Introduction to Public Health

Tigabu Kidie (BSc, MPH)

Department of Epidemiology and
Biostatistics
Institute of Public Health
University of Gondar
February, 2024
Course description
 This course is designed to give an introductory concept of
public health.

Lay and professional concept of health

The approaches in public health and clinical medicine

Relationship between health and development

Health systems, Primary health care and health for all

Definition of public health of disciplines

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 Learning objectives
At the end of this course, students will be able to;

Define health and public health, and identify the determinants of health

Explain the relationship between health and development

Describe the health system in Ethiopia

Explain Primary Health Care including components and principles

Explain major areas (courses) of public health

Describe the health status indicators and ways of identifying community

health problems
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Course contents
Unit 1:- Concept of health

Unit 2:- Public health versus clinical medicine

Unit 3:- Factors affecting health and models of diseases causation

theories

Unit 4:- Health and development

Unit 5:- Health systems

Unit 6:- Primary health care and health for all

Unit 7:- Identifying community health problems and ethical

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issues in public health
 References
Giday G; lecture note series; Introduction to Public health for health
science students; Mekelle University; 2005
Jira Ch, Feleke A &Mitike G; Lecture notes; Health Planning and
management for health Science students; Carter center; January
2004.
Short book of public health
Marcia; Public health nursing, 7th edition; Canada; 2008.
Sue; Nursing practice and health care a foundation text; 3rd edition;
Oxford University; 1998.
Ashok; Hand book of health education and community Pharmacy;
Delhi.
SR. Vashist; Text book of Health education and community
Pharmacy; Delhi; 2003.
N.K. Jain: Health education and community Pharmacy; Delhi; 1996.
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Lily; Environmental health and sanitation; 2 edition; 1993
nd
Unit-1 : Concept of Health

 By the end of this chapter you are expected to;

Define health

Describe the different concepts and perspectives

of Health.

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Concept of Health…

 What is health for you?

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 Concept of Health
 Health is an elusive term because the state of being
healthy can be viewed from a multitude of perspectives.
 There are various definitions of "Health", including:

1. From a lay point of view:-

• It is just to say that a person is normally doing his
activities and
• Does not outwardly show any signs of any disease
in him
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 Health…
2. In Oxford dictionary health means:-
• The state of being free from:-
• Sickness,
• Injury or disease,
• Bodily conditions;
• Or it is something indicating good bodily
conditions

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 Health…
3. Mahler includes
• The ability to lead socially acceptable and
• Economically productive life

4. WHO (1948) defined:-

• “A state of complete physical, mental, and social well
being and not the mere absence of disease or infirmity”

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Dimensions of Health
Health is multi-dimensional. It has the following dimensions;

1. Physical health: is concerned with anatomical integrity

and physiological functioning of the body.

• It means the ability to perform routine tasks without any physical

restriction

• All the body parts should be there

• All of them are in their natural place and position

• None of them has any pathology(deformity)

• All of them are doing their physiological functions properly 11

 Dimensions of health …
2. Mental health
 it is a state of wellbeing in which the individual;
• Realize his/her ability
• Can cope with normal stresses of life
• Can work productively and fruitfully
• Able to make contribution to his/her community
Mentally healthy adult shows behavior which confirms an awareness
of:-
• Self or personal identity,
• Coupled with a life purpose,
• A sense of personal autonomy and
• willingness to perceive reality and cope with its difficulties 12
Mentally healthy people are;
• Active, productive, persists with tasks until completed,
• Response flexibly in the face of stress,
• Receive pleasure from different sources,
• Accept once limitations realistically,
• Have a capacity
• To live with other people
• To understand their needs, and
• To achieve mutually satisfying heterosexual
relationship

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Dimensions of health …
3. Social wellbeing:

• is the ability to make and maintain acceptable interaction

with other people and environment.

• The ability to maintain one’s identity while:

• Sharing, cooperating, communicating, and
Enjoying others
• Participation in friendships, family& community life

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Dimensions of health …

4. Emotional health: is the ability of expressing emotions

in the appropriate way, for example to fear, to be happy, and
to be angry.

• The response of the body should be congruent with that of

the stimuli.

• It is related to mental health and includes feelings.

• It also means maintaining one’s own integrity in the

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 Dimensions of Health…
5. Spiritual Health : Some people relate health with religion;
for others it has to do with personal values, beliefs, principles
and ways of achieving mental satisfaction, in which all are
related to their spiritual wellbeing.

6. Intellectual Health: is the ability to learn and use

information effectively for personal, family, and career
development

Striving for continued growth and learning to deal with new

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challenges effectively
Smith’s model of health and illness
(Home work)

Clinical model

Role performance model

Adaptive model

Eudaimonistic model

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 Home Take assignment
What is the difference between illness, sickness
and disease ?

Define impairment, disability and handicap ?

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Unit-2: Public Health Vs clinical medicine

At the end of this chapter, the students are expected to:

Discuss the history of public health

Define public health and list its core activities.

Recognize the principal disciplines of public health

Describe the difference and similarities between clinical

medicine and public health.

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 Public Health Vs clinical medicine
Focus:
o The focus of public health is the population in general
while clinical medicine is the individual
Approach:
o The basic approach public health is prevention while the
approach of clinical medicine is cure
Target:
o The target of public health is healthy people but in
clinical medicine the target is patients

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 Public Health Vs clinical medicine
1) Health problem identification

Clinical medicine: History taking and physical

examination

Public health: through community diagnosis

2) Hypothesis generation

Clinical medicine: By developing differential diagnosis

Public health : through descriptive studies

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3) Testing hypothesis

Clinical medicine: Investigation to test the hypothesis

( laboratory, radiology, etc)

Public health : By analytical studies (case-control, cohort,

experimental studies)

4) Intervention action

Clinical medicine: prescribing medicine, surgery, etc

Public health : community intervention to prevent the disease

(health promotion, environmental measures, vaccination,
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screening program)
Public Health
Public health is defined as the science and art of preventing diseases,
prolonging life, promoting health through;

• organized efforts and informed choices of society, organizations, public and

private, communities and individuals.

It is concerned with the health of the whole population and the prevention of
disease from which it suffers.

It is the combination of sciences, skills and beliefs that is directed to the
maintenance and improvement of the health of all the people through
collective social actions.

Clinical medicine is concerned with diagnosing and treating diseases in

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individual patients.
Public Health…
The mission of public health is to “ fulfill society ’ s interest and
assuring conditions in which people can be healthy ”

• Public health is very much concerned with the needs of the public.

• Public health does not necessarily provide medical care to

individuals but rather assures conditions that support health.

• For example: smoking bans in restaurants and food - labeling

requirements are public health efforts to prevent harmful
exposures and to provide information to the public in order to
promote healthful choices.
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 Hallmarks of Public Health

• Although the issues facing public health may vary over

time, the underlying principles of public health remain

constant.

• There are three hallmarks of public health that define the

field and also provide a contrast to the related field of

medicine.
Hallmarks of Public Health…

• Public health and medicine often have the similar goals of

reducing the impact of disease and improving health and
quality of life, but there are some notable differences
between the two in the methods of reaching these goals.

• The hallmarks of public health are a philosophy of social

justice , a focus on populations, and a focus on
prevention

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Philosophy of Social Justice

• The term social justice has been used by various groups in

different contexts.

• In public health, the concept of social justice connotes the idea

that all individuals in a population should have access to the same

programs and services, regardless of social condition or standing.

• Public health seeks to provide a basic level of health provisions,

such as clean food and water, safe neighborhoods, and access to

health care services, to all members of a community or population.

 Philosophy of Social Justice

• In this vein, public health works to ensure there are no

health disparities.

• The goals of public health are

o The elimination of health disparities

o Increasing the quality and years of healthy life

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 Focus on Populations

• In public health, the focus is on groups of people or

populations rather than on individuals.

• Public health endeavors to implement programs that

benefit a group of people:
o Water fluoridation,

o Folic acid fortification of grain products,

o The development of safe walking trails throughout a city, etc.

 Focus on Prevention

• Indeed, public health focuses on preventing poor health outcomes

or exposures that lead to these outcomes, and this focus is a
hallmark of the field.

• Public health seeks to identify risk factors for disease and then
works to learn methods for eliminating or limiting these risk
factors to prevent populations from becoming ill or experiencing
poor health.

• In addition, public health typically aims to maintain health rather

than to address decrements in health after they have occurred.
Core functions of public health
The three core functions of public health are,
• Assessment,
• Policy development, and
• Assurance.

Form the foundation of all public health activity, both at the national
and local level.

It is through these functions that we identify and describe problems

within the system, design programs and create new laws to address
the issues, and ensure that the programs are implemented as intended.
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1. Assessment
Assessment entails gathering information about a health
problem in order to create a clear picture of the situation.

Once a public health issue has been fully assessed, the

public health community can use the information for
decision.

 If so, officials need to generate a plan to solve the

problem, and the process continues into the second core
function: policy development.
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2. Policy development
Policy development is the process of formulating the best
strategy to approach a public health problem and implementing
the new program or law.

This process is usually carried out by the local, state, or federal

government.

After new programs and policies are created and implemented, it

is essential to make sure that they are executed effectively.

This leads us to the third core function of public health:

assurance. 33
3. Assurance
• Through the first two core functions, a public health issue is first
clearly described and a program is designed and implemented to
address it.

• The final step is to assure that public resources are being used
responsibly to carry out the plan and that the success of public
health programs are monitored so they can be changed or
discontinued as deemed appropriate.

• This step is called assurance, and it is an ongoing function that

loops back into the process of assessment and policy development.
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Public health Core functions and Ten essential services

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36
Unique Features of Public Health
1. Basis in Social Justice Philosophy: This is the central
pillar of public health

2. Inherently political in nature

3. Dynamic and ever Expanding agenda

4. Link with government

5. Grounded in science

6. Use of prevention as a prime strategy

7. Uncommon culture and bond

 Social Justice Philosophy
• Justice indicates that there is fairness in the distribution of
benefits and burdens;

• How each member of a society is allocated his or her fair

share of collective burdens and benefits

• Factors that impede the fair distribution of benefits and

burdens: social class, racism, disability, etc..

• Collective action is necessary to neutralize or overcome those

impediments .

• Public health works to overcome those impediments.

Inherently Political Nature

• Public Health is both public and political in nature.

• The social justice component of public health stimulates

political conflict

• Governmental public health agencies seeking to serve

the interest of both government and public health are
frequently caught in the middle.
Expanding Agenda
• Prior to 1900, the primary problems addressed by public health were
infectious diseases and related environmental risks.

• After 1900, the focus expanded to include problems and needs of

children and mothers

• Middle of the century: chronic disease prevention and medical care

fell into public health

• Later, substance abuse, violence, injuries

• Recently: Bioterrorism, other disaster preparedness are also added to

the public health agenda
Link with Government
Public health is linked with government in two ways:

1. Issuing policies that govern the health of the

population

2. Directly provide programs and services that are

designed to meet the health needs of the population

Grounded in Science
• Often five basic sciences of public health are identified:
• Epidemiology,
• Biostatistics,
• Environmental Science,
• Management Sciences and
• Behavioral Sciences.
• Occupational Health,
• Nutrition, and
• Maternal and Child Health
• Epidemiology and Biostatistics are essential tools of
public health.
Focus on Prevention
• Prevention is the purpose of public health and is aimed
at preventing disease.
• However we are also preventing
• Deaths,
• Hospital admissions,
• Days lost from school and work
• Consumption of human and fiscal resources.
Uncommon Culture
• Public health is unique in that many different sciences, art
and methods can contribute towards the same outcome.

• Vast majority of public health workers are not formally

trained in public health.

• As a result public health professionals include

professionals from different disciplines, like
anthropologist, sociologist, psychologist, physicians,
nurses , nutritionist, lawyers , mangers …
 The 5 P’s of Public Health

• Prevention (individual and community-focused)

• Promotion (voluntary, education, advocacy)

• Protection (policies/regulations; enforcement)

• Population-based (communities, groups)

• Preparedness (e.g., bioterrorism, natural disasters,

pandemics)
 Disciplines of public health
 Nutrition: is the science of food, the nutrients and other
substances there in, their action, interaction and balance in
relation to health and disease.

 Reproductive health: is a state of complete physical, mental and

social being not only absence of disease or infirmity, in all matters
relating to reproductive system and to its functions and process.

 Environmental Health: the basic approach to environmental

control is first to identify specific biologic, chemical, social and
physical factors that represent hazards to health or well-being.46
Disciplines of public health…
Health Education: is defined as a combination of learning
experiences designed to facilitate voluntary actions
conducive to health. It is an essential part of health
promotion.
Epidemiology: is the study of frequency, distribution, and
determinants of diseases and other related states or events
in specified populations. The application of this study to the
promotion of health and to the prevention and control of
health problems is evident.
Health Economics is concerned with the alternative uses
of resources in the health services sector and with the
efficient utilization of economic resources such as
manpower, material and financial resources.
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Disciplines of public health…
Biostatistics is the application of statistics to biological
problems; application of statistics especially to medical
problems, but its real meaning is broader.
Health Service Management is getting people to work
harmoniously together and to make efficient use of
resources in order to achieve objectives.
Ecology: is the study of relationship among living
organisms and their environment.
Research: It is a systematic investigation towards
increasing knowledge. It aims at the discovery and
interpretation of facts, revision of accepted theories, or
laws in the light of new facts or practical application osuch
new theories or laws.
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Unit-3: Determinants of Health and models of
disease causation
 Factors affecting health / determinants of health

 Theories of diseases causation theories

• 19th century theories

• 20th century theories

Models of disease causation

• Epidemiologic triad
• Wheel
• Web
• Rothman’s pie

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Determinants of health
The causes of poor health are complex.
Understanding the determinants of health has an important
influence on the strategies to maintain and improve the
health
The determinants of health can be broadly classified as:
I. Individual (personality, behavior, biological, genetic,
lifestyle, educational) factors
II. Environmental (physical, social, interpersonal) factors
III. Socio-economic factors
IV. Service related factors

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Theories of disease causation
Each effort to prevent disease in the 19th century was based on
one or the other three theories of disease causality.
Nineteen century theories include;
1. Contagion theory
2. Supernatural theory
3. Personal behavior theory
4. Miasma theory
Twenty century theories
1. The Germ Theory
2. The Life Style Theory
3. Environmental theory
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1. Contagion theory

This theory was common at the beginning of the 19 th century.

Most official disease prevention activities were based on the

hypothesis that illness is contagious.

It required:
• Keeping sick people away from well people.
• The institution of quarantine of ships
• Setting up military cordons around infected towns
• Isolation of households if they were infected, and
• Fumigating or washing the bedding and clothing of the sick.
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2. Supernatural theory
In the early past disease was thought mainly due to either
the curse of GOD or due to evil force of the demons.
At least 10% of the people in developed countries and 30%
in developing countries still believe in supernatural origin
Even today superstitions are becoming major obstacles in
disease control
Most of the literates view that disease is the result of
microbes
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3. Personal behavior theory

This theory held that disease results from wrong personal

behavior.

In this formulation the source of the disease was not tied
up with the mysterious ways of God,

Instead people caused their own disease by living fully

unhealthy.

Hence, improper diet, lack of exercise, poor hygiene and

emotional tension become the focus of preventive actions.
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4. Miasma theory

• This theory argues that disease is caused by the odor of

decaying of organic materials.

• It dates back to the Hippocratic idea that disease is related

to climate.

• It contrasted sharply from the other three theories since it

conceptually separated the source of the disease from the
victim of the disease.

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 1. The Germ Theory (20th C theories)

This theory rapidly over took other explanations of disease causations.

It held the notion that microorganisms cause diseases and it is possible
to control diseases using antibiotics and vaccines.
Sometimes called “pure determinism”
• Each disease will be caused by a germ

• Without that germ that disease will not be caused

• By introducing that germ , that disease can be caused in animals

experimentally,
• And that germ can again be isolated from that sick animal experimented
with. 56
2. The Life Style Theory

• This holds that unhealthy lifestyles are causes for diseases.

• This hypothesis blames stress, lack of exercise, the use of

alcohol and tobacco improper nutrition for most chronic
diseases.

• This theory rejects the notion central to the classic germ

theory, that a single disease has a single etiology.

• Instead they emphasize the interrelatedness of many

variables in disease causality, principally those under57 the
3. The Environmental Theory

• Environmental theory explains that significant number of

chronic disease are caused by toxins in the environment
and

• It implies that disease prevention, instead of requiring

medical treatments or personal hygiene, demands change
in the industrial production.

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Models of disease causation
 There are several models of disease causation that help to
understand disease process.
 The most widely applied models are:
• The epidemiological triad (triangle)
• The wheel
• The web
• The sufficient cause and component causes models
(Rothman’s component causes model)
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Models of disease causation…
1. The epidemiologic triangle
It is he most familiar disease model,
depicts a relationship among three key factors in the
occurrence of disease or injury:
– agent,
– environment, and
– host.

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Models of disease causation…
2. The web of causation model
• Although the epidemiologic triad has contributed to the
understanding of disease etiology, the process that actually
generates disease or leads to injury is much more complex.
• This complexity is better portrayed with the web of causation

• was developed especially to enhance understanding of chronic

disease, such as cardiovascular disease.
• However, it can also be applied to the study of injury and
communicable diseases.
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62
Models of disease causation…
3. The Wheel model
• A model that uses the wheel is another approach to depict human
– environment relations.
• The wheel consists of a hub (the host or human), which has
genetic makeup as its core.
• Surrounding the host is the environment, schematically divided
into biological, social, and physical.
• The relative sizes of the different components of the wheel
depend upon the specific disease problem under consideration.
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64
Models of disease causation…
4. Rothman’s Pie model
The Rothman’s causal Pie model illustrates the factors
that act to cause disease as pieces of a pie, the whole pie
making up the sufficient cause for a disease.

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Unit-4: Health and Development
At the end of this course, the students are expected:

Differentiate development and economic growth.

Describe the relationship between the health and

development

66
Health and Development…
Individuals in good health are better able to study, learn
and be more productive in their work.

Improvements in standard of living have long been

known to contribute to improved public health.

Investment in health is necessary for the protection and

development of human capital.

Health affects labor market participation, productivity

and wages in labor market outcomes. 67
Health and Development…
Good health at individual, community , national level is a prerequisite for

full scale productivity and creativity.

Empirically, high levels of population health go hand in hand with high

levels of national income.

On the other side, Higher incomes promote better health through
• improved nutrition,

• better access to safe water and sanitation, and

• increased ability to purchase more and better ‐quality health care.

However, Good health may be not only a consequence but also a

cause of high income. 68

Discussion
What is economic development?

How does economic development differ from

economic growth?

What role does health play in development?

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Development Vs Growth
Economic development: is the combination of social,
economic and institutional processes, secured the means
for obtaining a better life.
Is the process by which a nation improves the economic,
political and social well-being of its people.
Economic growth may be one aspect of economic
development but is not the same.
Economic growth is :
A measure of the value of output of goods and services
within a time period
Increase in the total values of goods and services
produced.
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Characteristics of development
1. Rising share of industry, along with the failing share of
agriculture in GNP and increasing percentage of people who
live in cities rather than the countryside

2. Passing through periods of accelerating, then decelerating

population growth, during which the age structure of the
country changes dramatically.

3. Changes in consumption patterns as people no longer spend

all their income on necessities but instead move on to consume
durables and eventually to leisure-time products and services.
71
Characteristics of development…
4. Meeting the needs of the present without compromising
the ability of future generations to meets their own needs
(sustainability).

5. Participation (mainly) by the citizens of the country in the

process as well as the benefit.

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73
Unit-5: Health system
A health system is:

the sum of the organizations and resources whose shared

primary purpose is to improve health or to protect health.

Six building blocks constitute the health systems

framework

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 Session objectives
 At the end of this class students will be able to:

Describe the historical development of the health care system

Analyse the previous and current tiers of health care system

Analyse key health system building blocks and their interactions

Discuss the categories of current health care facilities

Describe the current health policies, strategies and reforms in

Ethiopia 75
Health system building blocks

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Health service approach and period

Approach Period

Traditional Medicine Immemorial

Period of introduction 1500 to 1900

The Italian interlude 1936-1941

The hospital/clinic based period 1941-1953

The basic Health service period 1953-1974

PHC period 1974-1991(Derg period)

HSDP 1996-2015(EPRDF)

Visioning Ethiopia’s path towards 2015-2035

UHC through PHC
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Health care system structure
Introduced during the period of socialism

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Four-tier health care delivery system
The four-tier system was introduced during HSDP-Ⅰ (1997-
2001)

Characterized by;

 Primary health care unit (PHCU), comprising one HC and

five satellite HPs

 District hospital,

Regional hospital
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Specialized hospital
Three-tier health care delivery system
• Ethiopia recently introduced a three-tier health care
delivery system.
• Was developed during HSDP-Ⅳ (2010-2015)

Level (Tier ) One - Primary Level

Level (Tier) Two - Secondary Level

Level (Tier) Three - Tertiary Level

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Current Ethiopian Health Tier System

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Level (Tier) One - Primary Level

 The woreda (district) includes:

A primary hospital (with population coverage of

60,000-100,000 ),
Health centers (15-25,000 people for rural, and 40,000
people for urban) , and
their satellite health posts (3-5,000 people) connected
to each other by a referral system.

82
Level (Tier) Two - Secondary Level

A general hospital with population coverage of 1-1.5

million people.

Level (Tier) Three - Tertiary Level

A specialized hospital that covers a population of 3.5- 5

million.

83
Team approach in health
In order to effectively respond to identified needs, health
persons must be able to work within a team framework in
which problem solving is approached in an integrated manner.

A health team must be in a position to effectively

communicate information to communities and individuals and
develop mechanisms, which facilitate their involvement in all
health activities.

A health team must also establish communication links with

other sectors and promote inter-sectoral collaboration. 84
Team approach…
The need for a better-integrated health care team occurs
because of;

Poor communication

Duplication of service

Lack of patient focus

85
Team approach…
• Poor communication: Lack of integrated record keeping
system result in an uneven and incomplete exchange of
information among the professionals who provide health care
services.

• Duplications of services: Lack of coordination and

communication at times leads to duplication of services. For
instance, if service provider does not have access to test results
previously ordered, a request will be made for new test.
86
Team approach…
Lack of patient focus: Patients are seeking continuity
and coordination of care, competence, accessibility and
timeliness, reasonable cost and some sense that someone
in the “system” cares about them.

When health care professionals do not work well together,

patients feel that commitment to them as individuals in
need of care is lost.

87
Health team
The health team may be defined as;

 a group of people who share a common health goal and

common objectives, determined by community needs,

to the achievement of which each member of the team

contributes, in accordance with his/her competence and
skill and in coordination with the functions of others.

88
 Characteristics of health team
The following are key characteristics of a well functioning
health care team
Patient centered focus

Establishment of a common goal

Confidence on other team members

Flexibility in Roles

Mechanisms for conflict Resolution

Development of effective communication

Shared Responsibility for team Action

Evaluation and Feedback 89

Unit-6: Primary Health Care
• PHC is
• An essential care based on practical, scientifically sound and
• Socially acceptable methods and
• Technology made universally accessible to individuals and
families in the community through their full participation and
• At a cost that the community and country can afford to
maintain at every stage of their development in the spirit of
self reliance and self determination

90
Primary Health Care…
It is the first level of contact of individuals,the family and community
with the national health system

Address the main health problems in the community providing :-

promotive, preventive,curative and rehabilitative services accordingly.

Involves, in addition to health sector, all related sectors and aspects of

national and community development.

Requires and promotes maximum community and individual self-reliance

and participation in the planning, organization, operation and control of
primary health care.

Included eight components at Alma Ata declaration. 91

Basic terms in the definition
Essential health care: Group of functions essential for the health
of the people given at lower level of health service. E.g. Medical
care, MCH/FP, school health, environmental health, control of
communicable diseases, health education, referral, etc.

Scientifically sound: Scientifically explainable and acceptable.

Socially acceptable methods and technology: intervention

should consider the local value, culture and belief.

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Basic terms in the definition…
Universally accessible: Because of the inequitable
distribution of the available resources, the services are not
reachable by all who need them.

Only a few can afford or within the reach to use them,

while the majority are excluded from the service.

Therefore, PHC being health care as close as possible to

where people live and work, guarantee universal
accessibility.
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Components of PHC
 Current PHC has 20 elements

1. Health education
• For promoting health
• For prevention of disease
• For maintenance of health
• Education to deal with the disease

2. Promotion of food supply and proper nutrition

• Improve food supply and proper nutrition
• Correction of faulty feeding practices
• Treatment and rehabilitation of malnourished children
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• Treatment and prevention of nutritional diseases
Components of PHC…
3. An adequate supply of safe water and basic sanitation

4. Maternal and child health care, including family planning.

main functions are

• Antenatal care

• Delivery services

• Post natal care

• Child care

• Family planning services

5. Immunization against the major infectious diseases

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Components of PHC…
7. Appropriate treatment of common diseases and injuries; and

8. Provision of essential drug

Components added after Alma Ata (1978) Declaration

9. Mental health

10. Dental health (oral health)

11. Control of ARI

12. Control of HIV/AIDS and other STDS

13. Occupational health 96

Components of PHC…
14. The use of traditional medicine

15. Expanded options of immunization

16. Provision of essential technology for health

17. Reproductive health needs

18. Health promotion as defined Ottawa charter and

endorsed by resolution

19. Prevention and control of non communicable diseases

20. Food safety and provision of selected 97

Principles of PHC
1. Inter-sectoral collaboration

2. community participation

3. Appropriate technology

4. Equity

5. Focused on prevention and promotion of health

6. Decentralization

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Principles of PHC…
1. Inter -sectoral collaboration

The causes of ill health are not limited to factors related to the
health sector,

Economic, social and cultural development cannot proceed

smoothly without concomitant and consequent health development,

Programs should be coordinated and activities should be integrated.

The importance:
• To save resources

• To identify community needs together.

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Principles of PHC…
2. Community participation

Who is producer of individual health?

Individuals and families should develop the capacity to

contribute to their health and the community’s development.

Community should not be passive recipients of services.

Emphasis is on strengthening the capacity of communities

to determine their own needs and take appropriate action.

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Principles of PHC…
Major advantages:

Programs are affordable and acceptable.

Create sense of responsibilities.

Consider real needs and demands.

Promote local community initiatives and technology.

Build the community’s capacity to deal with problems.

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Principles of PHC…
3. Appropriate technology

Criteria for appropriateness:

1. Effective: must work and fulfill its purpose

2. Culturally acceptable and valuable.

3. Affordable, i.e. cost-effective.

4. Locally sustainable.

5.Possessive of an evolutionary capacity: if its introduction and

acceptance can lead to further benefits.
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Example; mobile clinic for pastoralist community
Principles of PHC…
4. Equity

This is to close the gap between “those who have” and “those who have
nots”.

To achieve more equitable distribution of health resources.

5. Focus on prevention and health promotion

The important tasks for the planners are;

to readjust the imbalance in allocation of resources to preventive and

curative care and

enhancing the role of resources available to prevention and promotion.

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Principles of PHC…
6. Decentralization

Bringing decision making closer to the communities

served and to field level providers of services.

Greater potential for multi-sectoral collaboration

Enhance the ability to trap new resources for financing

health care

May lead to greater efficiency in service provision

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Unit-7: Community diagnosis
 Community diagnosis: Generally refers to the identification
and quantification of health problems in a community as a
whole in terms of morbidity and mortality rates and ratios, and
identification of their correlates for the purpose of defining
those at risk and those in need of health care.

 The activity is designed to assist the communities in

developing consensus about the priority health problems in
their individual communities and developing strategies to
address the issue identified.
105
106
 Community diagnosis
 The completion of the community diagnosis process should
answer the following questions for the community:
• Where is the community now?

• Where dose it want to go?

• How will it get their?

The purpose of community diagnosis is to define existing

problem, determine available resources, and set priorities for
planning, implementing and evaluating health action, by and
for the community 107
Sources of data

Published sources and records

Routine reports

Interviews in the community

Focus group discussions

Observation

Vital registration …

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 Health indicators
• Indicator is a statistic that indicates or points to another measure

• Health indicators are summary measures that are designed to

describe particular aspect of health and health system
performance

• Indicators should be valid, reliable, sensitive, specific, feasible,

and relevant.

• Morbidity indicators, mortality indicators, health service

coverage indicators
109
Public health ethics
Ethics: is derived from the Greek word ethos, meaning
custom or character

Study of the principles of human conduct or

human actions

The way we behave and the values that we hold

Is for judging right from wrong and good from bad

Concerned with justice, rights, respect of human dignity,

autonomy of the individual and respect of the community
110
Public health ethics…
Public health ethics seeks to understand and clarify
principles and values that guide public health actions,
offering a framework for decision-making and justifying
decisions.

 Public health actions are directed to populations, the

principles and values of the field can differ from those that
guide actions in biology and clinical medicine which are
more patient or individual centered
111
Public health ethics…
Ethical principles enable us to reach normative judgments

They guide our thinking by providing us with a basis for

determining how we should act when an ethical issue arises

There are four fundamental ethical principles that we consider

while we dealing with human study participants:-

1. The principles of respect for autonomy

2. The principle of beneficence

3. The principle of non maleficence

4. The principle of justice

112
Public health ethics…
1.The principles of respect for autonomy: - we have an
obligation to respect the autonomy of other persons,
which is to respect the decision made by other people
concerning their own lives. This is also the principle of
human dignity.

2.The principle of beneficence: we have an obligation to

bring about good in all our actions.

It is “doing what is best to the patient”.

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Public health ethics…
3. The principle of non-maleficence: we have an
obligation not to harm others: “First, do not harm”.

4. The principle of justice: we have an obligation to

provide others with whatever they are owned or deserve. In
public life, we have an obligation to treat all people equally,
fairly, and impartially.

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 Assignment
Group 1: Research method
Define research, types of research, application, research
cycle, research ethics, sampling and sampling techniques,
components of research proposal and research report
Group 2: Epidemiology
Define epidemiology, assumptions, branches, applications,
natural history of disease, levels of disease prevention,
infectious disease cycle, study designs (limitations and
strengths for each)
Group 3: Source of data
-Vital statistics, survey, census, health service records
(characterize each sources of epidemiologic and
demographic data) 115
Thank you !

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