Chapter 1

who define ____ in terms of the ability to do work or do activities with no apparent symptoms of disease in them?

A ____ may define _____ as a measure of the state of the physical bodily organs, and the ability of the body as a whole to function.

The globally accepted definition is that of the ____, which is “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”.

is viewed as a right, as a consumption good, and as an investment

first view

second view

third view

is the result of a combination of different factors.

what are the different perspectives in expressing the determinants of an individual or a community’s health?at

Every human being is made of genes. In addition, there are factors that are genetically transmittedfromparentstooffspring. Asaresult,there is a chance of transferring a defective trait. Modern medicine does not have a significant role in these cases.

according to WHO health is “a state of complete (1),(2), and (3) well-being and not merely the absence of (4) or (5)”

shows the relationship of the individual to community and society

is an organized effort focused on preventing diseases at the population level.

T OR F. The development of the discipline reveals that public health is limited to its role on disease prevention.

The key terms in defining public health are (1), (2), and (3).

is a key element in public health and is applicable to the community, clinics or hospitals, and in all other service settings.

refers to the goals of medicine to promote, preserve, and restore health when it is impaired; and to minimize suffering and distress.

is the process of restoring a person’s social identity by repossessing his/her normal roles and functions in society.

give 3 purpose of public health

give 3 elements of public health

is the science of food, nutrients and other substances therein, their action, interaction, and balance in relation to health and disease.

is defined as a combination of learning experiences designed to facilitate voluntary actions conducive to health. It is an essential part of health promotion

is the study of frequency, distribution, and determinants of diseases and other related states or events in specified populations. The application of this study to the promotion of health and to the prevention and control of health problems is evident.

is concerned with the alternative and efficient use of resources in the health services sector such as manpower, material, and financial resources

is the application of statistics to biological problem, especially to medical problems.

is getting people to work together harmoniously and efficiently use resources to achieve objectives.

is the study of population, especially with reference to size and density, fertility, mortality, growth, age distribution, migration, and the interaction of all those with social and economic conditions.

is a state of complete physical, mental, and social being, (not only absence of disease or infirmity) in all matters relating to the reproductive system and to its functions and process

is the basic approach to environmental control. It aims to identify specific biological, chemical, social, and physical factors that represent hazards to health or well-being; and modify the environment to protect people from harm. The principal components of environmental health are water sanitation and waste disposal, among others.

is the study of the relationship between living organisms and their environment.

is a conscious systematic investigation to acquire deeper knowledge or new facts about scientific or technical subjects. It aims to discover and interpret facts, revise accepted theories or laws in the light of new facts, or to practically apply such new theories or laws.

means the study of human groups as influenced by environmental factors, including social and behavioral factors.

give 5 public health campaigns

give 3 core areas of public health

have eradicated smallpox and suppressed measles, rubella, tetanus, diphtheria, and other infectious diseases in the United States and other parts of the world.

have declined as a result of public health measures like the increased use of seat belts and motorcycle helmets; and a decrease in drunk driving.

The decline in severe injuries and deaths related to mining, manufacturing, and construction, is a result of public health measures. Since 1980, safer workplaces have resulted in a reduction in the rate of fatal occupational injuries by approximately 40%.

Cleaner water and improved sanitation cut the spread of infectious diseases, such as typhoid and cholera. Education, condom use, and circumcision have reduced the incidence of human immunodeficiency virus (HIV).

The death rate for coronary heart disease has decreased by ____since 1972.

The decline in deaths from coronary heart disease and stroke has resulted from “risk-factor modification,” such as smoking cessation and blood pressure control.

Food has become safer and healthier due to decreases in microbial contamination and increases in nutritional content. Public health professionals have nearly eliminated major nutritional deficiency diseases such as rickets, goiter, and pellagra.

Better nutrition, the availability of antibiotics, greater access to health care, and technological advances in maternal and neonatal medicine all contribute to the decline in infant and maternal mortality.

Access to family planning and contraceptives has reduced infant, child, and maternal deaths through smaller families and longer intervals between children.

began in 1945 and currently reaches an estimated 144 million people in the United States. Reduced tooth decay (40-70% in children) and tooth loss (40-60% in adults) resulted directly from fluoridation.

The recognition of ___ use as a health hazard in 1964 and subsequent public health anti- smoking campaigns have prevented millions of smoking- related deaths.

is one of the key areas of public health. It is focused on promoting health and disease prevention through nutrition.

CN or PHN?
Focuses on issues that affect the whole population rather than the specific dietary needs of individuals

CN or PHN? Emphasizes promoting health and preventing disease in populations

CN or PHN? Focuses on issues that affect the whole population rather than the specific dietary needs of individualsCN OR PHN

CN OR PHN? Emphasizes promoting health and preventing disease in populations and groups

CN OR PHN? The population includes a wide spectrum of people and needs

CN OR PHN? The population is circumscribed to a local level that may consist of homogenous groups of people

CN OR PHN? The practice of community nutrition may include the delivery of nutrition programs and services

CN OR PHN? Community nutrition programs and services may be delivered by professionals and also by

CN OR PHN? The practice of public health nutrition may include the assessment for and design, management, and evaluation of nutrition programs and services

CN OR PHN? Public health nutritionists may train and supervise community nutritionists

CN OR PHN? Community nutritionist adheres to laws and policies; suggest policy

CN OR PHN? Community nutritionist adheres to laws and policies; suggest policy

CN OR PHN? Public health nutritionists may be employed at the federal, state, county, and city levels

CN OR PHN? Community nutritionists may be employed at the city or county levels, and by local non-profit and for-profit agencies that deliver nutrition services; community nutritionists may also be self employed

defined as the work (processes, practices, services, and programs) carried out in order to promote health and well-being in populations through nutrition. These functions can be classified into three categories:

3 functions of PHN

3 puspose of PHN

year of a dispensary was set up by Fr. Juan Clemente for treating indigents; which later became the San Juan de Dios Hospital. The San Lazaro hospital for contagious diseases was established, followed later by other hospitals in Cebu and Camarines Sur.

A Board of Vaccinators was created and later the office of “medicos titulares” or health officers.

The first medical school was founded, University of Sto. Tomas.

Carriedo waterworks was constructed which provided piped water to Manila residents.

A school for midwifery was established.

Koniger gave an account of an epidemic of beriberi in Manila in 1882-1883.

A Board of Health was established; concerns included control of epidemics and infectious diseases, beriberi, and sanitation.

A disease called “taon”, “taol” or “suba” afflicting infants was described by Manuel Guerrero; symptoms were those of infantile beriberi as earlier described by Hirota, a Japanese investigator; confirmed by Jose Albert in 1910.

The Bureau of Science was created

The College of Medicine was established under the University of the Philippines.

The Philippine General Hospital (PGH) was founded; Bureau of Science, College of Medicine, and PGH became centers of scientific instruction and research particularly on infectious diseases and beriberi.
First nutrition survey results were released.

A specific treatment for beriberi was discovered - tiqui-tiqui extract - by Vedder, Chamberlain, Quintos, and Guerrero.

The effectiveness of a simple dietary change in eradicating beriberi among Philippine scouts was demonstrated.

A law was enacted providing the free distribution of tiqui- tiqui (tiki-tiki) to indigent mothers.

This period saw the gradual transfer of leadership and responsibilities in public health from Americans to Filipinos. The government and the Rockefeller Foundation fellows were sent abroad to develop public health corps who
could assume leadership roles.

The Department of Health and Welfare was created, with ___ as the first Secretary.

A Board of Nutritional Research was created in ___.

The Philippine Association of Nutrition (PAN) was organized by Dr. Presentacion Perez (with Dr. Francisco O. Santos as first President), which played an important role in nutrition advocacy. One outcome of which was the creation of the Institute of Nutrition, with Dr. Juan Salcedo, Jr. as first director. This marked the beginning of organized nutrition activities. Later, after research became an integral function of the Institute, it was renamed Food and Nutrition Research Center (FNRC) and later, Food and Nutrition Research Institute (FNRI).

The results of a clinical survey done by Salcedo et al. was published in Bataan. This marked the beginning of a series of experiments and activities that became collectively known as Bataan Rice Enrichment Project (a landmark in the annals of public health, not only at the national level but internationally).

The Dietetic Association of the Philippines (DAP), now known as the Nutritionist-Dietitians Association of the Philippines (NDAP), was organized.

The Nutrition Foundation of the Philippines (NFP), the first private organization founded by Dr. Juan Salcedo, Jr. (National Scientist and the former Secretary of Health and Chairman of the National Science and Development Board), was organized to complement and supplement government efforts in food and nutrition activities. It pioneered the organization of nutrition councils, now known as nutrition committees, at all levels (regional, provincial, city, municipal, and barangay).

The National Coordinating Council on Food and Nutrition (NCCFN) was organized under the leadership of Dr. Coronado R. Pascual who succeeded Dr. Salcedo as Director of FNRC. This marked the first organized attempt to coordinate the nutrition activities of various government sectors (notably health, education, agriculture, and science) as well as of private organizations towards a single goal - improvement of the nutritional status of people.
Operations started at the NFP which was founded by Dr. Juan Salcedo in 1959. The NFP pioneered the organization of community nutrition councils, which became the prototype present-day nutrition committees.

The first Food Composition Table, undertaken by FNRC, University of the Philippines Los Baños (UPLB), and Philippines Women University (PWU) was published.

The National Nutrition Program office was established under the Department of Health (DOH), later named National Nutrition Service.

The Nutrition Service was created under the DOH

P.D. 1286, Nutrition and Dietetics Decree of 1977 was enacted requiring hospitals to hire licensed or registered nutritionist dietitians (RND), and that each province, city, municipal, and rural health unit should hire at least one RND.

P.D. 1569 was enacted to strengthen the Barangay Nutrition Program by providing a Barangay Nutrition Scholar (BNS) per barangay who is responsible for delivering nutrition services and related activities.

The Araw ng Sangkap Pinoy (ASAP) was launched.

Give Me Five was launched - a multimedia campaign led by the private sector to encourage Filipinos to eat five servings of fruits and vegetables everyday especially those rich in Vitamins A and C, and Iron.
KAIN (Koalisyon para Alagaan at Isalba ang Nutrisyon), a coalition of nutrition non-government organizations (NGOs) was organized.

Republic Act (R.A.) 8172 or the Act for Salt Iodization Nationwide (ASIN) was enacted. This law expands the membership of the NNC Governing Board into a Salt Iodization Advisory Board as the policy and coordinatingbody on the national salt iodization program and activities.

R.A. 8435 or the Agriculture and Fisheries Modernization Act assigning NNC was enacted to formulate the Basic Needs Program in coordination with the Department of Social Welfare Field Operation Service and Regional Field Units. The Basic Needs Program is a community-based program focused at meeting the basic needs of rural households. It assists rural workers, subsistence farmers and fisher folk to adjust to changing economic and employment conditions as agriculture and fisheries modernization progresses.

R.A. 8976 or the Food Fortification Law was enacted to assess food fortification every five years to determine which foods should be fortified with what nutrients.

The NNC was transferred from DA to DOH

is a professional with specialized education, training, and experience in the science and art of nutrition, whose major orientation is population/community-based programs.

In the Philippines, the practice of public health nutrition is backed up by Section 27 of P.D. 1286, known and cited as the "_____," which requires all nutrition agencies - whether government or private - to employ registered nutritionist-dietitians, and there should be at least one nutritionist-dietitian per province, city/municipality, and in rural health units.

what are the Core Functions of the Public Health Nutrition Workforce

what are the characteristics of a PHN in the PH?

Attributes of a Sound Professional and Ethical PHN Practitioner

The Nutritionist-Dietitian shall protect the public against fraud, misrepresentation, misinformation, and unethical practices concerning food, nutrition, and diet therapy.

The Nutritionist-Dietitian shall enlighten the public on the ways and means to good nutrition and on measures to prevent or rehabilitate malnourished conditions.

The Nutritionist-Dietitian must be a worthy example of the practice of good personal nutrition.

In cooperation with other professionals and co-workers in the community, the Nutritionist-Dietitian shall initiate and support activities to meet the health and nutritional needs of the public.

is the study of the distribution and determinants of health-related states, events or diseases in specific populations and the application of this study to control health or diseases (Last, 1998). It is also defined as the application of epidemiological techniques in understanding of disease causation among populations where exposure to one or more nutritional factors is believed to be important (Nelson, Beresford, and Kearney, 2004).

is the study of the nutritional determinants of disease in human populations. It is one of the branches of epidemiological research.

is defined as the course of the disease/ nutritional disorder over time from the earliest stage to termination.

four stages of natural history of a disease

is considered a cause if it precede a disease. A cause is termed sufficient when it inevitably produces or initiates a disease and is termed necessary if the disease cannot develop in its absence.

is influenced by the interrelations of the host, agent and environmental factors. A disease results from changes in their characteristics which cause an imbalance between the three factors.

characterized by genetics, age, gender, ethnic or racial origin, religion, family size, marital status, occupation, nutritionalstate and constitution, birth order, infection, behavior and level of resistance.

an element, substance or force, either animate or inanimate, the presence or absence of which may (following effective contact with a susceptible host under proper environmental condition) serve as a stimulus to initiate or perpetuate a disease process. Maybe biological, nutritive, chemical, physical or mechanical in nature.

inanimate surroundings and its feature

animate things such as flora, fauna, and
the human environment

occupation, ruralrban areas,
economic development, social disruption

What are the theories of disease causation? (9)

This theory is based on the hypothesis that illness is contagious. It required keeping sick people away from well people; institution of quarantine of ships (the traditional period was forty days quarantine) during which time ships, their crews, and cargos waited off shores or at some isolated islands; setting up military cordons around infected towns; isolation of households if they were infected; and fumigating or washing the bedding and clothing of the sick.

Ex: Leprosy

illstrate the disease as a process

The term “___” refers to the goals of medicine to promote, preserve, and restore health when it is impaired, and to minimize suffering and distress.

consists of actions to minimize future hazards to health and hence, inhibit the establishment factors (environmental, economic, social, behavioral, cultural) known to increase the risk of disease. Alter societal structures & thereby und erlying determinants

seeks to prevent the onset of specific diseases via risk reduction: by altering behaviors or exposures that can lead to disease, or by enhancing resistance to the effects of exposure to a disease agent. Examples include smoking cessation and vaccination.

Alter exposures that lead to d isease

includes procedures that detect and treat pre- clinical pathological changes and thereby control disease progression.

Detect & treat pathological process at an earlier stage when treatment can be more effective

Prevent relapses & further deterioration via follow-up care & rehabilitation

Examples include cardiac rehabilitation following a myocardial infarction, seeking to alter behaviors to reduce the likelihood of a reinfaction.

is defined as the application of a test to people who are yet asymptomatic for the purpose of classifying them with respect to their likelihood of having the particular disease/condition.

is defined as the routine observation and analysis of the occurrence and distribution of the disease and of the factors pertinent to their control/prevention, which permits timely action taking

prevalence and incidence rates

refers to the number of cases (new and old) in a defined population at a specified period or period in time. Prevalence measures are important in determining the health and nutrition needs of a population in terms of facilities, supplies, and manpower.

refers to the number of new cases of a disease that occur in a population during a specified time period.

is computed if all members are followed up for the same period of time.

is calculated if the members of the population are followed-up for different periods of time.

refers to the incidence of death from a disease in a population.

can be used in assessing the public health/public health nutrition situation. Determining the prevalence and incidence rates of diseases is just the beginning of understanding the problem. The causes of the diseases or factors associated with the diseases are also of interest as an input to the design of appropriate interventions.

allow nature to take its course, the investigator measures but does not intervene. They include studies that can be called descriptive or analytical

is limited to a description of the occurrence of a disease in a population and is often the first step in an epidemiological investigation

goes further by analyzing relationships between health status and other variables

involve an active attempt to change a disease determinant - such as an exposure or a behavior - or the progress of a disease through treatment, and are similar in design to experiments in other sciences.

A study that compares the rates of exposures and diseases in different populations using aggregate data on exposure and disease, not individual data

A study design in which persons with a disease (cases) are compared with those without the disease (controls) to see how their exposures to causative factors may have differed.

A study design in which data on exposures to possible risk factors for disease are collected from a group of people who do not have the disease under investigation. The subjects are then followed for a period of time to see whether the later development of disease is related to the factors that were measured.