Public Health

and Healthcare Ethics

MEDF 1021
Course Coordinator:
Professor Samuel Wong
School of Public Health & Primary Care
The Chinese University of Hong Kong

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 Learning Outcomes
At the end of this course, students should be able to:

• Define public health - today

• Describe 4 major global public health issues and their
determinants and potential solutions – 5 lectures and
tutorials
• Apply bioethical principles and theories in analyzing
contemporary public health problems – 2 lectures and
tutorials

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3
Guest Speakers
 Assessment Methods
• Media Reflective Work (group): 30%
– Best Prize for best 4 videos!
• Reflective Essay (1500 words): 30%
– Dean’s Best Essayists: A plaque and a cash
prize of HK$5000 each will be given to the top
5 students. Their essays will be published in
the faculty‘s Yearbook. Their names will be
engrafted on the plaques as Dean’s Best
Essayists.
• Final Exam: 40%
 Experiential learning:
reflective digital storytelling

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A Sample of Video

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 Essay
The long essay is expected to be submitted
by November 19, 2014 and should be an
individual work. The essay should be type-
written and should contain no less than 1500
words in English. The report should be
submitted to the TAs of their assigned
groups. The guideline of the essay will be
given on Blackboard and also be given
during the first tutorial.

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 Lecture 1:
Introduction to Public Health
Learning Outcomes for this
lecture:
By the end of lecture, you should be able to

• define public health and its key disciplines

• describe the health status of the Hong Kong
population using health indicators

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1. Defining Public
Health…

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What is Public Health?
• Public
– Latin “populus” or “poplicus” : “the people”
• Health
– “Health is a state of complete physical, mental
and social well-being and not merely the
absence of disease or infirmity.” (World Health
Organization, 1946)

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 What is Public Health?
“[Public health is…] The science and art of preventing disease,
prolonging life and promoting health through the organized efforts
of society, organizations, public and private, communities and
individuals. ” (Charles-Edward Amory Winslow, 1920)
•According to the UK’s Faculty of Public
Health:
-Public health treats the population as its
patient and is population-based
-Emphasizes collective responsibility for
health, its protection and disease
prevention
-Recognizes the key role of the state,
linked to a concern for the underlying
Charles-Edward Amory Winslow (1877-1957)
socio-economic and wider determinants
"a seminal figure in public health, not only in his of health, as well as disease
own country, the United States, but in the wider -Emphasizes partnerships with all those
Western world." who contribute to the health of the
population.

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 What is Public Health?

Public Health Medical Care

Patient• Public Health
Community vs. Medical Care
Individuals
Core functions Disease prevention and Treating ill patients
health promotion

Contribution to the US Life expectancy US Life expectancy increase

population health increase in 20th century = in 20th century = 5/30 years
improvement 25/30 years (Bunker et al. (Bunker et al. 1994)
1994)

Recognition of More abstract More obvious

achievements
Road to treatment A lot more complicated: Up to patients to accept the
political decision comes doctor’s treatment or not
into play

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 Determinants of Health

Upstream Factors Midstream Factors Downstream

Government Health system Physiological

Policies
H
Psychosocial
Determinants E
Global of health A
forces L
(social,
Disease T
physical Health behaviours
H
economic
environmental)
Biological
Culture Culture
(~70%) (~30%)

1.McKeown T. The role of medicine: Dream, mirage, or nemesis. London UK:Neufeld Provincial Hospitals Trust; 1976.
2 McKeown T, Record RG. An interpretation of the decline in mortality in England and Wales during the twentieth century. Population Studies 1975;29:391-422
3 McKinlay J, McKinlay SM. Medical measures and the decline of mortality.In Schwartz HD, editor. Dominant issues in medical sociology. 2nd edition ed. New
York: Random House; 1987.
Alperstein’s simplification of ‘Socioeconomic determinants of health.’ Turrell G et al. QU T. April 1999. Commonwealth Dept Health & Aged Care, Canberra
A Brief History of Public
Health

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John Snow’s Map

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John snow and cholera

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 Stopping the Epidemic

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http://www.uic.edu/sph/prepare/courses/chsc400/mods/images/pumphandle.jpg
Broad Street Pump

John Snow (1813-1858):

•Contributed to the formation of
“germ” theory
•He knew nothing about Vibrio
cholera
•His conclusion was only based on
observational data  “The Father
of Epidemiology”

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John Snow Pub

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What is Public Health?
• Based on scientific principles
• Uses a range of inter-disciplinary approaches in its
analysis of public health problems, including:

– Epidemiology & Biostatistics

– Health administration, policy and management
– Environmental health
– Public Health Biology: Biochemistry and
Molecular Biology & Nutrition
– Social and behavioral sciences

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Disciplines of Public Health
• Epidemiology:
– The study of the occurrence and distribution of health-
related states or events in specified populations,
including the study of the determinants influencing such
states, and the application of this knowledge to control
the health problems
– The science of public health
– Studies include surveillance, observation, hypothesis
testing, analytic research, and experiments
– E.g. John Snow and Cholera

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Disciplines of Public Health

• Biostatistics
• Application of statistics to biological problems
• Encompasses various fields including medicine,
agriculture, forestry and ecology
• Are often used in tandem with epidemiology
• E.g. estimating the number of deaths from gun
violence or looking at the trends in drunk driving
injuries by using math and science

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The SARS story……

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Public Health Biology

• Study of the molecular and genetic bases of

cellular processes
• Application of these research knowledge to
relevant public health problems, including
cancer, aging, neurological diseases,
fertility/infertility, and environmentally based
diseases
• E.g. SARS: the molecular structure of the
coronavirus; information on the virus life cycle,
host and vector etc.
Public Health Biology

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Social and behavioral sciences

• The application of the disciplines that explore

the activities of and interactions among
organisms and how human interacts with the
society to public health issues

• E.g. Changing hand washing (personal hygiene

practices) practices during SARS.
Social and Behavioral Science

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Environmental health
– Study of the health effects on populations of
exposure to physical, chemical, and biological
agents external to the human body and of
immediate and remote social, economic and
cultural factors (e.g. urbanization, agricultural
development, energy production/combustion)
related to these physical, chemical and biological
agents.
– E.g. the air we breathe; the water we drink; the
complex interactions between humans and their
surroundings; during SARS, can the pipes and air
ventilator be a source of spread?

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Environmental Science

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Health administration, policy and
management

• The field combines politics, business and science in

managing the human and fiscal resources needed to
deliver effective public health services
• To improve public’s health through legislative action
• E.g. managing the database at a school clinic; developing
budgets for a health department; creating policies for
health insurance companies; directing hospital services;
analyzing the impact of seat beat belt laws on traffic
deaths; monitoring legislative activity on a bill that limits
malpractice settlements

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Policy and Health Service Management and
Administration

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What are the greatest public
health achievements in the
20th century?

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 Greatest Public Health Achievements
of the 20th Century
1. Vaccination
2. Motor vehicle safety
3. Safer Workplace
4. Control of Infectious Disease
5. Decline in Deaths from Coronary Heart Disease and
Stroke
6. Safer, Healthier Food
7. Healthier Mothers and Babies
8. Family Planning
9. Fluoridation of Drinking Water
10. Recognition of Tobacco as a hazard

Source: http://www.whatispublichealth.org

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US CDC

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Public Health in Hong Kong

How does this affect you?

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How much do you know?
What is the leading cause of death in H.K.?

1. Heart disease
2. AIDS
3. Cancer
4. Stroke
5. Suicide

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 Leading Cause of Death in HK, 2011
Cause of death Mortality Rate (per 100,000)

1. Malignant neoplasms 185.4

2. Diseases of heart 89.3
3. Pneumonia 86.7
4. Cerebrovascular diseases 47.0
5. Chronic lower respiratory diseases 27.8
6. External causes 21.8
7. Nephritis, nephrotic syndrome and nephrosis 21.0
8. Septicemia 10.8
9. Dementia 10.6
10. Diabetes mellitus 6.5
All other causes 89.8
All causes 596.6
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CHP, Hong Kong 2011
Understanding Our Population

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Health indicators
What are the measures we
use to tell us about a
country’s health status?

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Mortality Rate
• Also called death rate or crude death rate
• An estimate of the portion of a population
that dies during a specified period
• The numerator is the number of persons
dying during the period
• The denominator is the number in the
population at risk of dying during that
period (person-years)
• Mortality rate = Number of deaths during
a specified period / Number of persons at
risk of dying during the period X 10n

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Infant Mortality and Maternal Mortality Ratio,
1982-2009

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Source: Centre for Health Protection, Hong Kong
 Infant Mortality Rate Comparison,
2010
Rank Country Deaths
Per 1,000 Live Births
224 (Lowest) Monaco 1.78
223 Singapore 2.32
222 Bermuda 2.46
219 Hong Kong 2.91
192 UK 4.78
180 USA 6.14
115 China 16.51
46 Cambodia 53.04
1 Angola 178.13

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Source: CIA World Factbook
 Life Expectancy
• Life expectancy
– The average number of years an individual of a
given age is expected to live if current mortality
rates continue to apply
– A statistical abstraction based on current age-
specific mortality rates
– A hypothetical measure and indicator of current
health
– NOT a rate!
• Life expectancy at birth
– Average number of years a newborn baby is
expected to live if current mortality trends continue
– Mortality in the first years of life (i.e., infant
mortality) can affect the life expectancy at birth
significantly

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 Life expectancy at birth (1971-2009)

Female

Male

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Source: Centre for Health Protection, Hong Kong
 Life Expectancy Comparison (2013)

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Source: CIA World Factbook
Population Pyramid, 2010 & 2031

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What health behavior indicators
we can use?

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 How Healthy is your Lifestyle?
Quiz…
 Quiz: Do you smoke?
1. Female - Never smoked
2. Female - Ex-smoker
3. Female - Currently smoke
4. Male - Never smoked
5. Male - Ex-smoker
6. Male - Currently smoke
 Smoking Pattern in HK (I)
 Proportion of males and female smokers aged 15 or above

 Department of Health, Apr 2009

6.3
5.8 13.6
22.1
10.1
15.1
Smoker
Ex-smoker
87.2 Never smoked
75.8
62.3

Female Male All

 Smoking Pattern in HK (III)
• Daily smoking prevalence has dropped to
11.1% in 2010, which is the lowest rate in
the past 30 years

• A drop of more than half from the high point

of 23.3% back in 1982

• A result of a collaborative force between the

Government and the community

• DH integrated smoking cessation hotline

• Had received 14,787 calls this year,
exceeding the number of calls received
in all of 2010 (13,880)

• Newly launched free smart phone

application for smoking cessation in August
2011

Source: Press Release August 24, 2011. Tobacco Control Office,

news.gov.hk
 Quiz: Exercise
During the past 30 days, how often did you
exercise in your leisure time, which at least
makes you breathe somewhat harder than
normal and sweat?

1. Once or more a day

2. 4-6 times per week
3. 2-3 times per week
4. Once a week
5. Less than once a week
 Physical Activity in HK
• Number of times engaged in an adequate amounts of physical activity
per week during lesire time (Leisure-time exercise)
• Department of Health, Apr 2009

<1 time/week
44.2 49.4
53.8 1 time/week

2-3
16.7 times/week
14.6
12.8 4-6
16.2 22.3 19.0 times/week
7+
7.9 8.8 8.3 times/week
8.6 7.3 8

Female Male All

Main concepts

Can you define public health?

What are the characteristics of public
health?
What are some examples of public
health issues in Hong Kong?

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 4 Global PH Problems

1. Climate Change & Health

2. Pollution and Health
3. Emerging Infectious Diseases
4. Non-communicable Diseases

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Learning Outcomes
By the end of lecture, you should be
able to:

• define public health

• describe the health status of the Hong

Kong population using health indicators

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 CONTACTS

• Prof. Samuel Wong (Course Coordinator):

yeungshanwong@cuhk.edu.hk
• Ms Carrie Mak (Undergraduate Programme):
carriemak@cuhk.edu.hk
• Mr Harry Wang (Lecturer):
haoxiangwang@cuhk.edu.hk
 Thank you!

http://www.sphpc.cuhk.edu.hk
Homepage of the School of Public Health
and Primary Care, CUHK
Email: yeungshanwong@cuhk.edu.hk

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Experience in Africa during the
epidemic of Ebola……
By Eliza Cheung