Social Determinants of Health Flashcards
what was the 1st ‘Dark Age of Public Health’
Ancient History.
Most cultures, religions etc, even very early/primitive ones, practiced cleanliness and personal hygiene
Often for religious reasons, e.g. to be pure in the eyes of their gods.
Epidemics seen as divine judgments on the wickedness of mankind
when was the 1st ‘Golden Age of Public Health’
Ancient Greece
• Hippocrates (460 BC – 370 BC)
• Airs, Waters, and Places : first systematic attempt to
describe causal relationship between human diseases and the environment
• Remained the theoretical basis for the thinking about endemic and epidemic disease until the new
sciences of bacteriology and immunology emerged at end of 19th century
when was the 2nd golden age of public health?
Ancient Rome
- Aquaducts
- Sewers
- Public baths
what was the 2nd dark age of public health?
• Middle Ages - Plague and pestilence
when was the 3rd golden age of public health?
Social reformers:
- In 1842, Edwin Chadwick argued that disease was the main reason for poverty, and that preventing disease would reduce the poor rates.
- Solutions similar to the approach of Romans i.e. public works with public passive recipients of interventions
describe the 1848 Public Health Act
- Imposed local boards of health in districts where the death rate was above the national average
- Other local boards of health could be established by petition
- Street cleaning, refuse collection, water supplies, and sewerage.
- Street paving and slum clearance began during the same period.
describe the 1872 and 1875 public health acts
1872 - Local Medical Officers of Health established
1875 - Enforced laws about slum clearance, provision of sewers and clean water, and the removal of nuisances.
when was the 4th ‘Golden Age of Public Health’
• 1899-1902: Boer War – half of men unfit for army • 1914-1918: First World War • 1939-1945: Second World War • 1906: free school meals • 1907: school medical examinations • 1908: Old-age pensions • 1911: National Insurance – Sickness and unemployment benefits for workers only • 1948: NHS established
who was Ignaz Philipp Semmelweis
• Hungarian physician working in Vienna
• Puerperal fever was common in
mid-19th-century hospitals
• Often fatal, with mortality at 10%–35%
• He observed that doctors’ wards had
three times mortality of midwives’ wards
• Hand-washing reduced mortality to below 1%
• Conflict with the established scientific & medical opinions
• Semmelweis could offer no acceptable scientific explanation for his findings
• In 1865, Semmelweis was committed to an asylum, where he died, ironically, of septicaemia at age 47
who was Heinrich Hermann Robert Koch (11 December 1843 – 27 May 1910)
came up with Koch’s postulates (1884)
• The microorganism must be found in
abundance in all organisms suffering from
the disease, but should not be found in
healthy organisms.
• The microorganism must be isolated from a
diseased organism and grown in pure culture.
• The cultured microorganism should cause disease when introduced into a healthy organism.
• The microorganism must be reisolated from the inoculated, diseased experimental host and identified as being identical to the original specific causative agent.
give examples of alcohol and tobacco interventions
• Increase public awareness
– Media campaigns
– Health warnings on products
• Pricing and taxation
• Advertising and merchandising by industry
• Restrictions and regulation at point of sale
• Addressing antisocial behaviour
• Clinical treatment for patients with problems
Describe the The intervention ladder from the Nuffield Council of Bioethics
- Do nothing or simply monitor the situation
- Provide information e.g. Campaign for 5 a day
- Enable choice e.g. ‘stop smoking programmes, cycle lanes, free fruit in schools
- Guide choices through changing the default policy e.g. Restaurants make health option the norm with chips as option
- Guide choices through incentives
- Guide choice through disincentives
- Restrict choice e.g. Removing unhealthy ingredients from food in shops or restaurants
- Eliminate choice
When is a more intrusive policy justified?
- Public generally supportive or at least not antagonistic
- Good evidence that initiative will produce the desired effect
- The restriction is proportionate to the risk to the public health
- The benefits to the public health out-weigh the downsides of the policy
- The people who are impacted by the policy are the ones most likely to benefit
- No less intrusive alternatives
- Initiative focuses on the specific behaviour and has limited impact on other aspects of public life
define determinant
: “a determining factor or agent; a ruling antecedent, a conditioning element; a defining word or element”
define determine
“to fix or decide causally; to condition as a cause or antecedent”
