community and public health

HCA 3306, Community Health 1

Course Learning Outcomes for Unit I Upon completion of this unit, students should be able to:

1. Determine strategies to confront prevalent community health issues facing the United States. 1.1 Compare and contrast medicine and community and public health. 1.2 Explain the most pressing challenges community and public health professionals have faced

and will face in the future

Course/Unit Learning Outcomes

Learning Activity

1.1 Unit Lesson Chapter 1 Unit I Assessment

1.2 Unit Lesson Chapter 1 Unit I Assessment

Required Unit Resources Chapter 1: Introduction to Community and Public Health

Unit Lesson

Introduction to Community Health Concepts It is widely regarded that C-E. A. Winslow is the father of public health as we know it. Winslow founded the Yale School of Public Health in 1915, and his ideas continue to be a major influence on worldwide community health practices today. His leadership transformed isolated and marginally effective health practices into the world’s first organized system for improving the health of a community, and that took place right here in America (Kemper, 2015). Winslow was responsible for stopping the spread of typhoid in public water supplies. He also played a key role in the early steps for a safer American workplace. He taught us how to greatly reduce the incidence of food poisoning in American homes and restaurants, and he worked to eradicate infant paralysis and insect- borne illness. He was one of the first researchers to prove the connection between poverty and disease and to emphasize the importance of safe housing for all. Undoubtedly, the teachings of Winslow have saved many thousands of lives, perhaps millions, over the decades since the founding of public health. There is no true way to estimate his impact (Kemper, 2015). Winslow taught us that public health is all about preventing disease, prolonging life, and promoting health through our organized efforts as community health professionals. That includes sanitation of the environment, control of disease spread, and early diagnosis and treatment of disease. It also includes creation of the necessary social machinery for maintenance of health, acceptable standard of living, and assurance that every citizen realizes these benefits as a birth right (Kemper, 2015).

Three Levels of Prevention Public health practices can be thought of in three levels, all of which are important for the health of a community.

UNIT I STUDY GUIDE

Introduction to Community and Public Health

HCA 3306, Community Health 2

UNIT x STUDY GUIDE

Title

• Primary level prevention is the promotion and protection of health.

• Secondary level prevention is the early diagnosis and treatment with control of the further spread of disease.

• Tertiary level prevention is the control of disability and rehabilitation back to health. Let’s consider each of these levels separately, and provide some examples for clarity. Primary prevention focuses on prevention with the active involvement of community members. It takes a team to advance the health of a community because health care professionals cannot do it alone. Since the vast majority of health problems truly are preventable with simple safety measures, we will begin there. A few key aspects of primary prevention are safe drinking water, safe disposal of waste materials, cleanliness of the living environment, and essential immunizations for children. Traffic control also falls under primary prevention, including the implementation of seatbelts in automobiles and effective traffic safety laws. Good nutrition at all ages is a key aspect of primary prevention as you will learn in this course. In some cases, mass screening for various diseases can also be undertaken as a form of primary health. Finally, health education is a crucial aspect of primary prevention. An informed community can make better choices for health. Currently, Americans do not consistently make the best individual decisions for health. That is evident in our dietary choices, smoking and alcohol consumption habits, and sexual safety practices. The next important improvements on the horizon for American community health will come not as a result of some new technology, but rather, as the result of better lifestyle decisions by individuals and families. The health education role for public health professionals is so important at this time! Secondary prevention works to reduce the influence of disease or injury that has already happened. This is typically accomplished by early detection and evidence-based treatment of conditions or injuries as early as possible. The goal here is to stop the progression of disease, or, in some cases, to slow down the progression of disease. Again, education is very important here, including the encouragement of patient personal strategies for prevention of re-injury or recurrence. Also important under secondary prevention is the implementation of programs to return clients to their best possible health and best functionality as soon as feasible, thereby preventing or reducing the long-term consequences of illness. One example of secondary prevention is frequent breast examination and mammography to identify breast lesions at the earliest stage when treatment can be effective. Daily 81mg aspirin therapy for patients with known cardiac history or cardiac risk factors is another example. Workplace modifications so that employees can safely return to their positions sooner also falls under secondary prevention. Tertiary prevention approaches illness from a longer-term perspective, focusing on chronic illness. Today, chronic disease is a major challenge for our nation. It is a positive thing that Americans are living longer and continuing to function longer, but many of us have chronic illnesses to cope with now. Such conditions include heart disease, type 2 diabetes, chronic obstructive pulmonary disease, and a variety of neuromuscular disorders. Tertiary prevention has the goal of reducing the impact of ongoing illness over time. The term “disease management” has recently been coined to describe this process of working with clients to help them stay well in spite of chronic disease. A few important examples of tertiary prevention include cardiac rehabilitation, pulmonary rehabilitation, type 2 diabetes support groups, arthritis support groups, and various kinds of vocational rehabilitation services.

An Example to Help You Understand To help you understand the differences between primary, secondary, and tertiary prevention, let’s look at an example. Let’s say you are the health commissioner for a community near a swimming hole that is used by children and adults alike. Health care professionals contact you and inform you that people are developing serious and persistent rashes after swimming.

HCA 3306, Community Health 3

UNIT x STUDY GUIDE

Title

You approach a manufacturing company upstream that is discarding a chemical into the river that feeds the swimming hole, and you order them to stop. This example is considered primary prevention because you removed a hazardous exposure to the community and preventing rashes from developing. When you ask lifeguards and swimmers to check for signs of a rash that can then be treated immediately, you are conducting secondary prevention. This form of prevention does not stop rashes from developing initially, but you reduce impact by treating the rashes early and allowing swimmers to recover quickly. When you set up programs that teach community members how to live with chronic rashes, you are conducting tertiary prevention. You are not preventing rashes from developing initially, nor dealing with them immediately, but you are reducing their impact over time.

Our Community as Our Client A great way to begin your study of community health is to think of the entire community as your client and not one patient at a time as we think of things in a clinic or hospital setting. So, if the community is our client, then clearly we must get to know that client very well. We need to identify and understand the client, and we need to clarify the health needs of the client. This is termed community diagnosis. We must come to understand the underlying factors that cause health problems in the community, and we must develop a plan and implement comprehensive services for the community. Everything in community health is needs-based, and the needs change significantly from one community to another. Community identification is how we explore and assess health status, determining factors that affect the health of community members. We look at the geographical area, the housing patterns, and climatic issues. We look at the population characteristics of the community and the lifestyles of people who live there. It is important to consider family types and sizes as well as cultural factors, including values and customs. Each community is unique, and we need to embrace that uniqueness. We also need to thoroughly understand our community before planning services. We need to understand and evaluate existing services in the community. Nothing is gained by replicating a service that already exists and already meets a need. Some communities have strong volunteer organizations that can help us but others do not. Finding the best ways to communicate with the community using communication channels is also important. Transportation to and from services must be considered, studied, and understood. How do we obtain all of this needed information? Observation visits can help us to learn more about the community, and informal meetings with community leaders, church groups, and civic clubs are instructive. Discussions with health care professionals can reveal a lot as well as a review of public health statistics and records. A formal community health needs assessment (CHNA) may be in order, and funding for that project can often be obtained through state, federal, or private grants. All of this leads to the community diagnosis, which is a written statement of the health needs and health problems of the community, determined after analysis of all available data from the community identification (CID) process. Health needs can then be prioritized for planning and implementation with community health actions and treatments.

Conclusion In this course, you will learn a great deal about community health in America. The topics are fascinating, and they are so important simply because health is so important and because human lives truly are at stake! As an aspiring health care leader, you need a solid understanding of community health as you begin climbing the health care career ladder. Whether you work directly in the public health sector or you manage a medical service organization of some kind, you will benefit from the community health perspective on everything you do.

HCA 3306, Community Health 4

UNIT x STUDY GUIDE

Title

Reference Kemper, S. (2015, June 2). C-E.A. Winslow, who launched public health at Yale a century ago, still influential

today. Yale News. https://news.yale.edu/2015/06/02/public-health-giant-c-ea-winslow-who-launched- public-health-yale-century-ago-still-influe