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Introduction to Public Health - Exam notes

Module 1- Health & social determinants Defining Health : ● “A state of physical, mental and social well being and not merely the absence of disease or infirmity.” ● “Health itself is a concept determined by culture and society and we may each have our own ideas about what it means to be healthy.” ● One of the most fundamental conditions in life and core to everyday life Health promotion: The 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 Dimensions of health 1. Physical: Ability of human body structure to function properly, have efficient bodily functioning, to be resistant to disease & physical capacity to respond to varied events 2. Social: Ability to interact with others, to have effective relationships with others inc. supportive culture around us & ability to successfully adapt to environment 3. Mental: ability to effectively process information, and act properly to be able to develop to the fullest potential, grow in awareness and consciousness 4. Emotional: To cope adjust and adapt, capacity to cope with life situations and grow emotionally through them 5. Spiritual: ability to identify own basic purpose in life, belief in some form of dynamic other than human 6. Environmental: relationship to external surroundings, or habitat or occupational may also include impact Determinants of health The social, economic and political conditions in which people grow, live, work and age and the structural drivers of those conditions Main determinants of health Determinants can influence health status positively or negatively. Includes: - Biological : i.e. Age - Behavioural : i.e. levels of physical activity, whether or not a person smokes, alcohol - Environmental : i.e. Air quality, - Social : i.e. employment status Ecological model of health outlining main determinants of health Developed to further the understanding of the dynamic interrelations among various person and interrelated environmental factors Ecologic or population health model Emphasises the importance of social and physical environments that strongly shape patterns of disease and injury as well as our response to them over the entire life cycle .

Introduction to Public Health - Exam notes

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. Health inequities: therefore involve more than inequality with respect to health determinants, access to the resources needed to improve and maintain health or health outcomes.

Module 2- Public health + health promotion Initial public health initiatives - Disease-oriented perspective - Epidemics of infectious diseases such as polio, typhoid, malaria and tuberculosis were major threats - Poor maternal and child health outcomes, exacerbated by malnutrition and poverty 10 public health achievements 1. Vaccination 2. Recognition of tobacco as a health hazard

Introduction to Public Health - Exam notes

3. Motor vehicle safety 4. Safer workplaces 5. Control of infectious diseases 6. Fewer deaths from heart disease and stroke 7. Safer and healthier foods 8. Healthier mothers and babies 9. Family planning and contraceptive services 10. Fluoridation of drinking water What is health promotion? The Ottawa Charter defines health promotion: “the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realise aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasising social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy lifestyles to well-being” 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 - 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 Some of the history of health promotion 1978: Alma Ata Declaration for Primary Health Care 1986: Ottawa Charter for Health Promotion 1997: Jakarta Declaration on Leading Health Promotion into the 21st Century 2005: Bangkok Charter for Health Promotion Three major principles: - Participation - Intersectoral collaboration - Equity Ottawa Charter for Health Promotion Health promotion action must occur on five fronts: 1. Build health public policy 2. Create supportive environments 3. Strengthen community action 4. Develop personal skills 5. Reorient health services LEVELS OF PREVENTION: Primary- prevention of disease in individuals (Healthy person) Secondary - Early signs

Introduction to Public Health - Exam notes

Tertiary - Tertiary prevention Primordial prevention - Forth form of prevention ; rarely mentioned - “Aspires to establish and maintain conditions to minimize hazards to health… It consists of actions and measures that inhibit the emergence and establishment of environmental, economic, social and behavioural conditions , cultural patterns of living known to increase the risk of disease” Creating supportive environments - Living and working conditions that are safe, stimulating, satisfying and enjoyable - May include policy or environmental changes that make it easier to make healthy choices for example: - Well-lit walking and cycling paths - Healthy food in school canteens Developing personal skills - Personal and social development - Includes providing information and education for health and life skills, for example: - Supermarket tours looking at food labels - Information on immunisation - Safe sex education at schools Ottawa Charter for Health Promotion - a number of essential prerequisites for health such as food, shelter, peace, income, stable ecosystem, sustainable resource use, social justice and equity; - health promotion as encompassing more than health care and lifestyles (focusing on well-being); and - five key strategies for health promotion Building health public policy - Building health public policy - Putting health on the agenda of all policy makers - May include legislation, fiscal measures, taxation and organisation change for example: - Higher taxes on cigarettes and alcohol - Compulsory wearing of seat belts - Smoking bans in public places Creating supportive environments - Living and working conditions that are safe, stimulating, satisfying and enjoyable - May include policy or environmental changes that make it easier to make healthy choices for example: - Well-lit walking and cycling paths - Healthy food in school canteens Strengthening community action - Empowerment of communities to take control of endeavours and destinies - May include measures to enhance self-help and social support or systems to increase public participation anddirection of health matters, for example: - Local Drug Action Groups - Neighbourhood Watch Program

Introduction to Public Health - Exam notes

Developing personal skills - Personal and social development - Includes providing information and education for health and life skills, for example: - Supermarket tours looking at food labels - Information on immunisation - Safe sex education at schools Reorienting health services - Developing a health care system that contributes to the prevention of illness and injury and promotes health - May include professional education and training and redirecting resources into prevention, for example: - School nurses conducting skin cancer checks at the beach - Mobile mammography screening vans - Aboriginal Health Workers conducting Pap smear screening in remote areas Module 3- Burden of disease Measuring health status - Health indicators are used to describe the health status of a population - Can provide patterns of disease in terms of age, gender, ethnicity, socioeconomic status & educational opportunity This data allows public health authorities to: - manage, evaluate and plan for health services; and - prevent, control and treat diseases & health problems Health Indicators They can include: 1. Morbidity 2. Mortality 3. Life expectancy Prevalence - Prevalence is a measure of disease that allows us to determine a person's likelihood of having a disease. - The number of prevalent cases is the total number of cases of disease existing in a population. Prevalence rate = Total number of cases of a disease in a population / the total population Incidence - Incidence is a measure of disease that allows us to determine a person's probability of being diagnosed with a disease during a given period of time. - Incidence is the number of newly diagnosed cases of a disease. - Incidence rate = number of new cases of a disease / number of persons at risk for the disease 2. Mortality - Mortality is another term for death. - Mortality rate = number of deaths due to a disease / total population 3. Life expectancy - Life expectancy is an indicator of how long a person can expect to live on average given prevailing mortality rates. - A boy born between 2009-2011 can expect to live to 79.7 years

Introduction to Public Health - Exam notes

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A girl would be expected to live to 84.2 years Men aged 65 in 2009–2011 could expect to live another 19.1 years compared with another 12.2 years in 1965–1967. - For women, life expectancy at age 65 was 22.0 years in 2009–2011 compared with 15.7 years in 1965–1967. Risk factors - Any factor which represents a greater risk of a health disorder or other unwanted condition or event. - Along with their opposites, protective factors, risk factors are also known as determinants. - Some risk factors can be modified. - Non-modifiable risk factors include age, gender, ethnicity & genes. Risk factors & Australia’s health - Risk factors contribute to over 30% of Australia’s total burden of death, disease & disability - Tobacco smoking is recognised as the single most preventable cause of ill health & death in Australia - Obesity, tobacco & alcohol feature in the top seven - preventable risk factors that influence the burden of disease, with over 7% of the total burden being attributed - to each of obesity and smoking, and more than 3% attributed to the harmful effects of alcohol. Population health funding Outcome: A reduction in the incidence of preventable mortality and morbidity in Australia, including through regulation and national initiatives that support healthy lifestyles and disease prevention. Programs: - Prevention, early detection and service improvement - Communicable disease control - Drug strategy - Regulatory policy - Immunisation - Public health Justifying health expenditure Important issues regarding health and welfare expenditure include: - Which areas are expanding the most rapidly and which areas are contracting in terms of funding? - Who finances these services? - How does expenditure by the Australian Government compared with that of state and territory governments? - How does expenditure compare between states and territories? - What are the respective roles of the government and private sectors in financing these services? Australian National Preventive Health Agency: “Promoting a healthy Australia” - Commenced 1 January 2011; Abolished 2014 - Supported governments to respond to the challenges posed by chronic conditions & their lifestyle related risk factors Prevention better than cure - Every $1 invested in Health Promotion can save over $5 in health spending. - Yet for every $100 health spending health promotion receives just 40c.

Introduction to Public Health - Exam notes

- Health Promotion can keep HALF A MILLION Australians out of hospital every year by - PREVENTING CHRONIC DISEASES like diabetes, cancers, stroke and depression. What to consider when rating a health issue - Seriousness of the problem (severity) - No. of people affected (prevalence) - Feasibility of effective action (changeability) - Particular groups affected (selectivity): does it affect - one group more than others? - Future trends if no action - Level of current action - Financial cost National Health Priorities of Australia (NHPA) - NHPAs are still important on governments’ agendas at both national and state levels - However, there is a recent surge of interest and focus on major risk factors - Risk factors often do not operate in isolation; they coexist and interact with one another Module 4 - Marginalised populations Social determinants of health - The social and physical environments in which people live determine their health, and to some extent vice versa. - Factors in society or in our living conditions that affect our health, for better or for worse, throughout life. 10 Social Determinants - The social gradient - Stress - Early life - Social exclusion - Work - Unemployment - Social Support - Addiction - Food - Transport Socioeconomic gradient of health

Health Equity “Health equity cannot be concerned only with health seen in isolation. Rather, it must come to grips with the large issue of fairness and justice in social arrangements, including economic allocations, paying appropriate attention to the role of health in human life and freedom”. Health inequality and inequity

Introduction to Public Health - Exam notes

“Health inequality is a generic term used to designate the measurable differences, variations and disparities in health achievements of individuals and groups whereas health inequity refers to those inequalities in health that are deemed to be unfair or stemming from some form of injustice” (Kawachi et al. 2002) Equality vs Equity

Determinants of marginalisation - Social stigmatisation - Early-life disadvantage - Financial hardship - Poor health - Social isolation Marginalised groups in Australia - Aboriginal and Torres Strait Islander peoples - Rural Australians - Socioeconomically disadvantaged - People with a disability - Prisoners - Other populations - Australian Defence Force personnel, - Veterans, Homeless, Refugees, Gay, Lesbian, Bisexual, - Transgender and Intersex (GLBTI) Life expectancy of Indigenous Australians Males: - 69.1 years (Indigenous); - 79.7 years (Non-Indigenous) Females: - 73.7 years (Indigenous); - 83.1 years (Non-Indigenous) Avoidable mortality Refers to deaths that could have been prevented with timely and effective health care, including early detection and effective treatment, as well as appropriate modifications of lifestyle behaviours Implications of colonisation - Dispossession - Physical genocide - Attempted cultural genocide - Violence

Introduction to Public Health - Exam notes

- Violation and denial of cultural rights - Assimilation - Forced separation - Incarceration in reserves and prisons Continued social disadvantage - Education - Employment - Income - Housing - Access to services - Social networks - Connection with land - Racism - Incarceration Health and social justice “Social justice approaches to health are a necessary underpinning for health systems in order for priority to be put on the achievement of health as a resource for life and as a human right. Understanding inequity in ethical terms provides the foundation for a public health model that overtly tackles health inequities and injustices, while also seeking to improve the health of populations overall.” (Kelleher & MacDougall 2009) Module 5: Global Health What is globalisation? - Greater movement of people, goods, capital and ideas - Reduction in barriers - Presents opportunities and challenges 1. Globalisation and economic growth - PRO: Economies of countries that engage well with the international economy have consistently grown much faster. - CON: Trade liberalisation rewards competitive industries and penalises non competitive ones. Social costs can be high. 2. Globalisation and standard of living - PRO: Countries which have had faster economic growth have then been able to improve living standards and reduce poverty. - CON: Some countries have been unable to take advantage of globalisation and their standards of living are dropping further behind the richest countries 3. Globalisation and health access - PRO: Improved wealth has led to improved access to health care and clean water which has increased life expectancy. - CON: Increased trade and travel have facilitated the spread of human, animal and plant diseases, across borders. Enabled the introduction of cigarettes and tobacco to developing countries 4. Globalisation and the economic market - PRO: Increased global income and reduced investment barriers have led to an increase in foreign direct investment which has accelerated growth in many countries.

Introduction to Public Health - Exam notes

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CON: The increasing interdependence of countries in a globalised world makes them more vulnerable to economic problems. 5. Globalisation and the environment - PRO: Positive environmental outcomes by encouraging the use of more efficient, less-polluting technologies and facilitating economies' imports of renewable substitutes for use in place of scarce domestic natural resources. - CON: The environment has been harmed as industries exploit inadequate environmental codes and corrupt behaviour in developing countries. 6. Globalisation and peace - PRO: Increasing interdependence and global institutions have enabled international political and economic tensions to be resolved. - CON: The major economic powers have a major influence in the institutions of globalisation, like the WTO, and this can work against the interests of the developing world. 7. Globalisation and technology - PRO: Improved technology has dramatically reduced costs and prices changing the way the world communicates, learns, does business and treats illnesses. - CON: Trade liberalisation and technological improvements change the economy of a country, destroying traditional agricultural communities and allowing cheap imports of manufactured goods. 8. Globalisation and communication - PRO: Modern communications and the global spread of information have contributed to the toppling of undemocratic regimes and a growth in liberal democracies around the world. - CON: Modern communications have spread an awareness of the differences between countries, and increased the demand for migration to richer countries. 9. Globalisation and labour - PRO: The voluntary adoption by global companies of workplace standards for their internationalised production facilities in developing countries has made an important contribution to respect for international labour standards. - CON: Globalised competition can force a 'race to the bottom' in wage rates and labour standards. 10. Globalisation and culture - PRO: International migration has led to greater recognition of diversity and respect for cultural identities which is improving democracy and access to human rights. - CON: Indigenous and national culture and languages can be eroded by the modern globalised culture. Terminology - Developed and developing or underdeveloped - Industrialised and industriali...