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Impact of EU Impact of EU Accession on Public Accession on Public

Health in CroatiaHealth in Croatia Development of a European Development of a European

Concept of Public HealthConcept of Public Health

Andrija Stampar School of Public HealthAndrija Stampar School of Public Health1717thth January 2011 January 2011

Christopher BirtChristopher Birt

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OriginsOrigins Goes back to the ancient Goes back to the ancient civilisations of Rome, civilisations of Rome, Greece, and many othersGreece, and many others

(e.g. Albumasar in (e.g. Albumasar in Baghdad)Baghdad)

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Since 1800…Since 1800…Dr William Henry Duncan (1805 – Dr William Henry Duncan (1805 –

1863)1863)•born in Liverpoolborn in Liverpool•qualified in medicine in Edinburgh in qualified in medicine in Edinburgh in

18291829•appointed MOH in Liverpool in 1847appointed MOH in Liverpool in 1847• saw link between housing and saw link between housing and

cholera, smallpox, typhus, etc.cholera, smallpox, typhus, etc.•worked to tackle poor housing and worked to tackle poor housing and

sanitary provisionsanitary provision

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Sir Edwin Sir Edwin ChadwickChadwick

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Sir Edwin Sir Edwin Chadwick, 1800 - Chadwick, 1800 - 18901890

•born and educated in Manchesterborn and educated in Manchester• friend of Jeremy Bentham and John friend of Jeremy Bentham and John

Stuart MillStuart Mill•1833 Royal Commission on condition 1833 Royal Commission on condition

of factory childrenof factory children•1839 first Sanitary Commission 1839 first Sanitary Commission

appointedappointed•1847 Commission on the health of 1847 Commission on the health of

LondonLondon

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Ignac Ignac SemmelweisSemmelweis

•born 1818, died 1865, in Budapest,born 1818, died 1865, in Budapest,•noticed mothers delivered by doctors noticed mothers delivered by doctors

died, while those delivered by nurses died, while those delivered by nurses survived,survived,

•observed that doctors did not wash observed that doctors did not wash hands properly,hands properly,

•discovered puerperal fever and its discovered puerperal fever and its preventionprevention

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Was this a golden Was this a golden age for PH in age for PH in

Europe?Europe?

• Medical Officers of Health (or equivalent Medical Officers of Health (or equivalent title)title)• usually a part of central or local usually a part of central or local governmentgovernment• significant influence on housing and significant influence on housing and educationeducation• prevention / control of environmental prevention / control of environmental hazardshazards• communicable disease control and communicable disease control and immunisationimmunisation• maternal and child healthmaternal and child health

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End of the First End of the First Golden Age?Golden Age?

By 1960 – 1990:By 1960 – 1990:• communicable disease and environmental communicable disease and environmental

health no longer the leading threats to health,health no longer the leading threats to health,• chronic diseases now heading mortality / chronic diseases now heading mortality /

morbidity threats,morbidity threats,• understanding of wider determinants of health,understanding of wider determinants of health,• health promotion “invented”,health promotion “invented”,• Ottawa Charter / Alma Ata Conference,Ottawa Charter / Alma Ata Conference,• New Public Health / rebirth of primary health New Public Health / rebirth of primary health

carecare

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Health Health PromotionPromotion

Defined as including health education, disease Defined as including health education, disease prevention, and health protection (Tannahill et al, prevention, and health protection (Tannahill et al, OUP, 1990)OUP, 1990)• Health educationHealth education increases awareness and influences increases awareness and influences

favourably attitudes and knowledge relating to the improvement favourably attitudes and knowledge relating to the improvement of health on both a personal and on a community basis.of health on both a personal and on a community basis.

• Health protectionHealth protection seeks, through legislative or other means, seeks, through legislative or other means, to promote healthier environments, within which healthy choices to promote healthier environments, within which healthy choices are easier to make.are easier to make.

• Disease preventionDisease prevention refers to measures taken to prevent refers to measures taken to prevent diseases or injuries rather than curing them or treating their diseases or injuries rather than curing them or treating their symptoms, within the scope of public health methods, working at symptoms, within the scope of public health methods, working at population level.population level.

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From 1975: a new From 1975: a new Golden Age?Golden Age?

4 strands of public health activity 4 strands of public health activity emerge:emerge:

•health promotion,health promotion,• communicable disease and communicable disease and

environmental health surveillance and environmental health surveillance and controlcontrol

•planning and evaluation of health planning and evaluation of health services: concepts of population needservices: concepts of population need

•great expansion of academic public great expansion of academic public health, both teaching and researchhealth, both teaching and research

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New Public Health

• addressed the wider determinants of health,• embraced new approaches to health

promotion,• brought PH perspective into primary care,• introduced epidemiology to health care

planning,•maintained communicable disease and

environmental health surveillance / control,• put good science at the heart of practice,• espoused evaluation of both PH practice and

PH projects

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Determinants of Determinants of healthhealth

• peace and absence of war,peace and absence of war,• wealth / poverty / distribution of resources,wealth / poverty / distribution of resources,• agriculture / diet / nutrition,agriculture / diet / nutrition,• employment, locus of control,employment, locus of control,• housing (heating, cooking, plumbing, etc.),housing (heating, cooking, plumbing, etc.),• tobacco, alcohol, other drugs,tobacco, alcohol, other drugs,• physical environment / open spaces,physical environment / open spaces,• transport: injuries, pollution, psychological effects, etc.,transport: injuries, pollution, psychological effects, etc.,• exercise and recreation: sport and culture, etc.,exercise and recreation: sport and culture, etc.,• education,education,• health services,health services,• etc.etc.

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““Healthy Plan-Healthy Plan-it” it” in Croatiain Croatia

Young-early Young-early drinkingdrinking

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Consequences of Consequences of addressing health addressing health

determinantsdeterminants•public health no longer limited to public health no longer limited to

professional (medical) control; it professional (medical) control; it belongs to everyone;belongs to everyone;

•public health no longer limited to public health no longer limited to local government, etc., needs to local government, etc., needs to influence decisions at all levels – influence decisions at all levels – global to localglobal to local

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In 1997 it was In 1997 it was calculated that:calculated that:

of all decisions affecting the health of European of all decisions affecting the health of European citizens, around 50% are taken at EU level (diet & citizens, around 50% are taken at EU level (diet & nutrition, environmental policy, employment law, nutrition, environmental policy, employment law, transport strategy, etc.) – so PH is very important at EU transport strategy, etc.) – so PH is very important at EU level.level.

BUT:BUT:• national and local government levels also important,national and local government levels also important,• also NGOs, community groups, etc.,also NGOs, community groups, etc.,• community development approaches to health community development approaches to health

promotion: outcomes may include (for example) promotion: outcomes may include (for example) community transport, fruit and vegetable deliveries, etc.community transport, fruit and vegetable deliveries, etc.

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So Public Health So Public Health activity may include:activity may include:

•multi-disciplinary trained public multi-disciplinary trained public professionals who will have a wide professionals who will have a wide variety of backgrounds,variety of backgrounds,

•other professionals, not self-other professionals, not self-identifying with public health, e.g. identifying with public health, e.g. teachers, dental nurses, police, teachers, dental nurses, police, social workers…..social workers…..

•parents, members of community parents, members of community groups, those working with NGOs of groups, those working with NGOs of various types….various types….

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A bit later I shall A bit later I shall considerconsider

how we might how we might systematise all systematise all

this public health this public health workwork

Now is time for questions and Now is time for questions and

discussion – thank you for discussion – thank you for listening!listening!