BCottrell, APHA 2004
You may end up somewhere else!
If you don’t know where you are going...
BCottrell, APHA 2004
complete the sentence:
“Health is . . . . . .”
In small groups
BCottrell, APHA 2004
Healthis NOTprimarilymedical
Health is a dynamic Health is a dynamic state of complete state of complete physical, mental, physical, mental, spiritual, and social spiritual, and social well beingwell being and not and not merely the absence of merely the absence of disease or infirmity.disease or infirmity.
WorldHealth
Organization,1998
BCottrell, APHA 2004
QUESTIONSQUESTIONS Describe what you seeDescribe what you see What is the problem?What is the problem? Where/How does this happen in real life?Where/How does this happen in real life? Why?Why? What can be done?What can be done? Who will do it?Who will do it?
De
at
h R
at
e (
pe
r M
illi
on
Ch
ild
re
n)
Whooping Cough Measles
Immunization Generally Available
1400
1200
1000
800
600
400
200
1850 1860 1870 1880 1890 1900 1910 1920 1930 1940 1950 1960
Death Rates of Children under 15, England and WalesD
ea
th
Ra
te
(p
er M
illi
on
Ch
ild
re
n)
1970
From T. McKeown, The Modern Rise of Population, New York Academic Press, 1976
T. McKeown, The Modern Rise of Population (New York Acedemic Press, 1976} p. 93
Standard Of Living
ImmunizationGenerallyAvailable
Reclaiming Our History: Equity and Public Health
PUBLIC HEALTH as a modern institution arose as a response to industrialization. Historic advances in health status resulted from its actions…
Abolition of child labor
Shortening the work day
Reductions in scale of poverty
Minimum wage
Improved sanitation
Food safety
Adequate housing
Did more to reduce deathand disease than medicine
or immunizations
Did more to reduce deathand disease than medicine
or immunizations (Adapted from Doak Bloss, Ingham Country Health Department, 2005)
Reclaiming Our History: Equity and Public Health
Today,PUBLIC HEALTH has moved toward a more managerial and technical role
Categorical, funded programs
Regulatory compliance functions
Solving discrete health problems
At the same time, widening and persistent inequities have
emerged, affecting all of society.
At the same time, widening and persistent inequities have
emerged, affecting all of society.
A biomedical (disease-based) paradigm
Public Health is a social enterprise, multidisciplinary by nature. It should naturally embrace a commitment to
eliminating health inequities as a goal.
Examples of “Trigger Information”
(Adapted from Doak Bloss, Ingham Country Health Department, 2005)
Ten leading medicalcauses of death, USA (2001)
Heart disease 700,142Cancer 553,768Stroke 163,538Chronic lung disease 123,013Accidents 101,537Diabetes 71,372Pneumonia and influenza 62,034Alzheimer’s disease 53,852Kidney disease 39,480Blood infections 25,192
National Center for Health Statistics, 2004
…and Lifestyle FactorsLeading to Half of Them
Tobacco 400,000Diet, Sedentary lifestyle 300,000Alcohol 100,000Infections 90,000Toxic agents 60,000Firearms 35,000Sexual behavior 30,000Motor vehicles 25,000Illicit drug use 20,000
McGinnis. JM; Foege, WH; JAMA 270:18, Nov 1993
1010millionmillion
77millionmillion
33millionmillion
WHO: Tobacco is the worst human disaster of the 20th
century.Annual Deaths Globally
1970
1999
2010
Underlying causes of death
Poverty17%
Tobacco17%
Diet & SL12%
All others50%
Alcohol4%
Hahn, RA, et al; (CDC) Epidemiology 6(5) 490-7, 1995
USA, 1991, ages 25-74
Genetics 20%
Medical 10%
Lifestyle 50%
Environment 20%
COMMUNITY
NaturalEnvironment
Social Environment BuiltEnvironment
Government/politics
Housing
Transportation/mobility
Access to Health Care
Economy/Employment
Arts/Culture
CommunitySafety
Individual and community Factors that Influence Health
Health is a dynamic Health is a dynamic state of complete state of complete physical, mental, physical, mental, spiritual, and social spiritual, and social well being and not well being and not merely the absence of merely the absence of disease or infirmity.disease or infirmity.
WorldHealth
Organization,1998
BCottrell, APHA 2004