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Community Health Overview

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Title: Community Health Overview


1
Community Health Overview
2
Section Objectives
  • Define health, community, community health,
    population health, public health, global health,
    environment.
  • Understand purpose/functions of public health.
  • Understand factors affecting community health.
  • Define capitalism and structure of capitalism.
  • Understand history of community/public health.
  • Importance of Lemuel Shattuck, John Snow.
  • Define major periods of U.S. capitalism.
  • Define major eras of social reform.
  • Define major periods of public health, 20th/21st
    C.
  • List major public health challenges for 21st C.

3
Health
4
Community
5
Community
6
Environment
7
Built environment
8
Population Health
9
Global Health
10
Environmental Health
11
Definitions
  • What is Health?
  • - Complete physical, mental, and social
    well-being, not just lack of disease. (WHO)
  • - Dynamic condition, multidimensional,
    resulting from adaptation of individuals to
    environment.

12
Definitions
  • What is Community?
  • - Group of people with common traits.
  • - Community characteristics membership
  • common symbols shared values
  • mutual influence shared needs and commitment
    shared emotional connection.

13
Definitions
  • Community Health Health status of defined group
    of people and actions and conditions, private and
    governmental, to promote and protect health.
  • Population Health Health status of people not
    organized, no group or local place identity, and
    actions and conditions to promote and protect
    health.

14
Definitions
  • Public Health Health status of defined group of
    people, and governmental actions and conditions
    to promote and protect peoples health.

15
Environment
  • The circumstances or conditions that surround an
    organism or group of organisms
  • Especially the external physical conditions that
    affect growth and survival
  • The complex social and cultural conditions that
    affect the individual or community.

16
Environmental health
  • The study and management of environmental
    conditions that affect our health and well-being.

17
Global health
  • Problems, issues, and concerns that transcend
    national boundaries
  • May be influenced by circumstances or experiences
    in other countries
  • Are best addressed by cooperative actions.

18
What do Public Health agencies do?
  • Purpose promote, protect, maintain health and
    welfare
  • Core functions of Public Health
  • Assessment (? blue)
  • Policy development (? green)
  • Assurance (? red)

19
Community vs. Personal Health
  • Personal Individual actions affecting
    individual or family health.
  • Community Actions to protect health of
    community or population.

20
Factors Affecting Community Health
  • Physical factors
  • Level of industry
  • community size
  • environmental quality
  • geographic setting.

21
Physical Factors
22
Factors Affecting Community Health
  • Economic/Social/Cultural factors
  • economic base, political system
  • Cultural beliefs, traditions, biases, religious
    traditions
  • socio-economic status social norms.

23
Economic/Social/Cultural Factors
24
Factors Affecting Community Health
  • Community Organization
  • How community organizes itself to mobilize
    resources
  • governmental vs. non-governmental services.

25
Factors Affecting Community Health
  • Individual Actions Community mobilizes the
    concerted efforts of many individual members.

26
Political Economy Approach to Public Health
  • Resources are allocated according to power, not
    according to efficiency or merit.
  • Behavior and dynamics of actors within health
    care sector and other economic sectors ?
    understood in terms of power (political and
    economic power) and class position.

27
What is capitalism?
28
Capitalism
  • An economic system, a mode of production,
    characterized by the following features
  • centralised private ownership of the means of
    production ? leads to a system of wage labor.
  • Driven by competition and making a profit.
    Innovation in production (to be better than the
    other company).
  • Accumulation and growth lead to innovation,
    technological progress (in manufacturing,
    medicine, science, services, agriculture).

29
Capitalism (cont.)
  • Capitalist system is subject to frequent crises
    (recessions, etc.), thus requiring government
    intervention (regulation, laws) to overcome
    crisis.
  • unequal distribution of the worlds finite
    resources ? for personal gain and private profit.
  • capitalism cant exist without inequality.

30
Historical modes of production
  • Primitive communism (e.g. hunting and gathering
    societies)
  • Kin-ordered modes (more advanced, based on
    tribes)
  • Slave-ordered modes (Roman, Greek,
    Indus/Euphrates civilizations)
  • Asiatic mode of production (ancient China,
    Egypt).
  • Feudalism Europe (middle ages), Latin America
    (colonial period)
  • Mercantilism transition to capitalism
  • Capitalism

31
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32
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33
Structure of capitalism
  • Economic base
  • -- capitalist relations of production (wage
    labor, competition).
  • -- capitalist forces of production (workers,
    environment, raw materials, technology, space for
    production)
  • Social/cultural/political superstructure
  • -- government, civil society (unions, media,
    education, religion, cultural institutions, etc.)
  • -- ideologies (national, regional, community)

34
Brief History of Community and Public Health
  • Evidence of community health in earliest
    civilizations
  • Northern India (bathrooms, sewers)
  • Egypt (water drainage)
  • Crete (toilets, sewers)
  • Sumer (prescription drugs, clay tablet)
    Egyptians (700 drugs)
  • Babylon (medical, health practices)
  • Early Bible (emphasis on hygiene, isolation of
    disease)

35
Code of Hammurabi (Babylon, 1900 B.C.E.)
36
Egyptian toilet
37
Indus Valley drainage
38
Indus Valley toilet
39
Roman Aqueduct
40
A Brief History of Community and Public Health
  • Ancient Greeks (sanitation, running water
    physical/athletic health)
  • Romans (aqueducts, sewer systems, Christian-built
    charity hospitals)
  • Middle Ages (500-1500 AD) separation from
    Romans turn to spiritual health great
    epidemics little progress in public health.

41
Black plague, Europe, 1600s
42
A Brief History of Community and Public Health
  • Renaissance/Exploration (1500-1700)
  • renewed interest in causes/cures of disease.
  • Great advances in natural sciences
  • use of epidemiology to investigate
  • diseases seen as environmentally caused
  • examined the sick to understand illnesses.

43
Major Periods of U.S. Capitalism
  • Free-market capitalism (liberalism)
    1760-1933. Very little regulation of markets and
    businesses. Based on Enlightenment value of
    individual as a rational actor.
  • Keynesian capitalism 1933-1980. Intervention
    of federal government in the economy, civil
    rights, worker rights development of social
    safety net.
  • Neoliberal capitalism 1980-present. Return of
    unregulated markets. Off-shoring of production
    deregulation of industries privatization of
    public-sector.

44
Community and Public Health under Capitalism
  • Industrial growth (18th cent.)
  • overcrowded cities,
  • poor urban sanitation and water
  • unsafe workplaces, poor workers,
  • intense use of child labor.
  • Epidemics of cholera, yellow fever, smallpox
    continue to ravage communities in Europe,
    America.
  • Medical advances (18th cent.) Edward Jenner,
    smallpox vaccination vaccination of military
    (GW) forerunner of U.S. Public Health Service
    (Marine Hospital Service, 1798).

45
Cholera epidemic, Europe 1800s
46
John Snow
  • Studied cholera epidemic, London, 1854.
  • Hypothesis epidemic caused by drinking water
    from Broad Street pump.
  • Predates discovery that microorganisms can cause
    disease.
  • Challenges miasmas (vapor) theory of contagious
    disease.

47
Broad Street pump
48
London, Broad Street Pump, 1854
49
Community and Public Health under Capitalism
  • 19th Century Early approach was minimal few
    advances, govt. hands-off (laissez faire)
    approach, medical fraud.
  • More epidemics London cholera epidemics (1849,
    1854) John Snows discovery challenges miasmas
    theory.
  • Louis Pasteur, 1862, France germ theory
    disproves theory of spontaneous generation.
  • Robert Koch, 1876, Germany discovery of anthrax
    microbe ushers in bacteriological period of
    public health.

50
Community and Public Health under Capitalism
  • 19th century in America westward expansion and
    laissez-faire approach toward public health by
    govt.
  • Lemuel Shattucks health report (beginning modern
    public health era, 1850)
  • 1875-1900 bacteriologic period of public
    health, discovery and description of many
    bacterial disease agents of communicable
    diseases.

51
Major Eras of Social Reform
  • Abolitionist Movement and the Civil War 1850s to
    1865.
  • Progressive Era 1890s to 1920
  • New Deal Era 1930s to early 1940s
  • Civil Rights Movement and the Great Society
    Late1940s -1960s

52
Lemuel Shattuck
  • Wrote health report for Mass., 1850.
  • Recommendations
  • creation of boards of health
  • collection of vital statistics
  • sanitary measures
  • disease research
  • Health education (alcohol, smoking, food)
  • Ushered in modern era of public health

53
Marine Hospital Service, 1798
54
Three Periods of Public Health in 20th/21st
century U.S.
  • Health Resources Development period, 1900-1960.
  • Social Engineering period, 1960s.
  • Health promotion period, 1970s to present.

55
Community and Public Health under Capitalism
  • 20th century health resources development
    period (1900-1960) medical schools, hospitals,
    nursing schools built.
  • Progressive Era, 1890-1920 social concerns, led
    Congress to pass legislation regulating food and
    other industries. Other advances womens right
    to vote local regulations on building/fire
    safety state workers compensation laws child
    labor laws.
  • 1920s Prohibition resulted in decline in
    alcohol-related problems.

56
Meat packing, early 1900s
57
Muckraking in the public interest
Investigative journalism exposes awful working
conditions and lack of food safety in meat
production.
58
Progressive Era reform movement Demonstrating
for fire safety in NYC.
59
Progressive Era reform movement
60
Tuberculosis Prevention, early 1900s
61
U.S. Public Health Service, 1912
62
U.S. Public Health Service officers, today
63
School nurse program, early 1900s
64
National Institutes of Health (1930)
65
Community and Public Health under Capitalism
  • Great Depression Led to passage of Social
    Security Act of 1935, the first entry of federal
    govt. into welfare arena. World War II led to
    medical advances enjoyed by broader civilian
    population.
  • Postwar years Hospital construction resumed.
    Attempts to plan national, state, and community
    health priorities failed.

66
New Deal Era, 1933-1938
Franklin Roosevelt ushers in regulations on
banking, retirement safety net, workers rights
(right to collective bargaining). Launches
massive job creation programs.
67
Public Works programs
68
Public Works
69
Elderly Poor, Great Depression
70
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71
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72
Roosevelt signs Social Security Act, 1935
73
Hospital construction, late 1940s
1950s(National Hospital Survey and Construction
(Hill-Burton) Act, 1946)
74
Center for Disease Control (1942)
75
1960s Era of Social Reform
Civil Rights Movement sets the stage for other
social movements and social reforms anti-war
movement environmental movement womens
equality movement gay rights movement. Public
health reforms follow close on the heels of the
Civil Rights Act (1964).
76
Community and Public Health under Capitalism
  • Period of social engineering (1960-1975)
    federal govt. took steps to improve access for
    disadvantaged to health care
  • -- Medicare assists in payment of medical
    bills for elderly and people with disabilities.
  • -- Medicaid assists in payment of medical
    bills for poor.

77
The Great Society Pres. Johnson signs Medicare
and Medicaid Acts, 1965
78
Reagan Era backlash against National Health Care
79
Clinton Health Care Reform (1994) Managed Care,
not National Health Care
80
Opposition to Clinton (Pres. and First Lady)
efforts for National Health Care
81
Countries with Universal Health Care
BlueUniversal health care Greenattempting to
start Universal health care OrangeU.S. funding
Universal health care through war effort
82
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83
Universal Health Care Movement
84
Community and Public Health under Capitalism
  • Health promotion period (1975-present)
    outgrowth of discovery of importance of lifestyle
    choices upon health.
  • Community health in 1990s and early 2000s faces
    at least five serious challenges
  • 1. Health care delivery single greatest
    community health care challenge in 1990s, and big
    in years ahead.

85
Community and Public Health under Capitalism
  • Current community health challenges
  • 2. Environmental problems recognized as both
    economic and health issues.
  • 3. Lifestyle diseases leading killers of
    Americans.
  • 4. Many communicable diseases AIDS, Lyme
    disease, tuberculosis, viral disease, still
    serious community health problem in America.

86
Community and Public Health under Capitalism
  • Current community health challenges
  • 5. Alcohol and other drug abuse costs
    thousands of lives and billions of per year.
  • 6. Terrorism, starting with 9/11 Bioterrorism
    as national concern. Bioterrorism -gt threatened
    or intentional release of biological agents for
    purpose of influencing the conduct of government
    or intimidating or coercing a civilian population
    to further political or social objectives.

87
Community and Public Health under Capitalism
  • Current community health challenges
  • 7. Natural disasters securing and rebuilding
    public health in face of hurricanes and other
    natural disasters has become a major economic and
    social issue, given the continuing consequences
    of global warming.
  • 8. Poverty and inequality. Widening gap in
    wealth. Health disparities and inequities
    between different populations.

88
Outlook for Community Health in 21st Century
  • World Planning Health for All by the Year
    2020.
  • United States plan for health of Americans,
    Healthy People 2010, will yield to a new document
    called Healthy People 2020.
  • Important to plan, particularly with huge
    challenges facing public health and environment.

89
Summary
  • Various definitions used in assessing community
    health health, community, etc.
  • Factors affecting community health physical,
    social/cultural, community organization,
    individual behavior.
  • Important arcs in history of community health
  • Ancient concern for community health, and
    organization for it (e.g. infrastructure,
    medicine)
  • Dominance of spiritual medicine during Middle
    Ages led to numerous epidemics. ? stagnation or
    backsliding of community health.
  • Era of exploration, science, and rise of
    capitalism and representative democracies brought
    significant advances in community health.

90
Summary
  • Renaissance (1500-1700) disease seen as
    environmentally-caused, not spiritually.
  • Enlightenment and early Capitalist industrial
    revolution (1700s) Science applied in medicine.
  • 1800s Modern era of public health ? germ
    theory, then bacteriological science.
  • 20th Century
  • Health resources development period (1900-1960)
    Social reform of Progressive Era (1890-1915), New
    Deal (1933-1936) ? public, private resources
    advance public health.
  • Social engineering period (1960-1973) Great
    Society (mid 1960s) ? govt. intervention in
    Medicare/Medicaid
  • Health promotion period (1974-present) advances
    in individual health and medicine, but failure to
    create national health care system.

91
Summary
  • Persistent public health issues
  • Inadequate health care system
  • Environmental degradation pollution, global
    warming
  • Natural disasters
  • Poverty and poor health
  • Lifestyle diseases and the built environment
  • Spread of communicable diseases
  • Alcohol and drug abuse
  • Threat of Terrorism
  • High stakes marketing of pharmaceutical solutions
    to many health problems.
  • Creating sustainable cities and economies Vs.
    uncontrolled free-market economies
  • Waging and preparing for wars
  • Planning for future of Public Health (WHO and
    U.S. Government), but within the constraints of
    global capitalist economic development
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