Introduction to Public Health

VIDEO

- Public Health
o Improving health of population
o Making people healthy - saving lives
- United States
o 1900 -> 1999
o Life Expectancy = increased by 30 years
 25 years are due to public health intervention
- What is it?
- How is it different from clinical medicine?
- Who does public health?
- How is it done?

- What health is?

o WHO – a state of complete physical, mental and social wellbeing rather than the
absence of disease.
o Determined by complex interaction between determinants or factors including
 individual characteristics
 lifestyles and behavior
 physical, social and economic environment
 social determinants of health
- How is it different from clinical medicine?
o A clinician’s main focus is the immediate health problem. It focuses on the individual.
o The public health approach – focuses on how and why accidents or certain actions
happen so that they can prevent it from happening again.
o Public health focuses on upstream factors to make beneficial changes to the entire
population.
- Who is responsible for public health?
o All healthy community rests in all sectors of society.
o Health departments have central role.
o It requires coordinated efforts of other stakeholders.
 Other areas of government
 Private sectors
 NGOs
 International Organizations
- How public health Works?
o Core Areas
 Protection
o Protects the community
 Control of infectious diseases
  Environmental hazards
 Healthy workplaces
 Managing health emergencies
 Prevention
 Vaccination
 screening
 Promotion
o Improving the health of the community
 Promoting health behaviors
 Improving the social determinants of health
o Enablers (to influence)
 Governances
 Advocacies
 Capacity
 Information

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.” – Charles Edward Armory Winslow

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

A Public Health Approach

 What is the problem? Surveillance systems for monitoring
 What is the cause? Risk Factor Identification
 What works? Intervention Evaluation
 How do you do it? Implementation

Public Health Core Sciences

Apply scientific methods.

 Surveillance
o Monitor public health situation.
 Epidemiology
o Enables where diseases originated how they move and how they are prevented.
 Laboratory
 o Perform tests, diagnosis, research, training, used in conjunction with surveillance.
o For health monitoring as well
 Informatics
o Deals with the method of collecting, compiling, and presenting health information.
o Enabling us to work better when helping.
 Prevention Effectiveness
o Closely link to PH policies
o Provide information for decision makers.

Applying the Public Health Approach

 Cholera — A Public Health Approach
 Cholera, a fatal intestinal disease, was rampant during the early 1800s in London, causing death
to tens of thousands of people in the area. Cholera was commonly thought to be caused by bad
air from rotting organic matter.

John Snow

 Physician best known for tracing the source of the cholera outbreak.
 Considered as the Father of Modern Epidemiology
 Through public health surveillance, discovered that cholera is due to contaminated water
sewage.
 Assisted by Reverend Henry Whitehead.
 Epidemiology — What is the Problem?
 Cluster of Cholera Cases, London — 1854


 Risk Factor Identification — What Is the Cause?
o Cluster of Cholera Cases and Pump Site Locations
 o
 Intervention Evaluation — What Works?
 Through continuous research, Snow understood what interventions were required
to:
o stop exposure to the contaminated water supply on a larger scale, and
o stop exposure to the entire supply of contaminated water in the area.
 Implementation — How Do You Do It?
 John Snow’s research convinced the British government that the source of cholera
was water contaminated with sewage.

Three Core Functions of Public Health

According to the Institute of Medicine

 Assessment - Systematically collect, analyze, and make available information on healthy

communities.
o Knowing what’s need to be done.
 Policy - Promote the use of a scientific knowledge base in policy and decision making.
 Assurance - Ensure provision of services to those in need.

Ten Essential Public Health Services

ASSESSMENT
1. Monitor Health
2. Diagnose and Investigate

POLICY
3. Inform, Educate, Empower
4. Mobilize Community Partnership
5. Develop Policies

ASSURANCE
6. Enforce Laws
 7. Link to/Provide Care
8. Assure a Competent Workforce
9. Evaluate
10. Research

Partners in the Public Health System

 Ensuring the Conditions for Population Health
 Community
 Clinical Care Delivery System
 Employers and Businesses
 The Media
 Academia
 Government Public Health Infrastructure

Health Care as a Partner in Public Health

Public Health
Population focus
Public health ethic
Prevention or public health emphasis
Joint laboratory and field involvement
Clinical sciences peripheral to professional
training
Public sector basis
Health Care
Individual patient focus
Personal service ethic
Diagnosis and treatment emphasis
Joint laboratory and patient involvement
Clinical sciences essential to professional training
Private sector basis

Other Partners in Public Health

 Media
o Vehicle for public discourse
o Health education and promotion
o Health communication
o Social media as catalyst
 Employers and Businesses
o Employer-sponsored health insurance programs
o Wellness initiatives and benefits
o Healthy workplaces and communities
 Government Agencies
o City planning
o Education
o Health in all policies
 Academia
o Education
o Training
o Research
 o Public Service

Determining and Influencing the Public’s Health

Health Determinants

 Genes and biology

o Sex, age, genetic makeup ( associated with race, ethnicity, etc)
 Health behaviors
o Eating habits, physical activities, etc.
 Social or societal characteristics
o Total Ecology, discrimination, quality of air & water, sanitation of the area, etc. food
choices, etc…
 Health services or medical care
o Insurance coverage, hospital responsiveness, immunity, level of education, access to
vitamins, etc.

What Determines the Health of a Population?

 Social/Societal Characteristics; Total Ecology

 Health Behaviors
 Medical Care
 Genes and Biology

Health Impact Pyramid

To address the determinants, there should be a plan of attack

(Increasing individuals effort needed) ^

 Counseling and Education; Tobacco warning labels

 Medical Care; Treatment of heart disease
 Preventive Medicine; Vaccinations; cholesterol screening
 Making Healthy Decisions the Default; Seatbelt laws, smoking restrictions
 Socioeconomic Factors; Poverty reduction, education

(Increasing public health impact) v

Defining Community

• A group of people with the potential for interaction (can be virtual or person-to-person)
• Its members have shared values and norms of behavior
• Has “sense of community”: can be a key factor in gaining support for the program and for maximizing
the health effects of some programs
• Membership
• Influence over what occurs within the community
• Shared values and needs fulfillment
 • Shared emotional connection

Three Elements of Community, with Their Characteristics

Element Characteristics of the Community Elements
People Values, beliefs, behaviors, size, membership, demographic characteristics, social and
economic status, sense of power or influence, sense of belonging
Place Geography, boundaries, housing, industry, air, water, land, virtual presence
Interaction Interpersonal communication, family based, education related, religion based,
politically related, recreationally focused, virtual communication

ECOLOGICAL APPROACH

Individual – knowledge, attitude, skills

Interpersonal – family, friends, social networks

Organizational – organizations, schools, workplaces

Community – Design, access, connectedness, spaces

Public Policy – National, provincial/territorial local laws and policy

Community Need Assessment

 Community needs assessment (also known as community health assessment) is a type of

evaluation that is performed to collect data about the health problems of a particular group. The
data collected for this purpose are then used to tailor the health program to the needs and
distinctive characteristics of that group.
 A community needs assessment is a major component of program planning because it is, done
at an early stage in the program planning and evaluation cycle.
 “Procedure used to collect data that describe the needs and strength of a specific group,
community, or population.”
 A systematic procedure for determining the nature and extent of problems experienced by a
specific population that affect their health, directly or indirectly (Porta, 2014)
 The process of identifying, analyzing and prioritizing the needs of a priority population (Mc
Kenzie, 2013).
 From CDC: A community health assessment (CHA), also known as community health needs
assessment (sometimes called a CHNA), refers to a state, tribal, local, or territorial health
 assessment that identifies key health needs and issues through systematic, comprehensive data
collection and analysis.
 Other terms include:
o Community analysis
o Community diagnosis
o Community assessment

Reasons for Needs Assessment

 For logical reason. (Before a “need” is met, it should be first, identified.)
 To ensure that (scarce) resources are allocated for maximum benefit .
 To prevent emotional decisions among planners.
 To provide focused intervention for the priority population.
 It determines the capacity of a community to address specific needs.
 It allows planners to apply the principle of equity and social justice in practice.

What will you Assess in the Community? (Type of Assessments)

 Socio-economic Characteristics
 Cultural characteristics
 Health-related Characteristics
 Environment and Healthcare System
 Marketing Assessment

Steps in Conducting The Assessment

 Step 1: Determine the purpose and scope.

 Step 2: Gather the data
 Step 3: Analyze data
 Step 4: Identify risk factors linked to health problem.
 Step 5: Identify the problem focus.
 Step 6: Validate the need.

Gathering data
 Gathering relevant data – data that are most applicable to the planning situation and will do the
best job to help planners identify the actual needs.
o Conduct literature search
o Locate secondary data – government agencies, national data, local data.
o Conduct primary data gathering.

Two Types of Needs Assessment Data

 Primary Data – collected by yourself through questionnaires, etc.
o Self-Assessment (HRAs)
o Written Questionnaires
 o Telephone interviews
o Face-to-face interviews
o Electronic interview
o Group interview
o Maybe gathered from opinion leaders, key informants, community forum, focus group
o Direct or indirect observation (walk-through)
 Secondary Data – “no contact data;” collected by someone else.
o Data from the government agencies, non-government agencies, existing records,
literature searches.