UNIT 1: Overview of Public Health related knowledge is essential to the

fullest attainment of health.

RATIONALE ● Informed opinion and active co-
- Deals with the integration of pharmacy operation on the part of the public are
practice in prevention of disease, of the utmost importance in the
promotion of health and prolongation of improvement of the health of the people.
life in public health settings. ● •Governments have a responsibility for
Primarily focuses: the health of their peoples which can be
● Factors affecting health fulfilled only by the provision of
● Indicators of general health in the adequate health and social measures.
community DIMENSIONS OF HEALTH
● Past and current issues (drug and non-
drug related, local and international)
pertinent to public health and laws and
policies.
● Interventions and programs that address
these issues
● Determination of roles of pharmacists in
Public Health
● Application of concepts

INTRODUCTION TO PUBLIC HEALTH

What is Health?
- Persons are healthy when they are
doing their activities with no apparent
symptoms of disease.
- Health is a state of being well and free
from disease (oxford students
dictionary, 1991)
From professional’s point of view:
a. A measure of the state of the physical
bodily organs, and the ability of the body
as a whole to function.
b. It refers to freedom from medically
defined diseases.

● According to WHO, “Health is a state of

complete physical, mental, and social What is Public Health?
well-being and not merely the absence ● “The science and art of preventing
of disease or infirmity” disease, prolonging life and promoting
● Health of all people is fundamental to the health through the organized efforts and
attainment of peace and security and informed choices of society,
is dependent on the fullest co-operation organizations, public and private
of individuals and States. communities, and individuals.” -CEA
● The extension to all peoples of the Winslow, 1920
benefits of medical, psychological and ● The sanitation of the environment
● Control of communicable infections
 ● Education of the individual in personal ● Obesity - Food labeling and promotion
hygiene of physical activity.
● Organization of medical services for
early diagnosis and preventive A PUBLIC HEALTH APPROACH
treatment of disease
● Development of the social machinery to
ensure everyone a standard of living
adequate for the maintenance of health

THE MISSION OF PUBLIC HEALTH

“Fulfilling society’s interest in assuring conditions
in which people can be healthy” - Institute of
Medicine
“Public Health aims to provide maximum benefit PUBLIC HEALTH CORE SCIENCES
for the largest number of people” - World Health
Organization

THE HISTORY OF PUBLIC HEALTH

Sanitation and Environmental Health
● 500 BCE - Greeks and Romans practice
community sanitation measures.
● 1840s - The Public Health Act of 1848
was established in the United Kingdom
● 1970 - The Environmental Protection
Agency was founded.
Pandemics
● Influenza - 500 million infected CHOLERA- A Public Health Approach
worldwide in 1918. - Cholera, a fatal intestinal disease, was
● Polio - Vaccine introduced in 1955; rampant during the early 1800s in
eradication initiative launched in 1988. London, causing death to tens of
● HIV - 34 million with HIV worldwide;
thousands of people in the area. Cholera
20% decline in new infections since was commonly thought to be caused by
2001. bad air from rotting organic matter.
Preparedness for Disaster Response John Snow, Physician
● Biologic Warfare - plague used as a
- Is best known for his work tracing the
weapon of war during the Siege of source of the cholera outbreak and is
Kaffa. considered the father of modern
● September 2001 - Public health
epidemiology.
surveillance conducted after the 9/11
attacks. EPIDEMIOLOGY
● Hurricane Katrina - Emergency Cluster of Cholera Cases, London - 1854
services, public health surveillance, and
disease treatment provided.
Prevention Through Policy
● Book of Leviticus - The world’s first
written health code.
● Tobacco Laws - Laws banning smoking
in public places.
 Ten Essential Public Health Services/Care
Cluster of Cholera Cases and Pump Site
Functions
Locations
- grouped under the three core functions.
These services are not a prescription for
what public health agencies should be
doing. Instead, they are intended to
serve as a descriptive tool to capture the
field of public health and to
communicate what public health
provides.

INTERVENTION EVALUATION – What

Works?
Through continuous research, Snow understood
what interventions were required to
- Stop exposure to the contaminated
water supply on a larger scale, and
- Stop exposure to the entire supply of
contaminated water in the area.

IMPLEMENTATION – How Do You Do It?

- John Snow’s research convinced the
British government that the source of -
cholera was water contaminated with
1. Monitor Health
sewage
2. Diagnose and Investigate
3. Inform, Educate, Empower
CORE FUNCTIONS AND ESSENTIAL
4. Mobilize Community Partnership
SERVICES OF PUBLIC HEALTH
5. Develop Policies
Three Core Functions of Public Health
6. Enforce Laws
7. Link to/Provide Care
8. Assure a Competent Workforce
9. Evaluate
10. Research

Possible Answers are listed with each

function:
1. Assessment
● Monitor health status: monitor Core Functions at Government Levels
smoking use among segments of the
population, such as youth.
● Diagnose and investigate health
problems: investigate risk factors
associated with tobacco use.
2. Policy Development
● Inform, educate, and empower people
about health concerns: Place public
service announcements on television
regarding the dangers of smoking.
● Mobilize community partnerships:
- The core functions, assessment, policy
Work with advocacy groups to develop
development, and assurance must be
antismoking interventions that will work
carried out at all levels of government —
in a specific community.
federal, state, and local for the overall
● Develop policies and plans: Passage
public health system to function
of Proposition 99 (the cigarette tax to
effectively. Looking at tobacco use
fund antismoking campaigns); smoke-
again, here are a few examples of each
free workplaces, apartment complexes,
function at the different governmental
and other shared spaces.
levels.
3. Assurance
● Enforce laws and regulations:
STAKEHOLDER ROLES IN PUBLIC HEALTH
Enforcement of policies and laws, such
Partners in the Public Health System
as placement of cigarette vending
machines.
● Link people to needed personal
health services: Address potential
barriers related to culture and the
language of materials, or staff serving
special population groups. In California,
ads in the tobacco control media
campaign were broadcast in Spanish
and Mandarin as well as English. - The field of public health is broad and
● Assure a competent public health interdisciplinary. Beyond government, it
and personal health care workforce: requires stakeholders with skills in
Ensure a knowledgeable workforce is in intervention programs, policies,
place to develop and implement the research, evaluation, and education.
antismoking campaign. What other sectors and fields can you think of
● Evaluate effectiveness: Ongoing that have a stake in public health?
evaluation of the campaign to ensure it - Transportation, housing, schools, city
works as desired; determining how it planning, or law enforcement.
might be improved. - Other partners include governments,
● Research for new innovative community groups, clinical care,
solutions to health programs: Take employers and businesses, the media,
insights gained from the field on what and academia, in addition to the
works and confirm them through infrastructure provided by government at
collaborative study with health all levels.
researchers.
Nongovernmental Organization Examples
peripheral to essential professional
- Nongovernmental organizations (often professional training training
referred to as “NGOs”) play a key role in
public health, especially at the Public sector basis Private sector basis
community level. NGOs serve many
different purposes from advocacy or Other Partners in Public Health
education to emergency relief and Media - social media serves as a vehicle for the
economic development. public’s discourse on public health concerns,
Organization Type Example and historically, public health agencies and other
partners have educated the public and promoted
Professional membership Philippine Public healthy behaviors through the news and
organizations Health Association entertainment media.
➔ vehicle for public discourse
Associations related to a Philippine Cancer ➔ Health education and promotion
specific health concern Society ➔ Health communication
➔ Social media as catalyst
Organizations of citizens Organization for
Employers and Businesses - contribute to the
focused on health concerns. Nonsmokers Rights
public’s health by providing health insurance, for
Foundations that support Bill and Melinda example. Workplaces also have wellness
health projects and influence Gates Foundation initiatives, such as gym subsidies that promote
public policy development the health of their employees.
➔ employer-sponsored health insurance
Health care as a Partner in Public Health programs
- Health care plays a vital role in ➔ Wellness initiatives and benefits
protecting and promoting the public’s ➔ Health workplaces and communities
health along with public health Government Agencies - Government agencies,
organizations. The two have differences such as CDC, work in partnership with state,
that are worth highlighting here. Public local, and tribal health departments. However,
health focuses on populations, while important contributions are made by other
clinical care focuses on the individual government agencies at all levels. City planning
patient. departments can include sidewalks and bike
- Health care and public health are paths to promote and support safe ways to
complementary. When they work exercise. Education departments can include
collaboratively, all people benefit. public health messages for students, implement
prevention in school health programs, and work
Public Health Health Care to ensure healthy food options at school.
Similarly, many other government agencies can
Population focus Individual patient work as partners in public health by including
focus health considerations in their policy
development.
Public health ethic Personal service ethic
➔ city planning
Prevention or public Diagnosis and ➔ Education
health emphasis treatment emphasis ➔ Health in all policies
Academia - educates and trains the public
Joint laboratory and Joint laboratory and health workforce, such as scientists,
field involvement patient involvement
epidemiologists, and informaticians. Additionally,
Clinical sciences Clinical sciences research conducted in academia is put to use in
the larger communities around the US and the which we live, plus our health behaviors
world. and to a lesser extent, our genes and
biology.
➔ education
- An example of the role these
➔ Training
determinants play in our daily lives is
➔ Research
through nutrition and physical activity.
➔ Public services Both are essential elements in
producing optimal health and should be
viewed in the context of such
DETERMINING AND INFLUENCING THE
environmental factors as
PUBLIC’S HEALTH
- social and cultural norms that
- certain factors determine a person's
influence food choices and
state of health. Scientists generally
physical activity,
recognize these health determinants for
- environmental characteristics,
any population.
such as availability (lack of
Health Determinants
healthy food, open space for
● Genes and biology: sex, age, genetic
exercise, or safety in urban
makeup. neighborhoods), and
● Health behaviors: smoking, eating
- sector influences, such as the
habits, physical activity.
marketing of processed food.
● Social/societal characteristics,
- All of these factors influence our
including the total ecology:
individual choices, which in turn,
discrimination because of income or
influence our overall health.
sex. where a person lives, including Health Impact Pyramid
especially air, water, and sanitation
quality.
● Health services/Medical care: quality
health care, insurance coverage.
What Determines the Health of a Population?

- As we move down the pyramid, the

public health impact grows greater.
However, As we move up the pyramid,
the amount of individual effort increases.
Starting at the top, we can do
- This chart is an estimate of how these counseling and education, perform
four major determinants influence health clinical interventions, have longer lasting
at the population level. preventive interventions, change the
- Notice the portion of the chart that context in which people operate so the
represents medical care. We spend default decisions they make are healthy,
trillions of dollars on health care, yet it and lastly, positively influence
only determines about 25% of our socioeconomic factors. A point to
health. The remaining 75% of what emphasize here is that we have to have
determines our health as a population is tradeoffs. We have to sometimes give
our total environment or ecology,
including the social environment in
 up resources in one area to have a banning smoking in certain public places
larger impact in another. have had substantial impact.
- At the base of the pyramid are public
health interventions that affect
socioeconomic factors. If we can
improve quality of life by helping people
out of poverty, providing basic
sanitation, improving their access to
education, healthy food, and medical
care, we can greatly improve a
population’s chances for a healthy life.
- This pyramid illustrates the impact of
Health as a Human Right: Alma Ata
different types of public health
Declaration
interventions. Let’s start at the top of the
May 1977
pyramid and work down.
- Counseling and education (in clinical ➔ The 30th World Health Assembly adopted
and other settings) is regarded by some Resolution WHO 30:43
as the essence of public health action, ➔ This resolution decided that the main
but unfortunately, it is not as effective as social targets of governments and the
we would like. That being said, at times, WHO should be the attainment by all the
counseling and education are the only people of the world by the Year 2000 a
forms of intervention available and, level of health that will permit them to
when applied consistently and lead a socially and economically
repeatedly, can have an impact. productive life.
Examples include warning labels on
cigarette packs and campaigns to September 12, 1978
promote tobacco cessation. ➔ The International Conference in Primary
- Moving to clinical interventions, ongoing Health Care was held at Alma Ata,
medical care for a health condition is an Kazakhstan, USSR.
example. In the case of cardiovascular ➔ This conference came up with ALMA
disease, these interventions can have a ATA DECLARATION which represents
considerable effect. However, we are a global idea about how to achieve
limited by a lack of access to certain world health.
patients who need care and lack of
➔ It was sponsored by the World Health
adherence to medical instructions in the Organization and UNICEF
real world.
- Long-lasting preventive medicine
interventions, vaccines for example, ALMA ATA DECLARATION
prevent 2.5 million deaths among
➔ “The main goal of Governments and
children around the world every year. In
World Health Organization in the coming
this case, a single dose or instance of
decades should be the attainment by all
an intervention can have a life-long
people of the world by the year 2000, a
effect.
level of health that would permit them to
- We make health decisions the default by
lead a socially and economically
changing the context in which behaviors
productive life”- 51st WHA in 1998
occur, making it difficult to avoid the
reaffirmed the declaration for the 21st
intervention. For example, changing the
century.
laws to require seat belt use in cars and
OBJECTIVES OF ALMA ATA
➔ To promote the concept of primary
health care
➔ To evaluate the present health care
situation
➔ To define the principles of primary
health care
➔ To define the roles of governmental,
national and international organizations
- The first International Conference on
➔ To formulate recommendations for the
Health Promotion, meeting in Ottawa
development
1979 this 21st day of November 1986,
hereby presents this CHARTER for
➔ The World Health Organization (WHO)
action to achieve Health for All by the
launched the Global Strategy for Health
year 2000 and beyond.
for All
- This conference was primarily a
response to growing expectations for
Philippines’s response to PHC
a new public health movement around
- PHC was adapted in the Philippines the world.
through Letter of Instruction 949, - Discussions focused on the needs in
signed by Pres. Ferdinand E. Marcos, industrialized countries, but took into
on October 19, 1979 account similar concerns in all other
regions.
Primary Health Care
Health Promotion
➔ •“an essential health care made
universally accessible to individuals ➔ process of enabling people to
and families in the community by means increase control over, and to improve,
acceptable to them through their full their health.
participation and at a cost that the ➔ To reach a state of complete physical,
community and country can afford to mental and social well-being, an
maintain at every stage of their individual or group must be able to
development in the spirit of self- identify and to realize aspirations, to
determination.”- WHO satisfy needs, and to change or cope
➔ Framework: People’s empowerment with the environment.
and partnership is the Key strategy to ➔ Health is a positive concept
achieve the GOAL, emphasizing social and personal
➔ “Health for all Filipinos by the year resources, as well as physical
2000 and Health in the Hands of the capacities.
People by the year 2020” ➔ Therefore, health promotion is not just
the responsibility of the health sector,
Mission of PHC
but goes beyond healthy life-styles to
➔ PHC aims to strengthen the health well-being.
care system by increasing
The Ottawa Charter for Health Promotion
opportunities and supporting
conditions wherein people will
manage their own health care.
Ottawa Charter for Health Promotion 1986
 strategies and implementing them to
achieve better health”.
➔ Full community participation occurs
when communities participate in equal
partnership with health professionals as
stakeholders in setting the health
agenda. A Definition (Rifkin et al. 1988)
4. Develop Personal Skills
➔ Skills which can promote an individual’s
health include those pertaining to
identifying, selecting and applying
These strategies are supported by five healthy options in daily life.
priority action areas as outlined in the
➔ Health education is life-long, so that
Ottawa Charter for health promotion:
people can develop the relevant skills to
meet the health challenges of all stages
of life, and to be able to cope with chronic
illness and disabilities.
➔ “Health education should be conducted
in all settings.”
5. Reorient Health Services
➔ Shift of emphasis from provision of
curative services.
1. Health Public Policy ➔ Health care system must be equitable
➔ pre-requisite for successful health and client-centered.
promotion
➔ characterized by a concern for health
and equity and an accountability for
health impact.
➔ According to the Adelaide Conference
(1988), “The main aim of HPP is to create
a supportive environment to enable the
people to lead healthy lives. Healthy
choices are thereby made possible and
easier for citizens”.
2. Create Supportive Environment
➔ A supportive environment is essential
for health.
➔ It covers the physical, social, economic,
and political environment.
➔ Everyone has a role in creating
supportive environments for health.
3. Strengthen Community Action:
Community Participation
➔ According to the Ottawa Charter, “health
promotion works through concrete and
effective community action in setting
priorities, making decisions, planning
 6. Public Health Policy
➔ Health-system pharmacists can PHARMACIST’S ROLE IN PUBLIC HEALTH
participate in the development of public
health policy concerned with local boards
of health as well as national programs.
➔ Example: best management practices in
the proper handling and disposal of
hazardous drugs.

What should be the public health activities of

a Pharmacist?

- In 1981, the role of the pharmacist in

public health is defined by the American
Public Health Association (APHA). This
association outlined that the role of the
pharmacist is now escalating beyond the
dispensation and distribution of
medicines, and health supplies.
- A pharmacist can provide many services
to public health that may include
pharmacotherapy, provide care, and
prevention measures
Activities where pharmacists can play an
important role to promote public health:
1. Population-based Care
➔ The Center for Advancement in
Pharmaceutical Education (CAPE)
Educational Outcomes suggested that
pharmacists should involve in both
patient-based and population-based
DOH PROGRAM care.
➔ DOHMajorProgramsProjects5KRAs.pdf
 ➔ Pharmacists can support public health ➔ Formulating appropriate policies, plans,
efforts using designing and providing and programs to meet those needs;
disease management programs. administering and evaluating the health
2. Prevention of Disease and program; and making the necessary
Medication Safety: improvements and changes at the macro
level can support subsequent
➔ They can help in the establishment of
improvements in community service
some screening programs to check out
programs, program evaluation, and
the status of immunization, and
research activities
identification of some undiagnosed
medical conditions.
➔ Medication safety and error prevention Health and Social Impacts
3. Health Education
➔ Health-system pharmacists can educate
their health care colleagues about the
safe and effective use of medication that
further improves use of medications.
➔ The pharmacists can also educate
community leaders like public office
holders, legislators, school officials,
regulators, and religious leaders who
involve in public health customs.
4. Research and Training
➔ A health-system pharmacist must get
adequate education and training to carry
out his responsibility in public health. ➔ Health stigma and Discrimination
➔ Health-system pharmacists should be Framework Stigma is a well-
expertise in pharmacoepidemiology, documented global barrier to health-
research methodology, and biostatistics seeking behavior [1], engagement in
with their applications in decision related care [2], and adherence to treatment [3]
to public health across a range of health conditions [4,
5]. As a distinguished and labelled
Bush and Johnson characterized public health
difference [6], stigma, Goffman notes,
pharmacy services as occurring on micro and
enables varieties of discrimination that
macro levels.
ultimately deny the individual/group full
➔ Micro-level activities emphasizing the social acceptance, reduce the
wellbeing of the patient occur frequently; individuals’ opportunities [7], and fuel
examples are tobacco cessation efforts, social inequalities [8]. Stigma influences
immunizations, health screening and population health outcomes by
referral, health education, patient worsening, undermining, or impeding a
counseling, and monitoring and number of processes, including social
responding to adverse drug events in an relationships, resource availability,
institution stress, and psychological and
➔ In contrast, macro-level functions behavioral responses, exacerbating
involve assessment, identification, poor health [9].
and prioritization of the public health ➔
needs in a community or population.