This document discusses public health in Pakistan. It begins by defining health and the role of public health in ensuring physical, mental, spiritual and social well-being through collective societal efforts. It then lists some recent health threats Pakistan has faced like dengue fever, hepatitis, polio and others requiring multi-agency responses. The top 10 causes of death in Pakistan are also provided. The document outlines the core functions of public health including health monitoring, policy development, health promotion, disease prevention and program evaluation. It discusses the federal government's role in public health and the importance of partnerships across different organizations and sectors for an effective public health system.

1. Public Health
Rashid Mureed
Email: rashid.Mureed@cepal.pk

2. Introduction
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Who is to blame for the innocent lives lost in Karachi as rains ...??

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4. If we look at the definition of health, we see that it encompasses a
broad range of conditions.
Health requires
• physical,
• mental,
• spiritual, and
• social well-being.
Ensuring conditions so that people can be healthy is the job of
public health. And in order to ensure physical, mental, spiritual, and
social well-being, public health requires that society work together,
collectively.
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Public Health

5. Recent Health Threats in Pakistan
 Dengue Fever 2013
 Hepatitis B & C in 2015
 Polio
 Chikungunya
(Malir & Khokhrapar Karachi, Sindh)
 Naegleria
These events required responses from more than one geographical area and
more than one agency, increasing collaboration and cooperation.
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6. Top 10 Causes of Death in the Pak
Rank Cause Of Death % Of Total Deaths
1 Heart Disease 8%
2 Cancer 8%
3 Lower-Respiratory Infections 8%
4 Stroke 6%
5 Diarrheal Diseases 6%
6 Neonatal Encephalopathy 5%
7
Chronic obstructive pulmonary
disease
5%
8 TB 5%
9 Pre-Term Birth Complications 4%
10 Diabetes 3%
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7. What does What does
medicine do? public health
do?
Saves lives one at a time Saves lives millions at a time
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8. Basics of Public Health
 Prevents epidemics and the spread of disease
 Protects against environmental hazards
 Responds to disasters and assists communities in recovery
 Prevents injuries
 Promotes healthy behaviors
 Assures the quality and accessibility of health services
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9. Public Health System
Schools
Community
Centers
Employers
Transit
Elected Officials
Doctors
EMS
Law
Enforcement
Nursing Homes
Fire
Corrections
Mental Health
Madrasa
General
Public
Nonprofit
Organizations
Neighborhood
Organizations
Laboratories
Home Health
HCs
Hospitals
Tribal Health
Drug
Treatment
Public Health
Agency
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10. Essential Services of Public
Health
1. 1. Monitor health status
2. 2. Diagnose and investigate
3. Inform, educate, and empower
4. 3. Mobilize community
5. 4. partnerships
6. 5. Develop policies and plans
1. 7. Enforce laws and regulations
2. 8. Link people to needed
services/assure care
3. 9. Assure a competent
workforce
4. 10. Evaluate health services
5. Research
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11. ASSESSMENT
of the health of the
community
ASSURANCE
of the public’s health
POLICY DEVELOPMENT
in the public’s interest
Core Functions of Public Health
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12. "Policy"
A course or principle of action adopted or proposed by an
organization or individual.
“Definition from the Google”
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13. Evolution of Health Policy
 Common Wisdom- Learned from direct observation
 Age of Discovery- Application of the scientific method
 Prospective Age – Population based analysis
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14. Policy Development
“Policy development is the means by which problem identification,
technical knowledge of possible solutions, and societal values join
to set a course of action."
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15. Policy Development
Problem
Identification
Technical Knowledge
Societal Values
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16. Problem Identification
 Anecdotes
 Media
 Public Health Data
 Epidemiology
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17. Technical Knowledge of Solutions
 Basic Science
 Clinical Studies
 Economics
 Law
 Health Behavioral theory- Pyschology
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18. Societal Values
 Political Process
 Legislative, Judicial & Executive expression
 Social & Political Sciences
 Interest Groups
 Town Hall Meetings
 Blogs, Web Pages
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19. Setting a Course of Action
Easier Said;
 Having a vision
 Setting goals
 Picking objectives
 Designing action steps
Than Done
 Legal and regulatory framework
 Funding
 Organizational structure to accomplish
 Work plan: staffing, equipment
 Cooperation or interest of those affected
 Patient/provider, customer/provider, community/leader relationships
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20. Public Health Functions
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21. Public Health Function-I
 Surveillance, analysis and evaluation of population’s health status
 Monitor health status to identify population or community health problems
 Diagnose and investigate health problems and health hazards in the
community
 Monitor environmental and health status to identify and solve community
environmental health problems
 Diagnose and investigate environmental health problems and health
hazards in the community
 Act as quickly as possible with efficacy in solving and improving these
problems
Example:
The Spanish National Health Survey detects tobacco/smoking as a public
health problem
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22.  Develop policies and plans that support individual and
community health efforts
Once the health problem is identified, public health seeks the best
interventions and strategies to solve the public health problem and
identify health and/or social actors or agents that can be carried out
in the best way possible
Example:
Identify effective policies that reduce the number of smokers in the
society
Public Health Function-II
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23.  Health Promotion
This is a public health function that tries to promote the health
of the population, educating in health from the different health,
education and mass media facilites
Example:
Implementation of preventive measures to advantage smoking -
free areas
Awareness-raising campaign in all the society sectors
Public Health Function-III
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24.  Disease Prevention
There are two strategies to address diseases prevention, the
high risk approach and the population approach
 High risk approach
The high risk approach is aimed at individuals particularly
predisposed to an illness and an individual prevention manner
is offered to them
 Population approach
The population approach attempt to control the factors of the
population as a whole without focusing on a specific collective matter
Public Health Function-IV
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25.  Disease Prevention (2)
 There are three levels of prevention
 Primary Prevention: to intervene before a disease appears
 Secondary Prevention: to intervene in pre-symptomatic phases
 Tertiary Prevention: to intervene when the individual is already ill. Try to mitigate the
effects of disease
Public Health Function-IV
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26.  To develop effective programs and health facilities to protect
health
The development and implementation of programmes that promote
health improvement of the population as a whole, with the condition that
they are based on efficacy scientific evidence based and that they
help to increase the population’s quality of life
Example:
To develop health programmes aimed to help smokers to give
up smoking and health facilities with this specific function
Public Health Function-V
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27.  Evaluation of public health policies, strategies and facilities
Having just implemented, whatever process included in society to
solve or improve the health problems must be evaluated, to check its
right performance and functioning and analyse if it is associated with an
improvement of the health problems for which were developed
Example:
To evaluate the effect caused by the implementation of these
politics and programmes on the number of smokers
Public Health Function-VI
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28. Federal Public Health
Responsibilities
 Ensure all levels of government have the capabilities to provide essential
public health services
 Act when health threats may span more than one province, a region, or
the entire nation
 Act where the solutions may be beyond the jurisdiction of individual
province
 Act to assist the province when they lack the expertise or resources to
effectively respond in a public health emergency (e.g., a disaster, or an
emerging disease)
 Facilitate the formulation of public health goals (in collaboration with
provinces and local governments and other relevant stakeholders)
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29. Other Roles of Federal Public
Health
Federal government plays a crucial role in
 Providing leadership, through regulatory powers, in setting health
Goals
Policies
Standards
Contributing operational and financial resources
Financing research and higher education
Supporting the development of scientific and technological tools needed to
improve the effectiveness of public health infrastructure at all levels
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30. “…The determinants of health are beyond the capacity of any one
practitioner or discipline to manage….We must collaborate to survive, as
disciplines and as professionals attempting to help our communities and
each other.”
—Institute of Medicine, 1999
Nongovernmental Organizations
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31. “It is logical to expect that there is strength in numbers and that
partnerships can mobilize material and human resources and be more
effective at achieving desired goals than individuals working alone.”
– Karen Glanz, Health Behavior and Health Education, 2002
Nongovernmental Organizations
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32. A Well-Functioning Public Health
System Has..
 Strong partnerships where partners recognize they are part of the public
health system
 Effective channels of communication
 System-wide health objectives
 Resource sharing
 Leadership by governmental public health agency
 Feedback loops among state, local, tribal, territorial, and federal partners
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33. Our goal is an integrated system of
partnerships
Federal NRSD
Provincial Health Departments
Local Health Departments
Pharma Companies
NGO’s & Pvt. Org.
Law
Enforcement
Community
Services
Environmental
Health
Healthcare
Providers
Philanthropy
Mosques
Transportation
Businesses
Media Schools
Mental
Health
Community
Coalitions
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