Professional Documents
Culture Documents
● Biostatistics
● Health administration, policy and management → legislative action
● Public health biology → molecular and genetic bases of cellular processes
● Social and behavioral sciences → activities and interactions among organisms
● Environmental health → physical, chemical and biological agents; social economic and cultural factors
● International/Global health → health concerns from global perspective
John Snow – “Father of Epidemiology”
Greatest public health achievements in the 20 th century:
*Vaccination *Safer and healthier food
Motor vehicle safety → seat belt Healthier mothers and babies
***Sanitation Family planning
Control of infectious disease *Fluoridation of drinking water
Improvement in education and technology Recognition of tobacco as a hazard
Leading cause of death in HK: 1) Cancer; 2) Heart disease; 3) Pneumonia; 3) Stroke
Health Indicators:
1. Mortality Rate (Death Rate)
An estimate of the portion of a population that dies during a specified period
Mortality rate = (No. of deaths during a specified period / No. of persons at risk of dying during the period) x 10 n
➢ Decreasing trend in Infant & Maternal Mortality Rate in HK
2. Life Expectancy
Average number of years an individual of a given age is expected to live if current mortality rates continue to apply
➢ Increasing trend for both male and female in HK [Female>Male because male has more alcohol consumption and
smoking behavior]
➢ Preston Curve → Increase in National Income per head, increase in life expectancy
➢ Aging population
Health Behavior Indicators:
1. Smoking Pattern
● Decreasing trend in HK
● Male > Female
2. Physical Activity
● Physical inactivity in the general public
Four Global Public Health problems:
1. Climate change and health
2. Pollution and health
3. Emerging infectious disease
4. Non-communicable disease (NCD)
Patient-Centred Healthcare
5 Principles Patient Engagement
Information Involvement in healthcare policy
Choice & empowerment Expression of opinions (ask and be asked)
Respect Patients’ complaints handling
Access and support Patient’s acquiring of information
Involvement in healthcare policy
Climate Change
Any significant changes in measures of climate that last for an extended period of time
➢ Causes: i) natural factors, ii) natural processes, iii) human activities
4 Dimensions Effects/Impacts
Temperature Increase in temperature level
- Vector-borne infections (e.g. Malaria, Dengue Fever) due to more vectors
for transmission → by 2080, 2 billion more people will be at risk of
Dengue
- Malnutrition, hunger and starvation → crop yield in Africa will drop by
50%
- Allergies & airway diseases
- Heat exhaustion & heat stroke
4
- Less cold- related death
Rainfall Changes in Rainfall
- Vector-borne infections due to breeding of microorganisms by pockets
of trapped rainwater
- Dehydration
- Malnutrition, hunger and starvation
- Environmental refugee
*** Rainfall flooding =/= Seawater flooding [contains salt which may pollute
drinking water]
Sea level Rise in Sea Level
*** Due to expansion of sea water surface & ice-cap melting upon heating
- Dehydration & diarrheal cases due to pollution of drinking water and
water used for farming
- Mental health, conflicts and war
- Environmental refugee
- Injuries and death
Extreme weather events More Disasters
- Environmental refugee
- Mental health conflict and war
- Human insecurity
- Injuries and death
*** Does NOT directly lead to earthquake or tsunami etc.
➢ Health impacts can be classified into: i) Non-communicable, ii) communicable, iii) environmental/context related
Greenhouse gases (CO, CH4, N2O, fluorinated gases): increases global temperature and climate changes
Air pollutants (Particulate Matter, O3, NO2, SO2): leads to bad health outcomes
At Risk Population
Everyone is exposed to the impact of climate changes → at different levels of risk depending on exposure to risk factors
Environmental Refugees: People who have been forced to leave their traditional habitat, temporarily or permanently,
because of a marked environmental disruption that jeopardized their existence and seriously affected their quality of life
Urban heat island: increase in average urban temperature
Quantifying/Measuring Real Health Impacts
● Discomfort & mild symptoms [greatest proportion]
● Self-care & self-medicate
● Help-seeking
● Hospital admission & clinic usage
● Death rate [highest severity]
Displacement Effect: impacts occur a certain period of time later, not immediately
➢ Mitigation Strategy is needed to proactively solve the problems instead of just addressing them
5 Steps to Public Health Actions
1. Aware
2. Concern
3. Understand
4. Capable
5. Endorsed
Cobenefits: Joint primary benefits resulting from the selection of one instrument aimed at reaching several targets and
should be counted as a benefit in benefit-costs analyses in the policy selection process
➢ improve health, ii) protect the environment
Sulphur Combustion of fossil fuel Ships, especially in ● Highly soluble in water to form sulphurous
Dioxide (SO2) containing sulphur container terminals acid (H2SO3)
● H2SO3 is a strong irritant of respiratory
mucosa → bronchial constricting
● Oxidation of H2SO3 to H2SO4 further form
sulphates SO42-, found in PM
Nitrogen Combination of nitrogen and Motor vehicles ✧ Nitrogen oxides, rather insoluble in water,
Oxides (NOx) oxygen in varying (buses and trucks in may react with water to form nitrous acid
proportions at high roadside), power (HNO2), which further oxidizes to nitric acid
temperature generation and gas (HNO3)
cooking ✧ NO2 used to represent conc. of all oxides
Ozone (O3) Complex reactions involving Air ● Irritates mucus membranes in mouth, nose
sunlight, hydrocarbon and and throat
NO2 ● Breathing difficulties, lung damages, worsens
asthma
Particulate Combustion of fossil fuel in Motor vehicles ✧ Carbon coated with toxic chemicals (e.g.
Matter (PM) motor vehicles polycyclic aromatic hydrocarbons and toxic
[PMx, where x = metals)
diameter or ✧ “Fine” PM: <2.5µm; “ultrafine” PM: 0.01µm –
less in µm] 0.1µm
✧ PM10 causes increased respiratory illness,
lung damages, cancer and premature death
✧ PM2.5 can be lodged in the deepest part of
lungs → more dangerous
✧ HK: 70% of PM10 is made up of PM2.5
People who suffer most from air pollution:
● Elderly
● Individuals with lung diseases (e.g. asthma) and heart disease
● Children and adults in outdoors
Health Impacts of Air Pollution
Epidemiological Studies: studies of the health of large groups of people
Toxicological Studies: studies of the effects of air pollutants on cells or laboratory animals
➢ Air pollution leads to deaths, illnesses of cardiovascular and respiratory system, poor lung function and health
problems in infants
Monitoring Air Quality
HK: EPD uses air quality monitoring stations routinely to monitor concentrations of air pollutants (SO 2, NO2, O3 and PM10)
based on Air Quality Objectives [Established in 1987 under Air Pollution Control Ordinance]
● Many countries have developed ambient air quality standards for the most harmful air pollutants (SO2, SO42-, NO2, O3,
CO, PM10, PM2.5 and H2S)
Air Quality Standards: Legal limits that identify the (i) maximum concentration level and (ii) time an air pollutant can be
present in air before it begins to cause health problems
Air Quality Guidelines: Produced by WHO in 2005
Solution
Inter-disciplinary efforts are required through utilizing expertise in urban planning, technology, policies, public health,
environmental health, and political will and public awareness
● Identify local sources and regional sources of problem
Local sources: implement policies in energy and transport to reduce emissions from major sources
Regional sources: implement environmental, economic and energy policies to foster regional collaboration in air pollution
monitoring and setting emission limits
Personal precautions: do not go jogging when air pollution index is high; wearing a facial mark does not help much; air
cleaner may help
Telomere: non-gene DNA at the ends of DNA strands in chromosomes, which are shortened during DNA replication, cell
division and DNA damage
➢ Entire loss in telomere would cause the cell to stop replicating or cell death
➢ Length determined by: level of telomerase, age and DNA damage
➔ Adequate telomere length is vital to maintaining cells including immune system cells
➔ Longer telomere length associated with increased resistance to disease and premature death in prostate, breast, lung
and colorectal cancers
Telomerase: an enzyme which restores telomere
➢ Cancer cells have high level of telomerase → immortal cell
Comprehensive positive lifestyle changes increase cellular telomerase activity, which reduces oxidative stress and
inflammation
Free radicals: highly reactive molecules with unpaired electrons which seek out and destroy healthy cells and DNA
➢ Causes oxidative stress that leads to aging
Antioxidant Enzymes: stabilizes free radicals and prevent damage to cells and tissues
✧ Superoxide dismutase (SOD): converts free radicals to H2O2
✧ Catalase: remove H2O2
✧ Glutathione peroxidase: remove H2O2
Nrf2: A protein messenger that activates antioxidant enzymes & down-regulates genes that promote inflammation
Hospital Authority (HA) established in 1990 to facilitate management and distribution of hospital beds
Hong Kong Academy of Medicine (HKAM) established in 1993 to foster development of postgraduate professional
training and set standards
➢ Most popular constituent colleges in HK commercial sector: Radiology, Ophthalmology, Anesthesiology, Dermatology
Family Medicine provides continuing, comprehensive and holistic care for individuals
New challenges of modern era: (i) ageing population, (ii) degenerative diseases, (iii) ethical & philosophical dilemmas