First Exam Coverage

COMMUNITY & PUBLIC HEALTH

MT122/L - 8671 | SECOND SEM - FIRST TERM | NOTES 2025-2026

★​ Joint Action
○​ “ source of community cohesion and
CHAPTER 1:
identity ”
INTRODUCTION TO HEALTH
○​ “ naturally to the creation of
community ”
Philippine 1987 Constitution Article II Section 15 ○​ A community is seen as emerging
“ Shall protect and promote the right to health of from joint actions of people through
the people and instill health consciousness among socializing, hanging out, conversing,
them. ” volunteering together, praying
together, and working together.
Health ★​ Social Tiles
★​ According to the World Health ○​ Interpersonal relationships
Organization (WHO), “ It is the state of ○​ Types of relationships: family,
complete physical, mental, and social parents, siblings, cousins,
well-being and not merely the absence of a roommates, lovers, partners,
disease. ” friends, neighbors, acquaintances
★​ According to the Ottawa Charter for ★​ Diversity
Health Promotion (1986), “ Resource for ○​ Goes beyond than just culturally
everyday life, not the objective of daily based ethnic distinctions
living. Health is a positive concept ○​ Focused on a larger societal view of
emphasizing social and personal resources community and made reference to
as well as physical capacities. ” differences in interpersonal
interaction
THE COMMUNITY ○​ Community within community
(stratification)

★​ Locus (Sense of Place)

○​ MacQueen et al. described it as COMMUNITY DEVELOPMENT
something which can be located or
described ★​ It is an important strategy in nation
○​ Village, community building.
★​ Sharing (Common interests and ★​ The United Nations (UN) broadly defines
perspective) community development as a process
○​ MacQueen et al. refer to sharing as where community members come together
an existence of “ shared perspective to take collective action and generate
” and “ common interests ” solutions to common problems.
○​ Community members should share ★​ In order to understand community
values, ideologies, vision, activities, development, one must first imagine
jargons, passions, opinions, community as a system.
interests, history, skin color, and
sexual identity

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★​ A system is an organized collection of units ★​ Institutionalize lessons learned through

interacting in various forms in order to policies and structures that will prevent
accomplish specific functions. occurrence of similar disease.
★​ The community can be further dissected ★​ Monitoring the health status of the
into other forms of systems such as the community members.
health system, political system, or social
class system. Community Health
★​ Each of the systems has its own parts or ★​ It is the study and improvement of the
subunits which can be interacting with health characteristics of a community.
other systems as well. ★​ Dealing with community means dealing
★​ Ex. Municipal Health System with both the “supply side” and the
“demand side”.
Community Health
Charles-Edward Amory Winslow states the science
FOUR BROAD ELEMENTS (HEALTH FIELD)
and art of preventing disease prolonging life and
promoting physical health and efficiency through
organized community efforts and sanitation of the 1.​ Human Biology
environment. ★​ Both physical and mental, which are
developed within the human body
Public Health was always associated with 2.​ Environment
Environmental Sanitation due to the biological link ★​ Matters related to health which are external
between unsanitary living conditions and practices to the human body
of diseases (Germ Theory). 3.​ Lifestyle
★​ “Aggression of decisions by individuals
Based from Winslow’s definition, Public Health which affect their health and over which
deals with the following: they more or less have control” - Lalonde
★​ Surveillance of emergence of diseases. (1981)
★​ Identification of diseases among 4.​ Health Care Organization
community members. ★​ Where most of the society’s efforts in
★​ Investigating factors that contribute to the improving health have been focused on this
existence of diseases. element
★​ Educating the community regarding ways ★​ Consists of quantity, quality, arrangement,
that will prevent them from acquiring the nature and relationships of people and
diseases. resources in the provision of healthcare
★​ Creation of strategies that will ensure ★​ Synonymous to Health Care System
sustained well-being among the
community.
LEVELS OF HEALTH CARE
★​ Provision of health services to address
community members who are already
having the disease or recuperating from Primary Health Care (rural units or barangay)
complications of the disease.

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★​ first point of contact; preventive care; ★​ size, shape, color, and composition of blood
maternal and child health services cells
★​ Usually done by:
Secondary Health Care (hospital-based; medical ○​ Medical Technologist - the
specialist and other medical professionals) laboratory scientist that collects
and analyzes the blood sample
Tertiary Health Care (more specialized form of ○​ Pathologist - finalizes, validates, and
healthcare; advanced services; cancer confirms the test results collected
management usually falls under this category) ○​ Phlebotomist - assistant or
personnel in the lab that does blood
collection process
THE REFERRAL PROCESS
★​ Materials:
○​ Microscope slides
★​ The referral system is two-way, a patient ○​ Spreader
who has recovered from illness or has ○​ Pipet
received appropriate care and will continue
receiving care at home. Blood Smear Microscopy
★​ The referral process begins at home where ★​ Scanner - initially view the debris and cell
the patient experiences some form of distribution
illness ★​ Oil Immersion Objective - confirms
suspicious anomalies
First Delay
★​ a delay in seeking care or may prove to be
detrimental to the patient’s condition BASIC BLOOD DETAILS
Second Delay
★​ health units may be far from a hospital and ★​ Hemoglobin - causes the natural “red”
for poorer communities, a medical color of blood
transport system may not always be ★​ Whole Blood - type of blood sample used in
available blood smearing
Third Delay
★​ a patient is brought to hospital but either
due to unavailability of medical specialists

BLOOD SMEAR

Blood Smear
★​ manual test that can be done by a medical
technologist, pathologist, and phlebotomist

Neutrophil

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-​ bacterial infection -​ WBC that pathologically increases during

-​ lilac pink granules allergic reactions
-​ 3-5 segments (more than 5 = sick) -​ orange-pink / orange-red
-​ also called segmenters -​ only WBC that is red-ish
-​ increases during parasitic infection and
Band Cells (Immature Neutrophil) allergic reaction

Monocytes

-​ c-shaped nucleus
-​ no filaments
-​ not properly segmented -​ increases during bacterial infections,
mostly in viral infection
-​ “C” shape / horseshoe shaped
-​ biggest WBC

Eosinophils Lymphocytes

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-​ main WBC that pathologically increases -​ blood clotting

during viral infection -​ shedding of megakaryocytes
-​ nucleus almost occupies the whole
cytoplasm
CELLS USUALLY SEEN IN A BLOOD SMEAR

Basophils Common Name Other Name

Red Blood Cells Erythrocytes/Discocyt

es/RBC/Red Cell

White Blood Cells Leukocytes/WBC

Platelets Thrombocytes

*Shape, Number and Appearance must be

considered when seen in a blood smear.

CHAPTER 2:
-​ can also be seen in rare conditions HISTORY OF PUBLIC HEALTH
-​ condensed granules (balas-balason)
-​ regulates allergic reaction
★​ Health or disease is seen as a “divine act”.
★​ Shamans or “medicine men” become
natural healers of the tribe,
★​ Shamans were skilled in:
1.​ use of herbs, usually gathered by
women
2.​ use of amulets, charms, or spells
that would supposedly ward off evil
3.​ the conduct of ceremonies that
would appease the gods
4.​ giving advice to individuals on how
Platelets
to maintain illness-free life

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★​ Geophagy: ingestion of clay or earth, was Black Plague

practiced as a mode of treatment of certain ★​ also known as the “Bubonic Plague” /
illnesses Black Death
★​ Trepanning: the drilling of a hole into a ★​ was caused by a bacteria, yersimia pestis,
human skull transmitted through flea bites
★​ swollen lymph glands (axillae, groin and
upper femoral area), gangrene
ANCIENT EGYPTIAN CIVILIZATION
(extremities), high fever, hematemesis
★​ religious leaders and scientists established
★​ established rudimentary baths and toilets hospices
in dwelling places
★​ they developed a form of writing surgical Yersimia Pestis
skills and inventing devices ★​ wayson stain - “safety pin” appearance
★​ mummification ★​ swells buboes

Hippocrates ★​ Some hospices become more specialized

★​ Father of Medicine such as leprosaries or leper houses wherein
★​ He contributed largely to the patients suffering from leprosy would be
professionalization of medicine, divorcing it housed or isolated.
from religious rituals and the supernatural. ★​ “Quarantine”
★​ He wrote De Aere, Aquis Et Loeis or Of air,
Water, and Land Leprosy
★​ The Constitution of Man ★​ mycobacterium leprae
★​ He established the Hippocratic School of ★​ armadillos or foot pads of mice
Medicine
★​ It was also the Greeks who came up with Schola Medica Salernitana or Salerno Medical
the concept of the Four Humors: Phlegm, School
Blood, Yellow Bile and Black Bile ★​ world’s first medical school
★​ teachers used Greco-Roman medical
Galen traditions complementing them with Arab
★​ Greek Physician who migrated to Rome, and Jewish perspectives
dissected monkeys ★​ Regimen Sanitatis Salernitanum
★​ His works became the foundation for the
study of Human Anatomy and his works Al-Razi (Muhammad ibn Zakariya Razi)
became scientific dodoma. ★​ Father of Pediatrics
★​ The Diseases of Children and was a
trailblazer in the field of Ophthalmology.

Avicenna (Abu Ali al-Husayn ibn Abd Allah ibn

ROMAN CIVILIZATION
Sina)

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★​ wrote the “The Canon of Medicine”, major ★​ Italian boards of health started
reference book for medical schools institutionalizing a system that would
worldwide until 16th century record and register deaths due to infectious
★​ one of the major contributions of Islam in diseases
medicine was the proliferation of female ★​ This form of death registration was referred
doctors since medieval muslims would only to as the Bills of Mortality
want female physicians to examine female
members of the household John Graunt
★​ he made a pioneering analysis of the bills of
Girolamo Fracastoro mortality in his book “Natural and Political
★​ he broadened the public's understanding of Observations Made Upon the Bills of
how epidemics or infections were spread Mortality” published in 1662
★​ he introduced the concept of fomites which
could be a vehicle carrying pathogen that
COLONIAL PERIOD
could cause diseases

Fomites ★​ Spanish explorer brought with the the

-​ inanimate objects contaminated by large smallpox virus to the Americas which
amounts of organisms decimated thousands of natives in the New
-​ ex. elevator button, door handle, World
cellphones, etc. ★​ Syphilis baffled European physicians,
people thought the water was the carrier of
Andrea Uesalius the disease, thus public baths were banned
★​ he wrote “On the Structure of the Human in most places
Body” where he described a detailed
structure of the human body Syphilis
-​ STI/STD
William Harvey -​ causative agent: treponema pallidum
★​ intensive study of human circulatory subsp. pallidum
system and properties of blood -​ Chancre: hard but painless

Anton Van Leeuwenhoek Malaria

★​ observed through a crude microscope -​ parasite (type of microorganism)
bacteria and other microorganisms, and -​ vector: female anopheles mosquito
initiated a new thinking on diseases and -​ genus: plasmodium
how they can be caused by microorganisms
Dengue
-​ virus
-​ vector: aedes aegypti
15TH CENTURY

Dr. John Snow

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★​ Father of Epidemiology
★​ he was able to elucidate how cholera was ★​ The Board of Health for the Philippine
transmitted by tracing the sources, which Islands was established through Philippine
was actually water pump Commission
★​ It was replaced by the Bureau of Health and
Cholera later renamed as Department of Public
-​ causative agent: vibrio cholerae Health and Welfare
-​ water pumps ★​ Dr. Jose Fabella: first secretary of
-​ TCBS Agar: Thiosulfate Citrate Biles Salt Department of Public Health and Welfare
Sucrose Agar (Yellow Colonies) ★​ Eventually became Department of Health
-​ discoverer: Dr. John Snow (DOH)
★​ San Juan De Dios Hospital: first hospital
Robert Koch’s Postulate established in the Philippines by Franciscan
1.​ The microorganism must be found in priest, Fr. Juan Clemente
abundance in all organisms suffering from ★​ University of Sto. Tomas (UST): first
the disease, but should not be found in medical school in the Philippines
healthy organisms; ★​ Medicos Titulares: an equivalent of our
2.​ The microorganism must be isolated from a provincial health workers today
diseased organism and grown in pure
culture. After WW2…
3.​ The culture microorganism should cause ★​ World Health Organization (WHO) was
disease when introduced into a healthy established in 1948
organism. ★​ The Centers for Disease Control and
4.​ The microorganism must be reisolated from Prevention (CDC) in Atlanta, USA
the inoculated, diseased experimental host
and identified as being identical to the Other development in Medical Technology:
original specific causative agent. ★​ Alexander Fleming: discovered penicillin,
led to introduction of antibiotics which
Louis Pasteur greatly reduced the number of deaths from
★​ spontaneous generation infection
★​ his work ranged from fermentation, ★​ Jonas Salk: developed inactivated polio
inoculation of vaccine against rabies, and vaccine; thus began widespread
the killing of bacteria in milk which is immunization
known as pasteurization ★​ Albert Sabin: developed live, attenuated
oral polio vaccine

Antibodies
-​ proteins produced by plasma cells
In the Philippines…
Antigen + B cell = Plasma Cell = Antibody
AMERICAN COLONIZERS

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Declaration of Alma-Ata on Primary Health Care more than or equal to 500 cells - HEALTHY
★​ Health is a human right 200-499 cells - HIV (acute)
★​ It defined primary health care and pushed less than 200 cells - AIDS
“Health for All” by the year 2000
★​ A year after the declaration, The Health Symptoms:
and Population Development Conference -​ unexplained weight loss
was held in Italy where selective Primary -​ night sweats
Health Care was introduced -​ kaposi’s sarcoma
★​ In 1892, the United Nations Children’s Fund
(UNICEF) came up with what is known as Viral Load
the GOBI strategy low VL = non-detectable levels (non-transmissible)
★​ GOBI: Growth Monitoring, Oral Rehydration high VL = + detectable
Therapy, Breastfeeding, and Immunization
★​ They later added FFF (GOBI-FFF) which Vertical Transmission/Mother-to-Child
stands for Family Planning, Food Transmission/Congenital Transmission
Supplementation, and Female Literacy.
Severe Acute Respiratory Syndrome (SARS)
★​ Outbreak in 2–3 in southern part of China,
EMERGING DISEASES
particularly in HongKong
★​ it spread to 37 other countries including the
★​ It can be defined as infectious diseases that Philippines where 14 cases were reported, 2
have newly appeared in a population or of whom died
have existed but are rapidly increasing in ★​ Swine flu (H1N1): an outbreak in 1998
incidence or geographic range, or that are ★​ 1997-2002: New strains of swine flu H3N2
caused by one of the NIAID category A, B, and H1N2
or C priority pathogens. ★​ Avian flu (H5N1): hit poultry workers in
HongKong, affected human population and
Acquired Immune Deficiency Syndrome (AIDS) poultry industry
★​ caused by Human Immunodeficiency Virus
(HIV) Peter Piot
★​ transmitted via unprotected sex, ★​ He discovered Ebola Virus while
contaminated blood transfusions, investigating a mysterious illness in
hypodermic needles, mother to child Zaire(also known as Congo)
during pregnancy and delivery or even ★​ Currently no cure for the disease
breastfeeding ★​ An Ebola vaccine is also being developed
★​ currently no cure for AIDS and has shown to be promising based in
★​ anti-retroviral treatment has shown to clinical trials
reduce the risk of death and complication
due to AIDS
THE FUTURE OF PUBLIC HEALTH

CD4+ T helper cells

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Dr. Jeffry Koplan wrote that “over the course of ★​ It is a certain data that must be considered
the past century, public health has grown both in in order to get a bigger picture about the
depth and breadth. Today, it addresses a wide ★​ A collection of information about the
range of issues; all infectious diseases including community
HIV/AIDS; all chronic diseases; violence; injury ★​ A summary of baseline conditions and
prevention; birth defects; and bioterrorism. Its trends in community and study are
practitioners are now more varied. In addition to
the doctors, nurses, engineers and nutritionists Considerations in doing community profiling:
who hold public health degrees, the field also A.​ Work and Levels of Employment and
embraces a wide range of professions in the Unemployment
behavioural and the social -​ occupational diseases
sciences-demographers, communications -​ income levels
specialists and specialists in evaluation science -​ self worth
and decision science.” B.​ Poverty and Income
-​ Poverty can be absolute or relative
-​ A large gap results in a big
CHAPTER 3:
difference in health and life
COMMUNITY HEALTH, EPIDEMIOLOGY AND
expectancy between rich and poor.
HUMAN BEHAVIOR This is known as Health Inequality.
Factors cited from WHO’s Community Health -​ It is one of the most significant
Needs Assessment (2001) factors affecting health across the
1.​ The physical environment in which people world and therefore information on
live, such as the quality of the air they this issue will be essential
breathe and the water they drink; C.​ Environment: The surroundings where
2.​ The social environment - the level of social people live and work directly affect their
and emotional support people receive from health. A number of factors should be
friends and/or family; monitored here.
3.​ Poverty, a significant factor worldwide, -​ pollution
which shortens and reduces enjoyment of -​ good sanitation
life -​ the lack of home
4.​ Behaviour and lifestyle - for example, -​ transport system
smoking causes lung cancer and coronary -​ social support
heart disease so a reduction in this -​ family and friendship networks
behaviour will reduce the disease -​ migration
5.​ Family genetics and individual energy - if -​ marginal groups
you come from a healthy family, you have -​ the opportunities for non-work
better chance of staying well social activities

Destabilizing Factors
COMMUNITY PROFILING

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★​ War, economic recession and natural 1.​ Locality Development: process-oriented,

disasters such as earthquakes, flood or creating a consensus and sense of
drought cooperation.
★​ They also affect health indirectly by 2.​ Social Planning: task-oriented,
reducing the resources available, increasing emphasizing rational-empirical
poverty and lowering social and economic problem-solving.
wellbeing of a population 3.​ Social Action: both task and process
oriented.

3 BROAD FACTORS THAT AFFECT THE

Himmelman (1992) developed a more
HEALTH OF A COMMUNITY
collaborative empowerment model emphasizing
Physical Social and Individual that communities should play a role in order to
Factors Cultural Factors achieve “real empowerment” and not just
Factors “community betterment”.

geography traditions behaviour

STEPS IN COMMUNITY ORGANIZING
environment norms
1.​ Problem Identification
community beliefs
size 2.​ Interface with community

industrial economy 3.​ People organization

development (micro and
4.​ Community profile and assessment
macro)
5.​ Goal-setting and formulation of
politics
strategies
income 6.​ Implementation of agreed strategies or
solutions
livelihood
7.​ Monitoring and evaluation

8.​ Sustaining gains, addressing emerging

COMMUNITY ORGANIZING
problems

Minkler and Wallerstein (1997), “the process by

which community groups are helped to identify
common problems or goals, mobilize resources
and in other ways develop and implement
strategies for reaching the goals they collectively
URINALYSIS
have set”.

3 Distinct Model of Practice: Changes in Urine at Room Temperature

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★​ Bacteria multiply and may cause turbidity

Urochrome Normal yellow color
and a positive protein reaction. (Straw yellow)
★​ Bacteria multiply and may cause turbidity
and a positive protein reaction. Dilute urine Colorless
★​ Bacteria convert urea to ammonia, which (overhydration)
increases pH. Concentrated urine Dark yellow, amber
★​ Bacteria metabolize glucose. (dehydration)
★​ RBC's lyse in dilute or alkaline urine.
★​ Casts lyse in alkaline urine. Bilirubin Yellow brown or olive
green. Yellow foam
★​ WBC's disintegrate.
shaking (liver disease)
★​ Bilirubin/urobilinogen are lost through
exposure to light and/or oxidation. Homogentisic acid Normal on voiding.
★​ Ketones are lost through evaporation. Brown or black on
standing, beginning at
surface
Bacteria came from the air.
Urea - waste product of blood. Melanin Brown or black on
High urea (urine) = Ammonia (odor) standing

Methemoglobin Brown or black due to

URINE VOLUME oxidation of
hemoglobin in acid
Normal Daily Volume 1200 - 1500mL urine

Normal day-night 2.1 - 3:1 Myoglobin “Cola” on standing

ratio
Blood/hemoglobin Pink or red when fresh.
Diuresis Increased urine “Cola” or “smoky”
production when standing. Cloudy
with RBC’s. Clear with
Polyuria >2000mL/day (e.g. hemoglobin
diabetes mellitus,
diabetes insipidus) Porphyria Port-wine
(red/reddish)
Oliguria <500mL/day (e.g.
dehydration, renal Drugs, medications, Green, blue, orange
disease, obstruction of food
urinary tract)
Pseudomonas Green, blue green
Anuria No urine production infection

Urobilinogen Colorless when

Anuria - A for absent excreted. Oxidized to
Dehydration - non-pathologic orange-red or
orange-brown urobilin

URINE COLOR AND CLARITY Crystals, WBCs, RBCs, Cloudy

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epithelial cells,
bacteria

CHEMICAL URINALYSIS BY REAGENT STRIP

Test Normal Principle Significance

pH First: 5- 6 Double buffer system Useful in evaluation of

Random: 4.5 - 8 acid-base balance,
management of UTI and
renal calculi

Protein Negative-trace Protein-error of Renal disease

indicator

Glucose Negative Glucose oxidase/ Diabetes mellitus

peroxidase

Ketones Negative Sodium nitroprusside Increased fat

reaction metabolism (e.g.
diabetes mellitus,
vomiting, starvation,
low carbohydrate diet)

Blood Negative Peroxidase-like activity Renal calculi,

of hemoglobin glomerular disease,
tumors, trauma,
pyelonephritis,
hemolytic anemia,
hemolytic transfusion
reaction, burns,
infections, strenuous
exercise

Bilirubin Negative Diazo reaction Liver disease, biliary

obstruction

Urobilinogen 1 mg/dL or 1 Ethrich unit Ehrlich’s reaction Liver disease, hemolysis

(p-dimethyl-aminobenz
al-dehyde)

Nitrites Negative Greiss reaction Urinary tract infection

Leukocyte esterase Negative Granulocytic esterase Urinary tract infection

reaction (leukocyte
esterase reaction)

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Specific gravity Random specimen: PKa change of Indication of kidney’s

1.003 - 1.030 polyelectrocyte concentrating ability
and state of hydration

FBS and HbA1c (Glycated/glycocylated hemoglobin) - also both ABNORMAL

Ketonuria - presence of ketones in urine

DIABETES MELLITUS LIVER DISEASE URINARY TRACT INFECTION

(UTI)

Glucose Bilirubin Nitrites

Ketones Urobilinogen Leukocyte Esterase

Blood (Pyelonephitis/Upper UTI)

CELLS IN THE URINE SEDIMENT

Cell Description Origin Clinical Significance

Squamous epithelial 40-50 micrometers. Lower urethra, vagina Usually none.

cell Flat. Prominent round Improperly collected
nucleus clean-catch specimen

Transitional epithelial 20-30 micrometers. Renal pelvis, ureters, Seldom significant

cell Spherical, pear-shaped, bladder, upper urethra
or polyhedral. Round
central nucleus

Renal tubular epithelial Slightly larger than a Renal tubules Tubular necrosis, toxins,
cell WBC. Round. Eccentric viral infections, renal
round nucleus rejection

Oval fat body Renal tubular epithelial Renal tubules Same as renal tubular
cell containing fat epithelial cells
droplets

White Blood Cell Usually Kidney, bladder, or Cystitis, pyelonephritis,

polymorphonuclear. urethra tumors, renal calculi
Approximately 12
micrometers. Granular
appearance

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Glitter cell WBC with brownian Same as WBC Same as WBC

movement of granules.
Stain faintly or not at all

Red Blood Cell Biconcave disk, Kidney, bladder, or Infection, trauma,

approximately 7 urethra tumors, renal calculi.
micrometers. Smooth. Dysmorphic RBCs
Non-nucleated indicate glomerular
bleeding

Diabetes Mellitus (3 P’s)

★​ Polyuria - excessive urine output
★​ Polyphagia - excessive hunger
★​ Polydipsia - excessive drinking (thirst)

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