PUBLIC HEALTH Education of the individual in personal hygiene
→ Organization of medical services for early
What is Health?
→ Persons are healthy when they are doing their
activities with no apparent symptoms of disease.
→ Health is a state of being well and free from
disease (oxford students dictionary, 1991)
From professional’s point of view:
→ A measure of the state of the physical bodily
organs, and the ability of the body as a whole to
function
→ It refers to freedom from medically defined
diseases.
→ WHO: Health is a state of complete physical,
mental, and social well-being and not merely the
absence of disease or infirmity
→ The enjoyment of the highest attainable standard
of health is one of the fundamental rights of every
human being without distinction of race, religion,
political belief, economic or social condition.
→ Health of all people is fundamental to the
attainment of peace and security and is
dependent on the fullest co-operation of
individuals and States.
→ The extension to all people of the benefits of
medical, psychological and related knowledge is
essential to the fullest attainment of health
→ Informed opinion and active co-operation on
the part of the public are of the utmost importance in
the improvement of the health of the people
→ Governments have a responsibility for the health
of their peoples which can be fulfilled only by the
provision of adequate health and social measures.
Dimensions of Health
What is Public Health?
→ “The science and art of preventing disease,
prolonging life and promoting health through the
organized efforts and informed choices of society,
organizations, public and private communities, and
individuals.” - CEA Winslow, 1920
How?
→ The sanitation of the environment
→ Control of communicable infections →
diagnosis and preventive treatment of disease →
Development of the social machinery to ensure
everyone a standard of living adequate for the
maintenance of health
The Mission of Public Health
→ “Fulfilling society’s interest in assuring
conditions in which people can be healthy.” -
Institute of Medicine
→ “Public health aims to provide maximum
benefit for the largest number of people.” -
World Health Organization
History of Public Health
Sanitation and Environmental Health → 500
BCE: Greeks and Romans practice community
sanitation measures
→ 1840s: The Public Health Act of 1848 was
established in the United Kingdom
→ 1970: The Environmental Protection Agency
was founded
Pandemics
→ Influenza: 500 million infected worldwide in
1918
→ Polio: Vaccine introduced in 1955; eradication
initiative launched in 1988 → HIV: 34 million
living with HIV worldwide; 20% decline in new
infections since 2001
Preparedness for Disaster Response →
Biologic Warfare: Plague used as a weapon of
war during the Siege of Kaffa
→ September 2001: Public health surveillance
conducted after the 9/11 attacks
→ Hurricane Katrina: Emergency services,
public health surveillance, and disease treatment
provided
Prevention Through Policy
→ Book of Leviticus: The world’s first written
health code
→ Tobacco Laws: Laws banning smoking in
public places
→ Obesity: Food labeling and promotion of
physical activity
Public Health Core Sciences (pic)
→ Prevention Effectiveness
→ Epidemiology
→ Laboratory
→ Informatics
→ Surveillance
Public Health Approach
 (10)Research

Core Functions at Government Levels

Assessment Policy Assurance
Development

Federal National Smoking Federal

tobacco ban on grants
public commercial for
health flights antismo
surveillance kin g
Cholera — A Public Health Approach → Cholera, research
a fatal intestinal disease, was rampant during the
early 1800s in London, causing death to tens of
State Monitor Increase Funding
thousands of people in the area. Cholera was state tobacco tax for
commonly thought to be caused by bad air from tobacco use campaign
rotting organic matter. through
Propositi
John Snow, Physician on 99
→ John Snow is best known for his work tracing the
source of the cholera outbreak
Local Report on County Resources
→ father of modern epidemiology local laws to help
tobacco use prohibitin smokers
Intervention Evaluation — What Works? g quit
smoking in in
Through continuous research, Snow understood bars multiple
language
what interventions were required to:
s
● stop exposure to the contaminated water supply
on a larger scale, and
● stop exposure to the entire supply of
Partners in the Public Health System
contaminated water in the area

John Snow’s research convinced the British

government that the source of cholera was water
contaminated with sewage

Core Functions and Essential Services of

Public Health

Three Core Functions of Public Health Nongovernmental Organization

(1) Assessment Examples
→ Systematically collect, analyze, and make Health Care as a Partner in Public Health
available information on healthy communities (2)
Policy Development
→ Promote the use of a scientific knowledge
base in policy and decision making
(3) Assurance
→ Ensure provision of services to those in need

Ten Essential Public Health Services/ Core

Functions
(1) Monitor Health
(2) Diagnose and Investigate
(3) Inform, Educate, Empower
(4) Mobilize Community Partnership
(5) Develop Policies Other Partners in Public Health
(6) Enforce Laws
(7) Link to/Provide Care Media
(8) Assure a Competent Workforce → Vehicle for public discourse
(9) Evaluate
→ Health education and promotion → This resolution decided that the main
→ Health communication social targets of governments and the WHO
→ Social media as catalyst should be the attainment by all the people of
the world by the Year 2000 a level of health
Employers and Businesses that will permit them to lead a socially and
→ Employer-sponsored health insurance economically productive life.
programs → Wellness initiatives and benefits
→ Healthy workplaces and communities September 12, 1978
→ International Conference in Primary
Government Agencies Health Care was held at Alma Ata,
→ City planning Kazakhstan, USSR.
→ Education → This conference came up with ALMA ATA
→ Health in all policies DECLARATION which represents a global
idea about how to achieve world health.
Academia → It was sponsored by the World Health
→ Education Organization and UNICEF
→ Training
→ Research
ALMA ATA DECLARATION
→ Public Service
→ The main goal of governments and world
health organization in the coming dacades
should be the attainment by all people of the
world by the year 2000, a level of health that
Determining and Influencing the Public’s Health
would permit them to lead a socially and
economically productive life
Health Determinants
→ 51st WHA in 1998 reaffirmed the
→ Genes and biology
declaration for the 21st century
→ Health behaviors
→ Social or societal characteristics
Objectives of Alma Ata
→ Health services or medical care
● To promote the concept of primary health care ●
To evaluate the present health care situation ● To
What Determines the Health of a Population?
define the principles of primary health care ● To
Health Impact Pyramid
define the roles of governmental, national and
international organizations
● To formulate recommendations for the
development

1979
→ The World Health Organization (WHO) launched
the Global Strategy for Health for All.

Philippines’ response to PHC

→ PHC was adapted in the Philippines through Letter
of Instruction 949, signed by Pres. Ferdinand E.
Marcos, on October 19, 1979

Primary Health Care

→ “an essential health care made universally
accessible to individuals and families in the
community by means acceptable to them through
their full participation and at a cost that the
community and country can afford to maintain at
every stage of their development in the spirit of
self-determination.”- WHO

→ Framework: People’s empowerment and

partnership is the Key strategy to achieve the GOAL,
Health as a Human Right: Alma
Ata Declaration “Health for all Filipinos by the year 2000 and Health
in the Hands of the People by the year 2020”
May 1977
→ The 30th World Health Assembly adopted Mission of PHC
Resolution WHO 30:43 → PHC aims to strengthen the health care system
 by increasing opportunities and supporting
conditions wherein people will manage their own
health care.
Ottawa Charter for Health Promotion 1986 →
The first International Conference on Health
Promotion, meeting in Ottawa this 21st day of
November 1986, hereby presents this CHARTER for
action to achieve Health for All by the year 2000 and
beyond.
→ This conference was primarily a response to
growing expectations for a new public health
movement around the world.
→ Discussions focused on the needs in industrialized
countries, but took into account similar concerns in
all other regions.
Health Promotion
→ process of enabling people to increase control
over, and to improve, their health.
→ To reach a state of complete physical, mental and
social well-being, an individual or group must be able
to identify and to realize aspirations, to satisfy needs, political environment.
and to change or cope with the environment.
→ Health is a positive concept emphasizing environments for health.
social and personal resources, as well as
physical capacities.
→ Therefore, health promotion is not just the
responsibility of the health sector, but goes
beyond healthy life-styles to well-being.
These strategies are supported by five
priority action areas as outlined in the
Ottawa Charter for health promotion:
1. Build Healthy Public Policy
2. Creative supportive environments for
health
3. Strengthen community action for health
4. Develop personal skills
5. Re-orient health services
Healthy Public Policy
→ pre-requisite for successful health promotion
→ characterized by a concern for health and
equity and an accountability for health impact. →
According to the Adelaide Conference (1988),
“The main aim of HPP is to create a supportive
environment to enable the people to lead healthy
lives. Healthy choices are thereby made possible
and easier for citizens”.
Create Supportive Environment
→ A supportive environment is essential for health.
→ It covers the physical, social, economic, and
→ Everyone has a role in creating supportive
Strengthen Community Action:
Community Participation
→ According to the Ottawa Charter, “health
promotion works through concrete and effective
community action in setting priorities, making
decisions, planning strategies and implementing
them to achieve better health”.
→ Full community participation occurs when
communities participate in equal partnership with
health professionals as stakeholders in setting the
health agenda. A Definition (Rifkin et al. 1988)
Develop Personal Skills
→ Skills which can promote an individual’s health
include those pertaining to identifying, selecting and
applying healthy options in daily life.
→ Health education is life-long, so that people
can develop the relevant skills to meet the health
challenges of all stages of life, and to be able to
cope with chronic illness and disabilities.
→ “Health education should be conducted in all
settings.”
Reorient Health Services
→ Shift of emphasis from provision of curative
services.
→ Health care system must be equitable and
client-centered.
3 GUARANTEES
(1) Population and individual-level interventions for
all life stages that promote health and wellness,
 prevent and treat the triple burden of disease,
dela complications, facilitate rehabilitation and
provide palliation
(2) Access to health interventions through
functional service Delivery Network
(3) Financial freedom when accessing these
intervention through Universal Health Insurance
Philippine Health Agenda (2016-2022)
ACHIEVE
What should be the public health
activities of a Pharmacist?
→ In 1981, the role of the pharmacist in
public health is defined by the American
Public Health Association (APHA). This
association outlined that the role of the
pharmacist is now escalating beyond the
dispensation and distribution of medicines,
and health supplies.
→ A pharmacist can provide many
services to public health that may include
pharmacotherapy, provide care, and
prevention measures.

Activities where pharmacists can play

an important role to promote public
health:

Population-based Care:
→ The Center for Advancement in
Pharmaceutical Education (CAPE)
Educational Outcomes suggested that
pharmacists should involve in both
patient-based and population-based care.

Pharmacist’s Role in Public Health

→ Pharmacists can support public health efforts

using designing and providing disease management
programs.

Prevention of Disease and Medication Safety: →

They can help in the establishment of some
screening programs to check out the status of
immunization, and identification of some
undiagnosed medical conditions.
→ Medication safety and error prevention

Health Education:
→ Health-system pharmacists can educate their
health care colleagues about the safe and effective
use of medication that further improves use of
medications.
→ The pharmacists can also educate community
leaders like public office holders, legislators, school
officials, regulators, and religious leaders who
involve in public health customs.
Public Health Policy:
→ Health-system pharmacists can participate in the
development of public health policy concerned with
local boards of health as well as national programs.
→ Example: best management practices in the
proper handling and disposal of hazardous drugs.

Research and Training:

→ A health-system pharmacist must get adequate
education and training to carry out his responsibility
in public health.
→ Health-system pharmacists should be expertise in
pharmacoepidemiology, research methodology, and
biostatistics with their applications in decision related
to public health.
→ Bush and Johnson characterized public health
pharmacy services as occurring on micro and macro
levels.

→ Micro-level activities emphasizing the wellbeing

of the patient occur frequently; examples are tobacco
cessation efforts, immunizations, health screening
and referral, health education, patient counseling,
and monitoring and responding to adverse drug
events in an institution

→ In contrast, macro-level functions involve

assessment, identification, and prioritization of the
public health needs in a community or population.

→ Formulating appropriate policies, plans, and

programs to meet those needs; administering and
evaluating the health program; and making the
necessary improvements and changes at the macro
level can support subsequent improvements in
community service programs, program evaluation,
and research activities

MARCOS ADMINISTRATION ● Vision of the Filipinos for their country: "The

Philippines shall be a country where all citizens
Ambisyon Natin 2024 are free from hunger and poverty, have equal
What is this Ambisyon Natin 2040? opportunities, enabled by a fair and just society
that is governed with order and unity. A nation
● It is a Vision, not a Plan where families live together, thriving in vibrant,
→ what Filipinos want to be culturally diverse, and resilient communities."
→ what Filipinos want to have
→ what Filipinos want to do ● The Life We Want: Prosperous, predominantly
middle class society where no one is poor, and
● Over the next 25 years for themselves and for where peoples live long and healthy lives in a
their country society that is trustworthy, smart, and innovative.

● Vision of the Filipinos for themselves: "In 2040, (1) Matatag

we will all enjoy a stable and comfortable ✓ Family is together
lifestyle, secure in the knowledge that we have ✓ Time with friends
enough for our daily needs and unexpected ✓ Work-life balance
expenses, that we can plan and prepare for our ✓ Strong sense of community
own and our children's future. Our family lives
together in a place of our own, and we have the (2) Maginhawa
freedom to go where we desire, protected and ✓ Free from hunger and poverty
enabled by a clean, efficient, and fair ✓ Secure home ownership
government." ✓ Good transport
✓ Travel and vacation
 resources for health development
(3) Panatag Invest in e health and data for decision
✓ Enough Resources for day-to-day needs and making
unexpected expenses Enforce standards, accountability and
✓ Peace and security transparency
✓ Long and healthy life
✓ Comfortable retirement Value all clients and patients, especially the poor,
marginalized and vulnerable
● ..matatag, maginhawa at panatag na buhay Elicit multi sectoral and multi stakeholder support
MATATAG for health
Own at least one car
Have enough money for day- to-day needs +
contingencies OUTCOMES:
● Estimates on average life expectancy at birth increased
Own a medium-sized home
in 2015–2020 relative to 2010–2015, but these still fell
below target.
MAGINHAWA
● Mortality rates among neonates, infants, and children
Decent work under five remained virtually unchanged between 2017
All children can finish college and 2022.
● The maternal mortality ratio increased to 144 per
PANATAG 100,000 live births (LB) in 2020 from 108 in 2018
Relax with family and friends ● The prevalence of modern family planning (MFP) use
Business owner among women of reproductive age slightly decreased
Able to take occasional trips around the by 0.6 percentage points (ppt) between 2017 and
country 2022, the fertility rate decreased from 2.7 children per
woman in 2017 to 1.9 in 2022.
● From vision to action Long-term ● LB among adolescent mothers aged 15–19 years old
Developmental Goals also decreased from 47 per 1,000 women in 2017 to
25 in 2022.
→ By 2040, Philippines will be: A prosperous,
predominantly middle-class society where no Slow progress was seen in childhood nutrition
one is poor; outcomes, with potentially lifelong health, education,
A healthy and resilient society; and, ultimately, economic effects. ● From 2015 to 2021,
A smart and innovative society, and the prevalence of stunting
among children under five years old decreased from
A high trust society.
33.4 to 26.7
● Wasting from 7.1 to 5.5 percent while overweight
remained at 3.9 percent.

Childhood immunization coverage has remained under

target.
● Proportion of fully immunized children (with basic
antigens) increased by two ppt in 2022 compared to
the 2017 baseline of 70 percent; it still did not meet the
95 percent target.

The triple burden of disease— communicable

diseases, noncommunicable diseases (NCD), and
globalization-related health conditions like
pandemics—continue to be a priority public health
concern.
● The PHILIPPINE HEALTH AGENDA → (AO ● NCDs related to unhealthy lifestyles and environments
2016-0038) aims to make universal health care and an increasingly ageing population are currently the
a reality felt by every Filipino, especially the leading cause of mortality among Filipino adults—and
poor and the marginalized. → ALL FOR the burden is increasing.
HEALTH TOWARDS HEALTH FOR ALL ● A rise in recorded incidence of tuberculosis (TB) from
2016 to 2020
● ACHIEVE
Advance quality, health promotion and Conditions directly related to urbanization,
primary care globalization, and the environment are also growing in
Cover all filipinos against health related importance, with disproportionate
financial risk vulnerability among poor households and
Harness the power of strategic human marginalized communities.
● Health risks from poor air quality and congested living
conditions are increasing, especially in urbanized
areas.
● Incremental increases in temperature and changing
rainfall regimes impact health directly and affect
livelihood
Major health sector reforms and plans intended to
improve financial protection and access to healthcare
services are being pursued, but significant obstacles
to implementation remain.
● Universal Health Care (UHC) Law (RA 11223) ●
Mental Health Act (RA 11036)
● National Integrated Cancer Control Law (RA 11215)
● First 1,000 Days Law (RA 11148)
● New Sin Tax Reform Law of 2020 (RA 11467)
→ which seeks to expand the country’s nutrition and health
programs to cover children from the first day of the 1. DEVELOP AND PROTECT CAPABILITIES OF
mother’s pregnancy to the their first two years
● Mandatory Reporting of Notifiable Diseases and Health
Events of Public Health Concern Act (RA 11332),
● Philippine Health Facilities Development Plan (PHFDP
2020–2040), and the
● National Human Resources for Health Master Plan
(NHRHMP 2020–2040).
→ The effectiveness of these reforms is limited by
fragmented health systems that hamper coordinated
planning and services, inequitable access to quality
primary- and higher-level health care services, and a lack
of sustained financing for local health interventions.13
Moreover, high variations in local government unit (LGU)
investments and actions for health persist, with damaging
effects on already-vulnerable communities and
populations.
There are sustained and growing gaps in absolute number
and inequitable distribution of health infrastructure and
human resources for health.15 The shortfall impedes 2.
progress in implementing No Co-payment policies in both
private and government hospitals, prevents delivery
systems from adjusting quickly to surges in health demand,
and further compromises health outcomes
already-vulnerable communities. Factors affecting the
maldistribution of health workers include disparities in pay
between private and public sectors, within the public sector,
and between national and local levels; limited capacity of
LGUs to hire health and nutrition workers; and poor
working conditions.
Gains from previously enacted health system reforms
in health care financing and service delivery are not 3. → PRACTICE GOOD GOVERNANCE AND
yet maximized.
● For example, Sin Tax Law
● Conditional cash grants (4P’s)
→ Health grant: 500/household
→ Education grant: 300/child (10 months) Max: 3
children
1. Pregnant women must avail pre- and post-natal
care, and be attended during childbirth by a
trained professional;
2. Parents or guardians must attend the family
development sessions, which include topics on
responsible parenting, health, and nutrition;
3. Children aged 0-5 must receive regular preventive
health check-ups and vaccines;
4. Children aged 6-14 must receive deworming pills
twice a year; and
5. Children-beneficiaries aged 3-18 must enroll in
school, and maintain an attendance of at least
85% of class days every month.
STRATEGY FRAMEWORK OF PHILIPPINE
GOVERNMENT PLAN 2023-2028
ECONOMIC AND SOCIAL TRANSFORMATION FOR
A PROSPEROUS, INCLUSIVE, AND RESILIENT
SOCIETY
INDIVIDUALS AND FAMILIES
a. PROMOTE HUMAN AND SOCIAL DEVELOPMENT
→ BOOST HEALTH
→ IMPROVE EDUCATION AND LIFELONG
LEARNING
→ ESTABLISH LIVABLE COMMUNITIES
b. REDUCE VULNERABILITIES AND PROTECT
PURCHASING POWER
→ ENSURE FOOD SECURITY AND PROPER
NUTRITION
→ STRENGTHEN SOCIAL PROTECTION
c. INCREASE INCOME-EARNING ABILITY →
INCREASE EMPLOYABILITY
→ EXPAND EMPLOYMENT OPPORTUNITIES →
ACHIEVE SHARED LABOR MARKET
GOVERNANCE
TRANSFORM PRODUCTION SECTORS TO
GENERATE MORE QUALITY JOBS AND
COMPETITIVE PRODUCTS
a. MODERNIZE AGRI-BUSINESS
in b. AGRICULTURE AND REVITALIZE INDUSTRY c.
REINVIGORATE SERVICES
→ a,b,c
→ PROMOTE TRADE AND INVESTMENTS →
ADVANCE R&D, TECHNOLOGY, AND
INNOVATION
→ ENHANCE INTER-INDUSTRY LINKAGES →
PROMOTE COMPETITION AND IMPROVE
REGULATORY EFFICIENCY
IMPROVE BUREAUCRATIC EFFICIENCY →
ENSURE MACROECONOMIC STABILITY AND
EXPAND INCLUSIVE AND INNOVATIVE
FINANCE
→ ENSURE PEACE AND SECURITY, AND
ENHANCE ADMINISTRATION OF JUSTICE →
EXPAND AND UPGRADE INFRASTRUCTURE
→ ACCELERATE CLIMATE ACTION AND
STRENGTHEN DISASTER RESILIENCE
 → the
Magna Carta for Public Health Workers (RA 7305 Nursing
Practice Act (RA 9173), and Barangay Heal Workers and
Benefits Act (RA 7883)

→ The social determinants of health refer to

“non-medical factors that influence health outcomes.”23
Settings that promote well-being and make
health-promoting opportunities and alternatives available
to households require collaborative and coordinated
action between national and local governments, as well
as government and private entities. Strategies include
enabling active transport environments, livable
communities, and efficient transportation; promoting safe
and conducive working and learning spaces for all
Filipinos; and ensuring access to safe drinking water,
basic sanitation, and nutritious food choices
→ Health literacy describes the ability to access, apprais → (a)
translate basic health research into practical aspects; (b)
promote low-cost and climate resilient innovations for
remote populations and vulnerable sectors based on
projected health needs and service delivery gaps in the
medium term; and (c) improve capacity for high quality
local vaccine and medicine development and production
(See Chapter 8)
Epidemiology
and correctly apply Comes from Greek words
health information. It is key to patie empowerment, healthy → epi = “on or upon”
behaviors, and appropria self-care. Well-designated, → demos = “people”
targeted, gender- an culture-sensitive social and behavior → logos = “the study of”
chang communication campaigns using multiple → Study of distribution and determinants of
communicatio media will continuously be implemented to health-related conditions or events on populations
encourag individuals and households to live healthily and
make goo choices for health. Existing platforms, such as but DEFINITION
n limited to the Pantawid Pamilyang Pilipino Program Family “the study of distribution and determine of health-related
Development Sessions, will be maximized fo health states or events in specific populations, and the
promotion and advocacy among poorer application of this study to control of health problems”

→ Three important components included in these

definitions are:
(1) Frequency
(2) Distribution → to improve medical care and provide administrative
(3) Determinants guidance for community health services
→ to promote the health and well being of society as a
→ The first component to be considered is measurement whole
of disease frequency, which involves quantification of the
occurrence of disease.
→ The second component is distribution of disease in Purposes of Epidemiology
terms of time, place, and person- who is getting the 1. To investigate nature / extent of health-related
disease, where and when the disease is occurring. phenomena in the community / identify priorities 2. To study
→ The third component, the determinant of disease natural history and prognosis of health-related problems
derives from the first two, since knowledge of frequency 3. To identify causes and risk factors
and distribution of disease is necessary to test an 4. To recommend / assist in application of / evaluate best
epidemiological hypothesis. interventions (preventive and therapeutic measures)
5. To provide foundation for public policy
Component:
→ Disease Frequency Scope of Epidemiology
● Rate and Ratio e.g Disease definition: characteristics or combination of
● Rate - incidence rate, prevalence rate etc character that best discriminate disease from non
● Ratio - sex ratio, doctor-population ratio diseased
Disease occurrence: the rate of development of new
→ Distribution of Disease cases in the population. The proportion of current
Disease in community → find causative factor v disease within population
Generate hypothesis Disease causation: the risk factors for disease
v development and their relative strength with respect to an
Descriptive epidemiology individual and population
Disease outcome: the outcome following disease onset
→ Determinants of Disease
and of the risk factors.
To test hypothesis
v Disease management: the relative effectiveness of
Analytic epidemiology proposed therapeutic interventions
v Disease prevention: the relative effectiveness of
Help in develop sound scientific program History proposed preventive strategies including screening

→ Hippocrates (circa 400 B.C.) attempted to explain Functions/Uses of Epidemiology

disease occurrence from a rational instead of a 1. To find causation of the disease
supernatural viewpoint 2. To describe natural history
→ John Graunt, a London haberdasher, published his 3. Description of health status of populations 4.
landmark analysis of mortality data in 1662. He was the Evaluation of intervention
first to quantify patterns of birth, death, and disease 5. Community diagnosis
occurrence, noting male-female disparities, high infant 6. Planning and evaluation
mortality, and seasonal variations 7. Investigate epidemics of unknown etiology 8.
Elucidate mechanism of disease transmission
Mid 1800’s
→ William Farr began to systematically collect and Epidemiologic Information
analyze Britain’s mortality statistics. → John Snow, an Case definition
anesthesiologist, conducted a series of investigations in Person
London that later earned him the title “the father of Place
epidemiology.” → discipline did not flourish until the end Time
of the Second World War
1. Case Definition
Aims of Epidemiology → Standard set of criteria
To describe the distribution and size of disease problems → Clinical and lab
in human populations. (Descriptive epidemiology) → Allows for comparison
To identify the etiological factors in the pathogenesis of
disease (Analytical epidemiology) Case Definition example:
To provide the data essential in planning, implementation → Smallpox
and evaluation of services for the prevention, control and → Clinical Description: An illness with acute onset
treatment of disease and setting up priorities among of fever >101 °F followed by a rash characterized by
those services. (Experimental epidemiology) vesicles or firm pustules in the same stage of
The ultimate aim of epidemiology is development without other apparent cause.
→ to eliminate or reduce the health problem or its → Laboratory Criteria for Confirmation: Isolation
consequences of smallpox (variola) virus from a clinical specimen,
or
 disease in a population, and observing the basic features
Case Definition Gradient of its distribution
→
Analytic epidemiology: investigating a hypothesis about
the cause of disease by studying how exposures relate to
disease
2. Person Descriptive epidemiology is antecedent to analytical
→ Age epidemiology: analytical epidemiology studies require
→ Sex information to ...
→ Race/Ethnicity → know where to look
→ Socio-Economic Status → know what to control for
→ Behaviors → develop viable hypotheses

3. Place Descriptive Epidemiology

→ Geographic Distribution organize and summarize data according to time, place,
~ Natural and person
~ Clustering vs. uniform (1) Time – disease rates change over time – the seasonal
→ Home increase in influenza with the onset of cold weather
→ Work → time data is usually shown on a graph
→ School
→ Hospital room (2) Place - describe a health event by place to gain insight
into the geographical extent of the problem.
Geographic Distribution → Residence
→ Birthplace
→ place of employment
→ school district
→ hospital unit, etc

(3) Person
→ inherent characteristics of people
→ Age
→ Race
→ Sex
4.
Time Acquired Characteristics
→ Onset of symptoms → Immunity
→ Incubation Period → Marital status
→ Infectious Period
→ Seasonality Activities
→ Baseline vs. epidemic → Occupation
→ Interval → Leisure activities
→ Use of medications/tobacco/drugs
~ Long-term trends
~ Shorter for environmental exposure Conditions under which people live
→ Socioeconomic status
→ Access to medical care
Types of Epidemiology
Descriptive Studies
Descriptive and Analytical Epidemiology (1) Steps in conducting a descriptive study. Descriptive
Descriptive epidemiology studies form the first step in any process of investigation.
→ Describes the occurrence of disease (cross → These studies are concerned with observing the
sectional) distribution of disease in populations.
(2) Analytic epidemiology 1. Defining the population.
→ Observational (cohort, case control, cross 2. Defining disease under study.
sectional, ecologic study) – researcher observes 3. Describing the disease.
association between exposure and disease, 4. Measurement of disease
estimates and tests it 5. Compare
→ Experimental (RCT, quasi experiment) - 6. Formulate hypothesis
researcher assigns intervention (treatment), and 1. Defining the population. Defined population may be
estimates and tests its effect on health outcome the whole population or a representative sample.
→ It can also be specially selected group such as age
Descriptive epidemiology: examining the distribution of and sex groups, occupational groups, hospital
 patients, school children, small community, etc.
Experimental
2. Defining disease under study determine the exposure status for each individual (clinical
3. Describing the disease trial) or community (community trial); we then follow the
→ Disease is examined by the epidemiologist by individuals or communities to detect the effects of the
asking three questions: exposure
~ When is the disease occurring—time distribution?
~ Where is it occurring—place distribution? ~ Who is Observational
getting the disease—person distribution? observe the exposure and outcome status of each study
participant
A. Time Distribution → cohort study - categorize subjects on the basis of their
Short-term fluctuations exposure and then observe them to see if they develop the
→ Common source epidemics: single health conditions being studied → case-control study -
exposure/point source—bhopal tragedy enroll a group of people with disease (“cases”) and a group
→ Propagated-infectious: Hep A without disease (“controls”) and compare their patterns of
previous exposures
Periodic fluctuations
→ Seasonal –measles (early spring) Case-control Studies
→ Cyclic - in pre-vaccinated era (peak 2-3 yr) → It start from effect and then proceed to cause → Both
exposure and outcome have occurred before start of the
Long-term or secular trends; diabetes, CVD study
→ The study proceeds backwards from effect to cause
B. Place Distribution → Select subjects based on their disease status. → The
International variations: control group should ideally come from the same
→ Cancer of stomach very common in Japan population that gave rise to the cases. → faster and more
→ less common in US cost effective
→ oral cancer - India
→ Breast cancer: Low - japan, high - western Cohort Study
National variations, e.g. Distribution of fluorosis, → It look at cause and proceed to effect
Rural-urban differences, e.g. → study before the disease manifests and proceed to study
→ CVD, Mental illness more common in urban over a period of time for the disease to occur.
areas. → Cohort means a group of people sharing a common
→ Skin diseases, worm infestations more common experience.
in rural areas. Case Control Studies Cohort Studies
Local distributions
→ e.g. Spot maps - John Snow in London to Proceeds from effect Proceeds from cause
incriminate water supply as cause of cholera to cause to effect
transmission in London.
→ cholera cases in proximity to water pump, 1854 Starts with the disease Starts with people
exposed to the risk
C. Person Distribution factor or suspected
Age cause
→ Measles is common in children,
→ Cancer in middle age Tests whether the Tests whether disease
→ Degenerative diseases in old age. suspected cause occurs more
occurs more frequently in those
Sex
frequently in those exposed than in those
→ Women- Lung cancer-less
with disease than not exposed
→ Hyperthyroidism- more
those without
Social class disease
→ Diabetes, Hypertension– upper class
Usually the 1st Reserved for the
4. Measurement of disease - Mortality/ Morbidity 5.
approach to the testing of precisely
Compare
testing of hypothesis, formulated hypothesis
→ Between different population, subgroups 6. but also useful for
Formulate hypothesis
exploratory studies
→ On the basis of all data epidemiologists form
hypothesis. Involves fewer study Involves larger
subjects number of subjects
Analytic Epidemiology
Used to search for causes and effects, or the why and the Yields results Long follow-up,
how. relatively quickly delayed results
 Suitable for study of Inappropriate when
rare diseases disease or exposure
under investigation is
rare

Generally, yields only Yields incidence rates,

estimate of relative relative risk,
risk (Odds ratio) attributable risk

Cannot yield Can give information

information about about more than one
disease other than disease outcome
that under study

Relatively inexpensive Expensive

Causation
CONCEPTS OF DISEASE OCCURRENCE Cause of
disease is a factor (characteristic, behavior, event, etc.)
Cross-sectional studies that influences the occurrence of disease
Cross-sectional study is also called prevalence study An increase in the factors leads to an increase in disease.
simplest form of observational study. Reduction of the factors leads to a reduction in disease
It is based on single examination of cross-section of
population at one point of time. If the sampling Epidemiologic triangle
methodology is accurate, results can be projected to traditional model of infectious disease causation.
the entire population. They are more useful for chronic AGENT
illnesses, e.g. hypertension.
Cross-sectional studies save on time and resources, but
provide very little information about natural history of
disease and incidence of illness.

Time is Key
→ Cross-section – Present: Disease and Exposure HOST ENVIRONMENT
→ Case Control – Present: Disease; Past: Exposure
→ Cohort – Present: Exposure; Future: Disease
1. Host
→ susceptible human or animal who harbors and
nourishes a disease-causing agent
2. Agent
→ a factor that causes or contributes to a health
problem or condition
3. Environment
→ all the external factors surrounding the host that
might influence vulnerability or resistance

Agent
→ Infectious microorganism - must be present for
disease to occur
→ Virus
→ Bacterium
→ Parasite
→ other microbe

Host factors
→ Intrinsic factors that influence an individual’s
exposure, susceptibility, or response to a causative
agent.
→ Age
→ Race
→ Sex
→ socioeconomic status
→ behaviors
 Web of Causation: Infant Mortality
Environmental factors 2. Multiple Causation
→ Extrinsic factors which affect the agent and the
opportunity for exposure
→ physical factors
→ biologic factors
→ socioeconomic factors

Epidemiology and Disease

Chain of Infection

→ Portal of entry – means by which an agent

enters a susceptible host Epidemic Disease Occurrence
→ Host – individual infected with the agent → Level of Disease - amount of a particular
Reservoir of an agent is the habitat in which an disease that is usually present in a community
infectious agent normally lives, grows, and multiplies.
→ Portal of exit is the path by which an agent
leaves the source host

Modes of transmission
● Direct – immediate transfer of the agent from a
reservoir to a susceptible host by direct contact or
droplet spread
→ Direct contact
→ Droplet spread

● Indirect – an agent is carried from a reservoir to a

susceptible host by suspended air particles or by
animate (vector) or inanimate (vehicle)
intermediaries
→ Airborne
→ Vehicle borne
→ Vector borne
→ Mechanical
→ Biologic

Theories of Causality in Health and Illness

Relationship between a cause and its effect 1.
Chain of Causation:

Chain of Infection
 with clustering of cases within a narrow interval of
time.
3. All cases develop within one incubation period.

Single exposure or “point source” epidemics B.

Continuous or repeated exposure
→ Frequently not always due to exposure to an
infectious agent
→ They can result from contamination of the
environment (air, water, food, soil) by industrial
pollutants
→ Ex. Minamata disease in Japan from consumption
of fish containing high concentrations of methyl
mercury

1. The exposure from the same source may be

prolonged-continuous, repeated or intermittent
2. No explosive rise in cases.
Epidemic Patterns
Common-Source Epidemics: → Ex. Cases occur over more than one incubation
→ Single exposure or “point source” epidemics. → period. Outbreak of respiratory illness, the
Continuous or multiple exposure epidemics. Legionnaire disease in 1976 in USA, was a common
→ Animal reservoir source, continuous or repeated exposure, no
evidence of secondary cases
Mixed Epidemics.
Slow ‘modern’ Epidemics: NC “non-communicable
diseases”

Common Source Epidemics

A. Single-exposure ‘point’ epidemics → Exposure is
Brief and simultaneous (immediate or concurrent)
exposure.
→ All cases develop within one incubation period (food
poisoning epidemics).
→ Features of epidemic curve:
1. Rises and falls rapidly, no secondary waves.
2. Tends to
be
explosive,
Propagated
Epidemics: → Person
to person. →
Arthropod vector

→ comprises a numerator, denominator, time

specification & multiplier.
→ The time dimension is usually a calendar year.
→ Rate is expressed per 1000, 10,000 or
100,000 selected according to convenience to
avoid fractions
→ used to estimate probability or risk of
occurrence of a disease or to assess the
accessibility or coverage of the healthcare
system.

Epidemic may start from a common source and then

continue as a propagated epidemic
Water borne epidemic as example the epidemic
reaches a sharp peak, tails (end) off gradually over
longer time of period
Propagated Epidemics
→ Ex: fetal death rate & fetal death ratio,
maternal mortality rate & maternal mortality ratio.
RATIO
→ A fraction in which the numerator is not part
of the denominator.
→ Ex: Fetal death ratio: Total no. of fetal
deaths/total no. of live births
→ Fetal deaths are not part of live births →
Other ex: doctor-population ratio, child-woman
ratio

Of infectious origin, with person to person
transmission (hepatitis A,E and polio epidemics).
Transmission continues till depletion of susceptible
or susceptible individuals are no longer exposed to
source of infection.
Communicability (speed of spread) depends on herd
immunity among exposed and opportunities for
contact with infective dose and secondary attack
rate.
Gradual rise and tails off over a longer period of
time.
Proportion
→ Specific type of ratio in which numerator is
included in the denominator and the resultant
value is expressed as % age.
→ E.g. 1: If there are 1000 boys and 800 girls
in a school, the proportion of boys:
→ Boys / Boys+ Girls= x 100 = 55%
→ E.g. 2: From 7,999 females aged 16 – 45 y/.
2,496 use modern contraceptive methods. →
The proportion of those who use modern
contraceptive methods = 2,496 / 7,999 x 100 =
31.2%
MEASUREMENTS OF MORBIDITY

EPIDEMIOLOGIC MEASURES Measures of Disease Frequency

Basic Measurement
→ Rate, Ratio and Proportion Incidence: No. of newly added disease cases in
→ Prevalence Rate a population at risk during a specified time
→ Incidence rate interval
→ Case fatality rate ➢ RATE:measure of the instantaneous rate of
→ Mortality rates(age specific/cause specific) disease;
→ Attack rate → useful in estimating length of time needed
→ Other measures to follow up individuals

Prevalence: The proportion of individuals in a

Rate
population who have disease at a specific point
in time
➢ RATIO: measure the individual risk of
disease
→ useful in estimating the probability that
 an individual will be ill at a specific point in
time
Incidence
→ Number of new cases of a disease which
come into being during a specified period of
time. → (Number of new cases of specific
disease during a given period)/(population at risk
during that period) x 100
→ Importance: If incidence increasing, it may
indicate failure or ineffectiveness of control
measure of a disease and need for better/new
health control measure.
Prevalence
→ Number of current/existing case (old and new)
of a specified disease at a point of time → It help
to estimate the burden of disease → Identify
potentially high-risk populations. They
are essentially helpful to plan rehabilitation
facilities, manpower needs, etc.
→ (Number of current case of a specified disease
at a point of time) / (estimated population at
the same point of time) x 100
→ Two types:
(1) Point P (day, week, month)
(2) Period P
→ Point P is the commonly used term
Point Prevalence
→ is the number of all current cases (old & new)
of a disease at one point in time in relation to a
defined population.
→ The “point” in point prevalence may consist of
a day, several days or even a few weeks
depending upon the time it takes to examine the
population sample.
Period Prevalence
→ Is the proportion of a population that has the
characteristic or disease at any point during a
given time period of interest. “Past 12 months” is
a commonly used timeframe. It includes cases
arising before but extending into or through to
the year as well as those cases arising during
the year.
Relationship between incidence and prevalence
→ Prevalence =Incidence x Duration
= No of infants dying during 1 year X 1000 No of
live births during the same period
→ IMR is an important indicator of the general
health conditions of a pop.
Attack rate (AR)
→ Useful for comparing the risk of disease in
groups with different exposures. The attack rate can
be specific for a given exposure.
Measurements of Mortality
Case fatality rate
→ Measure of the severity of a disease which
defined as the proportion of cases of a specified
disease or condition which are fatal within a
specified time
= no. of death from a disease in a specified period X 100
No. of diagnosed cases of disease in same period
= Total # of deaths due to a particular disease X 100
Total # of cases due to the same disease.
→ It is ratio of deaths to cases.
→ It is mainly used in Ac. Infectious diseases –
food poisoning, cholera, measles.
→ It is the killing power of a disease and is
closely related to virulence.
→ The CFR for the same disease may vary in
different epidemics because of changes in the
agent, host & environmental factors
Crude Death rate:
CDR = No. of deaths occurring in a specified 12 months period X
1000 No. of persons in the pop. at the mid-point of the 12
month period (mid year pop)
→ CDR - annual number of death per 1,000
population, CSDR: can be used for specific
age group
Cause Specific Death Rate
CSDR = No of deaths from a specific cause during a calendar year
No of persons in the mid point of that period X 1000
Age Specific Death Rate
ASDR = No. of deaths of a specific age
group No of persons in the pop. of
that age
IMR is a special age specific death rate
 → quality of life indicators: IMR, Literacy rate and
GNP
→ Infant mortality rate: Probability of dying
between birth and exactly one year of age
expressed per 1,000 live births.

PROPORTIONAL MORTALITY RATE → It

is sometimes useful to know what proportion of
total deaths are due to a particular cause (e.g.,
cancer) or what proportion of deaths are occurring
in a particular age group (e.g., above the age of
50 years).
→ It expresses the " # of deaths due to a
particular cause (or in a specific age gp.) per 100
(or 1000) total deaths."

Other measures
→ Maternal mortality ratio (MMR): The number
of women who die as a result of pregnancy and
childbirth complications per 100,000 live births in
a given year.
→ Crude birth rate: Annual number of births per
1,000 population.
→ Under-five mortality rate: Probability of dying
between birth and exactly five years of age
expressed per 1,000 live births.
→ Infant mortality rate: Probability of dying
between birth and exactly one year of age
expressed per 1,000 live births.
PHARMACO-EPIDEMIOLOGY emergence of the field of pharmacoepidemiology

DEFINITION → Pharma-coepidemiologist applies epidemiology

→ “The study of the use and effects of medications
in large numbers of people” – Strom
→ “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
→ “The study of drugs as determinants of health and
disease in the general unselected population.”-
Spitzer
→ It is called a bridge science bringing together
pharmacology and pharmacy, clinical specialties,
epidemiology, biostatistics, demography and social
sciences.
→ Epidemiology and clinical pharmacology are
the two main bridgeheads.
→ Pharmacoepidemiological studies identify the
associations between a drug and one or more
clinical events that had been missed in therapeutic
trials.
→ About 100,000 Americans die each year from
Adverse Drug Reactions, and 1.5 million US
hospitalizations each year result from Adverse Drug
Reactions (ADRs). Unfortunately, about 20-70% of
ADRs may be preventable. The harmful and the
negative side effects of drugs has led to the recent
principles:
(1) Study the effects of medications in human
populations.
(2) Conduct safety studies of drug use in large
populations
(3) Interested in common, predictable adverse drug
reactions as well as the uncommon and
unpredictable ones.
→ Pharmacoepidemiology studies quantify drug
use patterns and adverse drug effects.
For example:
(1) understanding the patterns of drug prescribing
(2) the appropriateness of use
(3) medication adherence and persistence patterns
(4) identification of predictors for medication use
Pharmacoepidemiology versus
Clinical Pharmacology
Pharmacology is the branch of medicine and
biology concerned with the study of drug action.
Clinical Pharmacology is the study of the
effects of drugs in humans.
Pharmacoepidemiology is a part of Clinical
Pharmacology and can provide vital information
about the positive and negative effects of any
 drug, resulting in a better evaluation of the risk/ therapy
benefit ratio for the use of a drug in a patient. (6) Drug Interactions
(7) Predictable ADRs
Clinical pharmacology is categorized into two (8) Uncommon and unpredictable ADRs
main areas: Pharmacokinetics and
Pharmacodynamics SOURCES OF DATA
The sources of drug data includes:
Pharmacoepidemiology includes contributions (1) Institutionalized medical records and databases
from both these fields, exploring the effects from hospital and pharmacy claims.
achieved by administering a drug regimen. (2) System wide databases from health insurance
claims or pharmaceutical organization.
Pharmacology versus Epidemiology (3) National databases like Medical Expenditure Panel
Survey, National Ambulatory Medical Care Survey.
Epidemiology is the study of the distribution (4) Field data like records from dispensers, sellers or
distributers or from small groups.
and patterns of health events, health
characteristics and their causes or influences in (5) Experimental clinical trial data.
well defined populations.
→ It is the cornerstone method of public health Postmarketing surveillance (PMS)
research, and helps inform policy decisions and→ is defined as the identification and collection of
evidence-based medicine by identifying risk information regarding drugs after their approval for use
factors for disease and targets for preventive in a population.
medicine → a method of systematically monitoring the safety
and effectiveness of new drugs in the real world using
a variety of patient types with many different comorbid
Pharmacoepidemilogy is a part of
diseases.
epidemiology since it deals with the effects of
drugs in large numbers of people or in a → Cornerstone of Pharmacoepidemiology → PMS
data demonstrate whether a patient has been exposed
population.
to the drug, and adverse health effects that required a
→ Despite the fact that
health care interaction.
pharmacoepidemiological approaches can be
useful in performing the clinical trials of drugs
Application of Pharmacoepidemiology
that are performed before marketing,
Government agencies & Health care plans: →
→ major application of these principles is after
Pharmacoepidemiology research is important for the
drug marketing.
government agencies like the Agency for Healthcare
→ Pharmacoepidemilogy acquires its focus of
Research and Quality (AHRQ) and the Centers for
inquiry from clinical pharmacology and its
Medicare and Medicaid Services (CMS) and
methods of inquiry from epidemiology.
Healthcare plans.

Practitioners:
→ Pharmacoepidemiological studies can help
Pharmacists, Physicians, Nurses and other Public
health care practitioners to make informed decisions
about treatment for patients.

Pharmacoepidemiological research in practice Pharmaceutical industries:

→ The pharmaceutical industry want to
includes:
understand how a drug is prescribed, used
(1) Evaluation of specific drug use in certain
and what are all the positive and negative
conditions,
outcomes.
(2) Patterns of drug use, that is, how it is being
used-how much, where, when and by whom, (3) Drug
taking behaviors in society. Academicians:
→ Academicians often conduct
pharmacoepidemiological studies to find
AIM of Pharmacoepidemiology answers to practice related questions
WHO targets its pharmacoepidemiological efforts to
ensure the quality, safety and efficacy of drugs. Attorneys:
The studies focus on: → Findings from pharmacoepidemiological
studies can be used as evidence that a drug
(1) Global trends in prescribing
product did or didn’t cause an event.
(2) Appropriateness of drug use
(3) Medication adherence
(4) Lifestyle effects on drug therapy Consumers and Patients:
(5) Special population (Elderly, Pediatric, etc.) drug → To learn about safety and effectiveness of
 drug products, patients and consumers rely
on pharmacoepidemiological studies.
ROLE OF PHARMACISTS AND PUBLIC
HEALTH PRACTITIONERS IN
PHARMACOEPIDEMIOLOGY
Practicing pharmacist is in a prime position
to help identify issues or problems that a
pharmacoepidemiologist may want to study
further. Ex. identifying and reporting adverse
drug events, which can then be studied using
pharmacoepidemiology techniques.
Pharmacists and public health practitioners
should be users of pharmacoepidemiology
research findings. Ex. making drug therapy
Pharmacy schools, public health schools, and
medical schools are including
pharmacoepidemiology in the curriculum
choices and making formulary
Pharmacists often conduct drug use
evaluations for drug products that are
associated with risk of adverse outcomes, are
of high cost or are of high volume.
Pharmacists in public health roles as well as
public health practitioners are often interested
in what occurs in the “field” (i.e., the “real
world”). Ex. monitor medication adherence
rates and the outcomes associated with
adherence in a large population.
Pharmacists and public health practitioners
also have the opportunity to participate and
conduct pharmacoepidemiology research.

SUMMARY
Pharmacoepidemiology is the study of the use and
effects of drugs in populations. This field is growing
because it is important for various stakeholders to
understand more about drug use in practice.

To provide safer and more cost-effective care, the

government, pharmaceutical companies, clinicians,
patients, policy makers, and others need to
understand the use of drugs in large numbers of
people.

Pharmacoepidemiology research can contribute to

postmarketing surveillance efforts, identifying new
indications for drug products, evaluating
interventions, describing medication use trends, and
informing policy.

Given the potential of pharmacoepidemiology, health

care professionals need to have a better
understanding of it and contribute to its
advancement.
DETERMINANTS OF HEALTH AND PUBLIC
HEALTH ISSUES HEREDITARY
→ Genetic inheritance provides predisposition to a
DETERMINANTS OF HEALTH wide range of individual responses that can affect
→ Factors such as where we live, the state of our health status throughout the lifespan.
environment, genetics, our income and education
level, and our relationships with friends and family all SOCIO-CULTURAL
have considerable impacts on health. → Greater support from families, friends and
communities is linked to better health.
a. Heredity → Culture - customs and traditions, and the beliefs
b. Socio-cultural of the family and community all affect health.
c. Socio-economic
d. Education SOCIO-ECONOMIC
e. Psycho-social → It has been observed time and again that those
f. Environmental with low socioeconomic status suffer poorer health
g. Crisis and Disasters outcomes than individuals with higher socioeconomic
h. Accessibility to Health Care status (SES)
→ Income and Employment
→ Income: less money leads to less health choice,
higher income provides you with better choices. →
Even the choice of location for where to live, better
parks, cleaner home, taking regular holidays etc. It all
contributes towards a better overall health status.
→ Employment: Your employment status and your
particular occupation has a large impact on your
health.
→ Unemployment, underemployment, stressful or
unsafe work is associated with poorer health.
EDUCATION
→ Health status improves with a person’s level of
education.
→ Education contributes to health and prosperity by
equipping people with knowledge and skills for
problem-solving, and helps provide a sense of control
and mastery over life circumstances.
→ It also improves people's ability to access and
understand information to help keep them healthy.
PSYCHO-SOCIAL
→ relationship that one's personality, mood states,
cognitive factors and social environment have with
his/her physical health.
→ “Psychosocial” factors such as stress, hostility, ● Description
depression, hopelessness, and job control seem
associated with physical health—particularly heart
disease.
ENVIRONMENTAL
→ Factors related to housing, air quality, water quality,
safe houses, and transportation systems all contribute
to health.
→ Environmental influences on health can be positive
or negative, and range from global, to national and/or
regional issues, to the local built environment, to the
social environment.
CRISIS AND DISASTERS
→ Disasters often have a significant impact on public
health.
→ Ex: Earthquakes, Typhoons, Landslides,
Volcanoes/Lahars = deaths, injuries, diseases, ● Program Components
disabilities → Cardiovascular Disease
ACCESSIBILITY TO HEALTH CARE
→ Both access to health services and the quality of
health services can impact health.
→ Lack of access, or limited access to health services ● Policies and Laws
greatly impacts an individual’s health status. → For
example, when individuals do not have health
insurance, they are less likely to participate in
preventive care and are more likely to delay medical
treatment.
→ Barriers to accessing health services include:
(a) Lack of availability
(b) High cost
(c) Lack of insurance coverage
(d) Limited language access
→ These barriers to accessing health services
lead to:
(a) Unmet health needs
(b) Delays in receiving appropriate care
(c) Inability to get preventive services
(d) Hospitalizations that could have been
prevented
PUBLIC HEALTH ISSUES IN LOCAL,
NATIONAL AND INTERNATIONAL CONTEXT
A. NUTRITION AND LIFESTYLE DISEASE
(Lifestyle-related Diseases)
→ Non-communicable diseases (NCDs)
include cardiovascular conditions (hypertension,
stroke), diabetes mellitus, lung/chronic
respiratory diseases and a range of cancers
which are the top causes of deaths globally and
locally.
→ These diseases are considered lifestyle
related and are mostly the result of unhealthy
habits. Behavioral and modifiable risk factors
like smoking, alcohol abuse, consuming too
much fat, salt and sugar and physical inactivity
have sparked an epidemic of these NCDs which
pose a public threat and economic burden.
→ “Health in All, Health by All, Health for All”
= KP (Kalusugan Pangkalahatan) or the
Universal Health Care (UHC)
→ Diabetes Mellitus
→ Cancer
→ Chronic Respiratory Disease
AO No. 2011-0003 or The National policy on
Strengthening the Prevention and Control of
Chronic Lifestyle Related
Non-Communicable Diseases
AO No. 2012-0029 or The Implementing
Guidelines on the Institutionalization of
Philippine Package of Essential NCD
Interventions (PhilPEN) on the Integrated
Management of Hypertension and Diabetes
for Primary Health Care Facilities
AO No. 2013-0005 or The National Policy on
the Unified Registry Systems of the
 Department of Health (Chronic
Non-Communicable Diseases, Injury Related
Cases, Persons with Disabilities, and
Violence Against Women and Children
Registry Systems)
AO 2015-0052 “National Policy on Palliative &
Hospice Care in the Philippines
AO 2016-0001: “Revised Policy on Cancer
Prevention and Control Program
AO 2016-0014 - Implementing Guidelines on
the Organization of Health Clubs for Patients
with Hypertension and Diabetes in Health
Facilities
B. OCCUPATIONAL DISEASES
1. Back Pains (31.4%)
2. Essential Hypertension (15.5%)
3. Neck-shoulder Pains (11.4%)
4. Occupational Asthma (5.4%)
5. Other Infections (5.3%)
health services at the local level.
2. Vision
→ “Healthy Filipino Workforce”
3. Objectives/Goals
→ By 2022, reduce the number of occupational
diseases and injuries by 30% from the 2015
baseline as identified in the Occupational Health
and Safety Profile of the Philippines.
4. Policies and Laws
→ 1961, Administrative Order No. 63
“Industrial Hygiene Code”
→ 1975, Presidential Decree No. 856 Code
on Sanitation of the Philippines (Chapter VII –
Industrial Hygiene)
→ 1987, Philippine Constitution of 1987
(Article II, Section 15) 2008, Joint
Administrative Order between
DTI-DENR-DA-DOF-DOH-DILG-DOLE-DOTC
No. 01 “The Adoption and Implementation of
the Globally Harmonized System of
Classification and Labelling of Chemicals
(GHS)”
→ 2012, DOH Administrative Order No.
2012-0020 “Guidelines Governing the
Occupational Health and Safety of Public
Health Workers”
→ 2013, DOH Administrative Order No.
2013-0018 “National Occupational Health Policy
for the Informal Mining, Transport and
Agricultural Sectors”
→ 2013, DOH Administrative Order No.
2013-0009 “National Chemical Safety
Management and Toxicology Policy
2013, DOH Department Personnel Order No.
2013-3584 “Designation of Undersecretaries
and Assistant Secretaries as Heads of
Technical and Operations Cluster for
Kalusugang Pangkalahatan, the Occupational
Health and Safety Committee for the
Department of Health and other Attached
Agencies” and its Reconstitution DPO No.
2014-2282 and 2014-2282-A “Reconstitution of
the Occupational Health and Safety Committee
for the Department of Health and other
Attached Agencies”

C. Non-communicable diseases
Alzheimer’s Disease
Cancer
● OCCUPATIONAL HEALTH PROGRAMS
Epilepsy
1. Background/Description
→ The program addresses the incidence of Osteoarthritis
occupational diseases and work-related Osteoporosis
diseases and injuries among workers through Cerebrovascular Disease (Stroke)
health promotion and protection in all Chronic Obstructive Pulmonary Disease
workplaces. It initially focuses on public (COPD)
health workers and informal sector workers Coronary Artery Disease
including, but not limited to those in agriculture, Heat Stroke
transport, and small-scale mining. → It aims to
High Blood Pressure or Hypertension
improve workers’ access to basic occupational
 Obesity and Overweight Malaria
Diabetes Measles
Depressive Disorders Meningococcemia
Substance Abuse: Alcohol Pertussis
Substance Abuse: Ecstasy Poliomyelitis
Rabies
D. Communicable diseases Severe Acute Respiratory Syndrome
Acute Respiratory Infection (SARS)
Influenza A (H1N1) Sore Eyes
Bird Flu (Avian Influenza) Tuberculosis
Chickenpox Typhoid Fever
Cholera
Dengue Government Health Programs
Diarrhea
Diphtheria ● ENVIRONMENTAL HEALTH PROGRAMS
Vision
Ebola
→ Environmental Health (EH) related diseases
Hand, Foot, and Mouth Disease are prevented and no longer a public health
Hepatitis A problem in the Philippines (based on on-going
Hepatitis B Strategic Plan 2019-2022)
Hepatitis C
HIV/AIDS Mission
Influenza → To guarantee sustainable Environmental
Leprosy Sanitation (ES) services in every community
Program Components
→ Drinking-water supply, Sanitation (e.g excreta,
sewage and septage management), Zero Open
Defecation Program (ZODP), Food Sanitation, Air
Pollution (indoor and ambient), Chemical Safety,
WASH in Emergency situations, Climate Change
for Health and Health Impact Assessment (HIA)

Partner Institutions
→ DENR, DILG, DPWH, DA, PIA
World Health Organization (WHO), UNICEF,
USAID, AusAID

Policies and Laws

PD No. 856 – Code on Sanitation of the
Philippines
EO No. 489 s. 1991 – The Inter-Agency
Committee on Environmental Health (IACEH)
National Objectives for Health (NOH)
2011-2016
DOH A.O. 2010-0021 - Sustainable
Sanitation as a National Policy and a
National Priority Program of the DOH
DOH A.O. 2014-0027 – National Policy on
Water Safety Plan (WSP) for All
Drinking-Water Service Providers
DOH A.O. 2017-0006 – Guidelines for the
Review and Approval of the Water Safety
Plans of Drinking-Water Service Providers
DOH A.O. 2017-0010 – Philippine National
Standards for Drinking Water (PNSDW) of
2017

● DOH Healthcare Waste Management Program

→ Name of Office: NCDPC
→ Government and Private hospitals, clinics,
 infirmaries and other healthcare facilities being
licensed by the Bureau of Health Facilities and
Services (BHFS) are included in this program.
The program coverage starts from waste
generation, segregation, collection, transport,
storage, treatment and up to final disposal.

● WHO IS RESPONSIBLE IN MONITORING

COMPLIANCE TO HCWM STANDARDS? →
The DENR and DOH are the responsible
agencies in monitoring compliance of
healthcare facilities to the mandated policies
in HCWM.
→ The DOH is responsible for on-site activities
while the DENR is responsible for off-site
activities related to HCWM. The DOH can be
represented by a composite team that include
representative/s from BHFS, NCHFD, NCDPC,
BHDT & NRL, and CHDs.