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. Drugs What is health? 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 Conceptis biomedical, absence of disease and/or disability • Leading Health Problemsdefined 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. Behaviouralconcept

13. Concepts of Health Promotion: Behavioural Approach I(Lifestyle, Public Health) • Health Conceptisindividualized, health as energy, functional ability, disease‑preventing lifestyles • Leading Health Problemsdefined 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.

14. 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

15. Socio-Environmental concept

16. 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.

17. 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

18. Health Field Concept: • Lifestyle • Human Biology • Environment • Health Care

19. 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).

20. 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).

21. Lifestyledepends 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.

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

23. 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 %.

24. Health Care.Health Services Administration/Management • Only the insignificant part (8-10 %) parameters of health are determined by a level of activity of medical institutions and efforts of medical workers.

25. 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.

26. 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.

27. Life Expectancy Map From Wikipedia

28. 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.

29. 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.

30. Most important problems of global health today • Communicable, maternal, perinatal and nutritional conditions • Noncommunicable diseases • Injuries

31. 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.

32. 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.

33. What is a health system?

34. 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.

35. 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.

36. " 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.

37. Public health professionals try to prevent problems from happening or re-occurring throughimplementing 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.

38. 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

39. 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.

40. 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.

41. 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.

42. 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.

43. 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.

44. 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.

45. 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.

46. 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.

47. 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.

48. 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.

49. 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.

50. 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.