it
Social Dimension: relates to feeling, love,
harmony with other thinking, curiosity of
members of society. mind, ability to cope with
life events etc.

Spiritual Dimension:
Searching the inner meaning
of life. For believers it’s
Intellectual Dimension:
connecting to the one who
Critical reasoning and
created the universe. For the
its implementation.
people with different beliefs,
it may be connecting to the
universe itself.
DETERMINANTS OF HEALTH
 DETERMINANTS OF HEALTH

So, what is “Determinants of health” in summary???

The factors that influence health and lie both within

the individual and externally in the society in which
they live are collectively known as determinants of
health.
 Indicators of Health
Indicator type
Mortality Indicator
Morbidity Indicator
Nutritional status indicators
Healthcare delivery indicators
Social and Mental health indicators
Others
*LBW = Low birth weight
**MDGs = Millennium Development Goals
***SDGs = Sustainable Development Goals
Example
Maternal mortality ratio, Under 5 mortality rate
Incidence, prevalence
Height of school children, LBW* prevalence
Doctor-population ratio, doctor-nurse ratio
Suicide rates (proxy)
MDGs** and SDGs***
Public
Health
Definition of Public
Health
THE MISSION OF PUBLIC
HEALTH
“Fulfilling society’s interest
in assuring conditions in
which people can be
healthy.”
—Institute of Medicine

“Public health aims to

provide maximum benefit for
the largest number of
people.”
—World Health Organization
 Public Health Key Terms
• Clinical care: prevention, treatment, and management of illness and
the preservation 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 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 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
 John Snow vs Jon Snow

“H” is the secret of knowledge

Father of Public Health Knows Nothing

History of Public Heath
 Phases of Public Health

Name of Phase Duration What started Efforts Result

Disease control 1880 – 1920 Increased death from
phase
communicable disease,
unhealthy environment
Health Promotion 1921 – 1960 Industrial age, poor
general
phase health of people,
decreased
productivity
Social Engineering 1961 – 1980 Increased burden of non-
phase communicable disease
Health for All phase 1981 - 2000 Inequity in health services
and health status in low-
income and high-income
countries
Sanitary legislation and Death from
reforming communicable disease
decrease
Health programs and Improvement of
initiatives general
(mostly taken by state) health
Identify risk factors, change in Not yet achieved the
social and behavioral aspects targets
Effort to reduce inequality Not yet achieved the
and
achieve health for all targets
through
Primary health care
 Public Health vs Clinical Medicine
Public Health Clinical Medicine
Primary focus Entire populations Individuals
Emphasis Disease prevention, health promotion, Disease/medical diagnosis, medical
policy development for the whole treatment and care for the individual
community patient
Service Public service ethic, as an Personal service ethic, in the context of
extension of concerns for the social responsibilities
individual
Paradigm A spectrum of interventions aimed at the Places predominant emphasis on medical care
environment, human behavior, and
medical care
Process Systems management Patient management
Outcome Healthy communities Healing
Research Applied; moves between laboratory and field Basic; moves between laboratory and bedside

Academics Life sciences central; Biological sciences central; social

social/behavioral sciences and sciences elective
public policy integral
Training Quantitativeessential Numerical (minor component)
THREE CORE FUNCTIONS OF
PUBLIC HEALTH

Systematically collect, analyze,

Assessment and make available information
on healthy communities

Policy Promote the use of a scientific

knowledge base in policy and
Development decision making

Assurance Ensure provision of services to

those in need
Ten Essential
Public Health
Services
 A Public Health Approach

Risk Factor Intervention Implementation

Surveillance
Identification Evaluation
(Finding the (Solving the
(Finding the (Finding the Problem with
Problem)
Cause) Solution) the found
solution)

Problem Response
 • Identification of the problem
(What is the problem) - John
Snow identified the Cholera
John epidemic
Snow • Identification of the cause
and (What is the reason) - John
Public Snow identified the source of
Health infection
approach • Evaluation of intervention
es (What works) - Realized that the
exposure needs to stopped

• Implementation (How to do it) -

He uprooted the tube-well
Partners in the Public Health System

Clinical Care
Community Delivery System

Government Ensuring the Conditions Employers

Public Health for Population and Businesses
Infrastructure
Health

Academia The Media

Institute of Medicine. The future of the public's health in the 21st century. W ashington, DC: The National Academies Press; 2002.
 Regional Variations in Public Health
Problems

Bangladesh
• Respiratory infections & Pneumonia
• Dengue
• Diarrhea and water-borne diseases
• Nutrition deficiency
• Maternal and child health
• Non-communicable disease
• Road safety
• T uberculosis
• Mental Health Issues & S ubstance abuse
problems
• Dengue, Helminths,T yphoid, L eprosy,
Cholera, Kala-azar
USA
• Alcohol-related harms
• Healthcare-associated infections
• Heart disease and stroke
• AIDS
• Obesity
• Prescription drug overdose
• Mental Health Issues
 Public Health
accomplishments
and Workforce

• Safe water and sanitation

• Vaccination
• Improved maternal and child
health
• Family planning
• Infectious disease control
• Safer and healthier foods
• Safer roads and safer
workplace
• Control of tobacco and other
drugs
 Primary Health Care (PHC)

"PHC is a whole-of-society approach to health

that aims at ensuring the highest possible level of
health and well-being and their equitable
distribution by focusing on people’s needs and as
early as possible along the continuum from health
promotion and disease prevention to treatment,
rehabilitation and palliative care, and as close as
feasible to people’s everyday environment." -
WHO
 Primary Health Care (PHC)

• Accessible - Closer to the people, takes care of most common health

problems

• Approach - Preventative measures and encouraging self-care

recommendations

• Primary health care also works as a referral system to higher centers

(Upazila Health Complex)

• Affordable

• Socially acceptable (to ensure community participation)

• Works on Health promotion and behavioral change communication

 There were 8 components/ elements:

1. Education about prevailing health problems

and methods of preventing and controlling
them.
2. Promotion of food supply and proper
ESSENTIAL nutrition.
COMPONENTS 3. An adequate supply of safe water and basic
sanitation.
OF PHC
4. Maternal and childcare, including family
planning.
5. Immunization against infectious diseases
6. Prevention and control of endemic diseases
7. Appropriate treatment of common diseases
and injuries.
8. Provision of essential drugs.
LEVELS OF HEALTH CARE
LEVELS
OF
HEALTH
CARE
Levels of health Care

Primary level of health care:

Village, Union Parishad, Upazila (Sub-district)
Secondary level of health care:
District Hospital
Tertiary level of health care:
Division, Capital city; Medical College Hospitals etc.
Special health care:
Emergency health care, Epidemic, pandemic, refugee camp
etc.
COMMUNITY
CLINICS
UPAZILA
HEALTH
COMPLEXES
MEDICAL COLLEGE HOSPITALS
THANK YOU ALL !!!