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Population
Impaired lung function: 10,000- 25 000
Admissions: 1 diagnosis COPD 909
Deaths: COPD 144
Known to GP: 5652
The Experience of Health
• Having Energy• Being loved, loving• Being in control• Fit, fitting in• Stress-free• Outdoors, nature• Friends, family• Giving/receiving, sharing
• Meaning in life• Able to do things I enjoy• Peak Physical shape• Happiness• Creativity• Spiritual contentment• Wholeness• Playfulness • Belonging
Model of Health
ConnectednessCommunity
Meaning, Purpose
Control, living
conditions
Vitality, Energy
Doing things one enjoys
Good SocialRelations
Physical
Mental Social
HEALTH
Adapted from work by LaBonte, R
Obesity / Food / Physical Activity / Active Travel:Tobacco Control / Smoking: Mental Health / Wellbeing / Suicide:Alcohol: Accidents:Fuel Poverty:Water:Air:
‘What is wrong with ‘Why are youunhealthy ?’
‘What is stopping youfrom being healthy ?’
Smoking Poor diet Lack of fitness Drug and alcohol
misuse Poor coping skills Lack of lifeskills
• Powerlessness• Isolation• Pollution• Stress• Hazardous living conditions
you ?’
Heart Disease Cancer HIV / AIDS Diabetes Obesity Mental Health Hypertension
Medical Approach BehaviouralApproach Approach
Socioenvironmental
Inequalities in Health• ‘ … even if we cure or prevent all leading causes of premature death
(including improving all those health behaviours that contribute to these diseases) … a new set of diseases will arise to kill or disable the poor years earlier than the rich’ LaBonte, Prof. R (1997) Health Visitor Journal, Vol. 70, No.2 p. 64
“The fundamental relation between spatial patterns of social deprivation and spatial patterns of mortality is so robust that a century of change in inner London has failed to disrupt it.” The Ghost of Christmas Past, Dorling et al, BMJ, 2000, 321: 1547-1551
• Health as a concept needs constantly to be contrasted with a medical reductionist model which emphasises fragmentation, towards a model of health as integral to and as a result of social justice. Adams and Armstrong 1996
Are we really thinking about healthAll Age All Cause Mortality
Are we asking the right questions?
• The world is in a mess, and much of this mess is of our own making
• Events such as the financial crisis and climate change are not quirks of the marketplace or quirks of nature.
• They are markers of massive failure in international systems that govern the way nations and their populations interact.
• The contagion of our mistakes shows no mercy: • WHO Director General: Dr Margaret Chan
The burden of collective action
• The pollution of air gives utility• We do not individually or collectively
discount the cost and impact• Tragedy of the commons
Life satisfaction has run approximately flat through time in Great Britain” Blanchflower and Oswald 2004 Journal of Public Economics 88 (2004) 1359 – 1386
Model of Healthy Communities
ViableAdequately Prosperous
Sustainable
Convivial
EquitableLivable
Community
Economy
EnvironmentHEALTH
Adapted from work by Hancock, T
Hancock’s Sustainability Duties
• Duty to other species– the health of humans cannot be purchased at the
expense of the health of other species and the ecosystem
• Duty to future generations– the health of present generations cannot be
purchased at the expense of that of future generations
Hancock’s Equity Duties
• Duty to the disadvantaged– the health of the advantaged cannot be purchased
at the expense of the health of the disadvantaged
• Duty to other places– the health of my community cannot be purchased
at the expense of that of other communities
Public Health Outcomes Framework
– Air Pollution: Inclusion of this indicator in the PHOF will enable DsPH to prioritise action on air quality
Public Health Outcomes Framework
– Air Pollution: Inclusion of this indicator in the PHOF will enable DsPH to prioritise action on air quality
– “Attitudes count, not numbers, and control is rooted not in hierarchy but in values and beliefs” Hunter, 2003
