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Lecture notes public health practice (CHL32806)
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Summary Health Promotion and Disease Prevention
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Public health practice summaryKnowledge clip 1:
Public health: The science and art of preventing disease, prolonging life and promoting health
through the organised efforts of society.
What is Health?
Absence of illness says what it is not).
A state of complete physical, mental and social well-being (WHO, 1948)
Ability to adapt and self manage in the face of social, physical and emotional challenges (Huber et al.,
2011) positive health
What are the organised efforts of society?
A wide variety of organisations are active in the field of public health. These organisations can act on
a local, national and international level. Examples: WHO (international), GGD, Friesland campina,
Ministry of Health, Welfare and Sport, Ministry of Education, St Joseph’s health care London, Albert
Heijn (private sector)
Science and art: The public health professional needs to work academically but needs to be a civil
engineer (Oxford handbook of public health practice, 2020).
Public health is an area in which organisations work together and in which professional work on the
interface of science, practice and policy.
Chapter 1:
Common health objectives and interdependencies of epidemiology and public health:
- They share partially complementary knowledge.
Epidemiology = the study of what is upon the people
Questions: What, who where, when why
Important people: James Lind, Edward Jenner, Ignaz Semmelweis (ontdekker dat je handen moet
wassen), John Snow (cholera occurance, via water supply in households)
- Epidemiology has developed from social medicine and statistics.
Can be characterized by:
- Population thinking
- Group comparisons
Hippocrates: The first who suggested that the development of human disease might be related to the
external as well as the personal environment of an individual.
- Endemics: diseases usually found in some places, but not in others
- Epidemics: Diseases that are seen at some times, but not others
,Roots of epidemiology:
- Acute disease investigation
- Medicine
- Statistics
- Social science
- Computer science
- Managerial science
- Genomics
Purpose of epidemiology: The prevention of disease and the promotion of health
History:
Pre-formal epidemiology 1662-1990
John Graunt: Schreef het boek ‘natural and political observations made upon the bills of mortality’.
William Farr: he systematically recorded the causes of death in England and Wales.
John snow: built upon the descriptive data provided by Farr, which led him to support the hypothesis
that cholera was waterborne and not airborne.
- Epidemiologists wisten zelf ook nog niet goed wat epidemiologie inhield
- infectious diseases, such as the plague and cholera epidemics (in the 19th century in London
- nutritional deficiences
- Staten begonnen aantal inwoners & dodenaantal te tellen
- Dokters zagen dat ziektes niet gelijkmatig verspreidden over populaties
- Social drive om uit te zoeken waardoor de ziektes veroorzaakt werden en behandeld konden
worden: Hygiene & Sanitation
- People travelled all over the world Disease imported, exported
- Group thinking started to emerge: ziektes blijven niet bij 1 persoon (infectious diseases)
This section has emphasized the temporal land spatial variation of disease. Many of the key persons
were medical professionals by training with an interest in the social dimensions of their work. Thus,
although epidemiology clearly developed from social medicine, it has – naturally- also been
developed and applied in clinical context.
Semmelweis: Puerperal fever discovered that you need to wash your hands.
Louis: wordt gezien als de eerste klinische epidemioloog: hij ontdekte population thinking and group
comparisons: are necessary to assess the true effect of treatments.
Early epidemiology 1900-1940
- Development phase in which some epidemiologic concepts and methods were assembled for the
first time into a theory of population thinking and group comparisons.
,- Transition of acute infectious to chronic disease (Frost started this with studies on tuberculosis)
- Interdisciplinary nature of epidemiology became more on the foreground
- Eerste epidemiology docent in Londen (heette Greenwood; the founding father who advanced early
epidemiology in Europe)
- Focus lag op non-communicable diseases (pellagra diarrhoea, dermatitis and dementia diet
(poor nutrition) was the key , vitamins)
Classical epidemiology 1940-1980
- Shift from infectious and acute disease to chronic diseases
- Large scale epidemiological studies started (large cohort studies)
- New epi-methods, study design; odds ratio was a close approximation to the relative risk.
- Became established academic field in US/UK
- TBC, Tobacco smoke
Focused on infectious diseases & chronic diseases (any disease). And the controversy about the
health effects of tobacco smoke
- Methodology. Case-control, cohort, ecological, RCT, stratification & regression.
Definition of epidemiology: The study of the distribution and determinants of health related states
of events in specific populations, and the application of this study to control health problems.
Modern epidemiology 1980-now
- All these different study design find a theoretical basis in RCT (random controlled trial)
- Modern epidemiology has led to a clear differentiation of expertise and the theoretical elaboration
of the discipline seems almost irrelevant to the daily activity of the epidemiologist in PHP.
Prevention strategies (prim, sec, tertiary)
- Large scale cohort studies and intervention trials
Definition of epidemiology: The ultimate goal of most epidemiologic research is the elaboration of
causes that can explain patterns of disease occurrence.
Any disease all aspects of human health
Current challenges in public health in western societies
- Infectious diseases like the plague, cholera and tuberculosis have left western societies
- Same for many nutritional deficiencies.
- several Sustainable development goals are directly or indirectly related to issues of public health
and well-being.
Public health and public health challenges are being reported:
International level: WHO, OECD, WDR
European level: European health report + health at a glance
Health status: increasing life expectancy:
- Due to improved housing, sanitation, nutrition, safe drinking water, vaccination, disease prevention
and medical care life expectancy increased.
- LE is rising on average by 3-4 months each year (in Europe)
5 diseases with the highest prevalence: diabetes, arthritis, coronary heart diseases, neck and back
pain, and hearing impairment.
Leading causes of death: Heart diseases and lung cancer.
, Major health risks
Most significant preventable risk factors: tabacco, unhealthy diet, alcohol consumption and physical
inactivity.
Health inequalities
- inequalities in mortality and health status across socio-economic groups in all countries.
- Inequalities do no appear to have reduced.
Enhance the well-being of the European population
Healthy life expectancy is being used in stead of life expectancy
Epidemiology and public health; what’s next
Descriptive epidemiology: helps to identify the health issues and needs in specified populations
Analytical epidemiology: primarily addresses the search for causes of disease.
Public health: the science and art of preventing disease, prolonging life and promotion health
through the organised efforts of society.
Health as the outcome:
Health is now seen as a resource for everyday life, not the objective of living it is a positive concept,
emphasising social and personal resources as well as physical capabilities.
Health is a result of dynamic interactions between individuals and communities in their societal
context.
Huber et al.: The ability to adapt and to self-manage in the face of social, physical, and emotional
challenges.
Determinants of health:
Marc Lalonde:
4 groups of determinants of health (useful especially at the level of local organisations):
1. Endogenic or person-related characteristics (genetic, biological)
2. Lifestyle (smoking, drinking, dietary habits physical activity
3. Physical and social environment (housing, playgrounds, cycle paths)
4. Health care (preventive action)
Dahlgren and Whitehead:
Rainbow-like layers around the individual, moving to the wider
society.
Intervention policies and programmes
Intervention = specific procedures, regimens or services conducted
with the objective of changing the direction of an expected
development in health status into a desirable direction.
they usually address the conditions that affect individual lifestyles at the level of determinants
Prevention = universal, selective, indicative (preventive measures at the level of large populations,
risk groups and the individual) and care-related prevention (close to the early stages in individual
health care).
For mental health and social well-being it is self-evident that they cannot be studied in individuals
independently from the communities to which they belong.
Health promotion is closely related to prevention. Health promotion = the process of enabling people
to increase control over their health and its determinants, and thereby improve their health.
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