Essential Public Health

Theory and Practice

How can society most effectively prevent disease and promote health? This is the challenge addressed by this textbook.

   Public health has been defined as the art and science of preventing disease, prolonging life and promoting health through the organised efforts of society. The ‘science’ is concerned with making a diagnosis of a population's health problems, establishing their cause, and determining effective interventions. The ‘art’ is to address these problems creatively. The aim of this book is to capture both the art and the science of the field.

Essential Public Health – Theory and Practice is divided into two major sections. The first part provides a toolkit of skills the practitioner must acquire, including coverage of all the disciplines underpinning public health. Part two describes the challenges faced, and explains how to go about the task. This section takes a life-course approach, considering the challenges of child public health, before moving on to the health of adults and older people. The section concludes with consideration of health inequalities, quality measurement techniques and global public health before examining opportunities to improve public health for the future.

   This will be essential reading for these training in health care, social care and related disciplines such as environmental health. It includes a CD containing interactive, self-assessment questions and exercises to test understanding.

Stephen Gillam is Director of Undergraduate Public Health Teaching, Department of Public Health and Primary Care at the Institute of Public Health, University of Cambridge and a GP in Luton/ Visiting Professor at the University of Luton.

Jan Yates is a Public Health Specialist with experience of public health practice in Primary Care Trusts and acute hospital and mental health settings. She is a qualified teacher.

Padmanabhan Badrinath is a Consultant in Public Health Medicine in Suffolk Primary Care Trust and an Affiliated Clinical Lecturer, Department of Public Health and Primary Care at the Institute of Public Health, University of Cambridge.

Essential
Public Health

Theory and Practice

Stephen Gillam, Jan Yates
Padmanabhan Badrinath

CAMBRIDGE UNIVERSITY PRESS
Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo

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/9780521869720

© S. Gillam, J. Yates and P. Badrinath 2007

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

Printed in the United Kingdom at the University Press, Cambridge

A catalogue record for this publication is available from the British Library

ISBN 978-0-521-86972-0 hardback
ISBN 978-0-521-68983-0 paperback

Every effort has been made in preparing this publication 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 publication. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use.

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Contents

Contributors

JENNY AMERY Department for International Development
1 Palace Street
London SW1E 5HE

CAROL BRAYNE Institute of Public Health
Addenbrooke’s Hospital Hills Road Cambridge CB2 2SR

RACHEL CROWTHER 327 Woodstock Road Oxford OX2 7NX

JOHN DANESH Department of Epidemiology and Medicine
University of Cambridge

TONY JEWELL Welsh Assembly Government
Cathays Park
Cardiff CF10 3NQ

RICHARD LEWIS Health Policy
King’s Fund
11–13 Cavendish Square
London WC1 0NS

DAVID PENCHEON Eastern Region Public Health Observatory
Institute of Public Health
Addenbrooke’s Hospital
Hills Road
Cambridge CB2 2SR

CHRISSIE PICKIN Health Promotion and Chronic Disease Prevention
Department of Human Services
Victorian State Government
Melbourne VIC 3000
Australia

VEENA RODRIGUES School of Medicine, Health Policy and Practice
University of East Anglia
Norwich NR4 7TJ

LINCOLN SARGEANT Institute of Public Health
Addenbrooke’s Hospital
Hills Road
Cambridge CB2 2SR

NICHOLAS STEEL School of Medicine Health Policy and Practice
University of East Anglia
Norwich NR4 7TJ

SARAH STEWART-Brown Division of Health in the Community
Warwick Medical School, LWMS
The University of Warwick
Coventry CV4 7AL

Foreword

Myriad challenges face international health today, fromthe prospect of hundreds of millions of tobacco-related deaths in thetwenty-first century, to thedevastation ofsub-SaharanAfricabyAIDS,tothe rise of cardiovascularandmetabolic diseases in many countries still laid lowby ancient communicable diseases. The tide of the tobacco epidemic is turning inBritain and in some other industrialised countries, but in these places further progress depends on greater use of proven life-saving interventions (such as those in the prevention of vascular diseases) as well as on appropriate responses to challenges posed by ageing populations, unhealthy lifestyles and major – but comparatively neglected – sources of disability such as mental and musculoskeletal diseases.

   The editors of thisbookhaveproduceda lucidandthoughtful account of critical perspectives and tools that will enable students and practitioners to understand andtacklesuchprevailing problemsin public health. This book’s appeal to healthcare professionals from many different backgrounds should help to advance the interdisciplinary approach to health promotion and disease prevention that the editors themselves wisely advocate.

John Danesh
Professor of Epidemiology and Medicine
University of Cambridge

Foreword

Public health knowledge and practice is derived from a number of different academic fields. This makes the specialty very stimulating but immediately confronts the student with a dilemma: breadth versus depth. This book strikes the right balance between the need for coverage of several relevant disciplines with the detail required to understand specific public health challenges. We all need to use the frameworks described here to locate our learning and practice.

   The three-domains model of public health practice described in the introduction has utility for all health workers – and we need to reflect on the location of information we use at the intersection of the three domains. Modern information technology provides assistance to health practitioners, e.g. through search engines and internet resources, but the growth in information and specialised knowledge characteristic of modern health systems can be overwhelming. For practitioners dedicated to improving public health there is always a ‘population of interest’. For example, for the health visitor deprived families in her locality, for the general practitioner a practice population, for the director of public health a whole population and for the paediatrician or children’s lead manager a subset of that population.

   The community diagnostic model and the life-course structure is welcome. This book is written to assist learning for students from many disciplines studying public health. They will benefit from the clarity of the authors’ approach, the wisdom distilled here and the recognition of our global and local public health challenges.

Tony Jewell
Chief Medical Officer, Wales

Acknowledgements

The authors would like to thank the following for their contribution: Sian Rees, Ian Sullivan, Sue Halliday, Peter Bradley, Ibrahim Abubakar, and John Powles. Thanks for encouragement and ideas are also due to family, friends, colleagues and – of course – our students.