International Public Health
HC1: Introduc.on
History of public health
1750-1850
• Industrial Revolu0on: bad working condi4ons and environmental pollu4on
• Urbaniza0on: unhygienic living condi4ons in ci4es
• Epidemics: infec4ous diseases (cholera, smallpox, TB, etc.) à high infant mortality
• Start formal public health policy: improvement of water supply, sanita4on, sewerage
1850-1900
• First interna4onal mee4ng on public health problems (1851): coopera4on
• Increase in knowledge about infec4ous diseases (cause, transmission)
• Insight into possible interven4on strategies: start targeted programs
1900-1945
• Decrease in (child) mortality
• An4bio4cs and medica4ons
• Start of academic training in health sciences
• First interna4onal organiza4on: Health Organiza0on of the League of Na0ons
(Geneva, 1920)
• Crea4on of charity organiza4ons (Rockefeller Founda4on)
1945-1980
• Establishment of the UN (WHO and UNICEF as public mandate)
• Interven4on strategies:
o Family planning
o Infec4ous diseases:
§ 1974: EPI (Expanded Program on Immuniza0on)
§ 1966-1980: Smallpox eradica4on
• PHC (Primary Health Care): Alma Ata Conference (1978)
• Research programs on emerging diseases
1980-1990
• The World Bank and IMF (UN organiza4ons) become important
• Economic crisis àhealth reforms
• Increasing role of NGO’s (non-governmental organiza0ons) in health services
• Focus on non-communicable diseases
• UNICEF’s campaign for child survival: GOBI FFF
o Growth monitoring, Oral rehydra4on, Breas]eeding, Immuniza4on
o Sexual health (Female) educa4on, Family spacing, Food supplements
• HIV/AIDS epidemic and establishment UNAIDS
,1990-2010
• Focus on cost-effec0veness
• PPP (Public/private partnership)
• A`en4on to CBPR (Community-Based Par0cipatory Research) and Transdisciplinarity
• More a`en4on to other health issues: chronic diseases, gun violence, injuries, etc.
2010-now
• Pandemic Preparedness
• Universal Health Coverage (UHC)
• Mental health, global surgery, etc.
Global health
Global health = “Health is influenced by social/structural forces; addressing roots of illness
(poverty, inequality, environmental degrada>on) requires social change.”
- Health problems that transcend na4onal boundaries: coopera4ve ac4ons necessary
- Focused on improving the health of en4re popula4on
- Specific a`en4on to social jus0ce (low/middle-income countries: high
morbidity/mortality, health system func4ons fragile)
- Focused on delivering health services that are: Accessible, Affordable, Appropriate,
Acceptable and with Good Quality.
Sustainable Development Goals
,Transdisciplinary Global Health
- Acknowledges complexity of health issues (climate change, pandemics, etc.)
- Transdisciplinarity = engagement of mul4ple stakeholders to address complex
societal challenges.
Key concepts:
• Power imbalance: ‘Global North’ and ‘Global South’
• Knowledge co-crea0on: Who’s knowledge is considered valid?
• Subjec0ve illness experiences: Whose experiences are considered valuable?
• Health inequity and social jus4ce: Who is deserving of care?
• Health systems: Why do health infrastructures vary within and between countries?
• Global poli0cs: How is popula>on health affected by fluctua>ng poli>cal climates?
, HC 2: Social Determinants of Health
Determinants
Causality results from the interplay of several factors (determinants)
- Determinant = influence, factor, (poten4al) cause
Progress
Determinants of health:
• Physical environment
• Medical care
• Gene4cs and biology
• Social circumstances (24%)
• Individual behaviour
à Determinants (= a pa`ern of interac4on between system elements) affect the health
outcome, and the impact depends on the societal system.
Social Determinants of Health
Social Determinants of Health (SDOH) = condi4ons in which people born, grow, work, age
- Shaped by distribu4on of money, power, resources at global, na4onal and local levels.
à “Societal systems, their components, and the social resources and hazards for health that
societal systems control and distribute, allocate and withhold, such that the demographic
distribu>on or trend of health outcomes is changed” (Hahn, 2021)
A lot of things are social determinants (age, previous infec4on, rank, etc.)
- Not symbol systems (alphabet) or geographic varia4on in soil composi4on
Social Gradient
Social gradient = phenomenon whereby people who are less advantaged in terms of SEP
have worse health (and shorter lives).
a) Thresholds for na4onal income per capita à low, middle or high-income country
HC1: Introduc.on
History of public health
1750-1850
• Industrial Revolu0on: bad working condi4ons and environmental pollu4on
• Urbaniza0on: unhygienic living condi4ons in ci4es
• Epidemics: infec4ous diseases (cholera, smallpox, TB, etc.) à high infant mortality
• Start formal public health policy: improvement of water supply, sanita4on, sewerage
1850-1900
• First interna4onal mee4ng on public health problems (1851): coopera4on
• Increase in knowledge about infec4ous diseases (cause, transmission)
• Insight into possible interven4on strategies: start targeted programs
1900-1945
• Decrease in (child) mortality
• An4bio4cs and medica4ons
• Start of academic training in health sciences
• First interna4onal organiza4on: Health Organiza0on of the League of Na0ons
(Geneva, 1920)
• Crea4on of charity organiza4ons (Rockefeller Founda4on)
1945-1980
• Establishment of the UN (WHO and UNICEF as public mandate)
• Interven4on strategies:
o Family planning
o Infec4ous diseases:
§ 1974: EPI (Expanded Program on Immuniza0on)
§ 1966-1980: Smallpox eradica4on
• PHC (Primary Health Care): Alma Ata Conference (1978)
• Research programs on emerging diseases
1980-1990
• The World Bank and IMF (UN organiza4ons) become important
• Economic crisis àhealth reforms
• Increasing role of NGO’s (non-governmental organiza0ons) in health services
• Focus on non-communicable diseases
• UNICEF’s campaign for child survival: GOBI FFF
o Growth monitoring, Oral rehydra4on, Breas]eeding, Immuniza4on
o Sexual health (Female) educa4on, Family spacing, Food supplements
• HIV/AIDS epidemic and establishment UNAIDS
,1990-2010
• Focus on cost-effec0veness
• PPP (Public/private partnership)
• A`en4on to CBPR (Community-Based Par0cipatory Research) and Transdisciplinarity
• More a`en4on to other health issues: chronic diseases, gun violence, injuries, etc.
2010-now
• Pandemic Preparedness
• Universal Health Coverage (UHC)
• Mental health, global surgery, etc.
Global health
Global health = “Health is influenced by social/structural forces; addressing roots of illness
(poverty, inequality, environmental degrada>on) requires social change.”
- Health problems that transcend na4onal boundaries: coopera4ve ac4ons necessary
- Focused on improving the health of en4re popula4on
- Specific a`en4on to social jus0ce (low/middle-income countries: high
morbidity/mortality, health system func4ons fragile)
- Focused on delivering health services that are: Accessible, Affordable, Appropriate,
Acceptable and with Good Quality.
Sustainable Development Goals
,Transdisciplinary Global Health
- Acknowledges complexity of health issues (climate change, pandemics, etc.)
- Transdisciplinarity = engagement of mul4ple stakeholders to address complex
societal challenges.
Key concepts:
• Power imbalance: ‘Global North’ and ‘Global South’
• Knowledge co-crea0on: Who’s knowledge is considered valid?
• Subjec0ve illness experiences: Whose experiences are considered valuable?
• Health inequity and social jus4ce: Who is deserving of care?
• Health systems: Why do health infrastructures vary within and between countries?
• Global poli0cs: How is popula>on health affected by fluctua>ng poli>cal climates?
, HC 2: Social Determinants of Health
Determinants
Causality results from the interplay of several factors (determinants)
- Determinant = influence, factor, (poten4al) cause
Progress
Determinants of health:
• Physical environment
• Medical care
• Gene4cs and biology
• Social circumstances (24%)
• Individual behaviour
à Determinants (= a pa`ern of interac4on between system elements) affect the health
outcome, and the impact depends on the societal system.
Social Determinants of Health
Social Determinants of Health (SDOH) = condi4ons in which people born, grow, work, age
- Shaped by distribu4on of money, power, resources at global, na4onal and local levels.
à “Societal systems, their components, and the social resources and hazards for health that
societal systems control and distribute, allocate and withhold, such that the demographic
distribu>on or trend of health outcomes is changed” (Hahn, 2021)
A lot of things are social determinants (age, previous infec4on, rank, etc.)
- Not symbol systems (alphabet) or geographic varia4on in soil composi4on
Social Gradient
Social gradient = phenomenon whereby people who are less advantaged in terms of SEP
have worse health (and shorter lives).
a) Thresholds for na4onal income per capita à low, middle or high-income country
