Program Name

Introduction to Public Health Practice

Module No. 4 – Public Health & Health

Systems

Prevention Health Services

Faculty Name :
Date:
Subject Code: School of Public Hea
Objective

At the end of this module, the students should be able to

 Describe the health system as a public health concern
 Discuss Natural history of disease
 Identify and describe the levels of prevention and modes of
intervention

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Learning Outcome
 The students will acquire knowledge about the natural history
of disease as well as the modes of intervention and will be able
to apply this knowledge for the prevention of health problems
in the community

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Content
 Public health system
 Natural History of Disease
 Levels of prevention
 Modes of intervention
 Health services pyramid

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Public health system
 Relationship between public health and other health activities has never
been clear.
 Different views prevail among health professionals
 Public health is part of the health system or the health system is part of
public health?
 Most components serve the same ends
 The term health system refers to all aspects of the organization, financing
and provision of programs and services for prevention and treatment of
illness and injury.
 The public health system is a component of this larger health system.
 Public commonly perceives the health system to include only medical care
and treatment aspects of the overall system.
 However, public health activities are part of larger set of activities that
focus on health, well-being, disease and illness.
Some questions to brainstorm
 Does the countries have a rational strategy for investing its resources to
maintain and improve people’s health?
 Is the current strategy excessive in ways that inequitably limited access to
and benefit from needed services?
 Is the health system accountable to its end-users and ultimate payers for the
quality and results of its services.
 The issues of health,
 Excess
 access,
 Accountability
 and quality
 Make the health system a public health concern
Prevention and Health service
 Health and illness are dynamic state that are influenced by
a wide variety of biological, environmental, behavioral,
social and health services factors acting through an
ecological model.
 The complex interaction of these factors results in the
occurrence or absence of disease or injury.
 Which in turn contributes to the health status of
individuals and populations.
Prevention and Health services
 Before we go to prevention, its necessary to understand
the Natural history of disease.
 The nineteenth-century revolution in thinking brought
about by Koch and Pasteur led to the recognition of
distinct stages in the development of a disease.
 If left untreated, a disease would evolve through a series
of stages that characterize its natural history
 But if an intervention is applied, the natural history is
modified, producing a typical clinical course for the
condition
Natural history of disease
General strategies to maintain health
before developing health
 Two general strategies that seek to maintain health by
intervening prior to the development of disease or injury.
 Health promotion
 Specific protection
 Both involve activities that alter the interaction of the
various health-influencing factors in ways that contribute to
either averting or altering the likelihood of occurrence of
disease or injury.
Health promotion and
Specific Protection
 Health promotion activities attempt to modify human
behaviors by increasing the ability to resist disease or
injury- including factors, thereby reducing or neutralizing
risks to health.
 Examples of health promotion activities include
interventions such as nutrition counseling, genetic
counseling, family counseling, and the myriad activities
that constitute health education
Health promotion and Specific Protection

 Health promotion also properly includes

 Provision of adequate housing
 Employment
 Recreational conditions
 Community development activities
 It is somewhat ironic that activities that focus on the state of
health and that seek to maintain and promote health are not
commonly perceived to be “health services.
 Specific protection activities provide individuals with resistance
to factors (such as microorganisms like viruses and bacteria) or
modify environments to decrease potentially harmful interactions
of health-influencing factors (such as toxic exposures in the
workplace).
Examples of specific protection
 Use of protective equipment for asbestos removal)
 Immunizations
 Occupational
 Environmental engineering,
 Regulatory controls
 Activities to protect individuals from environmental
carcinogens
 Exposure to second-hand or side-stream smoke
 Toxins
Early Case Finding and Prompt Treatment,
Disability Limitation, and Rehabilitation
 Early detection and prompt treatment reduce individual
pain and suffering and are less costly to both the
individual and society
 Interventions to achieve early detection and prompt
treatment include
 Screening tests
 Case-finding efforts
 Periodic physical exams
Screening tests, Case-finding efforts and Periodic
physical exams

 Screening tests are increasingly available to

detect illnesses before they become symptomatic.
 Case-finding efforts for both infectious and
noninfectious conditions are directed at
populations at greater risk for the condition on the
basis of criteria appropriate for that condition.
 Periodic physical exams
 Strategy targeting disease is disability limitation through
effective and complete treatment.
 Efforts largely aim to arrest or eradicate disease or to
limit disability and prevent death.
 The final intervention strategy focusing on disease—
rehabilitation—is designed to return individuals who have
experienced a condition to the maximum level of function
consistent with their capacities
Link with Prevention
 Prevention in relation to the stage of the disease or
condition.
 Preventive intervention strategies are considered
 Primary
 Secondary
 Tertiary
 Primary prevention

 Here the goal is to protect healthy people from

developing a disease or experiencing an injury in
the first place through reducing risk factor levels.
 For example:
 education about good nutrition, the importance of
regular exercise, and the dangers of tobacco, alcohol
and other drugs
 education and legislation about proper seatbelt and
helmet use
 regular exams and screening tests to monitor risk
factors for illness
 immunization against infectious disease
 controlling potential hazards at home and in the
workplace
Secondary Prevention

 These interventions happen after an illness or

serious risk factors have already been diagnosed.
The goal is to halt or slow the progress of
disease (if possible) in its earliest stages; in the
case of injury, goals include limiting long-term
disability and preventing re-injury.
 For example:
 telling people to take daily, low-dose aspirin to
prevent a first or second heart attack or stroke
 recommending regular exams and screening tests in
people with known risk factors for illness
 providing suitably modified work for injured
workers
Tertiary prevention

 This focuses on helping people manage complicated,

long-term health problems such as diabetes, heart disease,
cancer and chronic musculoskeletal pain. The goals
include preventing further physical deterioration and
maximizing quality of life.
 For example:
 cardiac or stroke rehabilitation programs
 chronic pain management programs
 patient support groups
 Prevention strategies in relation to population disease
status and effect on disease incidence and prevalence.
 Primary prevention aims to reduce the incidence of
conditions,
 Secondary and tertiary prevention seek to reduce
prevalence by shortening duration and minimizing the
effects of disease or injury
Relationship of health promotion and
specific protection to levels of prevention
Primary, secondary and tertiary
 Relationship with Health promotion and specific
protection are primary prevention strategies seeking to
prevent the development of disease.
 Early case finding and prompt treatment represent
secondary prevention, because they seek to interrupt the
disease process before it becomes symptomatic
 Disability limitation and rehabilitation are considered
tertiary-level prevention in that they seek to prevent or
reduce disability associated with disease or injury.
Links with Public Health and
Medical Practice
 Its allocation of responsibilities for carrying out the
various interventions.
 Three practice domains can be roughly delineated:
 Public health practice
 Medical practice
 Long-term care practice
Public health practice
 Primary goal: health promotion, specific protection and
early case finding.
 The concept of public health practice here is a broad one
that accommodates the activities carried out by many
different types of health professionals and workers, not
only those working in public health agencies
 Public health practice occurs in voluntary health agencies,
as well as in settings such as schools, social service
agencies, industry, and even traditional medical care
settings.
Health Care Pyramid Levels
Primary, Secondary and Tertiary medical care
Primary medical care
 Focuses on the basic health needs of individual and families
 First contact health care in the view of the patient
 Provides 80% of necessary care, includes comprehensive array of services,
 Onsite referral, health promotion and disease prevention
 Curative services
Secondary care
 Specialized care serving the major share of remain 20% of need beyond scope of
primary care.
 Physicians or hospitals provide secondary care , generally on referal from primacy
care
Tertiary medical care
 Highly specialized and technologically sophisticated medical and surgical care
 For complex conditions
 Provided in large medical centers or academic health centers.
Long-term care practices
 Long-term care is appropriately classified separately because of
the special needs of the population requiring such services and
the specialized settings where many of these services are offered.
 This, too, is changing as specialized long-term care services
increasingly move out of long-term care facilities and into home
settings.
 Everyone should be served by population-wide public health
services, and nearly everyone should be served by primary
medical care.
 However, increasingly smaller proportions of the total
population require secondary - and tertiary-level medical care
services
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Public Health and Medical Practice
Interfaces
 Public health and medical practice are presented as
separate domains of practice, there are many interfaces
that provide a template for either collaboration or conflict.
 Public health practitioners have traditionally deferred to
medical practitioners for providing the broad spectrum of
services for disease and injuries in individuals
 Medical practitioners have generally acknowledged the
need for public health practice for health promotion and
specific protection strategies
Summary
 Generally, primary preventive services are community-
based and are targeted toward populations or groups rather
than individuals.
 Early case-finding activities can be directed toward groups
or toward individuals
 Long-term care involves elements of both community-
based service and individually oriented service.

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References
 Principles of Public Health Practice, 3rd Edition, F.
Douglas
 Developing Practice for Public Health and Health
Promotion E-Book, 3rd Edition, Naidoo & Wills
 Park’s Textbook of Preventive and Social Medicine, 20th
Edition, K. Park
 Community Medicine with Recent Advances, 3rd Edition,
AH Suryakantha
 http://www.jblearning.com/samples/0763745251/45251_
CH03_049_072.pdf
 www.ashp.org/DocLibrary/Bookstore/P1725-
Chapter9.aspx
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 Thanks

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