Unit one

Introduction
MDG to
Health Needs Assessment
Public Health

Principles and
concepts of Public
Health
 Discussion points
Definition;
Health,
Diseases and Public Health in General
 Determinants Of Health
 Disease Causation
 Prevention Strategies
 …….
 Definition of major terms/
concepts
 Health
• The concept of health is often difficult
to define and measure

• It is a broad concept and experience.

Its boundary extends beyond the "sick”

It depends on:
1) The perception of individuals
2) The threshold - e.g. pain
3) the ability to recognize symptoms and
signs
 WHO …..definition

 Health:
is a state of complete physical, ment
al and social well-being and not mer
ely the absence of disease
or infirmity

 Wellness: an active process by which

an individual progresses towards
maximum potential towards healthy
condition, regardless of current
• Wellness is an active, lifelong process of
becoming aware of choices and making
decisions toward a more balanced and
fulfilling life

• Let you discuss about;

• What elements/components are poten-

tially determine individual wellness
(aspects of health)?
Components of Wellness

1.physical, e.g.:
• Ability to carry out daily tasks

• achieve fitness

• Maintain nutrition and proper body

fat
• Avoid abusing drugs, alcohol, or us-
ing tobacco products
• Generally to practice positive life-
style habits
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2. Social, e.g.:

• ability to interact successfully with

people and within the environment
of which each person is a part

• develop and maintain intimacy with

significant others

• develop respect and tolerance for

those with different opinions and
beliefs
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3. Emotional, e.g.:
• Ability to manage stress and express
emotions appropriately
• Ability to recognize, accept, and ex-
press feelings
• Ability to accept one’s limitations
4. Intellectual, e.g.:
• Ability to learn and use information
effectively for personal, family, and
career development

• Striving for continued growth and

learning to deal with new challenges
effectively
October 24, 2024 Azeb G 8
5. Spiritual, e.g.:
• Belief in some force (nature, science,
religion, or a "higher power") that
serves to unite human beings and pro-
vide meaning and purpose to life

• Includes a person’s morals, values, and

ethics
6. Occupational
• ability to achieve a balance between
work and leisure time
• beliefs about education, employment
and home influence
October 24, 2024 Azeb G personal satisfac-9
 Disease: the condition of the human body in
which something has gone wrong and has
upset the normal functions of the body including
the mind

• The International Classification of Disease

(ICD) distinguishes between three terms:
 Impairment
 any loss or abnormality of mental, anatomical
or morphological, physiological structure of
function
 Disability - is any restriction or lack,
resulting from impairment, of the
ability to perform an activity in a
manner or range considered normal
for a human being
 Absence of competent physical, in-
tellectual, or moral power, means,
and the like

 Handicap - is a long-term disadvan-

tage which adversely affects an indi-
 Aspects of health
 Physical health:
good body health, and is the result o
f regular exercise
, proper diet and nutrition, and
proper rest for physical recovery

 Mental health: individual's emo-

tional and psychological well-being

 Social health: the ability to make

and maintain relationships with
 Emotional Health: refers to our sense
of well-being and our ability to cope
with life events

• Concerned with the way we think and

feel

• It refers to our ability to acknowledge

and respect our own emotions as well
as those of others

 All these aspects:- emotional, physical,

 Holistic Concept of Health
 Quality of life that has dimensions and is
being influenced by many factors

 Interdependent and inter- related each other

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 Health maintenance
• Achieving health and remaining healthy
is an active process
• Effective strategies for staying healthy
and improving one's health include the
following elements:

 Nutrition
• What people eat affects their health and
performance, such as foods or food
components that cause diseases or dete-
riorate
October 24, 2024 health Azeb G 15
Exercise
• Frequent and regular physical exercise
is an important component in the pre-
vention of some of the diseases

 Hygiene and sanitation

• Hygiene is the practice of keeping the
body clean to prevent infection and ill-
ness, and the avoidance of contact with
infectious agents

October 24, 2024 Azeb G 16

Stress management
• Prolonged psychological stress may
negatively
impact health, such as by weakening
the immune system

Health care
• Health care is the prevention, treatm
ent, and management of illness and t
he preservation of mental and physic
al well being through the services all
ied
health professions 17
• According to the WHO, health care
embraces all the goods and services
designed to promote health, includ-
ing “preventive, curative and pal-
liative interventions, whether di-
rected to individuals or to popula-
tions”

18 18
Workplace wellness programs:
this can include things like promoting
health through
• onsite fitness centers,
• health education,
• wellness newsletters,
• access to health coaching,
• tobacco cessation programs

October 24, 2024 Azeb G 19

 Public Health Definition
• …the health status of a defined group of people and
the actions and conditions both private and public
(governmental) to promote, protect and preserve
their health.
 the science and the art of preventing disease, pro-
longing life & promoting physical health and effi-
ciency through organized community efforts for san-
itation of the environment, the control of community
infections
 defined …

 …, the education of the individual in principles of personal

hygiene, the organization of medical and nursing services
for the early diagnosis and preventive treatment of disease
and

 the development of the social machinery which will ensure

to every individual in the community a standard of living
adequate for the maintenance of health.[Charles Edward A.
Winslow ]
 The core functions of public health are

 Assessment : the diagnostic function (collection, assem-

bling, analysis)
 Researching to develop new insights and innovative so-
lutions;
 Monitoring the health status of the population;

 Policy development: formulating a strategic approach to

improving the community health

 Leading the development of sound health policy and

planning.
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 Core
 Assurance: making the services needed for the protection
of public health in the community are available and acces-
sible to everyone.
 Assuring the quality, accessibility, & accountability of
medical care;
 Reaching out to link high risk and hard to reach people
in medical services;
 Preventing epidemics;
 Protecting the environment, work place, food and wa-
ter;
 Promoting healthy behavior;
 Mobilizing community action;
 Responding to disasters;
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 Mission of public health

….“fulfilling society’s interest in assuring conditions

in which people can be healthy”.

Philosophies
The factor most significant in determining the
health of a community is its economic status

Effective public health programs save money on

medical costs in addition to saving lives.

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Determinants or factors
of public health
 Determinant/factors
• Physical Determinants:  Community Organization:
– Geography  Community size
– Environment  Arrangement and dis-
– Industrial development tribution of resources
(“relations of produc-
• Socio cultural Determinants: tion”)
– Beliefs, traditions & norms;
 Behavioral Determinants
– Economy
 Individual behavior and
– Politics;
life style
– Religion
 Environment: (Source of living)
Human ecology
 Physical Environment:
– condition of roads for driving (Vs Accidents, pollution)
 Climate:
– harvest, insect breading, etc (Vs famine, malnutrition)
– temperature, humidity, rainfall, radiation, altitude, etc
 Terrain: hilly, forest, desert, marshy, island

 Housing: ventilation, housing light, hazards etc

 Sanitation: drinking water, waste management, hygiene, etc

 Work place: noise, chemicals, etc

Social & Political environment:

– Life style, living status, poverty, education, gender status,

employment, food availability, etc
– governance, law, corruption, instability, etc

Geography: Kola, WeinaDega, Dega Vs diseases

 Other ways of looking in the
classification of factors
Four types
1. Predisposing Factor [as f(Host)]
Factors that may create a state of susceptibility
Ex: Age, (childhood, elderly); Sex, (women for depression)

2. Enabling Factors [as a f(env’t)]

Events or conditions that favor development of disease
or an outcome of interest.
 Factors such as low income, poor nutrition, bad housing, lack of
access to health Institutions
 Factors that assist in recovery from disease like maintenance of
good health could also be grouped here.
 Other…

3. Precipitating Factors [f(exposure]

– Events or conditions that favor exposure to a specific dis-
ease agent.
– They may be associated with the onset of the disease
Ex: Wound, physical trauma, Tetanus, STIs, HIV/AIDS

4. Reinforcing Factors [f(transmission]

– Factors that aggravate an established disease.
Ex: Repeated contact to infectious agent
Common cold within a household
 Multi-causal Theory
(Web of Disease Causation)
• It has even enlarged and elaborated on the host-
agent-environment triad wherein each of these fac-
tors affects the other

• The four models are:

1. Epidemiologic triangle & triad (balance beam) model

2.Sufficient and component causes model
3.Webs model
4.Wheel model of infectious diseases
 Models of causation

I. Models of Explanation
– It is a model that could assess reasons for an effect
happening
– It is more of social science phenomena

II. Ecological models

– It is a model applicable to infectious and non-infec-
tious causes of disease

III. Bradford-Hill criteria

– Criteria of causation

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 I. Models of Explanation
a. Idiographic model aims at a complete understanding of a
particular phenomenon, using all relevant causal factors
– Enumerates detailed/unique factors that lie behind some
action or social fact
– Lists all possible factors as reasons for the occurrence of
the outcome
b. Nomothetic model aims at a general understanding of a
class of phenomenon, using the smallest number of most relevant
causal factors.
The nomothetic model is probabilistic in its approach to causation.
It is the model typically used in social scientific research.
– Isolates the few key characteristics uniting similar cases
– Isolates the few core reasons of an outcome

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 a. Idiographic explanation
• Example- “Taking this introduction to public
health course”
• There are a number of reasons for why you are taking this
course. … if you start listing…. You can list thirty or forty …
– Reasons
…. may be high-minded, ….. to help you satisfy
your interest in exploring pedagogical methods.

…… may be more routine reason: the course is re-

quired, it fit into your schedule.
• If you list as many as you can it would help people to fully un-
derstood why you are doing it.
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 b. Nomothetic explanation
• But in a nomothetic explanation
– it offers a partial explanation for the behaviors that
represent many people.

– Such explanations are not singling out certain reasons

rather they provide a more generally applicable expla-
nation.

– Therefore, it is probabilistic, not certain or complete.

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 II. Three ecological models

1. The Epidemiologic Triangle (Triad)

– consist of three components
1) host, 2) environment and 3) agent.

– A change in any of the components will alter an existing

equilibrium to increase or decrease the frequency of the
disease.

AG H
EN O
T ST
ENVI-
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Epidemiologic triangle & triad (balance beam) model

Traditional model of infectious disease causation

Agent Agent Host

Host Environ-
ment Environment
Epidemiologic triangle Balance beam

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2. The Web of Causation
• The essence is that
– Effects (diseases) never depend on single isolated
causes,
RATHER it develops as a result of chains of inter-re-
lated causes.
• The large number of inter-related causes, are
considered as a “web”

Eg Pulmonary Tuberculosis-
• Patients lower immunity + M. Tbc
• Malnutrition, HIV/AIDS, Age, Cancer
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web model
• It is in response to the
idea of non-infectious
diseases having no
unique agent

• There is no single
cause

• Causes of disease are

interacting

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 A
D

3. The Wheel / Pie Modelcomponent causes model C B

• This has come for multi-factorial nature of causation in

many diseases.

Sufficient Cause:
• The whole components of a pie make the sufficient
cause for a disease.

– A disease may have only one factor as a sufficient

cause to develop a disease. Eg. Rabies

– A disease may have more than one sufficient cause,

each sufficient cause is composed of several compo-
nent causes.
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 Cont..
Multiple-causality of diseases

• In this traditional model, each component cause is seen as

necessary and sufficient cause in itself to produce the ef-
fect.

• Necessary cause: A causal factor whose presence is re-

quired for the occurrence of the disease.
– A factor (contributing) that is necessary (or with out which) the
disease doesn’t exist or occur

• Sufficient cause. A causal factor or collection of factors

whose presence is always followed by the occurrence of
the disease.
 Wheel cont..

Social
Agent environment

Host Agent

Genetic
Agent
core
Physical
(Humans) environment
Biologic
environment
Agent

The interaction of humans with infectious agents and their environment, a

person’s state of health represents a dynamic equilibrium – a balance of
 III. Bradford-Hill criteria
In judging the different aspects of causation,
 The correct temporal relationship is essential,

 Once the above fulfilled, weight should be given

to:
– Plausibility, [logically cause, clinical implication]
– Consistency, [other researches should support]
– dose-response relationship and
– Strength of the association
– Specificity of the relation

46
 Establishing Causality
 To establish whether two variables are causally related, we must es-
tablish:
 Time order (temporal relationship): The cause must
have occurred before the effect
 Statistical association: Changes in the value of the in-
dependent variable must be accompanied by changes
in the value of the dependent variable
 Rationale: There must be a logical and compelling ex-
planation for why these two variables are related
 Non-spuriousness: It must be established that the ‘in-
dependent variable X’, would be the cause of changes in
the dependent variable Y; 47
Models of Disease Prevention
 Models based on level

• Levels of prevention is related with natural history

of a disease
• It involves the interruption or slowing of disease
progression through appropriate interventions.
• It is through identifying modifiable causes of the
disease and its risk factors

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 Natural History of Diseases
• Refers to the progress of a disease process, in the
absence of intervention.

Usual time
of diagnosis
Pathologic Onset of
Exposure Changes Symptoms
Time

Stage of Stage of Stage of Stage of Recovery,

Susceptibility Subclinical Clinical Disability or Death
Disease Disease

• Natural history time lines for infection

and disease 50
 Cont….
• There are several stages during the course of a dis-
ease at which we can intervene in order to control
the disease.
• Three levels, (Primary, Secondary and Tertiary)

I. Primary prevention
Objectives –
 promote health,
 prevent exposure, and
 prevent disease.

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 Cont…
A. Health promotion (Primordial):
• It is general non-specific interventions that enhance
health and the body’s ability to resist disease
• It is more of communal than individual effect (govern-
ments, NGOs, international organizations effort)
• Example- improvement of socioeconomic status through
the provision of adequate….
– paid jobs,
– education,
– affordable and adequate housing and clothing, etc.
– Millennium Development Goal

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 Cont…

B. Prevention of exposure:
• Relatively specific compared to primordial pre-
vention

– Example for communicable disease

 provision of safe & adequate water, proper excreta dis-
posal,
 vector control;
 Provision of a safe environment at home

– Example of non-communicable
 Slow driving for prevention of car accident injury,

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 Cont…

C. Prevention of disease:
– Example -immunization.

– Some intervention can act at more that one level

• Example- Breastfeeding is an example of an
intervention which acts at all three levels of
primary prevention.

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 Cont…
II. Secondary prevention
–Interventions that act after the biological onset of
disease, but before permanent damage sets in.

–Objective - to stop or slow the progression of dis-

ease so as to prevent or limit permanent damage.

–Strategy - early detection and treatment of dis-

ease.

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 Cont…
III. Tertiary prevention
• Intervention that acts after permanent damage
has set in,

• Objective - to limit the impact of that damage.

• The impact can be physical, psychological, social

(social stigma or avoidance by others), and fi-
nancial.

• Strategy - is rehabilitative.
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