This document contains lecture materials on concepts of community health from Dr. Abdalla Hasballa Elmanna. The lectures define key terms like community, community health, and determinants of health. Community is defined as a group of people living in a defined geographical area with common characteristics and goals. Community health examines the health status and needs of a community. Determinants of health include individual factors like age and behaviors as well as environmental factors like the social, economic, and built environments that influence health.
The document discusses different community types like urban, suburban and rural communities. It also explores various concepts of health from the biomedical model to holistic approaches. The lectures outline tools for community health practice including community health assessments
This presentation describes what is new public health with adapted components from the previous eras of public health. Health promotion and evolution of public health is covered here.
This presentation describes what is new public health with adapted components from the previous eras of public health. Health promotion and evolution of public health is covered here.
The course offers an opportunity to develop a holistic understanding of Primary Health Care, its functions, and scope. The course attendants will learn the principles of Primary Health Care, the course is expected to help the students to understand and internalize international health and public health transition facilitating the integration of health sector with other sectors.
Global Conference on Primary Health Care
From Alma-Ata towards universal health coverage and the Sustainable Development Goals.
Astana, Kazakhstan, 25 and 26 October 2018
We, Heads of State and Government, ministers and representatives of States and Governments participating in the Global Conference on Primary Health Care: From Alma-Ata towards universal health coverage and the Sustainable Development Goals, meeting in Astana on 25 and 26 October 2018, reaffirming the commitments expressed in the ambitious and visionary Declaration of Alma-Ata of 1978 and the 2030 Agenda for Sustainable Development, in pursuit of Health for
All, hereby make the following Declaration.
Public Health studies Plays a major role in fighting off the biggest killers of humans. Public Health professionals, who have either studied a Public Health degree or Health Studies related course, are constantly battling against diabetes, cancer, heart disease and dementia to maintain the health and wellbeing of the population.
The course offers an opportunity to develop a holistic understanding of Primary Health Care, its functions, and scope. The course attendants will learn the principles of Primary Health Care, the course is expected to help the students to understand and internalize international health and public health transition facilitating the integration of health sector with other sectors.
Global Conference on Primary Health Care
From Alma-Ata towards universal health coverage and the Sustainable Development Goals.
Astana, Kazakhstan, 25 and 26 October 2018
We, Heads of State and Government, ministers and representatives of States and Governments participating in the Global Conference on Primary Health Care: From Alma-Ata towards universal health coverage and the Sustainable Development Goals, meeting in Astana on 25 and 26 October 2018, reaffirming the commitments expressed in the ambitious and visionary Declaration of Alma-Ata of 1978 and the 2030 Agenda for Sustainable Development, in pursuit of Health for
All, hereby make the following Declaration.
Public Health studies Plays a major role in fighting off the biggest killers of humans. Public Health professionals, who have either studied a Public Health degree or Health Studies related course, are constantly battling against diabetes, cancer, heart disease and dementia to maintain the health and wellbeing of the population.
The specialty which deals with population.
Comprises those doctors who try to measure the needs of sick and healthy.
Who plan and administer the services to meet the needs.
Who are engaged in research & teaching in the field.
The term community health in some countries has replaced the terms public health, preventive medicine and social medicine.
Community health refers to the health status of a defined group and the actions and conditions to promote, protect and preserve their health.
Community health is the part of medicine which is concerned with the health of the whole population and the prevention of diseases from which it suffers.
Dr. Pallavi's presentation on social science and oral health PallaviDivekar1
In this presentation I have covered all required data and information about Social science and oral health. Hoping it is useful for ur knowledge regarding the subject. Thank U :)
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Concepts of Community Health
1. Albaha University
faculty of Applied Medical Sciences
public health department
Concepts of Community Health
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
1
2. Lecture one
• Objectives:
1. The students should be able to:
• Define community
• Know the functions and features of
community
• Understand the characteristics and types of
community
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
2
3. Definition of Community
• A community is a collection of people who
• interact with one another and whose common interest
or characteristics gives them a sense of unity and
belonging
• A community is a group of people in define
• geographical area with common goal and
• objective.
• Communities are “systems composed of
• individual members and sectors that have
• a variety of distinct
• characteristics and interrelationships
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
3
4. Definition of the community
• Community(WHO)
• Is the social group determined by geographical
boundaries and or common values and interests.
• Its member known and interact with each others.
• Community is defined as any group of people who
share geographic space, interests, goals or history.
• Community is the group of people who have
common characteristics.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
4
5. Function of community
• The function of any community includes its
members’ sense of belonging and shared
identity, values, norms, communication, and
supporting behaviors.
• Some communities who may share almost
everything, while other communities (large,
scattered and composed of individuals) who
may share only there common interests and
involvement in certain goals.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
5
6. The Three Features of a Community
• Location: every physical community carries out its daily
• existence in a specific geographical location. The health
of the community is affected by this location, including
the placement of the service, the geographical features…
• Population: consists of specialized aggregates, but all of
the diversed people who live with in the boundary of the
community.
• Social system: the various parts of communities’ social
• system that interact and include the heath system, family
• system, economic system and educational system.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
6
7. Characteristics of Community
1.commninity is contiguous geographical area.
2.it is compose of people living together.
3.there are common organizations, eg., markets,
schools, banks, hospitals.
4.A community associated with specific name.
5. A community is created spontaneously over a
long period of time.
6. A community is a net work of human
relationships. It is place where our home is located,
children are educated, sick people are treated.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
7
8. Three types of Communities
There are special characteristics for each type
Urban Suburban Rural
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
8
9. Urban Community ( Cities)
Tall Buildings
Skyscrapers
• many people living close
together
• small amount of space
• not very much open space or
natural areas
Walk
taxi
Train
Bus
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
9
10. Urban Community
•One kind of community is an urban area. An
urban area is a city and the places around it.
•Examples:
–New York City
–Chicago
–Jedda
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
10
11. Suburban Community
• Close to, but not in, cities
• Fewer People Live in Houses or small
apartment buildings
not skyscraper
• many people have yards
• many natural areas.
Usually drive
Sometime walk or take the bus
Use the train
to get to the
city
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
11
12. Suburban Community
•A suburb is a community that is near a city.
The word part "sub" means near. The word
part "urb" means city. Most suburbs are not as
busy as cities. They have many parks and
fields.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
12
13. Rural Community
“the country” or farmland
•Fewer people
•A few buildings spread out over large
distances
•Lots of open space and natural areas
- Must drive
because it is
too far to walk
- Roads are not
paved, so people
need special
vehicles,
- Farms have
special types
of vehicles
(tractors)
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
13
14. Rural Community
• A rural area is mostly farmland. You can see
more land than houses. It resembles the
characteristics of the country or country life.
• Examples:
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
14
15. Lecture two
• Concepts of health
• Objectives
• The students should be able to
• Define health and understand the concepts
and determinants of health
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
15
16. Concept of Health
• Health is derived from the old Anglo-Saxon word
health, meaning safe, sound, or whole. Over the
years health has variety of meanings including
freedom from disease and quality of life.
• In the Oxford English Dictionary health is defined
as: ‘the state of being free from sickness, injury,
disease, bodily conditions; something indicating
good bodily condition’.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
16
17. Continuous -Concept Of Health
• An understanding of health is the basis of all
the health care.
• Health is not perceived the same way by all
the members of a community including
various professional groups (like biomedical
scientists, social scientists, health
administrators, ecologists) giving rise to
confusion about the concept of health.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
17
18. Continuous –Concepts of health
• Health has evolved over the centuries from the
concept of individual concern to a worldwide social
goal.
• The various changing concepts of health as follows:
1. Biomedical concept
2. Ecological concept
3. Psychosocial concept
4. Holistic concept
5. Physical concepts of health
6. Cognitive concept of health
7.Emotional concepts of health
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
18
19. 1. Biomedical concept
• Traditionally health has been considered as an
absence of the diseases and if someone was
free from disease, then that person was
considered healthy.
• This concept is known as biomedical concept,
and it is based on the “germ theory of the
disease.”
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
19
20. • Health means “absence of disease.”
• The medical profession viewed the human body
as a machine and disease is an outcome of the
breakdown of the machine, and one of the
doctor’s tasks was to repair the machine.
• This concept has minimized the role of the
environment, social and cultural determinants of
the health.
Continuous -Biomedical concept
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
20
21. • Developments in medical and social sciences
led to the conclusion that the biomedical
concept of health was inadequate
Continuous -Biomedical concept
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
21
22. 2. Ecological Concept
• Deficiencies in the biomedical concept gave rise
to other concepts.
• The ecologists put forward the concept of
ecological concept.
• Ecologists viewed health as a dynamic equilibrium
between man and his environment, and the
disease as a maladjustment of the human
organism to environment.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
22
23. 3. Psychosocial Concept
•Advances in social sciences showed that health is
not only a biomedical phenomenon, but one which
is influenced by social, psychological, cultural,
economic and political factors of the people
concerned.
•These factors must be taken into consideration in
defining and measuring health.
•Thus health is both a biological and social
phenomenon
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
23
24. 4. Holistic Concept
• The holistic model is a synthesis of all the above
concepts.
•Holistic concept recognizes the strength of
social, economic, political and environmental
influences on health.
•It has been variously described as
multidimensional process involving the wellbeing
of the person as a whole.
•The emphasis is on the promotion and
protection of health.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
24
25. • The holistic approach implies that all sectors of
the society have an effect on health, in particular,
agriculture, animal husbandry, food, industry,
education, housing, public works and other
sectors.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
25
26. 5. Physical concepts of health
• To understand physical health (Figure 1.2) you
need to know what is
• Considered to be physically unhealthy so that
you can contrast the two. Even though this
young person has a physical problem he may
still is healthy according to a wider definition
of health.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
26
28. Defining physical health
• Physical health could be defined as the ability to
perform routine tasks without any physical
restriction.
• The following examples can help you to
understand someone who is physically unhealthy:
• A person who has been harmed due to a car
accident.
• A farmer infected by malaria and unable to do
their farming duties.
• A person infected by tuberculosis and unable to
perform his or her tasks.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
28
29. 6. Cognitive concepts of health
The cognitive component of mental health is
really to do with thinking and being able to
work things out. It includes the ability of an
individual to learn, to have awareness
(consciousness) and to perceive reality. At a
higher level it also involves having a memory
and being able to reason rationally and solve
problems, as well as being able to work
creativity and have a sense of imagination.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
29
30. 7. Emotional component
• When you are implementing a health
extension program you may encounter various
feelings or emotions in households in your
community such as happiness, anger or
sadness. People might cry or laugh. The
emotional component of health is the ability
and skill of expressing emotions in an
‘appropriate’ way. Appropriate means that the
type of response should be able to match the
problem.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
30
31. Definition of health
• The World Health Organization (WHO) defines
health as a “state of complete physical, mental,
and social well-being, not merely the absence of
disease or infirmity” (WHO, 1947).
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
31
32. Limitation of the world health organizations
definition of health
1. Health is dynamic not state
2. The dimensions are in adequate
3. The definitions is subjective
4. Measurement is difficult
5. The definition is idealistic rather than realistic
6. Health is not an end but a means
7. The definition lack community orientation
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
32
33. What is the definition of community health?
• Community health, a field of public health,
is a discipline which concerns itself with the
study and improvement of the health
characteristics of biological communities.
While the term community can be broadly
defined, community health tends to focus on
geographical areas rather than people with
shared characteristics.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
33
34. Concept of Community Health
• Community Health concerned with the health status of
individuals affected and the extent of the health
problems and the quality of health services for the
community.
• To assess the state of health of this community has to
be knowledge and full understanding of the nature of
that society and its components, which include :.
1-study population: census of population distribution
by age and sex - immigration - births and infant
mortality rates.
2-study environmental characteristics: housing-work
environment-education-drinking water-economic and
social situation. Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
34
36. Foundations of Community Health
• The foundations of community health include the
history of community health practice, factors that
affect community and population health, and the tools
of community health practice. These tools include
epidemiology, community organizing, and health
promotion and disease prevention planning,
management, and evaluation.
36
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
37. What is the purpose of a Community
Health Assessment?
• Community health assessment is a systematic
examination of the health status indicators for a
given population that is used to identify key problems
and assets in a community. The ultimate goal of a
community health assessment is to develop
strategies to address the community's health needs
and identified issues
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
37
38. • Community organizing is a process by which the
problem-solving capacity of communities is enhanced
• Community organizing is another term for
"community development," which involves a high
level of community involvement in all aspects of
intervention activities.
• Community action entails a lower level of
community involvement than does community
organizing, but includes some measure of community
control over the implementation of interventions.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
38
39. Lecture three
Determinants of Health
The range of personal, social, economic, and
environmental factors that influence health
status.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
39
41. ADD Picture of Tree
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
41
42. Determinants of health
Individuals determinants of
health
• Biological status (age,
gender, ethnicity, genetics)
Socio-economic status
(education, employment,
income) Cognitive factors
(knowledge, attitudes,
values and beliefs)
Behaviors – (physical,
mental, social, spiritual
Environmental determinants of
health
• Social environment
• Cultural environment
• Economic environment
• Political environements
• Built environment
• Natural environment
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
42
43. Determinants of health fall under
several broad categories
1. Policymaking
2. Social factors
3. Health services
4. Individual behavior
5. Biology and genetics
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
43
44. 1. Policymaking
• Policies at the local, province, and national level
affect individual and population health.
Increasing taxes on tobacco sales, for example,
can improve population health by reducing the
number of people using tobacco products.
• Some policies affect entire populations over
extended periods of time while simultaneously
helping to change individual behavior.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
44
45. 2. Social Factors
• Social determinants of health reflect the social
factors and physical conditions of the
environment in which people are born, live,
learn, play, work, and age. Also known as
social and physical determinants of health,
they impact a wide range of health,
functioning, and quality-of-life outcomes.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
45
46. Social Determinants of Health
Life-enhancing resources, such as food supply,
housing, economic and social relationships,
transportation, education and health care,
whose distribution across populations
effectively determines length and quality of
life.
Reference: James S. (2002)
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
46
47. Why Are Social Determinants of Health
Important?
Addressing the social determinants of health is important because:
• These factors underlie preventable disparities in health status
and disease outcomes.
• Poor health outcomes are often the result of the interaction
between individuals and their social and physical environment.
• Policies that result in changes to the social and physical
environment can affect entire populations over extended periods
of time, while simultaneously helping people to change
individual-level behavior.
• Improving the conditions in which people are born, live, work,
and age will ensure a healthier population, thereby improving
national productivity, security, and prosperity through a healthier
workforce. Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
47
48. Examples of social determinants include:
1. Availability of resources to meet daily needs (e.g., safe housing and local food markets)
2. Access to educational, economic, and job opportunities
3. Access to health care services
4. Quality of education and job training
5. Availability of community-based resources in support of community living and
opportunities for recreational and leisure-time activities
6. Transportation options
7. Public safety
8. Social support
9. Social norms and attitudes (e.g., discrimination, racism, and distrust of government)
10. Exposure to crime, violence, and social disorder (e.g., presence of trash and lack of
cooperation in a community)
11. Socioeconomic conditions (e.g., concentrated poverty and the stressful conditions that
accompany it)
12. Residential segregation
13. Language/Literacy
14. Access to mass media and emerging technologies (e.g., cell phones, the Internet, and social
media)
15. Culture
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
48
49. Examples of physical determinants include:
1. Natural environment, such as plants, weather, or
climate change
2. Built environment, such as buildings or transportation
3. Worksites, schools, and recreational settings
4. Housing, homes, and neighborhoods
5. Exposure to toxic substances and other physical
hazards
6. Physical barriers, especially for people with disabilities
7. Aesthetic elements, such as good lighting, trees, or
benches
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
49
50. Each of these five determinant areas reflects a
number of critical components/key issues that
make up the underlying factors in the arena of
SDOH.
1. Economic Stability
• Poverty
• Employment
• Food Insecurity
• Housing Instability
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
50
51. Continuous
2. Education
• High School Graduation
• Enrollment in Higher Education
• Language and Literacy
• Early Childhood Education and Development
3. Social and Community Context
• Social Cohesion
• Civic Participation
• Discrimination
• Incarceration
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
51
52. Cont…
4. Health and Health Care
• Access to Health Care
• Access to Primary Care
• Health Literacy
5. Neighborhood and Built Environment
• Access to Foods that Support Healthy Eating
Patterns
• Quality of Housing
• Crime and Violence
• Environmental Conditions
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
52
53. 3. Health Services
• Both access to health services and the quality of
health services can impact health. Healthy People
2020 directly addresses access to health services
as a topic area and incorporates quality of health
services throughout a number of topic areas.
• Lack of access, or limited access, to health
services greatly impacts an individual’s health
status. For example, when individuals do not have
health insurance, they are less likely to
participate in preventive care and are more likely
to delay medical treatment.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
53
54. Barriers to accessing
• health services
include:
• Lack of availability
• High cost
• Lack of insurance
coverage
• Limited language
access
• Unmet health needs
• Delays in receiving
appropriate care
• Inability to get
preventive services
• Hospitalizations that
could have been
prevented
Lead
to
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
54
55. 4. Individual Behavior
• Individual behavior also plays a role in health
outcomes. For example, if an individual quits
smoking, his or her risk of developing heart
disease is greatly reduced.
• Many public health and health care interventions
focus on changing individual behaviors such as
substance abuse, diet, and physical activity.
Positive changes in individual behavior can
reduce the rates of chronic disease in this
country.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
55
56. Examples of individual behavior
determinants
• Diet
• Physical activity
• Alcohol, cigarette, and other drug use
• Hand washing
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
56
57. 5. Biology and Genetics
Some biological and genetic factors affect specific populations more than
others. For example, older adults are biologically prone to being in
poorer health than adolescents due to the physical and cognitive effects
of aging
Examples of biological and genetic social determinants of health
include:
• Age
• Sex
• HIV status
• Inherited conditions, such as sickle-cell anemia, hemophilia, and cystic
fibrosis
• Carrying the BRCA1 or BRCA2 gene, which increases risk for breast
and ovarian cancer
• Family history of heart disease
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
57
58. Lecture four
• History of public Health
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
58
59. Objectives
• At the end of this lecture, the students are expected to:
• Discuss the history of public health
• Define public health and list its core activities.
• Be aware of the definition of key terms in public
• health
• Recognize the principal disciplines of public
• health
• Describe the difference and similarities between
• clinical medicine and community health.
• Discuss the ethical issues and challenges in
• public health.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
59
60. History of public Health
Thehistoryofpublichealthgoesbacktoalmostaslongashistoryofcivilization.
IntheAncientSocieties(before500BC)thehistoryisthatofarcheologicalfindings
fromtheIndusvalley (NorthIndia)around2000BCwiththeevidenceof
bathroomsanddrainsinhomesandsewerbelowstreetlevel.Therewasevidenceof
drainagesystemsinthemiddlekingdomofancientEgyptinthetime2700-2000
BC.Therewerewrittenrecordsconcerningpublichealth,codesofHamurabiof
Babylon,3900yearsago.TheBookOfLeviticus(1500BC)hadguidelinesfor
personalcleanliness,sanitationofcampsites,disinfectionofwells,isolationof
lepers,disposalofrefusesandhygieneofmaternity.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
60
61. Continuous
• In The Classical Cultures (500 BC - 500 AD)
public health was practiced as Olympics for
physical fitness, community sanitation and
water wells in the era golden age of ancient
Greek; and aqueducts to transport water,
sewer system, regulation on street cleaning
and infirmaries for slaves by Romans.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
61
62. Continuous
• In the middle ages (500 - 1500 AD), health
problems were considered as having spiritual
cause and solutions. They were supernatural
powers for pagans and punishments for sins
for Christians. Leprosy, plague (Black Death)
during the 14th century and syphilis were
some of the deadliest epidemics resulted from
failure to consider physical and biological
cause.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
62
63. continuous
• The era of renaissance and exploration (1500
– 1700 AD) was the rebirth of thinking of
about nature of the world and humankind.
There was a growing belief that diseases were
caused by environment, not by spirits and
critical thinking about disease causation
e.g."malaria" - bad air.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
63
64. Continuous
• In the eighteen century, there were problems
of industrialization, urban slums leading to
unsanitary conditions and unsafe work places.
Edward Jenner (1796) demonstrated
vaccination against smallpox.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
64
65. continuous
• In the nineteenth century there were still
problems of industrialization but agricultural
development led to improvements in nutrition
and there was real progress towards
understanding the causes of communicable
diseases towards the last quarter of the
century. The Luis Pasture's germ theory (1862)
and Koch's Postulate (1876) were remarkable
progresses.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
65
66. Continuous
• Twentieth century has been the period of
health resources development (1900-1960),
social engineering (1960 - 1973), health
promotion (Primary Health Care), and market
period (1985 and beyond)
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
66
67. HISTORICAL MARKERS in the development
of Public Health (selected)
1700 BC :
The Code of Hammurabi – Rules governing medical
practice
1500 BC :
Mosaic Law – Personal, food and camp hygiene,
segregating lepers, overriding duty of saving of life
(Pikuah Nefesh) as religious imperatives.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
67
68. 400 BC Greece –
Personal hygiene, fitness, nutrition, sanitation,
municipal doctors, occupational health; Hippocrates
clinical and epidemic observation and environmental
health.
500 BC to AD 500 :
Rome – aqueducts, baths, sanitation, municipal
planning, and sanitation services, public baths,
municipal doctors, military and occupational health.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
68
69. 500 – 1000
Europe – destruction of Roman society and the rise
of Christianity; sickness as punishment for sin,
mortification of the flesh, prayer, fasting and faith as
therapy; poor nutrition and hygiene pandemics;
antiscience; care of the sick as religious duty.
1348 – 1350
Black Death – origins in Asia, spread by armies of
Genghis Khan, world pandemic kills 60 million in
fourteenth century, 1/3 to 1/2 of the population of
Europe.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
69
70. 1300 :
Pandemics – bubonic plague, smallpox, leprosy,
diphtheria, typhoid, measles, influenza,
tuberculosis, anthrax, trachoma, scabies and
others until eighteenth century.
1673 :
Antony van Leeuwenhoek – microscope,
observes sperm and bacteria.
1796 :
Edward Jenner – first vaccination against smallpox.
1830 : Sanitary and social reform, growth of science.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
70
71. 1830
Sanitary and social reform, growth of science.
1854
John Snow – waterborne cholera in London: the
Broad Street Pump.
1854
Florence Nightingale, modern nursing and hospital reform –
Crimean War
1858
Louis Pasteur proves no spontaneous generation of life.
1859
Charles Darwin publishes On the Origin of Species.
1862
Louis Pasteur publishes findings on microbial causes of
disease.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
71
72. 1876
Robert Koch discovers anthrax bacillus.
1879
Neisser discovers gonococcus organism.
1882
Robert Koch discovers the tuberculosis
organism, tubercle bacillus.
1880
Typhoid bacillus discovered (Laveran);leprosy
organism (Hansen); malaria organism (Laveran).
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
72
73. 1883
Robert Koch discovers bacillus of cholera.
1883
Louis Pasteur vaccinates against anthrax.
1884
Diphtheria, staphylococcus, streptococcus, tetanus organisms
identified
1890
Anti-tetanus serum (ATS)
1892
Gas gangrene organism discovered by Welch and Nuttal
1894
Plague organism discovered (Yersin, Kitasato); botulism
organism (Van Ermengem).
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
73
74. 1923
Health Organization of League of Nations
1926
Pertussis vaccine developed
1928
Alexander Fleming discovers penicillin
1929 – 1936
The Great Depression – wide spread economic collapse,
unemployment, poverty, and social distress in industrialized
countries.
1946
World Health Organization founded.
1977
WHO adopts Health for all by the year 2000
1978
Alma-Ata Conference on Primary Health Crae
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
74
75. 1979 WHO
declares eradication of smallpox achieved
1981
First recognition of cases of acquired immune deficiency syndrome (AIDS).
1989
International Convention on the Rights of the Child.
1990
W.F. Anderson performs first successful gene therapy.
1992
United Nations Conference on Environmental and Development,
Rio de Janiero
1992
International Conference on Nutrition.
1993
World Conference on Human Rights, Vienna.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
75
76. 1994
International Conference on Population
and Development, Cairo.
1998
WHO Health for All in the Twenty-first Century
adopted.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
76
77. Lecture No 5
continuous in -Public Health
77
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
77
78. Learner Objectives
• By the end of this lecture,
students will be able to…
1. Define public health
2. List the determinants of health
3. Identify one example of local or
province public health practice
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
78
79. What is Public Health?
• Definitions vary
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
79
80. What is Public health?
Charles-Edward Amory Winslow (1877 – 1957)
defined Public Health as : the science and art of
preventing disease, prolonging life, and promoting
physical health and efficiency through organized
community efforts for the sanitation of the
environment, the control of community infections,
the education of the individual in principles of
personal hygiene, the organization of medical and
nursing services for the early diagnosis and
preventive treatment disease, and the development
of the social machinery which will ensure to every
individual in the community a standard of living
adequate for the maintenance of health.Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
80
81. What is Public health?
• John M. Last’s Dictionary of Public
Health (2001) gives the following:
• Public Health is one of the efforts
organized by society to protect,
promote, and restore the peoples’
health.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
81
82. What is Public health?
• Public health is the combination of
sciences, skills, and beliefs that is
directed to the maintenance and
improvement of the health of all the
people through collective or social
actions.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
82
83. What is Public health?
• The programs, services, and institutions
involved emphasize the prevention of
disease and the health needs of the
population as a whole.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
83
84. What is Public health?
• Public health activities change with
changing technology and social values,
but the goals remain the same: to
reduce the amount of disease,
premature death, and disease-produced
discomfort and disability in the
population.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
84
85. What is Public health?
• Donald Acheson Report, 1988, UK
• The Acheson Report (1988) defines
Public health more succinctly as:
• The science and art of preventing
disease, prolonging life, and promoting
health through organized efforts of
society.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
85
86. Public Health vs. Medicine
86
• Public Health
– Population
– Disease Prevention
– Health Promotion
– Interventions
• Environment
• Human behavior
– Government (Some private)
• Medicine
– Individual
– Diagnosis
– Treatment
– Intervention
• Medical care
– Private (Some public)
Source: Brandt, AM and Gardner, M. 2000. American Journal Public Health. 90:707-715 .
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
87. Characteristics of Public Health
87
1. A broad social initiative or system.”
2. A body of knowledge and techniques
that can be applied to health-related
problems.”
3. Public health is literally (actually) the
health of the public as measured in
terms of health and illness.”
4. Social justice is said to be the
cornerstone of public health.”Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
88. Why public health is Important
1. Public Health Saves Money and Improves Quality of Life.
A healthy public gets sick less frequently and spends less money on health
care; this means better economic productivity and an
improved quality of life for everyone.
2. Improving Public Health Helps Children Thrive.
Healthy children become healthy adults. Healthy kids attend school more
often and perform better overall.1 Public health professionals
strive to ensure that all kids grow up in a healthy environment with
adequate resources, including health care.
3. Public Health Prevention Reduces Human Suffering.
Public health prevention not only educates people about the effects of
lifestyle choices on their health, it also reduces the impact
of disasters by preparing people for the effects of catastrophes such as
hurricanes, tornadoes and terrorist attacks.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
88
89. Public Health Aims:
1. Prevents epidemics and the
spread of disease
2. Protects against environmental
hazards
3. Responds to disasters and assists
communities in recovery
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
89
90. Public Health aims:
1. Prevents injuries
2. Promotes healthy behaviors
3. Assures the quality and
accessibility of health services
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
90
91. A Public Health System
• Who?
– Public entities
– Private entities
– Voluntary entities
• What?
– A network
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
91
93. Public health workforce:
• Diverse and Multidisciplinary
• Examples…
Biostatisticians
Dieticians
Environmental Health Specialists
Behavioral Health Specialists
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
93
94. A Public Health Approach
Surveillance
Risk Factor
Identification
Intervention
Evaluation
Implementation
94
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
94
95. Public health Core Components:
ASSESSMENT
of the health of the
community
ASSURANCE
of the public’s health
POLICY
DEVELOPMENT
in the public’s
interest
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
95
96. The 10 Essential Public Health Services
1. Preventing epidemics
2. Protecting the environment, workplaces, food and water.
3. Promoting healthy behavior
4. Monitoring the health status of the population
5. Mobilizing community action
6. Responding to disasters
7. Assuring the quality, accessibility, and accountability of medical
care
8. Reaching out to link high risk and hard to reach people to needed
services
9. Researching to develop new insights and innovative solutions
10. Leading the development of sound health policy and planning.Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
96
97. Public Health Approach
Public Health
Model
Medical
ModelVersus
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
97
98. Achievements in public health
1. Vaccination
2. Safer Workplaces
3. Safer & Healthier Food
4. Motor Vehicle Safety
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
98
99. Achievements
5. Control of Infectious
Diseases
6. Family Planning
7. Decline in Deaths from
Heart Disease & Stroke
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
99
100. Achievements
8. Recognition of Tobacco
Use as a Health Hazard
9. Healthier Mothers
and Babies
10.Fluoridation of Drinking
Water Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
100
101. Public Health Functions:
1. Prevents epidemics and the spread of disease
2. Protects against environmental hazards
3. Prevents injuries
4. Promotes and encourages healthy behaviors
5. Responds to disasters and assists
communities in recoveries
6. Assures the quality and accessibility of health
services
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
101
102. Public Health Fundamentals
1. Prevention (individual and community-
focused)
2. Promotion (voluntary, education, advocacy)
3. Protection (policies/regulations; enforcement)
4. Population-based (communities, groups)
5. Preparedness (e.g., bioterrorism, natural
disasters, pandemics)
• Closely linked to Environmental Health
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
102
103. Lecture 6
• Indictors of health
• Objective's
• Understand the variety of health indicators
and its measurements
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
103
104. What are Health Indicators? (1)
With the goal of good health in mind, think of
an indicator as
“…a measure that helps quantify the
achievement of a goal.”
-Mark Friedman
Health Indicators, Part I
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
104
105. What are Health Indicators? (2)
Power of indicators is comparisons
- over time (trends)
- geographic areas
- groups of people
and the focus on the most essential domains of
health.
Health Indicators, Part I
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
105
106. What are the bases for health
indicators?
Health indicators are based upon conceptual models for what
influences health status, based upon scientific research.
Models have evolved over time, as have definitions of health,
but trace historical improvements in health, e.g., increases in life
expectancy, declines in mortality due to infectious diseases.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
106
107. How are health indicators used?
Indicators are powerful tools for monitoring and communicating
critical information about population health.
Indicators are used to support planning (identify priorities, develop
and target resources, identify benchmarks) and track progress toward
broad community objectives.
Engagement of partners into civic and collaborative action (build
awareness of problems and trends, generate interventions).
Inform policy and policy makers, and can be used to promote
accountability among governmental and non-governmental agencies.
Health Indicators, Part I
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
107
108. INDICATORS OF HEALTH
• A variable which helps to measure changes ,
directly or indirectly (WHO,1981).
• A statistic of direct normative interest which
facilitates concise , comprehensive, and balanced
judgments about conditions of major aspects of
the society (H.E.W./USA,1969).
• The health indicators are defined as those
variables which measures the health status of an
individual and community.
108
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
109. Classification of Indicators of
Health
• Mortality Indicators
• Morbidity Indicators
• Disability Rates
• Nutritional Indicators
• Health Care Delivery
Indicators
• Utilization Rates
• Indicators of Social And
Mental Health
• Environmental
Indicators
• Socio-economic
Indicators
• Health Policy Indicators
• Indicators of Quality of
Life
• Other Indicators
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
109
110. Mortality Indicators
• Crude Death Rate
• Age Specific Death Rates
• Expectation of life
• Infant mortality rate
• Under-5 Proportionate Mortality rate
• Child Mortality Rate
• Maternal Mortality Rate
• Disease Specific Death Rate
• Proportional Mortality Rate
• Case fatality rate
• Year of potential life lost
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
110
111. INDICATORS OF HEALTH
• Mortality Indicators: Crude Death rate, Life
Expectancy, Infant mortality rate, Child
mortality rate, Under five mortality rate,
Maternal mortality ratio, Disease specific
mortality, proportional mortality rate etc.
• Morbidity Indicators: Incidence and prevalence
rate, disease notification rate, OPD attendance
rate, Admission, readmission and discharge
rate, duration of stay in hospital and spells of
sickness or absence from work or school.
111
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
112. Prevalence
• The total number of all individuals who have
an attribute or disease at a particular time
divided by population at risk of having
attribute or disease at this point of time or
midway through the period.
• Ex: Prevalence of TB (sputum+ve in
population) is 249 per 100000 population
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
112
113. INDICATORS OF HEALTH
• Disability Indicators: Sullivan's index, HALE (Health
Adjusted Life Expectancy), DALY (Disability Adjusted
Life Year).
• life expectancy at birth but includes an adjustment
for time spent in poor health.
• •Number of years in full health that a newborn can
expect to live based on current rates of ill-health
and mortality.
113
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
114. Disability Indicators
• Sullivan's index is a expectation of life free from
disability.
• HALE (Health Adjusted Life Expectancy)is the
equivalent number of years in full health that a
newborn can expected to live based on the
current rates of ill health and mortality.
• DALY ((Disability Adjusted Life Years))
expresses the years of life lost to premature
death and years lived with disability adjusted
for the severity of disability.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
114
115. MAJOR MEASURES USED ARE
• ( DALY = YLL+ YLD)
• 1. YEAR OF LIFE LOST: no of death at each age
multiplied by the expected remaining years of
life a/c to a global standard life expectancy.
• 2. Years lost to disability: no of incident cases
due to injury and illness is multiplied by the
average duration of disease and a weighing
factor reflecting the severity of disease on a
scale from 0 (perfect health) and 1(dead).
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
115
116. INDICATORS OF HEALTH
• Disability Indicators: Disability Rates are of two
categories
• Event type Indicators
• - number of days of restricted activity - bed
disability days - work-loss days within a specified
period
• Person type Indicators
• - limitation of mobility
• - limitation of activity: basic activity of daily living
116
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
117. INDICATORS OF HEALTH
• Nutritional Status Indicators:
• Positive health indicator
Anthropometric measurement of preschool
children, Prevalence.
i. Weight
ii. Height
iii. Mid-arm circumference
• Growth Monitoring of children
• Prevalence of low birth weight
117
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
118. INDICATORS OF HEALTH
• Health Care Delivery Indicators: Doctor-
population ratio, Bed-nurse ratio, Population-bed
ration, Population per health facility etc.
• Doctor-population Ratio – 1/1700 (Norm 1/1000)
• Nurse-population ratio – 0.8/1000 (Norm 1/500)
• Doctor- nurse ratio
• Population-bed Ratio – 8.9/10000
• Population per PHC/sub center
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
118
119. Health System Performance Indicators
• Access (additional)
– Trends in health insurance enrollment, range of benefits, exclusions,
premiums
– Rural health provider supply, linguistic or cultural barriers to getting care
• Cost
– Total health expenditures
– Health as share of Gross Domestic Product (GDP)
– Prescription drug costs
– Payments to hospitals, facilities
– Comparisons of resources used per patient between hospitals/areas
• Quality of care
– Effective care – receipt of recommended screenings, treatment, readmission
rates.
– Patient Safety – medical error
Health Indicators, Part I
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
119
120. INDICATORS OF HEALTH
• Utilization Rates:
o Actual coverage is expressed as the proportion of people in
need of a service who actually receive it in a given period,
usually a year.
• Depends on availability & accessibility of health services
and the attitude of an individual towards health care
system
• Direct attention towards discharge of social responsibility for
the organization in delivery of services
• immunization coverage, ANC coverage, % of Hospital
Delivery, Contraceptives prevalence rate, Bed occupancy
rate, average length of stay in hospital and bed turnover
rate etc.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
120
121. INDICATORS OF HEALTH
• Indicators of social and mental health: Rates of
suicides, homicides, violence, crimes, RTAs, drug
abuse, smoking and alcohol consumption etc.
• Environmental indicators: proportion of population
having access to safe drinking water and improved
sanitation facility, level of air pollution, water
pollution, noise pollution etc.
• Socio Economic Indicators: rate of population
increase, Per capita GNP, Dependency ratio, Level of
unemployment, literacy rate, family size etc.
121
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
122. Social Indicators (1)
Physical environment:
• Area-based measures, e.g., income/poverty, population density
• Access to public transportation, housing
• Environmental pollution, e.g., air and water quality.
Social environment:
• Income (individual/family)
• Education (e.g., high-school graduation rates, students
reading/doing math at grade level)
• Social support and connectedness.
Health Indicators, Part I
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
122
123. Social Indicators (2)
Child and family focused:
• Parental educational attainment
• Parent practices (e.g., breastfeeding, reading to child, regular
meal/bedtimes)
• Access to services such as early developmental screening
• Family social environment (e.g. parent stress, depression)
Health Indicators, Part I
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
123
124. INDICATORS OF HEALTH
• Health policy Indicators: proportion of GNP
spent on health services, proportion of GNP
spent on health related activities including
safe water supply, sanitation, housing,
nutrition etc. and proportion of total health
resources devoted to primary health care.
124
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
125. Indicators of Quality of Life:
• PQLI, IMR, Literacy rate, Life Expectancy at age
one etc.
• Commonly used to measure the cost
effectiveness of health interventions .
• Number of years of life added by a successful
treatment or adjustment for quality of life.
• Each year in perfect health is assigned a value
of 1 down to a value of 0 for death.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
125
126. Community participation
Objectives :
By the end of
this lecture the
students
should be able
to:
understand the concept of community participation
Be aware of the principles of community participation
Know the characteristics of community participation
Lecture 7
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
126
127. The modern affirmation that citizen and community participation is
pivotal to health and is critical in primary health services goes back to
the UN Declaration at Alma Ata, U.S.S.R. in 1978. World leaders there
agreed that
“The people have the right and duty to participate individually and
collectively in the planning and implementation of their health care. PHC
(Primary Health Care) requires and promotes maximum community and
individual self-reliance and participation in the planning, organization,
operation, and control of primary health care…”. World Health
Organization, 1978, p. 6
The concepts of community participation
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
127
128. Community participation :
Defined as “an on-going relationship
between citizens, health care
providers and other community
members and organizations to
improve health through dialogue”
Community participation/community
engagement
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
128
129. It is a social entity made of people or families who have the following characteristics:
Live in the same geographical area
Share common goals or problems
Share similar development aspirations
Have similar interests or social network or relationship at local level
Have a common leadership and tradition
Have common system of communication
Share some resources-water, school, etc
Are sociologically and psychologically linked.
CHARACTERISTICS OF COMMUNITY
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
129
130. The ultimate goal of community participation is for the community
and the health system
“to work as partners to have an impact on conditions that influence
the health of that community and improve population health”.
AIMS :
• The community develops self-reliance
• The community develops critical awareness
• The community develops problem solving skills
Community participation/community engagement
GOALS
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
130
131. • Community participations has three
• dimensions;
1. Involvement of all those affected in decision
making about what should be done and how
2. Mass contribution to the development
efforts to the implementation of decision
3. Sharing in the benefits of the program
DMENSIONS OF COMMUNITY
PARTICIPATION
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
131
132. 1. Relevance and accountability
2. Education status of the community
3. Community infrastructure (including
communication network)
4. Economic factors
5. Social and cultural factors
6. The level of inter-sectoral collaboration
FACTORS WHICH INFLUENCE THE DEGREE OF COMMUNITY
PARTICIPATION POSITIVELY
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
132
133. 7. Suppression of involvement and initiative by
projects which create dependency
8. Political stability
9. Good leadership
10. Motivated community
11. A sense of ownership
12. Locally available resources
FACTORS WHICH INFLUENCE THE DEGREE OF
COMMUNITY PARTICIPATION POSITIVELY
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
133
134. Critical values for effective
engagement include honesty,
•Respect,
•Authenticity,
•Openness and transparency,
•And trustworthiness.
The essential elements of participating
community
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
134
135. which include
1. diversity,
2. accessibility,
3. inclusivity, and capacity-building for all
participants;
4. integrity and accountability in engagement
practices;
5. outcomes that demonstrate genuine influence
and the impacts of the process;
6. and collaboration and improved governance.
Principles for participation
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
135
136. participation is premised on the existence of
certain organizational and community
capacities.
Organizational and community
capacities in participation
Community capacities
include:
• Leadership
• Networks
• Skills
• Power
• Resources
Organizational capacities
• Legitimating
• Rhetoric and policies, s
• Killed and educated staff,
• Managers who understand and
support engagement,
• And sufficient resources.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
136
137. Evaluation of the results of any engagement
process is critical for on-going improvements in
community health . Immediate results such as:
1. The level of participation
2. Quality of communication
3. The influence of the engagement in shaping
policy and practice
4. Cost-effectiveness
EVALUATION OF ENGAGEMENT
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
137
138. Enabling conversations
Facilitating discussions
Collaborating and building partnerships
Community health assessment activities
Developmental evaluation of engagement in action.
The skill set for community
participation
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
138
139. Some potential benefits of
community participation are:
Value to Communities:
Value for Primary Health Providers:• Increased access – to decision-makers, to information,
to others’ opinions, to new processes for making
decisions, to other parts of the community and the
organization.
• Better information and understanding – improved
understanding of the complexity of health care and
greater opportunities to make informed input into a
plan, a policy or a proposal.
• Sense of involvement – the mutual sense of ownership
for all parties is enhanced through shared
responsibility. Ideally, this should result in increased
capacity and sustainability of the efforts in
communities.
• Better outcomes – outcomes can be achieved that
utilize existing resources and more fully reflect the
aspirations of the client and the community.
• An increased range of ideas – community contributions
may surface ideas not apparent to service providers;
avenues are opened for the community to raise issues
incorporating local knowledge, resources, and expertise.
• Credibility and accountability is increased for primary
health with communities through dialogue and working
together. There are also increased opportunities for
explanation - a venue to give an account of the reasons
for the organization’s policies and actions.
• Networks, relationships and processes are established in
the local community that can benefit current and future
projects.
• A deeper understanding is developed around issues
through public information sharing, discussion and
deliberation.
• Improve democratic outcomes, including the equity or
fairness of a policy or project.
• Better decisions are achieved that incorporate the
communities’ aspirations, have less duplication, and are
sustainable.Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
139
140. • Concern for the common good
• Resources - education, health, recreation, socialization
- available and easily accessible to all
• Sustainable resource use and a healthy environment
• Connections and linkages vertically and horizontally in
the community
• Adequate incomes; no big gaps between rich and poor
• Good housing and safe neighborhoods
• Robust political debates where everyone is involved;
responsive governance
• Intergenerational caring
A more participated community might
be characterized by:
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
140
141. • Loss of hope
• Lack of trust
• No sense of a future
• Unhealthy individual behaviors and poor self-care
• A blaming, punishment mentality
• Poverty
• High rates of preventable illness
• Physical and psychological barriers to services
Characteristics of Less participated communities
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
141
143. Lecture 8
• Objectives
• By the end of this lecture the students will be
able to
• Understand Community health needs
assessment
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
143
144. Community health needs assessment
• What is a community health needs
assessment?
Community health needs assessment is
“a process that describes the state of health of
local people; enables the identification of the
major risk factors and causes of ill health; and
enables the identification of the actions needed
to address these.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
144
145. Profiling the population
Think about what you want to find out about your local
population. What information will help you define and
describe the community and its health needs? You may
find it helpful to ask yourself the following questions.
1. What are the key characteristics of the population?
2. What is the health status of the people?
3. What local factors are affecting their health and what
impact do they have (good and bad)?
4. What services are currently being provided?
5. What do local people see as their health needs
6. What are the national and local priorities for health?
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
145
146. Profiling the population
1- Characteristics of the population
• A number of elements will enable you to describe
the community you work in:
1. Geography: which area/population does this
profile cover?
2. Numbers: how many people?
3. Age distribution: what age are they?
– pre-school children
– school-age children and young people
– adults
– elderly people
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
146
147. Characteristics of the population
• Gender distribution: how many males and
females?
• Ethnicity and religion
• Language and literacy
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
147
148. Profiling the population
2-The health status of the population.
There are different ways of finding out about the
health status of the community:
1. people’s own views of their health
2. statistical information
3. qualitative surveys
4. the knowledge of local health care workers and
other agencies.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
148
149. There are a number of measures commonly
used to identify the health of a population.
• Mortality data
• Morbidity data
• Behavior measures
• Quality of life” measures
• Use of service information
• Health inequalities
– Who is disadvantaged in this community?
– Why are they disadvantaged?
– What can I do about it?
– Who has unmet needs in this community?
– Who does not access care in this community?
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
149
150. Profiling the population
3- Local factors affecting health
• Work and employment
• Poverty and income
• Environment
• Pollution.
• Sanitation
• Housing.
• Social cohesion
– Networks.
– Migration
– Marginal groups.
– Pleasure and leisure
• Destabilizing factors
• Resources, formal and informal
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
150
151. Profiling the population
4-What services are currently being provided?
• What illnesses do I see most of?
• What problems occupy most of my time?
• Do people I meet see themselves as sick?
• What do people tell me about their worries and health?
• What is the interventions am I using and how well do they
work?
• How many people are using the public health services?
• Are they from across all sections of the community?
• Do I see those whose needs are greatest?
• What changes have I seen take place in the community and
in the services I
• provide?
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
151
152. Profiling the population
5- What do local people see as their health needs
• Local people’s views of their health needs and resources.
• Involving local people will ensure that any service developed
will be based on need and be more likely to be acceptable to
the population.
• There will always be a great deal of expertise and knowledge
to draw on among the local population, in particular on what
assets exist, the factors that influence their health, what is
most important, local health beliefs and solutions to
problems.
• It is important that people are able to describe health
problems and solutions in their own terms.
• This may involve using less conventional methods such as
photographs, drawings or personal stories.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
152
153. Profiling the population
6- Local and national priorities
• National priorities are often set by governments and
influenced by the political and economic agenda.
• Local priorities will reflect national priorities as well as
issues identified by local groups, practitioners and
communities.
• When undertaking a needs assessment you will need to
discover what these priorities are in relation to health.
• Sometimes there can be
• a conflict between the national top-down agenda and
the needs identified locally.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
153
154. Section Two: How do you find out?
• The previous slides described the type of health information
you may need in order to identify health needs; the next stage
is to collect this information.
1. Describing the community
• Local views
• These can be obtained using a variety of methods that allow
for different perspectives.
• Professional views
• Local surveys
• Newspaper reports
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
154
155. Section Two: How do you find out?
2. Measures of health and of health inequalities:
• To obtain a full picture of health, information about
health should come from a variety of sources.
– A public health department
– Local health and social care managers
– Government departments
– work information
– own knowledge
• What am I seeing?
• What can I hear and smell?
• What, if anything, is missing?
• What is this telling me?
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
155
156. Section Two: How do you find out?
• Record the observations made.
• Casework information.
• The family health assessment
– The information that families provide about their
community at micro level is of good quality and can build
into an overall picture of the community if a sufficient
number of assessments are completed.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
156
157. Profile information
1. Characteristics of the population
• Geography
• Numbers
• Age distribution
• Gender distribution
• Ethnicity and religion
• Population trends
• Language and literacy
2. Health status of the population
• Measures of health
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
157
158. 3. Local factors affecting health
(positive and negative)
• Work and employment
• Poverty and incomes
• Environment
• Social cohesion
• Destabilizing factors
• Resources, formal and informal
4. Current public health officer work
5. Local people’s views of their
health needs and health services
6. Local and national priorities
Profile information
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
158
159. Section Three: What to do with the
information
1. What is the information telling you?
o compare your population with a larger group to ascertain
whether a health issue or disease rate is higher or lower
than expected;
o compare current information with that collected in
previous years to identify trends over time;
o identify significant gaps in the information;
o compare and contrast different types of information e.g.
statistics, client and professional views, surveys and
questionnaires; and
o look for positive features as well as problems; even the
most disadvantaged communities have strengths that can
form the building blocks for change.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
159
160. Section Three: What to do with the
information
2.Deciding on priorities
– How many people are affected?
– What is this information telling you about
equity?
– What is the impact on people’s lives?
– Are there appropriate and effective
interventions?
– Are the services adequate?
– Is the expertise and training available?
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
160
161. Section Three: What to do with the
information
• 3. Planning what to do:
• Being creative
• Involving the community
• Collaboration
• Health promotion
creating healthy public policies
building supportive environments
strengthening community action
developing personal skills
reorganizing health services
addressing inequalities.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
161
162. Section Three: What to do with the
information
• Prevention
– Primary prevention
– Secondary prevention
– Tertiary prevention
• Measuring success
– where you are now (baseline measures)
– where you are going (aim and objectives)
– how to get there (action plan)
– how you will know you have arrived
(evaluation/outcome measures).
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
162
163. Section Three: What to do with the
information
4. Taking action
You should now put your plans into action
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
163
164. Record of action plans
Health problem to
be addressed
objectives Action to be
taken
Who will do
it
Time scale Evaluation
and
measurement
Health problem to
be addressed
objectives Action to be
taken
Who will do
it
Time scale Evaluation
and
measurement
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
164
165. Models and Approaches to
Health Promotion
Lecture No 9
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
165
166. Concepts of health promotion
• The Ottawa Charter of Health Promotion
As discussed, health promotion is part of what is referred
to as the ‘new public health’. One of the most significant
events in the emergence of the ‘new public health’ was the
Ottawa Charter for Health Promotion that was formulated
at the first international conference on health promotion
that was held in Ottawa, Canada in 1986. Many people
regard the Ottawa Charter as the formal beginning of the
“new public health” movement. The “new public health”
movement is based on a social model of health rather than
on a medical model, which promotes dealing with health
problems at the root of their cause rather than just dealing
with the disease when, it arises
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
166
167. Concepts of health promotion
• A social view of health:
“implies that we must intervene to change those
aspects of the environment which are promoting
ill health, rather than to continue to simply deal with
illness after it appears, or continue to extort
individuals to change their attitudes and lifestyles
when, in fact, the environment in which they
live and work gives them little choice or support for
making such changes”
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
167
168. According to the Ottawa Charter, the core
activities of health promotion are:
1. Advocating:
to make political, economic, social, cultural, environmental,
behavioral and biological conditions favorable for health
2.Enabling:
to make people achieve the fullest health potential,
addressing in particular, issues of equity – i.e. providing access
to information, life skills and a supportive environment.
4. Mediating:
with government and non-government agencies, industry and
media to achieve coordinated action.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
168
169. The Five Principles of the Ottawa
Charter
The development and adoption of the Ottawa
Charter, saw a framework emerge that consisted
of five essential components;
1. Build Healthy Public Policy
2. Create Supportive environments
3. Strengthen Community Action
4. Develop Personal Skills
5. Reorient Health Services
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
169
170. 1. Build Healthy Public Policy
This puts health on the agenda of policy makers in
all sectors and at all levels and it directs them to be
aware of the health consequences of their
decisions. It includes legislation, fiscal measures,
taxation and organizational change. The aim of
having policy in health promotion is to make the
healthier choice the easier choice not only for
individuals and the wider community but for policy
makers as well.
Examples: Smoke free policies, compulsory wearing
of helmets, seatbelt legislation
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
170
171. 2. Create Supportive Environments
There are inextricable links between people and their
environment and this constitutes the basis for a socio-
ecological approach to health. Individuals, communities,
regions and nations need to recognize that living and
working conditions should promote health. These are
closely linked through the establishment of healthy public
policy.
Examples: Create user friendly, accessible breast feeding
areas in public areas, create user
friendly, accessible counseling services at schools and
places where young people gather. Shade
creation in schools.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
171
172. 3. Strengthen Community Action
Health promotion acts to empower communities to
recognize that they can and must take ownership and
control in order to determine their health. Communities
themselves should determine what their needs are and
how they can best be met. In order to strengthen public
participation in health matters there needs to be access
to education, information, learning opportunities and
funding. Community development is a process that by
which this can be achieved.
Examples: Create consumer organizations such as Nursing
Mothers Association of Australia, encourage the
development of support groups and community demands
for support services.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
172
173. 4. Develop Personal Skills To help
people
make effective decisions about their health they
need information, education and skills. This enables
people to use their knowledge and skills to take
control over their health and their environment.
This process needs to be facilitated in a range of
settings including school, home, work and the
community in order to be effective.
Examples: Education programs. Skill development.
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
173
174. 5. Reorient Health Services
The health system must be beyond clinical and curative services and needs to
focus on promoting health and preventing disease. Health services need an
expanded mandate that opens links between the health sector and the broader
social, political, economic and physical environments. There needs to be a much
greater balance between health promotion and curative services and the health
care system needs to work more closely with other sectors whose work impacts
on .The whole area of health care provider education needs also to be
examined to ensure that there is a focus on promoting health and preventing
disease as well as on clinical and curative services.
• Examples: Train staff to prevent, and recognize and manage early warning
signs of disease.
• Implement the policies of a Breast Feeding Promoting Hospital so that staff
encourage new
• mothers to breast-feed
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
174
175. Settings Approaches to Health
Promotion
1. Places:
Cities, towns, villages, neighborhoods
1. Organizations:
Schools, worksites, hospitals, daycares,
universities (most relevant to you)
1. Sectors:
Health services and regions, transport,
environment
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
175
176. Ethical considerations in health
promotion
1. Address the social determinants of health as the underlying
processes that influence the health and wellbeing of individuals
and communities;
2. Achieve community health through respect of the rights of
individuals and groups within the community;
3. Develop and evaluate policies, programs and priorities through
processes that ensure an opportunity for input from community
members;
4. Advocate and work for the empowerment of disenfranchised
community members, aiming to ensure that the basic resources
and conditions necessary for health are accessible to all;
5. Seek the information and evidence needed to implement effective
policies and programs that protect and promote health;
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
176
177. Continuous -Ethical considerations in
health promotion
6.Provide communities with relevant
information that they need to make informed
decisions on policies and programs while
obtaining the community’s consent for their
implementation;
7. Act in a timely manner on the information
they have within the resources and the mandate
given to them by the public;
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
177
178. Continuous -Ethical considerations in
health promotion
8. Incorporate a variety of approaches that anticipate and
respect diverse values, beliefs and cultures in the
community;
9. Implement policies and programs in a manner that
most enhances the physical and social environment;
Protect the confidentiality of information that can bring
harm to an individual or community if made public;
11. Ensure the professional competence of their
employees; and
12. Engage in collaborations and affiliations in ways that
build the public’s trust
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
178
179. Main approaches to health promotion
• Medical or preventative
• Behavioral change
• Educational
• Empowerment
• Social change
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
179
180. These approaches have different
objectives
• To prevent disease
• To insure that people are well informed and
are able to make health choices
• To help people acquire the skills and
confidence to take greater control over their
health
• To change polices and environments in order
to facilitate healthy choices
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
180
181. TOP-DOWN VS. BOTTOM-UP
•Priorities set by health
promoters who have
the power and
resources to make
decisions and impose
ideas of what should be
done
•Priorities are set by
people themselves
identifying issues they
perceive as relevant
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
181
182. The medical or preventative approach
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
182
183. Aims
• Reduce morbidity and premature mortality
• Target: whole populations or high risk groups
• Promotion of medical intervention to prevent
ill-health
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
183
184. Levels of interventions
• Primary prevention – prevention of onset of
disease, e.g. immunization; encouraging non
smoking
• Secondary prevention – preventing
progression of disease, e.g. Screening
• Tertiary prevention – reducing further
disability and suffering in those already ill; e.g.
rehabilitation, patient éducation, palliative
care
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
184
185. Popularity of medical approach
• Uses scientific methods, e.g. epidemiology
• Prevention and early detection of disease is
cheaper than treatment
• Top-down approach, i.e. led by experts, this
kind of activity reinforces authority of health
professionals who are viewed as having
necessary knowledge to achieve results
• Highly successful examples in the past, e.g.
eradication of smallpox
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
185
186. Disadvantages
• Focuses on the absence of disease rather than
on promoting positive health
• Based on a medical definition of health
• Ignores the social and environmental
dimensions of health
• Encourages dependency on medical
knowledge and compliance with treatments
• Removes health decisions from
nonprofessional people
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
186
187. Methods
• Preventive procedures need to be based on a
sound rationale derived from epidemiological
evidence
• Having an infrastructure capable of delivering
screening or immunization programs, e.g.
Trained personnel, equipment and laboratory
facilities, record keeping facilities, effective
and safe vaccine
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
187
188. Evaluation of medical approach
• Short term evaluation
– Increasing in percentage of target population
being screened or immunized
• Long term evaluation
– Reduction in disease rates and associated
mortality
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
188
190. Aims
• Encourages individuals to adopt healthy
behaviors which improve health
• Views health as a property of individuals
• People can make real improvements to their
health by choosing to change lifestyle
• It is people’s responsibility to take action to look
after themselves
• Involves a change in attitude followed by a
change in behavior
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
190
191. Disadvantages
• Depends on person’s readiness to take action
• Complex relationship between individual
behavior and social and environmental factors
• Behavior may be a response to a persons’ living
conditions which may be beyond individual
control (e.g. Poverty, unemployment)
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
191
192. Methods
• Campaigns to persuade people e.g.
– Not to smoke
– To adopt a healthy diet
– To undertake regular exercise, etc.
• Targeted towards individuals
• May use mass-media to reach them
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
192
193. Evaluation
• Theoretically it would appear simple by asking:
“Has the health behavior changed after the
intervention?”
• However, there are two main problems
– Change may become apparent only after a long
period
– Difficult to determine whether behavior change
was due to health promotion intervention
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
193
195. Aims
• To enable people to make an informed choice
about their health behavior by
– providing knowledge and information
– developing the necessary skills
• Not similar the behavioral approach, it does NOT
try to persuade or motivate change in a particular
direction
• OUTCOME is client’s voluntary choice which may
be different from the one preferred by health
promoter
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
195
196. Disadvantages
• ASSUMES THAT:
Increase in knowledge change in attitudes
behavior change
BUT:
• Voluntary behavior change may be restricted
by social and economic factors
• Health related decisions are very complex
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
196
197. Methods
• Aspects of learning:
–Cognitive Aspect (information and
understanding)
–Affective Aspect (attitudes and feelings)
–Behavioral Aspect (skills)
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
197
198. Aspects of learning
• Cognitive Aspect - Provision of information
about causes and effects of health-related
behaviors
– Provision of leaflets/booklets
– Visual displays
– One-to-one advice
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
198
199. Aspects of learning (Cont.)
• Affective Aspect - Provision of opportunities
for clients to share and explore their attitudes
and feelings
– One-to-one counseling
– Group discussions
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
199
200. Aspects of learning (Cont.)
• Behavioral Aspect - Helping clients develop
decision-making skills required for healthy
living
– Exploring Real life situations
– Role Play
– Examples: reaction when offered a drink /
cigarette / drugs; negotiating contraception use
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
200
201. Evaluation
• Increase in knowledge is easy to measure
(exam, pre-post questionnaire..)
• HOWEVER, Knowledge alone is insufficient to
change behavior
• Knowledge is rarely translated into behavior
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
201
203. • WHO defined health promotion as “enabling
people to gain control over their lives”
(empowerment)
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
203
204. Aims
• Helps people identify their own concerns and
gain the skills and confidence necessary to act
upon them
• This is the only approach to use a ‘bottom-up’
(rather than ‘top-down’) approach
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
204
205. Aims (Cont.)
• Clients have the right to set their own agenda
• Health promoter plays the role of a facilitator
rather than that of an expert, he/she Initiates
the process but then withdraws from the
situation
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
205
206. Aims (Cont.)
• Empowerment may involve both self-
empowerment and community empowerment
• Self-empowerment:
– Based on counseling
– Uses non-directive ways
– Increase person’s control over his/her own live
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
206
207. Aims (Cont.)
• For people to be empowered they need to:
1. Recognize and understand their
powerlessness
2. Feel strongly enough about their situation to
want to change it
3. Feel capable of changing the situation by
having information, support and life skills
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
207
208. Disadvantages
• Results are vague and hard to quantify
compared with those of other approaches
• Health promoter may feel uncomfortable in
handing over his expert role
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
208
209. Methods
• Examples of methods used in empowerment
approach:
– Nurses working with patients to develop a care
plan
– Teachers working with students to raise their self-
esteem
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
209
210. Evaluation
• Outcome evaluation: the extent to witch specific aims have
been met
• Process evaluation: The degree to which the group has
been empowered as a result of the intervention
• Evaluation includes qualitative methods that reveal
people's perceptions and beliefs ,
• Quantitative methods that demonstrate the outcome such
as behavioral change
• HOWEVER,
• Usually empowerment is a long term process
• Difficult to conclude that changes are due to the
intervention rather than some other factor
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
210
212. Aims
• Radical approach which aims to change
society not individual behavior
• Aims to bring changes in the physical,
economic and social environment
• Healthy choice to become the easier choice in
terms of cost, availability and accessibility
• Targeted towards groups and populations
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
212
213. Disadvantages
• It may require major structural changes
• Vulnerable to official disapprovals
• Requires political support from the highest
level, e.g. through legislation
• Needs support of the public
Dr.Abdalla Hasballa Elmanna Albaha
University email:dr.abdalla.sd@gmail.com
213