Transcript An overview of public health and its practice

Day 1 - Session 1
What is public health?
Dr Alison Hill
Director, South East
Public Health Observatory
Public health
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What is it? (Informed by today’s topical issues)
Early history
Who works in or contributes to public health?
How is it organised?
Main functions
Major public health issues
Some examples of practice
"Health care matters to all of us
some of the time,
public health matters to all of us
all of the time"
C. Everett Koop
What is health?
What public health issues are in the
papers today?
Take one of today’s topical health
issues
1 What is the issue?
2 What is the impact on health?
3 Who will be affected?
4 Who can promote change?
5 Who can oppose?
6 Who decides?
What is health?
“A state of complete physical , mental and social
well-being and is not merely the absence of
disease or infirmity.”
(World Health Organisation, 1948)
“The extent to which an individual or group is
able to realise aspirations, satisfy needs and to
change or cope with the environment “
(World Health Organisation, 1984)
What is Public Health?
The science and art of preventing disease,
prolonging life, and promoting health through
the organised efforts of society
Acheson 1988 in the Public Health in England report
• Public health is concerned with improving the
health of the population, rather than treating
the diseases of individual patients.
Chief Medical Officer
Well-being?
For these purposes we will consider
health and well-being to be the same
thing
Public health
Focuses on the entire population even when they are not ill
Rather than
Individuals when they become ill
Therefore
Public health regards the community as its patient
The Public Health Approach
Is population based
• Emphasises collective responsibility for health, its
protection and disease prevention
• Recognises the key role of the state, linked to a
concern for the underlying socio-economic and
wider determinants of health, as well as disease
• Emphasises partnerships with all those who
contribute to the health of the population
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http://www.fphm.org.uk/about_faculty/what_public_health/default.asp
Individual & Population Health
Individual
Population
History
Symptoms of
illness
Indicators of population health
Examination
Signs of illness,
bio- chemical tests
Surveillance, epidemiological
information, Health Needs
Assessment
Diagnosis
Label to describe
what has gone
wrong
Key health issues
Prognosis
Outlook
associated with
individual disease
Outlook associated with trends
and disease patterns
Treatment
Individual
interventions
Population based interventions,
Health Protection,
screening, Vacc & Imm, NSFs
The parable of the health worker
Every so often a drowning person is swept
alongside. The lifesaver dives in to the rescue,
retrieves the ‘patient’ and resuscitates them. Just
as they have finished another casualty appears
alongside. So busy and involved are the
lifesavers in all of this rescue work that they have
no time to walk upstream and see why it is that
so many people are falling in the river.
(Ashton and Seymour, 1988, The New Public Health)
Policies and strategies for promoting social
equality in health
Hill, Griffiths, Gillam. Public Health and Primary Care: Partners in Population Health. OUP 2007
W H Duncan (1805-1863)
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Liverpool Town Council (1847)
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Act of Parliament (specific to Liverpool): for the
Improvement of the Sewerage and Drainage of the
Borough of Liverpool
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UK’s first medical officer
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Died aged 57 “worn down by the uneven contest”
of struggling with Liverpool’s health problems
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Obituary: the health of Liverpool was so improved
that there was “no longer any occasion for the
salary of a medical officer at £700 per year”
Thanks to Dr Tim Crayford, DPH Croydon PCT
Sir John Simon
• First Medical Officer of Health for London
(1848)
• Medical Officer to the General Board of
Health (1855 c/o Public Health Act) Lecturer,
St. Thomas’ hospital
• Medical Officer to the Privy Council in (1859)
• President Metropolitan Association of
Medical Officers of Health (1856-65)
• Chief Medical Officer to the local
government board
• Published the first annual public health
reports
• Vaccination
• 'He endured, perhaps with too little patience,
the constantly recurring pinpricks of official
interference'
Thanks to Dr Tim Crayford, DPH Croydon PCT
John Snow
Who contributes to public health? (even
though it may not say so in their job description)
• 3 main categories (CMO)
– Professionals who spend some of their time in PH related
work – teachers, other healthcare workers, other
government officers, systems engineers
– Professionals who spend major part of their work in PH
issues – health visitors, health promotion, information,
EHO
– Specialists – strategic/senior level – ability to manage
change and lead PH programmes
• Who else?
What does it involve?
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Assessment of health needs
Monitor health status of population
Programmes for risk reduction/screening
Communicable disease control
Planning health services
Evaluation of provision of health services
Manage and implement change
Work with other agencies to maximise health
gain
How is PH organised?
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Department of Health (DH)
Strategic Health Authorities (SHA)
Primary Care Trusts (PCT)
Regional Public Health Groups (RPHG)
Local Authorities and Local Strategic
Partnerships
• Health Protection Agency (HPA)
• Public Health Observatories
• Faculty of Public Health (FPH)
Organisation of public health
DH
Other Government
Departments
FPH
RPHG
SHA
Regional offices
PCT
HPA
HPU
Local Authorities
Voluntary agencies
etc
Main functions
3 main areas
1. Health protection
2. Health and social care
3. Health improvement
1. Health protection
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Communicable disease control
Environmental health
Emergency planning
Disease and injury prevention
2. Health and social care
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Quality
Clinical effectiveness and efficiency
Clinical governance
Audit and evaluation
Service planning
3. Health improvement
• Inequalities
• Lifestyles
• Education/housing/employment/environment
– broader determinants of health
Link to inequalities – geographical
variations
• A boy in Manchester can expect to live over 7
years less than a boy in Barnet
• A girl in Manchester can expect to live 6 years
less than a girl in Kensington, Chelsea and
Westminster
• but there are pockets of deprivation
everywhere and health inequalities affect all
parts of the country
• Premature CHD deaths one of the biggest
reasons for inequalities
Drivers for Public Health (1)
Drivers for public health (2)
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Wanless and the PH imperative
Policy: Tackling Inequalities & Choosing Health
Public Service Agreements (PSA)
Community Service Agreements (CSA)
Local Authority Agreements (LAAs)
Local Strategic Partnerhsips (LSPs)
Local Operational Plans (LOPs)
Organisational change – reform agenda PBR /
PBC and new structures
• Financial imperatives and contrary aims
Summary
• Public Health contributes to health on a
population basis by assessing needs,
interventions and by implementing population
level changes by working within and beyond
the health sector
• Public Health is vital if we are to prevent illness
and have affordable health care, now and in
the future
• Organisational change and government
policies both help and hinder the public health
agenda
You should now know a little about:
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What is it?
Early history
Who contributes to public health?
How is it organised?
Main functions
Major public health issues
Some examples of practice