PRINCIPLES AND CONCEPTS OF PUBLIC

HEALTH

JM PS Sept2012

“HEALTH TRANSITIONS”

• Spectacular shifts in structure & patterns of disease that have taken place in most countries.

• “Demographic Transition”:• Changes in birth & death rates as countries change, so low fertility &

low mortality in modernised societies & High fertility & mortality in traditional societies.

• “Epidemiological Transition”:• Long term changes in patterns of disease and disability as countries

become more developed (changes in economics, social structures)

KEY ELEMENTS OF PUBLIC HEALTH

Health promotion

actions taken by governments to encourage behaviours amongst citizens that will produce better health. Health promotion activities include anti-smoking campaigns, encouraging healthy lifestyles and promoting better nutrition.

Health protectionactions taken directly by governments to prevent the development and spread of disease and illness. It includes activities such as health surveillance and the introduction of regulations to prevent the exposure of individuals to health hazards.

(Note: Above are strategic)

DOWNSTREAM V UPSTREAM THINKING

(McKinlay 1979)

McKinlay (1979) – frustrated with medical model - image

of swiftly flowing river to represent illness and the need for thinking ‘upstream’ & ultimate futility of ‘downstream’ endeavours (short term, episodic, individual).

Upstream is ‘where the real problems lie’ - as upstream endeavours focus on modifying economic, political, and socio-economic factors > the precursors of poor health throughout the world.

Conceptualising health from a population perspective.

Upstream thinking

UPSTREAM THINKING

What others can you think of?

PRINCIPLES OF HEALTH PROMOTIONWHO 1984,THE OTTAWA CHARTER 1986, JAKARTA WHO 1997

• Promote social responsibility for health Involve the population in the context of their everyday life. Shift focus from people at risk for specific disease• Increase investment and infrastructure for health development Action

on the determinants or causes of ill health. Co-operation between sectors and government. • Increase community capacity and empower the individual Combine

diverse approaches; individual communication and education, legislation, fiscal measures, organisational and community development • Expand partnerships for health Involvement of variety of health

professionals, particularly in primary care

POLICY AND PUBLIC HEALTH

• Policy outlines a set of objectives and rules that guide the activities of an organisation or an administration (Koelen & Van den Ban 2004).

• In public health terms it :defines priorities and scope for action in response to health needssets priorities in health care provisiongives a framework for health-care deliveryshapes and is shaped by key values and beliefs about health caresupports strategic planning and developmentestablishes systems for allocating resourcescreates a means of tackling inequalities.

HEALTH LITERACY

• Relatively new concept in health promotion.• Ability to comprehend health & self-care information, &

achieve health outcomes.• It relates to verbal communication, social interaction,

and capacity to act (Speros 2005). • WHO defined it as representing ‘the cognitive and social

skills which determine the motivation and ability of individuals to gain access to, understand, and use information in ways that promote and maintain good health’.

PUBLIC HEALTH PRACTICE

• Public health is concerned with the protection and improvement of the health of populations and communities and is based on the collection of health and social information in order to draw up accurate profiles on the health needs of the population’ (Robotham + Frost 2005).

UNDERPINNING KNOWLEDGE

Epidemiology Psychology

Sociology Microbiology Statistics Politics Management

Leadership Theory

EPIDEMIOLOGY

• Epi (upon), demos (the people), logos (to study).

• “Epidemiology is the study of the distribution and determinants of health-related states or events (including disease), and the application of this study to the control of diseases and other health problems.” WHO

• http://www.who.int/topics/epidemiology/en/

EPIDEMIOLOGY

• Terms ‘hazard’ and ‘risk’ central to epidemiology.• Hazard = potential to cause harm; risks = the

likelihood of causing harm.• Relative risk? – used to compare the incidence of

a disease or condition between group with a particular attribute or exposure to one without.• A measure of the strength of an association

between an exposure or attribute and a disease.

EPIDEMIOLOGY

• Quantitative and qualitative• Population perspective• Preventative perspective• Lind a British navy doctor – designed first clinical trial –

hypothesis that scurvy caused by lack of fruit intake. Sample size – 12 sailors – into 6 treatment groups. Given cider, sea water, vinegar, oranges and lemons.• Registration of deaths, births, morbidity.

RISK FACTORS

• Concept comes from modern epidemiology.• Aim to identify factors which may cause disease • Prevent disease by removing risk factor• When an exposure or attribute is identified as a risk

factor means that it is associated with an increased probability (risk) of the disease occurring. • A Necessary but not Sufficient effect

CONSIDER….

• Is tobacco a sufficient condition to develop lung cancer. The example of smoking. If everyone were a smoker would development of lung cancer be a genetic or environmental condition…….?

PREVENTION PARADOX (ROSE)

• What works at the population level may not work at the individual level• Small changes at individual level can make huge

difference at the population level

• Examples: breastfeeding, losing 10% of body weight, eating 5 a day……

PROTECTIVE FACTORS

• Factors that promote (protect) positive health and development.• Structured assessment of protective factors + • Structured assessment of risk factors > • Provides the foundation for prevention/intervention > • Strengthened, healthier and more sustainable

individuals and families.• Identification of vulnerabilities, resilience etc.

PROTECTIVE & RISK FACTORSADOLESCENT SEXUAL AND REPRODUCTIVE HEALTH

• Protective factors• discourage one or more behaviours that might lead to

negative health outcomes (e.g. having sex with many partners) • encourage behaviours that might prevent a negative health

outcome (e.g. using condoms and contraception).• Risk factors• ……are associated with one or more behaviours that might

lead to a negative health outcome. Work to discourage behaviours that might prevent them.

SOCIAL DETERMINANTS

• The social determinants of health are the conditions in which people are born, grow, live, work and age, including health systems.• These circumstances are shaped by the distribution of

money, power and resources at global, national and local levels, which are themselves influenced by policy changes.• The social determinants of health are mostly responsible

for health inequities – the unfair and avoidable differences in health status seen within and between countries (WHO).

SOCIAL DETERMINANTS

• Responding to increasing concern about persisting and widening inequities, WHO established the Commission on Social determinants of Health – final report launched in August 2008.

• 3 overarching recommendations:1. Improve daily living conditions2. Tackle the inequitable distribution of power, money and resources3. Measure and understand the problem and assess the impact of action.

POLITICAL AWARENESS

• An awareness of health policy and strategy when planning and developing interventions.

• Knowing which people or communities have influence over different issues, so appropriate messages go to the right people during any initiative.

• Encouraging pro-activity and participation.

PUBLIC HEALTH

• public health is about collectives and populations ..it is as much about social and political concepts as the medical one (Cowley 2002:6).• Independence, autonomy and empowerment are a

necessary base for individual health, yet in protecting the health of the public it may be necessary to impinge on these by state regulation and control.

• Cowley, S. (2002) (ed) Public Health in Policy and Practice: A Sourcebook for Health Visitors and Community Nurses

• McKinlay JB (1979) Epidemiological and political determinants of social policies regarding the public health. Social Science & Medicine. 541-58.

• Robotham, A, & Frost, M (2005) Health Visiting: Specialist Community Public Health Nursing London, Churchill Livingstone

• Health literacy: concept analysis

• Speros, C. 2005) Health literacy: concept analysis. Journal of Advanced Nursing. 50 6 533-40