History of Public Health in the Philippines PDF

HISTORY OF PUBLIC HEALTH IN THE PHILLIPINES AND INTRODUCTION TO COMMUNITY AND PUBLIC HEALTH Lalaine Rose R. Nuñez, RMT, DTA, MPH HISTORY OF PUBLIC HEALTH IN THE PHILIPPINES History of Public health in the Philippines based on socio-political periods 1. Pre-American Occupati...

HISTORY OF PUBLIC HEALTH IN THE PHILLIPINES AND INTRODUCTION TO COMMUNITY AND PUBLIC HEALTH Lalaine Rose R. Nuñez, RMT, DTA, MPH HISTORY OF PUBLIC HEALTH IN THE PHILIPPINES History of Public health in the Philippines based on socio-political periods 1. Pre-American Occupation (up to 1898 ) 2. American Military Government (1898-1907) 3. Philippine assembly (1907-1916) 4. The Jones law (1916-1936) 5. The Commonwealth (1936-1941) 6. Japanese occupation ( 1941-1945) 7. Post World war II (1945-1972) 8. Post EDSA revolution (1986 to present Read and understand the story I. PRE-AMERICAN OCCUPATION - Public health works began at the old Franciscan Convent in Intramuros where Fr. Juan Clemente put up a dispensary in 1577 for treating indigents in Manila. - This eventually became the San Juan de Dios Hospital. During Spanish time: 1. Creation of Board of vaccinators to prevent smallpox 2. Creation of board of health 3. Construction of carried waterworks 4. First medical school in the Philippines- UST 5. School of Midwifery 6. Public health laboratory 7. Forensic medicine Hospitals before the Americans came to Philippines: 1. General hospitals a) San Juan de Dios Hospital b) Chinese General hospital c) Hospicio de san Jose in Cavite d) Casa dela Caridad in Cebu e) Enfermeria de Santa Cruz in Laguna 2. Contagious Hospitals a) San lazaro Hospital b) Hospital de palestina in Camarines Sur c) Hospital delos Lesprosos in Cebu d) Hospital de Argencina in Manila for smallpox and cholera 3. Military hospital a) Hospital Militar de Manila b) Hospital Militar de Zamboanga 4. Naval Hospital a) Hospital dela Marie in Cebu b) Hospital de basilan 5. Other hospital/Asylums a) Hospicio de San Pascual Baylon in Manila b) Asylum of St. Vincent de Paul in Manila for poor girls c) Hospital of San Jose for orphaned children and mentally ill  Projects and activities II. AMERICAN MILITARY a) Established a garbage GOVERNMENT crematory - Control of epidemics b) Approved the first sanitary ordinance and such as cholera, rat control smallpox and plague c) Amoebic dysentery- - Fight against caused by contaminated communicable diseases water and unclean such as leprosy, vegetables, and malaria- diarrhea, malaria, Anopheles minismus flavirostris was pointed beri-beri out as vector. d) Cholera vaccine was first tried e) Confirmed that plague in man comes from infected rat f) Opened a leper colony in Culion g) Founded the manila Medical society and Philippine Island Medical Association h) Opened the UP College of Medicine i) Established Bureau of Science III. PHILIPPINE ASSEMBLY New waterworks in Manila was inaugurated to control cholera Nursing school at Philippine Normal School Hygiene and Physiology were included in curriculum of public elementary school Anti-TB campaign was started Philippine Tuberculosis Society was organized  Pasteur prophylaxis treatment against rabies was offered Opening of the Philippine General Hospital (PGH) Use of anti-typhoid vaccine was initiated Hypochlorite of lime was first used for treating the water supply of Manila Etiology of Amoebic dysentery was made clear Dry vaccine against smallpox was first used IV. JONES LAW YEARS Retrogression rather than progression in so far as the health was concern 1. Increase CDR- death rate per 1000 person 2. Increase IMR-infant death per 1000 3. Increase Morbidity- rate of incidence of disease Increased deaths from smallpox, cholera, typhoid, malaria, beri- beri and TB  Re-organization happened (re- organized the health service and encouraged effective supervision) 1. Study the cause and prevalence of typhoid fever 2. The composition, value and vitamin distribution of many Philippine foods were studied. 3. Schick test was used to determine the causes of diphtheria 4. Campaign against Hookworm was launched 5. Anti-dysentery vaccine was first tried 6. The roles of seafood in transmission of cholera and the pollution of fishing sector to typhoid were studied 7. First training course for sanitary inspector was given 8. Women and Child labor was passed 9. The mechanism of transmission of dengue fever through Aedes aegypti was studied 10. Construction of Novaliches dam 11. Establishment of School of Hygiene and Public Health 12. National Research Council of the Philippines was organized 13. BS in Education major in Health Education was opened in UP 14. Philippine Public Health Association(PPHA) was organized V. THE COMMONWEALTH PERIOD Process of gaining and maintaining altitude (because the later years under Jones Law was successful) The epidemiology of life threatening diseases was studied- diphtheria, yaws, dengue Research in the field of health was promoted UP school of Public health was established to train public health leaders Construction of Quezon institute for PTB patients  Research and Control of TB, Malaria, leprosy and yaws Development of Maternal and Child Health (MCH) 1939, creation of Department of Public Health and Welfare- Dr. Jose fabella as the first secretary 1940, Bureau of Census and Statistics was created to gather vital statistics Inequitable distribution of health services remained a problem 80% of those who died were never given medical attention. VI. JAPANESE OCCUPATION During this time, All public health activities were practically paralyzed THE WORLD WAR II After 5 years of Japanese occupation, public health tried to pick up the debris and rise from the ruins Survey: Increased incidence of TB, VD, malaria, leprosy and malnutrition. General sanitation has been reduced to level enough to constitute a national hazard US congress passed an emergency measures to control diseases: TB, VD, malaria. Leprosy, malnutrition Immunization program VII. POST WORLD WAR II - The Philippine Independence 1. Completion for a research on Dichlorodiphenyl trichlorothanel (DDT) saw dust as larvicide and DDT residual spraying of houses in the control of malaria. 2. Construction of the National Chest Center- for control case registry for TB, mass immunization with BCG 3. Industrial hygiene laboratory 4. Introduction of one- infection method for gonorrhea with penicillin 5. Creation of central Health laboratory in the Philippines 6. Creation of Institute of Nutrition under BRL, then it was transferred to National Institute of Science and Technology and was renamed as Food and Nutrition Research Center, it was again renamed as FNRI Manila was selected as Headquarters for the WHO Western pacific Office. Strengthening Health and Dental services in rural areas This is thru RHU program (per municipalities with 5,000-10,000 population) 1 Municipal Health Officer (MHO) 1 Public health Nurse (PHN) 1 Midwife 1 sanitary Inspector  Reorganization of DOH- creation of several offices 1. Dental health services 2. Malaria Education services 3. Disease Intelligence Center 4. Food and Drug Administration 5. National Schistosomiasis Control Commission 6. National Nutrition Program  Initiation of programs with multilateral assistance 1. WHO and UNICEF assisted TB and BCG programs 2. TB control program as basic service of RHU 3. TB sputum case finding by microscopy 4. Serum and vaccine production in Alabang 5. Expanded MCH and Mental Health Program 6. Training programs for Midwives 7. Strengthened graduate health programs at the UP-CPH  Development of family Planning Movement Launching of programs in cooperation with private sectors- top provide services to periphery ( indigents, minority groups) Rizal Development project 1. Restructuring of the DOH Rural Health Care Delivery System 2. Each barrio was provided with midwife 3. For, the first time, dengue virus was isolated from typical H fever cases VIII. MARTIAL LAW YEARS Creation of National Economic Development Authority (NEDA) Department of health was renamed as Ministry of Health (MOH) Accomplishment during this period: 1. Formulation of National Health Plan 2. Implementation of restructure Health care delivery system (primary, secondary, tertiary) 3. Construction of tertiary hospitals (Philippine heart center, Lung center, Kidney center,Lunsod ng kabataan) 4. Adaptation of the Primary Health Care 5. Promotive and preventive rather than curative care 6. Philippines was the first country to implement PHC 7. Launching of Operation Timbang and Mothercraft 8. Nationwide program providing supplementary food for infants and preschool children 9. Birth of integrated Provincial Health Office (IPHO) 10. Oral rehydration Therapy for the National Control of Diarrheal Diseases 11. Community-based health programs 12. Progress in Public Health research a. Nutrition council of the Philippines- to address problems on malnutrition b. RITM- for infectious and tropical diseases c. PCHRD- mandated to lead, direct and coordinate science and technology activities in health and nutrition. IX. EDSA REVOLUTION From Ministry of Health it was renamed again as Department of Health Increase in life expectancy slowed down Morbidity and Mortality rates from preventable causes stabilized at high rates Declined in infant and child mortality decelerated Increased incidence of malnutrition Declined practice of family planning X. AQUINO ADMINISTRATION 1987 constitution – more provision on health making comprehensive health care available Active participation of private sector and NGO Major activities influencing public health during this period 1. Milk code- EO51- required the marketing of breast milk substitute 2. Universal child and mother immunization 3. International safe and motherhood initiative was launched to reduced maternal mortality rate. 4. Act prohibiting discrimination against women (RA6725) 5. National Epidemic Surveillance System (NESS)- this was made to track down the occurrence of 14 diseases with potential causing outbreaks. 6. National drug policy and Generic Act- ensure the availability of safe, effective and affordable quality drugs (RA6675) 7. Local government code- from national government to governors and mayors (RA7160) 8. Organ Donation Act of 1991 (RA7170)- Legalizing donation of all or body parts after death for specified purpose.  XI. RAMOS ADMINISTRATION “Health in the Hands of People” and “Lets DOH it”- by the Sec. Juan Flavier Continue to adopt PHC as a strategy Memorable initiative during the leadership of Flavier: 1. National Immunization Day – BCG, DPT, OPV, MMR 2. Mother and Friendly Hospital Initiative 3. This strategy ensures the survival and health of children through breast feeding 4. Promotion of Philipine Traditional medicine- DOH and DOST 5. Hospital as Center of Wellness- transformed 45 government hospitals from disease places to centers of wellness 6. Yosi Kadiri- Anti smoking campaign 7. Araw ng Sangkap pinoy- aimed to prevent vitamin A, iron and iodine deficiency 8. Voluntary Blood Donation Program 9. Kung Sila’y Mahal mo Magplano- Family planning program 10. Doctors to the Barrio LAWS: 1. RA 7394- Consumer Act of the Philippines- an act providing penalties for manufacture, distribution and sales of adulterated foods, drugs and cosmetics 2. RA 7610- Special protection of Children against child abuse, exploitation and discrimination act 3. EO 39- which created the Philippines National AIDS Council as a national policy and advisory body in the prevention and control of HIV-AIDS 4. RA 7432 - Senior Citizen’s Act - which grant benefits and special privileges in order to maximize the contributions of senior citizen to nation building 5. RA 7719 - The National Blood services Act of 1994 which was passed to promote voluntary blood donation 6. RA 8172 - An Act of Salt Iodization Nationwide- providing salt iodization nationwide approved in 1996 and renamed FIDEL _fortified for Iodine Elimination) Reodica’s Seven Strategy Program 1. Expanded Program on Immunization (Oplan Alis Disease)- to eliminate polio, measles and neonatal tetanus 2. Nutrition- vitamin A, iron and iodine utilization (Araw ng Sangkap pinoy) 3. Family Planning 4. Tuberculosis prevention (Target, Stop TB) 5. Environmental sanitation (TKO) 6. STD-AIDS awareness prevention 7. Healthy Lifestyle program INTRODUCTION TO COMMUNITY AND PUBLIC HEALTH  Ecological (environmental) in perspective(VIEWPOINT), multi-sectoral (division) in scope and collaborative(2 WAY) in strategy PUBLIC It aims to improve the health HEALTH of community through an organized community effort The 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.  THE 3 CORE FUNCTIONS OF PUBLIC HEALTH 1 2 3 Assessment Policy Assurance Development  1 2 3 4 5 Monitor health Diagnose and Inform, educate, Mobilize Develop policies status to investigate and empower community and plans that identify health problems people about partnerships to support community health and health health issues identify and individual and problems hazards in the solve health community health community problems efforts The Ten Essential Public health Services  6 8 10 7 9 Enforce laws and Assure a Research for new regulations that Link people to competent public Evaluate insights and protect health needed personal health and effectiveness, innovative and ensure health services personal accessibility, solutions to safety and assure the healthcare and quality of health problems provision of workforce personal and health care when population based otherwise healthcare unavailable service The Ten Essential Public health Services  It is concerned with threats to the overall health of a community based on population health analysis. Public health is typically divided into 3 fields: BIOSTATISTICS EPIDEMIOLOGY HEALTH SERVICES CHARACTERISTICS OF PUBLIC HEALTH 1. It deals with 2. It deals with preventive rather population level- than curative rather than aspects of individual-level health. health issues. What is community? It is a group of people with common characteristics or interests living together within a territory or geographical (physical) boundary.  What is community? It is a group of people with common characteristics or interests living together within a territory or geographical (physical) boundary. Community as Client World Views on Community : 1. Family, community and society 2. Contradictions / Conflicts 3. Change  A. Individual a. Patient- an individual who is sick. b. Client- an individual who is well/not sick. B. Family A. Role/Relationship- Parents; Bi- 1. Family, parenting Community and *Mother is expected to have the ABILITY to provide care and usually Society takes the role of keeping the family well and healthy by combining: 1. Knowledge 2. Attitudes 3. Skills C. Community - CHN serves up to this level only. - Everything that affects the individual affects the family and eventually the community. 2.Contradictions / Conflicts - People in the community are always in constant conflict and faced with contradictions: 1. Individual: intrapersonal conflicts (conflict within the person/personal conflicts) 2. Family: interfamilial conflicts (conflict within the family/interpersonal conflicts) 3. Community: intercommunity (interfamilial conflicts) 4. Society: intra-societal conflicts (intercommunity conflicts) 3. Change -is inevitable because a community is a dynamic and is always changing * A CH worker should constantly assess the community to come up with suitable interventions. Community as Setting in CH Practice - Place where people under usual or normal conditions are found 1. Home- you render Family Health Nursing 2. Workplace- you render Occupational Health Nursing 3. Schools- you render School Health Nursing *Outside of purely curative institutions such as hospitals. *Are usually centers for wellness where you do health promotion and disease prevention. Health-Illness Continuum Models: A. Dunn’s High-Level Wellness Grid B. Travis’ Illness- Wellness Continuum A. Dunn’s High-Level Wellness Grid: - describes a health grid in which a health axis and an environmental axis intersect. - the grid demonstrates the interaction of the environment with the illness-wellness continuum. - The axis extends from peak wellness to death, and the environment axis extends from very favorable to very unfavorable. - The intersection of the two axes forms four quadrants of health and wellness. 1. High-level wellness in a favorable environment : - Ex is a person who implements healthy lifestyle behaviors and has the bio psychosocial, spiritual , and economic resources to support his lifestyle. 2. Emergent high-level wellness in an unfavorable environment : - Ex is a woman who has the knowledge to implement healthy lifestyle practices but does not implement adequate self-care practices because of family responsibilities, job demands, or other factors. 3. Protected poor health in a favorable environment : - Ex is an ill person whose needs are met by the health care system and who has access to appropriate medications, diet, and health care instruction. 4. Poor health in an unfavorable environment: - Ex is a young child who is starving in a drought-stricken country. B. Travis’ Illness-Wellness Continuum: - Ranges from high-level wellness to premature death. - It demonstrates two arrows pointing in opposite directions and joined at a neutral point. - Movement to the right of the neutral point indicates increasing levels of health and well-being for an individual achieved in three steps : 1. Awareness 2. Growth 3. Education -In contrast, movement to the left of the neutral point indicates progressively decreasing levels of health and premature death. Variables influencing health status, beliefs and practices : 1. Internal variables - include those which are usually non-modifiable such as: a. Biologic dimension - genetic makeup, sex, age, and developmental level all significant to a person’s health. b. Psychological dimension - emotional factors which include mind-body interactions and self-concept. c. Cognitive dimension - intellectual factors which include lifestyle choices and spiritual and religious beliefs. 2. External variables- the macrosystem which include: a. Environment - geographical locations determine climate, and climate affects health; environmental hazards. b. Economics - standards of living reflecting occupation, income and education is related to health, morbidity and mortality. c. Family and cultural beliefs: - the family passes on life patterns of daily living and lifestyles to offsprings (e.g. physical/emotional abuse or climate of open communication). - Culture and social interactions also influence how a person perceives, experiences, and copes with health and illness. d. Social support networks: - political/systems of governance; religion/church; mass media. 3. Agent-Host-Environment Model: also called the ecologic model by Leavell and Clark refers to the interplay of agent(causative/etiologic factor), host (possessing intrinsic factors), and the environment (extrinsic factors)  A. Etiologic Factors 1. Biological agents - virus, fungi, bacteria, helminthes, protozoa, ectoparasites 2. Chemical elements: a. Carcinogens: - e.g. those contained in Pringles, Toblerone b. GMO:contained in Nesvita c. Poisons: MSG d. Allergens e. Transfats 3. Nutritive elements : - excesses and or deficiencies e.g. marasmus & kwashiorkor 4. Mechanical factors : - accidents 5. Physical : - as when one is struck (strike) by lightning 6. Psychological : - such as stress B. Host: -Intrinsic factors include: 1. Exposure 2. Response (reaction) C. Environment: -Extrinsic factors includes: 1. Natural boundaries 2. Biological environment 3. Socio-economic (political boundary) 3. Health Belief Model: - refers to the relationship between a person’s belief and his behavior in health. - It pertains to three components of an individual’s perception 1. Susceptibility to an illness 2. Seriousness of an illness 3. Benefits of taking the action Example: In one HIV infection study  4. Evolutionary-based Model: - states that illness and death sometimes serve an evolutionary function. Elements considered in the theory are: 1. Life events - developmental variables and variables associated with changes such as accidents/relocation. 2. Lifestyle determinants 3. Evolutionary viability within the social context: - reflects the extent to which an individual functions to promote survival and well-being. 5. Control perceptions: - the extent to which a person can influence circumstances in life. 6. Viability emotions: - affective reactions developed for life events or lifestyle determinants. 7. Health outcomes: - physiological, behavioral and psychological status resulting from the interplay of those elements. 8. Health Promotion Model - directed at increasing client’s well-being. WHO definition (1978): - a state of complete physical, mental, and social well- being, not merely the absence of disease or infirmity (sickness). - Health is a social phenomenon. - It is an outcome of multi- causal theories of health and disease. - It is an outcome or by-product of the interplay of societal factors: a. Ecological 1. Biological 2. Physical b. Economic c. Political d. Socio-culture What is Community Health? - A part of paramedical and medical intervention or approach which is concerned with the health of the whole population. Its aims are : 1. Health promotion 2. Prevention of disease 3. Management of factors affecting health Major concepts of Public health: 1. Health promotion and disease prevention 2. People’s participation towards self-reliance : active and full involvement with people in the decision-making process: Assessment, planning, implementation, monitoring and evaluation. Public Health (definitions) Dr C E Winslow - The science and art of preventing disease, prolonging life, promoting health and efficiency through organized community effort to ensure everyone a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to realize his birthright of health and longevity(long life). Hanlon - It is dedicated to the common attainment of the highest level of physical, mental and social well- being and longevity consistent with available knowledge and resources at a given time and place. - It holds this goal as its contribution to the most effective total development and life on the individual and this society. (Holistic) Purdom - It prioritizes the survival of human species, the prevention of conditions which lead to the destruction or retardation of human function and potential in early years of life, the achievement of human potential and prevention of the loss of productivity of young adults and those in the middle period of life and the improvement of the quality of life especially in later years. Nightingale - The act of utilizing the environment of the patient to assist him in his recovery. - Any individual is capable of reparative process. THANK YOU FOR LISTENING