Free ebooks ==> www.ebook777.com www.ebook777.com Free ebooks ==> www.ebook777.com Essential Public Health Theory and Practice www.ebook777.com Free ebooks ==> www.ebook777.com Free ebooks ==> www.ebook777.com Essential Public Health Theory and Practice Stephen Gillam, Jan Yates and Padmanabhan Badrinath www.ebook777.com Free ebooks ==> www.ebook777.com CAMBRIDGE UNIVERSITY PRESS Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo, Delhi, Tokyo, Mexico City Cambridge University Press The Edinburgh Building, Cambridge CB2 8RU, UK Published in the United States of America by Cambridge University Press, New York www.cambridge.org Information on this title: www.cambridge.org/9781107601765 © Cambridge University Press 2007, 2012 This publication is in copyright Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press First published 2007 Second Edition 2012 Printed in the United Kingdom at the University Press, Cambridge A catalogue record for this publication is available from the British Library ISBN 978-1-107-60176-5 Paperback Additional resources for this publication at www.cambridge.org/9781107601765 Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate Every effort has been made in preparing this book to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation The authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this book Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use Free ebooks ==> www.ebook777.com Contents List of contributors Foreword to second edition Foreword to first edition Foreword to first edition Acknowledgements page vii ix xi xiii xiv Introduction Stephen Gillam Part I The public health toolkit Management, leadership and change Stephen Gillam and Jan Yates 13 Demography Padmanabhan Badrinath and Stephen Gillam 29 Epidemiology Padmanabhan Badrinath and Stephen Gillam 43 The health status of the population Padmanabhan Badrinath and Jan Yates 77 Evidence-based health-care Padmanabhan Badrinath and Stephen Gillam 90 Health needs assessment Stephen Gillam, Jan Yates and Padmanabhan Badrinath 104 Decision making in the health-care sector – the role of public health Jan Yates and Stephen Gillam 115 v www.ebook777.com Free ebooks ==> www.ebook777.com vi Contents Improving population health Stephen Gillam and Jan Yates 128 Screening Jan Yates and Stephen Gillam 10 Health protection and communicable disease control Jan Yates and Padmanabhan Badrinath 11 146 163 Improving quality of care Nicholas Steel and Stephen Gillam Part 183 Contexts for public health practice Introduction to Part – what we mean by contexts in public health? Jan Yates 12 The health of children and young people Kirsteen L Macleod, Rachel Crowther and Sarah Stewart-Brown 13 273 International development and public health Jenny Amery 18 257 Health policy Richard Lewis and Stephen Gillam 17 244 Health inequalities and public health practice Chrissie Pickin and Jennie Popay 16 227 Public health and ageing Lincoln Sargeant and Carol Brayne 15 209 Adult public health Veena Rodrigues 14 200 284 Sustainable development – the opportunities and the challenges for the public’s health David Pencheon 303 Glossary Index 315 326 Free ebooks ==> www.ebook777.com Contributors JENNY AMERY Chief Professional Officer Health and Education, UK Department for International Development, London PADMANABHAN BADRINATH Associate Clinical Lecturer, Department of Public Health and Primary Care, University of Cambridge, and Consultant in Public Health Medicine, NHS Suffolk CAROL BRAYNE Director, Institute of Public Health, Addenbrooke’s Hospital, Cambridge RACHEL CROWTHER Public Health Consultant, Oxford STEPHEN GILLAM Director of Public Health Teaching, School of Clinical Medicine, University of Cambridge, and Visiting Professor, University of Bedfordshire, and General Practitioner, Luton RICHARD LEWIS Director, Health Advisory Practice, Ernst & Young UK KIRSTEEN L MACLEOD Public Health Registrar, Bedfordshire DAVID PENCHEON Director, NHS Sustainable Development Unit (England) CHRISSIE PICKIN Deputy Director of Public Health, Tasmanian Department of Health and Human Services, Tasmania, Australia vii www.ebook777.com Free ebooks ==> www.ebook777.com viii List of contributors JENNIE POPAY Professor of Sociology and Public Health, Faculty of Health and Medicine, Division of Health Research, Lancaster University VEENA RODRIGUES Clinical Senior Lecturer in Public Health, Norwich Medical School, University of East Anglia, Norwich LINCOLN SARGEANT Public Health Consultant, NHS Cambridgeshire NICHOLAS STEEL Clinical Senior Lecturer in Primary Care, Norwich Medical School, University of East Anglia, Norwich and Public Health Consultant, NHS Norfolk Primary Care Trust SARAH STEWART-BROWN Chair of Public Health, School of Medicine, Warwick University, Coventry JAN YATES Public Health Consultant, NHS Midlands and East Free ebooks ==> www.ebook777.com Foreword to the second edition All health professionals need an understanding of the determinants of good health at population level This has been recognised both nationally in guidance to medical and nursing schools and internationally by the World Health Organization To help their patients through and beyond the episodes of illness that bring them into surgeries and hospitals, doctors need to understand the factors that propel patients there in the first place Moreover, as the costs of health care increase across the globe, tomorrow’s health professionals need a sound understanding of population-based approaches to promoting health and preventing ill health The first edition of this book was highly commended and the second edition begins with a section covering core public health knowledge and skills I am pleased to see that the first chapter considers public health leadership This is crucially important for being, in the jargon of the times, ‘distributed’ All of us working in the UK National Health Service, at one level or another, share responsibility for leadership, whether clinical or managerial, and for ensuring that priority is given to preventive care or to improving the curative services we offer I note that the second half of the book adopts the same life-course approach to improving population health as was used in the recent White Paper on public health: ‘Healthy Lives, Healthy People’ That too stresses the importance of multi-sectoral working to tackle the main causes of mortality and morbidity from infancy onwards A textbook of this nature, which brings together both principles and practice in a user-friendly format, is particularly timely Public health in England is undergoing a dramatic transformation with much of the workforce moving to local government The issues we face as public health practitioners, such as obesity, climate change and an ageing population, become even more challenging during such transitions This book should be valuable to students of medicine and other health professions but also to public health practitioners in other countries The second edition, like the first, will help prepare you to tackle some of the tough health challenges we face today Dame Sally C Davies Chief Medical Officer and Chief Scientific Advisor Department of Health London ix www.ebook777.com Free ebooks ==> www.ebook777.com Glossary the fulfilment of a role that is normal (depending on age, sex and social and cultural factors) for that individual Health The extent to which an individual or a group is able to realise aspirations and satisfy needs, and to change or cope with the environment Health is a resource for everyday life, not the objective of living; it is a positive concept, emphasising social and personal resources as well as physical capabilities Your health is related to how much you feel your potential to be a meaningful part of the society in which you find yourself is adequately realised Health equity audit A technique to identify how fairly services or other resources are distributed in relation to the health needs of different population groups or geographical areas Health improvement The theory and practice of promoting the health of populations by influencing lifestyle and socio-economic, physical and cultural environment through methods of health promotion, directed towards populations, communities and individuals Health inequality Differences observed between groups due to one group experiencing an advantage over the other group rather than to any innate differences between them Health inequity The presence of unfair and avoidable or remedial differences in health among populations or groups defined socially Health promotion The process of enabling people to exert control over and to improve their health As well as covering actions aimed at strengthening people’s skills and capabilities, it also includes actions directed towards changing social and environmental conditions, to prevent or to improve their impact on individual and public health High-risk strategy This targets preventative interventions at people most at risk of a disease Host A living organism on or in which an infectious agent can subsist Impairment In the context of health experience an impairment is any loss or abnormality of psychological, physiological or anatomical structure or function Incidence The number of new cases of illness commencing, or of persons falling ill, during a specified time period in a given population See also prevalence Incidence rate The rate at which new cases occur in a population www.ebook777.com 319 Free ebooks ==> www.ebook777.com 320 Glossary Incubation period The interval from exposure to onset of clinical disease Index case The first case identified in an outbreak Infant mortality The proportion of live births that die up to one year of age Infection (colonisation) This occurs when an organism enters the body and multiplies It may be termed infection when damage is caused and colonisation when no damage is caused to the host Acute infection implies a short-lived infection with a short period of infectivity Chronic infection refers to a persistent condition with on-going replication of the organism Latent infection refers to a persistent infection with intermittent replication of the organism Infectivity The proportion of exposed, susceptible persons who become infected (for a given number of organisms) Intention-to-treat analysis A method for data analysis in a randomised clinical trial in which individual outcomes are analysed according to the group to which they have been randomised, even if they never received the treatment they were assigned By simulating practical experience it provides a better measure of effectiveness (versus efficacy) Interviewer bias Systematic error due to interviewer’s subconscious or conscious gathering of selective data Koch’s (Henle–Koch’s) postulates These postulates should be met before a causal relationship can be inferred between an organism and a disease: The agent must be shown to be present in every case of the disease by isolation in pure culture The agent must not be found in cases of other disease Once isolated, the agent must be able to reproduce disease in experimental animals The agent must be recovered from this experimental disease Lead time bias If prognosis study patients are not all enrolled at similar, well-defined points in the course of their disease, differences in outcome over time may merely reflect differences in duration of illness Lead time bias occurs when detection by screening seems to increase disease-free survival but this is only because disease has been detected earlier and not because screening is delaying death or disease Length time bias Length time bias occurs if a screening programme is better at picking up milder forms of the disease This means that people who develop a disease that progresses more quickly or is more likely to be fatal are less likely to be picked up Free ebooks ==> www.ebook777.com Glossary by screening and their outcomes may not be included in evaluations of the programme Thus the programme looks to be more effective than it is Life expectancy The average number of additional years a person could expect to live if current mortality trends were to continue for the rest of that person’s life Generally given as a life expectancy from birth Likelihood ratio Ratio of the probability that a given diagnostic test result will be expected for a patient with the target disorder rather than for a patient without the disorder Maternal mortality ratio The number of deaths during pregnancy and up to 42 days after delivery, per 1000 live births Morbidity The impact of a disease which is not death Measures of morbidity include incidence and prevalence rates Mortality (rate) The number of deaths in an area as a proportion of the number of people in that area Needs These may be expressed by action, e.g visiting a doctor; or felt needs, e.g what people consider and/or say they need The need for health-care is often defined as the capacity to benefit from that care Negative predictive value (of a diagnostic or screening test) The proportion of persons testing negative for a disease who, as measured by the gold standard, are identified as non-diseased Neonatal mortality The proportion of live births who die within the first 28 days Non-specific immunity This is the natural barriers a host has to pathogens It includes mechanical barriers, body secretions, physical removal of organisms, phagocytosis and inflammatory response Normal distribution Many biological variables show a normal distribution of ranges between individuals within a population A probability density graph of the normal distributions takes the shape of a bell-shaped curve Number needed to treat (NNT) The number of patients who must be exposed to an intervention before the clinical outcome of interest occurred; for example, the number of patients needed to treat to prevent one adverse outcome Odds A proportion in which the numerator contains the number of times an event occurs and the denominator includes the number of times the event does not occur www.ebook777.com 321 Free ebooks ==> www.ebook777.com 322 Glossary Odds Ratio A measure of the degree of association; for example, the odds of exposure among the cases compared with the odds of exposure among the controls Outbreak A localised epidemic Health-protection professionals often look for two or more cases linked in time and place P value The probability (ranging from zero to one) that the results observed in a study (or results more extreme) could have occurred by chance Pandemic A global epidemic This term is sometimes used for a very large-scale epidemic Perinatal mortality The proportion of all births that die before birth or in the first week Placebo A substance that has no therapeutic effect, used as a control in interventional studies Policy An overall statement of the aims of an organisation within a particular context Population strategy Targets preventative interventions at the whole population Positive predictive value (of a diagnostic or screening test) The proportion of persons testing positive for a disease who, as measured by the gold standard, are identified as diseased Poverty Absolute poverty – a family’s ability to purchase essential goods (such as housing, heating, food, clothing and transport) Relative poverty – poverty in relation to the average income in a particular population (such as below 50% of the national average) Precision The range in which the best estimates of a true value approximate the true value See confidence interval Predictive value In screening and diagnostic tests, the probability that a person with a positive test is a true positive (i.e does have the disease) or that a person with a negative test truly does not have the disease The predictive value of a screening test is determined by the sensitivity and specificity of the test, and by the prevalence of the condition for which the test is used Prevalence The proportion of persons with a particular disease within a given population at a given time Point prevalence is the prevalence at one single point in time Period prevalence is the proportion of persons with a particular disease over a specified period of time Free ebooks ==> www.ebook777.com Glossary Prevention Primary prevention – actions designed to prevent the occurrence of the problem, e.g health education, immunisation Secondary prevention – actions designed to detect and treat the occurrence of a problem before symptoms have developed, e.g screening, early diagnosis Tertiary prevention – actions designed to limit disability once a condition is manifest, e.g limitation of disability, rehabilitation Prevention paradox Preventive measures bringing large benefits to the community offer little to each participating individual Primary health-care First-contact care provided by a range of health-care professionals: general practioners, nurses, dentists, pharmacists, optometrists, and complementary therapists working in the community Prognosis The possible outcomes of a disease or condition and the likelihood that each one will occur Prognostic factor Demographic, disease-specific, or co-morbid characteristics associated strongly enough with a condition’s outcomes to predict accurately the eventual development of those outcomes Compare with risk factors Neither prognostic nor risk factors necessarily imply a cause-and-effect relationship Prospective study Study design where one or more groups (cohorts) of individuals, who have not yet had the outcome event in question, are monitored for the number of such events which occur over time Public health The science and art of preventing disease, prolonging life and promoting health through the organised efforts and informed choices of society, organisations, public and private, communities and individuals Public health practice is the emphasis in this book, while public health may also be considered as a discipline or a social institution Public health practitioner In this book, includes anyone working in the broad field of public health, neither defined by formal qualifications nor restricted to a professional group Quality-adjusted life year (QALY) A health measure which combines the quantity and quality of life It takes year of perfect-health life expectancy to be worth and regards year of less than perfect life expectancy as less than Randomised controlled trial Study design where treatments, interventions or enrolment into different study groups are assigned by random allocation rather than by conscious decisions of clinicians or patients If the sample size is large enough, this www.ebook777.com 323 Free ebooks ==> www.ebook777.com 324 Glossary study design avoids problems of bias and confounding variables by assuring that both known and unknown determinants of outcome are evenly distributed between treatment and control groups Recall bias Systematic error due to the differences in accuracy or completeness of recall to memory of past events or experiences Relative risk The ratio of the probability of developing, in a specified period of time, an outcome among those receiving the treatment of interest or exposed to a risk factor, compared with the probability of developing the outcome if the risk factor or intervention is not present Reproducibility (repeatability, reliability) The results of a test or measure are identical or closely similar each time it is conducted Retrospective study Study design in which cases where individuals who had an outcome event in question are collected and analysed after the outcomes have occurred (see also case–control study) Risk The number of cases of a disease that occur in a defined period of time as a proportion of the number of people in the population at the beginning of the period Risk factor Patient characteristics or factors associated with an increased probability of developing a condition or disease in the first place Compare with prognostic factors Neither risk nor prognostic factors necessarily imply a cause-and-effect relationship Screening A public health service in which members of a defined population, who not necessarily perceive they are at risk of, or are already affected by, a disease or its complications, are asked a question or offered a test The aim is to identify those individuals who are more likely to be helped than harmed by further tests or treatment to reduce the risk of a disease or its complications Secular trend A trend over time, also termed temporal trend Selection bias A bias in assignment or a confounding variable that arises from study design rather than by chance These can occur when the study and control groups are chosen so that they differ from each other by one or more factors that may affect the outcome of the study In screening, selection bias occurs when the screening programme attracts people who are more or less likely to have the condition being screened for than the general population Sensitivity (of a diagnostic or screening test) The proportion of truly diseased persons, as measured by the gold standard, who are identified as diseased by the test under study Free ebooks ==> www.ebook777.com Glossary Social capital Networks, together with shared norms, values and understandings, which facilitate co-operation within or among groups and which may thereby improve health Specificity (of a diagnostic or screening test) The proportion of truly non-diseased persons, as measured by the gold standard, who are identified as non-diseased by the test under study Strategy A plan of action designed to achieve a series of objectives Stratification Division into groups Stratification may also refer to a process to control for differences in confounding variables, by making separate estimates for groups of individuals who have the same values for the confounding variable Strength of inference The likelihood that an observed difference between groups within a study represents a real difference rather than mere chance or the influence of confounding factors, based on both P values and confidence intervals Strength of inference is weakened by various forms of bias and by small sample sizes Surveillance The on-going, systematic collection, collation and analysis of data and the prompt dissemination of the resulting information to those who need to know so that an action can result Sustainability Requires the reconciliation of environmental, social and economic demands Sustainable development meets the needs of the present without compromising the ability of future generations to meet their own needs Survival curve A graph of the number of events occurring over time or the chance of being free of these events over time The events must be discrete and the time at which they occur must be precisely known In most clinical situations, the chance of an outcome changes with time In most survival curves, the earlier follow-up periods usually include results from more patients than the later periods and are therefore more precise Validity The extent to which a variable or intervention measures what it is supposed to measure or accomplishes what it is supposed to accomplish The internal validity of a study refers to the integrity of the experimental design The external validity (generalisability) of a study refers to the appropriateness by which its results can be applied to non-study patients or populations Years of life lost (YLL) Years of potential life relate to the average age at which deaths occur and the expected life span of the population Therefore, a measure of how many potential years are lost due to early death and provides a measure of the relative importance of conditions in causing mortality www.ebook777.com 325 Free ebooks ==> www.ebook777.com Index absolute risk reduction (ARR), 57 acceptability assessment, 118 access to medicines, 292–3 accountability, 25 action efficacy, 136 activities of daily living, 248 adults, 227 determinants of health, 228 health promotion, 239–41 mortality and morbidity causes, 228–39 cancer, 229–30 cardiovascular diseases, 230–2 diabetes, 155 mental health disorders, 236–9 obesity, 234–6 advocacy, 142, 143 age as an epidemiological variable, 48 at menopause, 72 ageing demography of old age, 245–6 end-of-life care, 254 health and, 246–9 health and social care, 252–3 prevention of age-related conditions, 249– 52 dementia, 252 falls, 251–2 primary prevention, 249–50 secondary prevention, 250 tertiary prevention, 251 ageing population, 35, 245–6 policy responses, 254–5 AIDS, 291 amniocentesis, 150 analytical studies, 62, 64 interventional studies, 66–9 observational studies, 64–6 aortic aneurysm, 151 screening, 155–6 attitudes to work, 22 attributable risk (AR), 58–9 smoking study, 59–60 audit, 192–3 significant event audit, 196 avoidable mortality, 41 326 Beauchamp and Childress principles, 125 behaviour change in practice, 137–9 in theory, 135–7 nudge approach, 139 stages in, 136–7 bias in screening programmes, 159–60 information bias, 71–2 lead time bias, 160 length time bias, 160 selection bias, 71, 159–60 body mass index (BMI), 234 breast cancer, 148 screening, 151–2, 157 burden of disease, 38–9, See also morbidity; mortality cancer, 229 cardiovascular diseases, 230–1 diabetes, 232 global burden, 285–7 mental health disorders, 236–7 obesity, 234 cancer, 229–30 registration, 84 cardiovascular diseases, 134–5, 230–2 burden of disease, 230–1 policy, 232 prevention, 231–2 risk factors, 231 Care Quality Commission (CQC), UK, 279 case fatality, 53–4 case reports, 63 case series, 63 case-control studies, 64–5 causal factors, 74–5 censuses, 39–40, 85 cervical cancer, 148 screening, 150, 155–6 chance, 70 change behaviour change in practice, 137–9 behaviour change in theory, 135–7 in public health practice, 25–7 Free ebooks ==> www.ebook777.com Index evaluation of effects of change, 100 implementation, 99–100 innovation adoption, 19–20 psychology of, 19–20 theories of, 18 child mortality, 209, 212, 214 global issues, 287–8, 289 child population, 211–12 child public health, 209 challenges, 213 determinants of child health, 213–19 behaviour and lifestyle, 218–19 child care, 216–17 ethnicity, 215 family structure, 216 individual and congenital factors, 215 media, 219 parenting, 215–16 peer relationships, 217 physical environment, 218 poverty and deprivation, 217–18 public services, 219 social capital, 218 global issues, 287–9 health policy, 224 health promotion, 219–21 obesity case study, 220–3 mortality and morbidity causes, 212, 214 Chlamydia trachomatis, 166 chorionic villus sampling (CVS), 150 citizens’ juries, 110 climate change, 304, See also sustainable development health co-benefits of action, 305 clinical governance, 194–5 clinical leadership, 24–5 clinical trials, 67–8 randomised controlled trials (RCTs), 66 Cochrane Database, 95 cohort studies, 65–6 communicable disease control, 165–72 global issues, 290–1, 292 outbreak investigation, 174 principles, 164–5 surveillance, 172–4 transmission control, 166–9 vaccination, 169–72, 173 community development, 141 community trials, 68–9 confidence interval (CI), 70 confounding, 72–4 confounding variables, 64 Consumer Assessment of Healthcare Providers and Systems programme, USA, 193 cost effectiveness assessment, 119–26 cost utility analysis, 121 cross functional teams, 22 cross-sectional studies, 63 data, 79 death rate, 79–81, See also mortality directly standardised death rate (DSR), 80–1 standardised mortality ratio (SMR), 80–1 under-5 mortality rate, 82 decision making, 116, See funding decisions dementia, prevention, 252 Demographic and Health Surveys (DHS) Project, 40 demographics disease burden, 38–9 fertility, 31–2 health transitions, 36–8 life expectancy, 34–5 methodological issues, 39–41 migration, 33–4 mortality, 32–3 old age, 245–6 demography, 29 population structure, 30 population trends, 31 deprivation, children, 217–18 descriptive studies, 62, 63 individual studies, 63 population studies, 63 desired health outcomes, 184–5 diabetes, 155 burden of disease, 232 prevention, 233 risk factors, 233 Diabetes Control and Complications Trial (DCCT), 68 diabetes screening, 155–7 diabetic retinopathy, 149 direct costs, 119 directly standardised death rate (DSR), 80–1 Directors of Public Health, disability, dimensions of, 247 disability-adjusted life years (DALYs), 38–9, 287 disaster planning and response, 179–81 disease burden., See burden of disease disease prevention., See prevention disease-specific approaches, 296 Down’s syndrome screening, 150 Duncan, William, 1–2 ecological fallacy, 63 economic evaluation, 119–23 education, 192–3 effectiveness assessment, 117–18, See also cost effectiveness assessment emergency planning and response, 179–81 emotional intelligence, 15 end-of-life care, 254 environmental public health, 177–9 epidemiology, 43–4 comparing risks, 54–7 concepts, 61 disease frequency measures, 49–53 www.ebook777.com 327 Free ebooks ==> www.ebook777.com 328 Index epidemiology, (cont.) incidence, 50–3 prevalence, 50 rates, 49 history, 44–5 interpretation of study results, 69–75 chance, 70 error, 70–4 validity, 74–5 number needed to treat (NNT), 57–8 population concept, 46–7 population impact measures, 58–9 smoking study, 59–60 types of studies, 62–9 analytical studies, 64 descriptive studies, 63 study designs, 62 variables, 47–9 error, 70–4 random error, 71 systematic error, 71–4 ethnicity, child health and, 215 evidence-based health-care (EBHC), 90–1 appraising the evidence, 96–9 asking a focussed question, 91–2 assessing evidence of effectiveness, 117–18 changing practice, 99–100 evaluating the effects of change, 100 limitations, 100–1 tracking down evidence, 92–6 evidence-based medicine (EBM), 91 external validity, 74 falls, prevention in old age, 251–2 family structure, child health and, 216 Farr, William, 44 fertility, 31–2 estimation, 40 Finagle’s law, 78 financial incentives, 100 financing health systems, 294–6 focus groups, 110 followers, 18 functional teams, 21 funding decisions, 115–16 acceptability assessment, 118 assessing evidence of effectiveness, 117–18 assessing need, 116–17 cost-effectiveness assessment, 119–26 economic evaluation, 119–23 ethical approaches, 124–6 identifying the proposed service, 116 value-based decisions, 123–6 gender inequalities, 297 General Household Survey, UK, 85 germ theory, global issues access to medicines, 292–3 barriers to health-care access, 297–8 burden of disease, 285–7 communicable diseases, 290–2 health improvement, 294–7 delivery, 293–4 organising and financing health systems, 294–6 people-centred or disease-specific services, 296–7 maternal health, 288, 290 measuring progress, 298–300 non-communicable diseases, 291–2 poverty, 286 poverty reduction priorities, 300 preventable illness and death among children, 287–9 reproductive health, 288–90 governance, 294 Graunt, John, 44 handicap, 247 health, 139–40 ageing and, 246–9 causes, 308–11 knowledge use by health professionals, 311–12 poverty relationship, 285 health-care in old age, 252–3 problems with, 188–9 health inequalities, 257–8, 280–2 approaches, 268–9 causes, 259–64 access to services, 264 material circumstances, 260–2 social status, 77–8 gender inequalities, 297 goals of public health, 265 implications for public health practice, 258, 269–70 life course perspective, 265–6 lifestyle and behaviour, 263–4 policy approaches, 264–5 responsibility for action, 266–8 health needs assessment, 108–14 agreeing local priorities, 110–11 comparative needs assessment, 109–10 epidemiological needs assessment, 108–14 objectives, 109 planning and strategy development, 111–13 theoretical perspectives, 104–7 health or health-care, 105 individual or population, 105 need, supply and demand, 105–6 health policy., See policy health profile, 78 health promotion, 139–44 adults, 239–41 child health promotion, 219–20, 221 obesity case study, 220–3 community development, 141 Free ebooks ==> www.ebook777.com Index health education, 140–1 healthy public policy, 141–2 legislative action, 141 mental health, 238–9 responsibility for, 142–4 tobacco control programme, 140 workplace case study, 239–41 health protection, 163–4, 281–2 communicable disease control, 165–72 principles, 164–5 emergency planning and response, 179–81 environmental public health, 177–9 outbreak investigation, 174 surveillance, 172–4 Health Survey for England, 85 health transitions, 36–8 health-related social marketing, 138 hip fracture, 251–2 HIV, 291 horizontal teams, 22 hospital episode statistics (HES), 83–4 human resources, 297–8 Illich, Ivan, immigrant screening, 152 immunisation, impairment, 247 incidence, 50–3 prevalence relationship, 53 incidence rate, 50–1 incremental costs, 120 Index of Multiple Deprivation, 86 indirect costs, 119 individual studies, 63 inequality measures, 86–7, See also health inequalities infant mortality, 81 infectious diseases, 166, See also communicable disease control drug resistance, 168 morbidity statistics, 83 transmission control, 166–9 vaccination, 169–72 influenza pandemic preparedness, 181 information bias, 71–2 innovation adoption, 19–20 instrumental activities of daily living, 248 internal validity, 74 International Classification of Diseases and Related Health Problems (ICD), 44 interventional studies, 62, 64, 66–9 clinical trials, 67–8 community trials, 68–9 interviews, 110 job satisfaction, 22 Joint Strategic Needs Assessments, 87, 117 knowledge, use by health professionals, 311–12 lead time bias, 160 leadership, 15–18 clinical leadership, 24–5 in public health practice, 25–7 styles, 16–17 lean technique, 195 legislation, health promotion, 141 length time bias, 160 life expectancy, 34–5, 82 income relationship, 35 medical care contribution, 3–4 life tables, 34–5, 41 lifestyle factors children, 218–19 health inequalities, 263–4 likelihood ratios, 157 Lind, James, 44–5 literature searches, 94–6 local health surveys, 86 lung cancer, 71–2 management, 13–14 clinicians’ role, 24–5 in public health practice, 25–7 tasks, 14 marginal costs, 120 market incentives, 277–8 Marmot Review, 266, 268, 280 maternal health, 288 maternal mortality, 33, 81, 288, 290 Pakistan, 69 McKeown, Thomas, 2–3 media influence on child health, 219 medical care contribution, 3–4 Medline, 95 menopause, age at, 72 mental health, 236–9 burden of disease, 236–7 policy, 239 prevention of disorders, 238–9 risk factors, 237–8 meta-analysis, 98 migration, 33–4 measurement, 41 mild cognitive impairment (MCI), 252 millennium development goals (MDGs), 298–300 Monitor, 279 morbidity, 83–4, 231, See also burden of disease adult morbidity causes, 228–39 child morbidity, 212 global issues, 287–8 statistics, 83–4 mortality, 32–3, See also burden of disease; death rate adult mortality causes, 228–39 avoidable mortality, 41 case fatality, 53–4 www.ebook777.com 329 Free ebooks ==> www.ebook777.com 330 Index mortality, (cont.) child mortality, 209–12, 214 global issues, 287–9 infant mortality, 81 maternal mortality, 33, 81, 288, 290 Pakistan, 69 measurement, 40–1, 78–82 neonatal mortality, 81 perinatal mortality, 81–2 Pakistan, 69 post-neonatal mortality, 81 proportional mortality, 81 smoking relationships, 59–60 standardised mortality ratio (SMR), 80–1 motivational needs, 24 National Child Measurement Programme (NCMP), UK, 220 National Institute of Health and Clinical Excellence (NICE), UK, 279 National Patient Safety Agency (NPSA), UK, 193 natural history of disease, 129–30 needs, 104–5 needs assessment, 116–17, See also health needs assessment neonatal mortality, 81 new public health movement, NHS, 6–7 structural reform, 278–9 nicotine gum, 55–6 notifiable diseases, 174 number needed to treat (NNT), 57–8 obesity, 234–6 burden of disease, 234 childhood, health promotion case study, 220–2, 223 effects on health, 235 policy, 233–6 prevention, 235–6 risk factors, 234–5 observational studies, 64–6 case–control studies, 64–5 cohort studies, 65–6 Odds Ratio, 54–5 old age., See ageing opportunity costs, 119 oral contraceptives, pulmonary embolism relationship, 65 organisational behaviour, 20–4 organisational culture, 21 organisational types, 21 outbreak investigation, 174 P value, 70 Pakistan, maternal and perinatal mortality, 69 panels, 110 parenting, child health and, 215–16 payment for performance, 194 peer relationships, children, 217 perinatal mortality, 81–2 Pakistan, 69 period prevalence, 50 PESTLE analysis, 18 PICO approach, 92 Plan–Do–Study–Act (PDSA) cycle, 192 planning, health needs assessment and, 111–13 point prevalence, 50 policy, 273 ageing population and, 254–5 cancer, 229–30 cardiovascular diseases, 232 child public health, 224 context for policy making, 274–5 England, 276–9 developments, 279–82 government priorities, 280 market incentives, 277–8 NHS structural reform, 278–9 objectives, 281 health inequalities, 264–5 health promotion, 141–2 implementation, 275–6 meaning of, 273–4 mental health, 239 obesity, 233–6 population, 46–7 child population, 211–12 health status, 77–8 inequality measures, 86–7 local health surveys, 86 morbidity measurement, 83–4 mortality measurement, 78–82 population surveys, 85 population attributable risk, 59 population censuses, 39–40, 85 population growth, 287 population structure, 30 population studies, 63 population surveys, 40, 85 population trends, 31 fertility, 31–2 life expectancy, 34–5 migration, 33–4 mortality, 32–3 post-neonatal mortality, 81 poverty, 286 child health and, 217–18 health inequalities and, 260–2 health relationship, 285 poverty-reduction priorities, 300 power, 71 sources of, 16 predictive values, 156–7 prevalence, 50 incidence and disease duration relationship, 53 prevention, 128–9 age-related conditions, 249–52 Free ebooks ==> www.ebook777.com Index dementia, 252 falls, 251–2 primary prevention, 249–50 secondary prevention, 250 tertiary prevention, 251 behaviour change in practice, 137–9 behaviour change in theory, 135–7 cancer, 229 cardiovascular diseases, 231–2 diabetes, 233 in clinical practice, 133–5 levels of, 130–1 mental health disorders, 238–9 obesity, 235–6 strategies, 131–3 prevention paradox, 132 primary prevention, 130 professionalism, 24–5 programme budgets, 120 proportional mortality, 81 proportionate universalism, 268 prostate cancer, 152 public health, child public health, 209 competence development, 312–13 core functions, 295 domains of, 4–6 environmental public health, 177–9 historical background, 1–3 new public health movement, Public Health England, 6, 282 pulmonary embolism, oral contraceptives relationship, 65 qualitative methods, 93–4 quality-adjusted life years (QALYs), 82, 121 disadvantages, 122 Quality and Outcomes Framework (QOF) payment system, 100 quality of care, 183–4 definition, 184 dimensions of, 185 evaluation, 185–8 improvement, 190–6 clinical governance, 194–5 education and audit, 192–3 lean technique, 195 market-based approaches, 193–4 regulation and standards, 190–1 root-cause analysis, 196 significant-event audit, 194–6 six sigma, 194–5 measurement, 184–5 problems with, 188–9 question, 91–2 questionnaire surveys, 110 random error, 70, 71 randomised controlled trials (RCTs), 66, 93 appraisal, 96 rapid appraisal, 110 registration of births and deaths, 40 regulation, 190–1 relative risk, 54–7 smoking study, 59–60 reproductive health, 288–90 resource distribution, 305–6 risk, 50 attributable risk (AR), 58–9 case fatality, 53–4 comparing risks, 54–7 population attributable risk, 59 risk factor thresholds, 133–5 root-cause analysis, 196 Rose, Geoffrey, 131 sampling error, 71 screening, 132–3, 146–7 criteria for programme establishment, 147– 52 the condition, 148–9 the programme, 151–2 the test, 149–50 the treatment, 150–1 harms and benefits, 147 monitoring programmes, 159–60 sources of bias, 159–60 other forms of screening, 152 screening test performance, 154–8 likelihood ratios, 157 predictive values, 156–7 sensitivity, 154–6 specificity, 154–6 test outcomes, 154 successful UK programmes, 152–3 scurvy, 45 secondary prevention, 131 selection bias, 71 in screening programmes, 159–60 self-directed teams, 22 self efficacy, 136 sensitivity, 154 calculation, 154–6 significant event audit, 194–6 six sigma, 194–5 smoking cessation, 55–6 mortality relationships, 59–60 tobacco control programme, 140 Social Action Research Project (SARP), 269 social capital, 218 social care in old age, 252–3 social exclusion, 297 social marketing, 138 specificity, 154 calculation, 154–6 standardised mortality ratio (SMR), 40, 80–1 www.ebook777.com 331 Free ebooks ==> www.ebook777.com 332 Index standards of care, 190–1 stillbirth rate, 81 strokes, 132 surveillance, 172–4 survival rates, 53–4 sustainable development, 304–8 food, 305 framework for action, 306–8 health co-benefits of action, 305 public health role, 308–13 causes of health, 308–11 competence development, 312–13 knowledge use by health professionals, 311–12 redistributing resources, 305–6 travel, 305 systematic error, 70–4 confounding, 72–4 information bias, 71–2 selection bias, 71 systematic reviews, 96–9 teams, 21–2 tertiary prevention, 131 therapeutic era, thrombolysis, 98–9 tipping point, 20 transactional leadership, 15 transformational leadership, 15 under-5 mortality rate, 82 user consultation panels, 110 vaccination, 169–73 validity, 74–5 value-based decisions, 123–6 vertical teams, 21 Whitehall study, 66, 264 whole-systems approach, 280 workplace health promotion, 239–41 years of life lost (YLL), 82 ... www.ebook777.com Essential Public Health Theory and Practice www.ebook777.com Free ebooks ==> www.ebook777.com Free ebooks ==> www.ebook777.com Essential Public Health Theory and Practice Stephen... Crowther and Sarah Stewart-Brown 13 273 International development and public health Jenny Amery 18 257 Health policy Richard Lewis and Stephen Gillam 17 244 Health inequalities and public health practice. .. activities of health professionals caring for individuals and public health workers tending populations (Table 1) Public health and today’s NHS For the last 40 years in the UK, public health specialists