Disciplines of Public Health

Public Health Approach

Surveillance
o What is the problem?
Risk Factor Identification
o What is the cause?
Intervention Evaluation
o What works?
Implementation
o How do you do it?

Public Health vs Medicine

Public Health Medicine
Focuses on population Focuses on individual
Public service ethic, tempered by concerns for Personal service ethic, aware of social
the individual responsibilities
Emphasis on prevention, health promotion for Emphasis on diagnosis and treatment, care for
whole community the whole patient
Public health paradigm employs spectrum of Medical paradigm places emphasis on medical
interventions aimed at environment, human care
behavior and lifestyle, and medical care
Multiple professional identities with diffuse Well established profession with sharp public
public image image

Healthy People 2020: Goals

Determinants of Health
Policy making
Social factors
o Social determinants
o Physical determinants
Health services
Individual behavior
Culture
Biology and Genetics

Factors that Affect Health

Defining Health Needs: Maslows Hierarchy of Needs

Defining Health Needs
Bradshaw (widely used taxonomy)
o 1. Normative needs
Defined by experts or professional groups
Reflects a professional judgement that a person deviates from required
standard
o 2. Felt needs
Defined by clients, patients, relatives, or service users
What people really want
Bottom up approach
o 3. Expressed needs
When felt needs become a demand
Expressed in words or action, it becomes a demand
When they ask for help or information, make use of a service
Measures adequacy of service provision

o 4. Comparative needs
Identified when people, groups, or areas fall short of an established standard
Areas are compared to each other on basis of provision of services met
 Compare similar groups in which one might be lacking

Questions
Consider these interventions available to women in childbirth. Has medicine created these
needs or are they needed improvements in technology?
o Prostaglandin to induce labor
o Epidural to reduce pain
o Electronic fetal monitoring
o Belt monitoring of contractions
o Elective caesarian section
Answer:
o Can be seen as consequence of medical advances but also as attempt to establish
doctors control over midwives
o Range of interventions may alienate women and make childbirth uncomfortable
experience, but also the availability of these services may create a need for them

Needs, Wants, Supply & Demand

Philosophy of Health Promotion

Philosophy has 3 branches:
1. Logic
Development of reasoned argument
2. Epistemology
Enquiry into the nature and grounds of knowledge and meanings
3. Ethics
How we ought to conduct ourselves
2 theories:
Deontology
o We have a duty to act in accordance with universal moral rules
Consequential Ethics
 o Whether an action is right or wrong depends on its end result

Duty and Codes of Practice

Kants Theory
o Act as if your action in each situation is to become law for everyone in the future
Would overall effect be good?
Do to others as you would to yourself
o Always treat human beings as ends in themselves NOT as means
Respect all people
Society of Health Education and Promotion Specialists (SHEPS)
o Practitioners have a duty to:
Care
Be fair
Respect person and group rights
Avoid harm
Respect confidentiality
To report

Consequentialism and Utilitarianisms: Individual and Commons

Concerned with ends AND means
Utilitarian Principle
o Person should always act in such a way that will produce more good than bad
Respond to moral dilemmas by reviewing the facts and weighing the consequences of
alternative courses of action
Problem:
o Does the greatest good justify harm or injustice to a few?
o Smoking is an example

Ethical Grid
Provides tool for practitioners to question basic principles and values and be clear about what
they mean and intend to do
Questions to ask ourselves:
o Central conditions in working for health
Am I creating autonomy in my clients, to direct their own lives?
Am I respecting autonomy of clients whether or not I approve of their direction?
Am I respecting everyone equally?
Do I work with people on the basis of needs first?
o Key Principles in working for health
Am I doing good and avoiding harm?
Am I telling the truth and keeping promises?
o Consequences of ways of working for health
Will my action increase the individual good?
Will it increase the good of a particular group?
Will it increase the good of society?
Will I be acting for the good of myself?
o External considerations in working for health
Are there any legal implications?
 Is there a risk attached to intervention?
Is the intervention most effective and efficient choice?
How certain is the evidence on which intervention is based?
What are views and wishes of those involved?
Can I justify my actions in terms of this evidence?

Autonomy
Free from pressures such as fear and want, a person should make the choice that they want
Autonomy should be attainable
People with disability or mental illness are assumed to be unable to make own choice
o No autonomy

Beneficence and Non-Maleficence Screening

Screening is never wholly routine and inclusive
o Targeted to identify risk groups and excludes certain categories of people usually on age
Screening is spaced because of economic considerations and therefore people may develop the
disease in the intervening period
Screening process may foster anxieties
Screening process may be uncomfortable and painful

Epidemiology
Study of the occurrence and spread of diseases in the population
Study of the frequency and distribution of disease
Data can build a picture:
o Showing the scale of problem
o Showing the natural history and etiology of conditions
o Showing causation and association
o Identifying risk
Descriptive Terms:
o Attack Rate
Rate at which a number of people develop infection per 100 people exposed
o Morbidity Rate
Number of cases divided by population at risk
Influenza
o Mortality Rate
Fraction of people who dies from the disease
AIDS, Ebola, Plague
Crude Death Rate
Number of deaths per 1000 people per year
o Incidence Rate
Number of new cases in specific time period in given population and provides
means of measuring the risk of an individual contracting diseases at certain time
Incidence = # people contracted/# people exposed
o Prevalence Rate
Number of total existing cases in a given population and useful to assess the
overall impact of the disease on society
Long duration diseases have higher prevalence
 Prevalence = New cases/Total Population at risk
o Communicable Disease
Diseases that can be transmitted from one person to another
Measles, colds and influenza
o Noncommunicable Disease
Diseases that are not transmissible
Pneumonia, diabetes, obesity
o Acute Disease
Some illnesses symptoms develop and then subside rapidly
Less than 7 days like measles and colds
o Chronic Disease
Symptoms persist for more than 7 days to years
o Symptomatic
Infected person has symptoms
o Asymptomatic
No obvious symptoms
o Latent Disease
Disease agent can remain inactive for extended period of time after which it
may reappear
Cold sores by herpes

Approaches to Health Promotion

Tannahill
Widely accepted by health care workers
o Useful to see potential in other areas of activity and see scope of health promotion
o Does not give insight into why practitioner may choose one over the other
3 spheres of activity:
1. Health education
Communication to enhance well-being and prevent ill health through influence
knowledge and attitudes
Immunization, screenings, nicotine gum
Lobbying for seat belt legislation
Ban on tobacco advertising
2. Prevention
Reducing or avoiding the risk of disease and ill health primarily through medical
interventions
Smoking cessation
3. Health Protection
Safeguarding population health through legislative, fiscal or social measures
Fluoridation of water
Workplace smoking policy