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
Health protection
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.
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)
DOWNSTREAM V UPSTREAM THINKING
(McKinlay 1979)
Upstream thinking
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
What others can you think of?
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 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 needs
 sets priorities in health care provision
 gives a framework for health-care delivery
 shapes and is shaped by key values and beliefs about health care
 supports strategic planning and development
 establishes systems for allocating resources
 creates 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 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.
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.
2.
3.
Improve daily living conditions
Tackle the inequitable distribution of power, money and resources
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