Health & wellbeing in society (public health)

What is the definition of public health?

• All organised measures (whether public or private) to prevent disease, promote health, & prolong life among the population as a whole

• Its activities aim to provide conditions in which people can be healthy & focus on entire populations, not on individual patients or diseases

What is the difference between public vs individual health?

Public health:

• Interventions are designed to affect large populations (e.g. national vaccination campaigns, food safety regulations, air quality measures & public health education, such as anti-smoking campaigns)

• Efforts target common risk factors & widespread health determinants (e.g. environment, behaviour & social conditions)

Individual health:

• Focuses on diagnosing & treating specific health problems on individual patients (often after onset of symptoms)

• Interventions are personalised, addressing the specific medical needs of each patients (e.g. surgeries, personalised medical consultations & prescription medications)

Why is the surveillance of diseases important?

• Crucial for early detection of outbreaks (e.g. flu, COVID-19) → enables a timely response to prevent the spread of infectious diseases

• Aids in understanding disease rates, population health trends & emerging health threats

• Public health agencies (e.g. WHO) rely on surveillance data to inform public health policies, guide resource allocation & coordinate international response

Why are vaccination programmes important?

• They protect against diseases (e.g. polio, measles, diphtheria, flue & COVID-19)

• They target vulnerable groups & aim for herd immunity to safeguard communities

  • campaigns can be global (e.g. WHO’s global eradication) or national (e.g. flu vaccines)

What is the purpose of health promotion (e.g. public health campaigns) ?

• Educate on disease prevention through healthy behaviours (e.g. exercise, diet, quitting smoking & safe sex)

• Targets lifestyle factors causing chronic diseases (e.g. heart disease, diabetes & cancer) while advocating for policies that support healthy living (e.g. parks, safe workplaces & limiting harmful substances)

What are the 3 different types of disease prevention?

• Primary prevention: prevents the onset of diseases (e.g. vaccination & healthy diets)

• Secondary prevention: aims for early detection & prompt treatment of diseases to limit their impact (e.g. cancer & high blood pressure screenings)

• Tertiary prevention: focusing on reducing the impact of already-established diseases through rehabilitation & long-term management (e.g. diabetes & heart disease)

Outline the sanitary movement (19th century)

• Causes: overcrowding, poor living conditions & diseases (e.g. cholera & typhoid)

• Key figures: Edwin Chadwick & John Snow

• Interventions: sewage systems, clean water, waste management & public health authorities

• Key law: Public Health Act 1848 → increased government involvement in public health

Outline the rise of bacteriology & germ theory (late 19th to early 20th century)

• Germ theory: Louis Pasteur & Robert Koch showed that microorganisms cause disease

• Public health shift: focus moved to controlling pathogens through vaccination, quarantine & hygiene

• Key interventions: vaccination campaigns, hygiene education, laboratories & improved food safety (e.g. pasteurisation)

Outline public health expansion & social medicine (mid-20th century)

• Post-WWII: public health expanded to chronic diseases & mental health, recognising social factors (e.g. housing, education & employment)

• Health systems: the NHS (1948) combined public health with healthcare; WHO coordinated global health efforts

• Prevention: focus shifted towards preventing chronic diseases through healthy lifestyles & education

• Health promotion: campaigns targeted smoking, alcohol misuse & unhealthy diets

Outline the focus on healthy equity (late 20th century to present)

Public health now focuses on social, economic & environmental factors affecting health:

• WHO Ottawa Charter (1986) promoted “Health for All” through addressing social determinants & empowering communities

  • SDOH: factors (e.g. poverty, education, gender, race, housing & healthcare access) influence health inequalities

• public health aims to reduce these inequalities by addressing their underlying causes

• WHO Commission on Social Determinants of Health (2005) highlighted how poverty & discrimination create health inequities

• Goal: equitable access to healthcare, education & healthy living conditions

What are the key themes of modern public health?

• Universal healthcare: ensure everyone can access essential health services without financial hardship

• Global health: initiatives (e.g. Millennium & Sustainable Development Goals) aim to reduce inequalities, especially for marginalised groups

• Mental health: recognised as essential to overall well-being, with efforts to reduce stigma & improve access to services

What are the key developments of modern public health?

• Health as a human right: everyone should have access to healthcare & healthy living conditions

• Community involvement: communities actively help identify & address their own health needs

• Environmental health: public health addresses pollution, climate change & their impacts on health

What is the definition of social determinants of health?

The non-medical factors that influence health outcomes…the conditions in which people are born, grow, work, live, age & the wider set of forces & systems shaping the conditions of daily life (WHO, 2023)

What is the socioecological rainbow model?

Shows how different levels influence health & behaviour:

• individual - knowledge, beliefs, genetics

• interpersonal - family & friends

• community - schools, workplaces, neighbourhoods

• societal - policies, culture, economy

Key idea: health is shaped by both individual & wider social/environmental factors

What is the definition of inequality, equality, equity & justice?

• Inequality: differences in health, resources or opportunities between people or groups

• Equality: everyone receives the same resources, opportunities or treatment

• Equity: resources & support are distributed according to individual needs to achieve fair outcomes

• Justice: ensuring fairness & equal rights, while addressing unfair disadvantages & discrimination

What is the definition of health inequalities?

Systemic differences in the health status of different population groups…that have significant social & economic costs both to individual & societies (WHO, 2018)

What is the difference between health inequalities & health disparities?

• Health inequalities: the underlying structural & systemic factors that create avoidable & unjust differences in health outcomes within a population → SDOH

• Health disparities: the observable differences in health outcomes between specific groups (e.g. racial or ethnic groups) without always addressing the systemic root causes → historical injustices, discrimination or bias

What are some causes of health inequalities?

• Physiological impacts: high blood pressure, high cholesterol & anxiety/depression

• Health behaviours: smoking, diet & alcohol

• Psycho-social factors: isolation, social support/networks & self-esteem/worth

• Wider determinants of health: income/debt, employment/quality of work, housing & education/skills

What are the 3 different types of public health interventions?

Policy-based interventions:

• legislation (e.g. tobacco control & mandatory seatbelt use)

• health promotion policies aimed at influencing behaviour (e.g. sugary drink taxes & smoke-free zones)

Community engagement:

• grassroots efforts, community-led initiatives & participatory models of health promotion

• empowerment & capacity building in communities

Preventive health programs:

• vaccination campaigns, screening programs & public awareness initiatives (e.g. HIV/AIDS awareness & cancer screenings)

What is the role of policy in public health interventions?

The policy introduces laws, regulations or programmes to improve health:

1. immediate effects: changes behaviour, access or the environment

2. short-term health outcomes: reduces risk factors or prevents illness

3. medium-term outcomes: improves overall health & reduces health inequalities

4. long-term outcomes: reduces disease, disability & premature death

5. broader social impact: improves quality of life, productivity, communities & reduces healthcare costs

What does the process of community engagement & participation involve?

Community represents the central focus, which is the group or population involved in engagement efforts:

• informing: providing relevant information to the community

• consulting: gathering feedback from the community

• involving: collaborating with the community on activities or decisions

• collaborating: partnering with the community on projects & decision-making

• empowering: giving control to the community to make key decisions

How is the effectiveness of interventions evaluated?

Through the use of assessment parameters:

• reach: how many people were affected by the intervention?

• efficacy: did the intervention achieve the desired health outcomes?

• adoption: was the intervention implemented widely across communities?

• sustainability: can the intervention be maintained over time?

What are the 3 barriers to effective public health interventions?

Political:

• lack of political will, government issues, conflict of interests can delay or prevent public health measures

• vaccine hesitancy

Social:

• cultural resistance, religious beliefs or lack of awareness can impede health interventions

• resistance to family planning programmes in certain communities

Economic:

• lack of funding or resources limits the reach & effectiveness of interventions

• underfunded healthcare systems struggling to implement large-scale health campaigns

How does sustainability & scalability play a role in public health interventions?

Sustainability:

• long-term success depends on continuous funding, community engagement & adaptive strategies

• HIV/AIDS programmes require long-term support to maintain access to anti-retroviral therapy

Scalability:

• expanding successful local programmes to national or global levels prevents logistical & financial challenges

• scaling up nutrition programmes for food security across diverse regions