1. The basic theoretical and organizational principles of modern public health services
Northern-West State Medical University named after I.I. Mechnikov
Department of Public Health and Health Care
Elena A. Abumuslimova
Ph.D., Associate Professor

2. The Universal Declaration on Human Rights:
“Everyone has a right to a standard of a living adequate for the health and well being of himself and his family, including food, clothing, housing and medical care.”
Universal Declaration of Human Rights, 1946
The idea that health is a human right was articulated in the United Nation’s Universal Declaration of Human Rights, created over 60 years ago at the inception of the organization. This idea is of pivotal importance in the development of the science of global health. Medical, public health, and nursing students need to be aware of the impact they can make on the global health in the future.
Essential Health Information: Is there a Right of Access?

3. - What does “health “ mean for you? - Which factors are most important
for health?

4. What is health? Drugs Family Feeling good Older people Smoking
Diabetes
Blood pressure
Food safety
Exercise
Positive health
Parenting
Water Fluoridation
Bad Housing
HIV/ AIDS
Heart Disease
Waiting Lists

5. Theories of health: the theory that health is an ideal state,
the theory that a person is healthy if she can function in a socially useful role,
the theory that health can be bought or given as if it is a commodity,
the theory that health is an ability or strength to adapt to the changing challenges and circumstances of life, etc..

6. Defining Health: The Medical Definition
The normal physical state, i.e., the state of being whole and free from physical and mental disease or pain, so that the parts of the body can carry on their proper function.

7. Defining Health: The World Health Organization
Health is a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity.
Health is a positive concept emphasizing personal resources, as well as physical capacities.

8. Three Broad Concepts of Health
Medical (Traditional)
Behavioural (Lifestyle)
Socio-Environmental (Structural)
These approaches lead to different definitions of problems, different strategies, different target groups, and different people responsible for the activities of promoting health.

9. Medical concept

10. Concepts of Health Promotion: Medical Approach I (Traditional, Biomedical)
Health Concept is biomedical, absence of disease and/or disability
Leading Health Problems defined in terms of disease categories and physiological risk factors such as physiological deviation from the norm: CVD, AIDS, diabetes, obesity, arthritis, mental disease, hypertension, etc.
CVD – cardiovascular disease

11. Concepts of Health Promotion: Medical Approach II
Principal Strategies: surgical interventions, drug and other therapies, health care, medically managed health behaviour change (diet, exercise, patient education, patient compliance), screening for physiological and genetic risk factors
Target: high risk individuals
General Approach: Individualized
Actors: physicians, nurses, allied health workers

12. Behavioural concept

14. Concepts of Health Promotion: Behavioural Approach I (Lifestyle, Public Health)
Health Concept is individualized, health as energy, functional ability, disease‑preventing lifestyles
Leading Health Problems defined in terms of behavioural risk factors: smoking, poor eating habits, lack of fitness, drug abuse, alcohol abuse, poor stress coping, lack of life skills, etc.
Life skills are behaviors used appropriately and responsibly in the management of personal affairs. They are a set of human skills acquired via teaching or direct experience that are used to handle problems and questions commonly encountered in daily human life. The subject varies greatly depending on societal norms and community expectations.

15. Concepts of Health Promotion: Behavioural Approach II
Principal Strategies: health education, social marketing, advocacy for public policies supporting lifestyle choices (e.g. smoking bans, low fat meat production, bicycle paths, advertisement bans)
Target: high risk groups, children and youth
General Approach: individualized, elements of societal focus as related to public policy
Actors: public health workers, illness‑related advocacy groups (e.g., Cancer Society), governments

16. Socio-Environmental concept

17. Concepts of Health Promotion: Socio-Environmental Approach I (Structural)
Health Concept is a positive state defined in connectedness to one's family/friends/community, being in control, ability to do things that are important or have meaning, community and societal structures supporting human development
Leading Health Problems defined in terms of psychosocial risk factors and socio‑environmental risk conditions: poverty, income gap, isolation, powerlessness, pollution, stressful environments, hazardous living and working conditions, etc.

18. Concepts of Health Promotion: Socio-Environmental Approach II (Structural)
Principal Strategies: small group development, community development, coalition building, political action and advocacy, societal change
Target: high risk societal conditions
General Approach: structural, focussed on organization of communities and society, development of just political/economic policies
Actors: citizens, social development and welfare organizations, political movements and parties

19. Health Field Concept: Lifestyle Human Biology Environment Health Care
According to the approaches there are 4 factors influenced on the health.

20. Lifestyle is a main medical-social factor of health
Features of a lifestyle :
labour activity and working conditions;
economic - household activity (a kind of dwelling, a floor space, a conditions of life, time spent for household activity, etc.);
the recreational activity directed on restoration of physical strengths and interaction with an environment;
social activity in family (care of children, family interrelations);
family planning and mutual relation of family members;
formation of behavioral characteristics and the social - psychological status;
medical-social activity (the attitude to health, medicine, aiming of healthy lifestyle).

21. Structure of a Lifestyle:
level of living (structure of incomes on the person),
quality of a life (the measured parameters describing a degree of social security of the person),
style of a life (psychological specific individual features of behavior),
mode of life (a national - social order of a life, a life culture).

22. Lifestyle depends on: social and economic structure of a society,
an educational level,
culture,
relations among people,
traditions,
social installations in family,
personal characteristics.
The most part of these factors together with hygienic characteristics of being, construct the generalized concept "lifestyle" which share of influence on health makes more than 50 % among all factors.

23. Environment air quality food protection radiation protection
solid waste management
hazardous waste management
water quality
noise control
environmental control of recreational areas
housing quality

24. Biological characteristics of a person
(the sex, age, a heredity, the constitution, temperament, adaptable opportunities, etc.) make in general share of influence of factors on health no more than 20 %.

25. Health Care. Health Services Administration/Management
Only the insignificant part (8-10 %) parameters of health are determined by a level of activity of medical institutions and efforts of medical workers.
Managing the database at a school clinic; developing budgets for a health department; creating polices for health insurance companies; and directing hospital services all depend on health administrators. The field of health services administration combines politics, business, and science in managing the human and fiscal resources needed to deliver effective public health services. Specialization can be in planning, organization, policy formulation and analysis, finance, economics, or marketing.

26. Parameters for an estimation of public health according the WHO:
Deduction of a total national product on public health services.
Availability of the primary medical-social help.
Coverage of the population by medical aid.
A level of population immunization.
A rate of pregnant women observed by qualified specialists.
A quality of food for children.
A level of children's death rate.
Average forthcoming life duration.
Hygienic literacy of the population.

27. Criteria of health Primary physical disability;
Medical-demographic (birth rate, death rate, a natural increase, infantile death rate, birth frequency of the prematurely born children, average forthcoming duration);
Morbidity (general, infectious, with temporary disability, according to medical surveys, the most important non-communicable diseases, hospitalization);
Primary physical disability;
Indices of physical development;
Indices of mental development.

28. Life Expectancy Map From Wikipedia
The life expectancy in prehistoric times was very low, 25–40 years, with men living longer than women; archaeological evidence of women and babies found together suggests that many women would have died in childbirth, perhaps accounting for the lower life expectancy in women than men. Today, the world’s life expectancy exceeds 70 years with women outliving men in most societies. What exactly was the cause of this dramatic shift in life expectancy? What can we do to replicate success of geographical regions in highlighted green so that countries highlighted in red could enjoy the same long life expectancy? What can we do to make green regions even “greener”?
From Wikipedia

29. Four levels of health:
Health of the separate person - individual health;
Health social and ethnic groups - group health;
Health of the population of administrative territories - regional health;
Health of a population, a society as a whole - public health.

30. Groups of health at complex adults health estimation:
1st group - healthy persons (not being ill within one year or seldom applying to the doctor and without disability);
2-nd group - practically healthy persons, with functional and some morphological changes or seldom being ill within one year (single cases of acute diseases);
3-d group - patients with frequent acute diseases (more than four cases and 40 days of disability per year);
4-th group - patients with durable chronic diseases (the compensated condition);
5-n group - patients with often aggravations of durable chronic diseases.

31. Most important problems of global health today
Communicable, maternal, perinatal and nutritional conditions
Noncommunicable diseases
Injuries
What are some of the most important problems in global health today? The landmark 1996 publication, “The Global Burden of Disease”, presented data from 1990 with data projections out to 2020 for three broad cause groups of health problems that, collectively, constitute the world's total disease burden. These are: Group 1, communicable, maternal, perinatal and nutritional conditions; Group 2, noncommunicable diseases; and Group 3, injuries. Within each of these broad groups are more specific conditions.
The 15 leading individual problems, based on DALYs (disability-adjusted life years) , were: (1) lower respiratory infections; (2) diarrheal diseases; (3) conditions arising during the perinatal period; (4) unipolar major depression; (5) ischemic heart disease; (6) cerebrovascular disease; (7) tuberculosis; (8) measles; (9) road traffic accidents; (10) congenital anomalies; (11) malaria; (12) chronic obstructive pulmonary disease; (13) falls; (14) iron-deficiency anemia; and (15) anemia.
Non-communicable diseases are the most widespread diseases seen by the majority of medical students in their practice. We need to work together to share our knowledge about these conditions for prevention and cure.

32. The leading individual problems, based on DALYs (disability-adjusted life years)
lower respiratory infections;
diarrheal diseases;
conditions arising during the perinatal period;
unipolar major depression;
ischemic heart disease & cerebrovascular disease;
tuberculosis;
measles;
road traffic accidents;
congenital anomalies;
malaria;
chronic obstructive pulmonary disease;
falls;
anemia & iron-deficiency anemia.

33. Non-communicable diseases are the most widespread diseases seen by the majority of medical students in their practice.
We need to work together to share our knowledge about these conditions for prevention and cure.

34. What is a health system?

35. What is a health system?
It is the sum total of all the organizations, institutions and resources whose primary purpose is to improve health.
A health system needs staff, funds, information, supplies, transport, communications and overall guidance and direction. And it needs to provide services that are responsive and financially fair, while treating people decently.

36. Where is the problem?
Problems with health systems are not confined to poor countries. Some rich countries have large populations without access to care because of inequitable arrangements for social protection. Others are struggling with escalating costs because of inefficient use of resources.

37. " Public health services" means activity on preservation, improvement, maintenance and strengthening of health of the population various groups.
The optimization of public health system is the major part of social - economical policy of the State.
Public Health is the science of protecting and improving the health of communities through education, promotion of healthy lifestyles, and research for disease and injury prevention. Public health professionals analyze the effect on health of genetics, personal choice and the environment in order to develop programs that protect the health of your family and community.
Overall, public health is concerned with protecting the health of entire populations. These populations can be as small as a local neighborhood, or as big as an entire country.
Public health professionals try to prevent problems from happening or re-occurring through implementing educational programs, developing policies, administering services, regulating health systems and some health professions, and conducting research, in contrast to clinical professionals, such as doctors and nurses, who focus primarily on treating individuals after they become sick or injured. It is also a field that is concerned with limiting health disparities and a large part of public health is the fight for health care equity, quality, and accessibility.

38. Public health professionals try to prevent problems from happening or re-occurring through implementing educational programs, developing policies, administering services, regulating health systems and some health professions, and conducting research.
Science of public health is also a field that is concerned with limiting health disparities and a large part of public health is the fight for health care equity, quality, and accessibility.

39. Public health is mainly composed of the following core areas:
Behavioral Science/Health Education
Biostatistics
Emergency Medical Services
Environmental Health
Epidemiology
Health Services Administration/Management
International/Global Health
Maternal and Child Health
Nutrition
Public Health Laboratory Practice
Public Health Policy
Public Health Practice
The field of public health is highly varied and encompasses many academic disciplines. However,

40. Behavioral Science / Health Education
Stopping the spread of sexually transmitted diseases, such as herpes and HIV/AIDS; helping youth recognize the dangers of binge drinking; and promoting seatbelt use.
Behavioral Science focuses on ways that encourage people to make healthy choices. This includes the development of community-wide education programs that range from promoting healthy lifestyles in order to prevent disease and injury, to researching complex health issues.
Public health workers also promote more efficient uses of health services, adopt self-care practices, and participate actively in the design and implementation of health programs.
Some examples of concentrations include mental health, aging, health promotion and disease prevention, public health practice, health education and behavior change, disability and health, and social research.

41. Biostatistics
Estimating the number of deaths from gun violence or looking at trends in drunk driving injuries by using math and science is the study of biostatistics.
Using biostatistics, health workers can identify health trends that lead to life-saving measures through the application of statistical procedures, techniques, and methodology.
Forecasting scenarios, identifying health trends within the community, explaining biological phenomena, as well as determining the causes of disease and injury, biostatistics are an integral part of public health. Biostatistics are often utilized in tandem with epidemiology.

42. Environmental Health
The air we breathe; the water we drink; the complex interactions between human genetics and our surroundings.
How do the built and natural environments influence our health and how can we reduce risk factors? These environmental risk factors can cause diseases such as asthma, cancer, and food poisoning.
Specialists from chemistry, toxicology, engineering, and other disciplines combine their expertise to answer these important questions. Environmental health studies the impact of our surroundings on our health.

43. Epidemiology
When food poisoning or an influenza outbreak attacks a community, the epidemiologists are asked to investigate the cause of disease and control its spread.
Epidemiologists do fieldwork to determine what causes disease or injury, what the risks are, who is at risk, and how to prevent further incidences.
Some of the most important health-related discoveries in history are associated with epidemiology including the landmark 1964 Surgeon General's report on smoking tobacco stating its harmful effects.
They spot and understand the demographic and social trends that influence disease and injury and evaluate new treatments.
The initial discovery and containment of an outbreak, such as West Nile virus, often comes from epidemiologists.

44. Health Services Administration/Management
Managing the database at a school clinic; developing budgets for a health department; creating polices for health insurance companies; and directing hospital services all depend on health administrators.
The field of health services administration combines politics, business, and science in managing the human and fiscal resources needed to deliver effective public health services. Specialization can be in planning, organization, policy formulation and analysis, finance, economics, or marketing.

45. International / Global Health
Globalization has linked our health more closely to one another than ever before. The rapid movement of people and food across borders means that a disease can travel from a remote village to an urban hub at breakneck speed. Global public health meets the rising health challenges that transcend national boundaries. This international field encompasses virtually all specializations in public health.
Addressing health concerns from a global perspective and encompassing all areas of public health (e.g., biostatistics, epidemiology, nutrition, maternal and child health, etc.). International health professionals address health concerns among different cultures in countries worldwide.

46. Maternal and Child Health
Providing information and access to birth control; promoting the health of a pregnant woman and an unborn child; and dispensing vaccinations to children are part of maternal and child health.
Professionals in maternal and child health improve the public health delivery systems specifically for women, children, and their families through advocacy, education, and research.

47. Nutrition
Promoting healthy eating and regular exercise; researching the effect of diet on the elderly; teaching the dangers of overeating and overdieting are the responsibility of public health nutritionists.
In short supply in both public and private sectors, this field examines how food and nutrients affect the wellness and lifestyle of population. Nutrition encompasses the combination of education and science to promote health and disease prevention.

48. Public Health Policy
Analyzing the impact of seat belt laws on traffic deaths; monitoring legislative activity on a bill that limits malpractice settlements; advocating for funding for a teen anti-smoking campaign.
Professionals in public health policy work to improve the public's health through legislative action at the local, state, and federal levels.

49. Public Health Practice
Public health is an interdisciplinary field and professionals in many disciplines such as nursing, medicine, veterinary medicine, dentistry, and pharmacy routinely deal with public health issues. A degree in public health practice enables clinicians to apply public health principles to improve their practice.

50. The major theoretical problems of public health services :
social conditionality of public health,
illness as a biosocial phenomenon,
the basic categories of public health services (public health, material - economic base, the staff, etc.),
forms and ways of development of public health services under various social and economic conditions, etc.

51. The main goals of science on public health and public health services :
study of medical-social factors, life conditions and a lifestyle influence on the public health;
development of scientifically proved recommendations on the prevention and elimination of adverse factors,
improving actions for increase of a level of health of the population;
an estimation of criteria of public health and quality of medical aid, and their optimization.

52. Main directions of development of public health service at the present stage:
protection of motherhood and the childhood,
creation of optimum social and economic, legal and medical-social conditions for strengthening health of women and children,
planning of family,
the solving of medical-demographic problems,
increasing of quality of health care.

53. Four categories of the general indices which characterize a condition of public health services in any country according to the World Health Organization (WHO):
the governmental policy in the field of public health service;
social and economic indices;
indices of security of the medical-social help;
Indices of health status of the population.

54. Structure of a subject “Public health and health care service”:
a history of public health services;
theoretical problems of public health services;
the state of health and methods of its studying;
the organization of medical-social security and medical insurance
the organization of medical aid to the population;
maintenance of sanitary-and-epidemiologic well-being of the population;
Economic forms of perfection of public health services, management, marketing and modelling of medical services;
the international cooperation in the field of medicine and public health services.

55. Methods of medical-social researches:
historical;
dynamic observation and the description;
sanitary – statistical method – as a basic;
the medical-sociological analysis;
expert estimations; expertise assessment method
the system analysis and modelling;
organizational experiment;
scheduled - normative, etc.

56. Objects of medical -social researches are:
groups of persons, the population of administrative territory;
separate establishments (polyclinics, hospitals, the diagnostic centres, the specialized services);
public bodies and establishments of public health services;
objects of an environment;
the general and specific risk factors of various diseases, etc.

57. The basic elements of health complex study and its determining factors
collecting of the information on health status;
processing and analysis of the information on health status;
promotion of hypothesis about mutual dependence of environment factors and health status;
directed study of environment factors and profound study of health characteristics;
revealing of quantitative dependences between environmental factors of and health characteristics;
decision-making on environmental improvement for primary morbidity prophylaxis;
realization of the accepted decisions;
efficiency control of the accepted decisions.

58. THANK YOU!
Be healthy!