1. Def P.H & Global burden of disease Flashcards
First Definition of Public Health? (Person & Def)
Prof. CEA Winslow USA (Bacteriologist) 1920
P.h is all about: Science &Art of :
- preventing disease
- prolonging (verlängern) life
- promoting physical health
WHO Definition
Public health refers to:
- all organized measures (public or private) -
- to prevent disease, promote health
- prolong life - among the population as a whole
How can we achieve the WHO definition?
- aim to provide conditions in which people can be healthy
- focus on entriere populations
- not only individual pat/diseases
Public Health Supports Conditions in which people can be healthy Basics P:H Grafik beschreiben
3 Basic Principles of Public Health?
- Population perspective
(Focus group people, population rather than one individual)
- Ethics
(Proportionality, no-harm principle, protection of most vulnerable groups)
- Evidence Based
Studien
Timelines & Milestones
- Ancient Greece 500-323 BC
- Roman EMpire 23BC-476 AD
- Middle Ages 467-1450 AD
- Birth of Modern Medicine 1650-1800
- Great Sanitary Awakening (18-1900)
- Modern P.H 20-12st century
Anciente Greece (500-323BV)
Did what for P&H?
- Aesculapius : symbol of medical prfession
- Person hygiene & fitness
- Maturalistc concept
Hippocrates
Hippocraes
Did what and when?
460-377 BC - Ancient Greece time
Father of western medicine = Hippocratic oath
He realized:
- Proclaimed causal relationships between health /& enviroment
- Disease &climare, water, lifestyle, nutrion
- 4 vital bodily fluids
Roman Empire 23BC - 476AD)
What have they done for PH?
Gret engineers
- Aqueducts
- transportation of water from source to villages
- Complex system of sewers (Kanalisation)
- Sanitation & hygiene & Admin
- Public baths
- Water supply
- Markets
- reporting systems in place
Middle Age
Was when?
What happend in this time?
476-1450 AD
Shift away from Greek & Roman values one step back!!
- Decline of hygiene & sanitation
- no rubbish collection
- butchers in the street
- no drains (Entwässerung)
- no toilts in poor areas
- No knowledge added
Plague
Plague
When was that?
Why is it important for PH?
14th Century
Black Death = killed 25-50% of the total population
- Beginnings of public healths tools
- Isolation pat, cleaning of areas with lime (Kalk)
- Quarantine or isolation
Birth of Modern Medicine
- Time
- What happend
1650-1900
Edward Jenner & Smallpox (Pocken)
- 1749 England
- Father of Immunology
- Smallpox killed a lot of childrean
- Variotion = he took material from sick person to infect healthy
- 1796 : first vaccination
Great Sanitary Awakening
Time
What happend
1800s-1900s
Health related consequences of industrial revolution
- Slums, overcrowding, bad housing, lack of drainge & sewerage
Focus on sanitation & changing physical enviroment=
- Water supply, monitoring community health status
Despite lack of scientific knowledge= Major developments in communicable disease control (TB, Cholers,Smallbox)
Hour of birth of Epidemiology, P;H
- Ignanz Semmelweiss (Childbed) & Joh Snow (cholera)
Social Medicine
- Edward Chadwick
Ignaz Semmelweis
1818-1865 Vienna
Child bed fever was a big problem , mortality women after childbirth 25%
Required physicians & med studens to wash hands & brush fingernails
Hygiene in hospitals
Contribution (beitrag) to the germ theory
John Snow
1832 London Cholera
- Cholera epidemic led to the birth of public health in England around 1840
- Growth of scientific knowledge
- fundamental concepts of epidemiology
Snow studied the epidemiology of cholera in London and discovered role of polluted (verschmutzt) drinking water
Epidemiological thinking?
Importance of careful data collection -
documentation of diesease rates before / after intervention -
evaluation of effectiveness
Birth of Social Medicine - Poverty in Focus
(Time Great Sanitary Awakening)
Connection between poverty & health
disease emerges from infavorable social conditions
- social justice
- Focus on vulnerable group
Edward Chadwick (1800-1890)
1842 Landmark research on disease as result of living conditions of poor people
1848 Gerneral Board of Health & Public Health Act
- Political claims oto develop medical supply ect.
Modern Public Health
>2000 - 21st century
Contagion (Ansteckung) Control
Germ theroy of disease as groundwork of modern public health
(Louis Pasteur & Robert Koch)
- Microorganisms can lead to disease (tetanus & diphteria causing bacteria
- New diagnostic test (TB skin testing, bacterial culture & chest X ray
- New vaccines
- Epidem. methods to understand diseases
(no Penicillin yet - 1928 Alexander Fleming )
What was the role of public health in 1950-1980?
Filling holes
This time was the era of effective medical interventions
Role:
Filling holes in health care system
Assist clinicians to effectively deliver clincal services
Help preventive efforts (practice of medicine)
What happend in 1950-1980?
Why is it so important for medicine and PH?
- Non communicable disease first time prominent issu
- recognized how harmful smoking is ect
- Randomized controll trails
- Regulation of drugs, vaccines & other interventions
Change in mid 1980-2000 Health Promotion & Disease Prevention?
Explain
Health Promotion & Diesease Prevention
- Individual level
- Smok, Alc, obesity
- Environmental movements
- Gases, toxic, nuclear
Examples of public H. Achievements 1999
- Moto vehicle safety
- Safer workplaces
- Control of infectious diseases
- Decline in deaths from coronary heart disease and stroke
- Safer & healthier foods
- Healthier mother & babies
- Family plannung
- Redcognition of tabacco use as health hazard
What are changes in 21 th Century?
- Globalization : New technologies
- Rises of evidence based p.h
- Collaborations between clinical care &p.h
- Complexity of p.h problems need complex solutions
- (Social norms, social system, environment, example obesity)
- Life course approach
- focus mother&children, ageing population
- Prolonging life - yes but also with high quality of life
21st Centruy Definition: Population Health
- The totality of all evidence-based public&private effort
- troughout the life cycle
- that preserve&promote health&
- prevent disease, disability&death
3 core functions of public health
Assessment: Whats the problem
Policy development : What can we do?
Assurance : is it appropriate what we do?
Research is linked to all services (in the middle)
10 essential services/activities related to 3 core functions
- Assessment
What the problem?
- Identify&solve community health problems
- Diagnose& investigate h problems & hazards (Gefahren) in the community
(Really understand a problem)
- Services/Activities in Policy Development
What can we do?
- Inform, educate&empower people aboout health issues
- Mobilize community partnerships & actions to tackle health problems
- develop policies &plans to support health efforts
- Services/Activities in Assurance (Sicherheit)
Is it appropriate what we do?
- Enforce laws®ulations & ensure safety
- Link people to needed health services & assure the provision off health services
- Assure a competent health workforce
- Evaluation , Quality of person ect.
What is the Global Burden of Disease (GBD) Project?
HALE
Healthy Life Expectancy
describe the average number of years that a person can expect to live in full health
(82 davon 64 gesund = 18 mit Krankheiten) = 64
YLL
Years of life lost
Person dies at the age of 50, natural death 86= life loss 36 yeasr
YLD
Years lived with a disability
Disability like 25, or 75 or 50%
Suffers sience the age of 50years and lives with 50% disability
86-50= 36:2= 18 years
DALY
DAL = YLL & YLD
Disability adjusted life years= Years of life Lost+ years lived with disability
Healthy life until 50
Years lived with disability 5 -> 50% = death
55 bis 86 = 21 years of life lost
Daly Picture
