Population Health Curriculum for Health Professionals

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Individual
Molecular
Society
Family
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Measurements of disease factors influencing health
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Objectives

• To understand the importance of parameters
  measuring healthy conditions social, cultural
  and economical.
• You students should also be capable to understand
  the role of human genetics, food and nutrition,
  infectious agents, environment and education in
  health status.

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What is Health?
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Individual
Molecular
Society
Family
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Health is a state of complete Physical, Mental,
and Social well-being and not merely the absence
of disease or infirmity. WHO, 1948
The Metaphysical Context of the Universe
Physical
Mental
Social
The Secular Dimensions of Health
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Two Major Aspects ofHealth

• Feeling Well
• Ability to Function

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Determinants of Health

• the complex inter-relationships of
• genetics
• social environment
• physical environment
• behavior
• health/illness services
• that determine the level of health and sense of
  well-being in an individual

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Genetics

• Body Size
• Special Abilities
• Disease Resistance
• Disease Susceptibility
• Genetic Diseases
• General Robustness

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Physical Environment

• Macro-environment
• Food and Water
• Air Pollution
• Micro-environment
• Home
• Workplace

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Social Environment

• Religion
• Race/Gender
• Socioeconomic Status
• Education
• Occupation
• Family Composition

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Socioeconomic Status, Income and Health

• Socioeconomic Status
• As GDP increases, the health of a nation
  increases
• In times of economic hardship, the incidence of
  disease increases

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Health Care

• Quality
• Availability
• Health has improved NOT because of steps taken
  while we are ill, but because we are ill less
  often.

Thomas McKeown, 1978
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Primary Prevention

• Measures taken to prevent the disease from
  occurring such as
• healthy lifestyle habits
• Immunizations

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Secondary Prevention

• Measures undertaken to facilitate early detection
• Screenings
• Diagnostic tests

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Tertiary Prevention

• Measures to minimize complications or
  exacerbation of injury or disease.
• Rehabilitation Therapy
• Patient counseling

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Rising Life Expectancy
Source United Nations (U.N.) Population
Division, Demographic Indicators, 1950-2050 (The
1996 Revision) (U.N., New York, 1996).
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Prevention and Religion

• Washing Hands
• Hands should be washed when one touches something
  polluted or unclean likewise, before or after
  eating.
• The Prophet, Peace Be Upon Him, said Whoever
  sleeps and his hands are not clean from fat and
  thereby gets harmed should blame no one but
  himself
• The Prophet, Peace Be Upon Him, used to wash his
  hands before eating

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Historical Examples of Global Prevention
Activities
Model for acute infectious agents
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Death rate for Tuberculosis, 1860-1960, United
States, Source US Bureau of the Census,
Historical Statistics of the United States
Colonial Times to 1970 (Washington, D.C
Government Printing Office, 1975), Part 1
pp58,63.  Note Data between 1860 and 1900 for
Massachusetts only.
Koch identified tubercle bacillus
Streptomycin introduced
Vaccination available
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The Sanitary Revolution and the Ascendancy of
Public Health

• The sanitary revolution produced the greatest
  transformation in the pattern of disease that the
  world had known since nomadic hunter-gatherers
  settled in permanent villages, and ultimately
  developed modern urban industrial communities

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Death Rates for Measles in Children Under Age 15,
England and Wales, 1850-1970
Source Thomas McKeown, The Modern Rise of
Population (Academic Press, San Francisco, 1976),
pp. 93, 96.
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Epidemiologic Transition, MexicoDecline in
Communicable, Rise of NCDs
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Example of successful prevention program in
Cuba VACCINATION PROGRAM RESULT
POLIO ELIMINATED SINCE
1962 DIPHTHERIA ELIMINATED SINCE 1969 NEWBORN
TETANUS ELIMINATED SINCE 1972 CONGENITAL
RUBELLA ELIMINATED SINCE 1989 MENINGITIS POST
MUMPS ELIMINATED SINCE 1989 MEASLES
ELIMINATED SINCE 1993 WHOOPING COUGH
TRANSMISSION INTERRUPTED SINCE 1994 RUBELLA
TRANSMISSION INTERRUPTED SINCE
1995 MUMPS TRANSMISSION
INTERRUPTED SINCE 1995 MORBIDITY MENINGOCOCCICA
L DISEASE REDUCTION 93 TYPHOID
FEVER REDUCTION 75 B
HEPATITIS REDUCTION 52
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Introduction

• Cervical cancer is the 2nd most common cancer
  among women globally
• Higher cervical cancer mortality in developing
  countries due to lack of effective screening
  programs

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Estimated impact of AIDS on under-5 child
mortality rates Selected African countries, 2010
Source US Bureau of the Census
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Death Rates for Coronary Heart Disease by Country
Men Ages 35-74, 1970 and 1993 (Rate/100,000)
750
FIN
USA
AUST
SCOT
NZ
CAN
500
SING
USSR
250
ITY
SPN
FRAN
JPN
HK
CHN
0
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Lifestyle Factors
Genes load the gun.Lifestyle pulls the trigger
Dr. Elliot Joslin
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What is the future of prevention?

• Globalization of Prevention
• Networking of people in prevention
• Sharing of data, knowledge and wisdom

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Objectives

• To understand the importance of parameters
  measuring healthy conditions social, cultural
  and economical.
• You students should also be capable to understand
  the role of human genetics, food and nutrition,
  infectious agents, environment and education in
  health status.