Northern-West State Medical University named after I.I. Mechnikov

Department of Public Health and Health Care

Elena A. AbumuslimovaPh.D., Associate Professor

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

- What does “health “ mean for you?

- Which factors are most important for health?

What is health?Drugs

Blood pressur

e

Older people Smoking

Food safety

Family

Bad Housing

Water Fluoridati

on

Exercise

Positive

health

Heart Diseas

e

Feeling good

Diabetes

Parenting

HIV/ AIDS

Waiting Lists

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..

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.

Defining Health: The World Health OrganizationHealth 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.

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.

Medical concept

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.

Concepts of Health Promotion: Medical Approach IIPrincipal 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

Behavioural concept

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.

Concepts of Health Promotion: Behavioural Approach IIPrincipal 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 youthGeneral Approach: individualized, elements

of societal focus as related to public policy Actors: public health workers, illness‑related

advocacy groups (e.g., Cancer Society), governments

Socio-Environmental concept

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.

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 conditionsGeneral 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

Health Field Concept:

LifestyleHuman BiologyEnvironmentHealth Care

Lifestyle is a main medical-social factor of healthFeatures 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).

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).

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.

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

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 %.

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.

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.

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.

Life Expectancy Map

From Wikipedia

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.

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.

Most important problems of global health todayCommunicable, maternal, perinatal

and nutritional conditionsNoncommunicable diseasesInjuries

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.

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.

What is a health system?

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.

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.

" 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.

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.

Public health is mainly composed of the following core areas: Behavioral Science/Health EducationBiostatisticsEmergency Medical ServicesEnvironmental HealthEpidemiologyHealth Services Administration/ManagementInternational/Global HealthMaternal and Child HealthNutritionPublic Health Laboratory PracticePublic Health PolicyPublic Health Practice

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.

BiostatisticsEstimating 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.

Environmental HealthThe 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.

EpidemiologyWhen 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.

Health Services Administration/ManagementManaging 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.

International / Global HealthGlobalization 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.

Maternal and Child HealthProviding 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.

NutritionPromoting 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.

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.

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.

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.

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.

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.

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.

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 insurancethe 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.

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.

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.

The basic elements of health complex study and its determining factorscollecting 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.