Public Health, Community Medicine & Epidemiology

Handout in Z:\Medical Student\CMD-SEM1\Prof Dr Than Winn\ Intro to Public Health 4 BMDHO

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Definition of Health

Health is a state of complete

physical, mental and social well-being and not merely the absence of disease or infirmity. (WHO, 1948)

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Public health (PH)

The science and art of

preventing disease, prolonging life preserving good health promoting health through: the organized efforts and informed choices of society, organizations, public and private, communities and individuals C.E.A. Winslow(1920)
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PH Activities
The prevention & control of communicable diseases, Early diagnosis and prevention of disease, The education of the individual in personal health and Ensure a standard of living adequate for the maintenance or improvement of health.
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Characteristics of public health

Less funding and public support than medical treatments.
E.g. heart surgery vs. diet and exercise programs to prevent heart disease.

The benefits of successful preventive interventions occur in the remote future.

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Characteristics of public health

Government action: many public health measures are exercised through coercion or the force of law.
Public health is focused on regulation and public policy

Consequentialist orientation.
Promoting public health means seeking to advance good health outcomes and to avoid bad health outcomes.
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THE SCOPE OF PUBLIC HEALTH 1. Health Promotion and Disease Prevention 2. Risk Reduction 3. Epidemiological and Other Public Health Research 4. Helps narrow the Structural and Socioeconomic Disparities between Haves and Have-Nots 5. Public Health is a global concern
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1. Health Promotion and Disease Prevention Programs designed to promote health and prevent disease and injury raise questions about
the responsibility of individuals to live healthy lives the governments role in creating an environment in which individuals are able to exercise their healthrelated responsibility the role of government in
coercing or influencing health-related behavior or in developing educational programs

The use of incentives, economic or otherwise, to promote good health

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2. Risk Reduction
Routine public health practice entails a number of interventions and policies designed to
prevent harm to individuals lower health risks within the population.

These include various forms of screening and testing of different age groups, Epidemiologic practice may not always follow appropriate ethical protocols on the human rights The collection of health information may involve intrusion of individuals privacy
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2. Risk Reduction
The responsibilities of the public health researcher regarding
individual notification protection of personal privacy and confidentiality

They are not yet clearly set out as a matter of consensus within the profession.
Example: HIV/AIDS in the past 2 decades faced problem in the employment of fairly standard practices such as
Anonymity of positive HIV test results. Contact tracing and partner notification to curb the spread of sexually transmitted diseases.
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3. Epidemiological and Other Public Health Research

Research with human subjects has been a central ethical problem for biomedicine for at least 100 years, but particularly since World War II. Is it an appropriate model for public health, one that may either pose no medical or other risks to individuals? Would it make informed consent impractical to gain in research encompassing large communities? Should the research standards used in the developed countries be exactly the same for those in developing countries?
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4. Structural and Socioeconomic Disparities Socioeconomic disparities have a major impact on health status. Equitable access to health care Less attention has been paid by the public health community and in the ethics literature to
ethical issues of occupational health and safety the ethical problems that arise when considering the health implications of environmental policy.
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How these goals and objectives are achieved.

1. Locally 2. Globally 3. At University level
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The role of Ministry of Health

For Public Health in Malaysia

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Vision
A nation working together for better health Malaysia will become a nation composed of individuals, families and healthy communities through health system fair and equitable, efficient, able to made available and appropriate technology available, compatible and appropriate to the customer environment. This system will also satisfy the
quality, innovation, health promotion, respect for human dignity and promote individual and community participation towards improving the quality of life

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Mission
To lead and work in partnership: To facilitate and support the people to:
attain fully their potential in health appreciate health as a valuable asset take individual responsibility and positive action for their health

To ensure a high quality health system that is:

customer centred equitable affordable efficient technologically appropriate environmentally adaptable innovative

With emphasis on:

professionalism, caring and teamwork value respect for human dignity community participation

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Organization
Consists of various agencies: Divisions State Health Departments Hospitals Institutions District Health Offices Colleges Health and Dental Clinics Public Health Laboratory
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Minister of Health DG Public Health Family H Disease Control Food safety Health Education Nursing Medical device Traditional Medicine Medical Practice Planning Engineering Tele-med Medical Research Vaccine Production HSR Public Health CRC

Medicine

Research

Institutes

Allied Health

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Health policy, planning and regulatory framework

Health planning in the Ministry of Health began in 1956 with the inception of the first Five-Year Malaya Plan (1956-1960). Since then, health planning has been carried out on five-yearly cycles. Current Rancangan Malaysia Ke-10 (2011-2015) Each five-year Plan provides the direction for health and health-related agencies to address the health needs of the population.
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Ministry of Health's mission, vision and objectives

The Ministry of Healths Vision for Health is of a nation working together for better health. The Mission of the Ministry is to
build partnerships for health to facilitate and support the people to attain their full potential in health motivate them to appreciate health as a valuable asset and take positive action to improve further and sustain their health status to enjoy a better quality of life.
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The role of World Health Organization (WHO) in International Health

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 WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for
providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends
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Six WHO Regions

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28 Countries in the WHO Western Pacific Region (WPRO)

Australia Brunei Darussalam Cambodia China Cook Islands Fiji Japan Kiribati Lao People's Democratic Republic Malaysia Marshall Islands Micronesia (Federated States of) Mongolia Nauru New Zealand Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Singapore Solomon Islands Tonga Tuvalu Vanuatu Viet Nam
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 In the 21st century, health is a shared responsibility, involving equitable access to essential care and collective defense against transnational threats.

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The role of WHO in public health

WHO fulfills its objectives through its core functions: providing leadership on matters critical to health and engaging in partnerships where joint action is needed; shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge; setting norms and standards and promoting and monitoring their implementation; articulating ethical and evidence-based policy options; providing technical support, catalysing change, and building sustainable institutional capacity; and monitoring the health situation and assessing health trends.

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The WHO agenda

1. Promoting development WHO activities aim at health development give priority to health outcomes in poor, disadvantaged or vulnerable groups. Attainment of the health-related Millennium Development Goals (MDG), preventing and treating chronic diseases and addressing the neglected tropical diseases are the cornerstones of the health and development agenda.
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2. Fostering health security

One of the greatest threats to international health security arises from outbreaks of emerging and epidemic-prone diseases. Such outbreaks are occurring in increasing numbers, fuelled by such factors as
rapid urbanization, environmental mismanagement, the way food is produced and traded, and the way antibiotics are used and misused.

The world's ability to defend itself collectively against outbreaks has been strengthened since June 2007, when the revised International Health Regulations (IHR) came into force.

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3. Strengthening health systems

For health improvement to operate, health services must reach poor and underserved populations. Areas being addressed include
the provision of adequate numbers of appropriately trained staff, sufficient financing, suitable systems for collecting vital statistics, and access to appropriate technology including essential drugs.
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4. Harnessing research, information and evidence

Evidence provides the foundation for
setting priorities, defining strategies, and measuring results.

WHO generates authoritative health information, in consultation with leading experts, to

set norms and standards, articulate evidence-based policy options and monitor the evolving global heath situation.
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5. Enhancing partnerships
WHO carries out its work with the support and collaboration of many partners, including
UN agencies and other international organizations, donors, civil society and the private sector.

WHO uses the strategic power of evidence to encourage partners implementing programmes with best technical guidelines and practices

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6. Improving performance
WHO participates in ongoing reforms aimed at improving its efficiency and effectiveness, both at the international level and within countries. WHO ensures its staff work in an environment that is motivating and rewarding.

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WHO Programmes and projects: Noncommunicable diseases (NCD)

Cancer Cardiovascular disease Diabetes Programme NCD Surveillance Mental health Oral health Prevention of Blindness and Visual Impairment Prevention of deafness and hearing impairment
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WHO Programmes and projects: Environment Household water treatment and safe storage Indoor air pollution International travel and health Ionizing radiation Occupational health Public Health and Environment

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WHO Programmes and projects: Medical Care Management for health services delivery Medical devices Millennium Development Goals (MDG) Diagnostic imaging Diagnostics and Laboratory Patient safety

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WHO Programmes and projects: Child health

Child and adolescent health and development Child growth standards Nutrition

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WHO Programmes and projects: Communicable Diseases

Malaria Dengue Lymphatic filariasis Polio Eradication Initiative Leprosy elimination Immunization service delivery and accelerated disease control
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Our curriculum
As a 5-star medical professional, you must learn, in additional to clinical medicine, the following:
Population medicine Research Medical Statistics

We teach FOUR modules to achieve all of the above

Epidemiology and public health in SEM 3 (Yr2) Research Methodology in SEM 4 (Yr2) Rural Health Posting in SEM 5 (Yr3) Urban Health Posting in SEM 6 (Yr4)
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Module 1: Epidemiology and Public Health (EPI) Semester 3

Summary of Module Contents

Principles & Concepts of Epidemiology LEC hr 1 1 1

TLA SGS hr

Introduction to Community Medicine History, Definitions and Measures in Epidemiology Review of Communicable Disease Concepts Non-communicable Diseases & Screening

TLA LEC hr 1 1
41 of 22

SGS hr

Epidemiology of Non-Communicable Diseases Screening of Diseases

Measures of Epidemiologic Parameters Morbidity and Mortality Risks and Associations Vital Statistics Standardization of Rates

TLA SGS LEC hr hr 1 1 1 1 1 1

42 of 22

Epidemiologic Principles & Practice of disease Prevention and Control LEC

TLA SGS

hr
Principles of Disease Prevention Investigation of an epidemic Immunization in Malaysia Causation in Epidemiology Disease Surveillance 1 1

hr

1 1 1 1 1

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Prevention and Control of Specific Diseases Epidemiology of Food and Waterborne Diseases Epidemiology of Vector Borne Diseases Epidemiology of Airborne Diseases Epidemiology of Close Contact Diseases Epidemiology of New and Emerging Diseases Prevention and control of occupational diseases End Module Exam for EPI

TLA LEC SGS

hr
1 1 1 1

hr

SEMINDSL

CTX on DSL 1

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Module: Research Methodology and Biostatistics (RMB) Semester 4

Summary of Module Contents

Topic Research Methodology Research Methodology: Preview 1 Cross-sectional 2 Case Control 3 Cohort 4 RCT SGS
Hands-on exercises: Analysis of Epi

Lec

TLA Prac

SGS

hr
1 1 1 1 1

hr

hr

2 2

Research Data (Comp Lab) using EpiInfo Total

19

16

Topic Concepts & Descriptive Statistics Introduction to Medical Statistics Descriptive Statistics Measures of Central Tendency Hands-on exercises: Introduction to SPSS Measures of dispersion Hands-on exercises: Data Entry Probability

TLA Lec Prac hr hr 1 1 1 2 1 2 1

Topic Probability, Distributions & Sampling Probability Distributions Estimation Sample Size Calculation Sampling Methods

TLA Lec hr 1 1 1 1 Prac hr

1 1 1

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Topic

TLA Lec Prac

Inferential Statistics & Hypothesis Tests Intro to Statistical inference/ Hypothesis testing
Statistical tests for quantitative data I: t tests ANOVA Statistical tests for qualitative data: Chi square test Correlation & Regression Revision on computer lab exercises

hr 1
1 1 1 1

hr

1 1 1 2 2

End Module Exam for RMB

Grand total [19 +(4x1)*2+(6x2)*2+ (1x2)*2] = 37+18=55 hrs

Summary
Health and public health were defined. Ways in which acceptable levels of health and public health can be achieved (locally and globally) were discussed. Curriculum which helps nurture 5-star medical professionals who care humanity by not just treating the sick but by promoting their quality of lives through a community approach which involves public health, epidemiology, research and statistics.
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