WAR 4106 Lecture 02

Concept of Public
Health
George Kimbowa
[email protected]

1
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 Health
❖ Health: is A state of complete physical, mental, social and
spiritual well-being and not merely the absence of disease
or infirmity.”
❖ in recent years the statement is amplified to include, “The
ability to lead a socially and economically productive life.”
Holistic concept of health:
❖ This concept recognizes the strength of social, economic,
political & environmental influences on health
Determinants of health:
❖ Heredity
❖ Health and family
❖ welfare services
❖ Environment
❖ Life-style
❖ Socio-economic conditions & Others
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 Concept of disease
❖ Disease result from complex interaction between man, an
agent and the environment.
❖ From ecological point of view disease is defined as
“maladjustment of the human organism to the
environment”.

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 Environment
❖ All that which is external to man is the environment
broadly speaking.
❖ The concept of environment is complex.
❖ The external environment or the Macro-environment is
said to be responsible for millions of preventable
diseases originating in it.
❖ Micro-environment is the Domestic environment in
which man lives.
❖ The term Internal environment is some time used for
the environment inside the body
External environment:
❖ “All that is external to the individual human host, living
and non-living, and with which he is in constant
interaction”.
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 Components of Environment:
❖ Physical: air, water, soil, housing, climate, geography, heat,
light, noise, debris, radiation, etc.
❖ Biological: man, viruses, microbial agents, insects, rodents,
animals and plants, etc.
❖ Psychosocial: cultural values, customs, beliefs, habits,
attitudes, morals, religion, education, lifestyles, community
life, health services, social and political organization.
❖ The environment is all external conditions, circumstances,
and influences surrounding and affecting the growth and
development of an organism or community of organisms.
❖ Environmental health is the study and management of
environmental conditions that affect the health and well-being
of humans.
❖ Environmental hazards may be biological, chemical,
physical, psychological, sociological, or site and location
hazards.
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 Biological hazards
❖ These are living organisms or their products that are
harmful to humans
A. Water-borne diseases are diseases that are
transmitted in drinking water
❖ Examples are polio virus, hepatitis A virus, Salmonella,
Shigella, cholera, amoebic dysentery, Giardia, and
Cryptosporidium.
❖ These disease organisms are shed into the water in
feces, and can produce illness in those who consume
untreated, contaminated water.
❖ Our municipal water treatment facilities are usually able
to purify water by removing these agents or killing them
by disinfecting the water.

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 Biological hazards
B-Food-borne diseases are diseases transmitted in or on food
❖ Examples of food-borne agents are the bacteria Salmonella,
serotype enteritidis, Escherichia coli 0157:H7, as well as
other agents.
❖ To protect against food-borne diseases, sanitarians from local
health departments routinely inspect food service
establishments (restaurants) and retail food outlets
(supermarkets) to verify that food is being stored and handled
properly.
C. Vector-borne diseases- are those transmitted by insects or
other arthropods
❖ Examples are St. Louis encephalitis and La Crosse
encephalitis transmitted by mosquitoes and plague and
murine typhus transmitted by fleas.
❖ Improper environmental management can cause vector-
borne disease outbreaks.George Kimbowa
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 II. Chemical hazards
result from mismanagement or misuse of chemicals resulting in
an unacceptable risk to human health
A. Pesticides are chemicals -that have been manufactured for
the purpose of reducing populations of undesirable organisms
(pests)
❖ Examples of categories of pesticides are herbicides and
insecticides.
❖ Most pesticides kill non-target organisms as well as the
target, or pest species.
❖ The wise use of pesticides can protect human health and
agricultural crops.
B. Environmental tobacco smoke (ETS)-is an environmental
hazard produced by millions that smoke
❑ Diseases associated with ETS include lung cancer and
perhaps heart disease.
❑ ETS contains 4, 000 substances.
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 II. Chemical hazards
B. Environmental tobacco smoke (ETS)
❑ The EPA has classified ETS as a Class A carcinogen.
❑ Smoking has been increasingly restricted from public buildings and
from many private work sites.
❑ Regulation of smoking seems to be the best approach to controlling
this pollutant
C. Lead is a naturally occurring element that is used in the
manufacturing of many industrial & domestic products
❑ Health problems associated with the over exposure to lead are
anemia, birth defects, bone damage, neurological damage, kidney
damage, & others.
❑ Exposure is by ingestion and inhalation.
❑ Children are particularly at risk from eating peeling lead paint.
❑ The prevalence of very high blood lead levels among young
children declined significantly between 1984 and 1994 primarily
because the removal of lead from gasoline.
❑ Occupational exposure is a major source of lead intake for adults.
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III. Physical hazards- include airborne particles, humidity,
equipment design and radiation
➢ Radon contamination results from over exposure to radon gas.
➢ Radon gas arises naturally from the earth and sometimes
occurs at dangerous levels in buildings and homes.
➢ Breathing in radon gas can cause lung cancer.
➢ Homes can be tested for the presence of radon gas for $20.
IV. Psychological hazards -are environmental factors that
produce psychological changes expressed as stress, depression,
hysteria.
V. Sociological hazards- are those that result from living in a
society where one experiences noise, lack of privacy &
overcrowding.
❖ Population growth may be a sociological hazard.
✓ Growth of living populations can be expressed as an S curve
with a lag phase, log phase and equilibrium phase.
✓ When environmental resources can support no further growth,
the population has reached the equilibrium phase and the
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environment is said to be at its carrying capacity
V. Site and Location Hazards
❑ Natural disasters are geographical and meteorological
events of such magnitude and proximity to communities
that they produce significant damage and injuries.
❑ Examples are cyclones, earthquakes, floods, hurricanes,
tornadoes, typhoons, and volcanic eruptions.
❑ The magnitude of devastation of these events can
sometimes be great.
❑ Biological, psychological and sociological hazards may
increase following a natural disaster.

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 Nomenclature of Public Health
❖ The nomenclature used to describe public health and its
component elements includes:
❑ Hygiene-embodied the early knowledge about value of
sanitation & personal cleanliness.
❑ As knowledge grew, hygiene was felt to be too narrow & a
broader term public health was used more widely.
❑ New terms were introduced to define special aspects of
the discipline.
❑ Some used the term ‘preventive medicine’; others
preferred ‘social medicine’, ‘community medicine’, or
‘community health’.
❖ “Public health is the science and art of preventing disease,
prolonging life and promoting health through the organized
efforts and informed choices of society, organizations,
public and private communities, and individuals.” (Charles-
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Edward Armory Winslow)
 Nomenclature of Public Health
❖ essential elements of modern public health:
i. collective responsibility;
ii. prime role of the state in protecting and promoting
the public’s health;
iii. partnership with the population served;
iv. emphasis on prevention;
v. recognizing underlying socio-economic
determinants of health and disease;

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The Dimensions 0f Public Health
It would be useful to explore the concepts contained in the four
terms that are commonly used to describe different aspects of
public health:
i. preventive medicine;
ii. social medicine;
iii. community health;
iv. community medicine.

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 The Dimensions of Public Health
❖ 1-PREVENTIVE MEDICINE
❖ Prevention is better than cure is one of the prime messages of
public health. It differentiates public health from the clinical
disciplines that are primarily involved with the care of the sick,
whilst public health emphasizes the avoidance of illness.
❖ Prevention was initially construed narrowly in terms of protective
measures like vaccination and improved nutrition that target only
healthy people with the aim of preventing the onset of disease.
❖ This concept was extended to cover the early diagnosis and
treatment of sick persons with the aim of preventing advanced
diseases and in the case of communicable diseases, in preventing
the spread within the community.
❖ A further extension of the definition covers the treatment of sick
individuals aimed at reversing damage and restoring function.
❖ This concept led to the classification of prevention into three levels
later to be differentiated into five stages .
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The Dimensions of Public Health

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2-SOCIAL MEDICINE-‘The poor die young’
❑ Rise of social medicine coincided with increasing
realization of the links between social status & the health
of individuals & communities.
❑ Statistical analyses of mortality & morbidity data show
strong correlation between the social stratification in
society & the pattern of health & disease.
❑ Numerous studies in many countries confirm this
association and point to the need for social interventions to
complement biomedical tools in improving the health of the
deprived sections of the community.
❑ The objective of social medicine is to identify the social
determinants of health & disease in the community & to
devise mechanisms for alleviating suffering & ill health
through social policies & actions.
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2-SOCIAL MEDICINE-‘The poor die young’
❑ Social medicine is based on certain fundamental
assumptions:
i. Health as a birthright. Everyone has the right to enjoy the
highest possible level of health.
ii. Responsibility of the state → duty of governments to
ensure that the people have the basic elements that would
enable families & individuals to maintain good health & that
they have access to good quality health care.
iii. Development & health are inter-related. Good health
promotes development, & development promotes health.
iv. Education promotes health. The strong association between
health & level of education is particularly marked with
regard to women’s education.
v. Social factors have a profound influence on health. Culture,
behaviour, social organization, allocation of family
resources,
04/07/2023 11:52 healthcare seeking behaviour, etc.
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Health and human behaviour
• Human behaviour is an important dimension of social medicine.
The link between health and human behaviour is a major area of
interest in public health with medical anthropologists and
sociologists providing specific professional expertise.
• The link between lifestyle & health is gaining more attention as
chronic diseases increasingly dominate the epidemiological
pattern.
• The risk factors associated with cancers, cardiovascular diseases,
diabetes & other chronic diseases relate to such lifestyle choices
as the use of tobacco & alcohol, diet, nutrition and exercise.
Access to and utilization of health services
▪ Behavioural scientists are also interested in healthcare seeking
behaviour of individuals & families ranging from the self-treatment
at home, to consultations with traditional medical practitioners.
▪ Social medicine emphasizes the relationship between social
factors & health status. It draws attention to the need for a
multidisciplinary approach to health with deep involvement of
social and behavioural scientists, economists, ethicists and
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political scientists.
 The Gift Of Water
❑ Water is essential to life. Sourcing
it and collecting it is not an option.
❑ Water means food security.
Water means health. Water
means safety and security.
Access to water and sanitation is
necessary to develop other areas
of a healthy life.
❑ Yet structural and economic
injustice has resulted in unequal
access to a God given resource.
❑ Over the past century, unclean
Water for crops in Timor Leste.
water, poor sanitation and unsafe Credit: Marden Dean

hygiene practices have claimed

more lives than anything else.
 Beneficial water uses
❑ since the intended use of a water dictates the water quality
requirements, delineation of water allocated for specific uses
is mandatory
❑ the traditionally accepted beneficial uses of water reflect the
multi-interest utilization of water resources.these uses include:
i. domestic water supply,
ii. industrial water supply,
iii. agricultural water supply,
iv. fisheries,
v. urban development,
vi. hydropower generation,
vii. transportation (navigation),
viii.Recreational waters,
ix. sanitation,
x. assimilation of wastes, and other activities
❑ these uses span a wide spectrum of water quality
requirements
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Water & sanitation in our world
today
1.8 2.3 billion
people lack access to
billion basic sanitation such as
people globally use a toilet or latrine. Of this
a source of drinking
water that is fecally 892 million
contaminated. people continue to
practice open
defecation.

80% of wastewater resulting from

human activities is discharged into rivers or
seas without any pollution removal.
Safe sanitation impacts all areas of life

IMPROVING HEALTH BETTER EDUCATION

443 million sick days are taken
1,000 children die each by children every year due to
day due to preventable water WASH related diseases.
and sanitation related
1 in 3 schools lack access to
diarrhoeal diseases which
water and basic sanitation.
could be prevented by
improved Water, Sanitation
and Health (WASH).

NUTRITION REDUCING INEQUALITY

In 2017, 151 million children 4 billion people lack access to
worldwide under age 5 suffered basic sanitation services, such as
toilets or latrines.
from stunting. One of the main
cause is WASH-related
diseases like diarrhea that
prevent the proper absorption of
nutrients from food.
 Gender Inequality
❖ In many countries around the world,
women are responsible for finding
and collecting water for their
families. This can be a dangerous
chore. Collecting water from
sources like rivers can include risk
of attack from animals such as
crocodiles.
❖ Women and girls can face disease,
Women and children spend 125
harassment, shame and the threat million hours each day
of violence because they have no collecting water.
safe sanitation choices.
❖ Many girls don’t attend school if
there are no safe and private toilets
available for menstrual hygiene
management.
Progress since the millennium development
goals (MDG) 2000-2015

Goal 7 of the MDGs was to ensure environmental sustainability,

including halving the proportion of people without access to safe water
and sanitation between 2000-2015. Global action has led to positive
results.

In 1990 MDG GOAL

76% of the global population used 88%
improved water sources

54% of the global population used

improved sanitation facilities. 77%
Progress since the millennium
development goals
WATER GOAL MET IN 2010 SANITATION GOAL MISSED

✓ 91% of the world’s X Only 68% of the global

population now access population now uses improved
improved sources of sanitation facilities (Goal was
drinking water. 77%)

X 8 /10 people in the world ✓ 2.1 billion people have

who live in rural areas are still gained access to improved
without a source of improved sanitation since 1990
drinking water
X 2.4 billion people still lack
X 663 million people still lack improved sanitation facilities.
access to improved drinking
water sources.
 Sustainable Development Goals

In 2015, the new Sustainable

Development Goals (SDGs) were
released.

These are 17 goals for

everyone, everywhere, aimed at
achieving three extraordinary
things in the next 15 years:
• End extreme poverty.
• Fight inequality & injustice.
• Fix climate change.
Credit: United Nations
 Goal 6 focuses on clean water & Sanitation
Ensure availability and sustainable
management of water and sanitation
for all

Some of the targets for 2030:

• achieve universal and equitable
access to safe and affordable
drinking water for all
• achieve access to adequate
sanitation and hygiene for all
• end open defecation, paying special
attention to the needs of women and
girls and those in vulnerable
situations Credit: United Nations

• improve water quality by reducing

pollution and eliminating dumping
COMMUNITY HEALTH
❖ Community health deals with the services that aim at
protecting the health of the community.
❖ The interventions vary from environmental sanitation including
vector control to personal health care, immunization, health
education and such like.
❖ It includes an important diagnostic element – ‘community
diagnosis’ – aimed at surveying and monitoring community
health needs and assessing the impact of interventions.
COMMUNITY MEDICINE
❖ This usually refers to services that are provided at the
community level and is now often encompassed in the new
term primary care.
❖ Community physicians, nurses and other health-care
personnel are involved in providing care at clinics, health
centres and in people’s homes.
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 Modern Public Health
❖ The modern concept of public health includes all these elements –
preventive medicine, social medicine, community medicine,
community health.
❖ Important features of modern public health include the following
characteristic features. It is:
i. multidisciplinary;
ii. multisectoral;
iii. evidence-based;
iv. equity-oriented.
1-Multidisciplinary
❑ Although medical practitioners constitute a vital segment of the
public health practitioners, the contributions from other health-related
disciplines are absolutely essential for achieving the goals of public
health.
❑ Thus, public health team would include, as required, doctors, nurses,
midwives, dentists & pharmacists; anthropologists, economists &
other social scientists; philosophers, ethicists & other experts on
moral sciences,
04/07/2023 11:52 educationists,George
communications
Kimbowa experts & managers
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 Modern Public Health
2-Multisectoral
❖ The health sector has two distinct roles. It is primarily
responsible for planning & delivering health services.
❖ It also has an important leadership function in mobilizing
intersectoral action.
❖ It should work with other ministries:
i. with public works on water & sanitation;
ii. with education on the health of school children & health
promotion;
iii. with transport on the control of road traffic accidents;
iv. & with agriculture on food security, nutrition, use of
pesticides & the control of zoonotic infections.

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 Modern Public Health
3-Evidence-based
❑ Modern public health demands that decisions should be
science-based and knowledge-based.
❑ As far as possible, policy-making should be made only after
objective analysis of relevant information.
❑ Where information is lacking, there is a clear indication for
gathering data & carrying out research to inform decision-
making.
❑ It is often stated that researchers should present their results
in a way that decision-makers can apply their findings.
❑ By the same token, policy-makers have responsibility to
ensure that their decisions are based on the best available
scientific evidence.
❑ Both researchers & policy-makers with their common interest
in promoting health of population need to work closely together
in generating & using sound evidence as basis of decision-
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making.
 Modern Public Health
5-Equity-oriented
❑ Public health programmes must be designed to promote equity
as the ultimate goal of all health action.
❑ The aim is to ensure for each member of society the highest
possible level of health.
❑ Public health programmes should actively monitor equity &
make necessary corrections.
❑ Public health practitioners must adopt a strong advocacy role in
persuading decision-makers & influential members of society
that, in long run, equity in health is to everyone’s advantage as
a means of securing sustainable development & strengthening
social contract among citizens from a wide variety of
backgrounds & between them & their governments.
❑ It should be made clear that solidarity with poor is not merely an
act of charity but a mechanism for promoting welfare of all
peoples.
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 Key Public Health Functions
Public health services perform
a wide range of functions,
which can be classified as four
key elements:
i. assessing & monitoring of
the health of population;
ii. planning, implementing &
evaluating public health
programmes;
iii. identifying & dealing with
environmental hazards;
iv. communicating with
people & organizations to
promote public health
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 Modern Public Health
Tropical Environment-the total
environment of human beings
includes all the living & non-
living elements in their
surroundings.
▪ It consists of three major
components: physical,
biological & social.
▪ The relationships of human
beings to their environment
is reciprocal in that the
environment has a profound
influence on them & they in
turn make extensive
alterations to environment to
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 Modern Public Health
Physical Environment-refers to non-living part of environment – air,
soil, water, minerals – & climatic factors such as temperature & humidity.
▪ Physical environment is extremely variable in tropics covering
deserts, savannahs, upland jungle, cold dry or humid plateaux,
marshlands, high mountain steppes or tropical rainforest.
▪ Climatic factors such as temperature & humidity have a direct effect
on humans, their comfort & their physical performance.
▪ Physical environment also exerts an indirect effect by determining
distribution of organisms in biological environment: plants & animals
which provide food, clothing & shelter; animals which compete with
humans for food; & parasites & their vectors which produce &
transmit disease.
▪ Humans alter natural characteristics of physical environment
sometimes on a small scale but often on a very large scale: from
clearing a small patch of bush, building a hut & digging a small canal
to irrigate a vegetable garden to building of large cities, draining of
swamps, irrigating arid zones, damming rivers & creating large
artificial lakes. Many such changes
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have proved beneficial but some
George Kimbowa 36
aspects of these changes have created new hazards.
 Modern Public Health
Biological Environment
❑ All the living things in an area – plants, animals & micro-organisms –
constitute biological environment. They are dependent on each other &
ultimately, on their physical environment. Nitrogen-fixing organisms
convert atmospheric nitrogen into nitrates that are essential for plant life.
❑ Plants trap energy from the sun by photosynthesis. A mammal may
obtain its nourishment by feeding on plants (herbivore) or on other
animals (carnivore) or both (omnivore).
❑ Under natural conditions, there is a balanced relationship between
growth & size of the population of a particular species, on one hand, &
its sources of food & prevalence of competitors & predators, on other
hand.
❑ Humans deliberately manipulate biological environment by cultivating
useful plants to provide food, clothing & shelter, & raising farm animals
for their meat, milk, leather, wool & other useful products. They hunt &
kill wild animals, & destroy insects which transmit disease or which
compete with them for food. In many parts of the tropics, insects, snails
& other vectors of disease abound & thrive. This is partly because
natural environment favours their
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Kimbowa but also because, in some
37 of
these areas, relatively little has been done to control these agents.
 Modern Public Health
Social Environment
❑ This is the part of the environment that is entirely
made by humans.
❑ In essence, it represents the situation of human
beings as members of society:
▪ family groups, village or urban communities,
▪ culture including beliefs & attitudes,
▪ the organization of society – politics & government,
▪ laws & the judicial system,
▪ the educational system,
▪ transport & communication,
▪ & social services including health care.

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 Modern Public Health
Health and Development
▪ The close link between health & development in other sectors
is clearly recognizable.
▪ There is a clear correlation between economic, industrial &
other indices of development & health status of populations &
communities.
▪ At one end of spectrum are industrialized, affluent developed
countries & at other end are least developed countries that still
rely largely on traditional agricultural practices & simple crafts.
▪ ‘developing countries’ is used to describe countries that have
not as yet achieved a high level of industrial and economic
development.
▪ Characteristic features of developing countries include
relatively low income, low literacy rates, low access to
electricity & other modern sources of energy, & high mortality
rates among vulnerable groups (children, pregnant women).
▪ These factors interact: illiteracy
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is associated with poverty;
39
 Modern Public Health
Health and Development
▪ There is much variation in the extent of technical development
in the various countries in the tropics.
▪ Some of these countries are now highly developed whilst
others are still in early stages.
▪ Some of developing countries show certain common features:
limited central organization of services, scattered populations
living in small self-contained units, low level of economic
development, limited educational facilities, & inadequate
control of common agents of disease.
▪ Some of these communities are still held tightly in vicious
circle of ignorance, poverty & disease.
▪ Rapid economic development & growth of modern industries
are causing mass migrations from rural to urban areas.
▪ Faster means of transportation, progress in education, control &
eradication of major endemic diseases, & other developments are
effectively
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disease,
Kimbowa poverty & ignorance. 40
 Modern Public Health
Health and Development
▪ At the same time new problems are emerging, including those
resulting from the social & psychological stresses imposed by
these bewildering changes & their destructive effects on
traditional family life & communal relationships.
▪ In these transitional societies there have been marked
changes in patterns of disease.
▪ Noncommunicable diseases & conditions are now replacing
communicable diseases which were formerly the predominant
causes of disability, disease & death.
▪ Malnutrition in the form of the deficiency of specific nutrients is
being succeeded by problems resulting from over-indulgence,
thus obesity is replacing marasmus as the predominant
nutritional problem.
▪ Alcoholism & drug abuse are emerging as manifestations of
social stresses & tensions
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 Modern Public Health
Ecological Approach to Public Health
❑ In public health, it is useful to consider reciprocal relationship
between humans & their total environment.
❑ In the search for causes of disease, it is not sufficient merely to
identify the specific agent of a disease, such as a virus or a
parasite, but it is desirable to identify influence of
environmental factors on the interaction between humans &
the specific agent.
❑ For example, the typhoid bacillus (Salmonella typhi) is known
to be causative agent of disease but occurrence of outbreaks
of typhoid is determined by various environmental factors:
i. water supply,
ii. methods of sewage disposal,
iii. prevalence of typhoid carriers,
iv. personal habits of the people (cleanliness),
v. use of raw water,
vi. 04/07/2023
attitude 11:52
to & use of medical services, including vaccination.42
George Kimbowa
 Modern Public Health
Ecological Approach to Public Health
❑ Similarly, a specific nutritional deficiency, such as
ariboflavinosis, should not be viewed merely as a discrete
metabolic defect but it should be seen in the context of the
food habits of the community including:
i. food taboos,
ii. level of education
iii. income of the population
iv. local agriculture.
❑ From this ecological approach, one can derive a rational
basis for control of disease within population.
❑ Typhoid control should go beyond treatment of individual
patient, to include immunization of susceptible groups,
protection of water supplies, safe disposal of waste &
improvement of personal hygiene.
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 Modern Public Health
Ecological Approach to Public Health
❑ Malnutrition is managed not only by giving pills containing
concentrated nutrients but also by giving suitable advice about
diet & promoting cultivation of nutritional foods both
commercially by farmers & privately in home gardens;
❑ In more complex situations management may extend to
promotion of welfare services such as unemployment benefits
& food supplements for needy.
❑ health worker should seek suitable opportunities for improving
the health of the people through action on the environment.
❑ These lessons should be repeatedly emphasized.
❑ individual & family can do much about cleanliness of home &
its immediate surroundings, thereby reducing occurrence of a
number of infectious diseases.
❑ Domestic accidents, especially in such high-risk areas as
kitchen & bathroom, can be prevented by careful attention to
environment
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 Modern Public Health
Ecological Approach to Public Health
❑ Individual needs to recognize how environment in home
affects health of family, why each person must act to
improve situation & what individual & family can do to deal
with the problem.
❑ community should be approached as a whole to deal with
widespread problems that affect many families, & also for
help with those problems which require action beyond
means of individual families.
❑ For example, certain environmental situations may require
organization at community level & must be designed in
context of culture of local community:
i. collection & storage of water to ensure that each family
has an adequate supply of safe water;
ii. disposal of human & other wastes;
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iii. control of other environmental hazards.
 Modern Public Health
Ecological Approach to Public Health
❑ In most developing countries, modern development
projects and urbanization are introducing new risks .
❑ It is therefore necessary to ensure that these new
initiatives should be carefully examined at community
level with regard to their appropriate siting & safe
management, with minimal risk to environment.
❑ At national & international level, large-scale projects such
as creation of artificial lakes, irrigation projects & mining of
minerals including oil, require careful assessment of their
environmental impact.
❑ The adverse effects can best be minimized by careful
planning so that as far as possible protective measures
can be incorporated into the design of these projects.
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 Modern Public Health
Ecological Approach to Public Health
❑ Some developed countries facing problems of disposing
of toxic chemicals & radioactive waste have resorted
to dumping them in developing countries.
❑ Serious concerns raised by these events should lead to
tighter international controls.
❑ Developing countries are also involved in dealing with
environmental issues which are of global dimensions:
i. denudation of the tropical forest & its probable adverse
effects on climate;
ii. use of chlorofluorocarbons (CFCs) that destroy the
ozone layer;
iii. & extensive use of fossil fuel
iv. & consequent increase in greenhouse gases identified
as the main cause of global warming.
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 Global health
What is global health?
❖ Health problems, issues, & concerns that transcend
national boundaries, which may be influenced by
circumstances or experiences in other countries, & which
are best addressed by cooperative actions & solutions
Global Health Issues
❖ Refers to any health issue that concerns many countries
or is affected by transnational determinants such as:
i. Climate change
ii. Urbanisation
iii. Malnutrition – under or over nutrition
❖ Or solutions such as:
a) Polio eradication
b) Containment of avian influenza
c) Approaches to tobacco control
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 Historical Development of Term
1-Public Health: Developed as a discipline in mid 19th
century in UK, Europe & US. Concerned more with national
issues.
❖ Data & evidence to support action, focus on populations,
social justice & equity, emphasis on preventions vs cure.
2-International Health: Developed during past decades,
came to be more concerned with
❖ the diseases (e.g. tropical diseases) and
❖ conditions (war, natural disasters) of middle and low
income countries.
❖ Tended to denote a one way flow of ‘good ideas’.
3-Global Health: More recent in its origin and emphasises a
greater scope of health problems & solutions
❖ that transcend national boundaries
❖ requiring greater inter-disciplinary approach
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 Disciplines involved in Global Health
a. Social sciences
b. Behavioural sciences
c. Law
d. Economics
e. History
f. Engineering
g. Biomedical sciences
h. Environmental sciences

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 Communicable Diseases & Risk Factors
❑ Infectious diseases are communicable

But..

❑ so are elements of western lifestyles:

i. Dietary changes
ii. Lack of physical activity
iii. Reliance on automobile transport
iv. Smoking
v. Stress
vi. Urbanisation
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 It’s the Real Thing

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 Key Concepts in Relation to Global Health
i. The determinants of health
ii. The measurement of health status
iii.The importance of culture to health
iv. The global burden of disease
v. The key risk factors for various health
problems
vi. The organisation & function of health
systems

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 1. Determinants of Health
i. Genetic make up
ii. Age
iii. Gender
iv. Lifestyle choices
v. Community influences
vi. Income status
vii. Geographical location
viii. Culture
ix. Environmental factors
x. Work conditions Source: Dahlgren G. and
Whitehead M. 1991
xi. Education
xii. Access to health services

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 1. Determinants of Health
Plus More General Factors Such As:

i. Political Stability
ii. Civil Rights
iii. Environmental Degradation
iv. Population Growth/Pressure
v. Urbanisation
vi. Development Of Country Of Residence

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 Multi-sectoral Dimension of the
Determinants of Health
i. Malnutrition – more susceptible to disease
and less likely to recover
ii. Cooking with wood & coal – lung diseases
iii. Poor sanitation – more intestinal infections
iv. Poor life circumstances – commercial sex
work and STIs, HIV/AIDS
v. Advertising tobacco & alcohol –addiction &
related diseases
vi. Rapid growth in vehicular traffic often with
untrained drivers on unsafe roads- road traffic
accidents
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 2. The Measurement of Health Status I
i. Cause of death- Obtained from death certification but limited
because of incomplete coverage
ii. Life expectancy at birth- average number of years a new-
borns baby could expect to live if current trends in mortality
were to continue for the rest of the new-born's life
iii. Maternal mortality rate-The number of women who die as a
result of childbirth and pregnancy related complications per
100,000 live births in a given year
iv. Infant mortality rate- number of deaths in infants under 1
year per 1,000 live births for a given year
v. Neonatal mortality rate- number of deaths among infants
under 28 days in a given year per 1,000 live births in that
year
vi. Child mortality rate- probability that a new-born will die
before reaching the age of five years, expressed as a number
per 1,000 live births
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 3. Culture & Health
❑ Culture: The predominating attitudes and behaviour
that characterise the functioning of a group or
organization
❑ Traditional health systems
❑ Beliefs about health e.g. epilepsy – a disorder of
neuronal depolarisation vs a form of possession/bad
omen sent by the ancestors
▪ Psychoses – ancestral problems requiring the
assistance of traditional healer/spiritualist
❑ Influence of culture on health
▪ Diversity, marginalisation and vulnerability due to
race, gender and ethnicity

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 4. The global burden of disease
❑ Predicted changes in burden of disease from
communicable to non-communicable between
2004 & 2030
✓ Reductions in malaria, diarrhoeal diseases,
TB & HIV/AIDS
✓ Increase in cardiovascular deaths, COPD,
road traffic accidents and diabetes mellitus
❑ Ageing populations in middle & low income
countries
❑ Socioeconomic growth with increased car
ownership
❑ Based on a ‘business as usual’ assumption
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 5. Key Risk Factors for Various Health Conditions
❑ Tobacco use – related to the top ten causes of
mortality world wide
❑ Poor sanitation & access to clean water-
related to high levels of diarrhoeal/water borne
diseases
❑ Low condom use – HIV/AIDS, sexually
transmitted infections
❑ Malnutrition – Under-nutrition (increased
susceptibility to infectious diseases) & over-
nutrition responsible for cardiovascular
diseases, cancers, obesity etc.

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 6-Organisation & Function of Health Systems
❑ A health system-comprises all organizations,
institutions and resources devoted to
producing actions whose primary intent is to
improve health (WHO)

❑ Most national health systems consist: public,

private, traditional and informal sectors:

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 Source: WHO statistics 2008

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Source: W.H.O. Statistics

 Health Patterns In Resource Rich Countries
❑ Lifestyle factors affecting physical and mental
health:

i. Smoking – one third of cancer deaths related

to smoking
ii. Drinking
iii. Healthy eating/nutrition
iv. Physical activity
v. Substance abuse

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 Food Safety
❑ Food Hygiene & Food Standards Inspections

❑ Food Complaints

❑ Food Sampling

❑ Food Poisoning Cases/Outbreaks

❑ Food Hazard Warnings

❑ Training

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 Principle Legislation (Assignment!!)
i. Food Safety Order

ii. Food Hygiene Regulations

iii. Health & Safety at Work order (Occupational Health &

Safety Act)

iv. Public Health Act

v. Pollution Control & Local Government Order

vi. Industrial Pollution Control Order

vii. Consumer Protection Act

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 Findings from Food
Hygiene Inspections…

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 The “Food Safety Officer”
❑ Power to enter & inspect food premises at all
reasonable hours
❑ Will visit the premises without advance notice
❑ Frequency of inspections determined by potential
risk & previous record of business
❑ Range of enforcement options available to officers
ranging from informal action (eg. verbal advice, use
of letters etc.), hygiene improvement notices,
emergency prohibition notices, prohibition orders,
seizure & detention, prosecution & formal caution
❑ Obstruction of officers is an offence

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 Is this what your kitchen is like?

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Would you like your chips from this Chippy?

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 Would you like your food cooked in
here?

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 I’ll take my drink without ice thanks!

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 Would you eat this meat?!

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 Food Complaints…

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 Apple Pie with a “Twist”

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 Apple Pie with a “Twist”

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 Death by misadventure…

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