Overview of Session The students are introduced to Community and Public Health, its scope of services as well as its development as a discipline in the Philippines, After the completion and review of the topic, the student should be able to explain the meaning and significance of Public Health in the Philippines.
The student will be able to › Define Public health › Discuss the scope of the subject › Trace the history of public health in the Philippines
PUBLIC HEALTH Ecological (environmental) in perspective(VIEWPOINT), multi-sectoral (division) in scope and collaborative (2 WAY) in strategy It aims to improve the health of community through an organized (planned) community effort The science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private communities and individuals.
It is concerned with threats to the overall health of a community based on population health analysis. Public health is typically divided into epidemiology, biostatistics and Health services. Environmental, social, behavioral, and occupational health and other important subfields.
1. It deals with preventive rather than curative aspects of health.2. It deals with population level- rather than individual-level health issues.
It is a group of people withcommon characteristics orinterests living together withina territory or geographical(physical) boundary.
Community as ClientWorld Views on Community : 1. Family, community and society 2. Contradictions / Conflicts 3. Change
1. Family, community and society :A. Individual : a. Patient : an individual who is sick. b. Client : an individual who is well/not sick.B. Family : A. Role/Relationship : Parents; Bi-parenting *Mother is expected to have the ABILITY to provide care and usually takes the role of keeping the family well and healthy by combining : 1. Knowledge 2. Attitudes 3. Skills * Ex: During Martial Law there was a food blockade giving nutrition problems to some places resulting to political insecurity and the CH nurses introduced some alternatives in : 1. Food and nutrition 2. Food preservation 3. Food technology
C. Community : * CHN serves up to this level only. * Everything that affects the individual affects the family and eventually the community.
2. Contradictions / Conflicts :People in the community are always in constant conflict and faced with contradictions : 1. Individual : intrapersonal conflicts (conflict within the person/personal conflicts) 2. Family : interfamilial conflicts (conflict within the family/interpersonal conflicts) 3. Community : intercommunity (interfamilial conflicts) 4. Society : intra-societal conflicts (intercommunity conflicts)
Note : People tend to have negative perspectives. In the Philippines, negative regional stereotyping is very common such as : a. Ilocanos : kuripot ---(positive : call them resourceful) b. Kapampangans : mayabang ---(positive : maybe they are assertive/artistic) c. Bicolanos : malibog---(positive : could be loving/warm hearted) d. Bisaya : aswang ---(positive : they are mysterious/interesting people) e. Mindanaoans : mamamatay tao (Muslims esp)-- -(positive : brave/courageous)* In CHN, we try to avoid negative perspectives, look for the source of the conflicts and try to find solutions. We must try to adapt positive perspectives in order to achieve a positive development (effect upward and onward movement).
3. Change : is inevitable (unavoidable) because a community is dynamic (active, full of life) and is always changing (not static).* A CH worker should constantly assess the community to come up with suitable interventions (actions are responsive to the people„s needs).
* Place where people under usual or normal conditions are found : 1. Home : You render Family Health Nursing 2. Workplace : You render Occupational Health Nursing 3. Schools : You render School Health Nursing* Outside of purely curative institutions such as hospitals.* Are usually centers for wellness where you do health promotion and disease prevention.
1. Health-Illness Continuum Models :A. Dunn’s High-Level Wellness Grid :describes a health grid in which a health axis and an environmental axis intersect. The grid demonstrates the interaction of the environment with the illness-wellness continuum.The axis extends from peak wellness to death, and the environment axis extends from very favorable to very unfavorable. The intersection of the two axes forms four quadrants of health and wellness.
Very favorable environment Protected poor High-level health wellnessDeath ------------Health----------------------Axis------------Peak Wellness Poor health Emergent high-level wellness Very unfavorable environment
1. High-level wellness in a favorable environment : Example is a person who implements healthy lifestyle behaviors and has the biopsychosocial, spiritual, and economic resources to support his lifestyle.2. Emergent high-level wellness in an unfavorable environment : Example is a woman who has the knowledge to implement healthy lifestyle practices but does not implement adequate self-care practices bec of family responsibilities, job demands, or other factors.
3. Protected poor health in a favorable environment : Example is an ill person whose needs are met by the health care system and who has access to appropriate medications, diet, and health care instruction.4. Poor health in an unfavorable environment : Example is a young child who is starving in a drought-stricken country.
* Requires the individual to maintain a continuum of balance and purposeful direction with the environment.* Involves progress towards a higher level of functioning, an open-ended and even expanding challenge to live at the fullest potential.
B. Travis‟ Illness-Wellness Continuum : Ranges from high-level wellness to premature death. It demonstrates two arrows pointing in opposite directions and joined at a neutral point. Movement to the right of the neutral point indicates increasing levels of health and well-being for an individual achieved in three steps :1. Awareness2. Education3. GrowthIn contrast, movement to the left of the neutral point indicates progressively decreasing levels of health and premature death.
Wellness Model PrematureLevel Disability symptoms signs awareness education growth HW Death neutral point (No discernible illness or wellness)
* Degree of client wellness that exists at any point in time ranging from optimal wellness condition, with availability of energy at its maximum, to death which represents total energy depletion.* A dynamic state that continuously alters as a person adapts to changes in the internal and external environment to maintain a state of physical, emotional, intellectual, social, developmental and spiritual well-being (Holistic).
1. Internal variables : include those which are usually non-modifiable such as :a. Biologic dimension - genetic makeup, sex, age, and developmental level all significant to a person‟s health.b. Psychological dimension - emotional factors which include mind-body interactions and self-concept.c. Cognitive dimension - intellectual factors which include lifestyle choices and spiritual and religious beliefs.
2. External variables : the macrosystem which include:a. Environment : geographical locations determine climate, and climate affects health; environmental hazards.b. Economics : standards of living reflecting occupation, income and education is related to health, morbidity and mortality.c. Family and cultural beliefs : the family passes on life patterns of daily living and lifestyles to offsprings (e.g. physical/emotional abuse or climate of open communication). Culture and social interactions also influence how a person perceives, experiences, and copes with health and illness.d. Social support networks : political/systems of governance; religion/church; mass media.
In Sept. 8, 1978 : UNICEF and WHO held the First International Conference on Primary Health Care in Alma Ata, USSRPHC Goal : Health for All by 2000! (bec of the high-level wellness model in 1978)In 1994, modified goal to Health for All by 2000 and Beyond because original goal was unattainable.LOI 949 : was signed by Pres Marcos on Oct 19, 1979 making Primary Health Care the thrust (focus)of the Department of Health.
Vision :Health for All Filipinos was set by DOH Sec Juan Flavier.Goal :Health for All Filipinos and Health in the Hands of the people by the Year 2020 (the 2nd phrase was suggested by the NGO : Bukluran Para sa Kalusugan).Mission :In partnership with the people, provide equity, access and quality health care esp to the marginalized which brought about the Sentrong Sigla movement in order to achieve it.
RA 7160 : The Local government Code of 1991 which resulted in devolution, which transferred the power and authority from the national to the local government units, aimed to build their capabilities for self- government and develop them fully as self-reliant communities.
Agent-Host-Environment Model : also called the ecologic model by Leavell and Clark refers to the interplay of agent (causative/etiologic factor), host (possessing intrinsic factors), and the environment (extrinsic factors)
A. Etiologic Factors :1. Biological agents : virus, fungi, bacteria, helminthes, protozoa, ectoparasites2. Chemical elements : a. Carcinogens : BBQ b. Poisons : MSG c. Allergens: Some seafood d. Transfats: Junkfoods3. Nutritive elements : excesses and or deficiencies e.g. marasmus & kwashiorkor4. Mechanical factors : accidents5. Physical : as when one is struck (strike) by lightning6. Psychological : such as stress
B. Host :Intrinsic factors include : 1. Exposure 2. Response (reaction)
C. Environment :Extrinsic factors include :1. Natural boundaries2. Biological environment3. Socio-economic (political boundary)
3. Health Belief Model : refers to the relationship between a person‟s belief and his behavior in health. It pertains to three components of an individual‟s perception : 1. Susceptibility to an illness 2. Seriousness of an illness 3. Benefits of taking the action Example: In one HIV infection study
Commercial sex workers Seafarer’s Nuns wivesSeriousness Yes Yes YesSusceptibility Unprotected penetrative sex Unprotected Care and support(MOT) a. vaginal : 1:1000 chance penetrative work b. anal : sex a. occupational male-male : 1:200 chance hazards-usually male-female: family planning give nurturing method care to the sick c. oral: b. needle-sticks Felatio : highest risk Cunnilingus: safest sex c. splash Analingus: no HIV risk accidents d. no recorded f-f HIV MOTPrevention: C and D B and C UniversalAbstinence(safe precautionssex)Be faithful(mutual monogamy)Correct, consistent &continuous use of condomsDo not penetrate (BCD : safer sex)
4. Evolutionary-based Model : States that illness and death sometimes serve an evolutionary function. Elements considered in the theory are : 1. Life events : developmental variables and variables associated with changes such as accidents/relocation. 2. Lifestyle determinants 3. Evolutionary viability within the social context : reflects the extent to which an individual functions to promote survival and well-being. 4. Control perceptions : the extent to which a person can influence circumstances in life. 5. Viability emotions : affective reactions developed for life events or lifestyle determinants. 6. Health outcomes : physiological, behavioral and psychological status resulting from the interplay of those elements.
5. Health Promotion Model : directed at increasing client‟s well-being.* Goal : enhance level of wellness.
6. WHO definition (1978) : a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity (sickness). * Health is a social phenomenon. * It is an outcome of multi-causal theories of health and disease. * It is an outcome or by-product of the interplay of societal factors : a. Ecological : 1. Biological 2. Physical b. Economic c. Political d. Socio-cultural
What is Community Health?A part of paramedical and medical intervention or approach which is concerned with the health of the whole population.A discipline that concerns with the study and betterment of the health characteristics of biological communities. Its aims are : 1. Health promotion 2. Prevention of disease 3. Management of factors affecting health
COMMUNITY HEALTH PANDEMIC - wide spread; epidemic over a wide geographic area and affecting a large portion of the population EPIDEMIC - spreading rapidly and extensively by infection and affecting many individuals in an area or a population at the same time. -an outbreak of a contagious disease that spreads rapidly and widely
Major concepts of Public health :1. Health promotion and disease prevention2. People‟s participation towards self- reliance : active and full involvement with people in the decision-making process : -assessment, planning, implementation, monitoring and evaluation.
Dr C E Winslow :The science and art of preventing disease, prolonging life, promoting health and efficiency through organized community effort.
Hanlon : It is dedicated to the common attainment of the highest level of physical, mental and social well- being and longevity consistent with available knowledge and resources at a given time and place. It holds this goal as its contribution to the most effective total development and life on the individual and this society. (Holistic)
Purdom : It prioritizes the survival of human species, the prevention of conditions which lead to the destruction or retardation of human function and potential in early years of life, the achievement of human potential and prevention of the loss of productivity of young adults and those in the middle period of life and the improvement of the quality of life especially in later years.
Nightingale : The act of utilizing the environment of the patient to assist him in his recovery. Any individual is capable of reparative process.
History of Public health in the Philippines based on socio-political periods1. Pre-American Occupation ( up to 1898 )2. American Military Government ( 1898-1907)3. Philippine assembly (1907-1916)4. The Jones law (1916-1936)5. The Commonwealth (1936-1941)6. Japanese occupation ( 1941-1945)7. Post World war II (1945-1972)8. Post EDSA revolution (1986 to present
1. Pre-American Occupation › 1577- Public health began at the old Franciscan Convent in Intramuros where Fr. Juan Clemente put up dispensary for treating indigents in Manila. -San Juan de Dios Hospital 1.2 During Spanish Time 1. Creation of Vaccinators to prevent smallpox 2. Creation of Board of Health 3. First medical school in the Philippines- UST 4. School of Midwifery 5. Public Health Laboratory 6. Forensic Medicine
1.3 Hospital before the Americans came to Philippines 1.3.1 General Hospitals 1. San Juan de Dios Hospital 2. Chinese General Hospital 3. Hospicio de San Jose in Cavite 4. Casa dela Caridad in Cebu 5. Enfermeria de Sta. Cruz in Laguna 1.3.2 Contagious Hospitals 1. San Lazaro Hospital 2. Hospital de Palestina in Camarines Sur 3. Hospital delos Lesporosos in Cebu 4. Hospital de Argencina in Manila for smallpox and cholera
2. American Military Government 2.1 Control of epidemics such as cholera, small pox and plague 2.2 Fight against communicable diseases such as common cold, Hepa A-D, chickenpox, SARS, flu, mumps, malaria, herpes, STD, measles 2.3 Projects and activities: 1. Garbage crematory 2. First sanitary ordinance and rat control 3. Cholera vaccine was first tried 4. Confirmed that plague in man comes from infected rat 5. Opened the UP College of Medicine 6. Establishes Bureau of Science
3. Philippine Assembly 1. Hygiene and Physiology were included in curriculum of public elementary school 2. Anti-TB campaign was started 3. Philippine Tuberculosis Society was organized 4. Opening of PGH (Phil. Gen. Hospital) 5. Use of anti-typhoid vaccine was initiated 6. Dry vaccine against small pox was first use
4. JONES LAW YEARS 4.1 Retrogression rather than progression in so far as the health was concern 1. Increase CDR 2. Increase IMR 3. Increase Morbidity 4.2 Increase deaths from smallpox, cholera, typhoid, malaria and TB
4.3 Re-organized happened (reorganized the health service and encouraged effective supervision) 1. Study the cause and prevalence of typhoid fever 2. Schick test was used to determine the causes of diphtheria 3. Campaign against Hookworm was launched 4. Anti-dysentery vaccine was first tried 5. First training course for sanitary inspector was given 6. Women and child labor law was passed 7. Mechanisms of transmission of dengue fever through Aedes aegyti was studied 8. Establishment of School of Hygiene and Public Health 9. National Research Council of the Philippines was organized 10. BS in Education Major in Health Education was opened in UP 11. (PPHA) Philippine Public Health Association was organized
5. COMMONWEALTH PERIOD 5.1 The epidemiology of life threatening disease was studied- diphtheria, yaws, dengue 5.2 Research in the field of health was promoted 5.3 UP School of Public Health was established 5.4 Development of Maternal and Child Health (MCH) 5.5 1939 – Creation of Dept. of Public Health and Welfare - Dr. Jose Fabella as the First secretary 5.6 1940- Bureau of Census and Statistics was created to gather vital statistics 5.7 In spite of development 1. Inequitable distribution of health services remained a problem 2. 80% of those who died were never given medical attention
6. JAPANESE OCCUPATION/WORLD WAR II 1. During this time, all public health activities were practically paralyzed. 2. Increase incidence of TB, veneral dses, malaria, leprosy and malnutrition.
7. POST WORLD WAR II 1. Philippine Independence 2. Completion of a research on Dichlorodiphenyltricholorothanel (DDT-as larvicidal/insecticide to control malaria 3. Introduction of one-infection method for gonorrhea with penicillin 4. Manila was selected as Headquarters for World Health Organization (WHO) Western Pacific Office 5. Strengthening Health and Dental services in rural areas (per municipalities with 5,000-10,000 population) 1 Municipal Health Officer 1 Public Health Nurse 1 Midwife 1 Sanitary Inspector
8. MARTIAL LAW YEARS 8.1 Creation of National Economic Development Authority 8.2 Department of Health was renamed as Ministry of Health (MOH)
8.3 Accomplishments during this period: 8.3.1 Formulation of National Health Plan › Construction of Tertiary Hospital o Philippine Heart Center o Lung Center o Kidney Center o Lungsod ng Kabataan / Phil. Childrens Medical Center › Adaptation of the Primary Health Care o Phil was the first country to implement PHC › Launching of Operation Timbang and Mothercraft o Nationwide program providing supplementary food for infants, pre-school and school children. NUTRIBUN- bread with vitamins 8.3.2 Progress in Public Health research RITM- Research Institute for Topical Medicine PCHRD- Philippine Council for Health Research and Development
9. EDSA REVOLUTION › From Ministry of Health, it was renamed again as Dept. of Health › Increase in life expectancy slowed down › Increased incidence of malnutrition › Declined practice of family planning
10. AQUINO ADMINISTRATION › 1987 Constitution- more provisions on health making comprehensive health care available › Major activities: Milk code- required the marketing of breast feed milk substitute Universal child and mother immunization RA. 6725- Act prohibiting discrimination against women NESS- National Epidemic Surveillance System RA. 6675- National Drug Policy and Generics Act RA. 7170- Organ Donation Act
11. RAMOS ADMINISTRATION › “Health in the Hands of People” and “Let‟s DOH it” –by Sen Juan Flavier Memorable initiative during leadership of Flavier › National Immunization Day BCG (Bacille Calmette-Guérin (BCG) is a live strain of Mycobacterium bovis developed by Calmette and Guérin for use as an attenuated vaccine to prevent tuberculosis and other mycobacterial infections.) DPT (diphtheria, pertussis(whooping cough) and tetanus) OPV –Oral Polio Vaccine MMR- Immunization shot against measles, mumps, and rubella (also called German measles)
Continuation….(Memorable initiative during leadership of Flavier) › Promotion of Traditional Medicine- Herbal Medicine › Yosi Kadiri › Araw ng Sangkap Pinoy- aimed to prevent Vitamin A, Iron and Iodine deficiency › Voluntary Blood Donation Program › Kung Sila‟y Mahal Mo Magplano- Family Planning Program › Doctors to the Barrio
Laws: › EO 39- which created the Philippines National AIDS Council as a national policy and advisory body in the prevention and control of HIV-AIDS › RA 7719- the National Blood Services Act of 1994, this to promote voluntary blood donation › RA 8172- Salt Iodization Nationwide (ASIN), providing salt iodization nationwide approved in 1996 and renamed FIDEL (Fortified for Iodine Elimination)