The basic theoretical and organizational principles of modern public health services

1
The basic theoretical and organizational
principles of modern public health services

• Northern-West State Medical University named
  after I.I. Mechnikov
• Department of Public Health and Health Care
• Elena A. Abumuslimova
• Ph.D., Associate Professor

2
The Universal Declaration on Human Rights

• Everyone has a right to a standard of a living
  adequate for the health and well being of himself
  and his family, including food, clothing, housing
  and medical care.
• Universal Declaration of Human Rights, 1946

3

• - What does health mean for you?- Which
  factors are most important
• for health?

4
What is health?
Drugs
Family
Feeling good
Smoking
Older people
Diabetes
Blood pressure
Food safety
Exercise
Positive health
Parenting
Water Fluoridation
Bad Housing
HIV/ AIDS
Heart Disease
Waiting Lists
5
Theories of health

• the theory that health is an ideal state,
• the theory that a person is healthy if she can
  function in a socially useful role,
• the theory that health can be bought or given as
  if it is a commodity,
• the theory that health is an ability or strength
  to adapt to the changing challenges and
  circumstances of life, etc..

6
Defining Health The Medical Definition

• The normal physical state, i.e., the state of
  being whole and free from physical and mental
  disease or pain, so that the parts of the body
  can carry on their proper function.

7
Defining Health The World Health Organization

• Health is a state of complete physical, mental,
  and social well-being and not merely the absence
  of disease and infirmity.
• Health is a positive concept emphasizing personal
  resources, as well as physical capacities.

8
Three Broad Concepts of Health

• Medical (Traditional)
• Behavioural (Lifestyle)
• Socio-Environmental (Structural)
• These approaches lead to different definitions of
  problems, different strategies, different target
  groups, and different people responsible for the
  activities of promoting health.

9
Medical concept
10
Concepts of Health Promotion Medical Approach I
(Traditional, Biomedical)

• Health Concept is biomedical, absence of disease
  and/or disability
• Leading Health Problems defined in terms of
  disease categories and physiological risk factors
  such as physiological deviation from the norm
  CVD, AIDS, diabetes, obesity, arthritis, mental
  disease, hypertension, etc.

11
Concepts of Health Promotion Medical Approach II

• Principal Strategies surgical interventions,
  drug and other therapies, health care, medically
  managed health behaviour change (diet, exercise,
  patient education, patient compliance), screening
  for physiological and genetic risk factors
  
• Target high risk individuals
• General Approach Individualized
• Actors physicians, nurses, allied health workers

12
Behavioural concept
13
(No Transcript)
14
Concepts of Health Promotion Behavioural
Approach I (Lifestyle, Public Health)

• Health Concept is individualized, health as
  energy, functional ability, disease-preventing
  lifestyles
• Leading Health Problems defined in terms of
  behavioural risk factors smoking, poor eating
  habits, lack of fitness, drug abuse, alcohol
  abuse, poor stress coping, lack of life skills,
  etc.

15
Concepts of Health Promotion Behavioural
Approach II

• Principal Strategies health education, social
  marketing, advocacy for public policies
  supporting lifestyle choices (e.g. smoking bans,
  low fat meat production, bicycle paths,
  advertisement bans)
• Target high risk groups, children and youth
• General Approach individualized, elements of
  societal focus as related to public policy
• Actors public health workers, illness-related
  advocacy groups (e.g., Cancer Society),
  governments

16
Socio-Environmental concept
17
Concepts of Health Promotion Socio-Environmental
Approach I (Structural)

• Health Concept is a positive state defined in
  connectedness to one's family/friends/community,
  being in control, ability to do things that
  are important or have meaning,
  community and societal structures supporting
  human development
• Leading Health Problems defined in terms of
  psychosocial risk factors and socio-environmental
  risk conditions poverty, income gap, isolation,
  powerlessness, pollution, stressful environments,
  hazardous living and working conditions, etc.

18
Concepts of Health Promotion Socio-Environmental
Approach II (Structural)

• Principal Strategies small group development,
  community development, coalition building,
  political action and advocacy, societal change
• Target high risk societal conditions
• General Approach structural, focussed on
  organization of communities and society,
  development of just political/economic policies
• Actors citizens, social development and welfare
  organizations, political movements and parties

19
Health Field Concept

• Lifestyle
• Human Biology
• Environment
• Health Care

20
Lifestyle is a main medical-social factor of
health

• Features of a lifestyle
• labour activity and working conditions
• economic - household activity (a kind of
  dwelling, a floor space, a conditions of life,
  time spent for household activity, etc.)
• the recreational activity directed on restoration
  of physical strengths and interaction with an
  environment
• social activity in family (care of children,
  family interrelations)
• family planning and mutual relation of family
  members
• formation of behavioral characteristics and the
  social - psychological status
• medical-social activity (the attitude to health,
  medicine, aiming of healthy lifestyle).

21
Structure of a Lifestyle

• level of living (structure of incomes on the
  person),
• quality of a life (the measured parameters
  describing a degree of social security of the
  person),
• style of a life (psychological specific
  individual features of behavior),
• mode of life (a national - social order of a
  life, a life culture).

22
Lifestyle depends on

• social and economic structure of a society,
• an educational level,
• culture,
• relations among people,
• traditions,
• social installations in family,
• personal characteristics.
• The most part of these factors together with
  hygienic characteristics of being, construct the
  generalized concept "lifestyle" which share of
  influence on health makes more than 50 among
  all factors.

23
Environment

• air quality
• food protection
• radiation protection
• solid waste management
• hazardous waste management
• water quality
• noise control
• environmental control of recreational areas
• housing quality

24
Biological characteristics of a person

• (the sex, age, a heredity, the constitution,
  temperament, adaptable opportunities, etc.) make
  in general share of influence of factors on
  health no more than 20 .

25
Health Care.Health Services Administration/Manage
ment

• Only the insignificant part (8-10 ) parameters
  of health are determined by a level of activity
  of medical institutions and efforts of medical
  workers.

26
Parameters for an estimation of public health
according the WHO

• Deduction of a total national product on public
  health services.
• Availability of the primary medical-social help.
• Coverage of the population by medical aid.
• A level of population immunization.
• A rate of pregnant women observed by qualified
  specialists.
• A quality of food for children.
• A level of children's death rate.
• Average forthcoming life duration.
• Hygienic literacy of the population.

27
Criteria of health

• Medical-demographic (birth rate, death rate, a
  natural increase, infantile death rate, birth
  frequency of the prematurely born children,
  average forthcoming duration)
• Morbidity (general, infectious, with temporary
  disability, according to medical surveys, the
  most important non-communicable diseases,
  hospitalization)
• Primary physical disability
• Indices of physical development
• Indices of mental development.

28
Life Expectancy Map
From Wikipedia
29
Four levels of health

• Health of the separate person - individual
  health
• Health social and ethnic groups - group health
• Health of the population of administrative
  territories - regional health
• Health of a population, a society as a whole -
  public health.

30
Groups of health at complex adults health
estimation

• 1st group - healthy persons (not being ill within
  one year or seldom applying to the doctor and
  without disability)
• 2-nd group - practically healthy persons, with
  functional and some morphological changes or
  seldom being ill within one year (single cases of
  acute diseases)
• 3-d group - patients with frequent acute diseases
  (more than four cases and 40 days of disability
  per year)
• 4-th group - patients with durable chronic
  diseases (the compensated condition)
• 5-n group - patients with often aggravations of
  durable chronic diseases.

31
Most important problems of global health today

• Communicable, maternal, perinatal and nutritional
  conditions
• Noncommunicable diseases
• Injuries

32
The leading individual problems, based on DALYs
(disability-adjusted life years)

• lower respiratory infections
• diarrheal diseases
• conditions arising during the perinatal period
• unipolar major depression
• ischemic heart disease cerebrovascular disease
  
• tuberculosis
• measles
• road traffic accidents
• congenital anomalies
• malaria
• chronic obstructive pulmonary disease
• falls
• anemia iron-deficiency anemia.

33

• Non-communicable diseases are the most widespread
  diseases seen by the majority of medical students
  in their practice.
• We need to work together to share our knowledge
  about these conditions for prevention and cure.

34
What is a health system?
35
What is a health system?

• It is the sum total of all the organizations,
  institutions and resources whose primary purpose
  is to improve health.
• A health system needs staff, funds, information,
  supplies, transport, communications and overall
  guidance and direction. And it needs to provide
  services that are responsive and financially
  fair, while treating people decently.

36
Where is the problem?

• Problems with health systems are not confined to
  poor countries. Some rich countries have large
  populations without access to care because of
  inequitable arrangements for social protection.
  Others are struggling with escalating costs
  because of inefficient use of resources.

37

• " Public health services" means activity on
  preservation, improvement, maintenance and
  strengthening of health of the population various
  groups.
• The optimization of public health system is the
  major part of social - economical policy of the
  State.

38

• Public health professionals try to prevent
  problems from happening or re-occurring through
  implementing educational programs, developing
  policies, administering services, regulating
  health systems and some health professions, and
  conducting research.
• Science of public health is also a field that is
  concerned with limiting health disparities and a
  large part of public health is the fight for
  health care equity, quality, and accessibility.

39
Public health is mainly composed of the following
core areas

• Behavioral Science/Health Education
• Biostatistics
• Emergency Medical Services
• Environmental Health
• Epidemiology
• Health Services Administration/Management
• International/Global Health
• Maternal and Child Health
• Nutrition
• Public Health Laboratory Practice
• Public Health Policy
• Public Health Practice

40
Behavioral Science / Health Education

• Stopping the spread of sexually transmitted
  diseases, such as herpes and HIV/AIDS helping
  youth recognize the dangers of binge drinking
  and promoting seatbelt use.
• Behavioral Science focuses on ways that encourage
  people to make healthy choices. This 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.
• Public health workers also promote more efficient
  uses of health services, adopt self-care
  practices, and participate actively in the design
  and implementation of health programs.

41
Biostatistics

• Estimating the number of deaths from gun violence
  or looking at trends in drunk driving injuries by
  using math and science is the study of
  biostatistics.
• Using biostatistics, health workers can identify
  health trends that lead to life-saving measures
  through the application of statistical
  procedures, techniques, and methodology.

42
Environmental Health

• The air we breathe the water we drink the
  complex interactions between human genetics and
  our surroundings.
• How do the built and natural environments
  influence our health and how can we reduce risk
  factors? These environmental risk factors can
  cause diseases such as asthma, cancer, and food
  poisoning.

43
Epidemiology

• When food poisoning or an influenza outbreak
  attacks a community, the epidemiologists are
  asked to investigate the cause of disease and
  control its spread.
• Epidemiologists do fieldwork to determine what
  causes disease or injury, what the risks are, who
  is at risk, and how to prevent further
  incidences.
• Some of the most important health-related
  discoveries in history are associated with
  epidemiology including the landmark 1964 Surgeon
  General's report on smoking tobacco stating its
  harmful effects.

44
Health Services Administration/Management

• Managing the database at a school clinic
  developing budgets for a health department
  creating polices for health insurance companies
  and directing hospital services all depend on
  health administrators.
• The field of health services administration
  combines politics, business, and science in
  managing the human and fiscal resources needed to
  deliver effective public health services.
  Specialization can be in planning, organization,
  policy formulation and analysis, finance,
  economics, or marketing.

45
International / Global Health

• Globalization has linked our health more closely
  to one another than ever before. The rapid
  movement of people and food across borders means
  that a disease can travel from a remote village
  to an urban hub at breakneck speed. Global public
  health meets the rising health challenges that
  transcend national boundaries. This international
  field encompasses virtually all specializations
  in public health.

46
Maternal and Child Health

• Providing information and access to birth
  control promoting the health of a pregnant woman
  and an unborn child and dispensing vaccinations
  to children are part of maternal and child
  health.
• Professionals in maternal and child health
  improve the public health delivery systems
  specifically for women, children, and their
  families through advocacy, education, and
  research.

47
Nutrition

• Promoting healthy eating and regular exercise
  researching the effect of diet on the elderly
  teaching the dangers of overeating and
  overdieting are the responsibility of public
  health nutritionists.
• In short supply in both public and private
  sectors, this field examines how food and
  nutrients affect the wellness and lifestyle of
  population. Nutrition encompasses the combination
  of education and science to promote health and
  disease prevention.

48
Public Health Policy

• Analyzing the impact of seat belt laws on traffic
  deaths monitoring legislative activity on a bill
  that limits malpractice settlements advocating
  for funding for a teen anti-smoking campaign.
• Professionals in public health policy work to
  improve the public's health through legislative
  action at the local, state, and federal levels.

49
Public Health Practice

• Public health is an interdisciplinary field and
  professionals in many disciplines such as
  nursing, medicine, veterinary medicine,
  dentistry, and pharmacy routinely deal with
  public health issues. A degree in public health
  practice enables clinicians to apply public
  health principles to improve their practice.

50
The major theoretical problems of public health
services

• social conditionality of public health,
• illness as a biosocial phenomenon,
• the basic categories of public health services
  (public health, material - economic base, the
  staff, etc.),
• forms and ways of development of public health
  services under various social and economic
  conditions, etc.

51
The main goals of science on public health and
public health services

• study of medical-social factors, life conditions
  and a lifestyle influence on the public health
• development of scientifically proved
  recommendations on the prevention and elimination
  of adverse factors,
• improving actions for increase of a level of
  health of the population
• an estimation of criteria of public health and
  quality of medical aid, and their optimization.

52
Main directions of development of public health
service at the present stage

• protection of motherhood and the childhood,
• creation of optimum social and economic, legal
  and medical-social conditions for strengthening
  health of women and children,
• planning of family,
• the solving of medical-demographic problems,
• increasing of quality of health care.

53
Four categories of the general indices which
characterize a condition of public health
services in any country according to the World
Health Organization (WHO)

• the governmental policy in the field of public
  health service
• social and economic indices
• indices of security of the medical-social help
• Indices of health status of the population.

54
Structure of a subject Public health and health
care service

• a history of public health services
• theoretical problems of public health services
• the state of health and methods of its studying
• the organization of medical-social security and
  medical insurance
• the organization of medical aid to the
  population
• maintenance of sanitary-and-epidemiologic
  well-being of the population
• Economic forms of perfection of public health
  services, management, marketing and modelling of
  medical services
• the international cooperation in the field of
  medicine and public health services.

55
Methods of medical-social researches

• historical
• dynamic observation and the description
• sanitary statistical method as a basic
• the medical-sociological analysis
• expert estimations expertise assessment method
• the system analysis and modelling
• organizational experiment
• scheduled - normative, etc.

56
Objects of medical -social researches are

• groups of persons, the population of
  administrative territory
• separate establishments (polyclinics, hospitals,
  the diagnostic centres, the specialized
  services)
• public bodies and establishments of public health
  services
• objects of an environment
• the general and specific risk factors of various
  diseases, etc.

57
The basic elements of health complex study and
its determining factors

• collecting of the information on health status
• processing and analysis of the information on
  health status
• promotion of hypothesis about mutual dependence
  of environment factors and health status
• directed study of environment factors and
  profound study of health characteristics
• revealing of quantitative dependences between
  environmental factors of and health
  characteristics
• decision-making on environmental improvement for
  primary morbidity prophylaxis
• realization of the accepted decisions
• efficiency control of the accepted decisions.

58
THANK YOU!
Be healthy!