HEALTH AND ENVIRONMENT /

ENVIRONMENTAL HEALTH

VICTOR CHEELO
 Five Elements to achieving PHC Goal

1. Reduce exclusion and social disparities in

health (Universal Coverage)
2. Organizing health services around
people’s needs and expectation
3. Integrate health in all the sectors
4. Pursue collaborative models of policy
dialogue (Leadership reform)
5. Increasing stakeholder participation
 Basic Principle of PHC
1. Equitable
– Health services must be provided equally to
all individuals irrespective of their gender,
age, caste, colour, location (Urban or rural)
and social class
2. Community participation
– Active involvement of the local community in
the decision making process and
implementation of health programs
 Basic Principle of PHC
3. Health workforce development
 Requires adequate numbers and trained health care
workers
4. Use of appropriate development
 Medical technology to be provided and be
accessible, affordable, feasible and culturally
acceptable by the community
5. Mult-sectoral approach
 Working together with other sectors in promoting
health and self reliance of communities
 Concept of Universal Health Care

• Refers to the provision of health care such that

all people obtain the health services they need
without suffering financial hardship when paying
for them.

• Universal Health care is to provide all citizens

with a health care they need without worry of
financial hardships
 Factors for Universal health care
to be in place
• Need a strong, efficient, well run health
system which meets priority health needs
through people centered integrated care
through:
– Effective health messages to encourage
people to stay healthy and prevent illness
– Early detection of health conditions
– Increased capacity to treat disease
– Health patients with rehabilitation
 Factors for Universal health care
to be in place
• Affordability: Financing health services
so people do not suffer financial hardships
• Access to essential medicines and
technologies: Diagnose and treat
medical problems
• Well trained and motivated health
workers: Provide services to meet
patients’ needs
 Service delivery
• Refers to how services are organised and
managed

• Health service: refers to both the organisation

that supplies care and to specific product which
is delivered

• Service delivery is one of the six building blocks

of a well functioning health system (WHO)
 System building blocks

1. Leadership/governance system

2. Health care financing

3. Health workforce

4. Medical products and technologies

5. Information and research

6. Service delivery
 Focus areas of PH
1. Health Protection
– These are set of activities within the public
health function
– Ensures safety and quality of food, water,
air, and general environment
2. Disease prevention
– There are four levels of disease prevention
– Primordial Prevention: Prevention of risk
factors themselves
2. Disease prevention cont.
– Primary Prevention: Seeks prevention of the
disease before it begins: Activities at this
level includes health promotion and
education as well as providing primary health
care services
– Secondary prevention: Detects disease in its
early stages and reduces its progression and
effects
– Tertiary prevention: Occurs when advanced
disease is already present, and reduces
complication and mortality
3. Health promotion

• Refers to the process of enabling people to

increase control over their health and its
determinant, and thereby improve their health
• It empowers people to make healthy life choices
• Three models of health influencing HP
– Biomedical Model of Health
– Social Model of Health
– Ecological Model of Health
 Three Models of Health
Influencing Health Promotion
1. Biomedical Model of health (Pre –
1970s)
– Focuses on risk behaviors and healthy
lifestyles
– Emphasizes health education – changing
knowledge, attitudes and skills
– Focuses on individual responsibility
– Treats people in isolation of their
environments
 Three Models of Health Influencing
Health Promotion Cont.
2. Social Model of Health (from 1970s
forward)

– Addresses the broader determinants of health

– Involves inter-sectoral collaboration
– Acts to reduce social inequities
– Empowers individuals and communities
– Acts to enable access to health care
 Three Models of Health Influencing
Health Promotion Cont.
3. Ecological Model of Health (Late 1970
onwards)
– Acknowledge the reciprocal relationship between
health related behaviors and the environments in
which people live, work and play
– Considers the environment is made up of different
subsytems
– Emphasizes relationships and dependencies between
these subsystem
– Comprehensive and multi-faceted, using a shared
framework for change at individual and
environmental levels
 Eight Key Elements of health
Promotion
i. Address the population as a whole in
health related issues
ii. Direct action to risk factors or causes of
illness or death
iii. Undertaking activities approach to
remedy risk factors in the community
iv. Promote factors that contribute to better
conditions of health of population
 Eight Key Elements of health
Promotion
v. Initiate action against health hazards
vi. Involve public participation in defining
health problems, deciding on action
vii. Advocate relevant environmental, health
and social policy
viii. Encourage health professionals’
participation in health education and
health policy
Thank you very much
Assessing the Health
of the Population
• Part 1 Introduction

• Part 2 The HNA 5 step process

– Used in assessing the health of the population
 Introduction
• Health Needs Assessment (HNA) is a systematic
review of the health issues facing a population,
leading to agreed priorities and resource
allocation that will improve health and reduce
inequalities.
• HNA provides ideal opportunities to reduce
inequalities by gathering evidence from
and about specific populations and for
utilising an evidence based approach to
affect service changes.
 Introduction
• Focuses on the entire range of individual
and collective factors (income and social
status, education, employment and
working conditions, social environment,
physical environment, gender, culture,
personal health and coping skills, healthy
child development, health services)
• The interaction among these factors
 How does HNA support
National Targets
• The Government’s aim is to reduce health
inequalities strategy by tackling the wider
determinants of health, such as poverty, poor
educational outcomes, unemployment, poor
housing and the problems of disadvantaged
populations.

• HNA provides a vital tool by being able to target

populations in most need of improved support
and services.
 Benefits HNA
• Strengthened community involvement in
decision- making
• Improved team and partnership working
• Development of professional skills and
experience.
• Improved communication with other
agencies and the public
• Better targeted services and use of
resources
 Links to other assessment tools

Health Impact Assessment (HIA)

Integrated Impact Assessment (IIA)
Health Equity Audit (HEqA)

Population Policy/ Project/ Programme

HNA HIA

HEqA IIA
The Five Steps of Health Needs Assessment

• Aim
A systematic process focussed on a target
population that sets priorities for
improving health and tackling local health
inequalities then plans effective change

• Result
clear priorities for action implementation of
effective local action plans
 Target population
The four main population types
1. Geographic at different levels eg Regional,
National, Provincial, District, neighbourhood
2. Settings for example schools, workplaces,
prisons, hospitals.
3. Shared social experience homelessness,
refugee, ethnicity, culture, age, sexuality.
4. Specific health experience diseases, mental
health, disabilities. Example: older people
living in a deprived neighbourhood
 Target population
Ensure you have:
• Clearly defined the population.
• Clarity around sub groups
Checked they match with National/local
priorities on reducing health inequalities?
 Setting Priorities
Criteria For Setting Priorities
Impact
• Which conditions / factors have the most
significant impact on local health?
Severity
Size
Changeability
• What can effectively be done about the
significant diseases / factors by those
involved?
 Setting Priorities Cont.
Acceptability
• What are the most acceptable changes
required for the maximum positive
impact?

Resource feasibility
• Are the resource implications of the
proposed actions feasible?
 Setting Priorities Cont.
Sources of needs information
• Data about population characteristics and the
severity and size of the health issues i.e. who,
when,where and what
• Perceptions of the profiled population
• Perceptions of people providing the services
• Perceptions of managers of commissioning /
Provider organisations
• Relevant national, local or regional priorities
 The 5 steps
Step 1: Getting started

who are the population to be assessed?

why are we doing this assessment?
who should be involved, when and how?
what skills are required?
 The 5 steps Cont.
Step 2: Identifying health priorities of
the population

what diseases or factors have a

significant impact?
which of these are changeable?
who are most at risk from these?
 The 5 steps Cont.
Step 3:Choosing priorities for change

what significant diseases, conditions or

factors affect this priority?
what can be done to improve this
priority?
what are the acceptable, feasible
changes?
what resources are required?
who will gain from these changes?
 The 5 steps Cont.
Step 4: Action planning

what are we aiming to do?

who is going to do it?
when is it going to be done?
How are we going to monitor and evaluate
the programme?
what is our implementation and
dissemination plan?
what is our risk assessment strategy?
 The 5 steps Cont.
Step 5: Moving on

what learning has emerged from the

project?
what needs to be done now/next?

Selection of next population/priority revisit

step 1
 Group Activity Step 1: Getting started

1. Select a population
2. How does this population relate to national, regional and local
priorities?
3. What would you hope the HNA to achieve (aims and
objectives)
4. Who would you want to be involved in the project (team,
stakeholders, senior /policy mangers, skills)
5. What resources would you require?
6. What data might be available about this population and from
where?
7. What challenges/ difficulties might you encounter setting up
this project?
8. How would you overcome these problems?