Public Health Notes PDF

Introduction to Public Marsha Ivey MSc (Stat) MSc(PH) Health Public Health and Primary Care 1 Public Health Definitions and Key Terms Background/History to Public Health Essential Public Health...

Introduction to Public Marsha Ivey MSc (Stat) MSc(PH) Health Public Health and Primary Care 1 Public Health Definitions and Key Terms Background/History to Public Health Essential Public Health Functions Topics to be covered The Public Health Approach Stakeholder Roles in Public Health Public Health Priorities an Issues in Caribbean 2 1  Learning Objectives describe the purpose of public health define key terms used in public health identify prominent events in the history of public health identify prominent public health priorities and issues in the Caribbean region state the essential public health functions recognise the core public health functions and services describe different stakeholders in the field of public health 3 Explanations for disease were based not on science, but on religion, superstition, and myth. Zeus crammed all the diseases, sorrows, vices, and crimes that Pandora’s Box afflict humanity into a box and gave it to Epimetheus, the husband of Pandora. Pandora opened the box, and all of the ills of the world flew out and spread throughout the human world. 4 2  What is Health “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” From the Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; entered into force on 7 April 1948. Definition not amended since 1948. 5 What is Public Health “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.” —CEA Winslow Winslow CEA. The untilled field of public health. Mod Med 1920;2:183–91. 6 3  “Public health is the art and science of promoting and protecting good health, preventing disease, disability, and premature death, restoring health when it is impaired, and maximizing the quality of life when health cannot be restored”. -John M Last 7 “The art and science of preventing disease, prolonging life and promoting health through the organized efforts of society” -(Acheson, 1988; WHO) 8 4  Public Health Mission & Aim Mission: Aim: Focus: groups protect, preserve and provide maximum of people, not promote the health of benefit for largest just an the public number of people individual. 9 Key Public Health Terms Clinical Care: prevention, treatment, and management of illness and the preservation of mental and physical well-being through the services offered by medical and allied health professions; also known as health care. Health Outcome: result of a medical condition that directly affects the length or quality of a person’s life. Intervention: action or ministration that produces an effect or is intended to alter the course of a pathologic process. Determinant: factor that contributes to the generation of a trait. Stedman TL, ed. Stedman’s medical dictionary. 28th ed. Baltimore, MD: Lippincott, Williams, and Wilkins; 2006. Farlex, Inc. The free dictionary. Huntingdon Valley, PA: Farlex, Inc.; 2014. Available at: http://www.thefreedictionary.com/. 10 5  Epidemic or outbreak: occurrence in a community or region of cases of an illness, specific health-related behavior, or other health-related event clearly in excess of normal expectancy. Key Terms cont’d Both terms are used interchangeably;??however, epidemic usually refers to a larger geographic distribution of illness or health-related events. Pandemic: denoting a disease affecting or attacking the population of an extensive region, country, or continent. ?? Population health: approach to health that aims to improve the health of an entire population. Prevention: action so as to avoid, forestall, or circumvent a happening, conclusion, or phenomenon (e.g., disease) Stedman TL, ed. Stedman’s medical dictionary. 28th ed. Baltimore, MD: Lippincott, Williams, and Wilkins; 2006. Farlex, Inc. The free dictionary. Huntingdon Valley, PA: Farlex, Inc.; 2014. Available at: http://www.thefreedictionary.com/. 11 Background to Public Health 14 6  The Evolving Need for Public Health 1700s-1800s Agricultural Revolution and The Age of Industrialization People moved from the farms to the cities Small pox inoculations - Lady Mary Wortley Montagu (British) Involved serious risks; introduced variolation to Britain; using smallpox virus in pus from blister in mild case and introducing to scratched skin of previously uninfected person; to promote immunity (1717 – 1721) Development of the smallpox vaccine - Edward Jenner (British) Worlds first vaccine; circa 1776; protective effect of cowpox Introduction of epidemiology – John Snow (British) 15 The Evolving Need for Public Health 1700s-1800s The Germ Theory of Disease - Louis Pasteur (French) Discovered principles for vaccination, microbial fermentation and pasteurization; causation an prevention of diseases renowned; The four postulates of infectious disease – Robert Koch (German) Founder of modern bacteriology; identified causative agents of TB, cholera and anthrax; support to concept of infectious diseases The unhealthy conditions of New York City tenements – Lillian Wald (American) Considered founder of American community nursing, founder of Henry Street Settlement NYC, advocate for nurses in public schools 16 7  Development of Public Health Sanitary Movement Origins of modern public health started in 1800’s with the sanitary movement Balance between the role of the individual and state protection Concept of contagion Control of disease and promotion of health through sanitation to ensure a healthy environment The Sanitary Movement - A John Snow Epilogue https://www.youtube.com/watch?v=cba7di0eL8I 17 18 8 19 Pandemics 20 9  Pandemics POLIO HIV COVID-19 Vaccine introduced 38.4 million living with 609M people in 1955; eradication HIV worldwide; 20% affected, 6.52M initiative launched in decline in new deaths; ongoing 1988, over 99% infections since 2001 threat since 2019 350K to 175 in2019 21 Disaster Preparedness and Response 22 10  Disaster Preparedness and Response Hurricane Biologic Gilbert(1988 C5)/Harvey (2017 C4) Warfare Irma(2017 C5)/Ida(2021 C4) Plague used as a Emergency services, weapon of war during public health the Siege of Kaffa surveillance, and disease treatment provided 23 Public Health is many things A System A Profession A Method Government Service The Health of the Public 25 11  Partners in the Public Health System 26 Structure of the Health Services Delivery System in Trinidad and Tobago Source: Ministry of Health Strategic Plan 2012-2016 27 12  Regional Health Authorities sub-divisions and Health Facilities, Trinidad and Tobago 28 Network of 105 health centres; 9 district health facilities (DHF); 10 hospitals All RHAs at least one DHF and a referral hospital Approximately two-thirds HC located in the western half of the island which is more densely populated Delivery of services decentralised to the RHAs MOH manages several vertical services and national programs: E.g. Insect Vector Control, National Blood Transfusion Service, and National Oncology Programmes Private sector health care uses a fee for service model, often expensive and beyond the capacity of most low-income earners. 29 13  Partners in Public Health Vehicle for public discourse Media Health education and promotion Health communication Social media as catalyst Employers/ Employer-sponsored health insurance programs Businesses Wellness initiatives and benefits Healthy workplaces and communities Government/ City planning Agencies Education Health in all policies Education Academia Training Research Public Service 30 Regional and International Partners Caribbean CARICOM Caribbean Public Caribbean Tourism PAHO/WHO and Development Secretariat Health Agency Organization (CTO) other UN Agencies, Bank, President's Food and International Emergency Plan for Agriculture World Bank, American European Union AIDS Relief Organisation (FAO) Development Bank (PEPFAR) Department for Centers for Disease International Public Health Control and Development Canada Prevention (DIFID) 31 14  Regional and International Partners Guided by the Government ~ signatory to several international and sub-regional health related conventions and agreements The UN Sustainable International Convention Framework Convention on Convention on the Rights Development Goals (SDG) on the Protection of the Tobacco Control; of the Child; (formerly MDGs); Rights of All Migrant; UN Declaration on NCDs Caribbean Cooperation in Port of Spain Declaration Health Agenda for the (2011); Health on Chronic NCDs (2007); Americas 2008-2017; Pan Caribbean Partnership Nassau Declaration; and against HIV/AIDS (PANCAP). 32 Approach to Public Health Public Health Medical Model Model Versus 33 15  Approach to Public Health Problems Problem RESPONSE Risk Factor Intervention Surveillance Implementation Identification Evaluation Source: CDC 35 11 Essential Public Health Functions Source: PAHO/WHO – EPHF Strategy to Strengthen Performance. 36 16  Three Core Functions of Public Health Systematically collect, analyze, Assessment and make available information on healthy communities Promote the use of a scientific Policy knowledge base in policy and Development decision making Ensure provision of services to Assurance those in need Institute of Medicine. The future of public health. Washington, DC: National Academies Press; 1988. 37 THE ESSENTIAL PUBLIC HEALTH FUNCTIONS IN THE AMERICAS 38 17  Public health in the 21st century 43 Administrators Biostatisticians Behavioral science/health education. Dieticians Biostatistics. Environmental health Environmental health. specialists Epidemiology. Epidemiologists Health services administration. Health care providers Health communication specialists Health educators Health law experts Labratorians Occupational health specialists Public health nurses Researchers Sanitarians Social scientists Toxicologists Others 44 18  Ten Great Public Health Achievements Worldwide, 2001--2010 Reductions in Child Vaccine-Preventable Access to Safe Water Malaria Prevention Mortality Diseases and Sanitation and Control Prevention and Control of Neglected Tuberculosis Control Tobacco Control Control of HIV/AIDS Tropical Diseases Increased Awareness Improved and Response for Preparedness and Improving Global Response to Global Road Safety Health Threats Source: MMWR 2011 https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6024a4.htm 45 Caribbean Public Health Achievements First in the Americas to eliminate poliomyelitis 1982: last case of poliomyelitis in the Caribbean Community Eradication strategies sustained - effective and timely AFP surveillance; maintaining vaccination coverage >95% 46 19  First to eliminate indigenous measles and rubella last reported case of indigenous measles – 1991; last imported case (tourist)- 1998; measles had been considered eliminated from the Americas since 2002 A country is considered disease-free if there have been no new cases for three years 2014 Disney outbreak – increased vigilance Caribbean region remains at high risk due to international travel related to tourism 47 NCD Declarations NCD edpidemic; problem worst in Americas – principally cardiovascular disease including heart disease, stroke, hypertension, diabetes, cancer and asthma First region in the world heads of government (CARICOM) met, discuss and make policy decisions to prevent and control chronic NCDs (2007) Declaration of Port-of-Spain - “Uniting to Stop The Epidemic of Chronic Non- Communicable Diseases”; 15 target items Initiated the UN General Assembly High-Level Meeting on NCDs in 2011 49 20  Caribbean Cooperation in Health IV (CCH IV) Mission To build the capacity of countries to improve the conditions for health for all, especially among vulnerable groups, and to develop and maintain cost-effective and efficient health systems Source: http://carpha.org/downloads/CCH-IV-Version7.pdf (pg 17) Source: http://carpha.org/downloads/CCH-IV-Version7.pdf (pg 17) 50 Epidemiologic transition and chronic non- communicable diseases (NCDs): CARICOM states have decreased infant mortality, Some Caribbean PH declining birth rates, increased life expectancy; Issues/Challenges thus increased burden of disease resulting from chronic and NCDs such as hypertension, diabetes, cancer, and obesity To be revisited due to COVID-19 51 21  Population structure, by age and sex, Trinidad and Tobago, 1990 and 2015 90+ 90+ 85-89 85-89 80-84 80-84 75-79 75-79 70-74 70-74 65-69 65-69 60-64 60-64 55-59 55-59 50-54 50-54 45-49 45-49 40-44 40-44 35-39 35-39 30-34 30-34 25-29 25-29 20-24 20-24 15-19 15-19 10-14 10-14 5-9 5-9 0-4 0-4 14 12 10 8 6 4 2 0 0 2 4 6 8 10 12 14 0 2 4 6 8 10 10 8 6 4 2 0 Percentage Percentage Men Women Men Women Source: Pan American Health Organization, based on the United Nations Department of Economic and Social Affairs, Population Division. Revision 2015, New York, 2015 52 Some Caribbean PH Issues/Challenges cont’d Training and distribution of human resources in health: Few countries in the region meet international indicators, such as number of doctors/nurses per 10,000 inhabitants, or hospital beds available per 1,000 inhabitants. Financing health systems: Changes in patterns of disease and increased longevity increase the cost of health care. 53 22  COVID-19 Infectious disease caused by newly discovered coronavirus – SARS-CoV-2. Impact on mental health, economic, education; inequities New normal Rapid research development; Access to COVID-19 Tools (ACT) Accelerator 54 POS Declaration on NCDs Progress made was variable; need to address issues such as the banning smoking in public places; trade related measures; banning advertisement of potentially harmful foods which specifically target children; elevating taxes on foods high in sugar, salt and trans-fats 55 23  Purpose of Public Health Prevent epidemics and control spread of disease Prevent injuries Promote and encourage healthy behaviors Protect against environmental hazards Respond to disasters and assist communities in recovery Assure the quality and accessibility of services 56 64 24  65 65 Summary Public Health Definitions and Key Terms Background to Public Health Public Health issues in Caribbean The Public Health Approach Core Functions and Essential Services of Public Health Stakeholder Roles in Public Health Determining and Influencing the Public’s Health 66 25  Resources Reference Texts Last John M. Public Health and Human Ecology. McGraw-Hill Professional, 1998 2nd Edition. R. Bonita, R. Beaglehole, T. Kjellström. Basic Epidemiology. 2nd edition. Geneva: World Health Organization; 2006. (pdf available online) Additional Resource Beaglehole R and Bonita R. Public Health at the Crossroads: Achievements and Prospects, Cambridge University Press, 2004. Pomerleau J and McKee M. Issues in Public Health, London, October 2016. Readings PAHO (2012). A century of public health in the Americas. Health in the Americas. Caribbean Cooperation in Health Phase IV (CCH IV) Theodore K and Edwards-Wescott P (2011). An assessment of Primary Care in the Caribbean Pre and Post Alma Ata Declaration and A way Forward. IJHSS Vol1 No 8. MMWR (pg814)- 10 great PH Achievements globally https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6024a4.htm 67 26  http://www.youtube.com ‘One Health’- the importance of working together /watch?v=sbFz166hoc0 What I’m going to talk about today? What is One Health? Why should we practice One Health? Why is One Health so relevant to today’s health challenges? Why ‘One Health’ in the Caribbean? What are we doing to promote One Health in the Caribbean?  “Finding solutions to difficult, cross-sectoral problems affecting human, animal, agricultural and environmental health through a transdisciplinary, collaborative approach” The International Health organisations are united behind a ‘One Health’ approach The time is right One Health is an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals and ecosystems. It recognizes the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and inter-dependent. The approach mobilizes multiple sectors, disciplines and communities at varying levels of society to work together to foster well-being and tackle threats to health and ecosystems, while addressing the collective need for clean water, energy and air, safe and nutritious food, taking action on climate change, and contributing to sustainable development.  One Health - Recognising the connections among the health of people, the environment and animals / agriculture One Health – the importance of working across disciplines and across sectors Who needs to be around the table to solve the problem ?  Who needs to be around that table? Human Input Policy Input Animal Input Doctors / Dentists / Pharmacists / Governments, NGOs Vets, animal technicians, Nurses, Communities, Teachers, International organisations, farmers, wildlife experts, General Public funding bodies livestock industries Academic Input Action plan to address the issue Pharmaceutical / Private Understanding, Research Sector Input Entomology / Epidemiology Vaccine / Drug Development Education, Communication Environmental Input Social Input Economic Input Environmental Determinants of Health Social Determinants of Health Economic Determinants of Health Impact of climate / land use change Develop a social case for Develop the economic case for sustainable investment sustainable investment There is an urgency to act now, now, now Why should we practice ‘One Health’ globally? What percentage of animal pathogens are zoonotic? Why should we practice ‘One Health’ globally? What percentage of recently emerging infectious diseases that affect humans are of animal origin?  “One Health” Humans, Animals and the Environment Most human pathogens have come through animals Animals often maintain pathogens in the environment – wildlife Animals are involved in the spread of the pathogens to humans Environmental factors are linked to the spread of many pathogens Need to follow a multidisciplinary “One Health” approach In the future – you guys need to work together to save the world! Think “One Health” in your work  Why ‘One Health’ in the Caribbean? Similar issues to address across the region Small Island states Lack of expertise – need to share Lack of money – need to share Shared culture and history One Health: Humans, animals and the environment Climate change, globalization, urbanization  A “One Health” approach to antimicrobial resistance (AMR) https://www.youtube.com/watch?v=xZbcwi7SfZE&vl=en  Antimicrobial resistance poses a fundamental threat to human health, development, and security. The commitments made today must now be translated into swift, effective, lifesaving actions across the Human, Animal, and Environmental health sectors. “We are running out of time” Dr Margaret Chan, Director-General of WHO 21st September 2016 AMR is a problem not just in our Hospitals, but on our Farms and in our Food, too. Agriculture must shoulder its share of responsibility, both by using antimicrobials more responsibly and by cutting down on the need to use them, through good farm hygiene. Dr José Graziano da Silva, Director-General of FAO. Sept 21st 2016 Common and life-threatening infections like pneumonia, gonorrhoea, and post-operative infections, as well as HIV, tuberculosis, and malaria are increasingly becoming untreatable because of AMR. Left unchecked, AMR is predicted to have significant Social, Health Security, and Economic repercussions that will seriously undermine the development of countries. The high levels of AMR already seen in the world today are the result of overuse and misuse of antibiotics and other antimicrobials in Humans, Animals (including Farmed Fish), and Crops, as well as the spread of residues of these medicines in Soil, Crops, and Water. Resistance to antibiotics is considered the greatest and most urgent global risk requiring international and national attention.  Who needs to be around that table? Human Input Policy Input Animal Input Doctors / Dentists / Pharmacists / Governments, NGOs Vets, animal technicians, Nurses, Communities, Teachers, International organisations, farmers, wildlife experts, General Public funding bodies livestock industries Antimicrobial Resistance Academic Input Pharmaceutical / Private Understanding, Research Sector Input Education, Communication Vaccine / Drug Development Environmental Input Social Input Economic Input Environmental Determinants of Health Social Determinants of Health Economic Determinants of Health Impact of climate / land use change Develop a social case for Develop the economic case for sustainable investment sustainable investment  “Our BIG Challenge” To promote and entrench a “One Health” approach to help solve some of the major health issues facing the Caribbean. “Changing the way people think about health issues” Top down Bottom up approach approach One Health Community engagement What do we need to do to change / action things? We have Identified an important gap – the need to empower professionals to become agents of change Need to build networks of Caribbean professionals who can support each other as change agents Enabling and empowering professionals from multiple sectors and countries across the Caribbean to lead and implement change in One Health and Climate Change and Health  Building networks of Caribbean Professionals to effect change: One Health Leadership Series: Climate Change and Health Leadership 30 One Health Leaders Fellowship Program: 12 Caribbean countries Climate Change and Health Leaders 16 Caribbean Countries https://sta.uwi.edu/fms/cch/ https://www.youtube.com/watch?v=0mL29J_J_bk  Video: https://www.youtube.com/wat ch?v=0mL29J_J_bk  Thanks for Listening! Application for 4th cohort of Climate Change and Health fellowship will OPEN in November 2023 Application information can be found at: https://sta.uwi.edu/fms/cch/ Please feel free to contact us for any more information: Stacey Adams - [email protected] Chris Oura - [email protected] One Health Book Link: https://collaboratif.cirad.fr/share/s/84vh- nPvSJWzrjnptvjF6Q Determinants of Pubic Health and Primary Care Unit Health  the determinants of health – Describe biological and behavioural Expected Discuss age, gender, heredity and ethnicity as major determinants Outcomes of health between the biological model Differentiate and the public health model of disease “Health is a multi- PHYSICAL MENTAL dimensional concept that transcends the mere absence of SOCIAL illness” In general, Public Health... Promotes and encourages healthy behaviors Prevents epidemics and the spread of disease Protects against environmental hazards Prevents injuries and violence Responds to disasters and assists communities in recoveries Assures the quality and accessibility of health services Public Health Approach Public Health Model Medical Model – Population – Individual – Disease Prevention – Diagnosis – Health Promotion – Treatment – Interventions vs. – Intervention Environment Medical care Human behavior – Private (Some public) – Government (Some private)  In the public health model of disease Public Health prevention, Model preventative interventions are described as either primary, secondary, or tertiary  Provide Tertiary interventions for those affected Secondary Programs targeted at families in need; alleviates identified problems and prevent escalation Universal Primary Programs targeted at entire population; provide support and education before problems occur Public Health Pyramid Public Health Model cont’d Incorporates traditional area diagnosis, treatment, and etiology; BUT Looks at epidemiologic surveillance of the health of the population at large, health promotion disease prevention and access to services  Approach to Public Health Problems Problem RESPONSE Risk Factor Intervention Surveillance Implementation Identification Evaluation Source: CDC Public Health Model cont’d Addresses health or social problems in a comprehensive way Considers human factors, characteristics of the source of harm, the environment, identifies causes suggests possible interventions. Takes a population approach to promote health and disease prevention. What determines how healthy someone is? Determinants of Health  Determinants of health – refer to factors that can positively or negatively affect ones health (Dimensions of health refer to parts of ones overall health)  Determinants of Health Definition “The range of behavioural, biological, socio-economic and environmental factors that influence the health status of individuals or populations.” – Adapted from the World Health Organization 1998. Health promotion glossary. Geneva: WHO, p. 6 4 types  Determinants of Health Conditions in the social, physical and economic environment in which people are born, live, work and age, including the access to the health care.  Determinants of Health Components Socio-economic General Political & Cultural Environmental Conditions Living and Housing Education Working Health Care Services Water and Sanitation Conditions Work / Unemployment Agricultural And Food Social Family Support Community Network Participation with Governmental Processes Individual & Age, Genetics, Life Style Sex Factors Behavioural Factors  Number of factors cause variations/differences in health status environmental, biomedical, lifestyle and behaviour, knowledge, attitudes and beliefs and Risk genetic contribution. vs They can act as Risk and/or Protective Protective Factors E.g. physical activity can have a positive impact Factors on health (protective factor) E.g. tobacco smoking can have a negative impact on health (risk factor)  Other determinants cannot be altered - like genetic contribution and sex Individual (one) factors has potential to influence health BUT A number of factors usually combine to determine health status. A wide variety of health differences between different population groups e.g city dwellers, rural and remote Biological& Lifestyle Determinants of Health Novick, LF. Used with permission.  Biological Determinants The Biological & Behaviourial Single Determinants Gene Biologic or host factors include: Blood Pressure Age genetics body structure Behaviours FUNCTIONING body functioning (responses BODY to health probs) Body Fitness Weight Behaviourial Factors behaviors that determine the susceptibility of the individual to Height disease other factors related to susceptibility  “inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain illnesses. Personal behaviour and coping skills – balanced eating, keeping active, smoking, drinking, and how we deal with life’s stresses and challenges all affect health.”- -WHO  Genetics determines gender, body type, hormone production and predisposition to disease Gender is a significant factor affecting health Men and women suffer different types of diseases at different ages Genetic Factors Disease mortality can differ by gender Females: longer life expectancy, report more illnesses, higher depression levels Males: report less illnesses, experience more violence, commit suicide in higher numbers BUT difference may also be due how they are socialised, economic impact, cultural and social factors limits or enhances male and female lives and health  - How likely a person is to develop a particular condition or disease - You can be predisposed to a condition but not necessarily develop it; but you are at increased risk Genetics – Predisposition - Some conditions include: - Cancer (breast and prostate) to Disease - Cardiovascular disease - Diabetes - Obesity - Depression Genetics – Hormones If levels of particular hormones are too high or too low problems can result E,g, oestrogen and testosterone Oestrogen - regulates menstrual cycle; essential for maintaining bone density Menopause - levels of oestrogen in females decline; can lead to a loss in bone density; increased risk of breaks/fractures; development of osteoporosis Genetics – Hormones cont. Testoterone – male hormone; small quantities in women Associated with higher rates of risk taking and smoking, contributing to ill health Levels decrease in men age 40; often results in symptoms such as loss of sex drive, fatigue and depression High Blood Pressure Hypertension means person has high blood pressure Blood unable to flow freely through the blood vessels Greater stress placed on heart to function Hypertension causes: Heart attack Stroke Cardiovascular disease and kidney failure Risk Factors: Stress Smoking Excessive alcohol consumption Genetics Poor diet Age Childhood diseases, Congenital diseases Mortality at both ends of age spectrum age specific Increase in the number of elderly Two-third in developing countries Increase prevalence of chronic diseases and disabilities. Ethnicity Some diseases (genetic disorders) more likely among people some ethnic groups certain versions genes passed down from ancestors shared genes may contain disease-causing mutation Examples sickle cell disease more common in people of African decent or Mediterranean heritage but can occur in any ethnic group. Chinese men and women tend to have lower CVD rates than the general population (Britian). On average, blood pressure is different in the differing ethnic groups Ethnic differences in mental health are controversial. "Ethnic background is an essential part of a patient's medical history,…It's one of the key areas to look for clues. A physician should consider ethnic background very heavily. If I know that a patient is of northern European extraction, I think along certain lines, like blood cell membrane defects or spherocytosis. If a patient's ancestors are from the Mediterranean, I think of thalassemias or G6PD deficiency. If someone is black, I think of sickle cell anemia and, if someone is of Southeast Asian descent, I think of hemoglobin E syndromes. But, at all times, I realize that any of these disorders can affect any group." http://news.stanford.edu/pr/91/911004Arc1132.html  Lifestyle and Behavioural Determinants of Health Lifestyle and Behaviours Life choices result in either positive or negative influence on health e.g. Drug use dietary choice physical activity working conditions and sexual practices Modifiable behavioral risk factors are leading causes of mortality Impact from lifestyle/behaviour directly linked to knowledge, attitudes and beliefs Knowledge, attitudes and beliefs Based on the knowledge a person has about an aspect of their health, and their evaluation of the importance or relevance of this information, they will form attitudes or beliefs about it. Access to reliable information may be difficult vital in gaining knowledge for maintaining health lifestyle. Tobacco Smoking Smoking cigarettes can result in: Various forms of cancer Cardiovascular disease Respiratory diseases such as emphysema and asthma Alcohol Consumption Excessive consumption can result in: Liver disease or cancer of the liver Obesity Road accidents Brain damage/memory loss  Physical Activity Many health benefits - Impacts in different ways (positive/negative) on health status Physical inactivity leads to obesity (associated diseases: CVD, diabetes, arthritis, respiratory conditions) Individuals use less energy than they consume which leads to weight gain Adequate physical activity - reduced rates of mental health isses, depression, stress, etc Exercise produces hormones called endorphins which promote feelings of happiness and wellbeing. Osteoporosis (associated with weight bearing activities) Lifestyle choices Personal behaviors play critical roles in the development of many serious diseases and injuries. Behavioral factors largely determine the patterns of disease and mortality  Risk Factors Biomedical Cause of ill health, Behaviour Cause of ill health, Risk Factors disability and Risk Factors disability and mortality mortality Poor diet and CHD, stroke, digestive cancers, Overweight Coronary Heart nutrition type 2 diabetes, gallstones, dental condition and Obesity Disease (CHD), Type Excess alcohol Heart Disease, stroke, high blood 2 diabetes, breast consumption pressure, accidents, mental cancer, gallstones illness, violence High Blood CHD, stroke Smoking Heart Disease, cancer including Pressure mouth, lung & cervical, stroke Inadequate Heart disease, stroke, type 2 Raised blood CHD, stroke physical activity diabetes, osteoporosis, bone cholesterol fractures, mental illness, obesity level Not vaccinated Measles, diptheria, tetanus, poliomyelitis  Trinidad and Tobago http://www.healthdata.org/trinidad-and-tobago Top 10 causes of total number of deaths in 2019 and percent change 2009-2019, all ages combined http://www.healthdata.org/trinidad-and-tobago http://www.healthdata.org/trinidad-and-tobago Top 10 risks contributing to total number of DALYs in 2019 and percent change 2009–2019, all ages combined  How do causes of death and disability compare to those in other locations? http://www.healthdata.org/trinidad-and-tobago Life-style makes the difference Diabetes mellitus Obesity Malnutrition. Population explosion. Mental health problems. Accidents/injuries Cancer Cardiovascular diseases AIDS & STDs.  Why Determinants of Health ? Root of the problems Direct Impact on Health Provides the strategies to use to promote health or prevent diseases. Predict Interact With Greatest Each other to Determinants Proportion of Produce of Health Health Status Health Variance. Structure Behaviours. http://en.healthnexus.ca/topics-tools/health-equity- topics/social-determinants-health Readings Last John M. Public Health and Human Ecology. McGraw-Hill Professional, 1998 2nd Edition. Chapters 1 and 8 Regional Papers PAHO: Health in the Americas 2017 https://www.paho.org/salud-en-las-americas-2017/?p=1123 Pages 1-43 (pdf version in myelearning)  26/09/2023 Determinants of the Environment and Health Dr. Jeffrey Edwards 1 Presentation Objectives At the end of the session, students should be able understand Health in its physical, mental and social context. The environment as an important factor in the interaction of Agent and Host in the ecological triad. The physical, biological and psychosocial environment and their impact on health. 2 1  26/09/2023 COURSE OUTLINE Concept of Health and disease. Determinants of health ---- Environmental determinant Interaction of agent, host and environmental factors ---- Epidemiological triad Definition of environment ---- Internal environment and External environment, Macro-environment and micro environment. Components of environment ---- Physical, Biological and Psychosocial. 3 Course Outline At the end of the session students should be able to: 1. Explain the potential health implications associated with housing such as overcrowding, accidents, poisoning etc 2. Explain what is meant by air quality and air pollution 3. Explain what is meant by water quality and list some water borne diseases 4. Discuss the health effects of noise 5. Briefly describe the role of the environmental health officer / public health inspector 4 2  26/09/2023 What is the environment? The trees, air, & soil around us ALL the places we live, work & play Our fields, farms & the food we grow Our oceans, lakes, and rivers 5 Definition of the Environment The circumstances, objects, or conditions by which one is surrounded OR The complex of climatic, edaphic (soil based), and biotic factors (living things in an ecosystem) that act upon an organism or an ecologic community/system OR All that which is external to the individual host. [It] can be divided into physical, biological, social, and cultural factors, any or all of which can influence health status in populations. −Last, J. M. (Ed.). (1995). A Dictionary of Epidemiology(3rd ed.). New York: Oxford University Press. 6 3  26/09/2023 COMPONENTS OF ENVIRONMENT: PHYSICAL: air, water, soil, housing, climate, geography, heat, light, noise, debris, radiation, etc. BIOLOGICAL: man, viruses, microbial agents, insects, rodents, animals and plants, etc. PSYCHOSOCIAL: cultural values, customs, beliefs, habits, attitudes, morals, religion, education, lifestyles, community life, health services, social and political organization. 7 Health “HEALTH IS A STATE OF COMPLETE PHYSICAL, MENTAL AND SOCIAL WELL-BEING AND NOT MERELY THE ABSENCE OF DISEASE OR INFIRMITY.” WHO (1948) HOLISTIC CONCEPT OF HEALTH: - This concept recognizes the strength of social, economic, political, cultural and environmental influences on health 8 4  26/09/2023 Determinants of Health Many factors combine together to affect the health of individuals and communities. Whether people are healthy or not, is determined by their circumstances and environment. To a large extent, factors such as where we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family all have considerable impacts on health Other factors include access and use of health care services. 9 CONCEPT OF DISEASE Trouble or a condition of the living animal or plant body or one of its parts that impairs the performance of a vital function A pathological process having signs and symptoms (or may be asymtomatic) which may affect the whole body or any of its parts. Its etiology, pathology, and prognosis may be known or unknown. Disease result from complex interaction between man, an agent and the environment. 10 5  26/09/2023 EPIDEMIOLOGICAL TRIAD ENVIRONMENT VECTOR AGENT HOST 11 Definitions Safe Free from harm or risk Secure from threat of danger, harm, or loss Zero risk Risk Possibility of loss or injury, peril The chance of loss; the degree of probability of such loss 12 6  26/09/2023 Environmental Health? Air Sunlight Food Noise Water Soil The study of how the environment affects your health. 13 Good Things Around Us Oxygen in the air Beautiful scenery to look at Nutrients in food Family & Medicine friends & vitamins There are many things around us that help us stay healthy. 14 7  26/09/2023 Hazards Bacteria & viruses Harmful chemicals Tobacco smoke Stress Loud noises A hazard is anything in the environment that can hurt you or make you sick. 15 Environmental Health Sciences National Institute of Environmental Health Sciences (NIEHS) charter: “The study of those factors in the environment that affect human health” Factors (“pollutants”or “toxicants”) in air, water, soil, or food Transferred to humans by inhalation, ingestion, or absorption Production of adverse health effects 16 8  26/09/2023 Facets of Environmental Health Environmental epidemiology −Associations between exposure to environmental agents and subsequent development of disease Environmental toxicology -Causal mechanisms between exposure and subsequent development of disease Environmental engineering - Factors that govern and reduce exposure Preventive medicine -Factors that govern and reduce disease development Law −Development of appropriate legislation to protect public health 17 WHO Definition of Environmental Health Environmental health comprises those aspects of human health, including quality of life, that are determined by physical, biological, social, and psychosocial factors in the environment. It also refers to the theory and practice of assessing, correcting, controlling, and preventing those factors in the environment that can potentially affect adversely the health of present and future generations. 18 9  26/09/2023 Should one be Concerned about Environment Health Issues Acute environmental catastrophes (high-level exposures) Chronic (low-level) exposures Indirect effects of global environmental changes 19 Environmental Catastrophies Minamata disease (1953–1961) −chronic poisoning by alkyl mercury compounds from industrial waste, characterized by (usually permanent) impairment of brain functions such as speech, sight, and muscular coordination. Seveso, Italy (1976) −Leak of toxic gas (TCDD) -A bursting disc on a chemical reactor ruptured and a dense white cloud that contained a small deposit of TCDD or dioxin (a highly toxic material) drifted offsite. - The nearby town of Seveso had some 17,000 inhabitants and No human deaths were attributed to TCDD but many individuals fell ill. 26 pregnant women who had been exposed to the release had abortions. Thousands of animals in the contaminated area died and many thousands more were slaughtered to prevent TCDD entering the food chain. Bhopal (1984) − more than 40 tons of methyl isocyanate gas leaked from a pesticide plant in Bhopal, India, immediately killing at least 3,787 people and causing 558,125 injuries resulting in significant morbidity and premature death for many thousands more 20 10  26/09/2023 Environmental Catastrophies Chernobyl (1986) −Nuclear reactor accident released large quantities of radioactive particles into the atmosphere, which spread over much of the western USSR and Europe. - The blast effects caused 2 deaths within the facility, later 134 were hospitalized with acute radiation symptoms, of which 28 firemen and employees died in the days-to-months afterward. In addition approximately 14 cancer deaths amongst this group of initially hospitalized survivors was to follow within the next ten years Milwaukee incident (1993) −Cryptosporidium in drinking water purification plant the largest waterborne disease outbreak in documented US history. The CDC showed that this outbreak was caused by Cryptosporidium oocysts that passed through the filtration system of one of the city's water-treatment plants, arising from a sewage treatment plant's outlet 2 miles upstream in Lake Michigan. Over the span of approximately two weeks, 403,000 became ill and at least 104 deaths have been attributed to this outbreak, mostly among the elderly and immunocompromised people. 21 The 3 parts of exposure The The The Source Contact Environmental of the hazard (inhaled fumes) Pathway (bus exhaust) (air) 22 11  26/09/2023 ENVIRONMENTAL IMPACT Environment (Physical, biological and psychosocial) Human activities health of individual 23 Increase in amount or virulence AGENT Introduction into setting where it has not been before Enhanced mode of transmission HOST ENVIRONMENT Change in susceptibility Conducive to interaction Factors that increase exposure between host and agent 24 12  26/09/2023 Climate Change and its Impact on Health Environmental consequences of climate change affect directly and indirectly the physical, social, and psychological health of humans and include : - extreme heat waves - rising sea-levels - changes in precipitation resulting in flooding and droughts - intense hurricanes - degraded air quality Climate change affects the social and environmental determinants of health – clean air, safe drinking water, sufficient food and secure shelter 25 Four layers of the Atmosphere Troposphere Starts at the Earth's surface and extends 8 - 14.5 km high. This part of the atmosphere is the most dense. Almost all weather is in this region. Stratosphere Starts just above the troposphere and extends to 50 km high. The ozone layer, which absorbs and scatters the solar ultraviolet radiation, is in this layer. Mesosphere Starts just above the stratosphere and extends to 85 km high. Meteors burn up in this layer Thermosphere Starts just above the mesosphere and extends to 600 km high. Aurora and satellites occur in this layer. 26 13  26/09/2023 Layers of the Atmosphere 27 Humans and the Environment The physical environment, our habitat, is the most important determinant of human health Protection of the environment and preservation of ecosystems are the most fundamental steps in preventing human illness Environmental problems are global and long-term Human belief systems are part of the problem 28 14  26/09/2023 Vulnerable Groups Low socioeconomic status Women Children Elderly Ethnic minorities Disabled Indigenous peoples All of whom are often more vulnerable because of— −Genetics −They are not empowered to change their environment 29 Environment All of the external conditions, circumstances and influences surrounding and affecting the growth and development of an organism or community of organisms These factors may be living organisms (biotic factors) or non-living variables (abiotic factors) such as temperature, rainfall, wind and ocean currents The interaction of organisms with boitic and abiotic factors form an ecosystem 30 15  26/09/2023 Types of Environment The external environment or the Macro-environment is said to be responsible for millions of preventable diseases originating in it. Micro-environment is the Domestic environment in which man lives. The term Internal environment is sometimes used for the environment inside the body 31 Environmental Hazards May be Biological Chemical Physical Psychological Sociological Site and location hazards. 32 16  26/09/2023 Biological hazards These are living organisms or their products that are harmful to humans Viruses Dengue Virus Chikungunya Virus Ebola Virus Bacteria Typhoid fever, Cholera, Shigella (dysentery), Salmonella, E. coli Protozoans Cysts: Giardia Lambia, Cryptosporidium Amoeba: Dysentery Plasmodium: Malaria, Paludism 33 Water Quality Water quality refers to the chemical, physical, biological, and radiological characteristics of water. It is a measure of the condition of water relative to the requirements of one or more biotic species and or to any human need or purpose (drinking, farming, fish production, swimming, industrial processing). Can be thought of as a measure of the suitability of water for a particular use based on selected physical, chemical and biological characteristics 34 17  26/09/2023 Water- Borne Diseases Water-borne diseases are diseases that are transmitted in drinking water Examples are polio virus, hepatitis A virus, Salmonella, Shigella, cholera, amoebic dysentery, Giardia, and Cryptosporidium. These disease organisms are shed into the water in feces, and can produce illness in those who consume untreated, contaminated water. Our municipal water treatment facilities are usually able to purify water by removing these agents or killing them by disinfecting the water. 35 Food-borne diseases Are diseases transmitted in or on food Examples of food-borne agents are Salmonella enteritidis, Escherichia coli 0157:H7, as well as other agents. To protect against food-borne diseases, sanitarians from local health departments routinely inspect food service establishments (restaurants) and retail food outlets (supermarkets) to verify that food is being stored and handled properly. 36 18  26/09/2023 Vector-borne diseases Are those transmitted by insects or other arthropods Examples are Dengue fever, CHIKV and Zika virus transmitted by mosquitoes and plague and murine typhus transmitted by fleas. Improper environmental management can cause vector-borne disease outbreaks. 37 Chemical hazards Result from mismanagement or misuse of chemicals that may result in increased risks to human health Pesticides are chemicals : that have been manufactured for the purpose of reducing populations of undesirable organisms (pests) 1. Examples of categories of pesticides are herbicides and insecticides. 2. Most pesticides kill non-target organisms as well as the target, or pest species. 3. The wise use of pesticides can protect human health and agricultural crops. 4. Misuse of pesticides can result in illness and death. 5. Some of the earlier developed pesticides such as DDT, were persistent and remained in the environment for months or years after their initial use. 6. Newer pesticides are less persistent in the environment. 38 19  26/09/2023 Air Quality and Air Pollution The term “air quality” means the state of the air around us. Good air quality refers to clean, clear, unpolluted air. Clean air is essential to maintaining the delicate balance of life on earth — not just for humans, but wildlife, vegetation, water and soil. Poor air quality (pollution) is a result of a number of factors, including topography and weather, emissions from various sources, both natural and human-caused. Poor air quality occurs when pollutants reach high enough concentrations to endanger human health and/or the environment – car emissions, tobacco smoke, factory/industrial emissions, moulds, chemicals released from synthetic fabrics etc 39 Types of Air Pollutants Natural Particulate matter (tiny solid/liquid particles that float in the air) −Volcanic ash −Radioactivity −Pollen dust −Smoke from fires Man-made Gaseous −Derived from combustion processes −Hydrocarbons −Oxides of sulfur and nitrogen compounds 40 20  26/09/2023 Six Criteria Pollutants CARBON MONOXIDE (CO) SULFUR DIOXIDE (SO2 ) NITROGEN DIOXIDE (NO2 ) TROPOSPHERIC OZONE (O3) LEAD VOLATILE ORGANIC COMPOUNDS (VOCS) 41 Volatile Organic Compounds: Up to Ten Times Higher Indoors than Outdoors Paints, Paint Thinners, Varnishes, Solvents Aerosol Sprays Air Fresheners, Candles, Incense Cleaning Supplies, Disinfectants Stored Fuels, Automotive Products Glues, Adhesives, Sealing Caulks Dry-cleaned Clothing New Carpeting Secondhand Smoke Pressed Wood Furniture Newspapers Moth Repellants Wood Preservatives Cooking 42 21  26/09/2023 Environmental tobacco smoke (ETS) An environmental hazard produced by tobacco smoke 1. Diseases associated with ETS include lung cancer and perhaps heart disease. 2. ETS contains approximately 4, 000 substances. 3. The EPA has classified ETS as a Class A carcinogen. 4. Smoking has been restricted from public buildings and from many private work sites. 5. Regulation of smoking seems to be the best approach to controlling this pollutant 43 Lead Is a naturally occurring element that is used in the manufacturing of many industrial and domestic products Health problems associated with the over exposure to lead are anemia, birth defects, bone damage, neurological damage, kidney damage, and others. Exposure is by ingestion and inhalation. Children are particularly at risk from ingesting peeling lead paint. The prevalence of very high blood lead levels among young children declined significantly between 1984 and 1994 primarily because the removal of lead from gasoline Occupational exposure is a major source of lead intake for adults. 44 22  26/09/2023 45 Environmental Pathways for Selected Toxic Agents Agent Disease Source Pathway Legionella Legionnaire’s Soil, Cooling Air, Building pneumophila disease towers Ventilation systems Salmonella Acute diarrhoea Human or animal Water, meat, eggs feces Dioxin Chloracne, Herbicides, Paper Air, Water, food SoftTissue Mills, Incinerators Tumours Pesticides Nervous System Agriculture Water, Food Toxicity Asbestos Asbestosis, Lung Insulation, Auto Air, Water Cancer Brakes 46 23  26/09/2023 Physical hazards Are factors within the environment that can harm the body without necessarily touching it. Includes airborne particles, humidity, equipment design and radiation Humidity Water in the atmosphere (damp, or high humidity) can encourage mould to grow which may be associated with respiratory problems. 47 Psychological hazards Are environmental factors that produce psychological changes expressed as stress, depression, hysteria. 48 24  26/09/2023 Sociological hazards Are those that result from living in a society where one experiences noise, lack of privacy and overcrowding. 49 Health Effects of Housing Cold/heat Falls Damp and mould Carbon monoxide Asbestos and Man-made mineral fibres (MMMF) Electromagnetic fields (EMF) – a ubiquitous exposure, though of variable intensity; uncertain epidemiological evidence Lead – mainly in old lead paint and water pipes/solder joints Noise Electrical hazards Structural failure Entrapment or collision 50 25  26/09/2023 Health Effects of Housing Explosions Uncombusted fuel gas Entry by intruders Hot surfaces and materials Domestic hygiene, pests etc Inadequate provision for food safety Contaminated water Inadequate lighting Poor ergonomics Crowding and space – a potentially very important factor that has bearing on the risks of accidents, fires, dampness and mould, mental well-being and a range of other adverse effects 51 Health effects of Noise Pollution Traffic is the main source of noise pollution in cities. Noise health effects are the health consequences of regular exposure, to consistent elevated sound levels. Elevated workplace or environmental noise can cause : - Hearing impairment - Annoyance (sensitive groups include the elderly, shift workers, persons vulnerable to physical or mental disorders) - Sleep disturbance - Hypertension (Acute exposure to noise activates nervous and hormonal responses, leading to temporary increases in blood pressure, heart rate, and vasoconstriction). - Ischemic heart disease 52 26  26/09/2023 Site and Location Hazards A. Natural disasters are geographical and meteorological events of such magnitude and proximity to communities that they produce significant damage and injuries. 1. Examples are cyclones, earthquakes, floods, hurricanes, tornadoes, typhoons, and volcanic eruptions. 2. The magnitude of devastation of these events can sometimes be great. 3. Biological, psychological and sociological hazards may increase following a natural disaster. 53 Role of the Environmental Health Officer/Public Health Inspector Monitoring of environmental conditions to identify and control risks to human health Investigation of public health complaints and abatement of nuisances Monitoring of waste water treatment and disposal systems Monitoring of drainage systems Monitoring solid and liquid waste management and disposal systems Inspection of schools, homes for the aged, health centers, hospitals and other residential care facilities. Inspection of factories, workshops, garages, public buildings and other commercial establishments 54 27  26/09/2023 Role of the Environmental Health Officer/Public Health Inspector Inspection of hotels and guest-houses Inspection, monitoring and registration of food establishments Conducting lectures on public health matters to various groups including food handlers Registration of food handlers Inspection of building plans and layouts to ensure compliance with public health requirements Monitoring and sampling of water supplies Inspection of meat at abattoirs Inspection of containerized cargo (foods) at ports, and/or premises of importer 55 Role of the Environmental Health Officer/Public Health Inspector Surveillance at ports to prevent the introduction and exportation of disease and vectors Identification and control of disease vectors in the general environment Collaboration with other agencies to address environmental/public health issues Enforcement of public health laws, regulations and bye- laws" 56 28  26/09/2023 Thank You !! 57 29  Introduction to Health and Primary Care Dr. Shastri Motilal MBBS Hons, DM Lecturer in Family Medicine 2024  Objectives By the end of this seminar you should be able to : 1. Define Health Primary Care and Primary Health Care 2. Define Social determinants of health and Universal Health Coverage 3. Outline the principles of Family Medicine 4. List the benefits of having a Primary Care Doctor? 5. Outline who is WONCA? How many of you consider yourselves healthy? ◼ Absence of a serious disease? ◼ Absence of physical symptoms ◼ Emotional well being? What is the single best thing we can do for our health? What is Health? ◼ “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” ◼ "a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities." What determines if someone is healthy? These are known as the social determinants of health These are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. Primary health care (different definitions) ◼ a level of service delivery (first contact care) ◼ a philosophy that underlies the health care system ◼ a set of activities ◼ a strategy for organising health services Primary health care concept: Alma Ata declaration ( WHO 1978) - a set of activities 1. Health education 2. Promotion of mental, emotional and spiritual health 3. Provision of essential drugs 4. Food supply and proper nutrition 5. Provision of safe water and basic sanitation 6. Immunisation 7. Maternal and child health care including family planning 8. Prevention and control of endemic diseases 9. Identification and control of prevailing health problems 10. Appropriate treatment of common diseases and injuries Fair Access to all citizens  Declaration on Primary Health Care Astana, 2018 ◼ The Global Conference on Primary Health Care in Astana, Kazakhstan in October 2018 ◼ 40 years later….. A new declaration! Why a new declaration? ◼ We still face many ongoing challenges. ◼ A primary health care (PHC) approach is the most effective way to sustainably solve today’s health and health system challenges. ◼ Universal Health Coverage (UHC) and the health-related Sustainable Development Goals (SDGs). ◼ The new declaration will renew political commitment to primary health care from Governments, non-governmental organizations, professional organizations, academia and global health and development organizations.  ◼ SDGs are the blueprint to achieve a better and more sustainable future for all https://www.youtube.com/watch?v=0XTBYMfZyrM&feature=youtu.be Universal Health Coverage ◼ Equity in access to health services - everyone who needs services should get them, not only those who can pay for them ◼ The quality of health services should be good enough to improve the health of those receiving services ◼ People should be protected against financial-risk, ensuring that the cost of using services does not put people at risk of financial harm. Primary care is... that care provided by physicians specifically trained for and skilled in comprehensive first contact and continuing care for persons with any undiagnosed sign, symptom, or health concern (the "undifferentiated" patient) not limited by problem origin (biological, behavioral, or social), organ system, or diagnosis. Subset of primary health care American Academy of Family Physicians. Primary Care. Cited [12th September 2013] Available from: http://www.aafp.org/about/policies/all/primary-care.html Primary care :Accessible ◼ Affordable ◼ Easy to reach ◼ User- friendly ◼ Available and timely ◼ To whom?  Age  Gender  Ethnicity  Disability  Social status  Lifestyle and Sexuality Questions? ◼ In an average month out of 1000 people.... ◼ How many have symptoms? ◼ How many see a doctor? ◼ Which doctor do the majority of patients see? The ecology of medical care. NEJM, White et al 1961  What is Family Medicine? ▪ Family medicine is the medical specialty which provides continuing, comprehensive health care for the individual and family. ▪ It is a specialty in breadth that integrates the biological, clinical and behavioral sciences. ▪ The scope of family medicine encompasses all ages, both sexes, each organ system and every disease entity. American Board of Family Medicine, Definitions & Policies Four Principles of Family Medicine 1. Family medicine is a community-based discipline 2. Family physician is a skilled clinician 3. The patient-physician relationship is central to the role of the family physician 4. Resource to a defined practice population The College of Family Physicians of Canada. Four Principles of Family Medicine. Cited [12th September 2013] Available from: http://www.cfpc.ca/principles/ Family medicine is a community based discipline ◼ Located within community it serves ◼ Community network of health care providers. Family physician is a skilled clinician ◼ All age groups ◼ All systems ◼ Wide range of conditions ◼ Undifferentiated problems Distribution of disease in Primary Care ◼ 65% disease self limiting  URTI, GIT, MS, Skin ◼ 20% chronic with permanent disability  Asthma, BP, DM, IHD ,Thyroid ◼ 15% life threatening  Acute chest infection, severe depression, acute MI, CVA, acute abdomen The patient-physician relationship is central to the role of the family physician ◼ Good doctor patient relationship is strongly linked to adherence and improvement ◼ Not just deals with the disease  Illness  Health Promotion  Mutual decision making  Realistic Resource to a defined population ◼ Educator ◼ Gatekeeper ◼ Researcher ◼ Advocacy for patients Who are the other members of the Primary Health Care Team? Practice manager Nurses Support staff: clerical staff. Midwives. District Health visitors. Dietitian Pharmacist Social Worker Physiotherapist What are the benefits of Primary Care? ◼ Reduced all-cause mortality ◼ Better health outcomes ◼ Less overall costs and more cost-effective ◼ Less hospitalization ◼ Less use of specialist services and ER visits ◼ More patient satisfaction ◼ Increase in access and equity Primary care is also an ideal opportunity to emphasize the other medical fields…. Who is WONCA? ◼ WONCA is an unusual, yet convenient acronym comprising the first five initials of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians. http://www.globalfamilydoctor.com What is WONCA's mission? ◼ promoting primary care ◼ promoting equity ◼ supporting academic organizations ◼ providing a forum for exchange of knowledge ◼ representing the policies and the educational, research of GPs to other organizations CCFP is part of WONCA North America What the single most important thing you can do for your health? What has been associated with reductions in... ◼ KNEE ARTHRITIS PAIN/DISABILTIY 47% COLON CANCER 30% ◼ DEMENTIA/ALZHEIMERS 50% BREAST CANCER 20- 80% ◼ DIABETES 58% ENDOMETRIAL CANCER ◼ HIP FRACTURES IN PM 20-40% WOMEN 47% LUNG CANCER 20% ◼ ANXIETY 48% ◼ DEPRESSION 30-47% ◼ DEATH 23% ◼ FATIGUE Exercise Summary ◼ Definitions ◼ Health ◼ Social determinants of health ◼ Universal Health Coverage ◼ Primary Health Care ◼ Primary Care ◼ Family Medicine and its benefits ◼ WONCA The single best thing we can do for our health? ◼ 23 and 1/2 hours: What is the single best thing we can do for our health? DocMikeEvans Thank You for not.... Comments or questions? References ◼ WHO. What are the advantages and disadvantages of restructuring a health care system to be more focused on primary care services? Jan 2004. Internet. Available from: www.euro.who.int/__data/assets/pdf_file/0004/74704/E82997.pdf [accessed 17th oct 2017] ◼ WONCA. Cited Oct 2017. Available from: http://www.globalfamilydoctor.com. [accessed 17th oct 2018] ◼ Sustainable Development Goals. Avaiable from: https://www.un.org/sustainabledevelopment/sustainable-development- goals/ [accessed 17th oct 2018] ◼ Declaration on Primary Health Care, Astana, 2018. http://www.who.int/primary-health/conference-phc/declaration [accessed 17th oct 2018] MDSC 1001:LEVELS OF PREVENTION AND DISABILITY DR. RAVEED KHAN MBBS,MPH,DM LECTURER-FAMILY MEDICINE  OBJECTIVES Define the various levels of disease prevention Describe examples for each level of prevention Define Disability Discuss the leading causes of disability in T&T Discuss the use of screening tests and explain the basic factors to be considered when using these tests.  DISEASE PREVENTION Closely related to Health Promotion. Health promotion and disease prevention programmes focus on keeping people healthy. Health promotion is defined by the WHO as: “The process of empowering people to increase control over their health and its determinants through health literacy efforts and multi-sectoral action to increase healthy behaviours.” Disease prevention focuses on prevention strategies to reduce the risk of developing chronic diseases and other morbidities. Natural History of Disease  LEVELS OF DISEASE PREVENTION Defined in terms of 4 levels -Primordial Prevention -Primary prevention -Secondary prevention -Tertiary prevention Pre-pathological Phase Pathological Phase  Primordial prevention Prevention of the emergence or development of risk factors. E.g. Many adult health problems like obesity and hypertension begin in childhood as a result of poor lifestyle habits e.g. Physical inactivity and consumption of obesogenic foods. Banning the sale of sugary drinks in primary schools is an example of primordial prevention.  Primary prevention Primary prevention refers to actions aimed at avoiding the manifestation of a disease. It can be defined as "action taken prior to the onset of disease, which removes the possibility that a disease will ever occur."  Image result for vaccination Examples of Primary Prevention Vaccination and post-exposure prophylaxis of children, adults and the elderly. Provi