CHAPTER 5: Public Health

Learning Objective
• Explain environmental engineering aspect within public health.

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 Health Determinant
•  Genetic
•  Behavioral
•  Social
•  Environmental
•  Personal health care

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 Public Health Definition
•  Public health can be defined as
–  An approach to health that aims to improve the health of an
entire nation
–  Involve activities: monitors, analyzes, and draws conclusions
about health concerns
•  Things that can pose a threat to public health range from
–  infectious disease outbreaks (e.g., influenza or Ebola viruses), to
–  chronic illnesses (e.g., heart disease, cancers, or diabetes), to
–  environmental disasters (e.g., hurricanes, tornadoes, or
earthquakes), to
–  biologic or chemical terrorism.

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 Public Health workforce

Important major areas of public health:
1.  Health Services
2.  Epidemiology – the science behind
public health
3.  Social/Behavioral Science
4.  Environmental Health
5.  Biostatistics
The Public Health System
Public Health System
Police
Home Health
EMS Community Churches Corrections
Centers MCOs
Health
Department
Parks

Schools
Elected
Doctors Hospitals Officials Nursing Mass Transit
Philanthropist Homes
Environmental
Civic Groups Health
CHCs Fire
Tribal Health
Economic
Laboratory Drug Mental Employers
Development
Facilities Treatment Health
 Public Health

•  Prevents epidemics and the spread

of disease

•  Protects against environmental

hazards

•  Responds to disasters and assists

communities in recovery
 Public Health

•  Prevents injuries

•  Promotes healthy behaviors

•  Assures the quality and accessibility

of health services
Core component of Public Health
POLICY
ASSESSMENT DEVELOPMENT
of the health of the
in the public’s interest
community

ASSURANCE
of the public’s health

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10 Essential Public health services

1.  Monitor health status to identify

community health problems

2.  Diagnose and investigate

health problems and health
hazards in the community

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10 Essential Public health services

3.  Inform, educate, and

empower people about
health issues

4.  Mobilize community partnerships

to identify and solve
health problems
10 Essential Public health services

5. Develop policies and

plans that support
health efforts

6.  Enforce laws and regulations that

protect health and
ensure safety
10 Essential Public health services

7.  Link people to personnel

health services and
assure the provision of
health care

8. Assure a competent public health

and health care
workforce
10 Essential Public health services

9.  Evaluate the effectiveness,

accessibility, and quality
of services

10. Research for new insights and

innovative solutions to
health problems
 PUBLIC HEALTH ‘POLICE POWERS”

1.  Inspections & closures

2.  Licensing & discipline of health professionals &
facilities
3.  Quarantine & isolation
4.  Vaccination, testing and treatment requirement
5.  Seizure, embargo and impounding of unsafe
substances
 Public Health vs. medical care
•  Skills are very often different
•  Public Health deals with populations, prevention and
policy, and includes research on all of these.
•  Treatment of individual patients is NOT its focus, but
rather populations at risk

 Public health Model

Public Health Medical

Model Versus Model
 MAJOR TYPES OF PUBLIC
HEALTH ACTIVITIES
1.  Surveillance
2.  Outbreak investigation
3.  Reference diagnosis and consultation
4.  Research (bench-to-field-to-prevention)
5.  Technical assistance & training (lab &
epidemiology)
6.  Initiate & support implementation projects
7.  Health policy and Health communication
•  [Philosophically founded on Epidemiology]
 1. surveillance
•  Ongoing systematic collection, analysis, interpretation and
dissemination of health data = information for action.
•  Provide info for descriptive epidemiology:
–  Person (age, sex, description)
–  Place (where)
–  Time (when)
•  Types of Surveillance:
1.  Active
2.  Passive
3.  Enhances passive
4.  Sentinel
5.  Syndromic : real-time indicator
 Why perform surveillance?
Because it can:
–  estimate the size of a health problem
–  determine where an illness is occurring
geographically
–  portray the natural history of a disease
–  detect epidemics or define a problem
–  generate hypotheses in research
–  monitor changes in infectious agents
–  detect changes in health practices
–  facilitate emergency planning

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 1. Surveillance System
•  Hospital syndromic
•  Environmental surveillance
surveillance
–  Water, air quality
–  Syndromes
•  24/7 phone duty
–  Diagnostic tests
•  Death surveillance
–  Bed and ventilator –  Pneumonia and influenza
availability
–  Unusual deaths
–  Prescription
pharmaceutical stocks/ –  Death certificates
usage •  OTC pharmaceutical
•  School surveillance surveillance
–  Absenteeism •  EMS surveillance
–  Syndromes •  ELCIDS food-borne disease
surveillance
•  Reportable disease
surveillance
 Environmental surveillance
•  Physical, chemical, biological, social, psychosocial and
aesthetic environment (air, water, sediment, aquatic biota,
wildlife, waste wastewater).
•  Covers policy and management practices, control and
prevention of environmental factors
 Terminology
used in epidemiology

•  Outbreak- cases number sudden increase in short time

•  Epidemic- larger cases number spread to wider area
•  Endemic- low incidence of disease constantly present in
population
•  Pandemic-disease spread cross the globe
•  Mortality- death incidence
•  Morbidity-fatal + nonfatal cases.
 Public health surveillance data
•  Voluntary reporting
•  Survey initiated by public health workers
•  Mandatory reporting
–  Highly communicable diseases
–  High mortality/morbidity rate diseases
–  Disease with strong public interest

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 What does ideal surveillance
system looks like?
•  Simple
•  Timely
•  Representative
•  Flexible
•  Sensitive
•  Strong predictive value
•  Acceptable to
–  The public
–  Health care providers
•  Cost-effective
•  Sensitivity
–  Few if any missed cases
–  Increased by having broad
case definitions
•  Positive predictive value
–  Almost all case reports
received for illnesses meet
the surveillance case
definition
–  Increased by adopting a
more restrictive case
definition
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 2. Outbreak investigation

The occurrence of more cases than is expected in a given
area over a period of time.

Types of Outbreak:
1.  Common source: everyone is exposed to same thing
2.  Propagated: spread gradually from a person to another
3.  Mixed: common source + propagation
4.  Others: zoonotic or vector-borne
 2. Outbreak investigation
Work flow:
Objectives:
1. Prepare for field work 1.  Describe the outbreak: person, place,
& time
2. Establish the existence of an outbreak
2.  Determine disease characteristics
3. Verify the diagnosis
•  Specific agent
4. Define and identify cases
•  Pathogenicity
1. Establish a case definition •  Incubation period
2. Identify and count cases •  Communicability
5. Perform descriptive epidemiology
6. Develop hypotheses 3.  Identify modes of transmission
7. Evaluate hypotheses •  Person-to-person/ Airborne/ Common
source (food or water)/Zoonotic/
8. Reconsider/refine hypotheses and Vector-borne
conduct additional studies
9. Implement control and prevention 4.  Identify additional cases and contacts
measures 5.  Identify the source of infection
10. Communicate findings 6.  Interrupt disease transmission—present
and future.

2. HOW TO CONTROL EPIDEMIC?

1.  Insect or animal reservoir- effective control by eliminate
them.
2.  Control transmission of pathogen
–  Food or water: water purification, pasteurised milk,
food protection law
–  Air-borne: difficult to control, wear mask
3.  Vaccination-tetanus, small pox, diphtheria, whooping cough,
polio myelitis
1.  MMR vaccine (mump, measles and rubella)
2.  HPV vaccine-given to young girl (prevent cervical
cancer) Signal flag called
‘YELLOW JACK’
4.  Quarantine- limit freedom of movement of infected
or LIMA
individual show ship is under
–  6 quarantinable diseases (international agreement) are: Quarantine.
1) smallpox, 2) cholera, 3) typhoid fever, 4) plague, 5)
yellow fever, 6) relapsing fever.

Prevention?
 Human Defence Against Disease
•  1st line of defence (ENVIRONMENTAL MANAGEMENT)- prevention. Apply
technology and art of science to control causative agent of disease in environment
before it gets to human. This use the environmental health element

•  2nd line of defence (PUBLIC HEALTH & PREVENTIVE MEDICINE)-based on human body
adaptation to prevent agent of disease. This include skin, mucous membrane, cilia,
tears- so, proper nutrition, good personal health practise, routine check up

•  3rd line of defence (PUBLIC HEALTH &PREVENTION MEDICINE)-if the 2nd defence are
not sufficient to prevent the entrance of pathogens, then use immunity (active and
passive) and phagocytosis (natural- leukocytes destroy pathogen in blood).

•  4th line of defence (CURATIVE MEDICINE)- when sick, need surgery-medication.
 The 1st line of defence vs. disease
•  Water quality management •  Water pollution control
•  Human waste disposal •  Environment safety & accident
prevention
•  Solid and hazardous waste management
•  Noise control
•  Rodent control
•  Housing hygiene
•  Insect control
•  Radiological health control
•  Milk sanitation
•  Recreational sanitation
•  Food quality management
•  Institutional environmental
•  Occupational health practice – assure healthy
management- prevent nosocomial
and safety of worker
infection
•  International travel sanitation
•  Land use management
•  Air pollution control
•  Product safety & consumer protection
•  Environmental planning
 Task to deal with Emerging
diseases
•  Surveillance at national, regional, global level
–  epidemiological,
–  laboratory
–  ecological
–  anthropological
•  Investigation and early control measures
•  Implement prevention measures
–  behavioural, political, environmental
•  Monitoring, evaluation
Public health Achievements

•  Vaccination

•  Safer Workplaces

•  Safer & Healthier Food

•  Motor Vehicle Safety

Public health Achievements

•  Control of Infectious
Diseases

•  Family Planning

•  Decline in Deaths from

Heart Disease & Stroke
Public health Achievements

•  Recognition of Tobacco Use

as a Health Hazard

•  Healthier Mothers and

Babies

•  Fluoridation of Drinking
Water
Current scenario of surveillance
system
•  Independent vertical control programmes?
•  Surveillance gaps for important diseases?
•  Limited capacity in field epidemiology, laboratory
diagnostic testing, rapid field investigations?
•  Inappropriate case definitions?
•  Delays in reporting, poor analysis of data and
information at all levels?
•  No feedback to periphery?
•  Insufficient preparedness to control epidemics?
•  No evaluation?
End of Chapter 5

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