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Level (3) - Semester (6) COMMUNITY MEICINE LECTURE 1 INTRODUCTION TO PUBLIC HEALTH DR STRANGE  PUBLIC HEALTH  1st Definition: ⎚ Art & science of: ① Promoting health ② Preventing disease Through organized efforts of the society ③ ⮅ Span...

Level (3) - Semester (6) COMMUNITY MEICINE LECTURE 1 INTRODUCTION TO PUBLIC HEALTH DR STRANGE  PUBLIC HEALTH  1st Definition: ⎚ Art & science of: ① Promoting health ② Preventing disease Through organized efforts of the society ③ ⮅ Span of healthy life  2nd Definition: ⎚ The combination of sciences, skills and beliefs that are directed to the maintenance & improvement of the health of all people.  Public health is the prevention and promotion of health through collective actions and policies.  Public health evolved through 1. Trial and error 2. With expanding scientific medical knowledge 3. At times controversial 4. Often stimulated by war and natural disasters.  The need for organized health protection grew as part of the development of community life, and in particular, urbanization and social reforms Ancient Civilizations:  Public health emerged from the ancient civilizations that practiced hygiene, sanitation & quarantine for religious & cultural reasons. It developed further:  with the scientific discoveries of Hippocrates, Pasteur, and others who established the causes and cures of disease. Dr Strange Page 1  Community - Horus Semester 6 – Lecture 1 20th & 21st Century Challenges:  It faced new challenges with the global pandemics of the 20th & 21st centuries that required international cooperation and surveillance. Ongoing Evolution in the 21st Century:  It continues to evolve with the emerging issues of the 21st century such as ▪ Climate change ▪ Health equity ▪ Bioterrorism ▪ Digital health Comparison between clinical medicine & community medicine: 1) Public Health Model 2) Medical Model Target ▪ Population ▪ Patients ▪ Disease prevention ▪ Diagnosis Main Goal ▪ Health promotion ▪ Treatment ▪ Environment ▪ Medical care Interventions ▪ Human behavior Sector ▪ Public (some private) ▪ Private (some public) Dr Strange Page 2  Community - Horus Semester 6 – Lecture 1  The science of food, including: 1 Nutrition ① The nutrients & other substances therein ② Their action, interaction & balance in relation to health and disease.  A state of complete physical❶, mental❷ & social❸ being not only absence Reproductive 2 of disease or infirmity, in all matters relating to reproductive system & to health its functions and process.  The basic approach to environmental control which involves: ① Identify specific factors that represent hazards to health or well-being (biologic – chemical – social – physical factors) ② To modify the environment in a manner that protects people from Environmental harmful exposures. 3 Health  The principal components of environmental health are: ① Water sanitation ② Waste disposal etc.  Achievement & maintenance of optimum level of health through the following elements: ① Health education ② Sanitary environment & socio-economic development Health 4 ③ Healthy lifestyle including: promotion ▪ Good nutrition ▪ Physical activity ▪ Avoid bad health habits like smoking ④ Legislation  A combination of learning experiences designed to facilitate voluntary Health 5 actions conducive to health. Education  It is an essential part of health promotion.  The study of frequency, distribution, and determinants of diseases and 6 Epidemiology other related states or events in among specific populations at a certain place and time. Dr Strange Page 3  Community - Horus Semester 6 – Lecture 1  Concerned with: Health ① The alternative uses of resources in the health services sector 7 Economics ② The efficient utilization of economic resources such as manpower, material and financial resources  A conscious action to acquire deeper knowledge or new facts about scientific or technical subjects.  It is a systematic investigation towards increasing knowledge. 8 Research  It aims at: ① The discovery & interpretation of facts ② Revision of accepted theories, or laws in the light of new facts ③ Practical application of such new theories or laws.  The application of statistics to biological problems; application of 9 Biostatistics statistics especially to medical problems, but its real meaning is broader  The process of: Health Service ① Getting people to work harmoniously together 10 Management ② To make efficient use of resources  Aim: achieve objectives  The study of relationship among living organisms & their environment.  It is the science, which deals with: ▪ The inter-relationships between the various organisms living in an area ▪ Their relationship with the physical environment. 11 Ecology HUMAN ECOLOGY: - Means the study of human groups as influenced by environmental factors, including social and behavioral factors.  The study of: ① Population, especially with reference to: ▪ Size ▪ Mortality ▪ Age distribution 12 Demography ▪ Density ▪ Growth ▪ Migration ▪ Fertility ② & the interaction of all those with social and economic conditions. Dr Strange Page 4  Community - Horus Semester 6 – Lecture 1 ❶ Epidemiology Discussed before ❷ Iceberg phenomena (Iceberg of diseases) See next page ⎚ Iceberg (IB) gives better concept of Disease Prevalence in Society ⎚ Hidden portion of (IB) is a challenge to Modern techniques in preventive medicine. ❸ Health Promotion and its elements ❹ Levels of Prevention → 1ry - 2ry - 3ry ❺ Rehabilitation ❻ Health equity: ▪ The state in which everyone has a fair and just opportunity to attain their highest level of health. Dr Strange Page 5  Community - Horus Semester 6 – Lecture 1  The Iceberg phenomenon is illustrated by pyramid of disease as following: Pyramid of disease ‫إضافة للفهم‬ Iceberg phenomenon BLOCK 1 ▪ Diseased – Diagnosed – Controlled. ABOVE THE SEA LEVEL (Tip of the iceberg) BLOCK 2 ▪ Diagnosed – Uncontrolled. BLOCK 3 ▪ Undiagnosed or wrongly diagnosed disease. BLOCK 4 ▪ Risk factors for disease. BELOW THE SEA LEVEL BLOCK 5 ▪ Free of risk factors. As you see “Blocks 1 & 2 of the pyramid correspond to the iceberg above the sea-level & Block 3 to 5 below sea level”  From Iceberg phenomenon & pyramid of disease we can see that: In many health problems, large numbers of cases are undiscovered or misdiagnosed. Correctly diagnosed cases in the community represent ONLY THE TIP OF THE ICEBERG. That’s mean that the real load of illness lies hidden in the community& not clinically apparent.  If not considered, there will be the following risk: ① Persons with in-apparent or undiagnosed infections → may transmit infection to others e.g. TB, meningitis, polio, hepatitis A & AIDS. ② Underestimation → Inadequate planning of health programs ending in failure. Dr Strange Page 6  Community - Horus Semester 6 – Lecture 1  Core functions are fundamental to achieving the goals of public health.  These are referred to as the Essential Public Health Functions (EPHF)  The core functions of public health include: ① Assessment ② Policy Development ③ Assurance The 10 essential public health services Dr. Strange Page 7  Community - Horus Semester 6 – Lecture 1  ASSESSMENT st (1 CORE FUNCTION OF PUBLIC HEALTH)  Involves the collection & analysis of information regarding health problems.  This means that public health professionals work to research health conditions, potential risks, and resources for communities related to health care and prevention. ESSENTIAL PUBLIC HEALTH SERVICE #1 Assess and monitor population health status, factors that influence health, and community needs and assets ESSENTIAL PUBLIC HEALTH SERVICE #2 Investigate, diagnose, and address health problems and hazards affecting the population Tools Of Public Health Assessment: ❶ Birth rates ❷ Fertility Indices ❸ Morbidity indices Number of new events in a specified period (×10n) ❹ Incidence Rate (I) = Number of persons exposed to risk during this period Number of people with the disease or condition at a specified time (old+ new cases) ❺ Prevalence Rate (P) = Total Number of examined population in the same locality and time ❻ Life expectancy Dr. Strange Page 8  Community - Horus Semester 6 – Lecture 1 ❼ Mortality Indices: Measure Denominator Numerator 10n Total number of deaths during a given time 1) Crude death rate Mid-interval population 100,000 interval Number of deaths assigned to a specific cause 2) Cause-specific death rate Mid-interval population 100,000 during a given time interval 100 Total number of deaths from all causes Number of deaths assigned to a specific cause 3) Proportionate mortality rate or during the same time interval during a given time interval 1,000 Total number of cases having the same Number of deaths assigned to a specific cause or 4) Case fatality rate 100 disease in the same year & locality disease during a given time interval Dr Strange Page 9  Community - Horus Semester 6 – Lecture 1  POLICY DEVELOPMENT nd (2 CORE FUNCTION OF PUBLIC HEALTH)  With the information gathered by those assessing public health → Policy development can begin.  Policy development involves the process of: ▪ Information sharing ▪ Consulting ▪ Citizen participation  to decide on public health measures. ESSENTIAL PUBLIC HEALTH SERVICE #3 Communicate effectively to inform and educate people about health, factors that influence it, and how to improve it ESSENTIAL PUBLIC HEALTH SERVICE #4 Strengthen, support, and mobilize communities and partnerships to improve health ESSENTIAL PUBLIC HEALTH SERVICE #5 Create, champion, and implement policies, plans, and laws that impact health ESSENTIAL PUBLIC HEALTH SERVICE #6 Utilize legal and regulatory actions designed to improve and protect the public’s health Dr. Strange Page 10  Community - Horus Semester 6 – Lecture 1  ASSURANCE rd (3 CORE FUNCTION OF PUBLIC HEALTH)  Involves active pushes to ensure communities are healthy and protected.  Those in public health assurance work to… ① Make health services available to people and their communities. ② Make sure these health services are: ▪ of high quality ▪ easily accessible for community members. ESSENTIAL PUBLIC HEALTH SERVICE #7 Assure an effective system that enables equitable access to the individual services and care needed to be healthy ESSENTIAL PUBLIC HEALTH SERVICE #8 Build and support a diverse and skilled public health workforce ESSENTIAL PUBLIC HEALTH SERVICE #9 Improve and innovate public health functions through ongoing evaluation, research, and continuous quality improvement ESSENTIAL PUBLIC HEALTH SERVICE #10 Build and maintain a strong organizational infrastructure for public health Dr. Strange Page 11  Community - Horus Semester 6 – Lecture 1 ❶ - Prevents epidemics & the spread of disease ❷ - Protects against environmental hazards ❸ - Responds to disasters and assist communities in recovery ❹ - Prevents injuries ❺ - Promotes healthy behaviors ❻ - Assures the quality, accessibility and accountability of health services ❼ - Monitoring the health status of the population ❽ - Mobilizing community action ❾ - Reaching out to link high-risk and hard-to-reach people to needed services ❿ - Researching to develop new insights and innovative solutions ⓫ - Leading the development of sound health policy and planning ❶ - Vaccination ❻ - Safer and healthier foods ❷ - Motor-vehicle safety ❼ - Healthier mothers and babies ❸ - Safer workplaces ❽ - Family planning ❹ - Control of infectious diseases ❾ - Fluoridation of drinking water - Decline in deaths from coronary heart - Recognition of tobacco use as a health ❺ ❿ disease and stroke hazard CDC, 1999 Dr. Strange Page 12  Community - Horus Semester 6 – Lecture 1 ❶ - Public Health Al ❻ - Vaccine Development ❷ - Public Health Informatics ❼ - Robotics ❸ - Mobile Health ❽ - Surgery & Public Health ❹ - Telemedicine ❾ - Genomics ❺ - Immersive Technologies ❿ - Precision Medicine  ROBOTICS IN HEALTHCARE  Medical robots fall into several categories: ① Surgical assistance Categories ② Modular ③ Autonomous  Using robots in the medical field helps improve patient care & outcomes while Advantages increasing operational efficiencies.  PRECISION MEDICINE known as "Personalized medicine”  That is an innovative approach to tailoring disease prevention & treatment that Definition takes into account differences in people's genes, environments, and lifestyles.  To target the right treatments to the right patients at the right time. The goal  Awareness of future risk could be fundamental for wellness given that genomics plays a role in 9 of the 10 leading causes of death Dr. Strange Page 13  Community - Horus Semester 6 – Lecture 1  TELEMEDICINE  Telemedicine allows a person to seek a doctor’s advice about nonemergency Definition situations that do not require an in-office visit. Usage  Currently, 76 % of hospitals in the United States connect with people at a distance.  They do this through video conferencing or other technology. Methods  A person may also get medical services through a secure portal  Where the doctor can access their Electronic Medical Record Database. ❶ Real-time video communication. ❷ Remote monitoring: ▪ Which involves health data being reported, collected, and evaluated, such as: - Blood pressures - Cardiac stats - Oxygen levels Types - Respiratory rates ❸ Store-and-forward ▪ Storing and sharing medical information, such as: - CAT scans - MRIs - X-rays - photos, videos, and text-based patient data  IMMERSIVE TECHNOLOGY  Refers to new ways of creating, displaying and interacting with applications, content and experiences by merging the physical world with a digital or simulated reality Dr. Strange Page 14