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Principles and concepts of Public Health Principles and concepts of Public Health

Principles and concepts of Public Health - PowerPoint Presentation

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Principles and concepts of Public Health - PPT Presentation

JM PS Sept2012 Health Transitions Spectacular shifts in structure amp patterns of disease that have taken place in most countries Demographic Transition Changes in birth amp death rates as countries change so low fertility amp low mortality in modernised societies amp Hig ID: 706947

social health amp public health social public amp disease factors risk determinants epidemiology development individual population upstream people policy

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Slide1

Principles and concepts of Public Health

JM PS Sept2012Slide2

“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)Slide3

K

ey 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 protection

actions 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

)Slide4

Downstream v Upstream thinking

(

McKinlay

1979)Slide5

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 thinkingSlide6

Upstream thinking

What

others can you think of?Slide7

Principles

of health promotion

WHO

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 diseaseIncrease investment and infrastructure for health development

A

ction

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

careSlide8

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 needs

sets priorities in health care provisiong

ives a framework for health-care deliveryshapes and is shaped by key values and beliefs about health caresupports strategic planning and development

e

stablishes

systems for allocating resources

creates

a means of tackling inequalities

.Slide9

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’.Slide10

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).Slide11

Underpinning knowledge

Epidemiology

Psychology

Sociology Microbiology

Statistics

Politics Management

Leadership TheorySlide12

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/Slide13

EpidemiologyTerms ‘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.Slide14

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.Slide15

Risk factors

Concept comes from modern epidemiology.

Aim to identify

factors which may

cause

disease

Prevent disease by removing risk factorWhen

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 effectSlide16

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…….?Slide17

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……Slide18

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. Slide19

Protective & Risk factors

adolescent

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.Slide20

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).Slide21

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:

Improve daily living conditions

Tackle the inequitable distribution of power, money and resources

Measure and understand the problem and assess the impact of action.Slide22

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.Slide23

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.Slide24

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