Public Health,

Health
Economics
Akuoko Ebenezer
PhD Candidate, FEFU
Email: [email protected]
•Module I. Theoretical Foundations of the discipline, Public
health policy
 Objectives
•At the end of this lesson, you should be able to know about;
1. The history of the development of the scientific discipline "public health and
health care".

2. Public health and health care as a science and subject of teaching.

Relationship of public health with other scientific disciplines.

3. Methods of public health study and evaluation.

4. Determinants of health.
5. The concept of prevention.
 History of public Health
Prehistoric Age
Use of supernatural powers for treatment and healing
Ancient Greek
i. Asclepius: God of medicine
ii. Hygeia : Goddess of health, oversaw cleanliness and taught how to live a long life (preventive medicine)
iii. Panacea: goddess of universal remedy. Had a potion with which she healed the sick (Curative medicine)
iv. Hippocrates – father of medicine, first to establish the natural cause of diseases

Ancient Roman empire

i. Focused on water and sanitation
ii. Built hospitals and medical centers and trained physicians
Dark Ages
i. Superstition crept back into beliefs about medicine, and people were taught that diseases were punishment from God.
ii. Overcrowded cities and settlements
ii. Plague of Justinian in 543 and the Black Death or bubonic plaque in 1348.
iii. Knowledge about treatment was unknown
iv. 1200s: passage of laws on sanitation, quarantine and isolation
Renaissance, enlightenment, and industrial revolution
i. Commerce, industry, trade, merchant fleets, and voyages of discovery
ii. vast epidemics of syphilis, typhus, smallpox, measles, and the plague continued to spread across Europe
iii. the sciences of anatomy, physiology, chemistry, microscopy, and clinical medicine opened medicine to a scientific base
iv. Medical schools in universities developed affiliations with hospitals
 Modern advancement in Public Health

1. Expansion in the sources of financing health care.

2. Deployment of ICT in healthcare (eg EHR, Telemedicine).

3. Expansion of legal relations and frameworks in health care

system.
 What is Health ?
•Lay Point of view: Persons are healthy when they are doing their activities with no apparent
symptoms of disease in them. The New oxford Dictionary of English describes health as ‘the
state of being free from illness or injury’.

•Professional points of view: From this point, health is defined as s a measure of the state of
the physical bodily organs, and the ability of the body as a whole, to function. It refers to
freedom from medically defined diseases.

•WHO definition: The world Health Organization (WHO) described health in 1948, in the
preamble to its constitution, as “A state of complete physical, mental, and social well-being and
not merely the absence of disease or infirmity”.
Determinants of Health
 Definition of Public Health
•Public Health is defined as “the art and science of preventing disease,
prolonging life and promoting health through the organized efforts of society”.

•Public health develops and conserves health and lengthens life by means of
community activities organized to secure environmental sanitation,
communicable disease control, early discovery and preventive treatment of
disease, and the education of the public in the principles of healthful living.
Public health as an art

The art of public health is to create, advocate for, and use opportunities to implement

effective solutions to population health and health care problems.

Public health as a science

•The science of public health is concerned with making a diagnosis of a population’s health

problems, establishing the causes and effects of those problems, and determining effective

interventions.
Functions / Objectives of Public Health
Disciplines of Public Health
Research methods in Public Health Study
(Epidemiology)
 Difference between Public Health and Clinical Medicine

•Clinical medicine is concerned with diagnosing illness, treating disease,

promoting health, and relieving pain and distress in individual patients.

•Public health is concerned with improving the health of populations and

reducing inequalities in health.

 Public Health as an educational discipline for medical students
• Effective medical practitioners must be concerned with contributing to each of
the goals of public health. Prevention is as much a part of the medical role as
cure.

• Doctors have often looked beyond their individual patients to improve the
health of the population. Their education at all levels should ensure that they
are equipped to make the most of this approach.

• Doctors with a clear understanding of their role within the wider context of
health and social care will influence the planning and organization of services.
 Population Health
• Population health is defined as the health outcomes of a group of individuals,
including the distribution of such outcomes within the group.

• These groups are often geographic populations such as nations or communities,

and can also be other groups such as employees, ethnic groups, disabled
persons, prisoners, or any other defined group.

• The health outcomes of such groups are of relevance to policy makers in both
the public and private sectors.
 Public Health Surveillance and Data
• Data form an integral aspect of population health studies.

• Data are the facts and figures collected, analysed and summarized for
presentation and interpretation.

• Data is collected through a system called surveillance.

• Surveillance is defined as “ … the ongoing systematic collection, analysis, and

interpretation of outcome-specific data for use in planning, implementation, and
evaluation of public health practice”.
 Types of surveillance
1. Active Surveillance: a systematic and comprehensive solicitation of
case data by designated staff supported for that purpose.

2. Passive surveillance: Collection of case data based on voluntary

compliance of reporting by physicians, laboratory staff and other
healthcare workers.
 Surveillance systems
1. Census
(0-14 +64)/(15-64)
2. Vital statistics
3. Survey =
4. Registries
Characteristics of a good surveillance system
•Class discussions

Why do you think population health data is

important?
 Intersectoral collaboration in public health
• The health of populations is determined not by health sector activities alone but
by social and economic factors, and hence by the policies and actions beyond the
mandate of the health sector.

• It is thus important for the health sector to work in collaboration with other
sectors to raise awareness of the co-benefits of acting together for people-
centered policies that promote health.

• By partnering with sectors outside the health sector, we are better able to address
the underlying causes of the conditions which create health and, especially,
health disparities.
Approach to intersectoral collaboration
 Public Health Policy
•Public health policy is defined as the laws, regulations, actions, and decisions implemented

within society to promote wellness and ensure that specific health goals are met. Policies can

range from formal legislation to community outreach efforts.

•Public health policy is crucial because it brings the theory and research of public health into the

practical world.

•Public health policies create action from research and find widespread solutions to previously

identified problems.
•Before public health policies are implemented, policymakers and
officials will go through an extensive research process to determine
what public health issues need to be addressed and formulate the best
subsequent solutions.

• Public health policy officials initiate strategies and policies around

both health intervention and prevention, to address physical, mental,
social, and economic well-being of populations.
 Common public health policies
1. Food Safety Policy: Food safety policies are very important to the general health of

individuals and people in society. Food-related illnesses are a significant concern, and it is the job

of public health officials to formulate policies to ensure that only food that is safe for

consumption is made available for the public.

2. Tobacco Use: Many public health officials have put measures in place to reduce the risks of

deaths and illnesses caused by tobacco consumption and smoking. Some of these policies include

increasing tobacco prices and creating tobacco-free areas in communities to protect non-smokers

from the effects of secondary smoking.

• HIV: Public health policy plays an important role in educating the public about HIV prevention, how to live

with the virus, treatment options, and preventing stigma. Public health policies, including increased access to

testing, birth control, and medicine, have been implemented to drastically reduce the impact and spread of the

virus in various communities.

• Alcohol: Alcohol abuse is one of the leading causes of vehicular accidents, violence, sexual assault, health

complications, and more. Public health policies are crucial in the fight to curtail alcohol dependence and reduce

its negative effects on users. Policies on alcohol differ depending on the community, but the most common

example is age restrictions in the consumption and purchase of alcohol.

 Home task
•Read about the World Health Organization
1. History
2. Goal
3. Headquarters
4. Structure and leadership
5. Management
6. Activities
 Disease prevention
• The goals of medicine are to promote health, to preserve health, to restore health
when it is impaired, and to minimize suffering and distress.

• These goals are embodied in the word "prevention"

• Disease prevention are actions aimed at eradicating, eliminating or minimizing

the impact of disease and disability, or if none of these are feasible, retarding the
progress of the disease and disability.
 Determinants of prevention
• Successful prevention depends upon:
• a knowledge of causation,
• dynamics of or early detection and treatment measures,
• an organization for applying detection and treatment measures to appropriate
persons or groups,
• continuous evaluation of and development of procedures applied to
transmission,
• identification of risk factors and risk groups,
• availability of prophylactics.
 Preventable Causes of Diseases

1. Biological factors and Behavioral Factors

2. Environmental factors
3. Immunologic factors
4. Nutritional factors
5. Genetic factors
6. Services, Social factors, and Spiritual factors
Levels of prevention
 Primordial Prevention
• Primordial prevention consists of actions and measures that
inhibit the emergence of risk factors in the form of
environmental, economic, social, and behavioral conditions and
cultural patterns of living etc .

• It is the prevention of the emergence or development of risk factors in countries

or population groups in which they have not yet appeared.

• For example, many adult health problems (e.g., obesity, hypertension) have their
early origins in childhood, because this is the time when lifestyles are formed
(for example, smoking, eating patterns, physical exercise).
• In primordial prevention, efforts are directed towards discouraging children from
adopting harmful lifestyles.
• The main intervention in primordial prevention is through individual and mass
education.

• Class Discussions:
With the concept of primordial level of prevention, should governments stop the
production and sale of alcoholic beverages and tobacco?
Should there be strict punitive laws on unsafe sexual practices? What is the place
of human rights in these discussions?
 Primary prevention
• Primary prevention can be defined as the action taken prior to the onset of disease, which
removes the possibility that the disease will ever occur.

• It signifies intervention in the pre-pathogenesis phase of a disease or health problem.

• Primary prevention may be accomplished by measures of “Health promotion” and “specific

protection”

• It includes the concept of "positive health", a concept that encourages achievement and
maintenance of "an acceptable level of health that will enable every individual to lead a
socially and economically productive life".

• Primary prevention may be accomplished by measures designed to promote general health

and well-being, and quality of life of people or by specific protective measures .
• It includes the concept of "positive health", a concept that encourages
achievement and maintenance of "an acceptable level of health that will enable
every individual to lead a socially and economically productive life".

• Primary prevention may be accomplished by measures designed to promote

general health and well-being, and quality of life of people or by specific
protective measures.
Primary prevention strategies
 Secondary Prevention
• Secondary prevention is defined as “ action which halts the
progress of a disease at its incipient stage and prevents
complications.”

• The specific interventions are early diagnosis (e.g., screening

tests, and case finding programs….) and adequate treatment.

• Secondary prevention attempts to arrest the disease process,

restore health by seeking out unrecognized disease and treating
it before irreversible pathological changes take place, and
reverse communicability of infectious diseases.

• It thus protects others in the community from acquiring the

infection and thus provide at once secondary prevention for the
infected ones and primary prevention for their potential contacts.
•WHO Expert Committee in 1973 defined early detection of health
disorders as “ the detection of disturbances of homoeostatic and
compensatory mechanism while biochemical, morphological and
functional changes are still reversible.”

•The earlier the disease is diagnosed, and treated the better it is for
prognosis of the case and in the prevention of the occurrence of other
secondary cases.
 Tertiary Prevention
•Tertiary prevention is used when the disease process has
advanced beyond its early stages.

•It is defined as “all the measures available to reduce or limit

impairments and disabilities, and to promote the patients’
adjustment to irremediable conditions.”

•Intervention that should be accomplished in the stage of tertiary

prevention are disability limitation, and rehabilitation.
 Rehabilitation
•Rehabilitation is “ the combined and coordinated
use of medical, social, educational, and vocational
measures for training and retraining the individual
to the highest possible level of functional ability.”
 Reading List
• 1. John Wiley & Sons. Public Health Foundations: Concepts and Practices.; 2010.

• 2. Chrysopoulos P. Hippocrates: The Greek Father of Modern Medicine. Greek Repoter.

https://greekreporter.com/2021/04/09/hippocrates-the-greek-father-of-modern-medicine/
#:~:text=Born on The island of,by the spirits or gods. Published 2021.

• 3. Taher M, Mannan A, Dulal S. Contribution of Greek Mythology and Civilization on

Medical Science- a Brief Analysis. Int J Adv Res. 2018;6(11):1095-1102.
doi:10.21474/ijar01/8098
•4. Theodore H. Tulchinsky and Elena A (2014). VaravikovaA History of Public Health
•5.CHRODIS + Recommendations on intersectoral collaboration to strengthen
Health Promotion and Disease Prevention
http://www.chrodis.eu/wp-content/uploads/2020/10/wp5-brochure-intersectora
l-collaboration.pdf
 NEXT WEEK

•Test
•Group Presentation on the Healthcare
System of Germany
•THANK YOU