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Public Health


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									     Public Health

A journey from Hippocrates to
      the present day…

                     Dr Manjeet K Sharma
                     July 2007
          Definitions Today
 "the science and art of preventing disease, prolonging
life and promoting health through the organised effort
of society."

Concerned with the health of populations.

Populations can be:
1. Geographical: such as neighbourhood, region or country
2. A client group: children, elderly people, people on low
3. People with a particular health problem: such as heart
   disease or mental illness.
Determinants of Health
             None of this is new!
                      No boundaries between
                      medicine, art , religion or
                      First to explain ‘origins of
                      Distinguished endemic from
                      epidemic diseases
                      Suggested a role for exercise,
                      diet, climate and water in
                      Understood the
                      interrelationship between man
                      and the env in disease
Hippocrates 460 BC    causation
  Those naturally very fat are more
liable to sudden death than the thin
                      Hippocrates 460BC
After the Greeks…
         Romans had a highly structured
         government system
         Collected huge tax revenues but
         spent in an extensive public
         health system:
         Chose carefully where to build
         Aqueducts created to bring filtered
         Sewers created
         Public baths created
         Didn’t trust doctors
         Believed more in public health
The Roman Public Health System
    was so successful that….

Life expectancy for citizens of Rome in
    30AD was longer than that for the
      citizens of London in 1300AD!
               Bills of Mortality
Before disease can be investigated and prevented, it is
        essential to know the size of the problem

  John Gaunt (1620 – 1674) analysed statistics which he
  gleaned from the ‘bills of mortality’

  His work laid the foundations for statistical writings that
  served the basis for the great sanitary reforms of the 19th

  He is regarded as one of the father’s of epidemiology

  Epidemiology is the science that underpins public health
What brought ‘Public Health’
 formally to England???
              1832 to 1855: cholera
              epidemics swept through
              John Snow plotted the
              geographical location of each
              Found most deaths occurred
              amongst those living near the
              ‘Broad Street Pump’
              Pump was removed
              As a result, there was improved
              sewage disposal and
              environmental regulation of
 What does modern day Public
  Health in the UK involve?

Health protection


Health promotion
            Health Protection
‘…to protect the community against infectious diseases and
                   other dangers to health’
Health Protection Agency (2003) is responsible

39 HPUs with specialist staff throughout the UK
responsible for:
    - Surveillance of infectious Ds in local popn
    - Coordinate Inv & cause of national &
       uncommon outbreaks
    - Advise the government on risks posed by
      various infectious diseases.

Work with PCTs, Acute trusts and Local authorities to ensure
local delivery of national targets for infectious diseases.
At a general practice level, this consists of adequate
vaccination coverage and adherence to local infection control
‘the systematic application of a test in order
to identify individuals at significant risk of
the disorder to warrant investigative or direct
preventative action’

Public health are responsible for the:
          -monitoring and quality control
          -assessing cost effectiveness
This is no mean feat!
          Health Promotion

    ‘is any activity that promotes health’

Root causes of ill health are:
        - Social               Action must take
        - Economic             place at all 3 levels
        - Env
           Health Promotion
National Level: NICE

PCTs and NHS are expected to lead at local level

Local Authorities have a crucial role: EHO, housing,
education, social services

Health promotion specialists in PH departments

Primary Health: Nurses, Health visitors and School

Health promotion programmes in Schools & Workplaces:
Healthy eating, sex education, smoking etc
In reality, public health as a specialty has
a huge remit

As the cost and burden of secondary care
increases prevention is the key.

Next time you read the BMJ take note of
how many articles have a public health
basis – I was surprised!!

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