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