Public Health
Introduction
4/13/2015
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Public Health-1920
“The science and art of Preventing disease,
Prolonging life and Promoting Health and
Efficiency through organized community
efforts for the
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Sanitation of the environment,
Control of communicable diseases,
Education of the individual in personal hygiene,
Organization of the medical and nursing services for
early diagnosis and medical treatment of diseases,
• Development of social machinery to ensure for every
individual a standard of living adequate for the
maintenance of health.”
Prof Winslow Yale University
Public Health At Work
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Preventive Medicine
• “The art and science of health
promotion, disease prevention,
disability limitation and rehabilitation”
1. Primary prevention
2. Secondary prevention
3. Tertiary prevention
Curative Medicine
“ A vast body of scientific knowledge,
technical skills, medicaments and
machinery that not merely treat the
disease but preserves life in a highly
organized way”
Social Medicine
• “The Study of man as a social being in his
total environment - It focuses on the
health of the community as a whole.”
Social Hygiene
• “The science of prevention and
treatment of sexually transmitted
diseases (STDs) including social
rehabilitation”
Community Medicine
“The art and science of application of
technical knowledge and skills to the
delivery of healthcare to a given community,
designed in collaboration with related
professions as well as human and social
sciences on the one hand, and community
on the other.”
WHO has suggested that every country should
have its own definition of Community Medicine
Comprehensive Health Care
• “The provision of personal (MCH, Child
Welfare, School Health, Occupational Health,
etc.) and impersonal health services (water
supply, communicable disease control, vector
control, etc.) to a community for the
prevention of disease, cure of illness, prevent
disability and economic insecurity and
dependency association with illness.”
Integrated Health Care
• “Bringing together all types of health
services to the community, preventive
and curative.”
Vertical Program
“A single program of health services for
community. For example, Expanded
Program on Immunization (EPI). The staff
of this service is only concerned with the
immunization project.”
Horizontal Program
“A health service delivery program which
covers the two dimensions of health,
personal and community health. Most
often the vertical programs are merged
into existing health facilities in which
case it becomes a horizontal program. In
principle the concept is that of
integration.”
Changing concepts in public health
The Pre-Industrial Era
- The physicians still practiced the medicine of ancient
Greeks by starving, bleeding and purging their
patients.
- Surgery was conducted without anesthesia.
- Often physicians went from one surgery to another
without washing their hands
- Only a few effective drugs were available (digitalis
and quinine)
- Epidemics of smallpox, yellow fever, cholera and
typhoid.
- Physicians with poor professional training handled
medical problems
Changing concepts in public health
The Modern Era
1.Miasma phase.(1850-1880)
2.Bacteriology phase.(1880-1910)
3.Health resources phase.(1910- 1960)
4.Social engineering phase.(1960- 1975)
5.Health promotion phase. (late 1970’s till
present)
Miasma Phase
(1850-1880)
• The phase in which disease was thought
to be caused by noxious vapours.
• William Farr was the proponent of this
theory.
Bacteriology Phase
(1880-1910)
• During this phase the means to
counteract specific diseases were made
possible by the discovery that specific
micro-organisms cause specific disease.
• Bacteriologists Louis Pasteur and Robert
Koch, demonstrated that microorganisms
cause infectious diseases.
Health Resources Phase
(1910- 1960)
• This phase was characterized by
enormous financial investments in
hospitals, health personnel, and
biomedical research.
Social Engineering Phase
(1960- 1975)
• The health advances brought about by
technology and resources weren’t
distributed evenly throughout the
population.
• Emphasis on equal access.
• In this phase equal access to health
services was prioritized through
legislation and policy.
Health Promotion Phase
(late 1970’s till present)
• The concept of “health field” became
popular which consisted of four equally
weighted elements to which death and
disease could be attributed:
1. Human biology (Heredity)
2. Environment
3. Lifestyle (Behaviour)
4. Inadequacies in current health care
provision
Health Promotion Phase
(late 1970’s till present)
• WHO was the principal mover in the field of
health promotion.
• WHO- UNICEF international conference in
1978 at Alma-Ata (USSR), attended by 134
countries.
• All member countries committed to the
principles of the Declaration of Alma Ata to
strive for Health for All by 2000.
• Primary health Care was the key to attaining
Health for All (HFA).
Major Reasons for Increased Longevity
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Improved sanitation
Provision of clean water
Universal immunization programs
Health education and prevention
practices
• Improved treatment and prevention of
chronic diseases (for recent advances)
http://ucatlas.ucsc.edu/cause.php
Major Preventable Risk Factors
• Substance abuse
– Tobacco
– Alcohol
– Drugs
• Unhealthy diet
• Physical inactivity
• Environmental/occupational hazards
Smoking Facts - 2010
• #1 cause of preventable deaths
(446,000/yr)
• 50% of children exposed to second-hand
smoke
• 24% of men and 18% of women smoke
• 31% of smokers earn wages below
poverty line
The Scope of Public Health
• Infectious diseases
• Chronic diseases
– Heart disease, metabolic disorders, cancer, etc.
– Mental health
• Nutrition disorders
• Health of the vulnerable
– e.g. poor, children, women, elderly, etc.
– Substance abusers: drugs, alcohol, tobacco
The Scope of Public Health
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Accidents/violence/injuries
Health equity
Occupational health
Environmental health
Strategies of Public Health
• Assess the current health situation
– Surveys
– Surveillance
– Morbidity and mortality reporting
• Identify the problem
Strategies of Public Health
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Research correlates of occurrence
Develop and evaluate interventions
Disseminate results
Influence policy to incorporate results
(science-based policy)
Intervention Strategies
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Immunization programs
Health education
Behavioral modification strategies
Community intervention/mobilization
Intervention Strategies
• Modification of environment
– Occupational environment
– Living environment (e.g. air quality)
• Surveillance/information systems
(evaluation)
• Policy development and implementation
• Political pressure
Graphic representation of the role of public health.
Brief History Pakistani Health System
1947-1955 (initial phase):
Replenishment of staff
BCG vaccination campaign
02xMedical colleges
1955-1960(1st five year plan):
06x New medical colleges
01x Nursing school was attached to each of
these medical schools
BRIEF HISTORY Cont--
1960-1965(2nd Five year plan):
 Medical Reform Commission.
 Rural Health Center scheme to cover 50000 population by
each unit.
 Family planning program.
 Malaria eradication
1965-1970 (3rd Five year plan):
 Tuberculosis Control Program
 Small pox eradication programs
BRIEF HISTORY Cont--
1970-1975(4th five year plan):
Major infrastructure of the public health care
system was set up in the 1970s.
 An expanded program of immunization.
 Malaria control program.
Tuberculosis control program.
 Family planning program.
Diarrhea and pneumonia control programs.
 National institute of health(To monitor above programs).
BRIEF HISTORY Cont--
• 1978-1983(5th five year plan):
• 6x new medical colleges.
• 3x new nursing schools.
• 1x public health school.
• Programs
to
combat
malnutrition,
adulteration & industrial hygiene
food
BRIEF HISTORY Cont--
1983-1988 (6th five year plan):
Extensive rural development program, provided
sound base for health for all by year 2000.
BRIEF HISTORY Cont--
1988-1993(7th five year plan):
Basic Health Units.
Rural Health Centers.
MCH services.
Family Health Project.
“Primary Healthcare strategy adopted
integral part of Healthcare system”
as
BRIEF HISTORY Cont--
1993-1998 (8th five year plan):
Health management information system (HMIS).
Social action program (SAP).
Prime Minister Program for Family Planning &
Primary Health Care.
BRIEF HISTORY Cont--
1998-2003(9th five year plan):
 Decentralization.
 Public private partnership.
 Privatization of health facilities.
New Health Policy 2001 considers health
sector investment as a part of government’s
Poverty Alleviation Plan.
HEALTH CARE SYSTEM
(Characteristics)
COMPLEX MIXED HEALTH SYSTEM
 Publicly financed govt health system
 Fee-levying private health sector
HEALTHCARE SERVICES
• Public
• 30%
Private
70%
Percentage of GNP spent on the health:
3-4%:
Percentage of GNP spent on private health care:2-3%
• Public Sector Expenditure: 0.54% of GDP
(2009-2010)
Source: Economic Survey of Pakistan repot: 2009-10
FOUR TIERS OF PUBLIC SECTOR
Tier
FACILITY/SERVICES
First
Outreach and community-based services, which
focus on immunization, sanitation, malaria control,
maternal and child health and family planning;
Second
The primary care facilities include Basic Health Units
(BHUs) and Rural Health centres (RHCs) mainly
preventive, outpatient and basic inpatient care.
Third
Fourth
The Secondary health care facilities which include
Tehsil Headquarters Hospital (THQH) and District
Headquarters Hospital (DHQH) for out patient,
inpatient and also specialist care.
Tertiary care hospitals located in the major cities for
more specialized inpatient care.
HEALTH CARE DELIVERY SYSTEM
Integrated Rural Health Complex
Health Care Providers
Population Served
Specialists, Doctors,
Tertiary
Nurses,
Hospitals
Paramedical Staff
Specialists,
Doctors, Nurses,
Paramedical Staff
MO,LMO, Dentist &
Paramedical Staff
Medical
officer&
Paramedical
Staff
District
Headquarters
Hospital
Rural Health
Centers
Basic Health
Units
© 2006 POPULATION REFERENCE BUREAU
Referral Centers
100,000 – 300,000
25,000 – 50, 000
5,000 – 10,000
Take Home Message
World Health Organization Clean Hands are Safer
Hands
4/13/2015