Community Health: Yesterday, Today, and Tomorrow
a) A Brief History of Community and Public Health
• Ancient Times: Early civilizations often had communal efforts to manage health, such as
public baths and waste management in Rome and Greece.
• Middle Ages: Bubonic plague and other epidemics highlighted the need for organized
public health responses. Quarantine methods were among the earliest forms of public
health intervention.
• 18th Century: The Enlightenment period saw the rise of scientific approaches to
medicine and health. Edward Jenner's smallpox vaccine in 1796 was a major milestone.
• 19th Century: Industrialization led to urbanization, overcrowding, and poor sanitation.
This prompted the development of public health systems. The work of pioneers like John
Snow in cholera outbreak management in London and the establishment of health
boards became significant.
• 20th Century: Major advancements in medicine, vaccines, antibiotics, and the
establishment of the World Health Organization (WHO) in 1948. The introduction of
health insurance, public health education, and a focus on preventing diseases like
HIV/AIDS.
• 21st Century: The focus has shifted to global health issues, non-communicable diseases,
mental health, and the impacts of climate change on public health.
b) Outlook for Community Health in the Twenty-First Century
• Emerging Challenges: New and re-emerging infectious diseases (e.g., COVID-19),
antibiotic resistance, and non-communicable diseases like obesity and diabetes.
• Technology Integration: Use of digital health tools, telemedicine, and data analytics in
improving health outcomes.
• Global Health Governance: Strengthening international cooperation and response to
health emergencies, promoting equity in health access globally.
• Health Equity and Social Determinants: Addressing disparities in health due to
socioeconomic factors, race, gender, and geography.
• Environmental Health: The impact of pollution, climate change, and urbanization on
community health, with a focus on sustainability and preventive measures.
2. Principles of Primary Health Care
a) Fundamentals of Creating and Maintaining a Healthy Community
• Community Participation: Engaging community members in health decision-making
processes. Example: Community health workers leading vaccination drives.
• Intersectoral Collaboration: Involving sectors like education, housing, and agriculture to
address the determinants of health. Example: School feeding programs to improve
nutrition.
• Equity in Access: Ensuring all community members have access to essential health
services regardless of their socio-economic status. Example: Mobile clinics in remote
areas.
• Prevention and Promotion: Focus on preventive measures rather than just curative
services. Example: Anti-smoking campaigns and vaccinations.
b) Healthy Policies for Healthy Communities
• Health-Inclusive Policies: Creating policies that promote health in all areas, not just
healthcare. Example: Urban planning policies that include green spaces to encourage
physical activity.
• Legislation and Regulation: Implementing laws that protect public health, such as
tobacco control laws, food safety regulations, and occupational health standards.
• Community Health Assessments: Regular assessments to identify health needs and
guide policy-making. Example: Conducting surveys to monitor the prevalence of chronic
diseases.
c) Communities of Place
• Geographic Communities: Focusing on health needs specific to a particular location,
such as rural versus urban health challenges.
• Cultural and Social Factors: Considering the cultural, economic, and social dynamics that
affect health in different communities. Example: Tailoring health education to be
culturally sensitive.
• Resource Allocation: Directing resources to areas with the greatest need, such as
funding rural health initiatives where services are scarce.
3. Primary Health Care in Practice
a) Primary Health Care in Practice
• Comprehensive Care: Providing a range of services from preventive care to treatment
and rehabilitation. Example: A community health center offering immunizations,
prenatal care, and chronic disease management.
• Accessibility: Ensuring that primary health care services are accessible to everyone,
especially marginalized groups. Example: Free clinics for uninsured individuals.
• Continuity of Care: Establishing long-term patient-provider relationships to improve
health outcomes. Example: Family doctors managing chronic conditions over time.
b) Assessing the Community
• Health Needs Assessment: Collecting data on the health status and needs of a
community to inform planning. Example: Surveys to determine the prevalence of
diabetes in a community.
• Resource Inventory: Identifying available resources such as healthcare facilities,
personnel, and community organizations. Example: Mapping existing clinics, hospitals,
and volunteer groups.
• Community Engagement: Involving community members in identifying their health
priorities. Example: Town hall meetings to discuss health concerns and potential
solutions.
c) Planning for Intervention
• Setting Objectives: Defining clear and measurable health goals based on the
community's needs. Example: Reducing the incidence of childhood obesity by 10% in
five years.
• Developing Strategies: Creating action plans that outline the steps needed to achieve
the health objectives. Example: Implementing school-based nutrition education
programs.
• Monitoring and Evaluation: Tracking progress and assessing the effectiveness of
interventions. Example: Regularly measuring the BMI of schoolchildren to monitor the
impact of nutrition programs.
4. Health and Wellness Throughout the Lifespan
a) The Early Years
• Prenatal and Postnatal Care: Ensuring mothers and infants receive proper care before
and after birth. Example: Programs providing free prenatal vitamins and regular check-
ups.
• Childhood Immunizations: Protecting children from infectious diseases through
vaccination. Example: National immunization campaigns against polio and measles.
• Early Childhood Development: Supporting cognitive, emotional, and physical
development in young children. Example: Early childhood education programs that
include health and nutrition components.
b) Transitions to Adulthood and Beyond
• Adolescent Health: Addressing the unique health challenges faced by teenagers, such as
mental health, sexual health, and substance abuse. Example: School-based mental
health services.
• Chronic Disease Management: Helping adults manage conditions like diabetes,
hypertension, and heart disease. Example: Community-based programs that offer
exercise and dietary counseling.
• Aging Population: Providing care and support for older adults, focusing on maintaining
independence and quality of life. Example: Senior centers that offer health screenings,
social activities, and fitness programs.
5. Organizations That Help Shape Community Health
a) Governmental Health Agencies
• Local Health Departments: Focus on community-specific health issues, such as outbreak
control and health education. Example: A city health department managing a local flu
vaccination campaign.
• State Health Agencies: Coordinate public health programs at the state level, such as
disease surveillance and health promotion. Example: State-wide tobacco cessation
programs.
• Federal Health Agencies: Implement national health policies and programs, such as the
Centers for Disease Control and Prevention (CDC) leading efforts in disease control and
prevention.
b) Nongovernmental Health Agencies
• Nonprofit Organizations: Work independently of government to address specific health
issues, often focusing on underserved populations. Example: The American Red Cross
providing disaster relief and blood donations.
• Advocacy Groups: Campaign for policy changes and raise awareness about health issues.
Example: The American Cancer Society advocating for cancer research funding.
• International NGOs: Operate globally to improve health outcomes in developing
countries. Example: Médecins Sans Frontières (Doctors Without Borders) providing
medical care in conflict zones.
INTRODUCTION: In reflecting on the twentieth century, it is easy to point to the tremendous
progress that was made in the health and life expectancy of many people of the world. Infant
mortality dropped, many of the infectious diseases have been brought under control, and better
family planning became available. However, there is still room for improvement! Individual
health behaviors, such as the use of tobacco, poor diet, and physical inactivity, have given rise to
an unacceptable number of cases of illness and death from noninfectious diseases such as
cancer and heart disease. New and emerging infectious diseases, such as severe acute
respiratory syndrome (SARS) and those caused by drug-resistant pathogens, are stretching
resources available to control them. And the events stemming from the attacks on the World
Trade Center in New York, the Pentagon in Washington, DC, and the failed terrorist attack on a
third site that ended with the crash of the airliner in western Pennsylvania on September 11,
2001 (now commonly referred to as 9/11) and the subsequent anthrax mailings have caused us
to refocus our priorities. Even with all that has happened in recent years in the United States
and worldwide, the achievement of good health remains a worldwide goal of the twenty-first
century. Governments, private organizations, and individuals worldwide are working to improve
health. Although individual actions to improve one’s own personal health certainly contribute to
the overall health of the community, organized community actions are often necessary when
health problems exceed the resources of any one individual. When such actions are not taken,
the health of the entire community is at risk.
This chapter introduces the concepts and principles of community health, explains how
community health differs from personal health, and provides a brief history of community
health. Some of the key health problems facing Americans are also described, and an outlook
for the twenty-first century is provided. Definitions
The word health means different things to different people. Similarly, there are other words that
can be defined in various ways.
Health - The word health is derived from hal, which means “hale, sound, whole.” When it comes
to the health of people, the word health has been defined in a number of different ways—often
in its social context, as when a parent describes the health of a child or when an avid fan defines
the health of a professional athlete.Until the beginning of the health promotion era in the mid-
1970s, the most widely accepted definition of health was the one published by the World
Health Organization in 1947. That definition states that “health is a state of complete physical,
mental, and social well-being and not merely the absence of disease and infirmity.”
1 However, in more recent times, the word has taken on a more holistic approach; Payne, Hahn,
and Mauer describe health in terms of six interacting and dynamic dimensions—physical,
emotional, social, intellectual, spiritual, and occupational.
2 We have chosen to combine these definitions of health and create our own. Thus, we define
health as a dynamic state or condition that is multidimensional in nature and results from a
person’s adaptations to his or her environment. It is a resource for living and exists in varying
degrees.“Many persons enjoy a state of well-being even though they may be classed as
unhealthy by others.”
3 Community Traditionally, a community has been thought of as a geographic area with specific
boundaries— for example, a neighborhood, city, county, or state. However, in the context of
community health, a community is “a group of people who have common characteristics;
communities can be defined by location, race, ethnicity, age, occupation, interest in particular
problems or outcomes, or common bonds.”
Public Health
Public health refers to the health status of a defined group of people and the governmental
actions and conditions to promote, protect, and preserve their health. Community Health
Versus Personal Health To further clarify the definitions presented in this chapter, it is important
to distinguish between the terms personal health and community health activities.
Personal Health Activities Personal health activities are individual actions and decision making
that affect the health of an individual or his or her immediate family members. These activities
may be preventive or cura tive in nature but seldom directly affect the behavior of
others.Choosing to eat wisely,to regu larly wear a safety belt,and to visit the physician are all
examples of personal health activities.
Community Health Activities Community health activities are activities that are aimed at
protecting or improving the health of a population or community. Maintenance of accurate
birth and death records, protection of the food and water supply, and participating in fund
drives for voluntary health organizations such as the American Lung Association are examples of
community health activities. Within this book, you will be introduced to the many community
health activities and to the organizations that are responsible for carrying them out.
The following are some of the key topics that are covered in this text:
• Organizations that contribute to community health • How communities measure health,
disease, injury, and death • Control of communicable and noncommunicable diseases • How
communities organize to solve health problems • Community health in schools • Community
health needs of people at different stages of life • Community health needs of special
populations • Community mental health • Abuse of alcohol, tobacco, and other drugs • The
health care delivery system • Environmental health problems • Intentional and unintentional
injuries • Occupational safety and health
Factors That Affect the Health of a Community
There are a great many factors that affect the health of a community. As a result, the health
status of each community is different.
- These factors may be physical, social, and/or cultural. They also include the ability of the
community to organize and work together as a whole as well as the individual behaviors of
those in the community.
Physical Factors
Physical factors include the influences of geography, the environ ment, community size, and
industrial development
