College aantekeningen Internationale Volksgezondheid (AB_470088)

International Public Health

Lecture 1
- Explain what the scope is of international public health as a field of study and practice
o Issues transcending borders
o Scientific enquiry based on data
o Focus on equality/ social justice
o Focus on dignity
o Focus on cosmopolitanism
o Emphasis on regions with high burden of disease and weak health systems
o Analysis of phenomena like globalization/urbanization/migrations
o Highly interdisciplinary
- Explain the historical evolution of international public health and discuss the importance of
international public health
o Public health science and art of preventing disease, prolonging life and promoting
health through the organized efforts of society
o History of (international) public health
 Before 19th century
 Hippocrates link environment and disease
 Quarantine for deadly infectious diseases
 Hospitals religious charity
 Colonial expansion spreading diseases
 Beginning 18th/19th century
 French Revolution right to health
 Industrial revolution wealth
o State responsible for population health measures and health
care services
 After 19th century
 1851 First international public health meeting
 Control of some infectious diseases cholera/plague/yellow fever
 Scientific developments on communicable diseases
 Better hygiene/sanitation control of epidemics
 Vaccination and antibiotics
o Biomedical paradigm dominates
o Focus on health care> health
th
 20 century
 1910-1945
o Reduction child mortality
o Schools of public health established
 1945-1990
o UN agencies/World Bank created
o Eradication of smallpox
o Universal childhood immunization
o HIV/AIDS
 1980s-2000
o Health promotion (unlike biomedical paradigm)
o Health > product of health services
 Prerequisites for health recognized (education etc)
o Importance of international public health
 Gain better understanding of the progress that is made so far
 Better understand the challenges that remain and learn how to address them
rapidly/effectively/efficiently/fairly



1

, - Explain in general foundational concepts and notions of international public health such as the
WHO definition of health, the difference between communicable and non-communicable
diseases, the concept of global burden of disease, social determinants of health, Millennium
Development Goals and Sustainable Development Goals
o WHO definition of health
 “Health is a state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity
o Communicable diseases transmittable
 Social/Economic impact
o NCDs long latency degenerative/complex/lifestyle diseases
 4 main NCDs Cardiovascular/diabetes/chronic respiratory/cancer
 + mental health
o Global burden of disease describe combination of morbidity/disability/mortality
measures in DALYs
o Social determinants of health conditions in which people are born/grow/live/work/age
o Millennium Development Goals & Sustainable Development Goals

Lecture 2
- List the different determinants of health and explaining their interconnectedness and their
impact on the health of individuals and populations
o Individual genetic make-up/sex/age
o Physical environment water/sanitation/air
pollution
o Employment/working conditions
o Access to health services
o Healthy behavior and coping
o Healthy child development
o Social environment
o Social determinants of health increased
attention (rainbow model)
 Conditions in which people are born,
grow, live and age and the wider set
of forces and systems shaping the conditions of daily life
 Include economic policies and systems, development agendas, social
norms, social policies and political systems
 Causes avoidable/remediable differences within and between countries
1. Personal & inborn factors
a. Genetic make-up inheric genetic markers et
b. Sex physical differences
c. Age at different ages vulnerable to different diseases
2. Individual lifestyle factors people’s own practices/behaviors
3. Social network social support/community/culture
4. Living & working conditions housing/access to safe water/nutrition/health services
5. Socioeconomic factors
a. Culture
i. shapes how one feels about illness/health
ii. Gender roles
b. Education
i. Brings knowledge of good health practices
ii. Provides opportunities for gaining skills etc enhancing social
status
c. SES
d. Environment (indoors/outdoors)
i. Safety of the environment

2

, - Explain and apply main health status indicators such as incidence, prevalence, mortality, case-
fatality ratio, morbidity and life expectancy
o Incidence (per 1000 or 100,000)
 New cases of the disease
o Prevalence (per 1000 or 100,000)
 Existing cases of the disease
o Mortality (per 1000 or 100,000)
 Number of deaths
 Different mortality rates neonatal/infant/child/maternal mortality ratio
o Case-fatality ratio (percentage)
 Proportion of those with a disease who die because of it
 Number of deaths from disease D/total population with D x 100
o Morbidity
 Disability that a person suffers as a consequence of the disease
 Who/how long/how severe
o Life expectancy
 Average from birth to death
- Explain various tools of analysis and measurement relating to global burden of disease and in
particular on HALE and DALYs
o HALE health adjusted life expectancy
 Years that will be lived in good health
o DALY disability adjusted life year
 Years lost due to premature death and years lived with disability
 Also modified by discounting and age weighting
- Discuss general trends impacting the health of individuals and populations such as population
growth, aging, urbanization
o Mortality/life expectancy
 Increased
 Child mortality decreased
o Causes of death
 Infectious diseases decreased
 Reduction in NCDs has stalled/reversed
o Disability
 Increased
 Mostly NCDs
o Health life expectancy and early death and disability
 Disparities by sex and level of development
o Risk factors
 More lifestyle related high blood pressure/smoking/high blood sugar
o Urbanization
o Population growth

Lecture 3
- Discuss the dynamic of poverty and explain the various definitions of the phenomenon and the
different parameters to measure it
o UNDP definition of poverty
 Deprived of income and other resources needed to obtain the conditions of life,
that enable them to play the roles, meet the obligations and participate in the
relationships and customs of their society
o Hard to measure contextual
o Levels of poverty
 Absolute



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