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Community Health:
 Yesterday, Today,
  and Tomorrow



     Chapter 1
Introduction
• Much progress made over last 100 years in
  health and life expectancy
• Achievement of good health is worldwide goal
  of 21st century
• Requires individual actions to improve
  personal health and organized community
  actions
20th Century Achievements in Public Health

• Vaccination              • Safer and healthier
• Motor vehicle safety       foods
• Control of infectious    • Safer workplaces
  diseases                 • Family planning
• Decline of deaths from   • Fluoridation of drinking
  CHD and stroke             water
• Healthier mothers and    • Recognition of tobacco
  babies                     use as a health hazard
Definition: Health
• Can mean different things to different people
• A dynamic state or condition of the human
  organism that is multidimensional in nature, a
  resource for living, and results from a person’s
  interactions with and adaptations to his or her
  environment
Definition: Community
• A group of people who have common
  characteristics
  • Can be defined by location, race, ethnicity, age,
    occupation, interest in particular problems or
    outcomes, or common bonds
• Characterized by
  • Membership, common symbol systems, shared
    values and norms, mutual influence, shared needs
    and commitment to meeting them, shared
    emotional connection
Other Definitions
• Public health – actions that society takes
  collectively to ensure that the conditions in which
  people can be healthy can occur
• Community health – health status of a defined
  group of people and the actions and conditions to
  promote, protect, and preserve their health
• Population health – health status of people who
  are not organized; have no identity as a group
• Public health is the most inclusive term
Personal Health Versus Community Health
• Personal health
  • Individual actions and decision making that
    affect the health of an individual or his or her
    immediate family members or friends
• Community health
  • Activities aimed at protecting or improving the
    health of a population or community
     • Maintaining birth and death records, protecting
       food and water supply, etc.
Factors that Affect the Health of a Community
Physical Factors
•   Geography
•   Environment
•   Community Size
•   Industrial Development
Social and Cultural Factors
•   Beliefs, traditions, and prejudices
•   Economy
•   Politics
•   Religion
•   Social norms
•   Socioeconomic status
Community Organizing
• A process through which communities are
  helped to identify common problems or goals,
  mobilize resources, and in other ways develop
  and implement strategies for reaching their
  goals they have collectively set
• Is not a science, but an art of consensus
  building within a democratic process
Individual Behavior
• Takes the concerted effort of many individuals
  to make a program work
• Herd immunity
  • The resistance of a population to the spread of
    an infectious agent based on the immunity of a
    high proportion of individuals
A Brief History of Community and Public
                    Health
• Almost as long as the history of civilization
• Knowledge of the past helps us better prepare
  for future community health challenges
Earliest Civilizations
• Many community health practices went
  unrecorded
• Practices may have involved taboos, rites, and
  spiritual beliefs
• Archeological evidence of community health
  activities dating back to 2000 B.C.
The Eighteenth Century
• Characterized by industrial growth
• Cities overcrowded, water supplies inadequate
  and unsanitary, problems with trash,
  workplaces unsafe
• 1796-Dr. Jenner demonstrated process of
  vaccination against smallpox
• Average age at death: 29 years
• First census taken: 1790
The Nineteenth Century
• Better agriculture lead to improved nutrition
• Federal government approach to health:
  laissez faire (noninterference)
• Epidemic problems in major cities
• Many scientific discoveries
• 1850: Shattuck report
• 1850: Modern Era of Public Health begins
The Twentieth Century
• 1900: life expectancy less than 50 years
  • Leading causes of death were communicable
    diseases
  • Vitamin deficiencies and poor dental health
    common in slums
Health Resources Development Period
                  (1900-1960)
•   Growth of health care facilities and providers
•   Reform phase (1900-1920)
•   1920s
•   Great Depression and WWII
•   Postwar years
Period of Social Engineering (1960-1973)
• Federal government became active in health
  matters
• 1965 Medicare and Medicaid established
• Improved standards in health facilities
• Influx of federal dollars accelerated rate of
  increase of cost of health care
Period of Health Promotion (1974-present)
• Identification that premature death traceable to
  lifestyle and health behaviors
• Healthy People publication established
Community Health in the Early 2000s
• Main Issues
  •   Health care delivery
  •   Environmental problems
  •   Lifestyle diseases
  •   Communicable diseases
  •   Alcohol and other drug abuse
  •   Health disparities
  •   Disasters
  •   Public health preparedness
Community Health in the 21st Century
• World Planning
  • Previous goals not met, but progress made
  • Widening inequities
  • Most attention on less developed and poorer
    countries
• United States Planning
  • Focused on 10 year blocks of time
  • Current plan outlines health agenda: Healthy
    People 2020
Healthy People 2020
• Four overarching goals:
  • Attain high-quality, longer lives free of
    preventable disease, disability, injury, and
    premature death
  • Achieve health equity, eliminate disparities, and
    improve the health of all groups
  • Create social and physical environments that
    promote good health for all
  • Promote quality of life, health development, and
    healthy behaviors across all life stages
Discussion Questions
• How do you define health?
• How can understanding the history of
  community health efforts better help today’s
  planning?
• How can Healthy People documents affect
  health outcomes?
• What role does the United States play in world
  health planning?

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Ch01 outline

  • 1. Community Health: Yesterday, Today, and Tomorrow Chapter 1
  • 2. Introduction • Much progress made over last 100 years in health and life expectancy • Achievement of good health is worldwide goal of 21st century • Requires individual actions to improve personal health and organized community actions
  • 3. 20th Century Achievements in Public Health • Vaccination • Safer and healthier • Motor vehicle safety foods • Control of infectious • Safer workplaces diseases • Family planning • Decline of deaths from • Fluoridation of drinking CHD and stroke water • Healthier mothers and • Recognition of tobacco babies use as a health hazard
  • 4. Definition: Health • Can mean different things to different people • A dynamic state or condition of the human organism that is multidimensional in nature, a resource for living, and results from a person’s interactions with and adaptations to his or her environment
  • 5. Definition: Community • A group of people who have common characteristics • Can be defined by location, race, ethnicity, age, occupation, interest in particular problems or outcomes, or common bonds • Characterized by • Membership, common symbol systems, shared values and norms, mutual influence, shared needs and commitment to meeting them, shared emotional connection
  • 6. Other Definitions • Public health – actions that society takes collectively to ensure that the conditions in which people can be healthy can occur • Community health – health status of a defined group of people and the actions and conditions to promote, protect, and preserve their health • Population health – health status of people who are not organized; have no identity as a group • Public health is the most inclusive term
  • 7. Personal Health Versus Community Health • Personal health • Individual actions and decision making that affect the health of an individual or his or her immediate family members or friends • Community health • Activities aimed at protecting or improving the health of a population or community • Maintaining birth and death records, protecting food and water supply, etc.
  • 8. Factors that Affect the Health of a Community
  • 9. Physical Factors • Geography • Environment • Community Size • Industrial Development
  • 10. Social and Cultural Factors • Beliefs, traditions, and prejudices • Economy • Politics • Religion • Social norms • Socioeconomic status
  • 11. Community Organizing • A process through which communities are helped to identify common problems or goals, mobilize resources, and in other ways develop and implement strategies for reaching their goals they have collectively set • Is not a science, but an art of consensus building within a democratic process
  • 12. Individual Behavior • Takes the concerted effort of many individuals to make a program work • Herd immunity • The resistance of a population to the spread of an infectious agent based on the immunity of a high proportion of individuals
  • 13. A Brief History of Community and Public Health • Almost as long as the history of civilization • Knowledge of the past helps us better prepare for future community health challenges
  • 14. Earliest Civilizations • Many community health practices went unrecorded • Practices may have involved taboos, rites, and spiritual beliefs • Archeological evidence of community health activities dating back to 2000 B.C.
  • 15. The Eighteenth Century • Characterized by industrial growth • Cities overcrowded, water supplies inadequate and unsanitary, problems with trash, workplaces unsafe • 1796-Dr. Jenner demonstrated process of vaccination against smallpox • Average age at death: 29 years • First census taken: 1790
  • 16. The Nineteenth Century • Better agriculture lead to improved nutrition • Federal government approach to health: laissez faire (noninterference) • Epidemic problems in major cities • Many scientific discoveries • 1850: Shattuck report • 1850: Modern Era of Public Health begins
  • 17. The Twentieth Century • 1900: life expectancy less than 50 years • Leading causes of death were communicable diseases • Vitamin deficiencies and poor dental health common in slums
  • 18. Health Resources Development Period (1900-1960) • Growth of health care facilities and providers • Reform phase (1900-1920) • 1920s • Great Depression and WWII • Postwar years
  • 19. Period of Social Engineering (1960-1973) • Federal government became active in health matters • 1965 Medicare and Medicaid established • Improved standards in health facilities • Influx of federal dollars accelerated rate of increase of cost of health care
  • 20. Period of Health Promotion (1974-present) • Identification that premature death traceable to lifestyle and health behaviors • Healthy People publication established
  • 21. Community Health in the Early 2000s • Main Issues • Health care delivery • Environmental problems • Lifestyle diseases • Communicable diseases • Alcohol and other drug abuse • Health disparities • Disasters • Public health preparedness
  • 22. Community Health in the 21st Century • World Planning • Previous goals not met, but progress made • Widening inequities • Most attention on less developed and poorer countries • United States Planning • Focused on 10 year blocks of time • Current plan outlines health agenda: Healthy People 2020
  • 23. Healthy People 2020 • Four overarching goals: • Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death • Achieve health equity, eliminate disparities, and improve the health of all groups • Create social and physical environments that promote good health for all • Promote quality of life, health development, and healthy behaviors across all life stages
  • 24. Discussion Questions • How do you define health? • How can understanding the history of community health efforts better help today’s planning? • How can Healthy People documents affect health outcomes? • What role does the United States play in world health planning?