Lecture 1
Health is a social issue
Inequalities in health in the European Union don’t exist primarily because of inequalities in health
care system but because of conditions people live in. Life expectancy in poorer neighbors and
countries is lower than richer neighbors and countries.
There is more than a individual question of being ill or being healthy. There is more at play than
individual factors: genetics, biology and lifestyle choices.
‘A toxic combination of bad policies, economics and politics is, in large measure, responsible for the
fact that a majority of people in the world do not enjoy the good health that is biologically possible.’
– WHO (2008), Commission on Social Determinants of Health
There is biological possibility for health, not the same for
everybody, but there are more distal factors influence the
health where we have no influence on. This is how
suboptimal health comes to be. It has large implications
for health promotion: not only individual factors we have
to be targetted (education), but also put in place policies
and interventions on the social level to impact those
more distal factors that play an important role in health .
Social determinants of health: conditions in which people are born, grow, live, work and age.
Introduction to (new) (public) health
What is health?
Clockwork model in medicine
We think of our body as a clock, as a machine, when all the parts of the clock are working
properly then the clock works (body is healthy), no action required, health taken for
granted
Biomedical perspective
Focus on breakdowns of the system, then the body is not healthy
Focus on fixing the broken part, and keeping the machine running
Labelling, classifying, diagnose, identifying
Health is more than absence of illness
There was a lot of critique on the clockwork model (recent years), because it is
mechanistic and focused on the absence of illness
Multiple issues at play for health: mental health for example
The clockwork model presumes a ‘normal health’ but health can be different for
everybody, it’s very subjective
‘Health is a state of complete, physical, mental and social well-being and not merely the
absence of disease or infirmity’ – WHO (1948)
What is positive health?
trying to reach optimal health in more aspects of health than only absence of sickness, so if you
look on health in more terms than only the absence of sickness, there is a lot you can work on,
more action required, we can always improve something
, when you look only at health as absence of sickness you only take action when you are ill, it’s
mechanic
strengths that contribute to good health and protect against illness (it can be different for
everybody!)
physical, mental, spiritual aspects
daily functioning, social participation
quality of life
much more focused on the subjective feelings of people
What is public health?
Health of populations, rather than individuals
So more holistic and in terms of ecosystems, what is making people healthy
Prevention rather than treatment (once the symptoms have occurred)
Protect people against health issues
Collective rather than personal interventions, no treating one person, but groups
Places, settings, location when many people van be targeted
Roots of public health
Date back to large outbreaks like cholera
To combat those infectious diseases
Collective health measures throughout history (e.g. 19 th century UK public health reforms)
What influences public health?
Clean water, public hygiene, solar systems have
helped against a lot of diseases
Tuberculosis declined significantly before any
treatment has been invented, due to improved
hygiene (hygiene hypothesis)
Population growth since 18th century due to
improved standards of living (hygiene
hypothesis- McKeown’s thesis 1979)
Limited contribution of curative medicine to overall mortality and population health
improvement (hygiene hypothesis- McKeown’s thesis 1979)
Main critique (Szreter, 1988) - Public health movement (working conditions, housing,
education, health services) have done more work, how improved economic conditions are
invested, so not only improved standards of living
Bhutan – focus on growth national happiness
WHO Healthy cities approach
Physical and social environments
Strong community, citizen participation
Focus on such outcomes as number of trusting people; availability of community spaces
Goof infrastructure for biking and public transport
Focus on quality of life and well-being
Healthy city is defined by a process, not an outcome
A healthy city is one that continually creates and improves its physical an social environments
and expands the community resources that enable people to mutually support each other in
performing all the functions of life and developing to their maximum potential
,Difference equity and equality equality is giving everyone the exact same resources, equality is
giving the resources people need given their circumstances
What is new public health?
Equity takes central stage (‘health for all’)
Health equity is social justice in health
All-encompassing system: all sectors and all policies should play their role in promoting health
Importance of citizen participation and involvement
No top-down decisions, people involved in treatment should be active participants in decision
making
How do we come from new public health to health promotion?
Building healthy public policy
Creating supportive environments
Reorienting health services (attuned to what people need)
Developing personal skill
(providing knowledge, promoting behavior changes)
Strengthening community action
Empirical evidence
‘often people jump to solutions without analyzing the problems to be addressed fully’ – Baum,
2016
Often people invent an intervention without
researching it properly
important for the assignment!
two main issues for research:
causes of, and contributors to, health
individual, social, structural factors
biology, behavior, support, environment,
policy, economy
effectiveness of polices and interventions
which approaches effectively influence
underlying factors?
Individual, social, structural approaches to
change
Different research methods:
Qualitative research (focus groups, in-depth interviewing, case studies, document analysis)
Quantitative research (monitoring and surveillance, case-control studies, cross-sectional and
longitudinal surveys, (non) randomized experimental studies)
Quality of evidence (meta-analysis, systematic reviews are the highest)
Lecture 2: Politics and welfare state, Individualism and globalization, social
position and inequity. And public health
Part 1: Politics, welfare state and public health
Public health is a political process.
, War on drugs – since 17th century in the USA. The government was concerned about wealth and
social impact the consumption of drugs in society. Later people took stuck on what this has implied.
Since the start of the war about 1 trillion dollars has been spent (1,6 million dollars drug arrests in
2010, 8 million arrested for pot since 2000).
Facts hardly even speak for themselves. The same infographic can been used to advocate about the
end of the war. It is framed in completely different way but says the same. This illustrate that facts
can be interpreted differently, politics frames the public health.
Corona – public health issue – government involved in making important choices (can be contested
by people who have different perspectives) and take particular measures – we live in times when the
notion that public health is a political issue is very obvious.
Article
Public health is always political, because the government is the only authority which can response
when a large part of the population is endangered. Protecting the population requires a lot of
resources that only the government can put together to an public advice. It requires political
prioritization.
-The public health response system has been put together into its position by elected officials
-for example Trump administration decided to to reduce the global health security directonate)
-president Trump wants to cut off the funds for the WHO
-when people requite treatment for a disease, they come to the domestic health care financing
operating on a regulatory landscape which reflects the priorities of the elected representatives.
-political decisions impact the public health systems.
-pandemic responses in any country are fundamental human endeavors led by governments put in
place by the people through a political process
Rudolf Virchow (1821-1902)
Founder of Social Medicine in Berlin
‘Medicine is a social science and politics is nothing else but medicine on a large scale’
He was the first to notice that public health is a political issue. He conveys the message that
health of people is influences by social factors and has a lot of consequences.
Public health is more than a technical issue for professionals and experts (not only doctors go about
health).
Evidence requires responses.
Limited resources imply choices (those choices may be made by professionals and experts, but there
are many people with many different choices about the resources, the choices are democratic and
definitely a political issue).
Health is a social issue
Inequalities in health in the European Union don’t exist primarily because of inequalities in health
care system but because of conditions people live in. Life expectancy in poorer neighbors and
countries is lower than richer neighbors and countries.
There is more than a individual question of being ill or being healthy. There is more at play than
individual factors: genetics, biology and lifestyle choices.
‘A toxic combination of bad policies, economics and politics is, in large measure, responsible for the
fact that a majority of people in the world do not enjoy the good health that is biologically possible.’
– WHO (2008), Commission on Social Determinants of Health
There is biological possibility for health, not the same for
everybody, but there are more distal factors influence the
health where we have no influence on. This is how
suboptimal health comes to be. It has large implications
for health promotion: not only individual factors we have
to be targetted (education), but also put in place policies
and interventions on the social level to impact those
more distal factors that play an important role in health .
Social determinants of health: conditions in which people are born, grow, live, work and age.
Introduction to (new) (public) health
What is health?
Clockwork model in medicine
We think of our body as a clock, as a machine, when all the parts of the clock are working
properly then the clock works (body is healthy), no action required, health taken for
granted
Biomedical perspective
Focus on breakdowns of the system, then the body is not healthy
Focus on fixing the broken part, and keeping the machine running
Labelling, classifying, diagnose, identifying
Health is more than absence of illness
There was a lot of critique on the clockwork model (recent years), because it is
mechanistic and focused on the absence of illness
Multiple issues at play for health: mental health for example
The clockwork model presumes a ‘normal health’ but health can be different for
everybody, it’s very subjective
‘Health is a state of complete, physical, mental and social well-being and not merely the
absence of disease or infirmity’ – WHO (1948)
What is positive health?
trying to reach optimal health in more aspects of health than only absence of sickness, so if you
look on health in more terms than only the absence of sickness, there is a lot you can work on,
more action required, we can always improve something
, when you look only at health as absence of sickness you only take action when you are ill, it’s
mechanic
strengths that contribute to good health and protect against illness (it can be different for
everybody!)
physical, mental, spiritual aspects
daily functioning, social participation
quality of life
much more focused on the subjective feelings of people
What is public health?
Health of populations, rather than individuals
So more holistic and in terms of ecosystems, what is making people healthy
Prevention rather than treatment (once the symptoms have occurred)
Protect people against health issues
Collective rather than personal interventions, no treating one person, but groups
Places, settings, location when many people van be targeted
Roots of public health
Date back to large outbreaks like cholera
To combat those infectious diseases
Collective health measures throughout history (e.g. 19 th century UK public health reforms)
What influences public health?
Clean water, public hygiene, solar systems have
helped against a lot of diseases
Tuberculosis declined significantly before any
treatment has been invented, due to improved
hygiene (hygiene hypothesis)
Population growth since 18th century due to
improved standards of living (hygiene
hypothesis- McKeown’s thesis 1979)
Limited contribution of curative medicine to overall mortality and population health
improvement (hygiene hypothesis- McKeown’s thesis 1979)
Main critique (Szreter, 1988) - Public health movement (working conditions, housing,
education, health services) have done more work, how improved economic conditions are
invested, so not only improved standards of living
Bhutan – focus on growth national happiness
WHO Healthy cities approach
Physical and social environments
Strong community, citizen participation
Focus on such outcomes as number of trusting people; availability of community spaces
Goof infrastructure for biking and public transport
Focus on quality of life and well-being
Healthy city is defined by a process, not an outcome
A healthy city is one that continually creates and improves its physical an social environments
and expands the community resources that enable people to mutually support each other in
performing all the functions of life and developing to their maximum potential
,Difference equity and equality equality is giving everyone the exact same resources, equality is
giving the resources people need given their circumstances
What is new public health?
Equity takes central stage (‘health for all’)
Health equity is social justice in health
All-encompassing system: all sectors and all policies should play their role in promoting health
Importance of citizen participation and involvement
No top-down decisions, people involved in treatment should be active participants in decision
making
How do we come from new public health to health promotion?
Building healthy public policy
Creating supportive environments
Reorienting health services (attuned to what people need)
Developing personal skill
(providing knowledge, promoting behavior changes)
Strengthening community action
Empirical evidence
‘often people jump to solutions without analyzing the problems to be addressed fully’ – Baum,
2016
Often people invent an intervention without
researching it properly
important for the assignment!
two main issues for research:
causes of, and contributors to, health
individual, social, structural factors
biology, behavior, support, environment,
policy, economy
effectiveness of polices and interventions
which approaches effectively influence
underlying factors?
Individual, social, structural approaches to
change
Different research methods:
Qualitative research (focus groups, in-depth interviewing, case studies, document analysis)
Quantitative research (monitoring and surveillance, case-control studies, cross-sectional and
longitudinal surveys, (non) randomized experimental studies)
Quality of evidence (meta-analysis, systematic reviews are the highest)
Lecture 2: Politics and welfare state, Individualism and globalization, social
position and inequity. And public health
Part 1: Politics, welfare state and public health
Public health is a political process.
, War on drugs – since 17th century in the USA. The government was concerned about wealth and
social impact the consumption of drugs in society. Later people took stuck on what this has implied.
Since the start of the war about 1 trillion dollars has been spent (1,6 million dollars drug arrests in
2010, 8 million arrested for pot since 2000).
Facts hardly even speak for themselves. The same infographic can been used to advocate about the
end of the war. It is framed in completely different way but says the same. This illustrate that facts
can be interpreted differently, politics frames the public health.
Corona – public health issue – government involved in making important choices (can be contested
by people who have different perspectives) and take particular measures – we live in times when the
notion that public health is a political issue is very obvious.
Article
Public health is always political, because the government is the only authority which can response
when a large part of the population is endangered. Protecting the population requires a lot of
resources that only the government can put together to an public advice. It requires political
prioritization.
-The public health response system has been put together into its position by elected officials
-for example Trump administration decided to to reduce the global health security directonate)
-president Trump wants to cut off the funds for the WHO
-when people requite treatment for a disease, they come to the domestic health care financing
operating on a regulatory landscape which reflects the priorities of the elected representatives.
-political decisions impact the public health systems.
-pandemic responses in any country are fundamental human endeavors led by governments put in
place by the people through a political process
Rudolf Virchow (1821-1902)
Founder of Social Medicine in Berlin
‘Medicine is a social science and politics is nothing else but medicine on a large scale’
He was the first to notice that public health is a political issue. He conveys the message that
health of people is influences by social factors and has a lot of consequences.
Public health is more than a technical issue for professionals and experts (not only doctors go about
health).
Evidence requires responses.
Limited resources imply choices (those choices may be made by professionals and experts, but there
are many people with many different choices about the resources, the choices are democratic and
definitely a political issue).
