UNIT I

Overview of Public Health Nursing in the Philippines

A. Global and National Health Situations

POPULATION
The global population was 2.8 billion in 1955 and is 5.8 billion now. It will increase by nearly 80
million people a year to reach about 8 billion by the year 2025. In 1955, 68% of the global population
lived in rural areas and 32% in urban areas. In 1995 the ratio was 55% rural and 45% urban; by 2025 it
will be 41% rural and 59% urban. giving a natural increase of about 220 000 people a day.

Today's population is made up of 613 million children under 5; 1.7 billion children and adolescents
aged 5-19; 3.1 billion adults aged 20-64; and 390 million over 65.

The number of people aged over 65 will rise from 390 million now to 800 million by 2025 - reaching
10% of the total population. By 2025, increases of up to 300% of the older population are expected in
many developing countries, especially in Latin America and Asia.

Globally, the population of children under 5 will grow by just 0.25% annually between 1995-2025,
while the population over 65 years will grow by 2.6%. The average number of babies per woman of
child-bearing age was 5.0 in 1955, falling to 2.9 in 1995 and reaching 2.3 in 2025. While only 3
countries were below the population replacement level of 2.1 babies in 1955, there will be 102 such
countries by 2025.

LIFE EXPECTANCY
Average life expectancy at birth in 1955 was just 48 years; in 1995 it was 65 years; in 2025 it will reach
73 years.

● By the year 2025, it is expected that no country will have a life expectancy of less than 50 years.

● Over 5 billion people in 120 countries today have life expectancy of more than 60 years.

● About 300 million people live in 16 countries where life expectancy actually decreased between
1975-1995

AGE STRUCTURE OF DEATH

● In 1955, 40% of all deaths were among children under 5 years, 10% were in 5-19 year-olds, 28%
were among adults aged 20-64, and 21% were among the over-65s.

● In 1995, only 21% of all deaths were among the under-5s, 7% among those 5-19, 29% among those
20-64, and 43% among the over-65s.

● By 2025, 8% of all deaths will be in the under-5s, 3% among 5-19 year-olds, 27% among 20-64 year-
olds and 63% among the over-65s
LEADING CAUSES OF DEATH
● In 1997, of a global total of 52.2 million deaths, 17.3 million were due to infectious and parasitic
diseases; 15.3 million were due to circulatory diseases; 6.2 million were due to cancer; 2.9 million
were due to respiratory diseases, mainly chronic obstructive pulmonary disease; and 3.6 million were
due to perinatal conditions.

● Leading causes of death from infectious diseases were acute lower respiratory infections (3.7
million), tuberculosis (2.9 million), diarrhea (2.5 million), HIV/AIDS (2.3 million) and malaria (1.5-2.7
million).

● Most deaths from circulatory diseases were coronary heart disease (7.2 million), cerebrovascular
disease (4.6 million), and other heart diseases (3 million).

● Leading causes of death from cancers were those of the lung (1.1 million), stomach (765 000), colon
and rectum (525 000) liver, (505 000), and breast (385 000).

HEALTH OF INFANTS AND CHILDREN

● The infant mortality rate per 1000 live births was 148 in 1955; 59 in 1995; and is projected to be 29 in
2025. The under-5 mortality rates per 1000 live births for the same years are 210, 78 and 37
respectively.

● By 2025 there will still be 5 million deaths among children under five - 97% of them in the
developing world, and most of them due to infectious diseases such as pneumonia and diarrhea,
combined with malnutrition.

● There are still 24 million low-birthweight babies born every year. They are more likely to die early,
and those who survive may suffer illness, stunted growth or even problems into adult life.

● About 50% of deaths among children under 5 are associated with malnutrition.

● At least two million a year of the under-five deaths could be prevented by existing vaccines. Most
of the rest are preventable by other means.

HEALTH OF OLDER CHILDREN AND ADOLESCENTS

● One of the biggest 21st century hazards to children will be the continuing spread of HIV/AIDS. In
1997, 590 000 children under 15 became infected with HIV.

● The transition from childhood to adulthood will be marked for many in the coming years by such
potentially deadly "rites of passage" as violence, delinquency, drugs, alcohol, motor accidents and
sexual hazards such as HIV and other sexually transmitted diseases..

● The number of young women aged 15-19 will increase from 251 million in 1995 to 307 million in
2025.

● In 1995, young women aged 15-19 gave birth to 17 million babies. Because of population increase,
that number is expected to drop only to 16 million in 2025. Pregnancy and childbirth in adolescence
pose higher risks for both mother and child.

HEALTH OF ADULTS
● Infectious diseases will still dominate in developing countries. This will be due largely to the
adoption of "western" lifestyles and their accompanying risk factors - smoking, high-fat diet, obesity
and lack of exercise.

● In developed countries, non-communicable diseases will remain dominant. Heart disease and
stroke have declined as causes of death in recent decades, while death rates from some cancers have
risen.

● About 1.8 million adults died of AIDS in 1997 and the annual death toll is likely to continue to rise
for some years.

● Diabetes cases in adults will more than double globally from 143 million in 1997 to 300 million by
2025 largely because of dietary and other lifestyle factors.

● Cancer will remain one of the leading causes of death worldwide. Only one-third of all cancers can
be cured by earlier detection combined with effective treatment.

● By 2025 the risk of cancer will continue to increase in developing countries, with stable if not
declining rates in industrialized countries.

● Cases and deaths of lung cancer and colorectal cancer will increase, largely due to smoking and
unhealthy diet respectively. Lung cancer deaths among women will rise in virtually all industrialized
countries, but stomach cancer will become less common generally, mainly because of improved food
conservation, dietary changes and declining related infection.

● Liver cancer will decrease because of the results of current and future immunization against the
hepatitis B virus in many countries.

● In general, more than 15 million adults aged 20-64 are dying every year. Most of these deaths are
premature and preventable.

● Among the premature deaths are those of 585 000 young women who die each year in pregnancy
or childbirth. Most of these deaths are preventable. Where women have many

pregnancies the risk of related death over the course of a lifetime is compounded. While the risk in
Europe is just one in 1 400, in Asia it is one in 65, and in Africa, one in 16.

HEALTH OF OLDER PEOPLE

● Cancer and heart disease are more related to the 70-75 age group than any other; people over 75
become more prone to impairments of hearing, vision, mobility and mental function.

● Over 80% of circulatory disease deaths occur in people over 65. Worldwide, circulatory disease is
the leading cause of death and disability in people over 65 years.

● Data from France and the United States show breast cancer on average deprives women of at least
10 years of life expectancy, while prostate cancer reduces male average life expectancy by only one
year.

● The risk of developing dementia rises steeply with age in people over 60 years. Women are more
likely to suffer than men because of their greater longevity.
 B. Definition and Focus

PUBLIC HEALTH
● Public Health is the science and art of preventing disease, prolonging life, promoting health and
efficiency through organized community effort for the:

● sanitation of the environment

● control of communicable diseases

● education of individuals in personal hygiene

● the organization of medical and nursing services for the early diagnosis and preventive treatment
of disease

● the development of the social machinery to insure 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.

COMMUNITY HEALTH

➢ Community health focuses on an overall geographic area rather than on shared characteristics such as
age or diagnosis. The defined area could be as small as a neighborhood, or it could encompass a city or
an entire region.
➢ It is a discipline which concerns itself with the study and improvement of the health characteristics of
biological communities. While the term community can be broadly defined, community health tends to focus on
geographical areas rather than people with shared characteristics.

PUBLIC HEALTH NURSING

public health nurses are able to educate people about health issues, improve community health and
safety and increase access to care.

Public health nurses believe a person’s health is affected by many factors, including genetic makeup, lifestyle
and environment. Instead of waiting for patients to come to the hospital with an illness, they go into
communities to try and help people improve their health and prevent disease.

For people who don’t have access to care, public health nurses may also provide direct health care services,
including preventive care, screening services and health education.

Public health nurses also:

• Monitor health trends and identify health risk factors unique to specific communities
• Set local priorities for health-related interventions to provide the greatest benefit to the most people
• Advocate with local, state and federal authorities to improve access to health services for underserved
communities
• Design and implement health education campaigns and disease prevention activities, such as immunizations
and screenings
• Tell people about locally available health care programs and services to improve access to care
• Educate and provide direct health care services to vulnerable and at-risk populations

COMMUNITY HEALTH NURSING

Community health Nursing is the synthesis of nursing and public health practice applied to promote and
protect the health of population. It combines all the basic elements of professional, clinical nursing with
public health and community practice.

COMMUNITY HEALTH NURSE RESPONSIBILITIES

What exactly does a community health nurse do? Simply put, they aim to improve the health of community
members. They do this in many ways, including through:

➢ Medical treatment
➢ Rehabilitation
➢ Health education
➢ Advocacy
➢ Research
➢ Collaboration with other healthcare workers and with government agencies

Community health nurses work in schools, churches, and government agencies. They focus on vulnerable
populations, including low-income families, people living in rural areas, immigrants, and individuals with
disabilities.