PUBLIC HEALTH

Ms. Janine Aliza B. Birog, MSPh, RPh

Lecturer
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Agencies set
to car out
organized
community • 1. Volunta
• private, suppo ed wholly or in large pa by non-tax funds
health e.g., NGOs, private clinics, private foundations

activities • 2. Governmental
• public, o cial or tax suppo ed e.g., government hospitals,
health centers, district hospitals

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PUBLIC HEALTH
•promoting
the science and a of preventing disease, prolonging
physical and mental health and e ciency thru: life, and
• Organized Community E o for:
• the sanitation of the environment
• the control of community infections
• the education of the individual in principles of personal hygiene
• the organization of medical se ice for the
• early diagnosis and treatment of diseases
•standard
the development of a social
of living adequate for machine which will ensure a
• the maintenance of health
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Public health may be conceptualized as
- Analyzing the health of a population and the threats it
faces is the basis for public health.
- Science of protecting the safety and improving the health
of communities through education, policy making and
research for disease and inju prevention.

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 De nition
Comprehensive def inition of Public health (Charles-Edward
Amo Winslow, 1920 ):
“The science and ar tof preventing disease, prolonging life,
and promoting health and ef ficiency through organized
community e o for:
- The sanitation of the environment
- The control of communicable infections
- The education of the individual in personal hygiene
- The organization of medical and nursing ser vices for the
early diagnosis and preventive treatment of disease, and
- The development of the social machiner yto ensure
eve one a standard of living adequate for maintenance of
health
So, organizing these benef its as to enable ever ycitizen to
realize his bi h right of health and longevity.
 Public Health Specialist and
Clinician
In the medical f ield, clinicians treat diseases and injuries of
one patient at a time. But in public health, we prevent
disease and injur y. Public health researchers, practitioners
and educators work with communities and populations. We
identify the causes of disease and disability, and we
implement large scale solutions.
For example, instead of treating a gunshot wound, we work
to identify the causes of gun violence and develop
inter ventions. Instead of treating premature or low bir th-
weight babies, we investigate the factors at work and we
develop programs to keep babies healthy.
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Instead of prescribing medication for high blood pressure,
we examine the links among obesity, diabetes and hea
disease—and we use our data to inf luence policy aimed at
reducing all three conditions.
In public health, microbiologists work to f ind a vaccine for
malaria, while behavioral scientists research ways to
discourage populations from smoking. Environmental health
scientists work to discover which foods prevent cancer, while
health policy analysts evaluate health insurance programs
and make recommendations. And epidemiologists identify
trends in health and illness, looking for links, causes and
inter ventions in areas such as HIV/AIDS, tuberculosis and
infant mo ality.
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 Public Health Health Care
Population focus Individual patient focus
Public health ethic Personal se ice ethic
Prevention or public Diagnosis and treatment
health emphasis emphasis
Joint laborato Joint laborato
and eld involvement and patient involvement
Clinical sciences peripheral to Clinical sciences essential to
professional training professional training
Public sector basis Private sector basis
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Components of PH
Public health is an interdisciplina eld. It includes:
- Epidemiology,
- Biostatistics
- Management of health se ices
- Environmental health,
- Community health,
- Behavioral health,
- Health economics,
- Public policy,
- Mental health,
- Occupational safety,
- Gender issues in health, and
- Sexual and reproductive health.
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Levels of Prevention

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 Rehabilitation
Rehabilitation is “the combined and coordinated use of
medical, social, educational, and vocational measures for
training and retraining the individual to the highest possible
level of functional ability.”

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Salutogenesis is a medical approach focusing on factors that
suppor thuman health and well-being, rather than on factors
that cause disease (pathogenesis). 25
 Public Health Activities
• Prevents epidemics
• Protects the environment, workplaces, housing, food, and
water
• Monitors health status of population
• Mobilizes community action
• Responds to disasters
• Assures quality, accessibility, and accountability of
medical care
• Researches to develop new insights and innovative
solutions
• Leads the development of sound health policy and
planning
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EVOLUTION/HISTORY OF PUBLIC HEALTH
• Current public health system play
handling major threats to the public health.a critical role in
• Intends
protection ofto provide
citizens some
from perspective
health threats on
came howto be a
public responsibility
address health threats. and on how the public health system
oresponsibility
How the ofpublic health problems became
the individuals in the community a

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• HEALTHY POLICIES FOR A HEALTHIER WORLD
• How public health became an impo ant target of any
community

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 • Personal hygiene
• Physical tness (Olympics)
• Naturalistic concept
o Disease is caused by imbalance between man and his
environment

TIMELINE
Hippocrates (b. 460 BC)
• Father of Western Medicine
• Believed that illness had a physical and rationalexplanation
• Looked for and described causal relationship between
disease and factors such as climate, soil, water, lifestyle,
and nutrition
o Coined the term epidemic
■ Epis (“on” or “akin to”)
■ Demos (“people”)
o Found the democratic oath and medicine
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 • Public Diversion of Human Waste: Necessa Tenet of
Public Health
• Adopted Greek health values
ROMAN • Great engineers
o Sewage system
EMPIRE (23
Plumbing technology was ve advance
Replaced leaky clay pipes with lead pipes (unfo unately,
Romans su ered from lead poisoning)
BC – 476 o Built aqueducts to bring water into the city
Pont du Gard in Southern France – The Romans constructed it
AD)

between 500 and 523 BC as an aqueduct to car freshwater to
the City of Nimes.
• Administration. Collected taxes to suppo public
se ices such as:
o Public baths
o Water supply and sewage system
o Restaurant inspection and markets (for availability of
food)
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 • Variolation (Smallpox Epidemic
around 1000 BC) – the process by
which material from smallpox
sores (pustules) was given to
CHINESE
people who had never had
smallpox.
• They believed that if you were
given these pustules, you would be
immune to smallpox.
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 • Shift away from Greek and Roman
values
o Physical body less impo ant than
spiritual self
Faith and prayer were the accepted
EUROPE

■
treatment for illness; Focused on spiritual
healing
o Decline of hygiene and sanitation.
• Beginnings of Public Health Tools
o Quarantine of ships and travelers for
40 days
■ Persons denied ent to infected ships
o Isolation of diseased individuals
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• Quarantine in Medieval Period.
o The practice of quarantine
began during the 14th centu to
protect coastal cities from plague
epidemics. Ships arriving in Venice
from infected po s were required to
sit at anchor for 40 days before
landing.
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 THE • 14th centu EU epidemic
o Epidemic disease in Western Europe between
PLAGUE / 1348 and 1530+ AD (the end of the Middle Ages
through the Renaissance)
BLACK • A disease caused by the bacterium Yersinia
pestis that circulates among wild rodents.
DEATH / o Remove bodies of the dead
o Burning of cities
BUBONIC • “bubo” = “groin”
• Bacteria → blood (lymph nodes) → lungs
PLAGUE
(sta of infection, “pneumonic plague”)
o Pneumonic plague, a severe lung infection
spread by sneezing, is also caused by the bacterium
Yersinia pestis.
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• • Death of 25% to 50% of population.
• o Worst from 1348 – 1352
• o Killed at least 25 million people in Europe (1/3 of the
• population)
• o Killed more than 60 million worldwide
• o Spreads through ships or trading.
• • Symptoms: sta with a high temperature, headaches, and vomiting,
followed by lumps appearing in the groin and armpits. Eventually, the victim
would be covered all over with black bruises; death would sho ly follow.
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 RENAISSANC
E (1400 – • A s and literature and exploration ourished.
1600 AD) • Explorers and traders unknowingly spread
GLOBAL diseases like smallpox, measles, and typhoid.
• This method of the spread of disease still exists
EXPLORATION
today (e.g., spread of SARS across countries, albeit in a
ve accelerated form).
• Killed 90% of indigenous people in New World
• Smallpox
o Rash, large pustules in the skin, fever,
restlessness, delirium, coma, death

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 AGE OF REASON
AND
ENLIGHTENMEN • WILLIAM HARVEY (English Physician, 1578 –
T (1650 – 1800 1657)
AD) BIRTH OF
MODERN
MEDICINE
• 1628 theories of circulation
o Demonstrated function of the hea and
38 circulato system
o Publication of his theories, “An
Anatomical Study of the Motion of the Hea and
of the Blood in Animals”
• First to suggest that humans and other
mammals reproduced via the fe ilization of an
egg by sperm.
• Used dissection (no microscope) to
create theories
 EDWARD
JENNER • 1796 cowpox experiment
(English o Vaccination of eight-year-old James Phipps
proved that cowpox or swinepox provided immunity
Physician, against smallpox (age-old tradition that people who
1749 – 1823)
had earlier caught the mild disease of cowpox did not
catch the normally fatal disease of smallpox)
o
swinepox
May 14, 1796 – inoculated Phipps with
o July 1 – inoculated Phipps with smallpox
• Coined the term vaccine (vacca, Latin for “cow
”)
• Laid the foundation of modern immunology as
a science

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 Produced a new set of public health




problems: Slums,
INDUSTRIALIZATIO
N AND
URBANIZATION Pove y, Disease
(1800s)


o Pove y is an indicator of poor
health, where you cannot access
medication and healthcare; only focuses
on daily su ival
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 “GREAT • Great strides in scienti c knowledge to help
SANITARY understand the origin and treatment of disease.
AWAKENING” • Interest in humanitarian ideals
• Acknowledge connection between pove y and
(1800s – 1900s) disease
BIRTH OF • Even today, pove y is the single best predictor
MODERN of poor
PUBLIC HEALTH
health.
• Returning to what the Romans had gured out,
new infrastructure for clean water and sewage removal
• Bi h of a system to monitor the health status
of
communities
o Monitoring disease cases, number of
childbi hs, problems a ecting the community, etc.
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 Michael • Plaque model of governmentality
o Treatment of cholera → Social medicine ( ux,
Foucault
circulation of air, location of cemeteries)
■ Control by not accessing the water supply
where cholera is present
o Miasma theo of disease
■ Disease from poor sanitation

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 Rise of Public
Health:

The Nineteenth • In the era of
unplanned
Centu : The industrialization in
nineteenth centu
Great Sanita , "The great sanita
Awakening
awakening"—
symbolizes the
identi cation of lth as
both a cause of
disease and a vehicle
of transmission, and
the ensuing embrace
of cleanliness as a
remedy.

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•- Illness came to be
seen as an indicator of
poor social and
environmental conditions.
•- Cleanliness was
embraced as a path both
to physical and moral
health.
•- Disease control
shifted from reacting to
intermittent outbreaks to
continuing measures for
prevention.
•With sanitation, public
health became a
societal goal and
•Protecting health
became a public
activity.
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 The
Developmen
t of Public
Activities in • - Edwin Chadwick, a London lawyer (1838), is one of
the most recognized names in the sanita reform
Health
movement.
• - Under Chadwick's authority, a commission
conducted studies of the life and health of the London
working class in 1838 and that of the entire count in
1842.

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• - The repo of these studies, ‘General Repo on the
Sanita Conditions’, was a document of the appalling
conditions in which masses of the working people were
compelled to live.
• - Chadwick documented that the average age at
death for the gent was 36 years; for the tradesmen,
22 years; and for the laborers, only 16 years.

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• To remedy the situation, Chadwick proposed what
came to be known as the "sanita idea."
• - His remedy was based on the assumption that
diseases are caused by foul air from the decomposition
of waste.
• - To remove disease, therefore, it was necessa to
build a drainage network to remove sewage and waste.
• - Chadwick's repo eventually was adopted in the
Public Health Act, of 1848 in UK, and subsequently
American Public Health Act 1872.

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Sur veillance is the continuous, systematic collection, analysis and interpretation of
health-related data needed for the planning, implementation, and evaluation of
public health practice.
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Cholera — A • Cholera, a fatal
Public intestinal disease, was
rampant during the
Health early 1800s in London,
causing death to tens of
Approach thousands of people in
the area. Cholera was
commonly thought to
be caused by bad air
from rotting organic
matter.

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John Snow, • John Snow is best
known for his work
Physician tracing the source of the
cholera outbreak and is
considered the father of
modern epidemiology.

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Epidemiolo
gy — What
is the
Problem?
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 Risk Factor
Identi cation —
What Is the Cause?
Cluster of Cholera Cases
around ‘Broad Street Pump’
Site Locations
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Implementation — How Do You Do It?
J oh n S n ow ’s re s e a rc h
c on vi n c e d t h e Br i t i s h
government that the source of
cholera was water
contaminated with sewage.
Thus Broad Street Pump to
supply water was sealed for
ever.

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 Three Core Functions of Public Health
Systematically collect, analyze,
Assessment and make available information
on population at risk to identify
health problems and priorities.
Policy
Development
Policy Promote the use of a scientif ic
knowledge base in policy and
Development decision making to solve
problems.

Assurance Ensure provision of ser vices to

those in need
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Ten Essential Public Health Se ices
1. Monitor Health
2. Diagnose and Investigate
3. Inform, Educate, Empower
4. Mobilize Community Pa nership
5. Develop Policies
6. Enforce Laws
7. Provide Care
8. Assure a Competent Workforce
9. Evaluate
10. Research

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 Core Functions at Government Levels
Policy
Assessment Development Assurance

Federal National tobacco

public health Smoking ban

on commercial
Federal grants

for antismoking
su eillance ights research

State Monitor state Increase Funding

tobacco use tobacco tax for campaign

Local Repo on local County laws Resources to

tobacco use prohibiting help
smoking in public smokers quit
places
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Stakeholder Roles in
Public Health
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Stakeholder Roles in Public Health
Community Clinical Care

Delive System

Government
Ensuring the Conditions
Employers

Public Health
for Population Health and Businesses
Infrastructure

Academia The Media

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 Other Pa ners in Public Health
• Vehicle for public discourse
Media • Health education and promotion
• Health communication
• Social media as catalyst
Employers
• Employer-sponsored health insurance
programs
and Businesses • Wellness initiatives and bene ts
• Healthy workplaces and communities
Government • City planning
Agencies • Education
• Health in all policies
• Education
Academia • Training
• Research
• Public Se ice
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Other major global health issues now at the forefront include:
- Infant mo ality
- Water scarcity
- Environmental risk factors (factor yemissions, car exhaust,
tobacco smoke, etc.)
- Tobacco use
- Obesity
- Global warming
- Terrorism
- Substance abuse
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International Agencies of Public Health
Impo ance

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As of Februa 2019, the total population of the world
exceeds 7.71 billion people

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Substance
Abuse

(Gamma-hydroxybutyrate)

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 New Concept on Public Health
“Public Health 2.0” refers to a movement that aims to make
the f ield of public health more accessible and user-driven by
employing pa icipato technologies.
Public Health 3.0 represents a challenge to business leaders,
community leaders, state lawmakers, and federal
policymakers to incorporate health into all areas of
governance.

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Institute of Medicine (IOM)
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WHO de nition • state of complete physical,
of Health
mental, and social well-being not
merely the absence of disease and
in rmity
• comprehensive rather than
physical
• qualitative than quantitative

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 Disease
•a diagnostic catego which classi es a
pa icular illness, symptoms, or pathological
components of the illness
Illness
CONCEPT OF •a highly personal stage wherein he lls
unwell, person's experience of his disease
HEALTH AND Normal Health
DISEASE
•state of well-being in which the individual is
free from disabling e ect and has su cient
vigor to car on the usual requirements of
life, with social adaptation that produces self
-grati cation and enjoyment
•a range rather than a speci c entity
Holistic Health
•views a person being whose psycho-
socialcultural-spiritual- relationships with the
environment directly a ect health

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 1. Genes
2. Nutrition
• essential causes of malnutrition
DETERMINANTS a. Failure to ingest food – pove y
b. Failure to utilize food – PKU, celiac
OF HEALTH AND disease, pernicious anemia
DISEASE c. Increase food requirements -
childhood, adolescence, pregnancy,
sickness
3. Population problem
4. Person's lifestyle
5. Iatrogenic disease

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 DISEASE CAUSATION AND NATURAL HISTORY OF DISEASE
THREE ECOLOGIC FACTORS OF DISEASE
1. Agent
• any element, substance, or force whether living or non-living, the presence or absence of
which can perpetuate a disease.
TYPES:
a. Living
• plant and animals (bacteria, fungi, molds, yeast, a hropods, helminths, protozoan)
b. Non-living
• Physical and Mechanical agents – extremes in temperature, light, electrocution, physical
trauma
• Chemical agents:
• exogenous – common poisons
• endogenous - toxic products of metabolism
c. Nutrient
• de ciency or excess is bad
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 • Genetic make up
• Age
2. Host

• a ve ebrate or • Sex
inve ebrate capable of • Race
getting infected by and
exposed to the agent

• Habits, customs, and tradition


HOST FACTORS OF • Exposure to the agent
DISEASE
• Defense mechanism of the host
• State of nutrition
3. Environment
• sum of the organism's external surrounding conditions and in uences that a ect
its life and development.

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THREE CATEGORIES:
1) Physical
• humidity, weather, topographic features
2) Biologic
• presence of living agent
3) Socioeconomic
• population density, priority is food not health, lack of awareness, presence of
fast food, urbanization, political commitment

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 • disease results from an
Biological laws for imbalance between a disease agent
Communicable and man
and Non- • nature and extent of the
Communicable imbalance depends on the nature
Disease
and characteristics of the host and
the agent
• the characteristics of the two
are in uenced considerably by the
conditions of the environment.
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ECOLOGIC Epidemiologic Triangle
MODELS • a change in one of the
components causes change in
OF the Other

DISEASE Web of Causation

CAUSATIO
• • Disease never depends on a
single isolated cause but
rather
N • develops as a result of chains
of causation
Wheel
• depicts the relationship of host
with its genetic material and
how it is in uenced by the
environment
• can be adjusted based on
eve factor’s involvement

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 • comprises the body of both qualitative and
quantitative
NATURAL • knowledge of agent, host and environmental factors
and
HISTORY OF • its development from the rst forces which initiate
DISEASE the
• process in the environment through the resulting
changes
• that take place in man and continuing until
equilibrium is
• reached, or defect, disability or death ensues

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 TWO
PHASES OF
THE
NATURAL
HISTORY OF
DISEASE [Link]-pathogenesis (state of susceptibility)
• • phase before man is involved
• • prelimina interaction of host, agent, and
environmental
• factors in disease production

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[Link] (stage of disability)
• course of the disease in man from the rst
interaction with
the disease, provoking stimuli to the changes in
the form and
function which results until equilibrium is
reached or
recove , defect, disability, or death ensues
• changes cause the signs and symptoms --->
diagnosis is
needed

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 POSSIBLE Recove
RESULTS OF – host can ward o infection or disease agent
• Balanced equilibrium
INFECTION

– forces of agent and host are equal so both are not
a ected;

dangerous because host becomes a healthy carrier (in
apparent infection)
• Subclinical conditions
– ve mild reaction that escape
• Clinical case
– full-blown case which way either be atypical or
typical

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 [Link] of agent
2. Suitable rese oir
REQUIREMENTS
FOR INFECTION INCUBATION PERIOD
TO OCCUR
• inte al between the time of ent of agent into the
host and
the onset of signs and symptoms
• time required for the agent to establish itself to
multiply or
secrete toxins.

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This varies based on the following
condition:
• Virulence, dose, and po al of ent
• Previous experience of the host
• State of natural resistance
• The inherent character of the
organism
3. Presence of susceptible host
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 • Clinical manifestation of disease which appear after
the
Clinical incubation period
• E.g., Fever- most common symptom: Continuous
Horizon
(dengue)
• Intermittent (malaria) - up and down fever but the
temperature reaches normal range
• Remittent (typhoid) – up and down fever but
temperature won’t be reaching normal range.

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 PORTAL OF ENTRY
• A suitable po al of ent is requisite for a successful
infection.
• The po al of ent may also be the po al of exit.
4. Suitable po al • Possible po als of ent :
of ent
• Respirato tract
• Mucous membranes
• Skin and subcutaneous tissue
• GIT
• Conjunctiva
• Placenta
• GUT
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5. Po al exit from
the host
6. Appropriate
means of
dissemination
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 1. Incubato
• having an elapsed time between rst exposure to
pathogen
and rst appearance of symptoms (measles)
TYPES OF 2. Convalescence
CARRIERS:
• despite disappearance of symptoms, the patient still
contains
the organism (cholera, diphtheria)
3. Tempora
• patient is infectious only during the period of illness
(in uenza)
4. Chronic
• patient continuously sheds o the infectious for a long
period
of time (typhoid, HIV, HBV, TB)
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Characteristics of the agents directly related to the host:

• ability to • ability to
1. Antigenicity induce antibody 2. Toxicity produce toxin 3. Invasiveness
production
• ability to
penetrate or original site of • ability to
grow within the illness 4. Virulence cause serious 5. Pathogenicity
host away from illness
the
• ability to
• ability to lodge in the host
cause disease 6. Infectivity and multiply in
the body of the
host
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LEVELS OF PREVENTION
PREVENTIO • is inhibiting the development of the disease before
it occurs
N and other measures which will interrupt or slow down
the
progression of the disease once it occurs.

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 GENERAL
HEALTH • measures employed in promoting health, not
directed to any
PROMOTION disease but se e to fu her the general health and well
(Primordial being
• Health education and motivation are impo ant in
Prevention)
this period.
(To increase awareness and the knowledge of people
on
how to improve health)
• Examples:
• Good standard of nutrition.
• Counseling and parent education
• Development of good habits of health and hygiene

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• Prompt utilization of available health facilities
• Adequate housing and recreation.
• No overcrowding, adequate ventilation
• Cleanliness of the surrounding
• Spo s activities
• Sex education and counseling before and during
marriage
• Genetics

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 •Use of measures against speci c disease agents by
establishing barriers against agents in the environment
• Altering susceptibility and reducing exposure (risk
SPECIFIC reduction)
PROTECTIO • Use of measures against speci c disease agents by
establishing barrier against agents in the environment
N
• Examples:
• Isolation and quarantine - isolate the cases, quarantine
the exposed.
• Control means of spread
• Spread of the disease through direct/indirect contact,
vector, vehicle, fomite.
• Proper waste disposal
• Food, water, and milk sanitation
• Immunization – increases resistance of host
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Avoidance of various carcinogenic agents
and
treatment of pre-cancerous lesions
• Protection against occupational hazards.
• Protection from accidents
• Controls of aspects of human behavior
such as dieta
habits, tobacco, drugs, and alcohol abuse
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 • Measures applied
SECONDARY during early
pathogenesis
PROTECTIO
N
• Early diagnosis and
Prompt treatment
• Applies during
subclinical (pre-
symptomatic) or early
clinical
phase of the disease

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Objectives:
1. Prevent spread of
infection if disease is
infectious.
(Eliminate agent and
rese oir)
2. To cure or arrest the
disease process in order to
prevent
complication
3. To prevent prolonged
disability
Ex: Case nding in PTB,
cancer screening

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 Applies to advanced
stage of pathogenesis
• To return the
C. TERTIARY individual to a useful
place in society and make
PREVENTIO
N maximum use of his
remaining capacities.
• Examples: DISABILITY
LIMITATION,
REHABILITATION,
INTENSIVE FOLLOW-UP,
AND TREATMENT OF
CASES
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[Link]

Science of Population
• Focuses its attention to
three human phenomena:
• Population size
• Composition of the
population
• Distribution of the
population in space
114
 1. Counts
• absolute numbers of a population or any demographic
event
occurring in a speci ed area during a speci ed time period.
TOOLS FOR
• Examples:
• 30,443,287 males in the Phil. in 1990
DEMOGRAP • 77,322 live bi hs in Manila in 1984
HY
2. Ratio
• single number that represents the relative size of two
numbers
• Relation of one population subgroup to another subgroup
in
the same population It takes the form of:
• When K = 100, the propo ion becomes a percentage.
• Example:
• 100 number of males sex ratio x number of females
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 3. Propo ion
• special type of ratio in which the numerator is pa of the
denominator o Relation of a population subgroup to the
entire population
TOOLS FOR • It takes the form:

DEMOGRAP
• When K = 100, the propo ion becomes a percentage.
4. Rate
HY • frequency of occurrence of events over a given inte al of
time
• Most rates are expressed per 1000 population
• Crude Rate – computed for an entire population
• Examples: Crude Death Rate (CDR), Crude Bi h Rate
(CBR)
*Speci c Rate – computed for a speci c subgroup (e.g.,
General Fe ility Rate)
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 V.
MEASURES
OF CENTRAL
TENDENCY 1. Mean
AND • The sum of the scores or values of a variable divided
DISPERSION by their number

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Median
•arranged
The value of the middle item when the items are
according to magnitude
•arranged
Middlemost
in obse ation in a set of obse ations
numerical order or in an array
• If n is odd, it is the middlemost obse ation
• If n is even, it is the mean of the two middlemost
obse ations
•magnitude
Arrange the obse
(array) andations according to
use the corresponding formula
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3. Mode
• The score of the values which occurs with the
greatest
frequency

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• Location of the measures of central tendency:
• • Symmetrical Distribution
• • Skewed to the Left
• • Skewed to the Right
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 B.
MEASURES
OF
DISPERSION
1. Range
2. Variance
3. Standard deviation
4. Coe cient of variation

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 1. Obse ational
VI. STUDY • obse e things happen
DESIGN
a. Descriptive - occurrence and distribution of diseases
b. Analytic - test for hypothesis
2. Experimental
• there is inte ention
a. True experiment - with randomization
b. Quasi-experiment - without randomization

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 • The ability of the test to distinguish between who
VALIDITY OF has the
disease and who doesn’t
TEST
• Measured by its ability to do what it is supposed to
do
• Components:
1. Sensitivity
• ability of the test to identify correctly those who
have the disease

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COMPARISON
OF RESULT OF A
DICHOTOMOUS
TEST WITH

ACTUAL
DISEASE STATUS

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