Unique features, Aims, Purposes and Models of Public Health

Unique features, values, purposes,
aims and models of public health
Nabin Lamichhane
Lecturer
Purbanchal University
MPH Program
Advance Concept of Public Health

Unique features of PH
1. Basis in Social Justice Philosophy
2. Inherently Political in nature
3. Dynamic Ever Expanding Agenda
4. Link With Government
5. Grounding in Science
6. Use of Prevention as a Prime Strategy
7. Uncommon culture and Bond
Unique features, values, purposes, aims
and models of PH

Unique Features of Public Health
Social Justice
Philosophy
Inherently
Political Nature
Expanding
Agenda
Link with Government
Grounded
in Science
Focus on
Prevention
Uncommon
Culture

Basis in Social Justice Philosophy
• Foundation of PH
• Social justice orientation of PH:
– To reduce the potential conflict and confrontation
that generates it.
and models of PH

Basis in Social Justice Philosophy
• Emerged around 1948 (with the birth of
modern public health)
• SJ: PH is properly a PH matter results in terms
of death, disease, well being and reflects the
decision and actions that society makes, for
good or for ill.
and models of PH

Basis in Social Justice Philosophy…..
• Justice : abstract concept determining how each
members of society is allocated his/her fair share
of collective burden and benefits.
– Social benefits: happiness, income, social status
– Social burden: restriction of individuals action and
taxation
and models of PH

Basis in Social Justice Philosophy….
• So, the justice dictates: fairness in the
distribution of benefits and burden. Injustice
occurs when persons are denied some
benefits to which they are entitled or when
burden is imposed unduly.
and models of PH

Basis in social justice Philosophy
• If access to health service or even health
itself- a social benefits (or if poor considered
to be burden)
• Clear link between justice and PH
and models of PH

Basis in Social justice Philosophy….
• Market Justice
– Emphasize personal responsibility as the basis for
distributing burden and benefits.
– Other than respecting the basis rights of other,
individuals are responsible primarily for their own
actions and are free from collective obligations.
– Individual rights are highly valued, where as collective
responsibilities are minimized.
– Individual assume primary responsibility for their own
health.
– There is little expectation that the society should act to
protect or promote the health of its members beyond
addressing risks that cannot be controlled through
individual action.
and models of PH

Basis in Social Justice Philosophy…
• SJ argues that the significant factors within the
society impede the fair distribution of benefits
of burden.
Examples
Social class distinction, heredity, racism, and
ethnic.
Collective action, often leading to the
assumption of additional burden, is necessary
to neutralize or overcome those impediments.
and models of PH

Basis in Social Justice Philosophy……
• In case of PH
– The goal of extending potential benefits of the
physical and behavioral sciences to all groups in the
society, especially when the burden of disease and
ill health within that society is unequally
distributed, is largely based on principles of social
justice.
– Many modern PH problems (even policy)
disproportionately affect some groups, usually a
minority of the population, more than others.
and models of PH

Basis in Social Justice Philosophy….
• In case of PH…….
–There is a critical challenge of PH health as a
social enterprise lies in overcoming the social
and ethical barriers that privets us from us.
resolution requires collective actions in which
those less affected take on grater burdens,
while not commensurately benefiting from
those actions.Unique features, values, purposes, aims
and models of PH

Basis in social justice philosophy…
• Extending the frontiers of science and
knowledge may not be as useful for improving
PH as shifting collective values for our society.
• Recent PH success, such as public attitude
towards smoking in both and private locations
and operating motor vehicles after alcohol.
These advances come through change in
social norms, rather than through bigger and
better sciences.
and models of PH

Inherently Political Nature….
• The social justice underpinnings of PH serve to
stimulate political conflict.
• PH : both Public and political in nature.
• Serves Population composites of many
different communities, cultures and values.
• Political allows for issues to be considered,
negotiated, and finally determined for
population.
and models of PH

• At the core of political processes are differing the
values and perspectives as to both the ends to be
achieved and the means for achieving those ends.
• Advocating cause and agitating various segments
of society to identify and address unacceptable
conditions that adversely affect health status
often lead to increased expectations and
demands on society, generally through
government.
and models of PH

• As a result, PH advocates appear at times a anti-
government and anti-institutional.
• Government PH agencies seeking to serve the
interest of both government and public health
are frequently caught in middle.
• This creates tensions and conflict that can put
these agencies at odds with government leaders
on the one hand and external public health
advocates on other.
and models of PH

Dynamic Ever Expanding Agenda…..
• Broad and ever-increasing scope
• Traditional domain of PH interest biology,
environment, lifestyle and health service
organization.
• Within each of these domain, any new Public
policy problems have been moved onto the PH
agenda as their predisposing factors have been
identified and found to fall into one or more of
these domain.
and models of PH

Dynamic Ever Expanding Agenda….
• The assignment of new problems to the PH
agenda is an interesting phenomena.
• For e.g. prior 1900, the primary problems
addressed by PH health were infectious diseases
and related environmental risks.
• After 1900, the focus expanded to include
problems and needs of children and mothers to
be addressed through health education and
maternal and child health services as public
sentiment over the health and safety of children
increased.
and models of PH

• In the middle of century, Chronic disease
prevention and medical care fell into PH’s
realm as an epidemiologic revolution began to
identify causative gents of chronic diseases
and links between use of health services and
health outcomes.
and models of PH

• Later, Substance abuse, mental illness, teen
pregnancy, long-term care, and other issues
fell to PH, as did several emerging problems,
most notably the epidemics of violence and
HIV Infection, including AIDS.
• The PH agenda expanded even further as a
result of the recent national dialogue over
health reform and how health services will be
organized and managed.
and models of PH

Dynamic Ever Expanding Agenda….
• From Communicable diseases to recent
concept of adverse impacts of Bioterrorism.
• In Nepal, perspectives of PH is also changing
from recognizing Health in constitution & the
need of management and organization is also
the agenda of PH.
and models of PH

Link with government…..
• PH is far more than the activities of federal,
state and local health department, many people
think only Govt. PH agencies when they think of
PH.
• Govt. does play a unique role in seeing that the
key elements are in place and that PH’s mission
get addressed.
and models of PH

Link with Government
• Only Govt. can exercise the enforcement
provisions of our public policies that limit the
personal and property rights of individuals and
corporations in areas such as retail of food
establishment, sewage and water system,
occupational health and safety consumer product
safety.
• Government: Convertor and facilitator role for
identifying and prioritizing health problems that
might be addressed through public resource and
actions.
and models of PH

Link with government
• Two general strategies of GOVT.
– Government can modify public policies that
influence health through social, environmental
conditions such as policies for education,
employment, housing, public safety, child welfare,
pollution control, workplace safety and family
support.
– Government is to directly provide programs and
services that are designed to meet the health
needs of the population.
and models of PH

Grounding in sciences
• One can continues to separate PH from many other
social movements--- is its grounding in science?
• The relationship is clear for the medical and physical
science govern our understanding of the biologic
aspect of human, microorganisms, and vectors as
well as the risk present in our physical environment
however it is also true for the social science of
anthropology, sociology and psychology that affect
our understanding of human culture and behaviors
influencing health and science.
and models of PH

Grounding in sciences…..
• Five basic sciences of Public health
– Epidemiology
– Biostatistics
– Environmental Sciences
– Management Science
– Behavioral Science
• These constitute the core education of Public
Health Professionals.
and models of PH

Grounding in Sciences…..
• The importance of solid & diverse scientific
base is both a strength and weakness of PH.
and models of PH

Focus on Prevention
• Prevention: most frequent and commonly
used synonymous word of public health.
• Prevention is widely appreciated and valued
concept .
• There are many targets for prevention as
there are various health outcomes and effects
to be avoided.
and models of PH

Focus on Prevention…..
• Prevention efforts often lack of constituency-
success result in unseen consequences
• Because of unseen consequences, people are
less likely to develop an attachment for or
support the efforts preventing them.
• Advocates for such causes as mental health
services, care for individuals with
developmental disabilities and organ
transplants often make their presence felt.
and models of PH

Focus on Prevention….
• The invisible constituency for prevention is partly a
result of inter-disciplinary nature of PH with no
predominant discipline, it is even more difficult for
people to understand and appreciate the work of
PH.
• From one perspective, the undervaluation of PH is
understandable, the majority of the beneficiaries of
recent and current PH prevention efforts have not
yet been born!!
• Despite its lack of recognition, prevention as a
strategy has been remarkably successful and
appears to offer great potential for future success.
and models of PH

Uncommon culture…..
• The tie that bind PH Professionals is neither a
common preparation through education and training
nor a common set of work experiences and work
setting.
• PH is unique in that the common link is a set of
intended outcomes towards many different sciences,
arts, and methods can contribute.
• As a results, PH professionals include anthropologist,
sociologist, psychologist, physician, nurse,
nutritionists, lawyers, economist, political scientists,
social workers, laboratories, managers, sanitarians,
engineers, epidemiologist, biostatician, gerentologist,
disability, specialist, and dozen of other professions
and disciplines.
and models of PH

Uncommon Culture…..
• All these professionals bound to common ends,
and all employ somewhat different perspective
from diverse education, training, and work
experiences.
• “Whatever it take to get the job done” is the
theme, suggesting that the basic task is one of
the problem solving around health issues. This
aspect of PH is the foundation for strategies and
methods that rely heavily on collaborations and
partnerships.
and models of PH

Uncommon Culture
• Multidisciplinary and inter-disciplinary
approach is unique among professionals,
calling into question whether PH is really
profession at all.
• There are several arguments that PH is not a
profession.
• There is no minimum credential or training
that distinguishes PH professionals either
other professionals or non-professionals.
and models of PH

Uncommon Culture….
• Only a tiny proportion of those who work in
organizations dedicated to improving the health of
the public possess one of the academic PH degrees
(MPH & several other master’s and doctoral degree
granted by school of PH and other institution)
• With the vast majority of PH workers not formally
trained PH , its difficult to characterize its workforce
as profession. In many respect it is more reasonable
to view PH as movement that profession.
and models of PH

Value of Public Health
Value:
• Something held to deserve
• The importance
• Usefulness, Principles or Standard
• The numerical amount, magnitude, quantity,
number
and models of PH

How can we measure the value of public health
efforts?
and models of PH

• Importance VS Value??
• Value ever increasing
• People Value Saying: Prevention is better than
cure.
and models of PH

• Value recognized due to :
– Saving illness
– Preventing exposure to toxic environment of
diseases
– Reducing death, injuries, and violence
and models of PH

Value of PH…….
• The value f PH in society can be described in
human terms as well as public opinion,
statistics of infection prevented, and values in
dollars and cents.
• Examines in terms of capacity (inputs),
process (practices and outputs) and outcome
(results)
and models of PH

Value of PH
• Ten Great PH Achievement in US, 1990-1999
– Vaccination
– Motor-vehicle safety
– Safer Workplaces
– Control of infectious diseases
– Decline in death from CHD and Stroke
– Safer and healthier foods
– Healthier mothers and babies
– Family Planning Fluoridation of drinking water
– Recognition of tobacco use as a health hazard.
– Source: Morbidity & Mortality Weekly Report, vol 48, No. 12, pp.
241-243, CDC, 1999
and models of PH

Models of PH
• Medical
• Non-Medical(social, Salutogenic)
• Holistic: Medical+ Non-Medical
and models of PH

Models of PH
• Non-medSocial Model
• Medical Model
• Bio-physical Model
• Salutogenic Model
and models of PH

Social Model of PH (Example)
Poor Housing,
severe damp,
Asthma suffer
Ill Health Due to
damp
Unable to work
due to ill Health,
Money stress
Ongoing Ill health
and poor housing
,lowered self
esteem
and models of PH

Social Model of PH
• This model emerged from the social model
of disability, which has been strongly
advocated by the disability rights
movement.
• It was developed as a reaction to the
traditional medical model. The social model
of health examines all the factors which
contribute to health such as social, cultural,
political and the environment.
and models of PH

Social Model of PH
• An example is poor housing: see diagram It is well
documented that both stress and low self esteem
can have a negative impact on health. “Low levels of
autonomy and low self esteem are likely to relate to
worse health.”
• (Marmot, 2003) CDHN believes that communities
know that their health is being affected by a variety
of issues.
• We also believe that communities can and should be
actively involved in identifying, planning, designing
and implementing solutions to health issues and
unjust health inequalities.
and models of PH

and models of PH

Salutogenic Model
and models of PH
1923- 1994

Aaron Antonovsky
• Father of salutogenesis
• American professor of Medical sociology
• Coined the term in 1968 to study an emerging
concept on “WHY DID SOME MANAGE TO AVOID
ILLNESS AND DO WELL UNDER EXTREME
STRESS?”
• Talks about Behavioral Immunity
• Book Published: Health, Stress and Coping (1979)
• Reject the "traditional medical-
model dichotomy separating health and illness".
and models of PH

Health, Stress & Coping
• Description of development of sense of
coherence (SOC)
• Pathogenesis – focus of health care is reducing
consequences of disease
• Morbidity hypothesis: at least 1/3 & possibly
majority of population is characterized by some
morbidity at any point in time
• Views health as a continuum
ease → dis-ease

Salutogenesis
Saluto (health) + genesis (origins)
• How do we stay healthy?
(unlike pathogenesis which studies the
causes of diseases)
• Why?
• “What are the stressors in the lives of poor
people that underlie the brute fact that with
regard to everything related to health, illness
& patient hood, the poor are screwed?”

Tension management
• 2 people confronted by same stressor, one
meets challenge & other doesn’t
• Tension: strain incurred by exposure to stressor
• Stress: reserved for the strain that remains
when tension is not successfully overcome
• Tension management: process of dealing with
this tension

Generalized Resistance Resources
• GRR → {physical, biochemical, artifactual-
material, cognitive, emotional, valuative-
attitudinal, interpersonal-relational, macro
sociocultural} → characteristic of an →
{individual, group, subculture, society} → that
is effective in → {avoiding, combating} → a
wide variety of stressors
• When a person regularly experiences the
availability of GRRs, a strong SOC develops

SENSE OF COHERENCE
• The "sense of coherence" is a theoretical
formulation that provides a central
explanation for the role of stress in human
functioning. "Beyond the specific stress factors
that one might encounter in life, and beyond
your perception and response to those events,
what determines whether stress will cause
you harm is whether or not the stress violates
your sense of coherence."
and models of PH

Sense of coherence (SOC)….
• Global orientation that expresses the extent to
which one has a pervasive, enduring &
dynamic feeling of confidence that one’s
internal & external environment are
predictable
• High probability that things will work out as
reasonably as can be expected
• Generalized, long-lasting way of seeing the
world & one’s position in it

Sense of coherence (2)….
• Shaped & tested, reinforced & modified
• Constant tendency towards consistency &
generalization, stability & continuity
• Weak SOC: Anticipate things will go wrong,
difficulty expecting needs to be fulfilled, lack
hope
• Strong SOC: Life is complicated, but
understood & in the end things will work out

Development of SOC
• Certain individuals & social groups likely to
have stronger SOC than others
• Social-structural & cultural-historical
situations provide developmental &
reinforcing experiences → strong SOC
• Different from internal locus of control
(Rotter) – “I am in control” vs. “Things are
under control”

3 components of SOC….
• Comprehensibility: Extent to which one
perceives stimuli as ordered, consistent, etc.
• Manageability: Extent to which one perceives
resources available as adequate to meet
demands.
• Meaningfulness: Extent to which one feels life
makes sense, some demands worth investing
in, challenges welcome.

Holistic Model of PH
• Holistic Health is actually an approach to life. Rather
than focusing on illness or specific parts of the body,
this ancient approach to health considers the whole
person and how he or she interacts with his or her
environment.
• It emphasizes the connection of mind, body, and spirit.
The goal is to achieve maximum well-being, where
everything is functioning the very best that is possible.
With Holistic Health people accept responsibility for
their own level of well-being, and everyday choices are
used to take charge of one’s own health.
and models of PH

Holistic Model of PH
• Ancient healing traditions, as far back as 5,000 years ago
in India and China, stressed living a healthy way of life in
harmony with nature.
• Socrates (4th century BC) warned against treating only
one part of the body “for the part can never be well
unless the whole is well.”
• Although the term holism was introduced by Jan
Christiaan Smuts in 1926 as a way of viewing living things
as “entities greater than and different from the sum of
their parts,” it wasn’t until the 1970s that holistic became
a common adjective in our modern vocabulary.
and models of PH

MEDICAL MODEL
• Developed during the age of
Enlightenment in the 18th Century, when
the traditional natural sciences began to
dominate academia and medical
practice.
and models of PH

Medical Model…..
• The belief that science could cure all illness and disease
has remained a core element of modern medicine.
• This concept of health may be easier to understand as
it makes health an attribute you can measure simply by
determining if a disease is present or not.
• However the strong emphasis on the absence of
disease as an indicator of good health, and the
overdependence on the influence of medical science in
health, ignores the power of other important
influences.
and models of PH

Public health as system
(for details PLEASE REFER TO THE
HANDOUT THAT I HAVE GIVEN YOU IN
THE CLASS
and models of PH

Public Health is many things
A System
A Profession
A Method
Government Service
The Health of the Public

Public Health as system
• Public health systems are commonly defined
as “all public, private, and voluntary entities
that contribute to the delivery of essential
public health services within a jurisdiction.”
This concept ensures that all entities’
contributions to the health and well-being of
the community or state are recognized in
assessing the provision of public health
services. (CDC)
and models of PH

PH as a system
• The public health system includes
– Public health agencies at state and local levels
– Healthcare providers
– Public safety agencies
– Human service and charity organizations
– Education and youth development organizations
– Recreation and arts-related organizations
– Economic and philanthropic organizations
– Environmental agencies and organizations
and models of PH

Aims of Public Health
• Overall, public health is concerned with
protecting the health of entire populations.
• To promote and protect health, prevent and
control health risk factors, diseases, injury and
encourage people for early diagnosis and
treatment.
• To ascertain the nature and extent of
preventable disease and disability in
community.
and models of PH

Aims of Public Health
• Increase the average span of life of people
• Increase the proportion of people with
optimal level of health.
• Decrease preventive morbidity and premature
mortality.
• Public health saves money, improves our
quality of life, helps children thrive and
reduces human suffering.
and models of PH

Purpose of Public Health
• To help people to attain greater level of health
and well being.
and models of PH

Major trends Shaping PH
• The span of public health is to look at some
notable public health campaigns.
– Vaccination and control of infectious diseases
– Safer and healthier foods
– Safe drinking water
– Healthier mothers and babies and access to family
planning
– Decline in deaths from coronary heart disease and
stroke
– Recognition of tobacco use as a health hazard.
– Motor-vehicle safety
and models of PH

Major trends
and models of PH

Applications and Innovations in PHM
EXAMPLE OF PHM : HEALTH BELIEF MODEL
• There was a widespread failure of screening programs
for tuberculosis around the decades of 1950s.
• The health belief model has been applied to predict a wide
variety of health-related behaviors such as being screened for
the early detection of asymptomatic diseases and receiving
immunizations. More recently, the model has been applied to
understand patients' responses to symptoms of
disease, compliance with medical regimens, lifestyle behaviors
(e.g., sexual risk behaviors),and behaviors related to chronic
illnesses, which may require long-term behavior maintenance
in addition to initial behavior change.
• Amendments to the model were made as late as 1988 to
incorporate emerging evidence within the field of psychology
about the role of self-efficacy in decision-making and behavior.
and models of PH

Public health model(PHM)
• A model that addresses health or social
problems in a comprehensive way.
• It considers human factors, characteristics of
the source of harm, and the environment,
identifies causes and suggests possible
interventions.
• The public health model takes a population
approach to health promotion and disease
prevention.

Public health model focuses not only on traditional
areas of diagnosis, treatment, and etiology, but also on
• epidemiologic surveillance of the health of the
population at large,
• health promotion,
• disease prevention, and
• access to and evaluation of services
Public health model(PHM)

Public Health Approach
Public Health
Model
Medical
ModelVersus

PHM
• Public health models aim to prevent problems
by
– targeting policies and interventions at the knownrisk
factors for the problem,
– quickly identifying and responding to problems if
they do occur, and
– minimising the long-term effects of the problems
-WHO, 2006
• In the public health model of disease prevention,
preventative interventions are described as either
primary, secondary, or tertiary interventions .

• The public health model is a concept with
application in many disciplines
 health,
 education
 social welfare.
• It is an epidemiological model that attemptsto
prevent or reduce a particular illness or social
problem in a population by identifying risk
factors.
PHM

Steps in designing a PHM
Define the problem
Identify risk and protectivefactors
Develop and testintervention
strategies
Assure widespread adoption and
evaluation

"who", "what","when",
"where" and "how"
associated with it.
•magnitude of the
problem by analyzing
data like number of
violence-related
behaviours, injuries,and
deaths
•Data demonstrates how
frequently violence
occurs, trends, and who
the victims and
perpetratorsare.
Risk Factor -Characteristic
that increases the
likelihood of a person
becoming a victim or
perpetrator ofviolence.
•Protective Factor - that
decreases thelikelihood
of a person becoming a
victim or perpetrator of
violence.
Research data andfindings
from needs assessments,
community surveys for
designing prevention
programs.
•Once programs are
implemented, theyare
evaluated rigorouslyto
determine their
effectiveness
programs having been
proved effective,must
be implemented and
adopted broadly.
• Communities are
encouraged to
implement programs
and to evaluate the
success.
• Dissemination
techniques to
promote widespread
adoption
PHM for violence prevention
Definethe
Problem
Identify Risk
andProtective
Factors
Develop and
TestPrevention
Strategies
Assure
Widespread
Adoption

Public health pyramid
Tertiary
Provide
interventions for
those affected
Secondary
(Programs targetedat
families in need toalleviate
identified problems and
preventescalation)
Primary (Universal)
(Programs targeted at entire
population in order toprovide
support and education before
problems occur)

Primary prevention
– Primary prevention consists of activities that are targeted
towards the whole community.
– These activities are meant to impact families and communities
prior to any allegations of abuse and neglect. Itincludes:
– Parent education programs and support groups that focus on
child development,and the roles and responsibilities of
parenting
– Family strengthening programs that enhance a family’s ability
to access existing services and resources to support positive
interactions among family members
– Public awareness campaigns that provide information on how
and where to report suspected child abuse and neglect
PHM for child welfare services

Secondary Prevention
– consists of activities targeted to families that have one or
more risk factors such as poverty, mental health problems,
marital discord, alcohol and drug use.
They include:
– Parent support groups that help parents deal with their
everyday stresses and meet the challenges and
responsibilities of parenting
– Home visit programs that provide support and assistance
– Earlyscreening of children with special needs
– Parent education programs focusing on teen parents, or
those undergoing substance abuse treatment programs
and problem families.

Tertiary prevention
– consists of activities targeted to families that have confirmed child
abuse and neglect reports.
– These families have already demonstrated the need for
intervention for services under child welfare programs.
They include:
– Parent mentor programs with stable, non-abusive families acting
as "role models" and providing support to families in crisis
– Intensive family preservation services with trained mental health
counsellors.
– Parent support groups that help parents transform negative
practices and beliefs into positive parenting behaviours and
attitudes
– Mental health services for children and families affected by
maltreatment to improve family communication and functioning

PHM: Uses
• Organize thinking
• Guide design of intervention
• Help us to evaluate the effects of intervention
for the benefit of the community at large

Types of public health models
• Health belief model
• Trans-theoretical model /Model of change
• Socio-ecological model
• PATCH model
• PERI model
• PRECEDE-PROCEED model

Innovations: PH 2.0
Public Health 2.0” refers to a movement that aims
to make the field of public health more accessible
and user-driven by employing participatory
technologies. Although there are several
definitions cited on the web and in the literature,
the general consensus is that Public Health 2.0
places an emphasis on the application of Web 2.0
principles, such as crowd sourcing, information
sharing, and user-centered design. Public Health
2.0 is conceptually similar to the term Health 2.0,
but is differentiated by its active focus on
population health, rather than individual health.
and models of PH

Innovations “Health 2.0”
• "Health 2.0" is a term introduced in the mid-
2000s, as the subset of health care technologies
mirroring the wider Web 2.0 movement. It has
been defined variously as including social media,
user-generated content, and cloud-based and
mobile technologies. Some Health 2.0
proponents see these technologies as
empowering patients to have greater control over
their own health care and diminishing medical
paternalism.
and models of PH

Innovations: Telemedicine
• Telemedicine is the use of telecommunication
and information technology to provide clinical
health care from a distance. It has been used
to overcome distance barriers and to improve
access to medical services that would often
not be consistently available in distant rural
communities.
and models of PH

Innovations
• In Research
• In Education
• In services
Of PUBLIC HEALTH
and models of PH

References
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and models of PH

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