An introduction to public health: the big picture

John Powles Jan 2008

Why look at the big picture?

Public health is concerned with reducing avoidable burdens of disease and injury in populations over time
So how and why such burdens have changed in the past is of intrinsic interest

Possible approaches to understanding how and why health levels have changed in the past

Narrative

Demographic / epidemiological / health transitions Increase of knowledge -> role of medicine Food supply

Roles of candidate causes

Institutional change

3 big narratives
Transition from early modern times to the present
1. 2.

In the West In the Third World

Emergence of diseases of civilisation in an evolutionary time frame

Broad plan

To give an introductory account of these 3 stories

To reflect on them with respect to

Understanding where we are at To identifying the explanatory categories which might be most helpful in understanding the wider determinants of health trends

Caveats

Definitive answers are not possible

Uncertainty is endemic

Disciplined inquiry can weed out the less plausible conjectures