English for special

purpose in 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 habitsSocial ViolenceDietary pattern Substance abuse(drug,alcohol)Medical facilitiesEnvironmentClimateAndHow 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 2001Total 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

SubstanceOrganized 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 process1. 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

1. Vaccination.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.

CDC, Morbidity and Mortality Weekly Report, December 24, 1999 / 48(50); 1141.

Challenges Ahead

New and Persistent Problems in Public

Health

Leading causes of death,worldwide2001

Respiratory infections7.0%

Injuries 9.0%

Cardiovascular diseases29.3%Malignant neoplasms

12.6%

Respiratory & digestive9.8%

Infectious & parasitic19.3%

Others8.6%

Perinatal conditions 4.4%

Source: WHO 2002

(suicide)

Leading infectious killers, worldwide 2001

Respi ratory i nfecti ons3. 9HI V/ AI DS 2. 9Di arrhoeal di seases2TB 1. 6Mal ari a 1. 1Measl es 0. 7

3. 9

2. 9

1. 6

1. 1

0. 7

2. 0

0

0. 5

1

1. 5

2

2. 5

3

3. 5

4

Respi ratoryi nfecti ons

HI V/ AI DS Di arrhoealdi seases

TB Mal ari a Measl es

Source: WHO 2002

Under-five mortality rate, 1990-2003

Child deaths per 1,000 live births

1990 2003

World 95 80

Developed regions 11 7

Commonwealth of Independent States

46 46

Developing regions 105 88

Northern Africa 87 38

Sub-Saharan Africa 185 172

Latin America and the Caribbean

54 32

Eastern Asia 48 37

Southern Asia 126 90

South-Eastern Asia 78 46

Western Asia 68 60

Oceania 86 77Source: 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.

We have made tremendous strides to

improve the health of the public, but the

challenge to do better remains

The future of public health

Leading cause of preventable deathLeading causes of preventable deaths in the United States as of the year 2000.

CauseNumber 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.

Economic impact

Individual liberty

Moral and religious opposition

Political interference with science

Why is public health controversial?Why is public health controversial?

Multiple Determinants of Health

Individual

Biology

Behavior

Physical Environment

Social Environment

Access to Quality Health Care

Policies and Interventions

Source: U.S. Department of Health and Human Services, Health People 2010

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.

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.

Preventive medicine

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?

MedicineIndividual Health

Public HealthPopulation Health

Best outcome for individual

Healthy communityBalance of individual

autonomy vs. limitations on individual

Balance in allocation of resources

Focus on prevention

MedicineIndividual Health

Public HealthPopulation Health

ThermometerStethoscopeIndividual data,

medical history

DemographicsVital statisticsEpidemiology