introduction to ph 11.01.2016
TRANSCRIPT
Vladimir Reshetnikov, MD, PhD, DMSc, professor, Honoured Doctor of
the RF, Head, Department for Public Health and Health Care
Introduction to Public HealthIntroduction to Public Health and andHealth Systems Health Systems
I.M. Sechenov First Moscow State Medical University
Department of Public Health and Health Care Organization
IntroductionIntroduction.. History of Department for Public Health and Health Care I. Sechenov`s FMSMU
Part I CONCEPT OF HEALTH. Determinants of Health. Globalization and Health.Model of Disease causation theories.
Part II PUBLIC HEALTH. History of public health. Definition of public health. Major disciplines in public health.
Part III HEALTH AND DEVELOPMENT
Outline of the lecture
February, 20, 1922 – the birthday-the 1st lecture by prof. Semashko
History of Department for Public Health and Health Care
Famous People at our department
MAISTRAKH Ksenia
Vasilyevna
1950-1955
KURASHOVSergei
Vladimirovich
1955-1965
SERENKOAlexander Fedorovich
1966-1982
ERMAKOV Vladimir Vasilyevich
1982-1993
KUCHERENKOVladimir
Zakharovich
1994 - 2013
History of Department for Public Health and Health Care
Students' Research Group
2015:2015:Maternal and Children's Health2016:2016: 1. 1.The Impact of Demographic Trends on Public Health in Different Countries.2. HIV/AIDS as a Public Health Challenge in Different Countries.
Results of the study were published:
• Mikerova M.S., Key O.K. Proven international students in Russia have a negative tendency to socio-emotional and medical lability);
• Glazachev O.S., Mikerova M.S., Key O.K. Ways of optimization of the research work of foreign medical students).
Students' Research Group
During 2 semesters, we will be studying 3 basic modules
• Public HealthPublic Health• Health CareHealth Care OrganizationOrganization • Health EconomicsHealth Economics
History of Department for Public Health and Health Care
Part I CONCEPT OF HEALTH. Health. Determinants of Health.
Globalization and Health.Model of Disease causation theories.
“A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”. (WHO, 1948)
Dimentions of Health:•Physical health•Mental Health•Social health•Emotional health•Spiritual Health
1. Health
• WHO constitution: enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion,
political belief, economic or social condition”.
1.1 Different perspectives on health
• The health field concept:• A. Human Biology
– Genetic Counseling– Genetic Engineering
• B. Environment– Life support, food, water, air, etc– Physical factors, climate, Rain fall– Biological factors: microorganisms, toxins,– Psycho-social and economic e.g. Crowding,
income level, access to health care– Chemical factors
1.2 Determinants of health
• Life style (Behavior)• Health care organization
– Availability of health service– Scarcity of Health Services – Acceptability of the service by the community– Accessibility– Quality of care
1.2 Determinants of health
Factors affecting health of a community
Socio-cultural Physicaldeterminant
Communityorganization
Behavioraldeterminant
Health of theCommunity
• Globalization is the process of increasing political and social interdependence and global integration that takes place as capital, traded goods, persons, concepts, images, ideas and Values diffuse across the stated boundaries (Hurrel & Woods 1995).
1.3 Globalization and Health
• Externalities of some diseases due to increased communication decreased human mobility
• Accelerated economic growth and technological advances have enhanced health and life expectancy
• Increasing effects of international and bilateral agencies
• Jeopardizing population health Via erosion of social and environmental conditions and exacerbating inequalities
Effects of Globalization on Health
• Fragmentation and weakening of labor markets due to greater power of mobile capital
• Tobacco induced diseases• Food markets & obesity as well as chemicals in
food• Rapid spread of infectious diseases• Depression in aged and fragmented
population• Adverse effects on the environment
Health risks of Globalization
19th century models•1. Contagion theory•2. Supernatural theory•3. Personal behavior theory•4. Miasma theory20th century models•1. The Germ Theory•2. The Life Style Theory•3. The Environmental Theory•4. The Multi Causal Theory
1.4 Model of disease causation theories
PART II
PUBLIC HEALTH
2.1 History of public health 2.2 Definition of public health 2.3 Major disciplines in public health
2.1 History of public healthHISTORICAL MARKERS in the development of Public Health (selected)• 1700 BC The Code of Hammurabi – Rules governing medical practice• 1500 BC Mosaic Law – Personal, food and camp hygiene, segregating lepers, overriding
duty of saving of life (Pikuah Nefesh) as religious imperatives.• 400 BC Greece – Personal hygiene, fitness, nutrition, sanitation, municipal doctors,
occupational health; Hippocrates –clinical and epidemic observation and environmental health.
• 500 BC to AD 500 Rome – aqueducts, baths, sanitation, municipal planning, and sanitation services, public baths, municipal doctors, military and occupational health.
• 500 – 1000 Europe – destruction of Roman society and the rise of Christianity; sickness as punishment for sin, mortification of the flesh, prayer, fasting and faith as therapy; poor nutrition and hygiene pandemics;antiscience; care of the sick as religious duty.
• 1348 – 1350 Black Death – origins in Asia, spread by armies of Genghis Khan, world pandemic kills 60 million in fourteenth century, 1/3 to 1/2 of the population of Europe.
• 1300 Pandemics – bubonic plague, smallpox,leprosy, diphtheria, typhoid, measles, influenza, tuberculosis, anthrax, trachoma, scabies and others until eighteenth century.
2.1 History of public health (2)• 1796 Edward Jenner – first vaccination against smallpox.• 1830 Sanitary and social reform, growth of science.• 1854 John Snow – waterborne cholera in London: the Broad Street
Pump.• 1854 Florence Nightingale, modern nursing and hospital reform –
Crimean War• 1858 Louis Pasteur proves no spontaneous generation of life.• 1862 Louis Pasteur publishes findings on microbial causes of
disease.• 1876 Robert Koch discovers anthrax bacillus.• 1882 Robert Koch discovers the tuberculosis organism, tubercle
bacillus.• 1880 Typhoid bacillus discovered (Laveran);leprosy organism
(Hansen); malaria organism (Laveran).
• 1883 Robert Koch discovers bacillus of cholera, Louis Pasteur vaccinates against anthrax.
• 1890 Anti-tetanus serum (ATS)• 1892 Gas gangrene organism discovered by Welch and Nuttal• 1894 Plague organism discovered (Yersin, Kitasato); botulism
organism (Van Ermengem).• 1926 Pertussis vaccine developed• 1928 Alexander Fleming discovers penicillin• 1946 World Health Organization founded.• 1977 WHO adopts Health for all by the year 2000• 1978 Alma-Ata Conference on Primary Health Care
2.1 History of public health (3)
2.1 History of public health (4)• 1979 WHO declares eradication of smallpox achieved• 1981 First recognition of cases of acquired immune deficiency
syndrome (AIDS).• 1990 W.F. Anderson performs first successful gene therapy.• 1992 United Nations Conference on Environmental and
Development, Rio de Janiero• 1992 International Conference on Nutrition.• 1993 World Conference on Human Rights, Vienna.• 1994 International Conference on Population and
Development, Cairo.• 1998 WHO Health for All in the Twenty-first Century adopted.
2.2 Definition of public healthPublic health - the science and art of preventing
diseases, prolonging life, promoting health and efficiencies through organized community effort.
Key Terms in the definition• Health Promotion• Prevention• Rehabilitation
2.2 Definition of public health• Health Promotion - activities intended to enhance
individual and community health well-being
The Elements of Health promotion:1. Addressing the population as a whole in health related issues 2. Directing action to risk factors or causes of illness or death;3. Undertaking activities approach to seek out and remedy risk factors in the
community that affect health;4. Promoting factors that contribute to a better condition of health of the
population;5. Initiating actions against health hazards,including communication,
education, legislation etc.;6. Involving public participation in defining problems;7. Advocating relevant environmental ,health , and social policy ;8. Encouraging health professionals’ participation in health education and
health policy.
2.2 Definition of public healthPrevention - to promote, to preserve, and to
restore health when it is impaired, and to minimize suffering and distress
3 levels of prevention:1. Primary2. Secondary3. Tertiary
2.2 Definition of public healthRehabilitation - the process of restoring a person’s
social identity by repossession of his/her normal roles and functions in society
High quality rehabilitation includes:1. Full assessment of people with disabilities and
suitable support systems;2. A clear care plan;3. Measures and services to deliver the care plan.
2.3 Major disciplines in public health
• Nutrition• Reproductive health• Environmental Health • Health Education • Epidemiology • Health Economics• Biostatistics • Health Service Management • Ecology• Demography
Responding to disasters;
Core activities in public health1. Preventing epidemics2. Monitoring the health status of the population; 3. Assuring the quality ,accessibility, and accountability of medical
care;4. Responding to disasters;5. Protecting the environment, work place ,food and water ;6. Promoting healthy behavior;7. Mobilizing community action;8. Reaching to develop new insights and innovative solutions;9. Leading the development of sound health policy and planning
Part III HEALTH AND DEVELOPMENT
3.1 The difference between development andeconomic growth 3.2 The role of health in development3.3 Relationship between health and
development3.4 Health and the millennium development
goals
3.1 The difference between development and economic growth
Development - both a physical reality and a state of mind in which society has, through some combination of social, economic and institutional processes, secured the means for obtaining a better life.
Economic growth - an increase in country’s productive capacity, identifiable by a sustained rise in real national income over a period of years.
3.1 The difference between development and economic growth (2)Development• Encompasses the total well-
being of individual, a community or a nation.
• Must be measured by the rate of economic growth
• Concerned with the total person, his economic,social, political, physiological, and psychic andenvironmental requirements.
Economic growth• Concerned with the area in
per capital earning of the people making up the nation.
• Is one characteristic of development?
• It is possible for a county to experience economic growth without development.
3.3 Relationship between health and development
Household Livelihood Security (HLS) - adequate and sustainable access to income and resources to meet basic needs, including:
1. Food, Proper Nutrition, Clean Water; 2. Health, Health Facilities and services; 3. Economic Opportunities; 4. Education; 5. Housing/Habitat Security; 6. Physical Safety; and 7. Time for Community Participation
3.4 Health and the Millennium Development Goals
The Millennium Development Goals (MDGs)1. Eradication of extreme poverty and hunger2. Achievement of universal primary education3. Promotion of gender equality and empowerment ofwomen4. Reduction of child mortality5. Improvement in maternal health6. Combating HIV/AIDS, malaria and other diseases7. Ensuring environmental sustainability8. Developing a global partnership for development
The means to a productive life
. The core political, social, and economic rights: • Equal rights. • Freedom from violence• Equal access to public services•Security of tenure and property rights for shelter, businesses, and other assets.
The key elements of adequate human capital: • Basic nutrition. • Health system • Literacy, skills
The essential infrastructure services: • Safe drinking water and basic sanitation. • Natural environment• Energy• Safe roads and transport • IT and communications