Assessment- collecting, analyzing, and using data to educate and improve public health.
Behavioral risk factors- risk factors in this category include behaviors that are believed to
cause, or to be contributing factors to most accidents, injuries, disease, and death during youth
and adolescence as well as significant morbidity and mortality in later life.
CDC- The Centers for Disease Control and Prevention (CDC) is part of the Department of
Health and Human Services. It provides federal leadership and funding in the prevention
andcontrol of diseases.
Chronic disease- A disease that has one or more of the following characteristics: it is
permanent, leaves residual disability
Demographic characteristics- measures of total population as well as percent of total
population by age group, gender, race and ethnicity, where these populations and sub-
populations are located, and the rate of change in population density over time, due to births,
deaths and migration patterns.
Disease- A state of dysfunction of organs or organ systems that can result in diminished quality
of life
Endemic- Prevalent in or peculiar to a particular locality or people
Environmental Factor - an extrinsic factor (e.g., geology, climate, insects, sanitation,health
services, etc.) that affects the agent and the opportunity for exposure.
Epidemic- A group of cases of a specific disease or illness clearly in excess of what one would
normally expect in a particular geographic area.
Epidemiology- the study of the distribution and determinants of health-related states or events
in specified populations, and the application of this study to the control of health problems.
Health indicator- A health indicator is a measure that reflects, or indicates, the state of health
in a defined population, such as the infant mortality rate.
Indicator- In public health terms, an indicator variable helps to measure changes directly or
indirectly.
Infant Mortality Rate- A death rate calculated by dividing the number of infant deaths during a
calendar year by the number of live births reported in the same year. It is expressed as the
number of infant deaths per 1,000 live births.
Infectious- Capable of causing infection or disease by entrance of organisms (e.g., bacteria,
viruses, protozoan, fungi) into the body, which then grow and multiply. Often used
synonymously with “communicable”.
Morbidity- Illness or lack of health caused by disease, disability, or injury
Mortality- A measure of the incidence of deaths in a population.
Outbreak- the occurrence of more cases of disease than would normally be expected in a
specific place or group of people over a given period of time
Prevalence- the proportion of people in a population who have some attribute or condition at
a given point in time or during a specified time period.
Vulnerable populations- A group of people with certain characteristics that cause them to be
at greater risk of having poor health outcomes. These characteristics include, but are not
limited to, age, culture, disability, education, ethnicity, health insurance, housing status,
income, mental health, and race.
Vectors- it refers to animals or other living organisms that carry or transmit diseases (e.g.,
rats, mosquitoes, foxes).
INTRODUCTION TO CPH
collective well-being of community members
“mainting wellness vs. treating illness”
WHAT IS A COMMUNITY
1. BIOLOGY- an interaction of group of various species in a common location
2. SOCIOLOGY- A group of people with a high degre of interaction that shares a common
purpose, belief or set of behaviours
WHAT IS PUBLIC HEALTH?
1. ECOLOGICAL IN PERSPECTIVE, MULTISECTORAL IN SCOPE, AND
COLLABORATIVE IN STRATEGY
2. IMPROVE HEALTH STANDARD OF THE COMMUNITY IN AN ORGANIZED
COMMUNITY EFFORT
WHAT IS HEALTH?
ACCORDING TO WORLD HEALTH ORGANIZATION(1978)
-A state of complete physical, mental, and social-wellbeing, and n not merely the
absence of illness/disease or infirmity
*health is a social phenomenom
*outcome of multi-casual theories of health and dse
*outcome or by-product of the interplay of societal factors (ecological, economical)
DISEASE?
-generally the harmful deviation from the normal structural or functional state of an
organism, usualy associated with signs and sympoms (WHO)
-the scientific paradigm of modern medicine, are abnormalities in the function and/or
structure of body organs and systems
ILLNESS?
-manifestations of imapairement, defefecs/pathology, or disability
- concept realted to personal experience of disease
WHAT IS A COMMUNITY AND PUBLIC HEALTH?
- according to AdventHealth University:
Public health focuses on the scientific process of preventing infectious diseases, while
community health focuses more on the overall contributors to a population's physical and
mental health.
EPIDEMIOLOGY
Branch of medicine that deals with the incidence, distribution,and possible control of dse and
other factors relating to health
DEMOGRAPHY
DEMOS (PEOPLE, SOCIETY) AND GRAPHIA (WRITING)
Study of demographics, the social characterictics and statistics of a human population.
Study that correlates the population size and composition (age, race) to how they change
through the interplay of fertility(births), mortality(deaths), and migration.
COMMUNITY AS THE CLIENT
What is a community - a group of people with common characteristics, interest that live
together in a territort or a geographical (physical) bundaries
world views on community:
1. Family, society, comunity
2. Contradictions/conflicts
3. Change
FAMILY, SOCIETY, AND COMMUNITY AS CLIENT
INDIVIDUAL
• Patient: an individual who is sick
• client: individual who is well/ not sick
FAMILY
• Role/Relationship: Parents: bi-parenting (the foundation of civilization and its values)
- a mother is expected to have the ability to provide and care and takes the role of
keeping the family healthy “ilaw ng tahanan’
-father “haligi ng tahanana”
* ANYTHING THAT AFFECTS THE INDIVIDUAL, AFFECTS THE FAMILY, AFFECTS THE
COMMUNITY
CONFLICTS/CONTRADICTIONS
- people in a community are always in a constant conflict
INDIVIDUAL: intrapersonal conflict
FAMILY: Interfamilial conflicts (conflicts within the family/interpersonal)
COMMUNITY: intercommunity (interfmilial)
SOCIETY: Intra-societal intra-societal conflicts (interccommunity conlicts)
PEOPLE TEND TO HAVE A NEGATIVE PERSPECTIVE TO ONE ANOTHER
In the PH, we have this negative regional stereotyping:
ilocanos- Kuripot (positive: resourceful)
kapampangans- Mayabang (assertive/artistic)
bicolanos- Malibog (loving)
visayans- aswang (mysterious)
mindanaoans- mamamtay tao (brave/courageous)
* AVOID NEGATIVE STEREOTYPING AND LOOK FOR THE SURCCE OF CONFLICT AND
TRY TO FIND A SOLUTION
CHANGE
INEVITABLE IN A COMMUNITY (bc community is dynamic)
* the role of the commnity health care or publi health care is to constantly assess the
community to come up with approciate interventions
WHAT IS COMMUNITY HEALTH?
A part of paramedical and medical intevention or approach which is concerned with the health
of the whole populaion
a discipline that concerns with the study and betterment of the health characteristics of biologic
communities.
it aims to:
• Health promotion
• dse prevention
• management of factors affecting health
PANDEMIC
-Widespread , epidemic over a wide geographic area and affecting a large portion of the
population
EPIDEMIC
-spreading rapidly and extensively by infection and affecting many individuals in an area or a
population at the same time.
- an outbreak of a contagious dse that spreads rapidly and widely
PUBLIC HEALTH (DEFINITIONS)
MAJOR CONCEPTS:
HEALTH PROMOTION AND DISEASE PREVENTION
People’s participation towards self-reliance; active and full engagement with the people in the
decision making process.
- assessment , planning, implementation, monitoring, and evaluation
* 3PS IN PUBLIC HEALTH (PROMOTION, PREVENTION, PROTECTION)
Dr C E Winslow:
-the science and art of preventing diseases, prolonging life, promoting health and efficiency
through organized community effort
HANLOM:
-it is dedicated to the common attainment of the highest level of physical, mental, and social-
wellbeing and longevity consistent with the available knowledge and resources at a given time
and place. it holds this goal as its contribution to the most effective total development and life
on the individual and this society. (Holistic)
PURDOM
- It prioritizes the survival of human species, the prevention of conditions which lead to the
destruction or retardation of human function and potential in early years of life, the achievemet
of human potenrial and prevention of the loss of productivity of young adults and those in the
middle period of life and the improvement of the quality of life especially in later years.
NIGHTINGALE
- The act of utilizing the environment of the patients to assist them in their recovery. Any
individual is capable of reparative process.
MODELS OF COMMUNITY HEALTH
Health-Illness Continuum Models:
Dunn’s High-Level Wellness Grid
-describes a health grid in which a health axis and an environmental axis intesect. The grid
demonstrates the intersection of the environment with the illness-wellness continuum.
-the axis extends from the peak wellness to death, and the environmental axis extends from
very favorable to very unfavorable. The intersection of the two axes forms four quadrants of
health and wellness.
High-level wellness in a favorable environment
- example is a person who implements healthy lifestyle behaviours and has the
biopsychosocial , spiritual, and economic resources to support this lifestyle.
Emergent high-level wellness is an unfavorable environment
- example is a woman who has the knowledge to implement healthy lfestyle practices but does
not implement adequate self-care practices bc of family responsibilities, job demands, and
other factors.
Protected poor health in a favorable environment
- example is a sick person whose needs are met by the health care system and who
has access to appropriate medications, diet and health care instructions.
4. Poor health in an unfavorable environment
-example is a young child who is starving in a drought stricken country.
Requires the individual to maintain a continuum of balance and purposeful direction with the
environment
* involves progress towards a higher level of functioning, an open-minded and even expanding
challege to live at the fullest potential.
Travis’ Illness-Wellness Continuum
-ranges from high-level wellness to premature death. it demonstrates two arrows
pointing in opposite directions and joined at a neutral point. Movement to the right of the netral
point indicates increasing levels of health and well-being for an individual that is achieved in
three steps:
i. Awareness
ii. Education
iii. Growth
* in contarst, movement to the left of the neutral point indicates progressively decreasing levels
of health and premature death.
Degree of client wellness that exist at any point in time ranging from optimal wellness
condition, with the availability of energy at its maximum, to death which represents total energy
depletion
a dynamic state that continously alters as a person adapts to changes in the internal and
external environments to maintain a state of physical, mental/intellectual,
social,developmental and spiritual well-being (Holistic)
Variables affecting health status, beliefs, and practices
Internal variables- include those which are usually non-modifiable such as:
i. Biologic dimensions: genetic make up, sex, age, and developmental level all sinifican
to person’s health.
ii. Psychological dimensions: emotional factors that include mind-body interactions and
self-concept.
iii. Cognitive dimension: intellectual factors that include lifestyle choices and spiritual
and religious beliefs.
EXTERNAL VARIABLES- The macrosystems which includes:
i. Environment: geographical locations determine climate (climate affects health);
environmental hazards
ii. Economics: standards of living reflecting occupation, income and education related
to health, morbidity, mortality.
iii. family and cultural beliefs: the family passes on the life patterns of daily living and
lifestyles to offsprings (ex. physical and emotioncal abuse). Cultural and special interactions
also infleunce how a person perceives, experiences, and copes w health and illness.
iv. Social suppor networks: Political/systems of social governance: religion/church;
mass media.
In september 9, 1978 - UNICEF and WHO held the First International Conference on Primary
Health Care in Alma Ata, USSR
PHC Goal: HEALTH FOR ALL by 2000 (bc of the high-level wellness model in 1978)
in 1994, modified goal to HEALTH FOR ALL by 2000 and Beyond because the original goal
cannot be acheived.
LOI 949 was signed by PFM on Oct 19, 1979 making the Primary Health Care the focus of the
Department of Health.
VISION: Health For All Filipinos was set by DOH Sec. Juan Favier
Goal: Health for All Filipinos and Health in the Hands of the people by the year 2020 (the 2nd
phrase was suggested by the NGO: Bukluran Para sa Kalusugan)
Mission:
In partnership with the people, provide equity, access and quality health care esp to the
marginalized which brought about the Sentrong Sigla movement in order to acheive it.
Agent-Host-Environment Model:
- also called the ecologic model by Leavell and Clark refers to the interplay of agent
(causative/etiologic factor), host (intrinsic factor), and the environment (extrinsic factors)
1. Etiologic factors
-Biologic agents: Virus, fungi, bacteria, helminthes, protozoa, ectoparasites
-Chemical elements: carcinogens, poisons, allergens, transfats
-Nutritive elements: excess or deficiencies (marasmus and kwashiorkor)
-Mechanical factors
- Physical: individual struck by lightning
-Psychological: stress
2. Host
-intrinsic factors (Exposure and response/reaction)
Environment
-Extrinsic factors
i. Natural boundaries
ii. Biological environment
iii. Socio-economic (political boundary)
D. HEALTH BELIEF MODEL
-Refers to the relationship between a persons belief and his behaviour towards health.
It pertains to three components of an individual’s perception:
1. Susceptibility to Illness
2. Seriousness of an Illness
3. Benefits of taking the action
E. Evolutinary-based Model
- states that illness and death sometimes an evolutionary function. Elements
considered in the theory are:
i. Life events: developmental variables and variables associated w changes such as
accidents/relocation
ii. Lifestyle determinants
iii. Evolutionary vaibility with the social context: extent to which an individual functions
to promote survival and well-being
iv. Control perceptions: the extent to wc the person can influence circumstances in life
v. Viability of emotions: affective reactions
vi. Health outcomes: physiological, behavioural and psychological status
F. HEALTH PROMOTION MODELS
- DIRECTED AT INCREASING CLIENT’S WELL-BEING
-Goal : Enhance level of wellness
The Health Field Concept
MARC LALONDE- The New Perspective document (concept of health and promotion)
DETERMINANTS OF HEALTH:
HUMAN BIOLOGY
LIFESTYLE
ENVIRONMENT
HEALTH CARE ORGANIZATION
HEALTH DETERMINANTS
HUMAN BIOLOGY - aspects of physical and mental health as a result of oragni make-up
LIFESTYLE- persons decisions and risks over the individual has control
ENVIRONMENT- Aspects of physical and social environment over which individial has little or
no control
HEALTH ORGANIZATIONS- institutional arrangements governig the provision of health
services; access and quality
HEALTH CARE DELIVERY SYSTEM
The Department of Health shall be responsible for the following:
− Formulation and development of national health policies, guidelines, standards and manual
of
operations for health services and programs
− Issuance of rules and regulations, licenses and accreditations
− Promulgation of national health standards, goals, priorities and indicators
− Development of special health programs and projects and advocacy for legislation on health
policies
and programs
DEPARTMENT OF HEALTH
The primary function of the Department of Health is the promotion, protection, preservation or
restoration of the health of the people through the provision and delivery of health services
and through the regulation and encouragement of providers of health goods and services.
(E.O. No. 199, Sec. 3)
In the pursuit of its vision and execution of its mission, the DOH has the following major roles:
A. Leader in health
B. Enabler and capacity builder
C. Administration of health services
VISION: Health as a right. Health for all Filipinos by the year 2000 and Health in the Hands of
the People by the year 2020.
MISSION: In partnership with the people to ensure equity, quality and access to health care
by:
− making services available
− arousing community awareness
− mobilizing resources
− promoting the means to better health
POST WORLD WAR II - 1945
- the Philippine Independence
-Completion of a research on Dichlorodiphenyltrichloroethane
(DDT) saw dust as larvicide and DDT residual spraying of
houses in the control of malaria.
-Construction of the National Chest Center-for control case registry for TB,
mass immunization with BCG.
-Creation of central Health laboratory in the Philippines
-Manila was selected as Headquarters for the WHO Western pacific Office.
Executive Order 288 (Februay 20, 1958)
Reorganization of DOH - Creation of several offices
1. Dental health services
2. Malaria Education services
3. Disease Intelligence Center
4. Food and Drug Administration
5.National Schistosomiasis Control Commission
6.National Nutrition Program
Devolution − the act by which the national government confers power and authority upon the
various LGUs to perform specific functions and responsibilities
THE PH HEALTH DELIVERY SYSTEM
DECENTRALIZED - health systems have been tailor-fitted for the specific situation for each
country
*Provincial Government: Provincial and District hosp
*Munical Government: RHUS and BHS
*City Government: City hosp, health centers, and Barangay health stations (BHS)
2 MAJOR PLAYERS OF HEALTH SERVICE DELIVERY
PUBLIC SECTOR
• Is financed through a tax-based budgeting
system at both national and local levels where
health care is generally given free at the point
of service
• The DOH is the leading health agency
• Regional, local health care centers, and the PGH
PRIVATE SECTOR
• Consists of the profit and non-profit providers
• It is market-oriented and where health care is
paid through user fees at the point of service
CLASSIFICATION OF HEALTH FACILITIES
According to ownership
A. Government
B. Private
According to scope of services
A. General Facilities/Hospitals – PGH, JRMMC
B. Specialty Centers/Hospitals – PHC, NKIT
Other Health Facilities
A. Primary Care Facility
− health centers, dental clinics, infirmaries, lying-in facilities
B. Custodial
− Custodial psychiatric facilities, substance/drug abuse treatment and rehabilitation centers,
sanitaria/leprosaria, and nursing homes
C. Diagnostic/Therapeutic facility
1. Laboratory
2. Radiologic
3. Nuclear medicine
D. Specialized out-patient facility, dialysis clinic, ambulatory surgical clinic, cancer
chemotherapeutic
center/clinic, cancer radiation facility and physical medicine and rehabilitation
center/clinic
The Rural Health Unit
− Commonly known as a health center, a primary level health facility in the municipality
− Focus: preventive and promotive health services and the supervision of BHSs under its
jurisdiction
− Recommended ratio of RHU to catchment population is 1 RHU:20000 population (DOH,
2009)
BARANGAY HEATH STATION
• The BHS is the first-contact health care facility that offers basic services at the barangay
level
• It is a satellite station of the RHU
• It is manned by volunteer BHWs under supervision of RHM
REFERRAL SYSTEM
− A set of activities undertaken by a health care provider or facility in response to its inability
to provide
the necessary health intervention to satisfy a patient’s need
− May be internal or external
• Internal – occur within the health facility; from one health personnel to another
• External – movement of patient from1 health facility to another
• An organizational structure for coordinating, linking and transferring responsibility of care
• May be done by:
− a generalist to a specialist
− a specialist to a specialist
− one hospital to another
TYPES OF REFERRAL:
1. Interval Referral
− the patient is referred for complete care for a limited period
2. Collateral Referral
− the referring medical doctor retains overall responsibility but refers patient for care of some
specific problems
3. Cross Referral
− the patient is referred to another MD, once accepted, the referring MD has no more
responsibility in the patient
4. Split Referral
− The responsibility is divided between 2 or more MD
*REFERRAL SYSTEM
COMMUNITY – BHS – RHU – MUNICIPAL
DISTRICT HOSPITAL – PROVINCIAL
HOSPITAL – MEDICLA REGIONAL CENTER
*INITIATION OF PROGRAM WITH MULTILATERAL ASSISTANCE:
1. WHO and UNICEF assisted TB and BCG
programs
2. TB control program as basic service of RHU
3. TB sputum case finding by microscopy
4. Serum and vaccine production in Alabang
5. Expanded MCH and Mental Health Program
6. Training programs for Midwives
7. Strengthened graduate health programs at the
UP-CPH
Development of family Planning Movement
Launching of programs in cooperation with private sectors- top provide services to periphery
( indigents, minority groups)
REODICA’S SEVEN STRATEGY PROGRAM
Carmencita Noriega-Reodica as the first woman Secretary of Health in March 1996.
1. Expanded Program on Immunization (Oplan Alis Disease)-
to eliminate polio, measles and neonatal tetanus
2. Nutrition- vitamin A, iron and iodine utilization ( araw ng
Sangkap pinoy)
3. Family Planning
4. Tuberculosis prevention (Target, Stop TB)
5. Environmental sanitation (TKO)
6. STD-AIDS awareness prevention
7. Healthy Lifestyle program
