COMPREHENSIVE NOTES ON PUBLIC HEALTH

FUNDAMENTALS
Based on Science of Public Health (PE10002) Examination Analysis

SECTION 1: CORE DEFINITIONS & FUNDAMENTALS

1.1 Public Health

Definition (CEA Winslow):
"The science and art of preventing disease, prolonging life, and promoting health through the organized efforts and
informed choices of society, organizations, public and private communities, and individuals."

Key Characteristics:

Multidisciplinary: Integrates biology, anthropology, public policy, mathematics, statistics, engineering, education,
psychology, computer science, sociology, medicine, business, and management
For Everyone, Everywhere, Everytime: Universal approach regardless of gender, wealth, ethnicity, sexual
orientation, or political views
Prevention-Focused: Prevention of disease and promotion of health is better than cure

Collective Action: Involves organized efforts at community, organizational, and governmental levels

Core Functions of Public Health:

• Assessment - Monitor health status and identify community health problems

• Policy Development - Develop policies and plans supporting health efforts

• Assurance - Link people to services and ensure competent workforce

1.2 Epidemiology

Definition:
"The study of the distribution and determinants of health-related states or events in specified populations and the
application of this study to control of health problems."

Purpose:

Understand why disease develops in some people and not others

Identify factors predisposing to or protecting against disease

Guide disease control and prevention strategies

Key Factors Influencing Disease:

Genetic factors
Environmental factors

Stress levels
Nutrition intake
Socioeconomic factors
Historical Context - John Snow's Cholera Outbreak Investigation (1854):
The British doctor investigated the Soho cholera outbreak in London, using geographical mapping and case investigation
to prove the contaminated Broad Street pump was the source of infection. This pioneering work established
epidemiological investigation as a key public health tool.

1.3 Germ Theory of Disease

Definition:
Germ theory states that many diseases are caused by the presence and actions of specific micro-organisms (pathogens
or germs).

Types of Microorganisms (Germs):

Bacteria
Viruses
Protozoa
Fungi

Limitations:

Unable to explain causation of non-communicable diseases

Disease is rarely caused by a single agent alone

Multiple factors contribute to disease occurrence

1.4 Health Promotion

WHO Definition (1998):

"Health promotion is the process of enabling people to increase control over the determinants of health and thereby
improve their health."

Scope:
Health promotion is NOT limited to individual action but includes:

• Actions to strengthen skills and capabilities of individuals

• Actions directed toward changing social, environmental, and economic conditions

Purpose of Health Promotion:

Positively influence health behavior of individuals and communities

Influence living and working conditions that affect health

Importance:

Improves health status at all levels (individual to national)

Enhances quality of life

Reduces premature deaths

Reduces healthcare spending significantly
Ottawa Charter for Health Promotion (1986) - Priority Actions:

1. Building healthy public policy - Put health on agenda of all policy makers
2. Creating supportive environments - Generate safe, stimulating, satisfying living and working conditions

3. Strengthening community actions - Empower communities in setting priorities and planning

4. Developing personal skills - Provide education and enhance life skills
 5. Reorienting healthcare services - Move beyond clinical services to health promotion

1.5 Prevention Levels

Primordial Prevention:

Prevents development of risk factors in the first place

Changes social and environmental conditions where risk factors develop

Example: Community programs to increase physical activity and reduce sodium in food supply

Primary Prevention:
Action taken prior to disease onset
Removes the possibility that disease will occur
Examples: Infection control, immunization, sanitation, health promotion

Secondary Prevention:
Halts disease progress at its early/incipient stage
Prevents complications

Largely domain of clinical medicine

Examples: Screening tests, case-finding programs, early treatment, specific interventions

Tertiary Prevention:
Used when disease process has advanced beyond early stages
Reduces or limits impairments and disabilities

Promotes patient adjustment to irremediable conditions

Examples: Disability limitation, rehabilitation, palliative care

SECTION 2: EPIDEMIOLOGY & DISEASE MEASUREMENT

2.1 Measures of Disease

Incidence
Definition:
Number of new cases occurring during a specified time period divided by the number of disease-free individuals at the
start of that time period.

Key Characteristic:

Focuses on NEW cases only

Essential for identifying emerging health problems

Used for intervention evaluation
Prevalence
Definition:
Number of people with the disease divided by total number of individuals in the population.

Comparison with Incidence:

Incidence = NEW cases (risk of developing disease)

Prevalence = ALL cases (burden of disease in population)

They are twin measures in epidemiology

Latent Period vs. Incubation Period

Incubation Period:

Period between exposure to infection and appearance of signs and symptoms

Communicable diseases
Example: COVID-19 has an incubation period of 2-14 days

Latent Period:

Period between exposure and appearance of signs and symptoms

Non-communicable diseases

May involve detectable pathologic changes before clinical symptoms appear

2.2 Screening and Validity

Validity of Screening Tests

Definition:
The ability of a test to distinguish between who has a disease and who does not.

Components of Validity:

Sensitivity:

Ability of test to identify correctly those who HAVE the disease

High sensitivity = Few false negatives
Important for: Serious treatable conditions

Specificity:

Ability of test to identify correctly those who DO NOT have the disease

High specificity = Few false positives

Important for: Avoiding unnecessary treatment

Clinical Significance:

A SENSITIVE test: Few people with disease are missed

A SPECIFIC test: Few people without disease are incorrectly labeled as having disease

Ideal screening test has BOTH high sensitivity AND high specificity
Reliability of Screening Tests
Definition:
Whether results obtained can be replicated if test is repeated.

Types of Variation:

Intra-observer Variation:

Same observer gets different results on repeated testing

Due to subjective factors in observer's conclusions
Examples: Physical examination findings, radiological interpretation

Inter-observer Variation:

Different observers get different results

Two examiners often derive different outcomes
Common in subjective assessment procedures

Importance:

If test results cannot be reproduced, value and usefulness are minimal

Reliability must be established before using test in practice

2.3 Outbreak Investigation

Definition:
Systematic process to identify source, cause, and control measures for unusual increase in disease cases.

Steps in Outbreak Investigation:

A. Identify the Case

Specify case definition (clinical criteria for diagnosis)

Conduct case finding using active and passive surveillance

Establish who qualifies as a confirmed case

B. Describe the Outbreak by Person, Place, and Time

Prepare line list: age, sex, disease status, possible exposure, exposure date, onset date, symptoms, lab results

Monitor time trends (epidemic curve)

Assess geographical distribution of cases
Identify patterns and clusters

C. Identify and Characterize the Cause

Examine Clinical Evidence: signs, symptoms, laboratory findings

Examine Epidemiological Evidence: common characteristics among cases, age distribution, source of infection,
incubation period

Examine Laboratory Evidence: diagnostic test results and confirmation

D. Perform Risk Factor Study

Develop hypotheses about exposure sources

Calculate relative risk by comparing exposed and unexposed groups
Identify specific risk factors contributing to disease
E. Intervene and Report

Remove the exposure (isolation, disinfection, recall of contaminated products)

Implement behavior change interventions
Treat or vaccinate at-risk individuals
Write comprehensive report
Disseminate findings to stakeholders

Continue surveillance for recurrence

2.4 Disease Surveillance

Definition:
"The ongoing systematic collection, analysis, and interpretation of health data essential to the planning, implementation,
and evaluation of public health practice closely integrated with the timely dissemination of these data to those who need
to know."

Purpose:

Monitor changes in disease frequency

Monitor changes in levels of risk factors

Identify outbreaks early

Guide intervention strategies

Types of Surveillance:

Passive Surveillance:

Uses available data on reportable diseases

Disease reporting mandated or requested

Responsibility on health care provider or district health officer

Limitations: Underreporting, incomplete reporting, risk of missing local outbreaks

Advantage: Inexpensive and relatively easy to develop

Active Surveillance:

Project staff make periodic field visits to health care facilities

Identify new cases and deaths from diseases of interest

Advantage: More accurate reporting than passive surveillance
Limitation: More resource-intensive

Principles of Disease Surveillance:

• Systematic and continuous collection of health data

• Analysis and interpretation of data

• Timely dissemination to stakeholders
• Integration with public health practice

• Support for planning, implementation, and evaluation

2.5 Measures of Association

Risk

Definition:
Probability of an event such as developing a disease occurring.

Relative Risk (Risk Ratio)

Interpretation:

RR = 1: No association between exposure and disease

RR > 1: Increased risk with exposure (harmful exposure)
RR < 1: Decreased risk with exposure (protective exposure)

Risk Difference

Use:
Indicates absolute excess risk attributable to exposure.

2.6 Epidemiological Study Designs

Descriptive Study Design

Outcome of interest described in terms of its distribution within population

No examination of association between factors

Used for: Hypothesis generation, disease mapping, preliminary investigation

Cross-sectional Study Design

Examines possible relationship between exposure and disease outcome

Both exposure and disease determined simultaneously for each subject

Used for: Prevalence surveys, hypothesis testing

Case-Control Study Design

Identifies group with disease (cases) and group without disease (controls)
Determines what proportion of each group was exposed to suspected risk factor
Used for: Rare diseases, disease outbreak investigation

Cohort Study Design

Selects group of exposed individuals and group of non-exposed individuals

Follows both groups to compare incidence of disease

Used for: Natural history of disease, etiology, intervention evaluation
Randomized Controlled Trials
Experimental design with random assignment to intervention or control group
Used for: Evaluating new drugs, treatments, health programs, screening tests
Gold standard for evidence

SECTION 3: BEHAVIORAL MODELS & FRAMEWORKS

3.1 Health Belief Model (HBM)

Origin: U.S. Public Health Service (1950s)

Original Use:
First used to understand failure of people to adopt disease prevention strategies, participate in screening, and comply
with medical treatments.

Key Constructs of HBM:

Perceived Threat:

Perceived Susceptibility: Individual's belief about likelihood of getting the disease

Perceived Severity: Individual's belief about seriousness of the disease

Perceived Benefits and Barriers:

Perceived Benefits: Belief that recommended action will reduce disease risk
Perceived Barriers: Belief about costs, side effects, and difficulties of recommended action

Modifying Factors:

Demographic factors (race/ethnicity, gender, age)

Psychosocial factors (social pressure, personality)

Cues to Action:

Internal cues: Symptoms, bodily sensations

External cues: Mass media campaigns, social media, health provider advice

Self-Efficacy:

Individual's belief in their ability to successfully perform recommended action

Confidence in ability to change behavior

Behavioral Mechanism:
Behavior influenced by:

1. Person's belief in personal threat of illness

2. Person's belief in effectiveness of recommended action

Action Likelihood (probability of adopting health behavior) depends on:

Perceived threat (susceptibility × severity)

Perceived benefits minus perceived barriers
Limitations of HBM:
• More descriptive than explanatory
• Does not suggest specific strategy for changing behavior
• No consideration to persons' attitudes, beliefs, habit-forming behaviors
• Ignores social acceptability and environmental/economic factors
• Individual constructs vary in usefulness depending on health outcome

• Should be integrated with other models accounting for environmental context

3.2 Theory of Planned Behavior (TPB)

Components:
Attitude:

Individual's positive or negative feelings about performing the behavior

Belief about likelihood that behavior will have expected outcome

Subjective evaluation of risks and benefits

Subjective Norm:

Individual's perception of social pressure to perform or not perform behavior

What important others think about the behavior

Motivation to comply with these important others

Perceived Behavioral Control:

Individual's belief about ease or difficulty of performing behavior

Sense of personal efficacy

Availability of resources and opportunities
Behavioral Intention:

Individual's intention to perform the behavior

Direct predictor of actual behavior

Formed by attitude, subjective norm, and perceived behavioral control

Application:
Purpose:
Predict individual's intention to engage in specific behavior at specific time and place.

Design:
Intended to explain all behaviors over which people have ability to exert self-control.

Key Principle:

Behavioral INTENTIONS are influenced by attitude about likelihood behavior will have expected outcome and
subjective evaluation of risks/benefits

Intention is strongest predictor of behavior change

3.3 Ottawa Charter for Health Promotion (1986)
The Ottawa Charter established a comprehensive framework for health promotion with multiple action levels and
strategies.

Five Priority Action Areas:

1. Building Healthy Public Policy

Put health on agenda of policy makers in all sectors at all levels

Ensure policy makers are aware of health consequences of their decisions
Accept government responsibility for health

2. Creating Supportive Environments

Encourage care of communities and natural environment

Generate living and working conditions that are safe, stimulating, satisfying, enjoyable
Assess health impact of rapidly changing environment
Protect natural and built environments
Conserve natural resources

3. Strengthening Community Actions

Enable concrete and effective community action

Support communities in setting priorities and planning strategies

Empower communities through knowledge and ownership

Develop community capacity for problem-solving

4. Developing Personal Skills

Provide information and education for health

Enhance life skills

Increase options available to people to exercise control over health

Support personal and social development

Enable learning throughout life

5. Reorienting Healthcare Services

Move beyond clinical and curative services toward health promotion

Share responsibility among individuals, communities, health professionals, and governments

Increase research focus on health promotion
Reform professional education and training

Three Core Strategies:

Advocacy:

Create essential conditions for health (political, economic, social, cultural, environmental, behavioral, biological)

Ensure conditions favor health

Enabling:

Ensure equal opportunities and resources

Enable all people to achieve fullest health potential
 Provide supportive environment, information, life skills
Mediating:

Coordinate action by all stakeholders

Coordinate between governments, health and other sectors, NGOs, media
Involve people as individuals, families, communities

SECTION 4: HEALTH ECONOMICS & STATISTICS

4.1 Quality Adjusted Life Years (QALY)

Definition:
A measure of disease burden that combines quality of life with quantity of life (years lived).

Formula:

Where:

1 = perfect health
0 = death

Purpose:

Compare health benefits of different interventions

Guide resource allocation decisions

Measure health gain from interventions

Include both mortality and morbidity in analysis

Application:

Economic evaluation of health programs

Cost-utility analysis
Priority setting in healthcare

4.2 Cost-Benefit Analysis

Definition:
"The comparative analysis of alternatives in terms of their costs and consequences."

Purpose:

Aid decision-making regarding health interventions

Weigh costs of intervention against benefits provided

Guide resource allocation

Key Principles:

Opportunity cost: Value of best alternative use of resources

Social vs. private costs and benefits
Marginal costs and benefits: Cost and benefit of one additional unit

Efficiency: Maximum benefit from available resources

Equity: Fair distribution of costs and benefits
Forms of Economic Appraisal:

• Cost Minimization Analysis - Find cheapest way to achieve outcome

• Cost Effectiveness Analysis - Compare cost per unit of outcome
• Cost Benefit Analysis - Compare total costs to total benefits
• Cost Utility Analysis - Compare cost per quality-adjusted life year (QALY)

Application in Public Health:

Evaluating disease prevention programs

Prioritizing health interventions
Justifying health spending
Improving healthcare efficiency

4.3 Scales of Measurement

Nominal Scale

Definition:
Categorical scale with no order among categories.

Characteristics:

No ranking or ordering
Categories are mutually exclusive

Used for classification only

Examples:

Gender (male, female)

Blood group (A, B, AB, O)

Disease status (present, absent)

Ordinal Scale

Definition:
Categorical scale where order or ranking among categories is important.

Characteristics:

Has inherent ranking or order

Distance between categories not equal

Cannot perform arithmetic operations

Examples:

Students' exam performance: very good, good, poor, very poor

Disease severity: mild, moderate, severe
Pain scale: none, mild, moderate, severe
Interval Scale

Definition:
Continuous scale where intervals between values have consistent interpretation.

Characteristics:

Has order and equal intervals

No true zero point
Lacks absolute reference point

Examples:

Temperature in Celsius (0°C does not mean no heat)

Calendar years

Ratio Scale

Definition:
Continuous measurement scale with constant interval and true zero point.

Characteristics:

Has order, equal intervals, and meaningful zero

True zero represents absence of attribute

Can perform all arithmetic operations

Most informative scale

Examples:

Height (cm)

Weight (kg)
Blood pressure (mmHg)

Age (years)

4.4 Descriptive Statistics

Measures of Central Tendency:

Mean (Average):

Sum of all values divided by number of values

Sensitive to extreme values
Most commonly used measure

Median:

Value with 50% of recorded values above and 50% below

If n is odd: Median = (n+1)/2 th value

If n is even: Median = average of n/2 and (n/2)+1 terms

Less sensitive to extreme values

Mode:
 Observation that occurs most frequently

Value having highest frequency

Useful for categorical data

Measures of Dispersion:

Variance:

Mean of squared deviation around mean

Measures spread of data around mean
Standard Deviation (SD):

Square root of variance

Measures average deviation from mean
Same units as original data
Uses: Describe variability, compare distributions, set confidence intervals

Uses of Statistical Thinking for Engineers:

• Design new products and systems that meet customer needs

• Refine existing products or processes

• Improve design based on data

• Develop and improve production processes

• Describe and understand variability

• Enable logical decision-making

• Optimize system performance

SECTION 5: ENVIRONMENTAL HEALTH & ENGINEERING APPLICATIONS

5.1 Environmental Health Overview

WHO Definition (1993):

"Environmental health comprises those aspects of human health, including quality of life, that are determined by physical,
chemical, biological, social and psychological factors in the environment. It also refers to the theory and practice of
assessing, correcting, controlling and preventing those factors in the environment that can potentially affect adversely the
health of present and future generation."

Global Disease Burden:

24% of global disease burden linked to environmental risk factors

94% of diarrhoeal diseases attributable to environmental factors
40% of communicable disease burden (infections, respiratory diseases, malaria, injuries)

34% of children's disease burden attributed to environment

Major burden in low-income countries
5.2 Environmental Risk Factors

Water, Sanitation, and Hygiene (WASH)

Impact:

Poor water quality, insufficient access to water, lack of sanitation, poor hygiene
Greatly increases: Diarrheal disease, intestinal worm infections, skin/eye diseases, water and sanitation-related
problems
Prevents school attendance (especially girls)

Current Status:

89% of world population has access to safe drinking water

770 million people depend on unimproved drinking water sources

2.8 billion people without improved sanitation (by end of 2020)

1.6 billion without access to safe drinking water
Concentrated in South Asia, Africa, Sub-Saharan countries

Right to WASH:
Increased access to safe water and sanitation is recognized as a human right.

Air Quality

Types:

Indoor household air pollution

Outdoor air pollution

Sources:

Increased use of motor vehicles

Industrial production

Burning of waste
Insufficient local energy production

Use of solid fossil fuels

Health Impact:

Respiratory diseases

Cardiovascular disease
Premature death

Urbanization
Definition:
Process of ongoing and rapid change in society and environmental landscape.

Causes:

Population migration from rural to urban areas

Urban demographic growth
Rapid, unplanned, unsustainable patterns of urban development

Health Implications:
 Creates focal points for emerging environmental hazards

Challenges: Solid waste disposal, wastewater management, safe water provision, sanitation, noise, food safety,
traffic, occupational injuries, air quality

Opportunities:

Potential for planned interventions and public health infrastructure

Concentration of resources and services

Natural Resources and Climate Change

Risks:

Shrinking forest cover

Unsustainable production systems
Climate change
Poor resource management
Loss of biodiversity

International Conventions:

• United Nations Convention to Combat Desertification (UNCCD) - Land degradation in drylands

• Convention on Biological Diversity - Global biodiversity protection

Agricultural Practices

Intensified Agriculture Impacts:

Monoculture focus
Cash crop dependency

Increased fertilizer, pesticide, and seed inputs

Increased contamination of water and land

Persistent Organic Pollutants (POPs)

International Response:

Stockholm Convention - Addresses transboundary POPs like DDT

Mercury emission reduction agreements

Occupational Health and Chemical Safety

Concerns:

Occupational health hazards

Chemical exposure
Electronic waste trade
Transboundary hazardous waste movement

International Agreements:

Basel Convention (1989) - Controls transboundary hazardous waste movement and disposal
Expansion needed for emerging waste categories
5.3 Environmental Health Intervention Areas

Classical Intervention Areas:

National and Local Level Programs:

• Drainage systems
• Safe management of human excreta
• Domestic water supply provision
• Hygiene education programs
• Vector and pest control
• Chemical safety
• Pollution reduction measures

• Food safety
• Solid waste management

Responsible Agencies:

Environmental health departments

Veterinary Inspectors

Occupational Health and Safety Units

Department of Agriculture

Public Health Inspectors

Municipalities

5.4 Role of Engineers in Public Health

Engineering Applications in Disease Prevention:

1. Development of Equipment and Machinery:

Diagnostic tools for early disease detection

Medical investigation equipment

Laboratory instruments

2. Digital and Electronic Communication:

Training and awareness programs

Health information dissemination

Telemedicine systems
Remote monitoring
3. Production Infrastructure:

Laboratory equipment for drugs and vaccine production

Manufacturing systems

Quality control equipment

4. Environmental Protection Tools:

Pollution assessment equipment

 Air quality monitoring systems

Water treatment technologies

Waste management systems

5. Diagnostic and Monitoring Equipment:

Thermal screening equipment

Smart watches and wearables

Pulse oximeters
Digital blood pressure measuring instruments
Rapid diagnostic kits
Glucometers
Digital weighing machines

Engineering Applications in Health Promotion:

Digital Health Promotion:

Applications of digital technologies to health

Smartphones for health information

Wearables and fitness trackers

Increased accessibility to health information

Online fitness training

Online education and health awareness

Health-Promoting Infrastructure:

Designed walking tracks and fitness centers

Occupational health improvements

Gyms and recreation facilities

Green energy systems

Motor-cycle and battery-run vehicles

Role in Breaking Disease-Poverty Cycle:

The Vicious Cycle:

Poverty → Lack of Education → Lack of Healthcare → Hunger → Diseases → Inability to work → Continued Poverty

Engineering Solutions:

1. Provide improved water and sanitation systems (WASH)

2. Design affordable healthcare delivery systems

3. Develop low-cost diagnostic and treatment equipment
4. Create job opportunities through infrastructure development
5. Implement waste management systems

6. Design affordable housing with proper sanitation

7. Develop sustainable agricultural practices
8. Create occupational safety systems
5.5 Health Management Information Systems (HMIS)

Definition:
"Tool which helps in gathering, aggregating, analyzing and using information for taking actions to improve the
performance of health systems."

Purpose:

Support hospital and health system management

Aid in job completion of healthcare providers

Manage information effectively

Data Management Scope:

• Clinical data
• Financial data
• Laboratory data
• Inpatient/Outpatient data

• Operation theater data

• Materials management

• Nursing records
• Pharmaceutical data

• Radiology data
• Pathology data

Mandate of HMIS:

"Ensure continuous flow of good quality disaggregated data on health of populations and health care services to assist in
local planning, programme implementation, management, monitoring and evaluation."

Strengths of HMIS:

• Promotes streamlining and standardization of data records

• Creation of integrated data warehouses

• Facilitates rationalization of reporting flows

• Enables customized reporting

• Supports indicator-based analysis
• Integration of various software applications (GIS, RIMS)

• Data quality validation

• Online transmission of reports
• Secure data storage and correct retrieval
• Supports procurement of healthcare goods

Role of Data Analytics (Engineer Perspective):

Surveillance systems improvement

Disease trend identification
Resource allocation optimization
Performance monitoring
 Evidence-based decision making

SECTION 6: DISEASE CAUSATION & NATURAL HISTORY

6.1 Epidemiological Triad Model

Disease results from interaction between:

1. AGENT - Causative factor

2. HOST - Person who gets disease
3. ENVIRONMENT - External factors

6.2 Types of Agents

Biological Agents:

Bacteria, viruses, protozoa, fungi

Nutrient Agents:
Proteins, carbohydrates, vitamins, minerals

Excess or deficiency results in nutritional disorders

Examples: Anemia, goiter, obesity, vitamin deficiencies

Physical Agents:

Excessive heat, cold, humidity, radiation, sound

Examples: Heat stroke, frostbite, hearing loss

Chemical Agents:
Endogenous: From within body (serum bilirubin → jaundice, calcium carbonate → kidney stone)
Exogenous: From outside (allergens, metals, gases, insecticides)

Mechanical Agents:

Crushing, sprains, dislocations

Social Agents:
Smoking, drug and alcohol abuse, unhealthy lifestyles

6.3 Host Factors

Definition:
Usually human or animals who can get disease.

Internal Risk Factors Influencing Host:

Genetic composition
Nutritional status
 Immunologic status

Presence of disease or medications

Psychological makeup
Age and sex
Behavioral and personal choices

Susceptibility and Response:

Influenced by factors such as genetic composition, nutritional and immunologic status, presence of disease, medications,
and psychological makeup.

6.4 Environmental Factors

Definition:
External factors that affect the agent and opportunity for exposure.

Types:

• Physical factors - Geology, climate, weather

• Biologic factors - Insects transmitting agent, vectors

• Socioeconomic factors - Crowding, sanitation, availability of health services

6.5 Natural History of Disease

Definition:
"The progression of a disease process in an individual over time, in the absence of treatment."

Phase 1: Pre-Pathogenesis Phase

Period preliminary to disease onset in man

Disease agent has not yet entered man

Factors favoring interaction of agent with human host are present in environment

Interaction of agent, host, and environment occurring

Phase 2: Pathogenesis Phase

Definition:
Begins with entry of disease agent into susceptible human host.

Events:

1. Disease agent multiplies in body

2. Induces tissue and physiological changes
3. Disease progresses through incubation period

4. Continues through early and late pathogenesis

Incubation/Latent Period:

Period between exposure to infection and appearance of signs and symptoms

Disease not apparent, but pathologic changes may be detectable with laboratory/radiographic/screening methods
Latent Period: Used for non-communicable diseases
Screening Window:
 Most screening programs attempt to identify disease during pre-symptomatic phase

Early intervention likely more effective than treatment after disease progression

Critical opportunity for secondary prevention

Pathogenesis Modifications:

Can be modified by interventions such as immunization and chemotherapy

Final Outcomes:
• Recovery
• Disability
• Death

SECTION 7: COMMUNICABLE VS NON-COMMUNICABLE DISEASES

7.1 Communicable Diseases

Definition:
"A communicable disease is one that is spread from one person to another through a variety of ways."

Direct Transmission:
1. Direct Contact - Example: Scabies

2. Droplet Infection - Example: TB, COVID-19

3. Contact with soil - Example: Parasitic infections (hookworm)

4. Inoculation into skin - Example: Hepatitis B, HIV

5. Vertical transmission (mother to baby in womb) - Example: HIV, congenital infections

Indirect Transmission:
1. Vehicle-borne - Example: Cholera, Typhoid (water and food)
2. Vector-borne - Example: Malaria, Dengue (mosquito)

3. Air-borne - Example: TB, Measles, COVID-19

4. Fomite-borne - Example: Skin disease via bed-sheets, clothes
5. Unclean hands and fingers - Example: Typhoid, Dysentery

7.2 Non-Communicable Diseases (NCDs)

Definition:
"Medical conditions or diseases that are not transmitted from one person to another person."

Characteristics:

Chronic diseases of long duration

Generally slow progression
Result of combination of genetic, physiological, environmental, behavioral and lifestyle factors
Examples:

Diabetes mellitus
 Cardiovascular disease

Cancers

Chronic respiratory illness

Obesity
Key Issues:

Increasing prevalence globally

Require long-term treatment

High cost of treatment
Major cause of mortality in developed and developing countries

KEY TERMS & DEFINITIONS SUMMARY

Term amp; Definition

Prevalence amp; Total number of cases in
population at given time
Incidence amp; Number of new cases
occurring in specific time period
Sensitivity amp; Ability to identify correctly
those with disease
Specificity amp; Ability to identify correctly
those without disease
Reliability amp; Whether test results can be
replicated
Validity amp; Ability to distinguish between
disease and no disease
Latent Period amp; Time between exposure and
symptoms (NCDs)
Incubation Period amp; Time between exposure and
symptoms (infectious diseases)
Relative Risk amp; Ratio of disease risk in
exposed to non-exposed
QALY amp; Quality-adjusted life year
(measure of health benefit)
HMIS amp; Health Management
Information System

ENGINEERING APPLICATIONS IN PUBLIC HEALTH - SUMMARY

As [Link] engineering students, your role in public health includes:

1. Technology Development:

Design diagnostic equipment and systems

Develop water purification technologies

Create waste management solutions
Implement data analytics systems
2. Infrastructure Development:
 Plan and design health facilities

Develop WASH systems

Create occupational safety systems

Design health-promoting built environments

3. Information Systems:

Develop HMIS platforms

Create health surveillance systems

Implement data management solutions
Build telemedicine systems
4. Disease Prevention:

Contribute to outbreak investigation through data analysis

Help design screening and surveillance systems
Develop equipment for early disease detection

Support vaccination program logistics

5. Health Promotion:

Design health-promoting digital applications

Create interactive health education tools

Develop wearable health monitoring devices

Design occupational health systems

6. Breaking Disease-Poverty Cycle:

Develop affordable healthcare technologies

Design low-cost water and sanitation solutions

Create sustainable agricultural practices

Build job creation infrastructure

EXAMINATION FOCUS AREAS

Based on the question analysis, prioritize study of:

High Priority Topics:

1. Definitions of Public Health, Epidemiology, Health Promotion, Prevention Levels

2. Incidence and Latent Period measurements

3. Outbreak investigation steps (10-step protocol)
4. Screening test reliability vs. validity (Sensitivity/Specificity)
5. Disease surveillance principles and types
Framework Knowledge:

1. Health Belief Model constructs

2. Theory of Planned Behavior components

3. Ottawa Charter 5 priority actions
4. Epidemiological Triad (Agent-Host-Environment)
Application Questions (Engineering Focus):

1. How engineers contribute to disease surveillance systems

2. Breaking the vicious cycle of disease and poverty
3. HMIS role in health outcomes
4. Data analytics in health
5. Environmental risk factors and engineering interventions
Statistics & Economics:

1. Scales of measurement (Nominal, Ordinal, Interval, Ratio)

2. QALY definition and use
3. Cost-benefit analysis basic concepts
4. Mean, median, mode, standard deviation

End of Comprehensive Notes

Prepared for: Science of Public Health (PE10002)

Date: November 28, 2025
Institution: KIIT School of Public Health, KIIT Deemed to be University
[1] [2] [3] [4] [5] [6] [7] [8] [9] [10]

1. [Link]

2. PPT-6_Env-[Link]

3. PPT-8_Epidemiology-[Link]

4. PPT-4_Introduction-[Link]

5. PPT-1-_Concept-[Link]

6. PPT-2_-[Link]

7. PPT-9_Epidemiology-[Link]

8. PPT-7_Science-[Link]

9. PPT-3_Concept-[Link]

10. PPT-10_Management-[Link]