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Public health and management Discipline

C1 Public health
Health status, health determinants and
health status measurement indicators
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Principles
The enjoyment of the highest attainable standard of health is one of the
fundamental rights of every human being without distinction of race,
religion, political belief, economic or social condition.
The health of all peoples is fundamental to the attainment of peace and
security and is dependent upon the fullest co-operation of individuals
and States.
The achievement of any State in the promotion and protection of health
is of value to all.
Unequal development in different countries in the promotion of health
and control of disease, especially communicable disease, is a common
danger.
Source: WHO Constitution
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What is Health?
a state of complete physical, mental and
social well-being and not merely the absence
of disease or infirmity
Population health: synthesis of individual
health in a global approach
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Complex internal
systems
Growing up and
getting old
Genetic background
Professional risks
Alimentary habits
and consumption
Leisure time risks
Social
Mental
Physical
Recovery
Curative
Preventive
Human biology
Behavior
Health system
Environment
HEALTH
STATUS
Lalonde Model
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USA Health determinants and HS resource
allocation
health contribution health resources of %
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19
43
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7.9
1.6
1.5
90
HUMAN
BIOLOGY
ENV
LIFE
ST
HEALTH
CARE
Dup: Dever G.E.A. n Le planification de la Sant; Rayneed Pineault
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Present health challenges
Expanding EU:
growing health gaps
Ageing
Population
Needs / resources
Climate Change, Pandemic
and Bioterrorism Threats
New Technology
and Innovation
Migration &
Cross Border
Healthcare
Lifestyle Related
Diseases
Globalisation
Ethics
Citizens want
more control
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A comprehensive model of the
determinants of health
Evans and Stoddart (1990).
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Multilevel approach to health
determinants
Institute of Medicine (2000).
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The Dahlgren-
Whitehead model
Dahlgren and
Whitehead (1991).
Institute for Futures
Studies, Stockholm,
Sweden
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Health Means Wealth 1/2
Source: M. Suhrcke, M. McKee, R. Sauto Arce, S. Tsolova, J. Mortensen The contribution of health to the economy in the EU, Brussels 2005
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PH definitions
Winslow, 1920 :
The science and art of preventing disease, prolonging life
and promoting physical health and efficiency through
organized community efforts for the sanitation of the
environment, the control of communicable infections, the
education of the individual in personal hygiene, the organization
of medical and nursing services for the early diagnosis and
preventive treatment of disease, and the development of the
social machinery which will ensure every individual in the
community a standard of living adequate for the maintenance of
health; so, organizing these benefits in such a fashion as to
enable every citizen to realize his birthright of health and
longevity.
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PH historical stages
The main development of Public Health
knowledge and practice could be followed in
four main phases (4):
1. hygiene phase (water, sewerage),
2. individualistic phase( immunization)
3. therapeutic phase
4. New Public Health.
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The New Public Health
Frenk (1993) :
The New Public Health addresses the systematic efforts to
identify health needs and to organize comprehensive health
services with a well-defined population base.
Thus includes:
- the process of information required for characterizing the
conditions of the population
- the mobilization of resources necessary for responding to
such conditions.
- The essence of public health is the health of the public;
therefore it includes the organization of personnel and facilities
for providing all the health services required for health
promotion, disease prevention, diagnosis and treatment of
illness, and physical, social and vocational rehabilitation.
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PH definitions
2000 World Health Organization
Public Health is a social and political action
aiming at improving health, prolonging life
and improving the quality of life among
whole populations through:
- health promotion,
- disease prevention and
- other forms of health interventions.
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the Newest Public Health
2003, the New Public Health was defined as
Use of theory, experience and evidence
derived through the population sciences to
improve the health of the population in a way
that best meets the implicit and explicit needs
of the community (the public).
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Public health aim
Aim: to prevent and reduce discomfort,
disease, invalidity, premature death and
increase healthy life through:
Health promotion - primordial prevention
Health protection (RF control at individual
level) Primary prevention
Morbidity control- secundary prevention
Regaining health /tertiary prevention
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Level of prevention
Primordial
Aim: reducing RF distribution, availability
policy, programmes, regulation
through intersectoral coordination and cooperation
Primary
Aim: avoiding occurrence of disease
Through measures for reducing RF at individual level:
immunization, condoms, Seat belt, screening for RF
Secondary
Aim: reducing prevalence of disease
by early diagnosis, avoiding complications, screening EBM
Tertiary-
Aim: reducing complication (impairment, incapacity,
disability, handicap rehabilitation, social reinsertion,
KT, counseling, palliative care
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PH How?
as intervention
multidisciplinary intervention focusing on population:
regulatory framework (imunization, hygiene,
occupational health, envirnmental regl) poluarii)
health programmes national/localleve
capacity building (legal framework, resources
financial-specialists-equipments, structures)
based on epidemiology application
proactive-preventive oriented target: healthy people
public health government /community/individual
responsibility
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PH - Why?
Why?
It empowers people to protect themselves
It act on health determinants beyond
individual control
It ensure evidence based understanding of
health status, dynamic, characteristics

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PH intervention when?
for issues
regarding population health and their
determinants
usually beyond individual intervention,
requiring society/community interventions
of general relevance
population intervention required
resources vs needs allocation
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Main domains of public health
Demography
Biostatistics
Epidemiology
Social sciences applied
Health service management
Law science
Etics
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Summarizing Public health is:
Medical Science studying population health
Science and art oriented on protecting people and their
health
Knowledge, attitudes and practice oriented to maintenance
and improvement of health
Health oriented intervention through all policies a social
and political action aiming at improuving health, prolonging
life and improuving the quality of life among whole
popuation through health promotion, disease prevention an
other health interventions(WHO).
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PH functions
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PH functions
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WHO: main RF WHO EURO
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Environment
Environmental hazards in workplaces and
communities may range from tobacco smoke to
pesticides to toxic housing.
Rural areas may present increased health risks from
pesticides and other environmental exposures
Some environmental threats to health can occur
because of urban living conditions: proximity to
industrial parks, lack of parks or green spaces
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THE PHYSICAL ENVIRONMENT AS A
DETERMINANT OF HEALTH
Environmental health problems:
global warming,
population growth,
habitat destruction,
loss of green space
resource depletion
These long-term environmental problems are not amenable
to quick technical fixes, and their resolution will require
community and societal engagement
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THE SOCIAL DETERMINANTS OF HEALTH
socioeconomic position
education,
income,
occupation,
race and ethnicity,
social networks and social support,
work conditions
gender
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THE SOCIAL DETERMINANTS OF HEALTH
People in lower socioeconomic positions are not only
more materially disadvantaged:
have higher levels of job and financial insecurity;
experience more unemployment, work injuries, lack of
control, and other social and environmental stressors;
report fewer social supports;
more frequently, have a cynically hostile or fatalistic
outlook
(Berkman and Syme, 1979; Karasek and Theorell, 1990;
Adler et al., 1994; Heaney et al., 1994; Bosma et al.,
1997).
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Lifestyle
Tobacco
Alcohol
Food
Physical activities
Other habits
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Body mass index is a measure of body fat based on
height and weight (kilograms divided by meters
squared, kg/m2).
A person with a BMI
18.5 - 24.9 normal weight,
25 - 29.9 overweight,
>30 obese.
BMIs above normal are associated with an increased
risk of morbidity and mortality.
A persons BMI is influenced by genes, behavior, the
environment, and interactions among these factors
Lifestyle
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33
Sursa: WHO, World health statistics, World Health Organization; 2007 (n USD)
Health systems resources USD
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PH in European Union
Article 152 of Amsterdam Treaty(1997)
1. A high level of human health protection shall be ensured in the
definition and implementation of all Community policies and
activities. Community action, which shall complement national policies,
shall be directed towards improving public health, preventing human
illness and diseases, and obviating sources of danger to human health.
Such action shall cover the fight against the major health scourges, by
promoting research into their causes, their transmission and their
prevention, as well as health information and education. The
Community shall complement the Member States' action in reducing
drugs-related health damage, including information and prevention.
2. The Community shall encourage cooperation between the Member
States in the areas referred to in this Article and, if necessary, lend
support to their action.
Member States shall, in liaison with the Commission, coordinate
among themselves their policies and programmes in the areas referred
to in paragraph 1. The Commission may, in close contact with the
Member States, take any useful initiative to promote such coordination.
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WHITE PAPER Together for Health: A
Strategic Approach for the EU 2008-2013
WHY?
demographic changes including population ageing
are changing disease patterns and putting pressure
on the sustainability of EU health systems.
pandemics, major physical and biological incidents
and bioterrorism pose potential major threats to
health.
a great evolution in healthcare systems in part as a
result of the rapid development of new technologies
which are revolutionising the way we promote health
and predict, prevent
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Principles
A STRATEGY BASED ON SHARED
HEALTH VALUES
HEALTH IS THE GREATEST WEALTH
HEALTH IN ALL POLICIES (HIAP)
STRENGTHENING THE EU'S VOICE IN
GLOBAL HEALTH
TOGETHER FOR HEALTH:
IMPLEMENTATION OF THE STRATEGY
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Strategic objectives
FOSTERING GOOD HEALTH IN AN
AGEING EUROPE
PROTECTING CITIZENS FROM HEALTH
THREATS
SUPPORTING DYNAMIC HEALTH
SYSTEMS AND NEW TECHNOLOGIES
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1. FOSTERING GOOD HEALTH IN AN
AGEING EUROPE
Population ageing (low birth rates + increasing
longevity)
By 2050 the number of people in the EU aged 65+
will grow by 70%. The 80+ age group will grow by
170%
Raising the demand for healthcare
Push up healthcare spending by 1 to 2% of GDP in
Member States by 2050 (a 25% increase in
healthcare spending as a share of GDP).
if people can remain healthy as they live longer,
the rise in healthcare spending due to ageing
would be halved.
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Actions:
Measures to promote the health of older people and
the workforce and actions on children's and young
people's health (Commission)
Development and delivery of actions on tobacco,
nutrition, alcohol, mental health and other broader
environmental and socioeconomic factors affecting
health (Commission, Member States)
New Guidelines on Cancer screening and a
Communication on European Action in the Field of
Rare Diseases (Commission)
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PROTECTING CITIZENS FROM
HEALTH THREATS
Actions
Strengthen mechanisms for surveillance and
response to health threats, including review
of the remit of the European Centre for
Disease prevention and Control
(Commission)
Health aspects on adaptation to climate
change
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SUPPORTING DYNAMIC HEALTH SYSTEMS
AND NEW TECHNOLOGIES
Community framework for safe, high quality
and efficient health services (Commission)
Support Member States and Regions in
managing innovation in health systems
(Commission)
Support implementation and interoperability
of e-health solutions in health systems
(Commission)
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TOGETHER FOR HEALTH:
IMPLEMENTATION OF THE STRATEGY
The Commission will put forward a Structured
Cooperation implementation mechanism
(Commission)
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Tools
Second Programme of Community Action in
the Field of Health
Safety and Health at Work Strategy 2007-
2012
7th Framework Programme on Research
Regional Policy programmes
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Health measurement
Indicators:
Result indicators = Health status indicators
Demographics
Morbidity
Mortality
Level indicators focusing on determinants
Health services/resources indicators
Socioeconomic indicators
Environmental indicators