Community Health and Public Health: An Overview
Community Review: Certain Health
Human Biology
- Human Biology
- Genetics (mating, mutation, natural selection)
- Life Cycle (different stages of life)
- Biological Rhythms
Phenomena or changes that occur with great regularity in a relatively short period of time.
Biological Rhythms Rating
- Circadian: Regulate organic phases of organs.
- Ultradian: Occur more than once a day (e.g., hair loss, heartbeat, nail growth).
- Infradian: Occur less than once a day (e.g., respiration).
Lifestyles
Behaviors and choices made from the alternatives available to people according to their socioeconomic circumstances and the ease with which they can choose one over another (WHO).
A set of behavioral patterns and daily habits of a person, i.e., “the style of life of a person is their way of life” (Latorre, JM ’75).
Lifestyles involve:
- Conduct
- Habit
- Characteristics
- Conditions
- Difficulties
- The Environment (H2O, atmosphere, etc.)
- Health System
Finding Healthcare
According to WHO, the health system is the set of direct and specific environments designed to make available to the largest number of individuals the resources for early diagnosis, appropriate treatment, rehabilitation, prevention, and health promotion.
Levels of Care
Level 1 Care
This is the first point of contact a user has with the health system. It addresses less complex cases requiring basic resources and occurs near where the citizen lives.
- Does not usually require hospitalization or special requests.
- If users need more care, they are referred to other levels.
- Attention is given by a core team of health professionals and encompasses a small population (5,000 to 25,000 depending on the community).
- Solves 80%-90% of problems (because it acts as a filter).
- Outpatient care, ambulatory, home, community centers, etc.
- Care for individuals and community groups.
- Considers the individual within their environment.
Level 2 Care
In-depth and specialized care.
- Comprehensive and continuous.
Solves more complex situations, either outpatient or hospitalization.
Provides the user with a wider variety of resources and more complex infrastructure. Population 200,000 to 250,000.
Level 3 Care
Super-specialized care.
All levels must be connected and accessed hierarchically. This organization does not dictate whether facilities are public or private.
Why Health Professionals Should Know User Habits
Habits are modifiable behavior patterns. Health personnel can modify them through prevention and health promotion.
For example, if a person smokes, this can be changed with anti-tobacco campaigns.
Starting in childhood, unhealthy habits can be changed, such as promoting a balanced diet to avoid future overweight.
Public Health and its Fields of Intervention
Current Concept
- Population health vision
- Science and practice discipline
- Multidisciplinary
- Joint activities
- Regulations
- Management
- Planning
- Descriptive
- Research
Principles
- Universality
- Social Justice
- Right to health
Objectives
- Improving health and quality of life
- Longevity
Target
- Community
- Risk groups
- Specific problems
- Environment
Responsibility
- Public health authorities
- Political
Characteristics
- Specific industry
- General
- Population-based
Areas
- Sanitation
- Medical service provision
- Disease, disability, and premature death prevention
- Research, statistics, and health indicators
- Preventive medicine (not individual assistance)
- Vaccination
- Creating health services
- Social health insurance (1883, Otto von Bismarck)
- Public health laws (policy level)
- Combating communicable diseases
- Environmental surveillance and control
- Medical care
- Prevention with vaccines
- Protecting population health
- Protecting workers
Community Health vs. Public Health
Community health represents a change in strategy based on the philosophy of public health. It is a step in the evolution of public health, bringing public health to communities. It requires structural changes in the reorganization of healthcare to meet its principles.
Basics
- Community-focused
- Decentralization for primary health care
- Health promotion
- Community participation
- Health education
Public health encompasses many people. Community health focuses on smaller communities.
Definition
- Evolution of public health
- Community responsibility
- Community participation
- User feedback
Principles
- Planning and development
- Attention to the physical and social environment
- Health promotion
- Working directly with the population
- Multi-professional approach
- Levels of care
The Alma-Ata Declaration and Primary Health Care (PHC)
The 1978 Alma-Ata declaration called for PHC reform.
PHC Features
- Comprehensive/inclusive
- Decentralized/active
- Permanent/accessible
- Planned
PHC involves:
- Population
- Health authorities
- Health professionals
- Other community sectors
- International organizations
The existing health system needed change. It was a time of crisis and social movements demanding the right to health. Countries began to consider profound change with a different philosophy, principles, strategy, and objectives. The goal was “health for all,” requiring structural changes.
Objective
The maximum possible health for the entire population.
Perspectives
- Philosophy
- Strategy
- Support level
- Preventive function
- Curative function
- Rehabilitative function
- Community health promotion
Conceptual Elements
- Comprehensive/integrated
- Continuous and permanent
- Accessible
- Community participation
- Teaching and research
- Evaluation
- Multidisciplinary team
- Activities adapted to community needs
Disagreement with the PHC Concept
- Different conceptions in developed vs. developing countries.
- Developed countries: Focus on the physician-patient relationship.
- Developing countries: Classical systems lacking reform and patient access.
PHC depends on community participation, which depends on health promotion empowerment.
PHC is based on the philosophy of community health, and its strategy is to implement community health.
Strategy Based on Vuori (HV)
Philosophy (Principles)
- Equity
- Social justice: General access for all individuals and families.
- Universality
- Responsibility
- Collaboration
Strategy
- Laws are needed to implement this strategy. The first step is decentralization, transferring powers.
Epidemiological Chain of Influenza A
- Susceptible host: Humans
- Causal agent: Influenza A H1N1 virus
- Source of infection: Infected person
- Transmission mechanism: Contact and airborne
- Portal of entry: Respiratory tract
IQ and Disability Prevalence: Level of Prevention
Primary Prevention
Actions aimed at reducing disease incidence and the risk of new cases (WHO).
Targets healthy populations, at-risk populations, and susceptible hosts.
Specific Actions (depending on the disease or problem)
- Chemical and physical barriers to prevent microorganism entry.
- Standard precautions.
- Avoiding contact with patients (and animals).
- Cleaning and disinfecting wounds.
- Health education for at-risk groups and caregivers.
- Natural and artificial immunization (passive and active).
- Primary chemoprophylaxis.
- Other appropriate actions.
Secondary Prevention
Actions aimed at reducing disease prevalence, duration, and evolution (WHO).
- Preventing ongoing disease transmission.
- Targeting healthy carriers or patients in the pre-symptomatic phase.
- Specific treatments based on early diagnosis and carrier identification.
- Methods for detecting and identifying carriers (e.g., surveillance, screening, contact tracing).
- Early diagnosis and treatment (secondary prophylaxis, dietary, surgical).
- Other precautions.
Tertiary Prevention
Actions aimed at reducing chronic disability prevalence and minimizing functional disabilities (WHO).
- Preventing ongoing disease transmission and undesirable consequences.
- Targeting patients in the symptomatic phase (acute, chronic, convalescent).
- Specific clinical diagnosis.
- Barriers to exit portals.
- Measures targeting transmission mechanisms.
- Controls and monitoring.
- Epidemiological records (case sheets, maps, surveys, contact tracing).
- Reporting cases if transmissible.
Early Osteoporosis Care and Prevention Level
Bone densitometry for early osteoporosis care is secondary prevention. It aims to determine the disease stage and the best treatment.
Environmental Factors and Professional Activities
This section needs further information to provide specific environmental factors and their relationship with professional activities.
Medical Waste Disposal
Three actions for proper medical waste disposal:
- Classification: Grouping waste according to risk levels (Group I: general waste, Group II: low-risk, Group III: hazardous, Group IV: cytotoxic).
- Packaging: Using appropriate containers (bags for Groups I & II, rigid containers for Group III, specialized containers for Group IV).
- Treatment and Disposal: Following regulations for each waste group (e.g., incineration, autoclaving, landfill).
Waste Classification
- Group I: Non-hazardous municipal waste (e.g., cardboard, paper).
- Group II: Non-hazardous special and inert waste (e.g., medical materials, probes, gloves).
- Group III: Hazardous waste (e.g., blood, sharps, cultures).
- Group IV: Cytotoxic waste (e.g., cytotoxic drugs, contaminated materials).
Incidence vs. Prevalence
Incidence: New cases appearing in a population over a specific time period. It represents the probability of healthy individuals developing the disease.
Prevalence: Proportion of individuals in a population with a particular disease at a specific time or period. It reflects the magnitude of the problem.
Incidence measures new cases, while prevalence measures existing cases.
Birth Rate
Number of births.
Immigrant Integration Models
- Assimilationist (France): Immigrants are expected to adopt the host culture and become French citizens. Policies aim for equal opportunities regardless of origin.
- Multiculturalist (UK): Recognizes cultural diversity but can lead to social segregation.
- Intercultural (Scandinavia, Holland, Canada): Promotes coexistence and equality through policies that articulate various cultural traditions. It encourages participation and respect for diversity.
Concept of Health
According to WHO, health is a state of complete physical, mental, and social well-being and not merely the absence of disease.