The concept of public health is constantly evolving to address new challenges and adapt to changing circumstances.

1. Changing concepts in public health
(Phasing of Public Health),
HEALTH-RELATED
QUALITY OF LIFE
19/7/2023
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‫روغتيا‬
‫عامه‬
‫ټولګی‬
‫دريم‬
• By : prepared by Associate prof. Dr Khushhal Farooqi
• 2023

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MODERN ERA OF PUBLIC HEALTH
The modern era of public health emerged due to several factors, including:
1. Advances in medical knowledge and technology
2. Increased awareness of the importance of hygiene and sanitation
3. Urbanization and industrialization
4. Outbreaks of infectious diseases
5. Development of public health laws and regulations
6. Growth of the medical profession and public health infrastructure
7. Improved access to healthcare and public health services
8. Emergence of epidemiology as a scientific discipline
9. Increased focus on prevention and health promotion
10.Collaboration and cooperation among governments, organizations, and communities

3. 1. Disease control phase, (Bacteriology Phase (1880-1910))
• During this time, there were significant advancements in the understanding and control
of infectious diseases, particularly those caused by bacteria.
• Public health during the 19th century was largely a matter of sanitary legislation and
sanitary reforms aimed at the control of man's PHYSICAL ENVIRONMENT, e.g., water
supply, sewage disposal, etc.
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Bacteriologists Louis Pasteur and Robert Koch, demonstrated that microorganisms cause infectious
diseases.

4. 1. Disease control phase, Bacteriology Phase (1880-1910)
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Some key developments during this phase include:
1. The discovery of the germ theory of disease, which helped establish the link between
microorganisms and illness.
2. The development of laboratory techniques for identifying and studying bacteria, such as
staining and culturing methods.
3. The identification of specific bacteria responsible for causing diseases such as tuberculosis,
cholera, and diphtheria.
4. The development of vaccines and antitoxins for preventing and treating infectious diseases.
5. The implementation of public health measures to control the spread of disease, such as
quarantine, isolation, and sanitation measures.
6. - The establishment of public health agencies and the growth of the public health
profession.

5. 2. Health Resources Phase (1910- 1960)
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This phase was characterized by enormous financial investments in hospitals, health
personnel, and biomedical research.
Some key developments during this phase include:
1. - The establishment of health education programs to promote healthy behaviors and
lifestyles.
2. - The development of diagnostic tools and technologies, such as X-rays and blood tests, to
aid in disease detection and diagnosis.
3. - The expansion of public health infrastructure, including the creation of health departments
and the hiring of public health professionals.
4. - The growth of hospitals and other healthcare facilities, as well as the development of
specialized medical fields.
5. - The implementation of social programs aimed at improving living conditions and reducing
poverty, such as housing and nutrition initiatives.
6. - The development of antibiotics and other medications to treat infectious diseases.

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Health Promotion Phase (late 1970’s till present)
• The Health Promotion Phase is a stage in the evolution of public health that began in the
1970s and continues to the present day.
• During this time, there was a shift in focus from disease prevention and control to health
promotion and disease prevention
• The emphasis was on promoting healthy lifestyles and preventing chronic diseases through
education, awareness, and behavior change.
The goal of this phase is to empower individuals and communities to take control of their health
and create environments that support healthy behaviors.
For example, this phase led to the development of public health campaigns promoting healthy
eating and physical activity, and the establishment of community health centers to provide access to
preventive care.

7. 3. SOCIAL ENGINEERING PHASE (1960-1980)
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• The Social Engineering Phase took place from the 1960s to the 1980s and focused on changing
the physical and social environment to promote health and prevent disease.
• The approach focused on making it easier for people to make healthy choices by using government
rules and regulations.
• For example, this phase led to
o the creation of laws requiring the addition of fluoride to public water supplies to promote dental
health, and
o the implementation of workplace safety regulations to prevent injuries and illnesses.

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SOCIAL ENGINEERING PHASE vs Health Promotion Phase

9. 4. HEALTH FOR ALL PHASE
1980-2000 AD
• The Health for All Phase is a global initiative launched by the World Health
Organization (WHO) in 1978(WHO was the principal mover in the field of health promotion).
• The GOAL of this initiative was to achieve universal access to primary
healthcare services by the year 2000, with a focus on promoting health
equity and reducing health disparities between different populations.
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10. 4. HEALTH FOR ALL PHASE…
• The Alma-Ata Declaration emerged as a major milestone of the 20th century in the field of
public health
• Inadequacies in current health care provision were noted.
• WHO- UNICEF international conference was held in 1978 at
Alma-Ata (USSR), which was attended by 134 countries.
• All member countries committed to the principles of the Declaration of Alma Ata to
struggle for Health for All by 2000.
• Primary health Care was the key to attaining Health for All (HFA).
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Universal Health Coverage(UHC)
UHC means that all people have access to the health services they need, when and where
they need them, without financial hardship.
• It includes the full range of essential health services, from
o Health promotion to prevention,
o Treatment,
o Rehabilitation, and
o Palliative care.
• Currently, at least half of the people in the world do not receive the health services they need.
• About 100 million people are pushed into extreme poverty each year because of out-of-pocket
spending on health.
• Over 930 million people spend at least 10% of their household income on health care.
https://www.who.int/health-topics/universal-health-coverage#tab=tab_1

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Universal Health Coverage(UHC) and health for all
https://www.who.int/health-topics/universal-health-coverage#tab=tab_1

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14. HEALTH-RELATED QUALITY OF LIFE
• Health-related quality of life (HRQL) focuses on the impact of health on a
person’s ability to live a fulfilling life.
• Health-related quality of life (HRQoL) is an assessment of how the individual's
well-being may be affected over time by a disease, disability, or disorder.
• Health-related quality of life (HRQOL) is an individual's or a group's perceived
physical and mental health over time.
For example
On the individual level, HRQOL includes physical and mental health perceptions (e.g., energy level,
mood) and their correlates—including health risks and conditions, functional status, social support, and
socioeconomic status.
On the group level a public health researcher might conduct a study to assess the HRQOL of a particular
community. This study might involve collecting data on factors such as the prevalence of chronic diseases,
rates of mental health disorders, access to healthcare services, and environmental health risks. The
researcher might also collect data on social and economic factors that can impact health, such as poverty,
employment status, and education level.

15. CDC uses a set of questions called the “Healthy Days Measures.” These questions include the following:
1. Would you say that in general your health is excellent, very good, good, fair or poor?
(General health status)
1. Now thinking about your physical health, which includes physical illness and injury, how many days
during the past 30 days was your physical health not good? (Physical health)
2. Now thinking about your mental health, which includes stress, depression, and problems with emotions,
how many days during the past 30 days was your mental health not good? (Mental health)
3. During the past 30 days, approximately how many days did poor physical or mental health keep you
from doing your usual activities, such as self-care, work, or recreation? (social health)
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How Does CDC Measure Population Health-Related Quality of Life?

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Both measure the value of a country's economic activity. The main difference is that GDP measures productivity
within a country's geographical boundaries and GNP records economic activity by that country's citizens
and businesses, regardless of location.
Indicators of development
Tikson (2005) will be presented on these five indicators:
1. Income per capita.
2. Economic structure.
3. Urbanization.
4. Savings Figures.
5. Quality of Life Index.
6. Human Development Index ( HDI )
Indicators of development are measures that are used to assess the economic, social, and
environmental progress of a country or region. Some common indicators of development
include:

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ABOUT PHYSICAL QUALITY OF LIFE INDEX= PQLI :
• It was created due to dissatisfaction with the use of GNP as an indicator
of development
• Increase in national income and per capita income are not the real indicators of
economic development, as it has a number of limitations.
• Increasing incomes of the country are concentrated in the hands of a few people,
which is not development.
• The development of a country should be such that the living standards of the poor
rise, and the basic requirements of the citizens are fulfilled.
Keeping this in mind, Morris Davis Morris presented the physical quality of life index, in short
known as the PQLI.

18. GNP: the total value of all the goods and services produced by a country in a year including income from foreign investments, divided by the number of
people living there: For countries which have a lot of foreign investments, GNP per capita is a more accurate economic indicator.
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'Gross National Product - GNP'

19. Physical Quality of Life Index (PQLI)
The Physical Quality of Life Index (PQLI) is an attempt to measure the QUALITY OF LIFE or WELL-
BEING of a COUNTRY. The value is the average of three statistics:
• It includes three indicators such as
۩ – Infant mortality
۩ – Life expectancy at age one.
۩ – Basic Literacy rate.
For each component (all equally weighted ), performance of a country is placed on a scale of 0 to 100
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Although the Physical Quality of Life Index (PQLI) is considered an improvement in measuring a
country's development, it still has some limitations.
1. One of these limitations is that it is difficult to measure the quality of life in a quantitative way.
2. Additionally, some critics argue that the PQLI is flawed because infant mortality and life expectancy
are closely related, which can cause overlap in the index's results.

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The UN Human Development Index is a more widely used means of measuring well-being.
• It was developed by Pakistani economist Mahbub ul Haq and was further used to
measure a country's development by the United Nations Development Programme
(UNDP)'s Human Development Report Office.[
• The Human Development Index (HDI) is a statistic composite index of
1. Life expectancy,
2. Education (mean years of schooling completed and expected years of schooling upon
entering the education system), and
3. Per capita income indicators, which is used to rank countries into four tiers of human
development.
HDI is divided into four tiers:
1. Very high human development (0.8-1.0),
2. High human development (0.7-0.79),
3. Medium human development (0.55-.70), and
4. Low human development (below 0.55).

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