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COMMUNITY AND PUBLIC HEALTH

PRELIMS

INTRODUCTION TO COMMUNITY & PUBLIC HEALTH  Pandemics

 HEALTH - a state of complete physical,

mental, and social well being and not merely
the absence of disease. (WHO, 1948)
 “the science & art of preventing disease,
prolonging life, & promoting health through
the organized efforts & informed choices of
society, organizations, public & private
communities, & individuals.” - CEA winslow
 “Community Health refers to the health status
of a defined group of people and the actions
and conditions, both private and public
(governmental), to promote, protect, and
preserve their health” - McKenzie et al., 2005  Preparedness for Disaster Response

PERSONAL HEALTH

 Ability to take charge of your health by

making conscious decisions to be healthy
 Physical well being of an individual
 Emotional, intellect, social, economical, and
spiritual wellness,

THE MISSION OF PUBLIC HEALTH

“Fulfilling society’s interest in assuring conditions in

which people can be healthy.” - Institute of
Medicine
 Prevention Through Policy
“Public health aims to provide maximum benefit
for the largest number of people.” - WHO

PUBLIC HEALTH KEY TERMS

 Clinical Care: prevention, treatment, &

management of illness & the preservation of
mental and physical well-being through the
services offered by medical and allied health
professions.

 Determinant: factor that contributes to the

generation of a trait.

 Epidemic or Outbreak: occurrence in a A PUBLIC HEALTH APPROACH

community or region of cases of an illness,
specific health-related behavior, or other
health-related event clearly in excess of
normal expectancy.

 Health Outcome: result of a medical

condition that directly affects the length or
quality of a person’s life.

HISTORY OF PUBLIC HEALTH

 Sanitation and Environmental Health

CHOLERA

 a fatal intestinal disease

 Rampant during the early 1800s in London,
causing thousands of deaths in the area

JOHN SNOW

 Best known for his work tracing the source of

the cholera outbreak
 Father of Modern Epidemiology

COMMUNITY AND PUBLIC HEALTH
PRELIMS
 Epidemiology - What is the Problem?
> Cluster of Cholera Cases, London - 1854
 Risk Factor Identification - What is the Cause?
> cluster of cholera and pump site locations
 Intervention Evaluation - What Works?
Through continuous research, Snow understood
what interventions were required to…
> stop exposure to the contaminated water
supply on a larger scale, and
> stop exposure to the entire supply of
contaminated water in the area
 Implementation - How Do You Do It?
> John Snow’s research convinced the British
government that the source of cholera was water
contaminated with sewage.
CONSUMER HEALTH EDUCATION
 Consumer Health refers to the decisions you
make about the purchase of product and
use of health information and services that
will have direct effect on your health.
 Health Information is the data and facts you
got from media and people including the
professionals and agencies.
 Health Products are those substances,
materials or equipment prepared or
manufactured for you to buy and use in the
maintenance of health and the treatment of
diseases. Example; foods, eyeglasses,
medicines, cosmetics, cars, appliances and
others.
 Health Services refer to health information,
actions, procedures or work furnished, or
supplied to help satisfy your needs and wants
as a consumer. This is services and things
people do to and for other people. Example
of health services; are medical consultation
and treatment, using the telephone, using
the electricity, and payment for
transportation, payment for haircut, payment
for news papers and your favorite magazines
and comics.
 Consumer Health Education is the process of
assisting you to acquire the correct
information and understanding so that you
will able to make wise decision about a
certain health item.
WHO IS A CONSUMER?
- We all are because we are all users. We use
goods and services every day. We need food,
clothing and shelter. We travel on buses and trains,
visit he doctors and dentist, go to the library, or
watch television. At home we use energy in the
form of gas, electricity, coal, expect clean
drinkable water from the tap.
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 Consumer - means a natural person who is a
purchaser, lessee, recipient or prospective
purchaser, lesser or recipient of consumer
products, services or credit.
DIFFERENT KINDS OF CONSUMER
 Spendthrift
 Close - fisted
 Wasteful
 Bargain addict
 Intelligent
 Panic buyer
 Impulsive buyer
CONSUMER SOURCE OF INFORMATION IN BUYING
PRODUCTS AND SERVICES
 Labels & Directions
 Practitioners
 Health Publications
 Consumer Advocacy Group
 Government Agencies
 Health Educators
 Family & Friends
 Advertisement and Commercials
 Folklore
 Mass Media
CONSUMER RIGHTS & RESPONSIBILITIES
Being good consumer means knowing what to
look out for and what to avoid. It means know
where and how to get the best value for money,
where to go if things go wrong. Your role as a
consumer has both right and responsibilities.
 The right to safety - To be protected against
products, production, processes and services
that are hazardous to health or life.
 The right to be informed - To be given facts
needed to make an informed choice and
protected against dishonest or misleading
advertising and labeling.
 The right to choose - to be able to select from
a range of products and services and
competitive prices with an assurance
satisfactory quality.
REPUBLICT ACT NO. 7394 - CONSUMER ACT OF THE
PHILIPPINES
It is the policy of the State to protect the interests of
the consumer, promote his general welfare and to
establish standards of conduct for business and
industry. Towards this end, the State shall
implement measures to achieve the following
objectives:
 Protection against hazards to health and
safety;
 Protection against deceptive, unfair and
unconscionable sales acts and practices
 Provision of information and education to
facilitate sound choice and the proper
exercise of rights by the consumer
 Provision of adequate rights and means of
redress
 Involvement of consumer representatives in
the formulation of social and economic
policies.

COMMUNITY AND PUBLIC HEALTH
PRELIMS
FACTORS AFFECTING COMMUNITY HEALTH
 Physical factors
 Social/cultural factors
 Community organizations
 Individual behavior
PHYSICAL FACTORS
 Industrial Development - communities that
are industrially developed are more likely to
be affected by numerous diseases due to
toxic waste products from the industries that
are released into water bodies and the
atmosphere and due to congestion of
settlement leading to slum development.
Hence, contagious diseases compared to
areas that are not industrially developed.
> Air Pollution
> water contamination from industrial
discharge
 Community Size - A densely populated or
over populated community can easily be
attacked by communicable diseases.
(overcrowding)
 Geographical location - Some communities
are more prone to diseases due to the
geographical location.
> for example: Some communities are located
in swampy areas ARE MORE PRONE TO DISEASES
especially during heavy rains they are affected by
floods which can lead…
@ manipulation of disease causing organisms if the
water is stagnant
@ to spread of disease causing organisms
For example malaria, diarrhea disease.
 Environment - A clean environment is very
vital to the proper health of a community
which minimizes the occurrence and
transmission of diseases, unlike a dirty
environment which easily leads to outbreak
of diseases.
SOCIAL/CULTURAL FACTORS
 Traditions Beliefs - Beliefs or traditions
possessed by communities greatly affect the
health of it’s people for example FEMALE
GENITAL MUTILATION (FGM)
 Economy - A community that is economically
well off has low chances of suffering from
disease breakouts because they have proper
health care and water drainage systems
unlike a poor community.
 Government - since the government involves
planning, implementing and provision of
community services such as water supply,
medical supplies and other needs which can
directly affect the community health.
COMMUNITY ORGANIZATIONS
 Community Organization - Ways in which
communities organize their resources such as
taxes which can be very helpful in control of
diseases and supply of sufficient and efficient
medical care even in times of crisis unlike
communities without proper accountability
of their taxes which can partly be allocated
to the health sector.
 Educational factors - poor education or
illiteracy affects the health of a community
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when people doesn’t have education on
how they can prevent themselves from
diseases.
> Example health education on the use of
mosquito treated nets to prevent malaria, health
education on the environmental hygiene so as to
prevent diseases such as cholera and trachoma.
INDIVIDUAL BEHAVIOR
 Individual behavior - Community health is
greatly influenced by individuals, their
personal health, habits etc. And in order to
achieve a healthy community, it takes a
team work. For instance proper disposal of
waste products from and individuals
compound, clearing all stagnant water in the
compound to prevent harboring of
mosquitoes, active smokers to quit smoking to
avoid passive smokers thus preventing lung
cancer, abstainance from sexual activities
and for sexually active individuals to use
protection to prevent the spread of HIV/AIDs
and STDs etc. Thus proper individual healthy
iving can greatly promote a healthy
community.
HUMAN BEHAVIOR
HEALTH BEHAVIOR
 These are actions taken directly or indirectly
which can affect health status
and well-being.
 All behavior is purposeful and is a response to
changed condition in the
individual’s total environment.
 It refers to the range of behaviors exhibited
by humans and which are influenced by
culture, attitudes, emotions, values, ethics,
authority, rapport, hypnosis, persuasion,
coercion and/or genetics.
 Refers to the actions of individuals, groups,
and organizations, as well as the
determinants, correlates, and consequences,
of these actions—which include social
change, policy development and
implementation, improved coping skills, and
enhanced quality of life.
"Those personal attributes such as beliefs,
expectations, motives, values, perceptions, and
other cognitive elements; personality
characteristics, including affective and emotional
states and traits; and overt behavior patterns,
actions, and habits that relate to health
maintenance, to health restoration, and to health
improvement” - David Gochman
Health Behavior & Lifestyle
 Health behaviors are learned during the
process of growth and development through
parental and peer modeling, information
acquired through media, and life changes.
Lifestyle is also learned and modeled, but it
has many components that are acquired
and changed as one moves through the life
cycle.
 Thus, when change occur throughout the life
cycle, modifications can take place in both
lifestyle and health behavior to
accommodate the life change.

COMMUNITY AND PUBLIC HEALTH
PRELIMS
CATEGORIES OF HEALTH BEHAVIOR
1. PREVENTIVE HEALTH BEHAVIOR
➢ any activity undertaken by individuals who
believe themselves to be healthy
for the purpose of preventing or detecting illness in
an asymptomatic state;
include self-protective behavior
2. ILLNESS BEHAVIOR
➢ any activity undertaken by individuals who
perceive themselves to be ill for
the purpose of defining their state of health
3. SICK-ROLE BEHAVIOR
➢ any activity undertaken by those who consider
themselves to be ill for the
purpose of getting well
4. BEHAVIOR AND LIFESTYLE HEALTH BEHAVIOR
➢ any action that is related to disease prevention,
health maintenance, health
improvement, or the restoration of health
5. HEALTH-RELATED AND HEALTH-DIRECTED
BEHAVIOR
➢ something that is done once, or something that
is done periodically, like
getting immunization or flu shot
6. SELF-CARE BEHAVIOR
➢ taking actions to improve or preserve one’s
health
➢ self-treatment of definable health problems
➢ primary prevention in the absence of any
symptoms
➢ complete home treatments
7. HEALTH CARE UTILIZATION BEHAVIOR
➢ use of health services, whether it be clinical;
public health services of the
services of medical care professionals
➢ behavior includes examining who uses the
medical services, when and why
they use these services, and how satisfied they are
with the services
8. DIETARY BEHAVIOR
➢ eating patterns that people engage in, as well
as behavior related to
consuming foods, such as shopping, eating, out, or
portion size
9. SUBSTANCE-USE BEHAVIOR
➢ use of both licit and illicit mood-altering
substances
10. SEXUAL BEHAVIOR
➢ health implications that ranges from
reproduction and child bearing to
sexually transmitted diseases and the most serious
HIV/AIDS
11. RECKLESS BEHAVIOR
➢ “risk taking behavior” and “risky behavior”
➢ putting themselves in situation not normally
required in daily living that
substantially increase the chance of illness, injury or
death
➢ observed in adolescents and in young adults,
especially young males
➢ related to individual’s tendency toward
impulsivity and sensation-seeking
COMMUNITY HEALTH EDUCATION
 the study and improvement of health
characteristics among specific populations.
Community health is focused on promoting,
protecting and improving the health of
individuals, communities, and organizations.
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Objectives of Health Education:
 To help people understand that health is an
asset in the community.
 Inspiring people to adopt health-promoting
behaviors by providing appropriate
knowledge and helping to develop a positive
attitude.
 Supporting people to make decisions about
their health and achieve the necessary
confidence and skills to put their decisions
into practice.
 To train the people with skills, knowledge, and
attitude.
 To promote the development and proper use
of health services.
 To develop desirable health practices and
health habits.
 To develop health consciousness in the
school and the community.
 To combat the superstitions and prejudices in
the community.
 To provide a healthful environment for
physical and mental growth.
HEALTH EDUCATION
 helps individuals to be empowered and
communities to live healthier by improving
the physical, mental, emotional and social
health through increasing their knowledge
and influencing their attitudes on caring for
their well-being.
 is a social science that aims to promote
health and prevent disease through
voluntary behavioral change activities.
 It is a combination of biological,
environmental, psychological, intellectual,
physical, and medical aspects of health
focused on helping individuals and
communities through self-enhancing skills
and activities.
 Is vital as it teaches us to appreciate the life
that we have by knowing the different ways
on taking care of it and helps us to be
informed what are the numerous risks that
may affect not only ourselves but also our
families and the community as a whole.
HEALTH EDUCATION WEEK
 yearly every third (3rd) week of October is
observed
 to increase the national awareness on major
public health issues and to promote a better
understanding of the role of health
education.
So how important is Health Education in our lives?
1. We can take care of ourselves better
➢ The further we know on our health the better we
can take care of ourselves.
Health Education advocates deeper
understanding of our health issues and
encourages us to trust on health care educators to
stay informed.
2. It helps appreciate the educators
➢ Health Education reminds us of the importance
of health care educators and

COMMUNITY AND PUBLIC HEALTH
PRELIMS
the contribution they make to the health of our
communities. Educators
share critical knowledge that can help us live
healthier lives.
3. Keeps us informed on our health to stay healthy
 Health education programs include
increasing our knowledge and influences
behavior change on physical, mental,
emotional and social health for our overall
well-being and health
4. It influences many areas of wellness within the
community
 It impacts many aspects of the community’s
wellness including chronic disease awareness
and prevention, maternal and infant health,
tobacco use and substance abuse, injury
and violence prevention, mental and
behavioral health, nutrition, exercise and
obesity prevention.
COMMUNITY HEALTH
 refers to simple health services that are
delivered by laymen outside hospitals and
clinics.
 is also the subset of public health that is
taught to and practiced by clinicians.
Community Health Volunteers and
Community Health Workers
 work with Primary Care Providers to facilitate
entry into, exit from and utilization of the
formal health system by community
members.
COMMUNITY HEALTH VOLUNTEERS
 are members of the local community who
have considerable knowledge of the health
services available to the community and are
used to identify and link beneficiaries or those
in need and the registered providers.
COMMUNITY HEALTH WORKERS (COMMUNITY
HEALTH ASSISTANTS
AND COMMUNITY HEALTH OFFICERS)
➢ are employees who do not necessarily come
from the local community but
have vocational, professional or academic
qualifications which enable them
to provide training, supervisory, administrative,
teaching and research services in community
health departments.
Community health services are classified into:
 PREVENTIVE HEALTH SERVICES
> such as chemoprophylaxis for Tuberculosis,
cancer screening and treatment of diabetes and
hypertension.
 PROMOTIVE HEALTH SERVICES
> such as Health education, family planning,
vaccination and nutritional supplementation
 CURATIVE HEALTH SERVICES
> such as treatment of jiggers, lice infestation,
Malaria and Pneumonia.
 REHABILITATIVE HEALTH SERVICES
> such as provision of prosthetics, Social work,
Occupational therapy, Physical therapy,
Counselling and other Mental health services.
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The WHO defines community health as:
 Environmental, Social, and Economic
resources to sustain emotional and physical
well-being among people in ways that
advance their aspirations and satisfy their
needs in their unique environment.
Principles Of Health Education
1. Credibility
2. Interest
3. Participation
4. Motivation
5. Comprehension
6. Reinforcement
7. Learning by doing
8. Known to unknown
9. Setting an example
10. Good human relations
11. Feedback
12. Leaders
 CREDIBILITY
➢ It is the degree to which the message to be
communicated is perceived as
trustworthy by the receiver
➢ Good health education must be consistent and
compatible with scientific
knowledge and also with the local culture,
educational system and social
goals
 INTEREST
➢ Health teaching should be related to the
interests of the people
➢ Health programme should be based on the
“FELT NEEDS”, so that it
becomes “people’s program”
➢ Felt needs are the real health needs of the
people, that is needs the people feel
about themselves
 PARTICIPATION
• A high degree of participation tends to create a
sense of involvement, personal
acceptance and decision –making
• It provides maximum feedback
• The Alma- Ata Declaration states “The people
have a right and duty to
participate individually and collectively in the
planning and implementation of
their health care”
• Health programmers are unlikely to succeed if
community participation is not an
integral part
 MOTIVATION
• In every person, there is a fundamental desire to
learn. Awakening this desire is
called motivation
• Two types of motives
1) primary motives - are driving forces initiating
people into action
2) secondary motives – are created by outside
forces or incentives
• Need for incentives is a first step in learning to
change
• Incentives may be positive or negative
• Main aim of motivation is to change behavior
• Motivation is contagious: one motivated person
may spread motivation
throughout a group
 COMPREHENSION
• Health educator must know the level of
understanding, education and literacy of

COMMUNITY AND PUBLIC HEALTH
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people to whom the teaching is directed
• Always communicate in the language people
understand.
• Teaching should be within the mental capacity
of the audience.
 REINFORCEMENT
• Repetition of message at intervals is necessary
• If the message is repeated in different ways,
people are more likely to remember
it.
 LEARNING BY DOING
• The importance of learning by doing can be best
illustrated by the Chinese
proverb “if I hear, I forget; if I see, I remember; if I
do, I know”
 KNOWN TO UNKNOWN
• We must proceed
“from the concrete to the abstract”
“from the particular to the general”
“from the simple to the more complicated”
“from the easy to more difficult”
“from the known to unknown”
• Here health communicator uses the existing
knowledge of the people as pegs on
which to hang new knowledge
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3. It is part of a larger community?
4. What smaller communities does it include?
 Health services locations (availability and
accessibility)
1. Where are the main health services?
2. Are there necessary health services outside the
community? Where?
A. LOCATION
 Demographic features
> Climate
▪ Is the community prepared to cope with
emergencies?
 Plant and animals
▪ What plants and animals pose possible threat to
health?
 Human-made environment
▪ What are the major industries?
▪ How have air, land, water been affected by
humans?
▪ What is the quality of housing?
▪ Access to health institutions?
B. POPULATION
 the health of any community is greatly
influenced by the population that lives in it.

 FEEDBACK Variables:
• The health educator can modify the elements of • SIZE: Affects number and size of health care
the system (e.g., message, institutions
channels) in the light of feedback from his ▪ Homogeneity of population and its needs
audience ▪ What is the population? Is it urban suburban or
• For effective communication, feedback is of rural?
paramount importance. • DENSITY: What is the density per square mile?
Increased density increases
 LEADERS stress. High and low density affect the availability
• Leaders are agents of change and they can be of health services. • COMPOSITION: What is the
made use of in health education age composition? Sex composition? Marital
work. status? Occupations and %
• The attributes of a leader are; • RATE OF GROWTH OR DECLINE: How has
✓ He understands the needs and demands of the population size changes
community over the past two decades? Health implications of
✓ Provides proper guidance, takes the initiative, is this change?
receptive to the
views and suggestions of the people; C. SOCIAL SYSTEM
✓ Identifies himself with the community;  The circumstances in which people are born,
✓ Selfless, honest, impartial, considerate and grow up, live, work, and age, as well as the
sincere; systems put in place to deal with illness. These
✓ Easily accessible to the people; circumstances are in turn shaped by a wider
✓ Able to control and compromise the various set of forces: economics, social policies, and
factors in the politics.
community;
✓ Possesses the requisite skill and knowledge of Variables:
eliciting • Health system
cooperation and achieving coordination of the • Family system
various official and • Economic system
non-official organizations. • Educational system
• Religious system
DIMENSION OF THE COMMUNITY • Welfare system
• Political system
Any community having three features; • Recreational system
✓ LOCATION • Legal system
✓ POPULATION • Communication system
✓ SOCIAL SYSTEM
10 ESSENTIAL PUBLIC HEALTH SERVICES
Community Profile Relating to locating variables?
 Boundaries (incidence of wellness and illness 1. MONITOR HEALTH STATUS to identify community
and spread of disease) health problems
1. Where is the community located? 2. DIAGNOSE AND INVESTIGATE health problems
2. What are its boundaries? and health hazards in the community.

COMMUNITY AND PUBLIC HEALTH
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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 ASSURE THE PROVISION OF HEALTH
CARE when otherwise unavailable.
8. ASSURE A COMPETENT public health and
personal health care workforce
9. EVALUATE EFFECTIVES, ACCESSIBILITY, AND
QUALITY of personal and population-based health
services.
10. RESEARCH FOR NEW INSIGHTS and innovative
solutions to health
problems.
COMMUNITY DIAGNOSIS
 It is a quantitative and qualitative
description of the health of citizens and the
factors which influence their health.
 It identifies problems, proposes areas for
improvement and stimulates action”.
 a comprehensive assessment of health
status of the community in relation to its social,
physical, and biological environment.
 It should be the first stage in planning health
programs for the betterment and the
improvement of any community. It includes;
✓ Definition of the community’s demographic
characteristics
✓ Environment
✓ Health status
✓ Available health and social services
Purpose: to defines existing problems, determine
available resources and set priorities for planning,
implementing and evaluating health action, by
and for the community.
COMMUNITY ANALYSIS
 The process of examining data to define
needs strength, barriers, opportunities,
readiness, and resources. Its product is the
community profile.
COMMUNITY ASSESSMENT
 the regular collection analysis and sharing of
information about health conditions, risks,
and resources in a community.
COMMUNITY DIAGNOSIS: USES
▪ Identify trends in illness, injury, and death and the
factors, which may cause these events.
▪ Identify available resources and their application
▪ Identify unmet needs.
▪ Identify community perceptions about health
issues.
▪ Collect data regarding specific populations.
▪ Identify at risk and high-risk populations that is frail
elderly, unemployed/underemployed people,
women with prenatal care, troubled teens,children
behind on immunizations, low birth weight.
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▪ Assess nutritional trends/needs, housing, jobs,
healthcare providers, social services, etc.
▪ Monitor changing community needs.
▪ Assess changing population trends.
COMMUNITY DIAGNOSIS: IMPORTANCE
▪ Provides baseline information about the health
status of community residents
▪ Ensures that decisions are based on solid
information and evidence. ▪ Helps set of priorities.
▪ Helps Regional Health Authorities assess
outcomes and results in the longer term.
▪ Gets community members, stakeholders and a
wide variety of partners
▪ Involved in the decision-making process, helps
them understand the difficult choices that need to
be made, and builds support and commitment for
addressing health needs on a community-wide
basis.
▪ Can be used to guide policy and program
development.
▪ Can assist in mapping out links and
interdependence to other sectors
▪ Can provide insight in to the fundamental causes
and pathways of identify opportunities for disease
prevention, health promotion and health
protection.
HEALTH INDICATORS
 Are summary measures that are designed to
describe particular aspects of health or
health system performance.
 Community can be diagnosed by using it.
Classification of health indicators:
▪ Mortality indicators
▪ Morbidity indicators
▪ Disability rates
▪ Nutritional status indicators
▪ Health care delivery indicators
▪ Utilization rates
▪ Indicators of social and mental health
▪ Environmental indicators
▪ Socio-economic indicators
▪ Health policy indicators
▪ Indicators of quality of life
▪ Other indicators
COMMUNITY DIAGNOSIS: STEPS IN
IMPLEMENTATION PHASE
 Determine the objectives
 Define the study population
 Determine the data to be collected
 Collecting the data
> Records review
> Surveys & Observations
> Interviews
> Participant observation
 Developing the instruments
> Survey questionnaires
> Interview guides
> Observation checklist
 Actual data gathering
 Data collection & Data summarization
 Data presentation
 Data analyses
 Problem identification
> Magnitude, trend, comparison
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PRELIMS
> Health Status, Health-related, Health > culture, habits, income, beliefs, and
Resource) attitudes, occupation, housing, educational
 Priority-setting systems, religion, etc.
> Nature of the condition/problem presented
▪ Classified as health status, health resources or ENVIRONMENTAL SANITATION
health related problems
> Magnitude of the problem This deals with the following areas:
▪ Severity of the problem which can be measured
in terms of the proportion of the population  Water - provision of safe and adequate
affected by the problem supply of water
> Modifiability of the problem  Waste - proper disposal of solid waste
▪ Probability of reducing, controlling or eradicating  Sewage - proper sewage disposal and
the problem treatment
> Preventive potential  Food - safeguarding of food (food hygiene)
▪ Probability of controlling or reducing the effects  Housing - provision of good housing
posed by the problem  Insect Vectors - control of insect vectors and
> Social concern pests
▪ Perception of the population or the community  Air - control of atmospheric pollution
as they are affected by the problem and their  Other Hazards - Elimination of noise, radiation,
readiness to act on the problem etc’
• Factors inherent in the disease (or health
problem) ECOLOGICAL CONCEPTS
• Technical resources for dealing with the problem
• Reaction of the public Objectives
• Economic aspects  Examine certain terms used in the study of
human ecology in relation to community
health
HUMAN ECOLOGY  Discuss ecological factors in disease
Components of the Environment distribution
 Consider a conceptual framework for
THE HUMAN ENVIRONMENT studying human ecology
 Human environment implies all the external
factors (living and non-living) which surround TERMS USED IN HUMAN ECOLOGY
man
 Ecology
COMPONENTS OF THE ENVIRONMENT  Human ecology
Environment is divided into 3 components:  Ecosystems
 Ecological homoeostasis
 Physical Environment  Health status
 Biologic Environment
 Social Environment DEFINITION OF TERMS

PHYSICAL ENVIRONMENT  Ecology - the science of mutual relationship

between organisms living in a defined space
 Comprises the non-living part of the and their patterns of adoption to their
environment: environment.
> water
> air  Human Ecology - the interrelated, complex
> soil interactions that exist between man and his
> housing environment.
> wastes, radiation etc. > effects of man-environment interactions
> the etiology or casual evolution of health
BIOLOGIC ENVIRONMENT and disease (population genetics, physiology,
immunological and nutritional status of the
 Biologic Environment includes all living population)
organism (plant and animal life) including; > human ecology is a subset of the general
> bacteria science of ecology
> viruses
> insects  Human Ecology of Diseases - the interaction
> rodents between human behavior (cultural and
socio-economic context) with environmental
SOCIAL ENVIRONMENT conditions to protect or prevent disease
among susceptible people.
 Part of the environment which plays a
prominent role in determining the mental  Ecosystem - the human ecosystem includes
health of man and includes all the conditions the natural environment and all the
affecting man as a member of the society dimensions of the man-made environment -
physical, chemical, biological, psychological
Example: including our culture and all its products.
> disease is embedded in the ecosystem of
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> A functioning interacting system,
composed of one or more living organisms and
their effective environment, both physical and
biological and its basic reserves of matter and
energy, its pattern of circulation of matter and
energy; the nature of its income (input) of matter
and energy; and the behavior or trend of its
entropy level (Fosberg, 1967)
 Ecological Homeostasis - Homeostatic (Gr:
homois - ‘similar’ and statis - ‘statet’ or
‘standing’) can be represented as a dynamic
maintenance of assigned values, parameters,
functions and trends of development or
decay
> ecosystems in a steady state that possess
the property of self-regulation (action and
reaction)
> similar in principle to a wide range of
mechanisms, such as homeostatic in living
organisms
 Health Status - health according to
ecological concepts, is a state of dynamic
equilibrium between man and his
environment
> health status is related to the ecology
(natural environment) within which people interact
and carry out their activities, human settlements
and amenities available.
FOUR MAIN PROPERTIES OF ECOSYSTEM
 The term/property, ‘Monistic’ I.e., man and
environment are brought together in a single
framework.
 Ecosystems are structured in a more or less
orderly, rational, and comprehensible way
 Ecosystems functions involve continuous
through-out of matter and energy
 Ecosystems are a part of general system
CONCEPTUAL FRAMEWORK
The Tripod of the Interrelationship:
 Habitat (Environment)
 Population
 Behavior (culture)
ENVIRONMENT/HABITAT
 Elements of physical and biologic
environment:
> the built environment
> health services
> physical environment factors
> economic determinants
POPULATION - characteristics and health status
 Demographic characteristics (age structure,
sex, education/literacy, marital status, race,
ethnicity, etc.)
 Population status - the genetics
 Human biochemical system
9
ECOLOGICAL FACTORS IN DISEASE DISTRIBUTION
 Many diseases result from an interaction
between the host and the environment
 Man-made alterations to the environment
can cause changes which favour certain
diseases
 By constantly altering his environment or
ecosystem by urbanization, industrialization,
deforestation, construction of irrigation
canals, man has created new health
problems
 Ecological factors are therefore at the root of
geographic distribution of disease
 Disease agents such as malaria which were
previously controlled have shown a
recrudescence
 Occurrence of zoonotic diseases such as
rabies, yellow fever, lassa fever, monkey pox
 Construction of irrigation systems and artificial
lakes has created ecological niches for
breeding of mosquitoes and snails causing
increased occurrence of malaria,
onchocerciasis and schistosomiasis, etc.
 Communicable diseases are now being
replaced by non-communicable diseases in
developing countries
 New sources of pollution, e.g motor vehicles
and chemical industries are responsible for
new environmental problems
 The depletion of ozone layer by flue gases
into the atmosphere poses serious
environmental health problems globally
HUMAN BEHAVIOR
 Covers activities of man that affect disease
ecology
 Behavior exposes individuals and populations
to some hazards and protects them from
others
 People move from once place to another;
hence, diseases spread
 Behavior affects quality of population by
controlling genetics such as through
marriage customs, nutritional status, food
customs, customs of deliberate childhood
exposure to immunization etc.
Characteristics of the Health Field Concept
 The HEALTH FIELD CONCEPT has many
characteristics which make it a powerful tool
for analyzing health problems, determining
the health needs of Canadians and choosing
the means by which those needs can be
met.
 One of the evident consequences of the
Health Field Concept has been to raise
HUMAN BIOLOGY, ENVIRONMENT and
LIFESTYLE to a level of categorical
importance equal to that of HEALTH CARE
ORGANIZATION. This, in itself, is a radical step
in view of the clear preeminence that HEALTH
CARE ORGANIZATION has had in past
concepts of the health field.
 A second attribute of the Concept is that it is
comprehensive. Any health problem can be
traced to one, or a combination of the four
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elements. This comprehensiveness is PUBLIC HEALTH
important because it ensures that all aspects
of health will be given due consideration and Core Functions and Essential Services
that all who contribute to health, individually
and collectively, patient, physician, scientist  Assessment - systematically collect, analyze,
and government, are aware of their roles & make available information on healthy
and their influence on the level of health. communities.
 Policy Development - Promote the use of a
 A third feature is that the Concept permits a scientific knowledge base in policy and
system of analysis by which any question can decision making.
be examined under the four elements in  Assurance - ensure provision of services to
order to assess their relative significance and those in need.
interaction. For example, the underlying
causes of death from traffic accidents can TEN ESSENTIAL PUBLIC HEALTH SERVICES
be found to be due mainly to risks taken by
individuals, with lesser importance given to  Assessment
the design of cars and roads, and to the > Monitor health
availability of emergency treatment; human > Diagnose and investigate
biology has little or no significance in this area.  Policy Development
In order of importance, therefore, LIFESTYLE, > Inform, educate, and empower
ENVIRONMENT and HEALTH CARE > Mobilize community partnerships
ORGANIZATION contribute to traffic deaths in > Develop policies
the proportions of something like 75%, 20%  Assurance
and 5% respectively. This analysis permits > Enforce laws
program planners to focus their attention on > Link to and provide care
the most important contributing factors. > Assure a competent workforce
Similar assessments of the relative importance > Evaluate
of contributing factors can be made for  System management
many other health problems. > Research

 A fourth feature of the Concept is that it CORE FUNCTIONS AT GOVERNMENT LEVELS

permits a further sub-division of factors. Again
for traffic deaths in the Lifestyle category, the
risks taken by individuals can be classed
under impaired driving, carelessness, failure
to wear seat-belts and speeding. In many
ways the Concept thus provides a road map
which shows the most direct links between
health problems, and their underlying causes,
and the relative importance of various
contributing factors.

 Finally, the Health Field Concept provides a

new perspective on health, a perspective
which frees creative minds for the recognition
and exploration of hitherto neglected fields.
The importance on their own health of the
behaviour and habits of individual
Canadians is an example of the kind of
conclusion that is obtainable by using the STAKEHOLDER ROLES IN PUBLIC HEALTH
Health Field Concept as an analytical tool.
Partners in the Public Health System
 One of the main problems in improving the
health of Canadians is that the essential
power to do so is widely dispersed among
individual citizens, governments, health
professions and institutions. This fragmentation
of responsibility has sometimes led to
imbalanced approaches, with each
participant in the health field pursuing
solutions only within his area of interest. Under
the Health Field Concept, the fragments are
brought together into a unified whole which
permits everyone to see the importance of all
factors, including those which are the
responsibility of others.

 This unified view of the health field may well

turn out to be one of the Concept’s main
contributions to progress in improving the
level of health.
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Non-governmental organization DETERMINING & INFLUENCING THE PUBLIC’S HEALTH

What Determines the Health of a Population?

Health Care as a Partner in Public Health

Other Partners in Public Health

Health Impact Pyramid
 Media
> vehicle for public discourse
> health education, promotion &
communication
> social media as catalyst

 Employers and Businesses

> employer-sponsored health insurance
programs
> wellness initiatives & benefits
> healthy workplaces & communities

 Government Agencies
> City planning
> Education
> Health in all policies

 Academia
> education
> training
> research
> public service

Public Health Core Sciences