Subject: Introduction To Public

Health
Given Credits: 2 ECTS

Magda Khutsishvili, Pharm B, MPH.

Lecturer in the University Of Georgia
School of Health Sciences
magda.khutsishvili@ug.edu.ge
Please, Introduce Yourself
• What is your name and what do you wish to be called?
• Where are you come from?
 Course-Description
The course covers:
• Fundamentals of public health and healthy lifestyle.
• values, principles and strategies of public health, social justice and health equity,
inequalities in health system.
• Social determinants of health, health promotion in vulnerable groups (children,
refuges and elderly).
 Main Bibliography
Introduction to Public Health 5th Edition, 2016 Health Systems Science 2nd Edition,2020
by Mary-Jane Schneider (Author) by Susan E. Skochelak, MD MPH (Editor)
 Evaluation of Students
• 7 Quizzes, each 2 points, overall: 14 points
• 7 oral exams, each 2 points, overall: 14 points
• 5 Situational tasks/Brief case, each 4 points, overall: 20 points
• Presentation-6 points and research paper-6 points
• Final Exam: 40 points
Lecture 1
Theme:
• Public Health: Science, Politics, and
Prevention
• Why is Public Health Controversial?
Reading materials:
• Introduction to Public Health 5th Edition
by Mary-Jane Schneider (Author)
chapters: 1 and 2 pages: 3-23
 What is Public Health?
• Public health is not easy to define or to comprehend.
The committee of study, conducted by the Institute of Medicine and published
in 1988 called: “The Future of Public Health”, gives a four-part definition
describing public health’s:
• Mission-the fulfillment of society’s interest in assuring the conditions in
which people can be healthy
• Substance-organized community efforts aimed at the prevention of disease
and the promotion of health
• Organizational framework-both activities undertaken within the formal
structure of government and the associated efforts of private and voluntary
organizations and individuals
• Core functions -Assessment, Policy development, Assurance
 Core Functions of Public Health

• Assessment: constitutes the diagnostic function, in which a public health

agency collects, assembles, analyzes, and makes available information on
the health of the population.
• Policy development: involves the use of scientific knowledge to develop a
strategic approach to improving the community’s health.
• Assurance: evaluates effectiveness, accessibility and quality of personal
and population-based health services.
 Public Health VS Medical Care
Distinctions and Similarities between them
Public Health Medicine
• improves the health of the population • Is concerned with individual patients.
• focuses on preventing illness. • focuses on healing patients who are ill.
• its achievements are more difficult to • its achievements have a real, recognizable
recognize benefit and the patient is grateful.
• Lack of attention to public health from • Greater attention to health care from
politicians and the general public politicians and the general public
• Based on Science • Based on Science
• Political decision is necessary before • Political decision is not necessary when
action can be taken to solve the doctor diagnoses an illness and it is up to
problem the patient to accept or reject the
doctor’s recommendation
 The Sciences of Public Health
The disciplines of public health can be divided into
six areas.
1. Epidemiology
2. Statistics
3. Biomedical Sciences
4. Environmental Health Science
5. Social Sciences
6. Behavioral Sciences
• The basic science of public health
• The study of epidemics
• Focuses on human populations, usually starting with an outbreak of
disease in a community.
• Epidemiologists look for common exposures or other shared
characteristics in the people who are sick.
• Provides the first indications of the nature of a new disease.
• prevents the spread of old, well-understood diseases
• identifies the causes of chronic diseases such as heart disease and cancer.
• The numbers in Statistics are diagnostic tools, which inform experts how healthy
or sick a society is and where its weaknesses are
• In order to understand what these numbers mean, it is necessary to understand
some statistical concepts and calculations
• Data can be collected based on births and deaths, causes of death, outbreaks of
communicable diseases, cases of cancer, occupational injuries and many other
health related issues
• Statistical analysis is an integral part of any epidemiologic study seeking the cause
of a disease or a clinical study testing the effectiveness of a new drug.
Biomedical Sciences
• Biomedical research is very successful to understand the major killers
of different diseases
• They provide the information and techniques from which successful
public health measures could bring infectious diseases under control
• Biomedical research is important to control both: infectious diseases
such as AIDS and non infectious diseases, such as: cancer and heart
disease
 Environmental Health science
• It is concerned with preventing the spread of
disease through water, air, and food
many new challenges to environmental health are
today, such as:
• Chemicals, which can be toxic and accumulate in
our environment,
• ultraviolet rays in sunlight
• ozone layer of the earth’s atmosphere, which is
depleted
• exposure to other kinds of radiation
 Social and Behavioral Sciences
people in modern societies are dying of
diseases caused by their behavior and the
social environment.
Some subgroups of the population have
poorer health overall than others, for
example;
• Black Americans have lower life
expectancy overall than white Americans,
even when their incomes are similar.
• People with low incomes are less healthy
than those with a higher socioeconomic
status
The main research question is: why many
people of all races behave in unhealthy and
how can we prevent self-destructive
behaviors.
 Prevention and Intervention in Public Health
Public health’s approach to health problems in a community is described as a five-step
process:
1. Define the health problem.
2. Identify the risk factors associated with the problem.
3. Develop and test community-level interventions to control or prevent the cause
of the problem.
4. Implement interventions to improve the health of the population.
5. Monitor those interventions to assess their effectiveness.
Types of Prevention
1. Primary prevention: prevents an illness or injury from occurring at
all
2. Secondary prevention: seeks to minimize the severity of the illness
or the damage
3. Tertiary prevention: seeks to minimize disability by providing
medical care and rehabilitation services.
 The chain of Causation Model
The second approach to design interventions for infectious diseases, is to think of an illness or injury as the
result of a chain of causation involving an agent, a host, and the environment.
• The agent may be a disease-causing bacterium or virus;
• The host is a susceptible human being;
• The environment includes the means of transmission by which the agent reaches the host, which may be
contaminated air, water and food or it may be another human being who is infected.
 Why is Public Health Controversial?
• Because, Depending upon how Public Health is defined, it may challenge people’s values
and demand sacrifices.
1. The mission of public health, defined by the Institute of Medicine report, “The Future
of Public Health” is fulfilling society’s interest in assuring conditions in which people
can be healthy.
2. Public health is a broad social movement, a campaign to maximize health for everyone
in the population through distributing benefits and responsibilities in an equitable way.
 Economic Impact as a controversial measure
• Public health measures have an economic impact.
The people or industries that must pay the price may not be the ones that will benefit
from the new protections.
Costs are usually more concrete and easier to calculate than benefits and the price may
need to be paid sooner while the benefit may not be achieved until later.
Furthermore, it is difficult to calculate whether this benefit is worth the cost
The difficulty in dealing with the economic impact of public health measures have been
illustrated by conflicts with the tobacco industry.
 Individual Liberty as a controversial measure
• Most controversial of public health measures are: requirements that restrict people’s
freedom for the purpose of protecting their own health and safety.
Examples of such measures include: requirements to wear seat belts when traveling in a
car and helmets when riding a motorcycle, also: restrictions on many drugs, such as heroin,
cocaine, marijuana, LSD and so on.
• Restrictions on individual behavior are criticized by Paternalists and
Libertarians

1.Paternalism thinks that children and young people can be restricted in their behavior on the
basis that they are not yet mature enough to make considered judgments as to their own best
interests.
Thus, there are laws that prevent juveniles from buying tobacco and alcohol, that require
them to wear bicycle helmets and seat belts and that require parental permission to obtain
birth control information or an abortion, or to go skydiving

2.Libertarianism thinks that it is acceptable to outlaw drunk driving but not drunkenness
itself. Similarly, smoking in indoor public places can be outlawed because the smoke bothers
others, while smoking itself cannot be regulated in adults.
Morality and Religiousness in opposition as
controversial measures
Some public health issues are controversial, because they
arouse moral or religious objections, for example:
• AIDS or other sexually transmitted diseases,
• teenage pregnancy
• low birth-weight babies

These measures are opposed by members of certain religious

groups who believe that they promote immoral behavior.

Public health approach to these problems includes: sex

education in schools and the provision of contraceptive
services, especially condoms.
Thank You For Your Attention!