PowerPoint Presentation · “Good health is important—it influences not just how we feel, but...

© Endeavour College of Natural Health endeavour.edu.au1

SOCH311

Session 1:

Introduction to Public Health

Department of Social Sciences


Welcome!

Acknowledgment to country


Session Overview

Welcome and introductions

overview of SOCH311

assessments

expectations

Activity

What is Public Health?

definitions

history

Principles & key concepts in public health

Health system & policy in Australia

SO_18/SOCH311 - Subject Outline_2018_CAC.docx


Introductions

Lecturer

Students


SOCH311 Subject Outline

Lectures

Assessments

Expectations

Overview of SOCH311

SO_18/SOCH311 - Subject Outline_2018_CAC.docx


Textbook

Liamputtong, P. (Ed). (2016). Public Health: Local and Global

Perspectives. Cambridge, UK: Cambridge University Press

- Chapter 1

Other

Australian Institute of Health and Welfare (2016). Australia’s health

2016. Australia’s health series no. 15. Cat. no. AUS 199. Canberra:

AIHW.

- Chapters 1 & 2

Read the forward to the WHO Traditional Medicine Strategy

Readings

https://www.aihw.gov.au/getmedia/9844cefb-7745-4dd8-9ee2-f4d1c3d6a727/19787-AH16.pdf.aspx?inline=true

http://apps.who.int/iris/bitstream/10665/92455/1/9789241506090_eng.pdf?ua=1


HEALTH:

DEFINITIONS AND

DISCUSSION


What is health to you?


Activity 1.1 Defining Health

Large group discussion activity

o What does health means to you?

Define it

o Identify;

• common themes between these

definitions, and,

• distinguishing features


What is Health?

A classical conceptualisation of health is the absence of disease or illness

Bio-medical focus on physical or biological aspects

Practiced by doctors and health care professionals

Diagnosis and treatment to cure disease/illness

10


What is Health?

A contemporary conceptualisation of health is a state of well being

11


What is Health?

A contemporary conceptualisation of health is a state of well being

12

WHO, 1986:

“To reach a state of complete physical, mental and social

well-being, an individual or group must be able to

identify and to realize aspirations, to satisfy needs, and

to change or cope with the environment. Health is,

therefore, seen as a resource for everyday life, not the

objective of living. Health is a positive concept

emphasizing social and personal resources, as well as

physical capacities”.


… a “complex outcome” influenced

by factors including genetic,

environmental, economic, social and

political circumstances

What is health?


AUSTRALIA’S HEALTH

2016

“Good health is important—it influences not just how

we feel, but how we go about our everyday lives. The

vast majority of Australians aged 15 and over report

their health as ‘good’ or better, but this can mean

different things to different people. It is now widely

accepted that health is much more than the presence or

absence of disease. It reflects genetic, lifestyle and

environmental factors; cultural influences;

socioeconomic conditions; and the availability and

quality of health care programs and services.”


Determinant of health

“A factor within and external to the

individual that determines their health;

the specific social economic and

political circumstances into which

individuals are born and live.”


A framework for the

determinants of health

Source: PHAA


Public Health is …

Medicine centres on treating ill-health while public health

focuses on preventing illness and promoting the

health of people

… based on the knowledge that health has a range of

determinants


Public Health is …

“the art and science of preventing

disease, prolonging life and

promoting health through the

organized efforts of society”(Acheson, 1988; WHO)

http://www.euro.who.int/en/health-topics/Health-systems/public-health-services


“ESSENTIALLY, PUBLIC

HEALTH CONTRIBUTES MORE

TO THE HEALTH OF PEOPLE

THAN MEDICINE CAN DO”



Historical development of

public healthThe organised effort …

• Rise of agricultural societies 10,000 years ago

• Ancient cities in China, Egypt, India, and the Incas

mastered the management of water, sewerage and

drainage

• Ancient Greece and Rome are synonymous with the

development of Public Health. Terminology such as

hygiene is derived from Hygeia the Greek goddess of

good health and sanitation from sanitas, Latin for health

• Hippocrates’ book Airs, Waters and Places systematically

presents the causal relationships between environment

and disease- earliest epidemiological text


Historical development

The organised effort …

• Decline in sanitation and hygiene standards

through the middle ages in Europe

• Epidemics e.g. leprosy and bubonic plague

… the Black Death killed 50 million people

during 14th century

• Industrial revolution 1730 – 1850 coincided with a sanitary revolution

in UK ... unplanned urbanisation created conditions for more

epidemics e.g. typhoid, cholera and TB

• Causal links between environment and disease strengthened …

miasma to water pumps

• Public works for sanitation reform- sewerage and waterworks

established


Historical developmentThe organised effort … the Australian experience

• Aboriginal and Torres Strait Islander peoples were protected by isolation,

small population and nomadic lifestyle until colonisation … devastated by

smallpox, influenza and syphilis

• Early colonial era characterised by

epidemics within growing population

• Similar conditions in Australian cities in1850s

as UK … sanitary solutions recognised but

progress was slow

• Since Federation the Commonwealth

government gradually exerted more power

and influence in public health …


Historical developmentThe organised effort … the Australian government role expanded

• 1908 federal maritime quarantine laws

• Australian Institute of Tropical Medicine 1910

• Commonwealth serum laboratories 1916

• Federal Department of Health 1921

• NHMRC established in 1936

• ‘populate or perish’, national fitness scheme (1930s)

• Foundations for national health insurance (1946) and the

welfare of Indigenous Australians (1967) laid

• National health campaigns – TB screening (1949) and Polio

vaccine (1956)

• By early 1960s DoH administered part or all of 22 Acts of

Parliament indicative of it’s increased role & responsibility


Historical development

The organised effort … the Whitlam

Government era early 1970s

• reflects highest point in

Commonwealth government’s role

in public health

• Far ranging health reforms with an

emphasis on universal access to

health care

• Community Health program

• Medibank scheme

• Health Insurance Commission

https://jenna-beck-f8w5.squarespace.com/whitlam-legacy-healthcare-social-security/?rq=medibank


HISTORY OF CONTEMPORARY

PUBLIC HEALTH

Old

to the …

New


FROM THE

OLD PUBLIC

HEALTH …

APPROACHES TO PUBLIC HEALTH


Old public health …

a behavioural emphasis

o Post-war improvements in health increased life

expectancy

o Rise of chronic disease as leading causes of mortality

and morbidity (heart disease and cancer)

o A behavioural approach became dominant in 1970s after

the Lalonde report identified health risk behaviours as a

determinant of health inequalities

o Focus on lifestyle as a determinant of health …

“self‐imposed risks” and “risk taking”

28


Approaches to public health

TO THE NEW

PUBLIC

HEALTH …

http://www.who.int/healthpromotion/conferences/previous/ottawa/en/

http://www.who.int/healthpromotion/conferences/previous/ottawa/en/



The new public health … a socio-environmental

dimension

o A bigger, more expansive picture of health

o Heralded by Ottawa Charter of Health Promotion

o Focusing on the social determinants of health

o Collective approach replaces individual approach

o Language shifts to inequity rather than inequality

http://www.who.int/social_determinants/en/

30

http://www.who.int/social_determinants/en/



The new public health is under-pinned by the

31


Public Health

‘Science and Art’

Australian Health ministers agreed on this definition in 1998 …

‘Public Health is the organised response by society to protect

and promote health and to prevent illness, injury and disability’

‘Public health is a social enterprise … concerned with the health of

the public’

‘Public Health is both art and science … of preventing disease,

prolonging life and promoting physical mental and psychological

health … through effectively addressing the multiple determinants of

health’ (Fleming & Parker, 2015 p.7)


Public Health

‘Science and Art’ o The science of public health

is about understanding the

determinants of health

o It is about using evidence as

a basis for decisions

o The art of public health has

more to do with the practice

and how science is

interpreted and implemented

according to population

needs and circumstances.


HIV: an Australian public

health success story

The Art …

Averting an epidemic in Australia took a

“bold … internationally heralded” harm

minimisation approach that partnered with

the communities most affected by HIVhttps://psmag.com/news/how-australia-eliminated-aids-as-a-public-health-

threat

https://psmag.com/news/how-australia-eliminated-aids-as-a-public-health-threat


PUBLIC or POPULATION or

HEATH PROMOTIONConflation of terminology …

Population Health is “… the study of health and disease in a population as specified by geographical, cultural or political guidelines” (RACGP)

Health Promotion is “… the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions” (WHO)


Prevention in public health

Primary prevention Initiatives to promote health and wellness

Secondary prevention Early diagnoses, prompt and effective treatment

and curtailing of illness

Tertiary preventionRestoration or maintenance of optimal

physical and social functioning to avoid

long term disability


Levels of intervention Stages of

disease

Examples

Primary Prevention

Preventing a disease from

occurring

Wellness Initiatives that prevent social isolation

among elderly people

Programs that teach children had a clear

for the teeth to prevent dental caries

Secondary prevention

Making early diagnoses and

giving prompt and effective

treatment to stop disease

progress, shorten the duration

of the tumours and prevent

complications from the

disease.

Illness Effective network of emergency services

Screening for complications that may

arise from diabetes

Diet modification for patients with

cardiovascular disease

Tertiary prevention

Preventing long term

impairments or disabilities

arising from disease, and

restoring or maintaining

optimal physical and social

functioning once the disease

process has stabilised

Disability Active rehabilitation following injury

A system for monitoring use of medicine

by patients with chronic illness

Support for patients self-help groups


Disciplines of public health

Biostatistics

Epidemiology

Environmental and Occupational

Health Sciences

Health Services Administration

Social and behavioural sciences


Main components of public

health worko Public health intelligence- gathering and analysing

information about the determinants of health, the causes

and patterns and trends of Health and ill-health

o Public Health interventions- Development of policy,

strategies and interventions aimed at prevention,

protection and promotion of health

o Public Health infrastructure- identification of needs

e.g. workforce training, information systems, regulatory

and legislative frameworks(The National Public Health Partnership (1998a) in Vivian, Smith and Fawkes,2014, pp. 6-7)


HEALTH SYSTEM

PUBLIC HEALTH


Types of health systemPublic financing Private Financing

Public Provision UK- National Health

Service

China- patient out of

pocket payment for

public hospital

Private Provision Australia- Medicare

+ private doctors

US- private health

insurance + private

doctors


The

Australian

context


Funding

health in

Australia


Health Policy in AustraliaBalancing efficiency, effectiveness & equity

The ‘strife of interests’ in health policy making (relevant

public/private and commonwealth /state systems) make

‘rational’ policy decisions difficult to achieve

• Policy making also reflects political, social and economic

interests

• Interest groups seek to influence policy decisions

(lobbyists, media advocacy) vs corporate rationalists

(health bureaucrats)

• Ideally policy is evidenced based (epidemiology +

economic data underpin decisions)

• Health economics is a popular tool and is influential in

decision-making but has limitations


Health metrics

DALYs

https://www.youtube.com/watch?v=3tDXwKVkn68&t=8s

https://www.youtube.com/watch?v=3tDXwKVkn68&t=8s

http://www.who.int/healthinfo/global_burden_disease/metrics_daly/en/


Health Workforce in Australia


o Half the Australian

health sector??

o The “Black Market

of Health Care” or

an untapped

resource?

o Can affect other

health utilisation:

Vaccines?

Chemotherapy?

o Workforce

characteristics

data

Complementary Medicine workforce

https://www.uq.edu.au/news/article/2011/08/more-complementary-medicine-practitioners-gps-some-rural-areas-research-finds

https://theconversation.com/reining-in-cowboys-of-complementary-medicine-242

http://www.abs.gov.au/AUSSTATS/[email protected]/Lookup/4102.0Chapter5202008


the TCM workforce in Australia

http://hwd.health.gov.au/webapi/customer/documents/factsheets/2015/Chinese Medicine - 2015.pdf

http://hwd.health.gov.au/webapi/customer/documents/factsheets/2015/Chinese Medicine - 2015.pdf


… it’s

complicated

WHAT DOES THE PH COMMUNITY THINK ABOUT

CM?

CM and Public Health


Public Health and CM



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