Essentials of public health frameworks in India

Basic Essentials of Public Health Frameworks: Dedicated to India
Dr Mithilesh Dronavalli 10/12/2020 Page 1 of 14
Basic Essentials of Public Health Frameworks
- By Dr Mithilesh Dronavalli
Table of Contents
IID+TREC+ (for every model)..................................................................................................................3
1) Policy & Program ................................................................................................................................3
2) Planning & Economics.........................................................................................................................3
3) Screening & Surveillance ....................................................................................................................3
4) Health Protection................................................................................................................................3
5) Epi & Teaching ....................................................................................................................................3
POLICY & PROGRAM ..............................................................................................................................4
IID........................................................................................................................................................4
TREC ....................................................................................................................................................4
TEAM:..................................................................................................................................................4
RESOURCES .........................................................................................................................................4
EVIDENCE ............................................................................................................................................4
CONSULT .............................................................................................................................................4
General............................................................................................................................................4
Sensitivities .....................................................................................................................................4
History and Context of Aboriginal People post invasion ................................................................4
Engage with Aboriginal Communities.............................................................................................5
Engage with Services Providers ......................................................................................................5
DITME......................................................................................................................................................6
DESIGN ....................................................................................................................................................6
Prioritise Needs...................................................................................................................................6
Levels (0/1/2/3) & Health Education ..................................................................................................6
Ottawa Charter ...................................................................................................................................6
LOGIC Model .......................................................................................................................................6
Features ..............................................................................................................................................6
Evaluation ...........................................................................................................................................6
Test Pilot .............................................................................................................................................6
Policy End-Game (PEG-FRAD) .................................................................................................................6
Decision Making......................................................................................................................................7

Implementation: .................................................................................................................................7
Media ..................................................................................................................................................7
Brief.........................................................................................................................................................7
PLANNING & ECONOMICS......................................................................................................................8
Health Services Planning.....................................................................................................................8
Hospital Quality Improvement............................................................................................................8
Health Economics................................................................................................................................8
SCREENING & SURVEILLANCE ................................................................................................................9
Screening.............................................................................................................................................9
Surveillance.........................................................................................................................................9
HEALTH PROTECTION...........................................................................................................................10
Risk Assessment....................................................................................................................................10
Hazard:..........................................................................................................................................10
Exposure........................................................................................................................................10
Dose-Response..............................................................................................................................10
Risk Characterisation / Uncertainties ...........................................................................................10
Risk Communication .....................................................................................................................10
Risk Management .........................................................................................................................10
Health Impact Statement......................................................................................................................11
Screen and SPADE.............................................................................................................................11
Outbreak Management ........................................................................................................................11
Disaster Management...........................................................................................................................12
1. Prevent..........................................................................................................................................12
2. Prepare..........................................................................................................................................12
3. Respond and Relief .......................................................................................................................12
4. Recovery........................................................................................................................................12
Quick Dot points on Communicable Disease........................................................................................12
EPIDEMIOLOGY & TEACHING:..............................................................................................................13
IMRAD ...............................................................................................................................................13
Critical Appraisal ...............................................................................................................................13
Levels of Evidence STROBE/ PRISMA/CONSORT:..............................................................................13
Plain Language Framework (Excellent Teaching):.................................................................................14

IID+TREC+ (for every model)
1) Policy & Program
2) Planning & Economics
3) Screening & Surveillance
4) Health Protection
5) Epi & Teaching

POLICY & PROGRAM
IID: Issue Identification & Define the Problem
1. Scenario (ST)
2. Context (LT)
3. PH Significance
4. Define the Problem: Who/Why/What/When/Where/Who wants it
5. History of Invasion of Aboriginal People, if relevant (Past and Social Disadvantage, Strengths and Barriers)
a. Past: (Stolen Generation/ Invasion and Ongoing Colonialisation / Cultural and Actual Genocide/ Dis-
empowerment /Deaths in Custody)
b. Social Inequity: (Low Education / Unemployment / Poverty / Mental Health / Addiction/ Stigma)
c. Strengths: Communal togetherness / Resilience / Not materialistic / Spiritual & Dream Time /
Yarning /Importance of Family / Extended Family
d. Barriers: Corruption / Exploitation / Neglect /Distrust / Alienation

TREC
TEAM:
1. Steering Committee
2. Team + You
3. Advisory Group
4. Task Force
5. Media Communication Team
RESOURCES (Time/Money/Experts) - Be Frugal
EVIDENCE
Collect: Qual/Quant new vs old / Multiple sources / Keep it local / Appraisal / no gold standard
/Other jurisdictions
CONSULT
General: Learning from Others and Reflecting
With Who / Why / How does it affect the plan
Sensitivities
Barriers / Outsiders / Broad Representation vs SIG / Language - Cultural - political/Targeted
Communication
Engage with Aboriginal Communities - Elders/ Role Models/mens' and womens' business/
AHLW/cultural sensitivities/yarning/Aboriginal Controlled Community Health Services/
Aboriginal Organisations/Community Get Togethers , Land Council (Represents all Aboriginal
Communities as a whole) / Community Led / Sustainability by the Aboriginal Community /
Competing Interests Reciprocity / Free (Social Disadvantage)
Engage with Services Providers
Aboriginal Health Services / AHMRC , NACCHO, Internal / External /Vertical/Horizontal /
Whole of Government or Society / SIG / Multicultural Societies / Health Services (0/1/2/3) /
Intersectoral Services

DITME
DESIGN
Prioritise Needs(Needs Assessmment & Analysis): Community Wants & Prevalence/
Burden vs Health Service Resources & Interest
Levels (0/1/2/3) & Health Education
Ottawa Charter
Personal Choice (PC)
Empowering Communities (EC)
Built Environments (BE)
Health Service (HS)
Health Policy (HP)
Tech
Poverty
Inter-sectoral Intervention (IS)
LOGIC Model
Features
Social Inequity, Politics/Cultural/ Linguistic, Sustainability
Evaluation
Aim/ Logic Model
Collect Evidence: QQ/new-old
Achieve pre-specified SMART Metrics (KPI) (Specific Measurable Achievable Relevant Time Bound)
Test Pilot
Policy End-Game (PEG-FRAD)
1. Fit
2. Revise
3. Authorise
4. Disseminate

Decision Making
1. Resources
2. Opportunity Cost
3. Evidence vs Morality
4. Risk vs Benefit
5. Politics and Cultural
Implementation:
Efficient Use of Resources / Worker Satisfaction / Streamlined Workflow
Media
Media Communication Team (for controversial issues)
Main Response: SOCO + Standard Response: We care
We have systems to investigate the matter and we are working on it
We are constantly updating our systems. .
Brief and Other Policy Instruments
1. Identify Issue
2. Define Problem
3. Research (Evidence: Qual/Quant)
4. Policy Options
5. Prioritise and Fit
6. Policy Recommendations
7. Revise, Authorise and Disseminate
The Policy Cylce - Engage with Stakeholders at Every Step

PLANNING & ECONOMICS
Health Services Planning
1.Winners and Losers
2. Regional/rural/Remote
3. Accessibility / Discrimination
4. Staffing vs Quality of Care
5. Impact of Health Services on SEIFA of Community
Hospital Quality Improvement
1. Evidence
2. Risk: RCA , Avoid & Reduce, Local vs State Guidelines / System issue / not individual
3. Coordinating team with all-inclusiveness
Health Economics
1. Feasibility
2. Approach
C: $
CB: $-$
CU: $-DALY
CE: $-DALY / $-DALY
CE Plane
3. Other: Data Accuracy / Discounting / Sensitivity Analysis
4. Non-Health Eco and Make Decisions

SCREENING & SURVEILLANCE
Screening
1. Disease
2. Test
3. Treatment
4. Program
5. Traps: Mortality better than survival analysis,
Lead Time Bias: Treating early disease shows inflated outcomes for 5 yr survival. Use
mortality and the Cancer Registry
Length Time Bias: People with severe disease die at a younger age before they can enter the
screening program. Understand natural history. Need registry and EMR.
Healthy user Bias: RCT required
Surveillance
1. Why: Managing Outbreak, Planning, Research
2. Which One: Passive/ Active/Enhanced (Outbreaks)/Sentinel)
3. Data: Collect Clean Analyse Report, Trigger Points
4.Stakeholder Co-operation
5.Evaluate : Usefulness, Accuracy, Take Action

HEALTH PROTECTION
Risk Assessment
Not linear
Hazard: Identify Hazard and Potential Harms
Exposure (Measure Dose): Routes of Ingestion, Dose-related (quant/Freq/start/stop)
(Internal /External /Noise-Radiation-Light-Air-Soil-Water-Food-Meds/Organ Affected/Sense
Affected)
Dose-Response
Cutoffs / Curves /Evidence
Vulnerable groups
Risk Characterisation / Uncertainties
Risk Communication
Know
Integrity
Engagement/Language/Cultural(Aboriginal people)
Political Context
Report and Monitor Evaluate
Risk Management
Eliminate
Reduce
Adapt

Health Impact Statement
Screen and SPADE
2. Scoping: Goal/Team/Plan/Detail
3. Profiling and Domains
Target Population
Collect Evidence
Consult
3b. Domains
SE/Sustainable/Culture/Health/Transport/Education/employment
4. Assessment
Appraise Evidence
Risk vs Benefit in each domain
5. Decision Making (Go-No Go and Why)
6. Evaluate
Evaluate Impact and Develop a HIA Risk management Plan
Outbreak Management - Not Linear (+ MEDIA +TEAM
1. Immediate Plan of Action and Inform MoH & DoH, acess relevant guidelines.
2. Define (TPP)
3. Collect Data (TPP)
4. Investigate: Epi Curve / CC Study/ and P-value
5. Intervene:
Environmental / CC Mgmt (FUP/Edu/Exclude/Treat/Vaccine/NHIG/Abx)/
Infection Control Precautions/Hand Hygiene/Co-ordinated Response/ Deep
Clean /FSANZ/ Emergency Orders/ Closing business / Cohorting
6. Reporting with QI

BasicEssentialsofPublicHealthFrameworks:DedicatedtoIndia
Community Cancer Cluster
1. Plausibility
2. Epidemiological Evidence
3. Standardized Incidence Ratios and Standardized Mortality Ratios
4. Environmental Health Risk Assessments
a. Dose/ Exposure
b. Latency
c. Proximity
d. Dose-Response
5. Full Study – Phase 3 (CC Cohort) – Takes A long Time
Disaster Management
1. Prevent
ICS: Leader, Planner, Do-er, Resourcer, Media Communicator
Intersectoral
All-Hazards /All Agencies
Disaster proof community
2. Prepare
Needs Assessment / Analysis & Prioritise Tasks
2-way Surveillance
Follow ICS
Surge workforce
Triage
3. Respond and Relief
Burnout and Mental Health Issues of Team
Necessities (SAWFISH) for Community and Evacuation Centre
Remove Threat & Evaluate
Control Outbreaks & Envt Health Response (EHO)
4. Recovery
Mental Health, Services (Council Liaison)
Damp/ Mould /Snakes/Food Supply/ Risk Assessment of Return to Housing
SAWFISH: S=Safety of First Responder, A=Air Quality, W=Water,
F=Food Security/Safety, I=Insect/Vermin/Vector/Infection/Injury,
S=Sanitation, H=Hygiene
Quick Dot points on Communicable Disease
Hepatitis A: Orofaecal route (sexual and food bourne)
Meningitis: Can die in 24 hours. very close contacts Abx moderately close contacts (Abx/Vacc) Measles: 0-3 MMR , 4-6 NHIG ,
7-9 partially effective NHIG
Pertussis: Prevent Exposure in less than 6m olds and pregnant women in their last month of pregnancy
Influenza: 3 ILIs with at least 1 definitive diagnosis is outbreak, infection control plus oseltamivir treatment or prophylaxis.
8days free of ILI outbreak closed.
STI spread: people with STIs must take reasonable precautions to prevent spread or can get fined or go to jail.

EPIDEMIOLOGY & TEACHING:
IMRAD
(Strengths & Limitations, Context, Future, Impact)
Critical Appraisal
Bias: ME/Con/Selection Bias/Chance)
T1: False Claim Alpha
T2: Rejecting True Finding Power
Provided ME/Conf/SB OK then P<0.05 is a real finding not due to chance.
If P> 0.05 then finding may still be real because the study was underpowered
Levels of Evidence STROBE/ PRISMA/CONSORT:
1) Strength: Exposure leads to high-level outcome change
2) Temporality: Exposure --> Outcome across time.
3) Gradient: Increasing Exposure & Effect or Inverse
4) Consistency: all regions and populations
5) Coherence: Lab= Clinical=Public
6) Specificity: Minimal confounders
7) Plausibility: Mechanism
8) Experiment: RCT or animal experiment.
9) Analogy: Similar Scenarios lead to Similar outcomes
P-value: If there is no effect, a P-value is a probability of finding an effect that is greater than or
equal to the one in your study. P < 0.05 means that the finding is likely not due to chance.
Formulas: Sensitivity: A/(a+c) Specificity: d/(c+d) PPV: a/(a+b) NPV: d/(c+d).
Sensitivity: Aim: don't miss potential cases. Not missing Illness.
Specificity: Ability to Pick up "normals no disease". Poor specificity leads to more expensive and
intrusive followup that causes unnecessary anxiety. Identifying Healthy among At-Risk.
Sensitivity and specificity are part of a trade-off as seen in a receiver operator curve.
Practical Benefits:
Sensitivity is good for screening program when all cases need to be identified.

Specificity is important as specificity prevents misdiagnosing normal patients, which leads to anxiety,
unnecessary treatment and treatment's complications.
Sensitivity and specificity are vertical. PPV and NPV are horizontal where test status is horizontal and
diseases status is vertical in a 2X2 table. Disease is Case(vertical). Exposure is Test(horizontal)
Plain Language Framework (Excellent Teaching):
1) Re-frame the question so anyone can understand.
2) Think systematically and break it down to components
3) Attack the question from different angles
4) Use an example, preferably in Health
5) Re-iterate or summarise
6) Check understanding
INCIDENT CONTROL SYSTEM
PLANNER Planning: Evidence gathering, appraisal , guidelines and recommendations
COMMUNICATOR Communications: Internal / Stakeholders / Public
DO-ER Operations: The Do-ers
RESOURCE-ER Logistics: Smooth workflow and resourcing operations
LEADER Commander: Public Health Technical Expertise / Reviewing Epi recommendations /
Co-ordination of Ops & Advising Stakeholders /
Needs Assessment (ST-MT-LT)

Basic Essential of Communicable Disease Management in Australia
Table of Contents
Gastro:..................................................................................................................................................... 1
Respiratory..............................................................................................................................................3
Other Vaccine Preventable Disease (Not Elsewhere Classified):............................................................5
Zoonotic: ................................................................................................................................................. 7
Sexually Transmitted Infection: ..............................................................................................................9
Other:....................................................................................................................................................10
Gastro:
Gastro Outbreak (Refer to NSW Health Guidelines) + MEDIA + TEAM + Not Linear
Red Flag | Escalate when required | Immediate Action  Define Case TPP
 Collect Data (Case History and Contract Tracing esp HH) (Oz Foodnet Questionnaire) (Genome Sequencing /
PCR (except Typhoid) / BC / Stool / Abx Sensitivity) / Line List TPP Demographics
 Investigate ( Epi Curve | CC study | Infectious Period and Incubation Period)
 Intervene: Depending on Risk : Exclude | Abx/NHIG/Vaccine |Environmental Health (Super chlorination) |
Food Recall or Ix SOPV | Pool | Sheets/Linen Bed/ Towel |Sex |Sanitations |Hygiene | Co-ordinated Effor | OH&S
 Report
Campylobacter: chicken / water / milk /pets
Exclude Food Handlers till 48 hrs after symptoms resolved
Cryptosporidium: FO route | Animals
Superchlorinate pools, log-reduction in bacteria, critical control points, heterotrophic plate count,
filtration and treatment including Ozone | Food Handlers till 48 hrs after symptoms resolved | CCC
until 24 hrs after |Don’t share bedsheets or swim in pool for 2 weeks
Hepatitis A: FO route: MSM | Homeless | PWID | O/S Travellers | Aboriginal people
FO route Food: Berries | Shellfish | lettuce & Water/ Sewage
Look back period (15-50 days) | Un-immune / IC contacts | Case Finding in High Risk
(Householder / CCC /Sex)
Exclude (14 days after onset) | Hygiene | No food prep or CCC or Sex or Sharing personal items or
Needles till 14 days from onset
PEP < 14 days post exposure: Chronic Liver Disease / HIV or IS: (NHIG & Vaccine) |
Healthy: <12m (NHIG) or > 40y (Combination of NHIG and/or vaccine) | 12m to 40 yo (Vaccine)
>14 days: Food Handler (Risk Assessment) otherwise Health and hygiene advice only

Listeria: Ready To Eat (Cheese Cold Meats etc) requires Food History 60 days | Miscarriage or Stillbirth or
infected baby
Prevention: Critical Control Points | Risk communication esp in pregnancy
Intervention: Last resort (Food Recall) | Economic and Business Impact
Salmonella: Prevent Transmission and eliminate point source (FORoute and Food eg Eggs))
CCC/Food Handler | Stay Home | No Food prep till 48 hrs
Shigella: FO, fomite, contact, sex : bloody diarrhoea | Sudden onset Systemic severe Compx e.g. HUS
Exclude if E-Coli | Look Back 3 days
Check Abx resistance |May need IV Abx
Householders | MSM | CCC | Crowding High Risk of Getting Shigella
Food vs No Food: Check MSM | SOPV | O/S Traveller / Contact with an ill person otherwise 3 days Food Hx
No Sex for a week | No swimming until 24 hrs post diarrhoea | no food handling / towels | Exclude Food
Handlers / HCW / RACF / CCC / till 48 hrs post diarrhoea
Typhoid: Rise of MDR in South Asia | Testing NOT PCR
FO route: Occupation | Household Contact travelled O/S | Food Hx (Local) | Social Gatherings |
Hospitalisations | Cotravellers (within 28 days of travel)
Ix: BC/Stool | Abx Sensitities | Check Food/Water if outbreak +2 Local acquired cases (Report Up). Contact
Tracing: Wider and Wider Bubbles using questionnaire +/- Test Stool
Exclude (low risk): from work and swimming until 48 hrs post Abx
Exclude (high Risk) Food Handlers or Carers of Elderly / Kids / Disabled until After Abx 2 stools 48 hrs apart I
Food Handler: OH&S

Dr Mithilesh Dronavalli 10/12/2020
Page 3 of 10
Respiratory
Diphtheria: Only toxigenic form needs PHU. Raw Milk / Animals / O-S Travellers / ?Vaxed
Presentation: URTI / sore throat / white membrane / cervical lymphadenopathy / Skin Ulcers
Testing: LB 7 days | NP swab  Test for Toxin | Abx Sensitivities
Contact Prevention: Abx / Observe / Vaccinate
Case: Isolate droplet prec | Antitoxin | Abx | Vaccinate
| 2 normal cultures 48 hours apart after which work / ccc/ school
Influenza Outbreak: 1 Lab notification + 2 cases within 72 hours of ILI / Flu Packs
ILI: (Fever >38 / Coryzal Symptoms / myalgia), Elderly (Fever / Confusion / Anorexia / dyspnoea)
RACF: OT/OP Infection Control Measure | vaccinate HCWs | send sick HCWs home | Hygiene
Aboriginal Communities: All about Community Engagement
Medical: Time and affordable Access to health care for testing and treatment / Vaccinate close
contacts / Educate
Hygiene: Control Measures, Reduce Overcrowding & Environmental Health Concerns
Other: Avoid flight travel & public Transport | Cruise Ship: Isolate, Educate, Control Measures
8 days no ILI patients then close outbreak.
Pertussis: Vaccinate during pregnancy or just before. (Cocooning).
Catarrhal: coryzal +/- mild fever or cough | Paroxysmal: Cough or post-tussive vomiting 1-2 weeks
Infants: Gasping , cyanosis, apnoea | Complications: pneumonia / encephalopathy / death
Goal: Protect Babies < 6 months old and women in last month of pregnancy and treat HH
Infectious: Cough +21 | Paroxysmal +14 | 5 days post Abx | LB 21 days.
Contacts: Close (>1hr in last month) | Householders | more conservative for newborns Prevention:
Give Abx with 14 days ASAP: Householders give Abx
CCC child < 12m and not full vaccinated, give Abx to all kids in same room
Nursery for kids / pregnant women / staff | Kids < 12m or kids with access to kids < 12 m
Those with access to pregnant women in their last month of pregnancy
Case: Contact Tracing, Isolate Case and give Abx within 14 days

Tuberculosis: MDR is growing (immune to Isoniasid or Rifampicin)/ I Escalate to CDB | Smear
Positive Sputum is HIGH Risk | Active TB: Treat & No work/CCC/School
Treating Doctor: Notify | Seek assistance from TB Service or PHU | Hospitalised patients
(airborne precautions | neg pressure team)
Contact Tracing: Find Source | Assess infectivity | wider Bubbles (prolonged exposure) | Contact
Trace by severity of risk (HH  workplace), reach out if case in high or medium risk group (Hx +
LTBI: TST/IGRA + CXR ) | Active TB is clinical or Lab Dx (Sputum Culture or NAT w/o previous LTBI
Non-Compliers: Culturally Sensitive Engagement & Health Education | Overcoming Barriers |
Working with Family | Case Management Team with Meetings | Warnings | DOTS | Public
Health Order to restrict movement. Issues: Stigma / Perceived Pt. Expense/ Being Perscuted
BCG In High Risk: to prevent Milliary TB, At-risk Aboriginal people, Kids/HCWs travelling to high
prevalence countries.
Migrants or Refugees: Active TB & LTBI screening at arrival TB Undertaking: FUP to Ix TB in
previous TB or suspicious CXR

Basic Essential of Communicable Disease Management in Australia.
Other Vaccine Preventable Disease (Not Elsewhere Classified):
Measles: (Escalate) Cough / Coryza / Conjunctivitis / Kolpik Spots / Rash (non-itchy / red /
bumpy (maculopapular) (head to trunk))  Death / Pneumonia / Encephalitis.
At-Risk: Not Vaccinatable eg: <9 months, Pregnant , IC, Malnourished, unimmune.
Not At-Risk: <1965 | Documented Measles | 2 MMR .
Infective: 1d prior fever or 4d +/- rash | LB: 10days from fever & 14 d from rash (esp. for IC)
Isolate Case | Testing (PCR (NP) | Urine | Serology | Genotyping ) |GP checkup outside clinic
Contact Trace: Define Contact Criteria (LB + Infectious Period | Case Finding (ED/GP/Media) after
patients leaves waiting—> Line List(Use AIR paper records up to 1990 if required.
PEP for those At-Risk: Within 3 days: NHIG for IC, Unimmune Pregnant mothers and <5m infants
of unvaccinated mothers. Otherwise vaccinate.
3-6 days: NHIG especially IC, unimmune pregnant women&HCW. 6-9 days Partially Effective
Meningococcal: LB < 7days (Quad Vax ACWY, Prev Mening B Only)
At-Risk (Vaccinate & Abx): Household contacts | Intimate Contacts | CCC | Unmasked HCW
providing CPR
Sporadic | Primary (index) : 2 linked cases (Co-primary: within 24 hrs | Secondary >24 hrs + Lab) |
Remote Aboriginal Community Outbreak: High Risk of sustained transmission >=2 cases in remote
Aboriginal Community within 4 weeks + lab-link : Clearance Abx for everyone
Organisation Outbreak: >=2 cases with lab link in 4 weeks & no close contact: Clearance Abx for
everyone.
Community Outbreak: Same area >= 3cases in 3 months and no Epi link and/or lab link,
clearance ABX and vaccinate in wider bubbles (for schools and universities as well)
Rubella: (FAR: Fever / Arthralgia / Rash: Face Down) LB: 14 days
Early Pregnancy <20w : congenital rubella (infectious for 1 year : stay away from unvaccinated/
stillbirth / miscarriage) DO NOT GIVE MMR TO PREGNANT WOMEN seek specialist care
Contacts: MMR and observe for 21 days
Mumps: Isolate for 9 days after swelling (possible meningitis or myocarditis) Malaise & parotid
swelling | Men: orchitis & Women: oophoritis
Shingles: Reactivation of VZ virus in dorsal root ganglion.
Complications: Spread of VZV esp to pregnant | blindness | Neuropathic Pain
Potent vaccine in Elderly (risk increases age) (70-79yo or $200)

Varicella: Pregnancy: Do not vaccinate pregnant ladies
Instead Administer VZIG +/- Antivirals otherwise at risk of Miscarriage in T1 or VZV Syndrome
before 20w | Late pregnancy or in neonate: high CFR.
Exclude 5days or blisters have dried | Exclude IC children from outbreak sites (eg schools) and IC
cases utpo 28 days post exposure

Zoonotic:
Barmah Forest Virus: Fever/Arthralgia/Rash (FAR) / Fatigue for Months. Midges |FUP Outbreak only
Botulism: Escalate: Dx & Treat Identify Source & Active Case Finding & Risk Communication
Source: Animal Guts or Soil or Canned Foods or Honey or PWID or Botox or Wounds  Botulism 
Neurotoxin for months & CFR 5-10% for early Dx &
Symptoms: Infant: Floppy Dehydrated Weak| Adult Fatigue & paralysis At-Risk: Kids < 12m
PH Intervention: Boutlism IG<7 days, Abx for Wounds & No Home Canning & No honey for Kids < 12m
Dengue: Nth Qld / TSI / Bali | Don’t vaccinate Seronegative | Difficult to Treat or Isolate Backpackers
Beware: Dense population + O/S traveller from Endemic Region | Sx: FAR | Haemorrhagic Fever
Qld Management Plan: Mosquito Surveillance | Vector Management Response | Mosquito Control |
Disease Surveillance & Control |
Dengue Outbreaks (1 local case or 1 probable case in dengue area): Cases: Work & Travel Hx,
should not travel to Dengue Areas (4d) and Avoid Mosquitoes for 12 days, no blood donation
Involve widespread Team PHN | ED| Labs | Media Comms | Surge Staffing | Data Management |
Local Government: PH order to prevent mosquito breeding on premise (Eliminate Infected
Mosquitos)
Hendra: Fruit bats infected  Horses (from bat urine/faeces) (Resp/neuro failure for Horse)
 Rarely to People (Autopsy) (No PPE | Horse Resp Secretions) (Fatal: Sore Throat & Headache
 Men/Encephalitis)
Prevention: No bat secretions in Horse Feed | Vaccinate Horses | Isolate and use PPE for Sick Horses
Leptospirosis: Farm Animals | Dogs | Rats(most): Test Urine | Tissue of Infected animal
contaminating water or food or soil (esp. flood water | skin abrasions)
MERS-CoVar: Camel/Camel Milk & Human to Human / often Sporadic
Sx: ASx to severe pneumonia | ILI | Gastro
Phase1 (Rapid if suspected case): Travel Hx within LB / Isolate/Line List/Lab Test. Phase2
(confirmed case):ICS +++Escalate
LB: 14 days | Infectious: Contact Prec until 24hrs post Sx
Close or Casual Contact: Monitor for 2 weeks | >15minF2F or shared space > 2h Check
WHO & notify WHO for case status Media Comms

Q-Fever: Exposure: Farm Animals | Urine/ Faecies/Milk esp. birth products | Aerosol or Dust
Cuts / Ingestion / H-H (blood / STI / vertical) |? bioterrorism
Sx: ILI / Hepatitis / Obstetirc / Infection: Heart/Brain/Bone/Resp/Liver/Obstetrics
At Risk: Animal Slaughter | Visiting high-risk envt | HH of workers (dust from clothes etc..) Vaccinate
Q-Fever vaccination register for high risk
Test then Vaccinate: Only for Seronegative & unvaccinated & non-pregnant or aged above 15yrs
FUP Req: Pregnant women | IS | Valvular disease
Involve: Safe Work | Farmers | PHN | Occ Physician | Council
OHS & Envt Health Lt Hazard: Cleanable equipment | Ventilation | Wet Dust suppression
Keep animals Far from Home | Vaccinate or PPE (P2) | Dispose of birth products (deep burial)
Confirm Case/Q-Fever Ix Form LB 1m / Educate Case & Co-exposed/ Workplace (Occ Hygienist)
Active Case Finding:Test ?Cases |Assess Vaccination Status| Vaccinate & Document | Exclude or PPE
Rabies/ Bat Lyssavirus: Microbat | (OS Only: Mammals) | Fatal | Head Esp. danagerous
Cat 1 : Lick | Cat 2 – Scratch no blood | Cat 3 : Scratch blood or bite
Weight-based HRIG: Unimmunised | Bat: Cat 2 & 3| Cat 3 : Mammals (Within 7 days of 1st
vax )
Wash with Soap and Water | Other people affected
PEP Rabies Vax: 0/3/7/14 & Single HRIG Refer to CD guidelines for exact schedule , esp.for IC

Sexually Transmitted Infection:
STI spread Laws: people with STIs must take reasonable precautions to prevent spread or
can get fined or go to jail.
Gonorrhoea: MDR on the rise, send to reference lab to estimate prevalence & test Abx sensitivities
Hepatitis B: PEP: Hep B IG & Vax (Skin < 72 hrs) (Sex < 2 wks) | Multiple Dose Vaccine
Cleared in 3-6m or Hep B carrier  Cirrhosis  Liver Cancer
Hep B is in vaccination schedule, At-Risk: Not Vaccinated: CALD and Aboriginal people prior to
Vaccination
HIV Strategy: Very low notifications: testing, treating, PREP, Condoms, Abstinence, TASP, Sex Ed,
IVDU Harm Reduction, Vertical Transmission
At-Risk: MSM +/- IVDU | Aboriginal people | Female Sex Workers | Heterosexual (Rising)
HTLV-1: Aboriginal Remote Communities need Health Promotion/Ed & Surveillance
Sex / IVDU / Breastfeeding | ASx or Paralysis or Leukemia

Other:
Anthrax: Source: Infected Animals | Spores | Cuts and Soil | Undercooked Meat | Bioterrorism Sx: GI
(Haematemesis) or Inhalation (ILI / Shock/ Mening) | High CFR
PH Measures: Isolate | Test | Escalate | Genotyping | Abx | Sterilise | Forensics | Contact Trace (Abx
10d skin and 60d inhalation| MAJOR ESCALATION
Legionella (Penumonia or Pontiac (mild) Fever/ILI): Pneumophilia : (Cooling Warm Water: Cooling
Water System / Cooling Tower (through Evaporation) / Hot Water System >60°C / Warm Water System
45°C (High Risk)/ Hospitals (shower heads): Esp in IC/Smoker/ + 50 yo) | Longbeache (Potting Mix)
LB 10 days: Urine Culture with match to envt sample | Ix within 500m radius
Cluster: 2+ cases in months (weeks for Outbreak) in nearby area
Refer to Envt Health Notes
Rheumatic Heart Disease: Aboriginal people are 122X more likely to get Rheumatic Fever. Decreased
Health Literacy, Lack of Timely Free Access to Health Care, Overcrowding. Die Around 40yo
3% of Strep throat will get RhF (Virulence / overcrowding / genetics ) | National Strategy
Register Available | 0: Housing / Health Ed / Hygiene | 1: Abx for sore throat or skin infections | 2:
Register and IM penicillin ?monthly | Tertiary : Cardiac and echo followup.
PC/EC: Edu / Community Champion / Advocacy / P2P support / (Reminder )Apps / Patient
Consultation | BE: Housing for Health |
HS: Culturally Friendly / flexible for itinerant population and work around patients and families /
Bundle with other services
HP: Notifiable | Data Sharing | PHN access to Abx |New Vax Req.
Viral Haemorrhagic Fever: MAJOR ESCALATE: Highly Unlikely| Increased Risk| Highly Likely (Risk Assessment)
Care for Case  Contact Trace & Prevent spread (esp HCW or Lab worker) (Prevent Panic)
ILI  V/D Drowsy  Bleeding | LB: 21 days & IP: many weeks | Special Ambulance & Lab | ICS|
Increasing Risk: Bodily Fluids of VHF | Funeral + Body contact | Lived or Worked in rural Lassa Fever
endemic areas |tick bite | Animal Slaughter
PH Interventions: (See the Flowchart)
Isolate & Restrict Entry | VHF PPE | Surgical Mask Pt and Vomit Bag | D/W ID Physician | Travel &
Exposure Hx | Immediate Transport to designated facility or Ensuite room | Engage clinical services
and Departments | Waste Contractor | Educate Staff | minimse tests | No Sex for 3 months
Zika: Same areas as Dengue| avoid sex 41 days | Infectious to vectors until 10d Post Sx& 3 days Pre |
Incubation period : 3 to 12 days.

COVID 19 Summary of Series of National Guidelines from Federal Department of Health
Urgent
Case:
Confirmed: NAT | Culture with PCR followup | Seroconversion
Probable Case: Lower level lab (NPSwab) & epi link & clinical
Suspect Case: Clinical & Epi or high suspicion clinical (non-specific)
Epi (14 days prior) : Close Contact | International or hotspot Travel | Cruise Ship | Frontline health
care workers
Isolate Cases until release from isolation criteria is met:
1. Mild symptoms or Asmyptomatic: 10 days since symptoms & fever resolves & substantial
recover from resp Sx in last 72 hours
2. Severe Illness:
a. Resolved forever & resp Sx for 3 days and 14 days since symptom onset
b. Symptoms not completely resolved: 20 days since onset | not immunocompromised
3. IC: 2 neg pcrs 24 hrs apart , after 7 days of onset
Isolation in home or community setting with airborne precautions.
Contact: 14 days of quarantine
Incubation: Upto 14 days
Infectious Period: Within 7 days – but not definitive
Flulike symptoms with increased severity in the elderly and the comorbid. Reinfection possible.
Prevention:
Restricting Travel
Personal Hygiene: 1.5 m away / avoid physical greeting
Wearing Masks
Surveillance (enter into NCIMS and NNDSS):
Identify / Isolate / Manage Cases
Quarantine and educate contacts
Manage clusters
Research / planning / at-risk groups
Brief Up: CD Branch → Australia Department of Health

Environment Health Risk Assessment Notes
Dr Mithilesh Dronavalli Page 1 of 10
Environmental Health Risk Assessments:
https://www.health.nsw.gov.au/environment/factsheets/Pages/default.aspx
ASBESTOS
Issue Identification:
Asbestos was commonly used in:
cement sheeting (fibro)
drainage and flue pipes
roofing, guttering and flexible building boards (eg Villaboard, Hardiflex, etc.). Similar cement
sheeting products are used today, but are 'asbestos free'
brakes, clutches and gaskets.
In the 1960's and 70's loose fibre asbestos was used in some parts of NSW as home roof insulation.
Asbestos fibres can pose a risk to health if airborne, as inhalation is the main way that asbestos
enters the body.
Hazard:
Inhaled asbestos leads to asbestosis, lung cancer and mesothelioma. Intact asbestos poses less
harm.
Exposure:
Removing, Disturbing or breaking down fibro leads to increased risk of harm.
Asbestos in roofs and piping’s lead to high concentrations of asbestos in the air.
Dose Response:
Low concentrations of Asbestos are in the air and not harmful.
Generally chronic exposure to high levels of asbestos leads to the harms mentioned
Risk Management:
Loose and bonded asbestos greater than 10 m2
need a licensed person.
Risk Communication: There is a list of accredited asbestos removalists and see yellow pages. Hotline
exists office of environment and Heritage.

Mould
Mould is a type of fungus. Present indoors and outdoors.
Mould may grow indoors in wet or moist areas lacking adequate ventilation. Many different types of
mould exist and all have the potential to cause health problems.
Hazards:
Mould emits spores that are allergenic when inhaled. (Coryza, Conjunctivitis, dermatitis, wheezing
and asthma attacks). Rarely fungal pneumonia or severe reactions.
Risk Characterisation:
Respiratory diseases including asthma and allergies are more sensitive.
Fungal pneumonia: Immunocompromised: Leukemia, HIV infection, taking chemotherapy or organ
recipients systemic steroid users) and with COPD are more at risk of mould infection particularly in
their lungs.
Risk Management
Reduce dampness
Increase Ventilation (fans, windows)
Reduce Humidity: (humidifies, flueless heaters, fish tanks and indoor plants)
Control Humidity (fix leaks, clean and dry floors and carpets otherwise replace)
Consult an expert for rising damp from the ground
Remove mould (detergent →Bleach with protective equipment →Dry), professional carpet cleaning
Talk to your landlord.
Occupational Hygienists can check for Mould.
Risk Communication:
See your doctor or call 000 from health problems due to mould.

LEAD Exposure in Children
Young children are most at risk from lead
Hazard:
Lead exposure can affect a child's mental and physical development. Behaviour/attention/learing.
Stunting, RBC & Kidney damage.
Harm to foetus as well.
Toxic to almost all organs/system. Salient damage.
Exposure:
Inhalation and Ingestion:
Soil and Dust: Degrading Houses with Lead Paint, brought in by pets, industrial activity.
Water: Pipe can be soldered with lead, Rain-Water Tanks may have lead dust settled in it or roof and
pipes may have lead.
Paints: (before 1970), Renovating houses with old paint,
Toys: Imported Toys (even though sold in Australia) or very old toys and cots may have leads
Work: Mining and Smelting
Hobbies: Taking lead home from clothes, skin and hair. (Shooting, glazed pottery, stain glass, fish
sinkers)
Dose Response:
Duration and Quantity. Safe Level of Lead in Children:
Adults: 10 µg/dl
Children: 10 µg/dl caused IQ reduction in children. Federal Guidelines – Need to check local
guidelines
Risk Management:
Wash, remove imported toy
Caution in repairing old houses, no kids and pregnant women nearby.
Keep children away from flaking paint
No playing in dirt
Replace Iron Calcium and Vitamin C.
Risk Communication:
Contact Public Health Unit

Legionnaire’s Disease
Legionella colonisation of the respiratory tract (Legionnaire’s Disease) leads to severe pneumonia
that maybe fatal esp. in vulnerable groups(health & aged care: upto 40%.
Pontiac fever is a milder infection caused by Legionella without pneumonia.
Hazard:
Source of Legionella (Water Cooling Tower/Potting Mix)→Legionnaire’s Disease: Pneumonia →
Fatal (Warm water not heated beyond 50 degrees Celsius leads to a biofilm of legionella
pneumophilia
Exposure:
Water, Amoeba, pipes and plumbing usually as a biofilm (Legionella Pneumophillia)
OR Soil Compost Potting mix (Legionella Longbeache)
Usually Inhaled
Dose-Response:
2-10 days incubation (exposure to symptoms), severe IC is >10 days
Risk characterisation:
New Born Babies, very old, smokers, diabetes, and IC/IS/Chemo are vulnerable
Risk management System
2. Have a team.
3. Updating Risk Management Plan
4. Identify potential hazards, previous notifications, and risk from sources
5. Implement controls and Monitor
6. Notification → fix issue, treat notification, act if problem persists (more
notifications)
7. Review plan
PH Response: Corfirm Case , Active Case Finding (cooling hot water / potting mix) Utilise & Updae RMP

Heat
Hazard: Life Threatening: Stroke, Exhaustion & Exacerbate Chronic Illness (eg heart attack)
Dose:
Dose Response:
Vulnerable populations include:
1. Olde adults = Chronic Disease
2. Pregnant Women = More sensitive to heat
3. Young children & Infants = Play outdoors
4. Chronic Disease (Heart disease, HTN, Kidney Disease, N/V/D)
5. Certain Medication that means you can’t cool down
6. Outdoor workers: Labourers, Gardeners, Fire Fighters
7. Socially Isolated
Risk Management:
a. Keep cool: Loose clothes, stay indoors, Close windows and doors and use awnings
b. Hydration: Carry Water & Avoid Alcohol / Soda /Tea/ Coffee
c. Be there for vulnerable people
d. Planning: Know weather, Be prepared and keep house cool, Emergency Contact,
Follow Dr Advice
Risk Communication: Read Factsheet

Silicosis
Hazard: Found in Rocks Sand and Clay generates airborne dust and causes silicosis (Incurable Chronic
Respiratory Disease and increased risk of lung cancer).
Dose:
Particles < 1/1000 mm (1-micron diameter) care respirable (can enter alveoli).
Increase silica exposure where cutting, sanding, drilling etc that creates fine dust. Sweeping or
blowing dust makes it worse. Resuspension of settled dust from clothing.
Dose-response: How much and How Long breathing dust
15 years for chronic silicosis
5-10 years for accelerated silicosis
Few months high concertation - acute silicosis
Safe: Air: 0.1mg/m3
over 8 hours LIMIT,
Risk Management:
Wet Cleaning Vacuum with HEPA filter.
Label Silica based Raw Products esp. respirable silica and provide safety data sheet
Air monitoring to meet standards in a logbook for 30 years. Make it readily available.
Significantly Exposed workers need health monitoring

PFAS
Hazard: Present in non-stick cookware, fabric, furniture, carpets, food packaging, some industrial
processes and fire-fighting foam. Very long to biodegrade in environment and humans. EPA
investigating high concentrations in industrial sites, airports, and fire-fighting training. Williamstown
contamination.
Thus far only animals show harms from PFAS. No consistent evidence for PFAS causing harm for
humans, but harm may still be undetected. Precautionary principle, especially pregnancy
Exposure: Seepage through water usage (bore, surface water, fishing. Dust , air, food, water and
consumer products, mainly FOOD.
Treated carpets and floors with wax and sealants for bias and infants.
Dose Response: Higher PFAS levels in those heavily exposed to PFAS. Tolerable daily intake levels
exist, along with drinking water, recreation water guidelines.
Risk Communication: Fact Sheet, Links
Risk Management: Blood levels are unnecessary at an individual level, but testing may be useful for
investigation at a population level. Restrict exposure to tolerable daily intake levels.

Bushire Smoke
Hazard: Smoke affects health.
Exposure: Smoke Concentration can be seen on Air Quality Index. Inhaled and irritates eyes.
Dose Response:
Vulnerable populations: Asthma, heart disease, lung disease, Elderly, children, pregnant women
Risk Management Plan:
1. Clinical: Asthma Management Plan, Medication Management
2. Monitor AQI and follow public health messages
3. Avoid vigorous outdoor activity
4. Keep indoors with Windows Shut, ventilate when smoke clears
5. Go to A/C venues
6. Avoid indoor air pollution: (smoking)
7. Face Masks: N95/P2:
a. Difficult in heart/lung condition.
b. Difficult to breathe, dizziness (remove face mask and go to A/C
venue)
c. Increases risk heat related illness
d. Fit mask correctly
e. Remove mask when moist and when in cleaner air.
8. Can use air purifier with high efficiency particle air (HEPA) for indoors in sealed
proportionate room.

Waste Water:
Hazard:
Blackwater: Water from toilet, high concentration of faeces, highly infectious
Greywater: Run off from laundry, wash basin, kitchen, shower – some human faeces, less infectious
Sewage: Combination of Black and Grey Water – Highly infectious
Sewage Overflow: Runoff from ground and roof surfaces may lead to sewage overflow from
sewers with grey water. Contaminates soil, plants, indoor and outdoor. Ingestion/inhalation
leads to V/D Giardia, Cryptosporidium, Hepatitis A, etc... needs Advice and EHO. Needs
temporary accommodation for residents, with trained professionals doing cleaning &
disinfecting of all areas, indoor,outdoor, pool, floors, furniture, mattress.
Risk Management:
Centralised: Trough pipes into sewerage systems and treated in a large sewerage plant into
recycled water for secondary non-drinking (non-potable) use (irrigation , flushing, gardens)
De-centralised sewerage management system: Through pipes into a system of treating plants for
local reuse.
KEY POINTS BELOW including RC
Incident notification and response protocol:
through critical control points,
health related and water related objectives
Microbiological criteria and end use
Enforceable orders under Public Health Act
Risk Communication: Update all users and providers of the system

Drinking Water:
Drinking plenty of water is good for health. Water quality is dependent on source and most people in
NSW receive good water. Australian Drinking Water Guidelines sets the bench mark for safe
drinking. NSW has a monitoring program. Bottled water is not safer than potable drinking water.
Hazards: Rare to cause gastro, other more common causes – poor personal hygiene, contaminated
food and swimming pools, contact with animals.
Dose-Response: Most contaminants in water are safe at certain concentrations. Higher
concentrations can make water unpalatable and even unsafe.
Risk Management: Chlorine is used to kill micro-organisms that cause disease. Many units use
fluoridation to protect tooth decay. Chlorine and Fluoridation are in safe levels. Allow water to settle
for a few hours to reduce the effect of chlorine. Alum and ferric chloride are used as filters but again
removed upon supply.
Use cold water tap for drinking and cooking. Hot water has more minerals.
If taps not used , flush water for 2-3 minutes before drinking.
Risk Communication:
Results on local water quality are available.
Factsheet
No need to filter water. But use a <1 micron filter to remove crypto or giardia or use a boiling /
reverse osmosis filter. Disinfection unit to inactivate bacteria or viruses.

Environmental & Health Impact Assessment Process after Consultation
1. Air Quality (including dust, odour, particulate matter, gases)
2. Biodiversity
3. Climate Change Risk
4. Flooding
5. Health and Safety
5.1. describe the current known health status of the affected population;
5.2. Environmental Health Risk Assessment
5.3. assess the effect of the project on other relevant determinants of health such as the level of
physical activity and access to social infrastructure;
5.4. assess opportunities for health improvement;
5.5. assess the distribution of the health risks and benefits; and
5.6. discuss how, in the broader social and economic context of the project, the project will
minimise negative health impacts while maximising the health benefits.
5.7. The Proponent must assess the likely risks of the project to public safety, paying particular
attention to pedestrian safety, subsidence risks, bushfire risks and the handling and use of
dangerous goods.
6. Heritage
7. Noise and Vibration - Amenity (airborne, ground borne, blasting, nearby properties &
businesses, sleep,
8. Noise and Vibration – Structural (Construction process, integrity of buildings, Aboriginal places,
Environmental Heritage)
9. Protected and Sensitive Lands – (sensitive coastal environment including wetlands, rainforest,
waves, dunes, sediments, beaches, marine life, waterfront land)
10. Socio-economic, Land Use and Property (increase opportunity and reduce socio-economic
impact)
11. Soils - Risks arising from the disturbance and excavation of land and disposal of soil are
minimised, including disturbance to acid sulfate soils and site contamination.
12. Sustainability – conserving natural resource, efficient use of resources (including NSW
Government)
13. Transport and Traffic – fit with existing transport systems and future planning
14. Urban Design – Visual appeal of surroundings, accessibility, and connectivity of communities
15. Visual Amenity – includes public open spaces and aesthetic appeal.
16. Waste - Effectively stored, handled, treated, reused, recycled and/or disposed of lawfully and in
a manner that protects environmental values.
17. Water – Hydrology – Impact of surface water and ground water, lakes, wetlands, marine water
are minimised. Sustainable use of water.

C O N T E N T S
Acknowledgements v
Foreword ix
Introduction xi
Chapter 1 Germ theory and parasites 1
Chapter 2 Sewage system management 29
Chapter 3 Healthy people, homes and dogs 73
Chapter 4 Rubbish storage, collection and disposal
and environmental management 133
Chapter 5 Pest control 167
Chapter 6 Water supply 237
Chapter 7 Environmental health program management
and community education 285
CONTENTS

G E R M T H E O R Y
A N D PA R A S I T E S
1 The environment 2
2 Disease and the environment 2
3 Environmental health 3
4 Germs and disease 3
4.1 What are germs? 3
4.2 Diseases caused by germs 5
4.3 The spread of germs 9
5 Parasites 14
5.1 What are parasites? 14
5.2 Diseases caused by parasites 16
5.3 Methods on how some important parasites are spread 18
6 Stopping the spread of germs and parasites 24
GERM
THEORY
AND
PARASITES
1
Environmental Health Practitioner Manual:
A resource manual for Environmental Health Practitioners working with Aboriginal and Torres Strait Islander Communities
1

H E A LT H Y P E O P L E ,
H O M E S A N D D O G S
1 Domestic and personal hygiene 75
2 Poor hygiene and disease 76
3 House design and health 78
4 House hygiene—cleaning 85
4.1 Cleaning equipment and materials 85
4.2 House cleaning tasks 86
4.3 House cleaning timetable 90
5 House cleaning—tidying and maintaining the yard 92
5.1 Equipment 92
5.2 Yard tidying and maintenance tasks 92
5.3 Yard tidying timetable 93
HEALTHY
PEOPLE,
HOMES
AND
DOGS
3
73

W AT E R S U P P LY
1 Water—its importance and sources 238
1.1 The importance of water 238
1.2 Sources of water 240
2 Water contamination and disease 246
2.1 Diseases which can come from polluted drinking water 246
2.2 Water contamination and how it can be prevented 247
3 Community water supplies 255
3.1 Town communities 255
3.2 Bush communities 256
3.3 The elevated tank 257
3.4 Pipe layouts in the community 257
4 Water supply contaminants and disinfection 259
4.1 Water supply contaminants 259
4.2 Disinfection 261
5 Contaminated water supplies 265
5.1 Signs of contaminated water 265
5.2 Testing for contaminated water 266
6 Treating contaminated water 274
6.1 Treating water with chlorine 274
6.2 Tank cleaning 280
7 Water supply plumbing 282
WATER
SUPPLY
6
237

E N V I R O N M E N TA L
H E A LT H P R O G R A M
M A N A G E M E N T A N D
C O M M U N I T Y E D U C AT I O N
1 Environmental health work 286
2 Starting and managing
environmental health work 286
2.1 The community council’s role 287
2.2 The environmental health practitioner’s role 289
3 Planning the environmental health program 289
4 Checklisting 292
5 Getting the job done 294
6 Reporting 295
7 Office work 298
8 Maintenance and storage of
equipment and tools 300
9 Community environmental
health education 301
9.1 Why community education is important 301
9.2 How to teach about good
environmental health 301
9.3 Teaching aids 304
9.4 Demonstrations and practice 307
9.5 Where teaching can be done 309
10 Community development 310
ENVIRONMENTAL
HEALTH
PROGRAM
MANAGEMENT
AND
COMMUNITY
EDUCATION
7
285

Aboriginal Suicide Prevention Strategy
Aboriginal Community Engagement then:
PC/EC:
Community & Personal Empowerment / Health and Wellness
Education.
Knowing when to Seek Help
Meaningful Training / Work / Cultural Empowerment
BE: Recreation - Sports
HS: Led by Aboriginal People (MH / Counselling / Role Model /
Child & Family Services / Primary Care
Yarning Strengths Based Culturally
Appropriate & No
Racism
Resilience Lifespan Avoid Self Harm
Remote/Rural/Urban
(ARIA)
Overcoming Stigma Free & Accessible
HP: Intersectoral Policy Co-ordination by Jurisdiction
Health School Justice
Family and Child
Services (FACS)
Housing Welfare
Industry / Employment Aboriginal
Controlled
Organisations
Evaluate Program

Prevention: Education, Overcoming Poverty,
Welfare Safety Net

Mental Health (MH) (Depression / Anxiety most
common)
Whole of Society Research (Policy / Programs /
Funding)
Holistic Health and Not Absence of Disease
Negative Feedback Loop with Worsening Mental Health:
Addiction Unemployment Stressful Work
Conditions
Violence Reduced Income Gender Discrimination
Domestic Violence Limits Education Unhealthy Lifestyle
CVD Human Rights Violation Social Disadvantage
Physical Health Relationships Physical Health
Public Health Interventions can Prevent MENTAL ILLNESS and improve
Mental Health Care
Cultural Resilience can overcome Mental Health Stigma.
Positive Feedback Loop with Improved Mental Health  Harmonious Society
Civil Political Economic Social Cultural
Education Employment Labour Justice Transport
Environment Housing Welfare

Road Injury Prevention
Collect Data  Causes  Assess Intervention  Intervene 
Monitor and Evaluate Data: ABS (Population Measure) |
Mortality Data | Coronial Info | In-patient Morbidity Local
Regional Sources: Hospital / ED data | Clinic Data | Data
Linkage
STATEWIDE POLICY for Aboriginal and non-Aboriginal people
● Road and roadside infrastructure
● Safer vehicles
● Lower speed limits
● Graduated licensing
● Behavioural and Penalty based program for drink
driving, seatbelt usage, speeding
● Roll Frame (Quad Bikes, etc)
● Blood Alcohol Level and
● EFFECTIVE but still many deaths and serious injury

Public Health Interventions for Addiction
Develop and Share Data and Evaluate Interventions
Harm Minimsiation
Reducing Supply
Reducing Demand
Harm Reduction
Harm Reduction
Access to Health Services and Support
Safe Injecting Spaces, Opioid Substitution Therapy
Relapse Prevention: Inpatient / Outpatient / Community / Post Treatment Assessment and Brief Interventions in Primary Care
Subsidised medication eg NRT, Single use needles,
Reducing Consequences of AOD use
Targeting high risk groups / risky periods in the life span (pregnancy, adolescents) to modify risky behaviours
Diversion services preventing incarceration, especially for Aboriginal people / youth / refugees
Future Research:
Reduce AOD hospital presentations Spread of BBV (HIV / Hep C)
Road Trauma
Passive smoking
Overdose Risk
Reducing Demand
• Community Awareness
• Treatment Services to Reduce Use
• Excise duty
• Early interventions targeting school,
youth to delay first use and prevent
uptake.
Alcohol:
Abstinence : Aboriginal People > Non-Aboriginal People Risky Drinking: Aboriginal > Non-Aboriginal people
Rising Poverty leads to Increased Use of Volatile Substances (Severe Neurological and Multiorgan Harm:
Community based Laws: (Use Opal instead of petrol / night patrol / petrol sniffing is illegal)
Reducing Supply
• Engage with suppliers and users at the point of supply
• Reduce manufacture of illicit substances
• Consistent laws regarding supply of AOD
• Excise tax for A&T
• Respond to new supply (Internet/ Postal/ Emerging Technologies (Dark-Web))
• Facilitate Community Engagement (Govt / Community /NGO ) that are Culturally Appropriate

Public Health Interventions for People Living with Disability
Health Services & Financial Support + Prevention & Knowledge Transfer Research
18% of Australians have a Disability (Severe Disability: 6%).
Surveillance: ABS Survey of Disability & Ageing: Sparse general data only. Need for a Registry
NDIS since 2013: Help with ADLs/IADLs (Self Care) eg mobility , communication & also Learning
x assistive technology (for example, wheelchairs, hearing aids, voice-recognition software)
x case management
x early childhood intervention services
x Learning and life skills development
x specialist accommodation
x respite care.
Financial Assistance:
Disability Support Pension (Pension + Concession Card)
Assisting with Study
Finding Work
Improving Vaccination Coverage:
Types of Coverage: Numerator is number vaccinated and denominator changes based on supply
line and target groups
Fixing Supply Line or Demand: Look at each step from program conception , to manufacture of
vaccine, logistics, vaccination storage ("Strive for Five"), delivery, reach, accessibility, social
disadvantage, multicultural community, Aboriginal Community, misinformation and distrust.
Measures: RCT Efficacy, Real World Effectiveness (Vaccination Failure (1-RR), cost-effectiveness,
side-effects.
Health Services:

CANCER + GENERAL Public Health Interventions
Public Health Interventions:
1) Health Education at a Community and Individual Level
2) Target Increased Risk Cohorts
3) Improve Free or Equitable, Timely, Culturally Appropriate
Access to Quality Health Services
4) Research
5) Other: (HPV Vaccination / Safe Sex / Prevent Needle Sharing)
Static Risk Factors:
Age, Family History, Genetics, Previous Cancer (Benign or Malignant)
Modifiable Risk Factors:
Smoking: Many types of Cancer
Obesity/Physical Activity/Alcohol (Breast / Bowel / Liver Cancer)
Safe Sex: Liver Cancer
HRT/OCP: Breast, Ovarian Cancer
Skin Cancer: UV-Protection:
Shade Protective
Clothes
Hat Sunglasses
Sunscreen Media
Campaign
Alert for High
UV Days
Overcoming
Global
Warming

Knowledge Transfer Cycle (KT Cycle)

METABOLIC DISEASES (Heart + Diabetes +
Vasculature)
• Diet
• Exercise
• Reduce LDL
• Smoking
• Control Diabetes
• Alcohol and Other Drugs
• Affordable Health Food Supply (esp. Remote and Rural
Aboriginal Communities)
• Primary Care
• Risk Calculator
• Affordable Access to Referral Services
• Community Awareness  NHF/Mass Media / for CALD & NESB
High Risk Groups:
• Aboriginal People
• Refugees
• Poverty
Diabetes Mellitus:
• Sugar Tax / Soft Drinks Focus
• Food Labelling and Government Endorsement
• Community Awareness (T2DM and Complications)
• Timely and Affordable Access to whole Body Comprehensive
Care

Osteoporosis
Primordial and Primary Prevention:
• Improve Diet and Exercise.
• Reduce or Cease Alcohol and Smoking and other Drugs
• Vitamin D
Comorbidity Risk Factors:
Diabetes
HIV
Cancer
Cancer Treatment
Secondary and Tertiary Clinical Care:
• Fracture Risk Assessment (DXA > 50 yo)
• Prevent Falls
• Assist GP
o Bisphosphonates
o Treating Comorbidities
• Physio
• Health Economics
• Health Education
o Long-term Treatment Adherence & Overcoming Side-
Effects
o Reassure regarding Patient Safety
Further PH Intervention:
Dental Checkup prior to Bisphosphonates on Medicare

Antimicrobial Resistance
AMR requires a multi-pronged solution where stakeholder engagement is crucial. People CARE. NPS
in Australia
Issues and Stats:
• 2/3 of Abx for Animals, some just for growth
• 100 trillion dollars of accumulated input by 2050.
• 10,000,000 lives by 2050
• 2/3 of people with respiratory infections get unnecessary Antibiotics
• Resistance to HIV drugs and TB Abx growing
• Antibiotics let to go into the river from pharma manufacturing plants
• New drugs esp TB, takes a long term investment
•
Interventions:
• Solutions need to be Driven by clinicians
• Improved Surveillance
• Health Education and Awareness: Do not insist on Abx, Not taking full course of Abx Hand
• Hygiene for clinicians and public
• Regulation of wrong practices (OTC Abx, Inappropriate Clinical care)
• Restricting prescription
• Policy collaboration across nations with evaluation programs a few years later
GLOBAL HEALTH ISSUES
• Universal health coverage and timely, accessible Health Care Systems
• Air pollution: lung, cancer, cvd
• Global warming UN Climate Summit
• NCD 70% of deaths: Tobacco, alcohol, diet , exercise, air (LDCs much more)
• Flu pandemic , monitoring strains, vaccine, pharma for LDCs
• Antimicrobial systems and High threat pathogens, VHF
• Preparedness for Public Health Emergencies - Surveillance,
• Vaccine hesitancy, Vaccines are very cost effective
• Eliminate CERVICAL CANCER, HPV vaccine
• Dengue, severe dengue can kill
• HIV, much progress, increasing testing , self testing

Global Sustainable Goals of Development:
Good Health and Well-being
1. Maternal Mortality
2. Deaths of Newborns and children under 5
3. Communicable Disease
4. Non-Communicable Disease
5. Substance Abuse
6. Road Traffic Accidents
7. Sexual and Reproductive Health-Care Services
8. Universal Health Coverage
9. Pollution
10.Tobacco
11.Vaccines and Medicines
12.Health Workforce
13.Global Health Risks
Global Child Mortality < 5 years of age (2019: 53/1000)
Under 5 is the highest risk of death (mainly neonatal mortality). After day 5 neonatal mortality
decreases significantly. Over 5 is mainly injury.
Economic prosperity, public health campaigns, vaccines and antibiotics: global reductions in child
mortality. 1960 to 1990 improved dramatically.
India has highest number of deaths in CM. 3 times that of China due to treated infectious diseases.
Sub Saharan Africa 33% of children died. India CM halved from 1990 to 2015.
Different levels of social disadvantage need different types of interventions.
1) Low: Diarrhoea, LRTI, malaria, vaccine preventable diseases.
2) Medium: Then intrapartum and preterm
3) OECD: Then congenital and preterm
Malnutrition: secondary cause of death. Responsible for 53% of deaths
• Main vaccinations (including HIb)
• Exclusive Breast Feeding till 6 months
• Complementary Feeding from 6-24
months
• Vitamin A
• Zinc
• Anti-Malarials
• Water
• Sanitation
• Safe Births: birthing kits
• Low Tech: cheap mechanical CPAP kits
for asphyxia)
• Folic acid (congenital disability)
• EBF until 6months, cheap, clean, not infectious, prevents stunting (height and weight for age)
• Intermittent treatment of pregnant mothers for malaria treatment without testing: Reduces
maternal and child mortality and low birth weight.
• Advocacy
• Delayed recognition, seeking and getting healthcare.
Interventions

Essentials of public health frameworks in India

Essentials of public health frameworks in India

Recommended

Recommended

More Related Content

What's hot

What's hot (12)

Similar to Essentials of public health frameworks in India

Similar to Essentials of public health frameworks in India (20)

Recently uploaded

Recently uploaded (20)

Essentials of public health frameworks in India