Community Health: Concepts, History, and Challenges

Community Health - Yesterday, Today, and Tomorrow

Definition of Health

• Health is a positive state of complete physical, mental, and social well-being, not just the absence of disease (WHO, 1948)
• Measures of health: morbidity rates, mortality rates, quality of life measurements, disability-adjusted life year (DALY), sickness impact profiles

Dimensions of Health

• Biological: interacting organisms sharing the same environment
• Sociological: a group of interacting people larger than a household living in a common location
• Psychological: includes intent, beliefs, needs, resources, preferences, and risks

Community

• A group of people who form relationships over time by interacting regularly around shared experiences
• Composed of people, place, identity, common culture, social system, and governing a place

Personal Health vs. Community Health

• Personal health: individual actions and decision-making that affect the health of an individual or their immediate family
• Community health: a field within public health that focuses on the health of people in the same geographic area

Factors Affecting Community Health

• Physical factors: geography, environment, community size, industrial development
• Social and cultural factors: beliefs, traditions, prejudices, economics, socio-economic status
• Community organization: ways in which communities organize their resources
• Individual behaviors: takes the concerted effort of many individuals to make a community program work

Public Health

• Definition: the science and art of preventing disease, prolonging life, and promoting healthy behaviors through organized efforts
• Goal: to improve the quality of life for the greatest number of people
• Core element of government's attempt to improve and promote the health and welfare of citizens

Brief History of Community and Public Health

• Evidence of community health practices in earliest civilizations (e.g., Northern India, Sumerian clay tablet)
• Middle Ages: little progress in public or community health
• Renaissance and Exploration: renewed interest in causes and cures of diseases
• 18th Century: Industrial growth and poor sanitary conditions
• 19th Century: beginning of the modern era of public health, bacteriologic period of public health
• 20th Century: health resources development period, reform period, health promotion period

Accomplishments (1900-1999)

• Vaccination: eradication of smallpox, elimination of polio, control of measles, rubella, tetanus, Hib, etc.
• Motor vehicle safety: large reductions in motor-vehicle-related deaths
• Safer workplaces: reduced work-related health problems
• Control of infectious diseases: typhoid, cholera, TB, STDs
• Decline in deaths from coronary disease and stroke: due to risk factor modification
• Safer and healthier foods: decreased microbial contamination, increased nutritional content
• Healthier mothers and babies: better hygiene, nutrition, and access to healthcare
• Fluoridation of drinking water: reduction in tooth decay
• Recognition of tobacco use as a health hazard: promote cessation, reduce second-hand smoking

Outlook for Community Health in the 21st Century

• Challenges: greatly reduce the burden of excess morbidity and mortality, counter potential threats to health, develop more effective health systems, expand the knowledge base
• Opportunities: healthier future for all, recognition of the importance of public health, increasing access to healthcare### Philanthropic Foundations
• Provide money for projects and research to benefit society, particularly in health improvement
• Have resources to support long-term or innovative research projects
• Examples include Bill and Melinda Gates Foundation, Rockefeller Foundation (e.g., vaccine for yellow fever), and Robert Wood Johnson Foundation (e.g., access to medical & dental care)

Service, Social, & Religious Organizations

• Members socialize with like-minded individuals
• Examples include Jaycees, Kiwanis Club, Rotary Club, American Legion, and Lion's Club
• Mission: Service to others in their communities

Corporate Involvement

• Corporations impact community health through environmental treatment, natural resource use, waste disposal, work environment safety, and product/service offerings
• Provide health care benefits to employees, including health and benefits packages, health and safety education programs, and worksite fitness and recreation programs

Levels of Health Care and Referral System in the Philippines

• National: National Health Services, Medical Centers, and Teaching and Training Hospitals
• Regional: Regional Health Services, Regional Medical Centers, and Training Hospitals
• Provincial/City: Provincial/City Health Services, Provincial/City Hospitals
• Emergency/District: Emergency/District Hospitals
• Rural Health Unit: Community Hospitals and Health Centers, Private Practitioners, and Barangay Health Stations

Levels of Care

Primary Level of Care

• First contact between community members and health facilities
• Health care provided by center physicians, public health nurses, rural health midwives, barangay health workers, traditional healers, and others at barangay health stations and rural health units

Secondary Level of Care

• Health facilities (private or government-operated): infirmaries, municipal, and district hospitals, and out-patient departments of provincial hospitals
• Capable of performing minor surgeries and simple laboratory examinations
• Given by physicians with basic health training
• Referral center for primary health facilities

Tertiary Level of Care

• Rendered by specialists in health facilities: medical centers (regional, provincial hospitals, and specialized hospitals)
• Referral center for secondary care facilities
• Provides complicated cases and intensive care
• Example: Philippine Heart Center

Note

• Higher levels of care have more qualified health personnel and sophisticated health equipment

Teaching Community and Public Health

• Uses a service-learning approach
• Important role of public health laboratory professionals (e.g., bacteriologists, microbiologists, biochemists) in diagnostic services
• Examples: BSMLS (Allied Medical Courses)

Service-Learning

• A teaching and learning approach integrating community service with academic study
• Enriches learning, teaches civic responsibility, and strengthens communities
• Engages students in reflection on community benefits and learning outcomes

Service-Learning Roles

• Composed of roles that integrate community service with academic study