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Prevention and Mental HealthPrevention---TreatmentPublic Health Approach,Goals of
Noncommunicable Disease Control Increasing Healthy Lifespan8Continuum of Health and Distribution in
a Population Implications of ModelPrevention and ControlPrevention StrategiesPrevention
StrategiesPrevention StrategiesInformation needsTypes of InformationInformation LoopPublic Health
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66. -ArialTimes New RomanDefault DesignPrevention and Mental HealthPrevention---TreatmentPublic
Health Approach)Goals of Noncommunicable Disease Control Increasing Healthy Lifespan6Continuum of
Health and Distribution in a Population Implications of ModelPrevention and ControlPrevention
StrategiesPrevention StrategiesPrevention StrategiesInformation needsTypes of InformationInformation
LoopPublic Health ApproachTargetsTargetsPrinciples of InverventionPrinciples of Invervention
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Prevention and Mental Health
Mens Sana in Corpore Sano
(A Healthy Mind in a Healthy Body)
….living in a healthy community
Major Vincent Fonseca, MD, MPH
OPHSA
Prevention---Treatment
Asklepios-deity of medicine and health
2 daughters
Panacea: represented treatment of people who are ill (“sickness care”)
Hygeia: represented living wisely and preserving health (“wellness care”)
Public Health Approach
“Surveillance:” What is the problem?
Risk Factor Identification: What are the causes?
Intervention Evaluation: What works?

67. Implementation: How should we do what works?
Evaluate impact and modify intervention
Goals of Noncommunicable Disease Control
Reduce the incidence of disease
Delay the onset of disability
Alleviate the severity of disease (increase function and improve the health-related quality of life)
Prolong the individual’s healthy life
Increasing Healthy Lifespan
Healthy life
Morbidity
70 years
80 years
(“Compression of Morbidity”)
Continuum of Health and Distribution in a Population
Perfect
Health
Disease
Cut-off
“Average”
Implications of Model
Simple linear model of disease or health progression
Individuals move in either direction
Physical, mental and social manifestations result from a complex interaction of factors at different
stages along continuum
As individuals move, so does the population distribution (health of the community)
Prevention and Control
Prevention Strategies
Primary: before disease develops
risk (or protective) factors must be known

68. modify factors to reduce disease incidence
Prevention Strategies
Secondary: reduce disease consequences
detects at an earlier, more treatable stage
natural history allows early detection
accurate screening tool
early treatment can alter consequences
screening tool is acceptable to populations at highest risk of disease
Prevention Strategies
Tertiary: prevent disability
prevent complications of disease
prevent progression of disease
provide rehabilitation
Information needs
Identify groups who are at risk of disease
Identify groups who experience benefits from interventions
Measure effects of interventions
Identify “new” factors
Types of Information
Mortality
Disability
Morbidity (inpatient and outpatient)
Risk Factors
Health Related Quality of Life
Functional Status
Information Loop
Information
Dissemination

69. Program
Evaluation
Program
Planning
Program
Implementation
Data
Collection
Data
Analysis
Data
Intepretation
Public Health Approach
“Surveillance:” What is the problem?
Risk Factor Identification: What are the causes?
Intervention Evaluation: What works?
Implementation: How should we do what works?
Evaluate impact and modify intervention
Targets
Population-based
common risk factors present in a large proportion of the population
most cases arise from intermediate or low-risk groups
small changes in intermediate risk group result in large changes in disease reduction
can be easier than changing high-risk groups
Targets
High-risk
disease is a personal and not a collective event
selective screening and care can be more cost-effective than mass screening

70. selective screening improves benefit:risk ratio
avoids interference with those who are at low risk
fits well with the traditional medical care framework
Principles of Invervention
Changes in underlying community norms are the key to widespread and long-term changes in health
Community-based approaches will contribute the most to reducing disease burden
Priority (target) population should be involved in developing intervention
Principles of Invervention
Actively involve community organizations
Clearly define intervention objectives
Base strategies on needs of the specific priority population
Use multiple intervention strategies
Adjust strategies based on evaluation
Strategies
Modify community conditions and norms
Establish and enforce health policies
Establish incentives
Enhance knowledge and skills
Provide screening and follow-up
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