2ND WEEK (LEC)
History of Public Health in PH
I. Pre-American Occupation
− Pub Health began at the old Franciscan Convent in
Intramuros where Fr. Juan Clemente put up a
dispensary (clinic) in 1577 treating indigents in
Manila
− Which became the San Juan de Dios Hospital
− Essence: Clemente helped people by treating them
w/o getting profit, clinic survived through
Solicitation.
During Spanish time:
1. Creation of Board of vaccinator to prevent
smallpox (best ex. of eradicated disease)
- Small pox: Variola virus
- Variolation: ancient Chinese inhales the
virus
- Cross immunity: protective effect against
virus
o Cowpox – material aspirated to ppl
o Vaccine, Latin for “vacca”
2. Creation of board of health
3. Construction of carried waterworks
4. First Med school in PH: UST
5. School of Midwifery
6. Pub Health laboratory
7. Forensic medicine
Hospitals before the American came to PH:
1. General hospitals – ppl will go to these hosp first
a. San Juan de Dios H
b. Chinese General H
c. Hospicio de San Jose in Cavite
d. Casa dela Caridad in Cebu
e. Enfermeria de Santa Cruz in Laguna
2. Contagious hospitals – HIV, meningitis
a. San Lazaro H (SLH): HIV patients (saccl)
o RITM – confirmation of HIV
b. Hospital de palestina in Camarines Sur
c. Hospital delos Lesprosos in Cebu – Lepros
patients
d. Hosp de Argencina in Mnl – smallpox and
cholera (causes diarrhea, CA: Vibrio
Cholerae)
3. Military Hospital
a. H Militar de Manila
b. H Militar Zamboanga
4. Naval Hospital
a. Hospital dela Marie in Cebu
b. Hospital de basilan
5. Other hospital/Asylums - Refugees, mentally ill
a. Hospicio de San Pascual Baylon in Manila
b. Asylum of St. Vincent de Paul in Manila for
poor girls
c. Hospital of San Jose for orphaned
children and mentally ill
II. American Military Gov.
− Control of epidemics such as cholera, small pox,
and plague (CA: Yersinia pestis, infected rats,
black death)
− Fight against communicable diseases such as
leprosy or Hansen disease (CA: Mycobacterium
leprae), diarrhea or acute gastroenteritis, malaria
(CA: Plasmodium species, Malarial smear,
Vector), and beri-beri (Vit B1 deficiency / Thiamin
def.).
− Leonine Face – chronic stage of leprosy,
disfiguration of the body
Projs and Acts:
a. Established a garbage crematory
b. Approved the first sanitary ordinance and rat control
(CA: Amoebiasis Entamoeba histolytica)
c. Amoebic dysentery (Parasite) – caused by
contaminated water and unclean veg, and malaria –
anopheles minismus flavirostris was pointed out as
vector.
d. Cholera vaccine was first tried
e. Confirmed that plague in man
comes from infected rat
f. Opened a leper colony in Culion, Palawan
g. Founded the manila Medical society and Philippine
Island Medical Association
h. Opened the UP College of Medicine
i. Established Bureau of Science
III. PH Assembly
– New waterworks in Manila was inaugurated to
control cholera (disinfection)
– Nursing school at Philippine Normal School (Ph
Normal University PNU)
o established norms; served as training ins
for the country’s 1st public schools
teacher
– Hygiene and Physiology were included in
curriculum of public elementary school
– Anti-TB (CA: Mycobacterium tuberculosis)
campaign was started
– Philippine Tuberculosis Society was organized
– Pasteur prophylaxis treatment against rabies was
offered
o Louis Pasteur – 1st described live
attenuated vax (attenuation: chemicals
are mixed)
– Opening of the Philippine General Hospital (PGH)
–
–
–
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Use of anti-typhoid vaccine was initiated
Hypochlorite of lime was first used for treating the
water supply of Manila
o Like bleach in water source
Etiology of Amoebic dysentery was made clear
o CA: Entamoeba histolytica
Dry vaccine against smallpox was first used
IV. Jones Law Yrs
– Retrogression rather than progression in so far
as the health was concern
1. Increase CDR - death rate per 1000
person
2. Increase IMR - infant death per 1000
3. Increase Morbidity - rate of incidence of disease
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Increased deaths from smallpox, cholera, typhoid,
malaria, beri-beri (B1 def. Thiamine) and TB
o Typhoid fever – CA: Salmonella typhi, Mary
Mallon: Typhoid Mary (carrier of TF)
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Re-organization happened (re-organized the health
service and encouraged effective supervision)
1. Study the cause and prevalence of typhoid fever
2. The composition, value and vitamin distribution of
many Philippine foods were studied.
3. Schick test was used to determine the causes of
diphtheria (CA: Corynebacterium diphtheriae)
4. Campaign against Hookworm (parasite, lives in
soil) was launched
5. Anti-dysentery vaccine was first tried
6. The roles of seafood in transmission of cholera
and the pollution of fishing sector to typhoid were
studied
7. First training course for sanitary inspector was
given
8. Women and Child labor was passed
9. The mechanism of transmission of dengue fever
(CA: Virus) through Aedes aegypti was studied
10. Construction of Novaliches dam
11. Establishment of School of Hygiene and Public
Health
12. National Research Council of the Philippines was
organized
13. BS in Education major in Health Education was
opened in UP
14. Philippine Public Health Association (PPHA) was
organized
2ND Week (LAB)
Introduction to CPH
Objectives:
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Define Public health
Discuss the scope of the subject
Trace the history of public health in the Philippines
⇒ Public Health
o Science and art of Preventing disease,
Prolonging life and Promoting health through
organized efforts and informed choices of
society, orgs, pub and private community and
indivs – by Charles-Edward A. Winslow
o Divisions:
1. Biostatistics
- Tracking trends, identifying, analyzing,
and applying health care to the
population.
2. Epidemiology
- Brings the aspects of biostatistics and
community health and identify the
factors that influence the overall health
of community.
3. Health Services
- Focus on projs and programs that will
lessen the occurrence of pub h
problems.
o Characteristics:
1. Preventive rather than curative
2. Population level rather than individual level
health issues
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Core Functions:
1. Assessment – diagnostic function
2. Policy development – strategies to improve
health
3. Assurance – actual treatment
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Under is the Ten Essential Pub H Services:
Assessment:
1. Monitor health status to identify community health
probs
2. Diagnose and investigate health probs and health
hazards in community
Policy Development:
3. Inform, educate and empower people about
health issues
4. Mobilize community partnerships to identify and
solve health problems
5. Develop policies and plans that support indiv and
community health efforts
Assurance:
6. Enforce laws and regulations to protect and
ensure health
7. Link people to needed personal health services
8. Ensure competent pub h and HCW
o
9. Evaluate effectiveness, accessibility, and quality
of health services
Serving All Functions
10. Research for development and innovation
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Travis’ Illness-Wellness Continuum – highlevel wellness to premature death; 2 arrows.
Community – Grp of people living together. Clients.
World Views on Community:
1. Fam, Community, Society
a. Individual:
- Patient: ppl who r sick
- Client: ppl who are well
b. Role / relationship: (e.g. parents r expected to
provide care)
- Knowledge
- Attitudes
- Skills
c. Community
- CHN serves up to this level only
- Everything that affects the fam,
eventually the community
2. Contradictions / Conflicts
a. Indiv – intrapersonal conflicts
b. Fam – interfamilial conflicts
c. Community – Intercommunity
d. Society – Intra-societal conflicts
e. Stereotyping – negative perspectives of ppl
about ppl
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Variables Influencing Health Status, Beliefs and
Practices:
1. Internal variables: non-modifiable
a. Biological dimension – genetic makeup
b. Psychological
dimension
–
mind-body
interactions & self-concept
c. Cognitive dimension – lifestyle choices
2. External variable: macrosystem
a. Environment – geographical locs, environmental
hazards
b. Economics – income, occupation, education
c. Fam & Cultural beliefs
d. Social support networks – mass media, politics,
religion
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Health for All by 2000 and Beyond: By Sec. Juan
Flavier, aims to provide health to all by the year 2020.
Primary Health Care: to PHC signed by Marcos on
Oct 19, 1979 making it the priority of DOH.
RA 7160 Local Gov Code of 1991: decentralization.
3. Change – inevitable; CH worker should
constantly assess the community to come up w/
suitable interventions.
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Community as Setting in CHN Practice
Place where:
1. Home – you render your fam to HN
2. Workplace – you render occupational HN
3. Schools – you render school HN
Models:
1. Agent-Host-Environment / Ecological Model by:
Leavell and Clark refers to interplay of agent
(etiological factor), host (intrinsic factors) and envi
(extrinsic factors).
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Health-Illness Continuum Models:
o Dunn’s High-Level Wellness Grid –
environment and health axis; association of
health environment.
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A. Etiologic Factors
1. Biological agents – virus, fungi, bacteria,
helminths, protozoa, ectoparasites.
2. Chemical Elements –
▪ Carnicogens
▪ GMO: Nesvita
▪ Poisons: MSG
▪ Allergens
▪ Transfats
3. Nutritive elements – excess or deficiencies
▪ Marasmus & kwashiorkor
4. Mechanical Factors – accidents
5. Physical – when one is struck by lightning
6. Psychological – such as stress
B. Host
Intrinsic factors:
1. Exposure
2. Response (rxn)
C. Environment
Extrinsic factors:
1. Natural boundaries
2. Biological envi
3. Socio-economic (political boundary)
2. Health Belief Model:
- Relationship bt a person’s belief and behavior in
health
- 3 Components of an individual’s perception:
1. Susceptibility to an illness
2. Seriousness of an illness
3. Benefits of taking action
3. Evolutionary-based Model:
- Illness and death serve an evolutionary function
- Elements considered:
1. Life events
2. Lifestyle determinants
3. Evolutionary viability within the social context
- how indiv function to promote survival and
well-being.
4. Control perceptions – where a person can
influence circumstances in life
5. Health outcomes – physio, behavioral, and
psychological status (interplay)
4. Health Promotion Model – enhance level of ppl’s
wellness.
5. WHO definition (1978) – a state of complete physical,
mental, and social well-being, not merely the absence of
disease or infirmity (sickness).
⇒ Community Health
o Paramedical and medical intervention or approach
concerned w/ the health of all population.
o It aims:
1. Health promotion
2. Prevention of disease
3. Management of factors affecting health
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Major Concepts of Pub H
o Health promotion and disease prevention
o People’s participation towards self-reliance; full
involvement w/ ppl in decision-making process:
Assessment,
planning,
implementation,
monitoring and evaluation.
Significant Individuals:
o Dr. E Winslow:
The science and art of preventing disease,
prolonging life, promoting health and efficiency
through organized community effort to ensure
everyone a standard of living adequate for the
maintenance of health, so organizing these
benefits as to enable every citizen to realize his
birthright of health and longevity.
o Hanlon
It is dedicated to the common attainment of the
highest level of physical, mental and societal
well-being and longevity consistent w/ available
resources at a given time and place. It holds this
goal as its contribution to the most effective total
development and life on the indiv and this
society. (Holistic).
o Purdom:
It prioritizes the survival of human species, the
prevention of conditions which lead to the
destruction or retardation of human function and
potential in early years of life, the achievement of
human potential and prevention of the loss of
productivity of young adults and those in the
middle period of life and the improvement of the
quality of life especially in later years.
o Nightingale:
The act of utilizing the environment of the patient
to assist him in his recovery.
Any indiv is capable of reparative process.