COMMUNITY AND PUBLIC HEALTH FOR MLS SECOND YEAR, FIRST SEMESTER

LECTURE TRANSCRIPT ACADEMIC YEAR 2023 - 2024

WEEK 1: INTRODUCTION TO COMMUNITY AND PUBLIC ● Is the principle of ensuring that everyone has an equal
HEALTH opportunity to achieve their full health potential,
regardless of their socioeconomic status, race, ethnicity,
WHAT IS PUBLIC HEALTH? or other factors
● Everyone can attain health advantages
HEALTH ENVIRONMENTAL CONDITIONS
● derived from “hal” ● Where people live and work
● A state of complete physical, mental, and social ● Ex.: RMTs are prone to hepatitis and other disease
well-being and not merely the absence of disease and causing agents
infirmity (WHO, 1946). BEHAVIORAL CHOICES
○ Not only based on physical, kasama si social and ● Lifestyle, diet, physical activity, substance abuse
mental ● Ex.: smoking, unhealthy diet
○ Social welfare involves social environment, living, AVAILABILITY OF QUALITY MEDICAL CARE
and working conditions - holistic quality of health ● No access to healthcare or limited access
● “A resource for everyday life, not the object of living, and ● Ex.: no medical insurance = no checkups
is a positive concept emphasizing social and personal ● Out of pocket expense - payment you make with your
resources as well as physical capabilities.” –WHO, 1989 money
○ Support individual functions in a society COMMUNITY
● A dynamic state or condition of the human organism that
● A geographic area with specific boundaries
is multidimensional (i.e., physical, emotional, social,
○ Ex of sp boundaries: san juan city, neighborhood
intellectual, spiritual, and occupational) in nature, a
● Community and Public Health
resource for living, and results from a person’s
○ a collective body of individuals identified by
interactions with and adaptations to his or her
common characteristics such as geography,
environment.
interests, experiences, concerns, or values
○ Physical, emotional, social, intellectual, spiritual,
■ Ex. LGBTQI - they don't live in one place but
and occupational - contributes to overall health
are loosely and share common identified
■ Financial - can afford quality and nutritious
characteristics
foods
● Communities are characterized by the following
■ Spiritual - magsimba lang mabait na ang
elements:
feeling
(1) membership - sense of identity and belongingness
■ Social - integral welfare
● Alumni group - same learning from same
○ Can have diseases and disabilities but still healthy
institution
INTERCONNECTIONS OF THE DETERMINANTS OF (2) common symbol systems
HEALTH ● Same ritual and ceremonies
(3) shared values and norms
(4) mutual influence - can make influence and
influence others
(5) shared needs and commitment to meeting them
(6) shared emotional connection
PUBLIC HEALTH
● A science and art of preventing disease, prolonging life,
promoting health and efficiency
○ through organized community effort for the
sanitation of the environment, control of
communicable diseases, and the education of
individuals in personal hygiene
● actions that society takes collectively to ensure
● Many different factors that determine health conditions in which people can be healthy
● Interactions of 5 domains ● Branch of medicine that deals with the diagnosis of
GESTATIONAL ENDOWMENTS health status of the community to give solution to the
● genetic factors problem seen in the community
● Less level of optimum health due to bad genes ● Medical health is individual health
● Ex. Diabetic parents can make diabetic children ○ Data is physiologic
SOCIAL CIRCUMSTANCES ● Uses statistical data
● Income, education, employment, housing ● Promotes and protect health of all people and their
● Primary approach to achieve health equity communities
Health Equity COMMUNITY HEALTH
● the absence of systematic disparities in health between
and within social groups that have different levels of ● health status of a defined group of people and the actions
underlying social advantages or disadvantages—that is, and conditions to promote, protect, and preserve their
different positions in a social hierarchy health

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COMMUNITY AND PUBLIC HEALTH FOR MLS SECOND YEAR, FIRST SEMESTER
LECTURE TRANSCRIPT ACADEMIC YEAR 2023 - 2024

○ Ex.: The health status of the people of Dasmariñas, ● Bible’s Book of Leviticus written; includes guidelines for
Cavite, and the private and public actions taken to personal cleanliness and sanitation. See Leviticus
promote, protect, and preserve the health of these 15:11-18
people would constitute community health. ○ Hebres wrote leviticus 1500 BC
● Slight different approach to public health ■ Keep clean body, isolation from lepers,
● Focus on the contributory factors to the diseases rather sanitation, protection of campsite, and
than the prevention of diseases pregnancy
POPULATION HEALTH CIRCA 1900 B. C. E.
● Perhaps the earliest written record of public health was
● Health outcomes of a group of individuals, including the the Code of Hammurabi; included laws for physicians
distribution of such outcomes within the group and health practice
○ Ex: Group of individuals: whether by age, gender, ○ Implies the important role of government to regulate
income, marital status, etc. health professionals
● Involves group of individual with shared characteristics ○ Provide for the people’s well being
GLOBAL HEALTH Code Of Hammurabi Relating To Surgical Activities
1. If a physician make a large incision with an operating
● health problems, issues, and concerns that transcend
knife and cure it, or if he open a tumor (over the eye) with
national boundaries, may be influenced by circumstances
an operating knife, and saves the eye, he shall receive
or experiences in other countries, and are best
ten shekels in money.
addressed by cooperative actions and solutions
2. If the patient be a freed man, he receives five shekels.
○ Ex. of Global Health issues: COVID-19, Zika Virus,
3. If he be the slave of some one, his owner shall give the
HIV/AIDS
physician two shekels.
● Always have the term worldwide in achieving health
4. If a physician make a large incision with the operating
equity
knife, and kill him, or open a tumor with the operating
DIFFERENCES OF COMMUNITY, PUBLIC, POPULATION, knife, and cut out the eye, his hands shall be cut off.
AND GLOBAL HEALTH 5. If a physician make a large incision in the slave of a freed
Community Health status, Defined group (geographically), man, and kill him, he shall replace the slave with another
Health determining contributors to health slave.
Public Health The science, actions taken to prevent, health 6. If he had opened a tumor with the operating knife, and
of population as a whole put out his eye, he shall pay half his value.
Population Health outcomes, groups based on shared 7. If a physician heals the broken bone or diseased soft part
Health characteristics of a man, the patient shall pay the physician five shekels
in money.
Global Health Worldwide, health problems
8. If he were a freed man he shall pay three shekels.
HISTORY OF PUBLIC HEALTH PART ONE : YEARS 9. If he were a slave his owner shall pay the physician two
BEFORE 1700s shekels.
10. If a veterinary surgeon perform a serious operation on an
HISTORY : EARLY CIVILIZATIONS ass or an ox, and cures it, the owner shall pay the
ANCIENT CIVILIZATIONS (BEFORE 500 B.C.E) surgeon one-sixth of a shekel as a fee.
PRIOR TO 2000 B. C. E. 11. If he perform a serious operation on an ass or ox, and kill
it, he shall pay the owner one-fourth of its value.
● Archeological findings provide 12. If a barber, without the knowledge of his master, cut the
evidence of sewage disposal sign of a slave on a slave not to be sold, the hands of this
and written medical barber shall be cut off.
prescriptions. 13. If any one deceive a barber, and have him mark a slave
● Sewage and toilet systems were not for sale with the sign of a slave, he shall be put to
already available death, and buried in his house. The barber shall swear: “I
did not mark him wittingly,” and shall be guiltless.
CLASSICAL CULTURES (500 B.C.E)
CIRCA 1500 B. C. E.
THE GREEKS
● men participated in
games of strength and skill
and swam in public facilities.
● involved in practice of
community sanitation;
● involved in obtaining
water from sources far away
and not just local wells.

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COMMUNITY AND PUBLIC HEALTH FOR MLS SECOND YEAR, FIRST SEMESTER
LECTURE TRANSCRIPT ACADEMIC YEAR 2023 - 2024

THE ROMANS NOTABLE EPIDEMICS

● Improved community
sanitation of Greeks;
● built aqueducts to
transport water from
miles away; built sewer ● The Black Death (543 – 1348)
systems; ● Leprosy (1200)
○ To bring clean ● Smallpox, diphtheria, measles,
water influenza, tuberculosis, anthrax,
● created regulation for and trachoma.
building construction, ● Syphilis (1492)
refuse removal, and street cleaning and repair;
● created hospitals as infirmaries for slaves.
● First to build the first hospitals
THE CHRISTIANS
● created hospitals as benevolent charitable organizations HISTORY : RENAISSANCE & EXPLORATION
○ Benevolent - non profit charitable organization 1500 - 1700

FALL OF ROMAN EMPIRE 476 C.E

● Rebirth of thinking about the nature of the world and

humankind.
● Time of great trade, experiences were not forgotten
● Belief that disease was caused by environmental, not
spiritual, factors.
○ Malaria = bad air
● Observation of ill led to more accurate descriptions of
● Most public health activities ceased symptoms and outcomes of diseases.
HISTORY : MEDIEVAL AGE ○ first recognition of whooping cough, typhus,
THE DARK AGES (500 C.E-1000 C.E) scarlet fever, and malaria as distinct and separate
diseases.
● 1662: John Graunt published the Observations on the
Bills of Mortality, the beginning of vital statistics.
○ Printed in london providing statistics of plagues
from parishes
● Epidemics (e.g., smallpox, malaria, and plague) still
rampant.
○ plague epidemic killed 68,596 (15% of the
population) in London in 1665.
● Explorers, conquerors, and merchants and their crews
spread disease to colonists and indigenous people
throughout the New World.
● Fall of Rome due to evil behavior and opposite extremes
○ Columbus built his first town on the nearby island
● Growing revulsion for Roman materialism and a growth
of Hispaniola. Lacking immunity to Old World
of spirituality.
pathogens carried by the Spanish, Hispaniola’s
● Health problems were considered to have both spiritual
indigenous inhabitants fell victim to terrible plagues
causes and spiritual solutions, a time referred to as the
of smallpox, influenza, and other viruses.
spiritual era of public health.
● Blaming diseases from God’s judgment HISTORY OF PUBLIC HEALTH PART TWO : 1700
ONWARDS
18TH CENTURY

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COMMUNITY AND PUBLIC HEALTH FOR MLS SECOND YEAR, FIRST SEMESTER
LECTURE TRANSCRIPT ACADEMIC YEAR 2023 - 2024

● Struck London
● Dr. John Snow believed that sewage dumped into rivers
and cesspools near town wells could contaminate water
supplies and cause cholera outbreaks.
○ studied the epidemic and hypothesized that the
disease was being caused by the drinking water
from the Broad Street pump.
○ Father of modern epidemiology
● Microorganisms can actually cause disease
● Characterized by industrial growth BEGINNINGS OF BACTERIOLOGICAL ERA OF PUBLIC
● Despite the beginnings of recognition of the nature of HEALTH
disease, living conditions were hardly conducive to good
health. ● 1862 : Louis Pasteur introduces Germ Theory of
○ Cities were overcrowded and water was unsanitary Diseases and later on Pasteurization of milk and gave
● Many jobs were unsafe or involved working in unhealthy way to theory of spontaneous generation
environments, such as textile factories and coal mines. ○ Spontaneous generation - living organisms
○ Workforce: poor, children, and indentured servants develop from nonliving matter
forced to work for longer hours ● 1876 : Robert Koch demonstrates the anthrax bacillus
○ Indentured servants - yes work no pay ● 1900 : Reed declares that mosquitoes are the source of
yellow fever.
20TH CENTURY

● 1796 : Edward Jenner introduces smallpox vaccine

○ Introduced the process of vaccination as a
protection ● 1945-1948: Foundation of WHO through the UN
diplomats
19TH CENTURY
○ April 7, 1948 : Constitution of WHO came into
force, basis of World Health Day
● 1959 – WHO Global Smallpox Eradication Program
○ 1980 – Smallpox declared to be eradicated
HISTORY OF PUBLIC HEALTH PART THREE : PUBLIC
HEALTH IN THE PHILIPPINES
PRE-SPANISH ERA (BEFORE 1545)
● Ancient Filipinos regarded health as a harmonious
● Predominance of Miasmas Theory relationship with the environment, both natural and
○ Vapors or miasmas are source of many diseases supernatural.
○ Remained popular though 19th century
● Bacteriological period of public health the period of
1875–1900, during which the causes of many bacterial
diseases were discovered
● Modern era of public health that began in 1850 and
continues today.
THE 1854 CHOLERA ENDEMIC

● Use of medicinal plants to cure various ailments.

● Malaria has been present in the Philippines for centuries.
FAITH HEALERS AND MEDICINAL PLANTS
● Ailments were believed to be caused by disharmony with
● Violent diarrhea and high mortality with some 600 deaths the spiritual world, and restoring health meant appeasing
in one week the gods through rituals.

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COMMUNITY AND PUBLIC HEALTH FOR MLS SECOND YEAR, FIRST SEMESTER
LECTURE TRANSCRIPT ACADEMIC YEAR 2023 - 2024

○ At the center of these rituals was the babaylan, the Japanese emperor Iemitsu in 1632 at the
mediator between the physical and spiritual worlds. time of Governor-General Juan Nino de Tabora.
○ Babaylan - in philippine indigenous communities, ○ Demolished in 1662 when the city was under the
has the ability to mediate the spirit world threat of invasion by the Chinese Pirate Chen Ch’e
● One of the most prized medicinal plants is the igasud Kung.
from the mountain regions of the Visayas. Its seed when ○ Now in rizal avenue
chewed is an antidote for poison. ● 1582 - Miguel de Loarca reported that inhabitants of
○ renamed Pepita of San Ignacio by Spanish Cebu were afflicted by itchy lesions and a certain
missionaries. "bubas."
TRADITIONAL COMPLEMENTARY AND ALTERNATIVE
MEDICINE (IN EAMC)
● Effective and safe use of alternative medicine
SPANISH ERA (1565 – 1898)

○ Accounts say this “bubas” came from Bohol when

raiders from Maluku infected the natives.
○ Maluku - Indonesia archipelago
● Introduction of safe water supply in 1690s
○ The water taken from various water sources are
stored in bamboo poles
● Spaniards attempt to westernize the practices of our ● 1871 – UST Faculty Of Medicine And Pharmacy was
ancestors. established.
● The San Lazaro Church and Hospital represents early ○ first medical school in the Philippines
medical healthcare in the Spanish era.
● The Spanish were not accustomed to the climate, food,
and other challenges of living in the Philippines hence
many succumbed to a number of diseases and were
treated in hospitals specially created for their welfare.
● HOSPITAL REAL
○ The very first hospital in the Philippines
○ Established in Cebu in 1565 by Miguel Lopez de
Legazpi as approved by King Philip II
○ Funded by king philip but struggled financially SMALLPOX
○ Relocated in Manila when the seat of power
transferred there.
○ exclusively for Spanish soldiers and sea sailors
○ destroyed during an earthquake on June 3, 1863
● HOSPITAL DE NATURALES (1578 BY FRAY
CLEMENTE)
○ Fray clemente - botanist that makes medicines
outside kumbento and eventually raised funds to
build facility
■ Worked for 20 years
○ 1583 - first time it burned
○ 1603 - Was destroyed by fire (following Fray ● 1574 Smallpox Epidemic – first recorded epidemic in
Clemente’s death). the country
○ A new location was chosen for the reconstruction ○ First acute infection that was discovered by
of the facility, a development that led to the spaniards
establishment of one of the oldest medical ● 1789 - a vessel from China traveling to the Ilocos region
institutions in the country, the Hospital de San was believed to be the probable source of an epidemic
Lazaro that soon spread to Manila and its neighboring provinces
● HOSPITAL DE SAN LÁZARO ● April 15, 1805 – Dr. Francisco de Balmis for smallpox
○ Site : Dilao (Paco) vaccine expedition as ordered by King Charles IV
○ Pinapadala yung mga lepers AMERICAN ERA (1898 – 1918)
■ Patron saint of lepers
● Focused on improving healthcare by building more
○ Demolished twice
hospitals and implementing measures to prevent the
○ The name was given after the hospital undertook
spread of diseases.
the care of 150 lepers sent to the Philippines by

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COMMUNITY AND PUBLIC HEALTH FOR MLS SECOND YEAR, FIRST SEMESTER
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● Formal medical education and more medical benefits ● Focused on health education targeting young children
were given to Filipinos. and their mothers
● Bureau of Public Health ○ Required school children to undergo health
○ Part of Aguinaldo’s examination once a year
government
○ Replaced by the Board of
Health for City of Manila upon
the takeover of the Americans
■ Headed by Dr. Frank
Bourns
● 1899 – Appointment of Dr. Guy
Edie as the first Commissioner of
the Board of Health
● 1901 – Board of Health for
● 1932 - Theodore Roosevelt Jr. becomes Gov. Gen
Philippine Islands
● 1933 – Reverted PHS to Bureau of Health
○ Became Insular Board of
○ Established Community Health and Social
Health
Centers (precursors of Barangay Health Centers
● 1902-1905 : Cholera epidemic claimed 200,222 lives.
that we know today)
○ 66,000 were children
○ Traveling X-ray clinics
○ 1905 – establishment of UP College of Medicine
and TB pavilions were
and Surgery using John Hopkins University as
set up in the provinces
their model
● 1934 – Dr. Jose Fabella is
● 1907 – enactment of the Leper Law
appointed as commissioner of
○ Compulsory apprehension of leprosy
Public Health and Welfare and
● 1917 – Mass Vaccination for Smallpox
soon as the first Secretary of
○ 25 million Filipinos were given the vaccine
Health and Public Welfare
AMERICAN ERA (1898 - 1918) TOWARDS FILIPINIZATION ○ During this period,
OF HEALTH SERVICES incidence of water-borne
● 1915 – Bureau of Health reorganized and renamed as diseases significantly
Philippine Health Services decreased due to the
● 1916 – enactment of Jones Law by Woodrow Wilson construction of a modern
○ Jones law withdrawal of water filtration plant in Manila that supplied safe
sovereignty of america in the quality water.
philippines until it is stable ● 1935 – Start of PH Commonwealth (Manuel L. Quezon)
○ PHS came under the ● 1939 – Department of Health and Public Welfare
supervision of the ○ Combination of PHS, Office of Public Welfare
Department of Public Commissioner, and Tuberculosis Commission
instruction JAPANESE OCCUPATION (1942 – 1945)
● Dr. Vicente de Jesus
● October 14, 1943 – inauguration of Japanese-
○ 1914 – appointed as the first
sponsored republic with Jose P. Laurel as President
Filipino Assistant Director of
Philippine Health Services ;
Became the Director in 1919
○ Started the Filipinization of
Health Services
FILIPINIZATION OF HEALTH SERVICES (1918 - 1941)
● 1921 – Warren Harding becomes
the US president
○ Immediate investigation and
evaluation of the conditions in
the Philippines headed by
Leonard Wood and William
Forbes
○ noted the lack of hospitals ○ Claro M. Recto – Commissioner of Education,
and dispensaries and the loss Health, and Public Welfare
of “zeal and vigor” among the ○ Dr. Eusebio Aguilar – Director of Health
health personnel. ● Increased incidence of malaria, TB, and severe
■ Zeal and vigor - gana malnutrition
or enthusiasm to do ● About 5,000 segregated lepers escaped in search for
something food

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COMMUNITY AND PUBLIC HEALTH FOR MLS SECOND YEAR, FIRST SEMESTER
LECTURE TRANSCRIPT ACADEMIC YEAR 2023 - 2024

SECOND COMMONWEALTH (1945 – 1946) ○ Major milestone of the twentieth century in the field
of public health, and it identified primary health care
● February 27, 1945 : as the key to the attainment of the goal of Health for
reconstitution of commonwealth All
with Sergio Osmena as ○ Dr. Jesus Azurin launched the nationwide
President implementation of the Primary Health Care
● A survey of the health and approach, which made him the first World Health
sanitary conditions in post-war Organization Sasakawa Health Prize recipient.
Philippines conducted by the ● People Power Revolution of 1986 – Aquino
United States Public Health Administration
Service (USPHS) reported grim ○ EO 119 – revert Ministry of Health to DOH
findings: ○ Dr. Alfredo Bengzon as the Secretary of Health
○ The cases of infectious ● 1992 – Magna Carta for Public Health Workers (RA
diseases were high; 7305)
malnutrition and beriberi ● 1995 – National Health Insurance Act (RA 7875)
were widespread; public ○ Signed by Fidel V. Ramos
sanitation was in a ○ Established PhilHealth
deplorable state; and destruction of health ● 2019 – Universal Health Care Act (RA 11223)
infrastructure posed new threats of cholera, plague, ○ Automatically enroll all filipinos in philhealth
smallpox, and other epidemics. ○ Afford healthcare benefits without card
THE DEPARTMENT OF HEALTH THE DEPARTMENT OF HEALTH - STRUCTURE
● October 4, 1947 : Establishment of DOH ● 2004 - EO 366 by Pres. Arroyo – basis of structure
○ Executive Order No. 94 by President Manuel ● National Government Level
Roxas ○ The DOH acts as the national lead agency in
○ separation of the health.
country’s health and ○ The DOH central office consists of 18 bureaus and
public welfare offices services
● Dr. Antonio C. Villarama as ○ DOH has 17 regional health offices, one for each
appointed Secretary. of the 17 administrative regions of the country.
● Had three distinct units ● Local Government Level
○ Bureau of Health ○ Municipal Health System
○ Bureau of Quarantine ■ Rural Health Units, Barangay Health
○ Bureau of Hospitals Stations
● Reorganized in 1958 under ○ City Health System
Pres. Elpidio Quirino through ■ Health Centers, BHS, City Hospitals, Medical
Executive Order 288 Centers
○ Decentralization of power into Eight Regional
Offices CURRENT CHALLENGES
● The Rural Health Act of 1954 transformed the ● COVID-19
puericulture centers to RHUs and health centers, a ● Dengue - caused by mosquitoes
national network of public health facilities at the ● HIV - attacks body's immune system can lead to AIDS
community level was organized in all cities and ● Tuberculosis
municipalities. ● Improving Health Care in Remote Areas
● Martial Law (1970s) LESSONS FROM A PANDEMIC
○ Transformed into Ministry of Health
○ Primary health-care approach was adopted as a
national policy in the late 1970s following the Alma
Ata Declaration
● THE ALMA ATA DECLARATION (SEPTEMBER 6-12,
1978)

● The etiological agent of a potential pandemic can

interact with the environment and can increase a host’s
susceptibility to this agent
● Inability to identify disease origins, cause of
transmission, and effective strategies to control it may be
due to lack of testing and studies of observations across
populations

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COMMUNITY AND PUBLIC HEALTH FOR MLS SECOND YEAR, FIRST SEMESTER
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● There shall be a systematic way to test associations

between exposure and outcome factors
● Agent - SARS COV 2 - disease causing
● Host - any uninfected persons and individual with
susceptibility characteristics
● Environment

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COMMUNITY AND PUBLIC HEALTH FOR MLS SECOND YEAR, FIRST SEMESTER
LECTURE TRANSCRIPT ACADEMIC YEAR 2023 - 2024

WEEK 2: INTRODUCTION TO BIOSTATISTICS AND compactly and so that they can be understood easily
EPIDEMIOLOGY ● Can be done through:
○ Tabular presentation
BIOSTATISTICS ○ Graphical presentation
● Collection, organization, analysis, interpretation of data SOURCES FOR DATA PRESENTATION
● Descriptive – summarize and present data in a form that
is easier to analyze (summary measures, tables, graphs, FREQUENCY DISTRIBUTION
rates, ratios and proportions) ● Data are grouped according to some scale of
○ Summary measures - measure of central location classification, where the sum of the entries is equal to the
and tendency. (mean, median, mode) total.
○ Ratios - compare one quantity against another ● The figures may either be in actual numbers, in percent
■ Described as an overview or in both.
■ Can be expressed as 𝑏
𝑎 ● The scales used may be qualitative, quantitative or both
■ Compare to different quantities
○ Proportion
■ Numerator is part of the denominator
𝑎
■ Can be expressed as 𝑎+𝑏
○ Rate - type of proportion that have time element or
factor
𝑎
■ 𝑎+𝑏
× 𝐾
■ K - factor to standardize the rate CORRELATION DATA
● Differs depends on the specifications of ● Compares two or more frequencies
the demographer ● Usually obtained from conducting epidemiologic studies
● Inferential – making estimates, predictions, ● Used to measure the magnitude of association between
generalizations of a given population (point and interval two quantitative data sets
estimates, hypothesis testing
● Variation – tendency of a given characteristic to change
from one individual or setting to another; or from the
same person in different periods of time.
○ phenomenon which result is the variables
● Variable – measurement or characteristic which changes
from one individual or setting to another; or from the
same person in different periods of time
TYPES OF VARIABLES
● Qualitative – labels for distinguishing
● Quantitative – expressed numerically and can be TIME SERIES DATA
arranged according to magnitude.
○ Discrete – whole numbers ● Data that are collected over a time period
○ Continuous –fractions/decimals ● Shows how the certain variable that is being discerned by
the data collected changes through time
LEVELS OF MEASUREMENT OF VARIABLES
● Nominal – labels only (qualitative)
○ Ex: genotype, blood type, zip code gender, race,
eye color, political party
● Ordinal – can be ordered or rank but same as nominal
(qualitative)
○ Ex: Socio economic status, education level, income
level, satisfaction rating
● Interval – zero does not mean absence of the
characteristic (quantitative)
○ Ex: Temperature (Fahrenheit and Celsius) , pH,
SAT score, credit score PARTS OF A TABLE
● Ratio – zero means absence of characteristic (ex. TITLE
Weight) (quantitative) ● Should state the objective of the table.
○ Ex: enzyme activity, dose amount, reaction rate, ● It should state the following clearly, briefly and
flow rate, concentration, pulse, weight, length comprehensively:
DATA PRESENTATION ○ what the figures in the body of the table stand for
○ how the data are classified
● It refers to the arrangement of any data in an orderly ○ where and when the data were obtained
sequence, so that they can be presented concisely and STUBS

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COMMUNITY AND PUBLIC HEALTH FOR MLS SECOND YEAR, FIRST SEMESTER
LECTURE TRANSCRIPT ACADEMIC YEAR 2023 - 2024

● Indicates the basis of classification of table rows ● studying the genetic differences associated with diseases
● The leftmost column of the table, which contain the and disease states
subjects to which the table data apply GENOMICS
COLUMN HEADINGS ● studying the biological activity of genes as they relate to
● Indicate the basis of classification of the columns or disease and treatment
vertical series of figures SPATIAL STUDIES
● Tips: In making your table, align your column headings in ● studying of the geographical distribution of diseases or
the same manner of alignment as the data below it; if not risk factors associated with disease
all aligned in the center.. ● Ex: prevalence of a certain disease condition & the
BODY OF THE TABLE certain factors that contribute to it.
● This is made up of the figures filling the cells or RESPONSIBILITIES OF A BIOSTATISTICIAN
compartments brought about by the coordinates of rows
and columns ● Designing and Conducting experiments on public health
● Tips: When filling your data in the table, always and its related fields.
remember these for the alignment: ● Collecting and Analyzing data to improve current health
○ Text aligned to the left programs and services.
○ Numbers aligned to the right ● Interpreting the results of the findings generated by data
■ Numbers are aligned to right because their collection efforts
values can easily be seen, especially the CONVERSATION ABOUT COVID-19 WITH
decimal places BIOSTATISTICIANS AND EPIDEMIOLOGISTS
○ Try to put in the numbers in the same number of
BIOSTATISTICIANS AND EPIDEMIOLOGIST CONCLUDED
decimal places as each other
THAT:
OTHER PARTS
● Medially-effective therapies may be available by fall 2020
● Marginal Totals
(July – September)
○ Refer to the column totals and row totals
● Vaccines will not be ready to deploy until 2021
○ Tables must always have these
PROVIDED that initial vaccine candidates prove
● Footnote
successful
○ Indicates the source of information
○ Solidarity – mega trial developed by WHO which
APPLICATION OF BIOSTATISTICS IN PUBLIC HEALTH studies the effective treatments as seen by
BIOSTATISTICS observational experiences in the hospital to be able
to eradicate covid-19 from patients.
● It is the collection, organization , analysis, and ● Different countries will become COVID-19 hotspots as
interpretation of data in the generation of inferences that local restrictions and social distancing are relaxed to
can be used to solve problems in public health advance the economy and the must be re-imposed.
UNDERSTANDING PUBLIC HEALTH ● Overall mortality is dependent on how social distancing is
Biostatistics has a great hand in dealing with certain public practiced.
health issues: ● Developing nations will be hardest-hit due to their limited
● Chronic diseases public health infrastructure.
● Cancer ● More rapid testing is needed before a gradual shift to the
● Human growth and development new normal can be considered.
● Relationships between genetics and the environment ○ Mass Testing (Targeted Testing) – target the
● Infectious diseases populations who are most at risk for Covid-19, test
● Epidemics everyone in that room, and tackle the
● Environmental health impact assessment asymptomatic.
● Universities will experience significant financial hardship
ROLE OF BIOSTATISTICS IN PUBLIC HEALTH RESEARCH as schools remain closed during the pandemic.
CLINICAL TRIALS ● Data science will be useful in the estimation of the
● studying the treatment effectiveness as well as screening prevalence of the disease, as well as the analysis of
and prevention methods in different populations. ongoing natural experiments on the pandemic response
● w/o biostats,, we won’t be able to calculate how INTRODUCTION TO EPIDEMIOLOGY
treatment A works against a certain controlled treatment
or how treatment A works better than treatment B. EPIDEMIOLOGY
● we can’t also be able to say that this method is more ● The study of the distribution of the determinants of
sensitive than the other one in screening. health-related states or events in specified populations,
● Ex: W/o the measures of the calculations that are brought and the application of this study to the control of health
about by biostats problems..
EPIDEMIOLOGICAL STUDIES TWO MAIN BRANCHES OF EPIDEMIOLOGY
● studying the causes and origins of disease in humans.
● W/o biostats, we will not have any epidemiological CLINICAL EPIDEMIOLOGY
measures of prevalence, incidence, any odds or risk ● Specific to medical statistics, specific patients
ratios. ● a specific course available as a masteral degree in many
HUMAN GENETICS universities

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PUBLIC HEALTH EPIDEMIOLOGY ● early detection and monitoring

● specific on populations especially during outbreaks, they ● Only done through accurate diagnostic methods.
provide solutions, needed to implement at time of ● Medical Laboratory scientists or Medical Technologists
outbreaks or public health emergencies are doing a very fundamental epidemiological concept at
EPIDEMIOLOGY OBJECTIVES this level.
TERTIARY
● Etiology (causative agent) of diseases and modes of ● reduce or eliminate impairments and disabilities.
transmission ● More in the field of doctors as well as physical therapists
● Extent of disease problems or those in the rehabilitation sciences.
● Natural history and prognosis
● Preventive and therapeutic measures DISEASE OCCURRENCE
● Development of public policy that can be derived from the CAUSALITY
evidence generated from the epidemiology studies. ● a factor that varies depending on the outcome
BIOMEDICAL PERSPECTIVE ● links the exposure variable (cause) and outcome
variable (effect)
● Disease spectrum (mainly on the symptoms it presents ● basically tells how the effect is actually due to the cause
and the clinical outcome it does) established.
● Natural history for diagnostic accuracy DIFFERENT WAYS OF DERIVING CAUSALITY
● Physiologic and genetic variables ● Epidemiologic triad
● Risk factors of disease ● Causal web
● Clarification of disease transmission ● Causal pie
PUBLIC HEALTH PERSPECTIVE STRATEGIES IN EPIDEMIOLOGY
● Community health needs
● Health goals, priorities, objective (to prevent and control DESCRIPTIVE STUDIES
some of our country’s public health problems) ● It is the study of the three epidemiologic variables
● Allocation and managing healthcare resources (person place time); formulate hypothesis
● Impact of health services ● Case study
FEW IMPORTANT PEOPLE ● Ecological study
● Prevalence study - rare public diseases that needs to be
THESE PEOPLE CONTRIBUTED TO THE FIELD OF addressed
EPIDEMIOLOGY:
● Hippocrates - seasonal variation of a disease ANALYTICAL STUDIES
○ Ex: The flu presents itself on a certain month of the ● It tests hypotheses, determine association between the
year. exposure and outcome
● John Snow – natural epidemiologic experiment for ● 2 Divisions of Analytical Studies: Observational and
cholera Experimental
○ He discovered that cholera came from a water ANALYTICAL STUDIES: OBSERVATIONAL STUDIES
stagnant source.
● Doll and Hill – first case-control study ● No manipulation of the exposure
● Dawber et. al – first cohort study ● Cross-sectional, Cohort, Case control
CROSS-SECTIONAL
STAGES OF THE NATURAL HISTORY OF A DISEASE ● Assess the exposure and outcome variables at one point
1. Susceptibility - risk factors are present, disease has not in a time; a snapshot of the current situation.
yet developed. 𝑝𝑟𝑒𝑣𝑎𝑙𝑒𝑛𝑐𝑒 𝑎𝑚𝑜𝑛𝑔 𝑒𝑥𝑝𝑜𝑠𝑒𝑑
● It yields a Prevalence Ratio = 𝑝𝑟𝑒𝑣𝑎𝑙𝑒𝑛𝑐𝑒 𝑎𝑚𝑜𝑛𝑔 𝑢𝑛𝑒𝑥𝑝𝑜𝑠𝑒𝑑
2. Subclinical disease – no signs or symptoms, but
● Says how the prevalence of an outcome/disease differs
pathologic changes are already occurring in the host.
between those who are exposed to the factor of interest
a. RMTs are important because they can give
vs. those who are not exposed.
laboratory results Ii\f a disease is present in the
● What does it mean if the prevalence ratio is higher than
absence of symptoms
1, less than 1 or equal to 1?
3. Clinical disease – signs and symptoms have already
COHORT
developed.
● A prospective study that follows up individuals who are
4. Recovery, disability or death – these may be realized
exposed to a factor to see if they developed the outcome
depending on how the 3 stages went through
of interest.
LEVELS OF PREVENTION ● Deals with exposure variables first and see if the
PRIMORDIAL outcome developed after the exposure has been studied.
𝑟𝑖𝑠𝑘 𝑜𝑓 𝑜𝑢𝑡𝑐𝑜𝑚𝑒 𝑎𝑚𝑜𝑛𝑔 𝑒𝑥𝑝𝑜𝑠𝑒𝑑
● prevent emergence of risk factors ● It yields a Risk Ratio = 𝑟𝑖𝑠𝑘 𝑜𝑓 𝑜𝑢𝑡𝑐𝑜𝑚𝑒 𝑎𝑚𝑜𝑛𝑔 𝑢𝑛𝑒𝑥𝑝𝑜𝑠𝑒𝑑
PRIMARY ● Says how great the effect of the exposure would be in
● control exposure to risk factors developing the outcome.
● In the primordial level, the risk factors are not yet present. ● What does it mean if the risk ratio is higher than 1, less
Whereas in the primary level, the risk factors are already than 1 or equal to 1?
there and we just need to control it. CASE CONTROL
SECONDARY ● A retrospective study that looks at those with the

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outcome of interest and reviews their past exposure of disease affecting individuals.
histories to see if they were exposed to the factor of ● Prevent occurrence
interest. ● Arrest progress
● Looks at the outcome first and see if the exposure is ● Reduce consequences
related to the outcome. ● Can be directed at the: agent is in its reservoir stage,
● Trohoc studies - term used for case control studies agent in its transit, at the susceptible population
during the older times because it was just literally the AGENT IS IN ITS RESERVOIR STAGE
opposite of cohort.
𝑜𝑑𝑑𝑠 𝑜𝑓 𝑜𝑢𝑡𝑐𝑜𝑚𝑒 𝑎𝑚𝑜𝑛𝑔 𝑒𝑥𝑝𝑜𝑠𝑒𝑑 ● Eliminate
● It yields an Odds Ratio = 𝑜𝑑𝑑𝑠 𝑜𝑓 𝑜𝑢𝑡𝑐𝑜𝑚𝑒 𝑎𝑚𝑜𝑛𝑔 𝑢𝑛𝑒𝑥𝑝𝑜𝑠𝑒𝑑
● Reduce communicability or ineffectivity of the agent
● Says how probable the outcome will be if you are ○ Treatment
exposed to the factor of interest ○ Isolation – separation for the period of
● What does it mean if the odd ratio is higher than if the communicability of the case.
odd ratio is higher than 1, less than 1 or equal to 1? ■ For sick people
ANALYTICAL STUDIES: EXPERIMENTAL / ○ Quarantine – limitation of movement of persons
INTERVENTIONAL STUDIES who do not have the disease but are exposed to the
agent for not longer than the agent’s maximum
● With manipulation of the exposure variable.
incubation period.
● A prospective study that randomizes individuals and
● For those who are basically well * Isolation and
gives them interventions to see if they do or do not
quarantine are not interchangeable
develop the outcome of interest.
● Requires professional license and professional training. AGENT IS IN TRANSIT
● Classified by the type of intervention or by the unit of ● Agents in transit are usually aimed at the vectors and
analysis: vehicles of disease
○ Prophylactic ○ Vectors – biological; anything alive that can
○ Therapeutic transfer disease. E.g. insects
○ Clinical Trial ○ Vehicles - non living things that can transfer
○ Community Trial disease. E.g. doorknobs, contaminated surface
Remember this ● Apply environmental control measures
Study type Assessing Measure of Measure of
AT THE SUSCEPTIBLE POPULATION
exposure and disease association
outcome frequency There are two types of strategies:
that can be ● Specific Strategies
calculated ○ Chemoprophylaxis – E.g. [PrEP] Pre-exposure
Cross- sectional Exposure and Prevalence ❖Prevalence prophylaxis (for HIV/AIDS) = administered before
outcome are ratio sexual intercourse
assessed at ❖Prevalence ○ Immunization – E.g. vaccination campaigns
one point in difference ● Non-Specific Strategies
time ○ Health promotion and education strategies
Cohort Exposure is Incidence ❖Risk ratio ○ Proper nutrition
assessed ❖Risk ○ Target the behaviors of the individuals
before the difference TYPES OF IMMUNITY
outcome ● Non-specific resistance – present at the time of birth or
Case control Outcome is None Odds ratio has developed during maturation.
assessed ○ E.g. immune cells that you are born with
before ● Specific resistance- acquired due to an exposure to a
exposure foreign substance.
Experimental Outcome is Incidence Treatment ○ If you have a disease, it makes you manufacture an
assessed effectiveness antibody specific to the disease
before
exposure TYPES OF SPECIFIC IMMUNITY
however ACTIVE
variable is ● The antigen is introduced and the body that makes
manipulated antibodies to defend against the infection.
(intervention) ● Naturally-acquired - acquired through the natural history
of disease processes.
○ E.g. sick with common flu
DISEASE PREVENTION AND CONTROL ● Artificially-acquired - antigen is deliberately introduced
PREVENTION ○ ex. Live, attenuated virus particles as vaccines in
● Elimination of specific disease by one or more measures MMR (inactivated form of antigen), BCG
of proven efficiency. PASSIVE
● Approaches and activities aimed at reducing likelihood ● The antibodies for the infection are the ones that are
introduced.

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● Naturally-acquired - transfer of antibodies from mother

to baby, either through the placenta or through the
mother’s milk
○ Breastfeeding is required for 0-2 years
infant/children to fully acquire the immunity.
○ A type of vaccine where the virus is in sleeping
state when it is introduced to you, it will induce the
disease process
● Artificially-acquired - injection of immune sera as
vaccines
○ ex. Anti-tetanus, antibodies, diphtheria, antitoxin
○ A type of vaccine that will build up your database of
the antibodies that are available

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WEEK 3A: INTRODUCTION TO NCD EPIDEMIOLOGY ● It is defined as a risk factor that cannot be reduced or
controlled by intervention.
WHAT IS NCD? ○ Age
○ Gender
● Chronic - long development and no recovery
○ Race
● Noncommunicable - non infectious, non contagious
○ Family history (genetics)
● Prolonged course - at birth there can be risk factors,
symptoms long develop COMMON RISK FACTOR
CHARACTERISTICS TOBACCO UNHEALTH PHYSICAL ALCOHOL
● Complex etiology (causes) USE Y DIET INACTIVITY USE
○ Marami pinanggalingan CARDIO- VASCULAR Yes Yes Yes Yes
DIABETES Yes Yes Yes Yes
● Non Contagious origin (non-communicable)
CANCER Yes Yes Yes Yes
● Multiple risk factors CHRONIC RESPIRATORY Yes Not Really Not Really Not Really
○ Genetics and hereditary factors
● Long latency period
○ From the exposure, sobrang tagal pa mag develop METABOLIC RISK FACTOR
ng symptoms ● “Metabolic" = biochemical processes
● Prolonged course of illness ● Aka physiologic risk factor
○ Long recovery sometimes none ○ Raised blood pressure
● Functional impairment or disability ○ Raised Total cholesterol
○ Can cause poor quality of life ○ Elevated Glucose
TYPES ○ Overweight and obesity
● Cardiovascular disease (coronary heart disease,
FOUR LEADING NCDs
stroke)
○ Involves heart and vessels of the brain, very ● CARDIOVASCULAR DISEASE
vascular in nature ● DIABETES MELLITUS
● Cancer ● CHRONIC RESPIRATORY DISEASE
● Chronic respiratory disease ● CANCER
○ Emphysema CARDIOVASCULAR DISEASE
○ Chronic pulmonary obstructive disease
● Diabetes Coronary heart Disease of the blood vessels
● Chronic neurologic disorders (alzheimer's disease and disease supplying the heart muscle
dementia) Cerebrovascular Disease of the blood vessels
● Arthritis/Musculoskeletal diseases Disease (Stroke) supplying the brain
● Unintentional injuries (from from traffic crashes) Peripheral Arterial Disease of blood vessels supplying
○ Accident is something you can prevent kaya hindi Disease (PAD) the arms and legs
na dapat accident ang term Congenital heart Malformations of heart structure
PHILIPPINE TRENDS disease existing at birth
1. Ischemic heart disease - loss of oxygen to the heart or Congenital - from birth may butas sa
heart attack, leading cause of death in the Philippines puso
2. Cerebrovascular diseases - stroke
3. Cancer
4. Diabetes mellitus
5. Hypertensive diseases - as early as 12 yrs old
RISK FACTORS
● Defined as any variable that increases your risk of
developing the disease
● Examples:
○ Behavior or lifestyle
○ Environmental exposure
○ Hereditary ● Formation of plaque due to damage (platelets building up
● Can be modifiable or nonmodifiable and covered by cholesterol)
MODIFIABLE RISK FACTOR ● Eventually blocking the blood flow
CVD: GLOBAL BURDEN
● Factors that can be reduced or controlled by intervention. ● CVDs are the #1 cause of death globally.
○ Physical inactivity - not exercising ● Most deaths were due to coronary heart disease (next:
○ Tobacco use - smoking, most modifiable stroke)
○ Alcohol use ● Over 80% CVD deaths occur in low- and middle- income
○ Unhealthy diet - (increased fat and sodium, low countries.
fruit and vegetable intake). ○ Because many poor people are not going to check
NON-MODIFIABLE RISK FACTOR ups and screening
● By 2030, almost 25 million people will die from CVDs

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DIABETES MELLITUS CANCER

● Diabetes mellitus (DM) is a disorder of metabolism —
inadequate control of blood levels of glucose.
TYPES:
1. Type I DM
2. Type II DM
3. Gestational DM - pregnant women
4. MODY - on young, as early as 8 yr old
5. Type III DM - found on alzheimer’s
4 MAJOR SYMPTOMS OF DIABETES
● “Always eating" - Polyphagia - red blood cells not eating
● “Always drinking” - Polydipsia due to high in glucose
● “Always urinating” - Polyuria especially at night
● Uncontrolled cell growth
because of polydipsia
● Space invading, can travel through the bloodstream
● Weight loss
CANCER: GLOBAL BURDEN
TYPE I DIABETES MELLITUS ● 70% of all cancer deaths occur in low- and middle-
● In Type I DM, the pancreas cannot produce and release income countries.
insulin. ○ Due to poor screening and lack of coverage from
● Pancreas is lazy, there you cannot control glucose government
● Pancreas dysfunction probably due to genetics mostly in ● Deaths from cancer are estimated to reach 13.1 million
pediatrics by 2030.
● About 30% of cancers are attributable to behavior risk
TYPE II DIABETES MELLITUS
factors.
● INSULIN resistance – your body does not respond well to LEADING CAUSES OF CANCER IN THE PHILIPPINES
insulin. ● Both Sexes: (BreLuCoLiPro)
● Red blood cells are consumers of glucose 1. Breast
● Red blood cells are lazy and causes insulin resistance 2. Lung
Type I Type II 3. Colorectal - colon cancer as well as cancer
Causes Genetics Genetics (family history) 4. Liver
Auto-immune problem Lifestyle Problem 5. Prostate
(pancreas is being Aging (poor glucose ● Females: (BreCerCoLuO)
destroyed) regulation in the elders) 1. Breast
Age of Mostly in young Mostly in adults 2. Cervical
Onset 3. Colorectal
Treatment Requires insulin May add insulin (not 4. Lung
necessarily required) 5. Ovary
Prevention No known prevention Lifestyle modification, ● Males: (LuCoProLiL)
early detection 1. lungs
2. Colorectal
GESTATIONAL DIABETES 3. Prostate
● On pregnant women 4. Liver
5. Leukemia - cancer of the blood
MODY
BREAST CANCER
● Maturity-onset diabetes of the young
● Seen on children ● Occurs commonly in women, rarely occurs in men
● 1 of 8 women will be diagnosed with breast cancer.
TYPE III DIABETES MELLITUS
RISK FACTORS:
● seen in patients with alzheimer's disease ● Hormone therapies
CHRONIC RESPIRATORY DISEASE. ● Weight and physical activity - especially the obese
● Genetics or family history - BRCA1 and BRCA2 genes
● A leading cause of death (among Filipinos)
● Age is the most reliable risk factor
● High under-diagnoses rates
○ Increasing age = increasing predisposition
● 90% of deaths occur in low-income countries
○ Many are smoking, it is harder to control LUNG CANCER
■ Nicotine - has a know effect of fulling ● Affects more men than women
■ Increase the price of cigarettes on senate ● More men are working in smoke filled occupations than
RISK FACTORS: women
● Cigarette smoke TWO MAIN TYPES:
● Environmental exposure (work, indoor air pollution) ● Small cell lung cancer - more dangerous
● Genes, Age ● Non-small cell lung cancer
● Infections RISK FACTORS:
● Socio-economic status ● Exposure to smoke or carcinogenic materials

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● Occupational exposure (radon (airplanes), asbestos Raised Blood glucose

(industry and manufacturing), uranium (weapons, Raised lipids
radiation)) Behavioral risk Tobacco use
● Family history - can be passed from one generation to factors Unhealthy diet
another Physical inactivity
Harmful use of alcohol
Underlying drivers Social determinants of health
● Annual income
● Education
● Employment
Globalization
Urbanization
Population aging

LEADING RISK FACTORS

● Focus only on the first five
%
1. High blood pressure 12.8
2. Tobacco use 8.7
3. High blood glucose 5.8
● First hand smoking - first to use the cigarettes 4. Physical inactivity 5.5
● Second hand - passive, nakalanghap ng smoke 5. Overweight and obesity 4.8
● Third hand - ket walang nag smosmoke pero may amoy, 6. High cholesterol 4.5
leftover particles 7. Unsafe sex 4.0
COLORECTAL CANCER 8. Alcohol use 3.8
RISK FACTORS INCLUDE: 9. Childhood underweight 3.8
● Aging - at age 50 need mag pa colonoscopy as early as 10. Indoor smoke from solid fuels 3.3
35 kapag my history
● Unhealthy diet and low exercise - obesity, and low-fiber CALCULATING PACK YEARS
diet
● Diabetes ● 𝑥 × 𝑦 = 𝑃𝑎𝑐𝑘 𝑦𝑒𝑎𝑟𝑠
● Family history of colorectal cancer ○ x = average # of packs smoked per day
○ y = # of years you smoked
CERVICAL CANCER 20 𝑠𝑡𝑖𝑐𝑘 1 𝑝𝑎𝑐𝑘
○ Conversion unit: 1 𝑝𝑎𝑐𝑘 or 20 𝑠𝑡𝑖𝑐𝑘
● Cancer of the female reproductive system
● 99% of cases linked to genital infection with human EXAMPLE PROBLEM #1
papillomavirus (HPV) The patient has smoked 5 packs per day for 10 years:
○ can modify cells to produce cancer only in women ● 5 𝑝𝑎𝑐𝑘𝑠 × 10 𝑦𝑒𝑎𝑟𝑠 = 50 𝑝𝑎𝑐𝑘 𝑦𝑒𝑎𝑟𝑠
○ Obtained through sexual intercourse
OTHER RISK FACTORS: EXAMPLE PROBLEM #2
● Smoking The patient has smoked 4 sticks per day for 5 years:
● Birth control pills for a long time (five or more years) ● 4 𝑠𝑡𝑖𝑐𝑘𝑠 ×
1 𝑝𝑎𝑐𝑘
= 0. 2 𝑝𝑎𝑐𝑘𝑠
20 𝑠𝑡𝑖𝑐𝑘𝑠
○ Pills control the levels of your hormones
● Having given birth to three or more children ● 0. 2 𝑝𝑎𝑐𝑘𝑠 × 5 𝑦𝑒𝑎𝑟𝑠 = 1 𝑝𝑎𝑐𝑘 𝑦𝑒𝑎𝑟𝑠
○ There should be 2 year gap on pregnancies to heal EXAMPLE PROBLEM #3
the organs Compute for smoking pack years:
● Having several sexual partners ● 7 sticks per day
RISK FACTORS ● 16 years
1 𝑝𝑎𝑐𝑘
CHALLENGES: ● 7 𝑠𝑡𝑖𝑐𝑘𝑠 × 20 𝑠𝑡𝑖𝑐𝑘𝑠
= 0. 35 𝑝𝑎𝑐𝑘𝑠
● Surveillance for non-communicable diseases can be ● 0. 35 𝑝𝑎𝑐𝑘𝑠 × 16 𝑦𝑒𝑎𝑟𝑠 = 5. 6 𝑝𝑎𝑐𝑘 𝑦𝑒𝑎𝑟𝑠
difficult because of: Note: Every cigarette you smoke reduces your expected
○ Lag time between exposure and health condition, lifespan by 11 minutes
○ More than one exposure for a health condition, and
○ Exposure is linked to more than one health
condition. TOBACCO USE

CAUSAL LINKS (TRIANGLE) ● Tobacco kills up to half of its users.

● Tobacco kills nearly 6 million people each year.
NCDs ● Annual death toll could rise to more than 8 million by
Physiologic risk Raised blood pressure 2030.
factors overweight/obesity ● Nearly 80% of the world’s 1 billion smokers live in low-
and middle-income countries.

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GLOBAL CHANGES IN DIET DETECTION

● More than or equal to 2 readings on more than or equal
● Increased overall daily consumption of: to 2 different occasions.
○ Daily calories, HYPERTENSION IS ALSO LINKED TO INCREASED
○ Fat and meats, and SODIUM INTAKE.
○ Energy dense and nutrient-poor foods such as: ● Water retention is caused by sodium and increased
■ Starches blood volume
■ Refined sugar ● Recommended intake: 1,500-2,300 mg/day or 2 tsp/day
■ Trans-fats ● DASH Diet: DIETARY APPROACHES TO STOP
GLOBAL CHANGES IN PHYSICAL ACTIVITY HYPERTENSION
● 10,000 steps per day dapat dati 5,000 DIETARY APPROACHES TO STOP HYPERTENSION
● 31% of the world’s population does not get enough
physical activity, attributable to:
○ Aging population
○ Transportation
○ Communication technology
HEALTH EFFECTS OF PHYSICAL INACTIVITY
● 6% Coronary Heart Disease
● 7% Type II diabetes
● 10% Breast Cancer
● 10% Colon Cancer
● 9% Premature mortality - mas maagang mamatay if 72 rs
old ang lifespan namamatay agad before that age
ALTERNATIVE TO 10,000 STEPS ACCORDING TO CDC
● 30 MINUTES PER DAY
● 5 DAYS PER WEEK
● 150 minutes per week tas humilata kana
GLOBAL ALCOHOL CONSUMPTION
● 11.5% of all global drinkers are episodic, heavy users.
● 2.5 million people die from alcohol consumption per year
● The majority of adults consume at low-risk levels.
MODERATE DRINKING PLAN HIGH CHOLESTEROL LEVEL
● 1.2 tablespoon of alcohol

● Females: 1 drink or less ● You don't need cholesterol because your liver produces
● Males: 2 drink or less it
● OR No alcohol at all
HIGH BLOOD SUGAR
HIGH BLOOD PRESSURE
FASTING BLOOD SUGAR
BLOOD PRESSURE CATEGORIES ● < 100 mg/dL - normal
Blood Pressure Systolic mmHg Diastolic mmHg ● 101-126 mg/dL - At risk Prediabetes
Category (upper number) (lower number) ● > 126 mg/dL - Diabetes
Normal Less than 120 and Less than 80 GLYCOSYLATED HEMOGLOBIN OR HbA1c TEST
Elevated 120-129 and Less than 80 ● HbA1c monitors blood sugar status in the past 3 months
High Blood Pressure 130-139 or 80-89 ● Can be taken at any time of the day
(Hypertension) Stage 1 ● NORMAL: < 5.7%
High Blood Pressure 140 or higher or 90 or higher ● PREDIABETES: 5.7-6.0%
(Hypertension) Stage 2 ● DIABETES: > 6.0%
Hypertensive Crisis Higher than 180 and Higher than 120 BODY MASS INDEX (BMI)
(consult your doctor /or
Nutritional Status Non-Asian BMI Asian BMI
immediately)
Underweight < 18.5

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Normal 18.5-24.9 18.5-22.9

Overweight 25-29.9 23-24.9
Pre-Obese - 25-29.9
Obese Class I 30 - 40
Obese Class II 40.1 - 50
Obese Class III > 50
BMI FORMULA
● Conversions:
○ 1 lb = 0.454 kg
○ 1 in = 0.0254 m
○ 1 kg = 2.2 lbs
○ 1 m = 39.37 in
● Metric
𝑤𝑒𝑖𝑔ℎ𝑡 (𝑘𝑔)
○ 𝐵𝑀𝐼 = 2
[ℎ𝑒𝑖𝑔ℎ𝑡 (𝑚)]
● Imperial
𝑤𝑒𝑖𝑔ℎ𝑡 (𝑙𝑏𝑠)
○ 𝐵𝑀𝐼 = 703 × 2
[ℎ𝑒𝑖𝑔ℎ𝑡 (𝑖𝑛)]

EXAMPLE PROBLEM #4
A thai patient weighs 74 kg with a height of a 5’9
12 𝑖𝑛
● 5𝑓𝑡 × 1𝑓𝑡
= 60 𝑖𝑛 + 9 𝑖𝑛 = 69 𝑖𝑛
0.0254 𝑚
● 69 𝑖𝑛 × 1 𝑖𝑛 = 1. 7526 𝑚
74 𝑘𝑔
● 𝐵𝑀𝐼 = 2 = 24. 42
[1.7526 𝑚]
● According to asian BMI, the thai patient is overweight
EXAMPLE PROBLEM #5
Filipino, weight = 62 kgs, height = 5’4” (metrical)
12 𝑖𝑛
● 5𝑓𝑡 × 1𝑓𝑡
= 60 𝑖𝑛 + 4 𝑖𝑛 = 64 𝑖𝑛
0.0254 𝑚
● 64 𝑖𝑛 × 1 𝑖𝑛 = 1. 6256 𝑚
62 𝑘𝑔
● 𝐵𝑀𝐼 = 2 = 23. 46
[1.6256 𝑚]
● According to asian BMI, the patient is overweight
REVIEWER
● Unanswered PPT

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COMMUNITY AND PUBLIC HEALTH FOR MLS SECOND YEAR, FIRST SEMESTER
LECTURE TRANSCRIPT ACADEMIC YEAR 2023 - 2024

WEEK 3B: EPIDEMIOLOGY OF COMMUNICABLE ● Virulence – degree of pathogenicity or disease

DISEASES producing ability of a microorganism
○ More virulent more possibility to cause disease
● Communicable - can be transmitted from one person to ● Immunogenicity – the ability or extent to which a
another, can be direct or indirect substance is able to stimulate an immune response
EPIDEMIOLOGY ○ Immune system is involved
○ There can be part of the microorganism that
● the study of the distribution and determinants of
stimulates an immune response
health-related states or events (including disease), and
● Toxigenicity – the capacity to produce toxin
the application of this study to the control of diseases and
○ Toxin can contribute to the production of disease
other health problems. (World Health Organization)
● Resistance – the ability of bacteria and other
● Important in public health because we want to control the
microorganism to resist the effect of an antibiotic to which
spread of disease
they were once sensitive
EPIDEMIOLOGIST
○ Many bacteria are becoming resistant
● Studies the factors that determine the frequency,
● Latency – a period in which the infection is present in the
distribution, and determinants of diseases in human
host without producing overt symptoms
populations
○ Latent infection - nasa patient na pero wala pang
● Profession and has masteral specifically for
symptoms or clinical manifestations
epidemiology
● Determinants - age, immunization, etc. EPIDEMIOLOGICAL TERMINOLOGY
● Develops ways to prevent, control or eradicate disease in COMMUNICABLE DISEASE
populations ● means an illness caused by an infectious agent or its
○ Programs by DOH control and eradicate toxins that occurs through the direct or indirect
○ Eradicate - disease is completely gone, hard to transmission of the infectious agent or its products from
achieve an infected individual or via an animal, vector or the
● Concerned with all types of diseases inanimate environment to a susceptible animal or human
○ Concerned with noncommunicable diseases as well host. (CDC)
EPIDEMIOLOGICAL TRIANGLE ● Disease that can be transmitted to another
CONTAGIOUS DISEASE
● Communicable diseases that are easily transmitted from
one person to another
● Can be transmitted very easily and effortlessly and
causes outbreaks
● Ex: covid-19 and measles
ZOONOTIC DISEASES
● Infectious diseases that humans acquire from animal
sources
● HIV/AIDS - initially from monkeys but because it is
passed now from person to person, it is no longer
zoonotic
COMMUNICABLE DISEASE CHARACTERISTICS
● Incubation period
● Basic model to study health problems ● Communicable period
● We will focus on the biological agent ● Generation time
● 3 Factors ● Gradient of infection
○ Host - age, sex, genetics, profile ● Carrier state
○ Agent - bacterial or viral ● Temporal trends
○ Environment - where do they live and what makes ● Community reaction
them susceptible ● Quantification of disease occurrence
● Disease is produced by exposure of a susceptible host to INCUBATION PERIOD
an noxious agent in the presence of environmental ● Time interval between the exposure to the agent and the
factors that aid or hinder agents of disease onset of signs and symptoms
AGENT CHARACTERISTICS (DEFINITION OF TERMS) ● Time when you are exposed until the time the signs and
● Infectivity – the characteristic of an agent that embodies symptoms manifest
capability of entering, surviving and multiplying and ● It is the time needed for the agent to multiply inside the
causing disease in a susceptible host host
● Pathogenicity – the ability to cause disease ● This is variable and different for each type of infection
○ Not all biologic agents can cause disease because ● Extrinsic incubation period
they are not pathogenic ○ Applicable in vector diseases
○ Ex: some strains and the normal flora

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○ Ex: Malaria - time involved between when a ● Seasonal – changes in disease trends within a year; is
mosquito takes a viremic blood meal and the time dependent on environmental conditions; vector density;
when that mosquito becomes infectious and behavior of the host
● Intrinsic incubation period - occurs in humans ○ By season of year, depende sa lugar na may 4
○ The time between a human being infected and the seasons
onset of symptoms due to the infection ● Annual – changes in disease trends over several years;
COMMUNICABLE PERIOD observable changes in those susceptible to the disease
● Secular – gradual changes in the occurrence of disease
● The time in which the infectious agent may be transferred over long periods of time; may be due to changes in
from an infected host to a susceptible host incidence, age distribution, or diagnostic ascertainment
GENERATION TIME COMMUNITY REACTION: EPIDEMIOLOGICAL
TERMINOLOGY
● Sporadic Diseases
○ Diseases that occur only occasionally within the
population of a particular geographic area
○ They are kept under control as a result of
immunization programs and sanitary conditions
○ Biglang dadami within the year followed by a fall or
decline
● Endemic Diseases
○ Diseases that are always present within the
population of a particular geographic area.
○ Disease never dies out completely
○ There is a specific geographic area
● The time between the infection of a primary case and its ■ Ex: Palawan - malaria endemic
secondary cases (Fine, 2003; Svensson, 2007) ○ Ex: Palawan - dati pag tag-ulan due to stagnant
● Time period na matransmit from first case to second case water, but today even in summer marami pa rin
RELATIONSHIPS: TIME PERIOD ● Epidemic Diseases
○ Outbreak
○ Epidemic – greater than usual number of cases of
a disease in a particular region, usually occurring
within a relatively short period of time
○ It usually follows a specific pattern in which the
number of cases of a disease increases to a
maximum and then decreases rapidly, because the
number of susceptible and exposed individuals is
limited.
○ Biglaang pagdami
■ Ex: from 2 cases, biglaang 5 or 10 cases
agad
○ Event in which a disease is actively spreading
○ Often used to describe problem that has gotten out
of control
● Pandemic Diseases
GRADIENT OF INFECTION ○ Occurring in epidemic proportions in many
● Difference between stages of the development of the countries simultaneously – sometimes worldwide.
disease; whether it is inapparent or severe ○ Not only in one region
● Inapparent – There are no visible signs or symptoms ○ Relates to geographic spread
● Severe – With clinical manifestations, high case fatality, ○ Describes disease that affects a whole country or
and high proportion of disease sequelae the entire world
● Is dependent on:
CARRIER STATE ○ Herd immunity
● State wherein a host is infected but does not manifest the ■ immunity of the community or population
disease’s signs and/or symptoms ■ the indirect protection from an infectious
● Prevention and control strategies must also focus on disease that happens when a population is
determining if this state is existent in infectious diseases immune either through vaccination or
● Important also to know the length of this state and the immunity developed through previous
carrier’s means of transmission infection.
● Maraming pwedeng mamatay ○ Exposure or Contact frequency, which is again
TEMPORAL TRENDS dependent on many factors.

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● Rabies - very important vaccination of dogs and cats

● STDs
INTERACTIONS AMONG PATHOGENS, HOSTS AND
ENVIRONMENT
FACTORS
● Factors pertaining to pathogen
○ Virulence of the pathogen - more virulent, more
disease causing
○ Way of pathogen to enter the body - through
inhalation or may sugat
○ Number of organisms that enter the body
● Factors pertaining to the host
QUANTIFICATION OF DISEASE OCCURRENCE: ○ Health status
EPIDEMIOLOGICAL TERMINOLOGY ■ If you are sick you are immunocompromised
○ Nutritional status
● Incidence
■ The malnourished are more susceptible to
○ Number of new cases of that disease in a defined
virus
population during a specific time period
○ Other factors pertaining to the susceptibility of the
● Prevalence
host
○ Period prevalence – number of cases of the
● Factors pertaining to the environment
disease existing in a given population during a
○ Physical factors – geographic location, climate,
specific time period
etc
○ Point prevalence – number of cases of the
■ Important for endemic diseases
disease existing in a given population at a particular
○ Availability of appropriate reservoir
moment in time
■ Carriers and reservoirs in that area
● Mortality Rate
○ Sanitary and housing conditions; adequate
○ Death rate
waste disposal; adequate healthcare
○ Ratio of the number of people who died of a
○ Availability of potable water
particular disease during a specified time period per
a specified population CHAIN OF INFECTION
● Morbidity Rate ● Goal is to break it
○ Usually expressed as the number of new cases of a
particular disease that occurred during a specified SIX COMPONENTS IN THE CHAIN OF INFECTIONS
time period per a specifically defined population
(usually per 1 000, 10 000 or 100 000 population)
● Mortality and morbidity - is not always the same case
● According to WHO, infectious diseases are responsible
for approximately half the deaths that occur in developing
countries
○ HIV/AIDS
○ Tuberculosis
○ Malaria
○ More than 300 million and more than 5 million
deaths per year are caused by these diseases.
● TB in the Philippines....
○ The Philippines is among the 8 countries where two
thirds of 2017 TB cases were found
○ The burden of TB in the country remains high
○ Based on the 2016 National TB Prevalence Survey,
there are about 1 million Filipinos with TB. Most of A PATHOGEN
the TB cases are found among males and highest ● Bacteria
in the 45-54 age group. ● Viruses
OTHER EXAMPLES OF COMMUNICABLE DISEASES ● Parasites
A RESERVOIR OF PATHOGEN
● Hepatitis A, B, C - for RMTs require vaccines for this ● People ● Food
because we are strongly exposed to this agent ● Animal/Pets (dogs, cats, ● Soil
● Measles reptiles) ● Water
● Flu - hard to combat because it is constantly evolving ● Wild animals
● Salmonellosis A PORTAL OF EXIT
● Shigellosis ● Mouth (vomit, saliva)
● MRSA ● Cuts in the skin (blood)
● Ebola ● During diapering and toileting stool

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COMMUNITY AND PUBLIC HEALTH FOR MLS SECOND YEAR, FIRST SEMESTER
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A MODE OF TRANSMISSION ○ Passive carriers – carry the pathogen without

● Contact (hands, toys, sand) having the disease, do not have disease but are
● Droplets (when you speak, sneeze or cough) carriers
A PORTAL OF ENTRY ○ Incubatory carriers – capable of transmitting a
● Mouth pathogen during the incubation period of a
● Cuts in the skin particular infectious disease.
● Eyes ■ Carriers in the incubation period
A SUSCEPTIBLE HOST ■ he/she can be preasymptomatic
● Babies ● People with weakened ○ Convalescent carriers – harbor and can transmit a
● Children immune system particular pathogen while recovering from infectious
● Elderly ● Anyone disease.
● Unimmunized people ■ During recovery they can still transmit
■ convalescent- patient is recovering.
STRATEGIES FOR BREAKING THE CHAIN OF INFECTION
○ Active carriers – have completely recovered from
the disease, but continue to harbor the pathogen
indefinitely.
■ They have recovered, but they are
continuously harboring organisms
● Mary Mallon – A cook who became a carrier of
salmonella enterica (salmonella typhi). She caused an
outbreak of typhoid fever in the US, specifically in places
where she cooked.
ANIMALS
● Important reservoirs of zoonoses
● Zoonoses – acquired by:
○ Direct contact with the animal (E.g. rabies)
○ Inhalation or ingestion of the pathogen
○ Injection of the pathogen by an arthropod vector
(E.g. dengue and malaria)
MEASURES TO CONTROL ZOONOSES:
● PPE when handling animals
● Animal vaccinations
● Proper use of pesticides
● Isolation or destruction of infected animals
● Proper disposal of animal carcasses and waste products
ARTHROPODS
● Animals
● To prevent infections from occurring, measures must be ● Insects (mosquitoes, biting flies, lice, fleas)
taken to break the chain of infection at some point (link) ● Arachnids (mites and ticks)
in the chain ● Vectors – when arthropods are involved in the
○ Ex: lockdown, quarantine, screening and isolation, transmission of infectious diseases (E.g ticks, fleas)
cleaning and disinfection, hand hygiene, wearing ARTHROPOD VECTORS
PPE, etc.
RESERVOIRS OF INFECTION
RESERVOIRS
● Any site where the pathogen can multiply or merely
survive until it is transferred to a host
● Living hosts, inanimate objects or materials
LIVING CARRIERS
HUMAN CARRIERS
● Most important reservoirs of human infectious diseases
● Carrier – a person who is colonized with a particular
pathogen but the pathogen is not currently causing
disease to that person
● Very important in the spread of staphylococcal and
streptococcal infections, hepatitis, diphtheria, dysentery,
meningitis, and STDs NONLIVING RESERVOIRS
● Types: INANIMATE RESERVOIRS
● Air – contaminated by dust and respiratory secretions

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COMMUNITY AND PUBLIC HEALTH FOR MLS SECOND YEAR, FIRST SEMESTER
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● Soil
● Dust – can carry spores of bacteria and dried bits of
human and animal excretions
● Food and milk – can be contaminated by careless
handling
● Water - can be contaminated with human and animal
fecal matter
● Fomites – inanimate objects capable of transmitting
pathogens
MODE OF TRANSMISSION
FIVE PRINCIPAL MODES OF TRANSMISSION
● Contact (direct or indirect)
● Droplet ○ Common masks are sufficient for large droplets
○ Transfer of pathogen via infectious droplets because their particles are heavy and does not fly
○ Maybe generated by coughing, sneezing and away that much
talking ○ KN-95 mask requirement for droplets that are very
● Airborne small because they can fly away and travel longer
○ Dispersal of droplet nuclei (smaller than 5um) distances
● Vehicular ● Indirect contact via food and water contaminated
○ Contaminated inanimate objects with fecal matter
● Vector transmission ● Indirect contact via arthropod vector
○ Various types of biting insects and arachnids ● Indirect contact via fomites that become contaminated
by respiratory secretions, blood, urine, feces, vomitus, or
exudates from hospitalized patients
○ Contaminated materials na ginamit - everything
should be sterilized
● Indirect contact via transfusion of contaminated
blood or blood products from an ill person or by
parenteral injection using non sterile syringes and
needles
○ Increased cases of HIV due to sharing of needles
WHO DEFINITION OF EPIDEMIOLOGICAL TERMS
RELATING TO INFECTIOUS DISEASES
CONTROL OF AN INFECTIOUS DISEASE
● Ongoing operations or programs aimed at reducing the
incidence or prevalence of that disease
● Control the number of cases and transmission of disease
ELIMINATION OF AN INFECTIOUS DISEASE
● Reduction of case transmission to a predetermined very
low level
ERADICATION OF AN INFECTIOUS DISEASE
● Achieving a status where no further cases of that disease
WAYS OF TRANSMISSION occur anywhere and where continued control measures
● Direct skin-to-skin contact are unnecessary
○ Transmission of infection can be prevented by ● Smallpox – the only eradicated disease
frequent handwashing ● The ultimate goal - no more cases
○ Do not kiss babies because they have
underdeveloped immune system REVIEWER
○ Your hands carry germs you can’t see - wash your ● https://quizlet.com/535487348/flashcards?funnelUUID=6
hands 2faf67a-f166-4e7b-97df-342a87d461de
● Direct mucous membrane-to-mucous membrane
contact by kissing or sexual intercourse
○ Most STDs are transmitted by this manner
● Indirect contact via airborne droplets or respiratory
secretions, usually produced as a result of sneezing or
coughing
○ Colds, influenza, measles, mumps, chickenpox,
smallpox, pneumonia
○ Infectious Droplet And Droplet Nuclei Travel
Lengths

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COMMUNITY AND PUBLIC HEALTH FOR MLS SECOND YEAR, FIRST SEMESTER
LECTURE TRANSCRIPT ACADEMIC YEAR 2023 - 2024

WEEK 4: SOCIAL DETERMINANTS OF HEALTH ○ NGOs programs to proportions who have access to
all education across all ages
● conditions in the environments where people are born, ● Focuses on the connection between persons access to
live, learn, work, play, worship, and age that affect a wide quality education and their health
range of health, functioning, and quality-of-life outcomes ● There was a strong association between health indicators
and risks - (WHO) and education levels
● Includes socioeconomic status, neighborhood, physical ● Early childhood education - self-development
environment, social support, access to healthcare, etc.
● High school education - New doors to further education
● Socioeconomic status - measurement that takes and employment
account the income and breadwinners of the families
● Poor people face barriers to higher educations, harder for
○ Evaluates family health and their access to them to secure high paying jobs and impact person’s
resources health and well-being
● Influences what a person eats, education, and toxin free
environment HEALTH CARE ACCESS AND QUALITY
● Lifestyle, and environment strongly influences their health ● Goal: Increase access to comprehensive, high-quality
● Important in health equities health care services.
SOCIAL DETERMINANTS OF HEALTH ○ Health care access - improve public access
■ clinics remote access are possible
○ Reduce the wait time for emergency department
○ Increase adults for screening disease
○ Increase community health services
● Encompasses person’s healthcare access and quality
● Factors
○ Access to primary healthcare
○ Health insurance coverage
○ Health literacy
● A lot filipinos have no health insurance, insufficient
money to afford healthcare services, too far way from
health centers
NEIGHBORHOOD AND BUILT ENVIRONMENT
● Goal: Create neighborhoods and environments that
promote health and safety.
○ Changes to improve public environment
● Social gradient - lower socioeconomic position have the ○ Company owners can increase safety and risks at
worse the health work
○ Phenomenon were the less advantaged have ○ Pedestrians and cycle files
worse health and shorter lives ● Considers persons housing and environment
● Grouped in 5 domains ● Factors included:
ECONOMIC STABILITY ○ Quality of housing
○ Access to healthy foods
● Goal: Help people earn steady incomes that allow them
to meet their health ○ Water quality
○ Career programs ○ Crime and violence
○ career counseling for stability ● Worldwide many people live in areas with high levels of
crime or pollutants, unsafe air and drinking water
● Link between person’s finances and their health
● Marginalized groups and low income households live in
● Factors
places that carry this risks
○ Poverty
● People inhaling second hand smokes
○ Employment
○ Food security and housing SOCIAL AND COMMUNITY CONTEXT
● Important to affording lifestyle choices and paying ● Goal: Increase social and community support.
medical care that keeps them healthy ○ Cannot be controlled individually
● Savings is very essential for emergency purposes ○ Fostering good relationships at work, at home and
● A lot of people in the Philippines live in poverty. Not community
everyone earns enough. May put people in greater ○ Implement programs that aim to get social support
disadvantages especially the crewnecks and disabled and the care they might need
EDUCATION ACCESS AND QUALITY ● Revolves around the ways a person lives, place they
learns and how it relates to the person health
● Goal: Increase educational opportunities and help
● Factors:
children and adolescents do well in school.

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COMMUNITY AND PUBLIC HEALTH FOR MLS SECOND YEAR, FIRST SEMESTER
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○ Participation UNEMPLOYMENT
○ Discrimination
○ Incarceration and imprisonment ● Job security increases health, wellbeing and job
satisfaction. Higher rates of unemployment cause more
○ Conditions in a workplace
illness and premature death
● Interactions between individuals between families and
● Linked to psychological consequences and financial
coworkers affect their health
problems
● impact on people’s mood and self-esteem
● Health effects start when their jobs are threaten
● Bullying affects child development and continue to
adulthood SOCIAL SUPPORT
THE SOLID FACTS ● Friendship, good social relations and strong supportive
networks improve health at home, at work and in the
● Outlines important facts as it relates to public policies
community.
● Covers 10 topics
● Social cohesion - defined as the of quality of social
THE SOCIAL GRADIENT relationships, the existence of trust, mutual obligations
● People's social and economic circumstances strongly and respect in communities or in the wider society
affect their health throughout life, so health policy must ● Social support and good social relations give good
be linked to the social and economic determinants of contribution to health
health. ● Social support makes people belong, cared for and
● Social gradient - describe the phenomenon whereby beloved
people who are less advantaged in terms of ● Supportive relationships help establish healthy behavior
socioeconomic position have worse health (and shorter patterns
lives) than those who are more advantaged. ADDICTION
● Social people at ladders, are at the risk
● Individuals turn to alcohol, drugs and tobacco and suffer
● The longer the live, the greater the physiological the wear
from their use, but use is influenced by the wider social
and tear they suffer
setting.
STRESS ● Ex: alcohol, drugs, tobacco
● Stress harms health. ○ Alcohol - car accidents, suicides, temporary
● You must try to balance release from reality
● Can continue anxiety, insecurity, low self-esteem, social ○ Tobacco - hard to quit, major drain on poor
isolation, and lack of control over work and home life, people’s income and costs health
have powerful effects on health ○ Drugs
● Increases the chances of poor mental health FOOD
● Why do psychosocial factors affect physical health
● Healthy food is a political issue.
○ In emergencies, our hormones prepare us to deal
● A good diet and adequate food supply is central for
with an immediate physical threat using the flight
promoting health and well being
and fight response
● Lack - malnourished (food poverty)
EARLY LIFE ● too much intake - diabetes, obesity, and cancer (pood
● The effects of early development last a life-time; a good plenty)
start in lifetime supporting mothers and young children. ● Poor people tend to use substitute cheaper processed
● Foundations of adult health foods over fresh foods
○ Linked at early childhood and at birth TRANSPORT
SOCIAL EXCLUSION ● Healthy transport means reducing driving and
● Social exclusion creates misery and costs lives. encouraging more walking and cycling, backed up by
● Absolute poverty - a lack of the basic material better public transport.
necessities of life ● These projects can promote health in 4 ways
○ Exercise
○ When person lacks basic necessities
○ Fatal accidents
● Relative poverty - means being much poorer than most ○ Social contact
people in society and is often defined as living on less ○ Reduces air pollution (low emissions to combat
than 60% of the national median income climate change and save gas)
○ Persons income is insufficient ○ Reduce traffic
● Increases risk of separation, disability, illness, etc.
WORK
● Stress in the workplace increases the risk of disease.
● Can fall under stress

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COMMUNITY AND PUBLIC HEALTH FOR MLS SECOND YEAR, FIRST SEMESTER
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WEEK 8: HEALTH PROMOTION, EDUCATION, AND THREE STRATEGIES (ApMcEi)/(AME)

LITERACY ● Advocate
○ More on the politicians and their commitment to
DEFINITION support health promotion
HEALTH PROMOTION ● Mediate
● the process of enabling people to increase control over ○ More on communities both public and private
and to improve their health sectors
● is viewed as a combination of health education ● Enable
activities and the adoption of healthy public policies. ○ Individuals to empower them
HEALTH EDUCATION HEALTH EDUCATION
● focuses on building individuals’ capacities through:
● Consciously constructed opportunities for learning
○ Educational motivational, skill-building and involving some form of communication designed to
consciousness-raising techniques. improve health literacy
○ Motivational - motivate people to do ○ improving knowledge
○ Skill building - learn on their own ○ developing life skills
HEALTH LITERACY ● not limited to the dissemination of health-related
● is an outcome of effective health education, increasing information but also:
individuals’ capacities to access and use health ○ fostering the motivation, skills and confidence
information to make appropriate health decisions and (self-efficacy)
maintain basic health.
○ the communication of information concerning the
HEALTH PROMOTION underlying social economic and environmental
conditions impacting on health
● The process of enabling people to increase control over
and improve their health ○ individual risk factors and risk behaviors
○ Health - state of complete physical, mental and ○ use of the healthcare system
social well-being and not merely the absence of HEALTH LITERACY
disease or infirmity.
● The degree to which people are able to access,
■ Social
understand, appraise and communicate information to
■ Environmental engage with the demands of different health contexts in
■ Economic order to promote and maintain good health across the
● Targets: life-course
○ Individual
FLOW FROM HEALTH PROMOTION TO LITERACY
○ Health Determinants
INTERNATIONAL CONFERENCE (WHO)
● Health promotion gained global recognition
● In Ottawa, Canada
OTTAWA CHARTER (1986)
FIVE ACTION AREAS (PolEnComPerSe)
● Building healthy public policy
○ Not enough without support from the government
○ Ex: seatbelt, helmet policy, no smoking - if walang
batas walang susunod
● Creating supportive environments
○ Includes built environments and natural
environments
■ Workplaces
■ Park places
● Strengthening community action
○ Involves collective efforts of community
● Starts with determinants of health which drives health
○ Ex: Fun runs, community kitchen, support
promotion
organizations
○ Where are you gonna focus
● Developing personal skills
○ Emergence of risk factors and risk conditions
○ Those that are giving materials, teaching, etc.
● Health education (teaching people, giving information)
● Reorienting health services
and public policies (supports)
○ Back then, health services are geared towards
○ HE - Targets individual health capacities
medical treatment
○ HPP - for environmental support
○ Today, there should be holistic approach

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● When they become educated and supported, you gain ○ Ex: Flu vaccine geographic barriers - delivery to
health literacy very far distances
● When people are health literate, they will change their ● Cues to action – factors that activate readiness to
practices resulting to improved health outcomes change
HEALTH EDUCATION PLANNING THEORIES ○ Ex: flu vaccine - they are ready to accept the
vaccine
● 1 The Rational Model ● Self-efficacy – confidence in one’s ability to take action
● 2 The Health Belief Model ○ Ex: flu vaccine - every month of january and people
● 3 Extended Parallel Process Model are ready to take action, they already accepted,
● 4 Transtheoretical Model of Change perception if they can really sustain the action
● 5 Theory of Planned Behavior
03 EXTENDED PARALLEL PROCESS MODEL
● 6 Activated Health Education Model
● 7 Social Cognitive Theory ● Based on the health belief model, this model proposes
● 8 Communication Theory that people, when presented with a risk message,
engage in two appraisal processes:
● 9 Diffusion of Innovation Theory
○ Susceptible and Severity
WHAT IS THIS FOR?
■ Susceptible - Ex: HIV, iisipin ng tao na hindi
● to understand and explain health behavior
ko yan kelangan since hindi naman
● to guide the identification, development, and nakikipag sex
implementation of interventions
■ Severity - Ex: HIV hindi naman kase malala
01 THE RATIONAL MODEL ○ Response Efficacy and Self-efficacy
● This model, also known as ■ Response efficacy - pag nag condom ba
the “knowledge, attitudes, talaga bang deins na ba magkaka HIV
practices model” (KAP) ■ Self Efficacy - Ex: marunong ba ako mag
● based on the premise that condom, can i maintain the use
increasing a person’s 04 TRANSTHEORETICAL MODEL OF CHANGE
knowledge will prompt a
behavior change. ● Behavior change is viewed as a progression through a
● Weakness: Knowledge is a series of five stages:
necessary but usually not ● People have specific informational needs at each stage,
sufficient factor in changing and health educators can offer the most effective
individual or collective intervention strategies based on the recipients’ stage of
behavior change
● Example: i told people from RECIPIENTS’ STAGE OF CHANGE
province to stop putting breast milk on sore eyes ● Precontemplation – no intention of taking action within
because it would cause infection and people will believe the next six months
it ○ Ex: Obesity and exercise - audience are not
intentional of giving in to your program or believe
02 HEALTH BELIEF MODEL
you
● One of the earliest behavior change models to explain ● Contemplation – intends to take action in the next six
human health decision-making and subsequent behavior months
● based on the following six constructs ○ Ex: Obesity and exercise - They are just thinking in
SIX CONSTRUCTS this stage, maybe i can exercise or go to gym
● Perceived susceptibility – beliefs about the chances of ● Preparation – intends to take action within the next 30
getting a condition days
○ Ex: Flu vaccine in an area where there is no flu ○ Ex: Obesity and exercise - they are ready to do it,
cases, people might not believe you they enrolled to the gym
○ Gives clue on who will be your target population ● Action – has changed behavior for less than six months
● Perceived severity – beliefs about the seriousness of a ○ Ex: Obesity and exercise - they are doing the
condition and its consequences action, There are hindrances, they exercised that
○ Ex: dikit dikit sila na nagkakaflu, but the severity of they enjoy it or not
flu is weak, people will not make tangkilik your ● Maintenance – has change behavior for more than six
program because it is not affecting them months
● Perceived benefits – beliefs about the effectiveness of ○ Can they maintain this lifestyle
taking action to reduce risk
○ Ex: will flu vaccine will no longer cause flu, is it
effective
● Perceived barriers – beliefs about the material and
psychological costs of taking action

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05 THEORY OF PLANNED BEHAVIOR ● According to this theory, three main factors affect the
likelihood that a person will change health behavior:
○ Self-efficacy
■ Ex: condom use - can they maintain the use
of condom
○ Goals
■ Ex: condom use - avoidance of HIV, causes
drive
○ Outcome expectancies
■ Ex: condom use - will it help me physically,
will it protect me from HIV, will my friends
accept me (socially)
● The theory holds that intent is influenced not only by the ● If individuals have a sense of self-efficacy, they can
attitude towards behavior but also change behavior even when faced with obstacles
○ the perception of social norms (the strength of
others’ opinions on the behavior a person’s own 08 COMMUNICATION THEORY
motivation to comply with those of significant
others)
■ Ex: smoking is bad - people wanted to stop
but their friends are using cigarettes, what
will be their influence
○ the degree of perceived behavioral control.
■ Ex: smoking is bad - can i control this
behavior
06 ACTIVATED HEALTH EDUCATION MODEL
● This is a three-phase model that actively engages ● More on communication
individuals in the assessment of their health. ○ Program will be more effective if there is good
THREE PHASE (AER) communication from sender (educator) to receiver
● The experiential phase actively engages individuals in (target population), as well as the message and
the assessment of their health chanel, absence of barriers, and the feedback is
good which means that the people being educated
○ Ex: old people with nutrient deficiency - involving in
really receives the message
screening
● This theory holds that multi level strategies are necessary
● The awareness phase presents information that
depending on who is being targeted
provides a rationale for including the previously
completed experiential activity and creates awareness of ○ tailored messages at the individual level
the target behavior ○ targeted messages at the group level
○ Ex: old people with nutrient deficiency - what are ○ social marketing at the community level
the diseases involved ○ media advocacy at the policy level
● The responsibility phase involves participants in the ○ mass media campaigns at the population level
change process, facilitates their identification and 09 DIFFUSION OF INNOVATION THEORY
clarification of personal health values, and develops a
customized plan for behavior change
○ Ex: old people with nutrient deficiency - explaining
their diet and maintenance
07 SOCIAL COGNITIVE THEORY

● This theory holds that there are five categories of

people:
○ Innovators - first to sign up, and accept
innovations
○ early adopters - interested population, checks if
okay yung mga unauna
○ early majority adopters - interested but needs
more push
○ late majority adopters - skeptical people
nagdadalawang isip pa, aantayin na nabakunahan
lahat

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○ Laggards - people have limited communication,

dinadayo pa ng mga health educators
● Health education depends of the type of these people
● By identifying the characteristics of people in each
adopter category, health educators can more effectively
plan and implement strategies that are customized to
their needs.
COMPONENT OF HEALTH EDUCATION PLANNING
MODELS

● Always start with engaging the priority population

● Understanding > Assessing > Developing > Planning >
Implementing > Evaluating
● (UADPIE)

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WEEK 9A: HEALTH AND DEVELOPMENT IN THE

PHILIPPINE CONTEXT

GEOGRAPHIC CHARACTERISTICS
● an archipelago in Southeast Asia with 7,641 islands
bordered by the West Philippine Sea and the Pacific
Ocean (World Atlas, 2018a)
● It is grouped into three geographic areas: Luzon, Visayas
and Mindanao
● located along the seismic Pacific Ring of Fire and Pacific
Typhoon Belt
● an archipelago in Southeast Asia with 7,641 islands
DEMOGRAPHIC PROFILE

●
HUMAN DEVELOPMENT INDEX
MEANING
● Human development index is used to measure how
development has improved human life
INDICATORS
● Human Development Index Rank
● Life Expectancy
● Infant Mortality Rate
● Maternal Mortality Rate
● Adult Literacy Rate
● Percentage of population below poverty line
● L
● Per capita G.D.P. etc

● H

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● MDG: Promote gender equality and empower women.

● GOAL 5: Gender Equality
HEALTH & WELL-BEING
● MDG:
○ Reduce child mortality.
○ Improve maternal health
● SDG: GOAL 3: Good Health and Well-being
COMMUNICABLE DISEASES
● MDG: Combat HIV/AIDS, malaria, and other diseases.
ENVIRONMENT
● MDG:
○ Ensure environmental sustainability
● SDG:
○ GOAL 6: Clean Water and Sanitation
○ GOAL 7: Affordable and Clean Energy
PARTNERSHIP FOR DEVELOPMENT
● MDG: Develop a Global Partnership for Development
● SDG: Goal 9: Build resilient infrastructure, promote
inclusive and sustainable industrialization and foster
innovation
RESPONSIBLE CONSUMPTION & PRODUCTION
WHO SUSTAINABLE DEVELOPMENT GOALS
● SDG: Goal 12: Ensure sustainable consumption and
production patterns
CLIMATE
● SDG: GOAL 13: Take urgent action to combat climate
change and its impacts*
LIFE BELOW WATER
● SDG: GOAL 14:Take urgent action to combat climate
change and its impacts
LIFE ON LAND
● SDG: Goal 15: Protect, restore and promote sustainable
use of terrestrial ecosystems
PEACE AND JUSTICE STRONG INSTITUTIONS
WHO MILLENIUM DEVELOPMENT GOAL ● SDG: Goal 16: Promote peaceful and inclusive societies
for sustainable developmentTH
SOCIO, ECONOMIC POLITICAL
● SDG: Goal 10: Reduce inequality within and among
countries
PARTNERSHIP FOR THE GOALS
● SDG: Goal 17: Strengthen the means of implementation
and revitalize the Global Partnership for Sustainable
Development
OUR FOCUS: SDG #3 ENSURE HEALTHY LIVES AND
PROMOTE WELL-BEING FOR ALL AT ALL AGES
GOOD HEALTH AND WELL BEING
FRAMEWORKS
POVERTY
● MDG: Eradicate extreme poverty and hunger
● SDG:
○ GOAL 1: No Poverty.
○ GOAL 2: Zero Hunger
○ GOAL 8: Decent Work and Economic Growth
EDUCATION
● MDG: Achieve universal primary education.
● SDG:
○ GOAL 4: Quality Education
GENDER

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2023 DOH BUDGET

● The leading cause of mortality in the Philippines in 2016

consisted of non-communicable disease like Ischemic
heart disease
DOH MANDATE
● develop national plans, technical standards, and
guidelines on health.
● regulator of all health services and products
● provider of special tertiary health care services and
technical assistance to health providers and
stakeholders.
● DevRegPro
HEALTH SERVICE DELIVERY
● The Philippines has a mixed public-private healthcare
system that operates within a fragmented environment.
● The private sector caters to only about 30 percent of the
population but is far larger than the public system in
terms of financial resources and staff (Oxford Business
Group, 2018).
● It provides healthcare that is generally paid through user
fees at point of service.
● About 65 percent of the 1,224 hospitals in the country
DOH FUNCTIONS (puro may tion)
● The primary function of the Department is the promotion,
protection, preservation or restoration of the health of
the people, how? (pppr)
● provision and delivery of health services and - regulation
and encouragement of providers of health goods and
services.
DOH ROLE AND FUNCTIONS
● The Department of Health (DOH) serves as the principal
health agency in the country. It plays three major roles:
as a health leader, enabler and capacity-builder, and
as an administrator of specific services

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○ Beneficiaries of Pantawid Pamilyang Pilipino

Program
● Senior citizens
● Persons with disability
● Sangguniang Kabataan officials
● Previously identified at point-of-service / sponsored by
LGUs
● Filipinos aged 21 years old and above without capacity to
pay premiums
NEW RATE OF CONTRIBUTION

UNIVERSAL HEALTHCARE ACT

● Republic Act (RA) No. 11223 or the Universal Health
Care (UHC) Act - May 7, 2021
● Objectives and vision
○ increasing financial risk protection particularly for
HEALTH FINANCING the poor, marginalized, and vulnerable;
● The National Health Insurance Act of 1995 created the ○ Enhancing health system responsiveness to make
Philippine Health Insurance Corporation (PhilHealth) Filipinos feel respected, valued, and empowered;
to provide health insurance coverage for all Filipinos but and,
enrolment was not made compulsory. ○ improving health outcomes with no major disparity
● In 2013, it was amended, expanding the among population groups
contribution-based national health insurance program ANNEX C. UNIVERSAL HEALTH CARE ACT
(NHIP) beyond formal employment to include the
underprivileged, sick, elderly, persons with disabilities
(PWDs) and women and children.
● It strengthened the roles of the LGUs and health
providers in NHIP enrolment.
● PhilHealth serves as the national social health insurance
agency which purchases services from public and private
providers on behalf of its members.
● However, healthcare provision, health regulation, facility
improvements and human resource deployment as well
as capacitation are still subsidized by the government,
mainly through the DOH.
DIRECT CONTRIBUTORS
● Employees with formal employment
○ Kasambahays
● Self-earning individuals; Professional practitioners
○ Overseas Filipino Workers
○ Filipinos living abroad and those with dual
citizenship
● Lifetime members
○ All Filipinos aged 21 years and above with capacity
to pay
INDIRECT CONTRIBUTORS
● Indigents identified by the DSWD

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WEEK 9B: HEALTH PROGRAMS IN THE PHILIPPINES

NICE TO KNOW

HEALTH PROGRAMS OF DOH

● Adolescent Health and Development Program
● Aedes-Borne Viral Diseases Prevention and Control
Program
● Belly Gud for Health
HEALTH PROMOTION
● Blood Donation Program
● In collaboration with different sectors and partners, the ● Cancer Control Program
Health Promotion Bureau (HPB) developed the Health ● Chronic-Kidney Disease Prevention and Control
Promotion Framework Strategy (HPFS) 2030 that ● Climate Change
serves as the roadmap and basis for national and local
● Dengue Prevention and Control Program
policies, programs, and activities on health promotion.
● Dental Health Program
● Early Childhood Care Development Program
● Emerging and Re-emerging Infectious Diseases Program
● Environmental Health Program
● Expanded Program on Immunization
● Filariasis Elimination Program
● Food and Waterborne Diseases Prevention and Control
Program
● Healthy and Productive Aging Program
● Infant and Young Child Feeding Program
● Integrated Management of Childhood Illness Program
● Leprosy Control Program
● Malaria Control and Elimination Program
● Mental Health Program
● Micronutrient Supplementation Program
● National Family Planning Program
● National Leprosy Control Program
● National Safe Motherhood Program
● Newborn Hearing Screening Program
● Newborn Screening Program • Occupational Health
Program
● Oral Health Program
● Persons with Disabilities
● Philippine Cancer Control Program
● Philippine Medical Travel and Wellness Tourism Program
● Philippine Organ Donation and Transplant Program
● Prevention of Blindness Program
● Rabies Prevention and Control Program
● Safe Motherhood Program
● Unang Yakap (Essential Newborn Care: Protocol for New
Life)
● Water Safety Program

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ADOLESCENT HEALTH AND DEVELOPMENT PROGRAM OBJECTIVES

● The National Voluntary Blood Services Program
OVERVIEW (NVBSP) aims to achieve the following:
● Targets adolescents aged 10-19 years. ○ 1. Development of a fully voluntary blood
● Mainly guided by the Convention on the Rights of donation system;
Children which states that the program must be in the ○ 2. Strengthening of a nationally coordinated
best interests of the child. network of BSF to increase efficiency by
● Primarily aims to provide adolescents access to quality centralized testing and processing of blood;
healthcare services. o Increased accessibility of ○ 3. Implementation of a quality management
adolescent-friendly facilities, programs, and health system including of Good Manufacturing Practice
providers for the Filipino youth. GMP and Management Information System (MIS);
OBJECTIVES ○ 4. Attainment of maximum utilization of blood
● Improve the health status of adolescents and enable through rational use of blood products and
them to fully enjoy their rights to health. component therapy; and
AEDES-BORNE VIRAL DISEASES PREVENTION AND ○ 5. Development of a sound, viable sustainable
CONTROL PROGRAM management and funding for the nationally
coordinated blood network.
OVERVIEW
○ Donation system, management system, network,
● The prevalence of aedes-borne viral diseases such as utilization
dengue is still a significant problem that the country faces
as it affects many Filipinos that can lead to severe CANCER CONTROL PROGRAM
complications and even death. Aside from the dengue, OVERVIEW
other aedes-borne viral diseases, such as zika and ● Serves as the framework for all cancer-related activities
chikungunya, are also controlled to eradicate their of the government.
transmissions.
● Aims to decrease the incidence of preventable cancer,
OBJECTIVES prevent and manage its recurrence, and provide access
● To reduce the disease burden of dengue, and to contain to quality healthcare for its treatment.
and prevent transmission of chikungunya and zika. OBJECTIVES
BARANGAY NUTRITION SCHOLAR (BNS) PROGRAM ● To reduce premature mortality from cancer by 25% in
2025.
OVERVIEW
● To ensure relative reduction of the following risk factors
● A human resource development strategy of the Philippine
for cancer:
Plan of Action for Nutrition, which involves the
recruitment, training, deployment and supervision of ○ a. 10% harmful use of alcohol
volunteer workers or barangay nutrition scholars (BNS). ○ b. 10% physical inactivity
● Presidential Decree No. 1569: ○ c. 30% tobacco use
○ Mandated the deployment of one BNS in every ● To guarantee the availability of the following services for
barangay in the country to monitor the nutritional selected population:
status of children and/or link communities with ○ a. Selected cancer screening
nutrition and related service providers. ○ b. Human Papilloma Virus and Hepatitis B
○ Mandated the NNC to administer the program in vaccination
cooperation with local government units. ○ c. Access to palliative care
OBJECTIVES ○ d. Drug therapy and counseling
● To be able to deliver nutrition and nutrition-related CHRONIC-KIDNEY DISEASE PREVENTION AND CONTROL
services to the barangay by caring for the malnourished
and the nutritionally vulnerable, mobilizing the OVERVIEW
community, and linkage building. ● Aims to reinforce strategies for the prevention and control
of CKDs such as lifestyle related disease prevention,
BLOOD DONATION PROGRAM facilitation of early detection and evaluation, and proper
OVERVIEW disease management for people with CKDs.
● Republic Act No. 7719: OBJECTIVES
○ Also known as the National Blood Services Act of ● To reduce premature mortality due to cardiovascular
1994, promotes voluntary blood donation to provide diseases, diabetes mellitus, chronic respiratory diseases,
sufficient supply of safe blood and to regulate blood chronic kidney diseases, and cancer by 25% by 2025.
banks. This act aims to inculcate public awareness ○ CVD, DM, CRD, CKD, cancer
that blood donation is a humanitarian act.
DENGUE PREVENTION AND CONTROL PROGRAM
● Aims to create public consciousness on the importance
of blood donation in saving the lives of millions of OVERVIEW
Filipinos. ● Dengue is the fastest spreading vector-borne disease in
the world endemic in 100 countries·

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○ Dengue virus has four serotypes (DENV1, DENV2, OBJECTIVES

DENV3 and DENV4) ● Reduced morbidity and mortality due to FWBDs including
○ Dengue has no treatment but the disease can be outbreaks.
early managed.
HIV, AIDS AND STI PREVENTION AND CONTROL
OBJECTIVES PROGRAM
● To reduce the burden of dengue disease.
OVERVIEW
DENTAL HEALTH PROGRAM ● The National HIV, AIDS and STI Prevention and
OVERVIEW Control Program (NASPCP) envisions ZERO new
● In the Philippines, toothache is a common ailment infections, ZERO discrimination, and ZERO AIDS-related
among schoolchildren, and is the primary cause of death.
absenteeism from school (Araojo 2003, 103-110). Dental ● Its mission is to improve access and utilization of
and oral diseases create a silent epidemic, placing a preventive primary health care services for HIV and STI
heavy burden on Filipino school children. while its goal is to reverse the trend of HIV epidemic by
OBJECTIVES reducing the estimated annual infections to less than
● Attainment of improved quality of life through promotion 7,000 cases by 2022.
of oral health and quality oral health care. OBJECTIVES
● To reverse the trend of HIV epidemic by reducing the
EMERGING AND RE-EMERGING INFECTIOUS DISEASE
estimated annual infections to less than 7,000 cases by
PROGRAM
2022.
OVERVIEW
IMMUNIZATION PROGRAM
● The health crisis brought about by the COVID-19 has
proved that there is still a lack of preparedness and OVERVIEW
response from our country when it comes to combating ● National Immunization Program, which was then
large scale epidemics and pandemics. known as Expanded Program for Immunization, was
● Aims to have an organized system that focuses on launched by the Philippine government on July 12, 1976
planning, development, and management of outbreaks with the assistance of World Health Organization (WHO)
due to infectious diseases that have the potential to and the United Nations Children’s Fund (UNICEF) to
become epidemics and pandemics. ensure that infants/children and mothers have access to
OBJECTIVE routinely recommended infant/childhood vaccines.
● Prevention and control of emerging and re-emerging ● Aims to reduce the morbidity and mortality among
infectious disease from becoming public health problems, children against the most common vaccine-preventable
as indicated by EREID case fatality rate of less than one diseases (VPDs) which includes tuberculosis,
percent. poliomyelitis, diphtheria, tetanus, pertussis and measles.
OBJECTIVES
FAMILY PLANNING PROGRAM
● Strengthen immunization services within the primary
OVERVIEW health care and eventually contribute to universal health
● Family planning is among the strategies of the country coverage and sustainable development.
in reducing unintended pregnancies thereby reducing the ● Leave no one behind by expanding equitable protection
incidence of unsafe abortions and maternal deaths. with vaccination for all ages.
● Aims to ensure equitable access to FP information and ● Reduce mortality and morbidity by proactively preventing
services to all regardless of marital, socioeconomic outbreaks of VPDs and providing timely response to
status, religion, ethnicity, and in any situation such as outbreak and other potential health crises related to
during health emergencies and disasters. immunization.
OBJECTIVES ● Effectively communicate and address hesitancies and
● To increase modern Contraceptive Prevalence Rate misinformation regarding immunization.
(mCPR) among all women from 24.9% in 2017 to 30% by MALARIA CONTROL AND ELIMINATION PROGRAM
2022
● To reduce the unmet need for modern family planning OVERVIEW
from 10.8% in 2017 to 8% by 2022. ● Malaria is a life-threatening disease caused by
plasmodium parasites transmitted by anopheles
FOOD AND WATERBORNE DISEASES PREVENTION AND mosquito or rarely through blood transfusion and
CONTROL PROGRAM sharing of contaminated needles.
OVERVIEW ● Untreated malaria may progress to severe illness and
● Food and Waterborne Diseases (FWBDs) refer to the even death.
limited group of illnesses characterized by diarrhea, OBJECTIVES
nausea, vomiting with or without fever, abdominal pain, ● Aims to eliminate malaria by adopting a health system
headache, and body malaise. These are spread or focused approach to achieve universal coverage with
acquired through the ingestion of food or water quality-assured malaria diagnosis and treatment,
contaminated by disease-causing microorganisms which strengthen governance and human resources, maintain
can be bacterial, parasitic, or viral.

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the financial support needed, and ensure timely and OVERVIEW

accurate information management. ● The rate of organ donation and transplantation is
MENTAL HEALTH PROGRAM significantly low in this country. The inadequate
knowledge of people about organ donation and
OVERVIEW transplant, along with limited workforce and facilities that
● Republic Act 11036, otherwise known as the Mental can handle these operations, are factors that result in the
Health Act, has been promulgated to enhance and low rate. Moreover, organ trafficking is prevalent mainly
integrate mental health service delivery to Universal due to poverty.
Health Care through promotion and protection of the OBJECTIVES
rights of persons using psychosocial health services and ● Aims to facilitate and oversee all organ donation and
increasing investments in mental health. transplantation activities in the country with a goal of
OBJECTIVES National Self-Sufficiency in Organ Donation and
● Ensures the implementation of the law through the Transplantation and Prevention of Organ Trafficking.
National Mental Health Strategic Plan (2019-2023),
PUBLIC HEALTH ASSOCIATE DEPLOYMENT PROGRAM
including balanced scorecards with indicators. This
(PHADP)
affirms the basic right of all Filipinos to mental health as
well as the fundamental rights of people who require OVERVIEW
mental health services. ● The overall goal of Universal Health Care or
NATIONAL TUBERCULOSIS TB CONTROL PROGRAM Kalusugan Pangkalahatan is to improve health
outcomes, provide financial risk protection and provide
OVERVIEW quality access to health services especially to the poor.
● Aims to reduce mortality and incidence from tuberculosis OBJECTIVES
in the country, reduce catastrophic costs and provide ● The PHA Deployment Program aims to:
patient-responsive health services. ○ A. Augment the workforce in the rural health units
OBJECTIVES from identified municipalities of needed public
● To reduce TB burden (TB incidence and TB mortality). health associates;
● To achieve catastrophic cost of TB-affected households. ○ B. Improve performance of health systems in the
● To responsively deliver TB service. Rural Health Units;
NEWBORN SCREENING PROGRAM ○ C. Provide work experience and employment for
public health graduates in rural areas and
OVERVIEW underserved communities; and
● Newborn screening (NBS) is an essential public health ○ D. Enhance the competencies of the public health
strategy that enables the early detection and associates aligned with the demand in the work
management of several congenital disorders, which if left environment.
untreated, may lead to mental retardation and/or death.
● Early diagnosis and initiation of treatment, along with RABIES PREVENTION AND CONTROL PROGRAM
appropriate long-term care help ensure normal growth OVERVIEW
and development of the affected individual. ● Rabies is an infection that affects humans usually
OBJECTIVES transmitted by a bite or scratch of an infected animal and
● By 2030, all Filipino newborns are screened and properly is considered a significant public health problem in the
managed for common and rare congenital disorders to country as it is one of the most acutely fatal infections
reduce preventable deaths of newborns. and responsible for the death of at least 200 Filipinos
annually.
PERSONS WITH DISABILITIES
● Effective and safe vaccines to prevent the disease in
OVERVIEW humans and animals have been available for decades.
● To strengthen multi-sectoral action to harmonize efforts of However, its elimination is hampered by poverty and
stakeholders. ignorance about the disease and its prevention.
● Clarify delineation of roles and responsibilities of ● Aims to prevent and control rabies infection by providing
concerned government agencies working for PWDs and promoting accessible vaccines, along with rabies
● Strengthen national capacity, both facilities and education and awareness, to the public.
manpower, to provide rehabilitation services for PWDs OBJECTIVE
from primary to tertiary level of care. ● To eliminate rabies as a public health problem, with
● Provide access to health facilities and services for PWDs. absence of indigenous cases for both human and animal.
● Strengthen registration database for PWDs. SCHISTOSOMIASIS CONTROL AND ELIMINATION
OBJECTIVES PROGRAM
● To address barriers and improve access and reasonable
accommodations of PWDs to health care services and OVERVIEW
programs. ● Schistosomiasis japonicum is an acute and chronic
disease caused by parasitic worms called trematodes or
PHILIPPINE ORGAN DONATION AND TRANSPLANT blood flukes. It is endemic in the Philippines and is
PROGRAM transmitted through contact with fresh water infested with

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the parasite that penetrates human and animal skin. In PROGRAMS NA HINDI TO/AIMS ANG OBJECTIVES
the Philippines, the total population at risk is
approximately 12.4 million with 2.7 million individuals ● Adolescent
directly exposed to the disease. ● Blood Donation
● Aims to eradicate the transmission and incidence of ● Dental Health
Schistosomiasis Infection in all endemic barangays by ● Emerging and re-emerging
2025. ● Food and Waterborne
OBJECTIVE ● Immunization
● Schistosomiasis Free Philippines. ● Newborn screening
SMOKING CESSATION PROGRAM ● PHADP
● Schistosomiasis
OVERVIEW
● Smoking
● Tobacco use has been widely recognized as one of the
● Water safety
commonly shared behavioral risk factors that lead to the
4 major non-communicable diseases (NCDs) which are ● Women and children
cardiovascular diseases, cancer, chronic respiratory PROGRAMS NA MAY AIMS/TO OVERVIEW
diseases and diabetes mellitus (CVD, Cancer, CRD,
● Blood donation
DM). It is one of the most serious avoidable risk factors
for premature death and chronic illness from ● Cancer control
tobacco-related diseases that needs to be addressed. ● CKD prevention
● Aims to reduce non-communicable diseases caused by ● Family
cigarette smoking. ● Immunization
○ Helps create an enabling environment to help ● Tuberculosis
current tobacco users quit, protect people from ● Rabies
secondhand smoke and prevent young people from ● Schistosomiasis
taking up the habit. ● Smoking
OBJECTIVE ● Water safety
● Reduce morbidity rates and premature mortality rates ● W&C
due to 4 major chronic diseases: cardiovascular,
diabetes, cancer and Chronic Obstructive Pulmonary
Disease (COPD) attributable to tobacco use.
WATER SAFETY PROGRAM
OVERVIEW
● Unsafe and contaminated drinking water is the primary
cause of high incidence of waterborne diseases,
specifically cholera, diarrhea, and typhoid.
● Aims to provide safe and accessible drinking water for
the public.
OBJECTIVE
● Universal access to safe drinking water by 2030.
WOMEN AND CHILDREN PROTECTION PROGRAM
OVERVIEW
● Women and Children Protection Program (WCPP)
provides technical and management support to ensure
that Women and Children Protection Units (WCPUs) are
established and operational as mandated under Section
40 of Republic Act 9262.
● Aims to provide medical assistance to violence against
women and their children (VAWC) survivors and increase
cases appropriately managed in health facilities.
OBJECTIVE
● The goal of the WCPP is to increase the number of
VAWC cases appropriately managed in health facilities.
To achieve this goal, the WCPP should focus on the
primary prevention and response through establishment
and ensuring the functionality of WCPUs, strengthening
management structures, capability building of public
health workers and hospital staff, health promotion and
advocacy.

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WEEK 10A: PRIMARY HEALTH CARE AND UNIVERSAL ○ In terms of government and non-government
HEALTH CARE support
TWO LEVELS OF PRIMARY HEALTH CARE WORKERS
PRIMARY HEALTH CARE OVERVIEW
● Barangay Health Workers – trained community health
● May 1977 - 30th World Health Assembly decided that workers or health auxiliary volunteers or traditional birth
the main health target of the government and WHO is the attendants or healers.
attainment of a level of health that would permit them to ○ Crucial role in the pandemic
lead a socially and economically productive life by the
● Intermediate level health workers- include the Public
year 2000.
Health Nurse, Rural Sanitary Inspector and Midwives.
● September 6 - 12, 1978 – First International Conference
○ Midwifes - important in delivery, trained in order to
on Primary Health Care (PHC) in Alma Ata, Russia
handle child delivery
(USSR)
● The Alma Ata Declaration stated that Primary Health ELEMENTS OF PRIMARY HEALTH CARE
Care (PHC) was the key to attain the “HEALTH FOR ● Education for Health
ALL” goal ● Locally Endemic Disease Control
● October 19, 1979 – Letter of Instruction (LOI) 949, the ○ (eg. dengue, malaria)
legal basis of Primary Health Care (PHC) was signed by
● Expanded Program on Immunization (old term)
Pres. Ferdinand E. Marcos, which adopted PHC as an
approach towards the design, development and ○ National immunization program NPI (new)
implementation of programs focusing on health ● Maternal and Child Health and Family Planning
development at community level. ● Environmental Sanitation and Promotion of Safe Water
Supply
DEFINITION OF PRIMARY HEALTH CARE ● Nutrition and Promotion of Adequate Food Supply
● Essential health care is made universally accessible to ● Treatment of Communicable Diseases and Common
individuals and families in the community by means Illness
acceptable to them, through their full participation and at ● Supply of Essential Drugs
cost that the community can afford at every stage of ○ Availability of most drugs
development.
○ Collaboration to attain health for all ESSENTIAL HEALTH CARE PROGRAMS
● An approach to health development, which is carried ● Family Health Program
out through a set of activities and whose ultimate aim is ● Prevention and Control of Non-communicable Diseases
the continuous improvement and maintenance of health (NDCs)
status ● Prevention and control of Communicable disease
● Guide in order to understand primary health care ● Environmental Health and Sanitation
GOAL OF PRIMARY HEALTH CARE ● Other priority health programs
● HEALTH FOR ALL FILIPINOS by the year 2000 FAMILY HEALTH PROGRAMS
● HEALTH IN THE HANDS OF THE PEOPLE by the year ● The following are the family health programs (MFCENO):
2020. ○ Maternal Health Program
OBJECTIVES OF PRIMARY HEALTH CARE (ent/sion) ○ Family Planning Program
○ Child Health Program
● Improvement of health care of the community.
○ Expanded Program Of Immunization
● Reduction in the prevalence of preventable,
communicable and other diseases Eg. diabetes. ○ Nutrition Program
● Reduction in morbidity and mortality rates especially ○ Oral Health Program
among infants and children. ○ Other Health Program
● Extension of essential health services with priority given MATERNAL AND CHILD HEALTH PROGRAM
to the underserved sectors. Marginalized sector
● The primary areas of work focus are:
● Improvement in Basic Sanitation
○ Increasing healthy birth outcomes;
● Development of the capability of the community aimed
■ Assuring that the mother is healthy so that
at self- reliance. Di masyadong umaasa nalang lagi
the child is healthy before being born
4 PILLARS OF PRIMARY HEALTH CARE ○ Promoting and assuring comprehensive primary
● Community Participation care for children, from birth to 21 year olds,
● Inter-Sectoral Coordination including children with special health care needs;
○ We need to depend on the different sector ○ Promoting healthy lifestyles among school-age
youth, ages 6-21, including children with special
● Appropriate Technology
health care needs;
○ Providing community with very good technology
○ Promoting access to safe, healthy child care,
● Support Mechanism Made Available including children with special health care needs;
and

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MATERNAL HEALTH SERVICES: children but also their intellectual and social
● Antenatal Registration - pregnant women can avail the development, resulting in life-long impact on school
free prenatal services at their respective health center. performance and overall productivity.
○ Can be given necessary vitamins and minerals as ● Breastfeeding, especially exclusive breastfeeding
the baby grows during the first half-year of life is an important factor that
○ Undergo screening to know if you are cesarean can prevent infant and childhood morbidity and mortality.
● Tetanus Toxoid Immunization - A series of 2 doses of ○ Prevent child mortality and morbidity
tetanus toxoid vaccination must be received by a ○ Breast milk is better across all tests done between
pregnant women one month before delivery and 3 formulated and cow’s milk
booster doses after childbirth FOOD FORTIFICATION
○ 1 shot na lang kapag maraming anak during their
pregnancy ● Food fortification law is vital in the promotion of optimal
○ A total of 5 doses - can give lifetime immunity health and to compensate for the loss of nutrients during
processing and storage of food.
● Micronutrient Supplementation - Vitamin A and Iron
supplement for the prevention of anemia and Vit. A ● There is an add on to the food
deficiency. ○ Ex: iodized salt - fortified with iodine
○ Iron - important for pregnant to prevent anemia ● The law requires a mandatory food fortification of staple
○ Important for the growing baby foods - rice, flour, edible oil, and sugar and voluntary food
fortification of processed food and food products.
● Treatment of diseases and other conditions - These is
(Vitamin A, Iron, lodine)
for the women who is diagnosed as under the high risk
● Fortification is "the addition of one or more essential
○ Ex: spiking blood pressure, abnormal choices of
nutrients to food, whether or not it is normally contained
foods
in the food, for the purpose of preventing or correcting a
FAMILY PLANNING PROGRAM demonstrated deficiency of one or more nutrients in the
GOAL population or specific population groups"
● To provide universal access to family planning NEWBORN SCREENING
information and services wherever and whenever these ● Newborn Screening Act of 2004 (RA 9288).
are needed. It aims to contribute to Reduce neonatal,
● Newborn screening (NBS) is a public health program
infant, under-five, and maternal deaths.
aimed at the early identification of infants who are
● Not just about availability and compliance of
affected by certain genetic metabolic/ infectious
contraceptives and condom but still a part but it is not the conditions.
purpose
● Newborn screening is ideally done in the 48th-72nd hour
OBJECTIVES
of life. However, it may also be done after 24 hours from
● To help couples and individuals achieve their desired birth.
family size within the context of responsible parenthood ● A few drops of blood are taken from the baby's heel,
and to improve their reproductive health to attain blotted on a special absorbent filter card and then sent to
sustainable growth. Newborn Screening Center (NSC)
● Ensure that quality FP services are available in DOH DISORDERS TESTED FOR NEWBORN SCREENING
retained hospitals, LGU managed health facilities and
● CH (Congenital Hypothyroidism) - results from lack or
private sector.
absence of thyroid hormone which is essential for the
CHILD HEALTH PROGRAM physical and mental development of a child.
● Newborns, infants and children are vulnerable age ● CAH (Congenital Adrenal Hyperplasia) - is an
groups for common childhood diseases. endocrine disorder that causes severe salt loss,
● To address problems, child health programs have been dehydration and abnormally high levels of male sex
created and available in all health facilities which hormones in both boys and girls. If not detected and
includes: treated early, babies with CAH may die within 7-14 days.
○ Infant and Young Child Feeding ● GAL (Galactosemia) - is a condition in which babies are
unable to process galactose, the sugar present in milk.
○ Newborn Screening (NBS)
Accumulation of excessive galactose in the body can
○ Expanded Program on Immunization (EPI) cause many problems, including liver damage, brain
○ Management of Childhood Illnesses damage and cataracts.
○ Micronutrient Supplementation ● PKU (Phenylketonuria) - is a rare condition in which the
○ Dental Health baby cannot properly use one of the building blocks of
○ Early Child Development protein called phenylalanine. Excessive accumulation of
○ Child Health Injuries phenylalanine in the blood causes brain damage.
INFANT AND YOUNG CHILD FEEDING ● G6PD (Glucose-6-Phosphate Dehydrogenase) - is a
condition where the body lacks the enzyme called G6PD.
● There is global evidence that good nutrition in the early Babies with this deficiency may have hemolytic anemia
months and years of life plays a very significant role, resulting from exposure to oxidative substances found in
affecting not only the health and survival of infants and drugs, foods and chemicals.

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EXPANDED IMMUNIZATION PROGRAM

● The EPI was launched in July 1976 by the DOH in
cooperation with WHO and UNICEF.
● The original objective was to reduce the morbidity and
mortality among infants and children caused by the
seven childhood diseases.
● Every Wednesday is designated as immunization day in
all parts of the country. ● Puwedeng yung MMR nalang para mas maraming laman
hindi lang pang-measles
● The EPI was launched in July 1976 by the DOH in
cooperation with WHO and UNICEF.. NUTRITION PROGRAM
● A fully immunized child: receives one dose of BCG and ● Malnutrition continues to be a public health concern in
Hepa B at birth, 3 doses of OPV, 3 doses of PENTA, and the country.
1 dose measles vaccine before the child's 1st birthday. ○ Mal - means wrong
○ Wrong type of nutrition, can be overweight or
underweight, wrong nutrition
● The common nutritional deficiencies are Vitamin A, Iron
and lodine.
● GOAL: To improve the quality of life of Filipinos through
better nutrition, improved health and increased
productivity.
● Programs and projects are: Micronutrient
supplementation, food fortification, nutrition information,
communication and education, home, school and
community food production and food assistance.
MICRONUTRIENT SUPPLEMENTATION
● It is one of the interventions to address the health and
nutritional need of infants and children and improve their
growth and survival.
● The twice-a-year distribution of Vitamin A capsules
through the "Araw ng Sangkap Pinoy" (ASAP), known
● BCG - taken anytime at birth or after to prevent as Garantisadong Pambata or Child Health Week is the
tuberculosis approach adopted to provide micronutrient supplements
● Puwedeng Pentavalent instead dun sa Hepa B nalang to 6-71 months old preschoolers on a nationwide scale.
para hindi maraming contents DENTAL HEALTH
○ Contains hepa b, a five in one vaccine
● Oral disease continues to be a serious public health
problem in the Philippines.
● The prevalence of dental caries on permanent teeth has
generally remained above 90% throughout the years.
About 92.4% of Filipinos have tooth decay (dental caries)
and 78% have gum diseases (periodontal diseases)
● Although preventable, these diseases affect almost every
Filipino at one point or another in his or her lifetime.
● Goal: Attainment of improved quality of life through
promotion of oral health and quality oral health care
TALK OF THE TOWN
PERSPECTIVE OF CITIZENS/PATIENTS/CLIENTS
● Typical talks of marites in a health facility
● Focused on financial problems in terms of health
PERSPECTIVE OF THE LOCAL IMPLEMENTERS
● Oral polio or inactivated can be used ● Typical talks of marites (workers + government) in a
● Rotavirus - for people who live in endemic areas which health facility
rotavirus causes severe diarrhea ● Still the financial burden hinders the attainment of Health
● Measles vaccine standalone or the threesm MMR for all
vaccine DOH MILESTONES
● 2019 - submission into law of the Universal health care
law

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○ An effort towards primary health care ● There are times that the local health center don’t have
○ Every filipino citizen shall be automatically included the medicine
into the National Health insurance Program ○ The problem is most people don’t have enough
○ Every Filipino shall be granted immediate eligibility money to buy the medicine
and access to preventive, promotive, curative, ● Whether we have the so-called thing of “health for all” I
rehabilitative, and palliative care for medical, dental, think we better off to answer that, remember that the
mental, and emergency health services target of this was 2020 and its 2023
RA 11223: UNIVERSAL HEALTH CARE ACT ● One thing to mention: during the pandemic in hospitals,
philhealth did not cover covid-19
GENERAL GUIDELINES ○ Zero billing - was not really implemented during
● To ensure equitable access to quality and affordable covid-19, medicines was paid out of pocket
health care and protection against financial risk expense
○ If hindi mahandle sa local center, then malipat sa
ibanf institution nakaya
● To progressively realize universal health care through
systemic approach and clear role delineation
○ pag may condition dapat kaya na siya ihandle ng
facility at hindi need magpunta sa malakihang
ospital kung saan mag cocongest lang sya don
UNIVERSAL HEALTHCARE MEANS
● Healthy living, school, and working environments
● Primary care provider team for every family
● Health spending is predictable, not “lahat libre”
○ Not necessarily na libre especially for the
dependent population
○ Kailangan may HMO card
○ Free part is only to help those who are in financial
burden
IT MEANS EVERYONE WINS
● Filipino/Patients are health literate, practice healthy
lifestyle, live in low-risk environments, receive effective
care without financial hardship
○ Should have access to your health professional for
instance health insurance without digging deep in
the pocket
● Payers (private insurers, governments, or self-pay
individuals) able to share provider behavior towards
quality and efficiency
○ The one that pays, there should be private and
government insurance to be part of the universal
healthcare
● Health care workers earn decent predictable income
and able to pursue career paths
○ Especially nurses and doctors now have fairly good
income
● Providers earn a positive margin for producing good
outcomes at low cost
● Suppliers of drugs, devices, and diagnostic tests that
improve outcomes and/or lower total costs find their
products incorporated into treatment protocols used and
reimbursed
○ Good supply medicine will encourage drug
suppliers to work with government to price
medicines at a good price
HEALTH FOR ALL
● Practice: all patient that will seek consultation like in the
local health center without UHC will be seen by the
doctor

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WEEK 10B: COMMUNITY AND PUBLIC HEALTH IN THE ● Expanded Program in Immunization
PHILIPPINES ● Maternal and Child Health Programs
● Essential Drugs
REVIEW ● Nutrition Programs
6 BUILDING BLOCKS (WHO, 2009) ● Treatment of Communicable Diseases
● Sanitation
● Disaster Risk Reduction and Management for Health
(DRRM-H)
● Mental Health
● Oral Health Services
● Drug Dependence
● Surveillance
AMBISYON NATIN 2040
● Word play of ambition and dream
VISION FOR THE COUNTRY:
● The Philippines, by 2040, will have a “prosperous,
predominantly middle-class society where no one is poor.
Our peoples will enjoy long and healthy lives, are smart
● Wag daw kakalimutan and innovative, and will live in a high trust society”.
● Where the UHC was anchored HOW ARE LAWS CREATED?
● Material to all health systems around the world ● POLICY : Definition A formal statement by a government,
WHO DEFINITION OF TERMS(WHO, 2009) organization or institution that expresses a set of goals,
the priorities within those goals and the preferred
● HEALTH state of complete physical, mental and social
strategies for achieving those goals; policy is based on
well-being and not merely the absence of disease or
the mandate of the institution (WHO)
infirmity.
DIFFERENT POLICY NOMENCLATURE AND HIERARCHY
● PUBLIC HEALTH as “the art and science of preventing
OF LAWS
disease, prolonging life and promoting health through the
organized efforts of society.” ● Republic Act - highest after constitution, act of legislation
○ Also known as : social medicine and community ● Presidential Decree
medicine(UK) ● Executive Order
● PRIMARY HEALTH CARE is a whole-of-society ● Administrative Order
approach to effectively organize and strengthen national ● Department Order
health systems to bring services for health and wellbeing ● Implementing Rules and Regulations
closer to communities. ● Guidelines
INSTITUTE OF MEDICINE DEFINITION OF TERMS (1994) ● Procedures
● Protocols
● PRIMARY CARE is the provision of integrated, ● Manual of Operations
accessible health care services by clinicians who are
POLICIES AT DIFFERENT LEVELS & WHO MAKES THEM
accountable for addressing a large majority of personal
POLICY WHAT IT IS WHO MAKES IT
health care needs, developing a sustained partnership
TYPE
with patients, and practicing in the context of family and
community. Republic Legislation used to create Congress of the
Act policy in order to carry out the Philippines
DOH PHILIPPINES DEFINITION OF TERMS (2020) principles of the Constitution - House of rep.
● PRIMARY CARE SYSTEM - refers to the structural and sen
characteristics of primary care which includes health Presidential Acts of the President providing Office of the
systems financing; distribution of primary care resources; Decrees and for rules of a general or President
competency of primary care providers; accessibility of Executive permanent character in
services; and continuity of care (longitudinal/vertical Orders implementation or execution
integration). of constitutional or statutory
● PRIMARY CARE PROVIDER NETWORK (PCPN) refers powers
to a coordinated group of public, private, or mixed PD - during P. Marcos
primary care providers, which serve as the foundation of EO - combining from office of
a Health Care Provider Network (HCPN). president after the 1987
HEALTH SERVICES IN DOH (ELEMENTS-D-MODS) constitution
Policy (AO, What must be done Department
● Educational – Health Information & Communication DO, DM)
● Locally Endemic Diseases

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- ex: UHC law have CURRENT HEALTH SYSTEM

implementing rules which is
an admin order by DOH CURRENT PHILIPPINE PUBLIC HEALTH SYSTEM
Guidelines How to implement the policy – Department
“technical how”
- ex: newborn screening etc.
Procedures How to implement the policy, Implementing
“administrative how” Units (RO,
- ex: UHC law, need IRR from Hospitals, LGUs,
department, ex financing how partners)
will it be implemented based
on the guidelines to regional
offices, hospitals in relation to
RA
Plan Who does what, when where ALL
- challenge: how can these be
localized, pagkukulang sa ● DOH oversees everything
implementation side HIERARCHY
● 16 CHDs
LOCAL GOVERNMENT CODE OF 1991 AND THE ● 81 Provinces
MANDANAS-GARCIA SUPREME COURT RULING ● 33 HUCs; 5 ICCs; 107 CCs
● 1,489 Municipalities
● The local government code 1991 - is a RA
● 42,045 Barangays
● Mandanas-garcia supreme court ruling - not a law but
how we interpret the law CURRENT CITY HEALTH OFFICE STRUCTURES
LOCAL GOVERNMENT CODE OF 1991 : HEALTH
DEVOLUTION
● Changed the way basic government health services are
delivered at the local government units
● Health Service Provision: From DOH to LGUs
○ Mas mabilis since hindi na kailangan umabot
papers sa malalayong lugar
● GOAL : Efficiency and Effectiveness of HSD through
empowered LGU
● Timon: city and health officer
CURRENT PROVINCIAL HEALTH OFFICE STRUCTURES

PRIMARY HEALTH SERVICES OF PHO/MHO/CHO

THROUGH ITS RHU AND BHS INCLUDE:
● Health education
● Control of locally endemic diseases such as malaria,
dengue, schistosomiasis and other notifiable disease (RA ● All provided by the local government code
11332) CURRENT PROVINCIAL HEALTH BOARD
● Immunization against TB, polio, measles, and tetanus,
among others (RA 10152)
● Maternal and child health and family planning (RA10354)
● Environmental sanitation and provision of safe water
supply (PD856)
○ Role of med techs in sanitation
● Nutrition
● Treatment of common diseases
● Supply of essential drugs
● Emergency and Disasters RRM-H (RA10121)
● Headed by the provincial health board

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UNIVERSAL HEALTH CARE ACT REPUBLIC ACT NO. EVOLUTION OF THE VARIOUS VERSIONS
11223

● House of representatives: HB 225, 5120, and 1975 ay

pinagsama sama ni Tan et al
● During the time of former secretary of health ● From the senate side, we have senator Recto, Ejercito,
● Approved the UHC act as strategized by DOH Hontiveros, and Angara
HISTORICAL BACKGROUND ● The meet of this is the Ejercito Bill
SITUATIONAL OVERVIEW: PHILIPPINES REMAIN DEEPLY ● Considered as champion of UHC act si Ejercito
UNDERSERVED ● Making of the law: Everything will be consolidated in the
bicameral committee, kapag pumasa yung versions ng 1,
2, 3 readings, lahat ng hindi magkasundo ay
pagsasamahin sa HB and SB ay pinagsasama then
iraratify then pipirmahan

● Day 1-3
○ He hosted the IRR UHC
SALIENT FEATURES OF THE UHC LAW
UHC REFORM PRINCIPLES
● Universality means ALL Filipinos
● Rank 6 out of 10 lalo na sa TB ● Equity means preferential regard for the unserved or
HEALTH OUTCOMES underserved
● High infant-child-maternal mortality rates, especially ● Accountability by clear role delineation,
among the poor (NDHS, FHS) purchaser-provider split, management and organizational
● 1 out of 3 children stunted (NNS 2015) reforms
● Immunization of children lowest in 25 years at 60% ● Sustainability by shifting emphasis to health promotion
(NDHS 20) and primary care and strategic purchasing
FINANCIAL RISK ● Participation by making information available and
● OOP at 56% of Total Health Expenditures (2014) understandable, providing platforms for citizens to
● Compliance to No Balance Billing for indigent and engage, recognizing private providers
sponsored members at 63% (2016) ● Social solidarity by pooling resources and enabling
● 1.5 million Filipinos pushed to poverty from access to mutual support for basic health services
health services (WB 2014) ● Individual responsibility for non-basic / fringe services
HEALTH SYSTEM RESPONSIVENESS na nakukuha mo na sa hospitals
● Inequitable distribution of health workers ● Progressive realization through fair and transparent
● Government health facilities remain overcrowded priority setting mechanisms
DECLARATION OF PRINCIPLES
● Integrated and Comprehensive Approach
○ Ensure health literacy, healthy living, and protection
from hazards and risks.
● Everyone is actively participating

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○ Whole-of-system Whole-of government, SUMMARY - REGULATION

Whole-of-society approach in the development of ● Mandating transparent pricing of health goods and
health policies services
● People at the Center ● Ensuring benefit complementation between PhilHealth
○ People-oriented approach centered on people’s and Private Health Insurance (PHIs) and Health
needs and well-being Maintenance Organizations (HMOs)
GENERAL OBJECTIVES ● Basic and non-basic accommodation bed ratio of
● To ensure equitable access to quality and affordable 90:10 for government hospitals, 70:30 for specialty
health care and protection against financial risk. hospitals, and 10:90 for private hospitals
● To ensure equitable access to quality and affordable ● Expanding scholarship programs, requiring 3 years
health care and protection against financial risk To return service in underserved areas for government
progressively realize universal health care through scholars, augmenting HRH through national health
systemic approach and clear role delineation workforce support system, primary care-oriented
○ Systemic approach - coordinated, not piecemeal education, health professionals registry
“band-aid” SUMMARY - SERVICE DELIVERY
○ Clear role delineation - know our role to play our ● Consolidating fragmented providers into province-wide
part well and city-wide service delivery networks to navigate and
UHC ACT DID NOT REPEAL THE LOCAL GOVERNMENT coordinate
CODE ● Institutionalizing primary care provider networks,
epidemiologic surveillance systems and health
promotion as minimum components of population-based
health services
○ Twin law of RA 11332
● Enabling income retention for all public providers
through a Special Health Fund
PROPOSED HEALTH SYSTEM
PROPOSED PHILIPPINE PUBLIC HEALTH SYSTEM

GOVERNANCE, FINANCING, AND REGULATION

SUMMARY - GOVERNANCE
● Streamlining PhilHealth Board from 17 to 13 members
● Requiring submission of health and financial data by
health care providers and suppliers harmonized to an
● Sineparate na yung services at pinag lump na siya, more
interoperable system; sharing of publicly-funded data
individual population based
sets
● Pag naimplement ang UHC law, si Provincial hospitals is
● Institutionalizing Health Technology Assessment as
magiging under na siya hindi na nakadugtong lang
prerequisite for public financing of goods and services,
and Health Impact Assessment for various programs, PROPOSED CITY/PROVINCIAL HEALTH OFFICE
policies, and projects STRUCTURES
● Strengthening medicines procurement, price negotiation
and affordability
SUMMARY - FINANCING
● Clarifying roles:
○ DOH and LGU for population-based services
○ PhilHealth for individual-based services
● Pooling funds to PhilHealth for all individual-based health
services (e.g. Sin Tax, PAGCOR, PCSO)
● Simplifying membership into two types: direct and
indirect contributory members ● Pinag-isa na si city at provincial
● Contracting by network based on adherence to quality ● However, pinag-iba ang service delivery at systems
and co-payment standards, and third party accreditation management

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● iu: Population and Individual based

● Health Systems Management: in relation to the six
building blocks
PROPOSED PROVINCIAL HEALTH BOARD

● The hospital was also organized

HOW INTEGRATION REFORM COMPLEMENTS COVID-19
RESPONSE
● Unified Governance of the LHS [LG 1] HR
● Pinagsama sama ang mga magka kaconnect ○ Functionality of the Provincial/ City Health Board
● Ang mga RHUs ay now under sa sa mga district Health ○ Strengthening of the Provincial/ City Health Office
Office ○ Emphasis on Inter-LGU Cooperation through
PRIMARY CARE PROVIDER NETWORK MOA/MOU
● HRH Management and Development [HW 1]
○ Certification of primary care health workers
○ Creation of Permanent Plantilla Positions for HRH
● Information Management [Info 1]
○ Provision of telemedicine services
○ Interoperability of EMR systems
● Epidemiology and Surveillance System [Info 2]
○ Functionality of epidemiology and surveillance
system
● Level 1 hospital - main center ● Procurement and Supply Chain Management [MPVT
● BHS - only in the provinces, gatekeeping 1]
● Birthing homes, school clinics, etc. ○ Functionality of supply chain management
● The goal here is to provide referrals to the first major ● Referral System [SD 1]
category bago mapunta sa hospital agad so to deload ○ Functionality of referral system
hospitals ○ Registration of Filipinos to primary care providers
UHC AND THE COVID-19 PANDEMIC ○ Adoption of Clinical Practice Guidelines
● Disaster Risk Reduction Management in Health [SD
2]
○ Institutionalizing the DRRM-H System
○ Fostering Inter-sectoral collaboration for resource
sharing and/ or mobilization
● Proactive and Effective Health Promotion Programs
or Campaigns [SD 3]
○ Implementation of population-wide health
promotion programs
○ Strengthening the roles of BHWs
UHC AND 8-PT HEALTH AGENDA
SA HEALTHY PILIPINAS, BAWAT BUHAY MAHALAGA
● HUMANISTIC
● UHC was truly used in the pandemic LEADERSHIP
● For instance, yung mga ambulances na ginamit sa ○ Having a deep
pandemic ay binili pa prior to the start of the pandemic understanding of
● Yung mga medical equipments were also available what motivates
people and the
genuine care and
concern for others
with the intention to
support and help

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COMMUNITY AND PUBLIC HEALTH FOR MLS SECOND YEAR, FIRST SEMESTER
LECTURE TRANSCRIPT ACADEMIC YEAR 2023 - 2024

● GOOD GOVERNANCE ○ Should have access to your health professional for

instance health insurance without out of pocket
spending
● Payers (private insurers, governments, or self-pay
individuals) able to share provider behavior towards
quality and efficiency
○ The one that pays, there should be private and
government insurance to be part of the universal
healthcare
○ No balance billing for the indigent
● Health care workers earn decent predictable income
and able to pursue career paths
○ Especially nurses and doctors now have fairly good
income
● Involves ensuring strategic policy frameworks exist and ● Providers earn a positive margin for producing good
are combined with effective oversight, coalition-building, outcomes at low cost
regulation, attention to system-design and accountability ○ Or else magsasara ang mga ospital
● HUMANISTIC LEADERSHIP AND GOOD ● Suppliers of drugs, devices, and diagnostic tests that
GOVERNANCE APPROACHES improve outcomes and/or lower total costs find their
products incorporated into treatment protocols used and
reimbursed
○ Good supply medicine will encourage drug
suppliers to work with government to price
medicines at a good price
● In order for change to happen, we must organize DOES NOT MEAN “LAHAT LIBRE”
ourselves and the sector through this ● Every Filipino family is matched to a primary care team,
8 PT AGENDA who ensures that they get the appropriate services they
need in the appropriate facility
● Every Filipino family’s health spending is predictable;
PhilHealth ensures they are protected from financial risk
WHAT WILL UHC BE FOR YOU?
UHC ENSURES THAT EVERYONE WILL BE RECEIVING
OPTIMAL HEALTH SERVICES.
● Every Filipino family is matched to a primary care team,
who ensures that they get the appropriate services they
need in the appropriate facility.
UHC ENSURES THAT NO PATIENT WILL BE LEFT ALONE.
● Creation of health networks that will navigate the
patients throughout the process of their Health Care
Needs. From BHS to Higher Health Facilities back to the
BHS
LGUS WILL BE PROVIDED WITH ADDITIONAL FUNDING
FOR HEALTH SERVICES.
● Health Services in the LGU will be funded through a
pooled fund. Health Workers will be incentivized and
compensated properly (Additional health workers may be
employed). Pooled fund will remain and be reflected as
● (1-3) Para Sa Bawat Pilipino LGU Income
● (4-6) Para Sa Bawat Komunidad LOCAL CHIEF EXECUTIVES AS CHAMPIONS OF HEALTH
● (7-8) Para Sa Bawat Health Worker ● LGUs will be empowered to lead on Public Health in their
● Related to population and individual health areas. Health Governance is key to a Healthy
Community. (RA 11223 did not explicitly repeal LGC)
LET’S PUT IT ALL TOGETHER
UNIVERSAL HEALTHCARE MEANS
UNIVERSAL HEALTH CARE AMBISYON 2040: MGA KASAMA SA DRAM NATIN IN 2040
IT MEANS EVERYONE WINS ● Healthy living, school, and working environments
● Filipino/Patients are health literate, practice healthy ● Primary care provider team for every family
lifestyle, live in low-risk environments, receive effective ● Health spending is predictable, not “lahat libre”
care without financial hardship

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COMMUNITY AND PUBLIC HEALTH FOR MLS SECOND YEAR, FIRST SEMESTER
LECTURE TRANSCRIPT ACADEMIC YEAR 2023 - 2024

● Care is provided by providers organized as

INTEGRATED NETWORKS
UNIVERSAL HEALTHCARE DOES NOT MEAN
● “ A cure all reform”: prescribed reforms need to careful
execution to ensure success
● “Lahat libre:” Basic health services will be free, but for
fees beyond the basics, every filipino family’s health
spending will be predictable
IN SHORT
HEALTH SECTOR ACCOUNTABILITY FRAMEWORK

● Applicability of all related laws in the Health sector

● Whole of gov and society - in UHC
●

Prepared by: TORRE, Bill Ritchie C., MT2C PAGE 49