Summary International Public Health Premaster Health Sciences
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Course
Volksgezondheid in internationale context
Institution
Vrije Universiteit Amsterdam (VU)
Deze samenvatting hoort bij de specialisatie International Public Health van de premaster health sciences. Hij bevat stof uit de hoorcolleges en responsiecolleges. Handig voor premaster health sciences studenten die deze specialisatie in de premaster gekozen hebben en/of volgend jaar international ...
Blok 1
HOORCOLLEGE 1 (Kevin de Sabbata): introduction
What is international public health (IPH) health problems and issues that transcend national
boundaries and may be best addressed by cooperative actions.
IPH bevat de volgende onderdelen:
Health = a state of complete physical, mental and social well-being and not merely the absence of
disease or infirmity (WHO, 1948).
Public health = science and art of preventing disease, prolonging life and promoting health through
organized efforts (and informed choices) of society (Winslow, 1920).
International health = relates more to health practices, policies and systems and stresses more the
differences between countries than their commonalities.
Global health = health problems and issues that transcend national boundaries and may be best
addressed by cooperative actions.
See ppt. for some characteristics of global health.
Since global health transcend boundaries and countries, a lot of people are involved in global health
(actually everyone is involved). However, there are different levels of involvement (top down noted).
- National (national hospitals, policy is national)
- Secondary healthcare level (hospital, policy at provincial level)
- Primary healthcare level (health centres in villages and districts)
- Community level (community health workers)
- Family and individuals
History of IPH:
Started during the industrial revolution (1750-1850): during this revolution the working conditions
were bad and living in the cities was unhygienic. As a result epidemics arose and led to infectious
diseases, like cholera, because of a lack of hygiene and healthy food. This resulted is high infant
mortality. Government started realising that there should be a general policy to stop and prevent this
kind of infections. In 1851, the first international meeting on public health was organized and they
developed strategies to improve health.
The results of these improvements came round 1900 (decrease of mortality). They also started with
academic training in health sciences and the first international health organization was established.
Important is that, at this time, there was recognition for major health problems.
The period between 1945 and 1980 is characterized by a political change: countries in Africa and Asia
got independency (eerst zag de westerse wereld de gezondheidsproblemen in deze landen ‘niet als
een westers probleem’. Na de onafhankelijkheid kregen deze landen het recht en een stem in de
mondiale gezondheidswereld en begon het westen in te zien dat de gezondheidsproblemen in deze
landen ook hún probleem was). In 1978 there was another milestone in the history of IPH: the Alma
Ata Conference. They thought about primary health care (PHC) strategies how to prevent diseases,
,instead of only curing them. In the 80’s the focus changed from communicable diseases to non-
communicable diseases (e.g. obesity, smoking habits). This means that prevention got more
important. However, during the 80’s, HIV and AIDS became one of the most common health issues.
From 1990 to the present: people live longer and medicine is more effective. This puts more pressure
on healthcare services. Because of this the public-private-partnership (PPP) arose (because just
public services wasn’t enough) and cost effectiveness got more important. Next to that there is more
focus on prevention and global health focusses more on chronic diseases (and not mostly on
infectious diseases).
Example of cost effectiveness: developing a vaccine for COVID-19 in just one year time.
In 2000, millennium development goals were created to improve human health. These goals were
quite effective, but needed more attention. The sustainable development goals (SDG’s) contains a lot
of health related topics.
WERKGROEP
Health is in the middle, but is influenced by other
factors (education, poverty and economy).
When you’re healthy, you have more chance to
participate in (higher) education and to be
economically healthy. Next to that you have less
chance to be/become poor. The other way round
indicates that when you are poor and not educated,
you have less chance of being healthy.
These elements are (reciprocal) related to eachother.
, Blok 2
HOORCOLLEGE 2 (Tomris Cesuroglu): health determinants, measurements and trends
Non-communicable diseases cause the highest burden. As well in Europe (84%) as worldwide (64%).
Non-communicable diseases includes chronic diseases (cancer, mental issues etc.)
The curve of fertility and mortality depends a lot on income. Higher income means less fertility ans
less mortality.
This model takes the social determinants more into account
than previous models did. The reason for this is that they
believed that health is related to a lot of social circumstances
and not only caused or based on biomedical status.
Determinants of health are more than merely medical factors.
Education is one of the most important determinants of health
(so not the income of people, but merely the level of education).
Indicators of health status (to measure the health status):
Incidence: how many new cases are there?
Prevalence: how many people do have the disease
Mortality: looks at the number of deaths (often per 100 000 or 1000 people). By child, infant or
neonatal mortality, it’s per 1000 child births (because not every country notes how many people are
in there country, but they do note how many childs are born. Therefore it’s more reliable per 1000).
Mortality = people that died because of the disease / people with the disease that didn’t die
Case fatality rate (CFR) calculates how many
people that have a disease, die because of that
disease.
Life expectancy: an average of how long people live (often biased because of a high child mortality
rate).
The measures mentioned above are all ‘single indicators’ but in public health we like to have
indicator that every single one of them into account at the same time. Solution: HALE and DALY.
Morbidity: the disability that a person suffers as a consequence of a disease. And the proportion of
illnesses in population (het aantal mensen dat in een bepaalde tijdspanne door een ziekte worden
getroffen).
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