HEALTH AND HEALTH DETERMINANTS PUBLIC HEALTH AND COMMUNITY HEALTH

Sonia Fernndez Balbuena Course 2011/12

HEALTH

CLASSIC CONCEPT Absence of illness

Subjective concept hard to define Not very useful

WHO
1946: A state of complete physical, social and mental well-being, and not merely the absence of disease or infirmity Strengths: positive definition and includes all the dimensions of human life Weakness: wellness health (utopic) Static and subjective

WYLLIE (1970)
Health is the perfect, continuing adjustment of an organism to its environment. Disease: would be an imperfect, continuing adjustment

TERRYS (1980)
State of physical, mental and social wellbeing and ability to function, and not merely the absence of illness or infirmity
Subjective: Feeling well Objective: Ability to function

Objective and dynamic (health degrees)

TERRYS (1980)

HEALTH DEGREES
Health +++ Feeling well ++ + + Illness ++ +++ Feeling ill

Ability to function

SALLERAS (1985)
Health High level of physical, mental and social wellbeing and ability to function
Health gain Loss of healh

Premature death

Signs Symptons Disability Defense and health promotion and disease prevention

Health restoration

Neutral zone
Community activities Education Economic policy

DETERMINANTS
The range of personal, social, economic and environmental factors which determine the health status of individuals or populations. Lalonde Health Factors (1974):
1. 2. 3. 4.

Genetic and biological factors Behavioural and attitudinal factors (lifestyle factors) Environmental factors (economic, social, cultural and physical factors) The organization of health care systems

LALONDE (weights)

PUBLIC EXPENDITURE

TARLOV (1999)
Genes and biology

Social/societal characteristics and ecology

Health behaviours

Medical care

Relative influence of the five major determinant categories of population health: rough approximations

ORAL HEALTH EXAMPLE: TOOTH DECAY

Biological factors: age, individual disease resistance Environmental: source of fluoride available for large groups of population Lifestyle: sugar diet, oral hygiene Dental care

PUBLIC HEALTH
Organized community effort aimed to: protect, foment and promote the welfare of the population when is healthy and to restore and re-establish their health when it is lost and, if necessary, to rehabilitate and reintegrate the sick, integrated into his social, professional and cultural media.

PUBLIC HEALTH
Responsibility of governments, who organizes the activities to improve the health of the population. Some are carried out by health services (prevention and restoration of health) but some have no direct relation to health services: -Education -Employment and wage policy -Construction of affordable housing -Roads -Social Security ...

PUBLIC HEALTH ACTIONS Restoration of health Ill person

Recovery/ death/ chronicity

Disease prevention and health protection Threat Health promotion Healthy

Risk factor (prevention) Enviromental (protection)

Maintain and expand the welfare state

PREVENTION
Any measure that reduces the likelihood of a disease, or stops it, or slow its progression Prevention can be:
Primary Secundary Tertiary

PREVENTION
Primary
Before the disease to appear Vaccination/ improve workplace

Secondary
Intervene in presymptomatic phase Cancer screening/ tooth decay screening

Tertiary
Reduce complications, cure, rehabilitate ... Usual health care

PREVENTION

as se di

e.

Clinical Medicine: 90% resources

lth ea h

Vulnerables PRIMARY

Diagnosis-early Intervention
SECONDARY

Rehabilitation TERTIARY

TBC EVOLUTION
4.000

Evolution of tuberculosis in 150 years

3.000

Koch
2.000

Chemoterapy
1.000 Cases per million population
18 38

Why this decline occurs?

18 80 19 1 50 960

BCG

CHRONIC DISEASES
It is not characterized by a unique syndrome or symptom It is a process nor a state

ACUTIZATION ADAPTATION HEALING CONVALESCENCE

DISABILITY AFTER-EFFECTS

RECOVERY

HIGH INFLUENCE OF ENVIRONMENTAL FACTORS

PUBLIC HEALTH
PUBLIC HEALTH is a complex discipline that extracts knowledge of a variety of sciences, specially:
-Demography -Statistics -Microbiology -Immunology -Food technology -Education -Communication -Clinical Medicine

-Epidemiology

COMMUNITY HEALTH
Responsibility and participation of the community to contribute for a better level of health for all its members. The community (citizens) participates actively to improve their health It is essential the health information and education of the community

HEALTH INEQUITIES
1992: The people from Harlem has a lower life expectancy than people from Bangladesh (F. J. Martin Santos)
STRUCTURAL FACTORS: - Education - Occupation - Income - Habitat - Environment LIFESTYLE FACTORS: - Nutrition - Drugs - Medicines - Sexual behavior - Exercise - Stress

HEALTH SERVICES FACTORS - Availability and accessibility (cost..) - Priority Vs Preventive care - Evaluation and effective control

DISEASES AND INEQUITIES

Less income Stigma Decreased economic ability and influence for decisions affecting the community

Personal and social malfunction

DISEASE

Deficiencies - Nutritional - Educational

RECOVERY

PREVENTION

INEQUITIESdisINEQUALITIES
Individual and free choices?

YES Determinants of differences in health

NO

Could the circumstances been modified/ controlled by humans?

YES Acceptable inequality Inacceptable inequality Inequity

NO Acceptable inequality

INEQUITIES
A difference in health that is systematic, socially produced (modiable) and unfair

Spanish National Health System (SNS)

3 administrative levels

1. Central 2. Regional 3. Health area

NHS (SNS)
1. Central
Ministry of Health (Ministerio de Sanidad y Consumo): Establishes general criteria for health coordination.

2. Regional
Each region manages their own health care services since 2004.

NHS (SNS)
3. Health Area
Basic structures of the health system Each Autonomic community establishes their health areas considering : population, socioeconomic and geographic factors, transport There is one general hospital at least for each health area

HEALTH CARE LEVELS

1-Primary Health care:
The health areas are divided in basic health zones with a Primary Healthcare Center for each zone. The primary health care professionals are general practitioners, paediatricians, nurses and social workers.

2-Specialized Health care:

Satisfy the welfare needs related with more complex health problems. There are specialized centers and hospitals

PRIMARY HEALTH CARE

Covers a broad range of health and preventative services, including health education, counseling, disease prevention and screening. It is essential health care made accessible at a cost a country and community can afford, with methods that are practical, scientifically sound and socially acceptable.

QUESTIONS
Make groups to work the following questions. Each group must have at least one copy of the notes What is the contribution from Community Health Into Public Health? Why disease can cause inequality? In which case you could say that inequality is acceptable?