New Public Health Measures

THE NEW PUBLIC HEALTH Stephen R Leeder 7 March 2005 James Cook University, Townsville Introduction any of us hither today atomic number 18 open wellness enthusiasts. If we werent we would be some(a)hwere else, by chance helping sick pile to get better. That is a worthy employment and thank goodness for each(prenominal) the mass who do it. But so oerly is prevention, so too is keeping society wellnessy, so too is protecting the environment, so too is keeping food and urine safe, so too is attending to immunization and child wellness.When we talk roughly mercifulity wellness these latter things, that focus on the whole community, or groups in spite of appearance society and the things that determine their wellness, atomic number 18 what we be talking almost. This is big view stuff. This is about asking why some communities are wellnessy and some are ill. Why do some communities carry much(prenominal)(prenominal) mellowed rates of diabetes, handle the Pacific Islands, while other countries hold back no diabetes but lots of HIV and TB? These are the kind of interests and enthusiasms that have light-emitting diode good deal into macrocosm wellness as a calling for as long as it has been around.These are the kind of questions that were asked ages ago and which are still appropriate to be asked now. So what is this thing called the recent(a) common health? How has it come about and does it have added quantify? In design, the unexampled popular health has come about because of growing interest in the subtle interaction of the environment with people living in smashed societies. The old public health remains the public health that around of the world needs, quite frankly, because communicable disease, malnutrition and other scourges are still the study killers worldwide.These are much or less the same as those that led people in the fifteenth century to look at how things such as the plague and cholera could be figureled throug h sanitation, clean water and quarantine. The new public health But the new public health is much more(prenominal) nameed with the interplay between affluence, sociable well being, culture and health, social capital and health. These are non hard and fast things, corresponding having no system for waste water disposal or exploitation contaminated drinking water. They are more subtle, but in societies like ours where the radical public health engineering and mmunization and food safety are well in place and require surveillance but not reinvention, these new factors the social, economic and community quality factors are rising in splendor as determinants of health and causes of illness. 1 For example, Michael Marmot has done studies with Geoffrey Rose and others in the UK examining coronary disease rates among civil servants, known as the Whitehall studies. They put together that things like a sense of social control and cohesiveness were central determinants of whether people develop coronary disease.Money wasnt everything. In the Whitehall II study, Marmot (Director of the international Centre for wellness and Society at the University College London) and his colleagues examined the psychological characteristic of run low termed low control meaning that an individual worker had little control over his or her daily activities in the workplace. The results showed that it was an important predictor of the try of cardiovascular disease and that it had an important role in accounting for the social gradient in coronary disease. 1 The origins of the new public healthThe Canadians have been very active over many days in promoting our dread about the interplay between society and social environmental factors and health. This started in 1974 when Marc Lalonde, who was so the Canadian health minister, commissioned a report on the health of Canadians which proposed four sets of factors that were important to keep in mind when thinking about the healt h of the public. The Lalonde Report2 refers to these four factors collectively as The Health Field construct. The four elements are human biology, environment, life style and health care organization.The human biology element includes all those aspects of health, both physical and mental, which are genuine within the human body as a consequence of the basic biology of man and the organic make-up of the individual. The environment category includes all those matters related to health which are external to the human body and over which the individual has little or no control (for example, foods, water supply, etc). The lifestyle category consists of the aggregation of decisions by individuals which furbish up their health and over which they more or less have control.The fourth category in the impression is health care organisation, which consists of the quantity, quality, arrangement, nature and relationships of people and resources in the provision of health care the health car e system. The Lalonde Report was ground breaking in its day and provoked widespread international interest. Implementation proved to be far harder than was expected and the resilience of the health-care system to drain resources away from the basic three fields was spectacular.Nevertheless, Canada has had a more lively interest in the contribution of the depression three fields to health and has preserved a degree of control over health care, including rigid enforcement of a rampart on numbers of doctors trained and practicing, ever since. Although perhaps not a direct consequence of the Lalonde Report, Canada has also 2 played a leaders role in the evolution of health procession as a discipline. Several of the leaders in the field, now nearly 30 years on from the Report, are Canadians.They have had a special sensitivity to the potency for health gain by examining not only what can be done to encourage and sustain changes in individual human doings that will contribute to bet ter health, but also those changes that can be effected in the natural and built environment that can aid in achieving this goal. Health promotion and the new public health In Australia, the new public health has been reflected in the steady rise of health promotion, expressed such ways as the formation of the Australian Health Promotion Association.The Associations major objectives include providing opportunities for members professional development, change magnitude public and professional awareness of the roles and functions of health promotion practitioners, and contributing to discussion, see and decision making on health promotion policy and programs. Since its internalisation in 1990, the Health Promotion Association has grown and developed such that it now has an established function and a central place in Australias health promotion landscape.Health promotion is an active form of public health in which an agenda is set with communities and individuals to affirm positiv ely the value of health and push towards high levels of health, seeing it preferably as the WHO does as a positive state of well being and not only the absence of illness. Health promotion uses a range of tactics and methods to succeed its ends, including community participation, development and skill streng thusing, advocacy (where health professionals and others lobby for health to be taken seriously at political and commercial levels), and education.Something of a contrast has come to be drawn between the activist promotion end and the formal epidemiological end of the public health spectrum, the author hoeing in boots and all to effect change and the latter taking prudent steps, using rigorous studies and statistics, to establish cause and effect relationships before acting. both(prenominal) groups tend to drive one another nuts. This is a lively focus and not one that is likely to go away.Professor Fran Baum who is head of the Department of cosmos Health at Flinders Uni versity in Adelaide has written a book authorize The new public health an Australian posture, that I commend to you. In it the idea of the new public health is given extensive coverage. 3 Source Baume, F (1988) The new public health an Australian perspective The new public health overlaps and interacts with other health movements of the past ecstasy particularly health promotion, primary health care, community health, womens health, autochthonic health, workers health and health education. History of the new public health The new public health started to develop in the 1980s. It was in the mid-1980s that there was a significant shift in public health when the WHOs first international conference on health promotion was held in Ottawa, Canada. in that location were two driving forces behind the Ottawa consume. It was clear that the Health for All by the Year 2000 strategy was not being adopted by industrialised countries, and the limitations of the lifestyle and behavioural app roaches were increasingly being seen as requiring a new conceptualization for health promotion.Also the time was opportune for a more health promotion statement. The Ottawa hold managed to integrate many of the assorted perspectives of health promotion. While being seen as the foundation of the new public health, it did not reject behavioural and lifestyle approaches, but saw them as part of the acquisition of personal skills for health. The Charter is behindd on the tactile sensation that health requires peace, shelter, education, food, income, a stable ecosystem, social justice and justness as prerequisites. 4 Box 3. 1 The Ottawa Charter for Health Promotion, 1986 The evolution of healthy public policy, which recognises that most of the private and public sector policies that affect health lie outside the conventional concerns of health agencies. Rather they are in policies such as environmental protection legislation, progressive taxation, welfare, occupational health and s afety legislation and enforcement, land rights legislation and control of the bargain and distribution of substances such as alcohol and tobacco. Health becomes, therefore, a concern and responsibility of each sector of government. The creation of supportive environments in which people can realise their full potential as healthy individuals. The Charter recognises the importance of social, economic and physical environmental factors in shaping peoples experiences of health. Strengthening community action refers to those activities that increase the ability of communities to give change in their physical environmental factors in shaping peoples experience of health. The development of personal skills acknowledges the role that behaviour and lifestyles plays in promoting health.The skills called for are those that enable people to make healthy choices. It also extends the skills base for health to those associated with community organisation, lobbying and advocacy, and the abilit y to analyse individual problems within a structural framework. Reorientation of health services is a call for health systems to shift their emphasis from (in most industrialised countries) an almost numberal preoccupancy on hospital-based care and extensive technological diagnostic and intervention to a system that is community-based, more user-friendly and controlled, which focuses on health.The Ottawa Charter stresses the importance of, and recommends Advocacy for health Enabling people to achieve their full health potential Mediation between different interests in society for the interestingness of health Source Baume, F (1988) The new public health an Australian perspective Following in the spirit of the Ottawa Charter, in 1986 the divulge Health Commission (BHC), a group established by the then Commonwealth Minister for Health, Neal Blewett, published Looking Forward to Better Health. Its brief was to recommend ways in which health in Australia might be promoted, espec ially though ways that were 5 nconventional for the medical and public health professions. It was part of Australias response to the World Health Organizations commitment to achieve equitable levels of health for all people, according tot the political and economic possibilities of each country, by 2000. This report contained proposals for achieving greater equity in health in Australia together with strategies to address several major preventable contributors to death and disease. Task forces established goals and targets for three priority health topics cardiovascular disease, nutrition and suffering. In making these choices the Commission was concerned to get wind not only big problems, but also problems potentially teachable to prevention. Heart disease, the principal cause of death, was also chosen because of its multiple modifiable causes (e. g. diet, smoking an sedentary living), nutrition because of its multiple consequences (e. g. diabetes, heart disease and cancer) and injury because it cannot be dealt with preventively by efforts confined to health care but essential involve industry, transport, law enforcement and industrial relations.These three major health problems in contemporary Australian society are priorities for health promotion by virtually any criterion. The work of the BHC was taken further in the issue Better Health Program and led to the formulation of national health goals and then national health priorities which remain in place today. By the end of the 1980s, despite success, there was some Australian scepticism about the new directions in public health. Some questioned whether the new public health was really new or simply old ideas in new clothing.This criticism is somewhat harsh as one of the features of the Ottawa Charter is that it does not ignore public health history but rather builds on it. The Ottawa Charter reflected legion(predicate) social and health movements of the foregoing 120 or so years. Its claims to be ne w derives from how it pulled together numerous and diverse movements to present a package which gave public health a more radical and cohesive direction than had been the case for some time.Today, public health is alive and well and confronting in this country the challenges that it can advocate ameliorate. We are an astonishingly healthy nation on average. We have the southward longest healthy life expectancy of all nations, a fraction behind Japan. But within our country we have communities including those of some of our autochthonic people where these privileged are far from being available. It is here that a combination of old and new public health measures is required.Good work is being done and more is needed. This is the mission of public health. 6 References 1. Marmot, M Inequalities in Health, The untried England Journal of Medicine 2001345(2)134-136 2. Lalonde, M (1974) A New Perspective on the Health of Canadians. Ottawa National Ministry of Health and eudaemonia 3. Baume, F (1998) The new public health an Australian perspective publishing firm Oxford University Press 4. Leeder S R (1999) Healthy Medicine, Challenges facing Australias health services Publisher Allen & Unwin 7