INTRODUCTION TO HEALTH  Developmental level

THIS CHAPTER INTRODUCES BASIC PRINCIPLES OF HEALTH,  Race

COMMUNITY HEALTH AND PUBLIC HEALTH, DEFINING  Sex
TERMS AND EXPLAINING VARIOUS FRAMEWORKS WITH 2) Emotional dimension
REGARDS TO UNDERSTANDING HEALTH IN CONTEXT OF  Refers to feelings, affect and person’s ability
COMMUNITY. to express these
 Belief in one’s worth
HEALTH IS A RIGHT!
 Has been known the long-term stress
 1987 Philippine Constitution Article II, Section 15 affects the body systems and anxiety affects
 “shall protect and promote the right of health habits
people and instill health consciousness 3) Intellectual dimension
among them”  Encompasses the cognitive abilities,
 Guides the State in its accountability to ensure educational background and past
every man, woman or child must have access to experiences, positive sense of purpose
quality and equitable health  Influence a client’s response to teaching
about health and reactions to health care
HEALTH during illness
 State of complete physical, mental and social well- 4) Spiritual dimension
being and NOT merely the absence of a disease or  Refers to the recognition and ability to
infirmity (World Health Organization) practice moral or religious principles or
 “resource for everyday life, not the objective of beliefs
daily living. Health is a positive concept emphasizing  relates to our sense of overall purpose in
social and personal resources as well as physical life
capacities.” (OTTAWA CHARTER FOR HEALTH 5) Socio-cultural dimension
PROMOTION, 1986)
 Concerns the sense of having support
WELLNESS available from family and friends; practices,
values and beliefs that determine health
 Integral method of functioning with which is  Refers to our ability to make and maintain
oriented toward maximizing the potential of which meaningful relationships with others
the individual is capable 6) Sexual dimension
 Requires that the individual maintain a continuum  Refers to the acceptance and ability to
of balance and purposeful direction within the achieve satisfactory expression of one’s
environment where he is functioning (Halbert Dunn) sexuality
The health of individuals and communities are affected by a  Feelings about ourselves, roles we play in
combination of many factors. society and reproduction

A person’s health is determined by his circumstances and DETERMINANTS OF HEALTH (WHO)

environment 1) Income and social status
DIMENSIONS OF HEALTH 2) Education
3) Physical environment
1) Physical dimension 4) Employment and working conditions
 Bodily aspect of health 5) Social support networks
 Refers to the more traditional definitions of 6) Culture
health as the absence of disease and injury 7) Genetics
 Can affect the other dimensions of health as 8) Personal behavior and coping skills
a decline in physical health can result in a 9) Health services
decline in other forms of health 10) Gender
 Genetic makeup
 Age SOCIAL WELL-BEING
  Not only is a person free from any physically
debilitating illness, but is also free from any
impediment that will obstruct him or her from
achieving his or her personal goals and aspirations
in life
“BEINGS” MODEL OF DISEASE CAUSATION
1. Biologic factors and Behavioral factors
 Influenced by gender, age, weight, bone
density and other biologic factors
 Human behavior – central factor in health
and disease
 Obesity and overweight
 Multiple behavioral factors
2. Environmental factors
3. Immunologic factors
 Smallpox – first infectious disease known
to have been eradicated from the globe
 Vaccination against disease conferred
individual immunity and produce herd
immunity
 Immunodeficiency – term that describes
inadequate immune function that
predisposes an individual to infections and
other illnesses
4. Nutritional Factors
 Japanese American living in Hawaii had a
much higher rate of MI than people of the
same age and gender in Japan, while
Japanese Americans living in California had
a still higher rate of MI similar individuals
in Japan
 Dietary variations
5. Genetic factors
 Genetic epidemiology
 Genetic screening – Congenital
hypothyroidism and phenylketonuria
6. Services, Social factors and Spiritual factors
 Iatrogenic disease occurs when a disease is induced
inadvertently by treatment or during a diagnostic
procedure
THE COMMUNITY
A community has five core elements (MACQUEEN ET. AL,
2001)
1) Locus
 Describe community as something which
can be located or described, thus implying
a sense of place, locale or geographical
boundaries
 Refers to specific areas such as
neighborhood, a village, a city or country
2) Sharing
 Refers to sharing as an existence of
“shared perspectives” and “common
interests” that would contribute to a sense
of a community
 Values, ideologies, vision, activities,
jargons, passions, opinions, interests,
histories, skin color and sexual identity
3) Joint action
 Described joint action as “source of
community cohesion and identity”
 Was seen as leading “naturally to the
creation of community”
 Socializing, hanging out, conversing,
volunteering together, praying together,
working together and getting things done
together
4) Social ties
 “interpersonal relationships” that formed
the foundation of the community
 Family, parents, siblings, cousins;
roommates, household; lovers, partners,
friends, neighbors, acquaintances; co-
workers, role models and support groups
 They create ties with other people whom
they can trust, whom they feel
comfortable with, who care about each
other, who are known to them and who
they grew up with.
5) Diversity
 It is focused on a larger societal view of
community and made reference to
differences in interpersonal interaction”
 It describes stratification among members,
“communities with a community” or
interwoven groups brought about by
variations in interactions among members
of the community.
COMMUNITY DEVELOPMENT
UNITED NATIONS
 Defines “community development” as a process
where community members come together to take
collective action and generate solutions to common
problems

SYSTEM
 An organized collection of units interacting in
various forms in order to accomplish specific
function or goal
 Simple or complex
 Open or closed
 Complex systems are open system
 Simple system can be connected with another
system to create a more complex system
COMMUNITY
 Composed of units
 Families, households, villages, neighborhoods or
districts
OTHER FORMS OF SYSTEMS IN A COMMUNITY
1) Health system
2) Political system
3) Social class system
MUNICIPAL HEALTH SYSTEM
MAYOR
✔ over-all health manager of the system
✔ Local chief executive of the municipal government
COMMUNITY HEALTH
GERM THEORY
 Louis Pasteur  
 Theory that certain diseases are caused by the
invasion of the body by microorganisms, organisms
too small to be seen except through a microscope
CHARLES-EDWARD AMORY WINSLOW (1920)
 Public Health is defined as “the science and art of
preventing disease, prolonging life and promoting
physical health and efficiency through organized
community efforts for sanitation of the
environment, the control of community infections,
the education of the individual in principles of
personal hygiene, the organization of medical and
nursing service for early diagnosis and preventive
treatment of disease, and the development of the
social machinery which will ensure to every
individual in the community a standard of living
adequate for the maintenance of health.”
WORLD HEALTH ORGANIZATION
 Public Health is defined as “the art of applying
science in the context of politics so as to reduce
inequalities in health while ensuring the best health
for the greatest number”.
PUBLIC HEALTH DEALS WITH THE FOLLOWING...
1) Surveillance of emergence of diseases
2) Identification of diseases among community
members
3) Investigating factors that contribute to the existence
of diseases
4) Educating the community regarding ways that will
prevent them from acquiring the diseases
5) Creation of strategies that will ensure sustained
well-being among the community
6) Provision of health services to address community
members who are already having the disease or
recuperating from complications of the disease
7) Institutionalize lessons learned through policies and
structures that will prevent occurrence of similar or
other diseases
8) Monitoring the health status of the community and
providing means that will ensure them of sustaining
their health and well being
COMMUNITY HEALTH
 Study and improvement of the health
characteristics of a community
Deals with processes that enable communities to
maintain and sustain their health and well-being
 It means dealing with the “supply side” and the
“demand side” of health
A NEW PERSPECTIVE ON THE HEALTH OF CANADIANS,
HEALTH FIELD CONCEPT
1) Human biology
 Described this element as aspects of health,
both PHYSICAL and MENTAL, which are
developed within a human body “as a
consequence of the basic biology of man
and the organic make-up of the individual”
2) Environment
 Described this element as those matters
related to which are external to the human
 body and over which “the individual has
little or no control”
3) Lifestyle
 Described this element as an “aggregation
of decisions by individuals which affect their
health and over which they more or have
less control”
4) Health care organization
 Quantity, quality, arrangement, nature,
relationships of people and resources in the
provision of health care
CONCEPT: THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM
SYSTEM
 Set of interrelated and independent parts that form
a complex whole, and each of those parts can be
viewed as a subsystem with its own set of
interrelated and independent parts
HEALTH SYSTEM
 Interrelated ways in which a country organizes
available resources for the maintenance and
improvement of the health of its citizens and
communities
 Consists of interrelated components in homes,
educational institutions, workplaces, communities,
the health sector and other related sectors
HEALTH SECTOR
 Deals with preventive care, performing
strategies and interventions that will
promote optimal health for the patients and
well-being of the general public
 Maternal and child health services
 Largely community-based
2. SECONDARY CARE
 Serves as referral center for primary health
facilities
 Usually provided by medical specialists and
other medical professionals to whom a
primary care professional has referred to
 Associated with hospital-based care
although not all secondary care physicians
are practicing in a hospital setting
 Cases referred to this level require a more
specialized type of service
 Can be either privately owned or
government operated
 Capable of performing minor surgeries and
some laboratory examinations
3. TERTIARY CARE
 Rendered by specialists in health facilities
 Services are far more advanced considering
that the medical cases referred to this level
are far more complex
 Referral center for secondary facilities
 Cancer management
 Advanced surgeries

 Groups of services or institutions in the

community/country, which are concerned with
the health protection of the population

HEALTH CARE DELIVERY SYSTEM

 Network of facilities and personnel, which carry

out the task of rendering health care to the
people

LEVEL OF HEALTH CARE

1. PRIMARY CARE
 Refers to activities or services provided by a
healthcare professional acting as first point
of contact or consultation for all patients
within a health care system
 “First Point of Contact”
 Barangay or village midwife or public health
nurse
 Family physician or general practitioner –
Primary care physicians

LESSON 2: HISTORY OF PUBLIC HEALTH
PRE-HISTORIC ERA
• supernatural perspective
• adopted “health-related practices”, not for health reasons
but merely for religious purposes
• health or disease is seen as a “divine act”
Shamans were skilled in:
• use of medicinal herbs
• use of amulets
• conduct of ceremonies that would appease gods or
supernatural beings and eventually revert the curse that
caused the illness
• giving advice to individuals on how to maintain an illness-
free life
Geophagy
• ingestion of clay or earth
• also used to cover wounds or cuts
Trepanning
• drilling a hole into a human skull
• believed that by drilling a hole into the skull will release the
evil spirit dwelling within the person which is causing the
disease
ANCIENT EGYPTIANS
• excavation revealed the establishments of rudimentary
baths and toilets in dwelling places
• gave high regard for personal cleanliness
• believed that their deities and spirits still played a role in
the causation of illness
• developed a form of writing and were able to keep records
of how certain illnesses should be cured or treated
• “mummification”
• shamans evolved not just as “summoners” of spirits and
conduits of gods’ messages and medical advice; developed
“surgical skills” and invented devices which appeared to be
prototypes of modern-day surgical instruments
ANCIENT GREEKS
• developed a form of writing and recording through which
precepts and norms were codified and documented
• started to re-think the way Ancient Egyptians looked at
health and illness
• “rational” or “logical” paradigm
• cultivated the desire for knowledge
Hippocrates
• Father of medicine
• contributed largely to the “professionalization” of medicine
• wrote De Aere, Aquis Et Locis (Of Air, Water, and Land)
where he proposed that diseases develop because of our
environment and not because of some form of divine acts
• first rational guide to establishment of a science-based
public health
• noted the effect of food, of occupation and even climate in
causing the disease
• established “Hippocratic School of Medicine”
• first to use the terms acute, chronic, epidemic, paroxysms,
and exacerbation:
o Acute - disease or disorder that lasts a short time, comes
on rapidly, and is accompanied by distinct symptoms
o Chronic - persists for a long period of time, lasting for 3
months or more
o Paroxysms - may be due to the sudden occurrence of
symptoms or the acute exacerbation (the abrupt worsening)
of preexisting symptoms
o Exacerbation - refer to an increase in the severity of a
disease or its signs and symptoms
o Endemic - constant presence and/ or usual prevalence of a
disease or infectious agent in a population within a
geographic area
o Epidemic - an increase, often sudden, in the number of
cases of a disease above what is normally expected in that
population in that area
o Pandemic - worldwide spread of a new disease
▪SARS-COV-2 - causative agent of COVID-19
“The Constitution of Man” (Hippocrates)
• health is achieved once these four humors maintain a
harmonious balance
• a person would get sick if one of these humors would be in
excess or inadequate
Four Humors
1. Phlegm - cough, colds and asthma, bronchitis, and
diseases of the lungs
2. Blood - heart disease, angina, nosebleeds, anemia,
diabetes, skin disorders, and acne
3. Yellow Bile - jaundice, gallstones, migraines, joint pain,
and swellings (arthritis)
4. Black Bile - constipation, ulcer, shaking and tics, will not
eat
ROMANS
• more focused on preventing illnesses rather than curing
them
• adopted Greek thinking when it comes to health and
medicine
• spent more of their wealth and efforts in developing
infrastructures that would develop their conquered states
• built sewers and aqueducts many of which still exist
today
• learned much about health and medicine through
wounded warriors or gladiators coming from various
conquests or games
• preferred studying on living persons
• believed that establishment of community sanitation
contribute to the maintenance of health and the
prevention of spread of diseases
• public baths
• built hospitals where they brought the sick and the
injured for treatment and study
Galen
• his works became a foundation for the human anatomy
and his work became scientific dogma
• from Greece to Rome
MIDDLE AGES OR “DARK AGES”
• landlords or serfs replaces monarchs
• monasteries established hospices that would cater to
travelling pilgrims who gets sick along the way
• landlords protected the villages and built forts which
later evolved into castles in order to provide defense
from potential invaders or plunderers
• concepts of sin-illness is consequence of sin and to
restore one’s health, it was necessary to make amends
with God and to have one’s sins forgiven
BLACK PLAGUE
• the “Bubonic Plague” - tell-tale bubos
• decimated 1/3 of Europe’s population over the span of
5 years
• caused by Yersinia pestis, transmitted through flea bites
(rodents, and such)
• persons infected would have swollen lymph glands
located at the axillae, groin, and upper femoral areas
• gangrene of the extremities, high fever, and
hematemesis, aching. lymph nodes become black
• initial symptoms include : vomiting, nausea, fever
• outbreak started in China and through the trade routes
the disease was brought to Europe
• “Black death” - covered in black boils
Quarantine
• state, period, or place of isolation in which people or
animals that have arrived from elsewhere or been
exposed to infectious or contagious disease are placed
• came from Italian word, Quaranta, which means 40
Isolation
• separates sick people from those who are not sick
EARLIER PART OF THE MEDIEVAL PERIOD
• medical schools began to developed around Europe and
Middle East Asia
• Schola Medicana Salernitana – world’s first medical
school
ISLAMIC MEDICINE
• developed strongly from influences of Greek and
Roman traditions
• Proliferation of female doctors
Al-Razi (Muhammad ibn Zakariya Razi)
• “Father of pediatrics”
• wrote the book, “The Diseases of Children”, and was
said to be trailblazer in the field of ophthalmology
• extensively wrote about medicinal plants and other
modes of therapy
Avicenna
• wrote “The Cannon of Medicine” which became a
major reference book for medical schools worldwide
until the middle of the 16th century
RENAISSANCE PERIOD
• Girolamo Fracastoro
o discovered fomites - vehicle carrying pathogens that
could cause disease
o broadened the public’s understanding of how
epidemics or infections were spread
• Andreas Vesalius
o wrote “On the Structure of the Human Body” where
he described a detailed structure of the human body
• William Harvey
o did intensive study of the human circulatory system
and properties of blood
o English physician who was the first to recognize the
full circulation of the blood in the human body and to
provide experiments and arguments to support this idea
Anton Van Leeuwenhoek
o Father of Microbiology
o observed through a crude microscope bacteria and
other microorganisms and initiated a new thinking on
diseases and how they can be caused by these organisms
o was the 1st scientist ever to give a detailed description
of red blood cells (1675) and human spermatozoa (1677)
or to see single-celled bacteria and protozoa. In 1683 he
MACM
scraped some tartar off of his own teeth, looked at it
under a microscope, and found living organisms
15TH CENTURY
• Italian board of health started institutionalizing a
system that would record and register deaths
• Bills of Mortality – form of death registration
John Graunt
• made a pioneering analysis of the bills of mortality in
his work “Natural Political Observations Made Upon
the Bills of Mortality”
• basis for evidence-based planning and evaluation of
public health interventions
AS EARLY AS 1500s
• parishes in England were already requiring the family
of the deceased prior to the burial certain
documentations which would be the equivalent to
modern-day death certificates
COLONIAL PERIOD
• exchange of diseases between colonizer and colonized
• Spanish to Americans (smallpox virus)
• Americans to Europe (syphilis - sexually transmitted
disease cause by treponema pallidum; thought to be
transmitted through water, thus the closing of public
baths)
Syphilis
• sexually transmitted infection that can cause serious
health problems if it is not treated
• divided into stages (primary, secondary, latent, and
tertiary)
• direct contact with a syphilis sore during vaginal, anal,
or oral sex
• The only way to avoid STDs is to not have vaginal,
anal, or oral sex. If you are sexually active, you can do
the following things to lower your chances of getting
syphilis:
Prevention
• protected sex (using latex condoms prevent
transmission of syphilis by preventing contact with a
sore. Sometimes sores occur in areas not covered by a
condom. Contact with these sores can still transmit
syphilis.)
• being in a long-term mutually monogamous
relationship with a partner tested negative for syphilis
• not to have vaginal, anal, or oral sex
NEW WORLD introduced new remedies in European
society (Medicinal plants)
• Quanine – from the South American Quina-quina tress
and became the first medicine against Malaria
• Carl Linnaeus – “Cinchona”
• Quianghao plant (Artemisia annua) – used by the
Chinese as early as the 2nd century in treating malaria;
Artemisinin was isolated from this plant
1800s
Charles Louis Laveran
• discovered parasites in the blood of the patients
suffering from symptoms of Malaria
Ronald Ross
• discovered the malarial parasites could be transmitted
by mosquitoes and patients would get infected by the
parasites through mosquito bites
Edward Jenner
• Father of Immunology
• pioneered the process of vaccination or immunization
• coined the term “vaccine” from the word “vacca” or
“cow”
• discovered the vaccine against the smallpox virus
• observed that while many are susceptible to smallpox, a
group of milkmaids was actually “resistant to the
disease”
• surmised that the exposure of the milkmaid to cowpox
made them resistant to smallpox
• tested this hypothesis by injecting cowpox pustule into
a named James Philips
• the boy should be resistant to smallpox afterwards
COLONIAL PERIOD
• public health challenges
• Edwin Chadwick
o wrote “report of the inquiry into sanitary conditions
of laborinf population of great britains”
o revealed the results of the Commission’s study on the
prevalence and causation of preventable diseases
• Dr. John Snow
o Father of Epidemiology
o was able to elucidate how cholera was transmitted by
tracing the source (water pump)
o Vibrio cholerae serogroup O1 or O139 (bacteria that
causes cholera)
• Florence Nightingale
o “The Lady with the Lamp”
o founder of modern nursing
o helped push for the professionalization of nurses
• Lilian Wald
o introduced the concept of public health nursing
• Robert Koch
o investigated the anthrax disease cycle in 1876, and
studied the bacteria that causes tuberculosis in 1882, and
cholera in 1883
o formulated Koch’s postulates
MACM

1. The microorganism must be found in abundance in all
organisms suffering from the disease, but should not be
found in healthy organisms
2. The microorganism must be isolated from a diseased
organism and grown in a pure culture
3. The cultured microorganism should cause disease
when introduced into a healthy organism
4. The microorganism must be re-isolated from the
inoculated, diseased experimental host and identified as
being identical to the original specific causative agent
Koch’s Postulates
• Louis Pasteur
o pasteurization
o challenged the predominant concept of spontaneous
regeneration\
IN PHILIPPINES
• American colonizers established the board of health for
the Philippine islands through Philippine Commission
• later replaced by Bureau of Health
• renamed as Department of Public Health and Welfare
• first secretary was Dr. Jose Fabella
• department became Department of Health
• Fr. Juan Clemente
o organized he dispensary that was the first hospital
established in the Philippines
o dispensary became San Juan De Dios Hospital
o University of Sto. Tomas – first medical school in the
country
AFTER WORLD WAR II
• World Health Organization (WHO) 1948
• Center for Disease Control and Prevention in Atlanta
Jonas Salk and Albert Sabin
• developed the polio vaccine
1. Acquired Immune Deficiency Syndrome (AIDS)
2. Severe Acute Respiratory Syndrome (SARS)
3. Swine flu
4. Avian flu
5. Ebola virus
6. Coronavirus disease (COVID-19)
Emerging Diseases
Acquired Immune Deficiency Syndrome (AIDS)
• caused by HIV (unprotected sex, hypodermic needles,
mother to child during pregnancy)
• transmitted via unprotected sex, contaminated blood
transfusions, hypodermic needles and mother to child
during pregnancy
• currently no cure for AIDS
• anti-retroviral treatment has been shown to reduce the
risk of death and complications
Swine Flu
• H1N1 virus
• direct contact with pigs
• 2009 to 2010 – WHO declared the flue caused by h1n1
to be a global pandemic
Avian Flu
• H5N1 virus
• direct contacts with infected animals and contaminated
environment
• refers to the disease caused by infection with avian
(bird) influenza (flu) Type A viruses
• human infections are primarily acquired through
direct contact with infected animals or contaminated
environments, these viruses have not acquired the ability
of sustained transmission among humans.
• humans can be infected with zoonotic influenza
viruses such as avian or swine influenza viruses.
Ebola Virus
• Ebola hemorrhagic fever
• discovered by Peter Piot
• Transmitted to people from wild animals and spreads
in the human population through human-to-human
transmission
• vaccines to protect against Ebola are under
development and have been used to help control the
spread of Ebola outbreaks Guinea and in the Democratic
Republic of the Congo (DRC)
Coronavirus Disease COVID-19
• infectious disease caused by a newly discovered
coronavirus
• on February 11, 2020, the WHO Director-General, Dr.
Tedros Adhanom Ghebreyesus, announced that the
disease caused by this new CoV was a “COVID-19,”
which is the acronym of “coronavirus disease 2019”
• causative agent: SARS-COV2
• based on the large number of infected people that were
exposed to the wet animal market in Wuhan City, China,
it is suggested that this is likely the zoonotic origin of
COVID-19
MACM
Lesson 3: COMMUNITY HEALTH, EPIDEMIOLOGY
AND HUMAN BEHAVIOR

WHO’S COMMUNITY HEALTH NEEDS

ASSESSMENT (2001)
1) Physical environment in which people live
2) Social environment
3) Poverty
4) Behavior and lifestyle
5) Family genetics and individual biology

COMMUNITY PROFILING
1) Work and levels of employment and COMMUNITY ORGANIZING
unemployment o The process of which community groups are
2) Poverty and income helped to identify common problems or goals,
3) Environment mobilize resources and in other ways develop
and implement strategies for reaching the goals
WORK AND LEVELS OF EMPLOYMENT AND they collectively set (Minkler and Wallerstein)
UNEMPLOYMENT
O Occupational diseases – ALL work affects TYPES OF COMMUNITY ORGANIZATION
health, both positively and negatively 1) Locality development – process-oriented,
O Income levels creating a consensus and sense of cooperation
O Self worth 2) Social planning – task-oriented; rational-
empirical problem-solving
POVERTY AND INCOME 3) Social action – both task and process-oriented
O Can be absolute or relative
O Health inequality STEPS IN COMMUNITY ORGANIZING
1) Problem identification
ENVIRONMENT 2) Interface with Community
O Pollution 3) People Organization
O Good sanitation 4) Community Profile and Assessment
O Lack of home 5) Goal-setting and Formulation of Strategies
O Transport systems 6) Implementation of Agreed Strategies or
O Social support Solutions
O Family and friendship networks 7) Monitoring and Evaluation
O Migration 8) Sustaining Gains, Addressing Emerging
O Marginal groups Problems
O Opportunities for non-work social activities
EPIDEMIOLOGY
DESTABILIZING FACTORS o Comes from the Greek words epi, meaning on or
“War, economic recession and natural disasters such as upon, demos, meaning people, and logos,
earthquake, floods or drought affect health directly meaning the study of
through their impact on mortality, disease patterns and o Study of the distribution and determinants of
lifestyle change; affect health indirectly by reducing the diseases and injuries in human populations
resources available for health services, increasing (Mausner and Kramer, 1985)
poverty and lowering the social and economic well- o Defined as the study of factors that determine
being of a population. They may radically lower the occurrence and distribution of disease in a
population numbers and increase fear and mental ill population
health.” o Accomplished by describing outbreaks and
designing studies to analyze them and to

MACM
 validate new approaches to prevention, control, o Interested in discovering risk factors that might
and treatment be altered in a population to prevent or delay
o Study of the distribution and determinants of disease, injury or death
health-related states or events in specified o Application of principles of epidemiology to
populations, and the application of this study clinical medicine
to the control of health problems o Investigators involved in clinical epidemiology
often use research designs and statistical tools
WHAT PUBLIC HEALTH PROBLEMS OR o Clinical epidemiologists often study patients in
EVENTS ARE INVESTIGATED? health care settings rather in community at large
Environmental exposures
o Lead and heavy metals
o Air pollutants and other asthma triggers
Infectious diseases
o Foodborne illness ETIOLOGY AND NATURAL HISTORY OF
o Influenza and pneumonia DISEASE
Injuries
o Increased homicides in a community ETIOLOGY
o National surge in domestic violence o Cause of a disease or abnormal condition

NATURAL HISTORY OF DISEASE

Non-infectious diseases o The way a disease progresses in the absence of
o Localized or widespread rise in a particular type medical or public health intervention
of cancer
o Increase in a major birth defect EPIDEMIOLOGIC TRIANGLE
Natural disasters
o Hurricanes Katrina and Rita (2005)
o Haiti earthquake (2010)
Terrorism
o World Trade Center (2001)
o Anthrax release (2001)

HOST
o “WHO” of the triangle, the person or organism
harboring the disease
o Host factors are responsible for the degree to
which the individual can adapt to the stressors
produced by the agent
AGENT
o “WHAT” of the triangle, whatever causes the
CLASSICAL EPIDEMIOLOGY disease
o Studies the distribution and determinants of o Biologic agents, chemical agents, physical
disease in populations and the community agents, social and psychological stressors
origins of health problems ENVIRONMENT
o “WHERE” of the triangle

MACM
 o External factors that cause or allow disease
transmission
o Influences the probability and circumstances of
contact between the host and agent
VECTORS
o “HOW” of the triangle
o Insects, arachnids and mammals
Endemic
o refers to the constant presence and/or usual
prevalence of a disease or infectious agent in a
population within a geographic area
Epidemic
o refers to an increase, often sudden, in the
number of cases of a disease above what is
normally expected in that population in that area
Sporadic
o refers to a disease that occurs infrequently and
irregularly
Outbreak
o carries the same definition of epidemic, but is
often used for a more limited geographic area
Cluster
o refers to an aggregation of cases grouped in
place and time that are suspected to be greater
than the number expected, even though the
expected number may not be known
Pandemic
o refers to an epidemic that has spread over
several countries or continents, usually affecting
many people
SOLUTIONS OF PUBLIC HEALTH PROBLEMS
AND UNINTENDED CREATION OF NEW
PROBLEMS
VACCINATIONS AND PATTERNS OF
IMMUNITY
o A vaccine provides herd immunity if it not only
protects the immunized individual, but also
prevents that person from transmitting the
disease to others
DIPTHERIA
o Vaccine-produced immunity in humans tends to
decrease over time
o This phenomenon has a different impact at
present, when infectious agent, than it did in the
past
o “Natural booster effect”
SMALLPOX
o Eradication was accomplished by effective
immunization
o “variolation”
POLIOMYELITIS
o Polio was officially eradicated in 36 Western
Pacific countries in 2000 and Europe was
declared polio free in 2002
o Polio remains endemic in only three countries
(Afghanistan, Pakistan and Nigeria)
HUMAN PAPILLOMAVIRUS (HPV)
o HPV vaccination protects against infection with
human papillomavirus
o Each year in United State, it is estimated that
HPV causes 32,500 cancers in man and women,
and HPV vaccination is thought to be able to
prevent most these cancers from developing.
SYPHILIS
o Caused by infection with bacteria known as
spirochetes and progresses in several stage
o Primary, secondary and latent stage
o Penicillin
EPIDEMIOLOGIC DATA MEASUREMENTS
INCIDENCE
o Frequency of occurrences of disease, injury or
death
PREVALENCE
o Number of persons in a defined population who
have a specified disease or condition at a given
point of time
RATES
o Number of events in a given population over a
specific period or at a given point of time
o Shows the relationship between a vital event and
those persons exposed to the occurrence of the
said event
MACM
CRUDE OR GENERAL RATES o Index of the obstetrical care needed and received
o Referred to the total living population by women in a community
o Must be presumed that the total population was
exposed to the risk of the occurrence of the
event

SPECIFIC RATE
o Relationship is for a specific population class or
FETAL DEATH RATE
group
o Measures pregnancy wastage
o Limits the occurrence of the event to the portion
o Death of the product of conception occurs prior
of the population definitely exposed to it
to its complete expulsion, irrespective of
CRUDE BIRTH RATE duration of pregnancy
o Average annual number of births during a year
per 1,000 persons in the population at the mid-
year
o Dominant factor in determining the rate of
population growth
NEONATAL DEATH RATE
o Measures the risk of dying the 1st month of life
o Serves as an index of effects of prenatal care and
obstetrical management of the newborn

CRUDE DEATH RATE

o Measure of one mortality from all causes which
may result in a decrease of population
INCIDENCE RATE
o Measures the frequency of occurrence of the
phenomenon during a given period of time

INFANT MORTALITY RATE

o Measures the risk of dying during the 1st year of
life
o Good index of the general health condition of a
community since it reflects the changes in the
environment and medical condition of a
community
PREVALENCE RATE
o Measures the proportion of the population which
exhibits a particular disease at a particular time
o Can only be determined following a survey of
the population concerned, deals with the total
(new and old) number of cases

MATERNAL MORTALITY RATE

o Measures the risk of dying from causes related
to pregnancy, childbirth and puerperium

MACM

ATTACK RATE
o More accurate measure of the risk of exposure
PROPORTIONATE MORTALITY
o Death Ratios
o Shows the numerical relationship between
deaths from all causes (or groups of causes), age
(or group of age) etc., and the total no. deaths
from all causes in all ages taken together
CASE FATALITY RATIO
o Index of a killing power of a disease and is
influenced by incomplete reporting and poor
morbidity data
PRESENTATION OF DATA
1) Line graphs
- shows peaks, valleys and seasonal trend
- used to show the trends of birth and death rates
over a period of time
2) Bar graphs
- each bar represents a quantity of terms of rates
or percentage of a particular observation
3) Area diagram (Pie chart)
- shows the relative importance of parts to be
whole
DISABILITY-ADJUSTED LIFE YEARS (DALY)
o Emerged as a measure of the burden of disease
o Reflects the total amount of healthy life lost, to
all causes whether from premature mortality or
from some degree of disability during a period
of time
DISABILITY-ADJUSTED LIFE YEARS
(DALY) INTENDED USE
o In setting health services priorities
o In identifying disadvantages groups and
targeting of health intervention
o In providing a comparable measure of output for
intervention, program and sector evaluation and
planning
LIFE SPAN
o Refers to the number of years a person lives
LIFE EXPECTANCY
o Refers to the number of years a person is
expected to live from a specified starting point
COLLECTING DATA METHODOLOGIES
o Surveillance Reporting
o Surveys
o Census
SURVEILLANCE REPORTING
o Health facilities are expected to submit monthly
and annual reports pertaining to identified health
data being monitored by the National
Government
SURVEYS
o Method of gathering any type of information or
data from a sample of individuals
o Sample means that the data is only taken from a
portion of the total population under study
o National Household Targeting System for
Poverty Reduction of the Philippine DSWD
- data bank and an information management
system which identifies who and where the poor
are in the country
CENSUS
o Opposite of survey
o Counting of data gathered from the entire
population
o Regularly occurring and official count of the
human population of a certain local
administrative unit
o Philippine Statistics Authority– agency that
conducts the census in the Philippines
MACM
BEHAVIOR CHANGE
SOCIAL COGNITIVE THEORY (BANDURA,
1986)
o Explains that human functioning can be
explained by a triadic interaction of behavior,
personal and environmental factors

THEORY OF PLANNED BEHAVIOR

o Suggests that behavior is dependent on one’s
intention to perform the behavior
o Intention
- determined by an individual’s attitude and
subjective norms
o Behavior
- determined by an individual’s perceived
behavioral control

TRANSTHEORETICAL MODEL
o Stages of Change Model
o A person undergoes at least six stages of change
or transformation

MACM
LESSON 4: HEALTH LEADERSHIP AND
GOVERNANCE

MACM