CPH Positive Health

Community Health – Yesterday, Today, and  Not only the absence of disease but
Tomorrow feelings of mental, physical well being,
full functioning body
Objectives:  State of physical fitness with ability to
cope, social support, adjustment,
 Describe the concepts and principles of
efficiency of mind and body.
community and public health
 Measures
 Differentiate between community health o Quality of life measurements,
and personal health, between community disabilityadjusted life year
health and public health. (DALY), sickness impact profiles
 Discuss the history of community health
and public health
 List serious health problems facing Health is multidimensional: (Wood and Patrick)
communities in the 1990s and early 2000,
and  Set of characteristics of individuals;
o Death
 Offer an outlook for community health in
o Disease
the 21st century in the world and the
o Impairment
Philippines.
o Functional limitation
Outline o Discomfort
o Disability
 Definition of terms o Handicap
 Factors that affect the health of a
community

HEALTH COMMUNITY
 Com (Latin ) = Together
HEALTH is a state of complete physical, mental,
 Munis (Etruscan) = to endow, provide or
and social well being and not merely the
to have exchange of services
absence of disease.” (WHO, 1948)
 A community is a group of people who
form relationships over time by
Health is a reflection of our ability to use interacting regularly around shared
intrinsic and extrinsic factor within each experiences, which are of interest to all
dimension of health to participate fully in for varying individual reasons
activities that contribute to growth and overall
development during each stage of the life cycle In:

HEALTH: Positive & Negative (ANN BOWLING) Biology - interacting organisms (people) sharing
the same environment
Negative Health
Geographical - area with specific boundaries
 Traditional
Sociology - – a group of interacting people
 Absence of disease, illness, or sickness
larger than a household living in a common
 Measures ill health or illness such as:
location
o Morbidity rates, mortality
rates, and routinely collected They must have a common:
statistics
  Intent o Private & public efforts of
 Beliefs individuals, group or
 Needs organizations
 Resources  Purpose:
 Preference o To promote, protect, and
 Risks preserve the health of those in
the community.
Composition of a community
1. People – interacting organisms
2. Place – locality Community Health Activities
3. Identity – sense of belongingness “we
 Maintenance of accurate birth and
feeling”
death records
4. Common Culture – share common
knowledge, beliefs, habits, customs,  Protection of the food and water supply
morals, and laws in governing a place  Participating in fund drives for voluntary
5. Social System – interdependence of health organizations
each member in the community FACTORS:
TYPES OF HEALTH Physical Factors
Personal Health  Geography
 Individual actions and decision making  Community size
that affect the health of an individual or  Environment
their immediate family  Industrial Development
 Influenced by: Social and Cultural Factors
o Environment
o Socio-economic level of people  Beliefs, tradition, and prejudices
 Social status and  Economies
income  Politics
 Religion
Personal Health Activities  Social norms
 Choosing to eat wisely  Socio-economic status
 Regularly wearing a safety belt Community Organization
 Visiting physicians for consultation
 Handwashing  Ways in which communities organize
their resources
Community Health
Individual Behaviors
 Focus: People in the same geographical
areas  Often overlooked factor
 Refers to the health status of a defined
group of people and the actions and
conditions, both private and public PUBLIC HEALTH
(governmental), to promote, protect,
and preserve their health.  Sum of all governmental efforts to
 Includes: promote, preserve the people’s health
 Science and Art:
o Preventing Disease
 o Prolonging Life
o Promoting Healthy Behaviors
 THROUGH:
o ORGANIZED EFFORTS
 TO:
o INFORMED COMMUNITIES How Public Health does it work
 PURPOSE:
o IMPROVE QUALITY OF LIFE
 is “the art of applying science in the
context of politics so as to reduce the
inequalities in health while ensuring the
best health for the greatest number.”
(WHO)
 is “the core element of governments’
attempt to improve and promote the
health and welfare of their citizens.”
Public Health’s Mission (Institute of Medicine,
The Future of Public Health, 1988)
 “…assuring conditions in which people
can be healthy”
 “…organized community efforts aimed
at the prevention of disease and the Examples:
promotion of health”
What the field of Public Health does?
 Prevent epidemics and spread of
disease
 Protect against environmental hazards
 Promote and encourage healthy
behavior
 Assure the quality and accessibility of
health services
 Prevent injuries
 Respond to disasters and assist
communities in recovery

5 PS OF PUBLIC HEALTH:
1. Prevention (individual and community-
focused)
 2. Promotion (voluntary, education,  Spiritual era, beliefs – spirits are the
advocacy) causes of diseases
3. Protection (policies/regulations;  Epidemics of communicable diseases
enforcement) common – plague= black death, others:
4. Population-based (communities, smallpox, diptheria, measles, influenza,
groups) tuberculosis, anthrax, trachoma, and
5. Preparedness (e.g. bioterrorism, natural syphilis
disasters, pandemics)
Period of Renaissance & Exploration (1500 to
Public Health Intervention 1700 A.D.)
 Focus:  Renewed interest in causes & cures of
o Prevent rather than treat a diseases
disease  diseases caused by environmental &
 Through: not spiritual factors
o surveillance of cases & the  there is literary and scientific revival
promotion of healthy behaviors
HISTORY
 Examples of Public Health Measures:
o Promote Hand washing Eighteenth Century = Industrial Growth
o Vaccination program
o Distribution of condom  Period of industrial growth & poor
sanitary conditions, epidemics of
cholera, yellow fever & smallpox
(Europe and America)
 Cities Overcrowded = water supplies
BRIEF HISTORY OF COMMUNITY AND PUBLIC inadequate & streets heaped with trash
HEALTH and garbage
 Workplace unsafe & unhealthy (fire
Evidence of community health practices in hazards, improper garbage disposal)
earliest civilizations  Edward Jenner develop vaccination
 Northern India: bathrooms and sewers against small pox
(Drain or pipe) also found in Middle Nineteenth Century
kingdom of ancient egypt
 Sumerian clay tablet: prescription drugs  Beginning of the modern era of public
 Code of Hammurabi: laws on physicians health
and health practices/282 laws/  Living conditions in Europe and England
Babylonian law code remained unsanitary
o An eye for an eye  Cholera (1849) - London – severe
 Book of Leviticus – found in the diarrhea-John Snow- water pump
bible/guidelines for personal cleanliness  Miasma Theory – miasma as source of
contagious diseae
Middle Ages (500 to 1500 A.D.)  Bacteriologic period of public health
 The period of European history form (1875-1900)
the fall of the roman empire to the late  Scientists = described a cause of disease
15th century & discovered a great number of
 little progress in public or community bacterial disease agents of
health communicable diseases
 o Louis Pasteur – Germ Theory of  Great Depression (1929-1935) – drop in
disease (disease can be caused tax revenues
by microorganisms) – disproves  Social Security Act of 1935 – provided
the theory of abiogenesis (living support in health depratments
things comes from nonliving  National Cancer Institute (1937)
things)  WW II resulted in a number of medical
o Robert Koch – utilized Bacillus advances
anthracis – o used of penicillin
o Other causative agent o developed of insecticide ddt,
discovered Dichloro-diphenyl-
 Gonorrhea – Neisseria dichloroethane
gonorrhoeae o CDC was formed- previously
 Typhoid fever – known as Communicable
Salmonella typhi Disease Center, now Center
 Leprosy – for Disease and Prevention
Mycobacterium leprae  Post war years, hospital construction
 Tuberculosis – resumed
Mycobacterium o Community health priorities
tuberculosis failed – many infrastructure
 Cholera – Vibrio were destroyed
cholerae o Polio vaccine (1950s)
 Diphtheria – o Pres. Eisenhower’s heart attack
Corynebacterium o Period of social engineering
diphtheriae (1960-1975)
 Tetanus – Clostridium  Government improved access to health
tetany care
 Pneumonia – o MEDICARE - elderly and with
Streptococcus comorbidity
pneumoniae o MEDICAID - poor
 Dysentery – Shigella  Health Promotion Period (1975-1990)
dysentery o Discovery of the importance of
o lifestyle choices
o 1980 – small pox was
Twentieth Century eradicated
 Health resources development period  Community Health in the 1990s & early
(1900-1960) 2000
o Medical Schools, hospitals & o 6 serious challenges
nursing schools o Faced 6 serious challenges:
o Great growth in healthcare 1. Improvement of health care
facilities and providers delivery
 Reform Period (1900-1920) 2. Solutions on environmental
o SOCIAL CONCERNS: Congress problems
passed legislation regulating 3. Preventing lifestyle diseases
food & other industries 4. Increasing communicable
o 1920s – decline in alcohol diseases: AIDS, tuberculosis,
related health problems viral diseases 5
(prohibition)
 5. Increasing number of Decline in Deaths from Coronary disease/Stroke
alcohol & drug abuse cases
6. Terrorism  Due to risk factor modification
 Smoking cessation
 Blood pressure control

ACCOMPLISHMENT (1900-1999): Safer and Healthier Foods

Vaccinations:  Decreased in microbial contamination &
increased in nutritional content
 Programs of population-wide
 Identifying essential micronutrients &
vaccinations:
establishing food fortification programs
o Eradication (reduce to zero
 Eliminated major nutritional deficiency
around the world) of smallpox
diseases: rickets (vitamin d), goiter
o Elimination ( reduce cases to
(iodine), and pellagra(vitamin b3 or
zero in certain city or specific
niacin)
parts od the world) of polio
o control of measles, rubella, Healthier Mothers & Babies
tetanus, diphtheria, Hib, etc.
o MMR- mumps, measles and  better hygiene & nutrition, availability
of antibiotics, greater access to health
rubella vaccine
care, and technologic advances in
Motor Vehicle Safety maternal & neonatal medicine
 Since 1990, infant mortality decreased
 Improvement of motor-vehicle safety = by 90% & maternal mortality decreased
large reductions in motor-vehicle- by 99%;
related deaths
 Access to family planning &
 Engineering efforts(highways), personal contraceptive services altered social &
behavior (helmets, seatbelts) economic roles of women.
Safer Workplaces Fluoridation of Drinking Water
 Work-related health problems:  Reduction of tooth decay and tooth loss
o Pneumoconiosis (deposition of o 40-70% in children
dust in the lungs) such as o 40-60% in adults
anthracosis(coal) (black lung) &
silicosis (silica dust) = reduced Recognition of Tobacco Use as Health Hazard
 Injuries & deaths related to:
o Mining, manufacturing,  Promote cessation of use
construction & transportation =  Reduction of second-hand smoking
decreased PUBLIC HEALTH IMPACT 2Oth CENTURY
Control of Infectious Diseases  Increase in life expectancy
 Typhoid & cholera (major cause of  World wide reduction in infant and
death early 20th century) child mortality
 Discovery of antimicrobial therapy: TB  Elimination or reduction of many
& STDs communicable diseases
Outlook for community health in the 21 ST  Goal: to promote, protect, and
CENTURY: maintain health in a community
 Healthy Future for All Governmental (Official) Health Agencies
 Challenges:
o greatly reduce the burden of  Governmental (official) health agencies
o funded by tax and headed by
excess morbidity and mortality
government officials
suffered by the poor
o countering potential threats to  Exists at 4 governmental levels:
o International, national, regional
health resulting from economic
crises, unhealthy environments (state) and local
or risky behaviors o International Health Agencies
o developing more effective o National Health Agencies
health systems o Regional/State Health Agencies
o expand the knowledge base o Local Health Departments
o Coordinated School Health
Programs
“Health care is vital to all of us some of the International Health Agencies
time, but public health is vital to all of us all of
the time.” (Koop)  World Health Organization (WHO)-
primary international health agency
o Founded in 1948, headquarters
ORGANIZATIONS THAT CONTRIBUTE TO in Geneva, Switzerland
COMMUNITY HEALTH  World Health Assembly
o Primary operating body
Objectives: o comprises delegates from each
of the member nations
 Discuss the various health organizations
 Purpose: To assist the people of
that help shape a community's ability to
member nations attain the best level of
respond effectively to health-related
health possible
issues/problems
 Noteworthy work of WHO:
 Describe each type of health agency
o Eradication of smallpox
 Explain the differences in their purposes
 1967: 10 to 15M
and responsibilities, their organizational
contracted; 2 M died,
structures, and their funding
others disfigured or
blinded
 1980: WHO declared
Introduction: total eradication of
1. Size and complexity of today's communities smallpox
 hindrance to respond effectively to National Health Agencies
health needs
2. Types of community health organizations:  A national government health
 Basis – source of funding & department/agency
organizational structure o Primary responsible for the
i. Governmental protection of the health &
ii. Quasi-governmental welfare of its citizens, example?
iii. Non- grovernmental  Responsibilities:
 o development of health policies  50 states (US), doctor appointed by the
o enforcement of health governor
regulations  3 purposes: To promote, protect, and
o provision of health services and maintain the health and welfare of the
programs citizen of the state
o funding of research and  Purposes represent the core function of
o support of their respective public health:
state/regional and local health o Health assessment
agencies o Policy development
 Department of Health & Human o Health assurance
Services (DHHS)
Local Health Department
o lead health agency (federal
government), U.S.A.  Local-level governmental health
o Public Health Service (PHS) organizations
comprises the following o Fund : local tax
agencies: o Purpose: provide health
 The Centers for Disease services to the people in their
Control & Prevention cities, counties, and parishes.
(CDC) o Organization and services vary
 The Food and Drug o Examples of mandated local
Administration (FDA) health services:
 Department of Health (DOH),  Inspection of
Philippines restaurants, buildings,
o Headed by Secretary of Health public transportation
o Appointed by the president & a systems, vital statistics
member of his cabinet (death & birth rates),
and detection and
Health-related Agencies
reporting of certain
Other agencies with health-related activities: diseases
o Department of Agriculture Coordinated School Health Programs
o Department of Education
“an organized set of policies, procedures and
o Department of Public Works and
activities designed to protect, promote and
Highways
improve the health and well being of students
o Department of Interior & Local
and staff, thus improving a student’s ability to
Government learn”
o Department of Social Welfare &
Development Includes:
o …many others
 Health education
 Healthful school environment and
 Health services
Regional (State) Health Departments
Problems/Barriers:
 17 Centers for Health Development (CHD)
o Formerly by region, headed by  Insufficient local administrative
medical directors commitment
o Dr. Abdullah Dumama, Jr., Region XI  Inadequately prepared teachers
  Too few school days to teach health in o Raise money to fund programs
the school year (majority on research)
 Inadequate funding o Educate both the professionals
 Lack of credibility of health education as and the public
an academic subject o Provide services to those with a
 Insufficient community/parental health problem
support o Advocate for beneficial policies,
 Concern for the teaching of laws, & regulations
controversial topics (sex education)
Professional Health Organizations
 Funded by membership dues
Quasi-governmental Health Organizations  Serve to protect and promote the
standards of the profession
 Receive funding from both public and  Examples: PAMET, PASMETH,
private sources  MISSION: To promote high standards of
 Have official health responsibilities but professional practice for their specific
operate independently of government profession, thereby improving the
supervision. health of the society by improving the
 Best known example: The American Red people in the profession.
Cross
 Other quasi-government organizations: Philanthropic Foundations
1. National Science Foundation  Provide money for projects and
2. National Academy of research to benefit society, more
Sciences directed toward improving health
Nongovernmental Health Agencies  Have money to give away; can support
long term or innovative research
 Funded by private contributions, projects
membership dues and grants  Examples:
 Not headed by government officials o Bill and Melinda Gates
foundation
Types of NGOs
o Rockefeller Foundation (vaccine
Voluntary Health Service or Social
for yellow fever)
Agencies
o Robert Wood Johnson
Professional Religious
Foundation (access to medical
Philanthropic Corporate
& dental care)

Voluntary Health Agencies Service, Social, & Religious Organizations

 Arose because of unmet health needs  Members enjoy social interaction with
o FOUNDATIONS, SOS, etc. similar interests
 Examples:  Examples:
o American Cancer Society o Jaycees
o Philippine Red Cross (RA# o Kiwanis Club
10072, 2009) o Rotary Club
o SMILE program o American Legion
o American Heart Association o Lion’s Club
 Purposes:
 o Missionaries of Charity 6. Barangay Health Stations
 MISSON: Service to others in their
communities
Primary Level of Care
Corporation Involvement in Community Health
 Primary health facility = usually the first
 Corporations affect community health:
contact between the community members
o the way it treats the
& the other levels of health facility
environment
 Health care provided by:
o by its use of natural resources
o center physicians, public health
o by the discharge of wastes
nurses, rural health midwives,
o the safety of the work
barangay health workers,
environment
traditional healers and others at the
o type of products & services
barangay health stations and rural
 Bottom line: health units
o HEALTH CARE BENEFITS TO
EMPLOYEES Secondary Level of Care
 Provision of health and benefits
 Health facilities either private owned or
packages, health and safety education
government operated (infirmaries,
programs, and worksite fitness and
municipal, & district hospitals & out-patient
recreation programs
departments of provincial hospitals)
 Capable of performing minor surgeries,
simple laboratory examinations
LEVELS OF HEALTH CARE AND REFERRAL SYSTE,  Given by physician with basic health
IN THE PHILIPPINES training
 Referral center for the primary health
facilities
Tertiary Level of Care
 Rendered by specialists in health facilities
including medical centers (regional &
provincial hospitals, and specialized
hospitals)
 Referral center for the secondary care
facilities.
 Complicated cases & intensive care
LEVEL OF CARE:  Example: Phil. Heart Center

1. National Health Services, Medical Centers,

Teaching and Training Hospitals NOTE: The higher the level:
2. Regional Health Services, Regional Medical
Centers and Training Hospitals  the more qualified the health
3. Provincial/City Health Services, personnel
Provincial/City Hospitals  the more sophisticated the health
4. Emergency/District Hospital equipment
5. Rural Health Unit, Community Hospitals and
Health Centers, Private Practitioners
Teaching Community and Public Health using
Service – Learning Approach
Need to incorporate?
Allied Medical Courses: BSMLS
 Important role in diagnostic services
 Public health laboratory professionals
o bacteriologists, microbiologists
& biochemists
o tests biological &
environmental samples in order
to diagnose, prevent, treat, &
control infectious disease in the
community
Service Learning
a teaching and learning approach that
integrates community service with academic
study to enrich learning, teach civic
responsibility, and strengthen communities,
while engaging students in reflection upon what
was experienced, how the community was
benefited, and what was learned.
Three Circles:
1. College/Universities
2. Target Community
3. Service Agency Outcomes of SL (pyramid)

SERVICE-LEARNING ROLES
All Service-Learning Programs are composed of
the following Roles

3H = Heart, head, and hands

STEPS:
1. Surveillance
a. What is the problem?
b. Define the violence problem through
systemic data collection
2. Identify risk and protective factors
a. What are the causes
b. Conduct research to find out why
violence occurs and who it affects
3. Develop and evaluate intervention
a. What works and for whom?
b. Design, implement, and evaluate
interventions to see what works
4. Implementation
a. Scaling up effective policy & programs
b. Scale-up effective and promoting
underdeveloped and evaluate their
impacts and cost-effectiveness