Intro To Public Health

Question 1

What is public health

Answer 1

What Is Public Health?
“The activities that ensure conditions in which people can be healthy. These activities include community wide efforts to identify, prevent, and combat threats to the health of the public. “

• Institute of Medicine Definition of Public Health

What Is Public Health?
•‘The science and art of preventing disease, prolonging life and promoting, protecting and improving health through the organised efforts of society.’ (Sir Donald Acheson; 1988)
•The field pays special attention to the social context of disease and health, and focuses on improving health through society-wide measures like vaccinations, the fluoridation of drinking water, or through policies such as seatbelt and non-smoking laws.

Question 2

State four principles of public health

Answer 2

Principles of Public Health
Public health is about PREVENTION.
This means intervening early and keeping people from getting sick or injured

Public health is about POPULATIONS.
This means focusing on groups of people rather than single individuals.

Public health is about HEALTH.
This means the broadest possible view of what makes and keeps us healthy including our mental health, everyday health choices, and our surroundings – not just health care services.

Public health is about LOCAL NEEDS.
This means identifying what a community needs to improve health and assuring effective action which uses local assets to solve unique challenges.

Question 3

What’s the difference between basic,clinical and public health

Answer 3

Who/What
is studied
For basic health it’s Cells, tissues,
animals
laboratory
For clinical health it’s
Patient seeking for health services attendance
For public health it’s
Populations or communities

Activity or research goal:

For basic health it’s,
Understand the mechanisms of disease and the effects of toxic substances

For clinical it’s,
Improve the diagnosis and treatment of disease

For public it’s,
Prevention of disease and health promotion

Examples:
Basic-
Toxicology,
inmunology
Clinical-
Pediatric and clinical nursing
Public -
Epidemiology,
Environmental Sciences

Question 4

State and explain seven functions of public health

Answer 4

Public Health Functions (I)
•Surveillance, analysis and evaluation of population’s health status: Monitor health status to identify population or community health problems
•Diagnose and investigate health problems and health hazards in the community
•Monitor environmental and health status to identify and solve community environmental health problems
•Diagnose and investigate environmental health problems and health hazards in the community
•Act as quickly as possible with efficacy in solving and improving these problems

2.Develop policies and plans that support individual and community health efforts:
Once the health problem is identified, public health seeks the best interventions and strategies to solve the public health problem and identify health and/or social actors or agents that can be carried out in the best way possible
Example:
Identify effective policies that reduce the number of smokers in the society

3.Health Promotion:This is a public health function that tries to promote the health of the population, educating in health from the different health, education and mass media facilites

Example:
Implementation of preventive measures to advantage smoking - free areas,

4.Disease Prevention:
There are two strategies to address diseases prevention, the high risk approach an the population approach:

•High risk approach
The high risk approach is aimed at individuals particularly predisposed to an illness and an individual prevention manner is offered to them
•Population approach
The population approach attempt to control the factors of the population as a whole without focus ing on a specific collective matter

There are three levels of prevention
•Primary Prevention: to intervene before a disease appears
•Secondary Prevention: to intervene in pre-symptomatic phases
•Tertiary Prevention: to intervene when the individual is already ill. Try to mitigate the effects of disease

5.To develop effective programs and health facilities to protect health:
The development and implementation of programmes that promote health improvement of the population as a whole, with the condition that they are based on efficacy scientific evidence based and that they help to increase the population’s quality of life

Example:
To develop health programmes aimed at helping smokers to give up smoking and health facilities with this specific function

6. •Evaluation of public health policies, strategies and facilities:
   Having just implemented, whatever process included in society to solve or improve the health problems must be evaluated, to check its right performance and functioning and analyse if it is associated with an improvement of the health problems for which were developed

.Prevents epidemics and the spread of disease

•Protects against environmental hazards

•Responds to disasters and assists communities in recovery

Prevents injuries

•Promotes healthy behaviors

•Assures the quality and accessibility of health services

Question 5

What is a public health system
Who are the workforce of the public health system

Answer 5

A Public Health System
•Who?
–Public entities
–Private entities
–Voluntary entities
(
MCOs
Home Health
Parks
Economic Development
Mass Transit
Employers
Nursing Homes
Mental Health
Drug Treatment
Civic Groups
CHCs
Laboratory Facilities
Hospitals
EMS
Community Centers
Doctors
Health Department
Churches
Philanthropist
Elected Officials
Tribal Health
Schools
Police
Fire
Corrections
Environmental )

•What?
–A network

Workforce
•Diverse and Multidisciplinary
•Examples…

         Biostatisticians
 
        Dieticians
 
        Environmental Health Specialists
 
        Behavioral Health Specialists

Question 6

What are the core components of a public health system
State the essential services of a public health system

Answer 6

ASSESSMENT
•of the health of the community

POLICY DEVELOPMENT
in the public’s interest

Assurance
of the publics interest

Services:

1.Monitor health status to identify community health problems

2.Diagnose and investigate health problems and health hazards in the community

3. Inform, educate, and empower people about
   health issues
4. Mobilize community partnerships to identify and solve health problems
5. Develop policies and plans that support health efforts

6.Enforce laws and regulations that protect health and ensure safety
7.Link people to personnel health services and assure the provision of health care
8.Assure a competent public health and health care workforce
9.Evaluate the effectiveness, accessibility, and quality of services
10. Research for new insights and innovative solutions to health problems

Question 7

State five determinants of health
State the difference between the public health approach and the medical approach

Answer 7

Determinants of Health
•Genetic
•Behavioral
•Social
•Environmental: Rain fall and climate can affect food supply under environment as a determinant of health
•Personal health care

Public health stresses the prevention of disease, while medicine deals with the prevention, diagnosis, and treatment of individuals.

Question 8

Explain the concept of agent host environment (concept of disease causation
Know the under 5 vaccines and when they are given

Answer 8

The triangular model was developed for infectious diseases.
•Disease spread requires a susceptible host and an infective agent, in an environment that brings them together:

Agent:
–virulence, infectivity of a pathogen; addictive qualities of substance of abuse,a host refers to organisms that carry diseases
•Environment:
–sanitary conditions; social context; availability of health care
Or environment refers to conditions that make it conducive for the agent to get into the host
•Host:
–Genetic susceptibility; resiliency; nutritional status; behaviour
Host is the habitat the agent lives in

Question 9

What is a population
What is an epidemic
Pandemic
Endemic
Know the diseases that are pandemic,endemic,epidemic

Answer 9

Definition of population (Merriam Webster)
•the whole number of people or inhabitants in a country or region
•the total of individuals occupying an area or making up a whole
•a group of individual persons, objects, or items from which samples are taken for statistical measurement

A disease is an epidemic when it occurs in a large number of people in a population at the same time
–A pandemic is widespread, usually worldwide
•An endemic disease is constantly present in a population, usually at low incidences(malaria is endemic in Africa or sub Saharan Africa)

Question 10

What are the goals of medicine
What is preventive medicine

Answer 10

Preventive medicine
•The goals of medicine are to promote health, to preserve health, to restore health when it is impaired, and to minimize suffering and distress.
•These goals are embodied in the word “prevention”

What is prevention?
•Actions aimed at eradicating, eliminating or minimizing the impact of disease and disability, or if none of these are feasible, retarding the progress of the disease and disability.
Concept of prevention:
•It is best defined in the context of levels, traditionally called primary, secondary and tertiary prevention. A fourth level, called primordial prevention, was later added.

Question 11

What are the determinants of prevention

Answer 11

Determinants of Prevention
•Successful prevention depends upon:
–a knowledge of causation,
–dynamics of transmission,
–identification of risk factors and risk groups,
–availability of prophylactic or early detection and treatment measures,
–an organization for applying these measures to appropriate persons or groups, and
–continuous evaluation of and development of procedures applied

Question 12

State five preventable causes of disease
(BEINGS)

Answer 12

Preventable Causes of Disease
•Biological factors and Behavioral Factors
•Environmental factors
•Immunologic factors
•Nutritional factors
•Genetic factors
•Services, Social factors, and Spiritual factors

Question 13

Explain Leavell’s levels of protection

Answer 13

Stage of disease
Pre-disease

Level of prevention
Primary

Type of response
Health promotion and specific protection

Stage of disease:
Latent disease

Level of protection:
Secondary prevention

Type of response :
Pre symptomatic
Diagnosis and treatment

Stage of disease
Symptomatic disease

Level of prevention
Tertiary prevention

Type of response
Disability limitation for
early symptomatic disease
•Rehabilitation for late
Symptomatic disease

Question 14

What are the levels of protection

Answer 14

Primordial prevention
Primary prevention
Secondary prevention
Tertiary prevention

Question 15

Explain primordial prevention

Answer 15

It’s the underlying condition leading to causation
Example exposure to HPV causing STI can cause cervical cancer so you can take HPV vaccines to prevent cervical cancer

Primordial prevention consists of actions and measures that inhibit the emergence of risk factors in the form of environmental, economic, social, and behavioral conditions and cultural patterns of living.

is the prevention of the emergence or development of risk factors in countries or population groups in which they have not yet appeared

•For example, many adult health problems (e.g., obesity, hypertension) have their early origins in childhood, because this is the time when lifestyles are formed (for example, smoking, eating patterns, physical exercise).

In primordial prevention, efforts are directed towards discouraging children from adopting harmful lifestyles

•The main intervention in primordial prevention is through individual and mass education

Question 16

Explain primary prevention
What does it include
What does it signify
How can it be accomplished
How is primary prevention achieved

Answer 16

Primary prevention can be defined as the action taken prior to the onset of disease, which removes the possibility that the disease will ever occur.
•It signifies intervention in the pre-pathogenesis phase of a disease or health problem.
•Primary prevention may be accomplished by measures of “Health promotion” and “specific protection”

It includes the concept of “positive health”, a concept that encourages achievement and maintenance of “an acceptable level of health that will enable every individual to lead a socially and economically productive life”.
•Primary prevention may be accomplished by measures designed to promote general health and well-being, and quality of life of people or by specific protective measures.

Primary prevention is achieved by health promotion (health education,environmental modifications,nutritional interventions,lifestyle and behavioural changes ) and specific protection(Immunization and seroprophylaxis,chemoprophylaxis,Use of specific nutrients or supplementations,Protection against occupational hazards,Safety of drugs and foods,Control of environmental hazards,e.g. air pollution

Question 17

Explain the primary prevention approaches
Give an e ample of primary prevention

Answer 17

Primary Prevention Approaches
•The WHO has recommended the following approaches for the primary prevention of chronic diseases where the risk factors are established:

–a. Population (mass) strategy
–b. High -risk strategy

Population (mass) strategy
•“Population strategy” is directed at the whole population irrespective of individual risk levels.

•For example, studies have shown that even a small reduction in the average blood pressure or serum cholesterol of a population would produce a large reduction in the incidence of cardiovascular disease

•The population approach is directed towards socio-economic, behavioral and lifestyle changes

High -risk strategy
•The high -risk strategy aims to bring preventive care to individuals at special risk.

•This requires detection of individuals at high risk by the optimum use of clinical methods.

Example: quarantine of sick people preventing a person from getting in contact w the causal factor
And making HIV people wear condoms to prevent their viral load form increasing if they end up sleeping with people who also have HIV but they’re not aware and to prevent them from giving it to other

Question 18

Explain secondary prevention
What are the specific interventions in sec prevention
According to WHO what is early detection of health disorders

Answer 18

Secondary prevention I
•It is defined as “ action which halts the progress of a disease at its incipient stage and prevents complications.”
Sec prevention an example is seeing the physician when you’re sick to prevent it from getting worse

•The specific interventions are: early diagnosis (e.g. screening tests, and case finding programmes) and adequate treatment.

•Secondary prevention attempts to arrest the disease process, restore health by seeking out unrecognized disease and treating it before irreversible pathological changes take place, and reverse communicability of infectious diseases.

•It thus protects others in the community from acquiring the infection and thus provide at once secondary prevention for the infected ones and primary prevention for their potential contacts.

Early diagnosis and treatment
•WHO Expert Committee in 1973 defined early detection of health disorders as “ the detection of disturbances of homoeostatic and compensatory mechanism while biochemical, morphological and functional changes are still reversible.”

•The earlier the disease is diagnosed, and treated the better it is for prognosis of the case and in the prevention of the occurrence of other secondary cases.

Question 19

Explain tertiary prevention
What interventions should be accomplished in the stage of tertiary prevention
What is the disability limitation

Answer 19

Tertiary prevention
•It is used when the disease process has advanced beyond its early stages.
•It is defined as “all the measures available to reduce or limit impairments and disabilities, and to promote the patients’ adjustment to irremediable conditions.”
•Intervention that should be accomplished in the stage of tertiary prevention are disability limitation, and rehabilitation.

Disease can cause impairment,impairment can cause disability,disability can cause someone to be handicapped

Question 20

What is impairment,handicap,disability,rehabilitation

Answer 20

Impairment
•Impairment is “any loss or abnormality of psychological, physiological or anatomical structure or function.”

Disability
•Disability is “any restriction or lack of ability to perform an activity in the manner or within the range considered normal for the human being.”

Handicap
•Handicap is termed as “a disadvantage for a given individual, resulting from an impairment or disability, that limits or prevents the fulfillment of a role in the community that is normal (depending on age, sex, and social and cultural factors) for that individual.”

Rehabilitation I
•Rehabilitation is “ the combined and coordinated use of medical, social, educational, and vocational measures for training and retraining the individual to the highest possible level of functional ability.”
(Medical rehabilitation,social rehab,vocational rehab,psychological rehab)

Question 21

What is the strategy for prevention

Answer 21

Strategy for Prevention:

Identify
Populations
at High
Disease Risk
(based on demography /
family history,
host factors..)

2.Assess Exposure

3.Conduct Research on
Mechanisms
(including the study of
genetic susceptibility)

4. Apply
   Population-Based
   Intervention
   Programs
5. Evaluate intervention programs
6. Modify existing intervention programs

Question 22

What is the concept of control And state five things it is aimed at reducing

Answer 22

Concept of control:
The term disease control describes ongoing operations aimed at reducing:
–The incidence of disease
–The duration of disease and consequently the risk of transmission
–The effects of infection, including both the physical and psychosocial complications
–The financial burden to the community.

Question 23

Control activities focus on what kinds of prevention
Explain disease eradication

Answer 23

Control activities focus on primary prevention or secondary prevention, but most programs combine both.

Control leads to elimination which leads to eradication

Disease Elimination
•Between control and eradication, an intermediate goal has been described, called “regional elimination”
•The term “elimination” is used to describe interruption of transmission of disease, as for example, elimination of measles, polio and diphtheria from large geographic regions or areas
•Regional elimination is now seen as an important precursor of eradication

Question 24

Explain disease eradication

Answer 24

Disease Eradication
•Eradication literally means to “tear out by roots”.

•It is the process of “Termination of all transmission of infection by extermination of the infectious agent through surveillance and containment”.

•Eradication is an absolute process, an “all or none” phenomenon, restricted to termination of an infection from the whole world. It implies that disease will no longer occur in a population.
•To-date, only one disease has been eradicated, that is smallpox.

Question 25

Explain monitoring

Answer 25

Monitoring
•Monitoring is “the performance and analysis of routine measurements aimed at detecting changes in the environment or health status of population” (Thus we have monitoring of air pollution, water quality, growth and nutritional status, etc).

•It also refers to on -going measurement of performance of a health service or a health professional, or of the extent to which patients comply with or adhere to advice from health professionals.

Question 26

Explain surveillance
What are the main objectives of surveillance

Answer 26

Surveillance
•surveillance means to watch over with great attention, authority and often with suspicion
•According to another, surveillance is defined as “the continuous scrutiny (inspection) of the factors that determine the occurrence and distribution of disease and other conditions of ill-health”

The main objectives of surveillance are:
–(a) to provide information about new and changing trends in the health status of a population, e.g., morbidity, mortality, nutritional status or other indicators and environmental hazards, health practices and other factors that may affect health

–(b) to provide feed-back which may be expected to modify the policy and the system itself and lead to redefinition of objectives, and

–(c) provide timely warning of public health disasters so that interventions can be mobilized.

Question 27

How are infectious diseases controlled

Answer 27

The 4Cs
Cases:
Diagnosis
notification
isolation(standard,strict,protective)
disinfection
treatment
follow up
release

Contacts-observation
Carriers-Detection
Community -Epidemiological investigation and containment

Question 28

State six achievements of public health

Answer 28

Achievements
•Vaccination

•Safer Workplaces

•Safer & Healthier Food

•Motor Vehicle Safety

Control of Infectious Diseases

•Family Planning

•Decline in Deaths from Heart Disease & Stroke

Recognition of Tobacco Use as a Health Hazard

•Healthier Mothers and Babies

•Fluoridation of Drinking Water

Question 29

Explain evaluation of control

Answer 29

Evaluation of control
•Evaluation is the process by which results are compared with the intended objectives, or more simply the assessment of how well a program is performing.
•
•Evaluation should always be considered during the planning and implementation stages of a program or activity.

•Evaluation may be crucial in identifying the health benefits derived (impact on morbidity, mortality, sequelae, patient satisfaction).

•Evaluation can be useful inidentifying performance difficulties.

•Evaluation studies may also be carried out to generate information for other purposes, e.g., to attract attention to a problem, extension of control activities, training and patient management, etc.