Basic Introduction to public health .ppt

introduction to public health

1. The Basics of Public Health

2. Learner Objectives
•By the end of this presentation,
participants will be able to…
1.Define public health
2.List the determinants of health
3.Identify one example of local or state
public health practice

3. What is Public Health?
•Definitions vary
•Key terms
–Population health
–Prevention

4. Public Health
~Vision~
Healthy People in Healthy Communities
~Mission~
Promote physical and mental health
and
Prevent disease, injury, disability

5. Definition of Public Health
•‘Public health is the science and art of preventing disease, prolonging life and
promoting physical health and efficiency through organised community efforts
for the sanitation of the environment, the control of community infections, the
education of the individual in principles of personal hygiene, the organisation
of medical and nursing service for the early diagnosis and preventive
treatment of disease, and the development of social machinery which will
ensure to every individual in the community a standard of living adequate for
the maintenance of health’. (Winslow, 1920)


Charles-Edward Amory Winslow (1877 – 1957)
Source: Yale School of Public Health

6. Definition of Public Health
•Sir Donald Acheson in 1988 defined it as: ‘the science and art of
preventing disease, prolonging life and promoting, protecting and
improving health through the organised efforts of society’
•The field pays special attention to the social context of disease and
health, and focuses on improving health through society-wide measures
like vaccinations, the fluoridation of drinking water, or through policies
such as seatbelt and non-smoking laws.

•Donald Acheson Report, 1988, UK

7. The Acheson report shows the link between health and
mortality

8. What is public health?
•Public health is considered to be about the health of people or communities, as
opposed to individual health
•The concept of public health is not unique and has changed over the years due
to changes in the health status of the population and the determining situations
of health. This definition of public health is directly linked to the wider
definition of health, found in the preamble of the constitution of the World
Health Organisation (1948), where health is referred to as "a state of complete
physical, mental and social well-being and not merely the absence of disease."
This means that public health aims to create the right conditions in order to
provide this state of health for the benefit of society.

10. Leading differences between basic, clinical and
public health activities and research
Characteristics Basic Clinical Public Health
Who/What
is studied
Cells, tissues,
animals
laboratory
Patient seeking for
health services
attendance
Populations or
communities
Activity or research
goal
Understand the
mechanisms of disease
and the effects of toxic
substances

Improve the diagnosis
and treatment of
disease
Prevention of disease
and health promotion
Examples Toxicology,
inmunology
Pediatric and clinical
nursing
Epidemiology,
Environment Sciences

11. Public Health Functions (I)
•Surveillance, analysis and evaluation of population’s health status
•Monitor health status to identify population or community health problems
•Diagnose and investigate health problems and health hazards in the community
•Monitor environmental and health status to identify and solve community environmental
health problems
•Diagnose and investigate environmental health problems and health hazards in the community
•Act as quickly as possible with efficacy in solving and improving these problems
Example:
The Spanish National Health Survey detects tobacco/smoking as a public health problem

12. Public Health Functions (II)
•Develop policies and plans that support individual and community
health efforts
Once the health problem is identified, public health seeks the best
interventions and strategies to solve the public health problem and
identify health and/or social actors or agents that can be carried out in
the best way possible
Example:
Identify effective policies that reduce the number of smokers in the society

13. Public Health Functions (III)
•Health Promotion
This is a public health function that tries to promote the health of the
population, educating in health from the different health, education and
mass media facilites
Example:
Implementation of preventive measures to advantage smoking - free areas
Awareness-raising campaign in all the society sectors

14. Public Health Functions (IV)
•Disease Prevention
There are two strategies to address diseases prevention, the high risk
approach an the population approach
•High risk approach
The high risk approach is aimed at individuals particularly predisposed to
an illness and an individual prevention manner is offered to them
•Population approach
The population approach attempt to control the factors of the population as a
whole without focus ing on a specific collective matter

15. Public Health Functions (IV)
•Disease Prevention (2)
•There are three levels of prevention
•Primary Prevention: to intervene before a disease appears
•Secondary Prevention: to intervene in pre-symptomatic phases
•Tertiary Prevention: to intervene when the individual is already ill. Try to
mitigate the effects of disease

16. Public Health Functions (V)
•To develop effective programs and health facilities to protect health
The development and implementation of programmes that promote health
improvement of the population as a whole, with the condition that they are based
on efficacy scientific evidence based and that they help to increase the
population’s quality of life
Example:
To develop health programmes aimed to help smokers to give up smoking and
health facilities with this specific function

17. Public Health Functions (VI)
•Evaluation of public health policies, strategies and facilities
Having just implemented, whatever process included in society to solve or
improve the health problems must be evaluated, to check its right performance
and functioning and analyse if it is associated with an improvement of the health
problems for which were developed
Example:
To evaluate the effect caused by the implementation of these politics and
programmes on the number of smokers

18. Public Health…
•Prevents epidemics and the
spread of disease
•Protects against environmental
hazards
•Responds to disasters and
assists communities in recovery

19. Public Health…
•Prevents injuries
•Promotes healthy behaviors
•Assures the quality and
accessibility of health services

20. A Public Health System
•Who?
–Public entities
–Private entities
–Voluntary entities
•What?
–A network

21. The Public Health System
MCOs
Home Health
Parks
Economic
Development
Mass Transit
Employers
Nursing
Homes
Mental
Health
Drug
Treatment
Civic Groups
CHCs
Laboratory
Facilities
Hospitals
EMS Community
Centers
Doctors
Health
Department
Churches
Philanthropist
Elected
Officials
Tribal Health
Schools
Police
Fire
Corrections
Environmental
Health

22. Workforce
•Diverse and Multidisciplinary
•Examples…
 Biostatisticians
 Dieticians
 Environmental Health Specialists
 Behavioral Health Specialists

23. Core Components
ASSESSMENT
of the health of
the community


ASSURANCE
of the public’s
health
POLICY
DEVELOPMENT
in the public’s
interest

24. 10 Essential Services
1.Monitor health status to
identify community health
problems
2.Diagnose and investigate
health problems and health
hazards in the community

25. 10 Essential Services
3.Inform, educate, and
empower people about
health issues
4.Mobilize community partnerships
to identify and solve
health problems

26. 10 Essential Services
5. Develop policies and
plans that support
health efforts
6.Enforce laws and regulations that
protect health and
ensure safety

27. 10 Essential Services
7.Link people to personnel
health services and
assure the provision of
health care
8. Assure a competent public health
and health care
workforce

28. 10 Essential Services
9.Evaluate the effectiveness,
accessibility, and quality
of services
10. Research for new insights and
innovative solutions to
health problems

29. Public Health Approach
Public Health
Model

Medical
Model


Versus

30. Determinants of Health

31. Determinants of Health
•Genetic
•Behavioral
•Social
•Environmental
•Personal
health care

32. Achievements
•Vaccination
•Safer Workplaces
•Safer & Healthier Food
•Motor Vehicle Safety

33. Achievements
•Control of Infectious
Diseases
•Family Planning
•Decline in Deaths from
Heart Disease & Stroke

34. Achievements
•Recognition of Tobacco
Use as a Health Hazard
•Healthier Mothers and
Babies
•Fluoridation of Drinking
Water

43. 1. INTRODUCTION

46. 1.1Definition
•Demography is the scientific study of human population which
includes study of changes in which population size, composition
and its distribution.
1.2 Concept and scope
Concept:
Demography is the branch of social size, structure, which deals with
the study of size, structure and distribution of populations, along
with the spatial and temporal changes in them in response to
birth, migration and ageing death.

47. Scope:
Demography is the science of population ,in its most general
meaning a population is a set of people who live in a specific
land area ,a commune, district and a country or contient etc.
A formal demography is concerned with the size, distribution,
structure and changes of the population

48. Importance…..

49. Reaffirming………
•Changes in population size
•Composition of population
•Distribution of population in space

54. 3.WORLD POPULATION TRENDS
•1800 : 1
st
billion
•1930: 2
nd
billion - 130
years
•1960 : 3
rd
billion - 30
years•1974
:
4
th
billion
- 15 years
•1987
:
5
th
billion
-12
years
•1999
:
6
th
billion
-12
years
•2014
:
7
th
billion
-15
years
•2025
:
8
th
billion
-
expected

55. •Three fourths of the world’s population lives
in the developing countries

56. 3.1 Birth and Death rates
•Birth rate: Decrease affected by:
•Changes in government attitudes towards
growth.
•Awareness and Education
•Increased availability of contraception
•Extension of services through F.P.
programme
•Marked change in marriage patterns

57. •Birth rate of WORLD fell gradually from 32.9 per 1,000 people
in1970 to 18.2 per 1,000 people in 2019.
•Death rate: Decrease affected
•Better MCH services
•Successful EPI immunization
•Diarrheal Disease Control and Acute Respiratory Infection
control programme
•Control of other infectious diseases
•The death rate for World in 2019 was 7.579 deaths per 1000
people, a 0.44% increase from 2018.

58. •Growth rate
•CBR-CDR= Current Annual Growth Rate
•GR like train
Rating
Annual
GR%
StationeryNo
growth
Slow <0.5
Moderate0.5-1
Rapid 1-1.5
Very rapid1.5-2
Explosive2-2.5>

59. Factors affecting GR:
•Age distribution, marriage customs,
cultural, social and economic factors.
•Peak around 1970
•2.2% Africa, 1.5% Asia, 1.3% Latin America,
0.2% in Europe.
•95% in developing countries
•1/3 population < 15yrs age group
•Estimated 10 billion by 2020
•Global total fertility rate 2.6%
•176 people/ minute

60. 4. DEMOGRAPHIC TRENDS IN INDIA
1.DEMOGRAPHIC INDICATORS : (major classifications)
1.Measurement of Mortality.2. Measurement of Morbidity.
3. Measurement of disability. 4. Measurement of natality.
5. Measurement of the presence, absence or distribution of the characteristics
or attributes of the disease. 6. Measurement of medical needs, health care
facilities, utilization of health services and other health related events. 7.
Measurement of the presence, absence or distribution of the environmental
and other factors suspected of causing the disease.
8. Measurement of demographic variables.

61. Demographic Trends in India
Rates, Ratios and Proportions
Epidemiologists express health events as Rates, Ratios and Proportions
Rate: Measures the occurance of some particular event in a population
during a given period of time period. It is the statement of the risk of of
developing a condition. It indicates the change in some event that takes
place in a population over a period of time
It comprises of:
1. numerator, 2. denominator and 3. multiplier.

62. Ratio: Expresses a relation in size between two random
quantities. (E.g)x : y (or) x/y
Proportion: Is a ratio which indicates the relation in magnitude of
a part of the whole. Expressed in terms of Percentage.
The numerator is always included in the denominator.A
Proportion is usually expressed as percentage.
(Eg) The no. of children with scabies at a certain time.
x 100 The total number of children in the village at the
same time

63. 4.1a. Demographic Indicators
The indicators are specified under 2 classifications
•Population Statistics:
•Population size,
•sex ratio,
•Density
•dependency ratio
•Vital Statistics:
•birth rate & death rate,
•natural growth rate,
•life expectancy at birth,
•mortality
•fertility rates.

64. Identify areas that need policy and programmed interventions, setting near and far term
goals, deciding priorities
India
•Land area : only 2.4% of world land area
•However support 17.5% of world’s population

65. 1921- big divide – absolute number of people added to the
population each decade has been on the increase.
India is now the second most populated country of the
world after China.
Population of India is 1.37 billion or 1,369 millions in 2019,
compared to 1.354 billion in 2018.
Population growth rate for 2019 is projected at 1.08%.

67. 4.2: Age & sex composition
•0-14 yrs : male population is 0.4% more than
female
•60+ : female population 0.7%more than
male
•Proportion < 14 yrs is showing decline
•Proportion of elderly > : burden on
health services in the country

68. 4.3: Age Pyramids:
Broad base
tapering
top
- typical of
developing
country

69. 4.4 Sex ratio:
•No of females/1000 males
•Sex composition is affected by
-mortality conditions of males and females
-sex selective migration
-sex ratio at birth
-Female deficit syndrome is considered
adverse because of social implications

70. •Low sex ratio indicates strong male child preference
•Consequent gender inequities
•Neglect of girl child resulting in higher mortality at younger
age
•Female infanticide
•Female feticide
•Higher MMR
The easy availability and accessibility of sex determination may
be a catalyst for the same

71. Sex Ratio in India:
•Females : 48.0%
•Males : 52.0%
•Sex Ratio: 1.08(Males to Females)
Kerala is the only state with 1,058 females per 1000
males
Sex ratio at birth: No.of females per 1000 males
•Affected by sex selectivity
•2014 – 2016 : 898
•There is urban - rural difference seen seen
•Tamilnadu sex ratio is 903: U = 915 and R = 926
Child sex ratio: 0 – 6 years
•Considerable fall has been seen
•1961 = 927& 2011 = 914

72. 4.5 Dependency Ratio:
Total dependency ratio (TDR) =
0-14 years of age + pop. >65 years x 100 population on 15 to 64 years
•Also called Societal dependency ratio and can be divided as
•Young age D.R.(0-14),
•Old age D.R.(>65 years).
•50.546 is the TDR (2016)

73. •Demographic bonus: connotes the period when the DR in a
population declines because of decline in fertility, until it starts
to rise again because of increasing longevity.
•Demographic burden: connotes the increase in the TDR during
any period of time , mostly caused by increased old age
dependency ratio.

74. 4.6 Density of the population
•One of the important indices of population
concentration is the density of population.
•It is defined as the number of persons living per
sq km.
•The population density of India in
•2016 was 401.4,
•2011 was 382 per sq km as compared to
•325 in 2001,
•267 in 1991
•and 77 in 1901.

75. 4.7 Urbanization
•No.of persons residing in
urban localities
•In India urban areas means:
•towns,
•places more than 5000 inhabitants,
•density not less 1000 persons per square mile or 390
per Sq km
•and atleast 3/4
th
of the adult male population are
employed in pursuits other than agriculture.
•according to

76. •1901 census = was 11.4%.
•2001 census = 28.53%
•2011 census = crossed 30% as per
•In 2017, the numbers increased to 34%,
•according to The World Bank,by 2030, 40.76% of
country's population is expected to reside in urban
areas.
•Annual urbanization increase is 2.8%

77. •Reasons for Urbanisation:
•Natural growth – through births
•Migration from villages for employment
•Attraction of better living conditions
•Availability of social services such as education,
health, transport, entertainment.
Continuous migration of people from rural to
urban will constitute a social crisis in India,
impacting quality of life.

78. 4.8 Family size
The total number of children a woman has borne at a point
in time
Completed family size: Total number of children borne by a
woman during her child bearing age between 15 – 45 years
*Family size depends on:
•duration of marriage,
•education of couple,
•the number of live births and living children,
•preference of male child,
•desired family size, etc
*Two child family norm long term demographic goal of
→
NRR=1

79. 4.9 Literacy and Education
•1948: Declaration of human rights stated that
everyone has a right to education, yet not
realised.
•Education is a crucial element in economic and
social development
•1991 census: literacy rate for the population
relating to seven years age and above

80. •Literate: read and write with understanding in any
language
•Literacy is generally associated with
•Modernization
•Urbanization
•Industrialization
•Communication
•Commerce

81. •Crude literacy rate
=No.of Literate persons x 100 Total population
in a given year
•Effective Literacy rate
= No.of Literate persons aged 7 and above x 100
Total population aged 7 and above in a given
year
•2001 : 304.1 million illiterates
•2011 : 272.9 million (decline of 31.1 million)

82. •Kerala tops with 93.91 % literacy rate
•Tamilnadu is 80.33%
•Compulsory education up to 14 years GOI
mandate.
4.10 Life expectancy
1.Life expectancy at a given age is
the average no.of years which a person of
that age may expect to live, according to the
mortality pattern prevalent in that country.

83. 1.Life expectancy at birth has been increasing globally.In
India it was
1.1901 :
23.63 & 23.96
2.2001 :
63.9 & 66.9
3.2011 :
64 & 67
4.2017 : 67
males and 70 females.

84. 7.SUMMARY
1.Introduction 1.1.Definition
1.2.Concept and Scope
2.Demographic Cycle
3.World Population Trends
1.Birth and Death rates
2.Growth rates
4.Demographic Trends in India
4.1Demo. Indicators
1.a. Rates, Ratios and
Proportions
4.2. Age & Sex Composition 4.3Age
Pyramids
4.4Sex ratio 4.5Dependency ratio
6.Density of population
7.Urbanisation 4.8Family size
4.9Literacy & education
10.Life expectancy
11.Health Information Systtem
12.Demographic Data
5.Methods of Data Collection
6.Analysis & Interpretation
7.Summary