PUBLIC HEALTH COMPONENTS

AND
DETERMINANTS OF HEALTH

Dr Nasrin Jahan

16 March 2015
Learning Objectives

Define Public Health

State the objectives of Public Health
State the scope and main areas of PH activities
Discuss the differentiating features between PH and
Preventive Medicine
Define Preventive Medicine and Social Medicine with their
span and scope
Discuss the differentiating features between PM and
Hospital Medicine
Discuss the dimensions, spectrum and determinants of
health
Definition of Public Health

The Science and Art of

Preventing Diseases
Prolonging Life

and
Promoting Health and Efficiency Of Population

Through an Organized Community Effort

 Modified Definition of
PH by WHO Expert
Committee in 1920

expert
PH has three parts:

a. the science and art of preventing

disease and prolonging life and
promoting health and efficiency
through an organized community
effort
 Modified Definition of
PH by WHO Expert
Committee in 1920

Three parts (continued):

b. It deals with
sanitation of the environment,
control of communicable infections,
educate individuals in the principle of
hygiene,
organize medical and nursing services
for early diagnosis and preventive
treatment of disease.
 Modified Definition of
PH by WHO Expert
Committee in 1920

Three parts (continued):

c. development of social machinery

that will ensure to
every individual in the community a
standard of living for the maintenance of
health,
organize the benefits to enable every
citizen to
realize his birth right of health and
longevity.
 Objectives of
Public Health is to:

From a and c:

Prevention of disease and prolongation of life

Promotion of health and efficiency

Elevation of the standard of living, adequate

for health maintenance

Provision of the right to health and longevity

Objectives of Public Health

From b

to achieve all the above-mentioned objectives

through organized community effort.

The purpose of the
department of PH

Scope
Purpose
and is to set
main intoineffect
areas publicfor the benefit
health of all
activity
the people of a community the practical lessons
of preventive medicine.

The scope of PH work is chiefly determined by

the knowledge of the causes of the preventable
diseases.

We do not know how to prevent all diseases.

However, effective ways to prevent or to reduce
the occurrence of at least a dozens of diseases
are well known.
 Scope and Span

Scope and main areas in public health activity

The 4 main areas of PH activities are:

Environmental control

Communicable disease control

Non-communicable disease control

Personal health services

Preventive Medicine:
Definition

Scope and mainThe

areas in public
science andhealth
art activity
of preventing disease, prolonging life
and
promoting health and efficiency
of groups of individuals
and
individual within these group
through
the interference of disease processes.
Preventive Medicine:
Definition (continued)

PM is a measures taken to prevent illness or

injury, rather than curing them.

This type of care is best exemplified by hand

washing and immunizations.

Preventive care may include screening tests

tailored to an individual's age, health, and
family history.

For example, a person with a family history of

certain cancers or other diseases would be
screening at an earlier age and/or more
frequently than those with no family history.
Preventive Medicine:
Span and scope

Three phases of natural history of diseases:

Pre-pathogenesis

Pathogenesis

Post-pathogenesis
Preventive Medicine:
Span and scope

Five levels of prevention:

Health promotion

Specific promotion

Early diagnosis

Prompt treatment

Disability limitation and rehabilitation

Preventive Medicine :

cover natural history of diseases in their entity,

covering all 3 phases:

pre-pathogenesis, pathogenesis and post-pathogenesis;

and

involving 5 levels of preventions.

Preventive Medicine

Pre-pathogenesis: constitute primary prevention

Level I: Health promotion -Implies increase in quantum of

health- a process of advancement towards positive health.

Level II: Specific protection - Implies application of

protective measures directed against specific disease entities
at a time when the diseases have not attached man
Pathogenesis: constitute secondary prevention

Level III: Early diagnosis and prompt treatment

Implies diagnosing a disease in the preclinical

phase, when no untoward (adverse) pathological
developments have occurred and

when prompt treatment is expected to result in

complete cure.
Post-pathogenesis: constitute of tertiary level of prevention

Level IV: Disability limitation -Applied when the earlier

levels have been denied or have failed to arrest the
disease process leading to advanced pathological
changes.

Level V: Rehabilitation -Applied as the last resort- the

patient who has been neglected long enough has
developed disabilities or the conventional treatment for
disability limitation has failed to restore the patient to
his original state.
 Differences between PH and PM
Differential Public Health
features
Objectives Prevent disease, prolong life
and promote health &
efficiency through an
organized community effect
Coverage Entire population.
Emphasis Stress on personal or
impersonal measures of direct
or indirect nature
Functionaries Well organized led by PH
experts
Overlap When practiced at group level,
it approaches in preventive
medicine
Operation Control, elimination and
eradication
Preventive Medicine
Prevent disease, prolong life
and promote health & efficiency
through interception of disease
process
Group of individuals or
individual in a group
Stress on personal level
measures of direct of nature
Health professional working
individually or in groups
When practiced in mass scale, it
becomes in public health
Risk intervention procedures in
variety of special clinics
Definition Social Medicine

The study of the

social, economical, environmental, cultural,
psychological and genetic factors

that have bearing on the health of a group of

individuals

and individuals within these groups.

Definition Social Medicine

The field of social medicine seeks to

understand how social and economic

conditions impact health, disease and the
practice of medicine.

nurture conditions in which this

understanding can lead to a healthier
society.
Social Medicine:
its span and scope

Social medicine : Runs parallel to clinical medicine and has

similar compartments, with the difference that while the unit of
clinical medicine is an individual, the unit of social medicine is
the society as a whole.

Social anatomy: Deals with the structure of the society

such as
demographic pattern, social stratification, social classes,
family system, religious groups,
social organizations/institutions,
political organizations,
leadership patterns, legal institutions,
economic institutions, welfare institutions etc.
Social Medicine:
its span and scope (2)

Social physiology: Deals with functioning of the society.

Covers all facets of life including lifestyle, martial practices,
disposal practices: eating habits, sleeping habits and etc

Social pathology: A compartment of social medicine that

deals with social problems impinging on health such as
alcoholism, prostitution, drug addiction, drug abuse, child
abuse, etc.
Social Medicine:
its span and scope (2)

Social diagnosis : Which should occur simultaneously

with the clinical diagnosis, implies the identification of various
social factors that may behave as antecedents

(A stimulus ie a verbal cue, activity, event or person) that

immediately precedes a behavior, concomitants or
consequences of diseases.

Social therapy : Entails the management of social

problems with medical consequences or medical problems
with social repercussions
(a bad result that continue to have an effect for a period of time)
Definition Community Medicine

A branch of medical practice that is concerned

with

promoting, maintaining,
and
when necessary restoring the health of human
communities

rather than with clinical care of individual

patients
 The differentiating features
between CM and HM

Differentiating Community Medicine Hospital medicine

features
Service area Provide health care to residents of Draws patient from ill-defined
a geographically defined area localities constituting its
constituting its operational field catchment area

Operational Both active and passive Only passive operational strategy

strategy operational strategies are applied
whereby providers as well as
consumers are on the move to
provide or consume health care
Organizational A well organized functionally
framework inter-linked network of
community health centres,
primary health centres,
dispensaries and sub-centres
is applied whereby responsibility
lies exclusively on the patients to
report in hospitals for seeking
treatment
A loose conglomeration of
primary, secondary and tertiary
care hospitals with little or no
functional linkage
The differentiating features
between
CM and HM

Differentiating Community Medicine Hospital medicine

features
Intersectoral Active coordination and
coordination cooperation with health and
health-related sectors in the
interests of community health
Virtually no interaction with health
and health-related sectors.
Preference for isolation and
competition rather than
coordination

Programme Promotes active participation in Has limited or little scope in

participation the operation of national health participation of national health
programmes programmes

Cost-benefit Gives high cost-benefit ratios by Gives poor cost-benefit ratios by

analysis involving minimum expenditure involving maximum expenditure
and yielding maximum results and yielding minimum benefit
Five Dimensions Of Diseases

Physical dimension

Mental dimension

Social dimension

Moral dimension

Spiritual ( or Financial ) dimension

Five Dimensions Of Health

Physical: Health and activity for endurance,

flexibility and strength.

Mental: Mental stimulation, creativity and career

exploration.

Social: Developing and maintaining satisfying

relationships.

Moral: adherence to an acceptable moral code, a

person of integrity.

Spiritual: Seeking meaning & purpose in your life.

Spectrum of Health

Negative Health at one end and Positive Health at

other end:

Negative health:
Mortality - prevention of death.

Serious morbidity- the prevention and control of

conditions that produce disability or chronic
illnesses

Minor morbidity- the handling of lesser illnesses

(in term of death & disability) environmental
conditions that create nuisance.

Typical, Atypical, subclinical and latent cases

Spectrum of Health

Positive Health:

The attainment of a full sense of personal vigor

and mental well being, as well as constructive
relationships with others in an environment that
promotes longevity and happiness.

It is ideal that NEVER reached.

Optimum health

The compromise between positive and negative

health, which is within the reach of individuals.
Investment towards optimum health is the best
investment of a nation.
The determinants of health

1. Personal determinants

2. Environmental determinants

3. Governmental determinants

G M Dhaar, I Robbani, Foundations of Community Medicine.2nd edition (page 23-24)

The determinants of health

1. Personal determinants

Genetic endowment

Health awareness

Healthy lifestyle

Sound philosophy of life

The determinants of health

2. Environmental determinants
Healthy family environment
Healthy physical environment
Healthy social environment
Healthy occupational environment

3. Governmental determinants
Socio-economic development
Appropriate health care
Political commitment
5 dimensions of disease

Physical dimension
Comprise its clinical manifestations and physiological
alterations with changes resulting from disease process.
It also includes complications, impairments, disabilities or
handicaps caused by the disease process.

Social dimension
Disease can originate from social causes and also can
give rise to social consequences. Number of diseases can
result in family disturbances, family tension and economic
burden.
Stigmatic disease may lead to disownment and
abandonment of patients.
Lifelong disabling disease can drain away family
resources.
Mental dimension
Diseases that are incurable, disabling or stigmatic cause
anxiety in patients, resulting in fear, apprehension,
depression and even suicidal tendencies.
Sigmatization is known to cause feeling of guilt, loneliness,
anger, resentment, isolation, frustration and depression.

Moral dimension
A disease should be conceived as an outcome of an
epidemiological process and not as a punishment for sins.
Stigmatization of diseases, with the rejection and
humiliation of patients, is a challenge to medical
profession.
Society should extend sympathy and support to AIDS
orphans.
Provision of medical care to sick is also a moral
responsibility of a welfare government.
Spiritual dimension

An indication of the attainment of higher

consciousness and communication to Creator.

A spiritual philosophy of life and afterlife

Surrendered to the dictates of the Creator

Who feels answerable for the act and omission and

commission so never indulge sinful or shameful
practices
Thank you