Dr. Sitti Patimah, M.

Kes
 Introduction to Public Health

• What is Public Health (history and definitions)

• Social and Biological Determinants of Health
(health and wealth; race, class, gender; chronic
diseases; infectious diseases)
• Topics in Public Health (obesity, breastfeeding,
tobacco, injury)
• Global Health Issues (globalization and
development; nutrition)
 Why Study Public Health History?

o To understand anything in a society, it is beneficial to

know something about its history.
o Any situation that we examine is always the result of
definite historical developments and trends.
o An examination of the historical development of our
present health care delivery system will allow us to create
future possibilities.
 A Definition of Public Health

Public Health is the science and art of preventing disease,

prolonging life and promoting physical health and efficiency
through organized community efforts for the sanitation of the
environment, the control of community infections, the
education of the individual in personal hygiene, the
organization of services for the early diagnosis and
preventive treatment of disease, and the development of
social machinery which will ensure to every individual in the
community a standard of living adequate for the
maintenance of health.
(Winslow C.E.A. (1920) The Untilled Fields of Public Health Science 51, 23)
 In the last few centuries, ‘Public Health’ has
emerged as a discipline and profession in its
own right, distinguishable from medicine by its
focus on health phenomena in populations
rather than in individuals.
 Both public health and medicine are practical
disciplines where implementing ‘what works’
may be given priority over answering the
question ‘how does it work?’
 Historically, people have been concerned with the
health problems of group living.
 Community action in the promotion of health and
the prevention and treatment of disease is the
basis of public health and its early roots.
 Public health history is the story of man's
attempt to protect himself and his fellows against
the health hazards of communal living
 Today, public health is the organized effort by
society to protect, promote, and restore the health
of its citizens. Public health activities emphasize the
prevention of disease and disability and concentrate
on the health and well-being of groups of people.

The goal of public health is to reduce discomfort,

disability, and disease in society and promote the quality
of life as well as attaining the highest level of physical,
mental, and social well-being utilizing available
knowledge and resources at a given time and place.
 Public health focuses on promoting health &
preventing illness in the population
 The problem for public health in measuring its
success is that it often takes many years to
see shifts in mortality & morbidity patterns as
a result of a range of public health
interventions introduced over many years
 As a result of these goals, public health
professionals are typically idealistic with a
strong sense of social responsibility
 Fundamental to the overall philosophy is the
accessibility of health care for all segments of
the population.
 The origins of public health: historical
perspectives

 Classical Greek - two rival Greek medical traditions

one based on disease classification and the other on
emphasing the individual patient. Both based on
observation, not divine causation. Hippocrates put
great emphasis on the environment in relation to
health and well-being
 The Romans and Chinese engineered safe water and
sanitary latrines dating from 4000 years ago. The
Romans also created a military medical service who
focused on the holistic well being of the troops.
In Europe and North America 3 phases of public health activity can
be identified in the last 150 years

First Phase
This movement was triggered by the appalling toll of death and disease
among the working classes in the mid 19th Century following the
industrial revolution.
In the 1830`s half of Manchester children died before their fifth birthday,
and in Liverpool a labourer had a life expectancy of 15 years.
Second Phase
Public Health focuses were
 housing
 sanitation
 clean water
The public health movement at this time resulted in Chadwick`s Public
Health Act of 1848 (in Britain)
 Third Phase
o The germ theory of disease causation and the future
potential of immunisation and vaccination became clear.
o Pressing environmental problems began to be dealt
with.
o The therapeutic era began in the 1930/40`s in Britain
with the advent of insulin and sulphonamides. Until that
the therapeutic ‘arsenal` had proved to be of little
efficacy.
o This period marks a weakening of the `public health`
focus for health services and a shift of resources to
hospital services, particularly teaching hospitals.
Preventive efforts began to focus on the individual
 ?Phase four
The new public health movement goes beyond the
understanding of human biology and recognizes
the importance of social and psychological aspects
as determinants of health and well-being.
The therapeutic era is being challenged; with most
countries experiencing a crisis in health care
costs, due to limitless demand and demographic
changes.
 When did science come into
public health?

 Public health is a population science.

 It studies disease and other health related
phenomena in populations, as opposed to clinical
medicine, which focuses on individuals.
 The first person to attempt to measure any health
related phenomenon in populations – the
essential approach of public health – was the
seventeenth century Briton, John Graunt.
• Historically, public health concepts have emerged parallel to
the evolution of ideas in science such as :
1. the germ theory of disease, the understanding of
nutritional deficiency states, and infective agents
and vectors.
2. Later, with the emergence of non-communicable
diseases, mainstream public health thinking has
contributed some unique ideas such as ‘risk factors’
and ‘causal complexes’.
3. in the recent history of public health, we see that
evolution of concepts has led to new investigative
methods, and emergence of newer technology has
thrown up new conceptual challenges.
This ongoing dialectic shapes the development of public
health as a science
• Modern public health is as much a product of thinking in social
science as in science.
• Especially in the twentieth century, strong ideas that have
influenced public health include the rights of man, and equity in
health.
• science tries to understand the world, social science has a vision of
society as it ideally should be, which is shared by public health.
• without the methodological rigor of science, this vision cannot be
validated.
• The strength of public health is that it tries to combine these two
approaches to understanding the world and our society.
• Scientific ideas thus constitute the foundations of modern public
health.
The Science of Public Health is about understanding the
determinants of health, what works and in what
circumstances. It’s about using evidence as a basis for
decisions about selecting interventions that work with
hard-to-reach & the economically & socially isolated

The art of public health has more to do with the practice

of public health and how the science is interpreted &
implemented according to population needs &
circumstances
 The Role of The Public Health Practitioner
(van der Maesen & Nijhuis, 2000 p 136)

1. Improving social conditions that stimulate health

2. Preventing social conditions that threaten health
3. Neutralising existing social condition that cause ill health
Fleming ML and Parker E, 2011
 The elements of public health practice :

• Assessing the health needs of a population.

• Working with local people to identify needs.
• Identifying groups most in need of health care and most
likely to benefit from health care; identifying health
inequalities and working to improve the health of the socially
excluded.
• Determining the social, economic and environmental factors
that impinge on health.
• Planning and implementing programmes that promotes and
protect health, both within the health sector and with other
sectors to address the wider threats [determinants] (eg.
Housing, transport).
• Assessing the impact of interventions on the health of the
population.
(Wanless, 2004; Hall and Elliman, 2004)
ACTORS IN PUBLIC HEALTH SYSTEM
Core Public Health Disciplines
Epidemiology

Biostatistics

Social and Behavioral/Health Education

Environmental Health

H Health Policy Management (or Health

Services Administration)
Epidemiology
• Taking into account various hereditary,
behavioral, environmental, and health care
factors, epidemiology is the study and control of
disease or injury patterns in human populations.
• Epidemiology focuses on determining the
cause(s) of disease or injury, the risks, who is at
risk, and how to prevent further incidences.
• Examples of careers in this field are:
communicable disease epidemiologist, public
health officer, health data analyst
Biostatistics
• Biostatistics is the application of statistical
procedures, techniques, and methodology to
identify health trends.
• Biostatistics are an integral part of public health
as it forecasts scenarios, identifies health trends
within the community, explains biological
phenomena, and determines the cause(s) of
disease and injury.
• Examples of careers in this field are: survey
statistician, health data analyst, research data
coordinator, biostatistician
Behavioral Science/Health Education

• Focuses on ways to encourage people to make

healthy choices, and includes the development of
community-wide education programs that range
from promoting healthy lifestyles in order to
prevent disease and injury, to researching
complex health issues.
• Examples of careers in this field are: health
education program coordinator, school health
educator, behavior scientist.
Environmental Health
• Environmental health improves public health
through identifying and addressing environmental
risk factors.
• Settings include: air quality, food protection,
radiation protection, solid waste management,
hazardous waste management, water quality, noise
control, environmental control of recreational areas,
housing quality, and vector control.
• Examples of careers in this field are: ecologists,
environmental consultant, oceanographer.
Health Services Administration/Health Policy
Management

• Health Services Administration combines politics,

business, and science in managing human and fiscal
resources needed to deliver effective public health
services.
• Specialties include: planning, organization, policy
formulation and analysis, finance, economics, or
marketing.
• Examples of careers in this field are: director of
strategic planning, medical care administrator,
gerontology coordinator.
Thank You
 Assignment

• 5 core disciplines of public health and how each

contributes to understanding the health of the public (1)
• cultural and social influences on public health (3)
• social and behavioral interventions affect population
health (3)
• the impact of the environment on public health (4)
• the roles of public health in addressing health disparities
and the needs of vulnerable populations (10)
 Groups Assignment
1. Determinants of health (2)
2. Biomedical basis of public health (5)
3. Social & Behavioral Factors in Health, and Health
Culture (3)
4. Health Protection & Promotion (6)
5. Ethics, Evidence & Practice (9)
6. Traditional Health care practices (7)
7. Community based health service (8)
Primary health care (8)
10. Environmental Issues in Public Health (2)
11. Contemporary Issue (obesity (11), breasfeeding
(12), tobacco (13)
 ASSIGNMENT
 Pilih salah satu judul di bawah ini untuk dibuat kan “
“Critical Review” sebagai pengganti Ujian Final IKM
 Tugas dikerjakan selama 1 minggu

1. Evidence based Health Intervention in Indonesia

2. The Impact of globalization on health in
Indonesia
3. Public health achievement & challenges in
Indonesia
4. The role of health in development in Indonesia