Case 1: The New Public Health
1 What are the definitions of communicable and ● C: “ illnesses caused by viruses or bacteria that people spread to one another through
non-communicable diseases? contact with contaminated surfaces, bodily fluidss”
● What are the measures (criteria) to determine ○ Contact with blood and bodily fluids; breathing in an airborne virus; or being bitten
by an insect
when a disease is communicable or not?
○ Last for a short period following a certain infection lifecycle
● Some examples of both. ● NC: “Diseases that are not spread through infection or through other people, but are
typically caused by unhealthy behaviors”
○ Caused by genetic, psychological, environmental, or behavioral factors
2 What are the differences and overlaps between CDs, ● Differences:
NCDs (and chronic and infectious diseases)? ○ C: Require an infection, transmittable diseases, Direct physical contact with an
● What are some exceptions (e.g. diseases that infected person, Breathing in an airborne virus, they can affect all individuals
equally
are infectious but not communicable)?
■ EG: HIV/AIDS, tuberculosis, malaria, influenza
○ NC: not infectious and cannot spread from one individual human or animal to
another, long-term health consequences, people in low- and middle-income
countries,
■ (globalization of unhealthy lifestyles has expanded NC diseases in recent
decades
● Chronic diseases and non-communicable diseases are usually used interchangeably,
while infectious diseases are a subgroup of communicable diseases.
3 What is the significance of New Public Health to ● 6 functions
communicable and noncommunicable diseases? ○ 1. Public health as health protection mediated through society's social structures
● How has the concept of NPH changed to fit this, ○ 2. Shaping distinct public health discipline by sanitary movement
and how has the knowledge increased? ○ 2. Contagion control
○ 4. Preventive medicine
○ 5. Primary healthcare
○ 6. Health Promotion
● NPH: Addresses health system management of both in & outpatients, relationships with
home care and primary care
○ Incorporate health policy, and health promotion in primary/secondary/tertiary
prevention
● Mission of NPH: “Maximize human health & well-being to help redress societal and global
inequalities”
, Case 2: Epidemiological Changes in Europe
1 What are the causes of the health gap? ● Geographical differences (living near factories), Cultural factors
a. Differences between West & East ● Social determinants of health (Disparities in income, education, employment
opportunities), Environmental factors, Lifestyle, and behaviors
● Tackling Cardiovascular disease with improved diet, reduced chol, effective treatment,
economic conditions
● East: Lowest life expectancy
● 10-year age gap between West & East Europe
● The difference in cardiovascular disease, e.g. smoking -> more prevalent in Eastern
Europe. (tobacco could be cheaper)
● More stressful occupation
2 What is the “theory of Abdel in 1971”? ● Historical shifts in the patterns of diseases and mortality that occur as societies undergo
a. Limitations of the theory economic and social development.
b. Suggestions made after criticism ● A framework for understanding how health and disease profiles change over time as
countries and regions transition from one stage of development to another.
● 3 distinct stages of epidemiological transition
● “Age of Pestilence & Famine” - High and fluctuating mortality rate, life expectancy with
low average life span
● “Age of receding pandemics” - declining mortality, steeper epidemics, increased
average life
● “Age of Degenerative Man-Made Disease” - Infectious agents are major contributors to
morbidity and morality taken over by anthropogenic cause
● Limitations:
○ Disagreement about the role of medicine in public health
○ Cities and organized societies trigger the first transition with social stratification
(socioeconomic tiers: wealth, income, race, education, and power)
3 Why is the epidemiological transition useful? ● Offers a historical perspective on the shifting patterns of society, makes us understand
that shift in the pattern of diseases.
● Helps us improve the healthcare infrastructure (so aspects are not always linear)
● Predicting future health needs
4 How has epidemiology changed in the past 100 ● Change focus on international challenges & chronic diseases. Technological
years? advancements, thus analysing data more efficiently.
a. How have definitions/criteria changed? ● Past: infectious diseases that were the cause of huge mortalities especially since
urbanisation was initiated
b. What trends are observed?
● Nowadays: all countries are suffering from NCD causing the greatest amounts of death
, Case 3: Hepatitis B and C
1 What are the different transmission routes of ● Children
Hepatitis? ○ HBV: Infected children often spread the virus to other children if there is frequent
- Look at adult level, children level and contact
○ HCV: From mother to child during birth (vertical transmission) as well as through
immunocompromised people (HIV or other
horizontal early childhood transmission
chronic diseases). ● Adult
a. Define the terms of the different levels. ○ Both HBV & HCV: Blood, transplantation tissues, semen, vaginal fluid
● HIV
○ HBV: One out of 10 people with HIV are estimated to also have hepatitis B (HBV)
○ 10% of people
○ HCV: about 21% have HIV
2 What is the disease prevalence/disease burden ● When travelling to a country where various forms of hepatitis are more prevalent you
across Europe? Why does it play a role? should be more wary when partaking in certain activities
● When there is a higher population within a country the likelihood of HBV and HCV
infections are likely to be higher.
3 What are the differences between HBV and HCV ● HBV:
and what are the consequences for public health? ○ Caused by DNA virus
a. (Look at WHO and ECDC website) ○ Has an available vaccine which needs 3 or 4 doses to work effectively, the first
dose should be taken within 24 hours of birth
○ Spread through bodily fluids
○ Testing: blood tests, you can be tested for both active and passive hepatitis.
When a person has anti-HBS antigen it means that the individual is immunised
and will be able to protect themselves from future hepatitis infections.
● HCV:
○ Caused by RNA virus
○ Doesn’t have an available vaccine
○ Can only be spread through blood
○ Treatment comes in the form of drugs but very high costs
○ Testing:
■ Testing for anti-HCV antibodies with a serological test identifies people
who have been infected with the virus
■ If ositive for anti-HCV antibodies, a nucleic acid test for HCV ribonucleic
acid (RNA) is needed to confirm chronic infection and treatment
4 What are the prevention measures against HBV and ● Promoting of HBV vaccines
HCV in Europe? ● Distribute more clean resources and not reuse medical equipment
● WHO Recommendation:
○ Therapy with pan-genotypic direct-acting antivirals (DAAs) for all adults,
