Untitled

Phc101
Governmental public health system in us is

A) highly centralized
B) lowest decentralized
C) highly decentralized
D) lowest centralized

Which type of prevention is concerned with eliminating risk factors for a
?disease
A. Clinical prevention
B. Primary prevention
C. Secondary prevention
D. Tertiary prevention

Which was a key secondary prevention in the 20th century
A. Antibiotics
B. Clean water
C. Improved sanitation
D. Vaccines

Which of the critical actors in the public health system constitute the backbone
A. Academia
B. Employers and business
C. Governmental public health agencies
D. Health care delivery syste

Methods used for primary prevention of infectious disease include all of
?the following with the exception of which one
A. Entrance and access barriers
B. Sanitation
C. Surveillance
D. Vaccinatio

?In the Unites States, what is the foremost cause of unintentional injuries
A. Gardening and lawn care
B. Motor vehicle accidents
C. Stairs
D. Workplace

Each of the following with the exception of which one is a division of the U.S. Public Health
Service?
A.Administration for Children and Families
B.Centers for Disease Control and Prevention
C.Food and Drug Administration
D.National Institutes of Health

All of the following with the exception of which one are identified as core
?functions that should be conducted by public health agencies
A. Assessment such as surveillance and epidemiology
B. Assurance that necessary services are provided
C. Education
D. Policy development including goals and resource allocation

Most of the U.S. federal government’s public health activities are based on its power to
tax and spend for the general welfare and what other factor?
A.Control foreign commerce

B.Establish a national set of weights and measures
C.Protect the citizens’ constitutional rights
D.Regulate interstate commerce

Which U.S. agency is responsible for the safety and labeling of the commercial supply of
meat, poultry, and egg products?
A.Centers for Disease Control and Prevention

B.Department of Agriculture
C.Food and Drug Administration
D.National Institutes of Health

Health problems can be divided into two broad types: diseases and what else?
A.Disabilities
B.Genetic predisposition
C.Injuries
D.Psychological impairments

Communicable disease is used interchangeably with what terms?

A.Autoimmune conditions
B.Chronic disease
C.Infectious disease
D.Noninfectious disease

Each of the following with the exception of which one would be classified as an intentional
injury?
A.Child abuse
B.Domestic violence
C.Motor vehicle crash
D.Suicide

PHC 101 Introduction to Public Health
Quiz 1 (2020 – 2021)
1. How many core functions and essential public health services are available in the US
public health services?
a. 2 core functions and 3 essential public health services

b. 3 core functions and 10 essential public health services
c. 3 core functions and 2 essential public health services
d. 10 core functions and 3 essential public health services
2. All of the following are examples of Ten Great Public Health Achievement during the 20th
century, EXCEPT:
a. Recognition of obesity as a health problem

b. Family planning
c. Safer workplace
d. Motor vehicle safety
3. Which of the following may classified as international injuries?
a. Elder abuse
b. Poisoning
c. Burning
d. Drowning
4. Which one of the following agencies is responsible for the safety and labelling of the
commercial supply of meat, poultry and egg products?
a. Centers for disease control and prevention

b. National institute of health
c. Environmental protection
d. U.S. Department of Agriculture
5. Which of the following represents the three levels of Organization of Public Health System
in the United States?
a. Professionals, people and local level

b. Federal, government and individual level
c. Government, community and local level
d. Federal, state and local level
6. Which one of the following constitutes the backbone of the public health system?
a. The governmental public health agencies

b. The academicians
c. Health care delivery system
d. The employers
7. Which of the following terms is defined as ‘a state of complete physical, mental and social
well-being and not merely the absence of disease or infirmity?
a. Preventive medicine
b. Health
c. Medicine
Quiz 1 (2020 – 2021)
d. Public health
8. Which of the following is one of the activities of Food and Drug Administration (FDA)?
a. Detect health problems and disease outbreaks

b. Provide public health leadership and training
c. Research and implement disease-prevention strategies
d. Regulates over the counter and prescription drugs
9. What is the mission of public health?
a. Fulfilling society’s interest in assuring conditions in which people be healthy

b. Assuring health in cities only
c. Enforcing international treaties in global trade and health
d. Protection of safety of some workers at workplaces
10. Which one of the following was a common infectious disease worldwide through the end
of the 19th century?
a. Plague
b. Influenza
c. Chicken pox
d. HIV
11. Which one of the following is an example of infectious disease?
a. Domestic violence
b. Influenza
c. Cardiovascular disease
12. Which was a key secondary prevention in the 20th century?
a. Vaccines
b. Antibiotics
c. Improved sanitation
d. Clean water
13. Which of the following is one of the public sources used for funding public health?
a. Donations
b. Fines by the high policy
c. Taxes
d. University fees
14. What method was use most successfully to address the problem of infectious disease in
industrializing countries during the 1800s?
a. Improvements in personal hygiene, such as hand washing

b. Vaccinations
c. Environmental engineering
d. Control of spreading, such as quarantine
15. What of the below factors is considered important determinants of health?
a. Physical environment
Quiz 1 (2020 – 2021)
b. Availability of resources
c. Technological advances
d. Mode of transportation
16. Which of the following is an important issue that affects the accessibility of the
healthcare services?
a. Health problems
b. Illness progression
c. Public health emphasis on prevention
d. Cultural competence
17. Which of the following is a known epidemiological, surveillance and disease-prevention

agency in the United States that has a national and international influence?
a. Substance abuse and mental health Services Administration (SAMHSA)

b. Agency for Toxic Substances and Disease Registry (ATSDR)
c. Centers for Medicare & Medicaid Services (CMS)
d. Centers for Disease Control and Prevention (CDC)
18. Which of the following represents one of the ten essential public health services?
a. Give more initiatives to rise up the level of performance

b. Improving hospital equipment, staffing and resource management
c. Set and impose fees for services
d. Monitor health status to identify community health problems
19. What do we mean by primary prevention?
a. Giving antibiotics
b. Efforts to minimize exacerbation of disease
c. Treatment of disease and injuries
d. All efforts that prevent disease and injury from occurring
20. Which one of the following is an example of infectious disease?
a. Cardiovascular disease
b. Domestic violence
c. Cancer
d. Influenza
21. Which of the following is one of primary prevention method to control the infectious
diseases?
a. Vaccinations
b. Antibiotics
c. Surveillance
d. Antimicrobial drugs
PHC 101
Quiz 2
Introduction to Public Health
1. What is the CDC’s (Centers for disease control and prevention) lead division for injury
prevention?
a. A national Center for Environmental Health (NCEF)
b. National Center for Food and Drugs (NCFD)
c. National Center for Injury Prevention and Control (NCIPC)
d. National Institute for Occupational Safety and Health (NIOSH)
2. Which of the following is NOT one of the Methods used for primary prevention of
infectious disease?
a. Vaccination
b. Surveillance
c. Sanitation
d. Entrance and access barriers
3. Which of the following health problem is responsible for a major portion of all
disabilities of
a. Influenza and pneumonia
b. Poisoning
c. Motor vehicle injuries
d. Cardiac arrest
4. Which of the following is NOT considered an important role in which the WHO controls
the infectious
a. Surveillance and monitoring
b. Developing drug therapies
c. Coordination of response to outbreaks
d. Reporting
5. Which one is an example of an important infectious disease today?
a. Seasonal influenza
b. Rubelia
c. Measles
d. Hepatitis A
6. Which one of the following is a risk factor for childhood obesity?
a. Increases physical activity
b. Parental behavior
c. Food preservatives
d. Walking to school
7. Which of the following pathogens creates the highest percentage of foodborne illness in
the United States?
a. Vectors
b. Parasites
c. Bacterial pathogens
d. Chemical agents
8. Which of the following increases herd immunity?
a. Highly quarantined community
PHC 101
Quiz 2
b. Vaccinated community
c. Nonvaccinated community
d. High populated community
9. Which one of the following refers to many different types of influenza viruses that
primarily affect birds and may affect other species, including humans?
a. Seasonal flu
b. Avian flu
c. COVID-19
d. Measles
10. In the United States, what is the foremost cause of unintentional injuries?
a. Motor accidents
b. Gardening and lawn care
c. Workplace
d. Stairs
11. Which of the following gives you the role of vaccines in controlling infectious diseases?
a. Reducing chronic diseases
b. To use the money taxes for healthcare
c. Increasing the availability of clinics
d. Reducing morbidity prevalence
12. Which of the following is the main goal of Nutrition, Physical Activity, and Obesity
Program (NPAO)?
a. Prevent and control obesity problems through healthy diet and physical activity
b. Decrease television viewing
c. Increase breastfeeding initiatives
d. Decrease consumption of sugar-sweetened beverages
13. Which of the following is an example of injuries?
a. Obesity
b. Suicide
c. Malaria
d. Diabetes
14. Which of the following health problems is responsible for a major portion of all
disabilities of person 18 to 64 years old?
a. Influenza and pneumonia
b. Poisoning
c. Cardiac arrest
d. Motor vehicle injuries
15. What term is defined as a disease outbreak that occurs over a wide geographic area and
affects a very high proportion of the population?
a. Contagion
b. Epidemic
c. Pandemic
d. Endemic
PHC 101
Quiz 2
16. Which of the following is a basic approach of the federal public health system toward
infectious disease control?
a. Medical examination
b. Changing the viral genetic information
c. Physical examination
d. Sanitation
17. Which one of the following six areas of childhood obesity, Robert Wood Johnson
Foundation addressed through prevention strategies?
a. Physical activity at school
b. Avoiding the stress
c. Decrease television viewing
d. Eating affordable food only
18. Which of the following is the principal primary prevention intervention focusing on the
child passenger safety initiative?
a. Education on the use of car safety booster seats and seat belts
b. Medical screening to identify children with post-traumatic stress
c. Education on reducing the use of seat belts
d. A drinking driver and increasing impaired driving
19. Which of the following is a major category of public health practice related to non-
infectious diseases and injury?
a. Disease and condition
b. Surveillance and research
c. Evidence based interventions
d. Public health system performance
20. What was the main focus of the Core Violence and Injury Prevention Program (Core
VIPP)?
a. Control and prevent street violence
b. Control eating disorders
c. Reduction of motor vehicle injuries
d. Prevent chronic diseases
21. The threat of an infectious disease depends upon which of the following?
a. Virulence of the Organism
b. All of the above
c. Number of people exposed
d. Availability of treatment
PHC101 QUIZ3
Which of the following is a characteristic of management leader?
A. a. can perform technical fixes with little to no risk

B. b. Tolerate hostility
C. c. Excellent judgement
D. d. Accepts casualties
Which of the following is not a group of the community?
A. Rural villages and towns

B. People with similar genes
C. Worksites
D. Schools
Which of the following is a level of message identification?
A. Compromising strategically with opponents in such of "craving in"

B. No interest in behavior change or becoming a messenger to others
C. Not able to be a messenger only
D. Interest in changing a behavior only
Which one of the following is a major approach to changing risky behaviors in a community?
A. Population based interventions

B. Efforts of a single person
C. Improvement in knowledge and attitude
D. Low morale by employees
which of the following are attributes for adaptive/extreme leader?
A. Able to manage fear

B. Strong logical responses
C. Collaboration to merge public health with primary care
D. Overcome the "know how"
PHC101 QUIZ3
Which of the following responses is responsible to cause significant losses with the association of changes
in culture, beliefs, and values?
a. Cultural response
b. Technical response
c. C. Adaptive response
d. Management response
Which of the following types of leadership requires changes in deep beliefs and values of an organization?
a. Technical leadership
b. Management leadership
c. Adaptive leadership
d. Cultural leadership
Which one of the following is a key feature of the Johnson & Johnson worksite wellness program?
a. Increased sick days

b. Cost-effective health care delivery
c. Decreased morale
d. Increased absences
Which level in the cultural egg is concerned toward the concepts of self/humans, nature, and super-
nature?
a. Institutions
b. Behaviors
c. Values
d. Worldview or deep beliefs
Which one of the following defines health in some cultures?

A. The absence of a disease
B. social and economical well-being
C. Being physically and mentally ill
D. The harmony with one's self, supernatural, and the environment
PHC101 QUIZ3
one of the following community engagements should be consider when trying influence behavior?
a. Institutions
b. Values and beliefs
c. Behavior change only
d. Educational level
is the degree of integration between primary care and public health that is most likely to lead
a. Mutual awareness
b. Partnership
c. Cooperation
d. Collaboration
Which one of the following is the degree of integration between primary care and public health
that is most likely to lead sustainability?
a. Mutual awareness
b. Partnership
c. Cooperation
d. Collaboration
Which of the following is described as impudence, temerity, and brazenness?

a. Risk and fear
b. Audacity
c. Vision
d. Culture
factors were associated with the largest

percentage of business health care costs?
a. Clinical costs
b. Absenteeism
c. Costs for medications
d. Presenteeism
Which of the following leaders are able to take risks for survival and growth of the organization?
a. Serious leader
b. Strong leader
c. Extreme leader
d. Management leader
PHC101 QUIZ3
a. Population based interventions
b. Low morale by employees
c. Efforts of a single person
Improvement in knowledge and attitude
Which of the following means the ability to see the broader social dimensions to the problems
specific to individuals or communities?
A. Risk and fear
B. Audacity
C. Vision
D. Overview
Which of the following concepts show the meanings of the acronym LEAP?
A. Leadership, Effect, Ability, and Perfectness
B. Love, Effect, Ability, and Proof
C. Love, Edge, Audacity, and Proof
D. Leadership, Edge, Audacity, and Proof
Which of the following are ents for building a healthy community?
A. Economics
B. Tax incentives
C. Effective local coalitions
D. Local statutes
A. Population based interventions

B. Efforts of a single person
C. Low morale by employees
D. Improvement in knowledge and attitude
PHC101 QUIZ3
Which of the following is one of the steps to successful work site wellness programs?
A. Cholesterol reduction
B. Incomplete evaluation
C. Lack of managements support
D. Create a supportive environment
Which one of the following is one of the nine principles of community engagement?
a. Be clear about the purposes of goals of the engagement

B. effort and communities you want to engage Be hesitant and not clear about the
community's culture and economic conditions
C .Try to work individually, because some communities cannot be trusted
Disorganization that will engage community and individuals who are seeking to effect
change
PHC 101 – Quiz 4
1. How are communicable diseases controlled?

a. Immunization and quarantine
b. Vital statistic collection
c. Cholesterol reduction
d. Sanitation and nutrition
2. Which one of the following is a public health core function?
a. Assessment
b. Monitoring health status
c. Research and innovative solutions
d. Diagnose and investigate
3. Which of the following reports have provided a plan for public health in the US?
a. IOM report
b. Public Health Workforce Report
c. Tax incentives
d. Emerson Report
4. Which one of the following deals with encouraging actions by other entities (private and
public)?
a. Assessment
b. Assurance
c. Policy development
d. Diagnose and investigate
5. Which of the following is one of the 7 priorities identified by the National prevention strategy?
a. Elimination of health disparities
b. Clinical and community preventive services
c. Healthy and safe community environment
d. Reproductive and sexual health
6. Which of the following is considered a population indicator of public health success?
a. Implementation and evaluation programs
b. Increase life expectancy
c. Increasing rate of chronic disease
d. Decreasing preventive strategies
7. Which one of the following are the optimal services in 1950s?
a. Sanitation
b. Supervision and regulation
c. Laboratory services
d. Maternal and child health
8. Which of the following is the role of the National Prevention, Health Promotion, and Public
Health Council (NPHPPHC)?
a. Control the vision of all types of organizations
b. Coordinate federal prevention, wellness, and public health activities
c. Provide strong leadership to public health programs
d. Organize local prevention and wellness activities
9. Which of the following does the Affordable Care Act fund?
a. WHO & CDC
b. CDC & NPHPPHC
c. NPHPPHC & PCORI
d. NACHO & PCORI
10. Which Of the following is one of the 4 strategic directions?
a. Empowered people
b. Healthy living
c. Tobacco free living
d. Active living
11. Which of the following are outcome measures of public health performances?
a. Prevention strategies
b. Access to health care
c. Premature death rates
d. Evaluation processes
12. Which of the following are successes in public health in the 20th century?
a. Steady increase in life expectancy and increase in death by chronic diseases
b. Steady decrease in life expectancy and increase in death by infectious diseases
c. Steady increase in life expectancy and decrease in death by infectious diseases
d. Steady decrease in life expectancy and decrease in death by chronic diseases
13. Which one of the following is a toll to help in community health assessments?
a. Public Health Evaluation Tool (PHET)
b. Post IOM report initiatives
c. Mobilizing for Action through Planning and Partnership (MAPP)
d. Local Health Departments (LHD)
14. Which of the following is another name for universal health coverage?
a. Access to health care
b. Quality health care
c. Health care reform
d. Overview of health care
15. Which one of the following are one of the six basic services?
a. Vital statistics
b. Clinical services
c. Disease rates
d. Life expectancy
16. What was public health known for before the 1900?
a. By its efforts
b. By its missions
c. By its deeds
d. By its intents
17. Which of the following concepts allowed shifting the emphasis from the services of public health
to its mission and functions?
a. Affordable Care Act (ACA)
b. Association of Public Health Administration (APHA)
c. Governmental presence at the local level (AGPALL)
d. Local Health Department (LHD)
18. Which of the following is the suggestion of AGPALL?
a. Ensuring the minimum standards in the community
b. Helping local government reaching their goals
c. Leadership and change serves community health
d. Modern public health practices involves more than provision and services
19. What is the cornerstone of public health?
a. Tertiary prevention
b. Program implementation
c. Program evaluation
d. Primary prevention
20. What is the foundation of public health?
a. Prevention strategies
b. Social justice
c. Excellent judgement
d. Population health
PHC101
Q 1: Which of the following was a cause of public response that led to the modern public
health during the industrial revolution?
a. Bad working conditions and disease outbreaks
b. World wars
c. Natural disasters such as volcanoes and floods
d. Welfare
Q 2: Which of the following public health services collect data related to risk factors and
disease incidence, including chronic and infectious diseases, exposures, and access to Care?
a. Immunization Services
b. Environmental Health
c. Surveillance and Epidemiology
d. Maternal and Child Health
Q 3: Which of the following has a mission of fulfilling society's interest in assuring

conditions in which people can be healthy?
a. Health illness
b. Sanitation
c. Non communicable disease
d. Public health
Q 4: Which of the following is a practice example of surveillance and research?
a. Provide services for victims of the health problem, including screening
b. Provide information on incidence, prevalence, and risk factors
c. Change social and/or physical environments to prevent health problems from occurring
d. Educate population at risk and related persons on how to reduce risk of the health problem
Q 5: Which of the following is defined as a state of complete physical, mental, and social
well-being and not merely the absence of disease or infirmity?
a. Health
b. Infectious diseases
c. Health Education
d. Hygiene
Q 6: Which of the following methods are used for the secondary prevention of infectious
disease?
a. Quarantine
b. Drug prescription
c. Vaccination
d. Sanitation
Q 7: Which of the following is one of major goals for Healthy People 2020?
a. Reduce self-inflicted injuries and death
b. Promote healthy lifestyles across all life stages
c. Ensure drug prescriptions
d. Identify disease etiology
Q 8: Which of the following is a preventive measure for childhood obesity?
a. Increase TV viewing
b. Increase physical activity
c. Sedentary lifestyle
d. Mostly eat out
Q 9: Which of the following is considered a global pandemic non-communicable disease?
a. Suicide
b. Severe acute respiratory syndrome (COVID-19)
c. Childhood obesity
d. Influenza
Q 11: How does the World Health Organization (WHO) define life expectancy?
a. Number of years of life that can be expected on average in a given population
b. Average number of years remaining for an individual or a group of people at a given age
c. Age at death for the most long-lived individual
d. Average length of life of all individuals born a given year
Q 12: What are the two broad classifications of health problems?
a. Alcohol and drug abuse
b. Disease and injuries
c. Cancer and diabetes
d. Disabilities and deaths

Q 13: Which of the following is a key measure where report card initiatives provide an
outcome evaluation?
a. Size effect
b. Population health status
c. Health care system successes
d. Identification of new diseases
Q 14: Who among the following is credited for identifying the Broad Street Pump as the
cause of Cholera Outbreak in London 1854?
a. Alexander Snow
b. John Snow
c. Alexander write
d. Edward Jenner
Q 15: Which of the following infectious diseases has many different types of viruses that
primarily affects birds and including humans?
a. Corona virus
b. Avian influenza
c. Seasonal influenza
d. Global influenza pandemics
Q 16: Which of the following federal agencies act as the United States government's
principal agency for protecting the health of all Americans and provide essential human
services, especially for those who are least able to help themselves?
a. Department of Defense
b. Environmental Protection Agency (EPA)
c. Department of Health and Human Services (DHHS)
d. Department of Veterans Affairs (DVA)
Q 17: Which of the following organizations in charge of regulating drugs and most food
products in the United States?
a. Food and Drug Administration (FDA)
b. Centers for Medicare & Medicaid Services (CMS)
c. Substance Abuse and Mental Health Services Administration (SAMHSA)
d. Indian Health Services (IHS)

Q 18: Which type of governmental public health system provided in the United States?
a. Centralized
b. Local
c. Decentralized
d. International
Q 19: Robert Wood Johnson Foundation focused on which of the following area to address
childhood obesity through prevention strategies?
a. Reduce drunk driving
b. Marketing restrictions to children
c. Evaluate past studies
d. Failure to wear seat belts
Q 20: Which of the following aspects constitute the Epidemiological triangle?
a. Agent, host, and atmosphere
b. Chemical, physical, and biological agents
c. Agent, host, and environment
d. Bacteria, viruses, and parasites
Q 21: Which state public health department work independently from other agencies?
a. Mixed-function agencies
b. Basket agencies
c. Umbrella agencies
d. Stand-alone agencies
Q 22: Which of the following organization is responsible for improving and protecting the
community by advancing the performance of health departments?
a. Public Health Accreditation Board
b. National Board of Public Health Examiners
c. American Public Health Association
d. Foundation to Advance Public Health
Q 23: Which of the following projects had begun in the 1800s and resulted in improved
control of infectious diseases and some of the greatest success of public health?
a. Car seatbelts
b. Nano Technology
c. Climate change
d. Environmental engineering
Q 24: What do we mean by primary prevention?
a. Disability
b. Prevent side effects of drugs
c. Minimize consequences of disability
d. Prevent diseases from occurrence
Q 25: Which of the following is one of performance criteria for public health system?
a. Responsibility
b. Power
c. Autonomy
d. Effectiveness
Dr Mohamed ehab 01010520202
Public health
test bank part 2
dr: Mohamed ehab
‫ال يحلل نشرة او تداوله‬

1. 1 Which of the following is a national prevention strategy of the

National Health Promotion and Public Health Council?
a) prevent agent
b) prevent disease
c) prevent death
d) Tobacco free living
2. Understanding and constructing budgets, interpreting financial data,
and correcting an organization’s financial status are the key skills of
which of the following?
a) Assessing workforce competency
b) Conducting research
c) Financial management
d) Information management
3. Which of the following is a basic component of any evaluation
program that refers to the expected results of implementing the
program, service, or policy?
a) Efficiency
b) Outcomes
c) Process
d) Structure
4. Which of the following is not a good way for people to enhance their
leadership skills ?
a) Appropriate training
b) Experiential learning
c) Keeping a dairy to reflect on daily encounters
d) Mentorship opportunities
5. What is the center of the cultural egg?
a) Behaviors
b) Ideology, Cosmology, Worldview
c) Institutions
d) Values
6. What does Human resources of public health infrastructure include?

a) Funding levels and financial management skills

b) The relationships among different system participants and the
mechanism that manage and coordinate collective actions
c) Various data, information, and communication systems
d) Workforce of public health and their knowledge, skills and abilities
7. Through which of the following approaches the external bodies
validate and recognize the public health workforce’s skill levels?
a) Credentialing approaches
b) Education and training approaches
c) Management approaches
d) Ranking approaches
8. What is the major premise of community engagment ?
a) allowing behaviors to dive institutional changes
b) changing underlying beliefs and values that drive risky behaviors in
order to make permanent changes in the risky behaviors
c) Gaining the support of key opinion leaders
d) Identifying those projects that build rather than eliminate deficiencies
9. Which type of public health organization focuses on the profits and
customer satisfaction?
a) community organization
b) private sector organization
c) public sector organization
d) voluntary organization
10. Which of the following is considered as the foundation of public
health according to Krieger & Birn (1998)?
a) Community engagement
b) Provision of tertiary health services
c) Rural health
d) Social justice
11. Which of the following steps to a successful worksite wellness
program is absolutely essential?
a) Collecting data and evaluating it
b) Creating a team

c) creating an operating plan and choose interventions

d) Getting management support
12.What is the definition of CER or Comparative Effectiveness Research?
a) Analysis of the benefits and harms of alternatives methods to prevent,
diagnose, treat, and monitor clinical conditions or to improve the
delivery of care
b) Assessment of the effectiveness of social marketing efforts
c) Estimation of the perceived value from public health initiatives
d) Evaluation of the equity of community public health care initiatives
13.Which of the following is one of Healthy People 2020Public Health
Infrastructure Objectives?
a) Build more hospitals
b) Create unique treatment for emergencies
c) Development of skilled workforce
d) Management and interpretation of budget
14.What is the federal agency that plays the most important role in
responding to public health emergencies and bioterrorist attacks?
a) Centers for disease control and prevention (CDC)
b) Health Resources and Services Administration (HRSA)
c) National Institute of Health (NIH)
d) The Department of Homeland security (DHS)
15.What are the three functions of public health?
a) Assessment, Commitment, Organization
b) Assessment, policy development, assurance
c) Policy development, Implementation, Evaluation
d) Intervention, Assessment, Organization
16.Which of the following is one of the public Health Practice examples of
Interventions to prevent and control the health problem ?
a) Control researches on cause and consequences of Health problem
b) Educate population at risk on how to reduce the risk of the health
problem
c) Evaluate effectiveness of Interventions
d) Provide Data for surveillance and research

17.Which of the following is a criticism of Healthy People Initiative?

a) Lack of data to assess progress
b) Presence of transparency about target –setting methods
c) Risk factors –specific approach
d) Short list of objectives that are easy to manage
18.Epidemiologic investigation is considered as disease detective
activities including which of the following?
a) Examining only environmental sample
b) Initiating disease report
c) Obtaining detailed information on location and types of possible
exposure
d) Providing the definitive identification of causative agent for both
biological chemical
19.Which of the following categories of biologic agents with significant
bioterrorism potential including agent that could be engineered for
mass dissemination in the future because of the availability, and easy
production and dissemination?
a) Category A
b) Category B
c) Category C
d) Category X
20.Which of the following is a true statement about public health in the
20th century?
a) Decrease in life expectancy
b) Increase death from infectious disease
c) Increase death of many chronic diseases
d) Increase in life expectancy
21.What are the main components of public health infrastructure?
a) Epidemiological investigations , priority setting and enforcement
activities
b) Human resources , Health intelligence , informational resources , fiscal
resources

c) Human resources , organizational resources , informational resources ,

fiscal resources
d) Workforce education and training and workforce management
22.Which of the following is not important concept in defining a
community?
a) Geopolitical area
b) People know each other by first name
c) Residents have a sense of shared responsibility of each other
d) Similar socio-economic status
23.Which of the following initiative can be viewed as a process
improvement in public Health System?
a) Accreditation and credentialing
b) Conducting conference and continuous Medical Education
c) Laws and regulations
d) Quality check
24.Which of the following approaches, health professions takes for
credentialing?
a) Accreditation
b) Certification
c) Citation
d) Documentation
25.Which of the following terms describe setting department to achieve
and how to achieve these plans?
a) Mission
b) Priority
c) Strategic plan
d) Vision
26.Which of the following is not a characteristic of extreme leaders?
a) Challenge tradition
b) Energetic and creative
c) Risk factors
d) Tolerant

27.Which of the following public health emergency preparedness and

response action is an example of the dissemination of information on
mail handling practices during the anthrax attacks in late 2001?
a) Epidemiologic investigation
b) Laboratory analysis
c) Risk communication
d) Surveillance
28.Which of the following organization has a role to reduce the use of
infective medical treatments?
a) American Cancer Society
b) Indian Health Service
c) National Center for Health Statistics
d) Patient –Centered Outcomes research Institute
29.What does the Public Health Surveillance activities helps in?
a) To evaluate health –funding sources
b) To gather information regarding general health status of population
c) To gather information regarding resources only
d) To monitor health status and risk factors in population
30.Which of the following is a component of strategic planning process?
a) Community development
b) Community mobilization
c) Raise funds through consumers of the service
d) SWOT analysis
31.What is the type of emergency exercise that is conducted in a
conference room setting with situation presented as verbal or written
problems or questions intended to generate discussion of actions
taken based on the emergency plan and standard operating
procedure?
a) Drill
b) Full scale
c) Functional
d) Tabletop

32.Which of the following is one of Healthy People 2020 Public Health

Infrastructure objectives?
a) Build more hospitals
b) Create unique treatment for emergencies
c) Development of skilled workforce
d) Management and interpretation of budget
33.Which of the following in the broad mission of public health?
a) Assuring healthy living conditions for people
b) Monitor the performance of health professionals
c) Provide funds for health research
d) Utilize advanced technology to improve health
34.What is the federal agency that plays the most important role in
responding to public health emergencies and bioterrorist attacks?
a) Centers for Disease Control and Prevention (CDC)
b) Health Resources and Services Administration (HRSA)
c) National Institutes of Health (NIH)
d) The Department of Homeland Security (DHS)
35.Which of the following is one of the public Health practice examples of
interventions to prevent and control the health problem?
a) Conduct researches on cause and consequences of health problems
b) Educate population at risk on how to reduce the risk of the health
problems
c) Evaluate effectiveness of interventions
d) Provide data for surveillance and research
36.Which of the following is a population – based survey, used for
estimating disease prevalence for major causes of death, measuring
the burden of infectious diseases and assessing risk factors for chronic
diseases?
a) Cohort studies
b) Environmental Surveys
c) National Health Surveys
d) Randomized Clinical Trails (RCT)

37.Epidemiologic investigation is considered as disease detective

activities including which of the following?
a) Examining only environmental sample
b) Initiating disease report
c) Obtaining detailed information on location and types of possible
exposure
d) Providing the definitive identification of causative agent for both
biological chemical
38.Which of the following statements is true about coalitions and
consortia?
a) They are informal partnerships working to achieve individual needs
b) They have less credibility
c) They include representations from all groups affected by a problem
d) They waste limited resources
39.Which of the following is a true statement about public health in the
20th century?
a) Decrease in life expectancy
b) Increase death from infectious disease
c) Increase death of many chronic disease
d) Increase in life expectancy
40.Which of the following is essential in researching for new innovative
solutions to health problems?
a) Continuous education in leadership problem
b) Continuous linkage with institutions of higher learning and research
c) Education and training of healthcare personal
d) Efficient processes for licensure of professional
41.Which of the following is a criticism of healthy people initiative?
a) Lack of data to assess progress
b) Presence of transparency about target –setting methods
c) Risk factors –specific approach
d) Short list of objectives that are easy to manage
42.What the three core functions of public health?
a) Assessment , commitment , organization

b) Assessment , policy development , assurance

c) Policy development , implementation , evaluation
d) Intervention , assessment , organization
43.Which of the following is essential in developing policies that support
community health efforts?
a) Develop primary prevention interventions to reduce infectious diseases
b) Eliminate socioeconomic disparities
c) Increase revenue of health services
d) Leadership development at all levels of public health
44.Which of the following terms can be defined as achieving the greatest
benefits using the minimum resources?
a) Effectiveness
b) Efficiency
c) Equity
d) Equality
45.Why leaders would prefer not to think about causalities?
a) Because it’s always helpful
b) Because it’s always uncomfortable
c) Because it’s easy to implement
d) Because it’s not painful
46.Which one of the following leads to extreme weather events and
increased temperature worldwide?
a) Climate change
b) Declining air quality
c) Environmental degradation from population growth and
industrialization
d) Population growth
47.Which of the following is an emerging global health threat to public’s
health?
a) Food and water shortage
b) Hygiene scarcity
c) Fruit scarcity
d) Poisons

48.Which of the following refers to health disparities?

a) Access to health is unequal
b) Access to health is equal
c) Public resources are available
d) Health policy
49.What would you call the groups of individuals linked together by
common goals and objectives?
a) Leadership
b) Management
c) Organization
d) Population
50.How can the various data, information, communication system, be
classified in the public health infrastructure?
a) Fiscal (financial ) resources
b) Human resources
c) Information resources
d) Organizational resources
51.Which of the following is one of the rules of Epidemiological
investigations and analysis?
a) To eliminate health status of the individual
b) To determine how bacteria or virus cause the disease
c) To determine the economic loss due to disease
d) To determine what is causing the disease
52.Which of the following is considered the cornerstone of public health?
a) Primary prevention
b) Tertiary prevention
c) Secondary prevention
d) Quaternary prevention
53.Which of the following states the most important and fundamental
factor of public sector organization?
a) Customer satisfaction
b) Financial profitability
c) Health and quality of life outcome

d) Human development
54.Which of the following has shifted its role from directing to advising
the public health agencies such as approving regulations, advising
/approving agency budgets, and hiring the agency director?
a) Advisory boards
b) Intergovernmental organization
c) Non- Governmental organization
d) Public health leaders
55.Which of the following is a threatened intentional release of biological
agents for purpose of influencing the conduct of government?
a) Bioterrorism
b) Preparedness
c) Risk communication
d) Surveillance
56.Which of the following is a population indicator of public health
success?
a) Increasing life expectancy
b) Increasing rates of disease
c) Increasing rates of premature death
d) Increasing rates of the preventable health problems
57.Which of the following does not describe the difficult task of the
extreme leader in an adaptive situation?
a) Engage the organization in identifying optimal solutions to reach the
goal
b) Facilitate the organization in owning their adaptive problems
c) Make compromises
d) Minimize the importance of the opposition
58.Which of the following is an essential goal of secondary and tertiary
prevention in public health?
a) Access to healthcare
b) Sanitation
c) Surveillance
d) Vaccination

59.Which of the following is included in risk communication?

a) Communicate the cause of the disease
b) Defective identification of causative agent
c) Effective public education and information
d) Orientation workshops
60.Which of the following is a financial tool that is systematically covering
the objective of organizations into plans for acquiring revenues and
controlling expenditures?
a) Budget
b) Cost –effectiveness analysis
c) Credentialing
d) Cross-sectional study
61.Which of the following is excluded from what an effective adaptive
leader must do?
a) Do not bear personal responsibility
b) Embody the beliefs and values of the organization
c) Practice what is being preached
d) Train by example
62.Which of the following terms describes “access to the conditions that
produce health is unequal?
a) Health disparities
b) Health promotion
c) Public health
d) Socioeconomic status
63.Which of the following factor was associated with the largest
percentage of business health care cost?
a) Absenteeism
b) Clinical costs
c) Costs for medication
d) Presenteeism
64.Which of the following data is encounter –based and used in public
health practice?
a) Aggregated data on a specific health event for a defined population

b) Data collected of individuals recipients of immunizations

c) Data sets that describe common environmental risks to a population
d) National surveys of health status and service utilization
65.Which of the following is a risk factor for motor vehicle injuries by teen
drivers?
a) Being 20 to 25 years old
b) Newly licensed teen
c) Safe driving patterns
d) Teen driving with adult passengers
66.Public health system’s performance is evaluated on “equity”. What
does equity mainly focus on?
a) Achieving the desired benefits of public health practices
b) Alternative practices achievement
c) Benefits achieved by public health practices compare to resources
expended
d) Effectiveness of public health practices in minimizing population health
disparities
67.Which of the following is a component of leadership qualities of the
acronym LEAP, where courage based on heart rather than ego ?
a) Audacity
b) Edge
c) Love
d) Proofs
68.What are the main functions of bio -surveillance and syndromes’
surveillance?
a) Detection of nontraditional early disease indicators such as work
absenteeism
b) Monitoring available response resources
c) Setting standards health safety
d) Training public and private personnel
69.Which of the following is another element of public approaches to
changing risky behaviors, beside community engagement?
a) Tax incentives

b) Local statutes
c) One-on-one counseling
d) Social marketing
70.Which community groups would require that engagement facilitator
be able to work with strong beliefs in the supernatural?
a) Faith –based groups
b) Rural villages and town not larger than 1000 to 1500 people
c) Schools
d) Worksites
71. Which of the following categories of biologic agents with significant
bioterrorism potential including agent that could be engineered for
mass dissemination in the future because of the availability, and easy
production and dissemination?
a) Category A
b) Category B
c) Category C
d) Catego ry X
. Which measure is commonly used the probability of dying between birth

and exactly 1 year of age that The United Nations International Childrenʼs
Emergency Fundʼs (UNICEF) definition?
A. Infant mortality rate (IMR)<
B. Years of potential life lost
C. Life expectancy
D. Quality-adjusted life years
- 3.Which one of the following is considered as the focus of social
marketing:
A. Quick behavioral change<
B. Environmental change
C. Health promotion
D. Continuing the risky behavior
5.Which among the following is a pitfall for worksite wellness:
A. Adequate resources

B. Complete evaluation
C. Increased confidentiality
D. Lack of management support <
6.Which among the following is associated with changes of deep beliefs,
values, habits, or current way of doing things within an organization :
A. Adaptive leadership<
B. Multi tasking
C. Technical leadership
D. Technology
7.Which one of the following term denotes “a bold and blatant disregard
from normal constraints”:
A. Audacity<
B. Disrespect
C. Fear
D. Risk
8.When faced with a number of technical, adaptive and complex mixed
problems with limited time, what is the best course of action for a leader:
A. Delegate the technical problems to competent staff <
B. Eliminate the technical improvements
C. Focus on the technical problems first to get the organization used to change
D. Work on the three problems with the greatest chance of being reduced and/or
eliminated
9.What are the three criteria that used to evaluate the public health
systemʼs performance:
A. Communication, collaboration, & Efficiency.
B. Monitoring, Collaboration & Effectiveness.
C. Effectiveness, Efficiency &Equity<
D. National Institutes of Health
10.What is the main emphasis in Public health
A. Secondary prevention
B. Primary prevention<
C. Tertiary prevention
D. Early detection
11.What is the level of risk usually involved in technical leadership
(Management) :
A- Average risk
B- High risk
C- Low risk
D- Management involves no risk

12.Which of the following attributes is associated with technical leadership

(Management):
A- Involves community engagement
B- Large in scope
C- Required at time of crisis
D- The ‘know howʼ and procedures already in place
13.What type of adjustments is needed when addressing the adaptive fixes:
A- Adjustment at the institutional level
B- Adjustments at the personal level
C- Adjustments in behavioural level
D- Adjustments in the deep beliefs of an organization <
14.What is the main focus of adaptive leaders in terms of their values and
beliefs:
A- Adaptive leaders are more committed to better paying jobs
B- Adaptive leaders are more committed to organizations with no problems
C- Adaptive leaders are more committed to outcomes
D- Adaptive leaders are more committed to personal advancement
15.What is the broad mission of public health:
A. Fulfill societyʼs interest in which the people can be health<
B. Providing health service equality
C. Encourage people to change bad life style
D. Prevent chronic disease
16.Which of the following is one of the promise of public health:
A. Public health serves all people regardless of income, age, race/ethnicity, or
other attribute.<
B. The work of public health is a societal effort only.
C. Public health does guarantee that all people will be healthy.
D. Public health is interested in treating illness
17.Which one of the following organization charged with systematically
investigating the effectiveness, efficiency, and equity of health care treatments:
A. National Prevention, Health Promotion, and Public Health Council
(NPHPPHC)<
B. Patient-Centered Outcomes Research Institute (PCORI)
C. Institute of medicine's
D. National centers for health statistics
18.Which of the following is one of public health roles in emergency
preparedness and response?
A. Develop and prioritize program options and implement an action plan
B. Association for Prevention Teaching and Research
C. Epidemiologic investigation and analysis<
D. Safe transportation

19.methods used for primary prevention of infectious disease include all of

the following with the exception of which one?
A. Entrance and access barriers<
B.Sanitation
C.Surveillance
D.Vaccination
20.All of the following with the exception of which one are identified as
core functions that should be conducted by public health agencies?
A. Assessment such as surveillance and epidemiology
B.Assurance that necessary services are provided
C.Education<
D.Policy development including goals and resources.
21.Which was a key secondary prevention in the 20th century?
A. Antibiotics<
B. Clean water
C. Improved sanitation
D. Vaccines
22.Which type of prevention is concerned with eliminating risks factors for
disease?
A. Clinical prevention
B. Primary prevention <
C. Secondary prevention
D. Tertiary prevention
23.In the US, what is the foremost cause of unintentional injuries?
A. Gardening and lawn care
B. Motor vehicle accidents<
C. Stairs
D. Workplace
24.Health problem ms can be divided into two broad types: disease and?
A. Disabilities
B. Genetic predisposition
C. Injuries <
D. Psychological impairment
25.Public health focuses on ensuring access to effective clinical care
rather than on providing the care. T or F? (T)
26.Each of the following with the exception of which one is a division of the
US Public Health Service?
A. Administration for children and families <
B. Centers for disease control and prevention
C. Food and drug administration
D. National institutes of health

27.What is one of the major criticisms of the health promotion movement?

A. Focusing on social institutions, such as grocery, stores, in affecting good
eating habits B. Minimizing the impact of political decisions
C. Not considering socioeconomic differences
D. Placing accountability for poor health on the individual <
28.Most of the US. Federal governments public health activities are based
on its power to tax and spend for the general welfare and what other
factor?
A. Control foreign commerce
B. Establish a national set of weights and measures
C. Protect the citizens constitutional rights
D. Regulate interstate commerce<
29. A core function of public health is?
a. Cleaning streets
b. Counseling c.
Policy development<
d. Self-selling
30. Decisions after assessment in public health, based on?
a. Accreditations
b. Evidence
c. Recourses and priorities
d. Values<
32. Decisions after assurance in public health, based on?
a. Accreditations
b. Evidence <
d. Values
33. In accreditation there is?
a. Assessment of personal hygiene
b. Improvement of school records
c. Measurement of communication objectives
d. Ongoing development of public health practice standards<
34. Community health assessment is?
a. Brain storming
b. Collaborative process<
c. Individual level
d. Research process
35. Health Improvement Plan?
a. Address issues from the Community Health Assessment<
b. Address issues from the internet
c. Address issues from the news paper

d. Address issues from the researches

36. Agency Strategic Plan guides to?
a. Addressing issues
b. Allocating resources<
c. Supporting patients
d. Training nurses
37. SWOT analysis occurs in?
a. Feedback
b. Monitoring
c. Stage of plan execution
d. Stage of plan of development<
38. What defined as the resources and relationships necessary to carry out
public healthʼs core functions and essential services in the community?
a. Accreditation
b. Feedback
c. Public health infrastructure<
d. SWOT analysis
39. Information Management in Public Health includes?
a. Distributing food
b. Health conferences
c. Publishing articles
d. Surveillance systems<
40. What Fiscal Management in Public Health deals with?
a. Buildings
b. Funds<
c. Media
d. Photos
41. Healthy People 2020 Public Health Infrastructure Objective?
a. Unique aspects of bioterrorism emergencies<
b. Development of new media
c. Control insects
d. Fiscal management
42. Community Resilience is?
a. Community Recovery<
b. Laboratory testing
c. Measures
d. Multiple exercises to test variety of responses Short answers (10 marks)

43. Which one of the following is one of the core function of public health
for modern public health responses during emergencies?
a. Encouraging private healthcare
b. Preventing epidemics
c. Develop research
d. Service inequality
44. Which one of the following determines the cause of the disease,
disease spreading and the potential risk groups?
a. Quantitative data analysis

b. Randomized controled trials
c. Epidemiological investigation
d. Documentary analysis
45. There has been an epidemic in a district in Riyadh with Tuberculosis.

What would you do, as a public health emergency team in order to prevent
further transmission?
a. Seal the building
b. Isolation and qurantine
c. Detoxification of the community
d. Cut off water supply
46. As part of an Incident Management Systems, which one of the following

maximises resource use, consolidates control, reduces communication
load and provides accountability?
a. Modular organization
b. Common terminology
c. Comprehensive resource management system
d. Cultural jamming answer

47. The selection and use of quantitative measures of public health system
capacities, process and outcomes to infrom public health leaders is
referred to as:
a. Public health leadership

b. Performamce measurement
c. Indicators
d. Health inequalities
48. which one of the following provides an in depth assessment of designs,

implementations and quality of interventions?
a. Preliminary reserach
b. Randomized controlled trails

c. Evaluation research
d. Experimental research
49. which one of the following is important while handling information?

a. Financial constrains
b. Health needs
c. confidentiality
50. The data sources that maintain births, deaths and fetal deaths,
marriages, divorces come mainly
which one of the following?
a. National health intervuew survey

b. National ambulatory care
c. vital statistics Answer
d. National medicare
51. The data regarding characterstics of patients and lengths of patient saty is
available from which one of the following?
a. National medicare
b. National hospital discharge survey
c. Vital statistics

62. which one of the following is considered as an exmaple for structural

components inhuman resources managment in public health?
a. Training
b. Supervision
c. Universities
63. Public and private partnerships in public health is an exmaple of which

component?
a. Structural
b. Organizational
c. outcomes
64. which one of the following is considered as a challenge is coaliations in

public health?
a. Building trust
b. facilitate achievement
c. Mutual goals
d. Lack of representation
65 .which one of the followmg is one of the Initial Basic Sic public health
sen ices"
.i Reserach and education
b Maternal and child health
c HIV AIDS
d Randomised controlled trials
d Social marketing
66. Public health prevention strategy infleunces on:

a. Conditions in which people live
b. politics and finances
0. People and economics
d. Reserach and development

67. Which one of the following contributed towards increase in life

expectancy and decrease inchildhood mortality by infectious diseases
during the 20th century?
a. Secondary care
b. improved health care investments
c. vaccinations and immunizations
d. Rehabilitation
68. Community health centers were developed in the USA, mainly to

provide services for?
a. People from high socio economic groups
b. Older people only
c. all people with no resources or advantages
d. Only regsitered wealthy patients who can pay
69. Which one of the following is considered as one of the four strategies
of National Prevention Strategy in the USA?
a. Empowering people
b. Invest in teritary care
c. Improve medical training
d. Financial stability
70. The genration and synthesis of evidence that compares the benefits
and harms of alternative methods to prevent, diagnose and treat and to
improve the delivery of care is known as:
a. Comprehensive reviews
b. comparative effectiveness reserach
c. Empirical research
d. systematic reviews
71. Increasing temperatures can cause:
a. Aggravate mental health disorders

b. decresae the affects of medicine
c. aggravate chronic diseases

72. What is the major goal of public health community engagement

facilitator in targeting the communities?
a. find horzontal communicators

b. Design interventions for welathy people
c. vertical communicators
d. Ignore diversity in community
73. Public health and community development primarily relate to the longer
range goals, that ofien fall into which level of Maslow's hierarchy of needs?
a. Physiological
b. dafcty safcty
c. Self-actualization
d. Estccm
Q1- A Core function of public health is:

a. Cleaning streets
b. Counseling
c. Policy development
d. Self-selling
Q2- Decisions after assessment in public health, based on:

a. Accreditations
b. Evidence
d. Values
Q3- Decisions after policy development in public health, based on:

e. Accreditations
f. Evidence
g. Recourses and priorities
h. Values
Q4- Decisions after assurance in public health, based on:

a. Accreditations
b. Evidence
d. Values
Q5- In accreditation there is:

a. Assessment of personal hygiene

b. Improvement of school records
c. Measurement of communication objectives
d. Ongoing development of public health practice standards
Q6-Community health assessment is:

a. Brain storming
b. Collaborative process
c. Individual level
d. Research process
Q7- Health Improvement Plan:

a. Address issues from the Community Health Assessment
b. Address issues from the internet
c. Address issues from the news paper
d. Address issues from the researches
Q7- Agency Strategic Plan guides to:

a. Addressing issues
b. Allocating resources
c. Supporting patients
d. Training nurses
Q8- SWOT analysis occurs in:

a. Feedback
b. Monitoring
c. Stage of plan execution
d. Stage of plan of development
Q9- What defined as the resources and relationships necessary to carry out
public health’s core functions and essential services in the community
a. Accreditation
b. Feedback
c. Public health infrastructure
d. SWOT analysis
Q10-Information Management in Public Health includes:

a. Distributing food
b. Health conferences
c. Publishing articles
d. Surveillance systems

Q11- What Fiscal Management in Public Health deals with?

a. Buildings
b. Funds
c. Media
d. Photos
Q12- Healthy People 2020 Public Health Infrastructure Objective:

a. Unique aspects of bioterrorism emergencies
b. Development of new media
c. Control insects
d. Fiscal management
Q13-Community Resilience is:

a. Community Recovery
b. Laboratory testing
c. Measures
Q14-Surge Management deals with:

a. Fiscal management
b. Services management
c. Training management
d. Volunteer Management
Q15- what is tabletop.

a. An exercise conducted in conference room
b. An exercise conducted on the site
c. A single exercise limited to one response
d. Multiple exercises to test variety of responses

:Chapter 1
APHA: American public health association*
They meet yearly to express public health priorities for that year, current PH issues and
activities
?(Mission of PH according to IOM (institute of medicine*
To fulfill society’s interest in assuming conditions which people can be healthy

?What does the mission of PH imply*
PH serves all people regardless of their social status .1

Work of PH is a societal efforts and benefits .2
PH doesn’t guarantee all people to be healthy .3
(PH is interested in promoting health (not treating illness .4
Improving health is a benefit to the society as a whole .5
(What are the 3 prevention types (cornerstone of PH*
Primary .1
All efforts of preventing disease and injury •
Eliminates risk factors for a disease •
Secondary .2
treatment of disease and injury that restores health w/o lasting consequences •
focus on early detection and treatment of disease •
Tertiary .3
actions that moderate chronic disease and disability and prevent their exacerbation •
attempt to eliminate or moderate disability associated with advanced diseases •
Definition of health*
State of complete physical, mental and social wellbeing and not merely the absence of
disease or infirmity
What are the determinants of health*
(physical environment (natural and built •
social environment •
genetic inheritance •
Jehan Otaibe / Ch 1 – Ch 6
Ha / Ch 7 – Ch 9
All the best ,
health behavior •
health care •
Relationship among these health determinants*
not independent of each other -

interconnected -
concept ms of ecology provide the framework for understanding how to model their -
interconnection
What is ecology*
Study of the relationships between organisms and their environment

what is an ecological approach*
When the person is viewed as embedded in the environment - both social and physical
And when the person is both influenced by and influences the environment
What are the ecological models & PH practice*
Epidemiological triangle .1
Developed and used to understand infectious disease transmission and provide a model
for preventing transmission and infectious disease outbreaks
Wheel of causation .2
Contains a hub with the host at its center
Surrounding the host is the total environment divided into biological, physical and
social environment
What does the ecological triangle consist of*
(agent* (microbial organism that causes the infectious disease* •

(host* (organism that harbors agent* •
(environment* (factors that facilitate transmission of agent and host* •
Procede-proceed model*
Developed in 1970s
Modified in 1990s
PROCEDE* stands for*
Ha / Ch 7 – Ch 9
All the best ,
Predisposing, Reinforcing, Enabling Constructs in Educational Diagnosis and
Evaluation
PROCEED* stands for*
Policy, Regulatory and Organizational Constructs in Educational and Environmental
Development
Criticism on Health Promotion*
placing locus of accountability on the individual it it is ineffective and unfair -
PROCEDE-PROCEED places more emphasis on the environment -
Chapter 2
Classification of Health Problems
(Diseases* (infectious and non infectious* •
(Injuries* (intentional and non intentional* •
.Know what each means and one example at least
Success of PH: Conclusion of Developments*
:primary prevention through •
sanitary engineering -
vaccines -
:secondary prevention through •
antibiotics -
antimicrobal drugs -
The Great PH achievements (1900-1999)* few examples*
Vaccination •
Safer workplaces •
Control of infectious diseases •
Healthier mothers and babies •
Safer and healthier foods •
Chapter 3
critical actors who are in position to greatly affect health 6*
Communists •
Ha / Ch 7 – Ch 9
All the best ,
Health care delivery systems •
Employers and business •
Media •
Academia •
Government •
Definition of Public Health*
Complex network of individuals and organizations that have the potential to play
critical roles in creating the conditions of health
main goals of health systems in Public Health 3*
improving health of the population •
responding to patients and societal expectations •
ensuring affordable care •
Organization of public health services in US performed at 3 levels*
Federal •
State •
Local •
*essential PH services 10*
I’ll mention 6
Monitor health status .1
Educate people about health issues .2
Evaluate effectiveness and quality of health systems .3
Link people to needed personal health services .4
Investigate health problems and hazards in the community .5
Develop policies and plans .6
(Key functions of CDC (center for disease control and prevention*
monitor and report nations health •
detect health problems •
research and implement disease-prevention strategies •
promote health behavior •
Ha / Ch 7 – Ch 9
All the best ,
provide PH leadership and training •
AHRQ - agency for healthcare research and quality*
Conduct and support health services •
Focus on a set of broad issues relating to clinical services and systems •
Chapter 4
:Primary prevention methods*
surveillance •
vaccination •
sanitation •
quarantine •
Secondary prevention methods*
Develop antimicrobal drugs •
provide access to these drugs •
Two major classes of infectious diseases addressed by public health*
Notifiable Infectious diseases •
Foodborne disease •
Functional areas of WHO*
surveillance and monitoring •
reporting •
coordinating of response to outbreaks •
?Control of foodborne diseases is increasingly difficult, why*
most food is grown on vast farms on industrial scale •
most food is processed on industrial scale •
much food imported from other countries •
little feeds food is grown locally •
*NNDSS*
National notifiable disease surveillance system
*MMWR*
Ha / Ch 7 – Ch 9
All the best ,
Morbidity and mortality weekly report
*FSIS*
(Food safety and inspection service (e.g. PulseNet
Chapter 5
Example of childhood health problem *
Motor Vehicle Injury
Childhood Obesity
Classifications of PH practice*
Surveillance and research
Interventions to prevent and control a health problem
( Prevention policies and practices* ( Motor Vehicle Injuries *
/Primary
; Children
Education parents
Enforcing child safety seat laws
; Teens
Education / Promote safe teen driving
Enforcement of laws related to driving
/Secondary
Providing services for victims of a health problem
; Risk factors of childhood obesity *
Genetic component
Lack of physical activity
Poor eating habits
Sedentary lifestyle
Parental behavior
Principle target areas *
Increase physical activity
Ha / Ch 7 – Ch 9
All the best ,
Increase the consumption of fruits / vegetables
Decrease sugar / candy
Decrease energy dense food
Decrease TV viewing
Chapter 6
Criteria of evaluating PH systems performance*
effectiveness •
efficiency •
equity •
Assessing PH performance at 2 levels*
(micro level (single groups, orgs, etc •
(macro level (countries, regions, states, nations •
Evidence-Based PH*
Development of information using scientific principles which can inform Ph practice so
that it’s effective, efficient and equitable
Basic Components of any evaluation of a program or system*
(structure* (resources available to the PH program* •
(process* (how the PH program was implemented* •
(outcomes* (expected results of implementing the program* •
(Council of Education for PH (CEPH*
Independent agency recognized by the US department of eduction to accredit schools of
PH and certain PH programs offered
Objectives of CEPH*
promote quality of PH education •
assure PH offered have been evaluated and meets standards •
encourage improvements in quality of education for the public •
National Board of PH examiners*
Independent organization
Established in 2005
Ha / Ch 7 – Ch 9
All the best ,
To make certain students and graduates from CRPH-Accredited schools have mastered
the knowledge and skill acquired
PHAB - Public Health Accrediation Board*
It has a goal to improve and protect health of every community
:Few of its Domains
investigate health problems •
inform and educate about PH issues •
enforce PH laws •
develop PH policies and plans •
evaluate processes and programs •
promote strategies for improvement •
Report Card initiative*
Can be viewed as outcomes evaluations of the PH system as a whole
:Collect, organize and present information about the outcomes
population health status •
morbidity •
mortality •
: Chpter 7
: ( Layers of culture ( Culture egg
● Behaviors and artifacts

● Institutions
● Values :
1. Ideology
2. Cosmology
3. Worldview
: Technical vs. Adaptive change
● Technical fix require no change in deep beliefs
Behavior
Institutions
● Adaptive fixes require change in deep beliefs
: Values
1. Ideology
Ha / Ch 7 – Ch 9
All the best ,
2. Cosmology
3. Worldview
: Extreme leadership
● Vision
● Risk and Fear
● Audacity
● Delegation
● Judgment and Compromise
● Casualties
: Chapter 8
: Major approaches to changing risky behaviors 3
Policy
Influencing individuals or families in a clinic like setting
Population based interventions
Communities that meet the definition of community can be divided into five general
: categories, including
Rural villages and towns
Worksites
Schools
Faith – based groups
Other groups
Poor health is bad for worksite wellness and impacts the workplace in several ways,
: including
Clinical care
Pharmaceuticals
Absenteeism
Presenteeism
Seven steps to successful worksite wellness programs have been identified by the
: wellness council of America
Get management support
Create a team
Collect data
Choose interventions
Evaluate
The IOM additionally identified essential principles for successful integration, including
:
Aligned leadership that bridges disciplines
Has the capacity to manage change
Ha / Ch 7 – Ch 9
All the best ,
Sustainability
Building for enduring value and impact
The sharing and collaborative use of data and analysis
: Chapter 9
: Population indicators of public health success include

Increasing life expectancy
Decreasing rates of premature death
Decreasing rates of disease, injury, and disability among the young
Decreasing rates of preventable health problems
Changes which furthers a public health imperative to assure access to health care
: through tow initiatives
. National Prevention , Health Promotion and Public health council
. Patient – Centered Outcomes Research Institute
The ACA aim is to decrease health care in two ways without reducing access to health
: care
NPHPPHC aim to reduce the demand for medical care through primary prevention
PCORI aim to reduce the use of ineffective medical treatments
The developed the national prevention strategy which have 4 strategic directions and 7
: targeted priorities
Strategic ;
Healthy and safe community environments
Clinical and community preventive services
Empowered people
Elimination of health disparities
Priorities ;
Active living
Tobacco – free living
Healthy eating
Mental and emotional well – being
Injury and violence – free living
: Global the threats to the public’s health
Climate change
The health consequences of war
Black swan events
Worldwide water and food shortages
Declining air quality
Ha / Ch 7 – Ch 9
All the best ,
Populations to fight for the conditions they need to ensure health for all , These
: conditions include
Safe workplace
Safe transportation
Access to quality health care
Clean air and drinking water
Sustaining incomes for all
: 2nd book
.. We don’t do sorry All the best
..And that’s whats important for we
Ha / Ch 7 – Ch 9
All the best ,
Which of the following are the core public health functions of assessment?
a. Enforcing laws and regulations that protect health and ensure safety
b. Monitoring health status and investigating health problems iÔ the community
c. DevelDping policies and plans that suppon community health efforts
d. Mobilizing community pannerships to identify and solve health problems
Which of the following is the responsibility of leadership positions?
a. Strengthening the mission of organizations
b. Organizes the vision of the committee
c. lnterpcts with the rnajör stakeholders
d. Ciovernmenting the organizatiDns
What type of prevention indicates the early detection and diagnosis of health problems?
a. Primary prevention
b. Not part of prevention programs
c. Tertiary prevention
d. Secondary preventron
Which of the following leaderships deals with the ‘know how’?
a. Adaptive leadership
b. Cultural leadership
c. Extreme leadership
d. Management leadership
Which of the following public health surveillance tools refer to new approaches ’to°public health
surveillance?
a. Decreasing rates of premature death
b. Later detectiDn of abnormal disease
c. Traditional early disease indicators
d. Bio-surveillänce and syridrom.ie surveillance

Which of the following is a program with a mission to encourage employees to accept responsibility
(ownership) for their health and well-being by providing them and their families with resources and
opportunities that would result in healthier lifestyles?
a. Physical Fitness Program
b. Johnson & Johnson Worksite Wellness Program
c. Parental Care Program
d. Maternal and Child Health Program
What is the role of health impact pyramid as a tool?
d. Describing different types of pubÍic health interveinioris
b. Describing different types of microbes
c. Investigating physical hazards
d. Describing infections diseases
Which one of the following leadership change require changes in the deep-engrained cultural beliefs
and values of the organization?
a. Technical and extreme change
b. Leadership change
c. Management change
,A Adäptive change
Which of the following is considered one of the 10 essential services of public hea’lth?
a. Respond to disaster
b. Monitor health statut
c. Evaluation
d. lmplernentation
Which one of the following is a Core Violence and Injury Prevention Program component?
a. Zone for mixed-use development
b. Begiönal Network Lëadër
c. Body Mass Index
d. Enfance infrastructure supporting walking

Which of the following is a robust tool of public health practice that can be used to create local
health systems that ensure the delivery of the essential public health services?
a. Mobilizing for Action Through Planning and Partnerships (MAPP)
b. Model Standards Framework (MSF)
c. Assessment Protocol for Excellence in Public Health (APEXPH)
d. Planned Approach to Community Health (PATCH)
Which of the following terms indicates the average number of years a person is expected to live full
health?
a. Years of Potential Life Lost (YPLL)
b. Quality-Adjusted Life Years (QALY)
c. Disability-Adjusted Life Years (DALY)
d. He thy Life Ex tancy (HALE)
What is the essential goal of secondary and tertiary prevention?
a. Promote natural environment
b- Access to hath fate
c. Preventing exposure to disease
d. Encourage unsafe behaviors
Which of the following are a major components of public health efforts to prevent infectious disease
outbreak?
a. HANES and FDA
b. CDC and NNDSS
c. CDC and WHO
d. CDC and IDA
What is the cornerstone of public health practice?
a. Funding grants
b. Diagnostic events
c. Treatment strategies
d. Primary prevention
Which one of the following is a tool io influence health-related behavior that works at the outer
behavioral layer of the cultural egg and is particularly useful in one-time behaviors?
a. Community access
b. Community engagement
c. Ecology
d. Social marketing
Which of the following terms is defined as the ability or the power to chief other people?
a. Culture
b. Leadership
c. Management
d. Vision
Which one of the following is a major partnership to develop interventions to prevent and control
childhood obesity?
a. World Health Organization (WHO)
b. Disability-Adjusted Life Years (DALY)
c. Nutrition, Physical Activi y. and Dbesity (NPACi)
d. Centers for Disease Control and Prevention (CDC)
What is the term used to define the unique aspects of bioterrorism emergencies?
a. Maternal mortality rate
b. Neonatal mortality rate
. Threatened óF ifltentiOnal release of bkilogic agents
d. lnfant mortality rate
What are the main classifications of injuries?
a. lnfectious and noninfectious
b. Benign and nonbenign
c. Temporary and persistent
d.international
Which types of skills composed by leadership?
fi. Adaptive and nical leadership skills
b. Adaptive leadership skills
c. Individual experience skills
d. Technical leadership skills
Which among the following is required for the community collaboration as per the nine
principles of community engagement?
a. Less resources
b. Long-term commitment
c. Poor planning
d. Short-term commitment
Which of the following is a practice example of interventons to prevent and control a health
problem?
a. Provide services for vhnims of health @oblem
b. Evaluate effectiveness of interventions
c. Conduct research on causes and consequences of health problem
d. Develop data systems necessary for surveillance and research
Which of the following is a primary federal agency that conducts, support biomedical
research into the causes, treatment, cure and prevention of a broad range of diseases?
a,: National lnstitutes 'if Health (NIH)
b. Indian Health Services (IHS)
c. Administration for Children and Families (ACF)
d. Administration for Community Living (ACL)
What are the emerging global threats t o the public’s health?

a. Climate C)aange
b. Change in public health programs
c. Shortage in public health leaders
d. Prevention strategy changes

Which of the following is one of the four strategic direction that is identified by the National
Prevention Strategy?
a. Elimioiitlnn of health disparitie3
b. Elimination of chronic disease
c. Set a permanent plan
d. Eradication of polio disease
Which of the following mechanisms do humans learn leadership by example?
a. Teaching and imitation
b. Experience and teaching
c. ExperJence, teaching, and imitation
d. Experience and imitation
What is the main role of Laboratory investigation and analysis in public health emergency
preparedness and response?
a. Early detection of abnormal disease pattern
b. Providing tlii defjiiltive identifichtlon Df Cdusative agenis
c. Remediation of environmental hazards
d. Contacting patients
Which of the following diseases belong to quarantine diseases according to the WHO’s International health
regulations?
a. Chronic illness
b. Cholera
c. Salmonellosis
d. Foodborne illness
Which of the following is a program introduced in 1996, to provide more intensive surveillance
of foodborne infections?
a. Food and Drug Administration (FDA)
b. Centers for Disease Control and Prevention (CDC)
c. Health Resources and Service Administration (HRSA)
d. Hazard AnalyN and Critical Ents I Point (HACCP)
Which of the following processes needed for the assurance function of public health?
a. Diagnosis and investigating health problems and hazards in the community
b. Enforcirig taws and regulations that protect healtlLand ensure safety
c. Developing policies and plans that support community health efforts
d. Monitoring health status to identify community health problems
Which one of the following term defined as the ability to*see the broader social dimensions
of what otherwise might be viewed as problems specific to certain individuals or
communities?
a. Values
b. Mission
c. Unique Vision
d. Audacity
In which of the following phases of strategic planning the SWOT Analysis is used?
a. Monitoring and adopting strategic plans
. sn iegic plan developinefit

c. Implementation strategy
d. Strategy tactical plan
Which of the following is one of the basic six services of local public health before 1950?
a. Assessing the adequacy of health services
b. Area wide planning and coordination
c. Operation of health facilities

What are the three core functions of public health?
a. Assessment, policy development, and program development
b. Assessment, program development and
assurance c, Assessment, policy develDpment, and
assurañce
d. Assessment, policy development, and event outcomes
Which is the first step , when we using an evidence-based process?

a. Identify relevant evidence
b. Evaluate the program or policy
c. Develop and prioritize program options and implement an action plan
d. Establish a statement pt the issue
Which of the following is an example of intentional injuries?

a. Children falling
b. B
ums c:
Suicide
d. Drowning
Which one of the following term refers to the situation where employees at work but not
performing
up to their potential due to poor health?
a. Worksite
wellness b,
Absenteeism
c, Presenteeism
d. Community engagement
Which one of the following term described by impudence, temerity, and brazenness?
a. Vision
b. Courage
c. Mission
A Audacity
Which one of the following term refers to the situation where employees absent from work due to
poor health?
a. Worksite wellness
b. Abseiueeism
c. Presenteeism
d. Community engagement
Which of the following is a key step for coalitions and other collaborative organizations?
a. Researching the proper ideas
b. Recruiting the right people
c. Organizing different facilities
d. Analyzing the right events
Which one of the following resources includes the relationships among the different system
participants and the mechanism that manages the collective actions?
a. Physical resources
b. Organizatiotial/resdurces
c. Information resources
d. Human resources
Which of the following does the complementary strategy rely on?
a. Internal bodies to know the health professional programs
b. Partnerships and organizational components for health outcomes
c. Health professions and organizations
d. External bpdiés to recogn0ié si‹ill levels by proféss)oria1 programs
Which of the following leadership problems are often considered crisis?
a. Individuals problems
b. Organizational problems
c. Technical problems
D. Adaptive propleme
Which of the following is an emergency exercise limited to a specific response activity and conducted
to instruct thoroughly through repetition and practice?
a. Full scale
b. Functional
c. Tabletop
d. Drill
Which of the following phases refers to developing a share vision of the ideal future for the
community?
a. Grganizing for success
b. Strategic issues
c. Assessments
d. Visioning
Which of the following helps to guide the efforts of public health agencies?
a. Technical and advisory boards
b. Management or advisory boards
c. Management and local boards
d. Cinverning or advisory hoards
Which one of the following is the common problem with social marketing?
a. Legal thoughts
b. Permanency of change
c. Engaging risky behaviors
d. Maturity in dealing
1. How many decision-making processes?‫مهم جدا‬
‫كم عدد عمليات صنع القرار؟‬

a. Recognize and define the problem or opportunity
b. Identify and analyze alternative course of action
c. Choose preferred course of action
d. Implement the preferred course of action
e. Evaluate results and follow up as necessary.
‫ التعرف على المشكلة أو الفرصة وتحديدها‬.‫ا‬
‫ تحديد وتحليل مسار العمل البديل‬.‫ب‬
‫ اختر مسار العمل المفضل‬.‫ج‬
‫ تنفيذ مسار العمل المفضل‬.‫د‬
‫ تقييم النتائج ومتابعتها عند الضرورة‬.‫ه‬
2. What are the techniques for team creativity?

‫ما هي التقنيات الخاصة بإبداع الفريق؟‬
o Associative play- making up and telling stories

o Cross-pollination
o Analogies and metaphors
‫اللعب النقابي وسرد القصص‬
‫التلقيح التبادلي‬
‫الشبيهات واالستعارات‬
3. What are the types of conflict?
‫ما هي أنواع الصراع؟‬
1- Substantive conflict: involves fundamental disagreement over ends

or goals to be pursued and the means for their accomplishment.
.‫ ينطوي على خالف جوهري حول الغايات أو األهداف التي يجب متابعتها ووسائل تحقيقها‬:‫الصراع الجوهري‬
2- Emotional conflict: involves interpersonal difficulties that arise over

feeling of anger, mistrust, dislike, fear, resentment, and the like
‫ ينطوي على صعوبات شخصية تنشأ بسبب الشعور بالغضب وعدم الثقة والكراهية والخوف‬:‫الصراع العاطفي‬
‫واالستياء وما شابه‬
4. What is the difference between functional conflict and dysfunctional
conflict?
‫ما هو الفرق بين الصراع الوظيفي والصراع المختل؟‬
1- Functional conflict (constructive conflict): results in positive

benefits to the group and it can bring important problems to the surface so
they can be addressed. (Positive conflict)
3- Dysfunctional conflict (destructive conflict): works to the

groups or organization’s disadvantage and it can decrease
performance and job satisfaction. (Negative conflict)
‫ يؤدي إلى فوائد إيجابية للمجموعة ويمكن أن يسبب مشاكل مهمة على السطح‬:)‫الصراع الوظيفي (الصراع البنّاء‬
)‫ (نزاع إيجابي‬.‫حتى يمكن معالجتها‬
‫ ويمكن أن يقلل من األداء‬، ‫ يعمل على الحرمان من المجموعات أو المنظمة‬:)‫الصراع الغير الفعال (صراع مدمر‬
)‫ (الصراع السلبي‬.‫والرضا الوظيفي‬
5. What are the stages of conflict? ً‫مهم جدا‬

‫ما هي مراحل الصراع؟‬
1. Antecedent conditions: set the conditions for conflict

2. Perceived conflict: substantive or emotional difference are sensed
3. Felt conflict: tension creates motivation to act
4. Manifest conflict: addressed by conflict resolution or suppression
‫ تحديد شروط الصراع‬:‫ الشروط السابقة‬.1

‫ الصراع المتصور اإلحساس باالختالف الجوهري أو العاطفي‬.2
‫ التوتر يخلق الدافع للعمل‬:‫ ورأى الصراع‬.3
‫ معالجه يحل النزاعات أو قمعها‬: ‫ الصراع الظاهر‬.4
6. What are indirect conflict management strategies?
‫ما هي استراتيجيات إدارة الصراعات غير المباشرة؟‬
Manages interdependence
Appeals to common goals
Upward referral
Altering scripts and myths
‫إدارة التكافل‬
‫يناشد األهداف المشتركة‬
‫احالة تصاعدية‬
‫تغيير البرامج النصية والخرافات‬
7. What are the direct conflict management strategies?
‫ما هي استراتيجيات إدارة الصراع المباشرة؟‬
Lose-lose strategies
Win-lose strategies
Win-win strategies
‫استراتيجيات خاسرة‬
‫استراتيجيات مربحة للجانبين‬
‫استراتيجيات مربحة‬
8. How we do manage interdependence conflict? ً‫مهم جدا‬

‫كيف ندير الصراع المتبادل؟‬
1- Decoupling: taking action to eliminate or reduce the required contact

between conflicting parties.
.‫ اتخاذ إجراءات إلزالة أو تقليل االتصال المطلوب بين األطراف المتنازعة‬:‫الفصل‬
2- Buffering: is another approach that can be used when the inputs of

one team are the outputs of another.
.‫ هو أسلوب آخر يمكن استخدامه عندما تكون مدخالت فريق واحد هي مخرجات أخرى‬:‫التخزين المؤقت‬
9. How we consider this negotiation is perfect? (Effective negotiation) ً ‫مهمم‬
‫جدا‬
)‫كيف نعتبر هذا التفاوض مثاليا؟ (التفاوض الفعال‬
1- Quality of outcomes: the negation results in a “quality” agreement

that is wise and satisfactory to all sides.
.‫ يؤدي النفي إلى اتفاقية "نوعية" تكون حكيمة ومرضية لجميع األطراف‬:‫جودة النتائج‬
2- Harmony in relationships: the negotiation is “harmonious” and foster

rather than inhibits good interpersonal relations.
.‫ التفاوض هو "متناغم" ويعزز العالقات الجيدة بين األشخاص‬:‫التناغم في العالقات‬
10. What are the approaches to distributive negotiation?

‫ما هي المناهج للتفاوض التوزيعي؟‬
1- Hard distributive negotiation: take place when each part holds out to
get its own way.
.‫ يحدث عندما يبرز كل جزء للحصول على طريقته الخاصة‬:‫التفاوض التوزيعي الصعب‬
2- Soft distributive negotiation: take place when one party or both

parties make concessions just to get things over them.
.‫ يحدث عندما يقوم طرف أو كال الطرفين بتقديم تنازالت فقط للحصول على األشياء‬:‫التفاوض التوزيعي الناعم‬
11. What are the third-party roles in negotiation? ً‫مهم جدا‬

‫ما هي أدوار الطرف الثالث في التفاوض؟‬
1- Arbitration: a neutral third party acts as judge with the power to issue a
decision binding for all parties.
.‫ طرف ثالث محايد يعمل كقاضي مع سلطة إصدار قرار ملزم لجميع األطراف‬:‫التحكيم‬
2- Mediation: a neutral third party to engage the parties in a negotiated

solution through persuasion and rational argument.
.‫ طرف ثالث محايد إلشراك األطراف في حل تفاوضي من خالل اإلقناع والحجة العقالنية‬:‫الوساطة‬
12. What are the types of position power? ً‫ادج مهم‬
‫ما هي أنواع قوة الموقف؟‬
1- Legitimate power: is the formal hierarchical authority that comes with

a position.
2- Reward power; comes from one’s ability to administer positive rewards
and remove or decrease negative rewards.
3- Coercive power: is the use of punishment when others do not comply
with influence attempts.
.‫ هي السلطة الهرمية الرسمية التي تأتي مع الموضع‬:‫القوة الشرعية‬-1
.‫ مكافأة السلطة ؛ يأتي من قدرة الشخص على إدارة المكافآت اإليجابية وإزالة أو تقليل المكافآت السلبية‬- 2
.‫ هي استخدام العقاب عندما ال يمتثل اآلخرون لمحاوالت التأثير‬:‫القوة القسرية‬-3
13. What is the difference between position and personal power?

‫ما هو الفرق بين الموقف والقوة الشخصية؟‬
1- Personal power: resides in the individual, and is generated in

relationships with others.
2- Position power: stems from the formal hierarchy or authority vested in
a particular role.
‫ ويتولد في عالقات مع اآلخرين‬، ‫ يقيم في الفرد‬:‫ السلطة الشخصية‬-1
.‫ تنبع من التسلسل الهرمي الرسمي أو السلطة المخولة لدور معين‬:‫ قوة الموقف‬-2
14. What are the types of personal power?

‫ما هي أنواع القوة الشخصية؟‬
1- Expert Power
2- Referent Power
‫ خبير محترف‬-1
‫السلطة المرجع‬-2
15. What is Leadership as Identity Construction process?
‫ما هي القيادة كعملية بناء الهوية؟‬
It is involves individuals negotiating identities as leaders and followers.

.‫إنه ينطوي على أشخاص يتفاوضون على الهويات كقادة وأتباع‬
o Claiming: refers to actions people take to assert their identity as a leader

or follower.
o Granting: refers to actions people take to bestow an identity of a leader or
follower onto another person.
.‫ يشير إلى اإلجراءات التي يتخذها األشخاص لتأكيد هويتهم كزعيم أو متابع‬:‫ادعاء‬
.‫ يشير إلى اإلجراءات التي يتخذها األشخاص إلضفاء هوية قائد أو متابع على شخص آخر‬:‫منح‬
16.What are the big five traits?
‫ما هي الصفات الخمس الكبرى؟‬
- Extraversion
- conscientiousness
- emotional
- stability
- openness to experience
‫االنبساط‬
‫الضمير الحي‬
‫العاطفية‬
‫االستقرار‬
‫النفتاح على الخبرة‬

17.What are the Contingency Theories?
‫ما هي نظريات الطوارئ؟‬
- The Contingency Model

- Findings from Contingency Theories
- Fiedler’s Leader-Match
- Problems with Contingency Approaches
‫نموذج طوارئ‬
‫ النتائج من نظريات الطوارئ‬-
‫ مباراة فيدلر ليدر ماتش‬-
‫ مشاكل مع نهج الطوارئ‬-
18. What are the leadership styles in Contingency Theories?
‫ما هي أساليب القيادة في نظريات الطوارئ؟‬
Directive leadership: is needed when subordinates want guidance and

direction in their jobs. It helps increases role clarity, self-efficacy, eff ort, and
performance. When the task is clear, directive leadership will have a negative
impact, as it will be seen as overly domineering—a “micromanaging” style—by
subordinates.
‫ فهو يساعد على زيادة‬.‫ هناك حاجة عندما يريد المرؤوسون التوجيه والتوجيه في وظائفهم‬:‫القيادة التوجيهية‬
‫ سيكون للقيادة التوجيهية‬، ‫ عندما تكون المهمة واضحة‬.‫ واألداء‬، ‫ واألداء الفعال‬، ‫ والكفاءة الذاتية‬، ‫وضوح الدور‬
.‫ من قبل المرؤوسين‬- "‫ أسلوب "اإلدارة الجزئية‬- ‫ حيث سيُنظر إليها على أنها مفرطة االستبداد‬، ‫تأثير سلبي‬
Supportive leadership: is needed when subordinates want emotional, not

task, support. Also, it’s beneficial for highly repetitive or unpleasant tasks. It
helps reduce stress by letting employees know the organization cares and will
provide help.
‫ إنه مفيد للمهام‬، ‫ أيضا‬.‫ والدعم‬، ‫ وليس المهمة‬، ‫ هناك حاجة عند المرؤوسين يريدون العاطفية‬:‫القيادة الداعمة‬
‫ فهو يساعد على الحد من التوتر عن طريق السماح للموظفين بمعرفة أن المنظمة‬.‫المتكررة للغاية أو غير السارة‬
.‫تهتم وسوف تقدم المساعدة‬
Achievement-oriented leadership: is needed for challenging tasks or when
subordinates need to take initiative. It helps employees gain confidence and
strive for higher standards. It increases expectations that eff ort will lead to
desired performance.
‫ فهو يساعد‬.‫ هناك حاجة للمهام الصعبة أو عندما يحتاج المرؤوسون إلى المبادرة‬:‫القيادة الموجهة نحو اإلنجاز‬
‫ إنه يزيد من التوقعات بأن األداء سوف يؤدي إلى األداء‬.‫الموظفين على اكتساب الثقة والسعي لتحقيق معايير أعلى‬
.‫المرغوب‬
Participative leadership: is best when subordinates need limited direction and

support. It allows employees to provide input. When tasks are repetitive, non-
authoritarian subordinates appreciate being involved to help break up the
monotony.
‫ يسمح للموظفين بتقديم‬.‫ هي األفضل عندما يحتاج المرؤوسون إلى التوجيه والدعم المحدودين‬:‫القيادة التشاركية‬
‫ يقدّر المرؤوسون غير السلطويين المشاركة في المساعدة على تفتيت‬، ‫ عندما تكون المهام متكررة‬.‫مدخالت‬
.‫الرتابة‬
19. What are the difference between Transformational

leadership and Transactional leadership?
‫ما الفرق بين القيادة التحويلية وقيادة المعامالت؟‬
1- Transformational leadership: involves inspirational relationships in

which both leaders and followers are positively transformed in the
process.
2- Transactional leadership: involves a focus on exchanging valued
goods in return for something leaders want.
.‫ تنطوي على عالقات ملهمة يتحول فيها القادة واألتباع بشكل إيجابي في العملية‬:‫ القيادة التحويلية‬-1
.‫ ينطوي على التركيز على تبادل السلع القيمة مقابل شيء يريده القادة‬:‫ قيادة المعامالت‬-2
20. What are the types of Complexity Leadership Theory?
‫ما هي أنواع نظرية القيادة المعقدة؟‬
1- Administrative leadership: occurs in formal, managerial roles and

focuses on alignment and control aimed at driving business results.
2- Entrepreneurial leadership: fuels innovation, adaptability, and change.
3- Adaptive leadership: operates in the interface between the
administrative and entrepreneurial systems and fosters conditions for
emergence.
‫والمراقبة التي تهدف إلى قيادة نتائج‬- ‫ يحدث في األدوار الرسمية واإلدارية ويركز على المواءمة‬:‫القيادة اإلدارية‬
.‫األعمال‬
.‫ تغذي االبتكار والقدرة على التكيف والتغيير‬:‫قيادة ريادة األعمال‬
.‫ تعمل في التفاعل بين النظم اإلدارية وتنظيم المشاريع وتعزز شروط الظهور‬:‫القيادة التكيفية‬
21. What are the difference between Authoritarian leadership and

empowering leadership?
‫ ما الفرق بين القيادة االستبدادية والقيادة التمكينية؟‬.21
1- Authoritarian (or autocratic) leadership: involves making decisions

independently with little or no input from others.
2- Empowering leadership: enables power sharing with employees by
clarifying the significance of the work, providing autonomy, expressing
confidence in the employee’s capabilities, and removing hindrances to
performance.
‫ تتضمن اتخاذ القرارات بشكل مستقل مع القليل من المدخالت أو عدم‬:)‫ القيادة االستبدادية (أو االستبدادية‬- 1
.‫تقديمها من اآلخرين‬
‫ والتعبير‬، ‫ وتوفير االستقاللية‬، ‫ يتيح تقاسم السلطة مع الموظفين من خالل توضيح أهمية العمل‬:‫ تمكين القيادة‬-2
.‫ وإزالة العوائق التي تحول دون األداء‬، ‫عن الثقة في قدرات الموظف‬
Ethical leaders should be:
:‫يجب أن يكون القادة األخالقيون‬
1. Communicate to followers what is ethical and allow followers to ask

questions and provide feedback regarding ethical issues.
2. set clear ethical standards, and ensure followers comply with those
standards by rewarding ethical conduct and disciplining those who don’t
follow standards
3. Take into account ethical principles in making decisions and ensure that
followers observe and follow this process.
‫التواصل مع المتابعين بما هو أخالقي والسماح للمتابعين بطرح األسئلة وتقديم مالحظات حول القضايا‬-1
.‫األخالقية‬
‫ وضمان التزام المتابعين لتلك المعايير من خالل مكافأة السلوك األخالقي‬، ‫وضع معايير أخالقية واضحة‬-2
‫وتأديب األشخاص الذين ال يتبعون المعايير‬
.‫مراعاة المبادئ األخالقية في اتخاذ القرارات وضمان التزام أتباع هذه العملية ومتابعتها‬-3
Saga: is an embellished heroic account of accomplishments.

.‫ هو عبارة عن حساب بطولي من اإلنجازات‬:‫ساغا‬
Rites: are standardized and recurring activities used at special times to
influence the behaviors and understanding of organizational members.
.‫ هي أنشطة موحدة ومتكررة تستخدم في أوقات خاصة للتأثير على سلوك وفهم أعضاء المنظمة‬:‫الطقوس‬
Rituals: are systems of rites
‫ هي أنظمة الطقوس‬:‫الطقوس‬
Cultural symbol: is any object, act, or event that serves to transmit cultural
meaning.
.‫ هو أي كائن أو فعل أو حدث يعمل على نقل المعنى الثقافي‬:‫الرمز الثقافي‬
22. What are the Process of Innovation?

‫ما هي عملية االبتكار؟‬
a. Idea creation
b. Initial experimentation
c. Feasibility determination
d. Final application
‫خلق الفكرة‬
‫التجريب األولي‬
‫تحديد الجدوى‬
‫التطبيق النهائي‬
23. What are the difference between Product and Process Innovations?
‫ما هو الفرق بين المنتج واالبتكارات العملية؟‬
Product innovations: introduce new goods or services to better meet customer

needs.
Process innovations: introduce into operations new and better ways of doing
things.
‫ تقديم سلع أو خدمات جديدة لتلبية احتياجات العمالء بشكل أفضل‬:‫ابتكارات المنتجات‬
‫ إدخال العمليات أساليب جديدة وأفضل في فعل األشياء‬:‫ابتكارات عملية‬.

Before midterm:
24. What are the building blocks for emotional intelligence?

‫ما هي اللبنات األساسية للذكاء العاطفي؟‬
- Self-awareness :ability to understand your own moods and emotions

- Self-regulation :ability to think before acting and to control bad impulses
- Motivation: ability to work hard and persevere
- Empathy :ability to understand the emotions of others
- Social skill: ability to gain rapport with others and build good
relationships
‫ القدرة على فهم المزاجية والعواطف الخاصة بك‬:‫ الوعي الذاتي‬-
‫ القدرة على التفكير قبل التصرف والتحكم في النبضات السيئة‬:‫ التنظيم الذاتي‬-
‫ القدرة على العمل الجاد والمثابرة‬:‫ الدافع‬-
‫ القدرة على فهم مشاعر اآلخرين‬:‫ التعاطف‬-
‫ القدرة على اكتساب عالقة مع اآلخرين وبناء عالقات جيدة‬:‫ المهارات االجتماعية‬-
25. What are the types of schemas?

‫ما هي أنواع المخططات؟‬
1- A script schema: is a knowledge framework that describes the

appropriate sequence of events in a given situation.
2- A self-schema: contains information about a person’s own appearance,
behavior, and personality.
3- Person schemas: sort people into categories—types or groups, in terms
of similar perceived features.
4- Prototypes: are pre-set bundles of features expected to be characteristic
of people in certain categories or roles
.‫ هو إطار معرفة يصف التسلسل المناسب لألحداث في حالة معينة‬:‫ مخطط سيناريو‬-1
.‫ يحتوي على معلومات حول مظهر الشخص وسلوكه وشخصيته‬:‫ مخطط ذاتي‬-2
.‫ من حيث السمات المتشابهة‬، ‫ أنواع أو مجموعات‬- ‫ تصنيف األفراد إلى فئات‬:‫ مخططات الشخص‬- 3
‫ هي مجموعات محددة مسبقا من الخصائص يتوقع أن تكون مميزة لألشخاص في فئات أو‬:‫ النماذج األولية‬-4
‫أدوار معينة‬
26. What are the Common Perceptual Distortions?
‫ ما هي التشوهات اإلدراكية الشائعة؟‬.26
1- Stereotype: assigns attributes commonly associated with a group to an

individual.
2- Halo effect: uses one attribute to develop an overall impression of a
person or situation.
3- Selective perception: is the tendency to define problems from one’s own
point of view.
4- Projection: assigns personal attributes to other individuals.
5- Contrast effect: occurs when the meaning of something that takes place
is based on a contrast with another recent event or situation.
6- Self-fulfilling prophecy: is creating or finding in a situation that
which you expected to find in the first place.
.‫ يعين سمات ترتبط عادة مع مجموعة لفرد‬:‫ الصورة النمطية‬- 1
.‫ يستخدم خاصية واحدة لتكوين انطباع عام عن الشخص أو الحالة‬:‫ تأثير الهالة‬-2
.‫ هو الميل إلى تحديد المشاكل من وجهة نظر الشخص‬:‫ اإلدراك االنتقائي‬- 3
.‫ يعين سمات شخصية لألفراد اآلخرين‬:‫ اإلسقاط‬-4
.‫ يحدث عندما يستند معنى الشيء الذي يحدث إلى تناقض مع حدث أو وضع حديث آخر‬:‫ تأثير التباين‬-5
.‫ هي خلق أو إيجاد في موقف توقعته في المقام األول‬:‫ نبوة تحقق الذات‬-6

27. What is the Megilino schema?
‫؟‬Megilino ‫ ما هو مخطط‬.27
Achievement :getting things done and working hard to accomplish

difficult things in life
Helping and concern for others: being concerned for other people
and with helping others
Honesty: telling the truth and doing what you feel is right
Fairness: being impartial and doing what is fair for all concerned
‫ إنجاز األمور والعمل بجد إلنجاز األشياء الصعبة في الحياة‬:‫اإلنجاز‬
‫ االهتمام باألشخاص اآلخرين ومساعدة اآلخرين‬:‫المساعدة واالهتمام باآلخرين‬
‫ قول الحقيقة وفعل ما تشعر به هو الصحيح‬:‫الصدق‬
‫ أن تكون محايدا وأن تفعل ما هو عادل لجميع المعنيين‬:‫اإلنصاف‬

28. Major Differences Between Bureaucratic and Complexity Assumptions
Bureaucratic Assumptions Complexity Assumptions
Environments stable, controllable Environments dynamic, uncontrollable
Hierarchical organizing systems using Self-organizing systems with no

centralized control centralized control
Coordination from hierarchy, formal
rules, Coordination from interactions within
Regulations system, simple rules
Change is linear, predictable Change is nonlinear, unpredictable
Value = adaptability and

Value = efficiency and reliability responsiveness
Direction set by a few leaders Direction set by participation of many
Leaders are experts, authorities Leaders are facilitators, supporters
‫ االختالفات الرئيسية بين االفتراضات البيروقراطية والتعقيدات؟‬.28
‫االفتراضات البيروقراطية‬ ‫افتراضات التعقيد‬

‫ يمكن السيطرة عليها‬، ‫البيئات مستقرة‬ ‫ ال يمكن السيطرة عليها‬، ‫البيئات ديناميكية‬
‫نظام التنظيم الهرمي باستخدام تحكم مركزي‬

‫نظام التنظيم الذاتي مع عدم وجود تحكم مركزي‬
‫ والقواعد الرسمية‬، ‫التنسيق من التسلسل الهرمي‬ ‫التنسيق من التفاعالت داخل‬
‫والقوانين‬، ‫ وقواعد بسيطة‬، ‫النظام‬
‫التغيير خطي ويمكن التنبؤ به‬ ‫ ال يمكن التنبؤ به‬، ‫التغيير غير خطي‬
‫القيمة = الكفاءة والموثوقية‬ ‫القيمة = القدرة على التكيف واالستجابة‬
‫االتجاه الذي حدده عدد قليل من القادة‬ ‫االتجاه الذي حدده مشاركة العديد‬
‫القادة هم الخبراء والسلطات‬ ‫ الداعمين‬، ‫القادة هم الميسرين‬

RAWAN AL-FAIFI
CH7: Public Health Leadership
Leadership: Organizing people around a common goal.
Leadership is composed of both:
1-technical(Management) 2- adaptive leadership skills(Extreme Leadership)
• Technical/Management Leadership
o “Know how” and procedures already in place
o Obvious solutions.
o Organization continues functioning as normal, with exception to possible
management changes
o Little risk
o Relatively comfortable
▪ it doesn’t require cultural beliefs
o Technical problems tend to be problems of individuals or small groups versus
the organization as a whole
• Adaptive/Extreme Leadership
o Adaptive problems is Large in scope ‫مشاكل التكيف كبيرة في النطاق‬
o Crisis
▪ Acute or chronic
o Solution determined through experimentation, new discoveries, multiple
adjustments
o Involves employees or whole organization to give up a belief, value, habit, or
current way of life or doing things
o People often resistant to the change from adaptive leadership
o Adaptive leaders are passionate, energetic, creative, unafraid to challenge
traditions, and risk takers
o Realm of community engagement
Leadership and Culture Layers of Culture (Cultural egg):
Ideology Cosmology
Values Institutions Behaviors
Worldview
Technical vs. Adaptive Change
Institutions and Behaviors:- Technical fixes require no change in deep beliefs
Ideology Cosmology Worldview and Values:- Adaptive fixes require change in deep beliefs
Extreme leadership :
1. Vision
2. Risk and Fear
3. Audacity
4. Delegation
5. Judgment and Compromise
6. Casualties
Ch.8 Building Healthy Communities

In order to build healthy communities, there are three major approaches to changing risky behaviors:
1. Policy
2. Influencing individuals or families in a clinic-like setting
3. Population- based interventions
Changing Health/Risky Behaviors:
1. Policy: Statute and Rule - Government and Business Organizations

2. Individuals: One on One - Clinics & Clinicians
3. Population Groups: Social Marketing AND Community Engagement- Public Health
Community Engagement Definition:
A major role of active, engaged communities throughout history has been to support and encourage the
health and well-being of community members.
Communities that meet the definition of community can be divided into five general categories,
including:
1. Rural villages and towns

2. Worksites
3. Schools (represent multiple subcommunities)
4. Faith-based groups
5. Other groups
Community Engagement and Maslow’s Hierarchy of Needs:
Physiological Safety-Security Love-Belonging Esteem Self-Actualization
Deficiency needs are generally more temporal in nature, focusing on the now, while growth needs relate
to longer-term goals and strategies .
Public health and community development primarily relate to longer-range goals, therefore falling into
the area of self-actualization.
Community deficiency needs must be met to a significant degree to release community energy for self-
actualization to facilitate community engagement for longer-range goals.
Community Engagement and Social Marketing:
• Behaviors and Institutions:→ Social Marketing: “I don’t care what a person thinks, feels or Believes,
I just want a change in the target Behavior.”
• Ideology Cosmology Worldview and Values:→ Community Engagement: “Changes in the beliefs,
feelings and thinking of individuals are essential for permanent changes of high risk behaviors”
9 Principles of Community Engagement (to beginning the engagement process):
1. Be clear about the purposes or goals of the engagement effort.

2. Become knowledgeable about the community’s culture, economic conditions, social networks,
3. Go to the community, establish relationships, build trust, work with the formal and informal leadership.
4. Remember and accept that collective self-determination is the responsibility and right of all people in a
community.
5. Partnering with the community is necessary to create change and improve health.
6. All aspects of community engagement must be recognized and respect the diversity of the community.
7. Community engagement can only be sustained by identifying and mobilizing community assets and strengths
8. Organizations that wish to engage a community as well as individuals seeking to effect change must be
prepared to release control of actions
9. Community collaboration requires long-term commitment by the engaging organization and its partners.
Comprehensive worksite wellness:
provides an excellent opportunity for the integration of public health and primary care.
Poor health is bad for worksite wellness and impacts the workplace in several ways, including:
1. Clinical care: outpatient clinics and hospital costs

2. Pharmaceuticals: medications
3. Absenteeism: employees absent from work due to poor health
4. Presenteeism: employees at work but not performing up to their potential due to poor health
Seven Steps to Successful Worksite Wellness Programs:
Seven steps to successful worksite wellness programs have been identified by the Wellness Council of
America (WCOA), and 7 Steps (GCCCCCE) include:
1. Get management support

2. Create a team
3. Collect data
4. Create an operating plan
5. Choose interventions
6. Create a supportive environment
7. Evaluate
An effective comprehensive worksite wellness program will be optimally effective if it strategically

combines population-based interventions.
Wellness behavior change using social marketing and community engagement techniques, along with
appropriate clinical interventions (chronic disease management, case management, call-a-nurse, and
onsite clinical services).
Degree of primary care and public health integration:
Isolation Mutual Awareness Cooperation Collaboration Partnership Merger
The IOM additionally identified essential principles for successful integration, including:
1. A shared goal of population health improvement

2. Community engagement in defining and addressing population health needs.
3. Aligned leadership that bridges disciplines, programs, and jurisdictions to reduce fragmentation and
foster continuity
4. Clarifies roles and ensures accountability, develops and supports appropriate incentives
5. Has the capacity to manage change
6. Sustainability, the key to which is the establishment of a shared infrastructure
7. Building for enduring value and impact
8. The sharing and collaborative use of data and analysis
Ch.9 Public Health: Promise and Prospects

✓ The promise of public health is the assurance that the context in which people live their lives will
promote health
✓ Public health as a field aspires to provide people with the opportunity to be healthy by ensuring
that their environments advance health.
✓ The cornerstone of public health is prevention, particularly primary prevention.
Social justice is the foundation of public health.
✓ The commitment to social justice defines the “public health sensibility”

✓ Public health assumes that all people are deserving of conditions that promote health.
Population indicators of public health success include:
1. Increasing life expectancy

2. Decreasing rates of premature death
3. Decreasing rates of disease, injury, and disability among the young
4. Decreasing rates of preventable health problems
What Are the Barriers to Public Health’s Success?
1. Changing the environment to change behavior is less consistent with the value of individual
accountability than attempting to hold the individual accountable for his or her own behavior or
situation Example: changing environment to encourage weight loss.
2. The development of the public health system as a predominantly government endeavor goes
against a strong conservative segment of the population that prefers the private over the public
sector in all societal activities. Conflict, compromise, and the weakening of public health initiatives
have resulted when private interests and the public good are not aligned
How Will Health Care Reform Affect the Future of Public Health?
• Access to health care is an essential goal of secondary and tertiary prevention
• Until recently, the United States was the only industrialized nation that did not guarantee at least a
basic level of health care for citizens
• 2010 Patient Protection and Affordable Care Act (ACA) changes which furthers a public health
imperative to assure access to health care through two initiatives:
o National Prevention, Health Promotion, and Public Health Council (NPHPPHC)
o Patient-Centered Outcomes Research Institute (PCORI)
• The ACA aim is to decrease health care costs in two ways without reducing access to health care or
decreasing health care quality:
o NPHPPHC aim to reduce the demand for medical care through primary prevention
o PCORI aim to reduce the use of ineffective medical treatments
National Prevention, Health Promotion, and Public Health Council (NPHPPHC):
• An organization charged with coordinating public health activities among all levels of government
with funds from the newly created Prevention and Public Health Fund.
• It developed the National Prevention Strategy which have four strategic directions and seven
targeted priorities.
7 Priorities of (NPHPPHC): 4 Strategic Directions of (NPHPPHC):
1. Tobacco-Free Living 1. Healthy and Safe Community

2. Preventing Drub Abuse and Excessive Alcohol Use Environments
3. Healthy Eating 2. Clinical and Community
4. Active Living Preventive Services
5. Injury- and Violence-Free Living 3. Empowered People
6. Reproductive and Sexual Health 4. Elimination of Health Disparities
7. Mental and Emotional Well-Being
Patient-Centered Outcomes Research Institute (PCORI):
• An organization changed with systematically investigating the effectiveness, efficiency, and equity
of health care treatments.
• PCORI funding distributed from the Patient-Centered Outcomes Research Trust Fund.
What Are the Emerging Global Threats to the Public’s Health?
1. Infectious disease pandemics

2. Worldwide water and food shortages
3. Climate change
4. Declining air quality
5. Environmental degradation from population growth and industrialization
6. The health consequences of war
7. Black Swan events: high impact with low probability of occurrence
Challenges for Public Health in the United States:
Public health professionals must develop organizing capabilities to mobilize communities, regions, and
populations to fight for the conditions they need to ensure health for all.
These Conditions include:
1. Adequate and safe housing

2. Safe workplaces
3. Nutritious and toxin-free food
4. Clean air and drinking water
5. Safe transportation
6. Opportunities for exercise and recreation
7. Access to quality health care
8. Sustaining incomes for all
9. Education that prepares all adults for meaningful participation in the economy
(Week12)Ch.5 Core Functions and Public Health Practices
Public health functions and practice before 1990:
• Public health was known more by its deeds than its intent, so measuring public health practices
focused primarily on measuring aspects of important public health services.
• Emerson report gave increased prominence to six basic services, these services had become widely
known as “ Basic Six” which stared before 1950 to 1970
Initial "Basic Six "Optimal" Services in 1950s:
1. Basic Six as minimal level

1. Vital statistics
2. Analysis and recording of health
2. Sanitation
data
3. Communicable disease control
3. Health education and information
4. Maternal and child health 4. Supervision and regulation
5. Health education 5. Provision of direct environmental
6. Laboratory services health services
6. Administration of personal health
Added in 1960s
services
1. Operation of health facilities 7. Coordination of activities and
services within the community
2. Area-wide planning and coordination
Added in the 1970s
• Coordinating, monitoring, and assessing the adequacy of health services
Public health functions and practice before 1990:
• A Governmental presence at the local level (AGPALL):

1. Emerged in the 1970s
2. It asserts that local governments are ultimately responsible and accountable for ensuring that
minimum standards are met in the community .
3. The AGPALL concept emphasize the leadership and change agent dimensions of community public
health practice and suggest that modern public health practice involves more than the provision of
services.
Public health functions and practice after 1990:

• IOM and Public Health Core Functions:
o The IOM examination explicated three public health’s core functions:
1. Assessment
2. Policy development
3. Assurance
1 -Assessment :Two important processes characterize the assessment function of public health:
✓ Monitoring health status to identify community health problems

✓ Diagnosis and investigating health problems and hazards in community
2 -Policy development: The key processes characterize the Policy development function are:
✓ Informing, educating, and empowering people about health issues

✓ Mobilizing community partnerships to identify and solve health problem.
✓ Developing policies and plans that support individual and community health effort
3 -Assurance :Five important processes needed for the assurance function of public health:
✓ Enforcing laws and regulations

✓ Linking people to health services
✓ Ensuring a competent public health and personal healthcare workforce
✓ Evaluating effectiveness, accessibility and quality of health services
✓ Researching for new insights and innovative solutions to health problems
Community health assessment and improvement tools:
• Several important new tools for public health practice came onto the scene to build the foundation
for public health practice.
✓ Assessment Protocol for Excellence in Public Health (APEXPH)
✓ Mobilizing for Action Through Planning and Partnerships (MAPP)
✓ Planned Approach to Community Health (PATCH)
✓ Model Standards framework (MSF)
MAPP Model:-
↓partnership Development: Establishing values and outcomes for process and determining the scope,
form, and timing for planning process and participants.
↓visioning: Developing a share vision of the ideal future for the community.
↓Four MAPP Assessments: Inform the planning process and drive the identification of strategic issues;
1. Community themes: collection of inputs and insights from the community to understand the
issues.
2. Local public health: analysis of mission, vision & goals by using performance measures of public
health services.
3. Community health status: assessment of indicators in 11 domains (quality of life, socioeconomic,
demographic, environment, behavioral risks, infectious diseases, sentinel event, social & mental
health, maternal & child health, health resources, health status.
4. Forces of change: identifies broader forces affecting the community such as technology.
↓Identify strategic Issues: Fundamental policy question for achieving the shared vision, arising from the
information developed in the previous phase.
↓Formulate Goals and strategies: Developing and examining options for addressing strategic issues,
including questions of feasibility and barriers to implementation.
↓
Evaluate plan
:- (Action Cycle) Implementation,
evaluation, and celebration of
achievement after LHD leaders have
selected and greed upon strategies.
Implement
Strategic planning includes series of key steps from lying the groundwork through implementing, evaluating, and
revising the plan.
• Preplanning calls for identifying key stakeholders, assessing the availability of important information, and
developing a plan, process and timeline for the Strategic planning project. These preparatory activates
provide a foundation for the step of developing clear statements of mission, vision, and values.
• Developing the mission and vison statements of an organization. This step is important in identifying and
addressing of strategic issues in order to achieve the vison.
• in examination of strategic issues phase, available relevant information collected then analyzed by using
methods such as (SWOT Analysis). This will lead to identification of emerging trends, key strategic issues and
priorities.
• Then these strategic issues and priorities will be translated to strategies, goals, objectives, timelines and
evaluation framework (a strategic planning document) which will be distributed to staff and stakeholders.
• After the plan is implemented, activates and objectives are monitored. Revision and updates for the original
plan is very important.
Strategic plans for public health organizations benefit greatly from preexisting community health
assessments and community health improvement plans.
(Week 13)Ch.7: Managing Public Health Infrastructure
Public Health Infrastructure Components:
• Public health infrastructure: the resources and relationships necessary to carry out public health’s
core functions and essential services in the community. Including:
1. Human resources: (workforce of public health and their knowledge, skills and abilities).
2. Organizational resources: (the relationships among different system participants-private and
public- and the mechanisms that manage and coordinate collective actions).
1. Informational resources: (various data, information, and communication systems).
2. Fiscal (Financial) resources: (funding levels and financial management skills)
Human Resource Management in Public Health:
• The people who do the actual work of public health are the most important component of public
health infrastructure.
• Workforce education and training are not sufficient, which complementary set strategies that
promote workforce development through human resources and workplace management activates
is also important .
• There are separate workforce development subsystems contribute to workforce development:
One focusing on education and training strategies and the other emphasizing workplace
management strategies .
• Managers and supervisors help to guide the professional development of workers .
• A complementary strategy to promote workforce competency depends on external bodies to
validate and recognize skill levels through professional credentialing programs .
• Health professions take various approaches to credentialing include: licensing, certifications, and
registrations
Organizational Management in Public Health:
• Organizational resources in Public Health include the complex web of federal, state, local, tribal,
health agencies and their public, private and voluntary sector partners and collaborates.
• Organizational aspects of public health systems:
o Organizations are groups of individuals linked together by common goals and objectives.
o Each organization takes on a structure to delegate its activates to specific units or
individuals and to coordinate the tasks among them.
o Many factors shape the organization’s ability to survive and thrive in a changing
environment including: its vision, mission, and leadership as well as key aspects of its
operations such as planning, collaboration, and communications.
o The public health organizations differ from private and voluntary ones.
▪ The bottom line of public sector measured in health and quality of life outcome;
while private sector the bottom line is often profits and costumer satisfactions.
▪ Community and voluntary organization is similar to public sector but the public
sector often have political and bureaucratic environments.
Organizational aspects of public health systems :
• Advisory Boards: Public health agencies at the state and local levels usually have advisory boards
to guide their efforts. Now the role of many local boards of health has shifted from directing to
advising the agency.
• Leadership: Within public health agencies, leadership position carries several different
responsibilities including: managing the agency, interact with major stakeholders, carry out some
larger official functions.
• Non Governmental Organization (NGOs): They have played important roles in public health
activates since 1900. For example: The National Tuberculosis Association worked for TB prevention
and treatment. Today, NGOs sponsor diverse public health services and research programs
including family planning, vaccine development, heart diseases and cancer prevention.
Coalitions and Consortia :
Combination of organizational resources is reflected in the collaborative links among various agencies and
organizations .It can be formed for short term efforts or established to address ongoing problems on long
term .It is a formal partnerships involving 2 or more groups working together to achieve specific goals
according to a common plan .It should include representations from all groups affected by the problem .
Advantages including that collaborative efforts can function more efficiently than single organization,
conserve limited resources and providing a pathway for reaching a larger part of the community, as well as
greater credibility.
Key steps for coalitions and other collaborative organizations are:
1. Analyze the program’s objectives and determine whether to form a coalition.

2. Recruit the right people.
3. Develop a set of preliminary objectives and activates .
4. Convene the coalition.
5. Anticipate the necessary resources .
6. Define the elements of a successful coalition structure .
7. Maintain coalition vitality .
8. Make improvement through evaluation.
Information Management in Public Health:
• Information resources that support public health practice include both the scientific basis of public
health and the data and information needed to assess and address health issues.
• Knowledge/ scientific base is provided through undergraduate and graduate level public health
education, training, and experience.
Two general categories of data sets used in public health practice:
1. Encounter or service-based data:

❖ Collected for purposes like reimbursement, eligibility, and evaluation of care.
❖ Common to programs that provide primary healthcare services such as nutrition, mental health,
substance abuse services as well as clinical preventive services such as immunizations or cancer
screening.
❖ Data are collected for individual recipients of these services.
❖ The aggregate from these data would provide useful information on health needs and the health
status of a population.
❖ Limitations including: it may not be representative of the larger population, an individual might
participate in more one than one service program, confidentiality and privacy issues.
2. Population based data:
❖ National surveys of health status and service utilization, behavioral risk surveys of the population.
❖ Information on specific health events and outcome for a defined population such as cancer
incidents registries.
❖ Data sets that describe risk or hazards common to a population such as environmental monitoring
data.
❖ Confidentiality and privacy issues.
Information Management in Public Health:
Information and Analytic Information and the Assessment

Information and surveillance Information and planning
Techniques Functions of Public Health
Information and Analytic Techniques: Information and the Assessment Functions of
Public Health:
1. The capacity of the public health system to
effectively use information expanded during the ❖ Information drives the assessment function
20th century. of public health in 3 ways:
2. This including study design and periodic 1. Public health agencies use surveillance
standardized health surveys. data to monitor community health status
3. Methods of data collection evolved from simple and to identify a new health risks or
measures of disease prevalence to more complex hazards.
studies and analyses such as case-control, cohort, 2. Information is needed on the
and RCTs. communities’ resources that are
4. National Health Surveys (population-based available to address those problems.
surveys) used for estimating disease prevalence 3. Presented this information to the policy
for major causes of death, measuring the burden makers in order to make more effective
of infectious diseases, assessing exposure to interventions
environmental toxicants, measuring the
population’s vaccination coverage, assessing risk
factors for chronic diseases.
Fiscal Management in Public Health:
❖ Financial resources can be viewed as both inputs and outcomes of the system. Economic measure of
human, organizational, informational resources plus the physical facilities and equipment.
❖ Fiscal Dimensions of the public Health System:
1. The public-sector sponsors many but not all the essential public health services framework.
2. Additional essential public health services imbedded in several other government-sponsored
programs such as maternal and child health programs, school health, mental health programs that
operated by federal and state agencies.
3. Also, some of these essential activities are supported by non-government organizations such as
education campaigns of voluntary health organization.
Fiscal Dimensions of the public Health System: The essential public health services divided into:
1. Population-based public health activities: One-fourth of essential public health services spending
($25-$30 billion) Or, about 1% of total national health expenditures. More than two-thirds derived
from nonfederal sources.
2. Personal healthcare activities: About 70% of essential public health services spending. $90-$95
billion.
Financial Management in Public Health:
❖ Financial management skills are important in all organizations especially for midlevel and
senior managers.
❖ The major financial management skills for public health professionals and managers including:
understanding and constructing budgets, interpreting financial data and communications, and
assessing and correcting an organization’s financial status.
❖ Budgets: is a financial tool for systematically converting the objectives of an organization into
plans for acquiring revenues and controlling expenditures.
‫مختصر جدا للمراجعة‬
(Week 14)Ch9: Public Health Emergency Preparedness and Response
Public Health Roles in Emergency 1-Surveillance: Effective preparedness and response rely on:
Preparedness and Response:
1. Monitoring diseases patterns
1. Public health surveillance 2. Investigating individual case reports
2. Epidemiologic investigation and 3. Using epidemiologic and laboratory analysis to target
analysis public health intervention strategies.
3. Laboratory investigation and
analysis 2-Epidemiologic investigation and analysis: Answers to these
4. Intervention questions inform efforts to mount rapid and effective
5. Risk communication interventions.
6. Preparedness planning ❖ Epidemiologic investigations seek to:
7. Community-wide response 1. Determine what is causing the disease
8. Unique aspects of bioterrorism 2. How the disease is spreading
emergencies 3. Who is at risk
9. Workforce preparedness
3-Laboratory investigation and analysis: Laboratories provide the
definitive identification of causative agents, both biological and
Category A
chemical and through various fingerprinting activities link cases to
1. Anthrax (Bacillus anthracis) a common source.
2. Botulism (Clostridium botulinum
4- Intervention: that protect individuals from risks associated with
toxin)
environmental hazards are many including:
3. Plague (Yersinia pestis)
4. Smallpox (variola major) 1. Setting standards for health and safety
5. Tularemia (Francisella tularensis) 2. Inspecting food production and importation facilities
6. Viral hemorrhagic fevers 3. Monitoring environmental conditions
(filoviruses [e.g., Ebola, Marburg] 4. Abating conditions that foster infectious disease
and
7. arenaviruses [e.g., Lassa, 5- Risk communication: Epidemiologic and laboratory
Matchup) investigations drive the initiation of actions intended to limit the
spread of diseases. In these situations, the importance of effective
Category B
public education and information activities to communicate risk to
1. Brucellosis (Brucella species) public cannot be overstated.
2. Epsilon toxin of Clostridium perfringens
3. Food safety threats (e.g., Salmonella 6- Preparedness planning: It include:
species, Escherichia coli
O157:H7,1.Shigella 1. Monitoring available response resources
1. 2. Glanders (Burkholderia mallei) 2. Establishing action protocols
2. Melioidosis (Burkholderia pseudomallei)
3. Simulating emergency events to improve readiness
3. Psittacosis (Chlamydia psittaci)
4. Q fever (Coxiella burnetii) 4. Training public and private sector personnel
5. Ricin toxin from Ricinus communis (castor 5. Assessing communication capabilities, supplies and
beans) resources
6. Staphylococcal enterotoxin B
7. Typhus fever (Rickettsia prowazekii) 7- Community-wide response: Public sector agencies play an
8. Viral encephalitis (alphaviruses [e.g.,
important role in community wide responses to emergencies.
Venezuelan equine encephalitis,
9. eastern equine encephalitis, western
8-Unique aspects of bioterrorism emergencies: Bioterrorism is
equine encephalitis)
10. Water safety threats (e.g., Vibrio cholerae, the threatened or intentional release of biologic agents for
Cryptosporidium parvum) purpose of influencing the conduct of government
Category C :- Emerging infectious diseases such as Nipah virus and hantavirus

National Preparedness and Response State and Local Public Health Preparedness and Response
Coordination: Coordination
❖ The terrorist events of 2001 result in a ➢ State agencies and assets: States rely on a variety of
series of new national policies and agencies to deliver public health emergency services.
priorities, one major development was ➢ ncident Command Systems: In order to manage resources
the creation of Department of Homeland effectively and facilitate decision making during
Security. emergencies, incident command systems (ICS) are wide use
❖ Federal agencies and assets including the by police, fire, and emergency management agencies.
following: o Key components of Incident Command Systems
1. Centers for disease control and (ICS)
prevention (CDC) 1. Common terminology
2. Health resources and services 2. Modular organization
administration (HRSA) 3. Integrated communications
3. Food and drug administration (FAD) 4. A unified command structure
4. National institutes of health (NIH) 5. Consolidated action plans
5. Office of the assistant secretary for 6. A manageable span of control
preparedness and response (ASPR) 7. Designated incident facilities
8. Comprehensive resource management
➢ Local agencies and assets: The front line of response to
public health emergencies is at the local level.
o First responders play key roles in:
1. Recognizing public health emergencies
2. Identifying unique personal safety implications
3. Identifying security issues
4. Understanding basic principles of patient care
based on the type of emergency event.
Good luck☺
Evidence-based public health is Direct parallel to evidence-based medicine
Evidence-based public health is a public health practice that has demonstrated effectiveness, efficiency,
and equitability based on scientific performance evaluation .
Evaluation Performance of public health system depends on :
1 Quality and commitment of the workforce
2. Quality of policies, services, and programs in public health organizations at every level
3 Quality of data available to assess performance
Centers for Disease Control and Prevention (CDC )
The main focus of social marketing is to change the behaviors.
Ten Essential Public Health Services

1) Monitor health status to identify community health problems.
2) Diagnose and investigate health problems and health hazards in the community.
3) Inform, educate, and empower people about health issues.
4) Mobilize community partnerships to identify and solve health problems.
5) Develop policies and plans that support individual and community health efforts.
6) Enforce laws and regulations that protect health and ensure safety.
7) Link people to needed personal health services and ensure the provision of health care when
otherwise unavailable.
8) Ensure a competent public health and personal care workforce.
9) Evaluate effectiveness, accessibility, and quality of personal and population-based health

services.
10) Research for new insights and innovative solutions to health problems.
Main health problems during Industrial Revolution:

1) Poor living and working conditions in Britain led to disease outbreaks and epidemics
2) Children at highest risk of death
3 )Lack of attention to safety in workplace
4) Wages earned were unable to pay for healthful living conditions
5) Nutritional deficiency diseases common

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Technical vs. Adaptive Leadership

Technical Leadership Adaptive Leadership
(Management) (Extreme leadership)
– “Know how” and procedures already in – Large in scope
place – Crisis
Acute or chronic
– Obvious solutions
– Solution determined through
– Organization continues functioning as experimentation, new discoveries,
normal, with exception to possible multiple adjustments
management changes – Involves employees or whole
– Little risk organization to give up a belief, value,
– Relatively comfortable habit, or current way of life or doing
things
Cultural beliefs require no change
– People often resistant to the change
– Tend to be individual or small-group from adaptive leadership
problems vs. organizational problems – Adaptive leaders are passionate,
energetic, creative, unafraid to
challenge traditions, and risk takers
– Realm of community engagement
________ ______
Audacity : is a bold and blatant disregard from normal constraints.
Delegation: Time , Appropriately delegate technical problems and Maintain focus on adaptive challenges.
9 Principles of Community Engagement :

1) Be clear about the goals of the engagement effort and the communities you want to engage .
2) Become knowledgeable about the community’s culture, economic conditions norms and values.
3) Go to the community, establish relationships, build trust, work with the formal and informal leadership
(horizontal communicators) .
4) Remember the self-determination is the responsibility and right of all people in a community .
5) Partnering with the community is necessary to create change and improve health .
6) community engagement must be recognized and respect the diversity of the community .
7 community engagement can be continued by assess strengths and by developing the community’s capacity and
resources to make decisions and take action .
8) Organizations that wish to engage a community should be flexible enough to meet its changing needs .
9) Community collaboration requires long-term commitment by the engaging organization and its partners .
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‫? ‪What is the broad mission of public health‬‬
‫‪The broad mission of public health is to “fulfill society’s interest in assuring conditions in‬‬
‫‪which people can be healthy” .‬‬
What is the(WHO) definition of Health ?
Health: a state characterized by anatomical, physiological, and psychological integrity;

ability to perform personally valued family, work, and community roles; ability to deal with
physical, biological, psychological, and social stress; a feeling of well-being; and freedom
from risk of disease and untimely death.
What is the main target of NPHPPHC ?
An organization charged with coordinating public health activities among all levels of
government with funds from the newly created Prevention and Public Health Fund .
What is the function and target of Comparative effectiveness research (CER) ?
the generation and synthesis of evidence that compares the benefits and harms
of alternative methods to prevent, diagnose, treat, and monitor clinical
conditions or to improve the delivery of care.
The purpose of CER is to assist consumer, clinicians, purchasers, and policy makers to make
informed decisions that will improve health care at both the individual and population
levels .
What is the function and target of The Patient-Centered Outcomes Research Institute
(PCORI) ?
Continuing the work started on a national CER program prior to ACA passage and decrease
health care costs in two ways without reducing access to health care or decreasing health
care quality.
Aim to reduce the use of ineffective medical treatments.
What Are the Emerging Global Threats to the Public’s Health ?
1) Infectious disease pandemics 2) Worldwide water and food shortages. 3) Climate change .
4) Declining air quality. 5) Environmental degradation from population growth and industrialization war .
6)Black Swan events – high impact with low probability of occurrence.
What are the promises of the Public health ?
Decreasing rates of premature death and years of potential life lost
Decreasing rates of disease, injury, and disability among the young
Decreasing rates of preventable health problems

What are the objectives of council on education for the public health CEPH’ ?
1) To promote quality in public health education through a continuing process of self-evaluation by the
schools and programs that seek accreditation
2) To assure the public health that institutions offering graduate instruction in public health have been
evaluated and judged to meet standards essential for the conduct of such educational programs
3) To encourage – through period review, consultation, research, publications, and other means –
improvements in the quality of education for the public
The important points in Public Health (PHC101) – SEU university – by: Ali Alnasser
Ch.1 Introduction and Overview

▪ The theme of the 2012 APHA Annual Meeting was Prevention and Wellness Across the Lifespan.
▪ According to the Institute of Medicine’s (IOM) the Mission of Public Health is to: Fulfill society’s interest in assuring
conditions in which people can be healthy.
▪ Prevention: The cornerstone of public health
▪ Prevention is the preferred strategy for public health
▪ Three types of prevention: Primary prevention, Secondary prevention, Tertiary prevention.
▪ Secondary prevention: Early detection, diagnosis, and treatment of conditions that can be cured or reversed.
▪ Tertiary prevention: Treatment of chronic diseases and other health conditions to prevent exacerbation and minimize
future complications.
▪ Public health emphasizes primary prevention which reduce the incidence of disease in a population.
▪ Public health’s role in secondary and tertiary prevention is to assure access to effective health care, rather than
providing the care itself.
▪ Physical Environment: It includes both the natural and built environments.
▪ Health threats arise from both the natural and built environments.
▪ Genetic inheritance:Increases or decreases the likelihood of health problems
▪ Health behaviors: Behaviors that benefit or harm health.
▪ Beneficial behaviors: include making healthy food choices, engaging in physical activity, and wearing seatbelts.
▪ Harmful behaviors: include smoking, abusing alcohol or other substances, and failing to use seat belts.
▪ Health care impacts health late in the causal chain.
▪ Definitions of health: It is a state of complete physical, mental, and social well-being and not merely the absence of
disease or infirmity.
▪ The determinants of health include: Physical Environment, Social Environment, Genetic Inheritance, Health Behavior,
Health Care.
▪ The term ecology refers to the study of the relationships between organisms and their environments.
▪ The ecological approach means that the person is viewed as embedded in the environment—both social and physical.
▪ Ecology and social ecology are fundamental to the public health perspective and its practice.
▪ Epidemiological triangle: It developed and used to understand infectious disease transmission and to provide a model
for preventing transmission and infectious disease outbreaks.
▪ Epidemiological triangle: It consists of Agent, Host and Environment.
▪ PRECEDE-PROCEED model developed in 1970s and has been applied since then, with modifications made in 1990s.
▪ PRECEDE: Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation.
▪ PROCEED: Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development.
▪ A 5-tier pyramid best describes the impact of different types of public health interventions and provides a framework
to improve health.
Ch.2 Origins of Public Health

▪ Romans built aqueducts to bring clean water to the city.
▪ In the 17th and 18th centuries, the Venetians controlled plague through surveillance and control of travel.
▪ The Industrial Revolution during the 18th and 19th centuries set the stage for public health as a professional field.
▪ Health problems have two broad categories; Diseases and Injuries. Diseases have two broad categories; Infectious and
Noninfectious. Injuries have two broad categories; Intentional and Unintentional.
▪ Infectious Diseases: caused by pathogenic microorganisms and transmitted from person to person or from species to
person: Used interchangeably with communicable disease, Examples: plague, tuberculosis, cholera, influenza, HIV.
▪ Noninfectious Diseases – not caused by pathogenic microbes, sometimes referred to as chronic diseases, however
chronic or acute can be applied to infectious or noninfectious diseases, Include dietary and autoimmune conditions,
hereditary diseases such as hemophilia, diabetes, cardiovascular disease and cancer, and mental health conditions such as
depression, anxiety.
▪ Intentional: self-inflicted or inflicted by others Includes suicide, homicide, domestic violence, child abuse, and elder
abuse, Intentional injuries may result in death or morbidity.
▪ Unintentional or accidental injuries: The most common result from motor vehicle crashes. Home and workplace are
sites of a great many unintentional injuries including burns, falls, drowning, poisonings, and lacerations.
▪ Health problems of the times: Poor living and working conditions led to disease outbreaks and epidemics, Children at
highest risk of death, Lack of attention to safety in workplace, Wages earned were unable to pay for healthful living
conditions, Nutritional deficiency diseases common.
▪ Public response to injuries and noninfectious diseases; End to abuse of workers, Child labor legislations were
passed, Permanent public health commitments to workplace safety, child and maternal health, safe and healthful
housing conditions, sanitary disposal of waste, and a safe and nutritious food supply.
▪ The conclusion of developments are: Primary prevention developments through: Sanitary engineering and Vaccines.
Secondary prevention developments through: Antibiotics and Antimicrobial drugs.
▪ Leading Causes of Death (United States 1900): Pneumonia and influenza, Tuberculosis, Diarrhea, enteritis, and
ulceration of intestines and Diseases of heart.
▪ Leading Causes of Death (United States 2006): Disease of heart, Malignant neoplasm, Cerebrovascular diseases,
Chronic lower-respiratory diseases, Unintentional injury.
▪ Ten Great Public Health Achievements United States, 1900 to 1999: Vaccination, Motor vehicle safety, Safer
workplaces, Control of infectious diseases, Decline in deaths from coronary heart disease and stroke, Safer and healthier
foods, Healthier mothers and babies, Family planning, Fluoridation of drinking water, Recognition of tobacco use as a
health hazard.
▪ Development of Public Health in Saudi Arabia:
▪ In 1925, King Abdulaziz established the Directorate of Public Health in Makkah, which focused on promoting
health during Hajj.
▪ King Abdulaziz issued a decree in 1926, creating the Health and Emergency Department (HED), which was
responsible for promoting public health, creating hospitals, and providing policies and procedures to ensure public
safety.
▪ In the 1970s the MOH establish its first development plan to improve national healthcare.
▪ The 1980s saw an increase in the number of healthcare facilities and public health promotion activities.
▪ There was a focus not only communicable disease, but also on chronic diseases like diabetes.
Ch.3 Organization and Financing of Public Health

▪ The 2003 Institute of Medicine (IOM) report defines six critical “actors” who are in a position to greatly affect health
Communities, The health care delivery system, Employers and business, The media, Academia and Government.
▪ Definitions of Public Health System: It is all public, private, and voluntary entities that contribute to the delivery of
essential public health services within a jurisdiction.
▪ Governmental public health agencies constitute the backbone of the public health system and bear primary, legally
mandated responsibility for assuring the delivery of essential public health services.
▪ Health systems have three main goals in public health: Improving the health of a population through preventative
programs and access, Responding to patient and societal expectations, Ensuring affordable care.
▪ The organization of public health services in US performed at 3 levels: Federal level, State level and Local level.
▪ Ten Essential Public Health Services:
1. Monitor health status to identify community health problems
2. Diagnose and investigate health problems and health hazards in the community
3. Inform, educate, and empower people about health issues
4. Mobilize community partnerships to identify and solve health problems
5. Develop policies and plans that support individual and community health efforts
6. Enforce laws and regulations that protect health and ensure safety
7. Link people to needed personal health services and ensure the provision of health care when otherwise unavailable
8. Ensure a competent public health and personal care workforce
9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services
10. Research for new insights and innovative solutions to health problems
▪ The Department of Health & Human Services (DHHS): The central federal agency responsible for health and health
care in the United States.
▪ DHHS’s 11 operating divisions:
1. Agency for Healthcare Research and Quality (AHRQ)
2. Agency for Toxic Substances and Disease Registry (ATSDR)
3. Centers for Disease Control and Prevention (CDC)
4. Food and Drug Administration (FDA)
5. Health Resources and Services Administration (HRSA)
6. Indian Health Service (IHS)
7. National Institutes of Health (NIH)
8. Substance Abuse and Mental Health Services Administration (SAMHSA)
9. Centers for Medicare & Medicaid Services (CMS)
10. Administration for Children and Families (ACF)
11. Administration for Community Living (ACL)
▪ Centers for Disease Control and Prevention (CDC): Established in 1946 as Communicable Disease Center, Preeminent
epidemiological, surveillance, and disease-prevention agency in the federal government.
Ch.3 Organization and Financing of Public Health

▪ Key functions of Centers for Disease Control and Prevention (CDC):
1. Monitor and report on nation’s health
2. Detect health problems and disease outbreaks
3. Research and implement disease-prevention strategies
4. Develop and advocate sound public health policies
5. Promote health behaviors
6. Provide public health leadership and training
▪ Agency for Healthcare Research and Quality (AHRQ): Conducts and supports a broad range of health services
research within research institutions, hospitals, and health care systems that informs and enhances decision making and
improves health care services, organization, and financing.
▪ Food and Drug Administration (FDA):
1. Charged with regulating drugs and most food products in the United States
2. Regulates over-the-counter and prescription drugs
3. Evaluates drug safety and efficacy and ensures that labeling and marketing of approved drugs are accurate
▪ National Institutes of Health (NIH):
1. Primary federal agency conducting and supporting biomedical research
2. Conducts and funds research into the causes, treatment, cure, and prevention of a broad range of diseases
▪ Centers for Medicare & Medicaid Services (CMS): Administers the largest health insurance programs in the US
country.
▪ Medicare: Provides health insurance for more than 54 million elderly and disabled Americans
▪ Medicaid: Provides health insurance for low-income persons with children and nursing home coverage for low-income
elderly adults.
▪ Children’s Health Insurance Program (CHIP): Provides health insurance for uninsured, low-income children who
are not eligible for Medicaid.
▪ State health departments structured in one of three ways: Stand-alone agencies, Mixed-function agencies and
Umbrella agencies.
▪ The majority of healthcare financing in all countries is funded by the government.
▪ Public sources of public health funding: Taxes, Other monies, such as fees and Collected by the government at the
federal, state, and local levels.
Ch.4 Infectious Disease Control
▪ Primary and secondary prevention are important public health practices related to infectious disease control.
▪ Primary prevention methods through 4 steps: Surveillance, Sanitation, Vaccination and Quarantine.
Secondary prevention methods through 2 steps: Developing antimicrobial drug therapies and Providing access to these
drug therapies.
▪ Two major classes of infectious diseases addressed by public health: Notifiable infectious diseases and Foodborne
diseases.
▪ CDC’s National Notifiable Diseases Surveillance System (NNDSS): A major component of the public health effort to
prevent infectious disease outbreaks.
▪ Results of NNDSS are published weekly in the Morbidity and Mortality Weekly Report (MMWR) and annually in a
year-end summary.
▪ The World Health Organization (WHO) plays a vital role in infectious disease control, particularly in: Surveillance
and Monitoring, Reporting and Coordination of response to outbreaks.
▪ Examples for notifiable infectious diseases: Pandemic Influenza and Avian Influenza, Hepatitis B, Tuberculosis and
Measles.
▪ Pandemic influenza: is a global public health emergency, no human disease that causes more illness and death in a
matter of months than an outbreak of pandemic flu.
▪ Avian influenza: refers to many different types of influenza viruses that primarily affect birds and may affect other
species, including humans.
▪ Seasonal influenza: occurs each and every year with some variation and causes approximately 36,000 deaths annually
in the United States alone.
▪ Ch.4 Infectious Disease Control

▪ Pandemic influenza: large numbers of deaths from pandemic influenza is determined primarily by following factors:
1. Number of people exposed
2. Virulence of the organism
3. Vulnerability of the affected populations
4. Effectiveness of primary prevention measures such as isolation
5. Availability of treatment
▪ Childhood vaccinations have been an essential public health strategy (primary prevention) to control diseases.
▪ Infectious disease agents in food are common sources of illness and the causes of mortality in some cases
▪ Common foodborne disease agents include: Bacillus cereus, Campylobacter jejuni, Escherichia coli (E. coli),
Salmonella, Shigella, Staphylococcus aureus.
▪ Control of foodborne diseases is increasingly difficult:
1. Most food is grown on vast farms on industrial scales
2. Most food is processed on industrial scales
3. Much food is imported from other countries
4. Relatively little fresh food is grown locally
▪ Control of Foodborne Diseases (Primary prevention); FSIS, HACCP and PulsNet.
▪ Risk of foodborne diseases increases with centralized production and distribution of commercially produced foods.
▪ At the federal level, the USDA’s Food Safety and Inspection Service (FSIS) is central.
▪ The USDA introduced the Pathogen Reduction and Hazard Analysis and Critical Control Point (HACCP) program
in 1996, which provides more intensive surveillance of foodborne infections in 10 states to ensure the safety of the meat,
poultry, and egg products
▪ PulseNet is another federal initiative to ensure safe food, a collaborative of the USDA/FSIS, Food and Drug
Administration (FDA), and CDC.
Ch.5 Injuries and Noninfectious Diseases
▪ Public health practice today in the areas of injury prevention and noninfectious disease control: Motor vehicle injuries
and Childhood obesity.
▪ Public health practice can be classified in the following way: Surveillance, Research and Interventions to prevent and
control a health problem.
▪ Motor vehicle injuries: The foremost cause of unintentional injuries.
▪ The National Center for Injury Prevention and Control (NCIPC) conducts surveillance for all injuries, including
motor vehicle injuries, through its Core Violence and Injury Prevention Program (Core VIPP).
▪ Two initiatives aimed at reducing motor vehicle injuries among children are: Child Passenger Safety and Teen Drivers.
▪ National Health and Nutrition Examination Survey (NHANES) designed to assess the health and nutritional status
of adults and children in the United States Includes demographic, socioeconomic, dietary, and health-related questions.
▪ Prevalence of childhood obesity has also been increasing from 13% in 1970s to 33% in 2004.
▪ Childhood Obesity ( 6 Risk factors): Genetic component, Socioeconomic status, Lack of physical activity, Poor eating
habits, Sedentary lifestyle and Parental behavior.
▪ Nutrition, Physical Activity, and Obesity Program (NPAO), its goal is: to prevent and control obesity and other
chronic diseases through healthful eating and physical activity.
▪ Robert Wood Johnson Foundation focused on six areas of childhood obesity to address through prevention strategies:
1. School foods and beverages
2. Healthy, affordable food
3. Physical activity at school
4. Pricing strategies
5. Physical activities in the communities
6. Marketing restrictions to children
Ch.6 Public Health System Performance

▪ The public health system’s performance is generally evaluated on three criteria :Effectiveness, Efficiency and Equity.
▪ Public health performance may be assessed at:
1. The micro level: for single groups, organizations, communities, and geographically specific populations. Ex: to
prevent smoking in a single group within a community.
2. The macro level: for counties, regions, states, and nations. Ex: to know how one region compares to another in rates
of smoking.
▪ The essence of evidence-based public health: is the development of information, using scientific principles, which can
inform public health practice so that it is effective, efficient, and equitable.
▪ Performance evaluation takes place in evidence-based public health at two levels:
1. The individual program, policy, or service level
2. The population level using population mortality and morbidity measures
▪ Basic components of any evaluation "program or system" are: structure, process, and outcomes.
▪ Population-level indicators: are often the measure of impact of : a Program, Service, or Policy.
▪ Population-level indicators: These include population mortality and morbidity rates.
▪ Sources of Evidence-Based Public Health:
2. Association of State and Territorial Health Officials (ASTHO)
4. The Cochrane Collaboration.
5. E-Roadmap to Evidence-Based Public Health Practice (EEBPHP).
6. National Association of County and City Health Officials (NACCHO)
7. New York State Department of Health (NYSDH).
▪ Accreditation and credentialing:
▪ Council on Education for Public Health (CEPH): Independent agency recognized by the U.S. Department of Education
to accredit schools of public health and certain public health programs offered in settings other than schools of public health.
▪ Quality and commitment of the workforce is addressed by: The Council on Education for Public Health (CEPH), the
Public Health Foundation’s (PHF) and National Board of Public Health Examiners (NBPHE).
▪ Quality of policies, services, and programs is addressed by: Accreditation of state and local public health departments
by the Public Health Accreditation Board (PHAB).
▪ Quality of data: Continually being developed by a number of agencies and organizations, particularly the CDC.
▪ The Council on Education for Public Health (CEPH): Accreditation of public health programs and schools.
▪ The Public Health Foundation’s (PHF): The core competencies project developed by Linkages Between Academia and
Public Health Practice.
▪ The National Board of Public Health Examiners (NBPHE): Certification of individual public health professionals.
▪ Core Competencies for Public Health Professionals Project (CCPHPP): Developed through its Council on Linkages
Between Academia and Public Health Practice.
▪ 3 tiers, which differentiate the skills needed by: entry-level individuals, individuals with management and/or supervisory
responsibilities, and senior-level managers and/or leaders of public health organizations.
▪ 8 skill domains within Core Competencies for Public Health Professionals Project:
1. Analytical/assessment
2. Policy development/program planning
3. Communication
4. Cultural competency
5. Community dimensions of practice
6. Public health sciences
7. Financial planning
8. Management
▪ National Board of Public Health Examiners (NBPHE): It independent organization, established in 2005, to make
certain that students and graduates from CEPH-accredited schools and programs of public health have mastered the
knowledge and skills acquired by contemporary public health, Administers the Certified in Public Health (CPH) exam
each year beginning in 2009.
Ch.7 Public Health Leadership (Week 9)

▪ Public Health Accreditation Board (PHAB): It has a goal “to improve and protect the health of every community by
advancing the quality and performance of public health departments”
▪ Domains of Public Health Accreditation Board (PHAB):
1. Investigate health problems and environmental public health hazards.
2. Inform and educate about public health issues and functions.
3. Engage with the community.
4. Develop public health policies and plans.
5. Enforce public health laws.
▪ Report Card Initiatives: can be viewed as outcomes evaluations of the public health system as a whole.
▪ Report Card Initiatives: Collect, organize, and present information about the outcomes that are central to the public
health system: Population health status, Morbidity and Mortality.
▪ State report cards: Many state and local health departments provide report cards on their progress and a report of the status
in the geographical area , Example: New York State has report cards for states and counties.
▪ America’s Health Rankings: 24-year-old report card initiative that ranks each state on health outcomes and health
determinants for the purpose of helping localities, counties, states, and regions make decisions about how to improve
population health
▪ Ecological model: that includes behaviors, policy, health care, and the community and other environments.
▪ County Health Rankings: Health-promotion and disease-prevention agenda for the United States.
▪ Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute: worked as partners to
create the County Health Rankings & Roadmaps program
▪ Health factors included in the rankings formula include: Health behaviors, Clinical care, Social and economic factors
and Physical environment.
▪ Effectiveness and Equity of Public Health System:
1. Life Expectancy and Age-Adjusted Mortality
2. Age-adjusted mortality
3. Quality of Life-Adjusted Measure
4. Infant, Neonatal, and Maternal Mortality
Ch.6 Public Health System Performance (Week 7)

▪ Strategic Planning Definition: Process of defining strategy, direction, and making decisions on allocating resources to
determine the direction of the organization.
▪ Generally, strategic planning deals with at least one of three key questions; What do we do? For whom do we do it?
How do we excel?
▪ Strategic Planning that Where is an organization going over the next year 3 to 5 years?
▪ Five Principles of Strategic Effectiveness of High-Performance Groups:
1. No relation between the time spent and implementation – need a “Good Enough” plan
2. Move quickly to implementation
3. Regularly review the progress
4. Make real time adjustments
5. Need to focus on results not activities
▪ Extreme Leadership (Risk and Fear): Must be willing to take risks, Risk involves fear, Frequent failures are inevitable,
Lessons from failures.
▪ Audacity Definition: a bold and blatant disregard from normal constraints
▪ Audacity: often related to courage, Synonymous with impudence, temerity, brazenness, Love vs. ego
▪ Delegation: Time, appropriately delegate technical problems, Maintain focus on adaptive challenges
▪ Judgment: Ability to facilitate others to reach a common goal
▪ Judgment and Compromise: Ability to see the big picture, Ability to facilitate others to reach a common goal
▪ Judgment and Authority: Art of disturbing people at a rate that can be handled, May possibly require extending beyond
one’s authority.
▪ Judgment and Letting Go: Assess situation and group engagement, Willing to delay discussion.
▪ Outcome: Focused on outcomes, Willingness to forgo more lucrative or respected positions
▪ Engagement: Facilitation of others
▪ Change: even a disaster, is an opportunity for positive change (Change May Be Good)
▪ Engagement and Resilience: Resources, People, Organization and community process.
▪ Four Levels of Message Identification:
1. No interest in a personal change of behavior or becoming a messenger to others
2. Interest in a temporary personal change of behavior but no interest in becoming a messenger to others
3. Interest in a permanent change of personal behavior but no interest in becoming a messenger to others
4. Interest in a permanent change of personal behavior and interest in becoming a messenger to others
▪ Response to Adaptive Resistance:
1. Perspective (Get on the balcony)
2. Think politically
3. Orchestrate the conflict
4. Assign the work appropriately
5. Hold steady
▪ Get on the Balcony: Allows the leader to gain the big perspective, make interventions, observe impacts, and then return
to the action
▪ Thinking Politically: Create appropriate partnerships, Identify who’s responsible for the problem, Acknowledge their
loss, Model the behavior, Accept casualties.
▪ Attributes of an adequate holding environment include:
1. Confidence that all opinions can be expressed without retribution
2. Enough cohesion of the group to offset the disruptive force of adaptive work
3. People feel safe to address difficult problems
▪ Rules of engagement for a holding environment include:
1. All ideas are heard (all participants listen to all comments)
2. All can talk and are encouraged to engage
3. There is no criticism of ideas as they are shared
4. All participants have a vested interest in the problem
5. The discussions shared will be confidential
▪ A leader’s vision must be clear, moving, and convincing. It must provoke confidence in people that what is being
asked of them to give up is worth the goal. A leader’s actions, passion, and non-verbal language.
Ch.8 Building Healthy Communities (Week 10) (‫)مهم جدا‬

▪ In order to build healthy communities, there are three major approaches to changing risky behaviors:
1. Policy
▪ Changing Health/Risky Behaviors:
1. Policy: Statute and Rule - Government and Business Organizations
2. Individuals: One on One - Clinics & Clinicians
3. Population Groups: Social Marketing - Community Engagement
▪ Community Engagement Definition: A major role of active, engaged communities throughout history has been to
support and encourage the health and well-being of community members.
▪ Communities that meet the definition of community can be divided into five general categories, including:
1. Rural villages and towns
2. Worksites
3. Schools (represent multiple subcommunities)
4. Faith-based groups
5. Other groups
▪ Community Engagement and Maslow’s Hierarchy of Needs: Physiological needs, Safety-Security needs, Love-
Belonging Needs, Esteem Needs, Self-Actualization Needs.
▪ Deficiency needs are generally more temporal in nature, focusing on the now, while growth needs relate to longer-term
goals and strategies .
▪ Public health and community development primarily relate to longer-range goals, therefore falling into the area of self-
actualization.
▪ Community deficiency needs must be met to a significant degree to release community energy for self-actualization to
facilitate community engagement for longer-range goals.
▪ Social Marketing: “I don’t care what a person thinks, feels or Believes, I just want a change in the target Behavior.” =
(Behaviors + Institutions)
▪ Community Engagement: “Changes in the beliefs, feelings and thinking of individuals are essential for permanent
changes of high risk behaviors” = (Ideology Cosmology Worldview + Values)
▪ 9 Principles of Community Engagement (to beginning the engagement process):
1. Be clear about the purposes or goals of the engagement effort.
2. Go to the community, establish relationships, build trust, work with the formal and informal leadership.
3. Partnering with the community is necessary to create change and improve health.
4. All aspects of community engagement must be recognized and respect the diversity of the community.
5. Community collaboration requires long-term commitment by the engaging organization and its partners.
▪ Comprehensive worksite wellness: provides an excellent opportunity for the integration of public health and
primary care.
▪ Poor health: is bad for worksite wellness and impacts the workplace in several ways, including:
1. Clinical care: outpatient clinics and hospital costs
2. Pharmaceuticals: medications
3. Absenteeism: employees absent from work due to poor health
4. Presenteeism: employees at work but not performing up to their potential due to poor health
▪ 7 Seven Steps to Successful Worksite Wellness Programs: Seven steps to successful worksite wellness programs
have been identified by the Wellness Council of America (WCOA), and 7 Steps (GCCCCCE) include:
1 .Get management support ‫ احصل على دعم اإلدارة‬.1
2 .Create a team
3 .Collect data ‫ إنشاء فريق‬.2
4 .Create an operating plan ‫ جمع البيانات‬.3
5 .Choose interventions
‫ إنشاء خطة التشغيل‬.4
6 .Create a supportive environment
7. Evaluate ‫ اختيار التدخالت‬.5
‫ خلق بيئة داعمة‬.6
‫ تقييم‬.7
Ch.8 Building Healthy Communities (Week 10)
▪ An effective comprehensive worksite wellness program will be optimally effective if it strategically combines
population-based interventions.
▪ Wellness behavior change using social marketing and community engagement techniques, along with appropriate
clinical interventions (chronic disease management, case management, call-a-nurse, and onsite clinical services).
▪ Degree of primary care and public health integration:
1. Isolation
2. Mutual Awareness
3. Cooperation
4. Collaboration
5. Partnership
6. Merger
▪ The IOM additionally identified essential principles for successful integration, including:
1. A shared goal of population health improvement
2. Community engagement in defining and addressing population health needs.
3. Aligned leadership that bridges disciplines, programs, and jurisdictions to reduce fragmentation and foster continuity
4. Clarifies roles and ensures accountability, develops and supports appropriate incentives
5. Has the capacity to manage change
6. Sustainability, the key to which is the establishment of a shared infrastructure
7. Building for enduring value and impact
8. The sharing and collaborative use of data and analysis
Ch.9 Public Health: Promise and Prospects (Week 11)

▪ The promise of public health is the assurance that the context in which people live their lives will promote health
▪ Public health as a field aspires to provide people with the opportunity to be healthy by ensuring that their environments
advance health
▪ The cornerstone of public health is prevention, particularly primary prevention.
▪ Social justice is the foundation of public health
▪ The commitment to social justice defines the “public health sensibility”
▪ Social justice: Public health assumes that all people are deserving of conditions that promote health.
▪ Population indicators of public health success include:
1. Increasing life expectancy
2. Decreasing rates of premature death
3. Decreasing rates of disease, injury, and disability among the young
4. Decreasing rates of preventable health problems
▪ What Are the Barriers to Public Health’s Success?
1. Changing the environment to change behavior is less consistent with the value of individual accountability than
attempting to hold the individual accountable for his or her own behavior or situation Example: changing environment
to encourage weight loss
2. The development of the public health system as a predominantly government endeavor goes against a strong
conservative segment of the population that prefers the private over the public sector in all societal activities. Conflict,
compromise, and the weakening of public health initiatives have resulted when private interests and the public good are
not aligned
▪ How Will Health Care Reform Affect the Future of Public Health?
▪ Access to health care is an essential goal of secondary and tertiary prevention
▪ Until recently, the United States was the only industrialized nation that did not guarantee at least a basic level of health
care for citizens
▪ 2010 Patient Protection and Affordable Care Act (ACA) changes which furthers a public health imperative to assure
access to health care through two initiatives:
o National Prevention, Health Promotion, and Public Health Council (NPHPPHC)
o Patient-Centered Outcomes Research Institute (PCORI)
Ch.9 Public Health: Promise and Prospects (Week 11)

▪ National Prevention, Health Promotion, and Public Health Council (NPHPPHC): An organization charged with
coordinating public health activities among all levels of government with funds from the newly created Prevention and
Public Health Fund. It developed the National Prevention Strategy which have four strategic directions and seven
targeted priorities.
▪ 4 Strategic Directions of (NPHPPHC):
1. Healthy and Safe Community Environments
2. Clinical and Community Preventive Services
3. Empowered People
4. Elimination of Health Disparities
▪ 7 Priorities of (NPHPPHC):
1. Tobacco-Free Living
2. Preventing Drub Abuse and Excessive Alcohol Use
3. Healthy Eating
4. Active Living
5. Injury- and Violence-Free Living
6. Reproductive and Sexual Health
▪ Patient-Centered Outcomes Research Institute (PCORI): An organization changed with systematically investigating
the effectiveness, efficiency, and equity of health care treatments. PCORI funding distributed from the Patient-
Centered Outcomes Research Trust Fund.
▪ What Are the Emerging Global Threats to the Public’s Health?
1. Infectious disease pandemics
2. Worldwide water and food shortages
3. Climate change
4. Declining air quality
5. Environmental degradation from population growth and industrialization
6. The health consequences of war
7. Black Swan events: high impact with low probability of occurrence
▪ Challenges for Public Health in the United States:
▪ Public health professionals must develop organizing capabilities to mobilize communities, regions, and populations to
fight for the conditions they need to ensure health for all.
▪ These Conditions include:
1. Adequate and safe housing
2. Safe workplaces
3. Nutritious and toxin-free food
4. Clean air and drinking water
5. Safe transportation
6. Opportunities for exercise and recreation
7. Access to quality health care
8. Sustaining incomes for all
9. Education that prepares all adults for meaningful participation in the economy
Ch.5 Core Functions and Public Health Practices (Week 12)

▪ Public health functions and practice before 1990:
✓ Public health was known more by its deeds than its intent, so measuring public health practices focused primarily on
measuring aspects of important public health services.
✓ Public health practice was evaluated through American Public Health Association (APHA).
✓ Emerson report gave increased prominence to six basic services, these services had become widely known as “ Basic
Six” which stared before 1950 to 1970
▪ Initial "Basic Six
1. Vital statistics
2. Sanitation
3. Communicable disease control
4. Maternal and child health
5. Health education
6. Laboratory services
▪ "Optimal" Services in 1950s:
1. Basic Six as minimal level
2. Analysis and recording of health data
3. Health education and information
4. Supervision and regulation
5. Provision of direct environmental health services
6. Administration of personal health services
7. Coordination of activities and services within the community
▪ Added in 1960s
1. Operation of health facilities
2. Area-wide planning and coordination
▪ Added in the 1970s
✓ Coordinating, monitoring, and assessing the adequacy of health services
▪ Public health functions and practice before 1990:
▪ A Governmental presence at the local level (AGPALL):
1. Emerged in the 1970s
2. It asserts that local governments are ultimately responsible and accountable for ensuring that minimum standards
are met in the community
3. The AGPALL concept emphasize the leadership and change agent dimensions of community public health practice
and suggest that modern public health practice involves more than the provision of services.
▪ Public health functions and practice after 1990:
▪ IOM and Public Health Core Functions:
▪ The IOM examination explicated three public health’s core functions:
1. Assessment
3. Assurance
1 -Assessment :Two important processes characterize the assessment function of public health:
✓ Monitoring health status to identify community health problems
✓ Diagnosis and investigating health problems and hazards in community
2 -Policy development: The key processes characterize the Policy development function are:
✓ Informing, educating, and empowering people about health issues
✓ Mobilizing community partnerships to identify and solve health problem.
✓ Developing policies and plans that support individual and community health effort
Ch.5 Core Functions and Public Health Practices (Week 12)

3 -Assurance :Five important processes needed for the assurance function of public health:
✓ Enforcing laws and regulations
✓ Linking people to health services
✓ Ensuring a competent public health and personal healthcare workforce
✓ Evaluating effectiveness, accessibility and quality of health services
✓ Researching for new insights and innovative solutions to health problems
▪ Several important new tools for public health practice came onto the scene to build the foundation for public health
practice.
✓ Assessment Protocol for Excellence in Public Health (APEXPH)
✓ Mobilizing for Action Through Planning and Partnerships (MAPP)
✓ Planned Approach to Community Health (PATCH)
✓ Model Standards framework (MSF)
▪ Strategic planning, standards, and accreditation:Three pillars of accreditation are:
1. Community Health Assessment
2. Community Health Improvement Plan
3. Organizational Strategic Plan
▪ Strategic plans for public health organizations benefit greatly from preexisting community health assessments and
community health improvement plans
▪ These three tools: define the minimal requirement for an effective public health organization. These three elements
comprise the basic prerequisites for PHAB accreditation. Public health organizations without these three pillars aren’t
living up to the standards and expectations of 21st century community public health practice.
▪ Strategic Planning Process:
1. SWOT Analysis: Market assessment, MVV and Organizational Assessment.
2. Strategy Identification and Selection.
3. Strategy Technical plan.
4. Rollout and Implementation.
5. Monitoring and Control.
Ch.7 Managing Public Health Infrastructure (Week 13)

▪ Public health derives its effectiveness from both its components and how they are blended together.
▪ Public health infrastructure has both static and dynamic attributes
▪ Static representation is foundation for public health activities
▪ Dynamic representation is the capacity or capability of that foundation to serve its purpose.
▪ Public Health Infrastructure Components:
▪ Public health infrastructure: the resources and relationships necessary to carry out public health’s core functions and
essential services in the community. Including human, informational, financial and organizational resources.
1. Human resources: (workforce of public health and their knowledge, skills and abilities).
2. Organizational resources: (the relationships among different system participants-private and public- and the
mechanisms that manage and coordinate collective actions).
3. Informational resources: (various data, information, and communication systems).
4. Fiscal (Financial) resources: (funding levels and financial management skills)
▪ Human Resource Management in Public Health:
▪ The people who do the actual work of public health are the most important component of public health infrastructure.
▪ Workforce education and training are not sufficient, which complementary set strategies that promote workforce
development through human resources and workplace management activates is also important .
▪ There are separate workforce development subsystems contribute to workforce development: One focusing on
education and training strategies and the other emphasizing workplace management strategies .
▪ Managers and supervisors help to guide the professional development of workers .
▪ A complementary strategy to promote workforce competency depends on external bodies to validate and recognize
skill levels through professional credentialing programs .
▪ Health professions take various approaches to credentialing include: licensing, certifications, and registrations
▪ Organizational Management in Public Health:
▪ Organizational resources in Public Health include the complex web of federal, state, local, tribal, health agencies and
their public, private and voluntary sector partners and collaborates.
▪ Organizational aspects of public health systems:
▪ Organizations are groups of individuals linked together by common goals and objectives.
▪ Each organization takes on a structure to delegate its activates to specific units or individuals and to coordinate the
tasks among them.
▪ Many factors shape the organization’s ability to survive and thrive in a changing environment including: its vision,
mission, and leadership as well as key aspects of its operations such as planning, collaboration, and
communications.
▪ The public health organizations differ from private and voluntary ones.
▪ The bottom line of public sector measured in health and quality of life outcome; while private sector the bottom line is
often profits and costumer satisfactions.
▪ Community and voluntary organization is similar to public sector but the public sector often have political and
bureaucratic environments.
▪ Organizational aspects of public health systems :
▪ Advisory Boards: Public health agencies at the state and local levels usually have advisory boards to guide their
efforts. Now the role of many local boards of health has shifted from directing to advising the agency.
▪ Leadership: Within public health agencies, leadership position carries several different responsibilities including:
managing the agency, interact with major stakeholders, carry out some larger official functions.
▪ Non Governmental Organization (NGOs): They have played important roles in public health activates since 1900.
▪ For example: The National Tuberculosis Association worked for TB prevention and treatment. Today, NGOs
sponsor diverse public health services and research programs including family planning, vaccine development, heart
diseases and cancer prevention.
▪ Coalitions and Consortia :Combination of organizational resources is reflected in the collaborative links among
various agencies and organizations .It can be formed for short term efforts or established to address ongoing
problems on long term .It is a formal partnerships involving 2 or more groups working together to achieve specific
goals according to a common plan .It should include representations from all groups affected by the problem .
Advantages including that collaborative efforts can function more efficiently than single organization, conserve
limited resources and providing a pathway for reaching a larger part of the community, as well as greater credibility.

▪ Coalitions and Consortia :
▪ Key steps for coalitions and other collaborative organizations are:
1. Analyze the program’s objectives and determine whether to form a coalition.
3. Develop a set of preliminary objectives and activates .
4. Anticipate the necessary resources .
5. Define the elements of a successful coalition structure .
6. Maintain coalition vitality .
▪ Information Management in Public Health:
▪ Information resources that support public health practice include both the scientific basis of public health and the
data and information needed to assess and address health issues.
▪ Knowledge/ scientific base is provided through undergraduate and graduate level public health education, training,
and experience.
▪ Two general categories of data sets used in public health practice:
▪ 1. Encounter or service-based data:
✓ Collected for purposes like reimbursement, eligibility, and evaluation of care.
✓ Common to programs that provide primary healthcare services such as nutrition, mental health, substance abuse
services as well as clinical preventive services such as immunizations or cancer screening.
✓ Data are collected for individual recipients of these services.
✓ The aggregate from these data would provide useful information on health needs and the health status of a
population.
✓ Limitations including: it may not be representative of the larger population, an individual might participate in more
one than one service program, confidentiality and privacy issues.
▪ 2.Population based data:
✓ National surveys of health status and service utilization, behavioral risk surveys of the population.
✓ Information on specific health events and outcome for a defined population such as cancer incidents registries.
✓ Data sets that describe risk or hazards common to a population such as environmental monitoring data.
✓ Confidentiality and privacy issues.
▪ Information Management in Public Health
1. Information and Analytic Techniques
2. Information and the Assessment Functions of Public Health
3. Information and surveillance
4. Information and planning

▪ Information and Analytic Techniques:
1. The capacity of the public health system to effectively use information expanded during the 20th century.
2. This including study design and periodic standardized health surveys.
3. Methods of data collection evolved from simple measures of disease prevalence to more complex studies and
analyses such as case-control, cohort, and RCTs.
4. National Health Surveys (population-based surveys) used for estimating disease prevalence for major causes of
death, measuring the burden of infectious diseases, assessing exposure to environmental toxicants, measuring the
population’s vaccination coverage, assessing risk factors for chronic diseases.
▪ Information and the Assessment Functions of Public Health: Information drives the assessment function of public
health in 3 ways:
1. Public health agencies use surveillance data to monitor community health status and to identify a new health risks
or hazards.
2. Information is needed on the communities’ resources that are available to address those problems.
3. Presented this information to the policy makers in order to make more effective interventions
▪ Fiscal Management in Public Health:
▪ Financial resources can be viewed as both inputs and outcomes of the system. Economic measure of human,
organizational, informational resources plus the physical facilities and equipment.
▪ Fiscal Dimensions of the public Health System:
1. The public-sector sponsors many but not all the essential public health services framework.
2. Additional essential public health services imbedded in several other government-sponsored programs such as
maternal and child health programs, school health, mental health programs that operated by federal and state
agencies.
3. Also, some of these essential activities are supported by non-government organizations such as education
campaigns of voluntary health organization
▪ Fiscal Dimensions of the public Health System: The essential public health services divided into:
1. Population-based public health activities: One-fourth of essential public health services spending ($25-$30 billion)
Or, about 1% of total national health expenditures. More than two-thirds derived from nonfederal sources.
2. Personal healthcare activities: About 70% of essential public health services spending. $90-$95 billion.
▪ Financial Management in Public Health:
▪ Financial management skills are important in all organizations especially for midlevel and senior managers.
▪ The major financial management skills for public health professionals and managers including: understanding and
constructing budgets, interpreting financial data and communications, and assessing and correcting an organization’s
financial status.
▪ Budgets: is a financial tool for systematically converting the objectives of an organization into plans for acquiring
revenues and controlling expenditures.
▪ Healthy People 2020 Public Health Infrastructure Objectives: 1. Skilled workforce 2. Data and information
systems 3. Effective public health organizations.
Ch.9 Public Health Emergency Preparedness and Response (Week 14)

▪ Public Health Roles in Emergency Preparedness and Response:
1. Public health surveillance
2. Epidemiologic investigation and analysis
3. Laboratory investigation and analysis
4. Intervention
5. Risk communication
6. Preparedness planning
7. Community-wide response
8. Unique aspects of bioterrorism emergencies
▪ Surveillance: Effective preparedness and response rely on:
1. Monitoring diseases patterns
2. Investigating individual case reports
3. Using epidemiologic and laboratory analysis to target public health intervention strategies.
▪ Epidemiologic investigation and analysis: Answers to these questions inform efforts to mount rapid and effective
interventions.
▪ Epidemiologic investigations seek to:
1. Determine what is causing the disease
2. How the disease is spreading
3. Who is at risk
▪ Laboratory investigation and analysis: Laboratories provide the definitive identification of causative agents, both
biological and chemical and through various fingerprinting activities link cases to a common source.
▪ Intervention: that protect individuals from risks associated with environmental hazards are many including:
1. Setting standards for health and safety
2. Inspecting food production and importation facilities
3. Monitoring environmental conditions
4. Abating conditions that foster infectious disease
▪ Risk communication: Epidemiologic and laboratory investigations drive the initiation of actions intended to limit the
spread of diseases. In these situations, the importance of effective public education and information activities to
communicate risk to public cannot be overstated.
▪ Preparedness planning: It include:
1. Monitoring available response resources
2. Establishing action protocols
3. Simulating emergency events to improve readiness
4. Training public and private sector personnel
5. Assessing communication capabilities, supplies and resources
▪ Community-wide response: Public sector agencies play an important role in community wide responses to
emergencies.
▪ Unique aspects of bioterrorism emergencies: Bioterrorism is the threatened or intentional release of biologic agents
for purpose of influencing the conduct of government
▪ Category A
1. Anthrax (Bacillus anthracis)
2. Botulism (Clostridium botulinum toxin)
3. Plague (Yersinia pestis)
4. Smallpox (variola major)
5. Tularemia (Francisella tularensis)
6. Viral hemorrhagic fevers (filoviruses [e.g., Ebola, Marburg] and
7. arenaviruses [e.g., Lassa, Matchup)

▪ Category B
1. Brucellosis (Brucella species)
2. Epsilon toxin of Clostridium perfringens
3. Food safety threats (e.g., Salmonella species, Escherichia coli O157:H7,
1. Shigella
2. Glanders (Burkholderia mallei)
3. Melioidosis (Burkholderia pseudomallei)
4. Psittacosis (Chlamydia psittaci)
5. Q fever (Coxiella burnetii)
6. Ricin toxin from Ricinus communis (castor beans)
7. Staphylococcal enterotoxin B
8. Typhus fever (Rickettsia prowazekii)
9. Viral encephalitis (alphaviruses [e.g., Venezuelan equine encephalitis,
10. eastern equine encephalitis, western equine encephalitis)
11. Water safety threats (e.g., Vibrio cholerae, Cryptosporidium parvum)
▪ Category C
▪ Emerging infectious diseases such as Nipah virus and hantavirus
▪ National Preparedness and Response Coordination:

▪ The terrorist events of 2001 result in a series of new national policies and priorities, one major development was the
creation of Department of Homeland Security.
▪ Federal agencies and assets including the following:
▪ Centers for disease control and prevention (CDC)
▪ Health resources and services administration (HRSA)
▪ Food and drug administration (FAD)
▪ National institutes of health (NIH)
▪ Office of the assistant secretary for preparedness and response (ASPR)
▪ National Incident Management System (NIMS)
▪ National Response Plan (NRP)
▪ The Robert T. Stafford Disaster Relief and Emergency Assistance Act (Stafford Act): is a United States federal law
designed to bring an orderly and systemic means of federal natural disaster assistance for state and local governments in
carrying out their responsibilities to aid citizens. Congress's intention was to encourage states and localities to develop
comprehensive disaster preparedness plans, prepare for better intergovernmental coordination in the face of a disaster,
encourage the use of insurance coverage, and provide federal assistance programs for losses due to a disaster.
▪ The Stafford Act is a 1988 amended version of the Disaster Relief Act of 1974. It consists of 6 six items.
▪ State and Local Coordination:
1. State agencies and assets
2. Incident Command Systems
3. Local agencies and assets
4. Private sector providers and other partners
5. Public perceptions and expectations
6. State and local preparedness grants
7. State and local emergency preparedness capabilities
▪ State agencies and assets: States rely on a variety of agencies to deliver public health emergency services.
▪ Incident Command Systems: In order to manage resources effectively and facilitate decision making during
emergencies, incident command systems (ICS) are wide use by police, fire, and emergency management agencies.

▪ Types of Exercises
▪ There are seven types of exercises. Exercises are either discussion-based or operations-based.
▪ Discussions-based Exercises familiarize participants with current plans, policies, agreements and procedures, or may be
used to develop new plans, policies, agreements, and procedures.
▪ Discussion-based Exercises include the following:
1. Seminar: A seminar is an informal discussion, designed to orient participants to new or updated plans, policies, or
procedures (e.g., a seminar to review a new Evacuation Standard Operating Procedure).
2. Workshop: A workshop resembles a seminar, but is employed to build specific products, such as a draft plan or policy
(e.g., a Training and Exercise Plan Workshop is used to develop a Multi-year Training and Exercise Plan).
3. Tabletop Exercise (TTX): A tabletop exercise involves key personnel discussing simulated scenarios in an informal
setting. TTXs can be used to assess plans, policies, and procedures.
4. Games: A game is a simulation of operations that often involves two or more teams, usually in a competitive
environment, using rules, data, and procedure designed to depict an actual or assumed real-life situation.
▪ Operations-based Exercises: validate plans, policies, agreements and procedures, clarify roles and responsibilities, and
identify resource gaps in an operational environment.
▪ Operations-based exercises include the following:
1. Drill: A drill is a coordinated, supervised activity usually employed to test a single, specific operation or function within
a single entity (e.g., a fire department conducts a decontamination drill).
2. Functional Exercise (FE): A functional exercise examines and/or validates the coordination, command, and control
between various multi-agency coordination centers (e.g., emergency operation center, joint field office, etc.). A
functional exercise does not involve any “boots on the ground” (i.e., first responders or emergency officials responding
to an incident in real time).
3. Full-Scale Exercises (FSE): A full-scale exercise is a multi-agency, multi-jurisdictional, multi-discipline exercise
involving functional (e.g., joint field office, emergency operation centers, etc.) and “boots on the ground” response (e.g.,
firefighters decontaminating mock victims).
▪ Private sector providers and other partners:

▪ In nearly all communities, government agencies play a central role in preparing for and responding to public health
emergencies. Often overlooked the critical contribution made by private sector healthcare providers and partners.
▪ State and local emergency preparedness capabilities: CDC identified 15 public health preparedness capabilities:
▪ Bio surveillance: Public Health Laboratory Testing- Public Health Surveillance & Epidemiologic Investigation
▪ Community Resilience: Community Preparedness - Community Recovery
▪ Countermeasures and Mitigation
1. Medical Countermeasure Dispensing
2. Medical Material Management & Distribution
3. Nonpharmaceutical Interventions
4. Responder Safety and Health
▪ Incident Management: Emergency Operations Coordination
▪ Information Management: Emergency Public Information & Warning and Information Sharing.
▪ Surge Management
1. Fatality Management
2. Mass Care
3. Medical Surge
4. Volunteer Management
▪ Key Trends in State and local emergency preparedness capabilities:
1. Public perceptions and expectations change quickly in the face of public health emergencies.
2. Public health activities are now linked with national security initiatives.
3. Models to plan and organize preparedness have changed frequently in past decade.
4. Federal role in public health increased significantly in past decade as a result of increased attention to preparedness.
5. Preparedness resources have resulted in stronger public health infrastructure and have even strengthened other public
health activities.
Chapter 1:
*APHA: American public health association *

They meet yearly to express public health priorities for that year, current
PH issues and activities
*Mission of PH according to IOM (institute of medicine)?*

To fulfill society’s interest in assuming conditions which people can be
healthy
*What does the mission of PH imply?*

1. PH serves all people regardless of their social status
2. Work of PH is a societal efforts and benefits
3. PH doesn’t guarantee all people to be healthy
4. PH is interested in promoting health (not treating illness)
5. Improving health is a benefit to the society as a whole
*What are the 3 prevention types (cornerstone of PH)*

1. Primary
• All efforts of preventing disease and injury
• Eliminates risk factors for a disease
2. Secondary
• treatment of disease and injury that restores health w/o lasting
consequences
• focus on early detection and treatment of disease
3. Tertiary
• actions that moderate chronic disease and disability and prevent their
exacerbation
• attempt to eliminate or moderate disability associated with advanced
diseases
*Definition of health*
State of complete physical, mental and social wellbeing and not merely
the absence of disease or infirmity
*What are the determinants of health*

• physical environment (natural and built)
• social environment
• genetic inheritance
• health behavior
• health care
*Relationship among these health determinants *
- not independent of each other
- interconnected
- concept ms of ecology provide the framework for understanding how
to model their interconnection
*What is ecology*
Study of the relationships between organisms and their environment
*what is an ecological approach*

When the person is viewed as embedded in the environment - both social
and physical
And when the person is both influenced by and influences the

environment
*What are the ecological models & PH practice:*

1. Epidemiological triangle
Developed and used to understand infectious disease transmission and
provide a model for preventing transmission and infectious disease
outbreaks
2. Wheel of causation
Contains a hub with the host at its center
Surrounding the host is the total environment divided into biological,
physical and social environment
*What does the ecological triangle consist of*

• *agent* (microbial organism that causes the infectious disease)
• *host* (organism that harbors agent)
• *environment* (factors that facilitate transmission of agent and host)
*Procede-proceed model *
Developed in 1970s
Modified in 1990s
*PROCEDE* stands for

Predisposing, Reinforcing, Enabling Constructs in Educational Diagnosis
and Evaluation
*PROCEED* stands for

Policy, Regulatory and Organizational Constructs in Educational and
Environmental Development
*Criticism on Health Promotion*

- placing locus of accountability on the individual it it is ineffective and
unfair
- PROCEDE-PROCEED places more emphasis on the environment
Chapter 2 (most important to me)
Classification of Health Problems

• *Diseases* (infectious and non infectious)
• *Injuries* (intentional and non intentional)
Know what each means and one example at least. ☝🏻
*Success of PH: Conclusion of Developments*

• primary prevention through:
- sanitary engineering
- vaccines
• secondary prevention through:
- antibiotics
- antimicrobal drugs
*The Great PH achievements (1900-1999)* few examples

• Vaccination
• Safer workplaces
• Control of infectious diseases
• Healthier mothers and babies
• Safer and healthier foods
*6 critical actors who are in position to greatly affect health*

• Communists
• Health care delivery systems
• Employers and business
• Media
• Academia
• Government
*Definition of Public Health *

Complex network of individuals and organizations that have the
potential to play critical roles in creating the conditions of health
*3 main goals of health systems in Public Health *

• improving health of the population
• responding to patients and societal expectations
• ensuring affordable care
*Organization of public health services in US performed at 3 levels*

• Federal
• State
• Local
*10 essential PH services*

I’ll mention 6
1. Monitor health status

2. Educate people about health issues
3. Evaluate effectiveness and quality of health systems
4. Link people to needed personal health services
5. Investigate health problems and hazards in the community
6. Develop policies and plans
*Key functions of CDC (center for disease control and prevention)*

• monitor and report nations health
• detect health problems
• research and implement disease-prevention strategies
• promote health behavior
• provide PH leadership and training
*AHRQ - agency for healthcare research and quality*

• Conduct and support health services
• Focus on a set of broad issues relating to clinical services and systems
*Primary prevention methods:*

• surveillance
• vaccination
• sanitation
• quarantine
*Secondary prevention methods*

• Develop antimicrobal drugs
• provide access to these drugs
*Two major classes of infectious diseases addressed by public health*

• Notifiable Infectious diseases
• Foodborne disease
*Functional areas of WHO*

• surveillance and monitoring
• reporting
• coordinating of response to outbreaks
*Control of foodborne diseases is increasingly difficult, why?*

• most food is grown on vast farms on industrial scale
• most food is processed on industrial scale
• much food imported from other countries
• little feeds food is grown locally
*NNDSS*
National notifiable disease surveillance system
*MMWR*
Morbidity and mortality weekly report
*FSIS*
Food safety and inspection service (e.g. PulseNet)
Chapter 6
*Criteria of evaluating PH systems performance *

• effectiveness
• efficiency
• equity
*Assessing PH performance at 2 levels *

• micro level (single groups, orgs, etc)
• macro level (countries, regions, states, nations)
*Evidence-Based PH*
Development of information using scientific principles which can inform
Ph practice so that it’s effective, efficient and equitable
*Basic Components of any evaluation of a program or system*

• *structure* (resources available to the PH program)
• *process* (how the PH program was implemented)
• *outcomes* (expected results of implementing the program)
*Council of Education for PH (CEPH)*

Independent agency recognized by the US department of eduction to
accredit schools of PH and certain PH programs offered
*Objectives of CEPH*
• promote quality of PH education
• assure PH offered have been evaluated and meets standards
• encourage improvements in quality of education for the public
*National Board of PH examiners*

Independent organization
Established in 2005
To make certain students and graduates from CRPH-Accredited schools
have mastered the knowledge and skill acquired
*PHAB - Public Health Accrediation Board*

It has a goal to improve and protect health of every community
Few of its Domains:

• investigate health problems
• inform and educate about PH issues
• enforce PH laws
• develop PH policies and plans
• evaluate processes and programs
• promote strategies for improvement
*Report Card initiative *

Can be viewed as outcomes evaluations of the PH system as a whole
Collect, organize and present information about the outcomes:

• population health status
• morbidity
• mortality
•
•
•
•
•
• What is the most important difference between the
fields of medicine and public health?
• What do we mean by the determinants of health?
• What does research indicate is the impact of each
determinant on human health?
• How do the 10 greatest achievements of public health
relate to the Health Impact Pyramid?
• Who were the champions of reform during the
Industrial Revolution?
• What was the relationship of child labor to public
health achievements during the Industrial Revolution?
• What is the lead public health agency at the federal
level and what are its major activities and
responsibilities?
• How does this federal public health agency interact
with the state departments of health?
• What agency is responsible for the Medicare program?
• What is the disease burden of influenza in the United
States and worldwide?
• Describe how an infectious disease outbreak would be
investigated.
• How successful have immunizations been in controlling
infectious diseases?
• What is the disease burden of chronic diseases in the
United States?
• Describe a community-based approach to reducing
obesity that emphasizes changing the context to make
individuals’ default decisions healthy.
• What is evidence-based public health and how does it
relate to evidence-based medicine?
• What is meant by public health system effectiveness,
efficiency, and equity?
• Where does the information on performance come
from?
SECOND EDITION
INTRODUCTION TO
PUBLIC
HEALTH
Promises and Practice
RAYMOND L. GOLDSTEEN
KAREN GOLDSTEEN
TERRY DWELLE
Chapter 1
Introduction and Overview

Outlines:
oThe promise of public health

oThe practice of public health
oHealth impact pyramid
oThe prospects for public health
3
The Promise of Public Health
Every year since 1873, the American Public Health

Association (APHA) has held an annual meeting
This meeting expresses the public health priorities for that

year and gives forum to the full range of current public
health issues and activities.
4
The theme of the 2012 APHA Annual Meeting was Prevention and
Wellness Across the Lifespan, and sessions spanned a wide array of
topics, including this sampling from among the hundreds of
presentations:
Measuring the Food Environment
Changing Planet, Changing Health: The Climate Crisis
More Than Oil: Health and Environmental Disasters
Addressing Health Inequities: Health Department Strategies
Immigrant, Migrant, and Transnational Perspectives on API Health
Fact or Fiction: Connections Between Tobacco Use and Weight
The Politics of Culture, Economics, and Religion in the Prevention and
Wellness of Refugee and Immigrant Communities
5
According to the Institute of (IOM) the Mission of Public Health is
to: Fulfill interest in assuring conditions in which people can be
First: Public health serves all people regardless of income, age,

race/ethnicity, or other attribute
Second: The work of public health is a societal effort with a societal
benefit.
Third: Public health does not guarantee that all people will be healthy, only
that all will enjoy the conditions that promote health
Fourth: Public health is interested in promoting health, rather than
treating illness
Finally: Improving health is a benefit; not only to individuals, but to the
society as a whole
6
Prevention: The cornerstone of public health
Public health is complementary to the clinical professions,

but not one of them
Critical difference between public health and clinical

professions relates to their strategies for creating health
Prevention is the preferred strategy for public health
7
Three types of prevention:
Primary prevention:
- Refers to all efforts that prevent disease and injury from occurring
- It concerned with eliminating risk factors for a disease.
Secondary prevention:
- Refers to treatment of disease and injury that restores health without
lasting consequences, either chronic disease or disability
- It focuses on early detection and treatment of disease
Tertiary prevention:
- Refers to actions that moderate chronic disease and disability and
prevent their exacerbation
- It attempts to eliminate or moderate disability associated with advanced
disease.
8
Remember :
Public health emphasizes primary prevention which reduce
the incidence of disease in a population
Clinical professions emphasize secondary and tertiary
prevention
Early detection, diagnosis, and treatment of conditions
that can be cured or reversed secondary prevention
Treatment of chronic diseases and other health
conditions to prevent exacerbation and minimize future
complications tertiary prevention
9
Secondary and Tertiary Prevention and Public Health :
While public health emphasizes primary prevention,
secondary and tertiary prevention are also important
Public health s role in secondary and tertiary prevention is to
assure access to effective health care, rather than providing
the care itself such as:
o Universal health care coverage
o Equitable distribution of health care resources
o Quality of care
10
The Practice of Public Health
How Do We Define Health?
Some definitions of health:

It is a state of complete physical, mental, and social well-
being and not merely the absence of disease or infirmity
It is a state characterized by anatomical, physiological, and
psychological integrity; ability to perform personally valued
family, work, and community roles; ability to deal with
physical, biological, psychological, and social stress;
a feeling of well-being; and freedom from risk of disease
and untimely death
It is diagnosable morbidity, disability, and premature
mortality
11
The Determinants of Health
The determinants of health include:

Physical Environment
Social Environment
Genetic Inheritance
Health Behavior
Health Care
12
Physical Environment:
It includes both the natural and built environments:
Natural environment features of an area that include its
topography, weather, soil, water, animal life, and other such
attributes
Built environment the structures that people have created
for housing, commerce, transportation, government,
recreation, and so forth
Health threats arise from both the natural and built environments:
Natural environment health threats weather-related
disasters and exposure to disease agents that are endemic in
a region
Built environment health threats exposures to toxins and
unsafe conditions, injuries, and other physical risks
13
Social Environment:
Social environment includes the major organizing concepts
of human life society, community, religion, social network,
family, and occupation:
o Cultural norms, values, and beliefs that are particular
to an individual s social context
o Socioeconomic status
o Race and ethnicity
o Nonphysical occupational factors
o Social integration, social networks, social support
14
Genetic inheritance:
Increases or decreases the likelihood of health problems
Health behaviors:
Behaviors that benefit or harm health
Beneficial behaviors include making healthy food choices,
engaging in physical activity, and wearing seatbelts
Harmful behaviors include smoking, abusing alcohol or other
substances, and failing to use seat belts
15
Health care as a determinant of health:
Health care impacts health late in the causal chain
Success of a health care system is affected by the other

determinants of health
16
Relationship among the determinants of health
Determinants of health are not independent of each other

They are interconnected, and the concepts of ecology
provide the framework for understanding how to model
their interconnectedness.
The term ecology refers to the study of the relationships
between organisms and their environments
The ecological approach means that the person is viewed as
embedded in the environment both social and physical
and is both influenced by and influences that environment.
Ecology and social ecology are fundamental to the public
health perspective and its practice
17
Ecological Models and Public Health Practice
1. Epidemiological triangle:
It developed and used to understand infectious disease
transmission and to provide a model for preventing
transmission and infectious disease outbreaks
It consists of:
o Agent microbial organism that causes the infectious
disease
o Host organism that harbors agent
o Environment factors that facilitate transmission of the
agent to the host; that is, physical, built, or social
environment
18
Epidemiologic triangle
Ecological Models and Public Health Practice

2. Wheel of causation:
It contains a hub with the host at its center. Surrounding
the host is the total environment divided into the biological,
physical, and social environments
20
Health Promotion and the Ecological Models in Public Health:

PRECEDE-PROCEED model:
PRECEDE-PROCEED model developed in 1970s and has been

applied since then, with modifications made in 1990s
o PRECEDE: Predisposing, Reinforcing, and Enabling

Constructs in Educational Diagnosis and Evaluation
o PROCEED: Policy, Regulatory, and Organizational Constructs

in Educational and Environmental Development
21
Criticisms of health promotion:
Placing the locus of accountability for poor health on the

individual but it is ineffective and unfair
Revised PRECEDE-PROCEED model places more emphasis on

the environment, with the focus still on providing the
blueprint for changing the behavior through
education or relying on psychological theories for
understanding how to motivate behavioral change
22
Population health and reemphasis of the social environment

in public health models:
Population health approach to public health focused on the

distal social environment power, wealth, and status as
the root cause of health problems
Findings that an social status, wealth, and power

have a profound influence on his/her chances of being
healthy
23
Population health and reemphasis of the social environment

in public health models:
There is an unequal distribution of power, wealth, and status
that give the advantaged the opportunities and resources to
live in healthier environments, engage in healthier
behaviors, and have access to better health care
Led to studies that offer explanations for undesirable health
behaviors where social context has a causal impact
Goal is to eliminate these health disparities/inequalities so
that everyone is advantaged to the conditions that produce
health
24
Health Impact Pyramid
A 5-tier pyramid best describes the impact of different types of
public health interventions and provides a framework to improve
health.
In this pyramid, efforts to address socioeconomic determinants
are at the base, followed by public health interventions that
change the context for health (e.g., clean water, safe roads),
protective interventions with long-term benefits (e.g.,
immunizations), direct clinical care, and, at the top, counseling
and education.
Public action and interventions represented by the base of the
pyramid require less individual effort and have the greatest
population impact.
Interventions at the top tiers are designed to help individuals
rather than entire populations.
25
Health Impact Pyramid
Increasing Population Increasing Individual

Counseling
Impact Effort Needed
and Education
Clinical
Interventions
Long-Lasting Protective
Interventions
Changing the Context to
Decisions Healthy
Socioeconomic Factors
26
Chapter 2
Origins of Public Health

Outlines:
oClassification of health problems.
oLife during the industrial revolution
oModern public health is born
oSuccess of public health measures
oDevelopment of Public Health in Saudi Arabia
2
Introduction:
In previous eras, societies have practiced in

that they may have provided healthful conditions for their
people:
Romans built aqueducts to bring clean water to the city
In the 17th and 18th centuries, the Venetians controlled
plague through surveillance and control of travel
However, the Industrial Revolution during the 18th and 19th
centuries set the stage for public health as a professional
field
3
Classification of Health Problems:
Health problems have two broad categories
Health
problems
Diseases Injuries
Infectious Noninfectious Intentional Unintentional
4
Classification of Health Problems (cont.):
Health problems have two broad categories:

Diseases:
Infectious caused by pathogenic microorganisms and
transmitted from person to person or from species to
person:
Used interchangeably with communicable disease
Examples: plague, tuberculosis, cholera, influenza, HIV
Noninfectious not caused by pathogenic microbes
Sometimes referred to as chronic diseases, however chronic or acute
can be applied to infectious or noninfectious diseases
Include dietary and autoimmune conditions, hereditary diseases such as
hemophilia, diabetes, cardiovascular disease and cancer, and mental
health conditions such as depression, anxiety
5
Classification of Health Problems (cont.):
Health problems have two broad categories:

Injuries:
Intentional: self-inflicted or inflicted by others
Includes suicide, homicide, domestic violence, child abuse, and elder
abuse
Intentional injuries may result in death or morbidity.
Unintentional or accidental injuries:
The most common unintentional injuries result from motor vehicle
crashes.
Home and workplace are sites of a great many unintentional injuries
including burns, falls, drowning, poisonings, and lacerations
6
Life During the Industrial Revolution:
Living conditions:
Cramped, airless housing
No clean water supply
No sanitary disposal of garbage and sewage
Poor diet
7
Life During the Industrial Revolution (cont.):
Factory life
Poor working conditions that led to injury, permanent
disability and disease
Long hours
Little rest
Poor ventilation
Exposure to dangerous equipment and chemicals
Harsh enforcement of workplace rules
8
Child labor
No minimum age restriction
Long working hours
Abuse used to enforce productivity
Exposure to dangerous equipment and toxic substances
9
Health problems of the times:

Poor living and working conditions led to disease
outbreaks and epidemics
Children at highest risk of death
Lack of attention to safety in workplace
Wages earned were unable to pay for healthful living
conditions
Nutritional deficiency diseases common
10
Modern Public Health Is Born:
Public response to infectious disease outbreaks:

High rate of infectious disease outbreaks such as cholera
outbreak brought about support for public health response
John Snow identifies the Broad Street pump as the cause of
cholera outbreak
Environmental engineering also a method used to address
the problem of infectious diseases, archetypical primary
prevention strategy, which design public systems to reduce
the impact of environmental risks on the public health.
Later in the century, the discoveries that led to vaccines
and antimicrobial therapies, such as penicillin, resulted in
further reduction in the threat of infectious diseases.
11
Modern Public Health Is Born (cont.):
Public response to injuries and noninfectious diseases

End to abuse of workers
Child labor legislations were passed
Permanent public health commitments to workplace
safety, child and maternal health, safe and healthful
housing conditions, sanitary disposal of waste, and a
safe and nutritious food supply
12
Success of Public Health Measures:
Environmental engineering projects that had begun in

the 1800s resulted in improved control of infectious
diseases and some of the greatest success of public
health
Advances in the microscope and microbiology led to
development of vaccines, the effective treatments for
infectious diseases, which prevent infectious diseases
13
Success of Public Health Measures (cont.):
The conclusion of developments are:

Primary prevention developments through:
Sanitary engineering
Vaccines
Secondary prevention developments through:
Antibiotics
Antimicrobial drugs
14
These developments changed dramatically the

causes of death for people in the 20th century, as
well as their age of death.
Thus, the success of public health efforts with
regard to infectious diseases is evident in changes in
the leading causes of death and in life expectancy
since the 19th century.
15
Leading Causes of Death: Leading Causes of Death:

United States 1900 United States 2006
Pneumonia and influenza Disease of heart
Tuberculosis Malignant neoplasm
Diarrhea, enteritis, and ulceration of Cerebrovascular diseases
intestines Chronic lower-respiratory diseases
Diseases of heart Unintentional injury
Stroke Diabetes mellitus
Nephritis
Accidents Influenza and pneumonia
Cancer and other malignant tumors Nephritis, nephritic syndrome, and
Senility nephrosis
Diphtheria Septicemia
16
Average Number of Years of Average Number of Years of
Life Remaining, 1900 Life Remaining, 2006
Age Years of life remaining Age Years of life remaining

0 49.24 0 77.7
1 55.20 1 77.2
5 54.98 5 73.3
10 51.14 10 68.4
20 42.79 20 58.6
30 35.51 30 49.2
40 28.34 40 39.7
50 21.26 50 30.7
60 14.76 60 22.4
70 9.30 70 14.9
80 5.30 80 8.7
17
Ten Great Public Health Achievements

United States, 1900 to 1999
1. Vaccination
2. Motor vehicle safety
3. Safer workplaces
4. Control of infectious diseases
5. Decline in deaths from coronary heart disease and stroke
6. Safer and healthier foods
7. Healthier mothers and babies
8. Family planning
9. Fluoridation of drinking water
10. Recognition of tobacco use as a health hazard
18
Development of Public Health in Saudi Arabia
Public health in Saudi Arabia has changed dramatically in the last century.
Medicine in the 1900s was generally provided by local healers for
common health problems such as tooth and back pain, and remedies
included herbs.
In 1925, King Abdulaziz established the Directorate of Public Health in
Makkah, which focused on promoting health during Hajj.
King Abdulaziz issued a decree in 1926, creating the Health and
Emergency Department (HED), which was responsible for promoting
public health, creating hospitals, and providing policies and procedures to
ensure public safety.
Al-Hashem, A. (2016). Health Education in Saudi Arabia: Historical overview. Sultan Qaboos University Medical
Journal, 16(3), e286 e292.[
19
Development of Public Health in Saudi Arabia
In the 1970s the MOH establish its first development plan to

improve national healthcare. Mandatory vaccination plans
were instituted, which contributed to a steep decline in the
under-five mortality rate, which is now fewer than 15 deaths
per 1,000 live births (World Bank, 2016).
The 1980s saw an increase in the number of healthcare
facilities and public health promotion activities. There was a
focus not only communicable disease, but also on chronic
diseases like diabetes
20
Health in Saudi Arabia:
The following chart shows the changes in the top ten causes of premature
death in Saudi Arabia from 2005 to 2015.
MOH & IHME. (n.d.) Saudi health interview survey results. Retrieved from 21
http://www.healthdata.org/sites/default/files/files/Projects/KSA/Saudi-Health-Interview-Survey-Results.pdf
Chapter 3
Organization and Financing

of Public Health
1
Outlines:
oIntroduction.
oDefinitions of Public Health System
oPublic Health system and Government
oOrganization of Public Health System
oFunding Public Health
2
Introduction:
The 2003 Institute of Medicine (IOM) report emphasizes that:
Public health extends beyond government and
encompasses the efforts, science, art, and approaches used
by all sectors of society to assure, maintain, protect,
promote, and improve the health of the people
The report defines six critical who are in a position
to greatly affect health:
- Communities
- The health care delivery system
- Employers and business
- The media
- Academia
- Government
3
Definitions of Public Health System
It is all public, private, and voluntary entities that contribute to the

delivery of essential public health services within a jurisdiction.
It is collective resources, infrastructure, and effort of all public, private,
and voluntary entities and their respective roles, relationships, and
interactions that contribute to the delivery of essential public health
services to the population within a jurisdiction
It is activities undertaken within the formal structure of government and
the associated efforts of private and voluntary organizations and
individuals
It is complex network of individuals and organizations that have the
potential to play critical roles in creating the conditions of health
4
Public Health system and Government:
According to CDC the governmental public health agency is

a major contributor and leader in the public health system,
but these governmental agencies cannot provide the full
spectrum of Essential Services alone.
Governmental public health agencies constitute the
backbone of the public health system and bear primary,
legally mandated responsibility for assuring the delivery of
essential public health services.
Governments also have the resources and legal authority
to implement public health policies and focus public health
missions that private actors generally lack.
5
Organization of Public Health System:
Health systems have three main goals in public health:

- Improving the health of a population through
preventative programs and access.
- Responding to patient and societal expectations.
- Ensuring affordable care
Although public health systems share the same goals, they do
differ in structure, strengths, and weaknesses.
What works for some countries would not work in others due
to such things as the geographic and population makeup, as
well as other factors.
World Health Organization (WHO), (2017). Health systems. Retrieved from http://www.euro.who.int/en/health-topics/Health-systems.
6
Organization of Public Health System in the United States:
The organization of public health services in US performed at

3 levels:
- Federal level
- State level
- Local level
It comprised of:
- Several departments and agencies within the federal
government
- At least one state-level agency for every state and
territory in the country
The governmental public health system in the US is highly
decentralized
7
Organization of Public Health System in the United States
Ten Essential Public Health Services
1.Monitor health status to identify community health problems

2.Diagnose and investigate health problems and health hazards
in the community
3.Inform, educate, and empower people about health issues
4.Mobilize community partnerships to identify and solve health
problems
5.Develop policies and plans that support individual and
community health efforts
8
Ten Essential Public Health Services (cont.)
6. Enforce laws and regulations that protect health and

ensure safety
7. Link people to needed personal health services and ensure
the provision of health care when otherwise unavailable
8. Ensure a competent public health and personal care
workforce
9. Evaluate effectiveness, accessibility, and quality of personal
and population-based health services
10. Research for new insights and innovative solutions to
health problems
9
Federal Public Health
The federal key activities can generally be

categorized in following groups:
- Allocation and distribution of resources to public health
actors
- Information generation and distribution
- Health care access assurance
- Regulation and enforcement
10
The central federal agency responsible for health and health

care in the United States is the Department of Health &
Human Services (DHHS).
Its mission is to act as the United States government s
principal agency for protecting the health of all Americans
and to provide essential human services, especially for those
who are least able to help themselves
Through 11 operating divisions, the DHHS administers more
than 115 health-related programs in a wide range of areas
11
11 operating divisions:
2. Agency for Toxic Substances and Disease Registry (ATSDR)
4. Food and Drug Administration (FDA)
5. Health Resources and Services Administration (HRSA)
6. Indian Health Service (IHS)
7. National Institutes of Health (NIH)
8. Substance Abuse and Mental Health Services Administration (SAMHSA)
9. Centers for Medicare & Medicaid Services (CMS)
10. Administration for Children and Families (ACF)
11. Administration for Community Living (ACL)
12
Centers for Disease Control and Prevention (CDC):

Established in 1946 as Communicable Disease Center
Preeminent epidemiological, surveillance, and disease-
prevention agency in the federal government
Key functions:
- Monitor and report on nation s health
- Detect health problems and disease outbreaks
- Research and implement disease-prevention strategies
- Develop and advocate sound public health policies
- Promote health behaviors
- Provide public health leadership and training
13
Centers for Disease Control and Prevention (CDC): (cont.)

The go-to agency for public health, with worldwide
influence
The scope of its activities is too great to be presented here,
but a few examples follow:
- CDC and Infectious Diseases
- CDC and Noninfectious Diseases and Injuries
- CDC and National Center for Health Statistics (NCHS)
- CDC and other offices & centers
14
Agency for Healthcare Research and Quality (AHRQ):

Conducts and supports a broad range of health services
research within research institutions, hospitals, and health
care systems that informs and enhances decision making
and improves health care services, organization, and
financing
Research focuses on a set of broad issues relating to both
clinical services and the system in which those services are
provided
15
Food and Drug Administration (FDA):

Charged with regulating drugs and most food products in the
United States
Regulates over-the-counter and prescription drugs
Evaluates drug safety and efficacy and ensures that labeling
and marketing of approved drugs are accurate
National Institutes of Health (NIH):
Primary federal agency conducting and supporting
biomedical research
Conducts and funds research into the causes, treatment,
cure, and prevention of a broad range of diseases
16
Centers for Medicare & Medicaid Services (CMS):

Administers the largest health insurance programs in the country:
1. Medicare:
- Provides health insurance for more than 54 million elderly and
disabled Americans
2. Medicaid:
- Administered jointly by the federal government and the states
- Provides health insurance for low-income persons with children and
nursing home coverage for low-income elderly adults
3. Children s Health Insurance Program (CHIP):
- Provides health insurance for uninsured, low-income children who are
not eligible for Medicaid
17
Administration for Community Living (ACL):

Focused on ensuring that older adults and people with
disabilities are able to have the option to live at home and
fully participate in their communities
Administration for Children and Families (ACF):
Works in partnership with states and communities to provide
critical assistance to vulnerable families while helping families
and children achieve a path to success
18
State Public Health
Primary legal authority for public health rests with the states
States have responsibility for implementing public health
programs and delivering public health services
Decision about whether or to what degree to participate in
federal public health system is left up to states, individually
State health departments structured/organized in one of
three ways:
Stand-alone agencies are independent from other agencies.
Mixed-function agencies are independent but also carry out
activities other than core public health activities.
Other state health departments are part of a larger umbrella
agency of state government which oversees several
departments.
19
Local Public Health
Implementation and delivery of most public health services

occurs at the local level:
- City
- County
- Region
State and local public health agencies form a very connected
system in most states:
- State offers high level of technical expertise at the
research and policy levels, while the local health
departments implement programs
20
Funding Public Health:
The majority of healthcare financing in all countries is

funded by the government.
Some countries provide universal healthcare for their
citizens, while others rely on private insurance, either in
whole or in part.
Healthcare that is publicly financed is generated through a
combination of general and earmarked taxes (also known
as social insurance contributions).
21
Funding Public Health United States:
Public sources of public health funding:
- Taxes
- Other monies, such as fees
- Collected by the government at the federal, state, and local levels
Other funding source from collective effort of many
:
- Health department
- Other social and human service agencies
- Primary care providers
- Community groups
- Volunteer organizations
- Businesses
- Hospitals , Schools and Religious organization
22
Organization of Public Health System in Saudi Arabia:
In the Middle East, public health systems are evolving to keep

up with the dramatic population growth and other changes
that have occurred in the region over the last 50 years.
With the rise of oil prices, the region has seen tremendous
economic growth in many of the countries, so healthcare
spending is on the rise.
This video examines the distribution of public health centers
in Saudi Arabia:
https://www.youtube.com/watch?v=qscwaqmEgwY
23
Organization of Public Health System in Saudi Arabia:
The following graphic illustrates the channel of reporting for

communicable disease in Saudi Arabia:
Azzedin, F., Mohammed, S., Yazdani, J. & Ghaleb, M. (2014). Designing a disease outbreak
notification system in Saudi Arabia. Computer Science & Information Technology, 4(6). Retrieved from
http://airccj.org/CSCP/vol4/csit42301.pdf
24
Chapter 4
Infectious Disease
Control
Outlines:
oIntroduction.
oNotifiable Infectious Diseases
oFoodborne Diseases
2
Introduction
Infectious disease control has historical significance for

public health. It provided many public health s early
successes and remains a major component of public health
practice today.
Primary and secondary prevention are important public

health practices related to infectious disease control
3
Introduction
Primary prevention methods through :

Surveillance: is the continuous, systematic collection,
analysis and interpretation of health-related data
needed for the planning, implementation, and
evaluation of public health practice (WHO)
Sanitation: To read more
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC29815
86/
Vaccination
Isolation and quarantine: help protect the public by
preventing exposure to people who have or may have a
contagious disease.
4
Introduction
Secondary prevention methods through:

Developing antimicrobial drug therapies
Providing access to these drug therapies
5
Introduction
Following are descriptions of public health practice related

to two major classes of infectious diseases addressed by
public health:
Notifiable infectious diseases
Foodborne diseases.
6
Notifiable Infectious Diseases:
A major component of the public health effort to prevent

infectious disease outbreaks is CDC s National Notifiable
Diseases Surveillance System (NNDSS):
NNDSS collects data from state and local authorities about selected
notifiable infectious diseases
CDC provides uniform criteria for reporting cases of notifiable diseases
CDC updates the notifiable disease list annually in collaboration with
the Council of State and Territorial Epidemiologists
Results of NNDSS are published weekly in the Morbidity and Mortality
Weekly Report (MMWR) and annually in a year-end summary
7
Internationally, the World Health Organization (WHO) plays a

vital role in infectious disease control, particularly in:
Surveillance and monitoring
Reporting
Coordination of response to outbreaks
Examples for notifiable infectious diseases:
Pandemic Influenza and Avian Influenza
Hepatitis B
Tuberculosis
Measles
8
Influenzas:
Pandemic influenza: is a global public health emergency,
no human disease that causes more illness and death in a
matter of months than an outbreak of pandemic flu
Avian influenza: refers to many different types of influenza
viruses that primarily affect birds and may affect other
species, including humans
Seasonal influenza: occurs each and every year with some
variation and causes approximately 36,000 death annually
in the United States alone
9
Influenzas:
large numbers of deaths from pandemic influenza is
determined primarily by following factors:
Number of people exposed
Virulence of the organism
Vulnerability of the affected populations
Effectiveness of primary prevention measures such as isolation
Availability of treatment
10
Childhood Vaccinations:
Childhood vaccinations have been an essential public health
strategy (primary prevention) to control diseases
Vaccinations have proven successful in preventing disease and
death:
In the United States, measles, polio, and hepatitis A are declined by 2007
Over 90% of children in Saudi Arabia are vaccinated against diseases that
are part of the WHO s Expanded Programme on Immunization (EPI) which
lead to decline communicable disease
Vaccinations save money as well as lives
The efficacy of childhood vaccinations is threated by public
opinion that opposes them.
World health Organization (WHO). (2016). Health Profile 2015: Saudi Arabia
11
Childhood Vaccinations:
By age 18, a child immunized according to schedule will have
been vaccinated against (CDC, 2010):
Hepatitis B
Rotavirus
Diphtheria and tetanus toxoids and acellular pertussis
Haemophilus influenzae type b
Pneumococcus
Poliovirus
Influenza (seasonal)
Measles, mumps, rubella
Varicella
Hepatitis A
Meningococcus
Human papillomavirus
12
Foodborne Diseases
Infectious disease agents in food are common sources of

illness and the causes of mortality in some cases
Common foodborne disease agents include:
Bacillus cereus
Campylobacter jejuni
Escherichia coli (E. coli)
Salmonella
Shigella
Staphylococcus aureus
13
Foodborne Diseases
The huge burden of disease from foodborne diseases

affecting thousands of people and causing many deaths.
Physicians and other health care professionals play a
critical role in the prevention and control of food-related
disease outbreaks because of the opportunity to identify
suspicious symptoms, disease clusters, and etiological
agents and report their findings to public health
authorities.
14
Foodborne Diseases
Control of foodborne diseases is increasingly difficult:

Most food is grown on vast farms on industrial scales
Most food is processed on industrial scales
Much food is imported from other countries
Relatively little fresh food is grown locally
Risk of foodborne diseases increases with centralized
production and distribution of commercially produced
foods
Failure to remove contaminants in a single production step
can result in shipment of contaminated food to millions
15
Control of Foodborne Diseases:
Primary prevention:
At the federal level, the USDA s Food Safety and Inspection
Service (FSIS) is central.
Notably, the USDA introduced the Pathogen Reduction and
Hazard Analysis and Critical Control Point (HACCP) program
in 1996, which provides more intensive surveillance of
foodborne infections in 10 states to ensure the safety of the
meat, poultry, and egg products
PulseNet is another federal initiative to ensure safe food, a
collaborative of the USDA/FSIS, Food and Drug
Administration (FDA), and CDC
16
Chapter 5
Injuries and
Noninfectious Diseases
Injuries and Noninfectious Diseases
The leading causes of death overall in USA, 2010:

1. Heart diseases
2. Malignant neoplasms
3. Chronic lower respiratory diseases
4. Cerebrovascular diseases
5. Unintentional injuries
6. Alzheimer's
7. Diabetes
8. Nephritis
9. Pneumonia
10. Suicide
2
The leading causes of death overall in KSA, 2015:
1. Road Injuries 9%
2. Diabetes 7%
3. Back/Neck Injuries 7%
4. Ischemic Heart Disease 6%
5. Depressive Disorders 5%
6. Congenital Anomalies of the Heart 5%
7. Drug Use 4%
8. Skin Disorders 3%
9. Chronic Kidney Disease 2%
10. Cancer 2%
3
The wide range issues related to injuries and noninfectious diseases
that are targeted by public health (CDC, 2014).
Diseases and conditions:
ADHD, birth defects, cancer, diabetes, fatal alcohol syndrome
Emergency preparedness and response:
bioterrorism, chemical and radiation emergencies, severe weather
Environmental health:
air pollution, carbon monoxide, lead, water quality, climate change
Healthy living:
bone health, physical activity, genetics, smoking prevention
Injury, violence, and safety:
brain injury, child abuse, falls, fires, poisoning, suicide, youth
violence
Workplace safety and health:
asbestos, chemical safety, construction, mining
4
Public health practice can be classified in the following way:
Provide information on incidence, prevalence, and risk factors
Conduct research on causes and consequences of a health problem
Evaluate effectiveness of interventions aimed at preventing and controlling the
health problem.
Develop data systems necessary for surveillance and research
Interventions to prevent and control a health problem
Education population at risk and related persons on how to reduce risk of the
health problem (primary prevention)
Change social and/or physical environments to prevent health problems from
occurring, which include advocacy and policy solutions (primary prevention)
Provide services for victims of the health problem, including screening,
treatment, and supportive services (secondary and tertiary prevention)
5
We are going to focus on the CDC activates;

however, we are going to discuss the state and
local interventions since these are the levels
where they are implemented
6
Motor Vehicle Injuries
The primary cause of unintentional injuries

The leading cause of years of potential life lost before
age 75
The leading cause of morbidity
Responsible for a major portion of all disabilities,
affecting about 25% of all persons 18 to 64 years old
Accountable for over $99 billion per year in medical
costs and lost productivity in the United States
7
Motor Vehicle Injuries (cont)
all injuries including motor vehicle injuries through its Core

Violence and Injury Prevention Program (Core VIPP)
the program supports 20 state health departments to strengthen the
capacity to collect and use data.
Core VIPP has 5 components (refer to book pg 144-145)
Base Integration Component (BIC)
Regional Network Leader (RNL)
Surveillance Quality Improvement (SQI)
State Falls Prevention
Motor Vehicle Child Injury Prevention Policy (MVP)
8
Motor Vehicle Child Injury Prevention

Policy (MVP)
4 of the 20 Core VIPP funded state partners
address the issue of motor vehicle related
injures among children and teens by:
using data to better understanding who is at risk and
what works to prevent the motor vehicle injures
Develop programs
Inform decision makers about strategies to help keep
drivers, passengers, pedestrians safe
9
2 Surveillance and research initiatives aimed to

reduce motor vehicle injuries among children are
1. Child Passenger Safety
Focuses on increasing the use of car and booster
seats and seat belts; reduce impaired driving; and
helping groups at risks include child passengers
and old adult drivers.
2. Teen Drivers
10
Surveillance and research (cont)
NCIPC identified risk factors for motor vehicle injuries
among children through the surveillance and research
functions:
1. A drinking driver
17% of motor vehicle death of children
2. Improper or no use of seatbelt or booster seat
Serious injuries can be reduced to half
3. Placing a child in the front seat of motor vehicle
Riding in the back seat reduces the risk of serious injuries to
children under 16 by 40%
11
NCIPC identified risk factors for motor vehicle injuries among
teens through the surveillance and research functions:
1. Being 16 to 19 years old (the risk is motor accidents is higher
than any age groups)
2. Male teens (deaths rate due to motor accidents is 2 times than
females)
3. Teen driving with passengers (the presence of teen passengers
increase the crash risk)
4. Newly licensed teen (crash risk is high during the 1st year)
5. Unsafe driving patterns (teens are more likely to speed and to
underestimate the dangerous situations)
6. Failure to wear seatbelts teens have the lowest rate of seat
belt use)
7. Drinking and driving (2010, 22% of drivers aged 15-20 who died
in motor crashes had been drinking)
12
Prevention Policies and Practices:
Public Health interventions for the Child Passenger
Safety and Teen Driver Initiatives.
Primary prevention:
Child Passenger Safety:
Educating parents to use car seats and seat belts for their children
Changing the social and/or physical environment by enforcing child safety
seat laws, safety seat distribution and education programs, community-wide
education and enforcement campaigns, and incentive-plus-education
programs
Teen Drivers:
Education to promote safe teen driving, including school-based instruction
programs, peer organizations, and social norming campaigns focused on
prevention of driving after drinking and riding with drinking drivers
Changing the social and physical environments include advocacy for building
safer motor vehicles, enforcement of laws related to driving after drinking,
and changing community attitudes about teen driving
13
Prevention Policies and Practices (cont)

Secondary and tertiary prevention
Providing services for victims of a health problem, including
screening, treatment, and supportive services
14
Childhood Obesity
Obesity is a worldwide problem, which begins

more frequently among children.
The Division of nutrition, physical activity and
obesity prevention & control.

Prevalence, incidence, risk factors and
consequences of obesity.
These info will then used to develop intervention.
15
Childhood Obesity
Overweight and obesity is abnormal or excessive fat
accumulation that may impair health
Body mass index (BMI): index of weight-to-height that is
calculated as the weight of an individuals in kilograms divided
by the square of the height in meters (kg/m2)
BMI is commonly used in studies of overweight and obesity in
populations and individuals, although it is not as accurate as
more expensive measures of overweight and obesity
Calculated for children and adults in the same way, but criteria used
to interpret BMI for children and adolescents are different from
adults
For children, overweight and obesity use age- and sex-specific
growth charts that are a series of percentile curves illustrating the
distribution of selected body measurements in children
16
Childhood Obesity (cont)
National Health and Nutrition Examination Survey (NHANES)
designed to assess the health and nutritional status of adults
and children in the United States
Includes demographic, socioeconomic, dietary, and health-
related questions
Findings
Prevalence of childhood obesity has also been increasing from 13%
in 1970s to 33% in 2004
Obesity affects every demographic in the United States
Considered pandemic as a result of the global distribution,
but because incidence rates continue to increase, it is not
thought to be endemic
17
Risk factors
Genetic component
Socioeconomic status
Lack of physical activity
Poor eating habits
Sedentary lifestyle
Parental behavior
Studies indicate individuals who are obese as children remain obese as
adults
Diseases that were once considered adult problems are now being
diagnosed in obese children
Diseases of kidneys, pancreas, heart, and circulatory system
Negative impact on social relationships and sense of well-being
Low social status in school; targets of bullying, teasing, and scorn resulting in
depression and low self-esteem
18
Prevention policies and practices
Nutrition, Physical Activity, and Obesity Program (NPAO)
To prevent and control obesity and other chronic diseases through
healthful eating and physical activity
Cooperative agreement between the NPAO and 23 state health
departments
Principle target areas:
Increase physical activity
Increase the consumption of fruits and vegetables
Decrease the consumption of sugar-sweetened beverages
Increase breastfeeding initiation, duration, and exclusivity
Reduce the consumption of energy-dense foods
Decrease television viewing
19
Prevention policies and practices (cont)
Robert Wood Johnson Foundation focused on six areas of childhood obesity
to address through prevention strategies:
School foods and beverages:
35% of a daily calories are consumed at school
Must replacing high-calorie foods and sugary drinks with healthier choices.
Healthy affordable food:
Having access to affordable, healthy foods is important for making healthy
choices.
However, today many families, especially low-income families, live areas where
there are few to no healthy options .
working to bring grocery stores to these areas and improve healthy options at
the existing convenience stores.
Physical activity at school:
This can be done in many ways: physical education classes, promoting walking
and biking to school, and through after-school activities.
20
Prevention policies and practices (cont)
Robert Wood Johnson Foundation focused on six areas of childhood
obesity to address through prevention strategies:
Pricing strategies:
They can be used as an incentive to purchase healthy foods, and also used as a
disincentive to not purchase less nutritious foods.
Physical activities in the communities:
These strategies include building parks and playgrounds, and promoting bike
and walking paths
Marketing restrictions to children:
Restricting the marketing of unhealthy food and drink options to children is
believed to be very cost effective
21
Chapter 6
Public Health System
Performance
1
Outlines:
o Accountability and Evidence-Based Public Health.
o Public Health System Improvement
2
Accountability and Evidence-Based Public Health
Evaluation of the public health system is increasingly important in

this era of accountability
The public health system s performance is generally evaluated on
three criteria:
(a)Effectiveness focuses on:
Are the desired benefits of public health practices achieved?
(b) Efficiency focuses on:
How do the benefits achieved by public health practices compare to
the resources expended to realize them?
Would alternate practices achieve greater benefits or the same
benefits using few resources?
(c) Equity focuses on:
Are public health practices effective in minimizing population health
disparities?
3
Public health performance may be assessed at:

- The micro level: for single groups, organizations,
communities, and geographically specific populations.
- The macro level: for counties, regions, states, and nations.
For example:
At the micro level, we may be interested in the success rate of
one public health program to prevent smoking in a single
group within a community.
At the macro level, we may want to know how one region
compares to another in rates of smoking.
4
Basic components of any evaluation program or system are:

structure, process, and outcomes:
Structure: refers to the resources available to the public health
program which include:
o Organization and financing
o Characteristics of the population targeted by the program
o Physical, social, and economic environments in which the program
occurs
Process: refers to how the public health program, service, or
policy was implemented
Outcomes: refer to the expected results of implementing the
program, service, or policy
o Program-specific outcomes are usually short-term goals
o Changes in health impact are usually longer-term goals
5
Population-level outcomes
Population-level indicators are often the measure of impact of a
program, service, or policy
These include population mortality and morbidity rates
- Age-adjusted death rates
- Disease-specific death rates
- Life expectancy
- Time lost to premature death
- Infant mortality rate (IMR)
- Healthy life expectancy (HALE)
- Quality-adjusted life years (QALY)
- Disability-adjusted life years (DALY)
- Years of healthy life (YHL)
6
Evidence-Based Public Health:

The essence of evidence-based public health is the
development of information, using scientific principles,
which can inform public health practice so that it is effective,
efficient, and equitable.
Evidence-based public health is an activity with direct

parallels to evidence based medicine, although some of the
specifics differ because of the differences between medicine
and public health.
7
Sources of Evidence-Based Public Health:

The following sites provide links to scientific studies and published
reports that provide practical guidance to local health
departments, health care providers, employers, and others on the
effectiveness of programs, services, and policies on achieving
public health goals:
Agency for Healthcare Research and Quality (AHRQ)
Association of State and Territorial Health Officials (ASTHO)
Centers for Disease Control and Prevention (CDC)
The Cochrane Collaboration
E-Roadmap to Evidence-Based Public Health Practice
National Association of County and City Health Officials (NACCHO)
New York State Department of Health
8
Public Health System Improvement
Accreditation and credentialing:

Accreditation and credentialing in public health can be viewed
as process-improvement initiatives.
Accrediting and credentialing initiatives focus on the process
of developing quality in these areas
1.Quality and commitment of the workforce
2.Quality of policies, services, and programs in public
health organizations at every level
3.Quality of data available to assess performance
9

1.Quality and commitment of the workforce is addressed by:
Accreditation of public health programs and schools by the Council
on Education for Public Health (CEPH).
2. Quality of policies, services, and programs is addressed by:
Accreditation of state and local public health departments by the
Public Health Accreditation Board (PHAB)
3. Quality of data:
Continually being developed by a number of agencies and
organizations, particularly the CDC
10

Council on Education for Public Health (CEPH)
Independent agency recognized by the U.S. Department of
Education to accredit schools of public health and certain public
health programs offered in settings other than schools of public
health
CEPH s objectives are:
To promote quality in public health education through a continuing process of self-
evaluation by the schools and programs that seek accreditation
To assure the public health that institutions offering graduate instruction in public
health have been evaluated and judged to meet standards essential for the conduct of
such educational programs
To encourage through period review, consultation, research, publications, and other
means improvements in the quality of education for the public
CEPH evaluates curriculum of programs and schools of public health
based on competencies developed by ASPH
11

Core Competencies for Public Health Professionals Project
Developed through its Council on Linkages Between Academia and Public
Health Practice
3 tiers, which differentiate the skills needed by entry-level individuals,
individuals with management and/or supervisory responsibilities, and
senior-level managers and/or leaders of public health organizations
8 skill domains within core competencies
Analytical/assessment
Policy development/program planning
Communication
Cultural competency
Community dimensions of practice
Public health sciences
Financial planning
Management
12

National Board of Public Health Examiners
It independent organization, established in 2005, to make
certain that students and graduates from CEPH-accredited
schools and programs of public health have mastered the
knowledge and skills acquired by contemporary public health
Administers the Certified in Public Health (CPH) exam each
year beginning in 2009
13

Public Health Accreditation Board (PHAB)
It has a goal to improve and protect the health of every community by advancing the quality and
performance of public health departments
Domains of PHAB:
Conduct and disseminate assessments focused on population health status and public
health issues facing the community
Investigate health problems and environmental public health hazards to protect the
community
Inform and educate about public health issues and functions
Engage with the community to identify and address health problems
Develop public health policies and plans
Enforce public health laws
Promote strategies to improve access to health care services
Maintain a competent public health workforce
Evaluate and continuously improve processes, programs, and interventions
Contribute to and apply the evidence base of public health
Maintain administrative and management capacity
Maintain capacity to engage the public health governing entity
14
Report Card Initiatives:

Report Card Initiatives can be viewed as outcomes evaluations
of the public health system as a whole
Collect, organize, and present information about the
outcomes that are central to the public health system:
Population health status
Morbidity
Mortality
Assume the impact of public health practices on these rates
even though not directly measuring exposure to specific
health service, program, or initiative in population considered
15

Healthy People:
Health-promotion and disease-prevention agenda for the United
States
Sets health objectives for the nation
Monitors progress towards achieving those objectives
Issues regular reports on the results
Acknowledges that even though agenda is national, improvements
will come through local actions, which affect the state, regional, and
national outcome reports
Has become strategic management tool for the federal government,
states, communities, and many private-sector partners
16

Healthy People (cont.):
Challenges and criticisms:
Its printed format constrains usability
Extensive list of objectives that are hard to manage
Disease-specific approach to organizing objectives that has not
encouraged crosscutting collaboration around risk factors
Lack of transparency about target-setting methods for specific
objectives
Lack of data to assess progress
Has raised awareness about the public health problems we have,
the progress we have made toward solving them, and the problems
that remain unsolved
17

State report cards:
Many state and local health departments provide report cards on
their progress and a report of the status in the geographical area
Example: New York State has report cards for states and counties
America s Health Rankings
24-year-old report card initiative that ranks each state on health
outcomes and health determinants for the purpose of helping
localities, counties, states, and regions make decisions about how to
improve population health
Ecological model that includes behaviors, policy, health care, and
the community and other environments
18

County Health Rankings:
Health-promotion and disease-prevention agenda for the United States
Robert Wood Johnson Foundation and University of Wisconsin Population
Health Institute worked as partners to create the County Health Rankings &
Roadmaps program
Focus on determinants of health and provide health rankings for almost every
county in America
Build on efforts of America s Health Rankings
Based on the idea that population health outcomes are influenced by health
factors and policies and programs
Health factors included in the rankings formula include:
Health behaviors
Clinical care
Social and economic factors
Physical environment
19
Effectiveness and Equity of Public Health System:

How does the U.S. public health system fare on effectiveness
and equity using population-level outcomes? the answer is
reflected in these measures
1- Life Expectancy
Life expectancy used as an assessment measure in at least two
ways:
Compare the life expectancy in one society to life
expectancy in another
Can compare life expectancies among subgroups within one
society
20

2- Age-adjusted mortality
Age adjustment statistically accounts for the fact that life
expectancy from birth is shorter for males than for females
In 2002, age-adjusted death rate was 8.5 per 1,000
population; 10.1 for males, 7.2 for females
21

3- Quality of Life-Adjusted Measure:
2002 HALE at birth for males was 67.2 years in the United
States, the lowest-ranked country of the 13; for females was
ranked 12 out of 13
2002 DALY per 100,000 population for all-cause death was
higher in the United States than in any of its 12 peer countries
22

4- Infant, Neonatal, and Maternal Mortality
2004, U.S. IMR was 6.0 per 1,000 live births the highest of
the 13 peer countries
2000 neonatal mortality was highest in the United States at 5
per 1,000 live births compared to its peer countries
Maternal mortality was 3rd highest, with 14 maternal deaths
per 100,000 live births
23
Chapter 7
Public Health Leadership

Introduction
Good leadership is essential for the well-being of any

organization, including public health.
Change in public health and health care system will require

exceptional management and extreme leadership skills to
effectively transition to meet the health and wellness needs
of the nation.
2
Leadership
Definitions:
The art of mobilizing others to struggle for shared aspirations
Organizing people around a common goal.
A process of social influence in which one person can enlist

the aid and support of others in the accomplishment of a
common task.
Demonstrating situational perception and action, power,

vision and values, charisma, and intelligence
3
Leadership
Leadership is composed of both technical and adaptive

leadership skills
Many executives are good managers (technical leadership)
and yet have an additional set of skills to guide organizations
through dangerous and confusing times (adaptive/extreme
leadership).
Leaders, including those in public health, must know when

and how to use both of these skill sets for the health and
wellness of the organization
4
Technical/Management Leadership
and procedures already in place

The solution is fairly obvious to an experience manager.
Organization continues functioning as normal, with exception to
possible management changes
Little risk
Relatively comfortable since it require change in cultural
beliefs values of the organizations.
Technical problems tend to be problems of individuals or small

groups versus the organization as a whole
5
Adaptive/Extreme Leadership
It associated with changes of the deep beliefs, values, habits,

or current way of doing things within the organization.
Adaptive problems are often considered crises (acute or

chronic).
Solution determined through experimentation, new

discoveries, multiple adjustments
6
Adaptive/Extreme Leadership
Involves employees or whole organization to give up a belief,

value, habit, or current way of life or doing things
People often resistant to the change from adaptive

leadership
Adaptive leaders are passionate, energetic, creative, unafraid

to challenge traditions, and risk takers
Realm of community engagement
7
Technical vs. Adaptive Leadership
Technical Leadership Adaptive Leadership
(Management) (Extreme leadership)
Adaptive problems is Large in scope
place Crisis
Acute or chronic
Obvious solutions
Solution determined through
Organization continues functioning as experimentation, new discoveries, multiple
normal, with exception to possible adjustments
management changes Involves employees or whole organization to
give up a belief, value, habit, or current way
Little risk of life or doing things
Relatively comfortable People often resistant to the change from
adaptive leadership
Cultural beliefs require no change Adaptive leaders are passionate, energetic,
Tend to be individual or small-group creative, unafraid to challenge traditions,
and risk takers
problems vs. organizational problems
Realm of community engagement
8
Leadership and Culture
Layers of Culture (Cultural egg):
Behaviors
Institutions
Values
Ideology
Cosmology
Worldview
9
Technical vs. Adaptive Change
Technical fixes
require no
change in
Behaviors Behaviors
deep beliefs
Institutions Institutions
Values Values
Ideology Ideology
Cosmology Cosmology
Worldview Worldview
Adaptive fixes
require
change in
deep beliefs
10
Extreme leadership : Vision
Leadership qualities begin with a unique vision.
Vision is deeply influenced by a beliefs and values,

worldview, the glasses through which he or she sees and
ultimately interprets the world around him or her.
When the beliefs and values of the organization and leader

closely align, leaders are positioned to be extreme leaders
in their organizations.
11
Show Them the Future
able to join hands with little white boys and girls and
Martin Luther King, Jr.
It must provoke confidence in people that what is being
actions, passion, and non-verbal language must shout

that we are totally persuaded this is the way the future
must be.
12
Extreme leadership: Risk and Fear
An adaptive/extreme leader must be willing to take risks
Risk is a natural part of the human experience, and we

accept it in many areas of our lives without realizing it .
Risk involves fear
13
Extreme leadership : Audacity
Definition: bold and blatant disregard from normal
Audacity often related to courage
Audacity described by impudence, temerity, and

brazenness is often driven by ego and meant to draw
attention to the leader where audacity based on heart is
courageous
14
Extreme leadership: Delegation
Leaders are often confronted with a plethora of technical,

adaptive, and complex, mixed problems with only so much
time to invest in solutions.
A reasonable option in a time crunch is to appropriately
delegate the technical problems to other competent staff,
thus freeing
Delegation helps adaptive/ extreme leader to focus on the

adaptive challenge
15
Extreme leadership: Judgment and Compromise
An extreme leader must see the big picture, how to get from
point A to point B
Judgment and compromise help the extreme leaders to
facilitate others to reach a common goal
16
Extreme leadership: Casualties
Leaders would prefer not to think about casualties since

always uncomfortable, painful, and a situation they want to
avoid .
Adaptive change will leave casualties
17
Chapter 8
Building Healthy Communities

Outlines:
oIntroduction.
oCommunity engagement
oComprehensive Worksite Wellness
2
Introduction
There is incredible power within local communities to truly

build healthy communities, and public health organizations
must understand how to tap that power in order to be
successful.
In order to build healthy communities, there are three major

approaches to changing risky behaviors:
1. Policy
3
Changing Health/Risky Behaviors
Population
Policy Individuals
Groups
Law - Social Marketing

One on One
and Rule - Community Engagement
Government and Clinics &

Business Public Health
Organizations Clinicians
4
Community Engagement
A major role of active, engaged communities throughout history has

been to support and encourage the health and well-being of
community members.
A community is often much more than a geopolitical area. A true

community show key characteristics like people who know each
other by first name and have a sense of shared responsibility for
each other. If these characteristics are met, community engagement
concepts can often be used.
These communities impact how members think, act, and believe
5
Communities that meet the definition of community can be divided into five
general categories: Rural villages and towns, Worksites, Schools, Faith-based
groups, Other groups
Fundamental community engagement concepts generally apply to engaging
all of these communities. However, there are unique concepts that apply to
each group.
Another major concept of community engagement is realizing that a

community does not exist in a vacuum within a target area; community
members are commonly members of multiple communities or
subcommunities in that area.
Consistent messages within these within all communities where individual belong will
result in reaching a behavioral threshold more quickly. Therefore, an effective
community engagement strategy is to engages many communities in a target area as
possible. 6
of Needs
Maslow described a hierarchy of needs that can be further
divided into deficiency needs and growth needs.
7
of Needs
Deficiency needs are generally more temporal in nature,
focusing on the now, while growth needs relate to longer-term
goals and strategies.
Public health and community development primarily relate to

longer-range goals, therefore falling into the area of self-
actualization.
Community deficiency needs must be met to a significant

degree to release community energy for self-actualization to
facilitate community engagement for longer-range goals
8
Community Engagement and Social Marketing
Social Marketing
believes. I just want a change in the target
Behaviors
convincing presentations with good, culturally
appropriate messages, and using effective message Institutions
channels at key times.
useful in one-time behaviors like immunizations Values
and cancer screenings.
Ideology
Cosmology
Community Engagement Worldview
of
individuals are essential for permanent changes of
high risk behaviors
9
9 Principles of Community Engagement
Items to consider prior to beginning the engagement process:

1. Be clear about the purposes or goals of the engagement effort and the
populations and/or communities you want to engage.
2. Become knowledgeable about the culture, economic
conditions, social networks, political and power structures, norms and
values, demographic trends, history, and experience with efforts by
outside groups to engage it in various programs. Learn about the
perceptions of those initiating the engagement activities.
10
Items necessary for engagement to occur:
3. Go to the community, establish relationships, build trust,
work with the formal and informal leadership (horizontal
communicators), and seek commitment from community
organizations (not structures) and leaders to create
processes for mobilizing the community.
4. Remember and accept that collective self-determination is
the responsibility and right of all people in a community.
No external entity should assume it can bestow on a
community the power to act in its own self-interest
(community engagement versus coercion).
11
Items to consider for making engagement successful:

5. Partnering with the community is necessary to create
change and improve health.
6. All aspects of community engagement must be recognized
and respect the diversity of the community. Awareness of
the various cultures of a community and other factors
affecting diversity must be paramount in planning,
designing, and implementing approaches to engaging a
community.
12
7. Community engagement can only be sustained by identifying

and mobilizing community assets and strengths and by
developing the capacity and resources to make
decisions and take action.
8. Organizations that wish to engage a community as well as
individuals seeking to effect change must be prepared to
release control of actions or interventions to the community
and be flexible enough to meet its changing needs.
9. Community collaboration requires long-term commitment
by the engaging organization and its partners.
13
Comprehensive Worksite Wellness
Comprehensive worksite wellness provides an excellent

opportunity for the integration of public health and primary
care.
Poor health is bad for worksite wellness and impacts the
workplace in several ways, including:
Clinical care: outpatient clinics and hospital costs
Pharmaceuticals: medications
Absenteeism: employees absent from work due to poor
health
Presenteeism: employees at work but not performing up
to their potential due to poor health
14
Seven Steps to Successful Worksite Wellness
Programs
Seven steps to successful worksite wellness programs have
been identified by the Wellness Council of America, and
include: (please read the book Pg. 227-229)
1. Get management support
2. Create a team
3. Collect data
4. Create an operating plan
5. Choose interventions
6. Create a supportive environment
7. Evaluate
15
An effective comprehensive worksite wellness program will be

optimally effective if it strategically combines population-based
interventions (wellness behavior change) using social
marketing and community engagement techniques, along with
appropriate clinical interventions (chronic disease
management, case management, call-a-nurse, and onsite
clinical services).
16
Building Healthy Communities by Integrating
Primary Care and Public Health
The Institute of Medicine (IOM) strongly suggested that

enhanced integration of public health and primary care with
more true collaboration and partnerships is essential to
building healthy individuals and communities in the future.
It identified a continuum of integration for primary care and
public health from isolation to merger
17
Building Healthy Communities by Integrating
Primary Care and Public Health
The IOM additionally identified essential principles for successful
integration, including:
1.A shared goal of population health improvement
2.Community engagement in defining and addressing population
health needs.
3.Aligned leadership that bridges disciplines, programs, and
jurisdictions to reduce fragmentation and foster continuity
4.Clarifies roles and ensures accountability, develops and supports
appropriate incentives
5.Has the capacity to manage change
6.Sustainability, the key to which is the establishment of a shared
infrastructure
7.Building for long-term value and impact
8.The sharing and collaborative use of data and analysis
18
Chapter 9
Public Health: Promise
and Prospects
Outlines:
oIntroduction.
oPublic Health Promise
oHealth Care Reform
oGlobal Threats to the Health
oChallenges for Public Health in the United States
2
Introduction
Remember!
The broad mission of public health is to
interest in assuring conditions in which people can be
So;
The promise of public health is the assurance that the
context in which people live their lives will promote health
Public health as a field aspires to provide people with the
opportunity to be healthy by ensuring that their
environments advance health
Therefore, the cornerstone of public health is prevention,
particularly primary prevention
3
Introduction
Remember!
Social justice is the foundation of public health
So;
The commitment to social justice defines the
health
Public health assumes that all people are deserving of
conditions that promote health
Indeed, public health practice may be thought of as
applied social justice.
4
Has Public Health Lived Up to Its Promise?
Population indicators of public health success include:

Decreasing rates of premature death
Decreasing rates of disease, injury, and disability among the
young
Decreasing rates of preventable health problems such as
injuries
5
What Are the Barriers to Public Success?
Changing the environment to change behavior is less

consistent with the value of individual accountability and
responsibility than attempting to hold the individual
accountable for his or her own behavior or situation
Example: changing environment to encourage weight loss
6
What Are the Barriers to Public Success?

The development of the public health system as a
predominantly government work against a strong conservative
segment of the population that prefers the private over the
public sector in all societal activities
Conflict, compromise, and the weakening of public health
initiatives have resulted when private interests and the public
good are not aligned.
This explains much of the collaboration between public,
private, and nongovernmental nonprofit organizations in
public health today.
7
How Will Health Care Reform Affect the Future
of Public Health?
Access to health care is an essential goal of secondary and tertiary

prevention
Until recently, the United States was the only industrialized nation
that did not guarantee at least a basic level of health care for
citizens
2010 Patient Protection and Affordable Care Act (ACA) changes
which furthers a public health imperative to assure access to health
care through two initiatives:
National Prevention, Health Promotion, and Public Health
Council (NPHPPHC)
Patient-Centered Outcomes Research Institute (PCORI)
8
How Will Health Care Reform Affect the Future
of Public Health?
The ACA aim is to decrease health care costs in two ways

without reducing access to health care or decreasing health
care quality:
NPHPPHC aim to reduce the demand for medical care
through primary prevention
PCORI aim to reduce the use of ineffective medical
treatments
9
How Will Health Care Reform Affect the Future of
Public Health?
National Prevention, Health Promotion, and Public Health Council

(NPHPPHC):
An organization charged with coordinating public health
activities among all levels of government with funds from the
newly created Prevention and Public Health Fund
It developed the National Prevention Strategy which have four
strategic directions and seven targeted priorities
4 Strategic Directions: 7 Priorities:
1. Healthy and Safe Community 1. Tobacco-Free Living
Environments 2. Preventing Drub Abuse and Excessive
2. Clinical and Community Preventive Alcohol Use
Services 3. Healthy Eating
3. Empowered People 4. Active Living
4. Elimination of Health Disparities 5. Injury- and Violence-Free Living
6. Reproductive and Sexual Health
10
How Will Health Care Reform Affect the Future of
Public Health?
Patient-Centered Outcomes Research Institute (PCORI):

An organization charged with systematically investigating
the effectiveness, efficiency, and equity of health care
treatments
PCORI funding distributed from the Patient-Centered
Outcomes Research Trust Fund
11
What Are the Emerging Global
Infectious disease pandemics

Worldwide water and food shortages
Climate change
Declining air quality
Environmental degradation from population growth and
industrialization
War
Black Swan events high impact with low probability of
occurrence
Oil leak from a deep-water well in the gulf of Mexico
1986 Chernobyl nuclear accident
12
What Are the Emerging Global
Population growth, climate change, and food and water

scarcity
Population growth
World population reached approximately 7 billion people by end of 2012
Growth rate of 1.15%
Attributable to steady growth in births each year and increased life expectancy
Between 2013 and 2025, Census Bureau estimates U.S. population will grow
by 9.5%
Climate change
Leading to extreme weather events and increased temperatures worldwide
These will impact availability of food and water
Population growth and climate change together will adversely
impact health through water and food scarcity
13
Challenges for Public Health in the United States
There are compelling cultural values and preferences for individualism and
the private sector, which are supported by powerful interests that favor the
status quo and constrain the ability to change the environment in ways
that would promote health.
Thus, these values and preferences work against an effective public health
system.
So, public health professionals must have skills to change them.
Also, Public health professionals must develop organizing capabilities to
mobilize communities, regions, and populations to fight for the conditions
they need to ensure health for all. These Conditions include:
Adequate and safe housing, Safe workplaces, Nutritious and toxin-free food, Clean air and
drinking water, Safe transportation, Access to quality health care etc.
14
Chapter 5
21st Century Community
Public Health Practice
Outlines:
Public health functions and practice before 1990s
Public health functions and practice after 1990s
Community health assessment and improvement tools
Strategic planning, standards, and accreditation

Public health functions and practice before 1990 :
Public health was known more by its deeds than its intent, so
measuring public health practices focused primarily on measuring
aspects of important public health services.
Emerson report gave increased prominence to six basic services,

these services had become widely known as Basic which
stared before 1950s to 1970s.
A Governmental presence at the local level (AGPALL):
Emerged in the 1970s
It states that local governments are ultimately responsible and
accountable for ensuring that minimum standards are met in the
community
The AGPALL concept emphasize the leadership and change agent
dimensions of community public health practice and suggest that
modern public health practice involves more than the provision of
services.
Public health functions and practice after 1990 :
IOM and Public Health Core Functions :
The IOM examination explicated three public core
functions:
1. Assessment
3. Assurance
1- Assessment:
Two important processes characterize the assessment function of

public health:
Monitoring health status to identify community health problems
Diagnosis and investigating health problems and hazards in

community
2- Policy development:
The key processes characterize the Policy development function are:
Informing, educating, and empowering people about health issues
Mobilizing community partnerships to identify and solve health

problem.
Developing policies and plans that support individual and

community health effort
3- Assurance:
Five important processes needed for the assurance function of public

health:
Enforcing laws and regulations
Linking people to health services
Ensuring a competent public health and personal healthcare workforce
Evaluating effectiveness, accessibility and quality of health services
Researching for new insights and innovative solutions to health problems

Community health assessment and improvement tools:
Several important new tools for public health practice came onto
the scene to build the foundation for public health practice.
Assessment Protocol for Excellence in Public Health (APEXPH)
Mobilizing for Action Through Planning and Partnerships

(MAPP)
Planned Approach to Community Health (PATCH)
Model Standards framework

Community Health Assessment and Improvement
Tools
Mobilizing for Action through Planning and partnerships (MAPP):

is the 2nd
National Association of County and City Officials in 1991.

APEXPH among the early post-IOM report tool for organizing self-
assessment and improvement for LHDs.
MAPP is a robust tool of public health practice that could be used
by communities with effective LHD leadership to create a local
system that ensures the delivery of the essential public health
services.
Establishing values and outcomes for process and
determining the scope, form, and timing for planning
process and participants
Developing a share vision of the ideal future for the

community.
Inform the planning process and drive the

identification of strategic issues;
a. Community themes: collection of inputs and insights
from the community to understand the issues.
b. Local public health: analysis of mission, vision &
goals by using performance measures of public health
services.
c. Community health status: assessment of indicators
in 11 domains (quality of life, socioeconomic,
demographic, environment, behavioral risks, infectious
diseases, sentinel event, social & mental health,
maternal & child health, health resources, health
status.
d. Forces of change: identifies broader forces affecting
the community such as technology.
Fundamental policy question for achieving the shared
vision, arising from the information developed in the
previous phase.
Developing and examining options for addressing
strategic issues, including questions of feasibility and
barriers to implementation.
(Action Cycle) Implementation, evaluation, and celebration

MAPP Model of achievement after LHD leaders have selected and greed
upon strategies.
Strategic planning, standards, and
accreditation:
Strategic planning includes series of key steps from lying the
groundwork through implementing, evaluating, and revising the plan.
Preplanning calls for identifying key stakeholders, assessing the availability of important
information, and developing a plan, process and timeline for the Strategic planning project.
These preparatory activates provide a foundation for the step of developing clear statements
of mission, vision, and values.
Developing the mission and vison statements of an organization. This step is important in
identifying and addressing of strategic issues in order to achieve the vison.
in examination of strategic issues phase, available relevant information collected then

analyzed by using methods such as (SWOT Analysis). This will lead to identification of
emerging trends, key strategic issues and priorities.
Then these strategic issues and priorities will be translated to strategies, goals, objectives,
timelines and evaluation framework (a strategic planning document) which will be distributed
to staff and stakeholders.
After the plan is implemented, activates and objectives are monitored. Revision and updates
for the original plan is very important.
Strategic plans for public health organizations benefit greatly from

preexisting community health assessments and community health
improvement plans, which these three tools define the minimal
requirement for an effective public health organization.
Public health was known more by its deeds than its intent, so
measuring public health practices focused primarily on measuring
aspects of important public health services.
Emerson report gave increased prominence to six basic services,

these services had become widely known as Basic which
stared before 1950s to 1970s.
Introduction
Public Health Infrastructure Components
Human Resource Management in Public Health
Organizational Management in Public Health
Information Management in Public Health
Fiscal Management in Public Health
Public health infrastructure: the resources and relationships
necessary to carry out public core functions and essential
services in the community.
Including human, informational, financial and organizational
resources.
Human resources (workforce of public health and their
knowledge, skills and abilities).
Organizational resources (the relationships among different
system participants-private and public- and the mechanisms
that manage and coordinate collective actions).
Informational resources (various data, information, and
communication systems).
Fiscal (Financial) resources (funding levels and financial
management skills)
The people who do the actual work of public health are the most
important component of public health infrastructure.
Workforce education and training are not sufficient, which a
complementary set strategies that promote workforce development
through human resources and workplace management activates is also
important.
There are separate workforce development subsystems contribute to
workforce development: One focusing on education and training
strategies and the other emphasizing workplace management
strategies.
Managers and supervisors help to guide the professional development
of workers.
A complementary strategy to promote workforce competency depends
on external bodies to validate and recognize skill levels through
professional credentialing programs.
Health professions take various approaches to credentialing include:
licensing, certifications, and registrations.
Organizational resources in Public Health include the complex web
of federal, state, local, tribal, health agencies and their public,
private and voluntary sector partners and collaborates.
Organizational aspects of public health systems:
Organizations are groups of individuals linked together by common goals and
objectives.
Each organization takes on a structure to delegate its activates to specific units
or individuals and to coordinate the tasks among them.
Many factors shape the ability to survive and thrive in a
changing environment including: its vision, mission, and leadership as well as
key aspects of its operations such as planning, collaboration, and
communications.
The public health organizations differ from private and voluntary ones.
The bottom line of public sector measured in health and quality of life
outcome; while private sector the bottom line is often profits and costumer
satisfactions.
Community and voluntary organization is similar to public sector but the
public sector often have political and bureaucratic environments.
Organizational aspects of public health systems:
Advisory Boards:
Public health agencies at the state and local levels usually have advisory
boards to guide their efforts.
Now the role of many local boards of health has shifted from directing to
advising the agency.
Boards have focused on roles such as approving regulations,
advising/approving agency budgets, and hiring the agency director.
Leadership:
Within public health agencies, leadership position carry several different
responsibilities including: managing the agency, interact with major
stakeholders, carry out some larger official functions.
Non Governmental Organization (NGOs):
They have played important roles in public health activates since 1900.
For example: the National Tuberculosis Association worked for TB prevention
and treatment.
Today, NGOs sponsor diverse public health services and research programs
including family planning, vaccine development, heart diseases and cancer
prevention.
Coalitions and Consortia:
Combination of organizational resources is reflected in the
collaborative links among various agencies and organizations.
It can be formed for short term efforts or established to address
ongoing problems on long term.
It is a formal partnerships involving 2 or more groups working
together to achieve specific goals according to a common plan.
It should include representations from all groups affected by the
problem.
Advantages including that collaborative efforts can function more
efficiently than single organization, conserve limited resources and
providing a pathway for reaching a larger part of the community, as
well as greater credibility.
Coalitions and Consortia:
Key steps for coalitions and other collaborative organizations are:
1. Analyze the program s objectives and determine whether to form a
coalition.
3. Develop a set of preliminary objectives and activates.
4. Convene the coalition
5. anticipate the necessary resources.
6. define the elements of a successful coalition structure.
7. Maintain coalition vitality.
Information resources that support public health practice
include both the scientific basis of public health and the data
and information needed to assess and address health issues.
Knowledge/ scientific base is provided through undergraduate
and graduate level public health education, training, and
experience.
1. Encounter or service based data:
Collected for purposes like reimbursement, eligibility, and
evaluation of care.
Common to programs that provide primary healthcare services
such as nutrition, mental health, substance abuse services as
well as clinical preventive services such as immunizations or
cancer screening.
Data are collected for individual recipients of these services.
The aggregate from these data would provide useful information
on health needs and the health status of a population.
Limitations including: it may not be representative of the larger
population, an individual might participate in more than one
service program, confidentiality and privacy issues.
2. Population based data:
National surveys of health status and service utilization,
behavioral risk surveys of the population.
Information on specific health events and outcome for a defined
population such as cancer incidents registries.
Data sets that describe risk or hazards common to a population
such as environmental monitoring data.
Confidentiality and privacy issues.
Information and Analytic Techniques
Information and the Assessment Functions of Public Health
Information and surveillance
Information and planning
Information and Analytic Techniques:
The capacity of the public health system to effectively use
information expanded during the 20th century.
This including study design and periodic standardized health
surveys.
Methods of data collection evolved from simple measures of
disease prevalence to more complex studies and analyses such
as case-control, cohort, and RCTs.
National Health Surveys (population based surveys) used for
estimating disease prevalence for major causes of death,
measuring the burden of infectious diseases, assessing exposure
to environmental toxicants, measuring the
vaccination coverage, assessing risk factors for chronic diseases.
Information and the Assessment Functions of Public Health:
Information drives the assessment function of public health in 3
ways:
1.Public health agencies use surveillance data to monitor
community health status and to identify a new health risks or
hazards.
2.
available to address those problems.
3.Presented these information to the policy makers in order to
make more effective interventions
Financial resources can be viewed as both inputs and outcomes of
the system.
Economic measure of human, organizational, informational
resources plus the physical facilities and equipment.
Fiscal Dimensions of the public Health System:
The public sector sponsors many but not all the essential public
health services framework.
Additional essential public health services imbedded in several
other government-sponsored programs such as maternal and
child health programs, school health, mental health programs
that operated by federal and state agencies.
Also, some of these essential activities are supported by non
government organizations such as education campaigns of
voluntary health organization
Fiscal Dimensions of the public Health System:
The essential public health services divided into:
1.Population-based public health activities
One-fourth of essential public health services spending ($25-
$30 billion)
Or, about 1% of total national health expenditures.
More than two-thirds derived from nonfederal sources.
2. Personal healthcare activities:
About 70% of essential public health services spending.
$90-$95 billion.
Financial Management in Public Health:
Financial management skills are important in all organizations
especially for midlevel and senior managers.
the major financial management skills for public health
professionals and managers including: understanding and
constructing budgets, interpreting financial data and
communications, and assessing and correcting an
financial status.
Budgets: is a financial tool for systematically converting the
objectives of an organization into plans for acquiring revenues
and controlling expenditures.
Public Health Emergency
Preparedness and Response
Public health roles in emergency preparedness and response
National public health preparedness and response
coordination
State and local preparedness coordination
What is the public health emergency? Examples?
Many refer to an occurrence or imminent threat of widespread or
severe damage, injury, or loss of life or property resulting from a
natural phenomenon or human activity.
After the 9/11 terrorist attack on the World Trade Center and
the bioterrorism events spreading anthrax through the US
postal system, the nation responded quickly by elevating
terrorism & bioterrorism preparedness and emergency
response to the top of the national agenda.
1. Surveillance
2. Epidemiologic investigation and analysis
4. Intervention through effective countermeasures
6. Preparedness planning
7. Community-wide response
1. Surveillance:
Effective preparedness and response rely on monitoring disease
patterns, investigating individual case reports, using epidemiologic and
laboratory analyses to target public intervention strategies.
A prompt recognition and reporting of outbreak cases to health
authorities is critical link in the public health chain of protection.
New approaches to public health surveillance include bio-surveillance
and syndromic surveillance.
They early detect of abnormal disease pattern and nontraditional early
disease indicator (pharmaceutical sales, school and work absenteeism, and
animal disease events).
Passive surveillance: rely on providers to initiate disease report.
Active surveillance: public health workers proactively seek information
from providers to monitor disease trends.
2. Epidemiologic investigation and analysis:
Epidemiologic investigation seek to determine
What is causing the disease
How the disease is spreading and
who is at risk
Answering these questions will help to make rapid and effective
interventions.
Methods for getting epidemiologic info characterized as disease detective

activities
Contacting patients
Obtaining detailed info on location and types of possible exposure
Examining both clinical and environmental samples
It provides the definitive identification of causative agents for both biological and
chemical.
Not all community have labs that are capable to identify rare or unusual diseases,
so, they need to link to higher level labs.
Public health labs must be equipped with specialized protective equipment and
facilities because of the dangerous agents.
4. Intervention through effective countermeasures:
The primary reason for collecting, analyzing, sharing info on disease is for
controlling.
Public health interventions that protect persons from risk associated with
environmental hazards including
Setting standards for health and safety
Inspecting food production and importation facilities
Monitoring environmental conditions
Abating conditions that foster infectious diseases (insect, animal control)
Remediation of environmental hazards by decontamination sites and facilities after they

identified
In sever and unusual circumstances of disease spreading, special emergency
powers put into effect limiting human and animal travel and restricting certain
types of business activities.
In these situations, the importance of effective public education and information

activities to communicate risk to public cannot be exaggerated.
Example, the dissemination of information on mail handling practices during the

anthrax attacks in 2001.
6. Preparedness Planning
Organizing responses to emergencies is an important public health role that
ensures the availability and accessibility of medical and mental health services.
Also, coordinated medical and public health responses ensures that emergency
medical services and medical treatment services are deployed in a rapid and
effective manner.
These planning foresees the needs for public health measures to be activated to
ensure the safety of responders and to prevent 2ry effects caused by further
disease transmission and injury.
Planning for these coordinated responses including:
monitoring available response resources
Establishing action protocols
Simulating emergency events to improve readiness
Training public and private sector staff
Assessing communication capabilities
Maintaining relationships with partner organizations to improve coordination.
Bioterrorism is the threatened or intentional release of biologic agents for the
purpose of influencing the conduct of government or intimidating a civilian
population to further political or social objectives.
These agents can be released by way of air, food, water, insect.
The list of biologic agents with significant bioterrorism potential including 3
categories:
1. Category A: Organisms that pose a risk to national security because
they can be easily disseminated or transmitted from person to person
They result in high mortality rates
Have the potential for major public health impact
They cause public panic and social disruption
2. Category B: 2nd highest priority organisms

they moderately easily disseminated or transmitted from person to person
They result in moderate mortality rates
3. Category C: 3rd highest priority organisms

Include emerging agents that could be engineered for mass dissemination in the future
because of availability, easy production, and dissemination and potential for high
morbidity and mortality rates.
2001 terrorist events resulted in a series of new national policies to
safeguard American citizens.
DHC is the recent federal agency that plays the most important role in
responding to public health emergencies and bioterrorist attacks.
However, several separate federal department and agencies have

roles in preparation for responding to public health emergencies:
Center of Disease Control and Prevention (CDC)
Health Resources and services Administration (HRSA)
Food and drug Administration (FDA)
National Institution of Health (NIH)
Office of the Assistant Secretary for Preparedness and Response (ASPR)
State agencies and assets
Similar to Federal, states rely on a variety of agencies to deliver public health
emergency services.
State health department and state emergency management agency playing the
most important roles.
Incident Command Systems (ICS)

In order to manage resources effectively and facilitate decision making during
emergencies, ICS are used by Police, fire, and emergency management
agencies.
It eliminates many common problems related to communication, terminology,
organizational structure, span of control, and other differences in response to
critical incidents (any natural, man-made event that threaten to cause the loss
of life or injury to people or damage the property).
Key components of Incident Command Systems (ICS)
Common terminology
Modular organization
Integrated communications
A unified command structure
Consolidated action plans
A manageable span of control
Designated incident facilities
Comprehensive resource management
Local agencies and assets
The front line of response to public health emergencies is at the local level.
First responders play key roles in:
Recognizing public health emergencies, including those that result from terrorist
attacks.
Identifying unique personal safety implications associated with the emergency
situation.
Identifying security issues that are unique to event or the to emergency medical
system response.
Understanding basic principles of patient care based on the type of emergency event.
Also, majority LHDs carry out activities related to epidemiology and
surveillance, communicable disease control, food safety, and restaurant
inspections.

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Phc101

Governmental public health system in us is

A.Control foreign commerce

A.Centers for Disease Control and Prevention

a. 2 core functions and 3 essential public health services

a. Recognition of obesity as a health problem

3. Which of the following may classified as international injuries?

a. Centers for disease control and prevention

a. Professionals, people and local level

a. The governmental public health agencies

a. Detect health problems and disease outbreaks

9. What is the mission of public health?

a. Fulfilling society’s interest in assuring conditions in which people be healthy

11. Which one of the following is an example of infectious disease?

12. Which was a key secondary prevention in the 20th century?

a. Improvements in personal hygiene, such as hand washing

15. What of the below factors is considered important determinants of health?

17. Which of the following is a known epidemiological, surveillance and disease-prevention

a. Substance abuse and mental health Services Administration (SAMHSA)

a. Give more initiatives to rise up the level of performance

19. What do we mean by primary prevention?

20. Which one of the following is an example of infectious disease?

Which of the following is a characteristic of management leader?

A. a. can perform technical fixes with little to no risk

Which of the following is not a group of the community?

A. Rural villages and towns

Which of the following is a level of message identification?

A. Compromising strategically with opponents in such of "craving in"

A. Population based interventions

which of the following are attributes for adaptive/extreme leader?

A. Able to manage fear

a. Increased sick days

Which one of the following defines health in some cultures?

Which of the following is described as impudence, temerity, and brazenness?

factors were associated with the largest

Which of the following are ents for building a healthy community?

A. Population based interventions

a. Be clear about the purposes of goals of the engagement

Introduction to Public Health

1. How are communicable diseases controlled?

a. Bad working conditions and disease outbreaks

c. Natural disasters such as volcanoes and floods

c. Surveillance and Epidemiology

d. Maternal and Child Health

Q 3: Which of the following has a mission of fulfilling society's interest in assuring

c. Non communicable disease

Q 4: Which of the following is a practice example of surveillance and research?

a. Provide services for victims of the health problem, including screening

b. Provide information on incidence, prevalence, and risk factors

a. Reduce self-inflicted injuries and death

b. Promote healthy lifestyles across all life stages

c. Ensure drug prescriptions

d. Identify disease etiology

Q 8: Which of the following is a preventive measure for childhood obesity?

b. Increase physical activity

d. Mostly eat out

Q 9: Which of the following is considered a global pandemic non-communicable disease?

b. Severe acute respiratory syndrome (COVID-19)

a. Number of years of life that can be expected on average in a given population

c. Age at death for the most long-lived individual

d. Average length of life of all individuals born a given year

Q 12: What are the two broad classifications of health problems?

a. Alcohol and drug abuse

b. Disease and injuries