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Samenvatting Public Health Practice
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Summary of 106 pages for the course HNE38606 Public Health Practice at WUR
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Evolution of epidemiology in society Epidemiology, as we know it today, was developed by those who were eager
to learn about contemporary health issues and who were willing to act
accordingly, in the times and places in which they lived.
Epidemiology has developed from social medicine and statistics, and can be
characterised by 'population thinking' and 'group comparisons'.
Historical descriptions of epidemiology distinguish a pre-formal phase, early
epidemiology, classical epidemiology and the current phase of modern
epidemiology.
Modern epidemiology has developed formalised theories that integrate study
design with methods of data analysis, descriptive statistics and causal
thinking in biomedical sciences.
In the evolution of epidemiology, descriptive studies and interventions have
gone hand in hand with unravelling aetiology and conducting preventive
actions, successively relevant to infectious diseases, nutritional deficiencies
and chronic disease aetiology.
The dominance of lifestyle-related health issues in Western societies calls for
the further development and application of descriptive and aetiological
studies in order to improve and test the effectiveness of preventive and health
promoting strategies
To further develop public health epidemiology, professionals in this discipline
require skills and expertise to integrate the local and (trans) national social
context with the policies, practice and research in their local situation
,Introduction
Lecture 1. Annemien Haveman-Nies (Chapter 1)
Public Health Practice
Why do we need to know public health practice?
If we know the system, if we know how policies are made and evaluated, we can
contribute to the policy-making process and influence the public health agenda
with our scientific knowledge.
Research versus policy
Research and policy are complete different worlds. Even though it was already
identified in 1950 that smoking is the biggest lifestyle cause, taxes were raised
on tobacco in 1972 and smoking regulation in Europe and the Netherlands was
introduced in 2004. Since the new government in 2010, there is a weaker smoke-
free hospitality law, effective treatment of tobacco addiction is no longer
reimbursed and STIVORO (expert centre on smoking) will lose its government
funding. What will happen to the prevalence of smokers?
Epidemiology and public health
History
Pre-formal Early Classical Modern
1662-1900 1900-1940 1940 - 1980 1980 onwards
Infectious Transition of acute Chronic diseases
diseases, infectious to
nutritional chronic disease Large-scale Intervention trials
deficiencies epidemiological (focus on clinical
Interdisciplinary studies (post- and lab situation,
Key figures: nature of WWII) need to focus on
Graunt, Farr, Snow epidemiology health problems)
New epi-methods,
study designs
Infectious disease > chronic disease > any disease > all aspects of
human health
The big picture of population health
How can epidemiology contribute to population health? Investigate how the
determinants are related to good health and how to optimize this. Health has an
central position; it is important for people to be productive to do things that are
meaningful for them. Determinants of health are for example: good diet, enough
physical activity, proper management / good health system and good
circumstances/conditions such as a good social and physical environment.
2
, Basic logic model
Interventions Determinants of Health of individuals
meant to modify health: endogenic and population, e.g.,
determinants by factors, lifestyle, according to
means of policies physical and social definition of WHO
and programmes environment, health and Ottawa Charter
care
Societal context (condition and circumstances) of public health, including the
interests of the communities involved and the interplay between policy, practice
and research.
The health of populations emerges from the distribution of its determinants,
which can be influenced by interventions. Public health epidemiology studies
these relationships and accounts for the interactions with the societal context at
all three levels.
The main determinants of health (Dahlgren and Whitehead,
2007)
Endogenic factors (age, sex hereditary
factors)
Individual lifestyle factors (smoking,
drinking, dietary habits, physical
activity, overweight)
Environmental factors
o Social and community influences
(areas for local health policy and
practice)
o Living and working conditions (to
some extent influenced by
(inter)national policies)
o General socioeconomic, cultural
and environmental conditions (to some extent influenced by
(inter)national policies)
Lalonde: endogenic or person-related characteristics, lifestyle, physical and social
environment, health care (including preventive action).
Health in the Netherlands
Causes of death Disability-adjusted life years
1. Coronary heart diseases (DALYs)
2. Lung cancer 1. Coronary heart diseases
3 2. Depression
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