New Public Health Measures

THE youthful PUBLIC HEALTH Stephen R Leeder 7 March 2005 James Cook University, Townsville Introduction All of us here today are human cosmoss wellness enthusiasts. If we werent we would be somehwere else, maybe helping depressed tribe to get better. That is a worthy calling and thank goodness for all the people who do it. But so too is prevention, so too is keeping society wellnessy, so too is protect the environment, so too is keeping food and water safe, so too is att destructioning to immunization and youngster wellness.When we talk about common purpose wellness these latter things, that focus on the whole familiarity, or groups indoors society and the things that determine their wellness, are what we are talking about. This is big picture stuff. This is about asking wherefore some communities are wellnessy and some are ill. Why do some communities invite such(prenominal)(prenominal) high rates of diabetes, like the Pacific Islands, while other countries engender no diabetes except dissever of HIV and TB? These are the kind of interests and enthusiasms that have led people into world wellness as a shareer for as long as it has been around.These are the kind of questions that were asked ages ago and which are til now appropriate to be asked now. So what is this thing called the juvenile exoteric health? How has it come about and does it have added value? In brief, the new public health has come about because of growing interest in the subtle interaction of the environment with people living in affluent societies. The disused public health remains the public health that most of the world needs, quite frankly, because communicable disease, malnutrition and other scourges are until now the major killers worldwide.These are more 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 get wordled with sanitation, clean water and quarantine. The new public health But the new public health is a good deal more concerned with the interplay amidst affluence, social well being, education and health, social capital and health. These are non hard and fast things, like having no system for waste water disposal or employ contaminated drinking water. They are more subtle, but in societies like ours where the basic public health engineering and mmunization and food safety are well in place and require surveillance but non reinvention, these new factors the social, economic and community quality factors are rising in immensity as determinants of health and causes of illness. 1 For example, Michael Marmot has d one(a) studies with Geoffrey Rose and others in the UK examining coronary disease rates among civil servants, know as the Whitehall studies. They found that things like a sense of social control and gummyness were crucial determinants of whether people develop coronary disease.Money wasnt everything. In the Whitehall II study, Marmot (Direct or of the International Centre for health and Society at the University College London) and his colleagues examined the psychological characteristic of work termed low control meaning that an separate worker had little control over his or her daily activities in the workplace. The results showed that it was an important predictor of the risk 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 years in promoting our understanding about the interplay surrounded by society and social environmental factors and health. This started in 1974 when Marc Lalonde, who was then the Canadian health minister, commissioned a score on the health of Canadians which proposed four sets of factors that were important to keep in mind when thinking about the health of the public. The Lalonde Report2 refers to these four factors collectively as The wel lness Field Concept. The four elements are human biology, environment, modus vivendi and health care organization.The human biology element admits all those aspects of health, both physical and mental, which are positive within the human embody as a impression of the basic biology of man and the sumal make-up of the individual. The environment crime syndicate 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 collection of closes by individuals which affect their health and over which they more or less have control.The fourth category in the concept 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 care system. The Lalonde Report was ground breaking in its day and provoked widespread gl obal interest. Implementation proved to be far harder than was expected and the resi craftnce of the health-care system to drain resources away from the kickoff tierce fields was spectacular.Nevertheless, Canada has had a more lively interest in the contribution of the first third fields to health and has preserved a degree of control over health care, including rigid enforcement of a restriction 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 leading role in the evolution of health advance 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 potential for health gain by examining not unaccompanied what burn be done to encourage and sustain changes in individual human doings that will contribute to better health, but also those changes that can be effected in the graphic and bui lt environment that can assist 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 tie-up.The Associations major objectives include providing opportunities for members professional development, increasing public and professional awareness of the roles and functions of health promotion practitioners, and contributing to discussion, debate and decision making on health promotion policy and programs. Since its incorporation 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 order of business is set with communities and individuals to affirm positively the value of health and push towards high levels of health, seeing it rat her as the WHO does as a positive state of well being and not simply the absence of illness. Health promotion uses a range of tactics and methods to achieve its ends, including community participation, development and skill strengthening, advocacy (where health professionals and others lobby for health to be taken seriously at political and commercial levels), and education.Something of a melodic phrase has come to be drawn between the activist promotion end and the formal epidemiological end of the public health spectrum, the former hoeing in boots and all to effect change and the latter taking wakeful steps, using rigorous studies and statistics, to establish cause and effect relationships before acting. Both groups tend to drive one another nuts. This is a lively tension and not one that is likely to go away.Professor Fran Baum who is head of the division of Public Health at Flinders University in Adelaide has written a book entitled The new public health an Australian perspec tive, that I commend to you. In it the idea of the new public health is devoted 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 decade particularly health promotion, primary health care, community health, womens health, Aboriginal 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 pillowcase in public health when the WHOs first international conference on health promotion was held in Ottawa, Canada. There were two driving forces behind the Ottawa employ. It was clear that the Health for All by the course 2000 strategy was not being adopted by industrialised countries, and the limitations of the lifestyle and behavioural approaches were increasingly being seen as requiring a new conceptualization for health promotion.Al so the time was opportune for a more health promotion statement. The Ottawa Charter managed to integrate many of the different 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 based on the belief that health requires peace, shelter, education, food, income, a steadfast ecosystem, social justice and equity as prerequisites. 4 Box 3. 1 The Ottawa Charter for Health Promotion, 1986 The Development of robust 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 guard legislation, progressive taxation, welfare, occupational health and safety legislation and enforcement, land rights legislation and control of the sale and dissemination of substan ces such as alcohol and tobacco. Health becomes, therefore, a concern and responsibility of each sector of government. The being 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 shape peoples experiences of health. Strengthening community action refers to those activities that increase the ability of communities to achieve 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 change people to make healthy choices. It also extends the skills base for health to those associated with community organisation, lobbying and advocacy, and the ability to analyse individual problems within a structural framework. Reorientation of health services is a call for he alth systems to shift their emphasis from (in most industrialised countries) an almost total concentration on hospital-based care and extensive technical 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 pursuit of health Source Baume, F (1988) The new public health an Australian perspective Following in the spirit of the Ottawa Charter, in 1986 the Better Health focal point (BHC), a group established by the then Commonwealth Minister for Health, Neal Blewett, published Looking in front to Better Health. Its brief was to recommend ways in which health in Australia might be promoted, oddly though ways that were 5 nconventional for the medical and public health professions. It was part of Australias response to the globe 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 injury. In making these choices the Commission was concerned to identify not only big problems, but also problems potentially amenable 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 must involve industry, transport, law enforceme nt 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 National Better Health curriculum 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 many social and health movements of the previous 120 or so years. Its claims to be new derives from how it pulled together many and diverse movements to present a package which gave public health a more radical and cohesive direction tha n had been the case for some time.Today, public health is alive and well and confronting in this country the challenges that it can assist ameliorate. We are an astonishingly healthy nation on average. We have the second longest healthy life expectancy of all nations, a fraction behind Japan. But within our country we have communities including those of some of our Indigenous people where these privileged are far from being available. It is here that a junto 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 fresh 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 Welfare 3. Baume, F (1998) The new public health an Australian perspective Publisher Oxford University Press 4. Leeder S R (1999) Healthy Medicine, Challenges facing Australias health serv ices Publisher Allen & Unwin 7