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
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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