Philosophy and purpose of public health Dadi s Argadiredja

LEARNING OBJECTIVE To state definitions of health To state definitions and scopes of public health, preventive medicine, social medicine, & community medicine To describe scientific approaches used in public health To describe goals and strategies of public health

DEFINITION OF HEALTH (1) a state of relative equilibrium of body form and function which results from its successful dynamic adjustment to forces tending to disturb it. It is not passive interplay between body substance and forces impinging upon it but an active response of body forces working toward readjustment (Perkins, 1938) something positive, a joyful attitude toward life, and a cheerful acceptance of the responsibilities that life puts upon the individual (Sigerist, 1941)

DEFINITION OF HEALTH (2)  a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity (WHO, 1948) a state characterized by anatomic integrity, ability to perform personally valued family, work, and community roles; ability to deal with physical, biologic, and social stress; a feeling of well- being; and freedom from the risk of disease and untimely death (Stokes et al., 1982)

DEFINITION OF HEALTH (3) a state of equilibrium between humans and the physical, biologic, and social environment, compatible with full functional activity (Last, 1987) keadaan sejahtera dari badan, jiwa dan sosial yang memungkinkan setiap orang hidup produktif secara sosial dan ekonomis (a state of physical, mental and social well-being that enables any individual to achieve socially and economically productive life) (Act No. 23, 1992)

DEFINITION OF PUBLIC HEALTH the science and the art of: (1) preventing disease, (2) prolonging life, and (3) promoting physical health and efficiency through organized community efforts for: (a) the sanitation of the environment, (b) the control of community infections, (c) the education of the individual in principles of personal hygiene, (d) the organization of medical and nursing service for the early diagnosis and preventive treatment of disease, and (e) 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 so organizing these benefits as to enable every citizen to realize his birthright of health and longevity (Winslow, 1920)

DEFINITION OF PUBLIC HEALTH (cont’d)  efforts organized by society to protect, promote and restore the people’s health. It is the combination of science, skills and beliefs that is directed to the maintenance and improvement of the health of all people through collective or social actions (Last, 1988)  what we, as a society, do collectively to assure the conditions for people to be healthy (IOM, 1988)  the organization and application of public resources to prevent, dependency, which would otherwise result from disease or injury (Pickett & Hanlon, 1990)

PREVENTIVE MEDICINE is the science & art of preventing disease, prolonging life, & promoting physical & mental health & efficiency PREVENTIVE MEDICINE is the science & art of preventing disease, prolonging life, & promoting physical & mental health & efficiency For groups & community by public health practitioners (specialized practice of PM) PUBLIC HEALTH PRACTICE For individuals & families by private health practitioners (general practice of PM) MEDICAL & DENTAL PRACTICE Through Intercepting disease Processes by community & individual action Leavell & Clark, 1958

Preventive Medicine: a specialized field of medical practice composed of distinct disciplines which utilize skills focusing on the health of defined populations in order to promote and maintain health and well-being and prevent disease, disability, and premature death (Last, 1987)

Social Medicine : a term used to emphasize the importance of man’s environment to his health. In this sense, environment includes the human society in which man lives and the multitude of complex interpersonal relationships that so profoundly affect his health (Leavell & Clark, 1958)

COMMUNITY MEDICINE a field of knowledge and practice concerned with the interaction of the individual and the world with regard to health and illness. Its activities are expressed in teaching, research and service with special attention to the health of human populations in communities where thy live. Certain characteristics distinguish the field: (1) it integrates knowledge from various disciplines, e.g. the physical, biological, and behavioural sciences in order to understand health and illness both in individuals and in communities; (2) it also attempts to apply that knowledge explicitly in regard to taking action to promote health and alleviate illness in the population; and (3) the achievement of both the integration and application requires that it have an interdisciplinary focus in the identification and resolution of health care problems in communities (Coe & Pepper, 1978)

COMMUNITY MEDICINE (cont’d) that branch of medical science which is concerned with the health needs and interventions of population groups of known size and composition. That is, it is concerned with health of what is commonly known as defined population groups (Lathem, 1979)

Scientific approaches in Public Health Epidemiology Biostatistics Biological & physical sciences Social sciences Demographic science

Ultimate goal of public health The prevention of disease The promotion of health Different between developed & developing countries

Prevention can be achieved through: Emphasizing preventive aspects of medical care Health education & behavioral modification Control of the environment for health Cultivating political will for public health initiatives

Public Health Strategies Surveillance Intervention: - reducing the number of individuals susceptible to infectious & chronic disease - treating people early in the course of disease - modifying the environment - promoting healthy behavior of both communities & individuals Evaluation

Reading assignment 1. Leavell HR, Clark EG. Preventive medicine for the doctor in his community: an epidemiologic approach. 2nd ed. New York: McGraw-Hill Book Company Inc.; 1958, p Detels R, Breslow L. Current scope and concerns in public health. In: Detels R, Holland WW, McEwen J, Omenn GS, editors. Oxford Textbook of Public Health. New York: Oxford University Press; 1997, p Schutchfield FD, Keck CW. Chapter 1: Concepts and Definitions of Public Health Practice. In: Principles of Public Health Practice. 2 nd edition. New York: Delmar Learning; 2003