Northern-West State Medical University named after I.I. Mechnikov
Department of Public Health and Health Care
Elena A. Abumuslimova
Ph.D., Associate Professor
The Universal Declaration on Human Rights:
 “Everyone has a right to a standard of a living adequate
for the health and well being of himself and his family,
including food, clothing, housing and medical care.”
Universal Declaration of Human Rights, 1946
 - What does “health “ mean for you?
- Which factors are most important
for health?
Drugs
What is health?
Family
Feeling good
Smoking
Older people
Blood
pressure
Diabetes
Food safety
Positive
health
Bad
Housing
HIV/ AIDS
Waiting
Lists
Exercise
Parenting
Water
Fluoridation
Heart
Disease
Theories of health:
• the theory that health is an ideal state,
• the theory that a person is healthy if she can function
in a socially useful role,
• the theory that health can be bought or given as if it is
a commodity,
• the theory that health is an ability or strength to adapt
to the changing challenges and circumstances of life,
etc..
Defining Health:
The Medical Definition
 The normal physical state, i.e., the state of
being whole and free from physical and
mental disease or pain, so that the parts of the
body can carry on their proper function.
Defining Health:
The World Health Organization
 Health is a state of complete physical, mental,
and social well-being and not merely the
absence of disease and infirmity.
 Health is a positive concept emphasizing
personal resources, as well as physical
capacities.
Three Broad Concepts of Health
 Medical (Traditional)
 Behavioural (Lifestyle)
 Socio-Environmental (Structural)
 These approaches lead to different definitions of
problems, different strategies, different target groups,
and different people responsible for the activities of
promoting health.
Medical concept
Concepts of Health Promotion:
Medical Approach I (Traditional, Biomedical)
 Health Concept is biomedical, absence of disease
and/or disability
 Leading Health Problems defined in terms of
disease categories and physiological risk factors
such as physiological deviation from the norm:
CVD, AIDS, diabetes, obesity, arthritis, mental
disease, hypertension, etc.
Concepts of Health Promotion:
Medical Approach II
 Principal Strategies: surgical interventions,
drug and other therapies, health care, medically
managed health behaviour change (diet, exercise,
patient education, patient compliance), screening for
physiological and genetic risk factors
 Target: high risk individuals
 General Approach: Individualized
 Actors: physicians, nurses, allied health workers
Behavioural concept
Concepts of Health Promotion:
Behavioural Approach I (Lifestyle, Public
Health)
 Health Concept is individualized, health as
energy, functional ability, disease-preventing
lifestyles
 Leading Health Problems defined in terms of
behavioural risk factors: smoking, poor eating
habits, lack of fitness, drug abuse, alcohol abuse,
poor stress coping, lack of life skills, etc.
Concepts of Health Promotion:
Behavioural Approach II
 Principal Strategies: health education, social
marketing, advocacy for public policies supporting
lifestyle choices (e.g. smoking bans, low fat meat
production, bicycle paths, advertisement bans)
 Target: high risk groups, children and youth
 General Approach: individualized, elements of
societal focus as related to public policy
 Actors: public health workers, illness-related advocacy
groups (e.g., Cancer Society), governments
Socio-Environmental concept
Concepts of Health Promotion:
Socio-Environmental Approach I (Structural)
 Health Concept is a positive state defined in
connectedness to one's family/friends/community,
being in control, ability to do things that
are important or have meaning, community and
societal structures supporting human development
 Leading Health Problems defined in terms of
psychosocial risk factors and socio-environmental risk
conditions: poverty, income gap, isolation,
powerlessness, pollution, stressful environments,
hazardous living and working conditions, etc.
Concepts of Health Promotion: SocioEnvironmental Approach II (Structural)
 Principal Strategies: small group development,
community development, coalition building, political
action and advocacy, societal change
 Target: high risk societal conditions
 General Approach: structural, focussed on
organization of communities and society, development
of just political/economic policies
 Actors: citizens, social development and welfare
organizations, political movements and parties
Health Field Concept:
 Lifestyle
 Human Biology
 Environment
 Health Care
Lifestyle is a main medical-social factor
of health
Features of a lifestyle :
 labour activity and working conditions;
 economic - household activity (a kind of dwelling, a floor space,
a conditions of life, time spent for household activity, etc.);
 the recreational activity directed on restoration of physical
strengths and interaction with an environment;
 social activity in family (care of children, family interrelations);
 family planning and mutual relation of family members;
 formation of behavioral characteristics and the social psychological status;
 medical-social activity (the attitude to health, medicine, aiming
of healthy lifestyle).
Structure of a Lifestyle:
 level of living (structure of incomes on the person),
 quality of a life (the measured parameters describing a
degree of social security of the person),
 style of a life (psychological specific individual features
of behavior),
 mode of life (a national - social order of a life, a life
culture).
Lifestyle depends on:
 social and economic structure of a society,
 an educational level,
 culture,
 relations among people,
 traditions,
 social installations in family,
 personal characteristics.
The most part of these factors together with hygienic
characteristics of being, construct the generalized concept
"lifestyle" which share of influence on health makes more
than 50 % among all factors.
Environment
 air quality
 food protection
 radiation protection
 solid waste management
 hazardous waste management
 water quality
 noise control
 environmental control of recreational areas
 housing quality
Biological characteristics of a person
 (the sex, age, a heredity, the constitution,
temperament, adaptable opportunities, etc.) make in
general share of influence of factors on health no more
than 20 %.
Health Care.
Health Services Administration/Management
 Only the insignificant part (8-10 %) parameters of
health are determined by a level of activity of medical
institutions and efforts of medical workers.
Parameters for an estimation of
public health according the WHO:
 Deduction of a total national product on public health
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services.
Availability of the primary medical-social help.
Coverage of the population by medical aid.
A level of population immunization.
A rate of pregnant women observed by qualified
specialists.
A quality of food for children.
A level of children's death rate.
Average forthcoming life duration.
Hygienic literacy of the population.
Criteria of health
 Medical-demographic (birth rate, death rate, a
natural increase, infantile death rate, birth frequency
of the prematurely born children, average
forthcoming duration);
 Morbidity (general, infectious, with temporary
disability, according to medical surveys, the most
important non-communicable diseases,
hospitalization);
 Primary physical disability;
 Indices of physical development;
 Indices of mental development.
Life Expectancy Map
From Wikipedia
Four levels of health:
 Health of the separate person - individual health;
 Health social and ethnic groups - group health;
 Health of the population of administrative
territories - regional health;
 Health of a population, a society as a whole public health.
Groups of health at complex adults health
estimation:
 1st group - healthy persons (not being ill within one year or
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seldom applying to the doctor and without disability);
2-nd group - practically healthy persons, with functional
and some morphological changes or seldom being ill
within one year (single cases of acute diseases);
3-d group - patients with frequent acute diseases (more
than four cases and 40 days of disability per year);
4-th group - patients with durable chronic diseases (the
compensated condition);
5-n group - patients with often aggravations of durable
chronic diseases.
Most important problems of global health
today
 Communicable, maternal, perinatal and
nutritional conditions
 Noncommunicable diseases
 Injuries
The leading individual problems,
based on DALYs (disability-adjusted life years)
 lower respiratory infections;
 diarrheal diseases;
 conditions arising during the perinatal period;
 unipolar major depression;
 ischemic heart disease & cerebrovascular disease;
 tuberculosis;
 measles;
 road traffic accidents;
 congenital anomalies;
 malaria;
 chronic obstructive pulmonary disease;
 falls;
 anemia & iron-deficiency anemia.
 Non-communicable diseases are the most
widespread diseases seen by the majority of
medical students in their practice.
 We need to work together to share our
knowledge about these conditions for
prevention and cure.
What is a health system?
What is a health system?
 It is the sum total of all the organizations,
institutions and resources whose primary
purpose is to improve health.
 A health system needs staff, funds, information,
supplies, transport, communications and overall
guidance and direction. And it needs to provide
services that are responsive and financially fair,
while treating people decently.
Where is the problem?
 Problems with health systems are not confined to
poor countries. Some rich countries have large
populations without access to care because of
inequitable arrangements for social protection.
Others are struggling with escalating costs
because of inefficient use of resources.
 " Public health services" means activity on
preservation, improvement, maintenance and
strengthening of health of the population various
groups.
 The optimization of public health system is the
major part of social - economical policy of the
State.
 Public health professionals try to prevent problems
from happening or re-occurring through
implementing educational programs, developing
policies, administering services, regulating
health systems and some health professions, and
conducting research.
 Science of public health is also a field that is concerned
with limiting health disparities and a large part of
public health is the fight for health care equity, quality,
and accessibility.
Public health is mainly composed of the
following core areas:
 Behavioral Science/Health Education
 Biostatistics
 Emergency Medical Services
 Environmental Health
 Epidemiology
 Health Services Administration/Management
 International/Global Health
 Maternal and Child Health
 Nutrition
 Public Health Laboratory Practice
 Public Health Policy
 Public Health Practice
Behavioral Science / Health Education
 Stopping the spread of sexually transmitted diseases, such as
herpes and HIV/AIDS; helping youth recognize the dangers of
binge drinking; and promoting seatbelt use.
 Behavioral Science focuses on ways that encourage people to
make healthy choices. This includes the development of
community-wide education programs that range from promoting
healthy lifestyles in order to prevent disease and injury, to
researching complex health issues.
 Public health workers also promote more efficient uses of health
services, adopt self-care practices, and participate actively in the
design and implementation of health programs.
Biostatistics
 Estimating the number of deaths from gun violence or
looking at trends in drunk driving injuries by using
math and science is the study of biostatistics.
 Using biostatistics, health workers can identify health
trends that lead to life-saving measures through the
application of statistical procedures, techniques, and
methodology.
Environmental Health
 The air we breathe; the water we drink; the complex
interactions between human genetics and our
surroundings.
 How do the built and natural environments influence
our health and how can we reduce risk factors? These
environmental risk factors can cause diseases such as
asthma, cancer, and food poisoning.
Epidemiology
 When food poisoning or an influenza outbreak
attacks a community, the epidemiologists are asked to
investigate the cause of disease and control its spread.
 Epidemiologists do fieldwork to determine what
causes disease or injury, what the risks are, who is at
risk, and how to prevent further incidences.
 Some of the most important health-related
discoveries in history are associated with
epidemiology including the landmark 1964 Surgeon
General's report on smoking tobacco stating its
harmful effects.
Health Services
Administration/Management
 Managing the database at a school clinic; developing
budgets for a health department; creating polices for
health insurance companies; and directing hospital
services all depend on health administrators.
 The field of health services administration combines
politics, business, and science in managing the
human and fiscal resources needed to deliver effective
public health services. Specialization can be in
planning, organization, policy formulation and
analysis, finance, economics, or marketing.
International / Global Health
 Globalization has linked our health more closely to one another
than ever before. The rapid movement of people and food across
borders means that a disease can travel from a remote village to
an urban hub at breakneck speed. Global public health meets
the rising health challenges that transcend national boundaries.
This international field encompasses virtually all specializations
in public health.
Maternal and Child Health
 Providing information and access to birth control;
promoting the health of a pregnant woman and an
unborn child; and dispensing vaccinations to children
are part of maternal and child health.
 Professionals in maternal and child health improve
the public health delivery systems specifically for
women, children, and their families through
advocacy, education, and research.
Nutrition
 Promoting healthy eating and regular exercise;
researching the effect of diet on the elderly; teaching
the dangers of overeating and overdieting are the
responsibility of public health nutritionists.
 In short supply in both public and private sectors, this
field examines how food and nutrients affect the
wellness and lifestyle of population. Nutrition
encompasses the combination of education and
science to promote health and disease prevention.
Public Health Policy
 Analyzing the impact of seat belt laws on traffic
deaths; monitoring legislative activity on a bill that
limits malpractice settlements; advocating for
funding for a teen anti-smoking campaign.
 Professionals in public health policy work to improve
the public's health through legislative action at the
local, state, and federal levels.
Public Health Practice
 Public health is an interdisciplinary field and
professionals in many disciplines such as nursing,
medicine, veterinary medicine, dentistry, and
pharmacy routinely deal with public health issues. A
degree in public health practice enables clinicians to
apply public health principles to improve their
practice.
The major theoretical problems
of public health services :
 social conditionality of public health,
 illness as a biosocial phenomenon,
 the basic categories of public health services
(public health, material - economic base, the
staff, etc.),
 forms and ways of development of public health
services under various social and economic
conditions, etc.
The main goals of science on public health
and public health services :
 study of medical-social factors, life conditions and a
lifestyle influence on the public health;
 development of scientifically proved recommendations
on the prevention and elimination of adverse factors,
 improving actions for increase of a level of health of the
population;
 an estimation of criteria of public health and quality of
medical aid, and their optimization.
Main directions of development of public
health service at the present stage:
 protection of motherhood and the childhood,
 creation of optimum social and economic, legal and
medical-social conditions for strengthening health of
women and children,
 planning of family,
 the solving of medical-demographic problems,
 increasing of quality of health care.
Four categories of the general indices
which characterize a condition of public
health services in any country according to
the World Health Organization (WHO):
 the governmental policy in the field of public
health service;
 social and economic indices;
 indices of security of the medical-social help;
 Indices of health status of the population.
Structure of a subject “Public health and
health care service”:
 a history of public health services;
 theoretical problems of public health services;
 the state of health and methods of its studying;
 the organization of medical-social security and medical
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insurance
the organization of medical aid to the population;
maintenance of sanitary-and-epidemiologic well-being of
the population;
Economic forms of perfection of public health services,
management, marketing and modelling of medical services;
the international cooperation in the field of medicine and
public health services.
Methods of medical-social researches:
 historical;
 dynamic observation and the description;
 sanitary – statistical method – as a basic;
 the medical-sociological analysis;
 expert estimations; expertise assessment method
 the system analysis and modelling;
 organizational experiment;
 scheduled - normative, etc.
Objects of medical -social researches are:
 groups of persons, the population of administrative
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territory;
separate establishments (polyclinics, hospitals, the
diagnostic centres, the specialized services);
public bodies and establishments of public health
services;
objects of an environment;
the general and specific risk factors of various
diseases, etc.
The basic elements of health complex
study and its determining factors
 collecting of the information on health status;
 processing and analysis of the information on health
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status;
promotion of hypothesis about mutual dependence of
environment factors and health status;
directed study of environment factors and profound
study of health characteristics;
revealing of quantitative dependences between
environmental factors of and health characteristics;
decision-making on environmental improvement for
primary morbidity prophylaxis;
realization of the accepted decisions;
efficiency control of the accepted decisions.