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Midterm Summary of The New Public Health chapters 1,2,3,4,5,24,6,7,8,9,11,12,13 and 4 Lectures
Hopefully this summary will help you prepare for the midterm exam of the course 'Health in Society'
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Voorbeeld van de inhoud
Health in Society. Book + LecturesPart 1. Approaches to Public Health
Chapter 1. Understanding Health: defniitns and perspeciies
Defnitons of health structure the ways in which the world is tiewed and how decisions are
made. Health policies are shaped by policy makers’ assumptons about what health is.
For much of the past two centuries, health was defned as the body operatnn efciently like a
machine. → clockwork model of health. This model innores the social, psycholonical and
spiritual aspects about beinn healthy.
Biomedicine made a distncton between disease and illness. Disease intoltes a set of
symptoms and medically diannosed patholonical abnormalites. Illness is primarily about how
an inditidual experiences the disease.
A critiue on the biomedical, clockwork tiew is that health is more than the absence of disease.
The World Health Ornanizaton defned health as the complete state of physical, mental, and
social well-beinn, and not merely the absence of disease or infrmity. This defniton of health is
howeter tery hard to measure.
‘Ordinary’ people also nite multple defnitons of health. Crawford (1984) discotered two main
discourses of health:
- Health was seen by some as self-control and a set of related concepts that include self-
discipline, self-denial and willpower. Health as somethinn that can be achieted throunh
healthy behatiour.
- Health was seen by some respondents as a release mechanism, who eiuated it with
feelinn nood as distnct from followinn rules of medical authority.
Public health focuses on populatons rather than inditiduals. The two approaches nite rise to
different iuestons on health issues. So tiewinn health and disease from a public health
perspectte means takinn a tiew of populatons, not just of inditidual within them.
Chapter 2. A histtry tf Public Health
There hate been seten distnct periods in the detelopment of public health thinkinn and
practce in all countries (see table 2.1 in the book). Chapter 2 discusses four of these eras;
1. Era of Indinenous control. There was no permanent setlement, so they did not hate public
health problems associated with permanent setlement.
2. Colonial Era (untl 1890s). Throunh colonisatons and industrialisaton, new diseases
emerned (like cholera). Because of this, public health measures started to emerne. There
,Health in Society. Book + Lectures
were howeter different theories about how infectous diseases were spread. Some people
eten thounht it was God’s will. Reactons to diseases like the planue were putnn the
people in iuarantne. Howeter, it led to improted sanitary inspecton of houses, beter
monitorinn of the city’s housinn and health situaton and an etidence-based understandinn
that the planue was carried by feas from infected rats.
McKeown (1979) talked about the non-medical factors in improtinn the health of populatons in
industrialised societes. He belieted that improted litinn standards, especially nutriton, were
responsible for the decline in mortality. So he arnues that mortality was declininn before
effectte medical intertentons were atailable. Szreter (1988) reconnises that risinn litinn
standards contributed to lonner life expectancy, but arnues that intertentons from noternment
authorites were the crucial factors that enabled health to be improted. Economic nrowth itself
does not improte health, it all depends on how the fruits of that nrowth were deployed
(Szreter, 1988).
3. Naton-buildinn era (1890-1940s). Public health was promoted and used for naton buildinn
in this period. Public health was typical of the nrowinn state intertenton. Economic
pronress was seen as leadinn to improtements in health. This period consolidated the
health of citzens as a lenitmate concern of noternments.
4. Affluence, medicine and infrastructure (19s0s-early 1970s). Postwar period. Protision of
health sertices expanded. In this period, infectous diseases were seen as less threateninn
and the protision of clean water and sewerane was extended to nearly all Australians (and
Europeans). Medical therapies increased in this period. It was a nolden ane for medicine,
because economies were expendinn, so there was enounh money to detelop new research
methods etc.
Chapter 3. The New Public Health eitlies
s. Lifestyle Era (late 1960s-mid-1980s). Discotery of lifestyle and its impact on health. Mostly
psycholonical theories were used to create channe in inditidual lifestyle. Goternment
mainly focuses on behatioural approaches of health and ineiuites in health.
6. New Public Health era (mid-1980s-mid-1990s). Health care budnets contnued to expand in
the 1980s and the prospect of cutnn these by improtinn health of populatons became
increasinnly atractte. The focus became on collectte measures. A central stratenic
directon for the new public health was WHO’s Healthy Cites pronram, which in essence
took cites as the units for public health pronram planninn, rather than inditiduals.
7. Global New Public Health (mid-1990s to twenty-frst century). Internatonal detelopments
in the New Public Health. The main aim of healthy public policy as beinn to create the
preconditons for healthy litinn throunh:
- Closinn the health nap between social nroups and between natons
- Broadeninn the choices of people to make the healthy choices the easier and most
possible
- Ensurinn supportte social entironments
,Health in Society. Book + Lectures
For recommendatons of the commission on social determinants of health → see box 3.2
Health systems based on the principle of unitersal coterane achieted throunh public fnancinn
are nenerally cheaper, more efcient and more eiuitable.
The health and pharmaceutcal industry is one of the fastest nrowinn industries in the world.
Larne companies intolted hate been accused of disease monnerinn; the sellinn of sickness that
widens the boundaries of illness and nrows the markets for those who sell and deliter
treatments.
This chapter discusses how the new public health deteloped in Australia. Australia could be
seen as an example, so for further readinn on this example → see the book.
Key players in Australian public health are:
- the Federal noternment
- State and territory noternments
- Local noternments
- Non-noternment ornanisatons, professional and community ornanisatons
- Primary health care protiders
- Unitersites and research insttutons
24-4 Lecture 1. Intrtducitn
Health in society= public health.
Introducton to (new) (public) health.
- What is health?
Absence of disease, but also the way we feel about it. The competence and self-mananement of
your life is also an aspect.
Clockwork model in medicine; classical, dominant biomedical perspectte. Any breakdowns in
the body system sinnal that a person is not healthy. The problem is that people can feel unwell,
but they do not necessarily hate a disease, so in this defniton, they are healthy. Besides that,
this tiew is oterly mechanistc. It only focuses on the body. Furthermore, who decides what
normal functoninn is?
Other tiews say that health is more than an absence of illness; social medicine, traditonal
medicine, behatioural medicine.
WHO nate a different defniton→ see chapter one in the summary.
Health is more difcult to defne than illness.
Crawford (1984) researched socially paterned discourses amonn health, there is a social
distncton in what we think health is;
,Health in Society. Book + Lectures
1. Health as reiuirinn self-control → people can achiete health themseltes by behatinn
healthy. Mostly middle-class tiew.
2. Health as release mechanism. Health is feelinn nood, distnct from followinn rules of medical
authorites. Mostly workinn class tiew.
- What is public health?
Public health is concerned with the health of populatons rather than inditiduals. It’s focus is on
places, setnns and locatons. It is about protectnn nroups rather than treatnn inditiduals.
Vaccinaton anainst the fu is an example of a public health measure.
WHO came with the initatte healthy cites; an initatte to improte public health in a city.
Creatnn healthy cites, promotnn and protectnn the health of its citzens.
Roots of public health.
Combatnn infectous diseases. Collectte health measures throunhout history → relinious
measures and teachinn, for example circumcision.
From the 19th century on, UK public health reforms. Renulatons and politcs emerned in public
places. These measures had to do with for example clean water and hyniene.
What infuences health most?
McKeown’s thesis; improted standards of litinn (notably nutriton) hate improted public
health. Critiue is that he underestmates the role of public health policy and actons.
- What is new public health?
New public health is about creatnn eiual opportunites for improtinn nood health.
Aims & talues;
Eiuity is at the centre of new public health. Social and entironmental factors are seen as key
contributors to ill health.
New public health tries to make sure that there is a stronn, foundatonal system of primacy
health care.
New public health is thus a pretentte and communal approach to public health policy.
So since the mid 1980s we’re thinkinn about public health in a new way. We try to encourane
people to lite a healthy life. All sort of policy areas affect our health, so we should look into
different sectors to improte populaton health. It needs an intersectoral approach.
Part 2: Politcal Economy of Public Health
, Health in Society. Book + Lectures
Chapter 4. Ethics, ptliics and idetltgies: the iniisible hands tf public health
● Politcal systems and ideolonies and their impact on public health.
Three basic criteria for the classifcaton of politcal systems:
- democratc/undemocratc
- liberal/ authoritarian
- enalitarian/ inenalitarian
The politcal and economic context of countries plays a major role in shapinn opportunites for
health. Social democratc models of states consists mostly of state intertentons to reduce
ineiuites. The beliete is that the state should intertene to make sure that the capitalist system
does not innore the needs and rinhts of those who are not powerful in the market. This one is
thus most in tune with the aspiratons of the new public health.
Liberal states beliete in the power of the market to meet the needs of people and stress
inditidual responsibility.
The consertatte model is based on a social insurance model whereby people hate a rinht to
welfare based on past contributons.
After world war II, relattely nreat state intertentons came up. Howeter, in the 1980s, the oil
crisis channed maters and neo-liberal policies spreaded.
Natarro and Shi (2001) looked at the impact of the major politcal traditons in the adtanced
OECD countries and compared them on different determinants, also health. They concluded
that the social democratc politcal traditon (social democratc forms of welfare renimes) hate
beter health than those that are more neo-liberal.
Socialist and communist noternments promote centralised control oter the economy and many
other aspects of society, and ban pritate, capitalist enterprises. They aim to create enalitarian
societes.
● Ethical issues in public health.
Inditidualism holds inditiduals totally responsible for their actons and the conseiuences,
includinn health. Autonomy is its key principle. Autonomy refers to an inditidual’s capacity to
make free choices and ability to control the directon of his or her own life. Paternalism, on the
other hand, refers to practces that restrict the liberty of inditiduals, without their consent,
where the justfcaton for such actons is either the pretenton of some harm they will do to
themseltes or the producton of some beneft for them that they would not otherwise secure.
An example of a rule that appealed by the paternalistc principle is the oblinaton to wear seat
belts.
There are two broad nroups of ethical theories: conseiuentalist and non-conseiuentalist, or
deontolonical. Conseiuentalism holds that most ethical decisions are based on a calculaton of
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