Public Health Concepts (PE4S159)

Week 1 Topic Overview

What is Public Health and where is it going?

Introduction
What is public health?
Public health has been defined as the science and art of preventing disease and promoting health
through organized societal efforts (McKee, 2011). Public health is a multidisciplinary field that focuses
on preventing illness at the population level rather than treating illness at the individual level as is the
focus of medicine (Aschengrau, 2003). Activities that are central to public health include assessments
of a population’s health status, identification of health problems and their causes, and the design of
solutions to address these problems. Solutions usually include interventions at the level of
communities such as educational programs to prevent young people from starting smoking, screening
programs to detect cancers at an early stage, and passing laws to prevent traffic accidents such as
requiring the wearing of seat belts (Aschengrau, 2003).
At an age of globalization, mastering the art of public health is paramount for effectively tackling
public health challenges. Sustainable public health in particular is more important than ever in the
21st century. Sustainable public health involves protecting not only the health of the current
generation but also of future generations by not compromising today on the resources that
tomorrow’s generations will need to live a healthy lifestyle. This has become necessary because of
the complexity and nature of health challenges of the 21st century. Some of the challenges of the 21st
century that public health practitioners are called to solve include climate change, mass urbanisation,
the rise of non-communicable diseases, adoption of a Western lifestyle globally, exploitation of finite
resources and economic policies accelerating inequalities (Rayner, 2012).

Main analysis
Why we must shift to a sustainable public health?
A powerful driver exacerbating the modern challenges and highlighting the need for a sustainable
public health is the changing demographics of the world population. Every human being has the right
to be healthy and this right gains increasing importance when living in a crowded world. A rise in the
world population has put pressure on the use and availability of energy, water resources, the food
system, and housing (Rayner, 2012). Are you consciously aware of how many people are currently

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living on earth? Has the size of the world population changed significantly over time? Take a few
moments to review the information presented in the graph below that illustrates the world
population growth over time and consider the implications of this growth.

(Source: http://www.indexmundi.com/blog/index.php/2013/07/15/world-population-growth-over-
time/, accessed 12-Sep-2017).
As can be observed in the graph, the world population started increasing rapidly after the 1950s.
Primary reasons for this have been economic development due to industrialization and subsequently
urbanization that have led to mortality rates declining faster than fertility rates, resulting in an overall
increase in the world population. The rapid increase in the global population growth rate is driven
largely by increases in the growth rates of less developed countries in Africa, Asia, Latin America, The
Caribbean, Melanesia, Micronesia, and Polynesia. The United Nations official estimate of the size of
the world population, as of mid-2017, is 7.55 billion people (United Nations. Department of Economic
and Social Affairs, Population Division, 2017).
If the natural resources of the earth are used faster than they can be naturally replenished and
regenerated, then this way of living cannot sustain the growing population on earth and subsequently
its health. Economic development in many countries has not been accompanied by a fair and
environmentally sustainable use of resources. As a result, we now face global challenges such as
climate change, scarcity of water, polluted air, acidified oceans, and degradation of land, all directly
and indirectly affecting our health (Sachs, 2015).
Let us elaborate on how climate change resulting from rapid unsustainable development affects our
health. Greenhouse gas emissions from human activities including fossil fuel combustion and
industrial processes are the main cause of global warming. The health effects of global warming have
been severe and diverse: droughts leading to famine and population displacements, increased
intensity of storms and hurricanes resulting in injuries and deaths, increased incidence of heat-
related deaths and illness, and increases in infectious diseases (Climate Change and Health, 2017).
However, climate change affects our health not only in the above ways. Greenhouse gases such as
CO2 reduce the nutritional quality of staple foods such as wheat and rice that have shown decreases
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in the amount of zinc and protein, respectively. Nutritional deficiencies are therefore another
consequence of climate change, in addition to asthma and heart disease that are related to reduced
air quality. The above indicate a clear connection between sustainable living and health.
Intertwined to unfair and unsustainable development is the issue of poverty. Income inequality and a
huge gap between the rich and poor in societies are associated with worse indicators of health for
these societies (Wilkinson, 2011). Research indicates that among developed countries the size of the
gap between rich and poor within a country and not the wealth of a country measured as gross
national income is linked to a lower index of health and social problems. The challenge therefore lies
in building healthy societies. But what constitutes a good society? Sachs (2015) suggests that a good
society is not only one that is wealthy, but one that is also socially inclusive, prosperous,
environmentally sustainable, and well governed.
Why is sustainable healthcare important?
Practicing sustainability in healthcare settings has multiple benefits for societies often referred to as
the ‘Triple win” (Nicholson, 2016). A sustainable healthcare system contributes to the building of
healthier lifestyles and communities, the reducing of long-term conditions, and the increase of health
equity. However, what does it mean for a country’s healthcare system to be sustainable? A
sustainable healthcare system is one that focuses on the prevention of disease in order to reduce the
need for healthcare, on practicing clinical medicine sustainably, and on leadership and management
that advocates for sustainable policies. The mission of the England NHS Sustainable Development
Unit is precisely the development of guidelines to improve sustainability in healthcare settings
(England. Sustainable Development Unit, 2009).

Sustainable healthcare: four action areas (Source: NHS England Sustainable Development Unit 2012)
Let us look at examples of how sustainable healthcare can focus on preventive healthcare (Nicholson,
2016). One example is health professionals who educate, inform, and motivate patients to be
physical active by replacing the use of private cars with other options such as walking, cycling and
public transportation. By promoting physical activity, multiple issues, including obesity, road traffic
accidents, and respiratory disease are reduced. At the same time, air pollution is decreased and

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street violence may be reduced because of pedestrianized public spaces. Another example is health
professionals providing dietary guidelines and education on healthy eating to reduce meat
consumption. A reduction in meat and dairy consumption positively affects diet-related
cardiovascular disease, cancers and obesity and simultaneously reduces methane emissions from
rearing livestock.

What kind of solutions are required to address the complexity of public health problems?
As can be observed from the examples above public health challenges are complex and require
complex solutions. Hanlon et al. (2013) discusses the varied approaches that are needed to solve
public health problems. These include a systems approach to address complex causal pathways that
may encourage disease and an ecosystem approach to protect our environments and natural
resources. For the latter a consensus understanding of ecological public health will need to be
reached. In addition, an ethical approach is necessary in order to protect human rights and improve
health equity. Lastly, a creative approach is fundamental for applying different ways of thinking to
solving complex problems. This must involve designing personal practice and institutional structures
that unblock the factors that hinder creativity.
Does law enforce the protection and improvement of a nation’s health?
It is imperative that a nation has a clear emphasis on public health in policy documentation. Such is
the case in the UK. UK health agencies such as Public Health Wales and Public Health England develop
strategic plans to improve population health within a defined timeframe. ‘Creating a healthier,
happier, and fairer Wales’ is a strategic plan created by Public Health Wales to guide priorities in
public health for 2017-20. Seven strategic priorities are outlined for focusing efforts to achieve the
greatest improvement in the health of future generations in Wales. To go a step further, the Welsh
Government has even enforced an act that requires 44 public bodies across Wales to work together
towards common pre-specified public health goals. Similarly, England has developed a strategic plan
for the period through 2020, with a focus on reducing inequalities and outlining a list of actionable
steps. You are requested to review these policy documentations by following up on this week’s
reading materials.

Public Health Policy Documentations, UK.

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Why is defining health important?

When working together toward common goals of improving health it is vital to have a common
understanding of the definition of health. Various definitions of health have been proposed. The
simplest one defines health as simply the absence of disease and relates to the biomedical model
of health where the healthcare system focuses merely on the provision of healthcare services. The
social model supports a different definition of health that has been well articulated by WHO in
1946 as ‘health is a state of complete physical, mental, and social well-being and not merely the
absence of disease or infirmity’. In this scenario, the healthcare system is called to address the
social, environmental, and political factors that influence health.
In order to address the wider social factors that influence health, policy makers and health care
systems will need to adopt appropriate interventions that are evidence-based and have been
shown to be effective at reducing the negative impact of social factors and improving health. The
interventions will need to cover several areas including housing and the living environment, the
work environment, transport, health and social care services, unemployment and welfare,
agriculture and food, water and sanitation, and education. Bambra et al. discuss all of these areas
and the state of research on interventions for these areas in their paper, which you are requested
to read for this week.

Conclusion
Why are death rates important?
We have discussed that given the large increase in the world population in the last 50 years and a
projected further increase in the future a sustainable approach to public health is necessary. Areas
of public health such as the healthcare system will benefit greatly from a sustainable approach and
the effects of this approach trickle down into society and the environment. By becoming aware of
the complexity of public health issues, we can turn our attention to designing complex solutions
appropriate for intricate problems. At the same time, the efforts of individuals, organizations, and
institutions can become concerted under the development of policy documentations and a unified
understanding of a social definition of health.
These coordinated efforts undoubtedly lead to the question of how do we assess the results of our
actions. How can we know that indeed we have made a difference and have improved the health
of a population? The answer lies in the use of public health indicators, the basic of which are death
rates. By measuring the number of people who have died prematurely over a certain time-period
and by type of disease, we can assess the effectiveness of a country’s health system. Furthermore,
we can make an informed decision on how to allocate money for the provision of health services
and welfare. At the same time, death rates can be used to determine the next focus of public
health action and determine priorities for policymaking. Lastly, mortality indicators can be used to
analyse trends of disease over time and to associate these with risk factors that can be then
targeted for prevention. With an understanding of basic concepts in public health covered this
week, we can begin to apply these principles to improve the lives of people across the world.

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References
Aschengrau, A and Seage, G. (2003) Essentials of Epidemiology in Public Health. London: Jones
and Bartlett.
Bambra et al. Tackling the wider social determinants of health and health inequalities: evidence
from systematic reviews. J Epidemiol Community Health. 2010 Apr; 64(4): 284–291.
Climate Change and Health (2017) Available at: https://www.hsph.harvard.edu/climate-
change/ (Accessed: 19 September 2017)
England. Sustainable Development Unit (2009) Fit for the future: Scenarios for low-carbon
healthcare 2030. [Online]. Available at: http://www.sduhealth.org.uk/news/64/is-the-nhs-fit-
for-the-future/# (Accessed: 24 August 2017)
Hanlon, P., Carlisle, S., Hannah, M. and Lyon, A. (2012) The Future Public Health. Berkshire:
McGraw Hill/OUP.
Nicholson, B., McKimm, J. and Allen, A. (2016) Global Health. London: Sage Publications.
Rayner, G. and Lang, T. (2012) Ecological Public Health: Reshaping the conditions for good
health. New York: Routledge.

Sachs, J. (2015) The age of sustainable development. New York: Columbia University Press.
Sim, F. and Mckee, M. (2011) Issues in Public health. Berkshire: OUP/McGraw Hill.
United Nations. Department of Economic and Social Affairs, Population Division (2017). World
Population Prospects: The 2017 Revision. [Online] Available at:
https://esa.un.org/unpd/wpp/Publications/Files/WPP2017_KeyFindings.pdf (Accessed: 25
September 2017)
WHO (1986) Ottawa Charter for Health Promotion. [Online]. Available at:
http://www.euro.who.int/en/publications/policy-documents/ottawa-charter-for-health-
promotion,-1986 (Accessed: 24 August 2017)
Wilkinson, R. and Pickett, K. (2011) The Spirit Level: Why More Equal Societies Almost Always Do
Better. London: Bloomsbury Press.
World Health Organization (2017) Constitution of WHO: principles. Available at:
http://www.who.int/about/mission/en/ (Accessed: 24 August 2017)