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Lernmaterialien für Public Health an der Universität Luzern

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Basic principles of health 

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Population Perspective

Focus on group of people/entire population with the aim of: disease prevention, health promotion, interventions on environment, public interventions


Ethics:

-Proportionality (are interventions adequate?)

-No-harm principle 

-Protection of the most vulnerable ones 

-->each person has the right for own decision, but sometimes people must be protected from other people's behavior  (mutual dependence) such as passive smoke

--> health equity is very important in public health,  everyone has to have the same chance to be healthy.


Evidence based 

Decision making, development, implementation & evaluation of public helath activities

--> must be guided by evidence


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Health inqualities: non-ordered groups

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-inqualities in health may also occur due to other variables of differentiation / dimensions of inqualities 

-not based on criteria that can be logically ranked, e.g. gender, ethnicity, religion, place of residence (urban vs rural)

In theory non-ordered, but is this reality? 

Africa Americans are more likely to die at early ages from all causes.  


--> there are differences between men and women but you can not per se say that men are higher on a hirarchy (in some countries maybe...)

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Socioeconomic postion (SEP): indices

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Multidimensional indices

  • Combination of SEP indicators education, income, occupation (often weighted) 

Advantage

  • Multidimensional "comprehensive" picture of SEP in comparision to single indicators 

Disadvantage 

  • Difficult to argue for weights, changes over time 
  • Status inconsistency, e.g. university degree but poorly paid job, Dr. phil Taxi driver

--> we often look at the indicators seperately!

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Roman empire (23BC - 476 AD)

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Important inventions with respect to hygiene:

-Aqueducts: transportation of water from source to villages, clean water is important for health! 

--> builded complex systems of sewers 

--> started to have public bath, organized water supplies, markets and reporting systems (if people got sick they reported it --> first attempt to be evidence based 

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Birth of modern medicine (1650-1800)

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lot of interesting interventions! 


Edward Jenner and smallpox

--> edward jenner = father of immunology


Facts he detected:

--> survivor of smallpox were immune after that

--> infected healthy people with a little bit of infected tissue as a preventive measure: invention of vaccinations 

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TESTE DEIN WISSEN

Great sanitary awakening (18-1900s)

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-health related consequences of industrial revolution 

--> creation of slums, overcrowding, bad housing, lack of drainage & sewerage

--> living condition dramatically changed!


-focus on sanitation & changing physical environment 

--> water supply, sewage removal, monitoring of community health status

---> control contamination of physical environment 


Despite lack of scientific knowlede: major developments in communicable disease control (tuberculosis, cholera, smallpox --> all related to sanitation)

--> hour of birth of epidemiology, public health, social medicine 

social environment that relates to health 


Ignaz Semmelweis: Childbed fever

--> he started to collect information about mortality

--> forced doctors to wash hands as a preventive measure

--> these hygiene standards reduced the mortality drastically! 

first time people realized that there could be something going on with germ (Keim) 


John Snow and Cholera

father of epidemiology, he found out that polluted water

caused the disease cholera 


epidemiological thinking: 

--> importance of careful data collection (he reported cholera cases)

--> documentation of disease rates before/after interventions

--> evaluation of effectiveness


Data collection can help planning interventions and see what's going on 

Awareness that the environment can have an impact of health, launched public health act in england: we need systematic data colelction to protect health of population 


Edward Chadwick and Poverty

Connection between poverty & health: disease emerges from unfavorable social conditons (social determinants!) --> social justice rises as importan concept (equity!) --> child mortality is more in poverty, they shifted the focus to that--> focus on vulnerable groups (still on cornerstone of public health) 


Edward Chadwick & Poverty: Extensive report on sanitary conditions of the population and their health states --> systematically gathering of data: need for action to support poor people to live in condtion where they can maintain their health led to the public health act:

General board of health & the publich health actpolitical claims to develop medical supply, water supply, sewerage waste disposal, establishment of local boards of health  

--> first time that on the political level the issue of public health was acknowledged 



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Public health definition (WHO 2011)

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Public health refers to…

-all organized measures (public or private) 

-to prevent disease, promote health & prolong life

-among the population as a whole (not targeted to individuals)


Public health activities

-aim to provide conditions in which people can be healthy

-are activities on a population level


--> so public health look at the different (social) determinants of health

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Summary

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-Incidence and prevalence of most diseases and mortality follow a social pattern 

  • people with lower education, income or occupational status are at increased disease and mortality risk 
  • phenomenon summarized under "social inequality in health" 

-Gradual increase in disease risk ("social gradient in health"): 

  • not only highest and lowest SEP groups differ in disease risk but gradual increase of risk 

-Pattern of social inequality is also evident when countries, regions, cities, neighborhoods or social groups are compared (inequalities on macro-,meso- and micro-level) 

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TESTE DEIN WISSEN

Middle ages (476-1450AD)

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Not much knowledge added regarding public health in this time, instead: 

Deterioration of roman infrastructures 

-Decline of hygiene & sanitation 

-physical body less important then spiritual self (religion)

--> villages got bigger but there were main issues that did not work as before no rubbish collection anymore, butchers slaughtered animals in the streets (infections)


Interesting of a public health perspective: 

Epidemic: plague (pest) 

-> tremendous risk for the population, mortality rate of 25-50%!! 

--> birth hour of some public health tools 

What tools could you imagine to stop the spread of the plague? 

--> isolation of patients, cleaning of areas with chalk, burning of rat infested areas

--> quarantine or isolation as intuitve measures to stop spread of diseases

Lösung ausblenden
TESTE DEIN WISSEN

History of Public Health

Ancient Greece (500-323 BC)

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Aesculapius, the symbol of medical profession has been founded


Personal hygiene and body fitness (lifestyle) came up

--> sanitation

--> olympic games were born


Hippocrates (father of western medicine): 

Rejected supernatural or religios theory of disease and proclaimed a causal relationship between health & environment (first idea of  bio psycho social model)

Disease, climate, water, lifestyle & nutrition 

--> publich health topics! 

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TESTE DEIN WISSEN

Occupation: indicator of the socioeconomic position


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-"Crystallizes" social position: defines income, access to social security systems and status 

-Health-relevance of job: directly related to risk factors, e.g.: hazards at work, psychosocial stress at work

-Hierarchy between job types difficult to establish (around 20`000 jobs) and only applicable to employed persons 


Measurement: 

  • Job position (self-employed, employee, employer, public servant) 
  • Occupational group by job type (leading position for example, manual or non-manual job)
  • Prestige of occupation 
  • Leading position or not 
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TESTE DEIN WISSEN

Income and wealth: indicator of the socioeconomic position 


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-Direct impact on life situation and therefore highly relevant for health, e.g.:

living and housing conditions 

neighborhood (big cities=rents are very high, people with higher income will live there - this can lead to deprived neighborhood where only poor people live)

access to health care 

consumption 

behavioraccess to leisure time activities


Measurement: 

Income; equivalence household income (weighted by household members) 

Wealth


But: difficulties in assessment due to tendency to non-response or biased responses

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Q:

Basic principles of health 

A:

Population Perspective

Focus on group of people/entire population with the aim of: disease prevention, health promotion, interventions on environment, public interventions


Ethics:

-Proportionality (are interventions adequate?)

-No-harm principle 

-Protection of the most vulnerable ones 

-->each person has the right for own decision, but sometimes people must be protected from other people's behavior  (mutual dependence) such as passive smoke

--> health equity is very important in public health,  everyone has to have the same chance to be healthy.


Evidence based 

Decision making, development, implementation & evaluation of public helath activities

--> must be guided by evidence


Q:

Health inqualities: non-ordered groups

A:


-inqualities in health may also occur due to other variables of differentiation / dimensions of inqualities 

-not based on criteria that can be logically ranked, e.g. gender, ethnicity, religion, place of residence (urban vs rural)

In theory non-ordered, but is this reality? 

Africa Americans are more likely to die at early ages from all causes.  


--> there are differences between men and women but you can not per se say that men are higher on a hirarchy (in some countries maybe...)

Q:

Socioeconomic postion (SEP): indices

A:


Multidimensional indices

  • Combination of SEP indicators education, income, occupation (often weighted) 

Advantage

  • Multidimensional "comprehensive" picture of SEP in comparision to single indicators 

Disadvantage 

  • Difficult to argue for weights, changes over time 
  • Status inconsistency, e.g. university degree but poorly paid job, Dr. phil Taxi driver

--> we often look at the indicators seperately!

Q:

Roman empire (23BC - 476 AD)

A:

Important inventions with respect to hygiene:

-Aqueducts: transportation of water from source to villages, clean water is important for health! 

--> builded complex systems of sewers 

--> started to have public bath, organized water supplies, markets and reporting systems (if people got sick they reported it --> first attempt to be evidence based 

Q:

Birth of modern medicine (1650-1800)

A:

lot of interesting interventions! 


Edward Jenner and smallpox

--> edward jenner = father of immunology


Facts he detected:

--> survivor of smallpox were immune after that

--> infected healthy people with a little bit of infected tissue as a preventive measure: invention of vaccinations 

Mehr Karteikarten anzeigen
Q:

Great sanitary awakening (18-1900s)

A:

-health related consequences of industrial revolution 

--> creation of slums, overcrowding, bad housing, lack of drainage & sewerage

--> living condition dramatically changed!


-focus on sanitation & changing physical environment 

--> water supply, sewage removal, monitoring of community health status

---> control contamination of physical environment 


Despite lack of scientific knowlede: major developments in communicable disease control (tuberculosis, cholera, smallpox --> all related to sanitation)

--> hour of birth of epidemiology, public health, social medicine 

social environment that relates to health 


Ignaz Semmelweis: Childbed fever

--> he started to collect information about mortality

--> forced doctors to wash hands as a preventive measure

--> these hygiene standards reduced the mortality drastically! 

first time people realized that there could be something going on with germ (Keim) 


John Snow and Cholera

father of epidemiology, he found out that polluted water

caused the disease cholera 


epidemiological thinking: 

--> importance of careful data collection (he reported cholera cases)

--> documentation of disease rates before/after interventions

--> evaluation of effectiveness


Data collection can help planning interventions and see what's going on 

Awareness that the environment can have an impact of health, launched public health act in england: we need systematic data colelction to protect health of population 


Edward Chadwick and Poverty

Connection between poverty & health: disease emerges from unfavorable social conditons (social determinants!) --> social justice rises as importan concept (equity!) --> child mortality is more in poverty, they shifted the focus to that--> focus on vulnerable groups (still on cornerstone of public health) 


Edward Chadwick & Poverty: Extensive report on sanitary conditions of the population and their health states --> systematically gathering of data: need for action to support poor people to live in condtion where they can maintain their health led to the public health act:

General board of health & the publich health actpolitical claims to develop medical supply, water supply, sewerage waste disposal, establishment of local boards of health  

--> first time that on the political level the issue of public health was acknowledged 



Q:

Public health definition (WHO 2011)

A:

Public health refers to…

-all organized measures (public or private) 

-to prevent disease, promote health & prolong life

-among the population as a whole (not targeted to individuals)


Public health activities

-aim to provide conditions in which people can be healthy

-are activities on a population level


--> so public health look at the different (social) determinants of health

Q:

Summary

A:


-Incidence and prevalence of most diseases and mortality follow a social pattern 

  • people with lower education, income or occupational status are at increased disease and mortality risk 
  • phenomenon summarized under "social inequality in health" 

-Gradual increase in disease risk ("social gradient in health"): 

  • not only highest and lowest SEP groups differ in disease risk but gradual increase of risk 

-Pattern of social inequality is also evident when countries, regions, cities, neighborhoods or social groups are compared (inequalities on macro-,meso- and micro-level) 

Q:

Middle ages (476-1450AD)

A:

Not much knowledge added regarding public health in this time, instead: 

Deterioration of roman infrastructures 

-Decline of hygiene & sanitation 

-physical body less important then spiritual self (religion)

--> villages got bigger but there were main issues that did not work as before no rubbish collection anymore, butchers slaughtered animals in the streets (infections)


Interesting of a public health perspective: 

Epidemic: plague (pest) 

-> tremendous risk for the population, mortality rate of 25-50%!! 

--> birth hour of some public health tools 

What tools could you imagine to stop the spread of the plague? 

--> isolation of patients, cleaning of areas with chalk, burning of rat infested areas

--> quarantine or isolation as intuitve measures to stop spread of diseases

Q:

History of Public Health

Ancient Greece (500-323 BC)

A:

Aesculapius, the symbol of medical profession has been founded


Personal hygiene and body fitness (lifestyle) came up

--> sanitation

--> olympic games were born


Hippocrates (father of western medicine): 

Rejected supernatural or religios theory of disease and proclaimed a causal relationship between health & environment (first idea of  bio psycho social model)

Disease, climate, water, lifestyle & nutrition 

--> publich health topics! 

Q:

Occupation: indicator of the socioeconomic position


A:

-"Crystallizes" social position: defines income, access to social security systems and status 

-Health-relevance of job: directly related to risk factors, e.g.: hazards at work, psychosocial stress at work

-Hierarchy between job types difficult to establish (around 20`000 jobs) and only applicable to employed persons 


Measurement: 

  • Job position (self-employed, employee, employer, public servant) 
  • Occupational group by job type (leading position for example, manual or non-manual job)
  • Prestige of occupation 
  • Leading position or not 
Q:

Income and wealth: indicator of the socioeconomic position 


A:

-Direct impact on life situation and therefore highly relevant for health, e.g.:

living and housing conditions 

neighborhood (big cities=rents are very high, people with higher income will live there - this can lead to deprived neighborhood where only poor people live)

access to health care 

consumption 

behavioraccess to leisure time activities


Measurement: 

Income; equivalence household income (weighted by household members) 

Wealth


But: difficulties in assessment due to tendency to non-response or biased responses

Public Health

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