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Lecture notes Health in society
- Instelling
- Universiteit Utrecht (UU)
Extensive notes of all lectures of the course health in society.
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Anne Ponsteensv lectures health in society
Lecture 1 - Introduction to new public health
- Not everybody can reach the same level of biological health due to genes or earlier
diseases
- Policies, economics and politics are in a large measure responsible for the health of
people → bad politics etc. make it impossible for a majority of people in the world to
enjoy their best biologically possible health
- There are social determinants of health, these are the conditions in which people are
born, grow, live, work and age (social groups)
- Individual health and social conditions/quality of life are connected, this means that
health policy shouldn’t only include personal health interventions but also social
service interventions
- What is health?
1. Old health - clockwork model in medicine: the body is a machine, the focus lies on
keeping the machine running and if something is broken it needs to be fixed
(meaning doctors are focussed on fixing bodily illnesses). Health is when the body
operates efficiently, like a machine
2. new health: criticism on the clockwork model, health is more than the absence of
illness. There are also mental illnesses and being healthy doesn’t mean the same to
everyone. WHO (1948): health is a state of complete physical, mental and social
well-being and not merely the absence of disease or infirmity
3. Positive health: more than the absence of sickness, focus on strengths that
contribute to good health and protect against illness (like physical, mental and
spiritual aspects). In positive health there is more attention for the overall quality of
life (also regarding daily functioning and social participation
- What is public health?
→ holistic, health of populations rather than individuals
→ protecting groups of people with an prevention approach rather than treatment
→ collective rather than personal interventions that target places, settings and
locations
- Collective health measures began around the 19th century in the UK. By increasing
public hygiene (trough access to clean water) many diseases decreased
- McKeown’s thesis (1979): improved living standards are more important than medical
advances (the illness tuberculosis decreased significantly even before any
treatments were invented because of an increase in public hygiene) → this is not the
case for all diseases because the way disease spread differs
- Main critique McKeown’s thesis from Szreter (1988): it was not only the living
standard that improved on itself, the public health movement had an important role
by providing better working conditions, housing, education, health services etc.
- An example is the WHO’s healthy cities approach which promotes physical and
social environments, strong communities and a focus on trust and community
spaces.
- A healthy city is defined by a focus on wellbeing and not objective physical health. It’s
also more of a process rather than an outcome, it’s more something that continuously
improves and evolves.
- What is new public health?
, Anne Ponsteen
- The difference between old and new public health is equity: not only a few groups,
but everyone should benefit from it; “health for all”
- New public health also:
- introduced an all-encompassing system: all sectors and policies should play a role
in promoting health
- increased the importance of citizen participation and involvement
- The Ottawa charter (initiative of the WHO) is the current consensus on how to
promote the new public health, these are the centerpoints:
1. building healthy public policy
2. Creating supportive environments for a healthy lifestyle
3. Reorienting health services
4. Developing personal skills (providing knowledge and education)
5. Strengthening community action (building a trusting community)
- Often people jump to solutions without analysing the problems to be addressed fully.
To prevent this from happening there is a health program planning cycle:
identify the health concern → conduct health needs assessment → program design
→ program implementation and evaluation → is the problem solved or not?
- There are 2 main issues for research:
1. causes of, and contributors to health
- individual/social structural factors but also biology, behaviour, support, environment,
policy and economy
2. effectiveness of policies and interventions
- which approaches effectively influence underlying factors → distinguish the
difference between individual, social and structural approaches to change
- The type of approach/solutions determines the research design (quantitative,
qualitative, experiment, questionnaire etc.)
Lecture 2 - Politics, inequity, and social determinants of health
- Rudolf Virchow (1821-1902): Medicine is a social science, and politics is nothing else
but medicine on a large scale (public health is a political process)
- There are multiple issues that should be considered when talking about public health:
population health, health system capacity, wellbeing/mental health, economic &
cultural life and the effect of a crises on national and international level
- Public health is more than a technical issue that should be covered by experts and
professionals → they might have different views, sometimes evidence requires
understanding and limited resources imply choices → hence the opinion of social
scientists can have a lot of value
- Considering the choices that have to be made about public health, there are different
interest groups like health professionals, concerned citizens, business community,
cultural institutions, the press, etc.
- Politics also shape how we view health issues since they (partly determine) our
worldview, values and ideologies → public health actions are expressions of
dominant political ideologies (baum)
- But how strong is the relation between politics and population health? →
meta-analysis by Muntaner et al., findings:
1. there is a positive association with welfare state generosity: more investments in
social policies means better public health
2. Positive association with social-democratic political tradition and democracy: lands
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