Public Health

Public health has been defined as "the science and art of preventing disease", prolonging
life and improving quality of life through organized efforts and informed choices
of society, organizations (public and private), communities and individuals. The public can
be as small as a handful of people or as large as a village or an entire city. The concept
of health takes into account physical, psychological, and social well-being. As such, according to
the World Health Organization, "health is a state of complete physical, mental and social
well-being and not merely the absence of disease or infirmity"

Purpose
The purpose of a public health intervention is to prevent and mitigate diseases, injuries and other
health conditions. The overall goal is to improve the health of populations and increase life
expectancy.

Component
Public health is a complex term, composed of many elements and different practices. It is a multi-
faceted, interdisciplinary field. For example, epidemiology, biostatistics, social
sciences and management of health services are all relevant. Common public health initiatives
include promotion of hand-washing and breastfeeding, delivery of vaccinations, suicide
prevention, smoking cessation, obesity education, increasing healthcare accessibility
Method
Public health aims are achieved through surveillance of cases and the promotion of healthy
behaviors, communities and environments. Analyzing the determinants of health of
a population and the threats it faces is the basis for public health.
Many diseases are preventable through simple, nonmedical methods. For example, research has
shown that the simple act of handwashing with soap can prevent the spread of many contagious
diseases. In other cases, treating a disease or controlling a pathogen can be vital to preventing
its spread to others, either during an outbreak of infectious disease or through contamination of
food or water supplies. Public health communications programs, vaccination programs are
examples of common preventive public health measures.
Organizations
World Health Organization (WHO)
The World Health Organization (WHO) is a specialized agency of the United Nations responsible
for international public health. The WHO Constitution, which establishes the agency's governing
structure and principles, states its main objective as "the attainment by all peoples of the highest
possible level of health". The WHO's broad mandate includes advocating for universal
healthcare, monitoring public health risks, coordinating responses to health emergencies, and
promoting human health and well-being. The WHO has played a leading role in several public
health achievements, most notably the eradication of smallpox, the near-eradication of polio, and
the development of an Ebola vaccine. Its current priorities include communicable diseases,
particularly HIV/AIDS, Ebola, COVID-19, malaria and tuberculosis; non-communicable
diseases such as heart disease and cancer; healthy diet, nutrition, and food
security; occupational health; and substance abuse.
Others
Most countries have their own governmental public health agency, often called the ministry of
health, with responsibility for domestic health issues.
Public health programs

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Most governments recognize the importance of public health programs in reducing the incidence
of disease, disability, and the effects of aging and other physical and mental health conditions.
However, public health generally receives significantly less government funding compared with
medicine. Although the collaboration of local health and government agencies is considered best
practice to improve public health. Public health programs providing vaccinations have made
major progress in promoting health, including substantially reducing the occurrence
of cholera and polio and eradicating smallpox, diseases that have plagued humanity for
thousands of years.
The World Health Organization (WHO) identifies core functions of public health programs
including:

 providing leadership on matters critical to health and engaging in partnerships where joint
action is needed;
 shaping a research agenda and stimulating the generation, translation and dissemination of
valuable knowledge;
 setting norms and standards and promoting and monitoring their implementation;
 articulating ethical and evidence-based policy options;
 monitoring the health situation and assessing health trends.
In particular, public health surveillance programs can:

 serve as an early warning system for impending public health emergencies;

 document the impact of an intervention, or track progress towards specified goals; and
 monitor and clarify the epidemiology of health problems, allow priorities to be set, and
inform health policy and strategies.
 diagnose, investigate, and monitor health problems and health hazards of the community
Historical perspective of public health
Historical Glimpse:
 Ancient Greeks(500-323 BC)
 Roman Empire(23 BC- 476 AD)
 Middle Age(476 – 1450 AD)
 Birth of Modern Medicine(1650 – 1800 AD)
 Great Sanitary Awakening(1800s – 1900s)
 Sanitary Reforms
 Modern Public Health (1900 & onwards)

1) Ancient Greeks:
 Physical hygiene
 Physical fitness
 Olympics
 Naturalistic concept(disease caused by imbalance between man and his environment)
 Hippocrates:
 Father of Western medicine
 Recognized body consist of 4 humors(Blood, Black Bile, Yellow Bile, Phlegm)
 To create balance in body(Exercise, nutrition, excretion, rest required)
 Coined the term Epidemic ‫ وباء‬and Endemic‫مقامی‬

2) Roman Empire:

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  Adopted Greek health values by hiring Greek(Physician as personal healer)

 Great engineers:

 Built sewage systems

 Aqueducts: an artificial channel for conveying water(Bringing fresh water in city)

 Establish bureaucratic system administration:

 Public baths

 Private water supply

 Physicians were employed by municipalities to provide health services

3) Middle Ages:
 Urbanizing in Europe

 Overcrowding

 Decline of hygiene and sanitation

 Major epidemic(‫) وباء‬of Bubonic Plague(Bubonic plague is one of three types of

plague caused by the bacterium) and Black death

 Faith and prayer were accepted treatment for illness

 Beginnings of PH tools

4) Birth of Modern Medicine:

 After industrialization Malnutrition, overcrowding, poor working condition contribute to
severe disease outbreak: typhus, typhoid, cholera

5) Great Sanitary Awakening:

 Growth in scientific knowledge

 Humanitarian ideals

 Connection between poverty and diseases

 Water supply and sewage removal

 Monitor community health status

6) Sanitary Reforms:
 1848 The Public Health Act created a General Board of Health in London
 In the 1850s The Epidemiologic Society of London was formed
 1869 State Board of Health
 Quarantine act, Quarantine law was formed
 Clean water
 Food inspection
 Soaps, disinfectants and pharmaceuticals
 Personal hygiene
 Public work departments(street cleaning, garbage collection)
 Public health departments and regulation

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 7) Modern Public Health:
Late 19th to Early 20th Century: Edwin Chadwick and John Snow pioneered the understanding of
sanitation and epidemiology, laying the foundation for modern public health practices.

Mid-20th Century: Post-World War II, the focus shifted to "health for all" with emphasizing primary
healthcare as pivotal.

Late 20th Century: Control of infectious diseases led to tackling chronic diseases. The emergence of
global health threats like SARS spurred (encourage) international cooperation.

21st Century: Recognition of social determinants of health gained prominence, alongside

technological innovations revolutionizing disease surveillance and healthcare delivery.

Reform Phase:
 1st School of Public Health established in 1918
 1st National level volunteer agency
 American Cancer Society

1920s:
 Period of slow development
 Health department increases
 Life expectancy increases

World War II:

 Decreased availability of funds and resources for public health
 Social security Act 1935 beginning of involvement of government in social issues including
health
 Health for all

Post War years:

 Antibiotic penicillin was made available
 Insecticide was made available
 Communicable Disease Center was setup
 Development of vaccine

Economic Determinants of Health

The economic determinants of health refer to the various socio-economic factors that influence the
health and well-being of individuals and populations. These factors play a crucial role in shaping
people’s health outcomes and can contribute to health inequalities within societies.

Here are some key economic determinants of health:

Income and Wealth:

The level of income and wealth an individual or household has is strongly associated with health
outcomes. Higher income generally leads to better access to healthcare services, nutritious food,
safe housing, and other resources that promote good health.

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Employment and Working Conditions:
Unemployment, job insecurity, and poor working conditions can have detrimental effects on health.
People in stable employment with good working conditions are more likely to have better overall
health outcomes.

Education:
Education is a significant determinant of health. Higher levels of education are associated with
better health outcomes and healthier behaviors. Education provides individuals with knowledge and
skills to make informed decisions about their health and access to better job opportunities.

Social Class and Social Status:

Socioeconomic status, often measured by occupation or educational attainment, is strongly
correlated with health. Individuals in higher social classes tend to have better health due to
improved access to resources and opportunities.

Access to Healthcare:
The availability and affordability of healthcare services can significantly impact health outcomes.
Lack of access to quality healthcare, including preventive care and treatments, can lead to poorer
health outcomes and health disparities.

Social Support Networks:

Strong social support networks, including family, friends, and community connections, can positively
influence health. Social support provides emotional, financial, and practical assistance during times
of illness or stress.

Income Inequality:
The level of income inequality within a society can have profound effects on population health. High
levels of income inequality are associated with poorer health outcomes, even for individuals in
higher income brackets.

Neighborhood and Physical Environment:

The physical environment in which people live, such as access to clean air, safe housing, green
spaces, and healthy food options, can impact health outcomes. Disadvantaged neighborhoods often
lack these resources, leading to adverse health effects.

Health Insurance Coverages:

The availability and extent of health insurance coverage can influence access to healthcare services
and affordability of treatments. Lack of insurance coverage can lead to delayed or inadequate care,
affecting health outcomes.

Government Policies and Social Programs:

Public policies, such as taxation, minimum wage laws, social welfare programs, and regulations on
industries, can have significant impacts on health and health disparities within a population. It's
Important to note that these economic determinants of health interact with other social and
environmental factors, creating complex relationships that influence individual and population

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health outcomes. Addressing these determinants requires a comprehensive and multisectoral
approach to promote health equity and improve overall population health

Political Determinants of Health

The political determinants of health refer to the impact of political systems, policies, and processes
on the health outcomes of individuals and communities. These determinants recognize that political
decisions and actions can have profound effects on population health and health equity.

Here are some key political determinants of health:

Governance and Political Stability:

The stability and effectiveness of governance structures within a country play a crucial role in
determining health outcomes. Good governance, transparency, and accountability are associated
with better health outcomes, while political instability and corruption can hinder effective health
policies and delivery.

Policy-making:
Political decisions and policies at various levels of government influence health outcomes. Policies
related to healthcare funding, access to healthcare services, social welfare, education, housing,
employment, and environmental regulations can significantly impact population health.

Health System:
The organization, structure, and functioning of the health system are influenced by political
decisions. The availability, accessibility, and quality of healthcare services, including preventive,
curative, and rehabilitative care, are shaped by political choices such as health financing
mechanisms, health workforce planning, and infrastructure development.

Social Determinants of Health

Many social determinants of health, such as income inequality, education, and housing, are
influenced by political decisions. Policies related to income redistribution, social protection
programs, education funding, urban planning, and housing policies can have significant implications

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for health outcomes.

Health Policy Implementation:

Effective implementation of health policies relies on political commitment, administrative capacity,
and resource allocation. Political will and support are crucial for successful policy implementation,
including strategies to address health disparities and social determinants of health.

Political Ideology and Values:

Different political ideologies and values can shape health policies and priorities. For example,
political ideologies that prioritize individualism and free markets may result in different approaches
to healthcare delivery compared to ideologies that prioritize social justice and equity.

Global Health Governance:

Political decisions made at the international level can impact health outcomes globally. Policies
related to international trade, intellectual property rights, development assistance, and global health
security can influence access to healthcare, availability of essential medicines, and responses to
infectious disease outbreaks.

Understanding and addressing the political determinants of health is crucial for promoting health
equity and improving population health. It requires collaboration between policymakers, public
health professionals, civil society organizations, and communities to advocate for policies that
prioritize health and well-being.

IMPACT OF HEALTH DISPARITIES ON RACE, CLASS AND

GENDER
IMPACT OF HEALTH DISPARITIES
Health disparities refer to differences in health outcomes or access to healthcare services among
different populations or social groups. These disparities can be influenced by various factors,

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including race, class, and gender. Here are some detailed impacts of health disparities on these
social determinants:

IMPACT OF HEALTH DISPARITIES ON RACE

Health disparities refer to differences in health outcomes between different population groups, and
race is a significant factor contributing to these disparities. While it is important to note that race
itself does not cause health disparities, the social and economic factors associated with race play a
significant role in creating and perpetuating these inequalities. Here are some key impacts of health
disparities on race:

Access to healthcare
Racial and ethnic minorities often face barriers to accessing quality healthcare services. Factors such
as limited availability of healthcare facilities in underserved areas, lack of health insurance, language
barriers, and cultural differences can all contribute to reduced access. As a result, minorities may
haveless access to preventive care, timely diagnosis, and appropriate treatment, leading to poorer
health outcomes.

Chronic diseases
Racial and ethnic minorities bear a disproportionate burden of chronic diseases such as diabetes,
hypertension, obesity, andcardiovascular disease. These conditions can result from a complex
interplay of genetic, environmental, and socioeconomic factors. Limited access to healthcare,
unhealthy living conditions, food deserts (areas with limited access to fresh, nutritious food), and
higher levels of stress due to racism and discrimination can contribute to the development and
progression of chronic diseases.

Maternal and infant health

Disparities in maternal and infant health persist among racial and ethnic minority groups. Rates of
maternal mortality and severe maternal morbidity are higher among Black women compared to
white women. Racial and ethnic minority infants also experience higher rates of preterm birth, low
birth weight, and infant mortality. These disparities are influenced by factors such as limited access
to prenatal care, higher levels of stress, implicit bias in healthcare, and socioeconomic factors.

Mental health
Racial and ethnic minorities often face disparities in mental health outcomes. They may experience
higher rates of psychological distress, depression, anxiety, and post-traumatic stress disorder (PTSD).
Discrimination, racism, and socioeconomic disadvantages contribute to chronic stress and adversely
impact mental well-being. However, minority communities often have limited access to mental
health services and face cultural and language barriers when seeking care.

Covid-19 impact
The COVID-19 pandemic has highlighted and exacerbated existing health disparities. Racial and ethnic
minorities, particularly Black, Indigenous, and Hispanic populations, have experienced higher rates of
infection, hospitalization, and death from COVID-19. Factors such as socioeconomic disadvantages,
crowded living conditions, limited access to healthcare, and a higher prevalence of underlying health
conditions contribute to these disparities.

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Addressing health disparities requires a multifaceted approach. It involves improving access to
healthcare, reducing socioeconomic inequalities, promoting culturally competent care, addressing
implicit bias in healthcare systems, and investing in social determinants of health such as education,
housing, and economic opportunities. Additionally, efforts to promote diversity, equity, and
inclusion in healthcare and research can contribute to more equitable health outcomes for all racial
and ethnic group.

IMPACT OF HEALTH DISPARITIES ON GENDER

Health disparities refer to the differences in health outcomes or access to healthcare services
experienced by different population groups. These disparities can be influenced by various factors,
including socioeconomic status, race/ethnicity, and gender. While health disparities affect both men
and women, there are specific ways in which they impact gender that are important to consider.
Here are some key points regarding the impact of health disparities on gender:

Health conditions
Certain health conditions affect men and women differently, leading to disparities in prevalence,
outcomes, and treatment. For example, women may face higher rates of certain reproductive health
issues such as breast cancer, cervical cancer, and maternal mortality. Men, on the other hand, may
experience higher rates of conditions like prostate cancer and cardiovascular diseases.

Access to healthcare
Gender can influence access to healthcare services due to a variety of factors. Women may face
unique challenges related to reproductive health, including access to contraception, family planning
services, and reproductive healthcare providers. On the other hand, men often face barriers in
seeking preventive care and mental health services due to societal expectations of masculinity.

Socioeconomic factors
Gender intersects with socioeconomic factors to create health disparities. Women, particularly those
from marginalized communities, may experience economic barriers such as lower income, limited
job opportunities, and lack of insurance coverage. These factors can restrict access to quality
healthcare services, leading to poorer health outcomes.

Health behaviors
Gender norms and societal expectations can influence health behaviors, which in turn impact health
outcomes. For example, men may be more likely to engage in risky behaviors such as smoking,
excessive alcohol consumption, or avoiding seeking medical help until symptoms worsen. Women,
on the other hand, may face pressures related to body image and weight, leading to unhealthy
dieting practices.

Mental health
Gender plays a role in mental health disparities as well. Women are more likely to experience
depression and anxiety, while men are more prone to substance abuse and suicide. Societal
expectations related to gender roles can contribute to these disparities, as men may be discouraged
from seeking help for mental health issues due to perceived weakness or stigma.

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Addressing health disparities related to gender requires a multi-faceted approach. It involves
recognizing and challenging gender norms and stereotypes, promoting gender-sensitive healthcare
services, improving access to reproductive healthcare, and addressing socioeconomic factors that
contribute to disparities. Additionally, promoting education and awareness about gender-specific
health conditions and encouraging healthy behaviors can help reduce these disparities.

Health disparities based on social class

In sociology, health disparities based on social class are a well-documented phenomenon. Social
class, which encompasses factors such as income, education occupation, and social status, has a
significant impact on an individual’s access to healthcare, health outcomes, and overall well-being.
This article aims to outline and explain the ways in which health differs based on social class.

1. Access to Healthcare
One of the key ways in which health differs based on social class is in the access to healthcare
services. Individuals from higher social classes tend to have better access to healthcare facilities,
including primary care physicians, specialists, and hospitals. They are more likely to have private
health insurance coverage, which provides them with a wider range of healthcare options and
shorter wait times for medical appointments.

On the other hand, individuals from lower social classes often face barriers to accessing healthcare.
They may lack health insurance or have limited coverage, making it difficult for them to afford
necessary medical care. This can result in delayed or inadequate treatment, leading to poorer health
outcomes.

2. Health Behaviors
Social class also influences health behaviors, which in turn impact an individual’s health status.
Individuals from higher social classes generally have more resources and knowledge to engage in
healthier lifestyle choices. They have access to nutritious food, exercise facilities, and leisure
activities that promote physical and mental well-being.

In contrast, individuals from lower social classes may face challenges in adopting healthy behaviors.
They may have limited access to affordable healthy food options, live in neighborhoods with limited
recreational spaces, and have higher levels of stress due to financial constraints. These factors
contribute to a higher prevalence of unhealthy behaviors such as smoking, excessive alcohol
consumption, and poor diet, which increase the risk of chronic diseases.

3. Environmental Factors
The social class also influences the environmental conditions in which individuals live, which can
significantly impact their health. Individuals from lower social classes are more likely to reside in
neighborhoods with poor air quality, inadequate sanitation, and limited access to green spaces.
These environmental factors contribute to higher rates of respiratory diseases, infectious diseases,
and mental health issues.

Furthermore, individuals from lower social classes may be exposed to occupational hazards due to
their limited job options. They may work in jobs that involve physical labor, exposure to harmful
substances, or stressful working conditions, which can have detrimental effects on their health in the
long run.

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4. Stress and Mental Health
Social class also plays a significant role in determining an individual’s exposure to chronic stressors,
which can have profound effects on mental health. Individuals from lower social classes often face
higher levels of stress due to financial instability, job insecurity, and limited social support networks.
This chronic stress can lead to mental health disorders such as anxiety and depression. In contrast,
individuals from higher social classes generally have more resources to cope with stress and access
to mental health services. They may have greater social support, flexible work schedules, and the
means to engage in stress-reducing activities such as therapy or vacations.

5. Health Literacy
Health literacy, which refers to an individual’s ability to understand and navigate health information,
is also influenced by social class. Individuals from higher social classes tend to have higher levels of
education and access to information, enabling them to make informed decisions about their health.
They are more likely to understand medical jargon, seek preventive care, and engage in health-
promoting behaviors.

Conversely, individuals from lower social classes may have limited health literacy, making it
challenging for them to understand complex medical information, navigate the healthcare system,
and advocate for their own health needs. This can result in delayed diagnoses, inadequate
treatment, and poorer health outcomes.

Conclusion
Social class has a profound impact on health disparities. Access to healthcare, health behaviors,
environmental factors, stress levels, and health literacy all contribute to the differences in health
outcomes among different social classes. Recognizing and addressing these disparities is crucial for
promoting health equity and ensuring that everyone, regardless of social class, has the opportunity
to live a healthy life.

Legal Foundation
For improvement and protection of public health, an adequate health system is required, but with
any system, public health laws are absolutely essential for proper and effective regulation of health
system. The scope of public health is not limited to one area, but it is very extensive. Hence, public
health laws are also wide based. In every aspects of community health, public health laws are
important. Therefore, to solve public health problems, effective laws are utmost essential.

Definition:-
• According to Gostin, "Public health laws are such legal forces and duties of organized society, by
which conditions for maintaining citizen's health are ensured."

• Public health law refers to a statute, or rule or local ordinance that has the purpose of promoting
or protecting the public health.

Objectives of public health act:-

 To protect and promote public health
 Control the risk to public health
 Promote the control of infectious disease

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  Prevent the spread of infectious diseases
 Recognizes the role of local governments in protecting public health

Characteristics of public health laws:-

 GOVERNMENT- Public health activities are the primary responsibility of government.
 POPULATION-Public health focus on the health of populations.
 RELATIONSHIP- Public health contemplates the relationship between the state and the
population.
 SERVICES-Public health deals with the provision of public health services.
 COERCION- Public health possesses the power to coerce the individual for the protection of
the community.

Effectivness of public health laws:-

By simply making public health laws health problems cannot be solved. To make the health laws
effective, the support of following factors are important:

➤ Useful health system for proper solving.

➤ Proper economic policies.

➤ Community participation.

➤ Constitutional support.

➤ Periodic review of the health laws.

➤ Strong political will to implement health laws.

➤ Proper resources.

Contents of public health legislation:-

1) General information about laws

General health code, rules, laws, constitution, fundamental rights, duties etc.

Social & economic aspects of health laws

Health care systems and the systems of implementing laws

2) Rules related to disease control and medical care

 Infectious disease
 Non-infectious disease

3) Mental health.

4) Care of aged and handicapped persons.

5) Laws related to smoking, tobacco, alcoholism and drug addiction.

6) Legal implication in family health. (eg, Child health and protection).

7) Death and issues related to it.

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8) Nutrition and food safety.

9) Consumer protection.

10) Drug preparation and different aspects related to it.

11) Occupational health and safety.

12) Environmental protection.

13) Training of health personnel.

14) Code of ethics and professional responsibilities.

Importance of public health laws at world level:-

 The chief objective of international health laws is to improve health status at international
level.
 To eradicate health risks for global environment or minimize them.
 Legal intervention by making health policies and laws to prevent non-communicable disease,
diabetes.
 Introduction and management of new techniques in area of health like biotechnologies,
information etc.
 To prevent health risks which may happen due to international travel.
• To assist international agencies and institutions in health management and
regulations.
• To increase awareness and interest regarding health in the entire world.

Obstacles of public health laws:-

• Health laws have to face many hindrances at local, regional, national and international levels.

• Hindrances produced due to social, political, administrative and economic fields are included in
this.

• In addition to these obstacles, trade and commerce, communication, technical and such
globalization related problems also create obstacle in implementing health laws properly.

MORAL AND ETHICAL FOUNDATIONS

• Public health ethical and moral foundations provide the guiding principles and values that shape
the field’s practices and decision-making processes. These foundations ensure that public health
efforts are conducted ethically and with a focus on promoting the well-being of populations. Here
are some key ethical and moral foundations of public health.

MORAL FOUNDATIONS OF PUBLIC HEALTH

The field of public health is built upon a set of moral foundations that guide its principles, values,
and goals. These moral foundations reflect the ethical considerations and responsibilities that
underpin public health practices. While different ethical frameworks may be applied within public
health, several core moral foundations are commonly recognized. Here are five key moral
foundations of public health.

Beneficence

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The principle of beneficence emphasizes the promotion of wellbeing and the prevention of harm.
Public health aims to maximize benefits and minimize risks to improve population health. This
foundation highlights the responsibility to prioritize actions and policies that have the potential to
enhance the health and well-being of communities and individuals.

Justice
Justice refers to the fair and equitable distribution of resources, benefits, and burdens within
society. In public health, justice involves ensuring that all individuals have equal opportunities to
access and receive healthcare services, as well as addressing health disparities and social
determinants of health. Public health professionals strive to reduce health inequities and promote
social justice.

Respect for autonomy

• Autonomy entails respecting the rights and choices of individuals. In public health, this moral
foundation recognizes the importance of informed consent, privacy, and individual decision-making.
Public health interventions should consider and respect the autonomy of individuals while balancing
the need to protect public health and promote the common good.

Non-maleficence
• Non-maleficence focuses on the duty to do no harm. Public health practitioners aim to minimize
risks and avoid actions that may harm individuals or communities. This foundation underscores the
importance of carefully assessing potential risks and benefits associated with public health
interventions and taking measures to mitigate harm.

Public trust and transparency

• Public health relies on trust between professionals, institutions, and the communities they serve.
Open communication, transparency, and accountability are essential in maintaining public trust.
Public health practitioners have a responsibility to provide accurate and timely information, involve
communities in decision-making processes, and address concerns to foster trust and collaboration.
These moral foundations serve as a framework for ethical decision-making and guide public health
professionals in their efforts to promote and protect the health of populations. It is important to
note that the application of these foundations can vary depending on cultural, social, and contextual
factors, and ethical dilemmas may arise when balancing competing interests and values.

ETHICAL FOUNDATIONS OF PUBLIC HEALTH

• The ethical foundations of public health provide a framework for guiding the principles and
practices in the field. These foundations encompass various ethical principles and considerations
that shape public health decision-making and actions. Here are some of the key ethical foundations
of public health:

Public good
• Public health is primarily concerned with promoting and protecting the health of the entire
population. It recognizes that collective well-being and the common good take precedence over
individual interests. This foundation highlights the importance of prioritizing actions and policies that
benefit the population as a whole, even if they may conflict with individual preferences or liberties.

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Prevention
• Prevention is a fundamental ethical principle in public health. Public health professionals focus on
preventing disease, injury, and other adverse health outcomes before they occur. This proactive
approach aims to reduce the burden of illness and enhance overall population health. Emphasizing
prevention not only reduces individual suffering but also contributes to the efficient use of
healthcare resources.

Equity and social justice

• Public health is committed to promoting fairness, equity, and social justice. This ethical foundation
recognizes that everyone deserves an equal opportunity to achieve good health and well-being.
Public health professionals work to address health disparities, social determinants of health, and
structural inequalities that contribute to health inequities. They strive to ensure that vulnerable and
marginalized populations receive equitable access to healthcare, resources, and opportunities.

Respect for individual rights and autonomy

• While public health focuses on the population, it also respects the rights and autonomy of
individuals. Public health interventions should strive to protect individual privacy, autonomy, and
informed consent. Balancing the needs of the community with individual rights can present ethical
challenges, requiring careful consideration and ethical analysis.

Evidence-based practice
• Ethical public health practice relies on the use of scientific evidence to inform decision-making and
interventions. Public health professionals have a responsibility to base their actions on sound
research, data, and evaluation. This foundation emphasizes the importance of transparency,
integrity, and accountability in public health practice.

Collaboration and engagement

• Public health ethics emphasizes the need for collaboration, engagement, and inclusiveness. It
recognizes that decision making processes should involve stakeholders, communities, and
individuals affected by public health interventions. This foundation acknowledges the value of
diverse perspectives, participation, and community empowerment in achieving public health goals.

These ethical foundations provide a moral compass for public health professionals, guiding their
efforts to protect and promote the health of populations while upholding ethical principles and
responsibilities. It is essential for public health practitioners to regularly reflect on these ethical
foundations and navigate complex ethical dilemmas that may arise in their practice

Public health structure

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 Macro-level structural capacity
Governance
Public health governance functions and structures vary. Public health governing bodies can support
and guide public health performance through six functions of public health governance:

1. leading or contributing to policy development;

2. ensuring adequate resources are available;

3. monitoring improvements;

4. engaging with partners;

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5. exercising legal authority; and

6. assuming responsibility for public health performance.

Governance structures were identified as an important factor influencing a city’s ability to have an
impact on population health. Centralized governance models have the potential to be more efficient,
coordinated and allow for costs to be shared and resources to be redistributed .In contrast, this
could decrease engagement with community members and responsiveness to local needs.

Consistent with some of the functions of public health governance described above, effective
partnerships between local, city and regional tiers of government are required for cities to have an
impact on population health. In addition, city leaders must understand and use the regulatory
powers within their control to impact population health.

The relationship between governance and public health performance is inconclusive

A governing board of health with a policy making role was positively associated with performance of
essential public health services. Organizational control in public health organizations can be
centralized, decentralized or mixed. There were varied findings on the impact of organizational
control on public health performance. In some studies, centralization of authority was associated
with better public health performance compared to decentralized or mixed structures. In other
studies shared state and local authority was associated with improved public health performance.

Boundaries
Jurisdictional size predicts public health performance. In many studies, the size of the jurisdiction
served by a public health organization had a strong association with public health performance.
Overall, public health organizations with larger jurisdictions performed better than smaller ones.
When public health organizations served a larger population they had increased capacity to provide
essential services. Most included studies did not report an optimal jurisdictional size, however in
studies that did, population size ranged from ≥50,000 to 100,000 people. In one included study,
population size was positively associated with performance up to 500,000 people but beyond that
public health performance declined. There was not enough evidence to determine whether
regionalization of public health services is associated with improved public health capacity and
performance.

Finance
Per capita funding and public health expenditures predict public health performance

Public health finances have a strong association with public health performance. Financial
considerations occur both at the macro and micro levels of public health systems. At the macro-level
,both expenditures per capita and expenditures per staff full-time equivalents (FTEs) are associated
with improved public health performance. At the micro-level, funding allocation and fiscal priorities
can influence public health performance. These can include allocation of resources to quality
improvement, innovation, information access, and training

Workforce size and composition

Workforce size and composition are associated with public health performance

Public health organizations with more staff perform better than organizations with fewer staff.
Specifically, a public health workforce with a high proportion of staff relative to the size of the

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population served is associated with better performance for most essential services. A workforce
with a mix of disciplines and diverse experience and training is also positively associated with
performance. The distribution of public health expertise at various levels of the public health system
is another important consideration when trying to influence population health.

Micro-level structural capacity

Workforce Development
Workforce development can support public health performance

At the micro-level, a skilled and competent workforce is essential to the performance of public
health organizations. Providing staff with opportunities for professional development and access to
technical assistance are considered high priorities. Workforce training is often on-the-job and
competency-based. The educational background(s) and competencies of the public health workforce
must be considered.

Leadership
The relationship between leadership and public health performance is inconclusive

Leadership is frequently cited as having an important influence on public health performance

however findings are mixed. The association between the educational training of public health
leaders and public health performance is inconclusive. Several leadership characteristics were
identified as high priority. This included public health leaders’ skills and background; values and
expectations; and use of participative decision-making. At the city level, leaders can have significant
impact on the social determinants of health through formal and informal powers. Outside of formal
governance structures and powers, leaders can influence population health by networking,
partnering with others, and creating a culture of learning, innovation and continuous improvement.
Leadership style and skills should fit with the model of governance (e.g. consensus-based decision-
making).

Organizational culture
Organizational culture can support public health performance

Organizational culture was identified as a high priority element of structural capacity that can
influence public health performance. Leaders help to shape organizational culture through free flow
of information, support for innovation and creating a learning organization.

Interorganizational relations
Interorganizational relationships can support public health performance

Relationships and partnerships are essential to a strong public health system. Involving outside
organizations in the planning and provision of public health services is associated with improved
public health performance. This could include schools, hospitals, social services, community
organizations, businesses, law enforcement and academic organizations. Cities need to be able to
link parts of the system internally as well as connect to other cities and external partners to impact
population health. These connections are useful to exchange lessons learned or to address shared
problems.

Infrastructure

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Physical infrastructure (e.g. facilities and equipment) is essential to public health capacity. However,
the evidence reviewed did not include research on the relationship between infrastructure and
public health performance.

Data and information sources

Access to information for evidence-informed decision-making is an element of structural capacity
that influences public health performance. The are other important information sources and
technologies that could impact the structural capacity of public health, however the evidence
reviewed did not include research on the effect of these on public health performance.

Quality improvement
Quality improvement (QI) processes are essential to assessing public health performance. QI
interventions can be used to “improve the efficiency or effectiveness of a program, process or
organization.” QI processes require careful consideration of the measures of public health
performance being examined. Most included studies did not link public health performance directly
to population health outcomes. There is a need to establish whether achievement of a public health
performance measure will improve population health.

• Interorganizational relations

• Infrastructure

• Data and information systems

Historical Trauma
What is Historical Trauma?
Historical trauma is multigenerational trauma experienced by a specific cultural, racial or ethnic
group. It is related to major events that oppressed a particular group of people because of their
status as oppressed, such as slavery, the Holocaust, forced migration, and the violent colonization of
Native Americans. While many in such a group will experience no effects of the historical trauma,
others may experience poor overall physical and behavioral health, including low self-esteem,
depression, self-destructive behavior, marked propensity for violent or aggressive behavior,
substance misuse and addiction, and high rates of suicide and cardiovascular disease. Acute
problems of domestic violence or alcohol misuse that are not directly linked to historical trauma may
be exacerbated by living in a community with unaddressed grief and behavioral health needs.
Parents’ experience of trauma may disrupt typical parenting skills and contribute to behavior
problems in children. Compounding this familial or intergenerational trauma, historical trauma often
involves the additional challenge of a damaged cultural identity. Clinical social workers first
described historical trauma among descendants of the Holocaust and the children of Japanese
Americans interned during World War II. The children and grandchildren of survivors commonly
experience attachment issues and isolation by their parents. Considerable work has also been done
with communities of Native Americans, who experienced repeated massacres and the forced
removal of children to federal and mission boarding and day schools. From her work with tribal
communities, clinician and researcher Maria Yellow Horse Brave Heart describes historical trauma as
the “cumulative emotional and psychological wounding over the lifespan and across generations,
emanating from massive group trauma experience.” Similarly, African Americans experienced
generations of slavery, segregation, and institutionalized racism that has contributed to physical,

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psychological, and spiritual trauma. For members of any of these communities, daily reminders of
racial discrimination can exacerbate individual responses to trauma. An understudied group who has
experienced historical trauma is the disability community. In the recent past, people with disabilities
have been subjected to biases and misrepresentations about their capabilities and lived experiences.
Attempts to eradicate people with disabilities have included eugenics campaigns, compulsory
sterilization, forced psychiatric treatment, and the institutionalization of people with intellectual
disabilities.

Why the Concept of Historical Trauma is Important for Human Services

Agencies
Human services programs are provided to a wide range of individuals including members of groups
who may experience historical trauma. By being mindful of unresolved grief and distrust of majority
groups or government programs, human service providers can more readily deliver programs to
reduce family stress, child abuse and neglect, substance misuse, mental health challenges, and
domestic violence. Human services providers and staff can better understand present day reactions
to events in the context of individual trauma narratives. Because trauma-related events have
occurred in the context of service provision, it is also important to be mindful of a potential lack of
trust in government-funded services, in research, and in health and mental health care. To build
trust, providers can be respectful, cognizant of different reactions to traumatic events within
communities, and focus on community strengths and resilience. With the understanding that all
communities are unique with distinct cultural norms and belief systems, human services personnel
are in a good position to support to members of the community with whom they are working.

Relevant Interventions and Approaches

Research is still emerging on the effectiveness of treatment methods for individuals experiencing
historical trauma. Treatment approaches are grounded in traditional healing methods and
ceremonial practices of communities. For example, Dr. Brave Heart has developed
psychoeducational group interventions delivered at geographic locations that are sacred to
members of tribal communities that involve ceremonies reinforcing cultural identity. Although even
top researchers in this field acknowledge the literature about historical trauma is controversial,
there is an important emphasis on the healing process, and overcoming the barriers to resolving
grief.

Key Concepts
• Historical trauma is intergenerational trauma experienced by a specific cultural group that has a
history of being systematically oppressed.

• Current lifespan trauma, superimposed upon a traumatic ancestral past creates additional
adversity.

• Historical trauma can have an impact on psychological and physical health.

• Historical trauma is cumulative and reverberates across generations. Descendants who have not
directly experienced a traumatic event can exhibit the signs and symptoms of trauma, such as
depression, fixation on trauma, low self-esteem, anger, and self-destructive behavior.

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• People coming into systems of services and support from communities who have been subjected
to historical trauma may believe the systems do not support them. They may experience triggers
that are re-traumatizing.

• Human services providers working with members of underserved cultural groups can help by
gaining a fuller understanding of clients’ historical and community context. Providers can also seek
and build alliances with local, respected individuals such as pastors and community leaders.

• Providers should recognize that cultural, racial, and ethnic groups are heterogeneous, and not
every member of a group has the same response to a current or past traumatic event.

• It is helpful to be open to traditional ways of healing and acknowledge community resilience

Cultural Competence
Cultural competence is the ability to understand, communicate and effectively interact with people
across cultures. Cultural competency involves appreciating cultural differences that affect
communication. It also involves the ability to adjust one's communication style to ensure that efforts
to send and receive messages across cultural boundaries are successful. In other words, it requires a
combination of attitude, knowledge, and skills. The good news is that you're already an expert in the
culture in which you grew up. You understand how your society works, how people are expected to
communicate, the meanings of common gestures and facial expressions, and so on. The bad news is
that because you're such an expert in your own culture, your communication is largely automatic;
that is, you rarely stop to think about the communication rules you're following. An important step
toward successful intercultural communication is becoming more aware of these rules and of the
way they influence your communication.

Key components of cultural competence include:

1. Awareness: Developing self-awareness of one's own cultural beliefs,biases, and assumptions.

This involves recognizing the influence of one's own culture on perceptions and behaviors.

2. Knowledge: Acquiring knowledge about different cultural practices, values, customs, and
worldviews. This includes understanding the historical, social, and economic factors that shape
different cultures.

3. Attitudes: Cultivating positive attitudes such as openness, curiosity, and respect towards
cultural differences. This involves challenging stereotypes, avoiding judgment, and embracing
diversity.

4. Communication: Developing effective communication skills to bridge cultural gaps and

foster understanding. This includes active listening, using appropriate verbal and nonverbal cues,
and adapting communication styles to different cultural contexts.

5. Collaboration: Working collaboratively with individuals from diverse backgrounds. This

involves recognizing and valuing the contributions of different perspectives, engaging in inclusive
decision-making processes, and promoting equitable outcomes.

6. Adaptability: Being flexible and adaptable in cross-cultural interactions. This includes

adjusting behaviors, practices, and policies to accommodate diverse cultural needs and preferences.

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Why is Cultural Competence Important?
1. Improved Relationships: Cultural competence fosters positive relationships by
promoting understanding, empathy, and trust between individuals from different cultural
backgrounds. It reduces misunderstandings and conflicts, enhancing communication and
collaboration.

2. Effective Communication: Culturally competent individuals are better able to

communicate and convey their thoughts and ideas across cultures. They can navigate language
barriers, adapt their communication styles, and avoid misinterpretations.

3. Inclusive Environments: Cultural competence creates inclusive environments where

individuals feel valued, respected, and included regardless of their cultural backgrounds. This leads
to enhanced productivity, creativity, and innovation.

4. Enhanced Service Delivery: In fields such as healthcare, education, and social services,
cultural competence ensures that services are tailored to meet the unique needs and preferences of
diverse populations. It improves the quality of care, educational outcomes, and overall service
delivery.

5. Global Citizenship: In an increasingly interconnected world, cultural competence is crucial

for global citizenship. It promotes understanding and appreciation of different cultures, contributes
to peacebuilding efforts, and facilitates cooperation across borders. Overall, cultural competence is
an ongoing process that requires continuous learning, self-reflection, and active engagement with
diverse cultures. It helps individuals and organizations foster inclusive and equitable environments
while promoting positive cross-cultural interactions

Health and Human Rights

Health and human rights are interconnected concepts that recognize the fundamental rights of
every individual to enjoy the highest attainable standard of physical and mental health. The
relationship between health and human rights is rooted in the understanding that health is a
fundamental human right, essential for the overall well-being and dignity of every person. The
concept of health as a human right is enshrined in international human rights instruments, such as
the Universal Declaration of Human Rights, the International Covenant on Economic, Social and
Cultural Rights, and the Convention on the Rights of the Child, among others. These documents
emphasize that everyone has the right to the enjoyment of the highest attainable standard of
physical and mental health, without discrimination.

Health and human rights intersect in various ways:

Right to Health:
The right to health is a fundamental human right that is recognized and protected under
international human rights law. It encompasses the right of every individual to enjoy the highest
attainable standard of physical and mental health, which includes access to healthcare, medicines,
sanitation, and other conditions necessary for good health.

Universal Declaration of Human Rights (UDHR):

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 Adopted by the United Nations General Assembly in 1948, the UDHR proclaims that “everyone has
the right to a standard of living adequate for the health and well-being of himself and of his family,
including food, clothing, housing, and medical care.” This declaration set the foundation for
recognizing health as a human right.

International Covenant on Economic, Social and Cultural Rights

(ICESCR):
ICESCR, adopted by the United Nations in 1966, further elaborates on the right to health. It
recognizes the right of everyone to enjoy the highest attainable standard of physical and mental
health and obligates states to take steps to prevent, treat, and control diseases, provide healthcare
services, and create conditions that ensure medical service and attention in the event of sickness.

Access to Healthcare:
Human rights frameworks emphasize the importance of equal access to healthcare services without
discrimination. This includes access to essential healthcare services, medicines, and vaccines, as well
as affordable and quality healthcare facilities.

Non-discrimination:
Health and human rights require that healthcare services be provided without discrimination based
on factors such as race, gender, ethnicity, religion, nationality, or social status. Discrimination in
healthcare can lead to disparities in health outcomes and violate human rights.

Right to Information:
Individuals have the right to access accurate and timely information about health-related issues,
including disease prevention, treatment options, and risks. The right to information enables
individuals to make informed decisions about their health and well-being.

Participation and Empowerments:

Human rights frameworks emphasize the importance of involving individuals and communities in
decisions that affect their health. Participation and empowerment enable individuals to advocate for
their rights, shape health policies, and hold governments and other stakeholders accountable.

Right to a Healthy Environment:

Health and human rights recognize the link between environmental conditions and health
outcomes. Everyone has the right to live in an environment that is conducive to good health,
including access to clean air, water, sanitation, and a safe living environment.

Right to Health in Emergencies and Conflict Situations:

Human rights frameworks underscore the need to protect and prioritize health in times of
emergencies, disasters, and armed conflicts. This includes ensuring access to healthcare, protecting
healthcare workers, and upholding the right to health for vulnerable populations, such as refugees
and internally displaced persons.

Promoting health and human rights requires collaboration among governments, international
organizations, civil society, and other stakeholders. It involves addressing social determinants of
health, advocating for policy changes, and ensuring accountability for human rights violations in the

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health sector. Overall, the recognition of health as a human right reinforces the importance of a
comprehensive and inclusive approach to healthcare that respects and protects the dignity and
rights of all individuals.

Public Health Financing and Advocacy

Public health financing refers to the allocation and management of financial resources to support
various aspects of public health, including disease prevention, health promotion, healthcare
delivery, and emergency preparedness. It involves the collection of funds, their distribution, and the
implementation of policies and programs to achieve public health goals. Here are the key elements
and components of public health financing:

1. Funding Sources:
Public health financing relies on diverse sources of funding, which can vary across countries and
jurisdictions. Common funding sources include government budgets, taxes (such as dedicated health
taxes or sin taxes), social insurance contributions, external aid and grants, donations, and public-
private partnerships.

2. Government Budgets:
Governments allocate funds for public health through their budgets. This involves determining the
amount of resources dedicated to public health and deciding on the allocation across different
programs and activities. Public health budgets can encompass national, regional, and local levels of
government.

3. Health Insurance:
In countries with health insurance systems, a portion of the funding for public health may come
from health insurance premiums or contributions. These funds are typically pooled and used to
cover a range of healthcare services, including public health programs and interventions.

4. Grants and Aid:

Many countries receive financial assistance for public health from international organizations, donor
agencies, and philanthropic foundations. These grants and aid can support specific initiatives,
research projects, capacity building, or infrastructure development.

5. Cost-Sharing:
Some public health services may involve cost-sharing mechanisms, where individuals or
communities contribute a portion of the costs. This can be through co-payments, deductibles, or
user fees. The aim of cost-sharing is to ensure financial sustainability and appropriate utilization of
resources.

6. Health System Financing:

Public health financing is closely linked to the broader health system financing. It involves the
coordination and integration of funds across different levels of care, including primary, secondary,
and tertiary healthcare services, to address both individual and population health needs.

7. Resource Allocation:

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Once funds are collected, they need to be allocated to various public health programs, initiatives,
and interventions. This process involves prioritizing health needs, assessing the costeffectiveness of
interventions, and considering equity and efficiency in resource distribution.

8. Program Implementation:
Public health financing also involves the implementation of programs and activities using allocated
resources. This includes establishing public health infrastructure, hiring and training personnel,
procuring necessary supplies and equipment, and delivering interventions to the target population.

9. Monitoring and Evaluation:

To ensure accountability and efficiency, public health financing requires robust monitoring and
evaluation mechanisms. This involves tracking the utilization of funds, assessing the impact and
outcomes of interventions, and making necessary adjustments to improve the effectiveness of
resource allocation.

10. Policy and Advocacy:

Public health financing is shaped by policy decisions and advocacy efforts. Governments, public
health agencies, civil society organizations, and other stakeholders play a crucial role in advocating
for adequate funding, influencing policy decisions, and promoting sustainable financing models for
public health.

Overall, public health financing is a complex and multifaceted process that involves the mobilization,
allocation, and management of financial resources to support public health programs, services, and
interventions. It requires collaboration and coordination among various stakeholders to ensure the
effective and equitable use of funds to improve population health outcomes

Health Advocacy
Health advocacy involves promoting and supporting initiatives, policies, and actions aimed at
improving public health and healthcare services. It encompasses raising awareness about health
issues, influencing policies to address health disparities, and empowering individuals to make
informed decisions about their health. Health advocates work to ensure equitable access to
healthcare, champion preventive measures, and challenge societal norms that hinder health and
well-being through education, lobbying, community organizing, and collaboration with stakeholders,
health advocacy strives to create healthier environments and foster positive health outcomes for all.

The main features of health advocacy include:

1. Public Awareness: Health advocates aim to raise awareness about health issues, including their
causes, effects, and potential solutions. This involves disseminating information through various
channels to educate individuals and communities.

2. Policy Influence: Health advocates work to influence policies at local, national, and international
levels to address health disparities, improve access to healthcare, and promote public health
initiatives. This may involve lobbying policymakers, participating in advocacy campaigns, and
engaging in legislative processes.

3. Community Empowerment: Health advocacy empowers individuals and communities to take

control of their health by providing them with the knowledge, resources, and support needed to
make informed decisions and advocate for their rights.

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4. Addressing Health Disparities: Health advocates focus on addressing health disparities by
advocating for equitable access to healthcare services, addressing social determinants of health, and
advocating for policies that reduce barriers to healthcare for marginalized populations.

5. Collaboration: Effective health advocacy often involves collaboration among diverse stakeholders,
including government agencies, healthcare providers, community organizations, and advocacy
groups. By working together, advocates can leverage their collective expertise and resources to
achieve common goals.

6. Evidence-Based Approach: Health advocacy is informed by scientific evidence and research to

ensure that interventions and policies are based on sound evidence of effectiveness and feasibility.

7. Long-Term Impact: Health advocacy aims to achieve sustainable, long-term improvements in

public health by addressing root causes of health issues, promoting preventive measures, and
advocating for systemic changes that create healthier environments and communities.

Health Equity
Definition
Health equity refers to the absence of avoidable and unfair differences in health outcomes and
access to healthcare services among different populations. It is based on the principle that everyone
should have a fair and just opportunity to achieve their highest level of health. Health equity
recognizes that some groups, such as racial and ethnic minorities, lowincome individuals, and
marginalized communities, experience greater barriers to good health due to social and systemic
factors.

Principles of Health Care

The following principles underpin the concept of health equity:

Fairness:
Health equity strives to ensure that everyone has a fair chance to attain optimal health. It focuses
on reducing disparities and providing equal opportunities for individuals to reach their full health
potential.

Social Justice:
Health equity is rooted in social justice principles, aiming to eliminate unjust and avoidable health
disparities. It emphasizes the importance of addressing the structural and systemic factors that
contribute to inequities.

Determinants of Health:
Health equity recognizes that health outcomes are influenced by a range of social determinants,
including socioeconomic status, education, employment, housing, environment, and access to
healthcare. Addressing these determinants is crucial to achieving health equity.

Intersectionality:
Health equity acknowledges that individuals may experience multiple forms of disadvantage or
discrimination based on intersecting social identities such as race, gender, age, and disability. It

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emphasizes the need to consider and address these intersecting factors to achieve equitable health
outcomes.

Social Determinants of Health

Social determinants of health are the social, economic, and environmental conditions in which
people live, work, and age. They significantly impact health outcomes and contribute to health
disparities. Some key social determinants include:

A- Socioeconomic Status:
Income, education, occupation, and wealth are strong predictors of health. Individuals with lower
socioeconomic status often face greater barriers to healthcare, have limited access to healthy living
conditions, and are at higher risk of chronic diseases.

B- Race and Ethnicity:

Racial and ethnic minorities often experience disparities in health outcomes, including higher rates
of chronic diseases, infant mortality, and lower life expectancy. These disparities result from a
combination of social, economic, and systemic factors, such as discrimination, limited access to
healthcare, and socioeconomic disadvantages.

C- Access to Healthcare:
Unequal access to healthcare services, including primary care, preventive care, and specialty care,
contributes to health disparities. Factors such as insurance coverage, geographic location,
transportation, and language barriers can hinder individuals' ability to obtain necessary care.

D- Physical Environment:
The quality of the physical environment, including air and water quality, exposure to toxins, access
to green spaces, and availability of healthy food options, affects health outcomes. Disadvantaged
communities often face environmental hazards and limited access to nutritious food, leading to
increased health risks.

E- Social Support and Networks:

Strong social support networks, community cohesion, and social connections have a positive impact
on health outcomes. Conversely, social isolation and lack of social support can contribute to poor
health. Addressing social determinants of health is essential for achieving health equity. It involves
implementing policies and interventions that aim to improve living conditions, provide equal
opportunities, and create supportive environments for all individuals.

Strategies for Promoting Health Equity

To promote health equity, various strategies and interventions can be implemented at different
levels, including:

A- Policy Interventions:
Implementing policies that address social determinants of health, such as affordable housing
initiatives, minimum wage laws, and educational reforms. Policies that ensure equal access to

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healthcare, support healthcare workforce diversity, and reduce discrimination also contribute to
health equity.

B- Health System Interventions:

Ensuring equal access to healthcare services through measures like expanding health insurance
coverage, increasing the number of healthcare providers in underserved areas, improving language
and cultural competency in healthcare settings, and implementing strategies to reduce healthcare
disparities.

C- Community Engagement:
Engaging communities and involving them in decision-making processes related to health policies
and programs. This includes empowering community members to identify their own health needs,
mobilizing resources, and implementing community-driven interventions that address specific health
disparities.

D- Health Education and Promotion:

Providing health education and promotion programs that are culturally sensitive and tailored to the
specific needs of diverse populations. This involves disseminating accurate health information,
promoting healthy behaviors, and addressing the social and cultural factors that influence health.

E- Data Collection and Research:

Collecting data on health disparities and monitoring health outcomes across different populations.
Research is essential for identifying the causes and determinants of health disparities, evaluating the
effectiveness of interventions, and informing evidence-based policies and practices.

F- Collaboration and Partnerships:

Collaboration among various stakeholders, including healthcare providers, policymakers, community
organizations, and advocacy groups, is vital for advancing health equity. Partnerships can leverage
resources, share knowledge and expertise, and coordinate efforts to address health disparities
comprehensively.

G- Advocacy and Social Movements:

Advocacy efforts can raise awareness about health disparities, promote policy changes, and foster
social movements aimed at addressing inequities. Grassroots organizations, civil rights groups, and
other advocacy entities play a crucial role in driving systemic change.

H- Workforce Diversity and Cultural Competency:

Promoting diversity in the healthcare workforce and ensuring cultural competency among
healthcare providers can enhance the delivery of equitable care. Recruiting and training a diverse
workforce, providing cultural sensitivity training, and supporting the career advancement of
underrepresented groups contribute to addressing health disparities.

• It's important to note that achieving health equity is a complex and ongoing process. It requires
sustained commitment, collaboration, and a multifaceted approach that addresses the underlying
social and systemic factors contributing to health disparities. By striving for health equity, societies

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can work towards creating a fair and just healthcare system where everyone has an equal
opportunity to lead a healthy life.

Communication
Communication is what represents us as people. It is our way to express ourselves, to exchange
information, also having a symbolic capacity. It is recognized that the communication is instrumental
(helps acquiring knowledge), but it also has a ritualistic function, in that it reflects people as
members of a social community. The efforts of interventions to change behaviours are also actions
of communication .Focusing more on the function of transmitting information exchange, the
symbolic, ritualistic function of communication is neglected. Therefore, in transmitting information –
which is the primary role of communication, it is important to consider the channels through which
messages are disseminated, to whom the message is addressed, how the public responds to the
message and what are the characteristics that have the greatest impact on the public. All these
highlight the components of the communication process: channel, source, receiver, message.
Regarding the ritualistic component, the target audience is conceptualized as members of a social
network, which interact with each other, participate in social activities and derive meaning from the
normal behaviours.

As a separate part of the process of communication, public health communication has become in
the recent decades, a concept and it is one of the basic components of public health. The
importance given to this concept is illustrated by the inclusion for the first time of a chapter on
communication in public health in the objectives of the Healthy People 2010 report. This represents
the scientific development, strategic dissemination and the critical evaluation of relevant, accurate
and accessible public health information.

The strategic, timely and effective communication plays the essential part to protect human health,
to prevent and control the occurrence of diseases, to improve the quality of life and to promote
health. Communication in public health derives from a range of disciplines, such as marketing,
journalism, public relations, psychology, computer science, epidemiology, health education, mass
communication, being already well known that the media influences people’s behaviour, either
directly or indirectly, on medium or long term. Communication in public health includes the study
and the use of communication strategies to inform and influence decisions at the individual or
community level in terms of improved health.

Communication in health contributes to all aspects of disease prevention and health promotion,
with special relevance in many contexts, such as the professional relation between physicians and
patients; the search for health information; patients’ compliance to the clinical recommendations;
developing messages and campaigns of public health; dissemination of information about health
risks, in other words, risk communication; educating consumers on how to access health services
system; development of IT applications in healthcare etc.

The best way to transmit health information is through health communication campaigns. Health
communication campaigns are taking into consideration changing or improving environmental or
economic conditions with impact on the health status, individual risk factors and risk behaviours,
therefore they must be well thought out so that the target audience be convinced that the changes
that they should do would be in their own interest. In general, the main goals of public health
communication campaigns are: raising awareness and improving public knowledge about some
aspects of public health; influencing perceptions, attitudes, beliefs, unhealthy behaviours; knowing
the benefits of changing the unhealthy habits; increased demand for health services; fighting certain

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myths or misconceptions; taking action to support the adoption of healthy behaviours; overcoming
barriers in terms of access to health services. Health communication campaigns can produce
changes at individual, organizational and community level or at society level.

The individual, interpersonal level is the fundamental level of public health communication because
the individual communication determines the health status. Thus, communication influences the
individual awareness, knowledge, attitudes, self-efficacy, personal skills and the commitment to
change behaviour. The actions directed to other people with a view to change behaviour can
influence change at individual level, by involving the patients to take care of their own health.

At group level, informal groups, communication can have a significant impact on improving health
through the relations that are formed within groups (workplace, school, hospital etc.). A healthy
behaviour adopted by some, will be taken as an example to others much easier.

Organizations, that represent larger groups in number, with well-defined structure and functions,
can transmit information about health to their members, can offer support to the implementation of
health campaigns or can even produce legislative changes.

Communities through their opinion leaders and decision makers represent true allies in influencing
and determining the changes in policies, products, services. By influencing communities, health
communication campaigns can promote awareness raising on a particular aspect of health, changes
in attitudes and beliefs, support for the adoption of healthy behaviours (e.g., at community level,
there can be established bicycle lanes that promote physical exercise). The last and perhaps the
most important level that can produce the change, is the society that can change the behaviour of
individuals by influencing norms, values, opinions, laws and policies. By changing attitudes and
behaviours at individual level, health communication campaigns at society level actually change the
social norms.

Communication campaigns are based on a number of principles: to be goal-oriented, namely to

inform, persuade, influence or motivate behavior change; are aimed at individuals, organizations,
societies; are directed to a relatively large audience; they do not bring commercial benefits to
individuals or to the society; are conducted over a period of time ranging from a few weeks to years;
are most effective, as it turned out, if the media are involved.

In order to conduct a successful and effective campaign, the following conditions must be met: the
production of high quality messages, choosing the best sources and transmission channels through
needs assessment, after conducting the necessary research; spreading the message to the target
audience frequently, consistently and in a sustained manner; drawing the attention of potential
receivers; encouraging interpersonal communication regarding the campaign theme; changes in
awareness, current knowledge, behaviour; producing changes at community and society level;
conducting evaluations to acquire systematic knowledge about the impact produced.

Health communication campaigns use a range of channels in order to transmit the message: media
through television and radio stations (thematic programmes, news, advertising, information
materials etc.); briefing sessions, individual or group counselling; thematic activities organized at
community level; school activities; marketing strategies; developing partnerships (local authorities,
non-profit associations that support the development of communication campaigns). A health
communication campaign alone cannot cause complex changes of behaviour without the extensive
programmes to support health promotion, including health services, the entire health system, health
technologies, as well as changes in legislation and policy. Also, a health communication campaign
may not be as effective in addressing all aspects regarding the transmitted messages, as the subject

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or the behaviour that is intended to be changed can be extremely complex or controversial, and the
target audience may be prejudiced or be distrustful to embrace change.

For a health communication campaign to produce the expected results (e.g. changing unhealthy
behaviours: reducing the consumption of sweets among children), it is crucial that it should be
based on rigorous planning, which if it is observed carefully, it can avoid crises and barriers in
implementation, as well as any possible additional costs. The main steps in designing a health
communication campaigns are: health problem analysis, data review and the identification of
possible solutions; establishing the purpose and the objectives of the campaign; determining the
target population; creating the messages to be transmitted as well as the different communication
channels; pre-testing, analyzing and reviewing the messages; campaign implementation and impact
assessment of the communication campaign. These steps are part of a cyclical, continuous process
of planning and quality adjustment, in which the last stage complements the first one

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