Vladimir Reshetnikov, MD, PhD, DMSc, professor, Honoured Doctor of

the RF, Head, Department for Public Health and Health Care

Introduction to Public HealthIntroduction to Public Health and andHealth Systems Health Systems

I.M. Sechenov First Moscow State Medical University

Department of Public Health and Health Care Organization

IntroductionIntroduction.. History of Department for Public Health and Health Care I. Sechenov`s FMSMU

Part I CONCEPT OF HEALTH. Determinants of Health. Globalization and Health.Model of Disease causation theories.

Part II PUBLIC HEALTH. History of public health. Definition of public health. Major disciplines in public health.

Part III HEALTH AND DEVELOPMENT

Outline of the lecture

February, 20, 1922 – the birthday-the 1st lecture by prof. Semashko

History of Department for Public Health and Health Care

Famous People at our department

MAISTRAKH Ksenia

Vasilyevna

1950-1955

KURASHOVSergei 

Vladimirovich

1955-1965

SERENKOAlexander Fedorovich

1966-1982  

ERMAKOV Vladimir Vasilyevich

1982-1993  

KUCHERENKOVladimir 

Zakharovich

1994 - 2013

History of Department for Public Health and Health Care

Students' Research Group

History of Department for Public Health and Health Care

Students' Research Group

Students' Research Group

2015:2015:Maternal and Children's Health2016:2016: 1. 1.The Impact of Demographic Trends on Public Health in Different Countries.2. HIV/AIDS as a Public Health Challenge in Different Countries.

Students' Research Group

Miss Ooi Kar Kay

Results of the study were published:

• Mikerova M.S., Key O.K. Proven international students in Russia have a negative tendency to socio-emotional and medical lability);

• Glazachev O.S., Mikerova M.S., Key O.K. Ways of optimization of the research work of foreign medical students).

 

Students' Research Group

We invite you to join our Students Research Group!

During 2 semesters, we will be studying 3 basic modules

• Public HealthPublic Health• Health CareHealth Care OrganizationOrganization • Health EconomicsHealth Economics

History of Department for Public Health and Health Care

Part I CONCEPT OF HEALTH. Health. Determinants of Health.

Globalization and Health.Model of Disease causation theories.

“A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”. (WHO, 1948)

Dimentions of Health:•Physical health•Mental Health•Social health•Emotional health•Spiritual Health

1. Health

• WHO constitution: enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion,

political belief, economic or social condition”.

1.1 Different perspectives on health

• The health field concept:• A. Human Biology

– Genetic Counseling– Genetic Engineering

• B. Environment– Life support, food, water, air, etc– Physical factors, climate, Rain fall– Biological factors: microorganisms, toxins,– Psycho-social and economic e.g. Crowding,

income level, access to health care– Chemical factors

1.2 Determinants of health

• Life style (Behavior)• Health care organization

– Availability of health service– Scarcity of Health Services – Acceptability of the service by the community– Accessibility– Quality of care

1.2 Determinants of health

Factors affecting health of a community

Socio-cultural Physicaldeterminant

Communityorganization

Behavioraldeterminant

Health of theCommunity

• Globalization is the process of increasing political and social interdependence and global integration that takes place as capital, traded goods, persons, concepts, images, ideas and Values diffuse across the stated boundaries (Hurrel & Woods 1995).

1.3 Globalization and Health

• Externalities of some diseases due to increased communication decreased human mobility

• Accelerated economic growth and technological advances have enhanced health and life expectancy

• Increasing effects of international and bilateral agencies

• Jeopardizing population health Via erosion of social and environmental conditions and exacerbating inequalities

Effects of Globalization on Health

• Fragmentation and weakening of labor markets due to greater power of mobile capital

• Tobacco induced diseases• Food markets & obesity as well as chemicals in

food• Rapid spread of infectious diseases• Depression in aged and fragmented

population• Adverse effects on the environment

Health risks of Globalization

19th century models•1. Contagion theory•2. Supernatural theory•3. Personal behavior theory•4. Miasma theory20th century models•1. The Germ Theory•2. The Life Style Theory•3. The Environmental Theory•4. The Multi Causal Theory

1.4 Model of disease causation theories

PART II

PUBLIC HEALTH

2.1 History of public health 2.2 Definition of public health 2.3 Major disciplines in public health

2.1 History of public healthHISTORICAL MARKERS in the development of Public Health (selected)• 1700 BC The Code of Hammurabi – Rules governing medical practice• 1500 BC Mosaic Law – Personal, food and camp hygiene, segregating lepers, overriding

duty of saving of life (Pikuah Nefesh) as religious imperatives.• 400 BC Greece – Personal hygiene, fitness, nutrition, sanitation, municipal doctors,

occupational health; Hippocrates –clinical and epidemic observation and environmental health.

• 500 BC to AD 500 Rome – aqueducts, baths, sanitation, municipal planning, and sanitation services, public baths, municipal doctors, military and occupational health.

• 500 – 1000 Europe – destruction of Roman society and the rise of Christianity; sickness as punishment for sin, mortification of the flesh, prayer, fasting and faith as therapy; poor nutrition and hygiene pandemics;antiscience; care of the sick as religious duty.

• 1348 – 1350 Black Death – origins in Asia, spread by armies of Genghis Khan, world pandemic kills 60 million in fourteenth century, 1/3 to 1/2 of the population of Europe.

• 1300 Pandemics – bubonic plague, smallpox,leprosy, diphtheria, typhoid, measles, influenza, tuberculosis, anthrax, trachoma, scabies and others until eighteenth century.

2.1 History of public health (2)• 1796 Edward Jenner – first vaccination against smallpox.• 1830 Sanitary and social reform, growth of science.• 1854 John Snow – waterborne cholera in London: the Broad Street

Pump.• 1854 Florence Nightingale, modern nursing and hospital reform –

Crimean War• 1858 Louis Pasteur proves no spontaneous generation of life.• 1862 Louis Pasteur publishes findings on microbial causes of

disease.• 1876 Robert Koch discovers anthrax bacillus.• 1882 Robert Koch discovers the tuberculosis organism, tubercle

bacillus.• 1880 Typhoid bacillus discovered (Laveran);leprosy organism

(Hansen); malaria organism (Laveran).

• 1883 Robert Koch discovers bacillus of cholera, Louis Pasteur vaccinates against anthrax.

• 1890 Anti-tetanus serum (ATS)• 1892 Gas gangrene organism discovered by Welch and Nuttal• 1894 Plague organism discovered (Yersin, Kitasato); botulism

organism (Van Ermengem).• 1926 Pertussis vaccine developed• 1928 Alexander Fleming discovers penicillin• 1946 World Health Organization founded.• 1977 WHO adopts Health for all by the year 2000• 1978 Alma-Ata Conference on Primary Health Care

2.1 History of public health (3)

2.1 History of public health (4)• 1979 WHO declares eradication of smallpox achieved• 1981 First recognition of cases of acquired immune deficiency

syndrome (AIDS).• 1990 W.F. Anderson performs first successful gene therapy.• 1992 United Nations Conference on Environmental and

Development, Rio de Janiero• 1992 International Conference on Nutrition.• 1993 World Conference on Human Rights, Vienna.• 1994 International Conference on Population and

Development, Cairo.• 1998 WHO Health for All in the Twenty-first Century adopted.

2.2 Definition of public healthPublic health - the science and art of preventing

diseases, prolonging life, promoting health and efficiencies through organized community effort.

Key Terms in the definition• Health Promotion• Prevention• Rehabilitation

2.2 Definition of public health• Health Promotion - activities intended to enhance

individual and community health well-being

The Elements of Health promotion:1. Addressing the population as a whole in health related issues 2. Directing action to risk factors or causes of illness or death;3. Undertaking activities approach to seek out and remedy risk factors in the

community that affect health;4. Promoting factors that contribute to a better condition of health of the

population;5. Initiating actions against health hazards,including communication,

education, legislation etc.;6. Involving public participation in defining problems;7. Advocating relevant environmental ,health , and social policy ;8. Encouraging health professionals’ participation in health education and

health policy.

2.2 Definition of public healthPrevention - to promote, to preserve, and to

restore health when it is impaired, and to minimize suffering and distress

3 levels of prevention:1. Primary2. Secondary3. Tertiary

2.2 Definition of public healthRehabilitation - the process of restoring a person’s

social identity by repossession of his/her normal roles and functions in society

High quality rehabilitation includes:1. Full assessment of people with disabilities and

suitable support systems;2. A clear care plan;3. Measures and services to deliver the care plan.

2.3 Major disciplines in public health

• Nutrition• Reproductive health• Environmental Health • Health Education • Epidemiology • Health Economics• Biostatistics • Health Service Management • Ecology• Demography

Responding to disasters;

Core activities in public health1. Preventing epidemics2. Monitoring the health status of the population; 3. Assuring the quality ,accessibility, and accountability of medical

care;4. Responding to disasters;5. Protecting the environment, work place ,food and water ;6. Promoting healthy behavior;7. Mobilizing community action;8. Reaching to develop new insights and innovative solutions;9. Leading the development of sound health policy and planning

A healthy person is the most precious product of nature.

Thomas Carlyle

Part III HEALTH AND DEVELOPMENT

3.1 The difference between development andeconomic growth 3.2 The role of health in development3.3 Relationship between health and

development3.4 Health and the millennium development

goals

3.1 The difference between development and economic growth

Development - both a physical reality and a state of mind in which society has, through some combination of social, economic and institutional processes, secured the means for obtaining a better life.

Economic growth - an increase in country’s productive capacity, identifiable by a sustained rise in real national income over a period of years.

3.1 The difference between development and economic growth (2)Development• Encompasses the total well-

being of individual, a community or a nation.

• Must be measured by the rate of economic growth

• Concerned with the total person, his economic,social, political, physiological, and psychic andenvironmental requirements.

Economic growth• Concerned with the area in

per capital earning of the people making up the nation.

• Is one characteristic of development?

• It is possible for a county to experience economic growth without development.

3.2 The role of Health in Development

3.3 Relationship between health and development

Household Livelihood Security (HLS) - adequate and sustainable access to income and resources to meet basic needs, including:

1. Food, Proper Nutrition, Clean Water; 2. Health, Health Facilities and services; 3. Economic Opportunities; 4. Education; 5. Housing/Habitat Security; 6. Physical Safety; and 7. Time for Community Participation

3.4 Health and the Millennium Development Goals

The Millennium Development Goals (MDGs)1. Eradication of extreme poverty and hunger2. Achievement of universal primary education3. Promotion of gender equality and empowerment ofwomen4. Reduction of child mortality5. Improvement in maternal health6. Combating HIV/AIDS, malaria and other diseases7. Ensuring environmental sustainability8. Developing a global partnership for development

The means to a productive life

. The core political, social, and economic rights: • Equal rights. • Freedom from violence• Equal access to public services•Security of tenure and property rights for shelter, businesses, and other assets.

The key elements of adequate human capital: • Basic nutrition. • Health system • Literacy, skills

The essential infrastructure services: • Safe drinking water and basic sanitation. • Natural environment• Energy• Safe roads and transport • IT and communications

Learn to take care of your own health, and you will never see a doctor.

Leonardo da Vinci