HEALTH CARE (lec)

BSMT 1 – 2ND SEMESTER | BATCH 2024

FOUNDATIONS OF PUBLIC HEALTH

“Health is a state of complete physical, mental, and social 4. HEBREWS (HEBREW MOSAIC LAW)
well-being and not merely the absence of disease or • Stressed prevention of disease through regulation of
infirmity” - WHO personal and community hygiene, reproductive and
Public health is derived from many historical ideas, trial maternal health, isolation of lepers and other
and error, development of sciences, technology and “unclean conditions”, and family and personal sexual
epidemiology. conduct as part of religious practice

OUTLINE 5. GREEKS
• Linked health to environment
I. History of Public Health • Wealthy people valued personal cleanliness,
a. Historical Roots
b. Milestones in the History of Public Health exercise, diet and sanitation
c. Major Achievements of Public Health in the 20th • Came up with the concept of the “Four Humors”:
Century phlegm, blood, yellow bile, and black bile
d. Conceptual Evolution of Public Health
e. The Future of Public Health • Hippocrates contributed largely to the
f. Definition of Public Health professionalism in medicine; he established the
II. The Health Field Concept Hippocratic School of Medicine, which was the first
a. Health Field Concept
b. Public Health
to use terms we still use today such as: acute,
c. Scope of Public Health chronic, endemic, epidemic, paroxysms, and
d. Levels of Health Care exacerbation
e. Focus of Community Health Practice
III. Concept of Community HIPPOCRATES
a. Community
b. Classifications of Community • Greek physician of
c. Components of Community the Age of Pericles
d. Community Health is considered one of
IV. Quality of Health: Community Action & Innovation
a. Health Promotion in Public Health the most outstanding
b. Community Organizing figures in the history
c. General Steps in Community Organizing of medicine
d. Centralized Health Care Services
e. Decentralized Health Care Services • Often referred to as
f. Effects of Health to the Community the Father of
Modern Medicine
• Noted the effect of
HISTORY OF PUBLIC HEALTH food, occupation,
and especially
HISTORICAL ROOTS climate in causing disease
• His book served as a guide for decisions regarding
1. BABYLONIANS the location of urban sites in the Greco-Roman
• Understood need for hygiene world, and may be considered the first rational
• Developed medical skills guide to the establishment of a science-based
public health
2. EGYPTIANS
• Developed a variety of pharmaceutical preparations 6. ROMANS
• Constructed earth privies and public drainage • In general, more focus on preventing diseases
systems rather than curing
• Established rudimentary baths and toilets in dwelling • Viewed medicine from a community health and
places social medicine perspective
• Developed surgical skills, even inventing devices • Emphasized regulation of medical practice
which appeared to be prototypes of modern-day • Galen - a Greek physician who migrated to Rome;
surgical instruments his works became the foundation for the study of
Human Anatomy
3. INDIGENOUS & TRIBAL SOCIETIES • Had provision of pure H2O
• Believed diseases were caused by malevolent • Had establishment of sewers and aqueducts, many
spirits or bad luck; thus, were the presence of of which still exist today
Shamans who were believed to be able to • Supervised Public food preparation
communicate with the spirit world and treat sickness
caused by such

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MIDDLE AGES OR MEDIEVAL PERIOD PROMINENT ARABIC SCHOLARS AND

Lasted from 5th to the 15th century PHYSICIANS
• The period after the fall of Roman Civilization • Al-Razi
• Western Europe experienced a period of social and o Known as the “Father of Pediatrics”
political disintegration. Large cities disappeared, o wrote the book: “The Diseases of Children”
replaced by small villages surrounding the castles of • Avicenna
landlords (Feudalism) o the author for “The Canon of Medicine”
• The only unifying force was Christianity; it was in the ▪ became a major reference book for medical
monasteries that the learning and culture of the Greco- schools worldwide until the middle of the 16th
Roman world was preserved. century
• Poor sanitary conditions
• Increase in communicable diseases (Cholera, Bubonic RENAISSANCE PERIOD
Plague, Small Pox) • Rise of scholars
• The most notorious epidemic: “The Black Plague” also • Girolamo Fracastoro - broadened the public’s
known as “Bubonic Plague” understanding of how epidemics or infections were
• Start of the movement of Health Education and spread
Personal Hygiene • Andreas Vesalius - wrote on the “Structure of the
• Early Christians preserved Roman and Greek Human Body”
ideologies; the roman catholic church especially • William Harvey - did an intensive study of the human
influenced how people looked at health and illness. circulatory system and properties of blood
• Religious convents and monasteries established • Anton van Leeuwenhoek - initiated a new thinking on
hospices to shelter travelers and sick persons diseases and how they can be caused by bacteria and
• Leprosy was the most important disease of the period; microorganisms through a crude microscope
exclusion of Lepers from community at large
• Quarantine or Isolation - method of separating lepers COLONIAL PERIOD
from those unaffected by the disease which is still one • Period of exchanged diseases between the colonizers
of the public health interventions being practiced until and the colonized. (e.g. Spanish brought smallpox to
today America)
• Leper houses (leprosia) were established, and it is • Explorers who came back from the New World brought
estimated that by the end of the 12th century there with them Syphilis which baffled European Physicians:
were 19,000 such houses throughout Europe people thought that water was the disease carrier, thus
• Isolation of leprosy cases during these times represent baths were banned in most places.
the earliest application of the public health practice still • European physicians who introduced remedies of
in use diseases in the European Society:
• As these events occurred, the responsibility for o Charles Louis Laveran - French surgeon &
communal functions was transferred from the feudal discovered parasites in the blood of patients
lords and church leaders to lay councils presided over suffering from symptoms of Malaria
by a hierarchy of hereditary or appointed officials o Ronald Ross - discovered malarial parasites could
• Public health activities such as overseeing the water be transmitted by mosquitoes and through
supply and sewerage, street cleaning, and supervision mosquito bites
of markets fell under the jurisdiction of councils o Edward Janer - the Father of Immunology,
pioneered vaccination or immunization; discovered
SALERNO MEDICAL SCHOOL the vaccine against smallpox
(Schola Medicana Salernitana)
INDUSTRIAL REVOLUTION
• World’s first med school • Rise of industries along with Colonial Period.
• A lay organization independent of the church • Advances in transportation, communication, and other
• Welcomed students of any race or creed forms of technology.
• Where the Regimen sanitatis Salernitanum (The • Public health challenges: sanitation & overcrowding
Salernitan Rule of Health) • Religious women started to provide nursing care in
o the first health guide for masses emphasized institutions and homes.
hygiene, diet, exercise, and temperance, is • Edwin Chadwick - secretary of England’s Poor Law
believed to have originated from. Commission; studied the prevalence & causation of
• Faculty included women who dealt with obstetric preventable diseases, particularly, the working poor in
issues and the renowned peripatetic scholar, England
Constantine the African (1020-1087) • Dr. John Snow - the Father of Epidemiology; he was
o Translated many important Arabic works to Latin able to elucidate how cholera was transmitted by
tracing its source which was actually a water pump
• Robert Koch - developed the field of bacteriology
• Louis Pasteur - introduced the concept on
fermentation, inoculation of vaccine against rabies and
killing the bacteria in milk known as “Pasteurization”

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MILESTONES IN THE HISTORY OF PUBLIC MAJOR ACHIEVEMENTS OF PUBLIC HEALTH IN

HEALTH THE 20TH CENTURY

• 1601 – Elizabethan Poor Law written • Vaccination to reduce epidemic diseases

• 1617 – Sisterhood of the Dames de Charite organized • Improved motor vehicle safety
by St. Vincent de Paul • Safer workplaces
• 1789 – Baltimore Health Department was established • Control of infectious diseases
• 1798 – Marine Hospital Service Department • Decline in death from cardiovascular disease
established in Dublin, where nuns visited the • Improvements in maternal and child health
poor • Family planning
• 1813 – Ladies Benevolent Society of Charleston, • Fluoridation of drinking water
South Carolina founded • Reductions in prevalence of tobacco use
• 1836 – Lutheran deaconess provided home visits in
Germany CONCEPTUAL EVOLUTION OF PUBLIC HEALTH
• 1855 – Beginning of tuberculosis campaign in the U.S.
• 1864 – Beginning of Red Cross
• 1948
o After World War II, WHO (World Health
Organization) was established
o Centers for Disease control and Prevention (CDC)
was established two years later
o John Salk & Albert Sabin discovered penicillin
and developed a vaccine against Polio
• 1976 – discovery of Ebola virus by Peter Piot in Zaire,
Africa
• 1977 – Small pox was eventually eradicated
• 1982 – Selective Primary Health Care was established THE FUTURE OF PUBLIC HEALTH
in Italy
• 1998 - Outbreak of Swine Flu H1N1 in the US • Today it addresses a wide range of issues:
• 1997-2002 – New strains of Swine Flu such as H3N2 o All infectious diseases (HIV/AIDS)
and H1N2 o All chronic diseases
• 1997 – Another strain of Avian Flu virus A(H5N1) hit o Violence
poultry workers in Hongkong o Injury prevention
o Birth defects
EARLY 20TH CENTURY o Bioterrorism
• Urgent health concern – infant mortality
• Public health continues to evolve as it responds to the
• Maternal and child health programs were initiated with
dynamic changes in society, both at the local and global
an emphasis on nutrition, medical care, and eventually
levels
health inspection in schools
• High rates of occupational diseases and industrial
injuries led to programs for industrial hygiene and
DEFINITION OF PUBLIC HEALTH
occupational health The science and art of preventing disease, prolonging life,
and promoting physical health and efficiency through
LATE 20TH CENTURY organized community efforts for the sanitation of the
• As infant and child mortality declined in the environment, the control of community infections, the
industrialized countries, life expectancy and the education of the individual in principles of personal hygiene,
proportions of the elderly in populations increased the organization of medical and nursing service for the early
• After World War II, epidemiological research diagnosis and preventative treatment of disease, and the
concentrated on identifying risk factors for these and development of the social machinery which will ensure to
other chronic diseases; A prominent role for behavioral every individual in the community a standard of living
factors was readily demonstrated adequate for the maintenance of health – Winslow, 1920

20TH CENTURY
• The rise of many developments in Public Health most THE HEALTH FIELD CONCEPT
of which are associated with social reforms
• Is a conceptual model of the determinants of health that
• Early part was predominated by infectious diseases
was used by the authors of visionary report released in
such as Polio & Yellow Fever
1974 and was written by public health scientists in the
• Development of retroviral treatment have shown to Canadian government department of national health
reduce risk of death and complications due to AIDS and welfare
• WHO 2003, outbreak of SARS (Severe Acute • Identifies 4 principal determinants of health:
Respiratory Syndrome)
• 2014 – sudden outbreak of Ebola virus in West Africa
including U.S.A.

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FOUR PRINCIPAL DETERMINANTS OF HEALTH o Family genetics and individual biology – if you
come from a healthy family you have a better
1. HUMAN BIOLOGY chance of staying well
2. ENVIRONMENT
3. LIFESTYLE 2. POLICY DEVELOPMENT: Refers to the efforts to
4. HEALTHCARE ORGANIZATION (our focus) develop policies that support the health of the
• Consists of the quantity, quality, arrangement, population including using of scientific knowledge and
nature, and relationships of people and resources in basis to make policy decision
the provision of health care

CHARACTERISTICS 3. ASSURANCE: Making sure that essential

community-oriented health services are available
One of the evident consequences of the health filed
concept has been… SCOPE OF PUBLIC HEALTH

• To raise human biology, environment and lifestyle to 1. Activities that must be conducted on a Community
a level of categorical importance equal to that of basis:
health care organization • Supervision of community food, water, and milk
• It is comprehensive; any health problem can be supplies as well as medications, household
traced to one, or a combination of the four elements products, toys, and recreational activities
• Permits a system of analysis by which any question • Insect, rodent, and other vector control
can be examined under the four elements in order to • Environmental pollution control including
assess their relative significance and interaction atmospheric, soil, and aquatic pollution, prevention
• Permits a further sub-division of factors of radiation hazards, and noise abatement
• Provides a new perspective on health, a perspective
which frees creative minds for the recognition and 2. Activities designed for prevention of illness,
exploration of hitherto neglected fields disability, or premature death:
• Communicable disease including parasitic infections
• Dietary deficiencies or excess
“Public health is dedicated to the common attainment of the
• Behavioral disorders including alcoholism, drug
highest levels of physical, mental, and social well-being
habituation, narcotic addiction, certain aspects of
and longevity consistent with available knowledge and
delinquency, and suicide
resources at a given time and place.” - Hanlon
• Mental illness including mental retardation
PUBLIC HEALTH • Allergic manifestations and their community sources
• Neoplastic diseases
• Primary goal: Prevention of disease and disability • Acute and chronic non-communicable respiratory
• It is a community-oriented and population-focused diseases
specialty area • Metabolic diseases
• Its overall mission is to organize community efforts that • Certain hereditary or genetic conditions
will use scientific and technical knowledge to prevent • Occupational diseases
disease • Home, vehicular, and industrial accidents
• Has three core functions: • Dental disorders including dental caries and
o Assessment periodontal disease
o Policy development • Certain risks of maternity, growth, and development
o Assurance
3. Activities related to Comprehensive Health Care:
1. ASSESSMENT: • Promotion of development, availability, and quality
• Systematic data collection on the population of health personnel, facilities, and services in the
monitoring the population’s health status and making broadest sense
information available about health of a community • Operation of programs for early detection of disease
• The following are factors cited from WHO Community • Promotion and sometimes operation of emergency
Health Needs Assessment (2001) published by the medical service systems
WHO Regional Office for Europe: • Promotion and sometimes operation of treatment
o Physical environment in which people live, such centers
as the quality of the air they breathe and the water • Facilitation of and participation of continuing
they drink education
o The social environment - the level of social and
emotional support people received from friends 4. Activities concerned with collection, preservation,
and/or family analysis, and use of vital records
o Poverty – which shortens and reduces enjoyment 5. Public education and motivation in Personal and
of life Community Health
o Behavior and lifestyle (e.g. smoking causes lung 6. Comprehensive Health Planning and Evolution
cancer and coronary heart disease) 7. Research – Scientific, Technical, and
Administrative

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LEVELS OF HEALTHCARE • E.g. eating nutritious food, routine immunizations,

etc.
1. HEALTH PROMOTION
• Activities to improve or maintain health issues 2. SECONDARY PREVENTION
o Ensuring adequate rest for toddlers • Focuses on the early identification and treatment of
o Designing the personality development of an existing health problems and after the occurrence of
adolescent health problems
o Retention of natural teeth • Encompasses those activities in the third level of
o Physical fitness and exercise health diagnosis and treatment
• Examples: • E.g. screening of glaucoma, diagnosis and
o Family – parenting education treatment of glaucoma
o Community – family planning services, basic
nutrition 3. TERTIARY PREVENTION
2. DISEASE PREVENTION • Aimed at returning the client to the highest level of
• Specific measures to prevent the disease or functioning possible following treatment of a health
disability categorized as: problem
a. Clinical – immunization and screening, diagnosis • Correlates with the 4th or the rehabilitative level of
and treatment of risk factors health care
b. Behavioral – focus on lifestyle changes • E.g. placing the client on maintenance diet after the
• Preventive health addresses areas such as loss of weight due to illness
immunizations, family planning, hypertension
control, and treatments of STD’s
CONCEPT OF COMMUNITY
o Environmental changes – societal efforts to create
a healthful environment
COMMUNITY
o Example:
▪ Family – providing support groups for parents VARIOUS DEFINITIONS OF “COMMUNITY”
with teenagers
▪ Community – fluoridation of water supply • “A group of people who reside in a specific locality and
exercise some degree of local autonomy in organizing
3. DIAGNOSIS AND TREATMENT their social life in such a way that they can base and
• The restoration level of Health Care; emphasizes on satisfy the full range of their daily needs” - Edward &
the early diagnosis and prompt treatment of Jone, 1976
adolescents for STD
• Example: • “A social group determined by geographic boundaries
o Family – providing counseling for marital problems and/or common values and interests; its members know
o Community – treatment and control of and interact with one another; it functions within a
hypertension particular social structure and exhibits and creates
norms, values, and social institutions” – WHO
4. REHABILITATION
• Limits incapacitation caused by health problems and • “It is a collection of people who share some important
to prevent recurrences features of their lives” (e.g. LGBT community, Filipino
• Example: expat community)
o Physical therapy of post stroke patient
o Family – may be assisted with the chronic Common in these definitions:
debilitation of the family’s breadwinner 1. Network of interpersonal relationships that
o Community – providing services to children of provide friendship and support to members
teenage parents 2. Residence in common locality
3. Solidarity, sentiments, and activities
• INTENT OF THE 1ST AND 2ND LEVELS: To promote
health and preventive disease COMMON ATTRIBUTES
• INTENT OF THE 3rd AND 4TH LEVELS: To prevent • Critical attributes that define a group of people as a
serious consequences arising from health problems community

FOCUS OF COMMUNITY HEALTH PRACTICE 1. GROUP ORIENTATION

• Through group membership an individual gains
1. PRIMARY LEVEL PREVENTION access to skills, services, necessities, and amenities
• Measures designed to promote general optimum of life that one cannot provide on one’s own
health or the specific protection of man against • For the community to continue to provide these
disease agents services it must safeguard its survival
• These are actions taken to prevent the occurrence • This is the reason why communities adopt GROUP
of health problems ORIENTATION in which the group’s goals takes
• Includes reducing the risk factors and preventing over the individual goals
environmental exposures

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2. BONDS BETWEEN INDIVIDUALS 2. EDUCATION

• In many forms such as lifestyle, shared ethnicity, • Laws, regulations, facilities, and activities affecting
culture, living in a specific geographic location, education
similar interests, goals, or occupation. The type of • Ratio of education to learners
bond between members determines the type of • Distribution of education facilities
community • Recipients of education
• Informal education facilities and activities existing in
CLASSIFICATIONS OF COMMUNITY the community

1. URBAN
3. FIRE AND SAFETY
• High density community
• Fire protection facilities and fire prevention activities
• Socially heterogenous population and their distribution in the community
• Complex structure, non-agricultural occupation • Police protection
• Characterized by complex interpersonal social
relations 4. POLITICS AND GOVERNMENT
2. RURAL • Political structures present in the community
• Usually small • Decision making process/pattern of leadership style
• Occupation of population is usually farming, fishing, observed
and food gathering • e.g. democratic, republic, decentralized
• Characterized by primary group relations; well–knit
and having a high degree of group feeling 5. HEALTH
• Health facilities and activities in the community
3. SUBURBAN • Distribution of health facilities
• An outlying part of a city or town • Utilization of health services
• A smaller place adjacent to or sometimes within
commuting distance of a city 6. COMMUNICATION SYSTEMS
• Characterized by the blending of urban and rural • Types of Communication existing in the community
o e.g. telephones, mail, telegrams, internet, etc.
OTHER TYPES • Forms of Communication (verbal, written, nonverbal)
• Formal and informal communication
• Communities with territorial bonds
o Have specifically defined territories and boundaries 7. ECONOMICS
that may be spatial (space), temporal, or both • General occupation of the population
o This reflects the “where and when” dimension of • Types of economic activities such as production,
the definition of community distribution, marketing, and buying of goods
o e.g. Velez college graduates from 1990 to 2000 • Income
form an association
8. RECREATION
• Communities with relational bonds • Recreational activities/facilities present
o Includes groups in which the bonds between • Consumers of these recreations and their
individuals is a common relationship rather than appropriateness
specific boundaries
COMMUNITY HEALTH
***None of the communities discussed are exclusive, any group
may represent more than one type of community. • The attainment of the greatest possible biological,
psychological, and social well-being of the community
as an entity and its individual members and is not just
COMPONENTS OF COMMUNITY
the sum of the health status of all community members
➢ THE CORE • Focuses on the health status of a group of people as
o Represents the people that make up the collective entity rather than as individuals
community
o Included are the demographics of the population as
QUALITY OF HEALTH: COMMUNITY ACTION &
well as the values, beliefs, and history of the people
INNOVATION
➢ EIGHT SUBSYSTEMS “participation is essential to sustain health promotion
action”
1. HOUSING
• Shelter, lodging, and dwellings provided for number HEALTH PROMOTION IN PUBLIC HEALTH
of people or for a community
• Adequacy and availability of the housing facilities to • The process of enabling people to increase control
the whole population over their health and improve it
• Housing laws/regulations governing the people • It represents a comprehensive, social, and political
process; it not only embraces actions directed at

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strengthening the skills and capabilities of individuals, DECENTRALIZED HEALTH CARE SERVICES
but is also action directed towards changing social,
environmental, and economic conditions so as to
alleviate public and individual health (Ottawa, 1986)
• Focused on behavioral changes such as smoking
cessation, diet, and exercise

COMMUNITY ORGANIZING

• The process by which community groups are helped to

identify common problems or goals, mobilize
resources, and in other ways develop and implement
strategies for reaching the goals they collectively have
set (Minklerand Wallerstein, 1997)

GENERAL STEPS IN COMMUNITY ORGANIZING • A decentralized healthcare system poses several pros
and cons in our society.
“Communities should play a lead role in order to achieve o Medical services are not as accessible compared
real empowerment and NOT just community to urban communities which allow and prompt
betterment” – Himmelman, 1992 LGU’s and other private sectors to launch new
ways of providing healthcare services such as tele-
1. Problem identification
visits, home video visits, and other e-healthcare
2. Interface with Community
services to the citizens in rural areas.
3. People Organization
o However, even with the emergence of electronic
4. Community Profile and Assessment
health care services, this will still not be in par with
5. Goal Setting and Formulation of Strategies
actual office visits where doctors can physically
• This process of following the 5 steps in community assess their patient’s conditions
organizing is necessary in: • Another concrete example of a decentralized
o Maintaining community health healthcare system would be the diagnostic centers here
o Understanding population in Cebu. Different testing centers provide varying
o Community health data normal reference ranges to lab results, but with a
centralized system, every diagnostic center would have
• Gathering and analyzing these types of health data are a uniform and standardized normal reference range for
part of the epidemiological study that can be conducted every type of lab test
in the community • A major disadvantage of a decentralized approach is
that flexibility is hard to attain especially with regards to
CENTRALIZED HEALTH CARE SERVICES resources.
• A centralized approach can easily shift its resources to
where and when they are needed.
o So for example, during the start of the COVID-
pandemic, the RT-PCR testing was only available
in major city areas here in Cebu and none of them
were available in a provincial area. This is due to a
decentralized healthcare approach. But if we were
fully centralized, the DOH could have shifted all its
resources to rapidly establish RT-PCR testing sites
all around Cebu, and not just the major city areas.

EFFECTS OF HEALTH TO THE COMMUNITY

• The quality and quantity of human resources depend

on the level of health of the people
• A healthy community produces a healthy citizenry
• A healthy community is an economically developed
• In this diagram showing a centralized healthcare community
system, we can infer that non-specialty care or primary • Less illness, disease, and disability imply a higher
care is integrated in the center of the model of modern quality of life
healthcare, reason being that physicians who specialize
in primary care are grounded in just about every field of
medicine that there is; so whatever you might be
experiencing, your first step would be to consult a
primary care physician

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TAKEAWAY POINTS:

• HEALTH FIELD CONCEPT

1. Human biology
2. Environment
3. Lifestyle
4. Healthcare organization

• PUBLIC HEALTH
o Assessment
o Policy development
o Assurance

• SCOPE OF PUBLIC HEALTH

1. Activities that must be conducted on a Community
basis
2. Activities designed for prevention of illness,
disability, or premature death
3. Activities related to Comprehensive Health Care
4. Activities concerned with collection, preservation,
analysis, and use of vital records
5. Public education and motivation in Personal and
Community Health
6. Comprehensive Health Planning and Evolution
7. Research

• LEVELS OF HEALTHCARE
1. Health Promotion
2. Disease Prevention
3. Diagnosis and Treatment
4. Rehabilitation

• FOCUS OF COMMUNITY HEALTH PRACTICE

1. Primary Level Prevention
2. Secondary Prevention
3. Tertiary Prevention

• QUALITY OF HEALTH: COMMUNITY ACTION &

INNOVATION
o Health Promotion in Public Health
o Community Organizing
o General Steps in Community Organizing
1. Problem identification
2. Interface with Community
3. People Organization
4. Community Profile and Assessment
5. Goal Setting and Formulation of Strategies
o Centralized VS. Decentralized Health Care
Services
o Effects of Health to the Community

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COLONIA, K., LOPEZ, H., & SULAPAS, T. | BSMT 1-E 8