Summary:
Lecture 1:
What’s in a word?
- Differences in health
o Any variation between people/ groups
- Health inequality
o Socially stratified/ ordered difference
- Health inequity
o Unnecessary and unfair social differences
- Health disparity
o Descriptive synonym for health inequality
- Health gap
o Common language term for health inequality
Social determinants of health: Conditions in which people are born, grow, live, work and age and the
differences in power, money and resources that give rise to these conditions.
Clockwork view in medicine
Health is when the body operates efficiently, like a machine.
Limitations:
- When the body is not diseased, it must be healthy
- This model does not take into account the social, spiritual and psychological aspect of health
- There is an idea of ‘normal’ functioning
WHO 1948 definition of health:
Health is a state of complete, physical, mental and social well being and not merely the absence of
disease or infirmity.
Criticisms of the WHO view
- Complete wellbeing contributes to medicalization
- Does not address living with chronic conditions
- Breadth of definition impractical to operationalize
Positive health:
Focus on resilience
The ability to adapt and self-manage in the face of social, physical and emotional challenges.
Six dimensions
- Bodily functions
- Mental functioning
- Meaningfulness
- Quality of life
- Participation
- Daily functioning
Criticisms of positive health view
- Not everyone has the capabilities to adapt/ self-manage
- Personal responsibility for occurring of ill health
- Operationalization of health and factors shaping health.
,Differences in views of health
Concepts of health consisting of multiple subthemes.
No consensus found on one overall concept of health
Different concepts that can lead to misunderstandings.
Top 3 concepts of health:
Public health is about changing a risk factor across a whole population which can have a great impact
on the incidence of disease.
- Health of populations rather than individuals
- Prevention approach instead of treatment
- Collective instead of personal interventions
19th century health: combatting infectious diseases, collective health measures throughout history.
Who Healthy cities approach: optimal biologically possible health
- Creating health promoting environment, through social participation
McKeown’s thesis (1979): improved living standards are more important than medical advances.
Critique from Szreter (1988): important role of public health movement, was about clean water,
sanitation public health approach.
Bhutan: gross national Happiness is more important than gross national Product
Nine domains of Gross national Happiness
1. Health
2. Time use
3. Education
4. Cultural diversity & resilience
5. Good governance
6. Community vitality
7. Ecological diversity & resilience
8. Living standards
9. Psychological wellbeing
New public health: Contemporary public health Baum
- Equity takes center stage = health for all optimal
- All-encompassing system: all sectors/ policies should play role in promoting health
- Strong primary health care for health promotion
- Importance of citizen participation and involvement
The Ottawa Charter new perspective on public health to ensure good health
1. Building healthy public policy
a. Policies that affect health lay outside conventional concerns
i. Environmental protection, social welfare, education, control on sale of
substances
b. Health becomes concern/responsibility of each sector of government
2. Creating supportive environments
, a. Social, economic, physical environmental factors shape experiences of health
b. Supportive environments = people can realize full healthy potential
3. Reorienting health services
a. Shift primary health services to community based system
b. Offer friendly/ controlled health services
4. Developing personal skills
a. Behavior/ lifestyle = role in shaping health
b. Developing those skills to make health choices
c. Enable people to become advocates/ lobbyists for communities
5. Strengthening community action
a. Support/ encourage collective organization/ taking action
b. Build communities ability to achieve change in physical/social enviornments
Baum: people jump to solutions without analysing the problems to be addressed fully
Issues for public health:
- Inequities, environment, economics, globalization.
Health program planning cycle
1. Identify the health concern: what is the problem?
2. Conduct health needs assessment: data collection, data analysis.
3. Program design: goal, objectives, logic model, methods.
4. Program implementation & evaluation.
Two issues for research:
1. Causes of, and contributors to, health:
1. Individual, social, structural factors.
2. Biological, behaviour, support, environment, policy, economy.
2. Effectiveness of policies and interventions:
1. Which approaches effectively influence underlying factors?
2. Individual, social, structural approaches to change.
, Lecture 2: Health and politics and policies
Politics influence public health majorly
Rudolf Virchow (1821-1902)
- Medicine is a social science, and politics is nothing else but medicine on a large scale.
Multiple political issues
- Health system capacity
- Collective measures
- Wellbeing and mental health
- Economic and cultural life
- National and international
Baum 2016: Public health actions are expressions of prevailing political ideologies.
Political about public health (Dawes
- Systematic structing relationships, distributing resources, administering power.
o Who is included (voting)
o How do we invest the money (government)
o How do we make decisions (policy)
Public health and political processes
- Positive association with welfare state generosity
- Positive association with social- democratic political tradition
- Positive association with democracy
- Negative association with globalization
Welfare state regimes (similar ideologies and policies or political traditions)
- Nordic: extensive state involvement and rights
- Continental: state and others, status maintaining Netherlands, Germany
- Anglo- saxon: more market, modest social benefits
- Southern: family and community, subsidiarity, low benefits
- Eastern: transformation away from universal protection
Influential social changes:
- Increasing dominance of individualism
- Ideological shift towards neo-liberalism
Implications for public health
- Personal choice vs government regulation
- Individual entitlement vs collective benefits
What is individualism:
- Self- directed and autonomous
- People and society is focused on the individual
What is collectivism:
- Embedded in social contexts, overlapping with close others.
- Being a part of others
Lecture 1:
What’s in a word?
- Differences in health
o Any variation between people/ groups
- Health inequality
o Socially stratified/ ordered difference
- Health inequity
o Unnecessary and unfair social differences
- Health disparity
o Descriptive synonym for health inequality
- Health gap
o Common language term for health inequality
Social determinants of health: Conditions in which people are born, grow, live, work and age and the
differences in power, money and resources that give rise to these conditions.
Clockwork view in medicine
Health is when the body operates efficiently, like a machine.
Limitations:
- When the body is not diseased, it must be healthy
- This model does not take into account the social, spiritual and psychological aspect of health
- There is an idea of ‘normal’ functioning
WHO 1948 definition of health:
Health is a state of complete, physical, mental and social well being and not merely the absence of
disease or infirmity.
Criticisms of the WHO view
- Complete wellbeing contributes to medicalization
- Does not address living with chronic conditions
- Breadth of definition impractical to operationalize
Positive health:
Focus on resilience
The ability to adapt and self-manage in the face of social, physical and emotional challenges.
Six dimensions
- Bodily functions
- Mental functioning
- Meaningfulness
- Quality of life
- Participation
- Daily functioning
Criticisms of positive health view
- Not everyone has the capabilities to adapt/ self-manage
- Personal responsibility for occurring of ill health
- Operationalization of health and factors shaping health.
,Differences in views of health
Concepts of health consisting of multiple subthemes.
No consensus found on one overall concept of health
Different concepts that can lead to misunderstandings.
Top 3 concepts of health:
Public health is about changing a risk factor across a whole population which can have a great impact
on the incidence of disease.
- Health of populations rather than individuals
- Prevention approach instead of treatment
- Collective instead of personal interventions
19th century health: combatting infectious diseases, collective health measures throughout history.
Who Healthy cities approach: optimal biologically possible health
- Creating health promoting environment, through social participation
McKeown’s thesis (1979): improved living standards are more important than medical advances.
Critique from Szreter (1988): important role of public health movement, was about clean water,
sanitation public health approach.
Bhutan: gross national Happiness is more important than gross national Product
Nine domains of Gross national Happiness
1. Health
2. Time use
3. Education
4. Cultural diversity & resilience
5. Good governance
6. Community vitality
7. Ecological diversity & resilience
8. Living standards
9. Psychological wellbeing
New public health: Contemporary public health Baum
- Equity takes center stage = health for all optimal
- All-encompassing system: all sectors/ policies should play role in promoting health
- Strong primary health care for health promotion
- Importance of citizen participation and involvement
The Ottawa Charter new perspective on public health to ensure good health
1. Building healthy public policy
a. Policies that affect health lay outside conventional concerns
i. Environmental protection, social welfare, education, control on sale of
substances
b. Health becomes concern/responsibility of each sector of government
2. Creating supportive environments
, a. Social, economic, physical environmental factors shape experiences of health
b. Supportive environments = people can realize full healthy potential
3. Reorienting health services
a. Shift primary health services to community based system
b. Offer friendly/ controlled health services
4. Developing personal skills
a. Behavior/ lifestyle = role in shaping health
b. Developing those skills to make health choices
c. Enable people to become advocates/ lobbyists for communities
5. Strengthening community action
a. Support/ encourage collective organization/ taking action
b. Build communities ability to achieve change in physical/social enviornments
Baum: people jump to solutions without analysing the problems to be addressed fully
Issues for public health:
- Inequities, environment, economics, globalization.
Health program planning cycle
1. Identify the health concern: what is the problem?
2. Conduct health needs assessment: data collection, data analysis.
3. Program design: goal, objectives, logic model, methods.
4. Program implementation & evaluation.
Two issues for research:
1. Causes of, and contributors to, health:
1. Individual, social, structural factors.
2. Biological, behaviour, support, environment, policy, economy.
2. Effectiveness of policies and interventions:
1. Which approaches effectively influence underlying factors?
2. Individual, social, structural approaches to change.
, Lecture 2: Health and politics and policies
Politics influence public health majorly
Rudolf Virchow (1821-1902)
- Medicine is a social science, and politics is nothing else but medicine on a large scale.
Multiple political issues
- Health system capacity
- Collective measures
- Wellbeing and mental health
- Economic and cultural life
- National and international
Baum 2016: Public health actions are expressions of prevailing political ideologies.
Political about public health (Dawes
- Systematic structing relationships, distributing resources, administering power.
o Who is included (voting)
o How do we invest the money (government)
o How do we make decisions (policy)
Public health and political processes
- Positive association with welfare state generosity
- Positive association with social- democratic political tradition
- Positive association with democracy
- Negative association with globalization
Welfare state regimes (similar ideologies and policies or political traditions)
- Nordic: extensive state involvement and rights
- Continental: state and others, status maintaining Netherlands, Germany
- Anglo- saxon: more market, modest social benefits
- Southern: family and community, subsidiarity, low benefits
- Eastern: transformation away from universal protection
Influential social changes:
- Increasing dominance of individualism
- Ideological shift towards neo-liberalism
Implications for public health
- Personal choice vs government regulation
- Individual entitlement vs collective benefits
What is individualism:
- Self- directed and autonomous
- People and society is focused on the individual
What is collectivism:
- Embedded in social contexts, overlapping with close others.
- Being a part of others
