1Public health and management Discipline

C1 Public health

Health status, health determinants and

health status measurement indicators

2Principles

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

3What 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

4Complex 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 systemEnvironmentHEALTH

STATUS

Lalonde Model

5USA Health determinants and HS resource

allocation

health contribution health resources of %

27

19

43

11

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

6Present 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

7A comprehensive model of the

determinants of health

Evans and Stoddart (1990).

8Multilevel approach to health

determinants

Institute of Medicine (2000).

9The 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 tosuch 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 healthpromotion, 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 thedefinition and implementation of all Community policies andactivities. 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, bypromoting research into their causes, their transmission and theirprevention, 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 MemberStates in the areas referred to in this Article and, if necessary, lendsupport to their action.

Member States shall, in liaison with the Commission, coordinateamong 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