Dr.

Hanish Bhurtun
Public Health
[email protected]
58398506
Administration &
Organization
 QQ: DO I need
to reference this
picture?
Am I allowed to
use this picture?
What should I
know about
referencing and
using a picture
that is not mine

In this 2017 photo, captured inside a clinical setting, a health care provider
was placing a bandage on the injection site of a child, who had just received
a seasonal influenza vaccine. Children younger than 5-years-old, and
especially those younger than 2-years-old, are at high risk of developing
serious flu-related complications. A flu vaccine offers the best defense against
flu, and its potentially serious consequences, and can also reduce the spread
of flu to others.
Picture adapted from unsplash.com accessed online (10.2.2020) at
https://unsplash.com/photos/TDoPeUSOD1c
 “the art and science of preventing
disease, prolonging life and promoting
health through the organized efforts of
society” (Acheson, 1988; WHO)

people can maintain to be healthy,

improve their health and wellbeing, or
Public prevent the deterioration of their health
Health

vaccinations, behavioural counselling,

or health advice.
What is health?

The word health is Signaling that the

derived from the health concerns the
old English word for whole person and
“heal” which his/her integrity and
means “whole”. well-being.
Discuss two and two

I am healthy To stay healthy I I become

because ….. need …. unhealthy when …..
What is health?

Two common meanings:

 Absence of disease (negative definition)

 Well- being (positive definition) “ a state of complete physical,

mental and social well-being, not merely the absence of disease or
infirmity” (WHO, 1946).
Health dimensions

 Physical (body)
 Mental, psychological (feeling able to cope)
 Emotional (develop and sustain relationships)
 Social (Social structures like gender or class, network)
 Spiritual (feeling of having a purpose in life)
 Sexual (ability to achieve a satisfactory expression of one’s sexuality)
 Various factors in interaction with each other affects our
health in a positive or negative direction are called for
health determinants.

Health
determinants
What affects
our health?
  Some factors we cannot affect; inheritance, sex and
age.
 Other factors are structural e.g. the society we live in,
the social economy, physical and social environment,
political decisions, housing, occupation, transport,
Health education.
determinants  Some determinants can be influenced by our own
decisions and our way of life; eating habits, sleep habits,
tobacco and alcohol habits to name a few. Good
social networks, good social support.
What does public health
mean?

Discuss two and two

 An interdisciplinary field

Studies about the structure of society, the

environment, occupational health,
health care system and living habits
What does Studies about social groups / health
public disparities, about socioeconomic status,
Health gender and ethnicity
mean Public health science is to analyze the
influence of these factors on health
Public Health is about creating the conditions for good
health for the population as a whole.
  Public health refers to the entire population's state of
health. It should not only be as good as possible, it
should also be equally distributed as possible.
 Working with public health is fundamentally about
Public creating favorable conditions and environments (social,
Health cultural, physical, political, economic and emotional).
 Public Health is also about providing opportunities for
peoples own healthy choices. For example, by giving
information about the importance of healthy food,
physical activity and moderate drinking, creating
tobacco-free environments.
 Public health is "the science and art of preventing
disease, prolonging life and promoting health through
the organized efforts and informed choices of society,
organizations, public and private, communities and
individuals" (1920, Winslow).
 It is concerned with threats to health based on
population health analysis. The population in question
can be as small as a handful of people or as large as all
the inhabitants of several continents (for instance, in the
case of a pandemic).
The focus of public health intervention is to
improve health and quality of life through
the prevention of disease and promotion
of healthy behaviors.

For example: Promotion of hand washing

and breastfeeding, delivery of
vaccinations, and distribution of condoms
to control the spread of sexually
transmitted diseases are examples of
common public health measures.
Modern public health practice requires multidisciplinary teams of
professionals including physicians specializing in public
health/community medicine/infectious disease, epidemiologists,
nurses, microbiologists, environmental health workers, dentist,
dietitians, nutritionists, public health engineers, public health lawyers,
sociologists, community development workers, communications
officers, and others.
 Another important part of public health work is research.
For example research about disparities in health, gender
Research and health and Socioeconomic Status and health.
  Epidemiology and Biostatistics
 Healthcare administration/ services
 Environmental Hygiene
 Social Medicine

Sub-fields of  Preventive medicine

Public  Occupational health

 Rehabilitating
health in
 And Community health, Behavioral health.
developed
and some
developing
countries
 The World Health organization (WHO) identifies core functions of public
health programs including:
 providing leadership on matters critical to health;
 shaping a research agenda and stimulating the generation,
translation and dissemination of valuable knowledge;
 setting norms and standards and promoting and monitoring their
implementation;
 articulating ethical and evidence-based policy options;
 monitoring the health situation and assessing health trends.
Public In particular, public health surveillance programs can:

Health  serve as an early warning system for impending public health

emergencies;
programs  document the impact of an intervention, or track progress towards
specified goals;
 monitor and clarify the epidemiology of health problems, allow
priorities to be set, and inform health policy and strategies.
 Public health surveillance has led to the identification
and prioritization of many public health issues facing the
world today, including HIV/AIDS, diabetes, tuberculosis,
obesity.

 Research on health disparities and the relation of

gender, ethnicity and class to health is another
important way of identification of risk factors for health.
Public health efforts are systematic, targeting Health
Promotion and Disease Prevention by creating
supportive environments or eliminate risks.
Distinctions Between Public
Health and Clinical Health
Professions

Public Health Clinical Health

Population Individual

Health Disease

Prevention and Diagnosis and

promotion treatment
 Health-promoting public health takes place

through
• the creation of structures and

methods at different levels to promote and

maintain the healthy in humans (e.g. bike

Health- with helmet)
promoting • by developing processes that involve and

public engage the entire population to participate in

health and affect their everyday lives in a positive

way (e.g. patient associations)

 Disease prevention public health aims to prevent people
become ill and suffer from accidents. It focus on those
Disease groups that are most vulnerable to health risks (e.g. help
pregnant women to stop smoking).
Prevention
Public
Health
  The work of public health worker/scientist is about
preventing disease and injury and to promote health and
quality of life.
 The public health training prepares for a variety of functions
within international aid work, occupational health services,
custom consulting, municipal public health, county
councils, health care, research and teaching.
 Public health scientist do not meet patients, they
Careers in investigate/work for promote/improve the health of the
larger groups.
Public  They cooperate with politicians, organizations, Government
and business leaders.
Health  Public health worker/scientist can work in authorities such as
county councils, municipalities, development projects,
National Food Administration, Board of Health and Welfare,
Public Health Institute. Or they can work as Public health
researchers, university lecturer.
Public
health objectives
Participation and influence in society

Economic and social prerequisites

Conditions during childhood and adolescence

Health in working life

Environments and products

Health-promoting health services

Protection against communicable diseases

Sexuality and reproductive health

Physical activity

Eating habits and food

Tobacco, alcohol, illicit drugs, doping and gambling

 You can measure public health through
epidemiological studies

Descriptive: highlights the first occurrence of a disease

or risk factor in different areas or over time. e.g. how
widespread mental illness has been among
adolescents in the last 10 years
Measuring Analytical: highlights causation by studying the
relationship between exposures and ill health. For
the public example, studying the relationship between stress and
health mental illness among adolescents
Evaluation: highlights how risk conditions and diseases
are affected by various prevention efforts. For
example assistance and homework Center at school
that can reduce stress among adolescents
 Mortality statistics (death rates e.g. in a
country per year)

Ways of
Morbidity statistics (Morbidity is an incidence
measuring of ill health. It is measured in various ways,
health often by the probability that a randomly
selected individual in a population at some
date and location would become seriously ill
in some period of time)
 Life expectancy Infant mortality rate

QALY (quality-adjusted life

Ways of
************************************
years)

measuring
health
Who measure (subjective and
objective health measures)
(self reported or measured by
medical staff)
 Children and adolescents

Elderly

Example of
target Migrants
groups for
public Vulnerable groups (drug users,
health homeless, criminals, prostitutes)
  http://europa.eu/pol/health/index_en.htm
 http://www.who.int/en/
 http://www.wfpha.org/
 http://www.whatispublichealth.org/what/index.html
Homepages
Public Training programs in Public Health were established
in the United States and in Europe from the 1920s.

Health
Education
  Schools of public health had already been established in
USA, Canada, Europe and North Africa. In USA for example in
Colombia, Harvard and Yale universities. By 1999 there were

Schools and twenty nine schools of public health in the US, enrolling
around fifteen thousand students.

degrees in  Over the years, the types of students and training provided
have also changed. In the beginning, students who enrolled
public in public health schools typically had already obtained a
medical degree; public health school training was largely a

health
second degree for medical professionals.

 Schools of public health offer a variety of degrees which

generally fall into two categories: professional or
academic.The two major postgraduate professional degrees
are the Master of Public Health (MPH) or Docotr of Philosophy
or doctor of Medicine (PhD) in Public Health.
 Suggested reading from:
http://www.whatispublichealth.org/
History of Public
Health in
Mauritius
Early British Rule

01 02 03 04
1810 – British Foundation of Civil hospital at A hospital for slaves
provide shelter and Military hospital at Grand Riviere in 1810 (l’hospital
medical treatment the port des noirs) –
to both British and crowded and not
French soldiers manageable
Some diseases before 1968

Smallpox

Cholera Pandemic in 1819

Malaria Fevers

Plague pandemic 1899

Spanish Influenza 1918

Public Health Ordinance No 32 of 1894 -95

Creation of Medical
Director as head – with Two branches - the
and Health
all powers medical and sanitary
Department

Medical branch – all

Sanitary branch –
public hospitals and
sanitary police and
dispensaries, including
sanitary works
estate hospitals
Sanitary problem in 1920

Defacation in the near-by cane fields

problematic in estates

Problem of Hookworms because of latrines

266,000 people infected

Dr. Balfour surveyed the public health and

sanitation in Feb. 1921
Independent Mauritius - 1968

British eliminated major diseases – smallpox, cholera,

plague, malaria, poliomyelitis, and typhoid

Tuberculosis was still here

Hookworms was still here

Malaria outbreak in 1998, but successfully

eliminated
Ministry of Health was formed

Dr Seewoosagur Ramgoolam
(1900-1984) – guiding MOH – formulation of health
principles determined the policies and develop health
administration of public programmes
health
Public health priorities after independence

Reinforce immunization among infants

Safe drinking water supply

Extension of primary health care to the whole

population

Free services in public health care

Non-communicable diseases

BETTER LIFESTYLE

DIABETES

HYPERTENSION

CEREBROVASCULAR DISEASES
 Mauritius as a member

Southern African
Organisation
Organization of Development
United Nations commune Africaine
African Unity Community (SADC)
et Mauricienne
– formed in 1992

1971 – third
Exchange of
commonwealth
information and
medical
expertise among
conference in
decolonized nations
Mauritius
Communicable disease control unit

AFTER THE COLONIAL PERIOD – IN 2005-2006 – CHIKUNGUNYA IN 2009 – DUNGUE BROKE OUT
COLONIAL MEDICAL AND SANITARY BROKE OUT – BUT DISAPPEAR IN
INSTITUTIONS WERE MAINTAINED 2007 DUE TO A STRONG PUBLIC
HEALTH
 Central Health laboratory (candos)

Communicable disease control unit (CDCU) – in Beau

Bassin

The Vector Biology and Control Division - in Curepipe

Units

Regional Health offices

Vector-borne diseases are human illnesses caused by

parasites, viruses and bacteria that are transmitted by
vectors.
Eve of independence

Special hospitals
Brown Sequard
8 general – leprosarium Two prison
Hospital at Beau
hospitals hospital at hospitals
Bassin
Powder Mills

Network of
Tuberculosis Sugar Estates –
dispensaries – Three hospitals in
hospital at 22 hospitals and
provided basic Rodrigues
Poudre d’Or 20 dispensaries
health

School of nursing
opened in 1957
at Victoria
Hospital, Candos
 After independence

MAURITIUS INSTITUTE OF AUGUST 1969 – NEW 1990 – ROSE BELLE 1982 – DISPENSARIES SOME PLACES –SOCIAL
HEALTH HOSPITAL IN HOSPITAL IN GRAND CONVERTED TO WELFARE CENTRES
(PAMPLEMOUSSES) – IN PAMPLEMOUSSES PORT DISTRICT PRIMARY HEALTH CARE BUILT IN 1950 -1960 –
FEB. 1989 – TRAINING DISTRICT (SSRNH) CENTRES WERE ENLARGED TO
AND RESEARCH AS ACCOMMODATE
MAJOR AIMS HEALTH UNITS
The Alma-Alta conference

Led to the Alma-Alta Conference

Main aim: primary
development of in Sep. 1978 in USSR by
Health care
Community Health WHO and UNICEF

Within 10 years – 50 new

First community Health health centres were
National Trust Fund for
center – Chamouny built in Mauritius and
Community Health Act
(Chemin Grenier) – Rodrigues – led to
passed in 1986
inaugurated by SAJ decentralization of
health services
 UOM – Diploma
course in Sanitary
Curative, Sciences with
preventive and modules such as
educational environmental
activities issues, health
statistics and social
work introduced

1985 report
recommendations

Nurse and Mid-

wives – trained 1999 – SSR Medical
locally at Nursing college
School of Candos
Decentralization

Mauritius divided in five regions – Health care services in Mauritius

regional Health Superintendent divided into 3 levels: Primary,
responsible for each region Secondary and Tertiary
Primary care, Secondary and Tertiary

Treatment for minor Provide vaccination Cases that cannot be Tertriary deals with
injuries and diseases and family planning treated – transferred to advance treatment
services a secondary centre – and surgery
hospital or medi-clinic
In 2011

Specialised hospitals: 1
psychiatric hospital, 1
5 regional hospitals 2 district hospitals Ears Nose and Throat
(ENT), 1 Eyes hospital,
1 Cardiac hospital

Each regional hospital

Private Sector – 17
– own set of LAB –
health institutions
Except virology
Pandemics
and  HIV/AIDS

epidemics –  Dengue
 Chikungunya
emerging  H1N1

and  At present –COVID 19, Dengue (again), leptospirosis

remerging
 Safe drinking water Influenzas virus
Sanitation problems
problems mutating

Weak immune system

in animals encaged –
Densely populated
risk of virus spreading Growing population
areas
from one species to
another

WHY? &
Challenges Ageing population Globalization
Speed of travel – very
fast

of the
Public
Health
Climate change –
vectors can adapt

System
Organisational
structure and
functions of the
current Mauritian
health system
&Types of health
services and
health care
delivery structures
01 02 03 04 05
Total population World Bank reports Statistics Mauritius Females: 78.7 years Males: 72.8 years
1.263 million (2022) a life expectancy shows a (2023) (2023)
of 75.7 years (total) breakdown by
for Mauritius in 2022 gender:
Health https://health.govmu.org/health/wp-
content/uploads/2023/08/Appendix-Health-Statistics-
Statistics report Report-2022-final.pdf
Health policy and
management with
regards to the delivery
 “Health policy refers to decisions, plans, and actions that
are undertaken to achieve specific health care goals
within a society. An explicit health policy can achieve
several things: it defines a vision for the future which in turn
helps to establish targets and points of reference for the
short and medium term. It outlines priorities and the
WHO expected roles of different groups; and it builds consensus
and informs people.”

Ref: https://www.who.int/topics/health_policy/en/
 people have access Prevention
to the health services
they need

Universal
Health
Coverage
Health promotion
Health policy

 Policies prohibiting tobacco and alcohol

use at the workplace.
 Policies requiring healthy foods to be
served at company meetings and
events.
 Policies allowing for flextime to exercise
or attend health programs.
Why we need policies
https://www.policymedical.com/hospital-policies-and-procedures-why-
need-them/
WHITE PAPER
on Health http://health.govmu.org/English/Documents/
http://health.govmu.org/English/Documents/whitepap.pdf

https://www.researchgate.net/journal/2322-
https://www.researchgate.net/journal/2322-5939_International_Journal_of_Health_Policy_and_Management_IJHPM

Sector whitepap.pdf 5939_International_Journal_of_Health_Policy_

http://health.govmu.org/English/Documents/whitepap.pdf https://www.researchgate.net/journal/2322-5939_International_Journal_of_Health_Policy_and_Management_IJHPM

and_Management_IJHPM
https://www.researchgate.net/journal/2322-5939_International_Journal_of_Health_Policy_and_Management_IJHPM

Development
& Reform
Public health and an ageing
population in Mauritius
Our needs are changing
Rise of Healthcare cost

 Reasons:
 1. Cost of Labor: nurses, doctors, environment, equipment
 2.
 3.
 4.
 5.
 The accumulation effect
More years
+
More people
+
More disease
+
More costs
=
More challenges
Population
ageing is a
global
phenomen that
is inevitable and
predictable
Million dollar
question? What are the long term predictors of institutionalisation
and need of care at the end of life?
Active life  Years lived without disability or need for care
 Increasing number of old people are surviving to past
expectancy 80 years
  The accumulation of changes in an organism or
object over time which increase vulnerability to
disease and death.
 Aging in humans refers to a multidimensional process
of physical, psychological, and social change.
 Some dimensions of ageing grow and expand over
time, while others decline.
 Reaction time, for example, may slow with age, while
Aging knowledge of world events and wisdom may
expand.
 Ageing is an important part of all human societies
reflecting the biological changes that occur, but also
reflecting cultural and societal conventions.
 Population ageing is constituted by a shift in the
distribution of a country's population towards greater
ages
  Aging occurs in all members of a given
species
Biological  Aging process is progressive
perspective  Aging process produces changes that
cause organ dysfunction which causes
to aging the organ or its system to fail eventually
Human Aging

 What is “normal” in the aging process -

primary aging
 More susceptibility to disease - secondary
aging
 Onset of aging indeterminable and
progression varied
 Genetic and environmental factors
 Active ageing; focus on
benefically effects of physical,
Usual ageing; the ordinary psychological and social
Normal ageing; ageing processes of ageing in activities ”the process of
without diseases population including the optimizing opportunities for
illnesses. health, participaton and
security in order to enchange
quality of life” (WHO)

Healthy ageing; we do not

Successful ageing; wide
only loose our health with age,
concept, inludes also the
it can be promoted during the
subjective health. Normative?
whole lifespan
 Avoiding
disease

Successful
Aging

Engagement Maintaining high

with life cognitive and
physical function

Rowe J.W & Kahn R.L (1998): Successful Aging. Dell Publishing. N.Y.
Health?

 Today, health is seen more or less as fuctional concept, a

resource to function optimally, rather than ”goal of life”
 This kind of thinking is suitable also for health promotion in old
age.
Health in old age?

 Functioning f.ex. ADL, walking ability

 Objective health (needed, when we need exact knowledge about e.g.
outcomes of different interventions or changes in health status)
f.ex diseases, medication, symptoms…

 Subjective health or well-being (give important information about e.g.

perceived health or quality of life.)

F.ex: Health-related quality of life, life satisfaction, self-rated health

Quality of life What is good quality of life for
you?
  An individual’s perception of his or her position in life in the
context of the culture and value system, and in relation to goals,
expectations, standards and concerns.

 It incorporates a person’s physical health, psychological state,

level of independence, social relationships, personal beliefs and
Quality of life relationship to salient features in the environment. (WHO,
1994).

 As people age, their quality of life is largely determined by

their ability to maintain autonomy and independence.
Ageing population in
Mauritius
http://statsmauritius.govmu.org/English/Documents/census.pdf
Public health and an
ageing population in
Mauritius
  Functioning f.ex. ADL, walking ability
 Objective health (needed, when we need exact
knowledge about e.g. outcomes of different
interventions or changes in health status)
f.ex diseases, medication, symptoms…

Health in old  Subjective health or well-being (give important

age? information about e.g. perceived health or quality of

life.)

F.ex: Health-related quality of life, life satisfaction,

self-rated health
Healthcare-
associated
infections
Some important basic
precautions to control
infection
 Hand hygiene
 Preventive barriers
 Aseptic working order
 Preventing of sharp objects causing
injuries
Isolation

SECONDARY –
Transmission-based
FIRST – basic
precautions such
precautions
as contact, droplet
and airway
 Besides standard precautions; knowledge
or suspicion of an infection, which
spreads via direct or indirect contact
Contact • Infection caused by multiresistant bacteria
• Herpes Simplex, wound infections
isolation • Many respiratory tract infections
 Infections which spread Close contact (1 m) menigitis, pneumonia
via big droplets when (Haemophilus influenzae
sneezing or coughing tai meningococcuc)

Droplet
isolation
difteria, pertussis, H1N1 mumps, rubella (Warning, strong graphic
images!)
 Single room Mask when Equipments in the
working close to patient room
patient

Droplet
isolation

Minimize patient Patient uses mask Cleaning last one

transferings in transfering of the patient
rooms
 Infections which chickenpox
spread far via
micropartcles in the air

Air isolation

measles Tuberculosis (lung or

larynx)
 Single room with special air condition system

Mask (special ventilator mask when treating lung tb patient)

Equipments in the patient room

Air isolation Minimize patient transferings

Patient uses mask in transfering

Cleaning last one of the patient rooms

Isolation for tb can be ended after 2 weeks, if the response

for medication is good
 MRSA Methicillin resistant ESBL Extended
Staphylococcus Spectrum Beta
Aureus Lactamase

The most
common
multiresitant VRE Vancomycin (Warning, strong

microbes resistant
enterococcus
graphic images!)
  https://www.lexpress.mu/article/hospitals-superbug-
dilemma
MRSA in
Mauritius
 The role of the surface environment in healthcare-
associated infections
Article to https://www.healthdesign.org/sites/default/files/article-
https://www.healthdesign.org/sites/default/files/article-pdfs/Weber-Anderson-Rutala-2013-CHD-KPS_0.pdf

read pdfs/Weber-Anderson-Rutala-2013-CHD-KPS_0.pdf
https://www.healthdesign.org/sites/default/files/article-pdfs/Weber-Anderson-Rutala-2013-CHD-KPS_0.pdf
Quality and cost of healthcare for individuals and
populations.
Critical issues in health services.
Basic concepts of quality

 Discussion
 Quality / (patient centred, Assessment, transparency)
 If Healthcare is a product?

 What is quality as a product?

Quality of Care

 A process for making strategic choices in health systems

 https://www.who.int/management/quality/assurance/QualityCare_B.Def.p
df
 In Mauritius: https://www.who.int/choice/country/mus/cost/en/
Debate

 Group divided into two

 Debate on quality vs cost & private vs public health care access

 Question. Should the quality of care be increased despite growing health

care costs?
 Global Environmental Health and Sustainable Development

 How teacher will evaluate the debate -

https://www.niu.edu/facdev/_pdf/guide/strategies/classroom_debate_rub
ric.pdf
Critical issues in health services and
environmental health
 https://www.conserve-energy-future.com/environmental-health-and-its-
issues.php
 https://apps.who.int/iris/bitstream/handle/10665/136943/ccsbrief_mus_en.p
df;jsessionid=0FAD49A054CE798D3CF80E1CF5AF99DB?sequence=1