CPH REVIEWER

Community and Public Health Concepts

Early Concepts of Disease

HUNTER-GATHERERS
- About 10,00 years ago, humans were Hunter-Gatherers.
- They had a short life span, not because of epidemics or illnesses.
- Their primary problem was finding enough food to eat (Cause of death).
- They lived and traveled in small groups and hunted and foraged for food.
- They barely have problems accumulating waste and with contaminated water and food
because they move a lot.

MYTHOLOGY, SUPERSTITION, RELIGION

- Primitive people believed in natural spirits that were sometimes mischievous or vengeful.
- The Greeks believed that the God Jupiter was angry about man accepting the gift of fire.
- Pandora opened the box made by Zeus, and all of the ills of the world flew out and
spread throughout the human world.

Little story:
Zeus crammed all diseases, sorrows, vices, and crimes that afflict humanity into a box. The box
was given to Epimetheus (husband of Pandora). Pandora was curious about what was inside
the box, Pandora waited for her husband to die before opening it. She opened the box, and
every disease, sorrow, vice, and crime spread.

THE AGRICULTURAL REVOLUTION

- From hunter mode to agricultural mode; this mode provided a secure supply of food and
enabled the expansion of the population.
- Domesticated animals provided not only food and labor; they also carried diseases that
could be transmitted to humans.
- People back then heavily relied on 1–2 crops, so their dytes(?) were often lacking in
protein, minerals, and vitamins.
- There was more opportunity for transmission of diseases.
- Garbage and waste accumulated, and rodents and insect vectors were attracted to
human settlements, providing a source of diseases.

THE HIPPOCRATIC CORPUS

- For many centuries, explanations of disease were based not on science but as an
imbalance of man.
- This is an early attempt to think about diseases, not as punishment from the gods, but as
an imbalance of man with the environment.
- This opened up the possibility of intervening to prevent disease or treat it

THE BUBONIC PLAGUE (1347- 1700S)

- Acute infectious disease, also called “Black death."
- This was caused by garbage. Garbage wasn’t disposed of properly, which attracted rats,
enabled the population to explode, and harbored the bacteria Yersinia pestis. Harbored
it for many years without major difficulty and plague epidemics in humans until human
behaviours created environments that brought people in proximity with the rats and
bacteria.
● Caused by Yersinia pestis (Bacterias are located at the inside of Fleas)
● Fleas: vectors
● Rats: natural reservoir
● Physical signs:
● Dark, tender, swollen nodules (buboes)
Miasmas theory
- Believed to be the cause of the plague.
- The invisible vapor that emanates from swamps or water areas and floods around the air
where they can be inhaled.
● Person-to-person contact
● Too much sun exposure
● Intentional poisoning

During the bubonic plague, this is when quarantine and isolations were implemented.

QUARANTINE & ISOLATION

• Travelers and merchandise that had potentially been exposed were isolated for a period of
time to ensure that they were not infected
• Italian word quarantena ~ 40- day period
• Quarantine: separation of an individual who has possibly been exposed to disease
• Isolation: separation of a person who has the disease

JOHN GRAUNT – THE BILLS OF MORTALITY (1662)

- Observations regarding common causes of death, higher death rates in men, seasonal
variation in death rates, and the fact that some diseases had relatively constant death
rates while others varied considerably.
- Estimated population size and rates of population growth.
- First, construct a “life table” in order to address the issue of survival from the time of
birth.

ANTON VAN LEEUWENHOEK (1670S)

- Father of Microscopy.
- Invented the microscope.
- First to see bacteria, yeast, protozoa, sperm cells, and RBCs.

JOHN PRINGLE & “JAIL FEVER” (1740S)

- A Scottish physician to the British forces. During the war of Austrian succession..
- He proposed a number of measures aimed at improving the health of soldiers, including
improvements in hospital ventilation and camp sanitation, proper drainage, adequate
latrines, and the avoidance of marshes.
- He wrote expensively on the importance of hygiene to prevent typhus or jail fever.
- Created the word influenza.

JAMES LIND & SCURVY (1754)

- James Lind suspected that citrus fruits could prevent scurvy based on some anecdotal
observations.
- Scurvy was a huge problem in sailors several centuries ago, because of the chronic lack
of fresh fruit and vegetables during long sea voyages
- Scurvy is a disease due to a deficiency in vitamin C due to weak connective tissues.

FRANCOIS BROUSSAIS & PIERRE LOUIS (1832)

- Francois Broussais was a prominent Parisian physician and a strong proponent of
bloodletting with leeches.
- He uses bloodletting to treat many diseases, including cholera.
- Pierre Louis was a contemporary of Broussais’ who believed in using numerical methods
to evaluate treatment.
- Louis studied bloodletting and found it ineffective.

IGNAS SEMMELWEIS & OLIVER WENDELL HOLMES (1840S)

- Postpartum sepsis (puerperal fever) was a common occurrence and was invariably
fatal.
 - Ignas Semmelweis required all attendants to wash their hands with chlorinated water to
control the spread of infection.

- Oliver Wendell Homes Sr. advocated for medical reforms and was a strong proponent
of the idea that doctors and nurses could carry puerperal fever from patient to patient.
- He presented a paper entitled “The Contagiousness of Puerperal Fever” at the Boston
Society for Medical Improvement

JOHN SNOW – FATHER OF EPIDEMIOLOGY

- He proposed a new hypothesis for how cholera was transmitted.
- Cholera is an infectious disease caused by Vibrio cholorae and became a major of threat
to the U.S. and Europe during 1800s.
- He tested this hypothesis systematically by making comparisons between groups of
people.
- He provided evidence for an association between drinking from the Broad St. well and
getting cholera
- He argued for an intervention which prevented additional cases (removal of the pump
handle)

THE SANITARY IDEA (1850-1875)

- In 1842, Edwin Chadwick, published a report entitled “Report into the Sanitary
Conditions of the Labouring Population of Great Britain” he proved that life expectancy
was much lower in towns than in the countryside.

- He was instrumental in creating a central public health administration that paved the way
for drainage, sewers, garbage disposal, regulation of housing, and regulations regarding
nuisances and offensive trades.

LOUIS PASTEUR (LATE 1800)

- He studied fermentation in wine and beer.
- He established by Pasteurization that microbes in milk or dairy products could be killed
by heating it to about 130 degrees Fahrenheit.
- He discovered that some microorganisms require oxygen, while others reproduce in the
absence of oxygen.
- He pioneered the idea of artificially generating weakened microorganisms as vaccines.
Aerobic- requires oxygen
Anaerobic - does not require oxygen.

PUBLIC HEALTH

1920 – CHARLES EDWARD A. WINSLOW

- 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 principles of
personal hygiene, the organization of medical and nursing 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.

STRATEGY IMPLOYED BY THE PUBLIC HEALTH

● Identify and define health problems
● Identify the determinants
● Develop and test interventions to control or prevent the problem
● Decline in death from cardiovascular disease
● Improvements in maternal and child health
● Family planning
● Fluoridation of drinking water
● Reductions in prevalence of tobacco use
CORE FUNCTIONS OF PUBLIC HEALTH
• Providing leadership on matters critical to health and engaging in partnerships where
joint action is needed.
• Shaping a research agenda and stimulation the generation, translation, and
dissemination of valuable knowledge.
• Setting norms and standard and promoting and monitoring their implementation.
• Articulation ethical and evidence- based policy options.
• Monitoring the health situation and assessing health trends.

Public health surveillance programs can:

• Serve as an early warning system for impending public health emergencies.
• Document the impact of an intervention, or track progress towards specified goals.
• Monitor and clarify the epidemiology of health problems, allow priorities to be set, and
inform health policy and strategies.
• Diagnose, investigate, and monitor health problems and health hazard of the
community.

CONTRIBUTION OF PUBLIC HEALTH TO MEDICAL CARE

• Assessing current services and evaluating whether they are meeting the objectives of
the health care system.
• Ascertaining requirements as expressed by health professionals, the public and other
stakeholders.
• Identifying the most appropriate interventions
• Considering the effect on resources for proposed interventions and assessing their
cost-effectiveness.
• Supporting decision-making in health care and planning health services including any
necessary changes.
• Informing, educating, and empowering people about health issues.

COMMUNITY HEALTH
- A community is a group of people who share a common place, experience, or interest.
These are people who live in the same are like a city, town, state, or country.

According to WHO,
- Community Health: Environmental, social, and economic resources are needed to
sustain emotional and physical well-being among people in ways that advance their
aspirations and satisfy their needs in their unique environment.
CATEGORIES OF COMMUNITY HEALTH
1. Primary healthcare/primary prevention
- Early avoidance and identification of risk factors that may lead to certain diseases and
disabilities.
- Examples: Immunizations, classroom teaching, awareness campaigns.
- Interventions during/when the disease hasn’t taken place yet.

2. Secondary healthcare and secondary prevention

- Improvements made in a patient’s lifestyle or environment after the onset of diseases or
disability.
- It makes the life of the patient easier.

3. Tertiary healthcare
- Patients need to be referred to specialists and undergo advanced medical treatment

POPULATION HEALTH VS INDIVIDUAL HEALTH

POPULATION HEALTH
- Refers to the health of the people or community.

➢Under Public health

➢Disease prevalence - the number of individuals within a population who have a particular
disease at a given time.
➢Disease incidence - the number of new cases of a particular disease in a population in a
given time period.

INDIVIDUAL HEALTH
- Deals with the medicine area.
➢ Under Medicine

PREVENTION VS TREATMENT AND CARE

PREVENTION
➢ Under Public health

TREATMENT AND CARE

➢ Under medicine

COMMUNITY ORGANIZATION
- A democratic instrument to create and sustain social change.
- Also defined as the process by which a community identifies needs, takes action and by
doing so develops cooperative attitudes and practices.
- Covers a series of activities at the community level aimed at bringing about desired
improvement in the social well-being of individuals, groups, and neighborhoods.
- Community work, community development, and community mobilization.