September, 08, 2017

Public Health
History and Challenges

Budi Setiawan, M.Sc

IKM & Epidemiologi Class
 Overview
• Definition
• History
• Challenge
• Public Health Approach
 Definition of Health
• The state of complete physical,
mental and social well-being and
not merely the absence of disease
or infirmity WHO, 1947
Definition of Public Health
• Public health is defined as the
science of protecting the safety
and improving the health of
communities through education,
policy making and research for
disease and injury prevention.
Definition of Public Health
• Activities that society undertakes
to assure the conditions in which
people can be healthy, including
organized community efforts to
prevent, identify and counter
threats to the health of the public.
Definition of Public Health
• The Acheson Report (1988)
defines Public health more
succinctly as:
• The science and art of preventing
disease, prolonging life, and
promoting health through
organized efforts of society.
 What is Public health ?
• John M. Last’s Dictionary of
Public Health (2001) gives the
following:

• Public Health is one of the efforts

organized by society to protect,
promote, and restore the peoples’
health.
 What is Public health?
• Public health is the combination of
sciences, skills, and beliefs that is
directed to the maintenance and
improvement of the health of all
the people through collective or
social actions.
 What is Public health?
• Public health activities change
with changing technology and
social values, but the goals
remain the same: to reduce the
amount of disease, premature
death, and disease-produced
discomfort and disability in the
population.
 Essential Public Health
Functions
• Monitor health status to identify
community health problems.
• Diagnose and investigate health
problems and health hazards in
the community.
• Inform, educate, and empower
people about health issues.
 Essential Public Health
Functions
• Mobilize community partnerships
to identify and solve health
problems.
• Develop policies and plans that
support individual and community
health efforts.
 Essential Public Health
Functions
• Enforce laws and regulations that
protect health and ensure safety.
• Link people to needed personal
health services and assure the
provision of health care when
otherwise unavailable.
 Essential Public Health
Functions
• Assure a competent public health
care workforce.
• Evaluate effectiveness,
accessibility, and quality of
personal and population-based
health services.
• Research for new insights and
innovative solutions to health
problems.
 History
Roman Civilization –
Public Health Achievements
• Roman civilization that succeeded the Athenian is well
known for its engineering and administrative
arrangements affecting public health
• E.g., inspection and removal of dilapidated buildings,
elimination of dangerous animals and foul smells,
supervision of weights and measures, supervision of
public bars and taverns, supervision of houses of
prostitution, regulation of building construction, etc.
• E.g., supply of good and cheap grain guaranteed to
the poor
 Cont’d
• E.g., many streets were paved and had gutters that
helped to drain by a network of underground conduits
• E.g., provision was made for the cleaning and repair of
streets and for removal of garbage and rubbish
• E.g., public baths were constructed and extensively
used
• E.g., an adequate and relatively safe water supply was
made available by construction of magnificent
aqueducts and water tunnels
– Many of these are still in use today, having been
incorporated into the present-day water and sewage
systems of Rome and other cities
 MIDDLE AGES
• Negative reactions to Greek/Roman influence
• Disregard of personal hygiene and sanitation
• Rise of pandemics -- e.g., cholera
• Leprosy
• Laws to isolate affected individuals; lack of
treatment or care
• The Black Death (Bubonic Plague)
 Key Events
Snow and Cholera
• Epidemiology: mapping cases of
cholera and household use of water
sources revealed pattern involving a
single water pump
• Removing the handle from the
Broad Street pump ended the
epidemic
Jhon Snow Map of Cholera
 Did you know that . . .
• In an 1881 report the SC Board
of Health identified swamp
drainage as an important tool in
stopping malaria, 10 years
before the mosquito was
identified as the specific vector
of the disease?
 Getting richer, but not for all
The poor
• Absolute poverty (<US$1 per
day) fell from 40% to 21%
from 1981-2001 (Chen &
Ravallion, 2004)
• 6.3 billion people on earth –
half lived on less than US$2
per day in 2003, an increase
of 50% over the past 20
years (The World Bank 2004)
• The poorest 50% of the
world’s population
accounting for just 5% of the
global income (Bornstein,
2004)
The rich
• 20% of the population
own 80% of the world’s
wealth (United Nation,
2005)
• Rich countries
accumulated wealth at
a much faster rate than
poor countries
=> Growing income
inequalities
 Now ???
INDONESIA !!!
 Public Health System
Activities
• Health promotion

• Disease prevention
 Prevention Triangles
Tertiary
Tertiary Medical Care
Prevention Secondary
Medical Care
Secondary
Prevention Primary Medical Care
Clinical Preventive Services
Primary
Prevention Population Oriented Prevention
 Public Implementation:
Health How do you
do it?
Approach Intervention
Evaluation:
What
works?
Risk Factor
Identification:
What is the
cause?
Surveillance:
What
is the
problem?
Problem Response
Questions
&
Discussion
 Discussion Time
• What has been your personal
awareness of public health?
• Have you ever visited a public
health program? Used a public
health service?
• What are current public health
issues in your community?
Conclusion
 Reference
• Globalization, Poverty & Health Inequality (Dr. Amy Po-Ying

HO Senior Lecturer, The Hong Kong Polytechnic University)

• The History of Public Health (Kristine M. Gebbie, DrPH, RN

Columbia University School of Nursing Center for Health Policy )

• Introduction to the Public Health Approach (Glyn G. Caldwell,

MD)