H L E D 2 2 0 - C O M M U N I T Y A N D E N V I R O N M E N TA L H E A LT H
Unit I:
Community Health
Kershelle Barker, MPH
Community Health
HLED 220 - UNIT I
OBJECTIVES
By the end of this lecture, students should be able to:
• Define ‘Community Health’ (including ‘Community’, ‘Health’ and ‘Public Health’)
• List at least 4 physical and social/socio-cultural factors which affect the health of a community
• Describe social determinants of health
• Describe the goals of community health
DEFINITIONS
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§
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§
Community
Health
Public Health
Community Health
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DEFINITIONS
Community
“A group of people with diverse characteristics who
are linked by social ties, share common perspectives,
and engage in joint action in geographical locations or
settings”
(MacQueen et al., 2001)
- encompasses population groups and the locus of
programs, interventions, and other actions
N.B. In Community Health, “community” tends to
focus on geographic areas rather than people with
shared characteristics.
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DEFINITIONS
Health
“State of complete physical, mental, and social wellbeing, and not merely the absence of disease or
infirmity”
(World Health Organization)
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DEFINITIONS
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)
Public Health is the larger umbrella under which
Community Health is represented.
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DEFINITIONS
Community Health
§
Field of public health
§
Study and improvement of the health
characteristics of populations within a shared
geographical area
§
Tends to focus on geographic areas rather than
people with shared characteristics
§
Aims to better understand the foundational blocks
of a given community and the role these structures
play in promoting healthy lives
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DEFINITIONS
Community Health
§
Covers a wide range of healthcare interventions
including:
§ Health Promotion
§ Disease Prevention
§ Treatment
§ Management and Administration of Care
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HISTORY
Implications of:
§ Murals
§ Agricultural Revolution
§ Superstition vs. Science
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HISTORY
Murals
§
25,000 BC – Murals on the walls of Spanish caves
documented physical deformities
§ Shows there was some understanding of
differences in physical makeup, and thus, of
health abnormalities
§
21,000 BC – Murals in China showed drawings of
persons digging wells
§ Shows they understood the importance/
necessity of clean drinking water
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HISTORY
Agricultural Revolution
§
~10,000 BC – Domesticated animals carried diseases
that could be transmitted to humans
§ Resulted in zoonoses (diseases transmitted from
animals to humans)
§
Heavy reliance on just one or two crops
§ Resulted in malnutrition (due to a lack of
variation in foods)
§
People lived in larger groups and stayed in the same
place
§ Contributed to easier/quicker spread of diseases
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HISTORY
Superstition vs. Science
§
During the Middle Ages, diseases and cures were
seen as “spiritual phenomena” caused by evil spirits
§
Science and medicine were seen as “evil”
§
As a result, many communities suffered from
diseases like plague and leprosy
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FACTORS
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§
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Physical
Socio-Cultural
Social Determinants
Think about how the following factors
can affect the health of a community
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FACTORS
Physical Factors
1. Development
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§
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Waste production and disposal
Pollution (Air, Water Land)
Infrastructure (Water, Electricity, Waste
Management etc.)
How does community development affect/influence
community members’ health?
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FACTORS
Physical Factors
2. Community Size
§
§
Overcrowding
Communicable Diseases
How does community size affect/influence community
members’ health? Consider ease of spreading,
controlling outbreaks…
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FACTORS
Physical Factors
3. Geographic Location
Climate
Flooding
Insect Vectors
§ Land – e.g. Swamp / Agricultural Lands
§
§
§
How does where a community is located affect/
influence community members’ health?
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FACTORS
Socio-Cultural Factors
Factors that represent parts of the way of life
for a society or specific group of people
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FACTORS
Socio-Cultural Factors
1. Social Networks, Social Support
Can contribute to:
§ Reduced Chronic Disease
§ Improved Mental Health
§ More positive Health Behaviours
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FACTORS
Socio-Cultural Factors
2. Economy
Socioeconomic Status
Poverty
Unemployment
§ Social Class
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§
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How does a community’s financial status affect/
influence community members’ health?
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FACTORS
Socio-Cultural Factors
3. Traditions/Beliefs
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“Rites of passage”
Old health remedies and practices
e.g. female genital mutilation
– used to control women’s sexuality; ensure virginity
before marriage
– leads to long-term negative health and mental
outcomes, including:
•
•
•
•
Infections
HIV transmission
Obstetric complications, fistulas
Psychological trauma
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FACTORS
Socio-Cultural Factors
4. Religion
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Beliefs about certain medicines/treatments
e.g. Donating Blood
– Jehovah’s Witnesses refuse blood transfusions;
e.g. Vaccination
– Muslim community leaders in Pakistan called polio
vaccines “a conspiracy”…“dirty Hindu drugs”…“[laced]
with pigs’ blood to send us all to hell”. This resistance
resulted in a rise in the incidence of polio in 2014.
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FACTORS
Socio-Cultural Factors
4. Religion
e.g. Birth Control
– Some religions are against contraception, resulting in
increased populations, inadequate resources, and
economic burden worldwide
What are some other religious beliefs that affect/
influence community members’ health?
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FACTORS
Socio-Cultural Factors
5. Worldview
Our worldview can influence how we treat others and
the environment:
– Anthropocentric worldview
- Humans dominate the natural world
§
– Biocentric worldview
- Humans are no more or less valuable than all others
– Stewardship worldview
- Humans are responsible for nurturing and caring for
the environment
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FACTORS
Socio-Cultural Factors
6. Education
§
There are associations between low education level
and increased morbidity, mortality, and poor health
outcomes
What are some ways in which education level can affect/
influence community members’ health?
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FACTORS
Socio-Cultural Factors
6. Education
e.g. Malaria and nets:
In a community with a high prevalence of malaria,
community workers distributed nets to be placed
around their beds (to keep mosquitoes out). However,
the residents were not educated about how the nets
would help and instead used them for fishing and other
uses. Malaria continued to spread due to a lack of
education/awareness.
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FACTORS
Socio-Cultural Factors
7. Government
Planning, implementation, and provision of
community services
§ Working conditions, public sector
§
How does the government’s provision of resources
affect/influence community members’ health?
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FACTORS
Socio-Cultural Factors
8. Access
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Good food
Healthcare
Transport
How does access (to goods, services, care etc.)
affect/influence community members’ health?
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FACTORS
Social Determinants of Health
Conditions in the environments in which 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.
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FACTORS
Social Determinants of Health
Examples of these resources include:
- Safe and affordable housing
- Access to education
- Public Safety
- Availability of healthy foods
- Local emergency/health services
- Environments free of life-threatening toxins
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Activity
INSTRUCTIONS
Choose any one of the following 4 photos, and identify the physical and socio-cultural
factors and social determinants of health which you believe affect the health of that
community.
Enter your answers on eSpace for Attendance (Unit 1 Forum).
*Be sure to include which photo you are referring to – 1, 2, 3 or 4)
GOALS &
ACHIEVEMENTS
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COMMUNITY HEALTH
GOALS
- Reduced morbidity and mortality
- Economic development
- Improved quality of life
- Opportunities for education and training
- Prevention of environmental degradation
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ACHIEVEMENTS
10 Great Achievements in Public Health
in the 20th Century
1. Immunizations
2. Motor Vehicle Safety
3. Workplace Safety
4. Control of Infectious Diseases
5. Reduced Heart Disease and Stroke
6. Safer and More Nutritious Foods
7. Improved Maternal Health – Healthier
Mothers and Babies
8. Family Planning
9. Fluoridation of Drinking Water
10. Tobacco Declared a Health Hazard
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Recap
1. Define Community Health.
2. Identify the physical factors which
impact on the health of a community.
3. Identify the socio-cultural factors
which impact on the health of a
community.
4. Describe social determinants of
health.
5. Describe the goals of community
health and some significant
achievements in the field.
HLED 220 - UNIT I
References
Akpinar-Elci, M. (2013). Social factors and cultural resources in environmental health. Lecture. St. George’s University,
Department of Public Health and Preventive Medicine.
Institute of Medicine (US) Committee on Assessing Interactions among Social, Behavioral, and Genetic Factors in Health;
Hernandez LM, Blazer DG, editors. (2006). Genes, behavior, and the social environment: Moving beyond the nature/nurture
debate. 2. The Impact of social and cultural environment on health. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK19924/
Karimjee, M. (2014 February 10). Pakistan: Where conspiracy theories can cost a child’s life. Global Post [Internet] Available
from www.globalpost.com/dispatch/news/regions/middle-east/140210/pakistan-where-conspiracy-theories-can-costchilds-life
Reblin, M. & Uchino, B.N. (2008). Social and emotional support and its implication for health. Current Opinion in Psychiatry,
21(2), 201-205. http://doi.org/10.1097/YCO.0b013e3282f3ad89
Richards, C. (2013). What is public health? Lecture. St. George’s University, Department of Public Health and Preventive
Medicine.