An introduction to public health reporting

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An introduction to public health reporting

• Thomas Abraham
• JMSC 0054

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What we are going to do over the next four classes

• Today An introduction to public health
• April 1 Public health issues in Hong Kong
• April 8 Reporting public health in Hong Kong-
  sources and stories
• April 11 Avian and pandemic influenza- should we
  be worried ?

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What is public health?

• Public health is concerned with the health of
  communities and societies
• Clinical medicine on the other hand focuses on
  disease in individual patients
• Public health studies ways to improve community
  health through disease prevention
• Public health interventions to improve community
  health include improving sanitation, promoting
  healthier lifestyles, vaccinations etc.

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Some definitions of public health

• The science and art of preventing disease,
  prolonging life and promoting health through the
  organised efforts of society Sir Donald Acheson
• What we as a society do collectively to assure
  the conditions in which people can be healthy
  Institute of Medicine.

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Which of these headlines is about public health,
and which is not?

• Scientists discover new drug to lower
  cholesterol
• Government unveils new measures to reduce road
  side pollution
• New surgical treatment increases success rate of
  liver transplants
• Vietnam announces fresh outbreak of bird flu
• Outbreak of diarrhoea forces kindergarten
  closure

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Why is public health reporting important?

• It deals with issues that are crucial to our
  lives and the lives of our readers- life, death,
  sickness and health
• Public money is used to fund the system, and
  public health officials are accountable to the
  public. The press has a role to monitor their
  performance

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Epidemiology a foundation for the practice of
public health

• Epidemiology
• Epi upon
• Demos people
• LogosStudy, word
• BMJ definition Epidemiology is the study of how
  often diseases occur in different groups of
  people and why.

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John Snow ( 1813-1858) the father of modern
epidemiology
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Cholera

• From around 1830, Britain and Europe were struck
  by several waves of cholera, causing hundreds of
  thousands of deaths
• In those days, doctors believed that cholera was
  caused by miasma or poisonous gases from sewers
  and swamps.
• Snow was not convinced- why did coal miners who
  worked far from sewers get cholera? Also, the
  first symptoms were always digestive- so he
  thought it must be to do with food or water

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• Snow became convinced the water supply was
  responsible
• He began a systematic study He knew that all
  residences in London were supplied by one of two
  water companies.
• Company A drew its water from a section of the
  Thames river polluted with sewage
• Company B drew its water from a section of the
  river that was farther away from the city and
  less polluted

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• Snow went to each house and where there had been
  a death and asked which company they got their
  water from
• He found that 38 of 44 cases were got their water
  from Company A
• He expanded his study to 334 cases, and found
  that 286 had their water from company A
• Snow thought he had very strong evidence of the
  influence that which drinking water containing
  sewage has on the spread of cholera

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• Snows critics were not impressed-there was no
  evidence of any kind of infectious agent in the
  water
• Snows technique- collecting data on the
  incidence and distribution of a disease to
  determine probable cause, is a basis of modern
  epidemiology

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Snows vindication
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The Broad Street pump

• In August 1853, a sudden outbreak of Cholera on
  Broad Street, close to Snows home in London.
• He noticed that most of the fatalities were close
  to a public water pump on the street.
• He got a list of all the victims, and calculated
  the distance from their houses to the pump
• 73 of 83 deaths were in homes closer to the Broad
  Street pump than any other pump.
• Of the 10 remaining, 8 had drunk at the pump-
  some were children who used to drink at the pump
  on the way to school

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• Persuaded health authorities to remove the handle
  from the pump so it could not be used- cases of
  cholera decreased.
• Importantly- also established that those living
  close by who had a separate source of water did
  not fall ill.

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Logical principles behind epidemiology that Snow
demonstrated

• Cause of a disease will lead to higher rates of
  illness among those exposed to the cause, then
  those not exposed
• Cause can be found by analysing patterns of
  occurrence of the disease in a population

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The challenges and rewards of public health
reporting

• Epidemiology, and public health, is based on a
  rigorous analysis of problems in order to find
  their probable cause, and then to intervene to
  remove the cause
• It is important to understand this logic in order
  to be able to report it
• The rewards intellectually satisfying to be able
  to understand and communicate to the public

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Global public health

• Touches on some of the most crucial issues in
  global society today
• HIV/AIDS. 40 million people are infected by HIV
  globally.
• 2.8 million die every year.
• 5 million people a year are infected
• By 2010, there could be 20 million AIDS orphans

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Other global infectious diseases

• Tuberculosis 9.2 million new cases reported in
  2006- 1.7 million deaths
• More than 1 million people a year die of malaria,
  mostly infants, young children and pregnant women
  in Africa
• A child dies of malaria every 30 seconds
  according to the WHO

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Some homework before the next class

• Wikipedia has a good entry on public health which
  you need to read http//en.wikipedia.org/wiki/Pub
  lic_health
• Visit the website of the Centre for Health
  Protection in Hong Kong http//sc.info.gov.hk/gb/w
  ww.chp.gov.hk .
• Look at the statistics section, and get an idea
  of what the major communicable diseases are in
  Hong Kong, average life expectancy, major causes
  of death etc.

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• Visit the website of the World Health
  Organziation ( www.who.org) and the Bill and
  Melinda Gates Foundation (http//www.gatesfoundat
  ion.org/default.htm)
• and look at the section on Global Health to get
  an idea of major global health issues.