Introduction_to_public_health[1].pptx . me

he fourth edition of the World Health Organization’s (WHO) Guidelines for drinking-water quality (GDWQ) builds on over 50 years of guidance by WHO on drinking-water quality, which has formed an authoritative basis for the setting of national regulations and standards for water safety in support of public health.

It is the product of significant revisions to clarify and elaborate on ways of implementing its recommendations of contextual hazard identification and risk management, through the establishment of health-based targets, catchment-to-consumer water safety plans and independent surveillance.

This first addendum updates the fourth edition. Updates reflect new evidence and further, provides additional explanations to support better understanding and application of the guidance.

1. MDG Health Needs Assessment Introduction to Public Health Principles and concepts of Public Health

2. Discussion points Definition of health, diseases and Public health in general Determinants of health disease causation Prevention strategies Globalization

3. Definition of major terms/concepts Health The concept of health is often difficult to define and measure It is a broad concept and experience. Its boundary extends beyond the "sick” It depends on: 1) The perception of individuals 2) The threshold - e.g. pain 3) the ability to recognize symptoms and signs

4. WHO …..definition Health: is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity Wellness: an active process by which an individual progresses towards maximum potential towards healthy condition, regardless of current state of health

5. Wellness is an active, lifelong process of becoming aware of choices and making decisions toward a more balanced and fulfilling life Let you discuss about; What elements/components are potentially determine individual wellness (aspects of health)?

6. Components of Wellness physical , e.g.: Ability to carry out daily tasks achieve fitness Maintain nutrition and proper body fat Avoid abusing drugs, alcohol, or using tobacco products Generally to practice positive life-style habits 30 August 2023 Azeb G 6

7. 2. Social, e.g.: ability to interact successfully with people and within the environment of which each person is a part develop and maintain intimacy with significant others develop respect and tolerance for those with different opinions and beliefs 30 August 2023 Azeb G 7

8. 3. Emotional , e.g.: Ability to manage stress and express emotions appropriately Ability to recognize, accept, and express feelings Ability to accept one’s limitations 4. I ntellectual , e.g.: A bility to learn and use information effectively for personal, family, and career development Striving for continued growth and learning to deal with new challenges effectively 30 August 2023 Azeb G 8

9. 5. Spiritual , e.g.: Belief in some force (nature, science, religion, or a "higher power") that serves to unite human beings and provide meaning and purpose to life Includes a person’s morals, values, and ethics 6. Occupational ability to achieve a balance between work and leisure time beliefs about education, employment and home influence personal satisfaction and relationships with others 30 August 2023 Azeb G 9

10. Disease: the condition of the human body in which something has gone wrong and has upset the normal functions of the body including the mind The International Classification of Disease (ICD) distinguishes between three terms: I mpairment - any loss or abnormality of mental, anatomical, physiological structure of function

11. Disability - is any restriction or lack, resulting from impairment, of the ability to perform an activity in a manner or range considered normal for a human being Handicap - is a long-term disadvantage which adversely affects an individual's capacity to achieve the personal and economic independence that is normal for one's peers

12. Aspects of health Physical health: good body health, and is the result of regular exercise , proper diet and nutrition , and proper rest for physical recovery Mental health: individual's emotional and psychological well-being Social health: the ability to make and maintain relationships with other people

13. Emotional Health: refers to our sense of well-being and our ability to cope with life events Concerned with the way we think and feel It refers to our ability to acknowledge and respect our own emotions as well as those of others All these aspects:- emotional, physical, and social—must function together to achieve overall health

14. Holistic Concept of Health Quality of life that has dimensions and is being influenced by many factors Interdependent and inter- related each other 14

15. Health maintenance Achieving health and remaining healthy is an active process Effective strategies for staying healthy and improving one's health include the following elements: Nutrition What people eat affects their health and performance, such as foods or food components that cause diseases or deteriorate health 30 August 2023 Azeb G 15

16. Exercise Frequent and regular physical exercise is an important component in the prevention of some of the diseases Hygiene and sanitation Hygiene is the practice of keeping the body clean to prevent infection and illness, and the avoidance of contact with infectious agents 30 August 2023 Azeb G 16

17. Stress management Prolonged psychological stress may negatively impact health, such as by weakening the immune system Health care Health care is the prevention, treatment, and management of illness and the preservation of mental and physical well being through the services allied health professions 30 August 2023 Azeb G 17

18. According to the WHO, health care embraces all the goods and services designed to promote health, including “ preventive, curative and palliative interventions , whether directed to individuals or to populations” 30 August 2023 Azeb G 18

19. Workplace wellness programs : can include things like onsite fitness centers, health education, wellness newsletters, access to health coaching, tobacco cessation programs 30 August 2023 Azeb G 19

20. Public Health Definition …the health status of a defined group of people and the actions and conditions both private and public (governmental) to promote, protect and preserve their health.

21. defined … …the science and the art of preventing disease, prolonging life & promoting physical health and efficiency through organized community efforts for sanitation of the environment, the control of community infections, the education of the individual in principles of personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and the development of the social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health.[ Charles Edward A. Winslow ]

22. The core functions of public health are 22 Assessment : the diagnostic function (collection, assembling, analysis) Researching to develop new insights and innovative solutions; Monitoring the health status of the population; Policy development : devising a strategic approach to improving the community health Leading the development of sound health policy and planning.

23. Core 23 Assurance : making the services needed for the protection of public health in the community are available and accessible to everyone. Assuring the quality, accessibility, & accountability of medical care; Reaching out to link high risk and hard to reach people in medical services; Preventing epidemics; Protecting the environment, work place, food and water; Promoting healthy behavior; Mobilizing community action; Responding to disasters;

24. Mission of PH… 24 ….“fulfilling society’s interest in assuring conditions in which people can be healthy”. Philosophies The factor most significant in determining the health of a community is its economic status Effective public health programs save money on medical costs in addition to saving lives.

25. Determinants or factors of health

26. Physical Factors Social / cultural Factors Community Organization Individual Behavior Health of the community

27. Determinant/factors Physical Determinants: Geography Environment Industrial development Socio cultural Determinants : Beliefs, traditions & norms; Economy Politics; Religion Community Organization : Community size Arrangement and distribution of resources (“relations of production”) Behavioral Determinants Individual behavior and life style

28. Environment: (Source of living) Human ecology Physical Environment : – condition of roads for driving (Vs Accidents, pollution) Climate : – harvest, insect breading, etc (Vs famine, malnutrition) – temperature, humidity, rainfall, radiation, altitude, etc Terrain : hilly, forest, desert, marshy, island Housing : ventilation, housing, light, etc Sanitation : drinking water, waste management, hygiene, etc Work place : noise, chemicals, etc

29. Social & Political environment: – Life style, living status, poverty, education, gender status, employment, food availability, etc – governance, law, corruption, instability, etc Geography : Kola, WeinaDega, Dega Vs diseases

30. Other ways of looking in the classification of factors Four types 1. Predisposing Factor [as f(Host)] Factors that may create a state of susceptibility Ex: Age, (childhood, elderly); Sex, (women for depression) 2. Enabling Factors [as a f(env’t)] Events or conditions that favor development of disease or an outcome of interest. Factors such as low income, poor nutrition, bad housing, lack of access to health Institutions Factors that assist in recovery from disease like maintenance of good health could also be grouped here .

31. Other… 3. Precipitating Factors [f(exposure] – Events or conditions that favor exposure to a specific disease agent. – They may be associated with the onset of the disease Ex: Wound, physical trauma, Tetanus, STIs, HIV/AIDS 4. Reinforcing Factors [f(transmission] – Factors that aggravate an established disease. Ex: Repeated contact to infectious agent Common cold within a household

32. Multi-causal Theory (Web of Disease Causation) It has even enlarged and elaborated on the host-agent-environment triad wherein each of these factors affects the other The four models are: Epidemiologic triangle & triad (balance beam) model Sufficient and component causes model Webs model Wheel model of infectious diseases

33. Models of causation Models of Explanation It is a model that could assess reasons for an effect happening It is more of social science phenomena Ecological models It is a model applicable to infectious and non-infectious causes of disease III. Bradford-Hill criteria Criteria of causation 33

34. I. Models of Explanation a. Idiographic model aims at a complete understanding of a particular phenomenon, using all relevant causal factors Enumerates detailed/unique factors that lie behind some action or social fact Lists all possible factors as reasons for the occurrence of the outcome b. Nomothetic model aims at a general understanding of a class of phenomenon, using the smallest number of most relevant causal factors . The nomothetic model is probabilistic in its approach to causation . It is the model typically used in social scientific research. I solates the few key characteristics uniting similar cases Isolates the few core reasons of an outcome 34

35. a. Idiographic explanation Example- “Taking this introduction to public health course” There are a number of reasons for why you are taking this course.  … if you start listing…. You can list thirty or forty … Reasons …. may be high-minded, ….. to help you satisfy your interest in exploring pedagogical methods.  …… may be more routine reason: the course is required, it fit into your schedule.  If you list as many as you can it would help people to fully understood why you are doing it. 35

36. b. Nomothetic explanation But in a nomothetic explanation it offers a partial explanation for the behaviors that represent many people. Such explanations are not singling out certain reasons rather they provide a more generally applicable explanation. Therefore, it is probabilistic , not certain or complete. 36

37. II. Three ecological models 1. The Epidemiologic Triangle (Triad) consist of three components 1) host , 2) environment and 3) agent . A change in any of the components will alter an existing equilibrium to increase or decrease the frequency of the disease. 37 ENVIRONMENT AGENT HOST

38. Epidemiologic triangle & triad (balance beam) model Traditional model of infectious disease causation Agent Host Environment Epidemiologic triangle Host Agent Environment Balance beam 38

39. 2. The Web of Causation The essence is that Effects (diseases) never depend on single isolated causes, RATHER it develops as a result of chains of inter-related causes . The large number of inter-related causes, are considered as a “ web ” Eg Pulmonary Tuberculosis- Patients lower immunity + M. Tbc Malnutrition, HIV/AIDS, Age, Cancer 39

40. web model It is in response to the idea of non-infectious diseases having no unique agent There is no single cause Causes of disease are interacting 40

41. Web of Causation Disease behavior Unknown factors genes phenotype workplace social organization microbes environment

42. Web of Causation - CVD 42 Disease smoking Unknown factors gender genetic susceptibility inflammation medications lipids physical activity blood pressure stress

43. 3. The Wheel / Pie Model component causes model This has come for multi-factorial nature of causation in many diseases. Sufficient Cause: The whole components of a pie make the sufficient cause for a disease. A disease may have only one factor as a sufficient cause to develop a disease. Eg. Rabies A disease may have more than one sufficient cause, each sufficient cause is composed of several component causes. 43

44. Cont.. In this traditional model, each component cause is seen as necessary and sufficient cause in itself to produce the effect. Necessary cause : A causal factor whose presence is required for the occurrence of the disease. A factor (contributing) that is necessary (or with out which) the disease doesn’t exist or occur Sufficient cause . A causal factor or collection of factors whose presence is always followed by the occurrence of the disease. 44 Multiple-causality of diseases

45. Wheel cont.. Genetic core ( Humans ) Social environment Physical environment Biologic environment Host The interaction of humans with infectious agents and their environment, a person’s state of health represents a dynamic equilibrium – a balance of forces. Agent Agent Agent Agent

46. III. Bradford-Hill criteria In judging the different aspects of causation,  The correct temporal relationship is essential,  Once the above fulfilled, weight should be given to: Plausibility, [logically cause, clinical implication] Consistency, [other researches should support] dose-response relationship and Strength of the association Specificity of the relation 46

47. Establishing Causality To establish whether two variables are causally related, we must establish: Time order (temporal relationship): The cause must have occurred before the effect Statistical association : Changes in the value of the independent variable must be accompanied by changes in the value of the dependent variable Rationale : There must be a logical and compelling explanation for why these two variables are related Non-spuriousness : It must be established that the ‘independent variable X’, would be the cause of changes in the dependent variable Y; 47

48. Models of Disease Prevention

49. Models based on level Levels of prevention is related with natural history of a disease It involves the interruption or slowing of disease progression through appropriate interventions. It is through identifying modifiable causes of the disease and its risk factors 49

50. Natural history time lines for infection and disease Usual time of diagnosis Pathologic Onset of Exposure Changes Symptoms Stage of Stage of Stage of Stage of Recovery, Susceptibility Subclinical Clinical Disability or Death Disease Disease 50 Time Natural History of Diseases Refers to the progress of a disease process, in the absence of intervention.

51. Cont…. There are several stages during the course of a disease at which we can intervene in order to control the disease. Three levels, (Primary, Secondary and Tertiary) I. Primary prevention Objectives – promote health , prevent exposure, and prevent disease. 51

52. Cont… A. Health promotion (Primordial): It is general non-specific interventions that enhance health and the body’s ability to resist disease It is more of communal than individual effect (governments, NGOs, international organizations effort) Example- improvement of socioeconomic status through the provision of adequate…. paid jobs, education, affordable and adequate housing and clothing, etc. Millennium Development Goal 52

53. Cont… Prevention of exposure: Relatively specific compared to primordial prevention Example for communicable disease provision of safe & adequate water, proper excreta disposal, vector control; Provision of a safe environment at home Example of non-communicable Slow driving for prevention of car accident injury, 53

54. Cont… Prevention of disease: Example -immunization. Some intervention can act at more that one level Example- Breastfeeding is an example of an intervention which acts at all three levels of primary prevention. 54

55. Cont… Secondary prevention Interventions that act after the biological onset of disease, but before permanent damage sets in. Objective - to stop or slow the progression of disease so as to prevent or limit permanent damage. Strategy - early detection and treatment of disease. 55

56. Cont… Tertiary prevention Intervention that acts after permanent damage has set in, Objective - to limit the impact of that damage. The impact can be physical, psychological, social (social stigma or avoidance by others), and financial. Strategy - is rehabilitative . 56

57. Public health and Globalisation

58. Public health and Globalisation 58 Globalisation (def) The strengthening of global flows of capital, goods, ideas and people across borders or institutions and the rules established to regulate these flows.

59. Cont… Globalization is the ways in which nations , businesses and people become more connected across national borders through increased economic integration, communication , cultural diffusion and travel. Globalization is also considered as a product of the interaction of technology, culture and economics leading to A compression of time (everything becoming faster), Space (geographic boundaries begin to blur ) and Cognition (awareness of the world as a whole). 59

60. Social determinants of health (SDH) It is a condition where people live, learn, work & play that affects a wide range of health risks & outcomes. Ex: poverty limits access to healthy foods &safe neighborhoods More education is a predictor of better health. Other SDH include unstable housing, low income, unsafe neighborhoods, substandard education, etc 60

61. Effect of Globalization & Public health Although responsibility for health care and public health system remains with national governments, The fundamental social, economic and environmental determinants of population health have become increasingly supranational . The increasing effect of international and bilateral agencies: Ex: as Adjustments; Global initiatives Externalities of some diseases due to: Increased communication; Increased mobility

62. Globalization Mixed believed on the effects of globalization Accelerated economic growth and technological advances contributing to the improvement of population’s health status Erosion of social and environment Jeopardizing population health via conditions and exacerbating inequalities

63. Globalization is GOOD for health & equity Trade liberalization will ultimately benefit every body through a trickle down effect Increase incomes of the poor & therefore for their health Policies of the IMF/WB have been a means of ‘cleaning’ up corrupt governments in poor countries Opens up communication around the world & creates a global village. This will result in more understanding & less conflict Provides a variety of consumers goods & enrich people’s lives

64. Globalization is BAD for health & equity Structured unfairness of the world trade system ensures unfair distribution of wealth and is strongly in favor of the rich strata of the rich countries; Increases inequalities both within & between countries; poor countries suffered from imposition of structural adjustment packages (SAP’S) which has affected the level of services and protection for local industries

65. Globalization is BAD Globalization threatens to flood the variety of cultures around the world. The threat of globalization will increase fundamentalism Migration poses considerable policy challenges to the governments of developed countries; Globalization imposes unhealthy diets on developing countries (nutrition transition is likely to be accelerated)

66. Public Health- Gains/ challenges Gains Increase in life expectancy Reduction of Fertility Eradication of Smallpox/ Guinea Worm Initial success in Leprosy/ TB/ Malaria 66 Problems Ageing Triple Morbidity burden Water / Vector borne diseases New Emerging Diseases [malaria, MDR-TB, HIV….] Life Style Diseases

67. Public Health- Challenges Understanding the nature of problems. Rural/ Urban Differentials Responsibility of all for Health Responsiveness of health system HMIS and Early Warning System Public, private, corporate and voluntary sector Inter-sectoral action for health Health Manpower Development 67

68. Group of three (each 3 based on Alphabetical order) Group A: Describe 1 2 and 3 Prevention for malaria? Group B. Describe 1 2 and 3 Prevention for HIV? Group C: Describe 1 2 and 3 Prevention for Polio? 68