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Collaborate across sectors and levels; 7.


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Employ mechanisms for public involvement; 8. Demonstrate accountability for health outcomes.

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The goal of Public Health is to improve the health of populations, and this chapter from the online Disease Control Priorities in Developing Countries has an excellent chapter on improving the health of populations: lessons from experience. Note: this chapter is from the 2nd edition - DCP3 will update many of the chapters Primary Health Care has been a strong 'relative' of Public Health, in fact a key component of improvements in Public health will be improvements in primary health care.

You can see the overview of the report here. Further: Going 'back' one stage, we might also want to think about what is 'health' - here are a series of audio lectures from the Johns Hopkins School of Public Health whose Open CourseWare series are freely available through the Internet and which we use consistently in Peoples-uni modules. We suggest you might want to listen to the first lecture, where part A defines health feel free to browse the other lectures if you wish. Of the various definitions of Public Health you will find in this Topic, which one do you think is most relevant to your setting, and why?

This session aims to help you apply knowledge and understanding to the methods of obtaining evidence that underpin Public Health. You should be able to:. We are probably all familiar with the notion of 'Evidence-Based Medicine', EBM, the term having been expanded to Evidence-Based Practice to go beyond clinical practice.

Introduction to epidemiology (understanding public health). - Drugs and Alcohol

An evidence base for Public Health is as important as it is for individual patient care in clinical practice - in fact probably more so since a Public Health policy may affect many thousands of individuals. One of the main differences is that it is much easier to design and undertake a randomised controlled drug trial amongst patients in fact EBM has been termed Pharmaceutical Based Medicine as so much of EBM deals with pharmaceutical agents , than it is to design high quality research into population-based interventions and collect evidence.

Here are some links to resources which discuss this issue in some detail. Why does it matter for developing countries? This matters even more for developing countries. Better utilization of evidence in policy and practice can help save lives, reduce poverty and improve development performance. For example, the Government of Tanzania has used the results of household disease surveys to inform health service reforms that helped reduce infant mortality by 40 per cent. In developing countries, the challenges of evidence-based policy are significantly greater that in the North.

Social and political environments are more difficult. Capacity is much more limited and resources are scarcer. Evidence based Public Health - presentation from the Epidemiology Supercourse. This presentation, one of those from the vast array available from the Epidemiology Supercourse , contrasts the evidence requirements of clinical and Public Health practice, and gives some examples relating to cesarean section.

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The population approach. As you will see in other parts of this module, and more clearly in other modules from the Peoples-uni, there is a real science in the study and application of evidence to populations. Here, we just give a flavour. Measuring the burden of illness on the population.

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There are a number of ways of measuring the impact of illness on a population, and the Global Burden of Disease measure as described on the WHO web site gives details of one important method. Population based interventions are well described by the Public Health Agency of Canada on their web site. This is from part of it:. Primary prevention involves activities aimed at reducing factors leading to health problems. Secondary prevention activities involve early detection of and intervention in the potential development or occurrence of a health problem.

Tertiary prevention is focused on treatment of a health problem to lessen its effects and to prevent further deterioration and recurrence. Because injury, chronic illness, infectious diseases, acute trauma and other health problems can significantly impact the population, population based prevention strategies are warranted.

Prevention activities occur primarily in the health care, public health and primary care systems. Since the factors leading to health problems are complex and include for example behavioural, socio-economic, cultural and other influences, the population health approach provides a framework for developing prevention strategies where all the determinants of health and their interactions are considered.

Public health interventions are defined by Rychetnik and Frommer as "organised activities intended to promote or protect health or prevent ill health in communities or populations, and are often directed at determinants of health or ill health. They are distinguished from clinical interventions, which are intended to prevent or treat ill health in individuals.

Public health interventions may include the following singly or in combinations :.

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The population approach to prevention is well described in the World Health Report for Another part of the World Health Report summarises the population approach nicely - partly reproduced below:. The distribution and determinants of risks in a population have major implications for strategies of prevention. Geoffrey Rose observed, like others before and since, that for the vast majority of diseases "nature presents us with a process or continuum, not a dichotomy". Risk typically increases across the spectrum of a risk factor.

Use of dichotomous labels such as "hypertensive" and "normotensive" are therefore not a description of the natural order, but rather an operational convenience.

Following this line of thought, it becomes obvious that the "deviant minority" e. This leads to one of the most fundamental axioms in preventive medicine: "a large number of people exposed to a small risk may generate many more cases than a small number exposed to high risk". Rose pointed out that wherever this axiom applies, a preventive strategy focusing on high-risk individuals will deal only with the margin of the problem and will not have any impact on the large proportion of disease occurring in the large proportion of people who are at moderate risk.

For example, people with slightly raised blood pressure suffer more cardiovascular events than the hypertensive minority. While a high-risk approach may appear more appropriate to the individuals and their physicians, it can only have a limited effect at a population level. It does not alter the underlying causes of illness, relies on having adequate power to predict future disease, and requires continued and expensive screening for new high-risk individuals.

In contrast, population-based strategies that seek to shift the whole distribution of risk factors have the potential to control population incidence. Such strategies aim to make healthy behaviours and reduced exposures into social norms and thus lower the risk in the entire population. The potential gains are extensive, but the challenges are great as well -- a preventive measure that brings large benefits to the community appears to offer little to each participating individual.

This may adversely affect motivation of the population at large known as the "prevention paradox".

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Introduction to epidemiology (Understanding Public Health)

Think about an example of the barriers to the introduction of an evidence-based policy to improve the health of the public in your setting, and relate these to the paper by Garner et al: Putting evidence into practice: how middle and low income countries "get it together". This session aims to develop an understanding of the way that various countries establish systems to protect and promote the health of the public, and critically evaluate the potential and the limitations of current initiatives to improve global health.

It is apparent that systems change is required to improve the health of populations.


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WHO identified 6 building blocks to strengthen health systems: Service delivery Good health services are those which deliver effective, safe, quality personal and non-personal health interventions to those that need them, when and where needed, with minimum waste of resources. Health workforce A well-performing health workforce is one that works in ways that are responsive, fair and efficient to achieve the best health outcomes possible, given available resources and circumstances i.

Health information system A well-functioning health information system is one that ensures the production, analysis, dissemination and use of reliable and timely information on health determinants, health system performance and health status. Medical products, vaccines and technologies A well-functioning health system ensures equitable access to essential medical products, vaccines and technologies of assured quality, safety, efficacy and cost-effectiveness, and their scientifically sound and cost-effective use.

Introduction to Public Health

Health systems financing A good health financing system raises adequate funds for health, in ways that ensure people can use needed services, and are protected from financial catastrophe or impoverishment associated with having to pay for them. It provides incentives for providers and users to be efficient. Leadership and governance Leadership and governance involves ensuring strategic policy frameworks exist and are combined with effective oversight, coalition-building, regulation, attention to system-design and accountability.

YouTube presentation. Global Health Initiatives Gobal Health Initiatives are described by WHO as: An emerging and global trend in health is a focus on partnerships - alongside public-private partnerships there are also a number global health initiatives. Such initiatives are thought to be one of the benefits of globalization. Global initiatives are typically programmes targeted at specific diseases and are supposed to bring additional resources to health efforts. Three major global health initiatives were launched between and Roll Back Malaria.