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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 incomes. 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 philosophy First to explain ‘origins of disease’ Distinguished endemic from epidemic diseases Suggested a role for exercise, diet, climate and water in health 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 cities Aqueducts created to bring filtered water 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 century. 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 London John Snow plotted the geographical location of each case 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 water. What does modern day Public Health in the UK involve? Health protection Screening 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 policies Screening ‘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: -introduction -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 nurses Health promotion programmes in Schools & Workplaces: Healthy eating, sex education, smoking etc Conclusions 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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