Introduction to Public Health PDF

# Community Health: CHP 310 ## Introduction to Public Health The image shows a slide from a presentation on Community Health: CHP 310, titled "Introduction to Public Health". A circular graphic at the bottom represents the concept of "well-being" and depicts five overlapping circles labeled "Phy...

# Community Health: CHP 310 ## Introduction to Public Health The image shows a slide from a presentation on Community Health: CHP 310, titled "Introduction to Public Health". A circular graphic at the bottom represents the concept of "well-being" and depicts five overlapping circles labeled "Physical," "Mental," "Social," "Spiritual," and "Emotional," emphasizing the multi-dimensional nature of health. ## 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. Analyze Determinants of Health and Disease in Communities. 3. Identify and analyze the dimensions of health about well-being. 4. Recognize, assess, and address inequities in health, and disparities in healthcare access. ## What is Health? ### Holistic Definitions (W.H.O., 1948) The World Health Organization defines health as "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 The most accepted definition of health is that of the World Health Organization: "Good health is a prerequisite for participation in a wide range of activities including education and employment." ## Health, Disease, Illness, Sickness, and Wellness * **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 the patient (e.g., chest pain). * **Sickness:** Social and cultural concept or belief for any disease in a broader sense (e.g., 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 (e.g., pericarditis). * **Wellness:** Person's experience for overall balance of physical, social, spiritual, emotional, intellectual, environmental, and occupational well-being. ## Three Perspectives: Disease, Sickness & Illness * **Disease:** Underlying pathology; biologically defined; a practitioner's perspective. The illness is seen in terms of a theory of disorder. * **Illness:** A person's subjective experience of their symptoms. What the patient brings to the doctor. * **Sickness:** Social and cultural conceptions of this condition; cultural beliefs and reactions such as fear or rejection; these affect how the patient reacts. Also covers what is considered a disorder suitable for medical treatment. ## Public Health, Community Health, Community Medicine, and Epidemiology * **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 that 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. ## Health-Illness Continuum Model and Spectrum of Health The image shows a diagram that depicts the **Health-Illness Continuum Model**. The model illustrates two paradigms: * **Treatment Paradigm:** Focuses on illness and disease, moving from pre-mature death through disability to symptoms, signs, and finally reaching a neutral point. * **Wellness Paradigm:** Emphasizes a shift towards a higher level of wellness, moving from awareness through education and growth to a high level of wellness. The image also presents a **Spectrum of Health**, highlighting different states of health: * **Unrecognized Sickness** * **Mild Sickness** * **Severe Sickness** * **Death** * **Positive Health** * **Better Health** * **Freedom from Sickness** ## Medical Conception of Disease (Natural History of Disease) The image depicts a timeline demonstrating the **Medical Conception of Disease**, dividing the course of a disease into two phases: * **Preclinical Phase:** This phase includes the biological onset of disease and the appearance of symptoms. * **Clinical Phase:** This phase includes the diagnosis of the disease, the initiation of therapy, and the eventual outcome (alive, dead, cured, etc.) ## Agent-Host Environment Model This model is primarily used for **describing causes of illness** rather than promoting wellness. It helps in identifying risk factors that result from the interaction of the agent, host, and environment. The diagram depicts the model as a triangle with the following factors: * **Host:** Age, sex, genetic profile, previous diseases, immune status, religion, customs, occupation, marital status, and family background. * **Environment:** Temperature, humidity, altitude, crowding, housing, neighborhood, water, milk, food, radiation, pollution, and noise. * **Agent:** Biological agents (bacteria, viruses, fungus), chemical (poison, alcohol, smoke), physical (trauma, fire), and nutritional (lack or excess). ## Dimensions of Good Health The concept of dimensions of health refers to the *different aspects or areas that contribute to overall well-being*. It is a **multi-dimensional process**. The image shows a diagram of five overlapping circles representing the dimensions of health: * **Physical** * **Mental** * **Social** * **Spiritual** * **Emotional** A combination of these five conditions defines **good health**. ## Dimensions of Health Explained * **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:** About your sense of purpose and meaning in life. All of these dimensions are interconnected, and one's well-being in one area can affect other areas. For example, poor physical health can negatively impact emotional health, while mental stress can make it harder to maintain social connections. Taking care of all of these dimensions can create a healthier and happier you. ## 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: * Economic level * Lifestyle * Family * 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. ## 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, showing respect, and tolerance for those with different opinions and beliefs. ## Other Dimensions of Health ### Spiritual Dimension * Includes principles and ethics, the purpose in life, religious beliefs, and values. * Important components of how a person behaves in health and illness. ### Vocational Dimension * 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) The World Health Organization "World Health Declaration" was signed by all member countries and emphasizes: * **Human Rights**: "Health for all" * **Improvement of health and well-being of people**: The aim of social and economic development. Good health is fundamental to sustainable economic growth. * **Enjoyment of the highest attainable standard of health**: One of the *fundamental rights* of EVERY human being. ## Determinants of Health Determinants of health are various factors that influence a person's overall well-being and likelihood of experiencing illness or disease. They can be categorized into different groups, including: * Social and Economic Environment * Physical Environment * Person's Behavior * Person's Characteristics ## 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 affect a wide range of health, functioning, and quality-of-life outcomes and risks." **SDOH can be grouped into 5 domains:** 1. **Education:** Access and quality 2. **Health Care:** Access and quality 3. **Economic Stability** 4. **Social and Community Context** 5. **Neighborhood and Built Environment** ## 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. * Social isolation and lack of social support **can lead to increased** stress, depression, and other health issues. ## Community Safety and Environment * Safe and supportive neighborhoods **promote** physical activity, access to healthy foods, and social engagement, all contributing to better health outcomes. * 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 preventative services and treatment, **can result in unmet healthcare needs, delayed diagnoses, and poor health outcomes.** ## SES: Main Socio-economic Status * **Education:** Illiterate, Elementary, Intermediate, Secondary, University, Post-graduate * **Occupation:** Unemployed, Laborer, Professional * **Income (per month):** < 1000, 1000-4000, 5000-14000, > 15000 * **Housing:** Hut House, Traditional House, Apartment, Villa * **Ownership:** Rented, Mortgaged, Owned 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. ### 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.** ## 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 These behaviors are generally more controllable than other determinants. ## Environmental Determinants of Health ### Physical Environment * Air (quantity and quality) * Water (quantity and quality) * Waste disposal * Housing * Climate: temperature, humidity, and rainfall * Geography * Heat * Light * Noise * Vibration * 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. ### 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 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.** ## Biological and Psychosocial Environment ### 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. * **Hormones:** Hormones are chemical messengers that regulate many bodily functions. Imbalances in hormone levels can lead to a variety of health problems. * **Microbiome:** The microbiome is the community of microorganisms that live in your gut. A healthy microbiome is essential for digestion, immune function, and overall health. ### Psychosocial Environment * **Habits**, **Customs**, **Ethnicity** and **Cultural Values** are all important factors. * **Ethnicity:** Identification with a social group on the grounds of language, culture, religion, common origin (ancestry), and shared history. * **Culture:** The complex social phenomenon of shared knowledge, beliefs, goals, values, attitudes, and practices. * **Religion/Morals:** Impact on education/health awareness, employment, community life, and housing. * **Political Organization:** Impacts on % GNP (Gross National Product), resource allocation, availability of services, and 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). ## Health Inequities ### Inequality vs Inequity * **Inequality** is generally unconditional: *all* people have different levels of something, but there's no explicit injustice. * **Inequity** is conditional: some people have less than others because there's something preventing them from having more (e.g., discrimination, lack of opportunity). ### Inequities Between Countries * Worldwide, differences in health and longevity are seen between rich and poor, men and women, and dominant and marginalized ethnic groups. * **Life Expectancy:** Varies greatly across countries, with higher life expectancies in developed countries and lower expectancies in developing nations. * **Infant Mortality Rate:** The risk of a baby dying between birth and one year of age, is much higher in lower-income countries. * **Maternal Death:** The risk of maternal death during or shortly after pregnancy is significantly higher in some countries compared to others. ### Inequities By Gender * **Indian Subcontinent:** Girls have a death rate nearly twice that of boys due to family behavior: * 1/6 deaths are due to neglect and discrimination. * Girls receive lower-quality immunization and nutritional care than boys. ## Resources and References * **Centers for Disease Control and Prevention(CDC):** "**[https://www.cdc.gov/publichealthgateway/sdoh/index.html](https://www.cdc.gov/publichealthgateway/sdoh/index.html)**" This website provides a comprehensive overview of SDOH. * **World Health Organization(WHO):** "**[https://www.who.int/health-topics/social-determinants-of-health.](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-determinants-health](https://health.gov/healthypeople/priority-areas/social-determinants-health)**" This website outlines SDOH as a key priority area for improving national health. ## 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 ## Thank You The last slide of the presentation shows a robot holding a computer screen that reads "Thank You!".