Public Health
● A science and art of preventing disease,
Health - derived from “hal”
● A state of complete physical, mental, and
social well-being and not merely the
absence of disease and infirmity (WHO,
1946).
● “A resource for everyday life, not the object
of living, and is a positive concept
emphasizing social and personal resources
as well as physical capabilities.” –WHO,
1989
● A dynamic state or condition of the human
organism that is multidimensional (i.e.,
physical, emotional, social, intellectual,
spiritual, and occupational) in nature, a
resource for living, and results from a
person’s interactions with and adaptations
to his or her environment.
Interconnections of the Determinants of Health
1. Gestational Endowments
2. Social Circumstances
3. Environmental Conditions
4. Behavioral Choices
5. Medical Care
Health Equity
● The absence of systematic disparities in
health between and within social groups
that have different levels of underlying
social advantages or disadvantages—that
is, different positions in a social hierarchy
Community
● A geographic area with specific boundaries
● Community and Public Health
➔ A collective body individuals
identified by common characteristics
such as geography, interests,
experiences, concerns, or values
● Communities are characterized by the
following elements:
1. Membership
2. Common symbol systems
3. Shared values and norms
4. Mutual Influence
5. Shared needs and commitment to
meeting them
6. Shared emotional connection
prolonging life, promoting health and
efficiency
➔ Through organized community effort
for the sanitation of the environment,
control of communicable diseases,
and the education of individuals in
personal hygiene
● Actions that society takes collectively to
ensure conditions in which people can be
healthy
Community Health
● Health status of a defined group of people
and the actions and conditions to promote,
protect, and preserve their health
➔ The health status of the people of
Dasmariñas, Cavite, and the private
and public actions taken to promote,
protect, and preserve the health of
these people would constitute
community health.
Population Health
● Health outcomes of a group of individuals,
including the distribution of such outcomes
within the group
➔ Group of individuals : whether by
age, gender, income, marital status,
etc.
Global Health
● Health problems, issues, and concerns that
transcend national boundaries, may be
influenced by circumstances or experiences
in other countries, and are best addressed
by cooperative actions and solutions
➔ Examples of Global Health issues :
COVID-19, Zika Virus, HIV/AIDS

➢ Prior to 2000 b. c. e. - Archeological
findings provide evidence of sewage
disposal and written medical prescriptions.
➢ Circa 1900 b. c. e. - Perhaps the earliest
written record of public health was the Code
of Hammurabi; included laws for
physicians and health practices
➢ Circa 1500 b. c. e. - Bible’s Book of
Leviticus written; includes guidelines for
personal cleanliness and sanitation. See
Leviticus 15:11-18
CODE OF HAMMURABI RELATING TO
SURGICAL ACTIVITIES
● If a physician make a large incision with an
operating knife and cure it, or if he open a
tumor (over the eye) with an operating knife,
and saves the eye, he shall receive ten
shekels in money.
● If the patient be a freed man, he receives
five shekels.
● If he be the slave of some one, his owner
shall give the physician two shekels
● If a physician make a large incision with the
operating knife, and kill him, or open a
tumor with the operating knife, and cut out
the eye, his hands shall be cut off.
● If a physician make a large incision in the
slave of a freed man, and kill him, he shall
replace the slave with another slave.
● If he had opened a tumor with the operating
knife, and put out his eye, he shall pay half
his value.
● If a physician heals the broken bone or
diseased soft part of a man, the patient shall
pay the physician five shekels in money.
● If he were a freed man he shall pay three
shekels.
● If he were a slave his owner shall pay the
physician two shekels.
● If a veterinary surgeon perform a serious
operation on an ass or an ox, and cure it,
the owner shall pay the surgeon one-sixth of
a shekel as a fee
● If he perform a serious operation on an ass
or ox, and kill it, he shall pay the owner
one-fourth of its value.
● If a barber, without the knowledge of his
master, cut the sign of a slave on a slave
not to be sold, the hands of this barber shall
be cut off.
● If any one deceive a barber, and have him
mark a slave not for sale with the sign of a
slave, he shall be put to death, and buried in
his house. The barber shall swear: “I did not
mark him wittingly,” and shall be guiltless.
➢ The Christians
○ Created hospitals as benevolent
charitable organizations
➢ Fall of Roman Empire 476 C.E
○ Most public health activities creased
➢ Growing revulsion for Roman materialism
and a growth of spirituality.
➢ Health problems were considered to have
both spiritual causes and spiritual solutions,
a time referred to as the spiritual era of
public health.
➢ The Black Death (543 – 1348)
➢ Leprosy (1200)
➢ Smallpox, diphtheria, measles, influenza,
tuberculosis, anthrax, and trachoma.
➢ Syphilis (1492)
➢ Rebirth of thinking about the nature of the
world and humankind.
➢ Belief that disease was caused by
environmental, not spiritual, factors.
○ Malaria = bad air
➢ Observation of ill led to more accurate
descriptions of symptoms and outcomes of
diseases.
➢ first recognition of whooping cough, typhus,
scarlet fever, and malaria as distinct and
separate diseases.
➢ 1662: John Graunt published the
Observations on the Bills of Mortality, the
beginning of vital statistics.
➢ Epidemics (e.g smallpox, malaria, and
plague) are still rampant.
○ plague epidemic killed 68,596 (15%
of the population) in London in 1665.
➢ Explorers, conquerors, and merchants and
their crews spread disease to colonists and
indigenous people throughout the New
World.
➢ Columbus built his first town on the nearby
island of Hispaniola. Lacking immunity to
Old World pathogens carried by the
Spanish, Hispaniola’s indigenous
inhabitants fell victim to terrible plagues of
smallpox, influenza, and other viruses.
➢ Struck London
➢ Dr. John Snow studied the epidemic and
hypothesized that the disease was being
caused by the drinking water from the Broad
Street pump.
➢ 1862 : Louis Pasteur introduces Germ
Theory of Diseases
➢ 1876 : Robert Koch demonstrates the
anthrax bacillus
➢ 1900 : Reed declares that mosquitoes are
the source of yellow fever.
➢ 1945-1948 : Foundation of WHO through
the UN diplomats
○ April 7, 1948 : Constitution of
WHO came into force, basis of
World Health Day
➢ 1959 – WHO Global Smallpox Eradication
Program
○ 1980 – Smallpox declared to be
eradicated

➢ Characterized by industrial growth

➢ Despite the beginnings of recognition of the
nature of disease, living conditions were
hardly conducive to good health.
➢ Many jobs were unsafe or involved working
in unhealthy environments, such as textile
factories and coal mines.
○ Workforce: poor, children
indentured servants
➢ 1796 : Edward Jenner introduces smallpox
vaccine.
➢ Predominance of Miasmas Theory
➢ Bacteriological period of public health
the period of 1875–1900, during which the
causes of many bacterial diseases were
discovered
➢ Modern era of public health the era of
public health that began in 1850 and
continues today .
➢ Ancient Filipinos regarded health as a
harmonious relationship with the
= environment, both natural and supernatural.
➢ Use of medicinal plants to cure various
ailments.
➢ Malaria has been present in the Philippines
for centuries.
➢ Ailments were believed to be caused by
disharmony with the spiritual world, and
restoring health meant appeasing the gods
through rituals.
○ At the center of these rituals was the
babaylan, mediator between the
physical and spiritual worlds.

➢ One of the most prized medicinal plants is
the igasud from the mountain regions of the
Visayas. Its seed when chewed is an
antidote for poison.
○ renamed Pepita of San Ignacio by
Spanish missionaries.
➢ Spaniards attempt to westernize the
practices of our ancestors.
➢ The San Lazaro Church and Hospital
represents early medical healthcare in the
Spanish era.
➢ The Spanish were not accustomed to the
climate, food, and other challenges of living
in the Philippines hence many succumbed
to a number of diseases and were treated in
hospitals specially created for their welfare.
➢ Hospital Real
○ The very first hospital in the
Philippines
○ Established in Cebu in 1565 by
Miguel Lopez de Legazpi as
approved by King Philip II
○ Relocated in Manila when the seat
of power transferred there.
○ exclusively for Spanish soldiers and
sailors
○ destroyed during an earthquake on
June 3, 1863
➢ Hospital de Naturales (1578 by Fray
Clemente)
○ 1603 - Was destroyed by fire
(following Fray Clemente’s death).
○ A new location was chosen for the
reconstruction of the facility, a
development that led to the
establishment of one of the oldest
medical institutions in the country,
the Hospital de San Lazaro.
➢ Hospital de San Lazaro
○ Site : Dilao (Paco)
○ The name was given after the
hospital undertook the care of 150
lepers sent to the Philippines by the
Japanese emperor Iemitsu in 1632
at the time of Governor-General
Juan Nino de Tabora.
○ Demolished in 1662 when the city
was under the threat of invasion by
the Chine Pirate Chen Ch’e Kung.
➢ 1582 - Miguel de Loarca reported that
inhabitants of Cebu were afflicted by itchy
lesions and a certain "bubas."
○ Accounts say this “bubas” came
from Bohol when raiders from
Maluku infected the natives.
➢ Introduction of safe water supply in 1690s
○ The water taken from various water
sources are stored in bamboo poles
➢ 1871 – UST FACULTY OF MEDICINE AND
PHARMACY was established.
○ first medical school in the Philippines
➢ 1574 Smallpox Epidemic – first recorded
epidemic in the country
➢ 1789 - a vessel from China traveling to the
Ilocos region was believed to be the
probable source of an epidemic that soon
spread to Manila and its neighboring
provinces
➢ April 15, 1805 – Dr. Francisco de Balmis
smallpox vaccine expedition as ordered by
King Charles IV
➢ Focused on improving healthcare by
building more hospitals and implementing
measures to prevent the spread of
diseases.
➢ Formal medical education and more
medical benefits were given to Filipinos.
➢ Bureau of Public Health
○ Part of Aguinaldo’s government
○ Replaced by the Board of Health for
City of Manila upon the takeover of
the Americans
○ Headed by Dr. Frank Bourns
➢ 1899 – Appointment of Dr. Guy Edie as the
first Commissioner of the Board of
Health
➢ 1901 – Board of Health for Philippine
Islands
○ Became Insular Board of Health

➢ 1902-1905 : Cholera epidemic claimed
200,222 lives.
○ 66,000 were children
➢ 1905 – establishment of UP College of
Medicine and Surgery using John Hopkins
University as their model
➢ 1907 – enactment of the Leper Law
➢ 1917 – Mass Vaccination for Smallpox
○ 25 million Filipinos were given the
vaccine
➢ 1915 – Bureau of Health reorganized and
renamed as Philippine Health Services
➢ 1916 – enactment of Jones Law by
Woodrow Wilson
○ PHS came under the supervision of
the Department of Public instruction
➢ Dr. Vicente de Jesus
○ 1914 – appointed as the first
Filipino Assistant Director of
Philippine Health Services ;
Became the Director in 1919
○ Started the Filipinization of Health
Services
➢ 1921 – Warren Harding becomes the US
president
○ Immediate investigation and
evaluation of the conditions in the
Philippines headed by Leonard
Wood and William Forbes
○ noted the lack of hospitals and
dispensaries and the loss of “zeal
and vigor” among the health
personnel.
➢ Focused on health education targeting
young children and their mothers
○ Required school children to undergo
a health examination once a year.
➢ 1932 - Theodore Roosevelt Jr. becomes
Gov. Gen
➢ 1933 – Reverted PHS to Bureau of Health
○ Established Community Health and
Social Centers (precursors of
Barangay Health Centers that we
know today)
○ Traveling X-ray clinics and TB
pavillons were set up in the
provinces
➢ 1934 – Dr. Jose Fabella is appointed as
commissioner of Public Health and Welfare
and soon as the first Secretary of Health
and Public Welfare
○ During this period, incidence of
water-borne diseases significantly
decreased due to the construction of
a modern water filtration plant in
Manila that supplied safe quality
water.
➢ 1935 – Start of PH Commonwealth (Manuel
L. Quezon)
➢ 1939 – Department of Health and Public
Welfare
○ Combination of PHS, Office of Public
Welfare Commissioner, and
Tuberculosis Commission
➢ October 14, 1943 – inauguration of the
Japanese Sponsored Republic with Jose P.
Laurel as President
○ Claro M. Recto – Commissioner of
Education, Health, and Public
Welfare
○ Dr. Eusebio Aguilar – Director of
Health
➢ Increased incidence of malaria, TB, and
severe malnutrition
➢ About 5,000 segregated lepers escaped in
search for food
➢ February 27, 1945 : reconstitution of
commonwealth with Sergio Osmena as
President
➢ A survey of the health and sanitary
conditions in post-war Philippines
conducted by the United States Public
Health Service (USPHS) reported grim
findings:
 ○ The cases of infectious diseases
were high; malnutrition and beriberi
were widespread; public sanitation
➢ People Power Revolution of 1986 – Aquino
was in a deplorable state; and
Administration
destruction of health infrastructure
○ EO 119 – revert Ministry of Health to
posed new threats of cholera,
DOH
plague, smallpox, and other
○ Dr. Alfredo Bengzon as the
epidemics.
Secretary of Health
➢ 1992 – Magna Carta for Public Health
Workers (RA 7305)
➢ October 4, 1947 : Establishment of DOH ➢ 1995 – National Health Insurance Act (RA
○ Executive Order No. 94 by President 7875)
Manuel Roxas ○ Signed by Fidel V. Ramos
○ separation of the country’s health ○ Established PhilHealth
and public welfare offices ➢ 2019 – Universal Health Care Act (RA
➢ Dr. Antonio C. Villarama was appointed 11223)
Secretary.
➢ Had three distinct units
➢ Reorganized in 1958 under Pres. Elpidio
➢ 2004 - EO 366 by Pres. Arroyo – basis of
Quirino through Executive Order 288
structure
○ Decentralization of power into Eight
➢ National Government Level
Regional Officies
○ The DOH acts as the national lead
➢ Rural Health Act of 1954 transformed the
agency in health.
puericulture centres to RHUs and health
○ The DOH central office consists of
centres, a national network of public health
18 bureaus and services
facilities at the community level was
○ DOH has 17 regional health
organized in all cities and municipalities.
offices, one for each of the 17
➢ Martial Law (1970s)
administrative regions of the country.
○ Transformed into Ministry of Health
➢ Local Government Level
○ Primary health-care approach was
○ Municipal Health System
adopted as a national policy in the
■ Rural Health Units, Barangay
late 1970s following the Alma Ata
Health Stations
Declaration
○ City Health System
■ Health Centers, BHS, City
Hospitals, Medical Centers
➢ Major milestone of the twentieth century in
the field of public health, and it identified
primary health care as the key to the
● COVID-19
attainment of the goal of Health for All
● Dengue
➢ Dr. Jesus Azurin launched the nationwide
● HIV
implementation of the Primary Health Care
● Tuberculosis
approach, which made him the
● Improving Health Care in Remote Areas
➢ first World Health Organization Sasakawa
Health Prize recipient.
Lessons from a Pandemic
● The etiological agent of a potential
pandemic can interact with the
environment and can increase a host’s
susceptibility to this agent
● Inability to identify disease origins, cause of
transmission, and effective strategies to
control it may be due to lack of testing
and studies of observations across
populations
● There shall be a systematic way to test
associations between exposure and
outcome factors

● Collection, organization, analysis,
interpretation of data
● Descriptive – summarize and present data
in a form that is easier to analyze (summary
measures, tables, graphs, rates, ratios and
proportions)
● Inferential – making estimates, predictions,
generalizations of a given population (point
and interval estimates, hypothesis testing
● tendency of a given characteristic to change
from one individual or setting to another; or
from the same person in different periods of
time
● measurement or characteristic which
changes from one individual or setting to
another; or from the same person in
different periods of time
Qualitative
➔ labels for distinguishing
Quantitative
➔ expressed numerically and can be arranged
according to magnitude
◆ Discrete - whole numbers
◆ Continuous - fractions/decimals
Nominal
➔ labels only = qualitative
Ordinal
➔ can be ordered or rank but same as nominal
= qualitative
Interval
➔ zero does not mean absence of the
characteristic (ex. Temperature) =
quantitative
Ratio
➔ zero means absence of characteristic (ex.
Weight) = quantitative
● It refers to the arrangement of any data in
an orderly sequence, so that they can be
presented concisely and compactly and so
that they can be understood easily and can
be done through: Tabular presentation &
Graphical presentation
Frequency Distribution
➔ Data are grouped according to some scale
of classification, where the sum of the
entries is equal to the total.
➔ The figures may either be in actual
numbers, in percent or in both.
➔ The scales used may be qualitative,
quantitative or both.
Time Series Distribution
➔ Data that are collected over a time period
➔ Shows how the certain variable that is being
discerned by the data collected changes
through time
Correlation Data
➔ Compares two or more frequencies
➔ Usually obtained from conducting
epidemiologic studies
➔ Used to measure the magnitude of
association between two quantitative data
sets
● Should state the objective of the table.
● It should state the following clearly, briefly
and comprehensively: what the figures in
the body of the table stand for, how the data
are classified, and where and when the data
were obtained

● Indicates the basis of classification of table
rows
● The leftmost column of the table, which
contains the subjects to which the table data
apply
● Indicate the basis of classification of the
columns or vertical series of figures
● Tips: In making your table, align your
column headings in the same manner of
alignment as the data below it; if not all
aligned in the center.
● This is made up of the figures filling the cells
or compartments brought about by the
coordinates of rows and columns
● Tips: When filling your data in the table,
always remember these for the alignment:
● Text aligned to the left
● Numbers aligned to the right
● Try to put in the numbers in the same
number of decimal places as each other
● Marginal Totals
○ Refer to the column totals and row
totals
○ Tables must always have these
● Footnote
○ Indicates the source of information
● The study of the distribution of the
determinants of health-related states or
events in specified populations, and the
application of this study to the control of
health problems
● Etiology of diseases and modes
transmission
● Extent of disease problems
● Natural history and prognosis
● Preventive and therapeutic measures
● Development of public policy
● Disease spectrum
● Natural history for diagnostic accuracy
● Physiologic and genetic variables
● Risk factors of disease
● Clarification of disease transmission
● Community health needs
● Allocation and managing healthcare
resources
● Health goals, priorities, objectives
● Impact of health services
● Hippocrates – seasonal variation of a
disease
● John Snow – natural epidemiologic
experiment for cholera
● Doll and Hill – first case-control study
● Dawber et.al. – first cohort study
1. Susceptibility – risk factors are present,
disease has not yet developed
2. Subclinical disease – no signs nor
symptoms, but pathologic changes are
already occurring in the host
3. Clinical disease – signs and symptoms
have already developed
4. Recovery, disability, or death
1. Primordial – prevent emergence of risk
factors
2. Primary – control exposure to risk factors
3. Secondary – early detection and monitoring
4. Tertiary – reduce or eliminate impairments
and disabilities
of

Causality – a factor that varies depending on the
outcome
➔ Epidemiologic triad
➔ Causal web
➔ Causal pie
1. Descriptive Studies – study of the three
epidemiologic variables (person, place, time);
formulates hypotheses
➔ Case study
➔ Ecological Study
➔ Prevalence Study
2. Analytical Studies – test hypotheses, determine
association between the exposure and outcome
➔ Observational – no manipulation of the
exposure variable
◆ Cross-sectional
◆ Case control
◆ Cohort
➔ Experimental studies – with manipulation of
the exposure variable
Cross - Sectional Studies
● Assess the exposure and outcome variables
at ONE POINT in time; a snapshot of the
current situation
● Yields a • 𝑃𝑅𝐸𝑉𝐴𝐿𝐸𝑁𝐶𝐸 𝑅𝐴𝑇𝐼𝑂 = 𝑝𝑟𝑒𝑣𝑎𝑙𝑒𝑛𝑐𝑒
𝑎𝑚𝑜𝑛𝑔 𝑒𝑥𝑝𝑜𝑠𝑒𝑑 / 𝑝𝑟𝑒𝑣𝑎𝑙𝑒𝑛𝑐𝑒 𝑎𝑚𝑜𝑛𝑔 𝑢𝑛𝑒𝑥𝑝𝑜𝑠𝑒𝑑
● Says how the prevalence of an
outcome/disease differs between those who
are exposed to the factor of interest VS
those who are not exposed
○ What does it mean if the prevalence
ratio is higher than 1? Less than 1?
Equal to 1?
Cohort Studies
● A prospective study that follows up
individuals who are exposed to a factor to
see if they develop the outcome of interest
● Yields a 𝑅𝐼𝑆𝐾 𝑅𝐴𝑇𝐼𝑂 = 𝑟𝑖𝑠𝑘 𝑜𝑓 𝑜𝑢𝑡𝑐𝑜𝑚𝑒 𝑎𝑚𝑜𝑛𝑔
𝑒𝑥𝑝𝑜𝑠𝑒𝑑 / 𝑟𝑖𝑠𝑘 𝑜𝑓 𝑜𝑢𝑡𝑐𝑜𝑚𝑒 𝑎𝑚𝑜𝑛𝑔 𝑢𝑛𝑒𝑥𝑝𝑜𝑠𝑒𝑑
● Says how great the effect of the exposure
would be in developing the outcome
○ What does it mean if the risk ratio is
higher than 1? Less than 1? Equal to
1?
Case Control Studies
● A retrospective study that looks at those
with the outcome of interest and reviews
their past exposure histories to see if they
were exposed to the factor of interest
● Yields an 𝑂𝐷𝐷𝑆 𝑅𝐴𝑇𝐼𝑂 = 𝑜𝑑𝑑𝑠 𝑜𝑓 𝑜𝑢𝑡𝑐𝑜𝑚𝑒
𝑎𝑚𝑜𝑛𝑔 𝑒𝑥𝑝𝑜𝑠𝑒𝑑 / 𝑜𝑑𝑑𝑠 𝑜𝑓 𝑜𝑢𝑡𝑐𝑜𝑚𝑒 𝑎𝑚𝑜𝑛𝑔
𝑢𝑛𝑒𝑥𝑝𝑜𝑠𝑒𝑑
● Says how probable the outcome will be if
you are exposed to the factor of interest
○ What does it mean if the odds ratio
is higher than 1? Less than 1? Equal
to 1?
3. Experimental/Intervention Studies
➔ A prospective study that randomizes
individuals and gives them interventions to
see if they do or do not develop the
outcome of interest
➔ Classified by the type of intervention or by
the unit of analysis
◆ Prophylactic
◆ Therapeutic
◆ Clinical Trial
◆ Community Trial
Prevention
➔ Elimination of specific disease by one or
more measures of proven efficiency
➔ Approaches and activities aimed at reducing
likelihood of disease affecting individual
➔ Prevent occurrence
➔ Arrest progress
➔ Reduce consequences
Can be directed at the:
➔ Agent when it is in its reservoir
➔ Agent when it is in transit to the new host
➔ At the susceptible population
 2. Passive – the antibodies for the infection are the
ones that are introduced
● Eliminate A. Naturally-acquired – transfer of antibodies
● Reduce communicability from mother to baby, either through the
○ Treatment placenta or through mother’s breast milk
○ Isolation – separation for the period B. Artificially-acquired – injection of immune
of communicability of the case sera as vaccines (ex. anti-tetanus
○ Quarantine – limitation of movement antibodies, diphtheria antitoxin)
of persons who do not have the
disease but are exposed to the
agent for not longer than the agent’s
maximum incubation period

● Apply environmental control measure

● These are usually aimed at the vectors and
vehicles of the disease

● There are two types of strategies.

● Specific strategies
○ Chemoprophylaxis
○ Immunization
● Non-specific strategies
○ Health promotion and education
strategies
○ Proper nutrition
○ Target the behaviors of the
individuals

NON-SPECIFIC RESISTANCE
➔ present at the time of birth or has developed
during maturation
SPECIFIC RESISTANCE
➔ acquired due to exposure to a foreign
substance
1. Active - the antigen is introduced and the body
makes antibodies to defend against the infection
A. Naturally-acquired – acquired through the
natural history of disease processes
B. Artificially-acquired – antigen is
deliberately introduced (ex. live, attenuated
virus particles as vaccines in MMR, BCG)
 ○ Unhealthy use (increased fat and
sodium, low fruit and vegetable
intake).
● Chronic conditions that do not result from an
(acute) infectious process and hence are
“not communicable.” ● It is defined as a risk factor that cannot be
● A disease that has a prolonged course, that reduced or controlled by intervention.
does not resolve spontaneously, and for ○ Age
which a complete cure is rarely achieved. ○ Gender
○ Race
○ Family history or genetics
● Complex etiology (causes)
● Multiple risk factors
● Long latency period
Tobacco Unhealthy Physical Alcohol
● Non-contagious origin (noncommunicable) Use Diet Activity Use
● Prolonged course of illness
Cardiovascular
● Functional impairment or disability
Diabetes

● Cardiovascular disease (e.g., Coronary Cancer

heart disease, Stroke)
Chronic
● Cancer Respiratory
● Chronic respiratory disease
● Diabetes
● Chronic neurologic disorders (e.g.,
Alzheimer’s, dementias) ● “Metabolic" = biochemical processes.
● Arthritis/Musculoskeletal diseases ○ Raised blood pressure
● Unintentional injuries (e.g., from traffic ○ Raised total cholesterol
crashes) ○ Elevated glucose
○ Overweight and obesity

1. Ischemic heart disease - lots of oxygen in

the heart 1. Cardiovascular Disease
2. Cerebrovascular diseases - brain veins 2. Diabetes Mellitus
3. Cancer 3. Chronic Respiratory Disease
4. Diabetes mellitus 4. Cancer
5. Hypertensive diseases

1. Coronary Heart Disease

➔ Disease of the blood vessels
● Behavior or lifestyle
supplying the heart muscle
● Environmental exposure 2. Cerebro-Vascular Disease
● Hereditary - genetics ➔ Disease of the blood vessels
● Can be modifiable or non modifiable supplying the brain
3. Peripheral Arterial Disease
➔ Disease of blood vessels supplying
● Factors that can be reduced or controlled by the arms and legs
4. Congenital Heart Disease
intervention.
➔ Malformations of heart structure
○ Physical activity
existing at birth
○ Tobacco use
○ Alcohol use
 ● CVDs are the #1 cause of death globally ● A leading cause of death
● Most deaths were due to coronary heart ● High under-diagnoses rates
disease (next: stroke) ● 90% of deaths occur in low-income
● Over 80% CVD deaths occur in low and countries
middle income countries ● Risk factors:
● By 2030, almost 25 million people will from ○ Cigarette smoke
CVDs ○ Environmental exposure (work,
indoor air pollution)
○ Genes, Age
● Diabetes mellitus (DM) is a disorder of ○ Infections
metabolism — inadequate control of blood ○ Socio-economic status
levels of glucose.
● Types:
○ Type I DM
■ In Type I DM, the pancreas ● 70% of all cancer deaths occur in low- and
cannot produce and middle income countries.
release insulin. ● Deaths from cancer are estimated to reach
○ Type II DM 13.1 million by 2030.
■ Insulin resistance - your ● About 30% of cancers are attributable to
body does not respond behavior risk factors
well to insulin
○ Gestational DM (Seeb in pregnant
women)
○ MODY (Maturity Onset Diabetes of
Young ● Both sexes:
○ Type III DM (Alzheimer's DIsease) 1. Breast
SYMPTOMS: 2. Lung
● Polyphagia - “Always eating” 3. Colorectal
● Polydipsia - “Always drinking” 4. Liver
● Weight loss
5. Prostate
● Polyuria - “Always urinating”
● Females:
1. Breast
Type I Type II
2. Cervix
Cause/s Genetics Genetics 3. Colorectal
Autoimmune Lifestyle Problem
problem Aging
4. Lung
5. Ovary
Age of Onset Mostly in young Mostly In adults ● Males:
Treatment Requires insulin May add insulin
1. Lung
2. Colorectal
Prevention No known Lifestyle modification 3. Prostate
prevention Early detection
4. Liver
5. Leukemia
 ● Surveillance for non-communicable
● Occurs commonly in women, rarely occurs diseases can be difficult because of:
in men ○ Lag time between exposure and
● 1 of 8 women will be diagnosed with breast health condition,
cancer. ○ More than one exposure for a health
● Risk Factors: condition, and
○ Hormone therapies ○ Exposure is linked to more than one
○ Weight and physical activity health condition.
○ Genetics or family history - BRCA1
and BRCA2 genes
○ Age is the most reliable risk factor!

● Affects more men than women

● Two main types:
○ Small cell lung cancer
○ Non-small cell lung cancer
● Risk factors:
○ Exposure to smoke
■ Firsthand - Active smoking
■ Secondhand - Passive
smoking
■ Thirdhand - Leftover
Particles
○ Occupational exposure (radon, 1. High blood pressure 12.8%
asbestos, uranium)
○ Family history 2. Tobacco use 8.7%

3. High blood glucose 5.8%

● Risk factors include: 4. Physical inactivity 5.5%

○ Aging
5. Overweight and obesity 4.8%
○ Unhealthy diet and low exercise
○ Diabetes 6. HIgh cholesterol 4.5%
○ Family history of colorectal cancer
7. Unsafe sex 4.0%

8. Alcohol use 3.8%

● Cancer of the female reproductive system
9. Childhood underweight 3.8%
● 99% of cases linked to genital infection with
human papillomavirus (HPV) 10. Indoor smoke from solid 3.3%
fuels
● Other risk factors:
○ Smoking
○ Birth control pills for a long time (five
or more years) Average # of packs smoked per/day X # of years
○ Having given birth to three or more you smoked
children ● Every cigarette you smoke reduces your
○ Having several sexual partners expected life span by 11 minutes
● Tobacco kills up to half of its users.
● Tobacco kills nearly 6 million people each
year.
● Annual death toll could rise to more than 8
millioN by 2030.
● Nearly 80% of the world’s 1 billion smokers
live in low- and middle-income countries

● Increased overall daily consumption of: BLOOD PRESSURE CATEGORIES

● Daily calories,
● Fat and meats, and Blood Pressure Category Systolic mm Hg Diastolic mmHg
● Energy dense and nutrient-poor foods such (upper number) (lower number)
as: NORMAL Less than 120 and Less than 80
○ Starches
○ Refined Sugar ELEVATED 120-129 and Less than 80
○ Trans-fats
HIGH BLOOD PRESSURE 130-139 or 80-89
(HYPERTENSION) STAGE
1
● 31% of the world's population do not get
HIGH BLOOD PRESSURE 140 or higher or 90 or higher
enough physical activity, attributable to: (HYPERTENSION) STAGE
○ "Aging populations, 2
○ Transportation, and
HYPERTENSIVE CRISIS Higher than 180 and/ Higher than 120
○ Communication technology (CONSULT YOUR or
DOCTOR IMMEDIATELY)

30 minutes and 5 days per week

● Walking
● Gardening
● Hiking
● Dancing
● Cycling
● Active recreation
● Swimming
Dietary
Approaches to
Stop
● 11.5% of all global drinkers are episodic, Hypertension
heavy users.
● 2.5 million people die from alcohol
consumption per year
● The majority of adults consume at low-risk
levels.
● Females: 1 drink or less or NO ALCOHOL
AT ALL
● Males: 2 drink or less or NO ALCOHOL AT
ALL
 <100 mg/dL NORMAL

101 - 126 mg/dL AT RISK

Prediabetes

>126 mg/dL DIABETES

● HbA1c Test - monitors blood sugar status

in the past 3 months
Diabetes >6.0% ● Thai patient
● Metric = 24.41
Prediabetes 5.7 - 6.0% ● Imperial = 24.36
Normal <5.7%

1. Difference between modifiable and

non-modifiable risk factors.
2. Enumerate 4 leading NCDs.
3. Enumerate types of diabetes.
NUTRITIONAL NON-ASIAN ASIAN BMI 4. Formula for smoking pack years.
STATUS BMI 5. Number 1 leading cause of cancer among
♂.
Underweight < 18.5 6. Number 1 leading cause of cancer among
Normal 18.5 - 24.9 18.5 - 22.9
♀.
7. What is “third-hand” smoking?
Overweight 25 - 29.9 23 - 24.9 8. Give the risk factors for cervical cancer.
9. Give the underlying drivers of NCD
Pre-Obese - 25.29.9 10. What is the normal BMI for Asians?
11. Transcribe DASH.
Obese Class I 30 - 40
12. Standard rule for detection of hypertension.
Obese Class II 40.1 - 50 13. What is the normal fasting blood sugar?
14. Compute for BMI:
Obese Class III >50 ○ Filipino, weight= 62 kgs, height= 5’4”
○ (5 x 12) + 4 = 64 inches
○ 64 x 0.0254 = 1.6256 m
○ 62 ÷ (1.6256)2 = 23.46

● the study of the distribution and
determinants of health-related states or
events (including disease), and the
application of this study to the control of
diseases and other health problems. (WHO)
● Studies the factors that determine the
frequency, distribution, and determinants of
diseases in human populations
● Develops ways to prevent, control or
eradicate disease in populations
● Concerned with all types of diseases
● Basic model to study health problems
● 3 factors:
○ Host
○ Environment
○ Agent
● Disease is produced by exposure of a
susceptible host to an noxious agent in the
presence of environmental factors that aid
or hinder agents of disease
INFECTIVITY
● the characteristic of an agent that embodies
capability of entering, surviving and
multiplying and causing disease in a
susceptible host
PATHOGENICITY
● The ability to cause disease
VIRULENCE
● degree of pathogenicity or disease
producing ability of a microorganism
IMMUNOGENICITY
● the ability or extent to which a substance is
able to stimulate an immune response
TOXIGENICITY
● The capacity to produce toxin
RESISTANCE
● the ability of bacteria and other
microorganism to resist the effect of an
antibiotic to which they were once sensitive
LATENCY
● a period in which the infection is present in
the host without producing overt symptoms
COMMUNICABLE DISEASE
● It means an illness caused by an infectious
agent or its toxins that occurs through the
direct or indirect transmission of the
infectious agent or its products from an
infected individual or via an animal, vector
or the inanimate environment to a
susceptible animal or human host. (CDC)
CONTAGIOUS DISEASE
● Communicable diseases that are easily
transmitted from one person to another
ZOONOTIC DISEASES
● Infectious diseases that humans acquire
from animal sources
INCUBATION PERIOD
● Time interval between the exposure to the
agent and the onset of signs and symptoms
● It is the time needed for the agent to
multiply inside the host
● This is variable and different for each type
of infection
● Extrinsic incubation period
COMMUNICABLE PERIOD
● The time in which the infectious agent may
be transferred from an infected host to a
susceptible host
 ● Endemic Diseases
GENERATION TIME ○ Diseases that are always present
● The time between the infection of a primary within the population of a particular
case and its secondary cases (Fine, 2003; geographic area.
Svensson, 2007) ○ Disease never dies out completely
GRADIENT OF INFECTION ● Epidemic Diseases
● Difference between stages of the ○ Outbreak
development of the disease; whether it is ○ Epidemic – greater than usual
inapparent or severe number of cases of a disease in a
● Inapparent – There are no visible signs or particular region, usually occurring
symptoms within a relatively short period of
● Severe – With clinical manifestations, high time
case fatality, and high proportion of disease ○ It usually follows a specific pattern in
sequelae which the number of cases of a
CARRIER STATE disease increases to a maximum
● State wherein a host is infected but does and then decreases rapidly, because
not manifest the disease’s signs and/or the number of susceptible and
symptoms exposed individuals is limited.
● Prevention and control strategies must also Quantification of disease occurrence
focus on determining if this state is existent ● Pandemic Diseases
in infectious diseases ○ Occurring in epidemic proportions in
● Important also to know the length of this many countries simultaneously –
state and the carrier’s means of sometimes worldwide
transmission ● Is dependent on:
TEMPORAL TRENDS ○ Herd immunity Exposure or Contact
● Seasonal – changes in disease trends frequency, which is again dependent
within a year; is dependent on on many factors.
environmental conditions; vector density; ○ Herd immunity if good for community
and behavior of the host ○ Contagious - disease spreads
● Annual – changes in disease trends over freely from contagious to susceptible
several years; observable changes in those people when no one is immunized.
susceptible to the disease ○ Susceptible (not immunised) - if
● Secular – gradual changes in the only some people are immunised
occurrence of disease over long periods of disease will still spread although
time; may be due to changes in incidence, those immunised are spared
age distribution, or diagnostic ascertainment ○ Immunised - spread of disease is
COMMUNITY REACTION contained when most people are
● Sporadic Diseases immunised as disease cannot
○ Diseases that occur only spread from immunsied people to
occasionally within the population of susceptible people.
a particular geographic area
○ They are kept under control as a
result of immunization programs and
sanitary conditions
 ● Hepatitis A, B, C
● Measles
INCIDENCE ● Flu
● Number of new cases of that disease in a ● Salmonellosis
defined population during a specific time ● Shigellosis
● MRSA
period
● Ebola
PREVALENCE ● Rabies
● Period prevalence – number of cases of ● STDs
the disease existing in a given population
during a specific time period
● Point prevalence – number of cases of the
disease existing in a given population at a FACTORS:
● Factors pertaining to pathogen
particular moment in time
○ Virulence of the pathogen
MORTALITY RATE ○ Way of pathogen to enter the body
● Death rate ○ Number of organisms that enter the
● Ratio of the number of people who died of a body
particular disease during a specified time ● Factors pertaining to the host
period per a specified population ○ Health status
MORBIDITY RATE ○ Nutritional status
○ Other factors pertaining to the
● Usually expressed as the number of new
susceptibility of the host
cases of a particular disease that occurred ● Factors pertaining to the environment
during a specified time period per a ○ Physical factors – geographic
specifically defined population (usually per 1 location, climate, etc
000, 10 000 or 100 000 population) ○ Availability of appropriate reservoir
● According to WHO, infectious diseases are ○ Sanitary and housing conditions;
responsible for approximately half the adequate waste disposal; adequate
healthcare
deaths that occur in developing countries
○ Availability of potable water
○ HIV/AIDS
○ Tuberculosis
○ Malaria SIX COMPONENTS IN THE CHAIN OF
● More than 300 million and more than 5 INFECTION:
million deaths per year are caused by these 1. A pathogen
diseases. 2. A reservoir of pathogen
● TB in the Philippines.... 3. A portal of exit
4. A mode of transmission
○ The Philippines is among the 8
5. A portal of entry
countries where two thirds of 2017 6. A susceptible host
TB cases were found
○ The burden of TB in the country
remains high
○ Based on the 2016 National TB
Prevalence Survey, there are about
1 million Filipinos with TB. Most of
the TB cases are found among
males and highest in the 45-54 age
group.

● To prevent infections from occurring,
measures must be taken to break the chain
of infection at some point (link) in the chain
RESERVOIR
● Any site where the pathogen can multiply or
merely survive until it is transferred to a host
● Living hosts, inanimate objects or materials
LIVING RESERVOIRS
● HUMAN CARRIERS
○ Most important reservoirs of human
infectious diseases
○ Carrier – a person who is colonized
with a particular pathogen but the
pathogen is not currently causing
disease to that person
○ Very important in the spread of
staphylococcal and streptococcal
infections, hepatitis, diphtheria,
dysentery, meningitis, and STDs
● ANIMALS
○ Important reservoirs of zoonoses
○ Zoonoses – acquired by:
■ direct contact with the animal
■ Inhalation or ingestion of the
pathogen
■ Injection of the pathogen by
an arthropod vector
○ Measures to control zoonoses:
■ PPE when handling animals
■ Animal vaccinations
■ Proper use of pesticides
■ Isolation or destruction of
infected animals
■ Proper disposal of animal
carcasses and waste
products
● ARTHROPODS
○ Animals
○ Insects (mosquitoes, biting flies, lice,
fleas)
○ Arachnids (mites and ticks)
○ Vectors – when arthropods are
involved in the transmission of
infectious diseases
NON LIVING RESERVOIRS
● INANIMATE RESERVOIRS include:
○ Air – contaminated by dust and
respiratory secretions
○ Soil
○ Dust – can carry spores of bacteria
and dried bits of human and animal
excretions
○ Food and milk – can be
contaminated by careless handling
○ Water - can be contaminated with
human and animal fecal matter
○ Fomites – inanimate objects
capable of transmitting pathogens
FIVE PRINCIPAL MODES OF TRANSMISSION
1. Contact (direct or indirect)
2. Droplet
➔ Transfer of pathogen via infectious
droplets
➔ Maybe generated by coughing,
sneezing and talking
 3. Airborne
➔ Dispersal of droplet nuclei (smaller
than 5um)
4. Vehicular
➔ Contaminated inanimate objects
5. Vector transmission
➔ Various types of biting insects and
arachnids
WAYS OF TRANSMISSION:
● Direct skin-to-skin contact
○ Transmission of infection can be
prevented by frequent handwashing
● Direct mucous membrane-to-mucous
membrane contact by kissing or sexual
intercourse
○ Most STDs are transmitted by this
manner
● Indirect contact via airborne droplets or
respiratory secretions, usually produced
as a result of sneezing or coughing
○ Colds, influenza, measles, mumps,
chickenpox, smallpox, pneumonia
● Indirect contact via food and water
contaminated with fecal matter
● Indirect contact via arthropod vector
● Indirect contact via fomites that become
contaminated by respiratory secretions,
blood, urine, feces, vomitus, or exudates
from hospitalized patients
● Indirect contact via transfusion of
contaminated blood or blood products
from an ill person or by parenteral
injection using non sterile syringes and
needles

● Control of an infectious disease

○ Ongoing operations or programs
aimed at reducing the incidence or
prevalence of that disease
● Elimination of an infectious disease
○ Reduction of case transmission to a
predetermined very low level
● Eradication of an infectious disease
○ Achieving a status where no further
cases of that disease occur
anywhere and where continued
control measures are unnecessary
 ● Social exclusion creates misery and costs
● Conditions in the environments where lives
people are born, live, learn, work, play, ● Absolute poverty - a lack of the basic
worship, and age that affect a wide range of
material necessities of life
health, functioning, and quality of life
outcomes and risks ● Relative poverty - means being much
1. Health Care Access and Quality poorer than most people in society and is
2. Neighborhood and Built Environment often defined as living on less than 60% of
3. Social and Community Context the national median income
4. Economic Stability
5. Education Access and Quality
ECONOMIC STABILITY
● Stress in the workplace increases the risk of
● Goal: Help people earn steady incomes that
allow them to meet their health needs disease
EDUCATION ACCESS AND QUALITY
● Goal: Increase educational opportunities
and help children and adolescents do well in ● Job security increases health, wellbeing and
school job satisfaction
HEALTH CARE ACCESS AND QUALITY
● Goal: Increase access to comprehensive,
high-quality care services
NEIGHBORHOOD AND BUILT ENVIRONMENT ● Friendship, good social relations and strong
● Goal: Create neighborhoods and supportive networks improve health at
environments that promote health and home, at work and in the community
safety ● Social Cohesion - defined as the quality of
SOCIAL AND COMMUNITY CONTEXT
social relationships and the existence of
● Goal: Increase social and community
support trust, mutual obligations and respect in
communities or in the wider society

● People’s social and economic

circumstances strongly affect their health
policy must be linked to the social and
economic determinants of healths
● Describe the phenomenon whereby people
who are less advantaged in terms of
socioeconomic position have worse health
(and shorter lives) than those who are more
advantaged
● Stress harms health
● Individuals turn to alcohol, drugs, and
tobacco and suffer from their use, but use is
influenced by the wider social setting
● Healthy food is a political issue
● Healthy transport means reducing driving
and encouraging more walking and cycling,
back up by better public transport

● The effects of early development last a

life-time; a good start in life means
supporting mothers and young children