About Fundamentals of Public Health

Core course 3 credit hours Evening: Mon & Tue 5 to 6:30 pm 1.5 hr session Morning: Fri 9am to 12 pm-3 hr session Outline: : This course reviews the scope and historical background of Public Health in developed and developing countries, principles, development and organization of health care system in Pakistan, primary health care, leadership in health care, health care economics, health education and health information system, public health emergencies and disease of public health importance, and public health surveillance. Books: 1. Oxford textbook of Public Health 2. Public Health and Preventive Medicine by MaxcyRosenau Last
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Dr Saadiyah Rao Senior Lecturer School of Public Health Dow University of Health sciences

Learning Objectives
To understand: health the definition of Public Health difference between public health professionals & clinicians services & function of Public Health and to enlist achievements of Public Health

Dr Saadiyah Rao - School of Public Health, DUHS

Concept of Health
The word health is derived from old English word hal:

sound, whole Prior to the period of the Hippocrates (around 5 BCE), health was perceived as a divine gift. He theorized that what we currently regard as health.

Dr Saadiyah Rao - School of Public Health, DUHS

Concept of Health
The word health means different things to different

people The most widely quoted definition of health was created by WHO in 1946...... over half a century ago health is a state of complete physical, mental, social well being and not merely the absence of disease and infirmity

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Concept of Health cont

Conference of Health promotion: WHO, 1986, the

concept of health was amplified: To reach a state of complete physical, mental, social well being, an individual or group must be able to identify aspirations, to satisfy needs, & to change or cope with environment. Health is a resource for everyday living; it is a positive concept, emphasizing social & personal resources as well as physical capabilities
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Concept of Health cont

More recently WHO has also indicated that health is

a cumulative state, to be promoted throughout life in order to ensure that the full benefits are enjoyed in later years Good health is vital for maintaining an acceptable quality of life

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Concept of Health cont

Critics argue that the WHO definition of health is

idealist, inflexible, and unrealistic, and that including the word complete in the definition makes it highly unlikely that anyone would be healthy for a reasonable period of time Others have defined health as a dynamic condition of the human organism that is multidimensional in nature i.e physical, emotional, social, intellectual, spiritual and occupational, a resource for living and results from persons interactions with and adaptations to his/her environment.
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Concept of Health cont

So, health can exist in varying degrees and is specific to each

individual and his or her situation Example: a quadriplegic can be healthy in the sense that his/her mental and social well being are high and physical health is as good as it can be Or this athlete?

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Concept of Health cont

Several other generally accepted definitions of the

health: Saracchi in his paper The World Health Organization needs to reconsider its definition of Health. BMJ 1997 defines health as a condition of well being, free of disease or infirmity, and a basic and universal human right Bircher (Towards a dynamic definition of health and disease. 2005) defines health as a dynamic state of well-being characterized by a physical and mental potential, which satisfies the demands of life commensurate with age, culture, and personal responsibility.
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Concept of Health cont

Health status is determined by interaction of five

domains: 1-Genetic make up 2-Social circumstances such as education, employment, income, housing, crime 3-Enviornmental conditions where people live & work i.e toxic agents, microbes, structural hazards 4- Behavioural choices such as diet, physical activity, substance abuse 5-Availabilty of medical care
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Concept of Health cont

Health fate of each of us is determined by factors not

acting in isolation but are interconnected Gene expression can be determined by environmental exposures & behavioural patterns Nature & consequences of behavioural choices are affected by social circumstances Our genetic predispositions affect the health care we need And our social circumstances affects the health care we receive
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Terms
Community Health
Public Health Population Health

These terms are used interchangeably by both laypeople & professionals Most people are referring to the collective health of those in society and actions/activities taken to obtain or maintain that health
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Community Health
Refers to health status of a defined group of people &

the action, conditions to promote, protect and preserve their health Example: People living in Essa nagri (slum area) Punjabis living in London (ethnicity)

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Public Health
Of the three terms Public Health is most inclusive C.E.A. Winslow, 1923 (pioneer in the development of this

discipline) characterized public health practice as the science and art of disease prevention, prolonging life, and promoting health and well-being through organized community effort for
the sanitation of the environment, the control of communicable infections, education of the individual in personal hygiene

the organization of medical and nursing services for the early

diagnosis and prevention of disease the development of the social machinery to assure everyone a standard of living adequate for the maintenance or improvement of health.
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 Report on Higher Education for Public Health 1976

Public Health: More contemporary definitions

restore other peoples health. The programs, services & institutions involved emphasize the prevention of disease & health needs of the change with changing technology & social values but the goals remain the same: to reduce the amount of disease, premature death & disease-produced discomfort & disability

efforts organized by society to protect, promote and

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Public Health: More contemporary definitions

The Institute of Medicine-USA (IOM) defined public

health in 1988 in its landmark report the future of public health as: the fulfilment of societys interest in assuring the conditions in which people can be healthy and organized community efforts aimed at the prevention of disease & promotion of health. What we, as a society, do collectively to assure the conditions in which people can be healthy. It links many disciplines & rests upon the scientific core of epidemiology
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Public Health: More contemporary definitions

Acheson Report UK, Committee of Inquiry, 1988the

science and art of preventing disease, prolonging life and promoting health through the organized efforts of society The fundamental maxim of public health is that the health of the individual is best ensured by maintaining the improving the heath of the community (David Satcher, Centers for Disease Control and Prevention, Emerging Infections: Getting Ahead of the Curve1995)

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 The process of mobilizing local, state/provincial,

national and international resources to assure the conditions in which all people can be healthy (Breslow/Detels, 1997) Public health does not guarantee optimal health, but creates the conditions under which it can be achieved by society

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Public Health System

Organizational framework of Public Health

encompasses activities undertaken within formal structure of government and the associated efforts of private & voluntary organizations and individuals, Even with such formal definitions, public Health activities are still considered as efforts only originating in federal, state and local governmental health departments

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Population Health
This term has emerged recently
It is similar to community health Primary difference is the degree of organization or

identity of people Refers to health status of people who are not organized and have no identity as a group or locality and actions & conditions to promote, protect and preserve their health Example: Men younger than 50years, adolescents, prisoners, white-collar workers
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Public health Vs Medical Care

"Health care matters to all of us some of the time, public

health matters to all of us all of the time"

(C. Everett Koop) In medicine the patient is the individual; in public health, the patient is the community Public health diagnoses the health of the community using public health sciences Treatment of the community involves new policies and interventions Goal of medicine is cure; goal of public health is prevention of disease and disability
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Public health Vs Medical Care

Medicine Medicine
Focus on individuals
Focus on individuals Diagnosis & treatment

Public Health Public Health

Focus on populations
Focus populations on Prevention & health

Diagnosis treatment Clinical& interventions

Prevention & health promotion

promotion

Well-established Clinical interventions profession,

standardized education & certification Well-established profession,

behavior interventions Environment & human behavior interventions

Environment & human Diverse workforce, variable

standardized education & certification

Clinical sciences integral;

Diverse workforce, education & education &variable certifications certifications

social sciences less emphasized

Clinical sciences integral; social sciences less emphasized Experimental studies with groups: RCTs

Social sciences integral;

Social sciences integral; clinical sciences to education peripheral to education

clinical sciences peripheral

control groups: RCTs. Experimental studies with control

Observational studies: case control & control & cohort studies 23 Dr Saadiyah Rao - School of Public Health, DUHS cohort studies

Observational studies: case

Vision of Public Health

Healthy people in healthy Communities !

The Goal of Public Health

The biologic, physical and mental well-being of all members of the global society, regardless of ethnicity, religion, gender, sexual orientation, country or political views. (Detels, 2003)

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The Scope of Public Health

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Source: http://www.ewashtenaw.org

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The Scope of Public Health

Infectious diseases Chronic diseases Heart disease, metabolic disorders, cancer, etc. Mental health Nutrition disorders Health of the vulnerable e.g. poor, children, women, elderly, etc. Substance abusers: drugs, alcohol, tobacco Accidents/violence/injuries Occupational health Environmental health Access to health care Quality of health care Dr Saadiyah Rao - School of Public Health, DUHS War

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Five Public Health Responsibilities

1.

Prevention of epidemics & spread of disease

2.

Protection of people against environmental Hazards & prevention of injuries

Promotion & encouragement of healthy behavior changes Quick response to the disaster & to assist the communities in recovery phase

3. 4.

5.

To assure quality, accessible, and affordable comprehensive health care services

http://www.health.ny.gov/press/reports/century/phc_terms.htm

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Public Health Approach

Risk Factor Identification: What is the cause?

Implementation: How do you do it? Intervention Evaluation: What works?

Surveillance: What is the problem?

Problem
Courtesy :Glyn G. Caldwell
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Response

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Core public health functions

Were outlined in the 1988 by Institute of Medicine report - The

Future of Public Health. In recent years there has been a growing sense that public health as a profession, as a governmental activity, and as a commitment of society is neither clearly defined, adequately supported, nor fully understood. ..current capabilities for effective public health action are inadequate. So, Assessment Policy development Assurance
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How to achieve these function?

Essential Public Health Services The Core Public Health Functions Steering Committee

developed the framework for the Essential Services in 1994. The Essential Services provide a working definition of public health and a guiding framework for the responsibilities of local public health systems.

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10 Essential Services of Public Health

Saadiyah Rao - School of Public Health, DUHS Public HealthDr Functions Project, U.S. Dept. of Health and Human Services

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 Assessment
Monitor health status to identify community health

problems Diagnose and investigate health problems and health hazards in the community Research for new insights and innovative solutions to health problems

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 Policy Development
Inform, educate, and empower people about health

issues Mobilize community partnerships to identify and solve health problems Develop policies and plans that support individual and community health efforts

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 Assurance
Enforce laws and regulations that protect health and

ensure safety. Link people to needed personal health services and assure the provision of health care Assure a competent public health and personal health care workforce Evaluate effectiveness, accessibility, and quality of personal and population-based health services
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1.Monitor Health Status to Identify Community Health Problems

Accurate, periodic assessment of the communitys health

status, including:
Identification of health risks and determination of health

service needs. Attention to vital statistics and disparities Health status of groups that are at higher risk than the total population Identifications of assets and resources

Utilization of methods and technology to interpret and

communicate data Population health registries

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2 .Diagnose and Investigate Health Problems and Health Hazards in the Community
Timely identification and investigation of health threats such

as disease outbreaks and patterns of infectious and chronic diseases and injuries, environmental hazards Active infectious disease epidemiology programs Availability of diagnostic services, including laboratory capacity of conducting rapid screening & high volume testing Population-based screening, case finding, investigation, and the scientific analysis of health problems Response plans to address major health threats

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3.Inform, Educate and Empower People about Health Issues

Health information, health education, and health promotion

activities designed to reduce health risk and promote better health

Initiatives using health education and communication

sciences to:
Build knowledge and shape attitudes
Inform decision-making choice Develop skills and behaviors for healthy living

Health communication plans and activities such as media

advocacy and social marketing. Health education and health promotion program partnerships with schools, faith communities, work sites, personal care providers, and others to implement and reinforce health promotion programs and messages. Dr Saadiyah Rao - School of Public Health, DUHS 37

4.Mobilize Community Partnerships to Identify and Solve Health Problems

Community development and identification of system

partners and stakeholders Coalition development Convening and facilitating partnerships among groups and associations (including those not typically considered to be health-related) in undertaking defined health improvement projects, including preventive, screening, rehabilitation, and support programs.

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5.Develop Policies and Plans that Support Individual and Community Health Efforts
Systematic health planning that relies on appropriate data,

develops and tracks measurable health objectives, and establishes strategies and actions to guide community health improvement at the state and local levels. Development of legislation, codes, rules, regulations, ordinances and other policies to enable performance of the Essential Public Health Services, supporting individual, community, and state health efforts.

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6.Enforce Laws and Regulations that Protect Health and Ensure Safety
The review, evaluation, and revision of laws and regulations

designed to protect health and safety to assure that they reflect current scientific knowledge and best practices for achieving compliance. Education of persons and entities obligated to obey or to enforce laws and regulations designed to protect health and safety in order to encourage compliance.

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 Enforcement activities include, but not limited to the

protection of drinking water; enforcement of clean air standards; regulation of care provided in health care facilities and programs; re-inspection of workplaces following safety violations; review of new drug, biologic, and medical device applications; enforcement of laws governing such as the seat belt usage and childhood immunizations.

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7.Link People to Needed Personal Health Services

Identifying personal health service needs of populations with

limited access, to a coordinated system of clinical care. Assuring the linkage of people to appropriate personal health services through coordination of provider services and development of interventions that address barriers to care (e.g., culturally and linguistically appropriate staff and materials, transportation services). Partnership with public, private, and voluntary sectors to provide populations with a coordinated system of health care.

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8.Assure a Competent Public and Personal Health Care Workforce

Assessment of workforce (including volunteers and other lay

community health workers) to meet community needs for public and personal health services. Maintaining public health workforce standards, including efficient processes for licensure/credentialing of professional and incorporation of core public health competencies needed to provide the Essential Public Health Services into personnel systems.

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 Education, training, development, and assessment of health

professional - including partners, volunteers and other lay community health workers - to meet statewide needs for public and personal health services.

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9.Evaluate Effectiveness, Accessibility, and Quality of Personal and Population-Based Health Services
Assessing the accessibility and quality of services delivered

and the effectiveness of personal and population-based programs provided. Evaluation answers
Are we doing things right? Are we doing the right things?

Evaluation must be ongoing and should examine: Personal health services Population based services The public health system
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 Evaluation should drive resource allocation and program

improvement Evaluation and critical review of health program, based on analyses of health status and service utilization data, are conducted to determine program effectiveness and to provide information necessary for allocating resources and reshaping programs for improved efficiency, effectiveness, and quality

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10.Research for New Insights and Innovative Solutions to Health Problems

Identification and monitoring of innovative solutions and

cutting-edge research to advance public health Linkages between public health practice and academic / research settings Epidemiological studies, health policy analyses and health systems research.

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Achievements of Public Health

The dramatic achievements of Public Health in the

20th century have improved our quality of life: an increase in life expectancy, world wide reduction in infant and child mortality, the elimination or reduction of many communicable diseases.

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Achievements of Public Health

Vaccination & Control of infectious diseases: Immunizations have virtually eliminated: Smallpox Diphtheria Pertussis Tetanus Polio Measles Rubella
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Achievements of Public Health

Motor-vehicle safety Decreased death toll Increased seat belt use Vehicle safety improvements Traffic safety regulation and enforcement Improved streets and highways

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Achievements of Public Health

Safer and healthier foods Safe and healthier foods are now common place because of: Hand washing Sanitation Refrigeration Pasteurization Pest control Healthier animal care, feeding, and processing Improved food supply safety
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Achievements of Public Health

Safer workplaces Mining safety Industrial safety Indoor air quality Ergonomics

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Achievements of Public Health

Decline in deaths from coronary heart disease

and stroke The leading cause of death in the U.S. despite a 60% decrease in death rates since 1950. Recognition of tobacco as a health hazard Smoking, once socially acceptable, is on the decline among U.S. adults. % of population who smoke 196542.4% 199724.7%
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Achievements of Public Health

Healthier mothers and babies
Maternal mortality rates down 99% Infant mortality rates down 90%

Improved standards of living

Technological advances in medicine Greater access to maternal and well-baby care Family planning Desired birth spacing and family size

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Task
Apply the core functions i.e: Assessment Policy development Assurance to a public health problem

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References
Foundations of community health. Jones & Bartlett
Bulletin of the World Health Organization: Re-

defining Health Article: stn & Jakob. 2005;83:802 CDC National Public Health Performance Standards Program

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