Introduction to Public Health PDF

Community Health: CHP 310 Introduction to Public Health 1  Learning outcomes By the end of the module participants should be able to: 1. Define and differentiate health and disease from individual and community perspectives 2. Analyzing Determ...

Community Health: CHP 310 Introduction to Public Health 1  Learning outcomes By the end of the module participants should be able to: 1. Define and differentiate health and disease from individual and community perspectives 2. Analyzing Determinants of Health and Disease in Communities: 3. Identify and analyze the dimensions of health about well-being. 4. Recognizing, assessing, and addressing inequities in health, and disparities in healthcare access. 2  What is Health Holistic Definitions (W.H.O. (1948)) Health is a “state of complete physical, mental and social well-being, and not merely (not only) the absence of diseases or infirmity (weakness)”. The most accepted definition is that of the World Health Organization: The World Health Organization (WHO) Constitution (1948, p1) “Good health is a prerequisite for participation in a wide range of activities including education and employment”. 3  Health? Disease? Illness? Sickness? Wellness? 4 Health: State of complete physical, mental and social well-being, and not merely (not only) the absence of diseases or infirmity Illness: Symptoms of any abnormality experienced by patient (Eg. chest pain) Sickness: Social and cultural concept or belief for any disease in a broader sense (Eg. heart attack) Disease: State of disorder or impairment for normal functioning body or organs or tissues or cells which is typically manifested (presented) by distinguishing (apparent) signs and symptoms (Eg. pericarditis) Wellness: Person’s experience for overall balance of physical, social, spiritual, emotional, intellectual, environmental and occupational well-being. 5 6  Public Health? Community Health? Community Medicine? Epidemiology? 7 Public Health/Preventive Health: Science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals Community Health: Branch of public health that focuses on studying, protecting, or promoting health within a community. Community Medicine/Preventive Medicine: Branch of medical science which deals with the identification and treatment of disease, prevention and promotion of health within the community. Epidemiology: The study of the distribution and determinants (factors) of health-related states or events in specified populations, and the application of this study to the control of health problems. 8  Health-illness continuum model ) Spectrum of Health o Unrecognized Sickness o Mild Sickness  Positive Health o Severe Sickness  Better Health o Death  Freedom from Sickness 9  Medical Conception of Disease (Natural history of disease) Preclinical Phase Clinical Phase ‘Outcome’ (alive, Biological Symptoms Therapy dead, onset of disease appear begun cured, etc) Diagnosis 10  Agent-host Environment Model This Model is used primarily in describing causes of illness rather than in promoting wellness. It helps in identifying risk factors that results from interaction of agent-host environment. 11 Factors related to Host: Age, Sex, genetic profile, previous diseases, immune status, religion, customs, occupation, marital status, and family background. Factors related to the Environment: Factors related to the agent: Temperature, humidity, altitude, crowding, Biological agents (bacteria, viruses, housing, neighborhood, water, milk, food, fungus), chemical (Poison, alcohol, radiation, pollution, and noise. smoke), Physical (trauma, fire,), and nutritional (lack or excess). 12  Dimensions of Good Health “Well-being” The concept of dimensions of health refers to: “the different aspects or areas that contribute to overall well-being”. a multi-dimensional process A combination of the above 5 conditions defines good health 13  Dimensions of Health  Physical dimension: about your body's health; how strong and healthy you are.  Mental dimension: about your mind and thinking clearly, feeling happy and motivated.  Emotional dimension: about your feelings and how you manage them.  Social dimension: about your connections with others and feeling good about your relationships.  Spiritual dimension: This is about your sense purpose and meaning in life. All these dimensions are connected. If you're not feeling well physically, it can affect your mood (emotional). If you're stressed (mental), it might be harder to connect with friends (social). By taking care of all these dimensions, you can create a healthier, happier you! 14  Dimensions of Health Physical Dimension of Health -Implies perfect functioning of organs, at optimum capacity, and in harmony. -Involves the ability to carry out daily tasks and achieve fitness. -A normal person: no evident disease, growth is comparable to peers. Social Dimension of Health Health practices and beliefs are strongly influenced by the person’s:  Economic level, lifestyle, family, and culture Low-income groups are less likely to seek health care to prevent or treat illness; High-income groups are more prone to stress-related habits and illness  Dimensions of Health Mental Dimension of Health Not merely (not only) the absence of mental illness, but also the ability to respond to the various experiences of life with flexibility and a sense of purpose. Mental health is a state of balance or harmony between the individual and others as well as between the individual and the environment Ability to interact successfully with people within the environment, maintaining healthy relations with others, and showing respect and tolerance for those with different opinions and beliefs.  Other Dimensions Spiritual Dimension of Health It includes principles and ethics, the purpose in life, religious beliefs, and values. All are important components of the way the person behaves in health and illness. Vocational Dimension of Health When work is fully adapted to human goals, work often plays a role in promoting both physical and mental health. The importance of this dimension is clear when individuals suddenly lose their jobs or retire. The WHO “World Health Declaration” (1998) was signed by all member countries: Human rights “Health for all”. 1. Improvement of the health and well-being of people is the aim of social and economic development. Good health is fundamental to sustainable economic growth. 2. Enjoyment of the highest attainable standard of health is one of the fundamental rights of EVERY human being. 18  Determinants of Health The determinants of health are the various factors that influence a person's overall well-being and likelihood of experiencing illness or disease. These determinants can be categorized into different groups, including: According to the World Health social and economic Organization: the determinants environment of health include: social and Determinants physical economic environment, the person’s environme behavior of health nt physical environment, and the person’s characteristics on person’s behavior characteristics  A- Social Determinants of Health What are the social determinants of health? “Social determinants of health (SDOH) are “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affects a wide range of health, functioning, and quality-of-life outcomes and risks”. SDOH can be grouped into 5 domains: 20  Social Determinants of Health Socioeconomic Status (SES): Income, education level, occupation, and wealth are key social determinants of health. Lower SES is associated with higher rates of chronic diseases, lower life expectancy, and poorer health outcomes. Social Support Networks: Strong social connections and support systems improve mental health, resilience (flexibility), and overall well-being. Conversely, social isolation and lack of social support can lead to increased stress, depression, and other health issues. 21  Social Determinants of Health Community Safety and Environment: Safe and supportive neighborhoods promote physical activity, access to healthy foods, and social engagement, all contributing to better health outcomes. Conversely, exposure to crime, violence, and environmental hazards can negatively impact health. Access to Healthcare Services: Availability, affordability, and quality of healthcare services are crucial determinants of health. Limited access to healthcare, including preventive services and treatment, can result in unmet healthcare needs, delayed diagnoses, and poor health outcomes. 22  SES: Main Socio-economic status  Education  Occupation  Income  Housing - These Socioeconomic status (SES) are associated with health outcomes, such as Mortality (deaths), Morbidity (diseases), Disability (handicaps), and Well-being (healthy status) People of higher SES have better health than people of lower SES.  Economic Determinants of Health Employment and Working Conditions: Stable employment, safe working conditions, and fair wages contribute to better health outcomes. Unemployment, hazardous work, and job insecurity are associated with higher rates of stress, mental health disorders, and chronic diseases. Income and Wealth Inequality: Income inequality is linked to disparities in health outcomes, with lower-income individuals experiencing higher rates of morbidity and mortality. Economic inequality can limit access to resources such as nutritious food, safe housing, and healthcare services. 24  Economic Determinants of Health Access to Education: Education is a powerful determinant of health, influencing health behaviors, health literacy, and socioeconomic opportunities. Higher levels of education are associated with better health outcomes, including lower rates of chronic diseases and longer life expectancy. Housing and Neighborhood Conditions: Access to safe and affordable housing, as well as neighborhood amenities such as parks, schools, and grocery stores, can impact health. Inadequate housing, overcrowding, and exposure to environmental pollutants contribute to poor health outcomes. 25  SES: Socio-economic status Education Illiterate Occupation Income Elementary Unemployed (per month) Intermediate Laborer < 1000 Secondary Professional 1 000- 4 000 University 5 000-14 000 Postgraduate ≥ 15 000 Housing Hut House Ownership Traditional house Rented Apartment Mortgaged Villa Owned B- Behavioral Determinants of Health -Nutrition/ food, Personal hygiene, Habits& customs, Smoking/passive smoking, Alcohol & substance abuse.  Exercise  Sleep  Violence/ abuse  Recreation  Compliance with medical treatment  Reaction to stress  C- Environmental Determinants of Health 1. Physical environment: Air, Water (quantity and quality), Waste disposal, Housing, Climate, temperature, humidity and rainfall, Air, Geography, Heat, Light, Noise, Vibration, and Radiation.  Air Quality: Exposure to air pollution from traffic, factories, and other sources can worsen respiratory problems, heart disease, and even cancer.  Water Quality: Contaminated water can lead to infectious diseases, diarrhea, and other health problems. Access to clean drinking water is essential for good health.  Waste Management: Improper waste disposal can contaminate water and soil, attract disease-carrying pests, and create air pollution. Safe and sustainable waste management practices are crucial for protecting health. 28  C- Environmental Determinants of Health 1. Physical environment:  Climate Change: Rising temperatures, extreme weather events, and changes in precipitation patterns can lead to heat stress, infectious diseases, respiratory problems, and displacement due to natural disasters.  Built Environment: The design of our communities, including access to green spaces, walkable neighborhoods, safe roads, and quality housing, can influence physical activity levels, mental well-being, and exposure to environmental hazards.  Chemical Safety: Exposure to harmful chemicals in air, water, soil, and consumer products can have various health effects, depending on the specific chemical and level of exposure.  Noise Pollution: Exposure to excessive noise from traffic, construction, and other sources can disrupt sleep, increase stress levels, and contribute to hearing loss. 29  C- Environmental Determinants of Health 2. Biological environment Genetics: Your genes play a major role in determining your susceptibility to certain diseases. For example, a family history of heart disease, cancer, or diabetes increases your risk of developing these conditions. Sex and gender: Biological differences between sexes can lead to variations in health risks and outcomes. Age: As you age, your body's systems become less efficient and more susceptible to disease. Nutrition: Eating a healthy diet is essential for good health. A diet rich in fruits, vegetables, and whole grains can help prevent chronic diseases such as heart disease, stroke, and type 2 diabetes. Hormones: Hormones are chemical messengers that regulate many bodily functions. Imbalances in hormone levels can lead to a variety of health problems, such as menstrual Microbiome: The irregularities, microbiome isinfertility, and thyroid the community disorders of microorganisms that live in your gut. A healthy microbiome is essential for digestion, immune function, and 30  3. Psychosocial environment Habits, Customs, Ethnicity, Cultural values. Ethnicity Identification with a social group on the grounds of: Language, culture, religion, common origin (ancestry), shared history Culture The complex social phenomenon of shared : Knowledge, Beliefs, Goals, Values, Attitudes and Practices Religion/Morals Education/health awareness, Employment, Community life, Housing  3. Psychosocial environment Political organization % GNP (Gross National Product) on health, resource allocation, availability of services, accessibility of services for all people. Health Services related determinants Health education, Mother and child health services, control of communicable diseases, and control of non-communicable diseases (NCDs).  INEQUALITY (unconditional) INEQUITY (conditional) Health inequities between countries Life Expectancy Children have dramatically different life expectancies depending on where they were born: Japan or Sweden: > 80 years; Brazil: 72 years; India: 63 years; African countries: < 50 years; Saudi Arabia: 75 years The infant mortality rate (the risk of a baby dying between birth and one year of age) is: 2 per 1000 live births in Iceland >120 per 1000 live births in Mozambique The risk of maternal death during or shortly after pregnancy is only one in 17400 in Sweden but it is 1 in 8 in Afghanistan. Health inequities between countries Worldwide between rich and poor, men and women, dominant and marginalized ethnic groups all lead to differences in health and longevity. by gender Indian Subcontinent(UN 1987-89): girls: death rate nearly twice that of boys due to family behavior. 1/6 death: neglect and discrimination. Less than boys: immunization and nutritional status.  References: Centers for Disease Control and Prevention (CDC): " https://www.cdc.gov/publichealthgateway/sdoh/index.html" This website provides a comprehensive overview of SDOH, including definitions, examples, and how they impact health outcomes. World Health Organization (WHO): " https://www.who.int/health-topics/social-determinants-of-health " The WHO website offers a global perspective on SDOH, their influence on health inequities, and their importance for achieving health for all. Healthy People 2030: https://health.gov/healthypeople/priority-areas/social-determinant s-health This website by the U.S. Department of Health and Human Services outlines SDOH as a key priority area for improving national health. 35  Further readings  Basic epidemiology / R. Bonita, R. Beaglehole, T. Kjellstrom. 2nd edition. 2006  Epidemiology. Manuals. Beaglehole, Robert. Kjellstrom, Tord. World Health Organization  Epidemiology for Public Health Practice. Robert H Friis, Thomas A. Sellers. 5th Edition 36 37