For Environmental Health Students - Carter Center
LECTURE NOTESFor Environmental Health StudentsIntroductionto EcologyWorku Legesse, B.Sc.,M.Sc., Ph.D.Teklu Mulugeta, B.Sc.Aragaw Ambelu, B.Sc.Jimma UniversityIn collaboration with the Ethiopia Public Health Training Initiative, The Carter Center,the Ethiopia Ministry of Health, and the Ethiopia Ministry of EducationNovember 2002
Funded under USAID Cooperative Agreement No. 663-A-00-00-0358-00.Produced in collaboration with the Ethiopia Public Health Training Initiative, The CarterCenter, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education.Important Guidelines for Printing and PhotocopyingLimited permission is granted free of charge to print or photocopy all pages of thispublication for educational, not-for-profit use by health care workers, students orfaculty. All copies must retain all author credits and copyright notices included in theoriginal document. Under no circumstances is it permissible to sell or distribute on acommercial basis, or to claim authorship of, copies of material reproduced from thispublication. 2002 by Worku Legesse, Teklu Mulugeta, and Aragaw AmbeluAll rights reserved. Except as expressly provided above, no part of this publication maybe reproduced or transmitted in any form or by any means, electronic or mechanical,including photocopying, recording, or by any information storage and retrieval system,without written permission of the author or authors.This material is intended for educational use only by practicing health care workers orstudents and faculty in a health care field.
PREFACEThere is generally scarcity of teaching/ learning materialsin the higher education institutions of Ethiopia. uction to Public Health are not appropriate to ourenvironmental and socio-economic set up.This lecture note is prepared primarily for health officerstudents, and is organized based on the course outline ofintroduction to public health in the curriculum of healthofficers. Nevertheless, the lecture note is deemed to beuseful for almost all degree and diploma health sciencestudents in the University and elsewhere in the country.Taking in to account the shortage of teaching /learningmaterials for the course- introduction to public health, thislecture note is recommended to be used as a referencefor students. Concepts, principles and terms are definedand described to reduce confusion.This material is presented in ten chapters. Chapters - 1and 2 present the definitions and various perspectives ofhealth and public health and discusses the determinantsof health. Chapters - 3, 4 and 5 deal with culture,traditional health care practice and family health. Chapteri
6 is about personal hygiene. Chapter 7 is about healthand development. In this chapter the difference betweendevelopment and economic growth, the role of health indevelopmentandhealthanddevelopmentintheEthiopian context are presented. Chapter 8 is abouthealth service in Ethiopia and the history, the structureand the developments of the health service. Chapter 9 isabout Primary Health Care and the definition, historicaldevelopment, concepts and philosophies of PrimaryHealth Care. Chapters 10 discusses community basedhealth services and team approach in the health service.All chapters begin with learning objectives, by indicatingwhat is expected from students on completion of thechapter. Furthermore, at the end of each chapter thereare exercises related to the core issues of the respectivechapter.ii
ACKNOWLEDGMENTSWe would like to express our sincere thanks andappreciations to The Ethiopia Public Health TrainingInitiative (EPHTI), The Carter Center, for the financial andmaterial support for the preparation of this lecture noteOur special thanks also go to Dr. Teweldeberhan Hailu,Mr. Awala Equar and Dr. Hagos Abraha, for their criticalreview and valuable contribution in the intra reviewprocess.Our thanks as well go to the participants of the interreview process. Mr. Amsalu Feleke, Dr. Adamu Addissieand Mr. Tesfaye Gobenea contributed a lot of additionalpoints and suggestions to this lecture note.The authors extend their appreciation to Drs Ahmed Aliand Misganaw Fantahun for their highly professionalediting and most helpful comments about many aspectsof the text.We are also grateful to Dr Hailu Yeneneh and Ato AkliluMulugeta for their guidance and encouragement and toMeseret Tsegaw, Mahlet Tilahun and Fekadu Tsege forthe facilitation in the preparation process.iii
At last, but not least, we would like to extend our deepappreciations to the staff of the College Of HealthSciences, Mekelle University.iv
ABBREVIATIONSAIDS-Acquired Immuno Deficiency SyndromeALERT-All Africa Leprosy Rehabilitation andTraining CenterALRI- Acute Lower Respiratory InfectionAURI- Acute Upper Respiratory InfectionANC- Antenatal CareARI- Acute Respiratory InfectionCHA- Community Health AgentsCHC- Community Health CareCHW- Community Health WorkerCIH-COMMUNITYINVOLVEMENTINHEALTHCPHC- Comprehensive Primary Health CareDPT- Diphtheria Pertusis and TetanusEPI- Expanded Program of ImmunizationFP- Family lrehydration,Immunization,Femaleeducation, Family Planning.HIV- Human Immuno Deficiency VirusHLS- Household Livelihood SecurityHSEP- Health Service Extension PackageIEC- Information Education Communicationv
MCH- Maternal and Child HealthMDG- Millennium Development GoalMOA- Ministry Of AgricultureMOE- Ministry Of EducationMOH- Ministry of HealthORT- Oral Rehydration TherapyPHC- Primary Health CarePHCU- Primary Heath Care UnitRH- Reproductive HealthSPHC- Selective Primary Health CareSTD- Sexually Transmitted DiseaseSTI- Sexually Transmitted InfectionTB- TuberculosisTBA- Traditional Birth AttendantTT- Tetanus ToxoidTTBA- Trained Traditional Birth AttendantUNICEF- United Nation Children’s FundWHO- World Health Organizationvi
TABLE OF CONTENTSPREFACE . iACKNOWLEDGMENT .iiiABBREVIATIONS . vCHAPTER ONE: CONCEPT OF HEALTH . 11.1 Objectives . 11.2 Health . 11.3 Different perspectives on Health . 51.4 Determinants of Health . 51.5 Globalization and Health . 101.6 Model of Disease causation theories . 121.7 Exercise . 18CHAPTER TWO: PUBLIC HEALTH . 192.1 Learning Objectives . 192.2 History of public health . 192.3 Definition of public health . 272.4 Major disciplines in public health . 322.8 Exercise . 39CHAPTER THREE: HEALTH AND CULTURE . 403.1 Learning Objectives . 403.2 Definition . 40vii
3.3 Relation of culture and health . 423.4 Exercise . 46CHAPTERFOUR:TRADITIONALHEALTHCAREPRACTICES . 474.1 Learning Objectives . 474.2 Introduction . 474.3 Structure of Traditional Medicine . 494.3.1 Ethno medical definition of Health . 504.3.1.1 Naturalistic ethnologies:. 524.3.1.2 Magico-religious domain . 534.4. Traditional Prenatal care . 544.5. Secular Healing . 574.5.1 Self care . 574.5.2 Empirical Practitioners . 584.6 Exercise . 60CHAPTER FIVE: FAMILY HEALTH . 615.1 Learning Objectives . 615.2 Family . 615.3 Family Health . 625.4 Exercise . 66viii
CHAPTER SIX: PERSONAL HYGIENE . 686.1 Learning Objectives . 686.2 Hygiene . 686.3 Exercise . 75CHAPTER SEVEN: HEALTH AND DEVELOPMENT . 767.1 Learning Objectives . 767.2 Introduction . 767.3 The difference between development andeconomic growth . 797.4 The role of health in development . 807.5 Relation ship between health and development . 817.6 Health and the millennium development goal . 867.7 Exercise . 88CHAPTER EIGHT: HEALTH SERVICE IN ETHIOPIA . 898.1 Learning Objectives . 898.2 History of health service development in Ethiopia 908.3 Reorganization of the health service delivery . 968.4 Health service coverage and distribution . 1048.5 Exercise . 107CHAPTER NINE: PRIMARY HEALTH CARE . 1089.1 Learning Objective: . 108ix
9.2 Introduction . 1089.3 Definition . 1099.4 Historical development of PHC . 1119.5 Components of PHC . 1139.6 PHC Principles . 1149.7 PHC Philosophy and strategy . 1249.8 PHC in Ethiopia . 1269.9 Exercise . 128CHAPTERTEN:COMMUNITYBASEDHEALTHSERVICES . 12910.1 Learning Objectives . 12910.2 Introduction . 12910.3 Community responsibility . 13210.4 Community health councils . 13310.5 Community involvement in health (CIH) . 13410.6 Team approach in health service . 13610.6.1 Need for the health service team . 13610.6.2 The health team . 13810.6.3 Leader of the health team . 14210.7 Exercise . 146Glossary . 147References . 157Authors . 160x
Introduction to EcologyiPrefaceThe combination of rapid population growth, industrialization and itsassociated urbanization has placed an ever-increasing pressure onlife supporting systems of developing countries such as Ethiopia.There is evidence that natural resources of Ethiopia such as riversand lakes are threatened by pollution discharged from towns/cities,institutions and industries. Indeed the problem becomes more acutein the river systems flowing through major cities. In the face of worldclimate change polluting such scarce natural resources may becomea limiting factor in future development of the nation. In situationswhere treated water supply is still unaffordable it may also expose thecommunities to water-borne diseases.Soil erosion is another eco-disaster affecting may countries. In thisrespect Ethiopia is believed to be the global spot where the worst soilerosion problem occurs as it is thought to lose 2 billion metric tons ofsoil each year to erosion. Anecdotal example such as Haiti can alsobe given where the topsoil has been absolutely removed by soilerosion. Some authorities believe that it may never recover from thiseco-disaster.Improper solid waste disposal such as household refuse and plasticsis another area of environmental concern in Ethiopia and it isbecoming more acute in urban and sub urban areas. Plastics in usefor various purposes at present are not biodegradable and will greatlyaffect the ecology of health and disease in the region.Although no authoritative sources exist regarding air pollution statusin Ethiopia, use of biomass fuels, congested traffic coupled withexcessive dependence on old imported cars is becoming a matter ofgreat concern. The precursors for air pollution formation, at least inAddis, are observed although the problem is not systematicallyquantified and the problem is not yet put in place.
Introduction to EcologyiiTo achieve sustainable development in Ethiopia, it is vital that theabove problems should be properly addressed and ecologicalintegrity of the nation be properly maintained. One mechanism ofachieving this could be to incorporate a course in ecology into thecurricula of teaching institutions at various levels. This course is thus,and attempt to introduce ecological principles and concepts forstudents specializing in health profession at intuitions of higherlearning in Ethiopia so that they can contribute their share tosafeguard our environment.
Introduction to EcologyiiiAcknowledgmentsWe are grateful to Ato Tesfaye Tilyae, Gondar College of MedicalSciences, for his invaluable suggestions on the first draft of thisteaching material. We also would like to extend our thanks for hisinception of the program and for The Carter Center in general for thefinancial assistance in sponsoring a series of workshops until this finalversion has been finalized. The comments and suggestions putforward by environmental health professionals at Jimma, Dilla as wellas alemaya universities deserve to be acknowledged. With out theirmeasurable input and sharp-eyed criticism it would prove difficult togive this lecture note its present shape.
Introduction to EcologyivContentIntroduction1. Learning Objectives12. Definition and Scope of Ecology13. Human Activities Affecting Health and the Environment3Review Question8Chapter OneIntroduction to Ecological Principles91. Learning Objectives92. Definition of Terms91.1 Introduction91.2 Concepts of Range and Limits151.3 Habitat and Ecologic Niche16Review Question18Chapter TwoEcosystem191. Learning Objectives192. Definition of Terms192.1 Introduction212.2 Structure of Ecosystem222.3 The carbon Cycle272.4 The Nitrogen Cycle292.5 The Phosphorus Cycle30Review Questions32Chapter ThreePopulation Dynamics331. Learning Objectives331.2 Definition of Terms333.1 Introduction343.2 Factors Affecting Population Size34
Introduction to Ecologyv3.3 Population Growth and Regulation363.4 Human Population Growth40Review Questions45Chapter FourThe Biosphere and its Pollution46Learning Objectives464.1 Introduction474.2 water Pollution474.3 Air Pollution524.4 Land/Soil Pollution55Review Questions62Chapter FiveNatural Resources and their Conservation63Learning Objective635.1 Introduction635.2 Types of Natural Resources645.3 Conservation of Natural Resources72Review QuestionsBibliography7576
Introduction to Ecology1INTRODUCTION1.Learning Objectives:At the end of this chapter, the student will be able to: Define the term ecology and discuss the levels of biologicalorganization at which ecological interactions occur. Discuss the scopes of ecology. Describe the causes and ways of preventing environmentaldiseases. Mention the effects of human activities on health and theenvironment.2.Definition and Scope of EcologyMan has been interested in ecology in a practical sort of way sinceearly in his history. In primitive society every individual, to survive,need to have definite knowledge of his environment, i.e., of the forceof nature and of the plants and animals around him.Ecology is one of the popular areas of sciences in biology. It is apluralistic science in the sense that it depends on a wide variety ofmethods and approaches rather than on a limited range of techniquesand concepts. Even if, it is thought as part of biology, one importantway in which ecology differs from most other branches of biology isthat it can be properly appreciated or studied only through amultidisciplinary approach involving close cooperation from expertisein several disciplines.DefinitionThe word 'Ecology' was coined from the Greek word 'oikos' meaning'house' or ' a place to live' to designate the study of organisms in theirnatural homes. Specially, it means the study of interactions of
Introduction to Ecology2organisms with one another and with the physical and chemicalenvironment. The term “logy” is to mean study.Another way of defining Ecology is to look at the levels of biologicalorganizations. The molecules of life are organized in specific ways toform cells; cells are grouped in to tissues; and tissues are arrangedto produce functional organs. The body organs are integrated toproduce organ system, and the entire array of these systemsconstitutes an organism. Organisms exist not just as a singleindividual, but in-groups called population. The various populations oforganisms that interact with one another to form a community;interdependent communities of organisms interact with the physicalenvironment to compose an ecosystem. Finally, all the ecosystems ofthe planet are combined to produce a level of organization known asthe biosphere. Ecology is concerned with the levels of organizationbeyond that of individual organism; i.e. population, community,ecosystem, and biosphere.ScopeWhether we are talking about humans or any other kind of organisms,certain principles govern the growth and stability of their populationsover time. These principles influence the pattern of relationships oforganisms with one another and their environment. These patterns, inall their varied forms, are the focuses of ecology. As a science,ecology seeks to treat the world of nature including its humancomponent with a single set of concepts and principles.Ecology deals with such questions as: Why natural communities are composed of certain organismsand not others; How the various organisms interact with each other and withthe physical environment; and How we can control and maintain these natural communities.
Introduction to Ecology3.3Human Activities Affecting Health and theEnvironmentHuman activities in an ecosystem have many drawbacks, unless weare approaching it in an environmental friendly way. The atmosphere,fertile soils, freshwater resources, the oceans and the ecosystemsthey support, play a key role in providing humans with shelter, food,safe water and the capacity to recycle most wastes. However,pressures exerted by humans, on the environment, in the form ofpollution, resource depletion, land use changes and others affectenvironmental quality. Degradation of environmental quality can, inturn, lead to adverse human exposures and eventual health effects.The pressures excreted by the driving forces are in many instancesincreasing. They relate to household wastes, freshwater use, landuse and agricultural development, industrial
This lecture note is prepared primarily for health officer students, and is organized based on the course outline of introduction to public health in the curriculum of health officers. Nevertheless, the lecture note is deemed to be useful for almost all degree and diploma health science students in the University and elsewhere in the country.
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