Overview of public health for medical school.

1. Introduction to
Public Health Topics
Christiane Riedinger, June 2014

2. What is Public Health
Public Health is the science of promoting health, preventing disease
and premature death of a population by systematic efforts of society,
communities or individuals, usually in the presence of limited financial
resources. It covers three key areas (but overlapping):
● Health protection - protection against infectious diseases and
environmental threats
● Health improvement - target individual behaviour or promote health
by education, legislation
● Health-care services - provide, analyse and improve/optimise
health-care services

3. Classification of Public Health Topics
1. SCIENTIFIC TOOLS used in public health
2. Common ANALYSES carried out in public health
3. EXECUTIVE SKILLS required in public health
4. THE PRACTICE of public health
5. SPECIFIC APPLICATIONS of public health

4. 1. Scientific Tools in PH
● Statistics
Analysis of large quantities of data to infer trends.
● Demography (Chapter 2 of PH book)
Analysis of size, structure and distribution of populations.
● Epidemiology (Chapter 3 of PH book)
Analysis of factors that determine or describe health and disease, such as incidence and
distribution, risk factors, as well as control of disease.
● Evidence-based approach (Chapter 5 of PH book)
Evidence-based practice is the conscientious, explicit and judicious use of current best
evidence to inform decisions and procedures. It consists of integrating individual expertise
with the best available external evidence from systematic research in order to improve
outcome.

5. 2. Common Analyses in PH
● Health status of a population (Chapter 4 of PH book)
A survey/study of a population’s health carried out by creating a health
profile, i.e. statistically analysing mortality, morbidity and the factors affecting
health and disease in the population of interest, including inequalities.
● Health needs assessment (Chapter 5 of PH book)
Health needs assessment is a systematic analysis of the health issues facing
a population leading to agreed priorities and resource allocation that will
improve health and reduce inequalities. Action is taken where measures have
a high/the highest impact, where changes are acceptable and can be
integrated into current practice, and are feasible in terms of resource
implications.

6. 3. Executive Skills in PH
● Management (Chapter 1 of PH book)
Developing and implementing public health measures requires
management and leadership skills, as does individual clinical practice.
Managing health-care services mainly consists of managing change.
● Decision making / Prioritisation (Chapter 7 of PH book)
Due to limited resources, one has to decide which public health
measures or clinical practices should be prioritised. This requires
identification of the health needs, analysis of the effectiveness of existing
services, economical evaluation, and ongoing assessment of the success
of any decision implementation as a basis for future improvements.

7. 4. Practice of PH
● Health improvement (Chapter 8) Carried out by directors of PH in PCTs, +nat. programs*
Health improvement comprises preventative measures and strategies for health promotion with the goal of
improving population health, at an individual or population level. Prevention is facilitated by targeting
individual behaviour in order to avoid contraction or manifestation of a disease or limit its outcome. Health
promotion targets the entire population through education, legislation, community development and sound
public policy regarding the prerequisites of health.
● Health protection (Chapter 10) Carried out by National Health Protection Agency
Health protection entails the disciplines and services that protect members of the society from infectious
diseases or environmental threats to their health, such as radiation, chemicals, contamination of resources,
dangers at the workplace, industrial accidents, natural disasters and terrorist acts. It aims to control threats
by developing national, local or individual policies for vaccinations, isolation procedures or emergency
protocols and carries out surveillance of health threats, in order to allow rapid response in case of an
outbreak.

8. 4. Practice of PH ctnd.
● Screening (Chapter 9)
Screening is systematic testing of a defined population/sub-group for risk factors or signs of an illness in
its pre-symptomatic, symptomatic or established stage, with the aim of prevention or a reduction in
morbidity and/or mortality. Action will be taken regarding those individuals who are more likely to be
helped than harmed by further investigations or treatment.
● Improving Quality of Care (Chapter 11) Carried out by directors of PH in PCTs, +nat. programs
Quality is the degree to which health services for individuals and populations increase the
likelihood of desired health outcomes and are consistent with current professional knowledge. Quality is
then evaluated according to criteria (e.g. Donbedian’s criteria of evaluation), in order to detect problems,
which can be tackled with tools of regulation, dissemination of best practice, market incentives or system-
type approaches.
● Health Policy (Chapter 16)
PH policy relates to the decision of governments mainly with regards to health-care but increasingly also
other public health domains. It is less evidence-based and depends on the political context and cultural
values within a society. PH officers/directors are based in primary care trusts and at the Health Protection
Agency but may soon be placed in local governments and a generalised Public Health Authority.

9. 5. Challenges of PH
● Children’s Health
● Women’s Health
● Adults Health
● Health of the Ageing Population
● Inequalities
● International Development
● Sustainable Development