What is public health Public health 2 What

What is public health?

Public health • • • 2 What is it? Who works in or contributes to public health? How is it organised? Main functions Major public health issues Some examples of practice

“Health care matters to all of us some of the time, public health matters to all of us all of the time” C. Everett Koop 3

What is health? “A state of complete physical , mental and social well-being and is not merely the absence of disease of infirmity. ” (World Health Organisation, 1948) “The extent to which an individual or group is able to realise aspirations, satisfy needs and to change or cope with the environment “ (World Health Organisation, 1984) 4

What is Public Health? The science and art of preventing disease, prolonging life, and promoting health through the organised efforts of society. Acheson 1988 in the Public Health in England report Public health is concerned with improving the health of the population, rather than treating the diseases of individual patients. Chief Medical Officer 5

Faculty of Public Health: approach Is population based • • • Emphasises collective responsibility for health, its protection and disease prevention Recognises the key role of the state, linked to a concern for the underlying socioeconomic and wider determinants of health, as well as disease Emphasises partnerships with all those who contribute to the health of the population http: //www. fphm. org. uk/about_faculty/what_public_health/default. asp 6

Individual & Population Health Individual Population History Symptoms of illness Indicators of population health Examination Signs of illness, biochemical tests Surveillance, epidemiological information, Health Needs Assessment Diagnosis Label to describe what has gone wrong Prognosis Outlook associated with individual Outlook associated with disease trends and disease patterns Treatment Individual interventions 7 Key health issues Population based interventions Health Protection, screening, immunisation

Who contributes to public health? (even though it may not say so in their job description) • 3 main categories • Professionals who spend some of their time in PH related work – teachers, other healthcare workers, other government officers, systems engineers • Professionals who spend major part of their work in PH issues – health visitors, health promotion, information, EHO • Specialists – strategic/senior level – ability to manage change and lead PH programmes • Who else? 8

What determines public health? • For example, physical activity levels – impact on obesity – impact on CHD risk – impact on risk of some cancers – impact on mental health • Most energy expenditure from daily routine, not sporting activities • Being sedentary may be an important risk factor March 2011

Levers to influence physical activity levels • Government: Health – information campaigns to promote more physical activity – rehabilitation services for people after a heart attack • Government: Sport – facilities for organised sport: gyms, clubs etc • Government: Transport – provision of public transport/ support for cars, cycling – facilities for safe/pleasant walking eg to school, leisure • Government: Education – physical activity in schools • Government: regulation of employers – workplace policies- changing facilities, parking etc March 2011

What does public health involve? • • 11 Assessment of health needs Monitor health status of population Programmes for risk reduction/screening Communicable disease control Planning health services Evaluation of provision of health services Manage and implement change Work with other agencies to maximise health gain

How is public health organised? • • 12 Scottish Government Health Department NHS Board Public Health Departments Community Health Partnerships (CHPs) NHS Health Scotland Local Authorities Health Protection Scotland (HPS) Faculty of Public Health (FPH)

Main functions of public health 3 main areas 13 1. Health protection 2. Health and social care 3. Health improvement

1 Health protection • • 14 Communicable disease control Environmental health Emergency planning Disease and injury prevention

2 Health and social care • • • 15 Quality Clinical effectiveness and efficiency Clinical governance Audit and evaluation Service planning

3 Health improvement • • • Inequalities Lifestyles Education/housing/employment/ environment - broader determinants of health 16

Scotland’s health is improving. But there are big differences between rich and poor. In 2006, men could on average expect 67. 9 years of healthy life and women 69 years. In the most deprived 15% of areas in Scotland, though, men could only expect 57. 3 years of healthy life and women 59 years. More babies born to mothers living in the most deprived fifth of areas have a low birth weight than those born to mothers living in the most affluent areas: 9% compared to 5%. People struggling with poverty and low income have poorer mental health and wellbeing than those with higher incomes or who find it easy to manage financially. There are large and increasing inequalities in deaths amongst young adults due to drugs, alcohol, violence and suicide. Equally Well 2008 March 2011

Actions to tackle inequalities • • • 18 Providing a sure foundation through a healthy pregnancy and early childhood improving opportunity for children and young people improving NHS primary care services tackling the major killers: CHD and cancer strengthening disadvantaged communities tackling the wider determinants of health

Summary • • • 19 Public Health contributes to health on a population basis by assessing needs, interventions and by implementing population level changes by working within and beyond the health sector Public Health is vital if we are to prevent illness and have affordable health care, now and in the future Organisational change and government policies both help and hinder the public health agenda