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Lecture and tutorial notes from Maria Chanmugan in Introduction to Public health ...

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INTRODUCTION TO PUBLIC HEALTH EXAM NOTES: MODULE ONE-HEALTH AND SOCIAL DETERMINANTS: WHAT IS HEALTH?  One of the most fundamental conditions in life and core to everyday life  “A state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity” WHO 1946  Dimensions of health o Physical o Social o Mental o Spiritual o Environmental  Health promotion approach to health: process of enabling people to increase control over and to improve their health  Public health approach: refers to all organised measures to protect health among populations, and to prevent disease, promote health and prolong life among the population as a whole DETERMINANTS OF HEALTH:

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The social, economic and political conditions in which people grow, live, work and age and the structural drivers of those conditions Proximal determinants: a determinant that is proximate or near to the change in health status Intermediate determinants: are the material factors, the

natural, physical and built environments and the health system inputs Distal determinants: include the national, institutional, political, legal and cultural factors that indirectly influence health by acting on the more proximal factors Determinants are fluid in expression

HEALTH EQUITY:  Equity is the absence of avoidable or remediable differences among groups of people whether those groups are defined socially, economically, demographically or geographically  It is the rights of people to have equitable access to services on the basis of need  Equality: giving everyone the same thing  Equity: giving individuals the right amounts of these things

SOCIAL GRADIENT (WILKINSON AND MARMOT 1998,2003):  Lower socio-economic conditions result in a shorter life expectancy than for those higher up on the socio-economic ladder MODULE TWO-PUBLIC HEALTH AND HEALTH PROMOTION: PUBLIC HEALTH FUNCTIONS: OLD PUBLIC HEALTH:  A social movement of the 19th century that worked to improve living conditions through the development of physical infrastructure, including water, sanitation and housing, as well as policy and legislation to support and drive change o Australia’s first public health act1854 NEW PUBLIC HEALTH:  An explicitly social and political approach to health development that emphasises knowledge to action on the social determinants of health, intersectoral action to support health, health public policy, environments for health, sustainable development and equity in health

HEALTH PROMOTION:  “the process of enabling people to increase control over the determinants of healthy and thereby improve their health” WHO 1986 OTTAWA CHARTER FOR HEALTH PROMOTION:  WHO led initiative  Landmark document laying out a clear statement of action that continues to provide framework for health workers around the world  Health promotion action must occur on 5 fronts: 1. Build health public policy 2. Create supportive environments 3. Strengthen community action 4. Develop personal skills 5. Reorient health services  3 basic strageies for health promotion- enable, mediate and advocare LEVELS OF PREVENTION:  Primary- prevention od disease in individuals  Secondary  Tertiary

MODULE THREE-BURDEN OF DISEASE: MORBIDITY RATE:  The rate of incidence of disease or illness  Reported by prevalence or incidence MORTALITY RATE:

A measure of the number of deaths in a defined population scaled to the size of that population per 1000 individuals per year LIFE EXPECTANCY:  An indicator of how long a person can expect to live on average given prevailing mortality rates 

RISK FACTORS:  Any factor which represents a greater risk of a health disorder or other unwanted condition or event  Non modifiable risk factors: age, gender, ethnicity and genes  Risk factors in Australia: o Contribute to over 30% of Australia’s total burden of death, disease and disability o Tobacco smoking is recognised as the single most preventable cause of ill health and death in Australia o Obesity, tobacco and alcohol feature in the top 7 preventable risk factors that influence the burden of disease POPULATION HEALTH FUNDING:  Outcome: a reduction in the incidence of preventable mortality and morbidity in Australia, including through regulation and national intiatives that support healthy lifestyles and diease prevention  Programs: o Prevention, early detection and service improvement o Communicable disease control o Drug strategy o Regulatory policy o Immunisation o Public health MEASURING DOFFERENCES IN EQUITY AND INEQUITY:  Health disadvantage: concentrates on differences between distinct segments of the population or between societies  Health gaps: focuses on the differences between the worst off and everybody else  Health gradient: examines the health differences across the whole spectrum of the population, acknowledging a systematically patterned gradient in health inequities EPIDEMIOLOGY:  Literally means what is upon the people  The study of health among populations ‘the study of the occurrence and distribution of health-related events, states and processes in specified populations, including the study of the determinants influencing such processes and the application if this knowledge to control relevant health problems’  Upstream approach  Pearce 1996 asserts that epidemiological research should focus on the social, political and cultural structures, systems and processes that lead to poor health and are amendable to modification MODULE FOUR-MARGINALISED POPULATIONS: MARGINALITY:  An involuntary position and condition of an individual or group at the edge of social, economic and ecological systems, preventing access to resources, assets and services, restraining freedom of choice, preventing the development of capabilities and causing extreme poverty

INTERSECTIONALITY:  Sociological theory that considers how various categories of oppression interact on multiple and often simultaneous levels, contributing to systematic social inequality

MODULE FIVE-GLOBAL HEALTH: WHAT IS GLOBAL HEALTH?  Strategies developed and implemented for health improvement across national boundaries TRANSNATIONAL:  Issues that affect health across countries and continents such as climate change and urbanisation GLOBAL PUBLIC HEALTH:  A term used to describe the impacts on health that result from globalisation WHO:  

Created in 1948 as a specialised agency of the UN Its fundamental goal ‘the attainment by all peoples of the highest possible level of health’

MILLENIUM DEVELOPMENR GOALS:  The eight-millennium development goals focus on poverty, hunger, education, gender equality, child mortality, maternal mortality, HIV/AIDS and water and sanitation. HUMAN RIGHTS:  The work of human rights is about inscribing certain moral principles into laws of countries and is led by international law  The Universal Declaration of Human Rights 1948 set out principles saying: o Human rights apply equally to all humans o All people are equal in dignity o Human rights are about freedom from discrimination, slavery, torture and arbitrary detention o Human rights are about freedom of movement, expression and religion, and about the right to life, liberty and security of the person and privacy o All people have the right to work, to health, to an adequate standard of education and housing  Reflective based practice is essential for a rights based practice o Health promotion enhances the capacity of rights-holders to claim their rights and duty bearers to fulfil their obligations  The Peoples Health Movement o A political and social movement as well as a health movement and is concerned with health as a human right as well as civil and political right. Its processes, activities and aspirations aim to change both the way power is distributed and the way it is used MODULE SIX-ECOLOGICAL HEALTH: WHAT IS CLIMATE CHANGE?  A change in global or regional climate patterns in particular a change apparent from the mid to late 20th century onwards and attributed largely to the increased levels of atmospheric carbon dioxide produced by the use of fossil fuels  Climate and health co-benefits: o Many of the drivers of climate change (eg. Fossil fuel burning, overconsumption of meat, poorly deisgned cities and overdependence on motorised transport) also contribute to many health problems (obesity, diabetes, respiratory and heart disease and road deaths) o Health gains can be achieved through interventions such as switching to cleaner, low carbon energy sources, urban planning that promotes active transport and reducing red meat and dairy consumption.

ECOLOGICAL VIEW OF HEALTH (BARTON, 2005)

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This figure takes an ecological view of health which situates the individual and their personal characteristics within their living and working conditions, the social and economic resources and opportunities available and importantly the built and natural environment

ECOLOGICAL PUBLIC HEALTH:  The outcome of complex interrelationships and interdependencies between human beings, the determinants of health and the broader environment in which they exist  The Earth Charter articulates four principles (help to describe relationship between the theoretical perspectives of ecology and public health practice) 1) Respect and care for the community of life 2) Ecological integrity 3) Social and economic justice 4) Democracy, nonviolence and peace WHAT IS ENVIRONMENTAL HEALTH?  It is 'concerned with creating and maintaining environments which promote good public health'  basic requirements for a healthy environment: clean air; safe and sufficient water; adequate and safe food; safe and peaceful settlements; safe workplaces; and a stable global environment MODULE SEVEN-NON COMMUNICABLE DISEASE AND INJURY:  Non communicable diseases account for 60% of global mortality  The other 40% are due to communicable diseases, maternal and child illnesses and violence and injuries  80% of NCDs are in low-middle income countries and 26% are premature deaths  Major NCDs are cardiovascular disease, cancer, diabetes and chronic respiratory disease which share common risk factors; tobacco, unhealthy diet, physical inactivity and harmful use of alcohol  For prevention of NCDs people need to employ health living choices  Tobacco control policies o If all countries implement and enforce 6 tobacco control policies populations worldwide could be protected from morbidity and premature death caused by tobacco o The WHO framework convention on tobacco control represents a regulatory strategy to address factors that drive the global tobacco epidemic, these factors include; global marketing, transnational tobacco advertising, trade liberalisation

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and direct foreign investment and the international movement of contraband and counterfeit tobacco products. It also addresses the importance of reduction strategies as well as supply issues Nutrition policy o Strong link between intake of trans fat, excessive salt consumption, low consumption of fruits and vegetables, high consumptions of sat fat and sugars and NCDs o The three major processes of globalisation are driving up these intakes; foreign direct investment in food processing and retailing, global food advertising and promotion, production and trade of agricultural goods o At an individual level health education is key Transnational corporations are major drivers of non-communicable disease epidemics and profit from increased consumption of tobacco, alcohol and ultra processed food and drink Alcohol and ultra processed food and drink industries use similar strategies as the tobacco industry to undermine effective public policy and programmes Unhealthy commodity industries should have no role in the formation of national or international policy for non-communicable disease policy Despite the common reliance on industry self regulation and public private partnerships to improve public health there is no evidence to support their effectiveness or safety In view of the present and predicted scale of non communicable disease epidemics the only evidence based mechanisms that can prevent harm caused by unhealthy commodity industries are public regulation and market intervention

MODULE EIGHT-COMMUNICABLE DISEASE  Capable of being transmitted from one person to another eg. o Blood borne diseases (hepatitis) o Gastrointestinal diseases (salmonellosis, typhoid) o Bacterial infections (tuberculosis) o Sexually Transmitted diseases (syphilis)  2008 communicable diseases in Australia accounted for 1.3% of all deaths  The emergence and re-emergence of communicable disease threats to human health has been exacerbated in recent times by o Climate change and changing land use patterns o Globalisation o Population mobility o Decreased vaccination rates o Accidental and malicious release of dangerous pathogens o STIS  Globally communicable diseases account for 50% of years life lost o 8% in high income countries o 68% in low income countries

PREVENTING INFECTIOUS DISEASE:  Effective hand hygiene  Safe sex  Safe travel  Vaccination MODULE NINE-EVIDENCE AND EFFECTIVENESS: WHAT IS HEALTH PROMOTION PLANNING?

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Based on good evidence and community consultation Has clear and achievable goals and objectives Allows for good evaluation at all stages of the cycle

HEALTH PROMOTION PLANNING CYCLE: CHANGING BEHAVIOUR K+A+S+E=B:  K=what do people need to KNOW?  A=what ATTITUDES will be helpful?  S= what SKILLS are required?  E= what ENVIORNMENT will support the behaviour  =B what BEHAVIOUR are we wanting to change or promote?

BEHAVIOUR CHANGE:  Individual level  Group/community level  Population level WHAT IS A PROGRAM PLAN?  A plan designed to create effective and sustainable change by taking a structured approach to the logic of goals, objectives, strategies and outcomes

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 Program logic= when program plans ensure that all conceptual and technical elements of the program are linked through logical connection

TYPES OF RESEARCH:  Descriptive: describing the problem  Analytic: identifying the causes and consequences of the problem  Evaluation: collecting data to judge whether interventions were successful and what did or did not work to address the problem UPSTREAM PUBLIC HEALTH INTERVENTIONS:  Those at the macro level including government policies, global trade agreements and investment in population health research DOWNSTREAM PUBLIC HEALTH INTERVENTIONS:  Those at the micro level including treatment systems, disease management and investment in clinical research INTEGRATED HEALTH PROMOTION:

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A program design that uses a mix of health promotion interventions across the upstreamdownstream continuum and capacity building strategies to address priority health and well being issues

MULTI LEVEL HEALTH PROMOTION;  A program design that simultaneously addresses two or more outcome levels such as individual, family, or group, community, organisational or societal TWO TIER HEALTH PROMOTION PLAN: TIER ONE:  Evidence of the problem  Determinants of the problem  Population of interest  Settings  Outcome levels TIER TWO:  Partnership development and rationale  Vision setting  Goals and objectives  Action mapping and strategy selection  Implementation  Evaluation and dissemination MODULE TEN-HEALTH EDUCATION FOR EMPOWERMENT: WHAT IS HEALTH LITERACY?  Involves 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  In Australia health literacy at a low level is 60% of the population and at an adequate level 40% of the population  Literacy levels are strongly correlated with health outcomes  It informs peoples capacity to maintain good health, prevent and manage communicable and non-communicable diseases HEALTH EDUCATION:  Aims to encourage and motivate individuals to adopt health promoting behaviours and to help individuals make decisions about their health and acquire the necessary confidence and skills to put their decisions into practice  Aims to advocate for changes in environment and health policy  Influence policy makers to implement changes  What is health education? o Communication of knowledge and the provision of experiences to help individuals develop attitudes and skills which will assist their adopting behaviour to improve and maintain health for themselves and others o About making informed decisions regarding health

FOUR MODELS OF HEALTH EDUCATION:  Traditional medical model-works through professional patient interaction, concerned witrh compliance and raising awareness of health risk and encouraging behaviour change  Client-cantered model-seeks to strengthen patient autonomy and encourages their active participation in treatment and disease management  Behaviour change model-designed to encourage healthy choices and for peope to take personal responsibility for their health decisions  Empowerment model – a process that also facilitates or enables people to gain control over the determinants of their health in order to Improve their quality of life

HEALTH PROMOTION:  Combination of educational, organisational, economic, social and political actions designed with meaningful participation to enable individuals, groups and communities to increase control over and to improve their health through attitudinal, behavioural, social and environmental changes

RISK AND PROTECTIVE FACTORS: MOST COMMON BEHAVIOURAL RISK FACTORS:  Smoking  Physical inactivity  Poor nutrition  Harmful use of alcohol

LEVELS OF PREVENTION: PRIMARY:

SECONDARY:

TERTIARY:

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Eg skin cancer: o Primary: slip, slop, slap o Secondary: screening programs o Tertiary: chemotherapy

RISK FACTORS: POOR NUTRITION:  Important factor in obesity prevention  Over 60% of Australian adults and 25% of children are overweight or obese  91% of people aged 15 and over do not consume sufficient serve of vegetables  50% do not consume sufficient serves of fruit PHYSICAL INACTIVITY AND SEDENTARY BEHAVIOUR:  Over 60% of Australians are not active enough to gain any health benefits  Physical in activity guidelines for different age groups  Sedentary behaviour guidelines: minimise the amount of time spent in prolonged sitting, break up long periods HARMFUL USE OF ALCOHOL:  Harmful levels are associated with increased risk of o Chronic disease o Cancer o Injury o Premature death  Australian guidelines- healthy male no more than 2 standard drinks on any day MODULE ELEVEN-POLICY FOR HEALTH: HEALTH POLICY:  A formal statement or procedure within institutions that defines priorities and the parameters for action in response to health needs, available resources and other political pressures PUBLIC POLICY:

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Actions developed by governments and public authorities to address a given problem or an interrelated set of problems Has a social purpose it is developed from a recognition that for people to lead healthy productive lives there must be an appropriate structural, environmental and social supports in place Values framework o Justice and fairness o Basic living standards for all people with a decent minimum income o Redistributive taxation and welfare support when people need it

ORGANISATIONAL POLICIES:  Organisational policies are developed by organisations to govern matters such as o Equal opportunity, staffing policies, diversity, anti-discrimination, bullying and harassment o Guidelines for practice, such as health promotion or counselling services o Protocols POLICY FOR ADVOCACY:  Policies developed by interest groups and NGOs as position papers and/or lobbying tools SOCIAL STRUCTURALISM:  Sees that the individual does not exist in isolation from wider social influences and determinants and sees health status as a profound indicator of social position, e...