Determinants of health
By: ABINET G.(BSC. PHO, MPH-N)
Contact: 0921250602

Teaching methods
 Lecture/Discussion
 Assignments
 Group work/Seminar
 Independent studies

Units to be covered
• Introduction to Human health, society and culture .
• Introduction to Psychological and behavioral determinants
of health
• Introduction to environmental health
• Social and cultural aspects of human health
• Psychological aspects of health and illness
• Introduction to safe water supply
• Social and cultural aspects of medicine
• Human development
• Food Hygiene
• Human health and socio- economic factors
• Health and human behavior
• Waste management

Cont…
• Culture
• Learning
• Housing and institutional Health
• Social Problems
• Vector and control
• Motivation and Emotion
• Process of Interaction
• Abnormal
• Behaviors and psychotherapy
• Occupational Health and Safety

By the end of the Course
1. Analyze socio-cultural determinants of health and disease at individual,
family and community level
2. Analyze socio-economic determinants of health and disease at individual,
family and community level
3. Analyze psychological and behavioral determinants of health and disease at
individual, family and community level
4. Analyze environmental and ecological determinants of health and disease
at individual, family and community level
5. Describe the relationship of human beings to their environment in relation
to health.
6. Apply the basic principles of environmental control
7. Instruct individuals, groups, and communities on proper human excreta
and refuse disposal, water source protection & storage
8. Acquire a clear understanding of personality development, mental
mechanisms and emotions in health and sickness
9. Explain the dynamics of society and common social problems

Introduction…
By the end of this session students will be able to:
 Define and understand different concepts in public health
 Understand the historical development of public health.
 Explain the main functions of public health
 Describe the essential health service of public health
 Describe the scope of public health

Introduction to PH
WHAT IS:
 Public
 Health, How do you perceive health?
 Communities
 Community Health
 Public Health

Public
 Public is about the what of belonging to the people; relating
to, or affecting, a nation, state, or community; opposed to
private.
 Health
 Professional points of view health is
defined as a measure of the state of the physical
bodily Organs, and the ability of the body as a whole to
function.
 It refers to freedom from medically defined diseases

 The WHO defines health as ‘a state of complete physical,
mental, and social well-being and not merely the absence of
disease, or infirmity’.
 Recently this statement has been expanded to include
the ability to lead a “socially and economically
productive life”.

 Community: a group of people who share or have common
intent, belief, resources, preferences, needs, risks and a number
of other conditions.
 WHO defines community as “a group of people, often living in
a defined geographical area who share a common:
 culture,
 values, and norms,
 are arranged in a social structure according to relationships
they have developed over a period of time”.

 Members of a given community gain their personal and social
identity by sharing common beliefs, values and norms.
 Muslim/Christian
 Communities may also be based on shared interests or
characteristics, such as race/ ethnicity, sexual orientation, age,
or occupation
 Black/white
 Homosexual/heterosexual
 Women/men
 Adolescents/children (infants, under5)
 sex workers/ long distance truck drivers

• Community health, a field within public health, that concerns
itself with the study and betterment of the health of
communities.
1. In 1923, C.E.A. Winslow defined public health as "the
science and art of preventing disease, prolonging life and
promoting physical health and mental health and efficiency
through organized efforts and informed choices of society,
organizations, public and private, communities and
individuals

Charles Edward A. Winslow defined public health as:
 the science and the art of preventing disease, prolonging life, and promoting physical
health and efficiency through organized community efforts for:
– sanitation of the environment,
– the control of community infections,
– 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.

2. John Last defines public Health: “Efforts organized by society
to protect, promote and restore the peoples health”.
3. It is the combination of science, skills and beliefs that is
directed to the maintenance and improvement of the health of
all the people through collective or social actions.

SO …
• In general PH:
• Is science and art of
preventing diseases,
prolonging life,
promoting health and
efficiencies through organized
community effort.
• It is the health of the whole community, and
preventing disease from which it suffers
• It is a combination of Sciences, skills and beliefs
that is directed to the maintenance and
improvement of the health of all the people

Brainstorming
• What do you think of Public Health professionals?(be in
group and discus)

 Most people think of public health workers
as physicians and nurses, but a wide variety
of other professionals work in public health,
including:
 veterinarians, sanitary engineers,
 microbiologists,
 laboratory technicians,
 statisticians,
 economists,
 administrators,
 industrial safety and hygiene specialists,
 psychologists,
 sociologists, and
 educators. How?

Philosophy and mission of PH
TEST YOURSELF
 What are the philosophy of public health?
 What are the mission of public health?
 What is the most significant factor in determining the
health of a community?

Philosophy
 Effective public health programs save money on medical
costs in addition to saving lives.
 When public health scientists are certain they know all
about the causes of a problem and what should be done
about it,
 A political decision is generally necessary before actions
can be taken to solve it (unlike medicine where it is only
up to the patient to accept or reject the doctors
recommendation).

Mission
 “Fulfilling society’s interest in assuring conditions in which
people can be healthy”.
 The factor most significant in determining the health of a
community is its economic status.
• What other determinants you know?

Scope
 Public health systems vary in different parts of the world, depending upon the
prevalent health problems.
 In the developing world, where sanitation problems and limited medical
resources persist,
– infectious diseases are the most significant threat
to public health.
– public health officials devote resources to
establish sanitation systems
– immunization programs to curb the spread of
infectious diseases,
– provide routine medical care to rural and
isolated populations.

Scope…
In industrialized nations:
 sanitary food and water supplies
 excellent medical resources have reduced rates of infectious
disease.
 Instead, accidents and diseases such as:
• lung cancer, heart attacks, strokes are among the leading
causes of death.
 In these areas, public health goals include:
• education programs to teach people how to prevent
accidents
• lessen their risk for disease,
• maintenance of the excellent disease prevention systems
already established.

Scope …
 public health workers may engage in
activities outside the scope of ordinary
medical practice. These include:
– inspecting and licensing restaurants;
– conducting rodent and insect control programs;
– checking the safety of housing, water, and food supplies.
– assuring overall community health,
 public health officials also act as advocates
for laws and regulations such as:
• drug licensing or product labeling requirements

Scope …
 Some public health officials are epidemiologists, who use
sophisticated computer and mathematical models ;
– to track the incidence of communicable diseases
– to identify new diseases and health trends.
 Others conduct state-of-the-art medical research to find
new prevention and treatment methods.

Scope ….
In general scope of PH can be categorized in to three
broad domains:
• Health protection: covers communicable diseases and environmental
hazards, such as exposure to toxic chemicals and poisons.
Exposure to hazardous substances at work is covered by the separate
discipline of occupational medicine.
• Health improvement: includes understanding the wider determinants of
health, such as housing, education, poverty and lifestyle risk factors and seeks
to improve health through health promotion and disease prevention.
• Improving services: is concerned with how the quality of health
services can be improved through evidence-based planning, the provision of
effective and cost-effective treatment and ensuring
that services are available to everyone who can benefit from them

History
• Difficult to select a date for the origins of the field of public
health.
• Some say it goes back to the time of Hippocrates who in his
book of Airs, water and places tried to present the casual
relation between environmental factors and disease.
1. 400 BC Hippocrates, whose book Airs, waters and places :
was the first systematic effort to present the casual
relations between environmental factors and disease and to
offer theoretical basis for an understanding of endemic and
epidemic diseases. READ MORE

History of PH in Ethiopia
 From traditional medicine to sector wide approach program
Traditional Medicine:
 Is a worldwide phenomenon
 Based on herbal cures often integrated with spiritual counseling and
providing both preventive and curative care.
 Have existed for thousands of years
 Often coexist today with modern medicine
 Has long history in Ethiopia
 Is part of the cultural pattern of the community it is

Modern medicine development in
Ethiopia
 Introduction and utilization of modern medicine in fragmentary
situations dates back to the start of the 16th century
 Modern medicine was introduced by different groups of people
ranging from religious and diplomatic missions to travelers,
traders, and invaders
 There were also preventive activities:
– measures to control cholera in the army of Emperor
Theodros (1855-1868)
– smallpox vaccination during the time of Emperor

 Further progress in the introduction and development of western
medicine was achieved during the reign of Emperor Menelik II (1889-
1916)
 The Russian mission established the 1st hospital (the Russian Red
Cross Hospital (Balcha) ) in Addis Ababa in 1897
 It was not until the start of the 20th century that the government took
full responsibility for operating the modern health service system
 The 1st government sponsored health facilities were established in
Harar by Ras Mekonnen and Menelik II Hospital in Addis Ababa in
1909
 READ MORE

PH and Medicine
• What is the difference between the two?

Q?