Defining Public Health

Dr. C.E. Winslow Definition of Public Health

• Public Health encompasses promoting health, preventing disease, prolonging life, and promoting efficiency through organized community effort
• The philosophy is to enable every citizen to realize their birthright to health and longevity

World Health Organization (WHO) Definition of Health

• Health includes physical, mental, and social well-being, not just the absence of disease or infirmity

Defining Public Health

• Public Health applies science within politics to reduce health inequalities and ensure the best health for the greatest number

Public Health Nursing in the Philippines (2005)

• Public Health Nursing is community health nursing practiced in the public sector
• Public Health Nurses are nurses in local/national health departments or public schools, regardless of their official title
• Nurses will take charge of the Municipal Health Officer’s (MHO) responsibilities if the MHO is unable to perform those duties.

Lillian Wald

• Coined the term Public Health Nursing, denoting a service available to all people in New York City

Ruth B. Freeman

• Community Health Nursing includes service by a professional nurse to individuals, families, groups, and communities

Ten Determinants of Health

• Higher income and social status correlate with better health
• Lower education levels correlate with poor health, more stress, and less self-confidence
• Safe water, clean air, healthy workplaces/houses/communities, and roads support good health
• People in employment are generally healthier, particularly with more control over their working conditions
• Stronger social support from families, friends, and communities is associated with better health
• Customs, traditions, and beliefs of family and community affect health
• Genetics contribute to lifespan, healthiness, and the likelihood of developing certain illnesses
• Balanced eating, exercise, avoiding smoking/excessive drinking, and effective stress management all affect health
• Access and use of services prevent and treat disease
• Men and women experience different types of diseases at different ages

Health as a Right

• According to the Universal Declaration of Human Rights, health is a right regardless of age, gender, or socioeconomic status
• The State and government protect individual rights and instill consciousness
• The government adapts comprehensive and integrated health programs

Social Determinants of Health

Economic Stability:

• Elements include employment, income, expense, debt, medical bills and support.

Neighborhood and Physical Environment:

• Elements include housing, transportation, safety, parks, playgrounds and walkability

Other Social Context Elements

• Items include social integration, support systems, community engagement, and absence of discrimination

Health Care System Info

• Aspects encompass health coverage, provider availability, provider linguistic and cultural competency, and quality of care

Health Outcomes Info

• Health outcomes include mortality, morbidity, life expectancy, health care expenditures, health status, and functional limitations

Ultimate Goal of Community Health Nursing

• The goal of community health nursing is raising the health level of the citizenry by helping communities and families cope with health threats and maximize potential for high-level wellness

Philosophy of Community Health Nursing

• Community Health Nursing is based on the worth and dignity of man
• The primary focus of Community Health Nursing is health promotion and the responsibility is health education
• The Community is the primary client & Active Partner of Care
• Nurses act as generalists through a client's life.
• Time with clients can be continuous.
• The nursing process is implicit within CHN practice

Proponents and Definitions of Community Health Nursing (CHN) and Public Health Nursing (PHN)

• Jacobson: teaching/health education
• Maglaya: Use of nursing process
• Shetland: worth and dignity of man
• Hanlon: Total development/Holistic approach
• Dr. C.E. Winslow: science and art
• Freeman: Occupational and School Health Nursing
• Ilona Kischbush: Collaboration
• Nisce, Reyala et al: Raise the level of citizenry
• Purdom: survival of human species

Basic Principles of Community Health Nursing

• Achieved through multi-sectoral efforts and promotion through teaching and care delivery in community health
• Self-reliance and enhanced capabilities are the primary goals

Roles of the Public Health Nurse

• Public Health Nurses act as managers, supervisors, care providers/clinicians, researchers, and health educators

Standards of Care in Public Health Nursing

• Assessment includes status of populations
• Diagnosis gives meaning to needs
• Outcome identification involves partnering to identify outcomes related to population status
• In planning, programs are developed based on identified needs
• Assurance includes instituting implementation policies, which serve as guides
• Evaluation determines if the desired outcomes have been achieved based on set programs

Specialized Fields of Community Health Nursing (CHN)

• Community Mental Health Nursing uniquely integrates nursing, mental health, social psychology, psychology, community networks, and basic sciences
• Occupational Health Nursing uses nursing principles/procedures to conserve worker health in all occupations
• School Health Nursing applies nursing theories/principles in caring for the school population

The Four Levels of Clientele

• Individual clients often represent the entry point of care, being the head of the family or community
• Family includes basic unit/focal point/center of care delivery

Examples

• Populations represent a specific point of care
  • Molo family at a health education session showing the importance of vaccination
  • Groups of maternal clients eligible for tetanus toxoid immunization
• Community is an entire point of care -A community of nurses advocating for increasing the compensation of nurses

The Individual as a Client

• The client may be well or sick, collaborates with a healthcare provider, and takes an active role
• The patient is typically sick or dependent on healthcare providers, assuming a passive role

Approaches to the Individual

• The atomistic approach regards the whole as the sum of its parts/subparts
• The holistic approach regards the whole as not equal and greater than the sum of its parts/subparts

Family Types

• Nuclear: father, mother, and child/children
• Binuclear: divorced/separated parents sharing conjugal rights with children
• Extended: nuclear family plus relatives, including three or more generations
• Beanpole: four or more generations; long parent-child relationships
• Single-Parent: either mother/father with biological/adopted children
• Stepfamily/Blended/Reconstituted: one separated/divorced/widowed adult, children, a new spouse, and or the spouse’s children
• Single State: never married/separated/widowed/divorced individual
• Same-Sex/Homosexual: gay/lesbian partners with/without a child from previous relationship
• Cohabiting or Communal: unrelated individuals sharing living quarters to achieve a sense of family/companionship/test relationship

Family Locus of Power

• Patriarchal/Patrifocal: man has the authority
• Matriarchal/Matrifocal: woman has the authority
• Egalitarian: husband and wife possess equal authority
• Matricentric: prolonged absence of father, the mother is the dominant presence

Family Place of Residence

• Patrilocal: live with or near the groom's parents' residence
• Matrilocal: live with or near the bride's parents' residence
• Bilocal: reside with either the groom's or bride's parents, dependent on factors
• Neolocal: reside independently from their parents
• Avunculocal: reside with or near the maternal uncle of the groom

Family Culture or Descent

• Patrilineal: affiliation through the father's relatives
• Matrilineal: affiliation through the mother's relatives
• Bilateral: affiliation through both parents' relatives

The Family Coping Index

• Physical Independence: ability to conduct daily activities
• Therapeutic Independence: ability to comply with therapeutic regimens
• Knowledge of Health Condition: understanding of the disease process
• Application of General & Personal Hygiene: ability to maintain hygiene and cleanliness
• Emotional Competence: emotional maturity in making decisions
• Family Living Pattern: how members relate with love, trust and respect
• Utilization of Community Resources: ability to know resources within the vicinity
• Health Care Attitude: how family relates to the provider
• Physical Environment: maintenance of a place conducive for living

The Family Life Cycle (Evelyn Duvall)

• Stage I: Beginning Family Task: compliance with laws
• Stage II: Early Child Bearing Family Task: emphasize pregnancy and immunization importance
• Stage III: Family with Pre-school Children Task: responsible parenthood concepts
• Stage IV: Family with School Age Children Task: responsible parenthood
• Stage V: Family with Teenagers Concepts for "letting go" and understanding the "generation gap"
• Stage VI: Launching Center Comply with legal requirements
• Stage VII: Family with Middle Adult Parents Transition from nest to retirement
• Stage VIII: Aging Family Positive acceptance of death

The Population Group as a Client

• A population group shares characteristics, developmental stage, or environmental exposures

Types of Communities

• Geopolitical/Territorial Communities: defined by natural and man-made boundaries
• Phenomenological/Functional Communities: relational, interactive groups that share a group perspective/identity

The Healthcare Delivery System

• It encompasses all policies, equipment, products, human resources, and services which address the health needs of people

World Health Organization (WHO)

• The global health organization was formed in April 1948, with the intention that all people should have the highest possible level of health

Millenium Development Goals (MDGs)

• The MDGs were created to uphold human dignity, equality, and equity
• The Health-related MDGs included combating HIV/AIDS, reducing child mortality, and improving maternal health

Sustainable Development Goals (SDGs)

• A set of goals adopted to end poverty, protect the planet, and ensure prosperity
• The Health-related goals include good health and well-being, zero hunger and clean water and sanitation

Categories of Health Care Delivery System

• Preventative measures include rehabilitation and disability prevention

Levels of Primary Health Care Workers

• Trained community health workers or healers typically act as village health providers
• General medical practitioners or assistants often act as intermediate level health workers.