Impact of EU Accession
on Public Health in
Croatia
Development of a European
Concept of Public Health
Andrija Stampar School of Public Health
17th January 2011
Christopher Birt
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Origins
Goes back to the ancient
civilisations of Rome,
Greece, and many others
(e.g. Albumasar in Baghdad)
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Since 1800…
Dr William Henry Duncan (1805 – 1863)
• born in Liverpool
• qualified in medicine in Edinburgh in
1829
• appointed MOH in Liverpool in 1847
• saw link between housing and cholera,
smallpox, typhus, etc.
• worked to tackle poor housing and
sanitary provision
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Sir Edwin
Chadwick
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Sir Edwin Chadwick,
1800 - 1890
• born and educated in Manchester
• friend of Jeremy Bentham and John
Stuart Mill
• 1833 Royal Commission on condition of
factory children
• 1839 first Sanitary Commission appointed
• 1847 Commission on the health of London
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Ignac
Semmelweis
• born 1818, died 1865, in Budapest,
• noticed mothers delivered by doctors
died, while those delivered by nurses
survived,
• observed that doctors did not wash hands
properly,
• discovered puerperal fever and its
prevention
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Was this a golden age
for PH in Europe?
• Medical Officers of Health (or equivalent title)
• usually a part of central or local government
• significant influence on housing and
education
• prevention / control of environmental hazards
• communicable disease control and
immunisation
• maternal and child health
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End of the First
Golden Age?
By 1960 – 1990:
• communicable disease and environmental
•
•
•
•
•
health no longer the leading threats to health,
chronic diseases now heading mortality /
morbidity threats,
understanding of wider determinants of health,
health promotion “invented”,
Ottawa Charter / Alma Ata Conference,
New Public Health / rebirth of primary health
care
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Health Promotion
Defined as including health education, disease prevention,
and health protection (Tannahill et al, OUP, 1990)
• Health education increases awareness and influences
favourably attitudes and knowledge relating to the improvement
of health on both a personal and on a community basis.
• Health protection seeks, through legislative or other means,
to promote healthier environments, within which healthy choices
are easier to make.
• Disease prevention refers to measures taken to prevent
diseases or injuries rather than curing them or treating their
symptoms, within the scope of public health methods, working at
population level.
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From 1975: a new
Golden Age?
4 strands of public health activity emerge:
• health promotion,
• communicable disease and environmental
health surveillance and control
• planning and evaluation of health
services: concepts of population need
• great expansion of academic public
health, both teaching and research
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New Public Health
• addressed the wider determinants of health,
• embraced new approaches to health
•
•
•
•
•
promotion,
brought PH perspective into primary care,
introduced epidemiology to health care
planning,
maintained communicable disease and
environmental health surveillance / control,
put good science at the heart of practice,
espoused evaluation of both PH practice and
PH projects
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Determinants of
health
•
•
•
•
•
•
•
•
•
•
•
•
peace and absence of war,
wealth / poverty / distribution of resources,
agriculture / diet / nutrition,
employment, locus of control,
housing (heating, cooking, plumbing, etc.),
tobacco, alcohol, other drugs,
physical environment / open spaces,
transport: injuries, pollution, psychological effects, etc.,
exercise and recreation: sport and culture, etc.,
education,
health services,
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etc.
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“Healthy Plan-it”
in Croatia
Young-early
drinking
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Consequences of
addressing health
determinants
• public health no longer limited to
professional (medical) control; it belongs
to everyone;
• public health no longer limited to local
government, etc., needs to influence
decisions at all levels – global to local
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In 1997 it was
calculated that:
of all decisions affecting the health of European
citizens, around 50% are taken at EU level (diet &
nutrition, environmental policy, employment law,
transport strategy, etc.) – so PH is very important at EU
level.
BUT:
• national and local government levels also important,
• also NGOs, community groups, etc.,
• community development approaches to health
promotion: outcomes may include (for example)
community transport, fruit and vegetable deliveries,
etc.
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So Public Health activity
may include:
• multi-disciplinary trained public
professionals who will have a wide
variety of backgrounds,
• other professionals, not selfidentifying with public health, e.g.
teachers, dental nurses, police, social
workers…..
• parents, members of community
groups, those working with NGOs of
various types….
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A bit later I shall
consider
how we might
systematise all this
public health work
Now is time for questions and
discussion – thank you for listening!
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