Yawen Cheng, ScD Associate Professor Institute of Health Policy and Management, College of Public...
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- Slide 1
- Yawen Cheng, ScD Associate Professor Institute of Health Policy
and Management, College of Public Health, National Taiwan
University Essentials of Global Health April 13, 2012 1 Unless
noted, the course materials are licensed under Creative Commons
Attribution- NonCommercial-ShareAlike 3,0 Taiwan (CC BY-NC-SA
3.0)Attribution- NonCommercial-ShareAlike 3,0 Taiwan
- Slide 2
- Why are public health researchers concerned about health
inequalities and social determinants of health? A brief review of
the development of public health sciences Existence and trends of
health inequalities What are the causes? Explanations? Job stress
problems as an example Causal explanations and the links to public
policies Documentary Unnatural Causes: In Sickness and In Wealth
(56 minutes) Discussion in group & preparation for the homework
2
- Slide 3
- Public health is the science and art of preventing disease,
prolonging life, and promoting health through the organized efforts
of society. Goal: biological, physical and mental well-being of all
members of society. Core courses: biostatistics, epidemiology,
health sciences 3 major branches Biomedical sciences Environmental
and occupational health sciences Health policy and management
3
- Slide 4
- Before the 20th century Contagion Miasma theory Social
production of health 4
- Slide 5
- 5 1964 SG Report 1974 Lalonde Report 1978 Alma Ata Declaration
1986 Ottawa Charter 2005 WHO CSDH Traditional Public HealthNew
Public Health Historical Evolution of Public Health 1883 Germany-SI
1948 UK-NHS 1961 Japan-NHI 1971 Canada-NHI 1989 Korea-NHI 1995
Taiwan-NHI 1911 Germany-RVO 2002 Thai-Mix 1848 UK-Public Health Act
1884 Kochs Postulates 1928 Penicillin Laissez-faireEfficiencyEquity
in AccessCost Control 1948 WHO Tung-Liang Chiang Medical care
systems Major health discourses
- Slide 6
- 6 Edwin Chadwick (1800-1890) Report of the Poor Law Commission
(1832) New Poor Law (1834) Report on the Sanitary Condition of the
Laboring Population (1842) Public Health Act (1848) Sanitary idea -
miasma theory Drainage system Central and local boards of
health
- Slide 7
- 7 Wikimedia German Federal Archive
- Slide 8
- In the 20th century Golden age of Germ theory (1900-1950)
Modern epidemiology (after 1950) emphasize on biomedical science
and life styles Emerging of social epidemiology (1990s~) emphasize
on social determinants 8
- Slide 9
- 9 Germ Theory of Disease proposes that microorganisms are the
cause of many diseases. Koch's postulates, formulated in 1884, are
four criteria designed to establish a causal relationship between a
causative microbe and a disease.
- Slide 10
- 10 Eugenic movement in the 1920s (1)birth control (2)marriage
regulation (3)Sterilization (4)immigrant restriction Slogan
liked:
- Slide 11
- 11 In 1988, Lalonde received WHO Medal for his exceptional
contribution to health policy; in 2002, he was selected by the Pan
America Health Organization as one of eleven Public Health Heroes.
(1974)
- Slide 12
- 12 RESPIRATORY TB MORTALITY England & Wales, 1840-1970
McKeown thesis The role of medicine: dream, mirage, or nemesis?
(London, 1976) The modern rise of population (New York: Academic
Press, 1976) The origins of human disease (Great Britain: TJ Press
Ltd, 1988) David Coetzee
- Slide 13
- Driving forces Long history of concept of social influence on
health Social political changes widening social inequalities in
health Changes in scientific knowledge on causality
Psycho-medicine: Evidences of psychosocial stress on health; all
disease and health status are influenced by psychosocial conditions
Influences from other disciplines 13
- Slide 14
- What are the causes? Healthcare systems? Biomedical factors?
Genetic factors? Life style? Environmental factors? Social factors?
The spider of the causal web? 14
- Slide 15
- Interventions are closely linked to causal interpretation
Medical Biological Behavioral Environmental Social, political,
structural 15
- Slide 16
- Health indicators Life expectancy Mortality (death rate)
Morbidity (disease rate) Disease survival Health-related quality of
life Social factors Social class (Marxian), Social economic status
(income, education, occupation), early life experiences Gender, sex
Place, neighborhood and community Racial and ethnic groups Policy
and social systems Politics, culture, trade, etc. 16
- Slide 17
- 17 Pre-menstrual syndrome Diabetes Hypertension Ischaemia Cough
with phlegm National Taiwan University Yawen Cheng Source: Marmot,
Health inequalities among British civil servants: the
WhitehallIIstudy, The Lancet Volume 337, Issue 8754, 8 June 1991,
Pages 13871393
- Slide 18
- 18 National Taiwan University Yawen Cheng Source: Marmot,
Health inequalities among British civil servants: the
WhitehallIIstudy, The Lancet Volume 337, Issue 8754, 8 June 1991,
Pages 13871393
- Slide 19
- 19 National Taiwan University Yawen Cheng Source: Marmot,
Health inequalities among British civil servants: the
WhitehallIIstudy, The Lancet Volume 337, Issue 8754, 8 June 1991,
Pages 13871393
- Slide 20
- 20 Cumulative Economic Hardship and Physical, Psychological,
Cognitive and Social Functioning in Alameda County, 1994 (Lynch
& Kaplan, NEJM 1997; 337: 1889-95) * Adjusted for age, sex,
BMI, pack-years of smoking, alcohol intake, and physical activity
National Taiwan University Yawen Cheng
- Slide 21
- 21 Drever F, Whitehead M, Roden M
- Slide 22
- 22 77.371.769.959.61991-1993 76.571.168.859.11988-1990
75.770.769.459.31984-1986 73.968.767.758.41978-1980
69.164.652.248.3 1964 47.742.713.59.8 1933 FMFM Han
ChineseAborigines*Year * Average of plain and mountain aborigines
National Taiwan University Yawen Cheng
- Slide 23
- 23 Ethnic Group Male Female Taiwanese 73 79 Plain Aborigine 62
(-11) 72 (-7) Mountain Aborigine 58 (-15) 69 (-10) Life expectancy
of aborigines and Han Chinese in Taiwan 2000 National Taiwan
University Yawen Cheng
- Slide 24
- 24 1976 1995 Tung-Liang Chiang National Taiwan University
Tung-Liang Chiang
- Slide 25
- Social selection Social heritage Social drifting Social
causation (exposure and resource) Material pathways environmental
hazards, infection, poor diet, limited access to health care
Psychosocial pathways Stress, negative emotions, learned
helplessness, lower self-efficacy and self-esteem 25
- Slide 26
- 26 Changes in Gini Coefficient: 1981~2008 National Taiwan
University Yawen Cheng
- Slide 27
- 27 World Map of Gini coefficient (2009)
- Slide 28
- Example 1:Job stress problems 28
- Slide 29
- Cases of karoshi (sudden death from overwork) occurred
frequently in Taiwan in recent years; most cases were young or
middle-aged men with cardiac or cerebrovascular causes of death
These cases were from a wide range of occupations and socioeconomic
groups, including truck drivers, engineers, physicians, trainees,
managers, professors etc. Controversies over karoshi claims for
workers compensation intensified, and there are growing public
concerns and anxiety on work stress. 29
- Slide 30
- 30 Labor Days March in Taipei (May 1, 2011) Main themes
strengthen regulations on working hours strengthen regulations on
outsourcing & dispatched work Improve OSH standards & labor
inspection March in support of pro-labor regulations Taiwan Labor
Front
- Slide 31
- Occupational health services Health monitoring, health
promotion & education Workers Regulations Work place Monitoring
of workplace hazards and risk assessment Compensation and
rehabilitation Inspection Monitoring and reporting systems Of
occupational injuries and diseases National Taiwan University Yawen
Cheng
- Slide 32
- 32 Data Source: IMD WORLD COMPETITIVENESS ONLINE 1995 - 2010
National Taiwan University Yawen Cheng
- Slide 33
- 33 Graph made by Shiuan-Be Wu. Data source: (1) Huberman, M.,
Working Hours of the World Unite? New International Evidence of
work time, 1870- 1913. The Journal of Economic History, 2004.
64(04): p. 964-1001; (2) OECD
(http://stats.oecd.org/index.aspx);http://stats.oecd.org/index.aspx
(3) US (http://www.bls.gov/cps/cps_aa2003.htm); (4) Japan
(http://www.stat.go.jp/english/data/chouki/19.htm);http://www.bls.gov/cps/cps_aa2003.htmhttp://www.stat.go.jp/english/data/chouki/19.htm
(5) Taiwan (Wu, 2011; Master thesis of the Institute of Health
Policy and Management, NTU). F D N UK C US J Korea TW1 TW2
International comparison of average annual working hours in
employees: 1870-2010 Shiuan-Be Wu
- Slide 34
- 34 Model of Job Stress and Health Major stressors Demands
(effort) quan., qual., emotional, sensory, etc. Job control
authority, skill Social support supervisor,coworker Work rewards
income, respect, esteem, fairness, security, support, etc. Role
conflicts Shift work Management Hazardous exposure Job strain
Stress- related illnesses Psychological: job dissatisfaction
depression anxiety Physiological: somatic complaints hypertension
hyperlipoidemia immune depression Behavioral: smoking drinking
sleep problems Age, Sex, Education, Personality, Coping disability;
accident; illness Other stressors Other social support National
Taiwan University Yawen Cheng
- Slide 35
- Developed by Robert Karasek and Tores Theorell in 1970s
Alienation as the main cause of job stress Emphasizing on job
enrichment, democracy in the workplace, and social support Product
of social democratic movement; political struggle to overcome
powerlessness, de-skilling and alienation 35
- Slide 36
- 36 Psychological demands Job control Low strain jobs High
strain jobs Passive jobs Active jobs strain Active learning
National Taiwan University Yawen Cheng
- Slide 37
- 37 Skill discretion Decision authority Psychological demands
Supervisor support Coworker support 1.Learn new things 2.No
repetitive work 3.Require creativity 4.High skill level 5.Variety
6.Develop own abilities 1.Own decisions 2.Decision freedom 3.Lots
of say 1.Work fast 2.Work hard 3.Excessive work 4.Not enough time
5.Conflicting demands 1.Supervisor concerned 2.Supervisor pays
attention 3.Helpful supervisors 4.Supervisor good organizer
1.Coworker competent 2.Coworker interest in me 3.Coworker friendly
4.Coworkers helpful Job control National Taiwan University Yawen
Cheng
- Slide 38
- 38
- Slide 39
- 39
- Slide 40
- 40 Photographed by National Taiwan University, Yawen Cheng,
May, 2010.
- Slide 41
- 41 www.osh.govt.nz
- Slide 42
- 42 Adjusted for age, sex, BMI, marital status, smoking, shift
work, work hours, job insecurity, and work-place social support.
SF-36 mental health score in relation to job control and demands -
micro-electronic workers in Taiwan (n=1,078) National Taiwan
University Yawen Cheng
- Slide 43
- 43 Comparison of job demands and job control measured by Job
Content Questionnaire for Men* * Sources: Karasek et al. 1998;
Kawakami et al 2004; Cheng et al 2003; EU- JACE study, 2002.
EU-North EU-Middle EU-South Japan (two companies) Taiwan Japan
(JSTRESS) US(NMEC) Canada-Quebec Netherlands Canada- Quebec(W)
National Taiwan University Yawen Cheng
- Slide 44
- 44 Proportion of workers, % Source: The1977 Quality of
Employment Survey and 1997 National Survey of the Changing
Workforce in the US Source: European Foundation Surveys EUUS
National Taiwan University Yawen Cheng
- Slide 45
- 45 Changes in Job Demands (2001-2010) National Taiwan
University Yawen Cheng
- Slide 46
- 46 Changes in Job Control (2001-2010) National Taiwan
University Yawen Cheng
- Slide 47
- 47 Macro level Politics, policy, law, enforcement Deregulation
Globalization Employer-labor power imbalance Economic factors
Impacts of new technology Cultural factors Mezzo level Flexible
labor Downsizing Outsourcing Contingent workers Multi-role workers
Floating wage Profit-oriented performance evaluation Micro level
Wage/benefit Workloads Job security Career prospect Skill
utilization Skill development Influence Participation Social
support Mutual trust Social integration Meaningfulness National
Taiwan University Yawen Cheng
- Slide 48
- 48 WHO
- Slide 49
- Choose one type of the health problems, and answer the
following questions Occupational injuries or occupational diseases
Coronary heart disease or hypertension Obesity Smoking Alcoholism
In your country or region, is there health inequality of this
health problem by social categories (e.g., education, occupational
grade, income, gender, ethnicity, neighborhood) ? If so, what might
be the cause (s)? What kinds of public policies do we need to
reduce social inequalities of this health problem? What obstacles
and opportunities may exist? 49
- Slide 50
- pag e WorkLicensing Author/ Source 4 Wikimedia commons
Dbenzhuser http://commons.wikimedia.org/wiki/File:Black_Death.jpg
2012/06/02 visited 4 Wikimedia commons Marcantonio Raimondi
http://commons.wikimedia.org/wiki/File:Il_Morbetto.jpg 2012/06/02
visited 5 This work is licensed by Tung-Liang Chiang for the use of
Essentials of Global Health ONLY. The copyright belongs to the
above mentioned creator(s) and GET does not have the authorization
right. 6 Wikimedia commons Adam sk
http://commons.wikimedia.org/wiki/File:SirEdwinChadwick.jp g
2012/06/02 visited 7 Wikimedia commons German Federal Archive
http://commons.wikimedia.org/wiki/File:Bundesarchiv_Bild_18
3-R68588,_Otto_von_Bismarck.jpg 2012/06/02 visited
- Slide 51
- pageWorkLicensing Author/ Source 7 Wikimedia commons Chnodomar
http://commons.wikimedia.org/wiki/File:Maerz1848_berli n.jpg
2012/06/02 visited 9 Wikimedia commons Tryphon
http://commons.wikimedia.org/wiki/File:RobertKoch_crop ped.jpg
2012/06/02 visited 9 Wikimedia commons Nicolas Andry
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lustrations_of_microorganisms.jpg 2012/06/02 visited 10 Wikimedia
commons Beao
http://en.wikipedia.org/wiki/File:Eugenics_congress_logo.png
2012/06/02 visited 11 New Perspective on the Health of Canadian, A
working document. by Minister of National health and Welfare Marc
Lalonde http://www.amazon.com/gp/customer-media/product-
gallery/B004D9IJVQ/ref=cm_ciu_pdp_images_0?ie=UTF8&
index=0&isremote=0 This work is used subject to the fair use
doctrine of Article 52, 65 Taiwan Copyright Act by GET. 2012/06/13
visited
- Slide 52
- pageWorkLicensing Author/ Source 12 This is from David Coetzee,
Infectious Disease Epidemiology Unit University of Cape Town PPT.
http://0rz.tw/FNcax This work is used subject to the fair use
doctrine of Article 52, 65 Taiwan Copyright Act by GET. 17 National
Taiwan University Yawen Cheng 18 National Taiwan University Yawen
Cheng 19 National Taiwan University Yawen Cheng 20 National Taiwan
University Yawen Cheng
- Slide 53
- pageWorkLicensing Author/ Source 21 This work is from : Drever
F, Whitehead M, Roden M. Current patterns and trends in male
mortality by social class (based on occupation). Popul Trends. 1996
Winter;(86):15-20. This work is used subject to the fair use
doctrine of 52, 65 Taiwan Copyright Act by GET. 22 National Taiwan
University Yawen Cheng 23 National Taiwan University Yawen Cheng 24
This work is licensed by Tung-Liang Chiang for the use of
Essentials of Global Health ONLY. The copyright belongs to the
above mentioned creator(s) and GET does not have the authorization
right. 24 This work is licensed by Tung-Liang Chiang for the use of
Essentials of Global Health ONLY. The copyright belongs to the
above mentioned creator(s) and GET does not have the authorization
right.
- Slide 54
- pageWorkLicensing Author/ Source 26 National Taiwan University
Yawen Cheng 27 Wikimedia commons Hysohan
http://commons.wikimedia.org/wiki/File:Gini_Coefficient_
World_CIA_Report_2009-1.png 2012/06/02 visited 30 This work is
licensed by Taiwan Labor Front, for the use of Essentials of Global
Health ONLY. The copyright belongs to the above mentioned
creator(s) and GET does not have the authorization right. 30 This
work is licensed by Taiwan Labor Front, for the use of Essentials
of Global Health ONLY. The copyright belongs to the above mentioned
creator(s) and GET does not have the authorization right. 30 This
work is licensed by Taiwan Labor Front, for the use of Essentials
of Global Health ONLY. The copyright belongs to the above mentioned
creator(s) and GET does not have the authorization right.
- Slide 55
- pageWorkLicensing Author/ Source 31 National Taiwan University
Yawen Cheng 32 National Taiwan University Yawen Cheng 33 This work
is licensed by Shiuan-Be Wu, for the use of Essentials of Global
Health ONLY. The copyright belongs to the above mentioned
creator(s) and GET does not have the authorization right. 34
National Taiwan University Yawen Cheng 36 National Taiwan
University Yawen Cheng
- Slide 56
- pageWorkLicensing Author/ Source 37 National Taiwan University
Yawen Cheng 38 This work is from : Karasek, R. and T. Theorell
(1990). Healthy Work - Stress, Productivity, and the Reconstruction
of Working Life. New York, This work is used subject to the fair
use doctrine of Article 52, 65 Taiwan Copyright Act by GET. 39 This
work is from : Karasek, R. and T. Theorell (1990). Healthy Work -
Stress, Productivity, and the Reconstruction of Working Life. New
York, This work is used subject to the fair use doctrine of Article
52, 65 Taiwan Copyright Act by GET. 40 National Taiwan University
Yawen Cheng, May 2010 40 National Taiwan University Yawen Cheng,
May 2010
- Slide 57
- pag e WorkLicensing Author/ Source 41
http://www.osh.govt.nz/publications/booklets/stress-
tools2008/models-stress.asphttp://www.osh.govt.nz/publications/booklets/stress-
tools2008/models-stress.asp This work is used subject to their
copyright page http://www.dol.govt.nz/common/copyright.asp
2012/8/14 visited 42 National Taiwan University Yawen Cheng 43
National Taiwan University Yawen Cheng 44 National Taiwan
University Yawen Cheng 45 National Taiwan University Yawen
Cheng
- Slide 58
- pageWorkLicensing Author/ Source 46 National Taiwan University
Yawen Cheng 47 National Taiwan University Yawen Cheng 48 This work
is from : WHO (2007). Employment conditions and health
inequalities, Commission on Social Determinants of Health
http://www.google.com.tw/url?sa=t&rct=j&q=&esrc=s&sour
ce=web&cd=1&ved=0CFYQFjAA&url=http%3A%2F%2Fww
w.who.int%2Fsocial_determinants%2Fresources%2Farticles
%2Femconet_who_report.pdf&ei=LmsOUID1BezOmAWAxIG
QDA&usg=AFQjCNHipIqKBRHupzEsR24mU8W5Wr51Pw&sig
2=0OGEphm_zc_nsULwRhzH7A This work is used subject to WHO copyright
notice: http://www.who.int/about/copyright/zh/
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