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Public health
Introduction to
public health and
preventive medicine
 Story of life expectancy
 Mortality Rate
CIA World Factbook 2007 Estimates for
Life Expectancy at birth (years).
按联合国会员排名
按国家或地区排
名
国家或地区
总预期寿
命
男性预期寿
命
女性预期寿
命
1
澳門特別行政區
84.33
81.36
87.45
1
2
安道爾
82.67
80.35
85.14
2
3
日本
82.07
78.73
85.59
3
4
新加坡
81.89
79.29
84.68
3
5
聖馬利諾
81.88
78.43
85.64
6
香港
81.77
79.07
84.69
7
吉布拉塔(英國)
80.9
78.5
83.3
5
8
瑞典
80.63
78.39
83
6
9
澳洲
80.62
77.8
83.59
7
10
瑞士
80.62
77.75
83.63
8
11
法國
80.59
77.35
84
12
根西島(英國)
80.53
77.53
83.64
9
13
冰島
80.43
78.33
82.62
10
14
加拿大
80.34
76.98
83.86
76
103
土耳其
72.88
70.43
75.46
76
103
中國 (mainland)
72.88
71.13
74.82
79
106
馬來西亞
72.76
70.05
75.65
80
114
巴西
72.70
69.0
76.50
81
107
聖克里斯多福及尼維斯
72.66
69.81
75.69
82
108
保加利亞
72.57
68.95
76.4
83
109
泰國
72.55
70.24
74.98
84
110
安地卡及巴布達
72.42
70.03
74.94
85
111
塞席爾
72.34
66.98
77.86
86
112
愛沙尼亞
72.3
66.87
78.07
87
113
哥倫比亞
72.27
68.44
76.24
173
203
索馬里
48.84
47.06
50.69
174
204
奈及利亞
47.44
46.83
48.07
175
205
查德
47.2
46.17
48.27
176
206
幾內亞比索
47.18
45.37
49.04
177
207
尼日
44.03
44.05
44
178
208
阿富汗
43.77
43.6
43.96
179
209
中非
43.74
43.69
43.79
180
210
吉布地
43.25
41.88
44.65
181
211
納米比亞
43.11
44.39
41.79
182
212
馬拉威
42.98
43.35
42.61
183
213
南非
42.45
43.21
41.66
184
214
莫三比克
40.9
41.4
40.4
185
215
獅子山
40.58
38.36
42.87
186
216
賴比瑞亞
40.39
38.93
41.89
187
217
賴索托
39.97
40.73
39.18
188
218
辛巴威
39.5
40.62
38.35
189
219
尚比亞
38.44
38.34
38.54
190
220
安哥拉
37.63
36.73
38.57
191
221
史瓦濟蘭
32.23
31.84
32.62
Major Reasons for Increased Longevity
 Improved sanitation
 Provision of clean water
 Universal immunization programs
 Health education and prevention practices
 Improved treatment of chronic diseases (for recent advances)
 Healthy life expectancy
 Disability Adjusted Life Expectancy
How it is caculated?










Morbidity and Mortality of commen diseases
Living habits
Social Violence
Dietary pattern
Substance abuse(drug,alcohol)
Medical facilities
Environment
Climate
And
How many year been disability in average
(subtract this number from life expectancy)
WHO 会员国主要国家健康预期寿命
( 1999 年)
排名
国
家
( 歲 ) 健康预期寿命 ( 岁
)
1
日本
74.5
2
澳洲
73.2
3
法国
73.1
4
瑞典
73.0
5
西班牙
72.8
6
意大利
72.7
7
希腊
72.5
7
瑞士
72.5
9
摩纳哥
72.4
10
安道尔侯国
72.3
10
圣玛利诺
72.3
12
加拿大
72.0
12
荷兰
72.0
14
英国
71.7
14
挪威
71.7
16
比利时
71.6
16
澳地利
71.6
18
卢森堡
71.1
19
冰岛
70.8
20
芬兰
70.5
20
马尔他
70.5
22
德国
70.4
22
以色列
70.4
24
美国
70.0
25
塞浦路斯
69.8
26
多明尼加
69.8
27
爱尔兰
69.6
28
丹麦
69.4
29
葡萄牙
69.3
29
新加坡
69.3
31
纽西兰
69.2
32
智利
68.6
33
古巴
68.4
33
斯洛法尼亚
68.4
35
捷克
68.0
36
牙买加
67.3
37
乌拉圭
67.0
37
克罗埃西亚
67.0
39
阿根廷
66.7
40
哥斯大黎加
66.7
.
.
.
.
.
.
81
中国大陆
62.3
.
.
.
.
.
.
.
.
.
186
乌干达
32.7
187
波札纳
32.3
188
尚比亚
30.3
189
马拉威
29.4
190
尼日
29.1
191
狮子山
25.9
Sources: UN Healthy
Life Expectancy
Ratings
J.P.Bunker’ s report
(1994 published)
 Life expentancy from 45-75 years
 Medical care contributes to only five years
 Improvement of public health contributes to the rest
Spending in 1992
 Average medical care cost for each person: $3007
 Public health spending for each person: $34
 Distribution of national health dollars on public
health:
 About 1%
Spending in 2001
 Total national health
expenditures:
 $1,424.5 billion
 Public health activities:
 $46.4 billion
 Distribution of national health dollars:
 86.8% to personal health services/supplies
 3.3% to government PH activities
Requirements for survival
 1.air
 2.water
 3.food
 4.shelter
 5.care
Health
 The United Nations' World Health Organization
defines health as
 "a state of complete physical, mental and social well-
being and not merely the absence of disease or
infirmity."
What is Public health?
In 1920, C.E.A. Winslow defined public health as
"the science and art of preventing disease, prolonging
life
and
promoting
health
through
the
organized
efforts and informed choices of society, organizations,
public and private, communities and individuals."
The history of public health
 Public health is an old concept, dating back to when
people first began living in communities. Through the
ages, governments have shown varying degrees of
concern for the public health.
 The ancients Greeks, and the Romans after them,
tried to ensure the health of their citizens by

providing a supply of clean water (via aqueducts
and pipelines),

managing the disposal of waste

working to control disease by hiring public
physicians to treat the sick.
 During the late 1800s European governments
began turning their attention to matters of
public health in an effort to control the spread
of disease. (Because Epidemics of leprosy, the
plague, cholera, and yellow fever).
 In the United States, the public health became
an official concern when in 1866 a cholera
epidemic struck the nation-for the eighteenth
consecutive year
What is Public health?
"the
science
and
art
of
preventing
disease,
prolonging life and promoting health through the
organized efforts and informed choices of society,
organizations, public and private, communities and
individuals."
 The 'science' is concerned with making a diagnosis
of a population's health problems, establishing their
cause, and determining effective interventions.
 The 'art' is to address these problems creatively.
 This definition underscores the broad scope of
public health and the fact that public health is the
result of society’s efforts as a whole, rather than
that of single individuals.
 In 2003, Detels defined the goal of public
health as:
The biologic, physical, and mental well-being of
all members of society regardless of gender,
wealth, ethnicity, sexual orientation, country, or
political views.
(This definition or goal emphasizes equity and the range of
public health interests as encompassing not just the physical
and biologic, but also the mental well-being of society.)
 Both WHO and Detels’ goals depict public health as
being concerned with more than merely the elimination
of disease.
 To achieve the WHO goal of ‘health for all’, it is
essential to bring many diverse disciplines to obtain the
optimal health （physical, biologic, and social sciences）
.
 The field of public health has adapted and applied
these disciplines for the elimination and control of
disease, and the promotion of health.
1988
<the future of public health>
 Mission:
 Substance:
 Organizational framework:
 Core functions:
mission
 The fulfillment fo society’s interest in assuring
the conditions in which people can be healthy
Substance
 Organized community efforts aimed at the
prevention of disease and the promotion of
health
Organizational framework
 Bothe activities undertaken within the formal
structure of government and the associated
efforts of private and voluntary organizations
and individuals
Core functions
 Assessment
 Policy development
 Assurance
 Monitor Health Status to Identify and Solve
Community Health Problems
 Diagnose and Investigate Health Problems and
Health Hazards in the Community
 Inform, Educate and Empower People About
Health Issues
 Mobilize Community Partnerships to Identify
and Solve Health Problems
 Develop Policies and Plans That Support
Individual and Community Health Efforts

Enforce Laws and Regulations That Protect
Health and Ensure Safety

Link People to Needed Personal Health
Services and Assure Health Care When
Otherwise Unavailable

Assure a Competent Public Health and Personal
Health Care Workforce

Evaluate Effectiveness, Accessibility, and
Quality of Personal and Population- Based
Health Services

Research for New Insights and Innovative
Solutions to Health Problems
5 steps process
 1. Define the health problem
 2. Identify the risk factors associated with the problem
 3. Develop and test community-level interventions to control or
prevent the cause of the problem
 4. Implement interventions to improve the health of the
population
 5. Monitor those interventions to assess their effectiveness
The science of Public health
 Epidemiology and statistics
 Biomedical sciences
 Social and behavior sciences
 Environmental sciences
 Health policy and management
 Health management
Ten Great Achievements in Public Health
1900-1999
Vaccination.
Weekly Report, December 24,
1999 / 48(50); 1141.
2. Motor-vehicle safety.
3. Safer workplaces.
4. Control of infectious diseases.
5. Decline in deaths from coronary heart disease and stroke.
6. Safer and healthier foods.
7. Healthier mothers and babies.
8. Family planning.
9. Fluoridation of drinking water.
10. Recognition of tobacco use as a health hazard.
1.
CDC, Morbidity and Mortality
Challenges Ahead
New and Persistent Problems in Public Health
Leading causes of death,worldwide
2001
Perinatal conditions
4.4%
Respiratory infections
7.0%
Others
8.6%
Infectious & parasitic
19.3%
Injuries
9.0%
Respiratory & digestive
9.8%
Source:
WHO 2002
Malignant neoplasms
12.6%
Cardiovascular diseases
29.3%
(suicide)
Leading infectious killers, worldwide
2001
Respiratory infections
3.9
4
3.9
HIV/AIDS
2.9
Diarrhoeal diseases
2
TB
1.6
3.5
Malaria
1.1
Measles
0.7
2.9
3
2.5
2.0
2
1.6
1.5
1.1
1
0.7
0.5
Source: WHO 2002
0
Respiratory
infections
HIV/AIDS
Diarrhoeal
diseases
TB
Malaria
Measles
Under-five mortality rate, 1990-2003
Child deaths per 1,000 live births
1990
2003
World
95
80
Developed regions
11
7
46
46
Developing regions
105
88
Northern Africa
87
38
Sub-Saharan Africa
185
172
54
32
Eastern Asia
48
37
Southern Asia
126
90
South-Eastern Asia
78
46
Western Asia
68
60
Oceania
86
77
Commonwealth of Independent
States
Latin America and the Caribbean
Source: United Nations Statistics Division, “World and regional trends”, Millennium Indicators Database, available from http://millenniumindicators.un.org (accessed June 2005); based on data provided by United Nations Children’s Fund and the World
Health Organization.
Statistics Division, Department of Economic and Social Affairs
Distribution of deaths by broad causes group and region
2001
Deaths (thousands)
Total
Group I
Group II
Group III
Group II/Group I ratio
World
56554
18374
33077
5103
1.8
Developed
15614
1441
12833
1320
8.9
Developing
40940
16933
20244
3783
1.2
Group I: Communicable diseases, maternal and perinatal conditions and nutritional deficiencies
Group II: Noncommunicable conditions
Group III: Injuries
Source: WHO (2002)
Health Disparities
Access and Outcomes
 Infant Mortality
 Cancer Screening and Management
 Cardiovascular Disease
 Diabetes
 HIV Infection/ AIDS
 Immunizations
Contemporary health issues
 The 20th century witnessed the transition of major disease burdens （
defined by death） from infectious and/or communicable diseases to
chronic diseases (Table 1.1.2).
 In 1900, the leading cause of death in the United States and other
developed countries was reported to be pneumonia and influenza.
 By the end of the century, diseases of the heart were the leading
cause of death, and pneumonia and influenza dropped to the seventh
place, primarily affecting the elderly.
 Communicable diseases
 Chronic diseases
 Mental illness
 Population changes: Ageing
 Pollution
 Disparity between the rich and the poor widen
Public health interventions
 One important task of public health professionals is to
raise the level of anxiety of the public about public
health problems to the level at which they will be
willing to take an appropriate action.
 Public health interventions can be divided into four
categories:
 biologic/environmental
 social/behavioral
 political
 structural
 The public health professional must use strategies in
all categories to achieve the maximum health of the
public.
biologic / environmental interventions
 The strategies:
 improved standard of living, including provision of
clean water and safe disposal of wastes.
 The most cost-effective biologic intervention
strategy is immunization
 Eliminate of vectors of disease: DDT
Social/Behavior interventions
 Most public health interventions depend ultimately on behaviour
( personal or community behavior).
 At the personal or individual level, promotion of good health
habits and avoidance of smoking, excess alcohol use, and other
dependency disorders are important interventions that have a
major impact on health.
Political interventions
 Public health is politics. Any process that involves
obtaining the support of the public will involve politics
and differing points of view. For example, the
campaign to stop smoking
Structural interventions
 The end result of the political process is the passage of laws
and regulations. This action, if implemented, can have a very
significant impact on the improvement of the health of the
public.
 For example, the law reducing the maximum speed in California
from 65 to 55 miles per hour had a significant impact on
lowering the automobile fatality rate
Impact of public health
 The dramatic achievements of public health in the 20th century
have improved our quality of life:
 an increase in life expectancy.
 world wide reduction in infant and child mortality
 elimination or reduction of many communicable disease.
 As life expectancy increases in many developing countries, more
people are developing those chronic diseases which have been a
major burden in developed countries for many decades. Unlike
developed countries, however, these countries still carry the
burden of infectious diseases which have been greatly reduced in
developed countries.
 Because of the rapid advances in travel and
communications, the developed world is threatened in
new ways and thus cannot afford to ignore the
problems of the developing world.
 Today, public health leaders must strengthen their
roles as advocates for improved population-based
health in an international, global community.
The future of public health
 We have made tremendous strides to improve the
health of the public, but the challenge to do
better remains
Leading cause of preventable death
Leading causes of preventable deaths in the United States as
of the year 2000.
Cause
Number of deaths resulting
Smoking
435,000 deaths or 18.1% of the total deaths
Overweight and Obesity
365,000 deaths or 15.2% of the total deaths.
Alcohol consumption
85,000 deaths or 3.5% of the total deaths.
Infections
75,000 deaths or 3.1% of the total deaths.
Toxic agents
55,000 deaths or 2.3% of the total deaths.
Motor vehicle collisions
43,000 deaths or 1.8% of the total deaths.
Incidents involving firearms
29,000 deaths or 1.2% of the total.
Sexually transmitted infections
20,000 deaths or 0.8% of the total.
Illicit use of drugs
17,000 deaths or 0.7% of the total deaths.
Why is public health controversial?
 Economic impact
 Individual liberty
 Moral and religious opposition
 Political interference with science
Multiple Determinants of Health
Policies and Interventions
Behavior
Physical
Environment
Individual
Biology
Access to Quality Health Care
Source: U.S. Department of Health and Human Services, Health People 2010
Social
Environment
What is preventive medicine?
 The branch of medicine that is concerned with
the prevention of disease and methods for
increasing the power of the patient and
community to resist disease and prolong life.
Preventive medicine
 is a medical discipline which focuses on preventing diseases and
promoting a general state of health and well being.
 In both Europe and the United States, it is considered to be a
board specialty, meaning that physicians can focus on preventive
medicine while they get their medical degree, and use the skills
they learn in school to reduce the outbreak of disease epidemics,
improve public health, and increase the general quality of life for
individuals all over the world.
Preventive medicine
 Healthcare:
health departments, academic institutions, state and
national government, international or global institutions
including the WHO, UN agencies or government
agencies like the CDC or NASA, organized medical
care programs in industry, voluntary health agencies,
and the military.
The history of preventive medicine
 Dating back for centuries to the time (Romes) when
people first realized that unclean water made them
sick, and that living conditions needed to be more
hygienic to prevent illness.
 Twentieth century, when numerous governments
founded disease prevention centers such as the
Centers for Disease Control and Prevention (CDC) in
the United States. These scientific establishments
began to set firm guidelines designed to minimize the
transmission of disease, improve hygiene, and enable
rapid responses to major outbreaks
 In addition to medicine and science, preventive
medicine also looks at economic and social issues,
as some populations are clearly more at risk of
contracting dangerous diseases than others.
 Many sociologists, psychologists, and economists work in
the field of preventive medicine to assist people of low
income, education, and social status all over the world.
Organizations which promote preventive medicine work
closely with these individuals in the hopes that all
people on earth can enjoy healthy, disease free lives.
Training:
 Generally requires 2 years in residency after a
clinical internship or transitional year.
 Training includes earning a Master of Public
Health (MPH) degree which is usually done in
one of the two years.
 There are three specialty areas within preventive
medicine:

General Preventive Medicine & Public Health

Occupational and Environmental Medicine

Aerospace Medicine
 Core courses:

biostatistics

epidemiology

management

administration

clinical preventive medicine

occupational or environmental health.

Specific career paths:

managed care

public health practice

occupational medicine

environmental medicine

aerospace medicine

clinical medicine

informatics

policy development

academic medicine

consulting

international medicine

and research.
What differences between
public health and medicine?
Medicine
Individual Health
 Best outcome for
individual
Public Health
Population Health
 Healthy community
 Balance of individual
autonomy vs. limitations on
individual
 Balance in allocation of
resources
 Focus on prevention
Medicine
Individual Health
Public Health
Population Health
 Thermometer
 Demographics
 Stethoscope
 Vital statistics
 Individual data,
 Epidemiology
medical history