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Health in society readings + lectures summary
- Instelling
- Universiteit Utrecht (UU)
Summary of all lectures and all the mandatory readings
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Health in Society, lectures + readings(201900017)
Readings Lecture 1 – Chapter 1/2/3
Chapter 1 Understanding Health: Definitions and Perspectives
Health
- Biomedical model (clockwork): dominates the Western health
discourse, viewing the body as a machine. Health is the absence of
disease, with disease seen as mechanical malfunctions in the body
- Critics neglects social, psychological, and spiritual factors +
making small health problems seem bigger to sell more medication
(disease mongering)
- WHO definition: health is a state of complete physical, mental,
and social well-being, beyond the mere absence of disease.
- Indigenous views focus on community, culture, and environment
- Lay people view health as complex, combining the absence of
illness, functionality, and well-being
- Health inequities: disadvantaged communities are aware of how
material conditions affect health, often associating health with social
justice and moral identity
Blaxter’s 8 perspectives on health
1. Health is not being ill
2. Health as a reserve of strength for recovery
3. Health as a behavior or a healthy lifestyle
4. Health as a physical fitness
5. Health as energy and vitality
6. Health as social relationships
7. Health as functionality
8. Health as psycho-social well-being (happiness and mental state)
Health in different contexts
- Health as self-control: seen as self-discipline, willpower, and self-
denial, mainly by middle-class and some blue-collar workers.
Thinness is valued as a sign of control; fatness is seen as a failure
- Health as release: viewed as feeling good, especially among
working-class males. Health rules are often rejected, and leisure is
seen as a release from societal pressures
Critical perspectives on health
- Marxist view: capitalist societies produce illness by prioritizing
profit over worker health. Health is functional, defined by
productivity rather than personal well-being
- Political economy perspective: focuses on social inequities in
health, emphasizing how economic and structural factors impact
collective health more than individual choices
- Individual responsibility: under capitalism, individuals are made
to feel responsible for their health, obscuring the broader social
causes of ill health
Health outcomes and collective contexts
, - DALYs (Disability-Adjusted Life Years) are used in public health to
measure the overall burden of disease
- It is calculated as years of life lost (due to premature death
compared to a standard life expectancy how many years of life
are lost when someone dies earlier than expected) and years lived
with disability (the years lived with a disability or illness, weighted
by the severity of the conditions)
- They can undervalue certain populations, such as the elderly or
disabled
- Healthy Cities: WHO’s Healthy Cities initiative stresses that
community and environmental factors, like clean environments and
social support, are critical for public health
- Health is not only individual but collective, shaped by structural
factors like housing, income distribution, and cultural dynamics
Chapter 2 A history of public health
The 7 eras of public health
1. The era of epidemics and infectious diseases (pre-1800s)
- Public health concerns were largely focused on controlling infectious
diseases, which were rampant due to poor sanitation and
overcrowding in urban centers
- Responses were reactive, with quarantine measures, basic
sanitation improvements, and rudimentary public health laws
enacted to control the spread of diseases, such as cholera and the
plague
- European colonization introduced public health challenges
2. Nineteenth-century public health movement (1800s)
- Marked by its first organized efforts to address health through social
reforms rather than medical interventions. The focus was on
improving sanitation, housing, and working conditions
- Public health pioneers promoted sanitation reforms, leading to
cleaner water, waste management, and improved urban planning,
which reduced disease prevalence
- Rising living standards (especially better nutrition) were the main
driver of declining mortality
3. Nation-building era (early 1900s – 1930s)
- Public health became closely tied to nation-building, with the state
promoting individual health as part of national strength and duty
- This period emphasized improving population health through school
medical exams, hygiene education, and public services aimed at
infants and mothers
- The state’s role expanded in education, social services, and
regulation to improve living conditions and health
4. Post-war public health and affluence (1940s-1970s)
- After WWII, there was a significant investment in social
infrastructure, including housing, education, and healthcare
services, fueled by postwar economic affluence
- Public health shifted towards more medicalized approaches,
focusing on immunization and treatment for diseases, like
, tuberculosis and polio, though much of the mortality decline had
occurred before these interventions
- High focus on infectious diseases, while broader social factors were
less emphasized during this period
5. The golden age of medicine (the 1950s-1970s)
- Marked by significant medical advancements (new drugs, surgeries,
organ transplants) that coincided with rising living standards in
Western countries
- Medicine gained prominence over public health, although most life
expectancy improvements had occurred due to earlier social
reforms rather than medical breakthroughs
6. Economic recession and public health resurgence (1970s-
1980s)
- The 1973 oil crisis and economic downturn ended the era of postwar
affluence, leading to cuts in public spending, including healthcare
- Public health started to regain attention, focusing on chronic
lifestyle diseases (like cardiovascular diseases and cancers) and
environmental determinants of health
7. New public health era (1980s – present)
- The ‘new public health’ movement embraced a holistic approach,
acknowledging social, economic, and environmental determinants of
health
- Public health expanded beyond infectious diseases to include
chronic diseases, lifestyle changes, and environmental health,
reflecting lessons learned from earlier eras
Theories of disease causation
1. Miasma theory
- Diseases were caused by ‘bad air’ or noxious smells from decaying
organic matter, such as rotting vegetation or human waste
- Proponents believed that exposure to foul odors, particularly in
overcrowded and unsanitary environments, led to illnesses like
cholera, typhoid, and malaria public health measures focused on
sanitation reforms to eliminate bad smells. Cities improved waste
management, sewage systems, and water supplies to reduce the
presence of harmful odors
- Although incorrect in its explanation of disease transmission,
miasma theory had practical benefits sanitation improvements
2. Germ theory
- Diseases were caused by microorganisms (bacteria, viruses, and
other pathogens) that could be transmitted between individuals or
through contaminated water, food, or surfaces
- It led to more targeted public health measures, such as sterilization,
vaccination, and quarantining of infected individuals
- Germ theory provided a scientific basis for identifying the exact
causes of diseases, leading to medical breakthroughs and more
effective interventions for preventing and treating infections
Chapter 3 The New Public Health Evolves
The 1970s: shift to lifestyles and medicine critique
, - Medical advancements were questioned for their limited impact on
life expectancy while rising costs highlighted diminishing returns
- The ‘lifestyle’ concept emerged, emphasizing individual behavior
and its impact on health
- Health Belief Model (HBM): a psychological model that attempts
to explain and predict health behaviors by focusing on individual
beliefs and attitudes
The 1980s: Ottawa charter and health promotion
- The Ottawa Charter (1986) became the foundation of the new
public health advocating for health promotion strategies involving
peace, equity, and social justice
- The charter emphasized policy changes, social movements, and a
broader view of public health beyond individual behavior
Health inequities and global health systems
- The MDGs are being revised into the SDGs, promising a broader
inclusion of social determinants perspectives
- The aspiration for ‘Health for all’ by 2000 was not achieved,
particularly in sub-Saharan Africa, where life expectancy declined
due to the HIV epidemic
- Health inequities have generally increased over the past two
decades, with criticism of WHO’s effectiveness in addressing global
health concerns
Challenges faced by health systems
- Global health initiatives often focus on specific diseases, leading to
fragmentation and local brain-drain from public health systems to
NGOs offering better salaries
- Wealthy nations also prioritize specific diseases and lifestyle
interventions over addressing underlying causes of ill health
- The effectiveness of health systems is more closely linked to the
proportion of public expenditure rather than total health spending
Public health funding
- Evidence suggests that universal access to health care through
public funding is more effective than privatized systems
- Countries like Australia and the UK, with predominantly public health
systems, show better health outcomes despite lower spending than
the US
- There are calls for massive investment in health systems to achieve
universal health coverage (UHC), with emphasis on
comprehensive primary health care as a cost-effective solution
Resisting medicalization
- Due to the rapid expansion of the health and pharmaceutical
industry, disease mongering has become a thing mild
conditions are medicalized to expand markets for the treatment
Changes in primary healthcare
- Divisions of general practice were created to help doctors work
better with community health services
- Medicare locals were set up to improve healthcare coordination but
faced cuts to community health services in some areas
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