LECTURE 1. Opening and introduction to course
Mostly done cancer tests: breast, cervix, and colon cancers.
The incidence of cancer is rising with 3000 patients per year. During COVID fewer diagnoses,
because people didn’t show up to their GP.
- Men: prostate, skin, lung, bowel. In the beginning, more men had lung cancer, but
now also women, because they started smoking later.
- Women: breast, skin, lung, bowel, lymph node and leukaemia.
o Woman started smoking later -> therefore they also started to get lung cancer
later. Hence, lung cancer is now an upcoming cancer type in women.
Survival rate (5-year survival) = W 70%, M 66%.
20 year prevalence: in 2032, 1 in 13 will have (a history of) cancer.
Oncology is a public health issue, oncology is the leading cause of death.
1/3 of all cancer types is due to behavioural and dietary risks:
- High BMI.
- Low fruit and vegetable intake.
- Lack of physical activity.
- Tobacco use.
- Alcohol use.
Public health: the science and art of preventing disease, prolonging life and promoting health
through the organized efforts of society.
Health is a state of complete physical, mental and social wellbeing and not merely the
absence of disease or infirmity.
- The focus of oncology and public health is on:
o Prevention.
o Increasing health care capacity.
o Making the organization of health care more efficient.
o Digitalization.
o Supporting the needs of patients and survivors.
o Increasing the quality of life and quality of end-of-life.
Answers to the quiz:
- More men than women are diagnosed with cancer in the Netherlands; probably
because diagnosis happen less in women – not that there are less women with
cancer.
- The incidence of cancer in the Netherlands in 2019 was about 119.000; the
prevalence is way higher.
- Breast cancer screening is an example of secondary prevention = early detection/
diagnosis; with secondary prevention the disease is already present– primary
screening is when the individual takes steps to prevent a disease from happening.
- 40-50% of new cancers causes are diagnosed during the working age (18-65) – for
instance because people are working until a later age.
,- More than 85% of all cancer types can be considered ‘rare’ cancer types.
- Most prevalent cancer type in women is breast cancer
- Most prevalent cancer types in men is prostate cancer
- In the Netherlands people usually get screened for colon cancer at the age of 55.
- In the Netherlands people usually get screened for breast cancer at the age of 50.
- In the Netherlands people usually get screened for cervical cancer at the age of 35.
- 1/3 of all cancer are caused by an unhealthy lifestyle
- 5-10% of all cancer have a genetical component
- Palliative care and intense life prolonging therapy can be combined.
- The prevalence of distress in patient with cancer is 1/3 of all patient.
- Colorectal cancer is the type of screening program that has the highest uptake rates
in the Netherlands together with breast cancer.
- Cannabis can be used to relieve pain in patients with cancer.
,LECTURE 2. Introduction in public health
X Definition of public health
The science and art of (1) preventing disease, (2) prolonging life and (3) promoting health in
the public through organized efforts and informed choices of society.
- Society: organizations, public and private, communities, and individuals.
- Public: communities, countries, or global health.
→ collective action to improve population health.
3 most important goals (3Ps):
- Preventing disease
- Prolonging life
- Promoting health
X Public health application
Three fields of public health research:
1. Epidemiology and community diagnosis.
o Epidemiology: the branch of medicine which deals with the incidence,
distribution, and possible control of diseases and other factors relating to
health.
o Community diagnosis: a quantitative and qualitative description of the health
of citizens and the factors which influence their health.
2. Collective prevention and health promotion.
o Screening and information.
3. Health care organization and performance
o How is health care (in a city) organized, how is health provided? How is the
access to health organizations (GP/ hospital) distributed? Is it accessible for
everyone?
Public health vs medical science:
- Public health and cancer: trying to decrease the risk factors – through screening.
o But also through environmental control.
- Populations: From local areas to the world population.
- Causes of diseases (causes of causes): From behaviours to broader environment.
o Advertisements for smoking banned, taxes for cigarettes - because it causes
smoking.
, o Why do people smoke? Why do people keep smoking?
- Prevention of disease: From individual patients to national policies.
o What can the government do to prevent it? What can the society do to
prevent disease?
o Smoking behaviour.
- General health outcomes: From quality of life to healthy life expectancy.
o Where do we get our gains, what can you do to improve this? is living longer
always better or quality of life?
X Public health function
- Assessment and monitoring:
o At a population level – how many people get cancer or how many are healthy?
o To identify health problems and priorities in risk populations.
▪ Mesothelioma risk with asbestos? Relation asbestos and mesothelioma
= 1 on 1. Working with asbestos has a huge latency period (can be 40
years) before mesothelioma occurs. 500-600 people are dying of
mesothelioma.
- Formulation of public policies:
o What kind of policy should be considered in the disease situation? What is
necessary to improve public health.
▪ What kind of policy should be used in asbestos, ban on asbestos?
- Access to appropriate and cost-effective care:
o Assure that all populations have access to health care.
▪ Including health promotion and diseases prevention services.