Community & Public Health
By: Juliene Natt A. Colantro
Vision
 Filipinos are among the healthiest people in
Southeast Asia by 2022, and Asia by 2040.
Mission
 To lead the country in the development of a
productive, resilient, equitable and people-
centered health system.
 HEALTH(definitions)
WORLD HEALTH ORGANIZATION(1995)
A state of complete physical, mental, and
social well-being and not merely the absence of
disease or infirmity.
Ottawa Charter for Health Promotion (1986)
resource of everyday life, not the objective
of daily living. A positive concept emphasizing
social and personal resources as well as physical
capacities
 PUBLIC HEALTH
- Ecological in perspective (external),
multi-sectoral in scope and collaborative in
strategy. It aims to improve the health of
community through organized community
effort.
- The science and art or preventing
disease, prolonging life and promoting
health through the organized community
efforts for the sanitation of the
environment, the control of community
infections, the education of the individual
in principles of personal hygiene, the
organization of medical and nursing service
for the early diagnosis and preventive
treatment of disease, and the
development of the social machinery
which will ensure to every individual in the
community a standard of living adequate
for the maintenance of health (Charles-
Edward Amory Winslow, 1920).
- The health status of a defined group of people
and the governmental actions and conditions to
promote, protect, and preserve their health.
PUBLIC HEALTH
- It is concerned with threats to the overall
health of a community based in population
health analysis.
- It is typically divided into epidemiology,
biostatistics and health services; environmental,
social, behavioral, and occupational health and
other subfields.
MAJOR CONCEPTS:
- Health promotion and disease prevention
People’s participation towards self-reliance:
active and full involvement with people in the
decision-making process: assessment, planning,
implementations, monitoring, and evaluation.
Deals with the ff (Winslow)
 Surveillance of emergence of diseases
 ID of diseases among community
members
 Investigating factors that contribute to the
existence of diseases
 Educating the community regarding ways
that will prevent them from acquiring the
diseases
 Creation of strategies that will ensure
sustained well-being among the
community.
 Provision of health services to address
community members who are already
having the disease or recuperating from
complications of the disease.
 Provision of health services to address
community members who are already
having the disease or recuperating from
complications of the disease.
 Institutionalize lessons learned through
policies and structures that will prevent
occurrence of similar or other diseases,
and
 Monitoring the health status of the
community and providing means that will
ensure them of sustaining their health and
well-being.
 CHARACTERISTICS:
- It deals with preventive rather than
curative aspects of health.
- It deals with population level- rather
than individual level health issues.
COMMUNITY comes from the old French
word “communite” which is derived from the
Latin “communitas” (cum. “with/together” +
munus, “gift”), a broad term for fellowship or
organized society.
- A group of people sharing common
geographic boundaries and/or common values
and interests.
- The group which functions within a
particular socio-cultural context (no two
Community & Public Health
By: Juliene Natt A. Colantro
communities are alike) and varying physical
environment and the people’s way of behaving
and coping differ from one group to another.
 solutions to common problems
5 core elements (MacQueen et. al., 2001)
1. Locus – sense of place, locale or geographical
boundaries. Ex. neighborhood, village, city or
country.
2. Sharing – shared perspectives and common
interests.
3. Joint action – source of community cohesion
and identity; leading naturally to the creation of
community
4. Social ties – interpersonal relationships that
formed the foundation of the community. Ex.
family, roommates, household, lovers, friends,
neighbors, coworkers, role models, support
groups.
5. Diversity – larger societal view of community
and made reference to differences in
interpersonal interaction.
 CHARACTERISTICS
 Membership - a sense of identity and
belonging.
 Common symbol systems - similar
language, rituals, and ceremonies.
 Shared values and norms.
 Mutual influence - community members
have influence and are influenced by each
other
 Shared needs and commitment to
meeting them
 Shared emotional connection - members
share common history, experiences, and
mutual support.
CLASSIFICATIONS
 Rural communities - A.K.A. open lands,
often agricultural in nature which is more
spacious and less densely populated.
 Urban communities - often known as city
or cities which are non-agricultural in
nature, are densely populated, and marked
by industrial products and technology;
Central Business Districts are found here.
 Suburban or rurban or the capitals -
usually the administrative capital of a
province characterized by a unique mix of
agriculture and industry.
Community Development
 Community roles – national development
and sustainable progress
 Important strategy in nation-building
 United Nations - a process where
community members come together to
take collective action and generate
 Can be compared to a system (simple or
complex/ open or closed) composed of
many units goal is to accomplish specific
function or goal
 System can be dissected to subsystems 
which affect each other results to an
outcome therefore a prerequisite in
community development
COMMUNITY HEALTH
 A part of paramedical and medical
intervention or approach which is
concerned with the health of the whole
population.
 A discipline that concerns with the study
and betterment of the health
characteristics of biological communities.
 The health status of a defined group of
people and the actions and conditions,
both private and public (governmental), to
promote, protect, and preserve their
health.
Its aims are:
- Health Promotion
- Prevention of Disease
- Management of factors affecting health
Deals with supply side - availability and
accessibility of health services and health
service providers.
Deals with demand side - health seeking
behavior (social acceptability and appeal of
available services and social structures)
CHARACTERISTICS OF A HEALTHY
COMMUNITY
 The physical environment is clean and safe
 The environment meets everyone’s basic
needs.
 The environment promotes social harmony
and actively involves everyone.
 There is an understanding of the local
health and environment issues.
 The community participates in identifying
local solutions to local problems.
 Community members have access to
varied experiences, interactions and
communication.
 The health services are accessible and
appropriate.
 The historical and cultural heritage is
promoted and celebrated.
 There is a diverse and innovative economy.
Community & Public Health
By: Juliene Natt A. Colantro
 There is a sustainable use of available
resources for all.
 “A healthy community is a place where people
provide leadership in assessing their own
resources and needs, where public health and
social infrastructure and policies support health,
and where essential public health services,
including quality health care, are available.”
PUBLIC HEALTH vs. COMMUNITY
HEALTH
- Public health includes community health.
- Public health is concerned with the health of
the communities as whole, especially the
preventive ones.
- Community health is concerned with the
health of the local communities (preventive,
medical and clinical care).
- Community health is the delivery system for
public health.
- Public health is placed on a larger scale since
issues are global, while community health is on
a smaller scale. Example of outcome measures:
Public health outcome: Estimation of
environmental health risks; Community health;
Measuring bronchial asthma cases among a
group of families at one district.
The Health Field Concept
Health Field - A term used to include all the
factors that affect health in addition to the
healthcare system. Developed and now called
the Health Field Concept, which is
divided into four elements:
1. Human Biology
2. Environment
3. Lifestyle
4. Health Care Organization
1. Human Biology
 Includes all those aspects of health, both
physical and mental, which are developed
within the human body as a consequence of the
basic biology of human beings and the organic
make-up of an individual.
 For example, age is one of the biological
determinants of health —because older people
are more at risk of developing non-
communicable
diseases such as cancer.
2. Environment
 Includes all those matters related to health
which are external to the human body and over
which the individual has little or no control.
Some examples of matters included in this
element include geography,climate, industrial
development and the economy.
 For example, people living in the lowland
areas (geographic factors) are more exposed to
malaria than people living in the highlands. If
the economic environment gets worse then
more people will have to live in poverty — and
this is very bad for their health.
3. Lifestyle
Made up of the habits and usual practices
of human beings which affect their health and
over which they more or less have control.
 For example people who are not sleeping
under insecticide treated bed nets are at more
risk of acquiring malaria.
4. Health Care Organization
 Consists of the arrangement and resources
that are used in the provision of healthcare —
often referred to as the healthcare system.
 For example if someone is sick from malaria
and there are no health facilities nearby to
treat the patient, the patient is more likely to
develop a severe complication and may even
die.
Organizations That Help Shape
Community Help International
Health Agencies
 World Health Organization (WHO)
- Its headquarters is located in Geneva,
Switzerland.
-Largest international health
organization. The primary objective as
stated in the constitution is the attainment
by all people of the highest possible level
of health.
 Six core functions of WHO
1. Articulating consistent, ethical and
evidence-based policy and advocacy
positions.
2. Managing information by assessing trends
and comparing performance; setting the
agenda for, and stimulating research and
development.
3. Catalyzing change through technical and
policy support, in ways that stimulate
cooperation and action and help to build
sustainable national and inter-country
capacity.
Community & Public Health
By: Juliene Natt A. Colantro
4. Negotiating and sustaining national and
global partnerships.
5. Setting, validating, monitoring and
pursuing the proper implementation of
norms and standards,
6. Stimulating the development and testing
of new technologies, tools and guidelines
for disease control, risk reduction, health
care management, and service delivery
 Department of Health (DOH)- Holds
the over-all technical authority on health
as it is a national health policy-maker and
regulatory institution.
 3 Major Roles:
1. Leadership in health
2. Enabler and capacity builder
3. Administrator of specific services
Attached Agencies
1) Philippine Health Insurance
Corporation(PHILHEALTH)
2) Philippine National AIDS
Councili(PNAC)
3) Philippine Institute of Traditional
Alternative Health Care(PITAH)
4) Population Commission(PC)
5) Dangerous Drugs Board(DDB)
6) National Nutrition Council(NNC)
7) Food and Drugs Administration(FDA)
 Three Levels of Primary Health
Care
Primary care - activities or services
provided by a healthcare professional acting as
first point of contact or consultation for all
patients.
- rural health units, clinics,
barangay health stations
- services are maternal
child (immunizations, family
planning, antenatal
perinatal care).
Secondary care - provided by medical
specialists and other medical professionals to
whom a primary care professional has referred
to.
- usually hospital
based.
- more specialized
type of service
Tertiary care
-more specialize form
-more complex cases
-more advanced services
-Fewer patients
ex. Cancer management or neurosurgeries
 Levels of Health Care Facilities
Primary Level - Includes the rural health
units, their sub-centers, chest clinics, malaria
eradication units, and schistosomiasis control
units operated by the DOH
-Puericulture centers operated by
League of Puericulture Centers;
- Tuberculosis clinics and hospitals of the
Philippine Tuberculosis Society.
- Private clinics, clinics operated by the
Philippine Medical Association.
- Clinics operated by large industrial firms
for their employees.
- Community hospitals and health centers
operated by the Philippine Medicare Care
Commission and other health facilities
operated by voluntary religious and civic
groups.
Secondary Level - These are the smaller,
non-departmentalized hospitals including
emergency and regional hospitals.
- Services offered to
patients with symptomatic
stages of disease, which require
moderately specialized
knowledge and technical
resources for adequate
treatment.
Tertiary Level - are the highly technological
and sophisticated services offered by medical
centers and large hospitals. These are the
specialized national hospitals.
- Services rendered at this level
are for clients afflicted with diseases
which seriously threaten their health
and which require highly technical
and and specialized knowledge, facilities
and personnel to treat effectively.
 Local Health Facilities (Six
Facility Levels)
1. Barangay Health Unit
- Managed by barangay and municipal
governments
- Primary level of care
2. Rural Health Unit
- Managed by municipal government
- Primary level of care
3. City Health Offices
- Managed by city governments
- Primary level of care
Community & Public Health
By: Juliene Natt A. Colantro
4. Municipal or district hospitals
- Managed by the Provincial government
- Secondary level of care
5. Provincial Hospitals
- Managed by Provincial government
- Tertiary level of care
6. Regional Hospital and Medical Center
- Managed by the DOH
- Tertiary level of care
Three Levels of Primary Health Care
Workers
1. Barangay Health Workers
- First contacts of the community and
initial links of health care.
- Provide simple curative and preventive
health care measures promoting healthy
environment.
- Participate in activities geared towards
the improvement of the socioeconomic level of
the community like food production program.
- Community health worker, volunteers or
traditional birth attendants.
2. Intermediate Level Health Workers
- Represent the first source of professional
health care
- Attends to health problems beyond the
competence of village workers
- Provide support to front-line health
workers in terms of supervision, training,
supplies, and services.
- Medical practitioners, nurses and
midwives.
3. First Line Hospital Personnel
- provide back up health services for cases
that require hospitalization
- establish close contact with intermediate
level health workers or village health workers.
- Physicians with specialty, nurses, dentist,
pharmacists, other health
professionals.
 Referral System/ Process
- A patient is transferred from one level or point
of care to another
 Two-way Referral System
- An organized two-way relationship between a
health care provider or physician in a health
care facility at one level of the health care
system and another health care provider or
physician in a health care facility at the same
or higher level of the health care system
HISTORY OF COMMUNITY AND
PUBLIC HEALTH
IN THE PHILIPPINES
The Pre-Spanish Era (Before 1565)
The Spanish Era ( 1565 to 1898 )
American Military Government ( 1898-1907)
Philippine assembly/ Congress (1907-1916)
The Jones law (1916-1936)
The Commonwealth (1936-1941)
Japanese occupation ( 1941-1945)
Post World war II (1945-1972)
Post EDSA revolution (1986 to present)
 The Pre-Spanish Era (Before
1565)
- our ancestors put faith in nature not only
for physical but also for spiritual sustenance.
Belief in the power of both the animate and
inanimate world was central to their way of life.
- Ailments were believed to be caused by
disharmony with the spiritual world, and
restoring health meant appeasing the gods
through incantations, dances and ritual
offerings that ranged from food, to clothing, to
blood sacrifice. At the center of these rituals
was the babaylan, mediator between the
physical and spiritual worlds.
- Early Filipinos were good physicians who
used medicinal herbs.
-Rural faith-healer prescribed well-
masticated betel-nuts leaves and areca nut
leaves which were spat onto the afflicted
portion of the body.
- One of the most prized medicinal plants
is the igasud from the mountain regions of
the Visayas. Its seed when chewed is an
antidote for poison. It was renamed Pepita of
San Ignacio by Spanish missionaries.
 The Spanish Era ( 1565 to 1898 )
1577 - Public health began at the old
Franciscan Convent in Intramuros where Fr.
Juan Clemente put up dispensary for treating
indigents in Manila.
- San Juan de Dios Hospital
The Spanish Era ( 1565 to 1898 )
- During Spanish Time
1. Creation of Vaccinators to prevent smallpox
2. Creation of Board of Health
3. First medical school in the Philippines- UST
4. School of Midwifery
5. Public Health Laboratory
6. Forensic Medicine
Hospital before the Americans came to
Philippines (General Hospitals)
1. San Juan de Dios Hospital
2. Chinese General Hospital
Community & Public Health
By: Juliene Natt A. Colantro
3. Hospicio de San Jose in Cavite
4. Casa dela Caridad in Cebu
5. Enfermeria de Sta. Cruz in Laguna
Hospital before the Americans came
to Philippines (Contagious Hospitals)
1. San Lazaro Hospital
2. Hospital de Palestina in Camarines Sur
3. Hospital delos Lesporosos in Cebu
4. Hospital de Argencina in Manila for smallpox
and cholera
 HISTORY OF COMMUNITY AND
PUBLIC HEALTH IN THE PHILIPPINES
American Military Government ( 1898-1907)
- Control of epidemics such as cholera,
small pox and plague
- Fight against communicable diseases
such as common cold, Hepa A-D, chickenpox,
flu, mumps, malaria, herpes, STD, measles
Projects and activities:
1. Garbage crematory;
2. Confirmed that plague in man comes from rat
3. First sanitary ordinance and rat control;
4. Opened the UP College of Medicine
5. Cholera vaccine was first tried;
6. Establishes Bureau of Science
Philippine assembly (1907-1916)
1. Hygiene and Physiology were included in
curriculum of public elementary school
2. Anti-TB campaign was started
3. Philippine Tuberculosis Society was organized
4. Opening of PGH (Phil. Gen. Hospital)
5. Use of anti-typhoid vaccine was initiated
6. Dry vaccine against small pox was first use

The Jones law years (1916-
1936)
4.1 Retrogression rather than progression in so
far as the health was concern
1. Increase CDR (Crude Death Rate)
2. Increase IMR (Infant Mortality Rate)
3. Increase Morbidity
4.2 Increase deaths from smallpox, cholera,
typhoid, malaria and TB
4.3 Re-organized happened (reorganized the
health service and encouraged effective
supervision)
1. Study the cause and prevalence of
typhoid fever
2. Schick test was used to determine
the causes of diphtheria
3. Campaign against Hookworm was
launched
4. Anti-dysentery vaccine was first tried
5. First training course for sanitary
inspector was given
6. Women and child labor law was
passed
7. Mechanisms of transmission of
dengue fever through Aedes aegypti was
studied
8. Establishment of School of Hygiene
and Public Health
9. National Research Council of the
Philippines was organized
10. BS in Education Major in Health
Education was opened in UP
11. (PPHA) Philippine Public Health
Association was organize.
The Commonwealth (1936-1941)
-The epidemiology of life threatening
disease was studied diphtheria, yaws,
dengue.
-Research in the field of health was
promoted
-UP School of Public Health was
established
-Development of Maternal and Child
Health (MCH)
*1939 – Creation of Dept. of Public Health
and Welfare - Dr. Jose Fabella as the First
secretary
*1940- Bureau of Census and Statistics
was created to gather vital statistics.
5.7 In spite of development
1. Inequitable distribution of health
services remained a problem.
2. 80% of those who died were never given
medical attention.
 Japanese occupation ( 1941-
1945)
1. During this time, all public health
activities were practically paralyzed.
2. Increase incidence of TB, venereal
diseases, malaria, leprosy and malnutrition.
 Post World war II (1945-1972)
1.Philippine Independence
2.Completion of a research on
Dichlorodiphenyltricholoroethane
(DDT- as larvicidal/insecticide to
control malaria)
3. Gonorrhea with penicillin
treatment
4. Manila was selected as
Headquarters for World Health
Organization (WHO) Western Pacific
Office
Community & Public Health
By: Juliene Natt A. Colantro
5. Strengthening Health and Dental
services in rural areas (per
municipalities with 5,000-10,000
population) 1 Municipal Health
Officer 1 Public Health Nurse 1 Midwife 1
Sanitary Inspector
Post World war II (1945-1972)
8. MARTIAL LAW YEARS
8.1 Creation of National Economic
Development Authority
8.2 Department of Health was
renamed as Ministry of Health (MOH)
8.3 Accomplishments during this
period:
8.3.1 Formulation of National Health
Plan
 Construction of Tertiary Hospital
o Philippine Heart Center
o Lung Center
o Kidney Center
o Lungsod ng Kabataan / Phil.
Childrens Medical Center
Accomplishments during this period:
8.3.1 Formulation of National Health Plan
 Adaptation of the Primary Health Care
 Phil was the first country to implement
PHC
 Launching of Operation Timbang and
Mothercraft
 Nationwide program providing
supplementary food for infants, pre-school
and school children.
- NUTRIBUN- bread with vitamins
Post World war II (1945-1972)
 MARTIAL LAW YEARS
Accomplishments during this
period:
 Progress in Public Health research
RITM - Research Institute for Tropical
Medicine
PCHRD - Philippine Council for Health
Research and Development
 Post EDSA revolution (1986 to present)
 From Ministry of Health, it was
renamed again as Dept. of Health
 Increase in life expectancy slowed
down
 Increased incidence of malnutrition
 Declined practice of family planning
AQUINO ADMINISTRATION
 1987 Constitution- more provisions
on health making comprehensive
health care available
Major activities:
 Milk code - required the marketing
of breast feed milk substitute
 Universal child and mother
immunization
 1987 Constitution- more provisions
on health making comprehensive
health care available
Major activities:
 RA. 6725- Act prohibiting
discrimination against women.
 NESS- National Epidemic Surveillance
System.
 RA. 6675- National Drug Policy and
Generics Act.
 RA. 7170- Organ Donation Act
RAMOS ADMINISTRATION
 “Health in the Hands of People” and
“Let‟s DOH it” – by Sen Juan Flavier
 Memorable initiative during
leadership of Flavier
 National Immunization Day
 BCG (Bacille Calmette-Guérin (BCG) is
a live strain of Mycobacterium bovis
developed by Calmette and Guérin
for use as an attenuated vaccine to
prevent tuberculosis and other
mycobacterial infections.)
 Memorable initiative during leadership of
Flavier
 National Immunization Day
 DPT (diphtheria, pertussis(whooping
cough) and tetanus)
 OPV – Oral Polio Vaccine
 MMR - Immunization shot against
measles, mumps, and rubella (also
called German measles)
 Promotion of Traditional Medicine-
Herbal Medicine.
 Yosi Kadiri
 Araw ng Sangkap Pinoy- aimed to
prevent Vitamin A, Iron and Iodine
deficiency.
 Voluntary Blood Donation Program
 Kung Sila‟y Mahal Mo Magplano-
Family Planning Program.
 Doctors to the Barrio
RAMOS ADMINISTRATION
Laws:
 EO 39 - which created the Philippines
National AIDS Council as a national
Community & Public Health
By: Juliene Natt A. Colantro
policy and advisory body in the
prevention and control of HIV-AIDS
 RA 7719- the National Blood Services
Act of 1994, this to promote
voluntary blood donation
 RA 8172 - Salt Iodization Nationwide
(ASIN), providing salt iodization
nationwide approved in 1996 and
renamed FIDEL (Fortified for Iodine
Elimination)