8. 8
Public health may be conceptualized as
-Analyzing the health of a population and the threats it faces is
the basis for public health.
-Science of protecting the safety and improving the health of
communities through education, policy making and research for
disease and injury prevention.
9. Comprehensive definition of Public health (Charles-Edward
Amory Winslow, 1920 ):
“The science and art of preventing disease, prolonging life, and
promoting health and efficiency through organized community
effort for:
- The sanitation of the environment
- The control of communicable infections
- The education of the individual in personal hygiene
- The organization of medical and nursing services for the
early diagnosis and preventive treatment of disease, and
- The development of the social machinery to ensure
everyone a
standard of living adequate for maintenance of health
So, organizing these benefits as to enable every citizen to
realize his birth right of health and longevity.
Definitio
n
10. 10
Public Health Specialist and
Clinician
In the medical field, clinicians treat diseases and injuries of one
patient at a time. But in public health, we prevent disease and
injury. Public health researchers, practitioners and educators
work with communities and populations. We identify the
causes of disease and disability, and we implement large scale
solutions.
For example, instead of treating a gunshot wound, we work to
identify the causes of gun violence and develop interventions.
Instead of treating premature or low birth-weight babies, we
investigate the factors at work and we develop programs to
keep babies healthy.
11. 11
Instead of prescribing medication for high blood pressure,
we
examine the links among obesity, diabetes and heart disease—
and we use our data to influence policy aimed at reducing all
three conditions.
In public health, microbiologists work to find a vaccine for
malaria, while behavioral scientists research ways to
discourage populations from smoking. Environmental health
scientists work to discover which foods prevent cancer, while
health policy analysts evaluate health insurance programs and
make recommendations. And epidemiologists identify trends in
health and illness, looking for links, causes and interventions
in areas such as HIV/AIDS, tuberculosis and infant mortality.
14. 14
Public Health Health Care
Population focus Individual patient focus
Public health ethic Personal service ethic
Prevention or public
health emphasis
Diagnosis and treatment
emphasis
field involvement
patient involvement
Clinical sciences peripheral to
professional training
Clinical sciences essential to
professional training
Public sector basis Private sector basis
15. 15
Components of
PH
Public health is an interdisciplinary field. It
includes:
- Epidemiology,
- Biostatistics
- Management of health services
- Environmental health,
- Community health,
- Behavioral health,
- Health economics,
- Public policy,
- Mental health,
- Occupational safety,
- Gender issues in health, and
- Sexual and reproductive health.
23. 23
Rehabilitatio
n
Rehabilitation is “the combined and coordinated use of medical,
social, educational, and vocational measures for training and
retraining the individual to the highest possible level of functional
ability.”
24. 25
Salutogenesis is a medical approach focusing on factors that
support human health and well-being, rather
than on factors that cause
disease
25. 25
Public Health
Activities
• Prevents epidemics
• Protects the environment, workplaces, housing, food, and
water
• Monitors health status of population
• Mobilizes community action
• Responds to disasters
• Assures quality, accessibility, and accountability of medical
care
•Reaches out to link high-risk and hard-to-reach people to
needed services
• Researches to develop new insights and innovative
solutions
• Leads the development of sound health policy and planning
26. 26
Differentiation among PH, Community
Medicine, Social Medicine & Preventive
Medicine
GREAT deal of confusion exists with regard to the meaning of
the terms "public health," "community medicine," "social
medicine," and "preventive medicine." The terms are often
used interchangeably, a practice which adds to the confusion.
Two basic concepts are at issue: public health on the one hand,
and community/social/preventive medicine on the other. The
latter three terms have different historical roots, but reflect a
more or less identical orientation.
27. 27
The key word: community, social and preventive medicine are
considered to be, a subdivision of the overall discipline. The
common denominator of all three of these terms is "medicine."
Indeed, they constitute a very minor subdivision of medicine.
The concept of public health, on the other hand, is that of a
major governmental and social activity, multidisciplinary in
nature, and extending into almost all aspects of society. Here
the key word is "health," not "medicine“.
30. 30
“Preventive Medicine"
The term "preventive medicine" stems in USA from a period
when public health was almost exclusively concerned with the
prevention of infectious diseases either by preventing the
occurrence of a disease or by halting a disease and averting
resulting complications after its onset and was dominated by
the medical profession.
"Social Medicine"
"Social medicine" is a product of France, Germany, Belgium and
other European countries. Firmly based in the medical
profession, it reflected a concern with the role of social factors
in the etiology of disease, and the need for government action
in the areas of disease prevention and medical care.
31. "Community Medicine"
"Community medicine" became prevalent in the United States
as a substitute for "social medicine," since the latter term
sounds too much like "socialism."
31
35. Rise of Public Health:
The Nineteenth Century: The Great Sanitary Awakening
In the era of unplanned
industrialization in nineteenth
century, "The great sanitary
awakening"—the identification of filth
as both a cause of disease and a
vehicle of transmission, and the
ensuing embrace of cleanliness—
was a central component of
nineteenth-century social reforms
and advancement in public health.
35
36. - Illness came to be seen as an indicator of poor social
and
environmental conditions, as well as poor moral and
spiritual conditions.
-Cleanliness was embraced as a path both to physical
and moral health.
-Disease control shifted from reacting to intermittent outbreaks
to continuing measures for prevention.
- With sanitation, public health became a societal goal and
protecting
health became a public activity. 36
37. 37
The Development of Public Activities in
Health
-Edwin Chadwick, a London lawyer (1838), is one of the most
recognized names in the sanitary reform movement.
-Under Chadwick's authority, a commission conducted studies
of the life and health of the London working class in 1838 and
that of the entire country in 1842.
-The report of these studies, ‘General Report on the Sanitary
Conditions’, was a document of the appalling conditions in
which masses of the working people were compelled to live,
and die, in the industrial towns and rural areas of UK.
-Chadwick documented that the average age at death for the
gentry was 36 years; for the tradesmen, 22 years; and for the
laborers, only 16 years.
38. 38
- To remedy the situation, Chadwick proposed what came to be
known as the "sanitary idea."
-His remedy was based on the assumption that diseases are
caused by foul air from the decomposition of waste.
To remove disease, therefore, it was necessary to build a
drainage
network to remove sewage and waste.
-Further, Chadwick proposed that a national board of health,
local boards in each district, and district medical officers be
appointed to accomplish this goal.
-Chadwick's report eventually was adopted in the Public Health
Act, of 1848 in UK, and subsequently American Public Health
Act 1872, which both promoted sanitation and engineering as
means of controlling disease.
41. 41
Beneficence refers to actions or rules aimed at benefiting
others.
The concept of non-maleficence is embodied by the phrase,
"first, do no harm," or the Latin, ‘primum non nocere’. “Non-
Maleficence” requires an intention to avoid needless harm or
injury that can arise through acts of commission or omission.
In common language, it can be considered “negligence” if you
impose a careless or unreasonable risk of harm upon another.
The principle of autonomy, views the rights of an individual to
self- determination. This is rooted in society's respect for
individuals' ability to make informed decisions about personal
matters with freedom.
42. 42
Social justice is a concept of fair and just relations between the
individual and society. Social justice assigns rights and duties in
the institutions of society, which enables people to receive the
basic benefits and cooperation.
Truth-telling, or veracity, can be defined as the avoidance of
lying, deception, misrepresentation, and non-disclosure in
interactions with patients or relevant to patient care.
52. Surveillance is the continuous, systematic collection, analysis and interpretation of
health- related data needed for the planning, implementation, and evaluation of
public health practice.
52
53. Cholera, a fatal intestinal
disease, was rampant
during the early 1800s in
London, causing death to
tens of thousands of
people in the area. Cholera
was commonly thought to
be caused by bad air from
rotting organic matter.
Cholera — A Public Health Approach
53
54. John Snow is best known for his
work tracing the source of the
cholera outbreak and is
considered the father of modern
epidemiology.
John Snow, Physician
54
57. Cluster of Cholera Casesaround ‘Broad Street Pump’ Site Locations
57
Risk Factor Identification — What Is the Cause?
58. 58
Intervention Evaluation — What Works?
Through continuous research, Snow understood what
interventions were required to
• stop exposure to the entire supply of
contaminated water in the area
59. Implementation — How Do You Do It?
John Snow’s research
convinced the British
government that the source of
cholera was water
contaminated with sewage.
Thus Broad Street Pump to
supply water was sealed for
ever.
59
60. Three Core Functions of Public Health
Assessment
Policy
Development
Assurance
Systematically collect, analyze, and
make available information on
population at risk to identify health
problems and priorities.
Promote the use of a scientific
knowledge base in policy and
decision making to solve
problems.
Ensure provision of services to
those in need
60
61. Ten Essential Public Health Services
1. Monitor Health
2. Diagnose and Investigate
3. Inform, Educate, Empower
4. Mobilize Community Partnership
5. Develop Policies
6. Enforce Laws
7. Provide Care
8. Assure a Competent Workforce
9. Evaluate
10. Research
61
63. Core Functions at Government Levels
Assessment
Policy
Development Assurance
Federal
State
National tobacco
public health
surveillance
Smoking ban
on commercial
flights
f
Federal grants
or antismoking
research
Monitor state
tobacco use obacco ta
t
Increase
x fo
Funding
r campaign
Report on local
tobacco use
County laws
moking in publi
s
prohibiting
c
places
Resources to help
63
smokers quit
Local
65. Partners in the Public Health System
Ensuring the Conditions
for Population Health
Community
Clinical Care
Delivery System
Government
Public Health
Infrastructure
Employers
and Businesses
The Media
Academia
65
66. Other Partners in Public Health
Media
Employers
and Businesses
Government
Agencies
• Vehicle for public discourse
• Health education and promotion
• Health communication
• Social media as catalyst
• Employer-sponsored health insurance
programs
• Wellness initiatives and benefits
• Healthy workplaces and communities
• City planning
• Education
• Health in all policies
• Education
Academia
• Training
• Research
• Public Service
66
73. 73
Other major global health issues now at the forefront include:
- Infant mortality
- Water scarcity
-Environmental risk factors (factory emissions, car exhaust,
tobacco smoke, etc.)
- Tobacco use
- Obesity
- Global warming
- Terrorism
- Substance abuse
84. 84
Ethical issues and challenges of Public
Health
1. Political conservatism : Reluctant to any change in health
policy.
2.Individualism – Individualistic societies resist the notion of
public health’s concern for the collective.
3.Economic impacts - Public Health regulations affects the
industries (E.g. tobacco), those paying for the public health
benefits may not necessarily be the beneficiaries (E.g.
Regulatory actions for worker safety raising costs to
consumers).
4.Preference for immediate result: People may not be willing to
pay costs for benefits that would accrue in the long future (E.g.
measures to limit global warming) and it is easier to calculate
current costs incurred for public health than the benefits that
would come later.
85. 85
5.Promoting public welfare versus individual liberty – Extent to
which governments should restrict individual freedom for the
purpose of improving community health.
6.Libertarianism – Restrictions on individual behavior for
protecting their own health (E.g. enforcing seat belts).
libertarianism claims that “the only purpose for which power
can be rightfully exercised over any member of a civilized
community ,against her / his will is if her/his act harms others(
E.g. regulate drunk behavior no drinking)
7.Public health measures and religion/moral – Some public
health measures are not acceptable on religious and moral
grounds ,(E.g. sex education and distribution of contraceptives
and/or condoms to adolescences),
86. 86
8.Values and responsibilities - Health authorities deciding on
values and choices of those they serve (e.g. whether some
one should not take the responsibility on behavior causing ill
health such as smokers, alcoholics, promiscuous people).
9.Surveillance versus cure – Surveillance is costly and time
taking; where as, cure is immediate benefit.
10.Dilemmas in Cost Benefit Analysis – Difficulty of valuing life,
and values to be assigned for the rich versus the poor.
Communicable diseases are illnesses that spread from one person to another or from an animal to a person, or from a surface or a food. Diseases can be transmitted during air travel through: direct contact with a sick person. respiratory droplet spread from a sick person sneezing or coughing.
AIDS
COVID-19
Babies of mothers who are exposed to illicit drugs, alcohol, and cigarettes are more likely to have low birthweight. Mothers of lower socioeconomic status are also more likely to have poorer pregnancy nutrition, inadequate prenatal care, and pregnancy complications--all factors that can contribute to low birthweight.
Illicit drugs refer to highly addictive and illegal substances such as Heroin, Marijuana, and
The field works to advance policies and programs to reduce chemical and other environmental exposures in air, water, soil and food to protect people and provide communities with healthier environments.
The following services are available under preventive medicine:
Blood pressure, diabetes and cholesterol tests.
Cancer screenings.
Counselling for depression.
Sexually transmitted infections.
Routine vaccinations against diseases such as measles or meningitis.
Counselling, screening and vaccines for healthy pregnancies.
Preventive Medicine, as the name suggests is about “preventing” diseases. Hence, it is largely the application of medical knowledge in the “prevention” of disease in “healthy” or apparently healthy individuals.
Community Medicine, on the other hand, is a larger specialty. It encompasses not just prevention of diseases and/or the complications arising from disease, but also includes promotion of good health, treatment of existing diseases.
