Scope & Concerns of Public Health

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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 historicalbackground of Public Health in developed and developingcountries, principles, development and organization ofhealth care system in Pakistan, primary health care,leadership in health care, health care economics, health

education and health information system, public healthemergencies and disease of public health importance, andpublic health surveillance.

Books: 1. Oxford textbook of Public Health 2. Public Health and Preventive Medicine by Maxcy-

Rosenau Last Dr Saadiyah Rao - School of Public Health, DUHS 1


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Dr Saadiyah RaoSenior LecturerSchool of Public HealthDow University of Health sciences


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Learning ObjectivesTo 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 3


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

sound, whole

Prior to the period of the Hippocrates (around 5BCE), health was perceived as a divine gift.

He theorized that what we currently regard as health.



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Concept of Health The word health means different things to different

people

The most widely quoted definition of health wascreated by WHO in 1946...... over half a century ago

health is a state ofcomplete physical, mental, socialwell 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 ofcomplete physical, mental, socialwell being, an individual or group must be able toidentify aspirations, to satisfy needs, & to change orcope with environment. Health is a resource for

everyday living; it is a positive concept, emphasizingsocial & personal resources as well as physicalcapabilities



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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 inorder to ensure that the full benefits are enjoyed inlater years

Good health is vital for maintaining an acceptablequality 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 includingthe word complete in the definition makes it highly

unlikely that anyone would be healthy for a reasonableperiod 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 andresults from persons interactions with and adaptationsto 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 physicalhealth 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 1997defines health as a condition of well being, free ofdisease or infirmity, and a basic and universal humanright

Bircher (Towards a dynamic definition of health and

disease. 2005) defines health as a dynamic state ofwell-being characterized by a physical and mentalpotential, which satisfies the demands of lifecommensurate with age, culture, and personalresponsibility.



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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.etoxic 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 environmentalexposures & behavioural patterns

Nature & consequences of behavioural choices areaffected by social circumstances

Our genetic predispositions affect the health care weneed

And our social circumstances affects the health carewe receive



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Terms Community Health

Public Health

Population Health

These terms are used interchangeablyby bothlaypeople & professionals

Most people are referring to the collective health ofthose in society and actions/activities taken to obtainor 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 andpreserve 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 scienceand 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. Dr Saadiyah Rao - School of Public Health, DUHS 15


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Public Health: More contemporary

definitions Report on Higher Education for Public Health 1976

efforts organized by society to protect, promote and

restore other peoples health. The programs, services &institutions involved emphasize the prevention ofdisease & health needs of the change with changingtechnology & social values but the goals remain thesame: to reduce the amount of disease, prematuredeath & disease-produced discomfort & disability



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definitions The Institute of Medicine-USA(IOM) defined public

health in 1988in its landmark report the future ofpublic health as:

the fulfilment of societys interest in assuring theconditions in which people can be healthy andorganized community efforts aimed at the preventionof disease & promotion of health. What we, as asociety, 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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definitionsAcheson Report UK, Committee of Inquiry, 1988the

science and art of preventing disease, prolonging lifeand promoting health through the organized efforts ofsociety

The fundamental maxim of public health is that thehealth of the individual is best ensured by maintainingthe improving the heath of the community (DavidSatcher, 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 theconditions 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 beachieved by society



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Public Health System Organizational framework of Public Health

encompasses activities undertaken within formalstructure of government and the associated efforts ofprivate & voluntary organizations and individuals,

Even with such formal definitions, public Healthactivities are still considered as efforts only originatingin federal, state and local governmental healthdepartments



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Population Health This term has emerged recently

It is similar to community health

Primary difference is the degree of organization oridentity of people

Refers to health status of people who are not organizedand have no identity as a group or locality and actions

& conditions to promote, protect and preserve theirhealth

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 communityusing public health sciences

Treatment of the community involves new policies andinterventions

Goal of medicine is cure; goal of public health isprevention of disease and disability



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Public health Vs Medical Care

Focus on individuals

Diagnosis & treatment

Clinical interventions

Well-established profession,standardized education &certification

Clinical sciences integral;social sciences less emphasized

Experimental studies withcontrol groups: RCTs.

Focus on populations

Prevention & healthpromotion

Environment & humanbehavior interventions

Diverse workforce, variableeducation & certifications

Social sciences integral;clinical sciences peripheralto education

Observational studies: casecontrol & cohort studies

Medicine Public HealthMedicine Public Health

Focus on individuals Focus on populations

Diagnosis & treatment Prevention & health promotion

Clinical interventions Environment & human behaviorinterventions

Well-established profession,

standardized education & certification

Diverse workforce, variable education &

certifications

Clinical sciences integral; socialsciences less emphasized

Social sciences integral; clinical sciencesperipheral to education

Experimental studies with controlrou s: RCTs Observational studies: case control &cohort studiesDr Saadiyah Rao - School of Public Health, DUHS 23


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Vision of Public HealthHealthy people in healthy Communities !

The Goal of Public HealthThe biologic, physical and mental well-being ofall members of the global society, regardless of

ethnicity, religion, gender, sexual orientation,country or political views. (Detels, 2003)


Th S f P bli H lth


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The Scope of Public Health

Source: http://www.ewashtenaw.orgDr Saadiyah Rao - School of Public Health, DUHS 25


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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 healthAccess to health care Quality of health careWar Dr Saadiyah Rao - School of Public Health, DUHS 26


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Five Public Health Responsibilitie1. Prevention of epidemics & spread of disease

2. Protection of people against environmental Hazards &prevention of injuries

3. Promotion & encouragement of healthy behavior changes

4. Quick response to the disaster & to assist the communities inrecovery phase

5. To assure quality, accessible, and affordable comprehensivehealth care services

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



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Public Health

Approach

Problem Response

Surveillance:Whatis the

problem?

Risk FactorIdentification:What is the

cause?

InterventionEvaluation:

Whatworks?

Implementation:How do you

do it?

Courtesy :Glyn G. CaldwellDr Saadiyah Rao - School of Public Health, DUHS 28


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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 acommitment of society is neither clearly defined, adequatelysupported, nor fully understood. ..current capabilities foreffective 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 in1994.

The Essential Services provide a working definition ofpublic health and a guiding framework for the

responsibilities of local public health systems.



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10 Essential Services of Public Health

Public Health Functions Project, U.S. Dept. of Health and Human ServicesDr Saadiyah Rao - School of Public Health, DUHS 31


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Assessment

Monitor health status to identify community healthproblems

Diagnose and investigate health problems and healthhazards 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 healthissues

Mobilize community partnerships to identify and solvehealth problems

Develop policies and plans that support individual and

community health efforts



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Assurance

Enforce laws and regulations that protect health andensure safety.

Link people to needed personal health services andassure 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 healthstatus, 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 andcommunicate 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 chronicdiseases and injuries, environmental hazards

Active infectious disease epidemiology programsAvailability 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 betterhealth

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 mediaadvocacy and social marketing. Health education and health promotion program partnerships

with schools, faith communities, work sites, personal careproviders, and others to implement and reinforce health

promotion programs and messages.Dr Saadiyah Rao - School of Public Health, DUHS 37


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4.Mobilize Community Partnerships to Identify

and Solve Health Problems

Community development and identification of systempartners and stakeholders

Coalition development

Convening and facilitating partnerships among groups andassociations (including those not typically considered to behealth-related) in undertaking defined health improvement

projects, including preventive, screening, rehabilitation, andsupport 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, andestablishes 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 theEssential 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 regulationsdesigned to protect health and safety to assure that theyreflect 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 andsafety in order to encourage compliance.



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Enforcement activities include, but not limited to theprotection of drinking water; enforcement of clean airstandards; regulation of care provided in health care facilities

and programs; re-inspection of workplaces following safetyviolations; review of new drug, biologic, and medical deviceapplications; enforcement of laws governing such as the seatbelt usage and childhood immunizations.



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7.Link People to Needed Personal Health

Services

Identifying personal health service needs of populations withlimited access, to a coordinated system of clinical care.

Assuring the linkage of people to appropriate personal healthservices through coordination of provider services and

development of interventions that address barriers to care(e.g., culturally and linguistically appropriate staff andmaterials, transportation services).

Partnership with public, private, and voluntary sectors to

provide populations with a coordinated system of healthcare.



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8.Assure a Competent Public and Personal

Health Care Workforce

Assessment of workforce (including volunteers and other laycommunity health workers) to meet community needs forpublic and personal health services.

Maintaining public health workforce standards, includingefficient processes for licensure/credentialing of professionaland incorporation of core public health competenciesneeded to provide the Essential Public Health Services intopersonnel systems.



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Education, training, development, and assessment of healthprofessional - including partners, volunteers and other laycommunity 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 deliveredand 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 systemDr Saadiyah Rao - School of Public Health, DUHS 45


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Evaluation should drive resource allocation and programimprovement

Evaluation and critical review of health program, based onanalyses of health status and service utilization data, areconducted to determine program effectiveness and to provideinformation necessary for allocating resources and reshapingprograms 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 andcutting-edge research to advance public health

Linkages between public health practice and academic /research settings

Epidemiological studies, health policy analyses and healthsystems 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 communicablediseases.



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HealthVaccination & Control of infectious diseases:Immunizations have virtually eliminated:Smallpox

DiphtheriaPertussisTetanus

PolioMeaslesRubella



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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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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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Health Safer workplaces

Mining safety

Industrial safety

Indoor air quality

Ergonomics



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Health Decline in deaths from coronary heart diseaseand 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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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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TaskApply the core functions i.e:Assessment

Policy developmentAssurance

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 StandardsProgram

Scope & Concerns of Public Health

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