COMMUNITY HEALTH NURSING 1 | NCM 104

CHAPTER 1: OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES

HEALTH • According to the Committee on Economic, Social and Cultural

• As a profession aimed at helping the population achieve better Rights, (United Nations, CESCR, 2000) the right to health
health through their own hands. consists of interconnected and indispensable components:
• As a science, it relies on an understanding the key towards 1. Availability
genuine development in investing in health and healthcare of - Requires that operational public health and channels
people regardless of age, gender, religion, and color (Sumile, of service delivery, products and services as well as
2018). programs be adequate for all.
• It is a shared, complex reality. 2. Accessibility
• Is multidimensional, the well-being of an individual is - Entails that health facilities, services and goods must
determined by factors such as biological and behavioral be made possible and obtainable to everyone.
characteristics, the physical and social environment. - Being non-discriminatory, physically accessible,
• Is a fundamental right of every individual regardless of race, economically accessible (affordable) and information
religion, political belief, economic and social condition. accessible are the four intersecting features of
accessibility.
EARLY, CLASSIC DEFINITION OF HEALTH
3. Acceptability
• “A state of complete, physical, mental, and social well-being and
- Corresponds to respect for medical ethics, being
not merely the absence of disease or infirmity” (World Health
culturally appropriate and gender sensitive.
Organization (WHO), 1958, p.1)
- This clearly define the need for health care centers,
• Social
products services and programs to be people-
o Means relating to living together in organized groups or
centered, able to accommodate the specific needs of
similar close aggregates (American Heritage College
diverse population groups and adheres to the
Dictionary, 1997, p.1291).
international standards of medical ethics for informed
o Refers to units of people in communities who interact with
consent and confidentiality.
one another.
4. Quality
• Social health
- Implies that the health facilities, commodities, and
o Connotes community vitality.
services must be in accordance with specific and
o It is a result of positive interaction among groups within
medical standards.
the community, with an emphasis on health promotion
- Quality health services need to be safe, effective,
and illness prevention.
people-centered, timely, equitable, integrated, and
• In the mid-1980’s, the WHO expanded the definition of health efficient.
to emphasize recognition of the social implications of health.
• Thus, health is: 3. Article II Section 11 and 15 of the 1987 Philippine
o “The extent to which an individual or group is able, on the Constitution
one hand, to realize aspirations and satisfy needs; and, on • At the National Level, affirms health as a fundamental human
the other hand, to change or cope with the environment. right and recognizes the obligation of the state to protect and
Health is therefore, seen as a source for everyday life, not promote the right to health of all Filipinos (Republic of the
the objective of living; it is a positive concept emphasizing Philippines Official Gazette, 1987).
social and personal resources, and physical capacities” • Department of Health (DOH)
(WHO, 1986, p.73) o Leads the health sector towards assuring quality health
care in promoting and protecting the health of all Filipinos.
HEALTH AS A HUMAN RIGHT
• Health as a human right is grounded in: MODELS OF HEALTH
• Guides the nurses in understanding health as a concept:
1. Universal Declaration of Human Rights (UDHR)
• Proclaimed by the United Nations (UN) General Assembly in 1. CLINICAL MODEL
Paris in Dec. 1948. • Health is the absence of signs and symptoms of disease and
• It set those fundamental human rights be universally protected. illness.
• Article 25.1 declares: “Everyone has the right to a standard of • Example:
living adequate for the health and well-being of himself and of o An adult individual who is not particular with his lifestyle
his family, including food, clothing, housing and medical care choices will only seek healthcare when chest pain is
and necessary social services” (United Nations, UDHR, 1948) . encountered and begins to suspect a cardiovascular
disease.
2. International Covenant on Economic, Social and Cultural
Rights (United Nations, CESCR) 2. ROLE PERFORMANCE MODEL
• Art.12: “Health is a fundamental human right indispensable • The ability to perform societal roles defines what health is,
for the exercise of other human rights. Every human being is failure to perform these roles means illness.
entitled to the enjoyment of the highest attainable standard of • Example:
health conducive to living a life in dignity. The realization of the o An employee who reported for work, even if he/she is
right to health may be pursued through numerous, febrile.
complementary approaches, such as the formulation of health 3. ADAPTIVE MODEL
policies, or the implementation of health programmes • Health is a dynamic state.
developed by the World Health Organization (WHO), or the
adoption of specific legal instruments” (United Nations, CESCR,
2000).
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CHAPTER 1: OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES

• An individual is considered to be healthy if he/she was able to

adjust positively to social, mental, and physiological. Illness
exists when the person fails to cope or becomes maladaptive to
these changes.
4. EUDAIMONISTIC MODEL
• An elevated (exuberant) level of wellness or well-being. Illness
is reflected by a lack of vitality.
• Derived from Greek terminology, this term indicates a model
that embodies the interaction and inter-relationships among
the physical, social, psychological and spiritual aspects of life
and the environment. 7. HEALTH BELIEF
• Illness is indicated by a denervation or languishing, a wasting • The Health Belief Model is a theoretical model that can be used
away, or lack of involvement with life. to guide health promotion and disease prevention programs.
5. WELLNESS-ILLNESS CONTINUUM • It is used to explain and predict individual changes in health
• A dichotomous depiction of the relationship between the behaviors.
concepts of health and illness. • It is one of the most widely used models for understanding
health behaviors.

• Movement from the center to the left demonstrates

movement toward health, movement from the center to the
right demonstrates movement toward illness.
• Moving above the line demonstrates movement toward
increasing wellness.
• Moving below the line demonstrates movement toward
decreasing wellness.

DETERMINANTS OF HEALTH AND DISEASE

• It is essential to the community health nurse to understand the
determinants of health and recognize the interaction of the
factors that leads to disease, death, and disability:
1. BIOLOGY
• The individual’s genetic make-up, family history, and any
physical and mental health problems developed during life.
• Examples:
• The health illness continuum is a graphic representation of the o Heredity, Aging, Diet, Physical Activity, Smoking, Stress,
wellness of an individual. Alcohol or Drug Abuse, Injury, Violence, or a Toxic on
• This concept was first proposed by John W. Travis. Infectious Agent.
• According to him a person is not only considered to be healthy • Behaviors interact with Biology in a common relationship, as
based on the absence of disease but also wellness of mental one may influence the other.
and emotional health. • If a person chooses behaviors such as alcohol abuse or smoking,
• The concept demonstrates that a person can have a terminal his/her biology may be changed as a result (example liver
disease and be emotionally prepared for death, while acting as cirrhosis, COPD, CVD).
a support for other people and achieving high-level wellness. • One’s Biology may affect behavior; if a person has Hypertension
• High-level wellness involves progression towards a higher level or Diabetes, he or she may choose to begin an exercise regimen
of functioning, an open-ended and ever-expanding future with and eat more healthfully.
its challenge of fuller potential, and the integration of the whole
2. BEHAVIORS
being.
• The individual’s responses to internal stimuli and external
6. AGENT HOST ENVIRONMENT conditions.
• The triad consists of an external agent, a susceptible host, and
3. SOCIAL ENVIRONMENT
an environment that brings the host and agent together.
• Includes interactions and relationships with family, friends,
• In this model, disease results from the interaction between the
agent and the susceptible host in an environment that supports coworkers, and others in the community.
transmission of the agent from a source to that host. • Has a great impact on the health of individuals, groups, and
communities.
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• Complex in nature because of differing cultures and practices. o These SDH are interrelated, and often cumulatively
• Examples: and indirectly affecting the health of the people.
o Social institutions - law enforcement, religious (Schramme & Ramon, 2018)
communities, schools, and government agencies are also CASE SCENARIO
part of the social environment. • A family of seven (7), a couple with five (5) kids; living in a
o Housing, public transportation and availability of depressed area in Metro Manila; both parents are high school
resources. drop outs, father working as a construction worker (not a
4. PHYSICAL ENVIRONMENT regular basis), earning below the minimum wage; mother is a
• Pertains to an environment that is experienced by the senses- full time housewife, cares for her infant, toddler, preschooler,
what is smelled, seen, touched, heard, and tasted. and two school aged children; not even one of the children goes
• Example: to school. To satisfy their hunger, the usual foods served every
o Presence of infectious substances in the environment, has meal are salt bread “pandesal” and instant noodles.
negative influence on health. o What are the health related problems may be identified in
the given scenario?
5. POLICIES AND INTERVENTIONS
• Can have a profound effect on the health of individuals, groups, NOTES
and communities. • At present, the public health sector is particularly working on
• Examples: the social determinants of health (Schrammer & Ramon, 2018).
o Policies Against Smoking in public places, • In order to improve health equity, WHO advocated for
o Seatbelt and Child restraint laws intersectoral actions; thus, leading to a multisectoral approach
o Litter Ordinances to health.
• Policies are implemented at local, regional, and national levels • Aside from the health sector, other essential sectors in the
by many agencies such as the Department of Health, society such as the government, civil society, local
Department of Education, Department of Interior and Local communities, business, global assemblies, and international
Government, Department of Transportation, and National agencies were made involved (CSDH, 2008).
Housing Authority. • Consequently, a better health outcome will be positively
• Expansion of access to quality health care is essential to instrumental to the attainment of the goals of the other sectors
decrease health disparities and to improve the quality of life (UN Platform on Social Determinants of Health).
and the quantity of years of healthy life. (USDHHS, 2013)
PUBLIC HEALTH NURSES
• Public Health Nurses must work with policy makers and
community leaders to identify patterns of disease and death
and to advocate for activities and policies that promote health
at the individual, family, aggregate, and population levels.
SOCIAL DETERMINANTS OF HEALTH AND DISEASE
• Social Determinants of Health (SDH) are:
o “Conditions in which people are born, grow, live, work and
age; might also be circumstantial elements as such
housing, work conditions and access to recreational
activities; circumstances that influence how an individual
will develop sickness, what risk factor they are exposed to,
how they access services; and is shaped by the distribution
of money, power and resources at global, national and
local levels” (CSDH, 2008)
• Every individual is a unit of a system.
o A person is a member of a family, community, population,
and society.
o Within each of these systems, there are conditions that
surround the person that may have an effect on his/her
well-being.
• SHD may also include:
1. Occupation,
2. Circumstances affecting the way in which people work,
3. Income,
4. Culture,
5. Religion,
6. Education,
7. Racial, and
8. Gender discrimination