Module 1

Lesson 1

Community

 is a social unit with commonality such as norms, religion ,values, customs , or identity.
Communities may share a sense of place situated in a given geographical area or in
virtual space through communication platforms. Durable relations that extend beyond
immediate genealogical ties also define a sense of community important to their
identity , roles, practice, in social institution as family , home , work , society or human
at large.

Public Health

 is the science and art of preventing disease, prolonging life, and promoting health and
efficiency through organized community efforts for the sanitation of environment, the
control of community infections, the education of individual in personal health , the
organization of medical and nursing services for the early diagnosis and preventive
treatment of disease.

Health as defined by World health Organization is “a state of complete physical, mental and
social well- being and not merely the absence of disease or infirmity.” Health is a
“fundamental resource to the individual, the community and to society” (Kickbusch, 1989:
13).

Community Health[1]

 refers to the health status of a defined group of people, or community, and the
actions and conditions that protect and improve the health of the community. It is a
discipline concerned with the study and improvement of the health characteristics of
different communities. It is a part of public health that focuses on individuals and their
role as determinants of their health and the other people's health. It is an important
field of study which focuses on the maintenance, protection, and improvement of the
health status of individuals and communities.

Types of Communities[1]

1. Geographical
 a community within an ecclesiastical or civil territory. Use of space, location of valued
resources in that space. (geographic focus can include countries, cities or towns,
neighborhoods, schools or other governmental districts, or a collection of ZIP codes)

2. Sectoral

 Various groups that people in the larger community might be divided into for reasons of
common social, political, economic, cultural, or religious interests. (farmers, fishermen,
vendors, women, workers, informal settlers, etc)

3. Functional

 Various groups who share common work purpose and expertise, professional or
administrative. (a school community with teachers, students, or administrators,
professional associations, etc,);

4. Rural, Urban, Rurban

 Rural:

o relationship in the rural community is closer, and person-to-person

communication is evident;

o usually produce their own food for subsistence;

o deep long-term relationships

o emphasis of shared values;

o influence of blood relationships in decision making

o homogenous type of culture

o belief on supernatural and superstitious beliefs

o underserved or limited access to basic goods and social services

 Urban:

o relationship in the community is artificial, transitory, business like.

o Large in terms of land area and population, advanced in science and technology.

o With favorable physical environment and diverse cultures.

o People are engaged in various occupations

  Rurban: communities show physical characteristics of an urban community, but
relationships are more rural in nature.

5. Tribal/Indigenous:

 also known “cultural communities” refers to a group or community swhich shares

common experiences that shape the way its members understand the world. It includes
groups that we are born into, such as race, national origin, gender, class, or religion. It can
also include a group we join or become part of.[2]

Concepts of Community[3]

Four relevant concepts of community and the different insights into the process of community
engagement.

1. Systems Perspective

 From a systems perspective, a community is like a living creature, comprising different

parts that represent specialized functions, activities, or interests, each operating within
specific boundaries to meet community needs.

Example: Schools focus on education, the transportation sector focuses on moving

people and products, economic entities focus on enterprise and employment, faith
organizations focus on the spiritual and physical well-being of people, and health care
agencies focus on the prevention and treatment of diseases and injuries (Henry, 2011).

 For the community to function well, each part must effectively carry out its role in
relation to the whole organism.

 A healthy community has well-connected, interdependent sectors that share

responsibility for recognizing and resolving problems and enhancing its well-being

 Successfully addressing a community’s complex problems requires integration,

collaboration, and coordination of resources from all parts (Thompson et al., 1990).
From a systems perspective, then, collaboration is a logical approach to health
improvement.
2. Social Perspective

 A community can also be defined by describing the social and political networks that link
individuals, community organizations, and leaders. Understanding these networks is
critical to planning efforts in engagement.

Example: tracing social ties among individuals may help engagement leaders to identify
a community’s leadership, understand its behavior patterns, identify its high-risk groups,
and strengthen its networks (Minkler et al., 1997).

3. Virtual Perspective

 Some communities map onto geographically defined areas, but today, individuals rely
more and more on computer-mediated communications to access information, meet
people, and make decisions that affect their lives (Kozinets, 2002).

Example: computer-mediated forms of communication such as email, instant or text

messaging, e-chat rooms, and social networking sites such as Facebook, YouTube, and
Twitter (Flavian et al., 2005). Social groups or groups with a common interest that
interact in an organized fashion on the Internet are considered “virtual communities”
(Rheingold, 2000; Ridings et al., 2002). Without question, these virtual communities are
potential partners for community-engaged health promotion and research.

4. Individual Perspective

 Individuals have their own sense of community membership that is beyond the
definitions of community applied by researchers and engagement leaders. Moreover,
they may have a sense of belonging to more than one community. In addition, their
sense of membership can change over time and may affect their participation in
community activities (Minkler et al., 2004).

 The philosopher and psychologist William James shed light on this issue in his writings.
James thought it important to consider two perspectives on identity: the “I,” or how a
person thinks about himself or herself, and the “me,” or how others see and think about
that person. Sometimes these two views agree and result in a shared sense of an
identity, but other times they do not.

 People should not make assumptions about identity based on appearance, language, or
cultural origin; nor should they make assumptions about an individual’s perspective
based on his or her identity (James, 1890).
  Today, the multiple communities that might be relevant for any individual including
families, workplace, and social, religious, and political associations suggest that
individuals are thinking about themselves in more complex ways than was the norm in
years past.

 The eligibility criteria that scientists, policy makers, and others develop for social
programs and research projects reflect one way that people perceive a group of
proposed participants, but how much those criteria reflect the participants’ actual view
of themselves is uncertain. Practitioners of community engagement need to learn how
individuals understand their identity and connections, enter relationships, and form
communities.

Lesson 2 Factors Affecting Community and Public Health

Introduction:

 The social, economic, cultural and physical environment in which people lives has a
significant effect on their health and well being. Although genetics and personal
behavior play a strong part in determining an individual's health, good health starts
where we live, where we work and learn, and where we play.

 Improving community health requires taking a broader view of the conditions that
create health and well being ,from how we plan and develop our urban spaces and
places to the opportunities for employment, recreation and social connection available
to all who live in them.

IMPORTANCE OF PUBLIC HEALTH[1]

A healthy community is a place where people provide leadership in assessing their own
resources and needs, where public health and social infrastructure and policies support health,
and where essential public health services, including quality health care, are available.

In a healthy community, communication, and collaboration among various sectors of the

community and the contributions of ethnically, socially, and economically diverse community
members are valued.
In addition, the broad arrays of determinant of health is considered and addressed and
individuals make informed, positive choices in the context of health-protective and supportive
environments, policies, and systems (Goodman et al., 1996; CDC, 1997; Norris and Pittman
2000)

When people are healthy, they are better able to work, learn and build a good life, and
contribute to society

FACTORS AFFECTING COMMUNITY AND PUBLIC HEALTH[2]

There are several factors that can affect community and public health, including:

1. Physical factors like the geographical and environmental position of a community,

which affect disease prevalence, community size (overcrowding), industrial development,
and levels of pollution.

2. Socio-cultural factors like beliefs, norms, and traditions, define attitudes toward health
and influence practices that are either beneficial or harmful to health.

3. Economic and political status of a community also affect the affordability and
availability of health care.

4. Community organization plays a role in the presence of healthcare options as well as

the extent to which members know the priorities and participate in lobbying and promotion
of community care.

5. Individual behavior, or Personal choices, such as the choice to get immunized or to

recycle waste, also contribute to the well-being of the whole community.

LESSON 3 Health Issues Relevant to the Community

Introduction:

Health and well being are affected by many factors -those linked to poor health, disability,
disease or death, are known as risk factors. A risk factor is a characteristic , condition, or
behavior that increases the likelihood of getting a disease or injury. Risk factors are often
presented individually, however in practice they do not occur alone. They often coexist and
interact with one another, for example physical inactivity overtime ,cause weight gain, high
blood pressure and high cholesterol levels. Together these significantly increase the chance of
developing chronic heart disease and other health related problems.
WHAT ARE THE LEADING CAUSES OF MORTALITY IN THE PHILIPPINES?[1]

The leading causes of death are diseases of the heart, diseases of the vascular system,
pneumonias, malignant neoplasms/cancers, all forms of tuberculosis, accidents, COPD and
allied conditions, diabetes mellitus, nephritis/nephritic syndrome, and other diseases of
respiratory system. Among these diseases, six are non-communicable and four are the major
NCDs such as CVD, cancers, COPD and diabetes mellitus.

WHAT ARE THE RISK FACTORS COMMONLY SHARED BY LIFESTYLE-RELATED DISEASES?[2]

The risk factors that are linked with lifestyle-related disease are smoking, unhealthy diet,
physical inactivity, and stress.

[3]The diseases that kill more Filipinos are called noncommunicable diseases (NCDs). The main
NCDs are diabetes, heart disease, stroke, cancer, and chronic diseases that affect the airways
and lungs. While these diseases affect different parts of the body in different ways, they often
share common origins. The good news is, many of these factors — such as unhealthy diet,
physical inactivity, tobacco use and harmful use of alcohol — are avoidable.

The Philippines is taking some good steps to prevent NCDs, like taxing tobacco use and sugary
drinks. But Filipinos are still at high risk of coming down with one or more of these deadly
diseases.

More than one third of people aged 15 years and above in the Philippines — some 15.7 million
children, women, and men — are smokers while over half of men and women aged 20 years old
and above are binge drinkers. More than one in five people have high blood pressure and only
half of the population does sufficient physical activity. The proportion of adults who are
overweight or obese has doubled in the last 20 years, and obesity in children and teens is rising
at an alarming rate. Over 90% of Filipino adults did not meet the WHO recommended intake of
400 grams of fruits and vegetables per day. About 30% of children suffer from stunting, a
condition which further predisposes them to an increased risk for obesity, diabetes, and
cardiovascular disease later in life.

MODULE 2

Lesson 1 Demography

Sources of Demographic Data

1.) Census - a census of population is defined as “the total process of collecting,

compiling and publishing demographic, economic and social data pertaining, at a
specified time or times, to all persons in a country or delimited territory.
Uses of Census:
a) It contains data useful in estimating or projecting population size during period/s other than
the census year.
b) It provides necessary demographic data used in national planning
There are two ways of allocating people enumerated during census-taking.
a). de jure method- assigns individuals to the place of their usual residence regardless of
where they were actually enumerated during the census.
b). de facto method – where people are allocated to the areas where they were physically
present at the census date regardless of where they usually live.
The following items are usually included in a minimum list of population characteristics:
 Age
 Sex
 Race or ethnic origin
 Number of children ever born (by married women)
 Literacy or educational attainment
 Marital Status
 Place of birth
 Occupation

2. Sample survey
 is another source of collecting population data. In a sample survey, information is
collected from a sample of individuals rather than from the entire population. A
sample consists of only a fraction of the total population. Several different
population samples can be drawn on the basis of sample surveys such as the number
of abortions, contraceptives used, etc. for the study of fertility.
3. Vital registration systems
 deal with the continuous recording of vital events like births, deaths, stillbirths,
marriages, adoptions, divorces and annulments as they occur in the population.
4. Continuing population registers
 This is another secondary source of collecting population data. It contains the
names, addresses, age, sex, etc. of every citizen, of those who migrate to other
countries and who enter the country. The population registers helps in verifying the
correctness of the census figures for that year
5. Other Records:
  Besides the population register, there are other records which are secondary
sources of demographic data in developed countries. They maintain population
records to meet social security schemes like unemployment insurance and
allowance, old age pension, maternity allowance, etc.
 Selective demographic data are also available from electoral lists, income tax payers’
lists, telephone subscribers’ lists, social security system, etc. Though such
administrative data are limited, they are helpful in providing for carrying out sample
surveys
Describing Population of Demography

A. Sex / Gender Composition – the sex ratio and the sex structures are the two most
common methods of describing the sex composition of a population.
1) Sex ratio – it compares the number of male individuals to the number of
females in the population. The formula used is:
Sex ratio = Number of Males x 100
Number of Females
The resulting figure represents the number of males for every 100 females in the population.
Example : Population of Male in Brgy. Santol Q.C = 7,432
Population of Female in Brgy Santol Q. C = 12, 468
Sex Ratio = 7,432 x 100 Answer: 59.6 (rounded off to 60)
12,468 Interpretation: For every 100 females in the pop.
of Barangay Santol Q. C ,there are 60 males.
2.) Sex structure – Compares the sex ratio across different categories/levels of another
characteristic , Ex: Sex structure across urban-rural classification or across different age groups
Example: Determine the Sex structure of ages 7- 14 years old in Barangay Santol Q.C.
# of male ages 7-14 yrs old = 1800
# of females ages 7-14 yrs. old = 2700
Solution: 1800 x 100 Answer: 66.7 (round off to 67)
2700
Interpretation of Sex Structure : For every 100 female ages 7-14 yrs
old, there are 67 males of the same age group in Barangay
Santol Q. C
 B. Age Composition – the following are used to describe the age-make-up of a population
1) Median Age – the middlemost age in a set of observation (ages) put in numerical order or in array. Median Age is the
value which cuts-off the upper 50% and lower 50% of the ages of the population. Used to gauge whether the population is young
or old.

Ex: Ages of 6 members of the family (arrange first from highest to lowest ) :
1) 45 2) 36 3) 25 4)22 5) 19 6) 12
Determine the location of the median age by dividing the number of observation into 2
Total number of observation ( ages) = 6 / 2 = 3 location of the median age
Therefore the median age is 25 yrs old , which means that 50% of the family members’ age are below 25 years old and the
other 50% are above 25 years old of age.

What if you only have 5 members of the family : 1) 45 2) 36 3) 25 4) 22 5) 19

Location of middlemost age is : 5 / 2 = 2.5 this falls between 36 and 25
To get the median age : 36+25 = 61/ 2 = 30.5 or 30 yrs old and 6 months is the median age,
which indicates that 50% of the family members’ age are below 30 yrs old and 6 months while the other
50% are above 30 yrs old and 6 months of age/

2) Dependency Ratio – it provides an index of age-induced economic drain on manpower resources. This ratio simply relates the
size of the dependent segment of the population (which is composed of very young children and the elderly groups) to the
economically productive age-group of the population.
The formula is:
Dependency Ratio= # of persons 0-14 yrs.old + # of persons ages 65 years and above x 100
# of persons 15-64 years old
Example: # of persons 15-64 years old in Brgy. Santol Q.C = 1,236
# of persons 0-14 yrs.old : 245
# of persons ages 65 years and above: 674
Solution : 245 + 674 = 919 x 100 Answer: 74
1,236 Interpretation: For every 100 economically productive
individuals, there are 74 dependents which they need to support.
Note: The higher the dependency ratio, the greater the burden carried by working-age people.
A low dependency ratio means that there are sufficient people working who can support the dependent population.
C. Age and Sex Composition – a very simple but effective way of describing the age and sex
composition of the population at the same time is by presenting these demographic data in a
graphic form called the

Population Pyramid. From this graph, one will be able to describe not only age and sex
structure of the population but will also be able to explain and describe the demographic trends
of the population in the past.
Other Population Characteristics and Measures
Life Expectancy at birth – the average number of years an infant is expected to live under the
mortality conditions for a given year.
 These figures are derived from life-table analyses
 Since mortality rates differ between sexes, values of life expectancy at birth are usually
calculated separately for males and females.
Describing the Population Distribution
Urban-rural distribution – Illustrates the proportion of people living in urban areas compared to
the rural areas.
Population density – Determines how congested a place is and has implication in terms of the
adequacy of basic health services present in the community.
Crowding Index – Describes the ease by which communicable diseases can be transmitted from
one host to another susceptible host.
Estimating Population

A. Natural Increase – is simply the difference between the number of births and the number of
deaths which occurred in a specific population within a specified period of time (usually one
year).
Example: Natural Increase = Number of births in 1992 minus number of deaths in 1992
= 1,684,395 - 319,579
= 1,364,816 persons
Rate of Natural Increase – when the difference between the number of births and deaths are
expressed relative to the population size.
Crude Birth Rate – Crude Death Rate
Example= 25.8/1000 - 4.9/1000
= 20.9 /1000

2) The second group of measures makes use of population counts obtained during two censuses
instead of data on just births and deaths. In other words, increases or decreases brought about
by migration are also taken into consideration. These are the absolute increase per year and
the relative increase in the population size.
 a) Absolute increase per year (b) = Pt – Po
t
Where: Po = population size at an initial time, o
Pt = population size at a latter time, t
t = number of years between time o and time t
Relative Increase

Relative increase = Pt – Po x 100

Po
where:
Po = population size at an initial time, o
Pt = population size at a latter time,

The population size of Cavite province as recorded during the 1980 census was 771,320 and this
increased to 1,150,458 based on the last census in 1990. What is the absolute increase per year
and the relative increase in the population size?
Given: 1980 (Po)= 771,320
1990 (Pt)= 1,150,458
Absolute increase per year (b) = 1,150,458 – 771,320
10
= 37, 914 individuals per year
Interpretation: During the 10-year period (between 1980 and 1990) 37,914 persons were
added to the population each year.

Estimating and Projecting Population

1) Inter-censal estimates refer to population estimates made on any date intermediate to two
censuses and take the results of these censuses into account.
2) Postcensal estimates – are estimates of population size on any date in the past or during a
current date following a census.
3) Projections – are population estimates made on any date following the last census for which
no current reports are available.

Estimation for Population Size For Future Date

 1.) Arithmetic Method
2.) Geometric Method
3.) Exponential Method
Module 3

Epidemiology

 Epidemiology is a study that describes events or occurrences, determinants and distribution of

health-related conditions or diseases in a specified population. It serves as the basis for public
health analysis, an evidence-based foundation in establishing health programs and policies.
Epidemiology is based on two assumptions: that the disease does not occur by chance, and the
disease occurs randomly distributed in the population.

Lesson 3 Immunity and Immunization

The environment contains a wide variety of potentially harmful organisms (pathogens), such as
bacteria, viruses, fungi, protozoa and multicellular parasites, which will cause disease if they
enter the body and are allowed to multiply. The body protects itself through a various defense
mechanisms to physically prevent pathogens from entering the body or to kill them if they do.

The immune system is an extremely important defense mechanism that can identify an
invading organism and destroy it. Immunization prevents disease by enabling the body to more
rapidly respond to attack and enhancing the immune response to a particular organism.

Each pathogen has unique distinguishing components, known as antigens, which enable the
immune system to differentiate between ‘self’ (the body) and ‘non-self’ (the foreign material).
The first time the immune system sees a new antigen, it needs to prepare to destroy it. During
this time, the pathogen can multiply and cause disease. However, if the same antigen is seen
again, the immune system is poised to confine and destroy the organism rapidly. This is known
as adaptive immunity.

Vaccines utilize this adaptive immunity and memory to expose the body to the antigen without
causing disease, so that when then live pathogen infects the body, the response is rapid and the
pathogen is prevented from causing disease. Depending on the type of infectious organism, the
response required to remove it varies. For example, viruses hide within the body’s own cells in
different tissues, such as the throat, the liver and the nervous system, and bacteria can multiply
rapidly within infected tissues.

Objectives:

1. define immunization, vaccination, immunity, antigen and antibody.

2. List different types of immunization.

3. Enumerate routine vaccination.

4. Describe common side effects of different vaccine .

5. Identify storage and transportation of vaccine.

While Task: Click the link for Video presentation about immunization.

Immunity and Immunization

Immunity. The ability of the body to identify and destroy foreign invaders or abnormal
substances before they can damage the body. This is attributed to specifically reactive cells
and/ or antibodies ( immunoglobulins), either naturally- occurring( without external stimulus),
actively developed, or received from some outside source.

Immune response. This is accomplished by the immune system ( leukocytes or white blood
cells). The response happens after an immunogen enters the human body and the body in turn
responds against it, e.g. bacteria, tissue transplants or anything foreign or “non-self “. This is
the mechanism of the human body for self-preservation. There are two forms of immune
responses, namely, humoral( performed by the antibodies/ immunoglobulins produced by
plasma cells ) and cell-mediated ( the agents are the immuned or reactive T cells)

Types of Immunity:

1. Natural Immunity. All the defense mechanisms inherent in a person

2. ptyalin

3. HCl in stomach

c, protease in the digestive system

1. normal flora I n the intestinal tract

2. normal flora in the vaginal tract

3. fatty acids of the skin

Even if man is endowed with the natural mechanisms, every individual has his own degree
of immunity.
 2. Specific/Acquired/Adaptive Immunity.

3. Active immunity- the individual forms the antibodies/ immunoglobulins

1) natural active- is acquired by an individual after recovery from infection due to the
development of antibodies and immuned cells which will give protection to the individual on re-
exposure to the same or similar agents.

2) artificial active- acquired after an individual is immunized/vaccinated with vaccines/

toxoids. Vaccines are either killed or attenuated organism, which will not cause disease but will
induce formation of antibodies that can protect the person from the disease when the person is
re- exposed to it, E.g. are salmonella vaccine, pneumonia vaccine. Toxoids are treated exotoxins
which induce formation of antibodies, too.. E.g. are tetanus toxoid.

1. Passive immunity- the individual receives ready-made antibodies/immunoglobulins

1) natural passive- this is acquired by an individual from the mother via placental
transfer( from the mother to the fetus in intrauterine life, and through the colostrum or
mother’s first milk which is produced during the first few months post-partum. The received
antibodies/immunoglobulins can protect the child from infections.

2) artificial passive- this is acquired by injection of antiserum/antibodies to the individual

seeking protection. E.g. is anti-rabies serum.

Three forms of protection against infectious disease:

1. Nonsusceptibility.

 This constitutes an absolute protection against particular diseases and is associated with
species characteristic. It is dependent upon inherited physiologic and anatomic
factors.This is illustrated by the fact that man is not subject to spontaneous infection by
certain animal pathogens, such as chicken cholera, hog cholera, and cattle plaque, nor
do lower animals contract many human diseases, including dysentery, measles,
gonorrhea, mumps, typhoid fever, and whooping cough.

 Physiologic factors such as body temperature and diet contribute to nonsusceptibility.

Classic early experiments with anthrax infections of frogs and chicken demonstrated the
influence of body temperature. These animals are normally nonsusceptible to anthrax,
but when frogs are inoculated with Baillus anthracis were warmed to 35 degree, as did
chickens when their body temperatures was artificially reduced from its normal of about
41 degrees Centigrade they succumbed to the infection.

2. Natural resistance.
  Nonspecific and variable and are determined by physical or physiologic conditions
that are subject to variation from time to time or between individuals. The normal
body possesses remarkable nonspecific resistance to infection. The first line of
defense is the physical and chemical barriers of the epithelium which renders the
intact skin impenetrable to foreign organisms. The stickiness of the mucous
membranes, the ciliated upper respiratory tract, the acidity/alkalinity of the various
parts of the digestive system are effect=ive against numerous pathogens.

 Physiologic and pathologic characteristics of the host, such as its general state of
nutrition, debilitation resulting from aging, fatigue,exposure to extreme
temperature, alcoholism, and concurrent disease, play an important part in
determining the likelihood of infection and deciding the outcome of established
disease.Animal tissues and body fluids contain various polypeptides and unknown
factors, many presumably genetic in origin, participate in natural resistance.

 In contrast to the foregoing, immunity is never absolute, it varies quantitatively

from one individual to another and from time to time within the same individual. It
is specific in the sense that it is directed against a given infectious agent; however,
some degree of cross- protection may be afforded against chemically related
infectious agents.

CHILDHOOD IMMUNIZATION SCHEDULE: from birth to 18 years old

Birth BCG 1 none

Hepatitis B 3 1

6 weeks DTP 3 3

HIB 3 1

IPV 3 1

PCV 3 1

Rotavirus 2 none

6 months Measles 1 none

Influenza 1 given yearly

 9 months JEV 1 1

12 months MMR 2 none

Varicella 2 none

Hepatitis A 2 none

9 years HPV 2 none

In 2019, WHO released the annual list of global health threats and vaccine hesitancy was
included in the list for the first time. In the Philippines, vaccination rate has gone down,
according to data from the Philippine Statistics Authority and the United Nations Children Fund(
UNICEF). There is no such thing as 100% effective vaccine, but cvaccinecan help indicduals not
to suffer the disease and do not have to be atrisk from its complications.

Immunization in Adults:

VACCINE 19-26 yrs. old 50-64 years old

Tetanus,diphtheria
1 dose TdaP, then booster every 10
Td/TdaP yrs
Pertussis(TdaP or Td)

MMR 1-2 doses

Varicella (VAR) 2 doses 2 doses

Zoster recombinant
2 Doses
(RZV is preferred)

Human Papilloma Virus

9-55 years old
(HPV) females

Influenza 1 dose per year

 Hepatitis A 2 doses

3 doses
Hepatitis B

MODULE 4

Lesson 1 HISTORY OF COMMUNITY HEALTH

BRIEF HISTORY OF COMMUNITY HEALTH[1]

The earliest recorded evidence of community health is from 25,000 BCE. Murals on the walls of
Spanish caves show physical deformities. These murals tell us that someone noticed and
documented differences in the physical state or appearance of community members.

Later murals in China show a group of people digging a well for drinking, giving us evidence that
the 21,000 BCE community members understood the importance of clean water for their
health.

In the Middle Ages, many diseases and cures were spiritual, and sciences like medicine were
thought to be evil. That could be the reason why so many communities suffered from diseases
like plague and leprosy. In the 19th century, the focus on community health increased.

A Commonwealth of Massachusetts paper by Lemuel Shattuck in 1850 outlined public health

needs in the state, and the work of Dr. John Snow, who removed the handle of the drinking
water pump on Brad Street in 1854 to fight the cholera epidemic, showed that community
interventions are indeed very important.

DIFFERENCE BETWEEN HEALTH EDUCATION AND HEALTH PROMOTION

HEALTH EDUCATION
Health education comprises consciously constructed opportunities for learning involving some
form of communication designed to improve health literacy, including improving knowledge,
and developing life skills which are conducive to individual and community health.

Health education is not only concerned with the communication of information, but also with
fostering the motivation, skills, and confidence (self-efficacy) necessary to take action to
improve health. Health education includes the communication of information concerning the
underlying social, economic, and environmental conditions impacting on health, as well as
individual risk factors and risk behaviors, and use of the health care system.

HEALTH PROMOTION

Health promotion is the process of enabling people to increase control over, and to improve
their health.

Health promotion represents a comprehensive social and political process, it not only embraces
actions directed at strengthening the skills and capabilities of individuals, but also action
directed towards changing social, environmental and economic conditions so as to alleviate
their impact on public and individual health.

Community participation is essential to sustain health promotion action.

 Build healthy public policy

 Create supportive environments for health

 Strengthen community action for health

 Develop personal skills, and

 Re-orient health services

Thus, health education and promotion may involve the communication of information, and
development of skills which demonstrates the political feasibility and organizational possibilities
of various forms of action to address social, economic, and environmental determinants of
health. In the past, health education was used as a term to encompass a wider range of actions
including social mobilization and advocacy.

LESSON 2
MODELS OF HEALTH PROMOTION

The kinds of health promotion programs that students and schools implement reflect the health
education models on which they are based. There are three main categories in which health
education models can be broadly placed:

 Behavioural Change Model

 Self-Empowerment Model

 Collective Action Model.

Behavioural Change Model

The behavioral change model came into use before the other two approaches. Many early New
Zealand health campaigns were based on this model, and it is still widely used, in conjunction
with other models, as part of comprehensive health campaigns.

The behavioural change model is a preventive approach and focuses on lifestyle behaviours
that impact on health. It seeks to persuade individuals to adopt healthy lifestyle behaviours, to
use preventive health services, and to take responsibility for their own health. It promotes a
'medicalised' view of health that may be characterised by a tendency to 'blame the victim'.

The behavioural change model is based on the belief that providing people with information
will change their beliefs, attitudes, and behaviours. However, this model has been shown to be
ineffective in many cases because it ignores the factors in the social environment that affect
health, including social, economic, cultural, and political factors.

Characteristics of Behavioural Change Model

 Focuses on health professionals' perceptions of health needs – suggests that 'experts'

know best.

 Transmits knowledge – increases people's knowledge of the factors that improve and
enhance health.

 Educates 'about' health.

 Uses health campaigns.

 Uses the transmission approach to teaching – the learners are largely passive.

 Often reflects 'healthism'*.

 May have a 'moralistic' tone.

  Emphasizes disease and other medical problems so tends to be negative and deficit
focused.

 Focuses on risks rather than on protective or preventive factors and takes a 'band-aid'
approach.

 Tends not to reflect the socio-ecological perspective.

 Does not consider determinants of health or consider who is responsible for health.

 May imply 'victim blaming'.

Self-Empowerment Model

This approach (also known as the self-actualisation model) seeks to develop the individual's
ability to control their own health status as far as possible within their environment. The model
focuses on enhancing an individual's sense of personal identity and self-worth and on the
development of 'life skills', including decision-making and problem-solving skills, so that the
individual will be willing and able to take control of their own life. People are encouraged to
engage in critical thinking and critical action at an individual level. This model, while often
successful for individuals, is not targeted at population groups and is unlikely to affect social
norms.

Characteristics of Self-Empowerment Model

 Develops a sense of identity.

 Promotes reflection in relation to others and society.

 Encourages people to reflect and change their views.

 Clarifies values.

 Helps people to know where, when, why, and how to seek help.

 Encourages independence.

 Uses critical thinking and critical action in relation to oneself.

 Uses the action competence process for the individual, recognizing determinants that
may be beyond their control.

 Fosters resilience and empowerment at a personal level.

 Enhances self-awareness.
  Focuses largely on the individual.

 Gives opportunities to celebrate individuality.

Collective Action Model

This is a socio-ecological approach that takes account of the interrelationship between the
individual and the environment. It is based on the view that health is determined largely by
factors that operate outside the control of individuals.

This model encompasses ideas of community empowerment, which requires people

individually and collectively to acquire the knowledge, understanding, skills, and commitment
to improve the societal structures that have such a powerful influence on people's health
status. It engages people in critical thinking to improve their understanding of the factors
affecting individual and community well-being. It also engages them in critical action that can
contribute to positive change at a collective level.

Given the importance of determinants of health, the use of a collective action model is more
likely to achieve healthy outcomes, both for individuals and for groups within society.

Characteristics of Collective action model

 Encourages democratic processes and participation 'by all for all'.

 Takes a student-centered/constructivist approach to teaching and learning.

 Takes determinants of health into consideration.

 Emphasizes empowerment for all participants.

 Educates 'for' health.

 Uses a social action or action competence process to work with others.

 Uses a whole community/school development approach.

 Views teachers and students as social agents.

 Uses critical thinking and critical action in relation to the individual, others, and society.

 Takes a holistic approach.

 Is based on authentic needs.

 Fosters resilience at wider community and societal levels – not just at an individual level.
Lesson 2 Epidemiological Triad

The epidemiological triad is best represented diagrammatically (see Figure 19). This represents
the interaction between an agent, host or persons and environment or place within a specific
time dimension. The epidemiological triad can be applied to non-infectious diseases where the
agent could be ‘unhealthy behavior, unsafe practices, or unintended exposures to hazardous
substances’ (Miller, 2002, p. 64).

Lesson 3 COMMUNITY-BASED PUBLIC HEALTH EDUCATION AND PROMOTION

Goal of Health Education and Promotion to Communities

It increases the quality, availability, and effectiveness of educational and community-based

programs designed to prevent disease and injury, improve health, and enhance quality of life.

Health Education and Promotion to Communities play a key role in the following:

 Preventing disease and injury

 Improving health

 Enhancing quality of life

Health status and related health behaviors are determined by influences at multiple levels:
personal, organizational/institutional, environmental, and policy. Because significant and
dynamic interrelationships exist among these different levels of health determinants,
educational and community-based programs are most likely to succeed in improving health and
wellness when they address influences at all levels and in a variety of environments/settings.
Health and quality of life rely on many community systems and factors, not simply on a well-
functioning health and medical care system. Making changes within existing systems, such as
improving school health programs and policies, can effectively improve the health of many in
the community.

For a community to improve its health, its members must often change aspects of the physical,
social, organizational, and even political environments in order to eliminate or reduce factors
that contribute to health problems or to introduce new elements that promote better health.
Changes might include:

 Instituting new programs, policies, and practices

 Changing aspects of the physical or organizational infrastructure

 Changing community attitudes, beliefs, or social norms

In cases where community health promotion activities are initiated by a health department or
organization, organizers have a responsibility to engage the community. Realizing the vision of
healthy people in healthy communities is possible only if the community, in its full cultural,
social, and economic diversity, is an authentic partner in changing the conditions for health.

Why is Public Health Education and Promotion Important?

 Health education improves the health status of individuals, families, communities,

states, and the nation.

 Health education enhances the quality of life for all people.

 Health education reduces premature deaths.

 By focusing on prevention, health education reduces the costs (both financial and
human) that individuals, employers, families, insurance companies, medical facilities,
communities, the state, and the nation would spend on medical treatment.

Education and promotion can be designed to reach people outside of traditional health care
settings. These settings may include:

 Schools

 Workplace

 Health care facilities

 Communities
  Use of online/social media platforms
Each setting provides opportunities to reach people using existing social structures. This maximizes
impact and reduces the time and resources necessary for program implementation and development.
Reaching out to people in different settings also allows for greater tailoring of health information and
education.

Some suggested topics to encourage and enhance health and wellness in the educating
communities:

 Chronic diseases

 Injury and violence prevention

 Mental illness/behavioral health

 Unintended pregnancy

 Oral health

 Tobacco use

 Substance abuse

 Nutrition

 Physical activity

 Obesity prevention

MODULE 5

Lesson 3 Preventive Measure of Disease Prevention and Control

Communicable Diseases: Prevention and Control

Communicable diseases are those diseases that may be transmitted from person to person,
food, water and/or animals and are the most common cause of school absenteeism.

Prevention and Control of the Spread of Communicable Diseases

The cooperation of school personnel, health department, physicians, parents and students is
essential.
Prevention and Control Measures are:

a. Enforcing immunization laws and practicing universal precautions/ bloodborne pathogen

procedures according to School Board policies, and OSHA regulations.

b. Ongoing health education relating to disease prevention, hygiene measures for students,
families and school personnel.

c. Implementing good hand washing procedures.

d. Implementing case isolation and effective treatment.

Prevention of Communicable Diseases

Transmission Process:

Communicable disease transmission is a dynamic process. The process is dependent on the

following:

Interaction of the agent (microorganism) the host (person), and the environment (conditions
present).

In order for a communicable disease to occur the following factors must be present:

a. A microorganism of sufficient strength (virulence)

b. A person who is susceptible (lowered immunity)
c. An environment supportive to the agent’s transmission

Types of Transmission:

Direct Transmission – occurs when an infectious agent enters a receptive portal, i.e., through
direct contact as: touching, kissing, biting, or projecting air droplets by sneezing, talking,
spitting, coughing.

Indirect Transmission – occurs when an infectious agent is deposited on control objects or

materials, i.e., toys, soiled clothes, bedding, cooking or eating utensils, food, water.

CPH LEC

LESSON 2: Isolation and Quarantine

Isolation
  separates sick people with a contagious disease from people who are not sick.

Quarantine

 aims to separate and restrict the movement of people who have been exposed to a
contagious disease to watch and see if they become sick. Quarantine helps to limit the
spread of communicable disease.

 Categories of Isolation

a. Strict Isolation.

 Strict isolation is used to prevent the transmission of all highly communicable diseases
that are spread by both, contact or airborne routes of transmission. Examples of such
diseases are chickenpox and rabies.

b. Respiratory Isolation.

 Respiratory isolation is used to prevent transmission of organisms by means of droplets

that are sneezed or breathed into the environment. Examples of such diseases are
influenza and tuberculosis.

c. Protective Isolation.

 Protective isolation is used to prevent contact between potentially pathogenic

microorganisms and uninfected persons who have seriously impaired resistance.
Patients with certain diseases, such as leukemia, who are on certain therapeutic
regimens are significantly more susceptible to infections.

d. Enteric Precautions.

 Enteric precautions are used to control diseases that can be transmitted through direct
or indirect oral contact with infected feces or contaminated articles. Transmission of
infection depends on ingestion of the pathogen. Examples of diseases requiring enteric
precautions are dysentery and hepatitis.

e. Wound and Skin Precautions.

  Wound and skin precautions are used to prevent the spread of microorganisms found
in infected wounds (including burns and open sores) and contact with wounds and
heavily contaminated articles. Conditions requiring these precautions include infected
burns, infected wounds, and infections with large amounts of purulent discharge.
Diseases that may require wound and skin precautions include herpes, impetigo, and
ringworm.

f. Blood Precautions.

 Blood precautions are used to prevent acquisition of infection by patients and

personnel from contact with blood or items contaminated with blood. Examples of
diseases that require blood precautions (refer to Lesson 1) are HBV and HIV/AIDS.

g. Discharge Precautions.

o Secretion precautions-lesions

o Secretion precautions-oral

o Excretion precautions

Quarantine

 aims to separate and restrict the movement of people who have been exposed to a
contagious disease to watch and see if they become sick. Quarantine helps to limit the
spread of communicable disease.

Categories of Quarantine

a. Complete or absolute quarantine

b. Modified quarantine

c. Enhanced community quarantine

d. General community quarantine

Health effects related to the environment

 Many aspects of the environment can affect our health. Environmental hazards can
increase the risk of disease, including cancer, heart disease and asthma.