MODULE 1:

INTRODUCTION TO
COMMUNITY AND
PUBLIC HEALTH
NURSING
 LESSON 1:
HEALTH AN EVOLVING CONCEPT,
THE GOAL OF NURSING IN THE
COMMUNITY
 LEARNING OBJECTIVES

• Upon completion of this 1st lesson topic, the BSN 2 students will be able to:
Discuss definitions of health;
Recognize the value of health as a human right;
Enumerate the various models of health;
Identify and give examples of the determinants of health and disease
Explain how the social determinants of health affect nursing practice
in the community, and
Relate One Health concept as a framework to community health
nursing practice.
 KEY TERMS

Health
Determinants of health
One Health Concept
Social determinants of health
Universal Declaration of Human Rights
 healthcare system
health outcomes
health promotion
Multisectoral Approach
Department of Health
 KEY TERMS

Models of Health
Community Health
Community Health Nursing
 Public Health
Basic Principles of CHN
Standards of CHN
HEALTH: KEY CONCEPT IN
NURSING
 DEFINITIONS OF HEALTH

NURSING
As a profession
- aimed at helping the population achieve better health
thru their own hands

As a science
- relies on an understanding the key towards genuine
development in investing on health and healthcare of
people regardless of age, gender, religion, and color
(Sumile, 2018)
 DEFINITIONS OF HEALTH

• HEALTH (in nursing science)

• -it is a shared, complex reality
• -is multidimensional, the well-being of an individual is determined by
factors such as biological and behavioral characteristics, the physical
and social environment.
• -is a fundamental right of every individual regardless of race, religion,
political belief, economic and social condition.
 D E F I N I T I O N O F H E A LT H
( W O R L D H E A LT H O R G A N I Z AT I O N )

“ a state of complete, physical,

mental, and social well-being and
not merely the absence of disease
or infirmity” (1958)
• Social means relating to living together in organized groups or similar
close aggregates (American Heritage College Dictionary, 1997, p.1291)

Refers to units of people in communities who interact with one

another

• Social health connotes community vitality and is a result of positive

interaction among groups within the community, with an emphasis on
health promotion and illness prevention.
“ Health is the extent to which an individual or group is able, on the
one hand, to realize aspirations and satisfy needs; and, on the other
hand, to change or cope with the environment. Health is therefore,
seen as a source for everyday life, not the objective of living; it is a
positive concept emphasizing social and personal resources, and
physical capacities” (1986).
 HEALTH AS A HUMAN RIGHT

• Health as a human right is grounded in:

1. Universal Declaration of Human Rights

(UDHR)-proclaimed by the United Nations (UN) General
Assembly in Paris on Dec. 1948
-it did set that fundamental human rights be
universally protected.
• Article 25.1 declares: “Everyone has the right
to a standard of living adequate for the health
and well-being of himself and of his family,
including food, clothing, housing and medical
care and necessary social services” (United
Nations, UDHR, 1948)
2. International Covenant on Economic, Social and Cultural
Rights (United Nations, CESCR)
Art.12: “ Health is a fundamental human right
indispensable for the exercise of other human rights. Every
human being is entitled to the enjoyment of the highest
attainable standard of health conducive to living a life in
dignity. The realization of the right to health may be pursued
through numerous, complementary approaches, such as the
formulation of health policies, or the implementation of
health programmes developed by the World Health
Organization (WHO), or the adoption of specific legal
instruments” (United Nations, CESCR, 2000)
• According to the Committee on Economic, Social and Cultural Rights,
(United Nations, CESCR, 2000) the right to health consist of
interconnected and indispensable components:
• 1. Availability-requires that operational public health and
channels of service delivery, products and services as well as
programs be adequate for all.
• 2. Accessibility- entails that health facilities, services and goods
must be made possible and obtainable to everyone. Being non-
discriminatory, physically accessible, economically accessible
(affordable) and information accessible are the four intersecting
features of accessibility.
• 3. Acceptability- corresponds to respect for the medical ethics,
being culturally appropriate and gender sensitive. This clearly
define the need for health care centers, products services and
programs to be people-centered, able to accommodate the
specific needs of diverse population groups and adheres to the
international standards of medical ethics for informed consent
and confidentiality.
• 4. Quality-implies that the health facilities, commodities and
services must be in accordance with specific and medical
standards. Quality health services need to be safe, effective,
people-centered, timely, equitable, integrated and efficient.
3. Article II Section 11 and 15 of the 1987 Philippine Constitution
-at the National Level, affirms health as a fundamental human right
and recognizes the obligation of the state to protect and promote the right to
health of all Filipinos ( Republic of the Philippines Official Gazette, 1987)

Department of Health (DOH)

Leads the health sector towards assuring quality health care in promoting and
protecting the health of all Filipinos.
 MODELS OF HEALTH

• Guides the nurses in understanding health as a concept:

• 1. Clinical Model
• Health is the absence of signs and symptoms of disease and illness.
Ex: An adult individual who is not particular with his lifestyle choices will
only seek healthcare when chest pain is encountered and begins to suspect a
cardiovascular disease.
• 2. Role Performance Model
• The ability to perform societal roles defines what health is, failure to
perform these roles means illness.
• Ex: An employee who reported for work, even if he/she is febrile.
• Guides the nurses in understanding health as a concept:
• 3. Adaptive Model
• Health is a dynamic state. An individual is considered to be healthy if
he/she was able to adjust positively to social, mental, and physiological.
Illness exist when the person failed to cope or become maladaptive to these
changes.
• 4. Eudaimonistic Model
• An elevated (exuberant) level of wellness or well-being. Illness is
reflected by a lack of vitality.
• Illness is indicated by a denervation or languishing, a wasting away, or
lack of involvement with life.
• Derived from Greek terminology, this term indicates a model that
embodies the interaction and inter-relationships among the physical,
social, psychological and spiritual aspects of life and the environment.
5. HEALTH ILLNESS CONTINUUM
• The concept demonstrates that a person can have a terminal
disease and be emotionally prepared for death, while acting as a
support for other people and achieving high-level wellness. High-
level wellness involves progression towards a higher level of
functioning, an open-ended and ever-expanding future with its
challenge of fuller potential, and the integration of the whole
being.
6. AGENT HOST ENVIRONMENT
7. HEALTH BELIEF MODEL
 DETERMINANTS OF HEALTH AND
DISEASE
It is essential for the community health nurse to understand the determinants of health and recognize the
interaction of the factors that leads to disease, death, and disability :
• 1. Biology
• The individual’s genetic make up, family history, and any physical and mental health problems
developed in the course of life. Heredity plays an important part in determining lifespan, state of
wellness and likelihood of developing illness. Aging, diet, physical activity, smoking, stress,
alcohol or drug abuse, injury, violence, or a toxic on infectious agent may produce illness or
disability, changing an individual’s biology.
Ex: genetics, hormones, age, gender, body weight, blood pressure, cholesterol levels, ethnicity,
functions of organs and body systems
• 2. Behaviors
• The individual’s responses to internal stimuli and external conditions.
Ex: tobacco smoking, alcohol consumption, drug misuse, physical activity levels, dietary
choices etc
• 3. Social Environment
• Includes interactions and relationships with family, friends, coworkers,
and others in the community.
• Has a great impact on the health of individuals, groups, and communities.
• Complex in nature because of differing cultures and practices.
Ex: Social institutions- law enforcement, religious communities, schools,
and government agencies, housing, public transportation and availability of
resources
• 4. Physical Environment
• Pertains to an environment that is experienced by the senses-what is
smelled, seen, touched, heard, and tasted.
Ex: housing, work environment, urban design and infrastructure, air quality
and climate and climate change.
• 5. Policies and Interventions
• Can have a profound effect on the health of
individuals, groups, and communities.
Ex: Policies Against Smoking in public
places,
Seatbelt and Child restraint laws
Litter Ordinances
Public Health Nurses must
work with policy makers
and community leaders to
identify patterns of disease
and death and to advocate
for activities and policies
that promote health at the
individual, family,
aggregate, and population
levels.
Determinant of Health
 Factors that combine
together to affect the
health of individuals and
communities.
* Biological
* Behavioral
* Social Environment
* Physical Environment
* Policies and
Interventions
 SOCIAL DETERMINANTS OF HEALTH

• Social Determinants of Health (SDH) are:

“ conditions in which people are born, grow, live, work
and age; might also be circumstantial elements as such
housing, work conditions and access to recreational
activities; circumstances that influence how an individual
will develop sickness, what risk factor they are exposed to,
how they access services; and is shaped by the distribution
of money, power and resources at global, national and
local levels” (CSDH, 2008)
• SHD may also include:
• occupation,
• circumstances affecting the way in which people
work,
• Income,
• Culture,
• Religion,
• Education,
• Racial, and
• Gender discrimination
 CASE SCENARIO

A family of seven (7), a couple with five (5) kids; living in

a depressed area in Metro Manila; both parents are high
school drop outs, father working as a construction worker
(not a regular basis), earning below the minimum wage;
mother is a full time housewife, cares for her infant, toddler,
preschooler, and two school aged children; not even one of
the children goes to school. To satisfy their hunger, the
usual foods served every meal are salt bread “pandesal”
and instant noodles.
What are the health related problems
may be identified in the given
scenario?
At present, public health sector is particularly working on the
social determinants of health (Schrammer & Ramon, 2018)
In order to improve health equity, WHO advocated for
intersectoral actions; thus, leading to a multisectoral approach to
health
Aside from the health sector, other essential sectors in the society
such as the government, civil society, local communities, business,
global assemblies and international agencies were made involved (
CSDH, 2008)
Consequently, a better health outcome will be positively
instrumental to the attainment of the goals of the other sectors
(UN Platform on Social Determinants of Health)
 ONE HEALTH CONCEPT: A FRAMEWORK
FOR COMMUNITY AND PUBLIC HEALTH
NURSING

The world in the present times, is faced with immense challenges for
health.
Jones, et al., 2008 reported the appearance of 335 infectious disease
among human population between 1940 and 2004
COVID 19 immergence in the past 2 years and still occurring at the
present.
Emerging infectious diseases (EIDs) are a matter of importance to
a great extent if there is a rapid increase in cases and high incidences
of deaths cased by these diseases (Petrosillo, 2019)
The most effective way to act in response to the threats of EIDs is
the One Health Approach-recognizing the connection between
human, animal, and environmental health (Johnson et al., 2019)
 consolidated interaction between human health, veterinary
medicine, and public and environmental health
professionals, clinicians, researchers, and agencies
functioning hand in hand for a worthwhile and sustainable
health interventions in addressing worldwide and
environmental health challenges. The reciprocal actions may
occur at several levels which is from management of
zoonotic infectious disease outbreaks to consolidated policy-
making and funding resolution (Day, 2011)
• One Health Approach Activities example includes:
National Rabies Prevention and Control Program
(NRPCP)
Avian Influenza Protection Program (AIPP)
Philippines Inter-agency Committee on Zoonoses
• Thus, guided by this framework, nurses in communities can
better promote awareness of people on how all these factors
impact wellness and spawn collective action for better
health.
END OF LESSON
Hope this helps!

Thank you!