PUBLIC HEALTH PROMOTION AND EDUCATION SCOPE OF HEALTH EDUCATION

HEALTH EDUCATION • Health care settings (health centers, clinics, hospitals)

• Any combination of leaming experiences designed to • Schools
facilitate voluntary adaptations of behavior conducive to • Communities
health. (Green, et.al., 1980) • Worksites (industries, offices, hotels, restaurants)
• Any combination of health education and related
organizational, economic, and environmental supports for FOUNDATIONS OF HEALTH PROMOTION AND EDUCATION
behavior of individuals, groups or communities conducive to Philosophical Beacon light to guide the health
health. (Green and Kreuter, 1991) educators in their work or the
• Components of definition: "why"
o Combination-there is no single best method Biomedical Content or the 'what'
o Designed means it is planned, not a hit or a miss Behavioral Science Foundation "How or theories or methods
process A good health educators should not only know the content (what) but
o Facilitates emphasizes educator-learner also how to deliver it effectively (how).
relationship, i.e. the assisting, helping and
supporting role of educator, not just telling HEALTH PROMOTION: EVOLUTION OF THE CONCEPT
o Voluntary adaptations, not manipulated or • Old Concept Primary Protection
coerced • Epidemiologic shift = "Tifestyle factor"
o Behavior as the target outcomes. • Public health education could have an impact on PH if joined
other sectors and bring multiple social forces.
CENTRAL CONCERN OF HEALTH EDUCATION: HEALTH BEHAVIOR • Behavior change that health education is able to effect can
Categories by Kasl and Cobb: only be maintained if supportive environment were provided
• Preventive health behavior through other sectors' effort (social, political, economic,
• Illness behavior biomedical, etc.) [Green]
• Sick role behavior • 1820-William Allison described the close association
between poverty and disease.
PREVENTIVE HEALTH BEHAVIOR • 1847-Rudolf Virchow posited that the remedy for epidemic
• Any activity undertaken by an individual who believes disease was prosperity, education and liberty.
himself to be healthy for the purpose of preventing health • 1920-Winslow depicted the definition of public health
problems or detecting illness in an asymptomatic state. • 1943-Ryle stated that while PH is preoccupied with
• Preventive health-related behaviors are also undertaken communicable diseases, social medicine includes all diseases
specifically to improve or enhance health. (primary and early of prevalence including non-communicable diseases and
detection) their correlation with social and economic conditions.
• Primary prevention behaviors aim to prevent the incidence • 1945-Sigerist defined the 4 major tasks of medicine:
of disease. promotion of health, prevention of illness, restoration of the
o Exercise to improve aerobic fitness and prevent sick, rehabilitation.
cardiovascular disease is an example of a primary • 1986-International Conference on Health Promotion;
preventive behavior. Ottawa Charter for Health Promotion
• Early detection (or secondary prevention) behaviors aim to
prevent early forms of disease from progressing. OTTAWA CHARTER FOR HEALTH PROMOTION
• This involves people who have already developed preclinical • Health Promotion is the process of enabling people to
disease or risk factors for disease but in whom the disease increase control over, and to improve, their health. (WHO,
has not yet become clinically apparent. 1998)
• 5 action areas of Ottawa Charter for Health Promotion
ILLNESS BEHAVIOR 1. Develop personal skills
• Any activity undertaken by an individual who perceives 2. Create supportive environment
himself to be ill; to define the state of his health and to 3. Community involvement
discover suitable remedy. 4. Re-orient health services
• There are different types of illness behavior-seek medical 5. Build supportive public policies
care for help; self-help strategies; decide to dismiss the
symptoms HEALTH EDUCATION/PROMOTION PRINCIPLES
• Illness behavior may be a mixture of behavioral decisions. • Health promotion involves the population as a whole in the
• An individual faced with recurring symptoms of joint pain context of their everyday life, rather than focusing on people
may turn to complementary or alternative medicine at risk from specific diseases.
• However, a sudden, sharp, debilitating symptoms may lead • Health promotion is directed towards action of the
one directly to a hospital emergency room. determinants or cause of health.
• Illness behavior is usually mediated by strong subjective • Health promotion combines diverse, but complementary
interpretations of the meaning of symptoms methods or approaches.
• Health promotion is primarily a societal and political venture
SICK ROLE BEHAVIOR and not a medical service.
• Any activity undertaken by an individual who considered • Successful with the presence of the following:
himself to be ill for the purpose of getting woll o Specific targets
• The sick role and the sick-role behavior could be seen as the o Careful planning, monitoring/evaluating
logical extension of illness behavior to complete integration o Financial, political, management support
into the medical care system. o Inter-sectoral collaboration
• It includes receiving treatment from medical providers, o Participant involvement
generally involves a whole range of dependent behaviors o Qualified personnel
and leads to some degree of exemption of one's usual
responsibilities. PROCESSES IN HEALTH EDUCATION AND PROMOTION
LEARNING PROCESS
FOUR CHIEF CHARACTERISTICS OF SICK ROLE OBJECTIVES
• The sick person is freed or exempt from carrying out normal • Explain the different learning theories and principles
social roles. • Identify the elements of learning Apply the learning theories
• People in the sick role are not directly responsible for their and health-related problems in the field
plight. • Describe how he learning process is affected by social factors
• The sick person needs to try to get well.
• The sick person must seek competent help and cooperate LEARNING
with medical care to get well. • A change in behavior as a result of experience
 • Confirmation or an invalidation of existing patterns of BANDURA'S SOCIAL COGNITIVE THEORY (1986)
behavior that lead to a strengthening or a weakening of old • Vicarious learning-learning by observing events, people or
behavior patterns situations in the social environment.

ELEMENTS OF LEARNING HOW PEOPLE LEARN

• Goal Content
• Readiness • Respond to needs, desires and problems
• Situation • Relevant and meaningful in their lives
• Interpretation Learning situations
• Response • Upholds personal dignity
• Consequence • Given a chance to express freely
• Reaction to thwarting • Physical conditions are conducive to adult learning
Method
THEORIES OF LEARNING • Real learning situations, actual setting
• Behaviorist/Associationist Theories • Practical activities, hands-on
o Pavlov's Classical Conditioning • Variety of ways
o Thorndike's Law of Exercise and Law of Effect • Allows group interaction
o Skinner's Operant Conditioning People
• Cognitive Theories • Ability to learn
o Tolmann's Cognitive Mapping • Rich resource for learning
• Humanist Theories • Need to engage in an interactive process
o Bandura's Social Cognitive Theory
COMMUNICATION PROCESS
PAVLOV'S CLASSICAL CONDITIONING OBJECTIVES
• Pairing of an unconditioned stimulus with a stimulus to be • Define communication process;
considered • Describe elements of the communication process;
• Enumerate the steps in the communication process;
THORNDIKE'S LAW OF EXERCISE AND LAW OF EFFECT • Analyze barriers to the communication process;
• LAW OF EXERCISE • Discuss the theories of communication.
o The more frequent the stimulus-response
connection issued, the stronger the association COMMUNICATION
o One learns by repetition • Process by which information is exchanged and understood
o Preparation of herbal medicines, remember steps by two or more people, usually with the intent to motivate
by heart and influence behavior. (Daft, 1988)
• LAW OF EFFECT • Creation or exchange of understanding between a sender
o The stimulus-reaction connection is strengthened and a receiver. (Rackich, 1985)
when a positive feedback (reward) follows it and • A dynamic process whereby human behavior both verbal and
this connection is weakened when an annoying or non-verbal is perceived and responded to. (Samovar and
discouraging consequence (punishment) follows Porter)
it.
o When mother win approval of in-laws regarding COMMUNICATION ELEMENTS
breastfeeding event is repeated Communication Model

SKINNER'S OPERANT CONDITIONING

• Burrhus Frederic Skinner (1904-1990)
• Learning takes place when certain acts (operations) are
associated with a reinforcement
• Reinforcement strengthens the chance of an operant
response occuring
• POSITIVE
o Behavior is followed by a pleasant stimulus
o Providing options for livelihood projects among
BHWs inspire them to update data board
• NEGATIVE
o Behavior is followed by the removal of an
unpleasant stimulus ELEMENTS OF THE COMMUNICATION PROCESS
o Continuous beeping in the car if you have not
• Source or sender - individual/group/ organization who has a
worn your seatbelt, to get rid of this, you would
purpose, information and/or need to communicate; initiates
have to fasten your seatbelt
the process.
• Message - physical form into which the sender encodes the
TOLMAN'S COGNITIVE MAPPING
information
• The ability to reorder and reconstruct parts of the events or
• Channel - mode of transmission
situations to provide "mental image" of what is being
• Receiver - target of sender's message
recalled.
• Feedback - reaction of the receiver to the message sent by
• Assumes that organisms form mental images or "maps" of
the sender
their surrounding as a major form of learning.
• Brought about by a reorganization, reconstruction of
STEPS IN THE COMMUNICATION PROCESS
perceptions and events.
• Thinking: genesis & framing of the idea in sender's mind
• Encoding: putting thought into some form (physical touch;
STUDIES/APPLICATION
visible movements; symbols)
• Studies on human mapping - assumptions is made that
• Transmitting: broadcasting the message via some medium
various parts of the environment are turned into a brain code
that reflects the arrangement of objects in the environment. • Perceiving: receiver must perceivable the incoming
o How humans arrange their home communities communication
(observe common landmarks in the area) • Decoding: receiver puts the incoming communication into an
o Sketch where they live, prominence of areas with understandable form
personal importance are moved close together • Understanding: the receiver understand the message as
intended to
3 TYPES OF JEJEMON THE CHANGE PROCESS
Mild Jejemon CHANGE
• h3LLO, how aR3 you3? 1k4w b4 s1 mR j3j3mon? • Cognition Change - a change in knowledge and/or perception
Moderate Jejemon of a person
• H3llou. miszy U! h@w @r3 y03h doing? • Attitude Change - a change in the individual's beliefs,
Severe Jejemon predispositions, intentions, and tendencies toward an
• haALLou3h... m Uzst4H n4hh? m1sZszX y UeehHhH? idea/object
THE TWO-STEP FLOW THEORY (KATZ AND LAZARSFELD) • Behavior Change - an alteration in an individual/ group's
Ideas that are disseminated through mass media are received mostly by knowledge, attitude and practices/activities
opinion leaders in the community. • Social Change - a departure from existing ways and means of
They, in turn, reinforce roles to influence others and spread ideas doing things which results in a change of relationships in the
through their interpersonal relationships. system (legislation)

The Two-Step Flow Model ELEMENTS OF CHANGE

Mass Media → Opinion Leaders → Followers 1. Innovation
2. Target of Change
THE DIFFUSION PROCESS 3. Change Agent
Acceptance of an idea goes through the following: 4. Strategies of Change
• Awareness
• Interest BARRIERS TO CHANGE
• Evaluation • Cultural
• Trial • Social
• adoption • Psychological
• Language Difficulties
COMMUNICATION-BEHAVIOR CHANGE MODEL • Motivation to Change
Based on communication inputs and outputs • Problem of Fit
• Input - elements of communication
• Output 12-step sequence of events that must occur between KELMAN'S THREE PROCESSES OF SOCIAL INFLUENCE
the exposure to the communication intervention and long Change can be distinguished into three processes characterized by a
term changes in the behavior distinct set of consequent conditions:
• Compliance
Input • Identification
• Source • Internalization
• Message
• Channel THEORY OF COGNITIVE DISSONANCE (FESTINGER)
• Receiver • Utilized the notion that people cannot tolerate discrepancy
• Destination or inconsistency between their own and other similar
person's attitudes
Output • Cognitive dissonance motivates change
• Exposure
• Attending to it YALE ATTITUDE CHANGE MODEL (HOVLAND)
• Liking, becoming interested in it In order for change to occur, there should be:
• Comprehending • Attention - need to make client listen to the message
• Skill acquisition • Comprehension - need to understand
• Yielding • Acceptance - enhanced by the advantages and
benefits/rewards presented
• Memory storage of content
• Retention - message must be remembered specially when no
• Information search and retrieval
immediate action is demanded by the message
• Deciding based on retrieval
• Behaving
HEALTH BELIEF MODEL
• Reinforcement of desired acts
• Hochbaum, Rosenstock and Kegels
• Post behavioral consolidating (maintenance)
• The model was first presented with only 4 key concepts
o Perceived susceptibility
PRINCIPLES OF COMMUNICATION
o Perceived severity
• People select what they see or hear
o Perceived benefits
• People interpret selectively what they see and hear o Perceived barriers
• People choose what they want to remember and what they • The concept of Cues to Action and Self Efficacy was added
want to forget later to stimulate behavior.
• Words do not have meanings
o Meanings are in people HOW TO MAKE ASYMPTOMATIC HYPERTENSIVE COMPLY WITH
o Meanings are in contexts, in relationships MEDICATION AND UNDERGO WEIGHT LOSS PROGRAM
Concept Potential Change
BARRIERS TO COMMUNICATION
Strategies
• Environmental Barriers
Perceived Asymptomatic people Inform that through
o Noise
Susceptibility may not follow a they have no symptoms,
o Competition for Attention
prescribed treatment they do in fact have HPN
o Time
Perceived May not be aware of HPN can lead to heart
• Terminology and Complexity of Message
Severity the consequences of attacks and strokes
• Personal Barriers non-compliance
Perceived Beliefs about the Taking prescribed
WAYS TO OVERCOME BARRIERS
Benefits effectiveness of taking medication or following
• Regulate the flow of information action to reduce risk or a recommended weight
• Encourage feedback seriousness loss program will reduce
• Simplify message language the risks without
• Listen actively negative side effects
• Restrain emotions and excessive
• Use non verbal cues difficulties
 Perceived Beliefs about the Reassurance, incentives In 1980, Green defined health education as “any combination of
Barriers psychological costs of and assistance may be learning experiences designed to facilitate voluntary adaptations of
taking action offered to better behavior conducive to health”. (Green et al 1980, pp7)
comply the
recommended regimen The National Task Force on the Preparation and Practice of Health
Cues to Patients sometimes Print materials, Educators (1983, p.5) defined health education as the “the process of
Action forget to comply reminder letters, or pill assisting individuals, acting separately or collectively, to make informed
calendars may be used decisions about matters affecting the personal health and that of
Self-efficacy Low self confidence Use strategies others.”
(behavioral contract
with incremental but The key words in these definitions are: process, i.e. a series of learning
achievable goals) to experiences; combination connotes that there is no single best method,
boost self confidence rather a combination is desirable; designed means it is planned, not a
and efficacy hit or a miss process; facilitates emphasizes educator-learner
relationship, i.e. the assisting, helping and supporting role of educator,
THEORY OF REASONED ACTION (AJZEN AND FISHBEIN) not just telling, voluntary adaptations, not manipulated or coerced and
Underscored importance of behavioral intention behavior as the target outcomes.
• Attitudes (feeling of personally performing behavior)
• Subjective norm (person's perception of social influence As previously noted the central concern of health education is health
about performing the behavior) behavior: Kasl and Cobb, define three categories of health behaviors as
• Perceived control over the behavior follows:
• Preventive health behavior: any activity undertaken by an
TRANSTHEORETICAL MODEL OF CHANGE (PROCHASKA AND individual who believes himself to be healthy for the purpose
DICLEMENTE) of preventing or detecting illness in an asymptomatic state.
• Developed in 1982 • Illness behavior: any activity undertaken by an individual
• A theoretical model of behavior change, which has been the who perceives himself to be ill; to define the state of his
basis for developing effective interventions to promote health and to discover suitable remedy.
health behavior change. • Sick role behavior: any activity undertaken by an individual
• The model describes how people modify a problem behavior who considered himself to be ill for the purpose of getting
or acquire a positive behavior. well. It includes receiving treatment from medical providers,
• Focuses on the decision making of the individual. generally involves a whole range of dependent behaviors,
and leads to some degree of exemption from one’s usual
• People go through stages before a final change is made
responsibilities.
• Pre-contemplation
• Contemplation
Health Promotion has lately assumed assumed prominence because of
• Preparation
the emerging public health problems. While in the past the umbrella
• Action
was health education with health promotion as only one of its ribs, some
• Maintenance authors have proposed to treat health promotion as a broader endeavor
and subsumes health education within its boundaries. Others do not
KAR'S PSYCHOSOCIAL MODEL make too much distinction between the two and use them
Behavior is a function of additive and interactive effects: interchangeably.
• Behavioral intentions
• Social support The Scope of Health Education
• Accessibility of information and services Health education covers the continuum of what Leavell calls the levels
• Internal locus of control of prevention from health promotion, specific health protection, early
• Action situation diagnosis and treatment, disability limitation to rehabilitation. While
health education plays an important role in the first phases, health
THEORY OF UNFREEZING, MOVING AND REFREEZING (LEWIN) promotion, it is an essential component of the other phases. All the
• Unfreezing - create awareness of the problem and the need program thrusts of the health care delivery system have corresponding
for change health education/promotion components. The various labels used for
• Moving - alternative action and goals are established health education programs and activities – dissemination of health
• Refreezing - change is generalized; follow up is needed to information, communication, social marketing, motivation programs,
reinforce practice behavior modification, health counseling, etc. – illustrate the scope,
diversity and boundaries of educational application in health.
Module 4- Health Promotion And Education
Health education as you will note is a compound word, health and Health education can take place in various settings, either
education. This means that health education should be viewed within formally/incidentally. The major settings are 1) health care settings in
the changing context of health and disease; within the changing health health, centers, clinics, hospital, health maintenance organizations
picture where life styles play an important role and within the accepted where health education for patients, their families, the surrounding
definition of health. The second word education comes from the Latin communities can take place and where the training of health care
word educe, which means to “lead out”. Hence, health education is not providers have become part of health care today; 2) schools where
just telling people what to do. Rather, it is leading out what people desirable health behavior is installed from the grades up through health
already know and believe and do about their health; modifying those teaching, supportive hygienic school environment, school health
that are undesirable, and developing desirable behaviors that are services, teachers training and the training of health professionals; 3)
conducive to health. It is definitely not a “one-shot” deal, but is a communities, where through the community organization approach,
process of providing learning experiences to people in order that they communities are able to identify their health problems, and through
may be able to define their health problems, personal, family and decision and actions, find solutions to their problems; 4) the worksite
community – and to take the needed actions for solving these problems. such as industries, offices, food establishments, entertainment
establishments, hotels, etc. where one can find captive groups with
Consider the following definitions given by authorities: specific health problems that are common to each group.
The Report of the Presidents Committee on Health Education
(Presidents Committee 1973 p.17) states: “Health education is a process Foundations of Health Education
that bridges the gap between health information and health practice”. It can be seen therefore that health education is a dynamic process that
should be attuned to the changing health challenges. Therefore, health
Simmonds (1976 p. 107) defined health education as the process of education cannot be a “bag of tricks”. It has to be founded on certain
“bringing about behavioral changes in individuals, groups and larger philosophies, theories, research and practice. The major foundations
populations from behaviors that are presumed to be detrimental to are:
health, to behaviors that are conducive to present and future health.
The philosophical foundation serves as a beacon light so that health The above events spurred the WHO, Health and Welfare Canada and the
educators may be properly guided in their work. For example, one Canadian Public Health Association to organize an International
philosophy of health education is that it should be people centered, not Conference on Health Promotion in 1986. The conference came out with
program or organization centered. The welfare of the people is what is now popularly known as the Ottawa Charter for Health
uppermost rather than organizational goals. Promotion which was adopted by 212 participants from 38 countries.
The Ottawa Charter defines health promotion broadly, as “the process
The biomedical foundation which gives health educators the content or of enabling people to increase control over and to improve their health”.
the what of health education programs. This is based on the findings of
biomedical sciences. Health educators must be updated in the recent The Ottawa Charter is notable in that, it emphasizes the active role of
findings in this field so that messages that are disseminated may be the public and its call for strong community action. “Health promotion
scientifically accurate. works through concrete and effective community action in setting
priorities, making decisions, planning strategies and implementing them
The behavioral science foundation provides the educator the HOW or to achieve better health. At the heart of the process is the
the theories or methods of bringing about behavioral change. empowerment of communities, their ownership and control of their
own endeavors and destinies”. The charter recommended the following
The Evolution of the Concept of Health Promotion strategies:
The prominence of health promotion came about as a result of the 1. Develop personal skill
changing patters of health and the corresponding emphasis on “life 2. Create supportive environment
style” as a factor. Life style is a composite expression of the social and 3. Community involvement
cultural circumstances that condition and constraint behavior. Although 4. Re-orient health services
health education had been successful to change singledirected acts, 5. Build supportive public policies
many policy makers and health officials were not confident that health
education could bring about changes in life styles. Public health The WHO cites the following principles of health promotion:
education could have an impact on public health only if it joined other 1. Health promotion involves the population as a whole in the context
sectors and brought multiple social forces to bear. The behavioral of their everyday life, rather than focusing on people at risk from specific
change that health education is able to effect can be maintained if diseases.
supportive environment were provided through the effort of other 2. Health promotion is directed towards action on the determinants or
sectors – political, economic, social, bio-medical, etc. (Green) cause of health. This requires a close cooperation between sectors
beyond health care reflecting the diversity of conditions which influence
As early as 1820, William Allison, a Britisher, described the close health.
association between poverty and disease. In 1847, Rudolf Vichrow, a 3. Health promotion combines diverse, but complementary methods or
German, posited that the remedy for epidemic disease was prosperity, approaches, including communication, education, legislation, fiscal
education, and liberty. In 1920, C.E.A. Winslow defined public health as measures, organizational change, community development and
the “art and science of preventing disease, prolonging life and spontaneous local activities against health hazards.
promoting health and efficiency through organized community effort 4. Health promotion aims particularly at effective and concrete public
for the sanitation of the environment, control of communicable participation. This requires the further development of problem-
infections, education of the individual in personal hygiene, organization defining and decision-making skills, both individually and collectively,
of nursing and medical services for early diagnosis and treatment of and the promotion of effective participation mechanisms.
disease and the development of the social machinery to ensure 5. Health promotion is primarily a societal and political venture and not
everyone a standard of living adequate for the maintenance of health a medical service, although health professionals have an important role
so organizing these benefits as to enable every citizen to realize his in advocating and enabling health promotion. (WHO Health Promotion
birthright of health and longevity”. In 1943, the first professor of Social Glossary 1990)
Medicine in Great Britain, Professor Ryle stated; while public health is
preoccupied with communicable diseases and their correlation with LEARNING PROCESS
social and economic conditions. “Empoy!” The pregnant Aling Marta sobs as her sick child is wheeled to
the emergency room. She thought that measles was a natural childhood
The first use of the term health promotion occurred in 1945 when Henry experience which every Nene and Totoy had to go through. Never did it
E. Sigerist, the great medical historian defined the four major tasks of cross her mind that bronchopneumonia was a possible sequelae. Thus,
medicine as 1) the promotion of health; 2) the prevention of illness; 3) she never brought Empoy to the health center for immunization. The
the restoration of the sick and 4) rehabilitation. According to him, child lies on his hospital bed, still breathing heavily but is already under
“health is promoted by providing a decent standard of living, good labor the care of Dr. Mendoza. The doctor explains Empoy’s condition to Aling
conditions, education, physical culture, means of rest and recreation” Marta and discusses how her future child can be protected against it.
and called for coordinated efforts of statement, labor, industry, The following year, she brings her new daughter to the health center for
educations and physicians. These concepts are found in the Ottawa vaccination.
Charter for Health Promotion which occurred 40 years later.
Aling Marta acquired a new behavioral pattern that of bringing her child
Sigerist listed three main points that must be included in a national to the health center for immunization, as a result of the child’s illness
health program: 1) free education for all, including health education; 2) experience. Learning is thus shown by a change of behavior as a result
the best possible working and living conditions; and 3) the best possible of experience. In some cases, it is the acquisition of new behavior
means of rest and recreation. patterns. In others, it may be a confirmation or an invalidation of
existing patterns of behavior which lead to a strengthening or a
The Health Promotion strategy was directed at changing life style. It weakening of old behavior patterns.
included educational programs directed at both individuals and
organizations and the promotion of additional resources for physical Elements of Learning
recreation. (Terrin) 1. Goal
Going back to Empoy’s example, the goal being referred to is the
The Report, Healthy People separated health promotion from disease mother’s bringing of her child to the health center for immunization.
prevention with the first referring to life style changes and the latter as This behavior change must be relevant to the needs and concerns of the
protection from environmental threats to health. person.

The health promotion movement is also reflected in the policy of WHO 2. Readiness
and UNICEF and their member countries concerning health education As an individual goes through the different stages in life, his/her tasks in
and health promotion as enunciated in the Alma-Ata Declaration in relation to the identified social roles vary. It is important that the person
1978. Said declaration designated “education concerning prevailing be “physically, mentally and emotionally prepared” to handle the
health problems and the methods of preventing and controlling them” change in behavior. At that stage in Aling Marta’s life, her social role as
as the first eight essential elements of Primary Health Care. The WHO a mother is the prevailing theme. Her readiness to learn is then linked
Global Strategy for Health for All in the Year 2000 gave education for with her shild nurturing task and the recent experience with the sick
health a prominent position never given it before. (Green) child.
3. Situation 2. that it involves shared meaning, so that for people to
The situation must provide the learner with viable alternatives. It should communicate, they must agree and have common
be a condition where the person can make a choice – one which would definitions of the terms they are using; and
allow the mother to think and evaluate her options. 3. that it is symbolic, which means that words, letters,
numbers, gestures, sounds, etc. only represent or
4. Interpretation approximate the intended ideas/meanings/messages.
The individuals we are dealing with does not live in a vacuum. As such,
the way he or she perceives things or interprets a situation is colored by Elements of the Communication Process
her background - socioeconomic status, values orientation, previous 1. Source or the sender
experience, and her interaction with other people – what they say, do, 2. Message
experience. She may accept or reject a health practice depending on her 3. Channel
own interpretation. 4. Receiver
5. Feedback
5. Response
The person will then act according to what she perceives and expects Communication Theories
will bring her the best result. 1. The Two Step Flow Theory – Katz and Lazarsfeld found that ideas that
are disseminated through mass media are received mostly by opinion
6. Consequence leaders in the community. These individuals in turn play relay or
The result of her response would either be a confirmation or a reinforcement roles to influence others and spread ideas through their
contradiction of her expectations. If the consequences prove to be interpersonal relationships.
favorable, then the likelihood of repeating the same response is very
high. If Aling Marta’s second child does not develop measles as a result 2. The Diffusion Process – five stages:
of immunization, then she is more likely to bring her next child for a. Awareness
vaccination. b. Interest
c. Evaluation
7. Reaction to thwarting d. Trial
If, however, the consequence is unfavorable or not consistent with her e. Adoption
expectations then she could either explore other alternatives “which
lead to changed behavior” or completely give up and lose hope. The 3. Communication-Behavior Change Model
person through will try to experiment with other behaviors which would Change Process
confirm her expectations. Health education and promotion is primarily targeting change of
cognition attitude and behavior of the individuals, groups and at large,
Learning Theories the society. Generally speaking, these changes may be defined as
1. Behaviorist Theories are often considered as associationist theories follows:
because of their learning towards the idea that learning results from the • COGNITION CHANGE – a change in knowledge and/or
association between stimuli and responses. In this group of theories, the perception of a person
“teacher-agent” play a very active role in controlling the stimuli and in • ATTITUDE CHANGE – a change in an individual’s beliefs,
rewarding or “punishing” the responses. The reinforcement of the predispositions, intentions and tendencies
responses is based on the desired behavior set by the “teacher-agent.” • BEHAVIOR CHANGE – an alteration in an individual/group’s
Examples of this group include the following: knowledge, attitude and practices.
a. Pavlov’s Classical Conditioning
• Thorndike’s Law of Exercise and Law of Effect Elements of Change
b. Skinner’s Operant Conditioning There are four (4) basic elements of change, namely:
1. Innovation – an idea, a set of behavior, a new technology, a
2. Cognitive Theories – view learning as a reorganization of a number of project, program introduced to effect change.
perceptions percolating in the mind of the learner. This group deals with 2. Targets of Change – an individual, a group of people, a
the processes involved in the creation of responses and development of segment of the community or the entire community itself.
insights. The focus here is on the different views of the nature of 3. Change agent – a person or a group of people introducing the
knowledge. innovation.
a. Tolman’s Cognitive Mapping 4. Strategies of Change – deliberate actions, set of activities,
approaches, tactics or processes designed to effect change.
3. Humanist Theories are fairly recent in origin. While some form of
stimulusresponse is also present, they feature the analyses of the nature Models of Attitude Change
of personality and society. What is highlighted is the active role of the 1. Kelman’s Three Processes of Social Influence
learner in creating the learning situation. This group of theories move 2. Theory of Cognitive Dissonance
from the limitation of norms to group learning. An example of the 3. Yale Attitude Change Model
humanist theories is Bandura’s Social Cognitive Theories.
Models of Behavior Change
COMMUNICATION PROCESS 1. The Health Belief Model
The word communication was derived from the Latin word “communis” 2. The Theory of Reasoned Action
which means “commonness”. The following definitions of several 3. The Communication-Behavior Change Model
authors are relevant to the goals/objectives of health promotion and 4. The PRECEDE-PROCEED Model
health education. 5. The Transtheoretical Model
6. Kar’s Psychosocial Model
Daft (1988) defined communication as the process by which information 7. Theory of Unfreezing, Moving, Refreezing
is exchanged and understood by two or more people, usually with the
intent to motivate and influence behavior. STRATEGIES/METHODS IN HEALTH EDUCATION/PROMOTION
1. Counseling
Rackich, et. al. (1985) defined communication as the creation or 2. Group Discussion
exchange of understanding between a sender and a receiver. This 3. Mass Media
definition is not restricted to words alone but includes all methods 4. Social Marketing
(verbal and nonverbal) through which meaning is conveyed to others. 5. Folk Media
6. Enter-Educate Approach
Porter and Roberts look at it as a process by which people attempt to 7. Training
share meaning via the transmission of symbolic messages. This 8. Community Organizing/Social Mobilization
definition calls attention to three essential parts:
1. that the term communication involves people, so that in the
process of understanding communication we are in fact
understanding the relationships of people;
PRINCIPLES AND FUNDAMENTALS OF ENVIRONMENTAL AND Solid Waste Management
OCCUPATIONAL HEALTH • Landfills
Environmental Health • Composting
• Branch of public health • Recycling facilities
• Concerned with all aspects of the natural and built • Solid waste transfer stations
environment that may affect human health
• Other terms used: environmental public health, Toxic Chemical Exposure
environmental health and protection Includes those in:
• Air, water or soil
Environmental Health • Workplaces
(as defined by the World Health Organization) • Consumer products
• Aspects of human health and disease that are determined by • Homes
factors in the environment
• Also refers to the theory and practice of assessing and Vector Control
controlling factors that can potentially affect health. Includes the control of:
• Mosquitoes
Environmental Health • Rodents
(as used by the WHO Regional Office for Europe) • Flies
Includes both the direct pathological effects of chemicals, radiation and • Cockroaches
some biological agents, and the effects (often indirect) on health and • Other animals that may transmit pathogens
well- being of broad physical, psychological, social and aesthetic
environment which includes housing, urban development, land use and Environmental Health Concerns
transport. • Safe drinking water
• Noise pollution control
Environmental Health Concerns
• Occupational health and industrial hygiene
• Air Quality
• Radiological health (exposure to ionizing radiation)
• Climate change
• Disaster Principles of Occupational Health & Safety
• Food safety Occupational Health and Safety
• Hazardous materials management • A cross-disciplinary area concerned with protecting the
• Housing health and safety of people engaged in work or employment
• Childhood lead poisoning • As a secondary effect, it may also protect co- workers, family
• Land use planning members, employers, customers, suppliers, nearby
communities and other members of the public who are
Environmental Health Concerns impacted by the workplace environment.
Air Quality
• Both ambient outdoor air and indoor air quality Hazard vs Risk
• Also comprises concerns about environmental tobacco • Hazard - anything that has the potential to cause harm
smoke • Risk - the likelihood that a particular hazard will occur

Disaster Hazards in the Workplace

• Disaster preparedness and response • Health hazards - environmental factors, or stressors in the
workplace, or etiologic agents of occupational diseases.
Food Safety • Safety hazards - may either be due to unsafe condition in the
• Those in agriculture workplace or unsafe act of the worker
• Transportation
• Food processing Classification of Health Hazards
• Wholesale and retail distribution and sale • Physical hazards
• Biological hazards
Hazardous Material Management • Chemical hazards
• Hazardous waste management • Ergonomic stressors
• Contaminated site remediation
• Prevention of leaks from underground storage tanks Physical Hazards
• Prevention of hazardous materials releases to the • Involve contact with various forms of energy
environment and responses to emergency situations • Environmental conditions in the workplace are mainly
resulting from such releases associated with the agents in the group hazards
• Examples: temperature (heat/cold); lighting; noise; of
Housing radiation; vibration
• Substandard housing abatement
• Inspection of jails and prisons Biological Hazards
• Childhood lead poisoning prevention Agents or organisms which transmit diseases to man and affect his or
• Land use planning her health adversely

Liquid Waste Disposal Chemical Hazards

• City wastewater treatment plants Substances used, and/or generated as raw materials, intermediate
• On-site waste water disposal systems, such as septic tank products, finished products and waste materials
systems, chemical toilets
Ergonomic Stressors
Medical Waste • Refer to factors that result in worker's discomfort, in relation
• Medical waste management and disposal to his/her job
• Training on medical waste handlers • Result in inability to attain optimum efficiency and
productivity
Recreational Water Illness Prevention
• Swimming pools Risk Assessment
• Spas • Requires risk to be managed to a level which is low as is
• Ocean and freshwater bathing places reasonably practical
• Should include:
o Identification of hazards
 o Identification of all affected by the hazard Sources of Toxic Air Pollutants
o Evaluation of the risk • Indoor sources (Some building materials, cleaning solvents)
o Identification and prioritization of the required • Natural sources (volcanic eruptions, forest fires)
actions
Routes of Exposure
Control Measures • Breathing contaminated air
Engineering Control • Eating contaminated food products (fish from contaminated
• Substitution waters, fruits and vegetables grown in contaminated soil on
• Isolation which air toxics have been deposited)
• Machine guards • Drinking water contaminated by toxic air pollutants
• Lockout/tag-out system • Ingesting contaminated soil
Automation Administrative Control • Skin contact with contaminated soil, dust or water
• Work transfer
• Jeb rotation Air Pollution Health Effects
• Rest breaks • Some 64,000 people in the USA may be dying prematurely
• Training each year from cardio-pulmonary causes linked to air
• Policies and procedures pollution
Use of Personal Protective Equipment (PPE) • It is estimated that in the most polluted cities, lives are
• Eye wear/goggles shortened by an average of one to two years.
• Barrier gowns • Can cause minor health condition (burning eyes and irritated
• Gloves throats)
• Mask • Cancer
• Safety shoes • Other serious health effects (damage to immune system,
• Face shields neurological, reproductive)

AIR, WATER AND LAND POLLUTIONS WITH SOLID WASTE Control of Air Pollution
MANAGEMENT • Prevent formation of pollutants
Air Pollution • Reduce the quantity of pollutants
• Air that contains one or more hazardous substance, • Apply air-cleaning technologies
pollutant or contaminant that creates a hazard to general • Change the process or equipment
health. • Change in lifestyle
• Usually measured in terms of "particulate matter" or the
number of particles of these potentially hazardous Water and Health
substances as a percentage of air. Water
• The safety and accessibility of drinking-water are major
Air Pollutants concerns throughout the world.
• Refer to toxic air pollutants, also known as hazardous air • Health risks may arise from consumption of water
pollutants contaminated with infectious agents, toxic chemicals, and
• Pollutants are known or suspected to cause cancer or other radiological hazards.
serious health effects, such as reproductive effects or • Improving access to safe drinking-water can result in tangible
adverse environmental effects. improvements to health

"Unhealthy Air" Water Related Diseases

The suggested Federal limit of an "average" of 50 micrograms of • Category 1: Water-borne diseases- water acts as the passive
"particulate matter per cubic foot of air (in a one-year period) is vehicle for the infecting agent.
considered poor air quality. • Category 2: Water-washed diseases- due to lack of adequate
water and poor personal hygiene.
Air Pollutants • Category 3: Water-based diseases- caused by infecting
• Examples of toxic air pollutants agents spread by contact with water.
o Benzene (from gasoline) • Category 4: Water-related vectors- diseases transmitted by
o Perchloroethylene (emitted from some dry insects which live close to water.
cleaning facilities)
o Methylene chloride (used as a solvent and paint Prevention and Control
stripper by industries) • Improvement in water quality
• Examples of other listed toxicants: • Making water sources readily available and accessible to the
o Dioxin public
o Asbestos • Improvement in hygiene and sanitation practices
o Toluene
o Metals (cadmium, mercury, chromium and lead Levels of Water Supply
compounds) • Level I- Point Source or Communal Well
• Level II- Communal Faucet System or Standpoint
Two Types of Sources of Air Pollution • Level III- Waterworks System with Individual Household
1. Stationary- can be subdivided into area sources such as agricultural Connection
production, mining and quarrying, industrial, point and area sources.
Basic Requirements of Drinking Water
2. Mobile- comprising any form of combustion-engine vehicles (e.g.,
• Free from pathogenic organisms
light duty gasoline powered cars, diesel powered vehicles, motorcycles,
• Free from compounds that have an adverse effect (acute and
aircraft, including line sources with emissions of gases and particulate
chronic)
matter from vehicle traffic)
• Fairly clear
• Not salty
Forms of Air Pollutants.
1. Suspended Particulate Matter (SPM, PM-10) • Free from compounds that cause an offensive taste or smell
Includes diesel exhaust, coal fly-ash, mineral dusts, metal dusts and • Not causing corrosion and not staining clothes washed on it.
fumes, and acid mists/pesticide mists.
Water Treatment Process
2. Gaseous Pollutants • Filtration -raw water is allowed to pass through a sand bed.
Include sulfur compounds, co, nitrogen compounds, organic • Coagulation and flocculation - removes colloidal particles
compounds, VOC, mercaptans from water.
 • Disinfection - physical methods (boiling, sedimentation, Functional Elements of Solid Waste Management
filtration); chemical method (chlorination)

Land Pollution and Solid Waste Management

What is Land Pollution?
Land pollution is the addition of undesirable matter to land that:
• damage the terrestrial organisms,
• reduce the uses of the land for agricultural, residential,
recreational or other purposes
• increase the risk of health hazards to man
Waste Generation
• Waste reduction at source is important to minimize waste
generation
• Amount of waste generated by type is important in solid
waste management planning
• It is also important in selecting collection equipment,
collection routes and disposal facilities

Factors Contributing to Increasing Amounts of SW

• Increasing populations
• Changing lifestyles
• Disposable materials*
• Excessive packaging*
*two largest contributors to waste volume
Sources of Land Pollution
Storage
• Accidental chemical spills
Why do you think "storage" is important in waste management?
o Soil contaminants are spilled onto the surface
• This can have a significant effect on characteristics of waste,
through many different activities
public health and aesthetic conditions.
o E.g., accidents involving vehicles transporting
• Segregation is the primary step in waste reduction and
hazardous waste to disposal sites.
recycling
• Improper disposal of chemicals and industrial waste
o Atmospheric fallout/ fumes emissions from metal
Collection of Solid Waste
refining works
• 50-70% of total cost of solid waste management is spent for
o Toxic and hazardous chemicals
collection
• Agriculture
• Frequency of collection and type of collection vehicles are
o Agricultural practices, including the use of
critical concerns
agricultural chemicals, are another primary
• Need for proper timing during collection
source of pollution on or near the ground surface
• Separate collection system for hazardous waste
• Mining and Quarrying
o Tailings dams can often be toxic due to the • Training of solid waste collection crew
presence of unextracted sulfide minerals, cyanide
Processing and Recovery
or mercury
• Transformation process includes reduction and recovery of
• Sewage sludge
conversion products and energy
o Untreated sewage can contaminate land and
bodies of water o Physical process
o Biological process
• Household solidwaste
o Thermal process
o Open dumping of solid waste
Transfer and Transport
Solid Waste Management
• Involves (1) transfer of waste from smaller collection vehicle
Solid waste comprise all waste arising from human and animal activities
to larger transport equipment; (2) subsequent transfer of
that are normally solid and that are discarded as useless or unwanted
waste to disposal site
Three General Categories • Transfer station is recommended if disposal site is relatively
• Municipal Solid Waste far (>15km)
o Waste arising from domestic, commercial and
institutional activities in urban areas
• Industrial Solid Waste
o Waste arising from industrial activity and typically
include rubbish, ashes, and hazardous waste
• Hazardous Solid Waste Disposal
o Waste that pose substantial danger immediately • Remaining waste
or over an animal life. It exhibit period of time to after waste
human, plant or the ff: toxicity, ignitability, reduction, recycling,
corrosivity, reactivity. reuse and processing
should be properly
What do you think are the Public Health implications of improper solid disposed
waste management? • Most common
disposal is Sanitary
Effects of Improper SW Management Landfill
• Aesthetic problems (eyesores, odor) • Safe and reliable long-
• Clogging of sewers, drains and river term disposal of solid
• Breeding place of insects and rodents waste is necessary.
• Surface and groundwater pollution • Sanitary Landfill refers to an engineered facility for the
• Contributes to air pollution disposal of solid waste designed. and operated to minimized
public health and environmental impacts.
Module 5: Environmental and Occupational Health Overall, nearly 900 million urban residents are exposed to unhealthy
This unit is about the interaction of man and his environment as it levels of sulfur oxide and more than one billion people are exposed to
affects his physical and mental health and social well-being. It focuses excessive dust and soot. Although sulfur oxide has decreased from 65 to
on environmental conditions that promote the transmission of disease 40M tons per year in developed countries, it has increased in slowly
and exposure to toxic chemicals and hazardous physical, biological and industrializing countries.
ergonomic conditions.
Sulfur and nitrous oxides emitted by fossil fuel-fired power stations are
This is an introduction to the field of environmental and occupational converted in the atmosphere to acids and eventually fall to the ground
health. In this unit, lessons deal with areas of special concern which as acid rain or snow. This has acidified many buffered lakes and soils and
include occupational and environmental hazards, land, water and air has contributed to forest dieback and destruction of larger forests.
resources and their pollution, hazard prevention and control measures. Health maybe affected if acidified water is used untreated in water
supplies since it contains higher concentrations of metals such as lead.
Definition of some key terms Also, as a result of air pollution, millions suffer from respiratory and
• Health: A state of complete physical, mental, and social other diseases.
wellbeing and not merely the absence of disease or infirmity.
(WHO) Forest – The main causes of soil destruction are leaving land bare during
• Public Health: The science and art of preventing disease, critical periods of the agricultural cycle when wind and rain can produce
prolonging life and promoting health through organized devastating losses and overexploration of marginal land exposes thin
efforts of society. unstable soils to the forces of erosion. The net result is that more than
• Environmental Health: Defined as the control of all those 25M tons of topsoil are removed from farm land every year.
factors in man’s physical environment which exercise, or
may exercise, a deleterious effect on his physical Forests prevent soil erosion and provide one of the nature’s principal
development, health or survival (WHO). It is that aspect of means of water management. When trees are removed, torrents of
public health that is concerned with those forms of life, water are allowed to run unchecked down steep hillsides, causing
substances, forces, and conditions in the surroundings of avalanches and flooding. Trees also play a role in stabilizing climate. So
man that may exert an influence on human health and well- far deforestation has added between one-quarter and one-third of the
being. carbon dioxide to the atmosphere and threatens to produce global
• Occupational Health: Aim at the promotion and warming.
maintenance of the highest degree of physical, mental, and
social well-being of workers in all occupations. It covers the Biodiversity – There are about 30 million species on earth of which one
following: and onehalf million species have been described. Majority are insects
o prevention among workers of departures from and the rest are vertebrates, plants, invertebrates, fungi, and other
health caused by their working conditions; microorganisms. Peak species diversity is observed in tropical forests
o protection of workers in their employment from and coral reefs.
risks resulting from factors adverse to health;
o placing and maintenance of the worker in an In rural communities, people make use of the earth’s biodiversity
occupational environment adapted to his directly by exploiting many different species for food, fuel, and raw
physiological and psychological ability. materials. Industrial societies use biodiversity indirectly by exploiting
In short, the aim of occupational health is the adaptation of work to man the genes from wild plants and animals to develop and improve crops,
and of each man to his job. (WHO) medicines, and chemicals.

Health Implications of Global Environmental/Occupational Problems Industry – Industry consumes 37% of the world’s energy and emits 50%
Man’s health depends on his ability to understand and manage the of the world’s carbon dioxide, 90% of the world’s sulfur oxides and
interaction between his activities and the physical and biological nearly all the toxic chemicals depleting the ozone layer. Every year, it
environment. produces 2100 million tons of solid waste and 388 million tons of
hazardous waste. There is widespread concern about the disposal of
1. Ecological Problems and Health Implications radioactive wastes from nuclear reactors.
Population – Any discussion on health, the environment and
development must include consideration of the size of the population. Transport – Transport is a large consumer of both land and energy. It
The world’s population grew more than fivefold between 1800 and 1990 uses 30% of the world’s energy, produces 60% of carbon monoxide
to reach over 500 million; projections suggest 8000 million by 2020. emissions, 42% of nitrogen oxide and 40% of hydrocarbon.
Population in the developed countries are now growing half a percent a
year while in developing countries, growth rates have fallen to slightly Ozone and Climate Change – The ozone veil which protects life on earth
more than 2% a year. from the sun’s ultraviolet B (UV-B) and other radiation is being damaged
by chemicals notably the chlorofluorocarbons (CFC) widely used in
Water – Fresh water is considered a renewable source, but there are refrigeration, as aerosols, and cleaners. The damage is caused by the
limits to the supplies available. Shortages of drinkable water and release of highly reactive forms of chlorine and bromine which form the
widespread pollution are increasingly common. Sixty-nine percent of all chemicals that damage the ozone layer. When gases containing
the water consumed in the planet is used in agriculture, mainly for chlorine, such as CFCs are broken down in the atmosphere, each
irrigation, 23% is used in industry and only 8% for domestic uses. chlorine atom set off reactions that may destroy hundreds of thousands
of ozone molecules. The current level of atmospheric chlorine is now
Of the 344 intermonitory stations in 59 countries, it was observed that two and a half times greater than in 1970.
10% of rivers are polluted principally by sewage – a problem mainly
confined in developing countries. Other pollutants both in developing Exposure to increased UV-B reduces the effectiveness of the body’s
and developed countries include pesticides, nitrate fertilizers, immune system, and increases disease rates for cataracts and skin
phosphates and oil. As a result, coastal areas have suffered, from algal cancer. Skin cancer risks are expected to rise among fair-skinned
blooms called red tides, coral bleaching, oil pollution and decline in the Caucasians in high-latitude zones. The incidence on non-melanoma skin
quantity of marine food. cancer would increase between 6 and 35 percent after the year 2050.
These increases maybe much larger in the southern hemisphere, where
Biological and chemical contamination of fishing beds and beaches ozone depletion has been more serious.
result in seafood poisoning and epidemics such as cholera. Ill-health
caused by biological agents in water and to certain extent in food, air, This data becomes very relevant to the Philippine situation because we
and soil is felt most acutely in developing countries where people are are located at the equator and thus receive more sunlight and at the
infected with malaria and other parasites, and children die of diarrheal same time, cataract is our number one cause of blindness. Because skin
diseases. pigmentation does not protect the body against changes in its immune
system, experts foresee an increase ofinfectious diseases. These health
Air – Air pollutants are mainly sulfur oxides from power stations and figures assume no change in human behavior.
industry; nitrogen oxide from power stations, industry, and vehicles;
carbon monoxide from vehicles; and soot and dust from burnt fuels.
Global warming affects climate and agriculture, changes rainfall Furthermore, it is difficult to immunize the entire population. Nutrition
patterns and upsets ocean currents. Food production could fall steeply and other measures to improve health are desirable but by no means
near the equator and tropics, while areas nearer the poles could have a assure any protection against disease and other hazardous conditions.
longer growing season. Flora and fauna could either flourish in a more Where environmental conditions foster the transmission of disease or
benign climate or perish in a less hospitable one, thus altering the provide other hazards, control measures protect the entire population.
structure of existing ecosystems. What crops could be grown would be
affected by changes in temperature and rainfall. Environmental and occupational hazards vary in their manifestation, but
one or more of certain fundamental principles of environmental control
Human health could be affected by even quite small changes in average are generally applicable.
mean temperature, and there is the prospect of some major diseases
flourishing in warmer conditions and of more resistant strains of Preventive and control measures include:
infection emerging. Although humans can adapt to moderate changes 1. ISOLATION
in temperature and to occasional extremes, this adaptive capacity is Isolation, that is separation by distance, protected man from epidemic
relatively low in infants and the elderly. before the rise of cities and the mobility of populations. However,
populations which developed under isolated conditions were extremely
Changes in temperature, rainfall, humidity and storm patterns may vulnerable to the ravages of disease when it was introduced to the
affect disease borne by vectors in two ways. First they will directly affect community. Natural waters remote from human habitation may be safe
the vector’s reproduction rate, biting rate, and the duration and to drink because no source of disease organisms exists. Population
frequency of human exposure. Second, they may modify agricultural remote from a mosquito breeding area are not subject to mosquito-
systems of plant species, thus changing the relationship between host borne diseases.
and vector. Development rates of malarial mosquitoes, for example,
increase with warmer temperatures, but these pests need wet areas in 2. SUBSTITUTION
which to breed. The snail-borne disease schistosomiasis or bilharziasis Substitution is frequently low cost, easily applied, completely effective
is likely to increase if global warming forces increased irrigation or method of environmental control. A simple application is the
causes people to migrate towards irrigation projects. And changed substitution of harmless cleaning fluid for a toxic one. A “clean”
human migration patterns, along with increased temperature and chemical manufacturing process may be substituted for one that creates
rainfall, may extend the geographic range of hookworms. air, water, or land pollution. The substitution of degradable detergents
for nondegradable ones and biological pesticides for persistent chemical
In the oceans, toxic “red tides” – which kill off marine life due to the pesticides are other examples.
proliferation of minute marine organisms called dinoflagellates – may
become more frequent as temperatures rise and nutrients from 3. SHIELDING
agricultural fertilizers leach into rivers and coastal water. The Shielding, as used here, is distinct from isolation. Shielding is the use of
proliferation will disrupt marine food stocks and raise incidences of barriers for protection while person remains in relatively close proximity
ciguatera poisoning, caused by eating tropical fish or shellfish which to the hazard. Safety glasses and protecting clothing are personnel
have consumed organisms that have ingested dinoflagellates. measures which may be employed. Screening for the exclusion of
mosquitoes and flies, and heat shields are other examples. On cafeteria
MAN-ENVIRONMENT RELATIONSHIPS lines glass sneeze guards are used to protect against food
The status of human health represents the result of complex contamination. Lead is used to restrict the emission of stray ionizing
interactions between the internal biological system and the total radiation from x-ray machines.
external environmental system. The environment is both natural and
modified by man’s work and presence. The elements of the 4. TREATMENT
environmental system of concern are shown below: Where other measures are not applicable, treatment of the hazard may
be employed. Treatment of solid or liquid wastes to render them less
hazardous is an example. Environmental treatment methods may be
used in conjunction with other methods such as dilution or dispersion
of contaminating substances.

5. PREVENTION
Minimizing exposure through restriction of activities, immunization
against disease, and the use of prophylactic agents may prevent
infections and as such, are measures which may be used to avoid the
effects of environmental hazards. One may use only boiled water and
cooked food when traveling in areas where drinking water is not safe or
sewage is used to irrigate low growing vegetables. The avoidance of
uncooked shellfish are similar practices.

CLASSIFICATION OF HEALTH HAZARDS IN THE WORKPLACE

Health hazards in the workplace are also referred to as environmental
THE ENVIRONMENTAL SYSTEM
factors agents or stresses, or etiologic agents of occupational diseases.
Life support systems provide the basis for human activities. As a result
of these activities, solid, liquid, and gaseous wastes are produced. The
Health hazards are usually classified into four (4) groups, namely:
wastes, in turn, may influence or interfere with the life support systems.
physical, chemical, biological, and ergonomic.
As we are engaged in the processes of living, we are exposed to a variety
of environmental hazards – some natural and some man-made. Wastes
PHYSICAL HAZARDS
from human activities may add to the environmental hazards and the
Physical hazards involve contact with various forms of energy.
environmental hazards may become so widespread as to affect the life-
Environmental conditions in a workplace are mainly associated with the
support system.
agents in this group.
They are encountered as:
PRINCIPLES OF OCCUPATIONAL AND ENVIRONMENTAL CONTROL
1. Noise
Society has available options for minimizing the adverse effects of
2. Vibration
disease: (1) medical treatment to terminate the disease and minimize
3. Defective illumination
its effects, (2) immunization to prevent the occurrence of the disease
4. Temperature extremes (heat, cold)
even if exposed or infected, (3) development of physical vitality to
5. Atmospheric pressure extremes (low, high)
improve resistance to the disease, and (4) environmental and
6. Radiation
occupational control to eliminate the hazards or hazardous condition or
6.1. non ionizing: ultraviolet, microwave, infrared, laser, etc.
separate or create barrier between the hazards and persons. Medical
6.2. ionizing
therapy is expensive, does not avoid completely the complications and
6.2.1. particular type
ravages of the disease. Is socially disruptive, and is not accessible and
6.2.1.1. alpha particles
available to all people. Not all conditions may be prevented by
6.2.1.2. beta particles
immunization and in many instances need to be renewed periodically.
 6.2.1.3. neutrons 1. Chemical processes which are responsible for the generation
6.2.2. electromagnetic type of carbon dioxide from the natural decomposition of organic
6.2.2.1. x-ray matter, respiration of animals and combustion processes.
6.2.2.2. gamma ray Oxygen, on the other hand, is produced from photosynthetic
activities of plants.
CHEMICAL HAZARDS 2. Solar and terrestrial radiation are absorbed by the earth’s
Chemical hazards include substances used and/or generated as raw land and water and are reflected or scattered by clouds.
materials, intermediate products, finished products and waste 3. Weather systems which are responsible for the distribution
products. They occur in the solid, liquid and gaseous state. For hazard of heat, dispersion, concentration, and transport of
evaluation purposes they are differentiated into: pollutants.
1. Particulate matter 4. Temperature inversion is a natural atmospheric
• Dust phenomenon that occurs in certain geographic areas and
• Fume under certain meteorological conditions. Under normal
• Smoke conditions, warm air from the ground surface moves upward
• Mist towards the cold air layer. However, when inversion occurs,
a warm air layer prevails over the ground level, preventing
2. Gases the diffusion of warm air layer upwards. This inversion occurs
when there is nocturnal cooling of air next to the ground, or
3. Vapors during period of cold, damp weather, or when there is a
movement of a warm front over a body of cool air.
Chemical agents may also be classified according to: physicochemical Temperature inversion is detrimental to health particularly
properties, target organ of toxicity, biologic effects. Information about in polluted areas because air pollutants do not disperse
a chemical agent can be obtained from manufacturers or distributors. easily and are held close to the ground level, therefore
Each chemical is documented through a Material Safety Data Sheet exposing the vulnerable population who are generally the
(MSDS). old, the ill and the very young.

BIOLOGICAL HAZARDS CARBON MONOXIDE

Biological hazards deal with living organisms which have been found to Carbon monoxide is a chemical asphyxiant, the toxic action of which
transmit diseases to man or to affect his health adversely. These are: stems from its formation of carboxyhemoglobin leading to tissue
1. Microbes (bacteria, viruses, fungi) hypoxia. Another mechanism of toxic action is similar to that of cyanide
2. Parasites (worms, protozoa) poisoning which attacks the cytochrome oxidase system or inhibits the
3. Insects (mosquitoes, flies) cellular respiration for acute carbon monoxide poisoning.
4. Rodents (rates, mice)
5. Birds Normal concentrations of Carboxyhemoglobin in the blood of non-
6. Other living organisms: snakes, scorpions, dogs, etc. smokers is about 0.5% due to endogenous production of carbon
monoxide from heme-catabolism. Among smokers, this could go up to
ERGONOMIC HAZARDS 15% in heavy smokers or in the case of our jeepney drivers- 21%. The
Ergonomic hazards are related to the fit between a worker and his job, severity of symptoms depends on the carbon monoxide concentration
to achieve optimum efficiency and productivity. Design of work and in inspired air, length of exposure and general health of the exposed
workplace should consider human factors e.g. anthropometric (body person. The features of acute poisoning are better known and easier to
dimension) measurements, physical, mental, and emotional capacities recognize than chronic exposure to low concentrations. With chronic
of people. Many work situations that are stressful ergonomically are exposure, the following symptoms are seen: headache, dizziness,
characterized by: nausea and vomiting, general weakness and rapid fatigability.
1. Prolonged working hours (more than 8-10 hours per day)
2. Awkward working positions or postures With increasing level of exposure to CO and a concomitant increase in
3. Speedy physical exertions COHb comes different cardiovascular and neurological effects. It has
4. Improper lifting (e.g. wrong technique; excessive loads) been found that persons that persons with a previous cardiovascular
5. Repetitive motions disease has a higher susceptibility to develop chest pain symptoms with
6. Prolonged standing or sitting exposure to the said air pollutant. And at very high levels even normal
7. Improper designed/constructed work facilities (e.g. chairs, individuals can experience neurological abnormalities.
tables, control panels, etc.)
8. High level of concentration at work. PARTICULATES
Deposition of particulates in the lungs force of impact upon the lining of
Psychosocial factors may also be included under ergonomic factors – the lungs and upper respiratory tract. In terms of size and density, the
e.g. unsatisfactory conditions of work (salary, rewards/incentives), lack smaller the particulate matter is, the lower it is deposited in the lungs.
of recognition, participation in planning, communication, etc.) Thi size is called respirable particulate which is less than 10um. Anything
bigger than this gets processes such as the mucociliary escalator.
AIR POLLUTION AND HUMAN HEALTH
For centuries, men have been aware of the adverse impacts of air There are three fates of particulates:
pollution on human health. In the 14th century, England prohibited use 1. Those that reach the alveolar spaces remains intact or engulfed by
of silver and armor smithing because they contributed to air pollution. macrophages may be unsheathed by mucus and removed by the muco-
In the 20th century, several episodes were documented in Europe and ciliary escalator mechanism.
the USA. Among them are those that occurred in Belgium’s Meuse River 2. Soluble particles maybe deposited in non-ciliated alveoli sacs and
Valley where high concentrations of pollutants stayed near ground level dissolved andenters the bloodstreams.
resulting to death of 60 persons. 3. The less soluble particles remain in the alveoli and may also create a
“black lung” appearance. This may happen among coal workers or any
In the Philippines, there is no known acute episode of deaths and illness worker in the dusty operations.
due to air pollution. However, this does not mean that air pollution is
not a problem in the country. In urban areas, this problem is becoming As in other air pollutants, pulmonary function is also compromised for
serious environmental and health concern that the government is persons chronically exposed to particulates and symptoms of COPD are
investing considerable resources just to mitigate the adverse impacts of seen.
air pollution.
Control of Air Pollution
The earth’s atmosphere is composed of several gases. The most Several approaches for controlling emissions of air pollutants are
abundant is nitrogen (78.09% by volume), followed by oxygen available:
(20.95%). In smaller quantities are argon and carbon dioxide.
1. Prevent formation of pollutants
The natural processes occurring in our atmospheric systems which The best way to control air pollution is to prevent it from happening.
affect the distribution and concentration of constituents in the air. This approach either eliminates the pollutant by substituting materials
or methods that do not produce it, or limits the amounts of key chemical WATER-BORNE DISEASES
elements available for pollutant production. Examples are using
substitutes to lead to improve the octane rating of gasoline and limiting
the permissible sulfur content in coal and oil burned in generating plants
and transport vehicles.

2. Reduce the quantity of pollutants

This can be achieved by improving the combustion efficiency of
furnaces, adding exhaust and emission controls to motor vehicles, and
keeping these vehicles properly maintained to minimize their emissions.

3. Apply air-cleaning technologies

To remove pollutants from airborne exhaust systems in processes that
generate vapors and the use of electric motors instead of gasoline
engines.

4. Change the process or equipment.

Examples of this approach are the use of fully enclosed systems in
processes that
generate vapors and the use of electric motors instead of gasoline
engines.

5. Change in lifestyle
Examples include using economic incentives to promote mass
transportation and car pooling, applying land-use management
techniques to restrict certain areas to residential, commercial, or
industrial use, and promoting the use of products that are readily The water-borne diseases are commonly know be due to biological
recycled. agents (bacteria, virus and parasites) but can also be due to chemical
substances which bring about non-infectious diseases. Common
examples of these chemical agents are lead, mercury, cadmium,
WATER POLLUTION AND HUMAN HEALTH
fluoride, arsenic. It is important to note that water-borne diseases can
Water Supply and Human Health
Water is essential to man, and animals and plants and without water, be effectively prevented by improvement in water supply quality and
life on earth would not exist. Have you ever wondered why people have pollution control of our water resources.
settled close to water sources say, along rivers, besides lakes or near
natural springs? CATEGORY 2. WATER-WASHED DISEASES
These are disease due to lack of adequate quantity of water and poor
personal hygiene which favor the spread of these diseases. Typical of
Indeed, where people live, some water is normally available for drinking,
domestic use and possibly for animals, like pigs, carabaos, cattle. This these are scabies, skin infections, pediculosis. Intestinal infection also
does not imply, however, that the available source of water is of belong to this group although they have been more identified as
sufficient capacity, nor that the water is safe and wholesome. infections due to lack of proper human waste disposal.

Diseases due to lack of water tend to be serious health hazard. When

On the contrary, in many rural areas of our country, people live in areas
people use with very little water, it may be impossible to maintain a
where water is scarce. Often, water has to be carried over some distance
or bought from vendors. This scarcity of water may also lead people to reasonable personal hygiene. There may be simply not enough water
use sources that maybe contaminated by human or animal wastes, and for washing oneself properly, or for cleaning food utensils and clothe,
thus dangerous to human health. and maintaining sanitation in the household.

So, how can these be prevented? Clearly, water-washed disease

Safe, adequate and accessible supplies of water, combined with proper
prevention depends heavily on the availability and accessibility of water
sanitation, are surely basic needs and essential components of primary
health care. They can help reduce many of the diseases affecting supply coupled with good personal hygiene practices rather than
underprivileged populations, especially those who live in rural and improving water quality.
urban fringe areas.
WATER-WASHED DISEASES
The next topic will introduce you to the different types of diseases that
are related to water, how they are acquired and more importantly, how
they can be prevented and controlled.

Diseases Related to Water

Are you aware of the so-called WATER RELATED DISEASES?

These diseases are somehow related to water since one way or another
water has played a role in their transmission.
CATEGORY 3. WATER-BASED DISEASES
Water-related diseases have been classified into four (4) categories. Water-based diseases do not spread directly from person to person.
These are caused by infecting agents spread by contact with water. An
CATEGORY 1 are the WATER-BORNE diseases since water acts as the essential part of the life cycle of the infecting agent takes place in an
passive vehicle for the infecting agent or the drinking water contains the aquatic animal. The most common and prominent example of this group
disease agent. Thus, drinking water quality is an important characteristic is schistosomiasis.
in disease transmission. However, all of these diseases depend also on
poor sanitation. The basic mode of transmission of this type of this disease is through
skin contact with contaminated water or encouraging the use of
alternative uncontaminated water, and provision and use of sanitary
excreta disposal facilities.

CATEGORY 4. WATER-RELATED VECTORS

Water-related vectors are diseases transmitted by insects which live
close to water. The infections are spread by mosquitoes, flies and other
insects that breed in water or bite near it. These vectors are especially
active and aggressive near stagnant open water.
List of Diseases Due to Water-Related Vectors practicable to test the water for all organisms that it might possibly
contain. Instead, the water is examined for a specific type of bacteria
which originates in large numbers from human and animal excreta and
whose presence in the water is indicative of fecal contamination. Such
indicator organism must be specifically fecal and free-living. Fecal
bacteria are member of a much wider group of bacteria, the coliforms.

Various water treatment processes have been developed. Some serve a

single purpose, others have multiple applicability. Often a treatment
result can be obtained in different ways.

Storage of water can be regarded as treatment method. For example,

Schistosomiasis cercariae are normally unable to survive 48 hours of
storage. The number of fecal coliforms and fecal streptococci will be
considerably reduced when the raw water is subjected to storage.
Storage allows sedimentation to take place reducing the settleable
solids content of the water. Storage, however, may promote algal
growth in the water. This effect will be minimized if storage tanks are
covered which also would prevent dust, insects, airborne pollution and
small animals from contaminating the stored water.

Filtration is a relatively simple process. Raw water is allowed to pass

through a sand bed, removing and retaining particles which cause
You must take note that prevention of the above categories of diseases turbidity, odor, and color from the water. Filtration also removes most
require three basic strategies: bacteria and disease causing organisms. The removal can be achieved
• Improvement in water quality; through two types of filtration: slow sand and rapid sand filtration.
• Making water resources readily available and accessible to
the consumer, and; Coagulation and flocculation are processes to remove colloidal particles
• Improvement in hygiene and sanitation practices. from water. Chemical coagulants are added to water to attract
negatively charged colloidal suspended matter, forming a gelatinous
Availability and Accessibility of Water mass called flocs. Rapid mixing is essential to provide maximum
In the Philippines, there are three levels of water supply services as interaction between the suspended matter and the coagulant. Once
classified by Water Sector authorities. These levels determine the coagulation is achieved, the water is slowly and gently stirred to enable
accessibility of water supply to the consumers. the fine flocs to agglomerate into larger particles that will rapidly settle.
This process is called flocculation. The flocs are then removed by
Level I – Point Source. A protected dug well, drilled or driven well, a rain sedimentation and filtration.
water tank or a developed spring with outlet but without a distribution
system. Water can be taken from these sources to a reservoir which is Disinfection is done in order to destroy or inactivate the disease-causing
provided with an outlet. This facility can serve about 15-25 households organisms present in water. It could be done by physical or chemical
and within reach of not more than 250 meters from the farthest user. means. Physical methods of disinfection include application of heat
(boiling, exposing stored water to sunlight), sedimentation, and
Level II – Communal Faucet System or Standpoint. This level refers to a filtration. Chlorination is the most common chemical method of
system composed of a source, a reservoir, piped distribution network disinfection. Chlorine compounds are usually used because of their
and communal faucet on standpost located not more than 25 meters availability in the local market. During disinfection, usually a slight
from the farthest house. For example is an improved spring with excess of chlorine is added so that a small residual chlorine will
transmission lines to several standpost. If you have in your house a pipe accompany the treated water. This strategy protects consumers in case
connection from any of water supply services and you make an bacterial contaminants later somehow gain access to the water during
extension outside of your house and put a faucet so as neighboring collection, storage and distribution. A public health concern with the use
houses could draw, fetch water from this point, this can be again of chlorine is the possible production of trihalomethane (THM) which
classified as Level II. In areas also where housing subdivisions are plenty, are known to be carcinogenic. These formed when the raw water being
they had an elevated water tank and pipe into individual household but chlorinated contains considerable amounts of organic matter.
if you extend and put a standpost outside your house wherein 5 to 10
households draw water from it, again this is classified as Level II. LAND POLLUTION
Pollution in general has been defined as the undesirable change in the
Level III – Waterworks System with Individual Household Connection. physical, chemical, and biological conditions of the environment which
This is a system with a source, transmission pipes reservoir and with will harmfully affect both living and non-living things. The presence of
piped distribution network for household faucets. It is generally suited black smoke in the atmosphere for example, it does not only affect the
for densely-populated areas. Examples are those with individual quality of air but also your health. If you are exposed to this kind of
household connection or in housing subdivisions with overhead tanks condition for a certain period of time, you may suffer from respiratory
and pipe distribution to individual household. diseases, heart ailments and others.

Water Quality Pollution of our land resources takes place when harmful substances are
The relationship between water quality and health effects has been introduced to the soil rendering it unsuitable for its best zoned use and
studied for many water quality characteristics. An examination of water making it unable to sustain life. When this thing happens, agricultural
quality is basically a determination of the organisms, and the mineral production decreases and the pace of industrialization slows down. Not
and organic compounds contained inthe water. only these, it may also cause negative effects on man’s health and the
degradation of the environment.
The basic requirements for drinking water are that it should be:
• Free from pathogenic (disease-causing) organisms; Land pollution does not take on its own. Although there are some
• Free from compounds that have an adverse effect acute or natural factors like volcanic eruptions and earthquakes that contribute
in the long term, on human health; to its occurrence, majority of them are caused by man.
• Fairly clear (i.e. low turbidity, little color);
• Not salty; According to the study conducted in 1986 by the National
• Free from compounds that cause an offensive taste or smell; Environmental Pollution Control (NEPC) now the Environmental
• Not causing corrosion or encrustation of the water supply Management Bureau (EMB), pollution of our land resources is caused
system, nor staining clothes washed on it. by the following major activities:
• Improper management of solid wastes from domestic,
The most important parameter of drinking water quality is the commercial and industrial activities;
bacteriological quality, i.e. the content of bacteria and viruses. It is not
 • Excessive use of fertilizers and pesticides from agricultural • Strategically located for easy collection;
activities; and • Provided with tight-fitting covers to prevent flies and rats
• Disposal of mine wastes and uncontrolled mining activities from getting in and to prevent the emission of foul odors;
from the mining industries. • Placed on an elevated platform to prevent them from
flooding caused by heavy rain; and
There are also other minor activities that cause land pollution such as • Made of materials that are not easily destroyed by animals
slash and burn (kaingin system), construction of hydropower plants and and other elements.
acid rain.
Collection of solid wastes. The most costly portion of an overall solid
Land Pollution from Solid Waste waste management scheme is the collection of solid wastes. Even in
Land pollution from solid wastes occur mostly in urban areas where the developed countries, almost 80% of the total budget for solid waste
population is concentrated and human activities are continuous and management is allocated for this activity.
intense. People produce millions of tons of solid waste each year and its
production is rapidly increasing. In the National Capital Region (NCR) Collection of refuse does not only involve the pick-up of waste from
alone, 5,000 tons of solid waste is generated everyday. residential areas, institutions and other establishments, but also the
transportation to a transfer station or to a disposal sites. Because of this,
Solid waste, which is also called refuse or municipal solid waste (MSW), a fleet of appropriate vehicle is necessary.
refers to all putrescible and non-putrescible materials except human
body wastes produced from the households, public markets, The maintenance and operation costs of these vehicles (including the
commercial and industrial establishments. It includes the following: cost of labor, worker’s compensation, fuel and equipment) make this
activity very expensive.
Garbage
These are left over vegetables, animal and fish materials from kitchens The following are some important points to consider in refuse
and food establishments. These materials have a tendency to give foul collection:
odors during decomposition. They also serve as food for flies and rats. • Regular and prompt collection of refuse, especially garbage,
is necessary to prevent the creation of problems of storage
Rubbish and foul odors for the community;
These are waste materials such as bottles, tin cans, papers, discarded • Refuse transported to disposal sites must be covered to
porcelain wares, metals and wood. These materials can be reused and minimize odors, prevent flies, and remove travelling “eye
recycled. sores”;
• Collection vehicles must be adequate and properly
Ashes maintained to eliminate collection delays and complaints
These are the residue from burning wood or coal. They become a from the community;
nuisance because of the dust associated with them • Mobile repair teams should be created to trouble shoot
breakdowns of collection vehicles;
Dead animals • Old collection vehicles must be replaced regularly;
These are dead dogs, cats and pigs which died from disease or was hit • The route to the final disposal should be as direct as possible
by cars and trucks on the streets and highways. from the point of origin;
• A master schedule for each collection route should be
Stable manure prepared for use by the driver; and
These are animal wastes from stable, pens and barns.
• Preferably, collection of waste should be done at night.
Street sweepings
Treatment and disposal of solid wastes. In our country, we have four
These are the dust, manure, leaves, cigarette butts, plastic and paper
main methods of treating and disposing our refuse and these are:
that are swept from the streets.
a. Open dumping;
b. Sanitary landfill;
When solid waste is not properly handled, it becomes a threat not only
c. Incineration; and
to our environment but also to our health. Uncollected refuse, aside
d. Composting.
from being an eyesore, emits bad odor. It attracts animals and rats and
becomes a breeding ground for vectors responsible for the transmission
of diseases such as leptospirosis, dengue fever, salmonellosis, and other
infections. It can also be a serious fire hazard and a serious health hazard
for scavengers, children playing and residents living within the vicinity
of the site. Solid wastes not properly disposed of also clog sewers, drain
and riverways, increasing health problems related to flooding and
waterlogged soils.

Land Pollution Prevention and Control

There are several methods and ways by which land pollution can be
prevented and controlled, and they are classified as follows:
a. Provision of engineering control measures;
b. Enforcement of policies and regulation; and
c. Community participation and action.

Solid Waste Management

The activities directly involved with the management of solid waste
from the point of generation to final disposal are grouped into three
functional elements, namely:
a. Storage
b. Collection; and
c. Treatment and disposal.

Storage of solid wastes. The proper storage of solid wastes is very

important if we are to prevent flies, rats and other insects from being
attracted by these wastes and to prevent the emission of offensive foul
odors. However, these can only achieved if storage containers are:
• Small enough to be easily carried when filled with waste;
• Sufficient number to store all the wastes generated between
collection times;