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Community and Public Health (Week 1)

Overview of Session
 The students are introduced to
Community and Public Health, its scope
of services as well as its development as
a discipline in the Philippines, After the
completion and review of the topic, the
student should be able to explain the
meaning and significance of Public
Health in the Philippines.

The student will be able to
› Define Public health
› Discuss the scope of the subject
› Trace the history of public health in
the Philippines

PUBLIC HEALTH
 Ecological (environmental) in
perspective(VIEWPOINT), multi-sectoral (division)
in scope and collaborative (2 WAY) in strategy
 It aims to improve the health of community
through an organized (planned) community
effort
 The science and art of preventing disease,
prolonging life and promoting health through
the organized efforts and informed choices of
society, organizations, public and private
communities and individuals.

 It is concerned with threats to the overall
health of a community based on
population health analysis.

 Public health is typically divided into
epidemiology, biostatistics and Health
services. Environmental, social,
behavioral, and occupational health
and other important subfields.

1. It deals with preventive rather
than curative aspects of health.
2. It deals with population level-
rather than individual-level health
issues.

It is a group of people with
common characteristics or
interests living together within
a territory or geographical
(physical) boundary.

Community as Client

World Views on Community :
1. Family, community and society
2. Contradictions / Conflicts
3. Change

1. Family, community and society :
A. Individual :
a. Patient : an individual who is sick.
b. Client : an individual who is well/not sick.
B. Family :
A. Role/Relationship : Parents; Bi-parenting
*Mother is expected to have the ABILITY to provide
care and usually takes the role of keeping the family well
and healthy by combining :
1. Knowledge
2. Attitudes
3. Skills
* Ex: During Martial Law there was a food blockade
giving nutrition problems to some places resulting to
political insecurity and the CH nurses introduced some
alternatives in :
1. Food and nutrition
2. Food preservation
3. Food technology

C. Community :
* CHN serves up to this level only.
* Everything that affects the individual
affects the family and eventually the
community.

2. Contradictions / Conflicts :
People in the community are always in
constant conflict and faced with
contradictions :
1. Individual : intrapersonal conflicts
(conflict within the person/personal
conflicts)
2. Family : interfamilial conflicts (conflict
within the family/interpersonal conflicts)
3. Community : intercommunity
(interfamilial conflicts)
4. Society : intra-societal conflicts
(intercommunity conflicts)

Note :
People tend to have negative perspectives. In the
Philippines, negative regional stereotyping is very
common such as :
a. Ilocanos : kuripot ---(positive : call them
resourceful)
b. Kapampangans : mayabang ---(positive :
maybe they are assertive/artistic)
c. Bicolanos : malibog---(positive : could be
loving/warm hearted)
d. Bisaya : aswang ---(positive : they are
mysterious/interesting people)
e. Mindanaoans : mamamatay tao (Muslims esp)--
-(positive : brave/courageous)

* In CHN, we try to avoid negative perspectives, look for the
source of the conflicts and try to find solutions. We must try to
adapt positive perspectives in order to achieve a positive
development (effect upward and onward movement).

3. Change :
is inevitable (unavoidable) because a
community is dynamic (active, full of life)
and is always changing (not static).

* A CH worker should constantly assess the
community to come up with suitable
interventions (actions are responsive to
the people„s needs).

* Place where people under usual or normal
conditions are found :
1. Home : You render Family Health Nursing
2. Workplace : You render Occupational Health
Nursing
3. Schools : You render School Health Nursing
* Outside of purely curative institutions such
as hospitals.
* Are usually centers for wellness where you
do health promotion and disease
prevention.

1. Health-Illness Continuum Models :
A. Dunn’s High-Level Wellness Grid :
describes a health grid in which a health axis
and an environmental axis intersect. The
grid demonstrates the interaction of the
environment with the illness-wellness
continuum.
The axis extends from peak wellness to death,
and the environment axis extends from
very favorable to very unfavorable. The
intersection of the two axes forms four
quadrants of health and wellness.

Very favorable environment

Protected poor High-level
health
wellness

Death ------------Health----------------------Axis------------Peak
Wellness

Poor health Emergent high-level
wellness

Very unfavorable environment

1. High-level wellness in a favorable
environment :
 Example is a person who implements
healthy lifestyle behaviors and has the
biopsychosocial, spiritual, and economic
resources to support his lifestyle.
2. Emergent high-level wellness in an
unfavorable environment :
 Example is a woman who has the
knowledge to implement healthy lifestyle
practices but does not implement
adequate self-care practices bec of family
responsibilities, job demands, or other
factors.

3. Protected poor health in a favorable
environment :
 Example is an ill person whose needs
are met by the health care system
and who has access to appropriate
medications, diet, and health care
instruction.
4. Poor health in an unfavorable
environment :
 Example is a young child who is
starving in a drought-stricken country.

* Requires the individual to maintain a
continuum of balance and purposeful
direction with the environment.
* Involves progress towards a higher level
of functioning, an open-ended and
even expanding challenge to live at the
fullest potential.

B. Travis‟ Illness-Wellness Continuum : Ranges
from high-level wellness to premature death.
It demonstrates two arrows pointing in
opposite directions and joined at a neutral
point. Movement to the right of the neutral
point indicates increasing levels of health
and well-being for an individual achieved in
three steps :
1. Awareness
2. Education
3. Growth
In contrast, movement to the left of the neutral
point indicates progressively decreasing
levels of health and premature death.

Wellness Model

Premature
Level Disability symptoms signs awareness education growth HW
Death neutral point
(No discernible illness or wellness)

* Degree of client wellness that exists at
any point in time ranging from optimal
wellness condition, with availability of
energy at its maximum, to death which
represents total energy depletion.

* A dynamic state that continuously alters
as a person adapts to changes in the
internal and external environment to
maintain a state of physical, emotional,
intellectual, social, developmental and
spiritual well-being (Holistic).

1. Internal variables : include those which are
usually non-modifiable such as :
a. Biologic dimension - genetic makeup, sex,
age, and developmental level all significant to
a person‟s health.
b. Psychological dimension - emotional factors
which include mind-body interactions and
self-concept.
c. Cognitive dimension - intellectual factors
which include lifestyle choices and spiritual
and religious beliefs.

2. External variables : the macrosystem which
include:
a. Environment : geographical locations
determine climate, and climate affects health;
environmental hazards.
b. Economics : standards of living reflecting
occupation, income and education is related
to health, morbidity and mortality.
c. Family and cultural beliefs : the family passes
on life patterns of daily living and lifestyles to
offsprings (e.g. physical/emotional abuse or
climate of open communication). Culture and
social interactions also influence how a person
perceives, experiences, and copes with health
and illness.
d. Social support networks : political/systems of
governance; religion/church; mass media.

In Sept. 8, 1978 : UNICEF and WHO held the
First International Conference on Primary
Health Care in Alma Ata, USSR

PHC Goal : Health for All by 2000! (bec of
the high-level wellness model in 1978)
In 1994, modified goal to Health for All by
2000 and Beyond because original goal
was unattainable.
LOI 949 : was signed by Pres Marcos on Oct
19, 1979 making Primary Health Care the
thrust (focus)of the Department of Health.

Vision :
Health for All Filipinos was set by DOH Sec
Juan Flavier.
Goal :
Health for All Filipinos and Health in the Hands
of the people by the Year 2020 (the 2nd
phrase was suggested by the NGO :
Bukluran Para sa Kalusugan).
Mission :
In partnership with the people, provide equity,
access and quality health care esp to the
marginalized which brought about the
Sentrong Sigla movement in order to
achieve it.

RA 7160 : The Local government Code
of 1991 which resulted in devolution,
which transferred the power and
authority from the national to the
local government units, aimed to
build their capabilities for self-
government and develop them fully
as self-reliant communities.

Agent-Host-Environment Model :
also called the ecologic model
by Leavell and Clark refers to
the interplay of agent
(causative/etiologic factor),
host (possessing intrinsic
factors), and the environment
(extrinsic factors)

A. Etiologic Factors :
1. Biological agents : virus, fungi, bacteria,
helminthes, protozoa, ectoparasites
2. Chemical elements :
a. Carcinogens : BBQ
b. Poisons : MSG
c. Allergens: Some seafood
d. Transfats: Junkfoods
3. Nutritive elements : excesses and or
deficiencies e.g. marasmus & kwashiorkor
4. Mechanical factors : accidents
5. Physical : as when one is struck (strike) by
lightning
6. Psychological : such as stress

B. Host :
Intrinsic factors include :
1. Exposure
2. Response (reaction)

C. Environment :
Extrinsic factors include :
1. Natural boundaries
2. Biological environment
3. Socio-economic (political
boundary)

3. Health Belief Model : refers to the
relationship between a person‟s
belief and his behavior in health. It
pertains to three components of an
individual‟s perception :
1. Susceptibility to an illness
2. Seriousness of an illness
3. Benefits of taking the action
Example: In one HIV infection
study

Commercial sex workers Seafarer’s Nuns
wives
Seriousness Yes Yes Yes
Susceptibility Unprotected penetrative sex Unprotected Care and support
(MOT) a. vaginal : 1:1000 chance penetrative work
b. anal : sex a. occupational
male-male : 1:200 chance hazards-usually
male-female: family planning give nurturing
method
care to the sick
c. oral:
b. needle-sticks
Felatio : highest risk
Cunnilingus: safest sex c. splash
Analingus: no HIV risk accidents
d. no recorded f-f HIV MOT
Prevention: C and D B and C Universal
Abstinence(safe precautions
sex)
Be faithful(mutual
monogamy)
Correct, consistent
&continuous use
of condoms
Do not penetrate
(BCD : safer sex)

4. Evolutionary-based Model : States that illness
and death sometimes serve an evolutionary
function. Elements considered in the theory
are :
1. Life events : developmental variables and variables
associated with changes such as
accidents/relocation.
2. Lifestyle determinants
3. Evolutionary viability within the social context :
reflects the extent to which an individual functions
to promote survival and well-being.
4. Control perceptions : the extent to which a person
can influence circumstances in life.
5. Viability emotions : affective reactions developed
for life events or lifestyle determinants.
6. Health outcomes : physiological, behavioral and
psychological status resulting from the interplay of
those elements.

5. Health Promotion Model :
directed at increasing client‟s
well-being.
* Goal : enhance level of wellness.

6. WHO definition (1978) : a state of complete
physical, mental, and social well-being, not
merely the absence of disease or infirmity
(sickness).
* Health is a social phenomenon.
* It is an outcome of multi-causal
theories of health and disease.
* It is an outcome or by-product of the
interplay of societal factors :
a. Ecological :
1. Biological
2. Physical
b. Economic
c. Political
d. Socio-cultural

What is Community Health?
A part of paramedical and medical
intervention or approach which is
concerned with the health of the whole
population.
A discipline that concerns with the study and
betterment of the health characteristics of
biological communities.
Its aims are :
1. Health promotion
2. Prevention of disease
3. Management of factors affecting
health

COMMUNITY HEALTH
 PANDEMIC
- wide spread; epidemic over a wide
geographic area and affecting a
large portion of the population
 EPIDEMIC
- spreading rapidly and extensively
by infection and affecting many
individuals in an area or a population
at the same time.
-an outbreak of a contagious
disease that spreads rapidly and
widely

Major concepts of Public health :
1. Health promotion and disease
prevention
2. People‟s participation towards self-
reliance : active and full involvement
with people in the decision-making
process :
-assessment, planning, implementation,
monitoring and evaluation.

Dr C E Winslow :
The science and art of preventing disease,
prolonging life, promoting health and
efficiency through organized community
effort.

Hanlon :
It is dedicated to the common
attainment of the highest level of
physical, mental and social well-
being and longevity consistent with
available knowledge and resources
at a given time and place. It holds
this goal as its contribution to the
most effective total development
and life on the individual and this
society. (Holistic)

Purdom :
It prioritizes the survival of human
species, the prevention of conditions
which lead to the destruction or
retardation of human function and
potential in early years of life, the
achievement of human potential and
prevention of the loss of productivity of
young adults and those in the middle
period of life and the improvement of the
quality of life especially in later years.

Nightingale :
The act of utilizing the
environment of the patient to
assist him in his recovery. Any
individual is capable of reparative
process.

History of Public health in the Philippines
based on socio-political periods
1. Pre-American Occupation ( up to 1898 )
2. American Military Government ( 1898-1907)
3. Philippine assembly (1907-1916)
4. The Jones law (1916-1936)
5. The Commonwealth (1936-1941)
6. Japanese occupation ( 1941-1945)
7. Post World war II (1945-1972)
8. Post EDSA revolution (1986 to present

1. Pre-American Occupation
› 1577- Public health began at the old
Franciscan Convent in Intramuros where Fr.
Juan Clemente put up dispensary for
treating indigents in Manila.
-San Juan de Dios Hospital
1.2 During Spanish Time
1. Creation of Vaccinators to prevent
smallpox
2. Creation of Board of Health
3. First medical school in the Philippines- UST
4. School of Midwifery
5. Public Health Laboratory
6. Forensic Medicine

1.3 Hospital before the Americans came to
Philippines
1.3.1 General Hospitals
1. San Juan de Dios Hospital
2. Chinese General Hospital
3. Hospicio de San Jose in Cavite
4. Casa dela Caridad in Cebu
5. Enfermeria de Sta. Cruz in Laguna
1.3.2 Contagious Hospitals
1. San Lazaro Hospital
2. Hospital de Palestina in Camarines Sur
3. Hospital delos Lesporosos in Cebu
4. Hospital de Argencina in Manila for
smallpox and cholera

2. American Military Government
2.1 Control of epidemics such as cholera, small
pox and plague
2.2 Fight against communicable diseases such as
common cold, Hepa A-D, chickenpox, SARS,
flu, mumps, malaria, herpes, STD, measles
2.3 Projects and activities:
1. Garbage crematory
2. First sanitary ordinance and rat control
3. Cholera vaccine was first tried
4. Confirmed that plague in man comes from
infected rat
5. Opened the UP College of Medicine
6. Establishes Bureau of Science

3. Philippine Assembly
1. Hygiene and Physiology were included
in curriculum of public elementary
school
2. Anti-TB campaign was started
3. Philippine Tuberculosis Society was
organized
4. Opening of PGH (Phil. Gen. Hospital)
5. Use of anti-typhoid vaccine was
initiated
6. Dry vaccine against small pox was first
use

4. JONES LAW YEARS
4.1 Retrogression rather than progression
in so far as the health was concern
1. Increase CDR
2. Increase IMR
3. Increase Morbidity
4.2 Increase deaths from smallpox,
cholera, typhoid, malaria and TB

4.3 Re-organized happened (reorganized the health
service and encouraged effective supervision)
1. Study the cause and prevalence of typhoid
fever
2. Schick test was used to determine the causes of
diphtheria
3. Campaign against Hookworm was launched
4. Anti-dysentery vaccine was first tried
5. First training course for sanitary inspector was
given
6. Women and child labor law was passed
7. Mechanisms of transmission of dengue fever
through Aedes aegyti was studied
8. Establishment of School of Hygiene and Public
Health
9. National Research Council of the Philippines was
organized
10. BS in Education Major in Health Education was
opened in UP
11. (PPHA) Philippine Public Health Association was
organized

5. COMMONWEALTH PERIOD
5.1 The epidemiology of life threatening disease was
studied- diphtheria, yaws, dengue
5.2 Research in the field of health was promoted
5.3 UP School of Public Health was established
5.4 Development of Maternal and Child Health
(MCH)
5.5 1939 – Creation of Dept. of Public Health and
Welfare
- Dr. Jose Fabella as the First secretary
5.6 1940- Bureau of Census and Statistics was created
to gather vital statistics
5.7 In spite of development
1. Inequitable distribution of health services remained
a problem
2. 80% of those who died were never given medical
attention

6. JAPANESE OCCUPATION/WORLD
WAR II
1. During this time, all public health
activities were practically paralyzed.
2. Increase incidence of TB, veneral
dses, malaria, leprosy and
malnutrition.

7. POST WORLD WAR II
1. Philippine Independence
2. Completion of a research on
Dichlorodiphenyltricholorothanel (DDT-as
larvicidal/insecticide to control malaria
3. Introduction of one-infection method for
gonorrhea with penicillin
4. Manila was selected as Headquarters for World
Health Organization (WHO) Western Pacific Office
5. Strengthening Health and Dental services in rural
areas (per municipalities with 5,000-10,000
population)
1 Municipal Health Officer
1 Public Health Nurse
1 Midwife
1 Sanitary Inspector

8. MARTIAL LAW YEARS
8.1 Creation of National Economic
Development Authority
8.2 Department of Health was renamed as
Ministry of Health (MOH)

8.3 Accomplishments during this period:
8.3.1 Formulation of National Health Plan
› Construction of Tertiary Hospital
o Philippine Heart Center
o Lung Center
o Kidney Center
o Lungsod ng Kabataan / Phil. Childrens
Medical Center
› Adaptation of the Primary Health Care
o Phil was the first country to implement
PHC
› Launching of Operation Timbang and Mothercraft
o Nationwide program providing
supplementary food for infants, pre-school
and school children.
NUTRIBUN- bread with vitamins
8.3.2 Progress in Public Health research
 RITM- Research Institute for Topical Medicine
 PCHRD- Philippine Council for Health Research and
Development

9. EDSA REVOLUTION
› From Ministry of Health, it was
renamed again as Dept. of Health
› Increase in life expectancy slowed
down
› Increased incidence of malnutrition
› Declined practice of family planning

10. AQUINO ADMINISTRATION
› 1987 Constitution- more provisions on health
making comprehensive health care available
› Major activities:
 Milk code- required the marketing of breast
feed milk substitute
 Universal child and mother immunization
 RA. 6725- Act prohibiting discrimination
against women
 NESS- National Epidemic Surveillance
System
 RA. 6675- National Drug Policy and
Generics Act
 RA. 7170- Organ Donation Act

11. RAMOS ADMINISTRATION
› “Health in the Hands of People” and “Let‟s DOH it”
–by Sen Juan Flavier
 Memorable initiative during leadership of
Flavier
› National Immunization Day
 BCG (Bacille Calmette-Guérin (BCG) is a live strain of
Mycobacterium bovis developed by Calmette and
Guérin for use as an attenuated vaccine to prevent
tuberculosis and other mycobacterial infections.)
 DPT (diphtheria, pertussis(whooping cough)
and tetanus)
 OPV –Oral Polio Vaccine
 MMR- Immunization shot against measles, mumps,
and rubella (also called German measles)

Continuation….
(Memorable initiative during leadership of Flavier)
› Promotion of Traditional Medicine- Herbal
Medicine
› Yosi Kadiri
› Araw ng Sangkap Pinoy- aimed to prevent
Vitamin A, Iron and Iodine deficiency
› Voluntary Blood Donation Program
› Kung Sila‟y Mahal Mo Magplano- Family
Planning Program
› Doctors to the Barrio

Laws:
› EO 39- which created the Philippines
National AIDS Council as a national policy
and advisory body in the prevention and
control of HIV-AIDS
› RA 7719- the National Blood Services Act
of 1994, this to promote voluntary blood
donation
› RA 8172- Salt Iodization Nationwide (ASIN),
providing salt iodization nationwide
approved in 1996 and renamed FIDEL
(Fortified for Iodine Elimination)

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Community and Public Health (Week 1)

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