Health and policy
Lecture 1: Introduction to the course and general topic Health and Policy
Learning objectives
After this lecture and reading the compulsory literature (ch1, 2 and 3 Eyler et al.) students can
describe and explain:
• Main concepts in public health
• Factors op influence on population health based on two basic models
• Social determinants and policy that influence people’s health
• Some theoretical approaches in the Public Health policy process (ch 3 by Eyler et al.)
Important concepts in this course:
More than one definition
Public Policy = refers to laws, regulatory measures, courses of action, and funding
priorities concerning a given topic by a governmental entity or its representatives
○ local or national governments actions
○ Definition of RIVM: PH refers to health protection + health promotion for the population
as a whole/specific groups, including prevention and early detection of diseases (Dutch
Public Health Act).
■ RIVM: it is not what the general practitioner (huisarts) does, because that
is individuals focus and public health is on the whole population or larger
specific groups
○ WHO definition: The science and art of preventing disease, prolonging life and promoting
mental and physical health and efficiency through organized community efforts. Public
health may be considered as the structures and processes by which the health of
populations is understood, safeguarded and promoted through the organized efforts of
society.
Health policy = refers to decisions, plans and actions that are undertaken to achieve specific
health care goals within a society (WHO)
● If you want to know how the general population's health is, you need to have an
indicator, measure and compare, life expectancy is the average age that someone, born
in a specific year, big difference between different regions in the world
● Life expectancy: indicator for population health. It reflects the overall mortality level of a
population; It summarizes the mortality pattern that prevails across all age groups in a
given year – children and adolescents, adults and the elderly.
○ Global life expectancy at birth in 2016 was 72.0 years (74.2 years for females
and 69.8 years for males)
○ Ranging from 61.2 years in the WHO African Region to 77.5 years in the WHO
European Region, giving a ratio of 1.3 between the two regions;
■ If you have a very high child mortality rate in a country, for every child that
dies under the age of 5 , you also need to have someone of the age of 80
■ Also differs in Europe, mediterranean diet, healthy lifestyle,
,Main factors of influence on Life expectancy:
Education:
● Males with the lowest education in the Netherlands live on average 7 years shorter than
those with the highest education
● This difference more than doubles (17 years) when looking at number of years living in
good health
● Education is related to income, what you can afford, where you can afford to live, if you
can afford a healthy lifestyle
● Very important factor
What determines our health: two basic models
1. The Health Field Concept model by Lalonde (1976)
2. The Socio-ecological Framework by Dahlgren and Whitehead (1991)
The Health Field concept model by Lalonde (1976)
● Rather old, but made a huge difference how people thought about health, what is
influencing health
● Before this idea, it was mainly that health was influenced by human biology (biological
and genetic factors) and health care
● But then he saw there were also different factors that influenced people’s health:
lifestyle and environment (physical and social), these were not treated in the health
care system
● As a result → public health was introduced
,The Socio-ecological framework by Dahlgren and Whitehead (1991)
● Elaborate on model of Lalonde
● It starts all with you constitution → Age, gender, genetics
● Then individual lifestyle factors, something that you develop from childhood onwards
→ school environment, family, friends influence this, all these social
● Environments influences your individual lifestyle
● Green circle: living and working conditions, opportunities in housing for example, is it
a safe and healthy environment where you live. Is there enough work, can you earn a
healthy , how societies differ in conditions and opportunities
● General socio economic cultural and environmental conditions: combination of what
society offers you and which choices you make
● Lifestyle is not only individual choice, it also has to do the conditions and opportunities
society offers
● The model assumes that interactions between individuals and their environment are
reciprocal, implying that an individual is influenced by his/her environment and the
environment is infl uenced by the individual.
● (1) the individual/intrapersonal sphere, (2) the interpersonal sphere, (3) the
organizational/institutional sphere, (4) the community sphere, and (5) the policy sphere
Social determinants in health
Life expectancy in the past century: grew for both men and women but women have a higher life
expectancy compared to men.
Factors related to increase life expectancy:
● Economic prosperity: if people get better education, live in less poverty conditions,
improved working circumstances, housing, improved food, water and air quality → is all
related to economic prosperity → can increase health
, ● Improved health care: better treatments, care, prevention and health promotion are
important factors in promoting people’s health
● Changing disease patterns: decrease of infectious diseases through both improved living
conditions, better treatment (antibiotics) and vaccination programs and increase of
chronic diseases
○ Now we see a more increase of chronic disease related to lifestyle factors
Economic prosperity and life expectancy: how are they related?
● GDP: growth domestic
● Life expectancy goes up as economic prosperity (GDP) increases
● If the GDP increases further from 3000 till 5000 the increase in life expectancy is almost
zero
● USA deviates from the curve, very high spending in health care but life expectancy is not
that high, why/how?
○ Lifestyle: obesity
○ Individualistic
○ Huge income inequality, you have very rich people and very poor people
○ Not a public safety net
