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Samenvatting Health in Society
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Health in societyLecture 1: Introduction to new public health (05-09-2019)
Social determinants of health: conditions in which people are born, live, work.
Poor people should not suffer poor health.
What is health?
Clockwork model in medicine: body is a machine. Health is when the body operates
efficiently, like a machine. All the parts should do their job and then it’s fine.
Health is more than absence of illness.
Positive health: strengths that contribute to good health and protect against illness. It’s
about feeling good. Physical, mental, spiritual aspects. People report a good quality of life.
Physical, mental and spiritual aspects. Daily participation and social participation. Quality of
life.
What is public health?
Health of populations rather than individuals.
- holistic/ecosystems understanding.
Preventions approach rather than treatment
- protecting groups of people.
Collective rather than personal interventions
- focus on places, settings, locations.
Roots of public health:
Combatting infectious diseases.
Collective health measures throughout history.
Trying to prevent these large outbreaks of diseases.
WHO healthy cities approach:
Psychical and social environments
Strong community: citizen participation.
Focus on such outcomes as number of trusting people: availability of community spaces.
,Enhance citizen’s participation, creating more trust. Free drinking water taps. Playgrounds.
What influences public health?
Figure about tuberculosis: Mckeown’s thesis: improved living standards were more
important than medical advances. It’s not the medicine, all the social determents were
crucial.
main critique: Important role of public health movement.
The nine domains of GNH: one domain is about health and the others are more about social
well-being. So, it is more about not only the absence of health.
Is this public health?
- Measles vaccination: yes
- Support programs to quit smoking: yes
- Treatment of STI infection: yes, because by treating the person he cannot spread the
diseases.
- Efficient public transport: yes, reducing car use less co2.
- No work email after 5pm:
New perspective on public health
Equity takes center stage (health for all): differences that are not caused by for example age
of biological differences.
All-encompassing system: all sectors of the society and all policies should play their role in
promoting health.
Importance of citizen participation and involvement.
The Ottawa charter
- building healthy public policy: most policies that affect health lie outside conventional
concerns of health agencies. Health becomes a concern and responsibility of each sector of
government
- environmental protection
- social welfare
- education
- control on the sale of substances
- creating supportive environments: Social, economic, and physical environmental factors
shape people’s experiences of health. Supportive environments must be created in which
people can realize their full healthy potential.
- reorienting health services: Shift primary health services from centralized, hospital- and
technology-based care to a community-based system. Offer user-friendly and controlled
health services.
- developing personal skills: Behaviour and lifestyle play a role in shaping health. Developing
those skills that enable people to make healthy choices. Enable people to become advocates
and lobbyists for communities.
- strengthening community action: Support and encourage collective organization and
taking of action. Build communities’ ability to achieve change in their physical and social
environments.
, Two main issues for research
Causes of, and contributors to, health
• Individual, social, structural factors
• Biology, behaviour, support, environment, policy, economy
Effectiveness of policies and interventions
• Which approaches effectively influence underlying factors?
• Individual, social, structural approaches to change
Lecture 2: Health and politics and policies
“Public health actions are expressions of prevailing political ideologies”
Politics and public health
Policy: is a critical aspect of health promotion and entails a wide range of approaches.
Policy and health promotion:
Key concepts:
• Values
Principles or standards of behavior: Judgement of what is important in life
• Ideologies
System of ideas and ideals as basis of economic or political theory and policy
• Political economy
Systems of distribution of income/wealth in the context of social (class) arrangements
Politics as sense-making
Political beliefs and values shape people’s often implicit notions of disease prevention
Hidden arguments (Tesh, 1988)
• What is a legitimate source of knowledge?
• What is the ideal structure of society?
“Answers to these questions guide scientists, policy makers, and ordinary citizens alike to
different constellations of facts about the causes of disease and, hence, to different
preferences for prevention policy”
Classification of political systems
Blondel (1990)
• Democratic/undemocratic
• Liberal/authoritarian
• Egalitarian/inegalitarian
Welfare state regimes Scandinavian/Nordic countries
Social-Democratic tradition – generous provisions
Anglo-Saxon countries
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