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English for special
purpose in Public health
Introduction to public health and preventive medicine
Story of life expectancy
Mortality Rate
CIA World Factbook 2007 Estimates for Life Expectancy at birth (years).
按联合国会员排名 按国家或地区排名
国家或地区 总预期寿命
男性预期寿命
女性预期寿命
1 澳門特別行政區 84.33 81.36 87.45
1 2 安道爾 82.67 80.35 85.14
2 3 日本 82.07 78.73 85.59
3 4 新加坡 81.89 79.29 84.68
3 5 聖馬利諾 81.88 78.43 85.64
6 香港 81.77 79.07 84.69
7 吉布拉塔(英國( 80.9 78.5 83.3
5 8 瑞典 80.63 78.39 83
6 9 澳洲 80.62 77.8 83.59
7 10 瑞士 80.62 77.75 83.63
8 11 法國 80.59 77.35 84
12 根西島( 英國) 80.53 77.53 83.64
9 13 冰島 80.43 78.33 82.62
10 14 加拿大 80.34 76.98 83.86
76 103 土耳其 72.88 70.43 75.46
76 103 中國 )mainland( 72.88 71.13 74.82
79 106 馬來西亞 72.76 70.05 75.65
80 114 巴西 72.70 69.0 76.50
81 107 聖克里斯多福及尼維斯 72.66 69.81 75.69
82 108 保加利亞 72.57 68.95 76.4
83 109 泰國 72.55 70.24 74.98
84 110 安地卡及巴布達 72.42 70.03 74.94
85 111 塞席爾 72.34 66.98 77.86
86 112 愛沙尼亞 72.3 66.87 78.07
87 113 哥倫比亞 72.27 68.44 76.24
173 203 索馬里 48.84 47.06 50.69
174 204 奈及利亞 47.44 46.83 48.07
175 205 查德 47.2 46.17 48.27
176 206 幾內亞比索 47.18 45.37 49.04
177 207 尼日 44.03 44.05 44
178 208 阿富汗 43.77 43.6 43.96
179 209 中非 43.74 43.69 43.79
180 210 吉布地 43.25 41.88 44.65
181 211 納米比亞 43.11 44.39 41.79
182 212 馬拉威 42.98 43.35 42.61
183 213 南非 42.45 43.21 41.66
184 214 莫三比克 40.9 41.4 40.4
185 215 獅子山 40.58 38.36 42.87
186 216 賴比瑞亞 40.39 38.93 41.89
187 217 賴索托 39.97 40.73 39.18
188 218 辛巴威 39.5 40.62 38.35
189 219 尚比亞 38.44 38.34 38.54
190 220 安哥拉 37.63 36.73 38.57
191 221 史瓦濟蘭 32.23 31.84 32.62
Major Reasons for Increased Longevity
Improved sanitation
Provision of clean water
Universal immunization programs
Health education and prevention practices
Improved treatment of chronic diseases (for recent
advances)
Healthy life expectancy
Disability Adjusted Life Expectancy
How it is caculated?Morbidity and Mortality of commen diseases Living habitsSocial ViolenceDietary pattern Substance abuse(drug,alcohol)Medical facilitiesEnvironmentClimateAndHow many year been disability in average (subtract this number from life expectancy)
WHO 会员国主要国家健康预期寿命
( 1999 年 )
排名 国 家 ( 歲 ) 健康预期寿命( 岁 )
1 日本 74.5
2 澳洲 73.2
3 法国 73.1
4 瑞典 73.0
5 西班牙 72.8
6 意大利 72.7
7 希腊 72.5
7 瑞士 72.5
9 摩纳哥 72.4
10 安道尔侯国 72.3
10 圣玛利诺 72.3
12 加拿大 72.0
12 荷兰 72.0
14 英国 71.7
14 挪威 71.7
16 比利时 71.6
16 澳地利 71.6
18 卢森堡 71.1
19 冰岛 70.8
20 芬兰 70.5
20 马尔他 70.5
22 德国 70.4
22 以色列 70.4
24 美国 70.0
25 塞浦路斯 69.8
26 多明尼加 69.8
27 爱尔兰 69.6
28 丹麦 69.4
29 葡萄牙 69.3
29 新加坡 69.3
31 纽西兰 69.2
32 智利 68.6
33 古巴 68.4
33 斯洛法尼亚 68.4
35 捷克 68.0
36 牙买加 67.3
37 乌拉圭 67.0
37 克罗埃西亚 67.0
39 阿根廷 66.7
40 哥斯大黎加 66.7
. . .
. . .
81 中国大陆 62.3
. . .
. . .
. . .
186 乌干达 32.7
187 波札纳 32.3
188 尚比亚 30.3
189 马拉威 29.4
190 尼日 29.1
191 狮子山 25.9
Sources: UN Healthy Life Expectancy Ratings
J.P.Bunker’ s report(1994 published)
Life expentancy from 45-75 years
Medical care contributes to only five years
Improvement of public health contributes to the
rest
Spending in 1992
Average medical care cost for each person:
$3007
Public health spending for each person: $34
Distribution of national health dollars on public health:
About 1%
Spending in 2001Total national health
expenditures:
$1,424.5 billion
Public health activities:
$46.4 billion
Distribution of national health dollars:
86.8% to personal health services/supplies
3.3% to government PH activities
Requirements for survival
1.air
2.water
3.food
4.shelter
5.care
Health
The United Nations' World Health Organization
defines health as
"a state of complete physical, mental and
social well-being and not merely the absence
of disease or infirmity."
What is Public health? In 1920, C.E.A. Winslow defined public health
as
"the science and art of preventing disease,
prolonging life and promoting health through
the organized efforts and informed choices of
society, organizations, public and private,
communities and individuals."
The history of public health
Public health is an old concept, dating back to
when people first began living in communities.
Through the ages, governments have shown
varying degrees of concern for the public health.
The ancients Greeks, and the Romans after
them, tried to ensure the health of their
citizens by
providing a supply of clean water (via
aqueducts and pipelines),
managing the disposal of waste
working to control disease by hiring public
physicians to treat the sick.
During the late 1800s European
governments began turning their
attention to matters of public health in
an effort to control the spread of
disease. (Because Epidemics of leprosy,
the plague, cholera, and yellow fever).
In the United States, the public health
became an official concern when in 1866 a
cholera epidemic struck the nation-for the
eighteenth consecutive year
What is Public health?
"the science and art of preventing disease,
prolonging life and promoting health
through the organized efforts and informed
choices of society, organizations, public and
private, communities and individuals."
The 'science' is concerned with making a
diagnosis of a population's health problems,
establishing their cause, and determining
effective interventions.
The 'art' is to address these problems
creatively.
This definition underscores the broad scope
of public health and the fact that public
health is the result of society’s efforts as a
whole, rather than that of single individuals.
In 2003, Detels defined the goal of public
health as:
The biologic, physical, and mental well-
being of all members of society regardless
of gender, wealth, ethnicity, sexual
orientation, country, or political views.
(This definition or goal emphasizes equity and the
range of public health interests as encompassing not
just the physical and biologic, but also the mental
well-being of society.)
Both WHO and Detels’ goals depict public health
as being concerned with more than merely the
elimination of disease.
To achieve the WHO goal of ‘health for all’, it is
essential to bring many diverse disciplines to
obtain the optimal health ( physical, biologic,
and social sciences ) .
The field of public health has adapted and
applied these disciplines for the elimination and
control of disease, and the promotion of health.
1988<the future of public health>
Mission:
Substance:
Organizational framework:
Core functions:
mission
The fulfillment fo society’s interest in
assuring the conditions in which people
can be healthy
SubstanceOrganized community efforts aimed at
the prevention of disease and the
promotion of health
Organizational framework
Bothe activities undertaken within the
formal structure of government and the
associated efforts of private and
voluntary organizations and individuals
Core functions
Assessment
Policy development
Assurance
Monitor Health Status to Identify and
Solve Community Health Problems
Diagnose and Investigate Health
Problems and Health Hazards in the
Community
Inform, Educate and Empower People
About Health Issues
Mobilize Community Partnerships to
Identify and Solve Health Problems
Develop Policies and Plans That Support
Individual and Community Health Efforts
Enforce Laws and Regulations That
Protect Health and Ensure Safety
Link People to Needed Personal Health
Services and Assure Health Care When
Otherwise Unavailable
Assure a Competent Public Health and
Personal Health Care Workforce
Evaluate Effectiveness, Accessibility,
and Quality of Personal and Population-
Based Health Services
Research for New Insights and
Innovative Solutions to Health Problems
5 steps process1. Define the health problem
2. Identify the risk factors associated with the problem
3. Develop and test community-level interventions to
control or prevent the cause of the problem
4. Implement interventions to improve the health of the
population
5. Monitor those interventions to assess their effectiveness
The science of Public health
Epidemiology and statistics
Biomedical sciences
Social and behavior sciences
Environmental sciences
Health policy and management
Health management
Ten Great Achievements in Public Health
1900-1999
1. Vaccination.2. Motor-vehicle safety. 3. Safer workplaces.4. Control of infectious diseases. 5. Decline in deaths from coronary heart disease and
stroke. 6. Safer and healthier foods.7. Healthier mothers and babies. 8. Family planning. 9. Fluoridation of drinking water. 10. Recognition of tobacco use as a health hazard.
CDC, Morbidity and Mortality Weekly Report, December 24, 1999 / 48(50); 1141.
Challenges Ahead
New and Persistent Problems in Public
Health
Leading causes of death,worldwide2001
Respiratory infections7.0%
Injuries 9.0%
Cardiovascular diseases29.3%Malignant neoplasms
12.6%
Respiratory & digestive9.8%
Infectious & parasitic19.3%
Others8.6%
Perinatal conditions 4.4%
Source: WHO 2002
(suicide)
Leading infectious killers, worldwide 2001
Respi ratory i nfecti ons3. 9HI V/ AI DS 2. 9Di arrhoeal di seases2TB 1. 6Mal ari a 1. 1Measl es 0. 7
3. 9
2. 9
1. 6
1. 1
0. 7
2. 0
0
0. 5
1
1. 5
2
2. 5
3
3. 5
4
Respi ratoryi nfecti ons
HI V/ AI DS Di arrhoealdi seases
TB Mal ari a Measl es
Source: WHO 2002
Under-five mortality rate, 1990-2003
Child deaths per 1,000 live births
1990 2003
World 95 80
Developed regions 11 7
Commonwealth of Independent States
46 46
Developing regions 105 88
Northern Africa 87 38
Sub-Saharan Africa 185 172
Latin America and the Caribbean
54 32
Eastern Asia 48 37
Southern Asia 126 90
South-Eastern Asia 78 46
Western Asia 68 60
Oceania 86 77Source: United Nations Statistics Division, “World and regional trends”, Millennium Indicators Database, available from http://millenniumindicators.un.org (accessed June 2005); based on data provided by United Nations Children’s Fund and the World Health Organization.
Statistics Division, Department of Economic and Social Affairs
Distribution of deaths by broad causes group and region
2001
Deaths (thousands)
Total Group I Group II Group III Group II/Group I ratio
World 56554 18374 33077 5103 1.8
Developed 15614 1441 12833 1320 8.9
Developing 40940 16933 20244 3783 1.2
Group I: Communicable diseases, maternal and perinatal conditions and nutritional deficiencies
Group II: Noncommunicable conditions
Group III: Injuries
Source: WHO (2002)
Health Disparities
Access and Outcomes
Infant Mortality
Cancer Screening and Management
Cardiovascular Disease
Diabetes
HIV Infection/ AIDS
Immunizations
Contemporary health issues
The 20th century witnessed the transition of major disease
burdens ( defined by death) from infectious and/or
communicable diseases to chronic diseases (Table 1.1.2).
In 1900, the leading cause of death in the United States and
other developed countries was reported to be pneumonia and
influenza.
By the end of the century, diseases of the heart were the
leading cause of death, and pneumonia and influenza dropped
to the seventh place, primarily affecting the elderly.
Communicable diseases
Chronic diseases
Mental illness
Population changes: Ageing
Pollution
Disparity between the rich and the poor widen
Public health interventions
One important task of public health
professionals is to raise the level of anxiety of
the public about public health problems to the
level at which they will be willing to take an
appropriate action.
Public health interventions can be divided into four categories:
biologic/environmental
social/behavioral
political
structural
The public health professional must use
strategies in all categories to achieve the
maximum health of the public.
biologic / environmental interventions
The strategies:
improved standard of living, including
provision of clean water and safe disposal of
wastes.
The most cost-effective biologic intervention
strategy is immunization
Eliminate of vectors of disease: DDT
Social/Behavior interventions
Most public health interventions depend ultimately on
behaviour ( personal or community behavior).
At the personal or individual level, promotion of good
health habits and avoidance of smoking, excess
alcohol use, and other dependency disorders are
important interventions that have a major impact on
health.
Political interventions
Public health is politics. Any process that
involves obtaining the support of the public
will involve politics and differing points of
view. For example, the campaign to stop
smoking
Structural interventions
The end result of the political process is the passage of
laws and regulations. This action, if implemented, can
have a very significant impact on the improvement of
the health of the public.
For example, the law reducing the maximum speed in
California from 65 to 55 miles per hour had a significant
impact on lowering the automobile fatality rate
Impact of public health
The dramatic achievements of public health in the 20th
century have improved our quality of life:
an increase in life expectancy.
world wide reduction in infant and child mortality
elimination or reduction of many communicable disease.
As life expectancy increases in many developing
countries, more people are developing those chronic
diseases which have been a major burden in developed
countries for many decades. Unlike developed countries,
however, these countries still carry the burden of
infectious diseases which have been greatly reduced in
developed countries.
Because of the rapid advances in travel and
communications, the developed world is
threatened in new ways and thus cannot afford to
ignore the problems of the developing world.
Today, public health leaders must strengthen their
roles as advocates for improved population-based
health in an international, global community.
We have made tremendous strides to
improve the health of the public, but the
challenge to do better remains
The future of public health
Leading cause of preventable deathLeading causes of preventable deaths in the United States as of the year 2000.
CauseNumber of deaths resulting
Smoking 435,000 deaths or 18.1% of the total deaths
Overweight and Obesity 365,000 deaths or 15.2% of the total deaths.
Alcohol consumption 85,000 deaths or 3.5% of the total deaths.
Infections 75,000 deaths or 3.1% of the total deaths.
Toxic agents 55,000 deaths or 2.3% of the total deaths.
Motor vehicle collisions 43,000 deaths or 1.8% of the total deaths.
Incidents involving firearms 29,000 deaths or 1.2% of the total.
Sexually transmitted infections 20,000 deaths or 0.8% of the total.
Illicit use of drugs 17,000 deaths or 0.7% of the total deaths.
Economic impact
Individual liberty
Moral and religious opposition
Political interference with science
Why is public health controversial?Why is public health controversial?
Multiple Determinants of Health
Individual
Biology
Behavior
Physical Environment
Social Environment
Access to Quality Health Care
Policies and Interventions
Source: U.S. Department of Health and Human Services, Health People 2010
What is preventive medicine?
The branch of medicine that is
concerned with the prevention of disease
and methods for increasing the power of
the patient and community to resist
disease and prolong life.
Preventive medicine
is a medical discipline which focuses on preventing diseases
and promoting a general state of health and well being.
In both Europe and the United States, it is considered to be a
board specialty, meaning that physicians can focus on
preventive medicine while they get their medical degree, and
use the skills they learn in school to reduce the outbreak of
disease epidemics, improve public health, and increase the
general quality of life for individuals all over the world.
Healthcare:
health departments, academic institutions, state
and national government, international or global
institutions including the WHO, UN agencies or
government agencies like the CDC or NASA,
organized medical care programs in industry,
voluntary health agencies, and the military.
Preventive medicine
The history of preventive medicine
Dating back for centuries to the time
(Romes) when people first realized that
unclean water made them sick, and that
living conditions needed to be more hygienic
to prevent illness.
Twentieth century, when numerous governments
founded disease prevention centers such as the
Centers for Disease Control and Prevention (CDC) in
the United States. These scientific establishments
began to set firm guidelines designed to minimize
the transmission of disease, improve hygiene, and
enable rapid responses to major outbreaks
In addition to medicine and science,
preventive medicine also looks at economic
and social issues, as some populations are
clearly more at risk of contracting
dangerous diseases than others.
Many sociologists, psychologists, and economists work
in the field of preventive medicine to assist people of
low income, education, and social status all over the
world. Organizations which promote preventive
medicine work closely with these individuals in the
hopes that all people on earth can enjoy healthy,
disease free lives.
Training:
Generally requires 2 years in residency
after a clinical internship or transitional
year.
Training includes earning a Master of
Public Health (MPH) degree which is
usually done in one of the two years.
There are three specialty areas within
preventive medicine:
General Preventive Medicine & Public Health
Occupational and Environmental Medicine
Aerospace Medicine
Core courses:
biostatistics
epidemiology
management
administration
clinical preventive medicine
occupational or environmental health.
Specific career paths:
managed care
public health practice
occupational medicine
environmental medicine
aerospace medicine
clinical medicine
informatics
policy development
academic medicine
consulting
international medicine
and research.
What differences
between public health
and medicine?
MedicineIndividual Health
Public HealthPopulation Health
Best outcome for individual
Healthy communityBalance of individual
autonomy vs. limitations on individual
Balance in allocation of resources
Focus on prevention
MedicineIndividual Health
Public HealthPopulation Health
ThermometerStethoscopeIndividual data,
medical history
DemographicsVital statisticsEpidemiology