Community Health Nursing 2022-2023 - Alexandria University

Community Health Nursing For Fourth Year Students Community Health Nursing Department 2022-2023 1  Prepared by Prof.Dr/Houaida Helal Professor of Community Health Nursing...

Community Health Nursing For Fourth Year Students Community Health Nursing Department 2022-2023 1  Prepared by Prof.Dr/Houaida Helal Professor of Community Health Nursing Community Health Nursing Department Faculty of Nursing, Alexandria University Assit.Prof/ Nadia Mahmoud Concepts of Health and Illness Assistant Professor Emeritus of Community Health Nursing Community Health Nursing Department Faculty of Nursing, Alexandria University Assit.Prof/ Eman Ahmed Aboelyazied Assistant Professor of Community Health Nursing Community Health Nursing Department Faculty of Nursing, Alexandria University Assit.Prof/ Ahlam Mahmoud Mohamed Assistant Professor of Community Health Nursing Community Health Nursing Department Faculty of Nursing Alexandria University Department of Community 2 Health Nursing  )12( ‫نموذج رقم‬ ‫توصيف مقرر دراسى‬ ‫بناء على المعايير االكاديميه المبنيه على الكفايات‬ 2017 ‫ابريل‬ ‫ األسكندرية‬: ‫جامعة‬ ‫ التمريض‬:‫كليــة‬ ‫تمريض صحة المجتمع‬: ‫قسم‬ :‫تاريخ اعتماد التوصيف‬ : ‫ بيانات المقرر‬-1 : ‫ المستوى‬/ ‫الفرقة‬ : ‫اسم المقرر‬ 100639 : ‫الرمز الكودي‬ Fourth year / 7th / 8th Semester Community Health Nursing Theoretical 3 credit hrs./ week :‫نظرى‬ :‫عدد الساعات المعتمدة‬ ‫ تمريض صحة المجتمع‬: ‫التخصص‬ 2 - Aim of the course: This course aims to provide community health nursing students with essential knowledge, skills and changing their attitudes in order to provide high quality care to individuals, families and communities within the context of primary health care and to work collaboratively with members of primary health care team and with other professionals and groups in different community health settings. I  : ‫ محتوي المقرر‬-3 1. Topic 1: Introduction to Community Health Nursing and Concept of Health (3hrs). Course 2. Topic 2: Health promotion and diseases prevention (3hrs) Content 3. Topic 3: Ethical and legal aspect of community health nursing (3hrs) 4. Topic 4: Global Health & Primary health care (3hrs) 5. Topic 5: Assessment of community health and community health problems (2hrs). 6. Topic 6: vulnérable population (3hrs) 7. Topic 7: Environmental health & Disaster management (3hrs) 8. Topic 8: Rural health (3hrs) 9. Topic 9: Urban development and culture diversity (3hrs) 10. Topic 10: School health (3hrs) 11. Topic 11: Handicap &Disability (3hrs) 12. Topic 12: Occupational health (3hrs) 13. Topic 13: Communicable diseases (3hrs) 14. Topic 14: Non communicable diseases and rehabilitation (3hrs) 15. Topic 15: Skin diseases (3hrs) 16. Topic 16: Home Health Care (3hrs) 17. Topic 17: Family health assessment and practice (3hrs). 18. Topic 18: Hospice Care (3hrs) II 19. Topic 19:Maternal and child health care program (3hrs) Students assessment :‫ تقويم الطالب‬-4 Midterm exam Oral exam :‫ األساليب المستخدمة‬-‫أ‬ Final written exam Methods used Midterm exam During 8th week ‫ التوقيت‬-‫ب‬ Oral exam During 15th week Time : Final Written exam During 15th week Midterm exam 5% ‫ توزيع‬-‫ج‬ Oral exam 10 % : ‫الدرجات‬ Final Written exam 50 % Mark Distribution ‫ قائمة الكتب الدراسية والمراجع‬-5 List of References - Community Health Nursing Book. Course note ‫ مذكرات‬-‫أ‬ - Electronic Booklet Murdaugh M, Ann Parsons M, Pender N (2018). Health Promotion in Nursing Practice). ‫ كتب ملزمة‬-‫ب‬ Pearson; 8th edition (April 12, 2018). Recommended Books Maurer F, Smith C (2015). Community and public health nursing practice: Health for families and populations. 3rd Ed, USA, Elsevier, 2015. Allender J, Rector C, Warner K (2014). Community Health Nursing: Promoting and Protecting Public's Health. 7th ed, Library of Congress; 2014. III  Yadav H, Chong M (2019): Community Health Nursing. 2nd Edition, Oxford, ISBN: 978- ‫ كتب مقترحة‬-‫ج‬ 983-47-2860-1. Evans D, Coutsaftiki D, Patricia C (2017). Health Promotion and Public Health for Nursing Students. 3rd Ed, (2017). 1. http:// www.cdc.org 2. http:// www.who.emro.org ‫ دوريات علمية أو‬-‫د‬..‫نشرات‬ 3. Journal of community health nursing 4. International Journal of public research IV  Course specification: Domain Competency Key Course objectives Subjects Teaching Media used Assessment or elements Outline Methods Evaluation DOMAIN 1: 1.1.1. Demonstrate 1.1.1.1. Discuss ethical Topic : Introduction to Interactive Lecture Power point - Midterm 1.1. Demonstrate Blended learning Data show understanding of dilemmas that Community health - Online Final PROFESSION knowledge, Discussion Educational video the legislative community health nursing oral exam AL AND understanding, Brain storming On Microsoft framework and the nurses confronting - Final written ETHICAL responsibility role of community during health education Topic : Ethical and legal Online lecture: teams exam PRACTICE and aspect of community Synchronized Zoom meeting health nurse in different community (lecture) accountability of health nursing and its regulatory settings Asynchronized the legal functions. Topic : Family health (lecture) obligations for 1.1.1.2. Discuss community different ethical and assessment and practice nursing practice legal principles in from community community health health nursing nursing. perspective. 1.1.1.3. Exhibit professional code of conduct and ethical values 1 1 1 4. Build an ethical value system for informed nursing practices regardless individual and family ' culture 1.1.2. Apply 1.1.2.1. Apply ethical Topic : Ethical and Interactive Lecture Power point Midterm value principles when solving legal aspect of Blended learning Data show - Online Final statements in ethical dilemma during community health Discussion Educational video oral exam V  nurses’ code of assessment, caring of nursing Brain storming On Microsoft - Final written ethics and families Topic : community Online lecture: teams exam professional assessment synchronized Zoom meeting conduct for (lecture) Topic : Family health Asynchronized ethical decision assessment and practice (lecture) making 1.1.3. Practice 1.1.3.1. Follow ethical Topic : Ethical and legal Interactive Lecture Power point Midterm community principles when aspect of community Blended learning Data show - Online Final health nursing in teaching of students in health nursing Discussion Educational video oral exam accordance with the school, mother in Topic : community Brain storming On Microsoft - Final written Online lecture: teams institutional/ primary care setting, assessment exam Synchronized Zoom meeting national when assessing families (lecture) legislations, and community needs/ Topic : Family health assessment and practice Asynchronized policies and problems (lecture) procedural guidelines considering client /family rights. 1.1.4 Demonstrate 1.1.4.1. Discuss Topic : Ethical and legal Interactive Lecture - PowerPoint Midterm responsibility and different ethical aspect of community presentation - Online Final accountability for competencies in health nursing Online lecture - PDF oral exam maternal and child education process -Synchronized - Videos - Final written health care within Topic : Maternal and (lecture) exam the scope of child health -Asynchronized professional and Topic : School health (lecture) practical level of Group discussion competence. Brain storming 1.2. Behave in 1.2.1.Conduct 1.2.1.1. Supplement Topic: Ethical and legal Interactive Lecture Power point Midterm way that reflect ethical decision ethical role during aspect of community Blended learning PDF - Online Final ethical standard making when family and community health nursing Discussion Educational video oral exam of the profession assessment Brain storming On Microsoft - Final written Online lecture: teams VI  assessing family Topic: community Synchronized Zoom meeting exam and community assessment (lecture) Asynchronized Topic : Family health (lecture) assessment and practice Topic: Rural health 1.3.1.1. identify Unit : Urban development 1.3. Identify and community rights Topic: Ethical and legal Interactive Lecture Power point appropriately Blended learning PDF 1.3.1. professional aspect of community Discussion Educational video respond to ethics in health nursing Brain storming On Microsoft relevant issues community health - Midterm Topic :community Online lecture: teams arising during nursing and - Online Final assessment Synchronized Zoom meeting (lecture) oral exam community community rights Topic : Family health Asynchronized - Final written assessment in assessment and practice (lecture) exam accordance with institutional Topic : Rural health legislation, policies, Unit : Urban development Topic: vulnerable procedures' guidelines and professional ethics VII  Domain Competency Key elements Course Subjects Teaching Media used Assessment or objectives Outline Methods Evaluation Domain 2: 2.1.Provide 2.1.1.Conduct 2.1.1.1. Identify Topic : Primary health Interactive Lecture Power point - Midterm HOLISTIC holistic and holistic and focused common needs and care Blended learning PDF - Online Final PATIENT- evidence-based assessment of problems Discussion Educational video oral exam CENTERED community community in diverse affecting women, Topic : Maternal and Brain storming On Microsoft - Final written CARE health nursing settings as school, child health Online lecture: teams child, school age exam -Synchronized Zoom meeting care in different primary health care. children Topic : School health (lecture) practice settings. -Asynchronized (lecture) 2.1.2. Provide holistic 2.1.2.1. Build up nursing care that the competencies addresses community of community needs & problems. health nursing activities with best evidence- based practices to improve health care. 2.1.3. Provide holistic 2.1.3.1. Develop Topic : community Interactive - Power point - Midterm client/family- culturally assessment Lecture -PDF - Online Final centered care appropriate - Blended -Educational oral exam respecting people Topic : Family health learning video - Final written nursing care plans assessment and diversity. -Discussion On Microsoft exam for families of practice -Brain storming teams diverse cultures - Online lecture: Zoom VIII  2.1.3.2Elaborate how Synchronized meeting health of the family (lecture) Topic : School health influence health of Asynchroniz community Topic : Home care ed (lecture) Domain Competency Key elements Course Subjects Teaching Media used Assessment or objectives Outline Methods Evaluation 2.2 Provide 2.2.1 Determine 2.2.1.1. Enumerate Topic : Family health Interactive - Power point - Midterm health education health related characteristics of assessment and practice Lecture -PDF - Online Final based on the learning needs of community health - Blended -Educational oral exam needs/problems mother, child nurses as an Topic : School health learning video - Final written of the students / family, effective health Topic : Mental health -Discussion On Microsoft exam patient/client community, educator. -Brain storming teams within a vulnerable population Topic : Rural health - Online lecture: Zoom nursing within the context of 2.2.1.2. Discuss the Topic : Urban Synchronized meeting culture, main characteristics framework development (lecture) of health educator values and norms Topic: vulnerable Asynchroniz. and the role of population ed (lecture) community health nurse Topic: Chronic diseases 2.2.1.3.Discuss the elements of clients, mother, child, school age children assessment. 2.2.1.4.Discuss major objectives of antenatal, natal, post-natal care IX Domain Competency Key elements Course Subjects Teaching Media used Assessment or objectives Outline Methods Evaluation 2.2.2. Assess the 2.2.2.1Assess Topic: Family health Interactive - Power point - Midterm factors that different factors Lecture -PDF - Online Final influence the influencing Topic : School health - Blended -Educational oral exam client's and family’s designing patient Topic: Chronic diseases learning video - Final written ability, including lesson plan -Discussion On Microsoft exam readiness to Learn -Brain storming teams 2.2.2.2.Construct and levels of health - Online lecture: Zoom problem oriented literacy. Synchronized meeting record and short. (lecture) term plan Asynchroniz according to the ed (lecture) holistic family, mother, child, clients and school age children. assessment 2.2.2.3. Demonstrate holistic nursing care through selection of appropriate methods of nursing care delivery system for meeting mother, child, school age children, clients and family needs. X Domain Competency Key elements Course Subjects Teaching Media used Assessment or objectives Outline Methods Evaluation 2.2.3. Use 2.2.3.1. Apply Topic : Health promotion Interactive - Power point - Midterm educational principles learning principles and diseases prevention Lecture -PDF - Online Final and counseling during conducting - Blended -Educational oral exam techniques short term plan, Topic : Family health learning video - Final written appropriately and problem-oriented assessment and practice -Discussion On Microsoft exam effectively record on according -Brain storming teams Topic : Skin diseases with diverse to the client, family - Online lecture: Zoom populations Synchronized needs and problems Topic : Chronic diseases meeting (lecture) Asynchroniz ed (lecture) 2.2.4. Communicate 2.2.4.1. Apply Topic : Health Interactive - Power point - Midterm health information communication promotion and diseases Lecture -PDF - Online Final and coordinate principles during prevention - Blended -Educational oral exam health conducting learning video - Final written education/promotion teaching session -Discussion On Microsoft exam activities effectively -Brain storming teams according to family 2.2.4.2 design /clients' needs - Online lecture: Zoom effective evaluation Synchronized meeting plan to (lecture) communicate the Asynchroniz result with the ed (lecture) learners 2.2.5. Utilize 2.2.5.1 Plan Topic : Health Interactive Lecture - Power point - Midterm information from education session promotion and diseases - Blended learning -PDF - Online Final variety of reliable for the clients and prevention -Discussion -Educational oral exam sources for planning family considering - Online lecture: video - Final written and improving health the collected Synchronized On Microsoft exam (lecture) promotion and health information and teams Asynchronize education different available d (lecture) Zoom resources meeting XI  Domain Competency Key Course Subjects Teaching Media used Assessment or elements objectives Outline Methods Evaluation Domain No 3:. 3.1. Demonstrate 3.1.1. Develop & 3.1.1.1.Describe Topic : School health Interactive - Power point - Midterm MANAGING effective implement community nursing Lecture -PDF - Online Final PEOPLE, managerial and evidence- based care of students in the Topic : Chronic - Blended -Educational oral exam QUALITY AND leadership skills care plans. school with different diseases learning video - Final written WORK in the provision health needs and -Discussion On Microsoft exam ENVIRONMENT of quality - Online teams problems during community school years lecture: Zoom health nursing Synchroniz meeting care ed (lecture) Asynchr onized (lecture) 3.2 Provide safe, 3.2.1.Communicate 3.2.1.1.Describe Topic : Ethical and Interactive - Power point - Midterm competent and health information community nursing legal aspect of Lecture -PDF - Online Final and coordinate care of child according community health - Blended -Educational oral exam effective care health nursing. learning video - Final written to health needs and education/promotion -Discussion On Microsoft exam activities effectively problems during Topic : - Online teams according to family childhood years /clients needs Environmental health lecture: Zoom 3.2.1.2. Describe Synchroniz meeting Topic: Occupational community nursing ed (lecture) care of women and in health Asynchr the different health Topic : Disaster onized needs and problems management (lecture) during antennal and postnatal periods XII  3.3 Provide a safe 3.3.1Act to protect 3.3.1.1Discuss Topic. Ethical and legal Online - Power point - Midterm clients and their aspect of community lecture: -PDF - Online Final working different ethical health nursing., environment that families from principles in teaching Synchroniz -Educational oral exam prevents harm unsafe, illegal, or video - Final written conduction Topic: Environmental ed (lecture) unethical care health Asynchr On Microsoft exam for clients and 3.3.1.1.Apply different Topic :Occupational practices in onized teams workers. occupational protocols Zoom different work (lecture) health , settings. and guide lines Discussi meeting Topic: Disaster on management Domain Competency Key Course Subjects Teaching Media used Assessment or elements objectives Outline Methods Evaluation Domain No 4. 4. 1. Utilize 4.1.1. Use 4 1 1.1 Use computer Topic: Primary health Interactive - Power point - Midterm INFORMATICS information and different sources effectively to retrieve care Lecture -PDF - Online Final AND technology to of data related to data about in health - Blended -Educational oral exam Topic : Record and TECHNOLOGY reinforce health contemporary care information to learning video - Final written Report care delivery, standards of remain current with -Discussion On Microsoft exam practice and advances - Online teams communicate, Clients care. lecture: Zoom manage in knowledge Synchroniz meeting knowledge and ed (lecture) 4.1.1.2 use different support decision sources of data Asynchr making for client collection to assess onized and families care. clients and family (lecture) readiness to learn 4.1.1.3. Evaluate the benefits of computerized information management to overcome documentation obstacles. XIII  Domain Competency Key elements Course objectives Subjects Outline Teaching Media used Assessment or Methods Evaluation 4.1.2. Apply 4.1.2.1. Use Topic : Primary health care Interactive - Power point - Midterm technology and technology in Lecture -PDF - Online Final Topic : Maternal and child information planning and - Blended -Educational oral exam health management tools to analyzing data and learning video - Final written support safe care and information. Topic : School health -Discussion On Microsoft exam evaluate their impact - Online teams on mother, child lecture: Zoom school age children, Synchroniz meeting vulnerable ed (lecture) population, family Asynchr outcomes. onized (lecture) DOMAIN 5: 5.1. Collaborate 5.1.1.Maintain 5.1.1.1.Integrate Topic : Primary health care Interactive - Power point - Midterm INTER- with colleagues inter-professional communication skills Topic: Maternal and child Lecture -PDF - Online Final PROFESSIONAL and members of collaboration, in a inter professional - Blended -Educational oral exam COMMUNICATI health the health care variety of settings to context during health learning video - Final written ON team to maximize health care delivery. Topic: School health -Discussion On Microsoft exam outcomes for the - Online teams facilitate and Topic : vulnerable cleints, families and lecture: Zoom coordinate care communities. population Synchroniz meeting provided for 5.1.2.1.Elaborate how ed (lecture) individuals, to adapt 5.1.2. Apply Asynchr families and standardized communication styles onized communities communication in ways which are (lecture) approach to facilitate appropriate to different experience transition vulnerable groups across different health care settings ‫رئيس القسم‬ ‫منسق المقرر‬ ‫د هويدا هالل‬.‫أ‬ ‫د أحالم محمود‬.‫م‬.‫أ‬ XIV Table of contents Introduction to Community Health Nursing & Health.......................................................................... 3 Global Health............................................................................................................................................ 26 Assessment of Community Health and Community Health Problems................................................ 40 Vulnerable Population............................................................................................................................. 52 Environmental Health.............................................................................................................................. 58 The Concept of Environmental Risk & Disaster Management............................................................ 76 Rural Health.............................................................................................................................................. 81 Urban Development.................................................................................................................................. 90 Culture diversity..................................................................................................................................... 100 School Health......................................................................................................................................... 103 Handicap & Disability............................................................................................................................ 130 Occupational health................................................................................................................................ 148 Communicable diseases.......................................................................................................................... 155 The Universal Precaution Standard of infection control.................................................................... 169 Non communicable Diseases (NCDs) and Rehabilitaion.................................................................... 176 Skin Diseases........................................................................................................................................... 191 Home Health Care................................................................................................................................. 208 Family Health Assessment and Practice............................................................................................ 217 Hospice Care........................................................................................................................................... 231 Maternal and Child Health Program (MCH)...................................................................................... 248 References................................................................................................................................................ 289 Page | 1 Community Health Nursing Page | 2 Community Health Nursing  Introduction to Community Health Nursing & Health Goal: Provide the community with nurse graduate who are equipped with the knowledge, skills, and attitudes needed in the field of community health nursing. Intended Learning Objectives of Course (ILOs) a. Knowledge and Understanding: 1. Define the historical development of community health nursing 2. List the factors affecting the health of any community 3. List the characteristics of community health nursing 4. List the settings for practicing community health nursing 5. Define health and prevention b. Intellectual Skills: 1. Discuss the factors influencing the development of community health nursing 2. Identify the functions of community health nursing 3. Enumerate the principles of community health nursing 4. Identify the health system and health services in Egypt 5. Discuss the role of community health nursing 6. Discuss the concepts of disease and prevention 7. Recognize the different health indicators c. Professional and Practical Skills 1. Assess health status of community using different indicators 2. Asses other recourses available in community 3. Differentiate between the hospital nurse and community health nurse 4. Apply levels of prevention on any selected health problems 5. Illustrate major community health problems d- General and Transferable Skills: 6. Apply the role of community health nurse 7. Recognize the concepts of health and disease 8. Apply levels of prevention on any community health problem 9. Use principles of community health nursing 10. Use ethical consideration Page | 3 Community Health Nursing  Content Outline: 1) Concept of health, Health promotion and disease prevention: ▪ Definition of health ▪ Components of health ▪ Determinants of health ▪ Importance of good health and effect of poor health ▪ Common health problems ▪ Health promotion and disease prevention ▪ Levels of prevention ▪ Health indicators 2) Community Health & Community Health Nursing: ▪ Definition of community health ▪ Factors affecting the health of any community ▪ Local community health services ▪ Basic functions of public health ▪ Factors influencing the development of community healthy nursing ▪ Characteristics of community healthy nursing ▪ Difference between hospital and community health nurse ▪ Settings for practicing community healthy nursing ▪ The role of community healthy nursing 3) Ethical considerations in community health care settings Definitions of Health - Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (World Health Organization).it is a dynamic state of well-being of the individual and the society; of physical, mental, spiritual, economic, political and social well- being; of being in harmony with each other, with the natural environmental and with God” Page | 4 Community Health Nursing  The Components of Health: https://theworldbook.org/types-of-health/Common health problems These include: Physical: Malaria, anemia, measles, diarrheal disease, tetanus, malnutrition, blindness, poliomyelitis, tuberculosis. These are all preventable. Mental: the stresses and strains of modern life and competition resulting in anxiety and mental stress, and possibly an inability to behave normally in society. Schizophrenia is the commonest serious mental disorder. Social: the “stigma” attached to some diseases/conditions, e.g. immorality, sexually transmitted diseases, abortion, infertility, accidents, alcoholism and drug addiction. Page | 5 Community Health Nursing  Importance of good health and effects of poor health - Health is important for enjoyment of life, economic wellbeing, the happiness of the family and the wealth of the nation. Some of the effects of poor health are included in Fig. 1. Fig (1): The effects of poor health. Degrees of illness and wellness - “Health is a dynamic state of well-being of the individual and the society; of physical mental, spiritual, economic, political and social well-being; of being in harmony with each other” - These are variations in degrees of health. Health always involves a “continuum” i.e. a range of degrees from optimal health at one end to death or total disability at theother. As well the health of the individual, family, group or community moves back and forth along this continuum throughout life. Travis’s Illness-wellness continuum - The Illness-Wellness Continuum is a graphical illustration of a wellbeing concept firstproposed by Travis in 1972.The concept assumes that wellbeing is a dynamic rather than a static process. Heath is usually in a state of flux, either improving or deteriorating. The level of illness increases as one move toward; total disability or death while the level of wellness increases as one move toward optimal health. At any given time, a person canbe placed at some point along the continuum. Page | 6 Community Health Nursing  - The Illness-Wellness Continuum proposes that individuals can move farther to the right, towards greater health and wellbeing, passing through the stages of awareness, education, and growth. Worsening states of health are reflected by signs, symptoms and disability. Traditionally the majority of health care was focused on treatment of acute and chronic conditions at the illness end of the continuum. Gradually the emphasis shifted to include attention to health end of the continuum. Community health practice ranges over the entire continuum. It always works to improve the degree of health in individuals, families, groups and communities. Community health nursing practices emphasizes the promotion and N.B. preservation of health and the prevention of illness. Determinants of health and wellbeing: Page | 7 Community Health Nursing  The Determinants of Health and Wellbeing, The Health Map (Barton And Grant, 2010) Page | 8 Community Health Nursing  Health promotion and disease prevention Health Promotion: Promotion of health is recognized as one of the most important components of public health and community health practice. Health promotion includes all efforts that seek to move people closer to optimal wellbeing or higher levels of wellness. It is the process of enabling people to increase control over and to improve their health. Health promotion is described by the World Health Organization as "the science and art of helping people change their lifestyle to move toward a state of optimal health." Optimal health is defined as a balance of physical, emotion, social, spiritual and intellectual health. Choosing a healthy lifestyle can help improving health and reduce the incidence and impact of health problems, recovery, coping with life stressors, and improving quality of life. Lifestyle change can be made easier through a combination of efforts to increase knowledge, change behavior and create environments that support good health practices. The concept of prevention: Prevention means anticipating and averting problems or discovering them as early as possible in order to minimize potential disability and impairment. Prevention includes a wide range of activities aimed at reducing risks or threats to health. The concept of prevention is best defined in the context of levels, traditionally called primary, secondary and tertiary prevention. Levels of Prevention I- Primary prevention: Primary prevention includes measures taken to keep illness or injuries from occurring. It is applied to a generally healthy population and precedes disease or dysfunction by interventions designed to promote optimum health by preventing exposures to hazards that cause disease or injury, altering unhealthy Page | 9 Community Health Nursing  or unsafe behaviors that can lead to disease or injury, and increasing resistance to disease or injury. This is accomplished in the period before a person is diseases by interventions designed to promote optimum health by: 1) Health promotion Health education to general people. Good standard of nutrition. Attention to personally development. Provision of adequate housing, recreation and agreeable working condition. Marriage counseling and sex education. Periodic selective examination. Environmental sanitation. 2) Specific protection Health education to risk group. Use of specific immunization. II- Secondary prevention (When the disease process is established in humans). Secondary prevention involves efforts to detect and treat existing health problems at the earliest possible stage when intervention may lead to its control or eradication This is done through: 1- Early diagnosis and prompt treatment Case finding measures. Screening surveys. Selective examination. 2-Disability limitation and prevention of complication Adequate treatment to arrest the disease process and to prevent complications. Page | 10 Community Health Nursing  Provision of facilities to limit disability. III) Tertiary prevention: It deals with the disease or accident out comes. It aims to soften the impact of an ongoing illness or injury that has lasting effects. This is done by helping people manage long- term, often-complex health problems and injuries (e.g. chronic diseases, permanent impairments) in order to improve as much as possible their ability to function, their quality of life and their life expectancy. It includes rehabilitation of the patient and provision of hospital and community facilities. Page | 11 Community Health Nursing  Leavell’s Levels of Prevention Leavell’s Levels of Prevention Page | 12 Community Health Nursing  Indicators of health: Health indicators are used to measure health status of the community. They are quantifiable characteristics which are used as supporting evidence for describing the health of a population. They are parameters or variables that can measure changes in the level of health. Uses of indicators: Marker of progress. Motivate people to action Stimulate actions Force policy makers and mangers to rethink. Monitor the progress. Monitor health program at different levels. Characteristics of Health Indicators 1.Valid: They should actually measure what they are supposed to measure 2.Reliable: The answers should be the same if measured by different people in similar circumstances. 3.Sensitive: They should be sensitive in the situation concerned 4.Specific: They should reflect changes only in the situation concerned 5.Feasible: They should have the ability to obtain data needed 6.Relevant: They should contribute to the understanding of the phenomenon of interest. Types of Heath indicators: Rates Ratio Number Page | 13 Community Health Nursing  Classification of Health Indicators: 1. Mortality rate indicators. 2. Morbidity rate indicators. 3. Disability rate indicators. 4. Nutritional status indicators. 5. Health care delivery indicators. 6. Utilization rates. 7. Indicators of social and mental health. 8. Environmental indicators. 9. Socio-economic indicators 10. Health policy indicators. 11. Indicators of quality of life. 12. Other indicators. Health for all by the year 2000 Indicators -Alma Ata Declaration (1978-2000 ) Millennium Developmental Goals indicators (2000-2015) Sustainable Developmental Goals Indicators (2015-2030) Page | 14 Community Health Nursing  Community Health: This consists of all measures taken to promote the physical, mental and social well- being of individuals and families and the local community. It includes the components of primary health care i.e. sufficient clean water and food; breathing clean air; living in a dry, clean house; disposal of harmful and unhealthy waste; elimination of germ and bacteria, education of the young, prevention and curing of illness, providing for adequate mental, physical and social recreation. Factors affecting the health of any community include: Environmental factors (e.g. climate, water, sanitation, refuse, pollution and roads) Social and cultural factors (e.g. culture, beliefs, values, education and social level). Organizational factors. Agricultural and technological factors. Prevalent diseases. Presence of trained health care personnel. Local community health services These are usually divided into two branches (environmental and personal health services). They work closely together and with the local government, schools, community leaders and other important local agencies. The community health officer supervises both branches. 1- Environmental health services These are under supervision of the public health superintendent, sanitary inspectors and their assistants. They are concerned with: Adequate supply of safe drinking water. Refuse collection and disposal. Supervision of housing conditions (factors, schools, and private dwellings). Prevention and control of communicable disease. Collection of health statistics. Health education. 15  Pollution and health hazards. Provision and supervision of sanitation. Enforcement of regulations concerning health (e.g. food hygiene, slaughterhouses, etc.). 2- Personal health services There are under supervision of the physicians, midwives, community health nurses and aids or auxiliaries. They are concerned with: General curative out-patient services. Maternity care. Care of the “under-fives” children and immunization. Care of school children. Consultative clinics. Clinics for special diseases, e.g. tuberculosis, leprosy. Care of the elderly and handicapped. These services are provided through: Health centers which provide a combination of services and perhaps a few inpatient beds. Maternity’s which provide maternity services and immunizations. Clinics which provide some of the above. Dispensaries staffed by health auxiliaries and assistants which provide essential very basic services and refer more serious cases. Mobile clinics which visit more remote areas, usually on a regular basis, and provide an “on the spot” combination of some of the above. Home visits which are done routinely and in cases of special need. 16 | P a g e  Community Health Nursing Community Health Nursing is a synthesis of nursing practice and public health practice applied to promoting and preserving the health of populations. The nature of this practice is general, comprehensive and holistic. It is not limited to a particular age or diagnostic group. It is continuing, not episodic. The dominant responsibility is the population as a whole. Therefore, nursing directed to individuals, families, or groups contributes to the health of the total population. Health promotion, health maintenance, health education, coordination and continuity of care are utilized in a holistic approach to the family, group, and community. The nurse’s actions acknowledge the need for comprehensive health planning, recognize the influences of social and ecological issues, give attention to population to risk and utilize the dynamic forces which influence change. Community Health Nursing is defined as A field of nursing that applies knowledge and skills from nursing and public health toward the promotion of optimal health for the total community. Public health is defined as The science and art of: Preventing disease. Prolonging life. Promoting physical and mental health and efficiency. Through Organized community efforts. Towards The sanitation of the environment. Control of communicable diseases. 17 | P a g e  Education of the individual on principles of health. Organization of medical and nursing services for the early diagnosis and treatment of disease. The development of social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health. Basic functions of public health 1- Control of communicable diseases. 2- Environmental sanitation. 3- Maternal and child health. 4- Health education. 5- Laboratory services. 6- Viral statistics. Any community health program is built on these 6 basic functions in addition to school, industrial and rural health programs. Local community health services These are usually divided into two branches (environmental and personal health services). They work closely together and with the local government, schools, community leaders and other important local agencies. The community health officer supervises both branches. 1- Environmental health services: - These are under supervision of the public health superintendent, sanitary inspectors and their assistants. They are concerned with: Adequate supply of safe drinking water. Refuse collection and disposal. 18 | P a g e  Supervision of housing conditions (factors, schools, and private dwellings). Prevention and control of communicable disease. Collection of health statistics. Health education. Pollution and health hazards. Provision and supervision of sanitation. Enforcement of regulations concerning health (e.g. food hygiene, slaughterhouses, etc.). 2- Personal health services: - There are under supervision of the physicians, midwives, community health nurses and aids or auxiliaries. They are concerned with: General curative out-patient services. Maternity care. Care of the “under-fives” children and immunization. Care of school children. Consultative clinics. Clinics for special diseases, e.g. tuberculosis, leprosy. Care of the elderly and handicapped. These services are provided through: Health centers which provide a combination of services and perhaps a few inpatient beds. Maternity’s which provide maternity services and immunizations. Clinics which provide some of the above. Dispensaries staffed by health auxiliaries and assistants which provide essential very basic services and refer more serious cases. Mobile clinics which visit more remote areas, usually on a regular basis, and provide an “on the spot” combination of some of the above. Home visits which are done routinely and in cases of special need. 19 | P a g e  Characteristics of Community Health Nursing: 1- It is a field of nursing i.e., a specialty within the larger discipline. 2- It combines the specialized knowledge of public health with nursing practice (e.g., epidemiology, vital statistics…etc.) 3- It is population oriented and does not deal only with individual clients. 4 -It emphasizes health rather than disease or illness. 5- It involves interdisciplinary collaboration i.e. teamwork with other professionals. 6- It promotes client participation by fostering a sense of responsibility among people for their own health. Principles underlying community health nursing practice 1- The practice is population oriented, comprehensive &holistic. 2- Promotion of health and prevention of illness is first order priority. 3- Community health nursing practice uses measurement and analysis. The need to collect and examine data before sound decision making is fundamental to community health nursing practice. Analysis of health states, environmental factors, health related services, economic patterns and social policy are among the foci of community health evaluation and research. 4- Community health nursing practice utilizes the principles of management and organization necessary for effective management of health care and organization of services. The philosophy of Community Health Nursing Is belief that all persons have the capacity and the potential to develop better physical health and improve psychosocial well-being, dependent upon their desires, willingness to change, and adaptability to prescribed therapies. Nursing practice assists individual and families in adjusting their health need and wants, resolving health problems the social, emotional, and physical environment, and facilitating coping abilities to achieve higher levels of wellness. 20 | P a g e  Standards for Community Health Nursing Standards for community health nursing are stated in a systematic approach to nursing practice in areas of assessment, planning, implementation, and evaluation. Difference between hospital nurse and the community health nurse Hospital Community nurse nurse Setting - Works in - Works in community hospital settings, homes, schools, industries, hospitals…etc Nursing - Specialized i.e. - Generalized i.e. works with role works with all groups and different specific age or diseases diseases - Interdependent - Interdependent within the within the health health sector and other sector. sectors. - Provide - Provide comprehensive care comprehensive to individual, families and care to community. individual patients only. - Applies - Applies professional practice professional Ng with basic community health practice nursing practice. 21 | P a g e  Nursing - Conditions - Prevailing health problems concern requiring and community needs. Total hospitalization population especially under i.e sick served and high- risk groups. individuals and disabled. Nursing - Main principle - principle in her practice is practice in her practice is prevention, early case curative, finding, health teaching, prevention of follow up and family self- complication direction i.e. focuses mainly and health on primary prevention. teaching i.e. focus mainly on secondary and tertiary prevention. - Patient well to - Improved patient, family and be discharged. community health and self- care. - The nurse is the - The nurse is a guest. hostess. 22 | P a g e  Settings for practicing community health nursing: - Community health nurses can work in a variety of settings: 1- Homes 2- Ambulatory setting 3- Schools 4- Occupational health settings 5- Residential institution 6- The community at large The Role of the Community Health Nurse Community health nurses assume a variety of roles. These include: 1- Care Provider (Functional Role): In community health practice, providing nursing care is different than in hospitals. This is because the target of service expands beyond the individual to include families, groups, and communities. Nursing care is designed to meet the special needs of the client, which are identified from the assessment made by the nurse. Health is the main focus in community health nursing practice. The community health nurse uses many different skills in the care provider role such as skills in observation, listening, communication and counseling. 2- Educator: Health teaching is part of good nursing care and one of the major functions of the community health nurse being mainly concerned with health promotion. As educators, community health nurses facilitate client’s understanding and learning facts about health and health promotion. This could be achieved by sharing information with the client either formally e.g. through health classes in different clinics or informally at home. Community health nurses also act as counselor to individuals and groups. This educational role will increase the health awareness of the individuals, families and community at large. 23 | P a g e 3- Manager (administrative role): In community health, the nurse’s role as a manager includes managing family care handling a caseload, administering a clinic, or planning a project. The manager role also involves leading, planning, organizing coordinating, staffing, supervising, motivating and controlling service activities. 4- Leader: Through her/his role as a leader, the community health nurse stimulates interest in health promotion, initiates therapy, guides in decision making, direct a preventive program, influences a health policy and effects change. Thus, the community nurse becomes an agent for change. 5- Collaborator: The community health nurse is a member of the health team, assumes the role of collaborator between the different personnel of the team. The health team includes physicians, nurses, social workers, nutritionist, dentist, health educators, lab technicians…etc. 6- Coordinator: The community health nurse plays an important role in coordinating between the different services in the community. 7- Advocate: The role of the community health nurse in client advocacy is to help the client to gain greater independence and direct the health care system to the client by influencing change. She also helps to direct attention to inadequate or improper care and or service provided to the client. 8- Researcher: The researcher role is an integral part of community health nursing practice. It helps to 24 | P a g e  identify needs, evaluate effectiveness of care, and develop theoretical basis for community health nursing practice. 9- Role in evaluation: Evaluation is a continuous process and part of the daily activities of the community health nurse. The community health nurse evaluates the effectiveness of care provided to individuals, families or groups. She also evaluates the effectiveness of the services in health programs in special settings, she uses available help to study and evaluate her own job performance and plan for continuing professional growth. She also contributes to the evaluation of workers for whom she shares supervising responsibility. Ethical consideration in community health nursing Ethical principles: Are basic truths or laws that guide behavior.it is also called standards and provide the framework for practice of professional nursing. Ethical principles 1- Respect for autonomy 2- Informed consent 3- Beneficence 4- Nonmaleficence 5- Justice 6- Confidentiality 7- Veracity 8- Fidelity 25 | P a g e  Global Health Outline: 1. Introduction. 2. Definition of terms: ▪ Global health, ▪ global health system 2. Importance of global health: 3. Key actors in global health 4. Functions of the Global Health System Primary health care and Health for all ▪ A Brief History of Primary Health Care ▪ Definition of Primary Health Care ▪ Importance of Primary Health Care ▪ Objective of Primary Health Care ▪ Principal of Primary Health Care ▪ PHC strategic approaches ▪ Elements of Primary Health Care ▪ PHC: Extended elements ▪ Approach of Primary Health Care ▪ PHC services in Egypt ▪ Barriers of Primary Health Care ▪ Primary health care facilities in Egypt Health for all ▪ The Meaning of “Health for All by the Year 2000 Millennium Development Goals Sustainable developmental goals 26 | P a g e  Introduction - Global Health is a new field within public health sciences that integrates the knowledge from fields such as epidemiology, medicine, economy and the behavioral sciences. Global health is a dynamic multidisciplinary field that uses a diversity of interventions to promote sustainable economic growth, support human rights, mitigates threats to security, and help people around the world live longer, healthier lives. Definition of terms  Global health - Global health is an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide.  Global Health Systems focuses on issues such as governance, health care financing, and human resources for health. Engagement is often at a national or sub national level and the objects of analysis are institutions and countries. Importance of global health: Generate new knowledge and theories about global health issues, influential factors, and develop global solutions. Distribute the knowledge through education, training, publication and other forms of knowledge sharing. Apply the global health knowledge, theories, and intervention strategies in practice to solve global health problems. Establish evidence-based global solutions, including strategies, frameworks, governances, policies, regulations and laws. Improve worldwide health, Improve Access to health care services Provide high quality of health care for all population Helping and maintain global security. 27 | P a g e  Functions of the Global Health System Research and Development Health technologies such as drugs, vaccines, and diagnostics were developed primarily by and for populations in the industrialized world. Today there is increasing evidence of contributions from the South to global health research Financing and Resource Allocation International financing and resource allocation for health in developing country Monitoring, Evaluation, and Learning The global health system currently poorly manages monitoring and evaluation (M&E). National and sub national organizations for conducting M&E and promoting critical learning are relatively weak, and incentives for strengthening them are almost nonexistent Primary health care and Health for all A Brief History of Primary Health Care - In 1978, at an international conference convened by the World Health Organization (WHO) and UNICEF (United Nations Children’s Fund) in Kazakhstan, the 134 members of the World Health Assembly of World Health Organization ratified the Declaration of Alma-Ata (World Health Organization, 1978). The declaration committed member states to supporting Primary Health Care (PHC) as a policy to achieve the WHO definition of health as “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Definition of Primary Health Care according to World Health Organization (WHO), ‘is a basic health care and is a whole of society approach to healthy well- being, focused on needs and priorities of individuals, families and communities.’ Important of Primary Health Care ▪ Primary Health Care focuses more on quality health service and cost-effectiveness. ▪ Primary Health Care focuses on “Health for all” 28 | P a g e ▪ Primary Health Care integrates preventive, promotive, curative, rehabilitative and palliative health care services. ▪ Primary Health Care can be easily accessible by all as it includes services that are simple and efficient with respect to cost, techniques and organization. ▪ Primary Health Care promotes equity and equality. ▪ Primary Health Care improves safety, performance, and accountability. ▪ Primary Health Care advocates on health promotion and focuses on prevention, screening and early intervention of health disparities. ▪ Primary Health Care is also perceived as an integral part of country’s socio-economic development Objectives of Primary Health Care (PHC): ▪ To increase the programs and services that affects the healthy growth and development of children and youth. ▪ To boost participation of the community with government and community sectors to improve the health of their community. ▪ To develop community satisfaction with the primary health care system. ▪ To support and advocate for healthy public policy within all sectors and levels of government. ▪ To provide reasonable and timely access to primary health care services. ▪ To apply the standards of accountability in professional practice. ▪ To establish, within available resources, primary health care teams and networks. ▪ To support the provision of comprehensive, integrated, and evidence-based primary health care services. Principles of PHC Availability: all citizens, "Equitable", 24 hours. Accessibility: geographically "1 h. travel", socially, functionally 29 | P a g e  Affordability: Cost. Acceptability: Consumer’s satisfaction Appropriateness: scientific Comprehensiveness health care Continuous: from womb to tomb Coordinated. Multi-sectional “agriculture, education, communication, housing, industry” Community participation: It is the process by which individuals and families assume responsibility for their health and welfare and to develop the capacity to contribute to their community's development. The community can participate in planning, implementation and management of health services. Emphasis on the prevention: The focus of care should be on prevention rather than on cure. Use appropriate technology: Methods, procedures, techniques and equipment's should be scientifically valid, adapted to local needs and acceptable to users and to those for whom they are used. The intersectional system: Health care is regarded on only a part of total health development. Other sectors such as education, housing….ect. PHC strategic approaches GOBI-FFF Growth monitoring: to prevent most child malnutrition before it begins Oral rehydration therapy Breastfeeding Immunization Family planning (birth spacing) Female education 30 | P a g e  Food supplementation: “iron & folic A. fortification/supplementation to prevent deficiencies in pregnant women Elements of PHC o Education for Health o Locally endemic disease control o Expanded program for immunization o MCH including responsible parenthood o Essential drugs o Nutrition o Treatment of communicable & non-communicable diseases o Safe water & sanitation PHC: Extended elements in the 21st Century: Expanded options of immunization Reproductive health needs Provision of essential technologies for health Health promotion Prevention and control of non-communicable diseases Food safety and provision of selected food supplements. PHC approaches: ▪ The medical approach: its objective is the medication of the individual illness. ▪ The health services approach: in which the community takes an active role in delivery of health care services. ▪ The community development approach: in which the community members are actively involved in the decision on how to improve their condition PHC services in Egypt a. prevention services: o Health education 31 | P a g e  o Counseling o Growth monitoring o Supplementing micronutrients to infants o Family planning o Support environmental sanitation, safety. o Vaccination of compulsory vaccines o Food safety o detection & screening tests for neonatal anomalies, for TB, for risky pregnancy, for malignant tumors. b. Curative services: o Treatment of communicable & non communicable diseases. o Control of epidemics & endemic diseases. o First aid & emergency care. o Referral of needy cases to higher care level. o Provision of some drugs. o PHC mainly provides preventive services. Curative services constitute 20% only! This concept must be practiced & understood by all health care providers. Barriers affecting proper implementation of PHC: ▪ Poor socio-economic conditions. ▪ Inappropriate education. ▪ High level of fertility. ▪ Poor environmental conditions. ▪ Poor communication and transportation facilities. ▪ Lack of human and material resources. 32 | P a g e  Primary health care facilities in Egypt: The Egyptian constitution states that health care is the right of every citizen, and this is provided by a mixture of governmental services, health insurance facilities, health services for the military, police sand railway workers and the private sector. I- Urban health facilities include: 1- Private services: This includes diagnostic services, radiology and pathology as well as private clinics. 2- Governmental services: which include separate preventive services, MCH centers, family medicine clinics, health offices, school health services, and outpatient departments (poly clinics). ▪ MCH centers: They staffed by doctors, assistant midwives and nurses as well as a pharmacist and laboratory technician; occasionally a dentist and nutritionist may be available. ▪ School health units: covering primary, preparatory and secondary school children from catchments areas. ▪ Polyclinics: It is a separate outpatient department within the general hospital. It increases the cooperation and ease of referral between primary and secondary care. All major specialists are involved, along with a pharmacy, laboratory, and radiological department. ▪ Hospital emergency department: Are used by the majority of "out- of- hours" illness, both minor and serious. ▪ Health office: Responsible for the registration of births and deaths inoculations of the adult population, food hygiene inspection and the notification follow up of parasitic and infectious diseases. 33 | P a g e ▪ Health insurance: Its function is to provide diagnosis and treatment and if necessary, referral to a health insurance polyclinic or out-patient department of a health insurance hospital and to organize "sickness" or "off work" certificates. II- Rural health facilities: o Rural health units: each unit covers a population of up to 9.000 and provides MCH services, including family planning, immunization, the supervision of public health measures as well as curative care, primary care for children, and a special ORT units, the acute services are open 24 hours per day. o Rural health centers: covering a larger population of up to 20.000. It has 6-10 beds and open 24 hours a day. The service is similar to the rural health unit considerably more curative working being carried out. As in the health unit, a pharmacy and laboratory are provided. o Rural hospitals: providing the same preventive and curative services as rural units to population up to 40.000, but in addition to, providing some secondary care. Health for all WHO declared “Health for all by the Year 2000,” creating a goal for national governments that coincided with other UN efforts to address the global and political situation in the 1970s. The Meaning of “Health for All by the Year 2000 Health for all” is thus a holistic concept calling for efforts in agriculture, industry, education, housing, and communications, just as much as in medicine and public health. Medical care alone cannot bring health to hungry people living in hovels. Health for such people requires a whole new way of life and fresh opportunities to provide themselves with a higher standard of living. 34 | P a g e  Millennium Development Goals The United Nations Millennium Development Goals (MDGs) are 8 goals that UN Member States have agreed to try to achieve by the year 2015. MDG 1: End poverty and hunger MDG 2: Achieve universal primary education MDG 3: promote gender equality and empower women MDG 4: Reduce child mortality MDG 5: Improve maternal health MDG 6: Combat HIV/AIDS, malaria and other diseases MDG 7: Ensure environmental sustainability MDG 8: Develop a global partnership for development Sustainable developmental goals The Sustainable Development Goals (SDGs) are a universal call to action to create a fairer, just, and equitable world ensuring no one is left behind. Current global health priorities, such as the targets of the United Nations (UN) Sustainable Development Goals (SDGs), are ambitious. Setting an agenda for the next 15 years, targets have been established to drastically reduce maternal mortality and premature mortality from no communicable diseases; end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases; achieve universal health coverage; and ensure universal access to sexual and reproductive health care services, among others. While vast improvements have been made in global health in the past decades. 35 | P a g e Link between global health and Sustainable Development Goals "SDGs"2030 The adoption of the 2030 Agenda for Sustainable Development in September 2015 was a landmark moment for the community health. The SDGs goal 3 and some of its targets focused on promote health for all population. Goal 3: Ensure healthy lives and promote well-being for all at all ages Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being. Target 3.5: Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol. Target 3.6: By 2020, halve the number of global deaths and injuries from road traffic accidents. Target 3.7 The pandemic and its response are making hindering the achievement or the maintenance of these targets, even though the region was well on track to achieve them In addition to goal 3, NCDs are related to other goals; Goal 1: End poverty in all its forms everywhere. Populations in low- and middle-income countries (LMICs) are at increased exposure to risk factors for NCDs can experience loss of household income from unhealthy behaviors, poor health and premature death. The cost of treatment and/or loss of employment and income push vulnerable people and families deeper into the poverty cycle. Goal 2: End hunger, achieve food security and improved nutrition and promote sustainable agriculture. Malnutrition in all its forms, overweight & obesity and under nutrition, are risk factors for NCDs such as heart disease, cancer, and type II diabetes. Goal 4: Ensure inclusive and quality education for all and promote lifelong learning. 36 | P a g e Education and literacy, particularly for health, are essential for reducing exposure to common risk factors for NCDs, such as malnutrition, physical inactivity, tobacco use, and harmful use of alcohol. Goal 5: Achieve gender equality and empower all women and girls. Women and girls are disproportionately affected by NCDs and their risk factors. Women and girls often face a triple burden of poor health from reproductive and maternal health conditions, communicable diseases, and NCDs. Goal 6: Ensure access to water and sanitation for all. Access to clean water is essential for nutrition and reducing pollution, all of which contribute to healthy lives. Goal 7: Ensure access to affordable, reliable, sustainable and modern energy for all. Air pollution is the second leading cause of deaths from non-communicable diseases (NCDs), after tobacco-smoking. In 2018, the third United Nations high-level meeting on NCDs recognized household and outdoor air pollution as a risk factor for NCDs, alongside unhealthy diets, tobacco-smoking, harmful use of alcohol and physical inactivity. The main NCDs associated with air pollution include ischemic heart disease, stroke, chronic obstructive pulmonary disease and lung cancer. Interventions to reduce exposure to air pollution and improve air quality have huge potential in protecting health and contributing to reducing the burden of NCDs. Goal 8: Promote inclusive and sustainable economic growth, employment and decent work for all. 37 | P a g e  - Promoting full and productive employment and decent work for all includes investing in healthy workplaces and well-designed wellness programs. NCDs cause disabilities that prevent people from finding and/or sustaining employment. 57% of people diagnosed with cancer have to give up work or change roles. Almost 50% of all stroke survivors are unemployed after one year https://www.un.org/development/desa/disabilities/about-us/sustainable-development-goals-sdgs-and-disability.htm for more info