OUR LADY OF FATIMA UNIVERSITY

College of Pharmacy

MODULE 3
PHARMACOEPIDEMIOLOGY
PART 1 OF 2
WEEK 2 (DAY 2 OF 6)
NOTES

Introduction to
1 Pharmacoepidemiology
 Pharmacoepidemiology

 “The application of epidemiologic

knowledge, methods, and reasoning to
the study of the effects (beneficial and
adverse) and use of drugs in human
populations.”
 Porta and Hartzema, 1987
 Pharmacoepidemiology

 “Pharmacoepidemiology is the study of

drugs as determinants of health and
disease in the general unselected
population.”
 Spitzer, 1991
 Pharmacoepidemiology

f) logos
 “It is the study of the use of and the
I ←
effects of drugs in large numbers of
people.”
 Strom, 2006
 Pharmacoepidemiology

 “It is defined as the study in real

conditions and in large populations of
use, effectiveness and risks of drugs.”
 Montastruc, 2018
 Clinical Trials

  Clinical evaluation of drugs, before their approval is

based on the specific methodology: experimental
design of the comparative clinical trial with
randomization of exposure.
  Thus, clinical trials with their three phases (phase I: healthy
volunteers, phase II: first trials in patients, phase III: large
multicenter trials) are performed, like any experimental
study, according to a very strict methodology, following
previously defined inclusion and exclusion criteria.
clinical trials they are research studies performed in people that are aimed at evaluating a medical
surgical or behavioral intervention they are the primary wave that researchers find out if a new
treatment like a new drug or diet, or medical device. For example: pacemaker. is safe and effective in
people clinical trial plays an integral role in the development of new medical approaches.
Clinical trials are a type of research that studies new tests and treatments and evaluate
their effects on human health outcomes usually, the people volunteer to take part in this
clinical trials to test medical interventions including drugs, cells and other biological
products, surgical procedures, radiological procedures devices, behavioral treatments
and preventive care.
Clinical trials are carefully designed reviewed and completed and need to be approved
before they can start to promotes in a market or a release in the market people of all ages
can take part in clinical trials.

phase 1 given in a healthy volunteer, the studies usually test new drugs for the first time
in a small group of people to evaluate a safe dosage range and identify the side effects.

Phase 2 first trials in patients is a phase 2 study so that these treatments that have been
found to be safe in phase one but no need a larger group of human subjects to monitor
for any adverse effects
Phase 3 these are for larger or multicenter trials they are perform like any experimental
study according to a very strict methodology following previously defined inclusion and
exclusion criteria. for the phase 3 studies they are conducted on a larger populations and
in different regions and countries and are often the step right before a new treatment is
been approved by the fda.
discovery and preclinical trials
- so discovery this is drug discovery know where we conduct experimental research coming from the different plant or animal sources and of course, we all know that the first testing
is should be on animals or also known as animal trial or in laboratory trial
*in vivo using animal subjects like for example albino mice, rats and rabbits
*in vitro using mga equipments or apparatuses in our laboratory setting
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However, clinical trials are limited…
 Insufficiencies of Clinical Trials

  Conclusions of clinical trials are necessarily partial and

limited. It does not consider heterogeneity of the
patients in the conditions of real life, as well as the
different clinical forms of the disease, drug
interactions and difference between physicians,
countries or treated populations.
The mandatory insufficiencies of clinical trials and unfortunately no conclusions of clinical trials
are necessarily partial and limited they are only show for the patients included in the trials
clinical trials. Clinical trials do not take into account (heterogeneity) so thus, discrepancies take
note 30 between 60% of the population receiving the drugs in clinical trials and those treated in
real life have been shown.
 Insufficiencies of Clinical Trials

  These data are often summarized as ‘‘the five too’’ of

clinical trials:
•  Too few patients (Not more than 1500)
setting ; taking many medication

•  Too simple (not including usually polypathological or

real life

polymedicated patients)
•  Too often concerned with median ages (excluding very
young or old subjects)
•  Too narrow (respecting very restrictive and well-defined
indications)
•  Too brief (including for example patients treated for only a few
months for a chronic disease)
PHASE 4
 Pharmacoepidemiology

  Pharmacoepidemiology
•  It is defined as the study in real conditions and in
large populations of use, effectiveness and risks of
drugs
•  Also known as post-marketing surveillance of
drugs or Phase IV clinical trials

applied in red life

-
 Pharmacoepidemiology

  It is the study of the use of and the effects of drugs in

large numbers of people (Strom, B.L. 2006).

  Originated from two components:

  “pharmaco” and “epidemiology”
 Pharmacoepidemiology
scope :
  It concerns conditions of their use (or misuse),
analysis of medical, economic or rational factors of
their use, large-scale verification of their long-term
effectiveness, quantification of their ADRs
(pharmacovigilance), quality of drug information,
monitoring of self-medication.
NOTES

Difference of Pharmacoepidemiology
2 from Clinical Pharmacology and
Epidemiology
 Clinical
Epidemiology Pharmacology
↳
study of distribution
the
and determinants of
disease in a population

Pharmacoepidemiology
of
study of utilization and effects
-

Omgs in a large members of people

 Pharmacoepidemiology vs.
Clinical Pharmacology
  Pharmacology is the study of the effects of drugs.
  Clinical pharmacology is the study of the effects of
drugs in humans.
  Pharmacoepidemiology can be considered, therefore,
to fall within clinical pharmacology.
 Pharmacoepidemiology vs.
Clinical Pharmacology
  Pharmacoepidemiology is a branch of clinical
pharmacology that investigates the use of the drug in
real conditions of life after marketing and thus, far
from the experimental limitations of clinical trials
 Pharmacoepidemiology vs.
Clinical Pharmacology
  Clinical pharmacology optimize the use of drugs
following the principle that the therapy should be
individualized or tailored to the needs of the specific
patient at hand.
•  Requires determination of a risk/benefit ratio
•  For example, consider a patient with a serious infection, serious liver impairment, and mild
impairment of his or her renal function. In considering whether to use gentamicin to treat the
infection, it is not sufficient to know that gentamicin has a small probability of causing renal
disease. A good clinician should realize that a patient who has impaired liver function is at a
greater risk of suffering from this adverse effect than one with normal liver function.
Pharmacoepidemiology can be useful in providing information about the beneficial and
harmful effects of any drug, thus permitting a better assessment of the risk/benefit balance for
the use of any particular drug in any particular patient.
 Pharmacoepidemiology vs.
Clinical Pharmacology
  Clinical pharmacology is divided into two basic areas:
pharmacokinetics and pharmacodynamics.
Together, these two fields allow one to predict the
effect one might observe in a patient from
administering a certain drug regimen.

kinetics .

body
→
drug -
LADNER
action
dynamics
-

drug
→
body
-

mech .

of
 Pharmacoepidemiology vs.
Clinical Pharmacology
  Pharmacoepidemiology encompasses elements of
both of these fields, exploring the effects achieved by
administering a drug regimen.
  Pharmacoepidemiology can be used to shed light on
the pharmacokinetics of a drug, such as exploring
whether aminophylline is more likely to cause nausea
when administered to a patient simultaneously taking
cimetidine. However, to date this is a relatively
unusual application of the field.
 Pharmacoepidemiology vs.
Epidemiology
  Epidemiology is the study of the distribution and
determinants of diseases in populations.
  Since pharmacoepidemiology is the study of the use
of and effects of drugs in large numbers of people, it
obviously falls within epidemiology as well.
 Pharmacoepidemiology vs.
Epidemiology
  Epidemiology is also traditionally subdivided into two
basic areas. The field began as the study of infectious
diseases in large populations, i.e., epidemics. More
recently, it has also been concerned with the study of
chronic diseases.
  The field of pharmacoepidemiology uses the
techniques of chronic disease epidemiology to study
the use of and the effects of drugs.
 Pharmacoepidemiology vs.
Epidemiology
  Although application of the methods of
pharmacoepidemiology can be useful in performing
the clinical trials of drugs that are performed before
marketing, the major application of these principles is
after drug marketing.
  This has primarily been in the context of post-
marketing drug surveillance, although in recent years
the interests of pharmacoepidemiologists have
broadened considerably.
  END OFMODULE 3
  PART 1
 OUR LADY OF FATIMA UNIVERSITY
College of Pharmacy

MODULE 3
PHARMACOEPIDEMIOLOGY
PART 2 OF 2
WEEK 2 (DAY 4 OF 6)
NOTES

Potential Contributions of
3 Pharmacoepidemiology
 Potential Contributions of
Pharmacoepidemiology
1.  Provides information which supplements the
information available from premarketing studies—
better quantitation of the incidence of known
adverse and beneficial effects:
a.  Higher precision How close
b.  In patients not studied prior to marketing, e.g., the
elderly, children, pregnant women
c.  As modified by other drugs and other illnesses
d.  Relative to other drugs used for the same indication
 Potential Contributions of
Pharmacoepidemiology
2.  Provides new types of information not available
from premarketing studies: clinical trial
a.  Discovery of previously undetected adverse and
beneficial effects
listed in ADR: minimal
•  Uncommon effects -
not

•  Delayed effects After prolong used ofthe drug thalidomide)

withdrawn
- 's Ex -
Mrs Kaul )
-1 birth Neos , cause
PhyfeYeah}
.

b.  Patterns of drug utilization

intentional
c.  The effects of drug overdoses accidental
-

or

d.  The economic implications of drug use

↳ right price 1
for the market society
 Potential Contributions of
Pharmacoepidemiology
3.  General contributions of pharmacoepidemiology
a.  Reassurances about drug safety
b.  Fulfillment of ethical and legal obligations
NOTES

Applications of
4 Pharmacoepidemiology
 Application Fields of
Pharmacoepidemiology
  Pharmacoepidemiology, by supplementing and
expanding data from clinical trials, develops three
main areas of interest.
A.  Prescription and drug consumption studies EPD MS
B.  Study of drug effectiveness pharma vigilance report
-
- s Foa

C.  Risks associated to drugs

 Prescription and Drug
Consumption Studies
  World health organization (WHO) defines the use of
drugs as ‘‘marketing, distribution, prescription and
use of drugs in a society, with special emphasis on the
resulting medical, social and economic
consequences’’. → Drug utilization definition
 Prescription and Drug
Consumption Studies
  These studies define the conditions of the real use of
drugs after their marketing. They investigate the
quantitative and qualitative characteristics of treated
patients, prescribers or prescribed quantities.
 Prescription and Drug
Consumption Studies
  They also consider national or regional differences in
drug use, determinants of prescription and
differences from validated indications. These studies
show that prescription and consumption depend on
multiple factors, some rational (ensuing from
conclusions of clinical trials) and other irrational
(linked to symbolic images of drugs or social,
economic and educational factors).
 Prescription and Drug
Consumption Studies
  The importance of these last factors in every day
practice is steadily increasing. These studies underline
several inconsistencies between the basic
pharmacological data, the conclusions of clinical trials
and the prescription and use in real life of drugs.
   For example, in the current field of
prescription in older patients or in those
suffering from dementia, it is possible to
EXAMPLE

show the high prescription level of

atropinics (anti-muscarinic) or
benzodiazepines (two pharmacological
classes with well-established and
theoretically well-known deleterious
effects on memory), but also the too low
prescription of analgesics.
aspects
Dmg B : ADD
A. effectiveness
Utilization review c) medical
= :

abuse dependence
{
2) Social i. A .pt attitude b.
tic non adherence
-
drug
D. unavailability of drug
minimization
3) chthonical A. cost
-
-

B cost benefit
c . it effectiveness
D . " utility
 Study of Drug Effectiveness

  In pharmacoepidemiology, efficacy of a drug is

studied by focusing on two essential aspects (not
taken into account in clinical trials): first, its long-
term action, over several months or better several
years, in order to bring closer to the daily clinical
practice and the prescriber’s goal.
 Study of Drug Effectiveness

  Then, the drug effects are investigated on the so-

called ‘‘hard’’ criteria, i.e., clinical criteria translating a
quantitative improvement of the patient’s health.
 Study of Drug Effectiveness

  These are only three clinical criteria for such an

evaluation:
  1) decrease in morbidity,
  2) decrease in mortality (total mortality and not
specific mortality like cardiovascular one) and
  3) improvement of quality of life (analyzed using
appropriate and valid scales)
 Study of Drug Effectiveness

  The clinical criteria therefore differ from the

intermediate criteria (i.e., biological,
electrocardiographic, radiographic, ultrasonic criteria)
often used in clinical trials which, obviously, are not a
relevant final objective for the medical prescription.
1) long term effect
2) clinical criteria
-
final objective
used in clinical trial
b) Intermediate criteria
-

L measurable
 Study of Drug Effectiveness

  These notions of intermediate criteria and clinical

criteria allow discussing the notion of drug efficacy.
Two words can summarize and differentiate this
notion.
 Study of Drug Effectiveness

  First, the word ‘‘efficacy’’ describes the effect of drugs

on intermediate criteria (i.e., biological,
electrocardiographic, radiographic, ultrasonic criteria)
and, second, the word ‘‘effectiveness’’ describes the
effects of drugs on the three clinical criteria relevant
to patient’s health, as defined above.
 Study of Drug Effectiveness

  Thus, some drugs can be effective (‘‘efficacy’’) without

‘‘effectiveness’’ in the pharmacoepidemiological
sense as defined above: for example, fibrates,
although decreasing decrease triglyceride and
cholesterol levels, have no effect on total mortality or
cardiovascular deaths.
7
 Study of Drug Effectiveness

  It is now important to understand that the use of non-

experimental plans (i.e., use of
pharmacoepidemiology methods) also makes it
possible to study the benefit of drugs.
 Study of Drug Effectiveness

  These studies are important since they evaluate the

drug in real life, i.e., in patients coming from all over,
taking many drugs, often discontinuously and
suffering from diseases at different stages.
   For example, it is not necessary to perform
a comparative clinical trial to demonstrate
the interest of an antagonist in agonist
EXAMPLE

intoxication (such as naloxone in

methadone overdoses).
   Cohort studies have demonstrated the
effectiveness of anticoagulants in the
prevention of venous thromboembolism.
EXAMPLE
   The use of the case-control method has
proved the place of lidocaine, beta-
blockers or anticoagulants in the
EXAMPLE

prevention of death after myocardial

infarction, or the interest of antibiotics in
the prophylaxis of endocarditis after
infection.
 Study of Drug Effectiveness

  In these examples, the comparative clinical trials

came only several years later to confirm these results
from these non-experimental studies.
 Study of Drug Effectiveness

  The example of vaccines is even clearer since they are

marketed only after studies using intermediate
(virological) criteria.
 Study of Drug Effectiveness

  These studies also reveal new long-term favorable

effects but also allow to compare the effects of drug
versus other therapeutic choices (drug or not), not
evaluated before marketing.
 Study of Drug Effectiveness

  They also investigate the consequences of variations

in dosage, repartition of doses during the day as well
as the characteristics of the disease (seriousness,
clinical subtype, etc.) or the patient (age, sex
ethnicity, socio-economic factors, geographic
location, nutritional status) in the effects of the drug.
studies
) study of
1)
s
Observational study
study a) meta analysis this
3 cohort
.

a
C Review
.

control study
b b) systematic
-

. case

C .
Ease reports
2) Experimental study
a randomized control study
RQ
.

b .

quasi experimental study

 Risks Associated to Drugs

  These studies complement the role of alert and

identification of adverse drug reaction profile played
by spontaneous reporting and pharmacovigilance
stricto sensu.
  Pharmacoepidemiology quantifies risk at the -

population level.

Pharmacovigilance is the science and activities relating to the detection,

assessment, understanding and prevention of adverse effects or any other
medicine/vaccine related problem. WHO
 Risks Associated to Drugs

  Following the pioneer pharmacoepidemiological work

measuring the risk of pulmonary arterial hypertension
with amphetamine appetite-suppressant drugs,
several studies were performed and
pharmacoepidemiological studies are now part of any
pharmacovigilance survey.
 Pop Quiz

  TRUE or FALSE:
False 1.  Clinical trials can detect adverse effects that are
uncommon, delayed, and unique to high risk
population.
False 2.  effects in large numbers of people.
Clinical pharmacology is the study of drug
 Pop Quiz

True 3.  Pharmacoepidemiology can contribute

information about drug safety and effectiveness
that is not available from premarketing studies.
false 4.  Rofecoxib is withdrawn from the market because
animal studies shows it can increase risk of
- .

stroke and heart attack.

4M 5.  Knowledge of ADRs and drug-interactions are
product of pharmacoepidemiology.
 ASSIGNMENT

  Reminder: Prepare for Online Quiz.

  Assignment :
  1. Identify the various determinants of health
  2. Describe one (1) example of a current public health
issue and identify ways in resolving this issue.
  3. Provide five (5) different government and non-
government health programs and their importance.
  Note: Submit this thru email before the first lecture
on Module 4.
MODULE 4:
DETERMINANTS OF HEALTH
AND PUBLIC HEALTH ISSUES
UNIT 4.1: DETERMINANTS OF HEALTH
I. SOCIAL DETERMINANTS
OF HEALTH
UNIT 4.1: DETERMINANTS OF HEALTH
SOCIAL DETERMINANTS OF HEALTH

SOCIAL DETERMINANTS OF HEALTH ARE

ECONOMIC AND SOCIAL CONDITIONS THAT
INFLUENCE THE HEALTH OF PEOPLE AND
COMMUNITIES.
SOCIAL DETERMINANTS OF HEALTH

ACCORDING TO WORLD HEALTH ORGANIZATION,

THE SOCIAL DETERMINANTS OF HEALTH ARE THE
CONDITIONS IN WHICH PEOPLE ARE BORN,
GROW, LIVE, WORK AND AGE.
SOCIAL DETERMINANTS OF HEALTH

THESE CIRCUMSTANCES ARE SHAPED BY THE

DISTRIBUTION OF MONEY, POWER AND
RESOURCES AT GLOBAL, NATIONAL AND LOCAL
LEVELS.

THE SOCIAL DETERMINANTS OF HEALTH ARE

MOSTLY RESPONSIBLE FOR HEALTH INEQUITIES –
THE UNFAIR AND AVOIDABLE DIFFERENCES IN
HEALTH STATUS SEEN WITHIN AND BETWEEN
COUNTRIES.
SOCIAL DETERMINANTS OF HEALTH

ACCORDING TO DEPARTMENT OF HEALTH, SOCIAL

D E T E R M I N A N T S O F H E A LT H A R E T H O S E
C H A R AC T E R I S T I C S O F S O C I E T I E S A N D
COMMUNITIES IN WHICH PEOPLE LIVE THAT HAVE
AN IMPACT ON THEIR HEALTH. THESE INCLUDE THE
LEVEL OF EDUCATION, WATER AND SANITATION,
HOUSING, EMPLOYMENT, FOOD PRODUCTION,
AMONG OTHERS.
FACTORS RELATED TO HEALTH
OUTCOMES INCLUDE:
¨  HOW A PERSON DEVELOPS DURING THE FIRST FEW
YEARS OF LIFE (EARLY CHILDHOOD DEVELOPMENT)
¨  HOW MUCH EDUCATION A PERSONS OBTAINS AND
THE QUALITY OF THAT EDUCATION
¨  BEING ABLE TO GET AND KEEP A JOB
¨  WHAT KIND OF WORK A PERSON DOES
¨  HAVING FOOD OR BEING ABLE TO GET FOOD (FOOD
SECURITY)
¨  HAVING ACCESS TO HEALTH SERVICES AND THE
QUALITY OF THOSE SERVICES
¨  SOCIAL RELATIONSHIPS IN THE COMMUNITY
IMPORTANCE OF HEALTH
DETERMINANTS
¨  COMMON DISEASES HAVE ROOTS IN LIFESTYLE,
SOCIAL FACTORS AND ENVIRONMENT.
SUCCESSFUL HEALTH PROMOTION DEPENDS
UPON A POPULATION-BASED STRATEGY OF
PREVENTION. WE NEED TO FOCUS ON THOSE
FACTORS (DETERMINANTS) WHICH HAVE THE
MOST INFLUENCE ON THE HEALTH OF THE
POPULATION
CONTEMPORARY CONCEPT OF
HEALTH:
¨  BIOLOGICAL DETERMINANTS
¤  GENETICS
¤  BEHAVIORS THAT DETERMINES THE SUSCEPTIBILITY OF THE INDIVIDUAL
TO DISEASE
¤  OTHER FACTORS
¨  ENVIRONMENTAL DETERMINANTS
¤  PHYSICAL ENVIRONMENT
¤  CONDITIONS OF LIVING
¤  TOXIC AGENTS
¤  INFECTIOUS AGENTS
¨  SOCIAL DETERMINANTS
¤  POVERTY
¤  EDUCATION
¤  CULTURAL ENVIRONMENTS
 POP QUIZ
A.  BIOLOGICAL
B.  ENVIRONMENTAL
C.  SOCIAL

C 1.  POVERTY
A 2.  GENETICS
C 3.  EDUCATION
B 4.  TOXIC AGENTS
A 5.  BEHAVIORS
II. INDICATORS OF HEALTH
UNIT 4.1: DETERMINANTS OF HEALTH
INDICATORS OF HEALTH
a.  Life expectancy
b.  Infant mortality rate
c.  Mortality rate/ maternal mortality rate
d.  Morbidity
e.  Incidence of disease
 Indicators of health
A.  LIFE EXPECTANCY

§  average number of years that a person can

expect to live at a given age
§  simplest indicator of population health
§  affected by infant mortality
§  72.0 years was the average life expectancy at
birth of the global population in 2016 (74.2
years for females and 69.8 years in males)
§  Healthy life expectancy (HALE) at birth was 63.3
years globally in 2016
Indicators of health
B. INFANT MORTALITY RATE
¤  number of death of infants less than 1 year old per
year per 1000 births
¤  INDICATOR of overall health of a population]
¤  In 2017, 4.1 million (75% of all under-five deaths )
occurred within the first year of life
¤  The risk of a child dying before completing the first
year of age was highest in African Region (51 per
1000 live births)
¤  Globally, the infant mortality rate has decreased
from estimated rate of 65 deaths per 1000 live
births in 1990 to 29 deaths per 1000 live births in
2017.
¤  Annual infant deaths have declined from 8.8 million
in 1990 to 4.1 million in 2017.
C. MATERNAL MORTALITY RATE
¤  most common indicator of population health because it is a
READILY AVAILABLE
¤  Indicates the no. of deaths associated with childbirth per
100,000 women
¤  Everyday in 2017, approximately 810 women died from
preventable causes related to pregnancy and childbirth
¤  94% maternal deaths occur in low and lower middle income
countries
¤  Young adolescent (ages 10-14 years) face a higher risk of
complications and death
¤  MORTALITY RATE – no. of deaths that occur for a specific
population per 100,000.
¤  Standardized, adjusted so the rate compares populations with same age
distribution
D. MORBIDITY
–  Level of disease in a
population
–  Amount of disease or
disability present in a
population
–  Seems to be the BEST
INDICATOR of
population health BUT
measurement of overall
morbidity is difficult to
gauge and unavailable
for most populations
http://www.doh.gov.ph/kp/statistics/morbidity.html#2005
WHO 100 CORE HEALTH INDICATORS
WHO 100 CORE HEALTH INDICATORS
 POP QUIZ

72 1.  LIFE EXPECTANCY AT BIRTH IN THE YEAR 2016

pppidihd 2.  AMOUNT OF DISABILITY IN A POPULATION
8. to 3.  NO. OF WOMEN WHO DIED EVERYDAY BECAUSE
OF CHILBIRTH IN THE YEAR 2017
Infant
portabiratelity 4.  INDICATOR OF OVERALL HEALTH POPULATION
mortality 5.  NO. OF DEATHS THAT OCCUR IN A SPECIFIC
rate
POPULATION
DETERMINANTS OF HEALTH
BY LEVEL
UNIT 4.1: DETERMINANTS OF HEALTH
 DETERMINANTS OF HEALTH BY LEVEL

INDIVIDUAL COMMUNITY STATE/NATIONAL GLOBAL

•  Physical •  Economics •  Communication •  Communications

characteristics •  Food supplies network •  Public health
•  Socioecomomic •  Water and •  Government •  Violence
status sanitation •  Public health •  Global climate
•  Educational •  Housing system change
attainment •  Physical •  Health insurances
•  Psychological environment and Health system
factors •  Social
•  Behavior environment
•  Education and
social services
•  Local
government
•  Primary care
INDIVIDUAL LEVEL
Determinants of health:
Individual level
These characteristics cannot be separated from individual,
it may be inherited or acquired.

PERSON-ENVIRONMENT INTERACTION
- central to the ecological approach to health and
involves:
a.  Positive interactions with environment that improve
health
b.  Negative interactions with environment that are
detrimental to health and results to illness
 Determinants of health:
Individual level
Physical Genetic susceptibility to breast cancer
Immunity protects against specific diseases
Low level of physical fitness increases likelihood of
back injury
Increase in the amount of body fat increases the
risk of developing disease
Socioeconomic Poverty has been identified as GREATEST SINGLE
status KILLER
Lack of economic resources

Sierra Leone (Africa) - highest infant mortality rate

(160.3), 8th lowest individual income
Norway – 5th lowest infant mortality rate, 3rd highest
individual income
Determinants of health:
Individual level
Educational Maternal education level is strongly related
attainment to children’s health
Increased education is associated with
behaviors that improve health
Psychological Childhood abuse/neglect increase likelihood
factors of poor health as an adult
Stress
Behaviors Behaviors with negative impact on health
(smoking)
Behaviors with positive impact on health
(regular exercise)
COMMUNITY LEVEL
Determinants of health:
Community level
¨  Conditions in the immediate environment of a
person
¨  Affect how people behave, the type of experiences

they have, and the activities in which thy engage

Determinants of health:
Community level
Economics Availability of employment enables residents to
buy necessities
Taxes can be used to provide health care
Food supplies Malnutrition from the quantity or quality of food
UNDERWEIGHT – single most powerful factor
affecting disease burden
Over nutrition resulting from wide availability of
inexpensive, calorie dense foods

Water and Diseases( typhoid fever, hepatitis, diarrhea and

sanitation cholera) from contaminated water
Garbage waste disposal prevents vector borne
diseases
Determinants of health:
Community level
Housing Adequate spaces prevents airborne
diseases and reduces indoor air pollution
Presence of rats from structural defects
Bird flu from chickens kept in house
Physical Poisoning from pollution
environment Safe streets and pedestrian walkways
Adequate drainage
Social Cultures that promotes healthy lifestyles
environment Exploitation of vulnerable populations
Fairness in allocation of resources
Determinants of health:
Community level
Education and social Schools and teachers for children to be
services educated
Post-secondary educational institutions
train young adults so that they can
earn a living
Social services
Local government Plans and infrastructures required to
respond to disaster
Competence to recognize community
health issues and take action to address
Primary care Access to high quality primary care
Access to basic medications
Timely medical interventions prevent
mortality and morbidity
Determinants of health:
Community level
Primary care Essential medications
-  Meet the priority of the local population
-  Affordable and effective
-  Readily accessible
STATE/NATIONAL LEVEL
Determinants of health:
State/national level

Communication TV and internet accessibility for all

networks residents
Highway system allow
transportation of foodstuff
Air travel permits emergency
evacuation of injured persons
Government Competent elected officials who can
recognized a health issues
Passage of laws that protect the
health of residents
Determinants of health:
State/national level
Public health system Surveillance activities identify disease
outbreaks quickly and prevents spread
of disease
Assurance that preventive services are
provided
Collection of data needed to recognize
new disease
Proposal of laws that promote the
health of residents
Health insurance/ Government that assures disadvantaged
health system groups have access to services
Laws and regulation that assure all
residents have access to high quality
primary care
GLOBAL LEVEL
Determinants of health:
Global level

Communication TV and internet accessibility for all

network residents
Highway system allow transportation of
foodstuff
Air travel permits emergency evacuation
of injured persons
Public health Organizations that enable multiple
organization countries to address a global health threat
Determinants of health:
Global level
Violence Largest impact on population health
War injures local residents as well as
interferes with their ability to obtain the
necessities of life
War diverts resources from health
promoting activities
Terrorism and gang violence results in
injury and health
Global climate Changes increase the number of weather
change related disaster( JAPAN-TSUNAMI,
YOLANDA)
Spread of diseases formerly restricted to
tropical areas to more temperate zone
(malaria)
 POP QUIZ
A.  INDIVIDUAL
B.  COMMUNITY
C.  NATIONAL
D.  GLOBAL

¥
1.  CLIMATE CHANGE
2.  HEALTH INSURANCE
3.  VIOLENCE
4.  PRIMARY CARE
A 5.  CHILD ABUSE
DETERMINANTS OF HEALTH
UNIT 4.1: DETERMINANTS OF HEALTH
A. HEREDITY
A. HEREDITY
¨  THE PHYSICAL AND MENTAL TRAITS OF EVERY
HUMAN; TO SOME EXTENT IS DETERMINED BY
GENES.

¨  GENETIC MAKE UP IS UNIQUE AND CANNOT BE

ALTERED AFTER CONCEPTION

¨  A NUMBER OF DISEASES ARE GENETIC IN NATURE

A. HEREDITY
¨  SOME BIOLOGICAL AND GENETIC FACTORS
AFFECT SPECIFIC POPULATIONS MORE THAN
OTHERS.

¨  FOR EXAMPLE, OLDER ADULTS ARE BIOLOGICALLY

PRONE TO HAVING POORER HEALTH THAN
ADOLESCENTS DUE TO PHYSICAL AND COGNITIVE
EFFECTS OF AGING.
A. HEREDITY
¨  SICKLE CELL DISEASE IS A COMMON EXAMPLE OF
GENETIC DETERMINANT OF HEALTH. SICKLE CELL IS
A CONDITION THAT PEOPLE INHERIT WHEN BOTH
PARENTS CARRY THE GENE FOR SICKLE CELL. THE
GENE IS MOST COMMON IN PEOPLE WITH
ANCESTORS FROM WEST AFRICAN COUNTRIES.
MEDITERRANEAN COUNTRIES, SOUTH OR CENTRAL
AMERICAN COUNTRIES, CARRIBEAN ISLANDS,
INDIA AND SAUDI ARABIA.
A. HEREDITY
¨  EXAMPLES OF BIOLOGICAL AND GENETIC SOCIAL
DETERMINANTS OF HEALTH INCLUDE:
¤  AGE
¤  SEX
¤  HIVSTATUS
¤  INHERITED CONDITIONS, SUCH AS SICKLE CELL
ANEMIA, HEMOPHILIA AND CYSTIC FIBROSIS
¤  CARRYING THE BRCA1 OR BRCA 2 GENE, WHICH
INCREASES RISK FOR BREAST AND OVARIAN CANCER
¤  FAMILY HISTORY OF HEART DISEASE
GENES AND GENETIC DISEASES
 GENES AND HUMAN DISEASES
¨  GENE – A UNIT OF HEREDITARY INFORMATION
THAT OCCUPIES A FIXED POSITION (LOCUS) ON A
CHROMOSOME. THEY PLAY A ROLE IN THE
OCCURRENCE OF INFECTIOUS DISEASES LIKE
TUBERCULOSIS AND AIDS AS WELL AS SOME NON
COMMUNICABLE DISEASES LIKE CANCER AND
DIABETES
genetic disorders can be caused by mutations

mutations in multiple genes like the multifactorial inheritance disorder a combination of gene
mutations and environmental factors or damage to chromosomes or changes in the number or
structure of interior chromosomes the structure that carry the gene.
 GENES AND HUMAN DISEASES
1. GENES AND CHROMOSOMAL DISEASES
¤  DOWN SYNDROME – TYPE OF MENTAL RETARDATION
CAUSED BY EXTRA GENETIC MATERIAL IN
CHROMOSOME 21. THIS CAN BE DUE TO A PROCESS
CALLED NONDISJUNCTION, IN WHICH GENETIC
MATERIAL FAIL TO SEPARATE.
n  CHARACTERISTICS: DECREASED MUSCLE TONE, FLAT FACE,
EYES SLANTING UP, IRREGULAR SHAPED EARS, ABILITY TO
EXTEND JOINTS BEYOND THE USUAL, LARGE SPACE
BETWEEN THE BIG TOE AND ITS NEIGHBORING TOE,
LARGE TONGUE RELATIVE TO THE MOUTH, ETC.
other name, trisomy 21 i have 47 chromosome -
21 -
- 3
normal : 4.6
GENES AND HUMAN DISEASES
2. MONOGENIC DISEASES - RESULTS IN
MODIFICATION OF A SINGLE GENE OCCURING IN
ALL CELLS OF THE BODY.
¨  THREE CATEGORIES:
¤  DOMINANT – INVOLVES DAMAGE TO ONLY ONE
GENE COPY
¤  RECESSIVE – OCCURS DUE TO DAMAGES IN BOTH
COPIES OF GENE
¤  X-LINKED – LINKED TO DEFECTIVE GENES ON THE X
CHROMOSOMES (SEX CHROMOSOMES)
-

Y linked
- -

Defective genes on Y chromosomes

↳ inheritance from father to son
GENES AND HUMAN DISEASES
A. THALASSAEMIA

¤  BLOOD RELATED GENETIC DISORDER WHICH

INVOLVES THE ABSENCE OF OR ERRORS IN GENES
RESPONSIBLE FOR PRODUCTION OF HEMOGLOBIN,
A PROTEIN PRESENT IN THE RED BLOOD CELLS.
GENES AND HUMAN DISEASES
B. SICKLE CELL ANEMIA
¨  IS A BLOOD RELATED DISORDER THAT AFFECTS THE
HEMOGLOBIN MOLECULE, AND CAUSES THE
ENTIRE BLOOD CELLTO CHANGE SHAPE UNDER
STRESSED CONDITIONS.
¨  IN SICKLE CELL ANEMIA, THE HEMOGLOBIN
MOLECULE IS DEFECTIVE, AFTER THEY GIVE UP
THEIR OXYGEN, SOME MAY CLUSTER TOGETHER
AND FORM LONG, ROD LIKE STRUCTURES WHICH
BECOME STIFF AND ASSUME SICKLE SHAPE.
GENES AND HUMAN DISEASES
C. HAEMOPHILIA
¨  IS A HEREDITARY BLEEDING DISORDER, IN WHICH
THERE IS A PARTIAL OR TOTAL LACK OF AN ESSENTIAL
BLOOD CLOTTING FACTOR.
¨  IT IS A LIFELONG DISORDER THAT RESULTS IN
EXCESSIVE BLEEDING.
¨  TWO FORMS:

¤  HAEMOPHILIA A – CLASSICAL HAEMOPHILIA (COMMON,

DEFIECIENCY IN BLOOD CLOTTING FACTOR 8)
¤  HAEMOPHILIA B – CHRISTMAS DISEASE (DEFIECIENCY IN
BLOOD CLOTTING FACTOR 9)
GENES AND HUMAN DISEASES
D. CYSTIC FIBROSIS
¨  GENETIC DISORDER THAT AFFECTS THE RESPIRATORY,
DIGESTIVE AND REPRODUCTIVE SYSTEMS INVOLVING
THE PRODUCTION OF ABNORMALLY THICK MUCUS
LININGS IN THE LUNGS AND CAN LEAD TO FATAL
LUNG INFECTION.
¨  SYMPTOMS: VERY SALTY TASTING SKIN, PERSISTENT
COUGHING, WHEEZING, SHORTNESS OF BREATH,
EXCESSIVE APPETITE BUT POOR WEIGHT GAIN,
GREASY AND BULKY STOOLS
GENES AND HUMAN DISEASES
E. TAY SACHS DISEASE
¨  FATAL GENETIC DISORDER IN WHICH HARMFUL

QUANTITIES OF A FATTY SUBSTANCE CALLED

GANGLIOSIDE GM2 ACCUMULATE IN THE NERVE
CELLS OF THE BRAIN.
¨  TWO FORMS:

¤  INFANTILETAY-SACHS DISEASE
¤  LATE ONSET TAYS-SACHS DISEASE (CHRONIC GM2-
GANGLIOSIDOSIS)
GENES AND HUMAN DISEASES
F. FRAGILE X SYNDROME
¨  CAUSED BY A FRAGLE SITE AT THE END OF THE

LONG ARM OF THE X CHROMOSOME.

¨  GENETIC DISORDER THAT MANIFEST THROUGH A

COMPLEX RANGE OF COGNITIVE AND

BEHAVIORAL PHENOTYPES.
¨  MOST COMMON CAUSE OF INHERITED

RETARDATION
GENES AND HUMAN DISEASES
G. HUNTINGTON S DISEASE
¨  DEGENERATIVE BRAIN DISORDER, IN WHICH

AFFLICTED INDIVIDUALS LOSE THEIR ABILITY TO

WALK, TALK, THINK AND REASON.
¨  THEY EASILY BECOME DEPRESSED, AND LOSE THEIR

SHORT TERM MEMORY CAPACITY.

¨  AN AUTOSOMAL DOMINANT GENETIC DISORDER.

¨  THE DISEASE BEGINS BETWEEN AGES 30-45

GENES AND HUMAN DISEASES
3. GENES AND NON COMMUNICABLE DISEASES
¨  MOST DISEASES INVOLVE MANY GENES IN
COMPLEX INTERACTIONS, IN ADDITION TO
ENVIRONMENTAL INFLUENCES.
¨  AN INDIVIDUAL MAY NOT BE BORN WITH A
DISEASE BUT MAY BE AT HIGH RISK OF
ACQUIRING IT.
¨  THIS IS CALLED AS GENETIC PREDISPOSITION OR
SUSCEPTIBILITY DUE TO THE PRESENCE OF ONE
OR MORE GENE MUTATIONS.
GENES AND HUMAN DISEASES
A. CANCER
¤  OCCURS BECAUSE OF MUTATIONS IN THE GENES
RESPONSIBLE FOR CELL MULTIPLICATION AND
REPAIR.
¤  THE CHANGES WHICH A CELL UNDERGOES IN THE
PROCESS OF MALIGNANT TRANSFORMATION IS A
REFLECTION OF THE SEQUENTIAL ACQUISITION OF
THESE GENETIC ALTERATIONS.
¤  THE MOST PREVALENT CANCERS INCLUDING LUNG,
STOMACH, COLON, LIVER, BREAST AND
ESOPHAGUS CANCER.
GENES AND HUMAN DISEASES
B. DIABETES
¨  DISEASE IN WHICH THE BODY DOES NOT PRODUCE OR
PROPERLY USE INSULIN.
¨  INSULIN IS A HORMONE THAT IS NEEDED TO CONVERT
SUGAR, STARCH AND OTHER FOOD INTO ENERGY
NEEDED FOR DAILY LIFE.
¨  TYPES
¤  TYPE 1 DIABETES – RESULTS FROM BODY S FAILURE TO
PRODUCE INSULIN Dependent ( D Mellitus)
-
.

¤  TYPE 2 DIABETES – RESULTS FROM INSULIN RESISTANCE WHICH

IMPLIES THAT THE BODY FAILS TO PROPERLY USE INSULIN ( not dependent )
¤  GESTATIONAL DIABETES – TYPE OF DIABETES IN PREGNANT
WOMEN
GENES AND HUMAN DISEASES
C. CARDIOVASCULAR DISEASE
¨  CORONARY HEART DISEASE, CEREBROVASCULAR DISEASE,
HEART FAILURE, RHEUMATIC HEART DISEASE, CONGENITAL
HEART DISEASE
¨  CVD MAY RESULT FROM A VARIETY OF GENETIC CAUSES,
INCLUDING SINGLE-GENE MUTATIONS, THE INTERACTION
OF MULTIPLE GENES AND ENVIRONMENTAL FACTORS
¨  ECONOMIC TRANSITION, URBANIZATION,
INDUSTRIALIZATION, AND GLOBALIZATION BRING ABOUT
LIFESTYLE CHANGES THAT ALSO PROMOTES HEART
DISEASE
¨  MAJOR RISK FACTORS: SMOKING, UNHEALTHY LIFESTYLE,
HYPERTENSION, DIABETES, HIGH CHOLESTEROL AND
PHYSICAL INACTIVITY
GENES AND HUMAN DISEASES
D. ASTHMA
¨  DISEASE IN WHICH THE AIRWAYS BECOME
BLOCKED OR NARROWED.
¨  SYMPTOMS: COUGHING, WHEEZING, SHORTNESS
OF BREATH, TIGHTNESS IN THE CHEST.
¨  TYPES OF ASTHMA:
¤  EXERCISE-INDUCED
¤  ALLERGYINDUCED
¤  OCCUPATIONAL ASTHMA
¤  CHRONIC ASTHMA
GENES AND HUMAN DISEASES
4. GENES AND COMMUNICABLE DISEASES
¨  THERE ARE SOME MAJOR COMMUNICABLE

DISEASES WHICH CAN BE TREATED WITH GENETIC

BASED INTERVENTIONS, HIV/AIDS, TUBERCULOSIS,
AND MALARIA ARE SOME OF THE EXAMPLES.
 POP QUIZ
DIABETES
TYPE 1 1.  A HEREDITARY DISEASE THAT RESULTS OF THE
BODY S INABILITY TO USE OR TO PRODUCE
INSULIN
HEREDITY? )
2.  ALSO KNOWN AS HE GENETIC MAKE UP
CYSTIC
FIBROSIS
3.  A DISEASE CHARACTERIZE BY COUGHING,
WHEEZING AND SHORTNESS OF BREATH
HAEMOPHILIA
4.  A HEREDITARY BLEEDING DISORDER
FRAGILE
SYNDROME
F
5.  MOST COMMON CAUSE OF INHERITED
RETARDATION
B. SOCIO-CULTURAL
B. SOCIO-CULTURAL -

Behavior

¨  THESE ARE CUSTOMS, LIFESTYLES, AND VALUES

THAT CHARACTERIZE A SOCIETY.

¨  CULTURAL ASPECTS INCLUDES AESTHETICS,

EDUCATION, LANGUAGE, LAW AND POLITICS,
RELIGION, SOCIAL ORGANIZATIONS,
TECHNOLOGY AND MATERIAL CULTURE, VALUES
AND ATTITUDES.
B. SOCIO-CULTURAL
¨  FRAMEWORK THAT EMPHASIZES THE
RESPONSIBILITY OF SOCIAL AND CULTURAL
CONTEXT IN HUMAN LEARNING

¨  MIXTURE OR INTERACTION OF SOCIAL AND

CULTURAL ELEMENTS
B. SOCIO CULTURAL
¨  ETHNICITY –BELIEFS, CUSTOMS, NORMS, VALUES, TRADITIONS
¨  THE LIFE EXPECTANCY OF AFRICAN IS 7 YEARS SHORTER THAN EUROPEANS
¨  LANGUAGE - LITERACY
¨  RELIGION AND SPIRITUAL BELIEFS
¨  GENDER – EQUALITY
¨  MEN ARE MORE LIKELY TO HAVE CORONARY HEART DISEASE THAN WOMEN
¨  SOCIO-ECONOMIC CLASS – POVERTY AND DEPRIVATION
¨  AGE – OLDER VS ADOLESCENT VS CHILD GROUP
¨  SEXUAL ORIENTATION – FEMALES (MATERNAL KNOWLEDGE AND CARE)
¨  GEOGRAPHIC ORIGIN
¨  GROUP HISTORY
¨  EDUCATION – EARLY EDUCATION ON GOOD EATING HABITS AND LIFESTYLE
¨  UPBRINGING – EARLY LIFE
¨  LIFE EXPERIENCE
B. SOCIO CULTURAL
¨  PERSONAL HYGIENE
¨  NUTRITION

¨  IMMUNIZATION

¨  SEEKING EARLY MEDICAL CARE

¨  FAMILY PLANNING

¨  CHILD REARING

¨  DISPOSAL OF EXCRETA AND REFUSE

LIFESTYLE
¨  IT IS COMPOSED OF CULTURAL AND BEHAVIORAL
PATTERS AND LIFE LONG HABITS
¨  LIFESTYLE ARE LEARNT THROUGH SOCIAL

INTERACTION WITH PARENTS, PEER GROUPS,

FRIENDS, SIBLINGS AND MASS MEDIA
¨  LIFESTYLE SOME TIMES IS HEALTH PROMOTING OR
HEALTH INHIBITING
LIFESTYLE
¨  BEHAVIORAL FACTORS
¤  INDIVIDUALSOCIAL BEHAVIOR
¤  DIRECT CONTROL

¤  E.G. SMOKING HABITS, ALCOHOL CONSUMPTION,

EATING HABITS, EXERCISE ROUTINES
¨  CULTURAL FACTORS
¤  INFLUENCES GROUPS WHO SHARE COMMON
BACKGROUND
¤  AS A RESULT OF NORMS AND VALUES WITHIN A
NEIGHBORHOOD OR COMMUNITY OR AGE GROUP
LIFESTYLE
¨  DEPENDS ON ECONOMIC STATUS (RICH AND
POOR)
¨  CULTURAL VALUES (VEGETARIAN AND NON-

VEGETARIAN)
¨  SOCIAL VALUES (STATUS OF WOMEN)

¨  PERSONAL HABITS (SMOKING, DRUGS OF ABUSE)

¨  BEHAVIORAL PATTERN (HIGH RISK BEHAVIOR)

 POP QUIZ
A. HEALTH PROMOTING
B. HEALTH INHIBITING

B 1.  SEDENTARY LIFESTYLE

B 2.  SMOKING HABITS
B 3.  SLEEP DEPRIVATION
A 4.  BALANCED DIET
I 5.  ALCOHOLISM
C. SOCIO ECONOMIC
C. SOCIO ECONOMIC
¨  HEALTH STATUS IS DETERMINED BY THEIR LEVEL OF
THEIR DEVELOPMENT PER CAPITA GNP,
EDUCATION, NUTRITION, EMPLOYMENT,
HOUSING, POLITICAL SYSTEM, ETC.
¨  STRUCTURAL DETERMINANTS THAT RESULT IN

UNEQUAL DISTRIBUTION OF MATERIAL AND

MONETARY RESOURCES
¨  SOCIOECONOMIC POSITION: EDUCATION,

OCCUPATION, INCOME, GENDER, RACE/

ETHNICITY AND SOCIAL CLASS
C. SOCIO ECONOMIC
1. ECONOMIC STATUS
Gross National Product

¨  GNP IS THE MOSTLY USED MEASURE OF ECONOMIC

PERFORMANCE
¨  ECONOMIC PROGRESS; A MAJOR FACTOR IN
REDUCING MORBIDITY, MORTALITY, INCREASING LIFE
EXPECTANCY AND IMPROVING QUALITY OF LIFE
¨  IT DETERMINES THE PURCHASING POWER,
STANDARD OF LIVING, QUALITY OF LIFE, FAMILY
SIZE, PATTERN OF DISEASES AND DEVIANT
BEHAVIOUR IN THE COMMUNITY
 C. SOCIO ECONOMIC
2. EDUCATION
¨  IT IS A FACTOR INFLUENCING HEALTH; ESPECIALLY
FEMALES
¨  THE WORLD MAP OF ILLITERACY CLOSELY
COINCIDES THE MAPS OF POVERTY,
MALNUTRITION, ILL HEALTH, HIGH INFANT, CHILD
AND MATERNAL MORTALITY RATES.
¨  EDUCATION COMPENSATES THE EFFECTS OF
POVERTY ON HEALTH IRRESPECTIVE OF THE
AVAILBALITY OF HEALTH FACILITIES
Single most important important modifiable social determinants of health
Income and Education are the two big one correlates strongly with life expectancy and most health status
measures under social
 EDUCATION DETERMINANTS
1. Literacy and language - this is understanding the health
information and how to access health services.
2. Early childhood development - develops good behavior
lifestyle towards health
3. Vocational training
4. Higher Education
5. Employment opportunities - more access to employment
with job security retirement plans and health measures.
INFLUENCE OF EDUCATION IN HEALTH
1. education leads to greater employment opportunities
2. education can improve health by increasing health knowledge link with social and
psychological factors that affects the health
3. mothers educational attainment decreases infant death rates and maternal mortality

so according to study for infants born to caucasian mothers with fewer than 12 years of
schooling or 2.4 times more likely to die before their first birthday then infants born to
mothers with 16 or more years of education including african, american, hispanic, american
indian and asian or pacific islander infants this is according to the study of NCHS.

another study conducted in the us and says that higher levels of education are associated with
better health or lower mortality.

and another is the high scoop of perry preschool project indicate beneficial outcomes even in
adolescence and adulthood such as your teenage pregnancy lower rates of high school
dropouts and better earnings and employment prospects which may independently improve
health chances.
C. SOCIO ECONOMIC
3. OCCUPATION/ EMPLOYMENT
¨  STATE OF BEING EMPLOYED IN PRODUCTIVE

WORK PROMOTES HEALTH

¨  THE UNEMPLOYED SHOW HIGHER INCIDENCE OF

ILL HEALTH AND DEATH

¨  FOR MANY LOSS OF WORK MAY MEAN LOSS OF
INCOME, STATUS AND MAY CAUSE PSYCHOSIAL
AND SOCIAL DAMAGE.
¨  HEALTHY WORK PLACE IS ALSO IMPORTANT
C. SOCIO ECONOMIC
4. POLITICAL SYSTEM
¨  HEALTH IS ALWAYS RELATED TO THE POLITICAL
SYSTEM
¨  OFTEN OBSTACLES TO IMPLEMENTATION OF HEALTH
TECHNOLOGIES ARE NOT TECHNICAL BUT RATHER
POLITICAL
¨  DECISIONS CONCERNING RESOURCE ALLOCATION,
MAN POWER POLICY, CHOICE OF TECHNOLOGY
AND THE DEGREE TO WHICH HEALTH SERVICES ARE
MADE AVAILABLE AND ACCESSIBLE TO DIFFERENT
SEGMENT OF SOCIETY ARE EXAMPLES OF A
POLITICAL SYSTEM
POP QUIZ
¨  WHAT ARE THE FOUR SOCIO ECONOMIC
DETERMINANTS? AND THEIR EFFECT ON HEALTH?
1) Economic status

2) Education

9) occupation / Employment
4) Political system
D. PSYCHOSOCIAL
 D. PSYCHOSOCIAL
¨  ENCOMPASSES THE MENTAL, EMOTIONAL, SOCIAL
AND SPIRITUAL DIMENSIONS OF WHAT IT MEANS
TO BE HEALTHY.
¨  IT IS THE RESULT OF COMPLEX INTERACTION
BETWEEN A PERSON S HISTORY AND HIS OR HER
THOUGHTS ABOUT AND INTERPRETATIONS.
¤  MENTAL (THINKING)
¤  SOCIAL (RELATING)
¤  SPIRITUAL (BEING)
¤  EMOTIONAL (FEELING)
psychosocial is pertains the influence of social factors on an individual's mind or behavior
and to the interrelation of behavioral and social factor that is according to oxford dictionary
Erikson's
stages of
psychosocial
development
D. PSYCHOSOCIAL
¨  PSYCHOSOCIAL DETERMINANTS
¨  GOAL FRUSTRATIONS,
¨  NEGATIVE LIFE EVENTS,

¨  UNEMPLOYMENT,
¨  STRESS,

¨  BEREAVEMENT,

¨  PESSIMISTIC EXPLANATORY STYLES,

¨  HARDINESS
D. PSYCHOSOCIAL
¨  TYPES OF DISEASES CAUSED BY PSYCHOSOCIAL
FACTORS:
¤  GASTROINTESTINAL DISORDER
¤  COMMON COLD
¤  CARDIOVASCULAR DISEASE

¤  CANCER

¤  LYMPHOCYTE FUNCTION

¤  PHYSICAL ILLNESS
D. PSYCHOSOCIAL
¨  STRESS
¤  CAUSES: STUDY, WORK, AND RELATIONSHIPS
¤  LEADS TO: ANXIETY, INSECURITY, LOW SELF ESTEEM,
SOCIAL ISOLATION, LACK OF CONTROL
¤  ALL WHICH AFFECTS HEALTH

¨  THOUGHTS, FEELINGS AND MOODS

SIGNIFICANTLY EFFECT:
¤  ONSETOF DISEASE
¤  COURSE OF THE DISEASE

¤  MANAGEMENT OF THE DISEASE

D. PSYCHOSOCIAL
¨  FACTORS AFFECTING PSYCHOSOCIAL HEALTH
1.  THE FAMILY – CHILDREN RAISED IN HEALTHY
NURTURING, HAPPY FAMILIES.
D. PSYCHOSOCIAL
2. MACRO ENVIRONMENT
¨  PERSISTENT STRESSORS, UNCERTAINTIES, AND

THREATS.
D. PSYCHOSOCIAL
3. SELF EFFICACY AND SELF ESTEEM

¨  SELF EFFICACY – BELIEF IN ONE S ABILITY TO

PERFORM A TASK SUCESSFULLY

¨  SELF ESTEEM – SENSE OF SELF-RESPECT AND SELF-

WORTH
D. PSYCHOSOCIAL
4. LEARNED HELPLESSESS AND LEARNED OPTIMISM

¨  LEARNED HELPLESSNESS - PATTERN OF

RESPONDING TO SITUATIONS BY GIVING UP
BECAUSE OF REPEATED FAILURE IN THE PAST

¨  LEARNED OPTIMISM – TEACHING ONESELF TO

THINK POSITIVELY
D. PSYCHOSOCIAL
5. PERSONALITY
¨  UNIQUE MIX OF CHARACTERISTICS THAT DISTINGUISH
YOU FROM OTHERS
¨  IT DETERMINES HOW WE REACT TO CHALLENGES OF
LIFE, INTERPRET OUR FEELINGS AND RESOLVE OUR
CONFLICTS
¤  EXTROVERSION
¤  AGREEABLENESS
¤  OPENESS TO EXPERIENCE
¤  EMOTIONAL STABILITY
¤  CONSCIENTIOUSNESS
¤  RESILIENCY
D. PSYCHOSOCIAL
6. LIFE SPAN AND MATURITY
¨  TRANSITION TO INDEPENDENCE

¨  REQUIRES SUCCESFUL COMPLETION OF TASK

¤  PROBLEM SOLVING
¤  EVALUATING DECISIONS
¤  DEFINING AND ADHERING PERSONAL VALUES

¤  ESTABLISHING CASUAL AND INTIMATE RELATIONSHIPS

POP QUIZ
¨  ENUMERATE THE DISEASES ASSOCIATED WITH
STRESS
¨  ENUMERATE THE POSSIBLE CAUSES OF STRESS
E. ENVIRONMENTAL
E. ENVIRONMENT
¨  HIPPOCRATES WAS THE 1ST TO RELATE DISEASE AND
ENVIRONMENT.

¨  THERE ARE TWO TYPES OF ENVIRONMENT:

1.  INTERNAL OR MICRO ENVIRONMENT – PERTAINS TO
THE EACH AND EVERY COMPONENT PART, EVERY
TISSUE, ORGAN, SYSTEM AND THEIR HARMONIOUS
FUNCTIONING.
2.  EXTERNAL OR THE MACRO ENVIRONMENT – INCLUDE
ALL THOSE THINGS MAN IS EXPOSED TO. MAYBE
DIVIDED INTO PHYSICAL, BIOLOGICAL AND
PSYCHOSOCIAL COMPOSITION.
E. ENVIRONMENT
EXTERNAL OR MACRO ENVIRONMENT
A.  PHYSICAL – AIR, WATER AND SOIL

B.  BIOLOGICAL – PLANTS, ANIMALS AND MICROBES

C.  SOCIAL – CULTURE, BELIEFS AND TRADITION

E. ENVIRONMENT
¨  IT IS ESTABLISHED THAT ENVIRONMENT HAS A DIRECT
IMPACT ON THE PHYSICAL, MENTAL AND SOCIAL
WELL BEING OF THOSE LIVING IN IT.
¨  THE ENVIRONMENTAL FACTORS INCLUDE:
1.  HOUSING
2.  WATER SUPPLY
3.  WASTE MANAGEMENT
4.  PSYCHOSOCIAL STRESS
5.  FAMILY STRUCTURE
6.  ECONOMIC SUPPORT SYSTEMS
E. ENVIRONMENT
¨  ENVIRONMENT QUALITY DETERMINANTS
¤  HAZARDOUS WASTE
¤  AIR POLLUTION
¤  WATER POLLUTION
¤  AMBIENT NOISE
¤  RESIDENTIAL CROWDING
¤  HOUSING QUALITY
¤  EDUCATIONAL FACILITIES
¤  WORK ENVIRONMENTS
¤  NEIGHBORHOOD QUALITY
ENVIRONMENTAL POLLUTION
• AIR POLLUTION
• WATER POLLUTION
AIR POLLUTION
AIR POLLUTION CATEGORY
¨  OUTDOOR POLLUTION
¨  INDOOR POLLUTION
AIR POLLUTION CONTAMINATION

¨  CHEMICAL
¨  PHYSICAL

¨  BIOLOGICAL
AIR POLLUTION VULNERABLE
GROUPS
¨  LARGEST ENVIRONMENTAL HEALTH RISK
¨  MILLIONS OF DEATH

¤  ELDERLY

¤  CHILDREN

¤  CHRONIC LUNG
¤  HEART DISEASE
OUTDOOR AIR POLLUTION
NATURAL HUMAN
(BIOGENIC) (ANTHROPOGENIC)

POLLEN INDUSTRY

BUSHFIRE BURNING
FOSSIL FUEL

MOTOR
DUST VEHICLE
ANTHROPOGENIC

PM Aka: SOOT NO2 CO

PARTICULATE NITROGEN DIOXIDE CARBON
MATTER •  VEHICLE EXHAUST MONOXIDE
•  INDUSTRY •  INDUSTRY •  INCOMPLETE BURNING
•  VEHICLE EXHAUST •  POWERPLANTS OF CARBON
•  DUST STORMS •  GAS STOVETOPS •  VEHICLE EXHAUST
•  BUSHFIRES •  INDUSTRY
can cause problems such as
•  DIAMETER wheezing coughing colds flu
•  INCINERATORS
•  PM5, PM 10, PM 2.5 and bronchitis •  BUSHFIRES
Less than 10 micrometer in can cause accidental or suicidal
diameter is the most harmful deaths which can induce little
sooth
coma within 5 minutes or more
 ANTHROPOGENIC

SO2 Pb O3
SULFUR DIOXIDE LEAD OZONE
•  BURNING OF •  METAL AND ORE •  SUNàCHEMICALS
SULFUR PROCESSING •  NATURALLY
CONTAINING •  CAR EXHAUST OCCURING
FUELS processing car exhaust amounting OZONE à
•  POWER PLANT of 10 microgram per dl in children PROTECTIVE
can cause low intellectual
•  REFINERIES capacity, hyperactivity and for
BARRIER
organizational skills They cause Release of inflammatory
they are released into the air it may be markers or ozone induced asthma
converted into sulfuric acid and wherein the airway hyperactivity
sulfuric trioxide they cause a burning and neutrophilia.
sensation in the nose and throat
difficulty in breathing and asthma
attacks in susceptible individuals
INDOOR AIR POLLUTION
¨  INADEQUATE VENTILATION
¨  HEAT HUMIDITY
¨  SOLID FUELS
¨  COOKING
¨  HEATING
¨  TOBACCO SMOKE most common exogenous cause
¨  PESTICIDES
¨  BUILDING MATERIALS
¨  ASBESTOS
¨  CLEANING PRODUCTS
Environmental Pollution
¨  Air pollution
¤  Sulfur dioxide,
¤  Carbon monoxide,
¤  Ozone- ozone that accumulates in the lower atmosphere
(ground-level ozone) is one of the most pernicious air
pollutants
¤  Nitrogen dioxide,
¤  Lead
¤  Particulate matter

¨  Collectively known as SMOG

Ozone toxicity
¨  Ozone toxicity is in large part mediated by the
production of free radicals,
¨  Causes release of inflammatory markers

¨  exposure is much more dangerous for people with

asthma or emphysema.
¨  Ozone-induced asthma is associated with airway
hyper-reactivity and neutrophilia
Sulfur Dioxide
¨ Sulfur dioxide is produced by power plants burning
coal and oil, from copper smelting, and as a
byproduct of paper mills.
¨  Released into the air, it may be converted into

sulfuric acid and sulfuric trioxide, which cause a

burning sensation in the nose and throat, difficulty in
breathing and asthma attacks in susceptible
individuals.
Particulate matter
¨  Particulate matter (known as soot ) is emitted by
coal- and oil-fired power plants, by industrial
processes burning these fuels, and by diesel
exhaust.
¨  Fine or ultrafine particles that are less than 10 m
in diameter are the most harmful .
Carbon monoxide
¨  CO is a nonirritating, colorless, tasteless, odorless
gas produced by the incomplete oxidation of
carbonaceous materials. Its sources include
automotive engines, industrial processes using fossil
fuels, wood and charcoal burning with an
inadequate supply of oxygen, and cigarette smoke
¨  CO is included here as an air pollutant, but it is also
an important cause of accidental and suicidal
death. In a small, closed garage, the average car
exhaust can induce lethal coma within 5 minutes
Lead
¨  There are many sources of lead in the environment,
such as from mining, foundries, batteries, and spray
painting, which constitute occupational hazards.
¨  Subclinical lead poisoning may occur in children

exposed to levels of lead below 10 g/dL,

causing low intellectual capacity, behavioral
problems such as hyperactivity, and poor
organizational skills. Especially in children
Tobacco
¨  Tobacco is the most common exogenous cause of
human cancers, being responsible for 90% of lung
cancers. The main culprit is cigarette smoking, but
smokeless tobacco (snuff, chewing tobacco, etc.) is
also harmful to health and an important cause of
oral cancer
¨  Smoking is the most preventable cause of human

death.
Tobacco
¨  Exposure to environmental tobacco smoke (passive
smoke inhalation) is also associated with some of the
same detrimental effects that result from active
smoking. It is estimated that the relative risk of lung
cancer in nonsmokers exposed to environmental
smoke is about 1.3 times higher than that of
nonsmokers who are not exposed to smoke.
HEALTH EFFECTS
¨  SHORT TERM
¨  LONG TERM

¨  MINOR EFFECTS

¤  EYE, NOSE THROAT IRRITATION

¨  MAJOR EFFECTS
¤  HEART OR LUNG DISEASE, CANCER
REDUCING AIR POLLUTION

GOVERNMENT INDUSTRY INDIVIDUALS

•  STANDARDS •  REDUCE •  REDUCING
•  REGULATION EMISSIONS RELIANCE ON
•  POLICIES •  PREVENT FOSSIL FUELS
•  CLEAN ENERGY ACCIDENTS
•  TECHNOLOGICAL
INNOVATION
AIR QUALITY MONITORING
¨  LAWS TO REGULATE AIR QUALITY
¨  AIR QUALITY STANDARDS

¨  SET BY EACH COUNTRY

¨  SPECIFY CONCENTRATION OF POLLUTANTS

¨  CRITERIA OF POLLUTANTS

¨  AQI -AIR QUALITY INDEX

WATER POLLUTION
WATER POLLUTION
¨  WATER POLLUTION
¤  CONTAMINATION OF BODIES OF WATER BODIES (E.G
LAKES, RIVERS, OCEANS, AQUIFERS AND
GROUNDWATER)
Water pollution
¨  Water that moves below the ground's surface
undergoes a filtering that removes most
microorganisms. For this reason, water from springs
and deep wells is generally of good quality.
¨  The most dangerous form of water pollution occurs

when feces enter the water supply

SOURCES OF WATER POLLUTION
¨  POINT – REFER TO THE POLLUTANTS THAT
BELONG TO A SINGLE SOURCE
¤  EMISSION FROM FACTORIES INTO THE WATER
¤  CITY STORM DRAIN
SOURCES OF WATER POLLUTION
¨  NON-POINT – NPS
¤  POLLUTANT EMITTED FROM MULTIPLE SOURCES.
¤  CONTAMINATED WATER AFTER RAINS THAT HAS
TRAVELED THROUGH SEVERAL REGIONS MAY ALSO
BE CONSIDERED AS A NON POINT SOURCE OF
POLLUTION
TYPES OF WATER POLLUTION
¨  NUTRIENT POLLUTION
¨  SURFACE WATER POLLUTION
¨  OXYGEN DEPLETING-
¨  GROUND WATER POLLUTION
¨  MICROBIOLOGICAL
¨  SUSPENDED MATER
¨  CHEMICAL WATER POLLUTION
¨  OIL SPILLAGE
¨  INDUSTRIAL WASTE (SULPHUR)
¨  SEWAGE AND WASTE WATER –WASTE WATER
¨  MINING ACTIVITIES- PROCESS OF CRUSHING ROCK AND EXTRACTING
COAL
¨  OCEAN AND MARINE DUMPING
NUTRIENT POLLUTION

WASTEWATER, FERTILIZERS, AND SEWAGE WITH HIGH LEVELS

OF NUTRIENTS. ALGAE AND WEED GROWTH IN THE WATER
WATER UNDRINKABLE AND CLOG FILTERS
Upon the decay of algae oxygen depletion happens in the shallow water during summer.
It favors the growth of dinoflagellates was also cause the red tide
¨  Eutrophication by biodegradable detergents:
Abundant accumulation of nutrients that support the
growth of algea and other organisms
¤  Upon the decay of algea, oxygen depletion happens in
the shallow water during summer.
¤  Eutrophication favors the growth of dinoflaggelates
which cause red tide.
SURFACE WATER POLLUTION

HAZARDOUS SUBSTANCES COMING IN

CONTACT WITH THE BODY OF WATER
OXYGEN DEPLETING

WHEN TOO MUCH BIODEGRADABLE MATTER (THINGS THAT EASILY DECAY)

ENCOURAGES MICROORGANISM GROWTH
AEROBIC ORGANISM DIE AND ANAEROBIC ORGANISM GROW MORE TO PRODUCE
HARMFUL TOXINS SUCH AS AMMONIA AND SULFIDES
GROUND WATER POLLUTION

PESTICIDES AND CHEMICAL TO SOILS WASHED

DEEP INTO THE GROUND BY THE RAIN
MICROBIOLOGICAL

PEOPLE DRINK UNTREATED WATER (STRAIGHT

FROM A RIVER OR STREAM)
MICRO ORGANISMS LIKE VIRUSES, BACTERIA
AND PROTOZOA
SUSPENDED MATTER

SUBSTANCES OR PARTICLES AND CHEMICALS

DO NOT EASILY DISSOLVE IN WATER
CHEMICAL WATER POLLUTION

POINT SOURCE POLLUTION

CHEMICALS USED TO CONTROL WEEDS, INSECTS AND PESTS
SULPHUR NON METALLIC SUBSTANCE THAT IS HARMFUL TO MARINE LIFE(INDUSTRIAL)
METALS AND SOLVENTS
OIL SPILLAGE

OIL SPILLS
DEATH TO FISH
CHEMICAL POLLUTION
Chemical Pollution
¨  Chemical Pollution . Industrial and agricultural
chemicals leached from the land enter water in
great amounts and in forms that are resistant to
biodegradation.
¨  Excessive nitrates from agricultural fertilizers

¤  When ingested, the nitrate is converted to nitrite by

bacteria in the gastrointestinal tract. Nitrite competes
for oxygen in the blood and is especially likely to harm
infants.
SEWAGE AND WASTE WATER

SEWAGE IS THE TERM USED FOR

WASTEWATER THAT OFTEN CONTAINS FECES,
URINE AND LAUNDRY WASTE
CHEMICALLY TREATED AND WITH
MICROORGANISMS
MINING ACTIVITIES

PROCESS OF CRUSHING THE ROCK AND

EXTRACTING COAL AND OTHER MINERALS
FROM UNDERGROUND
OCEAN AND MARINE DUMPING

PAPER WASTE, FOOD WASTE, PLASTIC,

RUBBER, METALLIC AND ALUMINUM WASTE
EFFECTS OF WATER POLLUTION
¨  DEATH OF AQUATIC ANIMALS
¨  DISRUPTION OF FOOD CHAIN

¨  DISEASES

¨  DESTRUCTION OF ECOSYSTEM
PREVENTION OF WATER POLLUTION

¨  NEVER THROW RUBBISH AWAY ANYHOW

¨  USE WATER WISELY

¨  DO NOT THROW CHEMICALS, OILS, PAINTS, AND

MEDICINES DOWN THE SINK OR DRAIN OR THE

TOILET
¨  BUY MORE ENVIRONMENTALLY SAFE CLEANING
LIQUIDS AT HOME
¨  DO NOT OVERUSE PESTICIDES AND FERTILIZERS
Water Treatment
¨  Coagulation and Filtration: The water then
undergoes flocculation with Aluminum potassium
sulfate, the removal of colloidal materials such as
clay, which is so small (smaller than 1O um) that it
would otherwise remain in suspension indefinitely.
¨  After flocculation, the water is treated with
filtration: passing it through beds of 2 to 4 feet of
fine sand or crushed anthracite coal.
¨  Ozone treatment: highly reactive form of oxygen
that is formed by electrical spark discharges and
UV light
¤  Leaves no taste or odor
¤  Primary disinfectant treatment followed by chlorination

¨  Chlorination: Before entering the municipal

distribution system, the filtered water is chlorinated.
¨  Water treatment plants produce ozone by passing dry
air between high-voltage electrodes in tanks called
ozonators
Sewage Treatment
¨  Screening out of large, floating materialsà
sedimentation tank to settle out more solid matter.
¨  Sludge: sewage solids collecting on the bottom
Biochemical Oxygen Demand (BOD)

¨  a measure of the biologically degradable organic

matter in water. Primary treatment removes about
25- 35% of the BOD of sewage.
¨  BOD is determined by the amount of oxygen

required by bacteria to metabolize the organic

matter.
¨  High BOD means high chance of eutrophication

once the water is released in the lake

Secondary Treatment
¨  Designed to decrease BOD and remove most
organic matter
¨  In this process, the sewage undergoes strong
aeration to encourage the growth of aerobic
bacteria and other microorganisms that oxidize the
dissolved organic matter to carbon dioxide and
water.
¨  Two Common Methods:
¤  Activated sludge system
¤  Trickling filter
Tertiary system
¨  Tertiary treatment is designed to remove essentially all
the BOD, nitrogen, and phosphorus.
¨  Tertiary treatment depends less on biological treatment
than on physical and chemical treatments. Phosphorus
is precipitated out by combining with such chemicals as
lime, alum, and ferric chloride. Filters of fine sands
and activated charcoal remove small particulate matter
and dissolved chemicals.
¨  Nitrogen is converted to ammonia and discharged in
to the air in stripping towers. Some systems encourage
denitrifying bacteria to form volatile nitrogen gas.
Finally, the purified water is chlorinated.
SOIL POLLUTION
SOIL POLLUTION
¨  THE CHANGE IN PHYSICAL, CHEMICAL AND
BIOLOGICAL CONDITION OF THE SOIL THROUGH
MAN S INTERVENTION RESULTING IN
DEGRADATION.
CAUSES OF SOIL POLLUTION
•  LANDSLIDES

NATURAL
•  HURRICANES

CAUSES

•  URBANIZATION

MANMADE
•  INDUSTRIAL WASTE
•  MINING
•  AGRICULTURAL WASTE

CAUSES •  DOMESTIC WASTE

•  GRABAGE GARBAGE
•  RADIOACTIVE WASTE
'
CONTROL MEASURES
¨  BIODEGRADABLE WASTES USED FOR BIOGAS
¨  NONBIODEGRADABLE WASTE MAY BE RECYCLED

¨  PLANTING OF TREES

¨  DISPOSAL OF HAZARDOUS RADIOACTIVE WASTE

¨  SOLID WASTE BE USED FOR ELECTRICITY

GENERATION
¨  MINIMISED THE USE OF CHEMICAL FERTILIZER AND

PESTICIDES
POP QUIZ
¨  ENUMERATE THE ENVIRONMENTAL FACTORS
¨  ENUMERATE THE AIR POLLUTANTS AND WATER

POLLUTANTS
F. CRISES AND DISASTERS
F. CRISES AND DISASTER
¨  DISASTER – CALAMITY, CATASTROPHE,
EMERGENCIES OR CRISIS
¨  A SUDDEN CALAMITOUS EVENT THAT CAUSES

SERIOUS DISRUPTION OF THE FUNCTIONING OF A

COMMUNITY OR A SOCIETY CAUSING
WIDESPREAD HUMAN, MATERIAL, ECONOMIC
AND ENVIRONMENTAL LOSES.
F. CRISES AND DISASTER
¨  CRISIS – ANY SITUATION THAT IS THREATENING
OR COULD THREATEN TO HARM PEOPLE OR
PROPERTY, SEROIUSLY INTERUPT BUSINESS,
DAMAGE REPUTATION AND/OR NEGATIVELY
IMPACT SHARE VALUE.

¨  RISK – AN EVALUATION OF THE PROBABILITY OF

OCCURRENCE AND THE MAGNITUDE OF THE
CONSEQUENCES OF ANY GIVEN HAZARD
F. CRISES AND DISASTER
¨  DISASTER MANAGEMENT – THE RANGE OF
ACTIVITIES DESIGNED TO MAINTAIN CONTROL
OVER DISASTER AND EMERGENCY SITUATIONS
AND TO PROVIDE A FRAMEWORK FOR HELPING
AT RISK PERSONS AVOID OR RECOVER FROM THE
IMPACT OF A DISASTER
¤  MITIGATION (MINIMIZING THE EFFECTS)
¤  PREPARATION/PREPAREDNESS (HOW TO RESPOND)

¤  RESPONSE (EFFORTS TO MINIMIZE THE HAZARDS)

¤  RECOVERY (RETURNING THE COMMUNITY TO
NORMAL)
F. CRISES AND DISASTERS
¨  DISASTERS DIRECTLY IMPACT THE HEALTH OF THE
POPULATION RESULTING IN PHYSICAL TRAUMA,
ACUTE DISEASE AND EMOTIONAL TRAUMA.
¨  DISASTERS MAY INCREASE THE MORBIDITY AND

MORTALITY ASSOCIATED WITH CHRONIC DISEASE

THROUGH THE IMPACT OF THE HEALTH CARE
SYSTEM
¨  DEATH, INJURIES, DISEASES, DISABILITIES,

PSYCHOSOCIAL PROBLEMS, AND OTHER HEALTH

IMPACTS CAN BE AVOIDED OR REDUCED BY
DISASTER RISK MANAGEMENT
TYPES OF HAZARDS/DISASTERS:
¨  NATURAL : EARTHQUAKE, LANDSLIDES, TSUNAMI,
CYCLONES, FLOOD OR DROUGHT
¨  BIOLOGICAL: EPIDEMIC DISEASE (SARS, INFLUENZA

H1N1 AND H5 N1), PANDEMIC DISEASE

(COVID-19) INFESTATION OF PESTS
¨  TECHNOLOGICAL:CHEMICAL SUBSTANCE,
RADIOLOGICAL AGENT, TRANSPORT CRASHES
¨  SOCIETAL: CONFLICT, STAMPEDES, ACTS OF

TERRORISM
F. CRISES AND DISASTER
¨  10 DEADLIEST NATURAL DISASTERS IN 2018
1.INDONESIA: EARTHQUAKE & TSUNAMI (SEPT. DEATHS: 2, 783)
2. INDONESIA: EARTHQUAKE (JULY DEATHS: 468)
3. INDONESIA: TSUNAMI (DEC. DEATHS: 430)
4. GUATEMALA: VOLCANIC ERUPTION (DEATHS: 425)
5. INDIA: FLOODS (DEATHS: 361)
6. JAPAN: FLOODS (DEATHS: 220)
7. NIGERIA: FLOODS (DEATHS: 200)
8. PAKISTAN: HEAT WAVE (DEATHS: 180)
9. NORTH KOREA: FLOODS (DEATHS: 151)
10. PAPUA NEW GUINEA: EARTHQUAKE (DEATHS: 145)
POP QUIZ
A. NATURAL
B. BIOLOGICAL
C. TECHNOLOGICAL
D. SOCIETAL
B 1.  COVID 19
D 2.  TERRORISM
A 3.  FLOOD
C 4.  CHEMICAL SUBSTANCE
A 5.  TSUNAMI
G. ACCESIBILITY TO HEALTH CARE
G. HEALTH SERVICES
¨  HEALTH AND FAMILY WELFARE COVER A WIDE
SPECTRUM OF PERSONAL AND COMMUNITY
SERVICES FOR TREATMENT OF DISEASES,
PREVENTION OF ILLNESS AND PROMOTION OF
HEALTH.
¨  THE PURPOSE OF HEALTH SERVICES IS TO
IMPROVE THE HEALTH STATUS OF THE
POPULATION
G. HEALTH SERVICES
¨  BOTH ACCESS TO HEALTH SERVICES AND THE
QUALITY OF HEALTH SERVICES CAN IMPACT
HEALTH.

¨  LACK OF ACCESS, OR LIMITED ACCESS, TO HEALTH

SERVICES GREATLY IMPACTS AN INDIVIDUAL S
HEALTH STATUS. FOR EXAMPLE, WHEN PEOPLE
DON T HAVE HEALTH INSURANCE THEY ARE LESS
LIKELY TO PARTICIPATE IN PREVENTIVE CARE AND
MORE LIKELY TO DELAY MEDICAL TREATMENT.
G. HEALTH SERVICES
¨  BARRIERS TO ACCESSING HEALTH SERVICES:
¤  LACK OF AVAILABILITY
¤  HIGH COST

¤  LACK OF INSURANCE COVERAGE

¤  LIMITED LANGUAGE ACCESS
G. HEALTH SERVICES
¨  THESE BARRIERS LEADS TO:
¤  UNMET HEALTH NEEDS
¤  DELAYS IN RECEIVING APPROPRIATE CARE

¤  INABILITY TO GET PREVENTIVE SERVICES

¤  HOSPITALIZATIONS THAT COULD HAVE BEEN
PREVENTED
LIST OF HEALTH SERVICES
THE PHILIPPINES HEALTH REVIEW SYSTEM

HEALTH SYSTEMS IN TRANSITION

VOL. 8 NO. 2 2018
G. HEALTH SERVICES
1. NATIONAL PROGRAMMES
¨  THESE ARE RUN BY THE DEPARTMENT OF HEALTH,

THAT PROVIDE LOCAL GOVERNMENT WITH

COMMODITIES, WHICH WERE PROCURRED IN
BULK AT THE NATIONAL LEVEL.
¤  IMMUNIZATION
¤  MATERNAL HEALTH
¤  TB

¤  MALARIA
G. HEALTH SERVICES
2. PATIENT PATHWAYS
¨  PERSONAL HEALTH SERVICES ARE PROVIDED BY

PUBLIC AND PRIVATE SECTORS, WHICH RUN

PARALLEL TO EACH OTHER ACROSS VARIOUS
LEVELS OF CARE IN A FREE-MARKET SITUATION.
G. HEALTH SERVICES
3. PRIMARY/AMBULATORY CARE
¨  IN THE URBAN SETTING AMABULATORY SERVICES

IS AVAILABLE IN HEALTH CENTRES OPERATED BY

THE CITY GOVERNMENT, PRIVATE CLINICS AND
OUTPATIENT DEPARTMENT OF PRIVATE HOSPITALS.

¨  ALSO THERE NOW EXIST MALL-BASED PRIMARY

CLINICS, WHICH OFFER A WIDE RANGE OF
DIAGNOSTIC SERVICES.
G. HEALTH SERVICES
4. INPATIENT CARE
¨  INPATIENT CARE IS AVAILABLE IN PUBLIC AND

PRIVATE HOSPITALS, WHICH ARE LOCATED IN

HIGHLY URBAN OR SEMI-URBAN SETTING.

¨  INPATIENT SERVICES COVER BOTH ORDINARY AS

WELL AS LIFE-THREATENING, CATASTROPHIC
CONDITIONS.
G. HEALTH SERVICES
5. PHARMACEUTICAL CARE
¨  MOST FILIPINOS AVAIL MEDICINES FROM A
PRIVATE RETAIL DRUGSTORE WHICH CAN BE
FOUND IN URBAN AND RURAL COMMUNITIES.
¨  MEDICINES ARE ALSO PROVIDED IN PUBLIC
FACILITIES INCLUDING HEALTH CENTRES AS WELL
AS DISTRICT AND PROVINCIAL HOSPITALS.
¨  LOCAL GOVERNMENTS ARE RESPONSIBLE FOR
ENSURING THE AVAILABILITY OF ESSENTIAL
MEDICINES IN THEIR HEALTH FACILITIES
G. HEALTH SERVICES
6. EXPANDED PROGRAM ON IMMUNIZATION (EPI)
¨  IMMUNIZATION SERVICES ARE AVAILABLE IN

PUBLIC HEALTH CENTRES NATIONWIDE.

7. MATERNAL HEALTH SERVICES

¨  PRIVATE HOSPITALS OR PUBLIC HEALTH FACILITIES
LIKE BIRTHING STATION PROVIDES ACCESS TO
DELIVERY AND PRENATAL CARE
G. HEALTH SERVICES
8. FAMILY PLANNING SERVICES
¨  AVAILABLE IN REGIONAL HEALTH CENTERS AS

WELL AS PUBLIC AND PRIVATE HOSPITALS

9. NATIONAL TUBERCULOSIS PROGRAM

¨  PERSONS WHO NEED ANTI-TB TREATMENT CAN
GO TO PUBLIC HEALTH CENTRES WHERE
DIAGNOSIS BY SPUTUM MICROSCOPY AND
MEDICINES SHOULD BE AVAILABLE
G. HEALTH SERVICES
10. MALARIA PREVENTION AND CONTROL
11. SCHISTOSOMIASIS PREVENTION AND CONTROL
12. HUMAN IMMUNODEFICIENCY/AIDS
PREVENTION AND CONTROL
¨  THE DOH HAS DESIGNATED 50 HUBS

NATIONWIDE WHERE ANTIRETROVIRAL MEDICINES

ARE AVAILABLE. THESE HUBS ARE FOUND IN
DESIGNATED PUBLIC HOSPITALS AND SOCIAL
HYGIENE CLINICS.
G. HEALTH SERVICES
13. EPIDEMIC SURVEILLANCE
¨  THERE IS A NETWORK OF EPIDEMIOLOGY

SURVEILLANCE UNITS COMPOSED OF UNITS AT

THE CENTRAL, REGIONAL, PROVINCIAL AND CITY
LEVELS.

14. NON COMMUNICABLE DISEASE PREVENTION

AND CONTROL
15. MENTAL HEALTH
G. HEALTH SERVICES
16. DISASTER RISK MANAGEMENT FOR HEALTH
¨  NDRRMC – NATIONAL DISASTER RISK REDUCTION

AND MANAGEMENT COUNCIL

¨  PHILIPPINE NATIONAL RED CROSS

¨  LOCAL GOVERNMENT UNITS

17. DRUG REHABILITATION

¨  A PERSON NEEDING REHABILITATION FOR

SUBSTANCE OF ABUSE WOULD FIND SERVICES IN

ANY OF THE 49 REHABILITATION FACILITIES IN THE
COUNTRY.
G. HEALTH SERVICES
18. EMERGENCY CARE
¨  GOVERNMENT EMERGENCY SERVICE

¨  AMBULANCE SERVICE (PRIVATE HOSPITALS)

19. LONG TERM CARE

¨  FOR THE ELDERLY, DISABLED PERSONS AND
CHRONICALLY SICK PERSONS
¨  THERE ARE NO PUBLIC FACILITIES

¨  RELIGIOUS AND PRIVATE FACILITIES

G. HEALTH SERVICES
20. PALLIATIVE CARE
21. DENTAL CARE
22. COMPLIMENTARY AND ALTERNATIVE MEDICINES
(CAM) AND TRADITIONAL MEDICINE
23. HEALTH SERVICES FOR SPECIFIC POPULATIONS
POP QUIZ
¨  WHAT ARE THE 4 NATIONAL PROGRAMMES OF
DOH? Immunization Maternal Health
, ,
malaria
tuberculosis ,

¨  WHAT ARE THE AGENCIES INCHARGE IN DISASTER

RISK MANAGEMENT?
¨  GIVE THE BARRIERS IN ACCESSING HEALTH

SERVICES lack of availability High

:
,
limited languor
cost
,
lack of insurance coverage ,

ge Access
-
H. EDUCATION
H. EDUCATION
¨  EDUCATION IS THE SECOND MAJOR
INFLUENCING FACTOR IN AFFECTING THE HEALTH
OF THE POPULATION
¨  THE WORLD MAP OF ILLITERACY CLOSELY

COINCIDES WITH THE MAPS OF POVERTY,

MALNUTRITION, ILL HEALTH, HIGH INFANT AND
CHILD MORTALITY RATES
¨  STUDIES INDICATES THAT EDUCATION TO SOME

EXTENT COMPENSATES THE EFFECTS OF POVERTY

ON HEALTH.
H. EDUCATION
¨  IS THE SINGLE MOST IMPORTANT MODIFIABLE
SOCIAL DETERMINANT OF HEALTH

¨  INCOME AND EDUCATION ARE THE TWO BIG

ONES THAT CORRELATE MOST STRONGLY WITH
LIFE EXPECTANCY AND MOST HEALTH STATUS
MEASURES
H. EDUCATION
¨  EDUCATION DETERMINANTS
¤  LITERACY AND LANGUAGE – UNDERSTANDING
HEALTH INFORMATION AND HOW TO ACCESS
HEALTH SERVICES.
¤  EARLY CHILDHOOD DEVELOPMENT – DEVELOPS
GOOD BEHAVIORS, LIFESTYLE TOWARDS HEALTH
¤  VOCATIONAL TRAINING

¤  HIGHER EDUCATION

¤  EMPLOYMENT OPPORTUNITIES – MORE ACCESS TO

EMPLOYMENT WITH JOB SECURITY, RETIREMENT
PLANS AND HEALTH INSURANCE.
H. EDUCATION
¨  INFLUENCE OF EDUCATION ON HEALTH
¤  EDUCATION LEADS TO GREATER EMPLOYMENT
OPPORTUNITIES
¤  EDUCATION CAN IMPROVE HEALTH BY INCREASING
HEALTH KNOWLEDGE
¤  LINKED WITH SOCIAL AND PSYCHOLOGICAL
FACTORS THAT AFFECTS HEALTH
¤  MOTHER S EDUCATIONAL ATTAINMENT DECREASES
INFANT DEATH RATES AND MATERNAL MORTALITY.
POP QUIZ
¨  ENUMERATE THE EDUCATION DETERMINANTS
1) literacy and language
2) Early Childhood Development
3) Vocational training
4) Higher Education
5) Employment Opportunities