COMMUNITY AND PUBLIC HEALTH GUIDEBOOK

1 What is Public Health?

Learning Objectives:

After this session, students should be able to:

• Understand the concept, history, and scope of public health.

• Identify and explain key theories and models in public health.
• Analyze the key operations and services of public health systems.
• Describe the role of different stakeholders in the field of public health
• List some determinants of health
• Recognize how individual determinants of health affect population health

Introduction

Public health is a complex discipline that has strong historical connections to society. The discipline is
frequently misconstrued as solely a governmental pursuit or a means of delivering healthcare to individuals
needing more financial means. Nonetheless, it is an intricate and extensive discipline that aims to enhance
health results in populations, safeguard communities from health hazards, and guarantee health fairness for all
individuals. The purpose of this manual is to clarify the concept of Public Health and offer a thorough
comprehension of its theories, models, best practices, and practical applications.

What is health?

In order to establish a clear understanding of public health, it is necessary to begin with defining the concept of
health itself. In order to comprehend public health, it is necessary to analyze the fundamental nature of health
and its constituent elements. This understanding is crucial for healthcare professionals and policymakers alike.

The World Health Organization (WHO) has defined health as "a state of complete physical, mental, and social
well-being, and not merely the absence of disease or infirmity."

The preamble of their constitution outlines the fundamental elements necessary for comprehending the notion
of health.

• Every human being, regardless of ethnicity, religion, political beliefs, economic status, or social
circumstance, has the inherent right to the best possible level of health.
• The well-being of all individuals is crucial for achieving peace and stability, and it relies on the complete
collaboration of individuals and nations.
• The advancement of any nation in promoting and safeguarding public health benefits everyone.
• The disparity in the progress made by various countries in promoting health and managing diseases,
particularly communicable diseases, poses a widespread threat.
• Ensuring that all individuals have access to the advantages of medical, psychological, and associated
knowledge is crucial for achieving optimal health.
• The significance of well-informed viewpoints and proactive collaboration from the public cannot be
overstated in enhancing public health.
• Governments bear the duty of safeguarding the well-being of their citizens, which can only be
accomplished by implementing sufficient health and social policies.

Public Health at a Glance

Definition

Public health encompasses the scientific and artistic practices aimed at preventing disease, enhancing well-
being, and extending lifespan through the coordinated endeavors of society. This is a comprehensive social
enterprise that methodically tackles health-related challenges from a population perspective.

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According to Dr. CE Winslow, public health is the combination of scientific knowledge and artistic skills aimed
at preventing diseases, extending lifespan, and enhancing health and productivity through coordinated
community actions. These actions include improving environmental sanitation, controlling the spread of
communicable diseases, educating individuals about personal hygiene, establishing medical and nursing
services for early disease detection and prevention, and creating social systems that guarantee every
individual a sufficient standard of living to maintain good health. The ultimate goal is to ensure that every
citizen can enjoy good health and a long life.

Conversely, the World Health Organization (WHO) has defined it as "the practice of utilizing scientific
knowledge within the realm of politics to decrease health disparities while simultaneously promoting optimal
health for the largest population."

In addition, Acheson's prominent definition from 1988 highlights the importance of illness prevention, life
extension, and the promotion of human health through well-coordinated initiatives and informed decisions
made by society. This is a restatement of the previous definition provided by CE Winslow.

Thus, public health focuses on the overall well-being of communities and populations as a whole. Its mission is
to advance the promotion of health, the prevention of disease, and the extension of life. This commitment
is achieved through various social efforts that range from individual initiatives undertaken by public health
experts to broader policy changes aimed at addressing the underlying factors that influence health on a
systemic level.

Essential Services

The mission of public health is to promote and protect the health of people and the communities where they
live, learn, work, and play. Public health professionals accomplish this mission by:

1. Monitoring the health status of a community to identify potential problems. (situation analysis)
a. Diagnosing and investigating health problems and health hazards in the community.
2. Disease prevention and control/epidemiological surveillance through diagnosis and investigation
3. Educating and empowering people about health issues and how to maintain and improve their health
(Inform, educate, empower)
4. Mobilize community partnership and collaboration
5. Developing policies that support individual and community health efforts.
6. Enforcing laws and regulations that protect health and ensure safety.
7. Linking people to needed personal health services and ensuring the provision of healthcare when
otherwise unavailable.
8. Ensuring a competent public and personal healthcare workforce.
9. Evaluating the effectiveness, accessibility, and quality of personal and population-based health
services.
10. Researching new insights and innovative solutions to health problems.

In essence, the mission is to extend healthy life spans, reduce the burden of disease and disability, and secure
a healthier environment through a societal effort beyond the confines of the healthcare system.

In the Philippines, the Department of Health set the vision and mission as the following:

Vision: A global leader for attaining better health outcomes, competitive and responsible health care system,
and equitable health financing.

Mission: To guarantee equitable, sustainable, and quality health for all Filipinos, especially the poor, and to
lead the quest for excellence in health.

Key Terms Used in Public Health

1. Epidemiology: The study of the distribution and determinants of health-related states or events in specified
populations, and the application of this study to control health problems.

2. Determinants of health: Factors that influence an individual's or population's health, which can include
biological, socioeconomic, psychosocial, behavioral, or social in nature.

3. Prevention: Efforts to prevent the occurrence of disease or injury, typically categorized as primary (before it
occurs), secondary (early detection), or tertiary (after it has occurred) prevention.
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4. Health promotion: The process of enabling people to increase control over and to improve their health
through lifestyle changes.

5. Surveillance: The continuous, systematic collection, analysis, and interpretation of health-related data
needed for the planning, implementation, and evaluation of public health practice.

6. Outbreak: An occurrence of a disease greater than would otherwise be expected at a particular time and
place.

7. Pandemic: An epidemic that has spread over several countries or continents, usually affecting a large
number of people.

8. Health equity: The attainment of the highest level of health for all people, with a focus on removing
disparities and inequalities in health status due to factors such as race, gender, income, or geographic location.

9. Social determinants of health: Conditions in the environments where people are born, live, learn, work,
play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

10. Communicable diseases: Illnesses caused by microorganisms such as bacteria, viruses, fungi, or
parasites that can be spread, directly or indirectly, from one person to another.

11. Non-communicable diseases: Diseases not passed from person to person, often chronic in nature, such
as heart disease, stroke, cancer, diabetes, and chronic lung diseases.

12. Environmental health: The branch of public health that focuses on the relationships between people and
their environment, promotes human health and well-being, and fosters healthy and safe communities.

13. Health policy: Decisions, plans, and actions undertaken to achieve specific healthcare goals within a
society.

Theories and Models

The Health Belief Model posits that health behavior is influenced by an individual's own beliefs and perceptions
regarding an illness or health issue, as well as their understanding of the available measures to mitigate its
occurrence.

The Health Belief Model (HBM) is a highly acknowledged conceptual framework in health behavior theory. This
text elucidates the modifications and upkeep of health-related behaviors, as well as forecasts an individual's
health behavior by assessing their belief in the risks presented by health issues (perceived susceptibility and
severity), perceived advantages and obstacles to taking health-related actions, stimuli that prompt action, and
an individual's confidence in their ability to achieve success in an action (self-efficacy).

Health Belief Model

Adapted from Rosenstock IM, Strecher VJ, Becker MH. Social learning theory and the health belief model. Health Educ Q.
1988;15(2):175–183.

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Ottawa Charter: An international health promotion guide that advocates for health equity.

The Ottawa Charter for Health Promotion, developed in 1986, is an international agreement that advocates for
a holistic view of health, emphasizing the need for health equity, empowerment of individuals and communities,
and the necessity of enabling environments for health. The charter identifies five critical strategies for health
promotion: building healthy public policy, creating supportive environments, strengthening community action,
developing personal skills, and reorienting health services (World Health Organization, 1986).

The Ottawa Charter for Health Promotion, established during the 1st International Conference on Health
Promotion in 1986, outlines a comprehensive approach to achieving global health for all by the year 2000 and
beyond. This charter was a response to the need for a new public health movement worldwide, building on
previous initiatives such as the Declaration on Primary Health Care at Alma-Ata and the World Health
Organization's Targets for Health for All document.

Fundamental principles and components of the Ottawa Charter include:

Definition of Health Promotion: Health promotion is the process of enabling individuals and communities to
enhance control over and improve their health. It emphasizes a holistic approach to well-being, encompassing
physical, mental, and social dimensions. Health is considered a resource for daily life, and health promotion
extends beyond the responsibility of the health sector to encompass broader aspects of life.

Prerequisites for Health: The fundamental conditions and resources essential for health include:
• Peace
• Shelter
• Education
• Food
• Income
• A stable ecosystem
• Sustainable resources
• Social justice, and;
• Equity.

The charter underscores that a secure foundation in these essential prerequisites is necessary for health
improvement.

Advocacy: Health is recognized as a crucial resource for personal, economic, and social development. Health
promotion advocates for favorable conditions through actions in political, economic, social, cultural,
environmental, behavioral, and biological domains.

Enablement: Health promotion aims to achieve health equity by reducing disparities in health status and
providing equal opportunities and resources. This involves creating a supportive environment, ensuring access
to information, developing life skills, and offering opportunities for healthy choices. Empowerment is
highlighted, emphasizing that individuals must have control over factors influencing their health.

Mediation: Recognizing that various sectors influence health, the charter calls for coordinated action by
governments, health and social sectors, non-governmental and voluntary organizations, local authorities,
industry, and media. It emphasizes the involvement of individuals, families, and communities, as well as the
responsibility of professionals and social groups in mediating between diverse societal interests for the pursuit
of health.

Adaptation to Local Context: Health promotion strategies and programs should be tailored to local needs,
considering the unique social, cultural, and economic systems of individual countries and regions.
The Ottawa Charter serves as a foundational document in the field of health promotion, providing a
comprehensive framework for global efforts to enhance health and well-being.

Public Health – A General Historical Perspective

1. Sanitation and Environmental Health

Public health works to ensure a healthy environment by encompassing the control of disease and promotion of
health through sanitation. Sanitation and environmental health history has spanned across centuries and has
worked to contain infectious disease through environmental measures:
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a. 500 BCE

During approximately 500 BCE, the civilizations of ancient Greece and Rome demonstrated a strong
understanding of public health, particularly in relation to sanitation measures. The Greeks and Romans
recognized the importance of clean environments for disease prevention and overall well-being.

In terms of water supply, they constructed elaborate systems to bring clean water to cities. One of the most
iconic symbols of Roman engineering, the aqueducts, were used to transport water from clean sources into
urban areas. This water was used not only for drinking but also for public baths, an essential element of
Roman public life.

Sanitation was advanced for its time as well. They developed sewage systems and public latrines to dispose of
waste effectively, limiting the spread of harmful pathogens. In Rome, waste was removed from the city via an
impressive sewage system known as the Cloaca Maxima.

The Greeks and Romans also built hospitals and provided medical care for the sick. They believed in
balancing the “four humors” (blood, black bile, yellow bile, and phlegm) to maintain health and developed diets,
exercise programs, and even surgical procedures to treat diseases.

These advances undoubtedly contributed to the overall health of the population and serve as a testament to
the fact that public health practices, especially those related to sanitation, have been a crucial part of human
societies for centuries.

b. 1840s

The Public Health Act of 1848 was instituted in the United Kingdom to address sanitation and environmental
health concerns. It marked a pivotal step in establishing public health regulations to safeguard community well-
being.

c. 1970

In 1970, the Environmental Protection Agency (EPA) was founded in the United States. The EPA is a federal
agency tasked with protecting human health and the environment by enforcing regulations and policies related
to air and water quality, hazardous waste management, chemical safety, and other environmental concerns. Its
establishment marked a significant commitment to addressing and regulating environmental issues at the
national level.

2. Pandemics

Pandemics are epidemics or outbreaks of disease that spread far and wide affecting populations of multiple
continents.

a. Influenza

In 1918, a global influenza pandemic occurred, affecting an estimated 500 million people worldwide. This
pandemic, commonly known as the Spanish Flu, was caused by the H1N1 influenza A virus. It remains one of
the most severe pandemics in history, leading to substantial morbidity and mortality. The high infection rate and
the rapid global spread of the virus highlighted the challenges of managing infectious diseases on a global
scale, emphasizing the need for effective public health measures and international cooperation in responding
to such health crises.

b. Polio

In 1955, a significant milestone in public health was achieved with the introduction of the polio vaccine.
Developed by Dr. Jonas Salk, the vaccine played a crucial role in preventing poliomyelitis, a highly contagious
viral disease that can lead to paralysis. Following the vaccine's introduction, a global initiative to eradicate polio
was launched in 1988 by the World Health Organization (WHO), UNICEF, Rotary International, and the
Centers for Disease Control and Prevention (CDC).

The eradication initiative aimed to eliminate polio from every country through widespread vaccination
campaigns, surveillance, and other preventive measures. While substantial progress has been made, complete
eradication has proven challenging due to various factors such as geopolitical issues, vaccine access, and
local challenges in implementing vaccination programs. Despite these challenges, ongoing efforts continue to

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work towards the ultimate goal of a polio-free world. The initiative serves as a testament to the importance of
coordinated global efforts in tackling infectious diseases.

c. HIV

The HIV pandemic, which emerged in the late 20th century, has had a profound impact on global public health.
As of the current data, approximately 34 million people are living with HIV worldwide. Over the years,
concerted efforts have been made to address the HIV/AIDS crisis, leading to significant progress.

One notable achievement is the observed 20% decline in new HIV infections since 2001. This decline is
attributed to widespread awareness campaigns, increased access to antiretroviral therapy (ART), education
programs, and the promotion of safe practices. While progress has been made, challenges remain, including
issues of stigma, discrimination, access to healthcare, and ensuring sustained prevention efforts.

Ongoing initiatives focus on further reducing new infections, improving access to treatment, and enhancing
support systems for those living with HIV. The global response to the HIV pandemic underscores the
importance of a comprehensive, multi-sectoral approach to addressing complex public health challenges on a
worldwide scale.

3. Preparedness for Disaster Response

a. Biological warfare

Biological warfare involves the use of infectious agents or toxins to harm or kill humans, animals, or plants,
often with the intention of gaining a military advantage. A historical example of biologic warfare occurred during
the Siege of Caffa in the 14th century. The city of Caffa, located on the Crimean Peninsula, was under siege by
the Mongols.

Facing a desperate situation, the besieging Mongol army reportedly catapulted plague-infected corpses into
the city, which was a known practice during medieval sieges. The intention was to spread the Black Death, a
deadly pandemic caused by the bacterium Yersinia pestis, among the defending forces within the city. The
devastating consequences of the Black Death, with its high mortality rate, contributed to the Mongols' military
success in capturing Caffa.

This historical event highlights the dark and destructive potential of biologic warfare, where infectious diseases
are deliberately weaponized to achieve military objectives. Contemporary international agreements, such as
the Biological Weapons Convention, seek to prohibit the development, production, and use of biological
weapons, emphasizing the need to prevent the use of disease as a tool of war.

b. September 2001

In September 2001, following the terrorist attacks on September 11th, the United States witnessed a
coordinated response to address not only the immediate aftermath of the attacks but also potential public
health threats that could arise. Public health surveillance played a crucial role in monitoring and managing
health-related issues in the aftermath of the 9/11 attacks.

After the collapse of the World Trade Center towers, concerns emerged about the potential health risks
associated with the dust and debris released into the air. Public health officials and agencies, including the
Centers for Disease Control and Prevention (CDC) and the Environmental Protection Agency (EPA), initiated
comprehensive surveillance systems to monitor the health of rescue and recovery workers, residents, and
others exposed to the environmental contaminants.

Health surveillance efforts focused on tracking respiratory conditions, mental health issues, and other potential
health effects linked to the exposure. Various studies and monitoring programs were implemented to assess
the short-term and long-term health consequences of the 9/11 attacks on individuals in the affected areas.

This post-9/11 public health surveillance not only provided valuable insights into the health impacts of the
disaster but also informed future disaster response and recovery strategies. The experience underscored the
importance of integrating public health surveillance into emergency response efforts to effectively address both
immediate and lingering health concerns following large-scale disasters.

c. Yolanda

Typhoon Haiyan, known locally as Yolanda, struck the Philippines in November 2013, causing widespread
devastation and resulting in a significant public health crisis. The impact of the typhoon posed various health
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challenges, including injuries, displacement, and the risk of infectious diseases. Here is an overview of the
public health issues and the response efforts:

Injuries and Casualties:

• The typhoon caused extensive damage to infrastructure and homes, leading to injuries and casualties.
• Immediate medical attention was required for trauma care, wound management, and surgical
interventions.

Displacement and Crowded Conditions:

• Thousands of people were displaced, leading to crowded conditions in evacuation centers.

• Overcrowded and unsanitary conditions in shelters increased the risk of infectious diseases, including
respiratory infections and waterborne diseases.

Water and Sanitation Issues:

• The destruction of water supply systems and sanitation infrastructure created challenges in ensuring
access to clean water and proper sanitation.
• Contaminated water sources posed a risk of waterborne diseases such as cholera and diarrhea.

Vector-Borne Diseases:

• Stagnant water and debris provided breeding grounds for disease vectors such as mosquitoes.
• Increased risk of vector-borne diseases like dengue fever and malaria necessitated vector control
measures.

Healthcare System Strain:

• The disaster strained the healthcare system, with many health facilities damaged or rendered
inoperable.
• Emergency medical teams and field hospitals were deployed to provide healthcare services in the
affected areas.

Response Efforts:

• International and local aid agencies, along with the Philippine government, coordinated efforts to
provide immediate relief and address public health issues.
• Emergency medical teams and public health experts were deployed to assess and respond to the
health needs of the affected population.
• Vaccination campaigns, particularly for preventable diseases, were conducted to mitigate the risk of
outbreaks.
• Water purification systems were set up, and hygiene promotion activities were implemented to ensure
access to clean water and promote good sanitation practices.
• Mental health support services were offered to address the psychological impact of the disaster on
survivors.

The response to Typhoon Haiyan highlighted the importance of a comprehensive and coordinated approach in
addressing public health challenges during and after a disaster. The lessons learned from Yolanda continue to
inform disaster preparedness and response strategies in the Philippines and globally.

Supplementary Readings:

WHO Philippines Response to Typhoon Haiyan (Yolanda): the first six months - Philippines | ReliefWeb. (2014,
May 9). Reliefweb.int. https://reliefweb.int/report/philippines/who-philippines-response-typhoon-haiyan-yolanda-
first-six-months

4. Prevention Through Policy

a. The Book of Leviticus

The Book of Leviticus, found in the Old Testament of the Bible, is considered by many scholars to be one of the
earliest written health codes in human history. Comprising the third book of the Torah, Leviticus provides a

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detailed set of laws and regulations attributed to Moses. These laws, often referred to as the Levitical laws,
cover various aspects of life, including religious rituals, morality, and notably, health and hygiene practices.

b. Anti-Smoking Laws

The Philippines has implemented various laws and regulations to control and reduce smoking, particularly in
public places. It's important to note that laws can change, and it's advisable to check for any updates or
amendments to the regulations. Here's an overview of the tobacco control laws and no-smoking policies in the
Philippines:

Republic Act No. 9211 (Tobacco Regulation Act of 2003):

• This comprehensive law, also known as the Tobacco Regulation Act, was enacted to promote a
healthful environment and protect the public from the harmful effects of smoking and exposure to
tobacco smoke.
• It prohibits smoking in enclosed public places and public vehicles, including schools, hospitals,
government offices, and other similar locations.
• The law also mandates the placement of graphic health warnings on tobacco packaging to inform the
public about the health risks associated with smoking.

Executive Order No. 26 (Providing for the Establishment of Smoke-Free Environments in Public and
Enclosed Places):

• Issued in 2017 by then-President Rodrigo Duterte, this executive order aims to establish smoke-free
environments in public and enclosed places.
• It prohibits smoking in public and enclosed places, as well as within a 10-meter radius from entrances,
exits, and outdoor places of public buildings.
• The order also sets guidelines for designated smoking areas (DSAs) in certain establishments.

Local Government Ordinances:

• Several local government units (LGUs) in the Philippines have implemented their own ordinances to
strengthen tobacco control measures.
• LGUs may impose stricter regulations on smoking in public places and may also enact policies related
to the sale and advertising of tobacco products.

Graphic Health Warnings:

• The law requires the inclusion of graphic health warnings on cigarette packages to educate the public
about the dangers of smoking.
• The warnings typically include images depicting the harmful effects of smoking on health.

Penalties and Enforcement:

• Violators of anti-smoking laws may face penalties, fines, or even imprisonment, depending on the
gravity of the offense.
• Enforcement is carried out by local government authorities, health officers, and law enforcement
agencies.

The tobacco control measures in the Philippines aim to create a healthier environment, protect non-smokers
from secondhand smoke, and reduce the prevalence of smoking-related diseases. While progress has been
made, effective enforcement and public awareness are crucial for the successful implementation of these laws.
It's recommended to stay updated on any changes to tobacco control regulations in the Philippines.

Public Health Approach

1. Surveillance (problem identification/needs assessment)

2. Risk Factor Identification
3. Intervention Evaluation (operational plan)
4. Implementation

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Core Sciences

1. Epidemiology
2. Laboratory
3. Informatics
4. Surveillance
5. Prevention Effectiveness

Adapted from Centers for Disease Control and Prevention (CDC). Introduction to Public Health. In: Public Health 101 Series. Atlanta,
GA: U.S. Department of Health and Human Services, CDC; 2014.

Example of the Public Health Approach – Cholera

Surveillance (What is the Problem):

Problem Identification: John Snow's cholera investigation began with a keen observation of the unusually
high number of cholera cases centered around the Broad Street area in London. By mapping the cases, he
visually identified a concentration of illness, raising the question of a potential common source.

Field Surveillance: Snow conducted extensive fieldwork to collect data on cholera cases, systematically
documenting each instance and gathering information about the affected individuals. This meticulous
surveillance allowed him to understand the scope and distribution of the problem.

Risk Factor Identification:

Water Source Investigation: Through careful interviews and data collection, Snow identified a common risk
factor—the consumption of water from the Broad Street pump. He observed that individuals who used this
water source were more likely to contract cholera, leading him to consider contaminated water as a key risk
factor.

Comparative Analysis: Snow compared the health outcomes of individuals who used different water sources,
drawing correlations between the Broad Street pump and cholera cases. This analytical approach helped him
narrow down the specific risk factor contributing to the outbreak.

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Intervention Evaluation:

Pump Handle Removal: Snow proposed a bold intervention based on his findings—the removal of the pump
handle. By persuading local authorities to take this action, he aimed to disrupt the source of contaminated
water and prevent further transmission of the disease.

Real-time Evaluation: The intervention was implemented promptly, and Snow continued to monitor cholera
cases in real-time. The subsequent decline in cases around the Broad Street area served as an immediate
evaluation of the intervention's effectiveness.

Implementation:

Advocacy and Action: Snow's role extended beyond data analysis; he actively advocated for public health
measures. His successful persuasion of authorities to remove the pump handle demonstrated effective
implementation of an evidence-based intervention.

Public Health Impact: The removal of the pump handle had a profound impact on the cholera outbreak,
leading to a significant reduction in new cases. Snow's approach showcased the practical implementation of a
public health intervention informed by thorough surveillance and risk factor identification.

John Snow's cholera investigation exemplifies a comprehensive application of the public health approach.
From problem identification through surveillance to risk factor identification, intervention evaluation, and
implementation, Snow's work remains a landmark example of how a systematic and evidence-based approach
can effectively address a public health crisis. His pioneering efforts laid the groundwork for modern
epidemiology and the broader field of public health. He is now known as the Father of Modern Epidemiology.

Roles of Stakeholders in Public Health – Recognizing Health as a Team Effort

Institute of Medicine. The future of the public's health in the 21 st century. Washington, DC: The National Academies Press; 2002.

Community:

Role: Actively engages in health promotion, prevention, and awareness activities.

Responsibilities: Adopts healthy behaviors, participates in community health programs, and advocates for
local health needs.
Impact: Community involvement enhances the effectiveness of public health initiatives and fosters a culture of
health and well-being.

Healthcare Delivery System:

Role: Provides medical care, preventive services, and health education.

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Responsibilities: Ensures accessibility, affordability, and quality healthcare services for individuals and
communities.
Impact: Essential for treating illnesses, managing chronic conditions, and promoting overall health within the
population.

Employers and Businesses:

Role: Contribute to the occupational health and well-being of employees.

Responsibilities: Implement workplace wellness programs, provide health insurance, and create a healthy
work environment.
Impact: A healthy workforce improves productivity, reduces absenteeism, and supports overall community
well-being.

Media:

Role: Communicates health information, educates the public, and shapes perceptions.
Responsibilities: Disseminates accurate health information, supports health campaigns, and raises
awareness.
Impact: Influences public attitudes, behaviors, and decision-making, playing a crucial role in public health
communication.

Academia:

Role: Conducts research, educates future healthcare professionals, and contributes knowledge.
Responsibilities: Generates evidence-based solutions, trains the next generation of public health leaders, and
informs policy development.
Impact: Advances public health through research findings, innovations, and a well-trained workforce.

Government Public Health Infrastructure:

Role: Develops and implements public health policies, regulations, and programs.
Responsibilities: Monitors health trends, ensures public safety, allocates resources, and responds to health
emergencies.
Impact: Shapes the overall health of the population, enforces health laws, and coordinates national health
efforts.

Recognizing that health is a collaborative approach, these stakeholders play interconnected roles. Their
collective efforts contribute to the development and maintenance of a robust public health system, addressing
the diverse needs of individuals and communities. Collaboration fosters a comprehensive and integrated
approach, ensuring the well-being of the population on multiple fronts.

Determinants of Health – Public Health Lens

Genetics and Biology: While acknowledging the role of genetics and biological factors, the WHO emphasizes
their interaction with other determinants. Genetic predispositions contribute to health outcomes but are
influenced by broader environmental and social contexts.

Health Behaviors: Individual behaviors, lifestyle choices, and adherence to preventive measures are integral
to health. The WHO emphasizes the importance of promoting positive health behaviors to prevent diseases
and enhance overall well-being.

Social and Societal Factors: The WHO underscores the critical role of social and economic conditions,
including income, education, and employment, in shaping health outcomes. These factors contribute to
disparities in health access and outcomes.

Environmental factors, such as access to clean water, safe housing, and air quality, are highlighted by the
WHO. These elements significantly impact health and well-being on both individual and community levels.

The WHO recognizes the significance of social support systems and community engagement in fostering
mental health and resilience. Social connections contribute to a sense of belonging and support during
challenges.

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Healthcare Services: Access to healthcare services, the quality of care, and the effectiveness of health
systems are key determinants. The WHO underscores the need for equitable healthcare provision to address
health disparities.

Guide Questions

1. How does the definition of public health reflect its goals and operations?

2. How can public health models be applied to current health crises?

3. How has public health contributed to health improvements in your community?

4. Explain the interplay between social, economic, and environmental factors in

public health.

Supplementary Readings:

Official Gazette. (2003, June 23). Republic Act No. 9211 | GOVPH. Official Gazette of the Republic of the
Philippines. https://www.officialgazette.gov.ph/2003/06/23/republic-act-no-9211/

Executive Order No. 26 s. 2017 | GOVPH. (n.d.). Official Gazette of the Republic of the Philippines.
https://www.officialgazette.gov.ph/2017/05/16/executive-order-no-26-s-2017/

References

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World Health Organization. (2021). Determinants of Health. https://www.who.int/news-room/questions-and-

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World Health Organization. (2024). Constitution of the World Health Organization. World Health Organisation.
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12 | J a c l y n P. L e y s o n - A z u e l a , R M T, M D , M P H
University of the Immaculate Conception