COMMUNITY & PUBLIC HEALTH • Health status of a community is associated with

a number of factors such as health care access,

Community, defined (based on attributes)
economic conditions, social and environment
• A collection of people who interact with one issues as well as cultural practices.
another and whose common interests or
• OLOF (individuals, families, communities)
characteristics form the basis for a sense of
unity or belonging (Allender, 2009)

• Group of people who share something in

common and interact with one another and
may share a geographic boundary (Clark, 2008)

• A locality-based entity, composed of systems of

formal organizations reflecting society’s
institutions, informal groups and
aggregates(Goeppinger, 2008)

• A group or collection of locality-based

individuals , interacting in social units and
sharing common interests, characteristics,
values, and/or goals (Famorca,et al.,2013)

Two main types

• Geopolitical – defined or formed by both

natural and manmade boundaries and include
barangays, municipalities/cities, provinces,
regions, nations; congressional districts and
neighborhoods

• Phenomenological – relational, interactive

groups, in which the place or setting is more
abstract, and people share a group perspective
or identity based on culture, values, interests,
goals. Also described as functional; Examples
are schools, churches, groups/organizations

• Rural, Urban, Suburban; Rurban

Other related terms

• Population – group of people having common

personal/environmental characteristics

• Aggregates – subgroups or subpopulations that Characteristics of a Healthy Community

have some common characteristics or concerns
(Clark, 2008) 1. Awareness that “we are a community”

Health is the goal of Public Health 2. Conservation of natural resources

• State of complete physical, mental, and social 3. Recognition of and respect for the existence of sub
well-being and not merely the absence of groups
disease or infirmity (WHO, 1958)
4. Participation of subgroups in community affairs
• The extent to which an individual or group is
5. Preparation to meet crises
able, on the one hand, to realize aspirations and
satisfy needs; and, on the other hand, to change 6. Ability to solve problems
or cope with the environment.
7. Resources available to all
Health is therefore seen as a resource for everyday life,
8. Communication through open channels
not the objective of living; it is a positive concept
emphasizing social and personal resources, and physical 9. Settling disputes through legitimate mechanisms
capacities (WHO, 1986
10. Participation by citizens in decision making
Community Health
11. Wellness of a high degree among its members
Public Health Assure competent public
health and personal
“ science and art of preventing disease, prolonging life, healthcare workforce
and promoting health and efficiency through organized Evaluate effectiveness,
community effort”(Winslow, 1920) accessibility and quality of
personal and population-
Refer to p.5, Intro to Public Health by Schneider
based health services
“fulfilling society’s interest in assuring cnditions in
which people can be healthy” (IOM,1988)`` SERVING ALL FUNCTIONS Research for new insights
and innovative solutions to
“dedicated to the common attainment of the highest health problems
level of physical, mental , and social well-beng and
longevity consistent with available knowledge and
resources at any given time and place (Hanlon,1984)
Five step process of PH approach to health problems
What is Public Health? in the community

Core Functions of Public Health Define the health problem

• Assessment
Identify the risk factors associated with the
• Policy Development problem.
• Assurance
Develop and test community-level interventions to
Focus of Public Health control or prevent the cause of the problem.

• Prevention Implement interventions to improve the health of

the population.
• Intervention
Monitor those interventions to assess their
effectiveness.

TEN ESSENTIAL PUBLIC

HEALTH SERVICES Elected Features of Public Health
CORE FUNCTIONS SERVICES
• Basis in social justice philosophy
ASSESSMENT Monitor health status to
identify community health • Inherently political nature
problems
• Dynamic, ever-expanding agenda
Diagnose and investigate
health problems and health • Grounding in the sciences
hazards in the community.
• Use of prevention as a prime strategy
POLICY DEVELOPMENT Inform, educate, and
• Uncommon culture and bond
empower people about
health issues. Philippine Healthcare Delivery System

Mobilize community
partnerships to identify
and solve health problems.

Develop policies and plans

that support individual and
community health efforts.

ASSURANCE Enforce laws and

regulations that protect
health and ensure safety.

Link people to needed

personal health services
and assure the provision of
health care when
otherwise unavailable.
National Objectives for Health • Invest in eHealth and data for decision making
2016-2022
• Enforce standards, accountability and
• “All for Health towards Health for All” transparency

(Lahat Para sa Kalusugan! Tungo sa Kalusugan Para sa • Value clients and patients
Lahat)
Elicit multi-stakeholder support for health
• All Life Stages & Triple Burden of Disease
Advance health promotion, primary care and quality
Pregnant, newborn, infant, child, adolescents, adults
• 1. Annual health visits for all poor families
and elderly
• 2. PhilHealth to contract with functional
• Communicable diseases; Non-
networks* of PCB providers and DOH provide
communicable including malnutrition;
additional resources*
disease of rapid urbanization and
Industrialization • 3. Transform selected DOH hospitals into multi-
specialty, end referral “mega-hospitals”, i.e.
Health Goals to attain SDGs
teaching/training, reference laboratory
• Financial Risk Protection
• 4. Enact/enforce measures to improve access to
– Filipinos, especially the poor are lifesaving interventions and reduce exposure to
protected from high cost of health care risk factors for premature deaths and disability

• Better Health Outcomes • 5. Establishing expert bodies for health

promotion (Public Health Philippines) and
– Filipinos attain the best possible health
surveillance and response (Philippine CDC)
outcomes with no disparity
– *District hospital paired up with 10+
• Responsiveness
RHUs or private clinics *HFEP,
– Filipinos feel respected, valued, and deployment vaccines, medicines,
empowered in all of their interaction trainings
with the health system
Cover all Filipinos against financial health risk
VALUES
• .1. Mobilize more funds Sin Tax | PAGCOR,
• EQUITABLE & INCLUSIVE TO ALL PCSO | Increase Premium | Collection Efficiency

• TRANSPARENT & ACCOUNTABLE • 2. Enroll remaining 8% from non-formal sector

into PhilHealth
• USES RESOURCES EFFICIENTLY
• 3. Expand PhilHealth benefits Outpatient
• PROVIDES HIGH QUALITY SERVICES diagnostics, drugs, blood & blood products
SDN..Services are delivered by networks that are • 4. Recalculate case rates & link payment to
• FULLY FUNCTIONAL (Complete Equipment, quality
Medicines, Health Professional) • 5. Improve contracting and enforce terms
• COMPLIANT WITH CLINICAL PRACTICE Primary care trust fund | Network-based
GUIDELINES contracting

• AVAILABLE 24/7 & EVEN DURING DISASTERS • 1. Publish information that can trigger better
performance • Prices of common drugs and
• PRACTICING GATEKEEPING services • Non-compliant / erring providers •
• LOCATED CLOSE TO THE PEOPLE (Mobile Clinic National Objectives for Health to guide
or Subsidize Transportation Cost) strategies and investments by different
stakeholders
• ENHANCED BY TELEMEDICINE
• 2. Set up dedicated performance monitoring
Health Strategy: unit • Ghost patients and/or surprise visits •
ACHIEVE Medical audits or third-party monitoring
• Advance health promotion, primary care and • 1. Publish information that can trigger better
quality performance • Prices of common drugs and
services • Non-compliant / erring providers •
• Cover all Filipinos against financial health risk
National Objectives for Health to guide
• Harness the power of strategic HRH
 strategies and investments by different • 3. Set up participation & redress mechanism 4.
stakeholders Significantly reduce turnaround time and
improve transparency of processes
• 2. Set up dedicated performance monitoring
unit • Ghost patients and/or surprise visits • Elicit multi-sector, multi-stakeholder support for health
Medical audits or third-party monitoring
1. Harness and align Private Sector in planning SDN,
Harness the power of strategic HRH intervention, and supply side investments

• 1. Make health professions curricula responsive 2. Ensure convergence with other government
to local and global needs agencies in delivering services (DOH, DENR, DSWD,
DepEd)
• 2. Review government HRH compensation
package such that ARMM, IP, GIDA will have – Advocate for Health in All Policies
highest pay
– Multi-sectoral work with different
• 3. Shift to competency versus profession-based agencies to build healthy living,
frontline complement working, schooling environments,
healthy cities, and Health in All Policies
• 4. Provide scholarships, financial incentives
– Mandate Health Impact Assessment for
• 5. Institute return service schemes *clinicians
large-scale, high-risk development
and allied health professionals, managers,
projects, e.g. mining, power plants, oil
researchers and policymakers
rigs
Invest in eHealth and data for decision making
3. Governance
• 1. Require online data* submission as
- Budget Development
requirement for licensing & contracting of
health facilities and drug outlets - Monitoring and Evaluation

• 2. Mandate the use of Electronic Medical Elicit multi-sector, multi-stakeholder support for health
Records (EMR) in all health facilities
1. Harness and align Private Sector in planning SDN,
• 3. Invest in nation-wide surveys, administrative intervention, and supply side investments
data and disease registries
2. Ensure convergence with other government
• 4. Automate major business processes agencies in delivering services (DOH, DENR, DSWD,
DepEd)
• 5. Facilitate open access to anonymized data
– Advocate for Health in All Policies
* clinical and administrative
– Multi-sectoral work with different
Enforce standards, accountability and transparency
agencies to build healthy living,
1. Publish information that can trigger better working, schooling environments,
performance healthy cities, and Health in All Policies

– Prices of common drugs and services – Mandate Health Impact Assessment for
large-scale, high-risk development
– Non-compliant / erring providers projects, e.g. mining, power plants, oil
– National Objectives for Health to guide rigs
strategies and investments by different 3. Governance
stakeholders
- Budget Development
2. Set up dedicated performance monitoring unit -
Ghost patients and/or surprise visits - Monitoring and Evaluation

- Medical audits or third-party monitoring History of Public Health, US

Value clients and patients especially the poor and Major Eras
vulnerable
• Prior to 1850 – Battling Epidemics
• 1. Focus all efforts on the poorest 20 million
• 1850-1999 - Building State and Local
Filipinos
Infrastructure
• 2. Make all health entitlements simple and
• After 1999 - Preparing for and responding to
explicit
community health threats
WEEK 2: Models and Frameworks of Public Health

Understanding Influences of
Public Health

HEALTH FIELD CONCEPT

BIOLOGY

ENVIRONMENT

LIFESTYLE (HUMAN BEHAVIOR)

HEALTHCARE ORGANIZATIONS

OLOF
Law of Supply

Like the law of demand, the law of supply demonstrates

the quantities that will be sold at a certain price. But
unlike the law of demand, the supply relationship shows
an upward slope. This means that the higher the price,
the higher the quantity supplied. Producers supply
more at a higher price because selling a higher quantity
at a higher price increases revenue.

• Health Care Economics

– Law of Supply and Demand

– Managed Care Reimbursements

– Gatekeeping

Law of Demand When supply and demand are equal (i.e. when the
supply function and demand function intersect) the
• if all other factors remain equal, the higher the
economy is said to be at equilibrium. At this point, the
price of a good/SERVICE, the less people will
allocation of goods is at its most efficient because the
demand that good. In other words, the higher
amount of goods being supplied is exactly the same as
the price, the lower the quantity demanded.
the amount of goods being demanded.
• People will naturally avoid buying a product
Thus, everyone (individuals, firms, or countries) is
that will force them to forgo the consumption
satisfied with the current economic condition.
of something else they value more.
At the given price, suppliers are selling all the goods
• Demand curve is a downward slope.
that they have produced and consumers are getting all
the goods that they are demanding
 Disease Causation

• Miasmic theory – poor environmental

conditions (polluted water, improper human
waste/garbage disposal); unspecific

• Germ theory – specific microrganism found in

the environment which can be
isolated/identified from the affected host;
specific

• Epidemiological triad – disease occurs in the

presence of three iter-related factors: agent,
host, environment

HEALTHCARE ECONOMICS

Reimbursement in Managed Care

Epidemiological Disease Triad

Understanding Clients (Individual, Family and

Community)

• General Systems Theory

– Open system

– Client is considered as a set of

interacting elements that exchange
energy, matter or information with
external environment to exist

– Individual is a set of several dimensions

that are interdependent and
Drivers interrelated
• Consumer health economics – Family/group/aggregate are sets of
– More practitioners in urban centers interrelated individuals

– Philhealth Reimbursement and Healthcare Behavior

Capitation • Health Belief Model (Hockbaum; Rosenstock)
– HC is both capital and labor intensive – Behavior is a function of health beliefs
– Technology driven care – Influence of different variables on the
• Obsolescence individual’s health related behavior

• Innovation • Perceived Susceptibility, P

Severity, P Benefits, P Barriers;
– Healthcare behavior Cues to Actions and, Self-
efficacy

• Learning theories

– Behavioral: conditioning
 – Cognitive: perceptual thinking,
information processing; metacognition

– Social (Bandura) : behavior adopted

through imitation and modeling but
with cognitive awareness

Community Health Practice

• Primary Health Care

– Concepts and Principles

• Voluntary Community
cooperation/involvement

• MBN as a common social goal

(food, clothing, shelter,
environment, livelihood, health
education Health and Human Development

• PHC --- better quality of Life; as • Ecological Models: Health, Human Development
a strategy differ from village to and Community Ecosystem (evolving…)
village thus must be in
• Integration of social sciences with
harmony with existing
natural sciences
institutions and daily life; as a
public service a) Mandala of Health (Hancock, Perkins and
Welsh, 1980s) major determinants of health as
• Services are Accessible,
bases for teaching
Acceptable, Available and
Affordable; b) Model of Human Development (Hancock, 1989)
Partnership/Linkages between
- 2 principles of PH for “socially sustainable
community and agencies (Gos
development”: ecological sanity and social
and NGOs); Community
justice
Participation and Self reliance;
Social Mobilization; - Economic activity must not only preserve the
Decentralization environment but also preserve and enhance
the social system and strengthen the social
– E-L-E-M-E-N-T-S
resources of a community
Community Health Practice
- c. Health and Community Ecosytem (Hancock,
• Public health model – 1993)

– use of epidemiological concepts but - d. Human Ecosystem model (Hancock, 2000)

with little attention on analyzing social
Community Planning and Development
conditions
• Precede-Proceed Model (Green and Kreuter)
• Health as a Multi-factorial Phenomenon
– HP focused systematic planning that
Disease Prevention
seeks to empower individuals with
• Health Promotion Model (Pender,1996) knowledge, motivation, skills and active
community participation . Copar
– Biopsychosocial influences of health
behavior

• Individual Characteristics and

Experiences

• Behavior-specific cognitions
and affect

• Behavioral Outcome
Human Ecology, Demography and Epidemiology perspectives and to identify groups needing
special attention.
Human Ecology
 Study work of health services with a view of
 Interrelationship of organisms and their
improving them
environments
 Estimate risk of disease, accidents, defects and
 Totality of pattern of relations between
chances of avoiding them
organisms (human beings) and their
environment  Identify syndromes by describing distribution
and association of clinical phenomena in
Environment
population
 Circumstances, objects or conditions by which
 Complete clinical picture of chronic diseases
one is surrounded
and describe their natural history
 Complex of physical, chemical and biotic factors
 Search for causes of health and disease by
(climate, soil, and living things) that act upon an
comparing experience of groups and clearly
organism or an ecological community and
defined by their composition, inheritance,
ultimately determine its form and survival
experience, behavior and environments
 Aggregate of social and cultural conditions that
EPIDEMIOLOGY
influence the life of an individual or community
 Deals with
Human Demography
◦ Distribution of disease/health status of
 Statistical study of human populations
populations in terms of age, gender,
especially with reference to its size and density
race, geography and time
Epidemiology
◦ Causation of disease – explanations of
 Deals with the incidence, distribution and the patterns of causal factors
control of disease in a population
◦ Natural history of disease
 The sum of the factors controlling the presence
◦ Evaluation of health interventions
or absence of a disease or pathogen
Epidemiology and Surveillance
Historical background
 Established in regional and some local health
 Hippocrates’ observation that environmental
agencies
factors influence the occurrence of disease
(2000 years back)  Mainly responsible for providing timely and
accurate information on diseases within a
 John Snow studies (1848-1854)
locality
 Richard Doll and Andrew Hill –relationship
between tobacco use and other possible factors ◦ Infectious diseases with outbreak
to lung cancer using long term cohort studies. potential

Scope and Importance ◦ Assisting LGUs during outbreak

(control)
 Focus on population – one selected from
specific area or country at a specific time ◦ Providing information package and
technical assistance
 Tool for improving public health, backbone of
disease PREVENTION  Types of Surveillance

Epidemiology 1. Public health – on-going systematic collection,

analysis , interpretation and dissemination of
Uses (Morris) health data
 Study history of a health population and rise 2. Surveillance system – information loops or
and fall of diseases and changes in their cycles involving healthcare providers, public
character health agencies and the public;
 Diagnose health of community and condition of - reporting of cases and feedback of
people to measure distribution of illness in surveillance information
terms of incidence, prevalence, disability and
mortality, to set health problems in
Epidemiological Studies  Persons – age, sex and occupation

Classification  Place – urban/rural, socio-economic areas

A. Approach to Observation Factors that contribute to epidemic occurrence:

1. Prospective 1. Agent – new, changes in the number of living

organisms
Forward, vertical perspective; e.g. cohort study
2. Host – lower resistance during disasters; water
Show cause and effect
and milk supply; sewage disposal, changes in
Study certain groups over a period of time eating habits

2. Retrospective 3. Environment – changes in physical environment

including temperature, humidity, rainfall which
past events, records of past epidemiological directly or indirectly influence equilibrium of
investigation the agent and host
Not show cause and effect Basic determinants and Health Problems
3. Cross-sectional Health Profile
horizontal, e.g. Prevalence study  Demographic data to determine the nature and
Show level of occurrence extent of public health problems-

4. Case control Info on who are affected; whereabouts

Has positive and negative exposure to dse agents ◦ 62.8% rural in 1980 distributed among
13 regions including NCR
Combination e.g. experimental, quasi-experimental
◦ Urban population grew from 37.2% in
Diseases under Surveillance 1980 to 48.60% in 1990 and 54.1% in
A. Laboratory diagnosed – cholera, Hep A and 1995
Hepa B, malaria, typhoid fever ◦ 1/3 of the population can be found in
B. Clinically diagnosed – dengue hemorrhagic key cities including Cebu, Iloilo, CDO,
fever, diptheriae, measles, meningococcal dse, Davao, General Santos, NCR
neonatal tetanus, pertussis, rabies, leptospirosis
◦ Areas proximal to these cities are also
and poliomyelitis (acute flaccid paralysis)
urbanizing such as northern and
B. Dses based on pattern of occurrence and distribution southern Luzon

1. Sporadic – intermittent occurrence of few ◦ Morbidity and mortality data (adult,

isolated and unrelated cases in a given locality; infant and maternal forms
e.g. rabies in the Phils.
◦ Morbidity and mortality indicate the state of
2. Endemic – continuous occurrence throughout a health of a community and success or failure of
period of time of the usual number of cases in a health interventions
given locality; e.g. Schistosomiasis
◦ Age and sex distribution
3. Epidemic – unusually large number of cases in a
◦ As reported by DOH, influenza,
relatively short period of time
pneumonia, diarrhea and bronchitis
4. Pandemic – simultaneous occurrence of disease remain the top 5 leading causes of
epidemic in several countries; of international morbidity
perspective
◦ Malaria is re-emerging
Epidemiological triangle
◦ Infectious but preventable dses of
Three (3) components poverty and underdevelopment
Agent, Non-communicable (dses of the heart and malignant
neoplasms are on the rise)
Host,
VITAL STATISTICS
Environment
STATISTICS – systematic approach in obtaining,
Epidemiology Variables
organizing and analyzing numerical facts so that
 Time – epidemic period, year conclusion may be drawn from them
  Births Neonatal Death Rate (NDR) – measures risk of dying
during the first month of life; serves as an index of the
 Marriages, divorce and separation
effects of prenatal care and obstetrical management of
 Illnesses (reportable or under surveillance the newborn

 Deaths Specific Death Rate – describes more accurately the risk

of exposure of certain class/group of population to
Uses particular diseases; render more comparable and thus
 indices of community health status reveal the real problem of public health

 for planning, implementing, monitoring and Incidence Rate (IR) – measures the frequency of
evaluation of public health programs/projects occurrence of the phenomenon during a given period of
time
Sources of data-
Prevalence Rate (PR) – measures the proportion of the
 Population census population which exhibits a particular disease at a
 Registration of vital data particular time; determined through a survey of the
population concerned
 Health surveys
Attack Rate (AR) – more accurate measure of the risk of
 Studies and researches exposure
Key terms and indices in Vital Statistics Swaroop’s Index –proportion of deaths of people aged
50 years and up; estimate of chronic disease.
Rate – relationship between a vital event and those
persons exposed to the occurrence of the vital event -The higher the Swaroop’s index of a population, the
within a given area and during a specified period of greater the proportion of the deaths among those who
time. Ex: prevalence rate were able to reach the age of 50 years.
Ratio – relationship between two numerical qualities or Proportionate Mortality (PM) – death ratios which
measures of events without taking particular shows the numerical relationship between deaths of all
considerations to the place and time causes (or group of causes), age (or group of age) and
the total number of deaths from all causes in all ages
Crude or general – refer to the total living population
taken together
presumed to be exposed to the risk of occurrence of an
event Case Fatality Ratio (CFR) – index of the killing power of
a disease; influenced by incomplete reporting or poor
Specific – relationship for specific class or population
morbidity data
group
Adjusted or Standardized Rate – done to render the rate
of 2 communities comparable; adjustment for the
Crude Birth Rate (CBR) - measurement of the natural differences in age, sex and other factors which influence
growth or increase of the population the vital events; employ these methods:

Crude Death Rate (CDR) – measurement of mortality - by applying observed specific rates to standard
from all causes which may result in a decrease in population
population
- by applying specific rate of std population to
Infant Mortality Rate (IMR) – a measure of the risk of corresponding classes or groups of the local population
dying during the first year of life; good index of the
Ways of presenting data
general condition of a community because it reflects
the changes in the environment and medical condition  Tabular
of a community
 Textual
Maternal Mortality Rate (MMR) – a measure of the risk
of dying from causes related to pregnancy, childbirth  Graphical
and purpuerium; index of obstetrical care needed and line graph…. Trends over a period of time
received by women in a community
bar graph…. Expresses quantity in terms of
Fetal Death Rate (FDR) – measures pregnancy wastage rates or % of a particular observation
or death of a product of conception occurring prior to
its complete expulsion, irrespective f duration of pie chart….. Shows the relative importance of
pregnancy parts to the whole
Assignment:
Formulas; Process of Tabulations

 Formulas

 Parts of a table

 Grouping

◦ Number of groups

◦ Grouping by age

◦ Establishing class intervals; upper and

lower limits

◦ Cross classification

◦ Arrangement of tables