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Understanding of Public Health

Health and Public Health

Do you think she is healthy?

Her name is Tsang Tsz

She is blind and deaf
She reads book by

1.1 Definition of HEALTH

WHO (World Health Organization) defines





1.1 Definition of HEALTH

Refers to physical health
Proper functioning of all systems and organs in the body
Refers to mental health
Including emotion, senses, memory
Refers to social well-being
Positive interpersonal relationship and community life

1.1 Definition of HEALTH

Health is not merely the absence of disease or infirmity.
There is a close relationship between physical and

mental health, as well as social well-being. For

example, emotional stress may lead to heart diseases.
The definition of health is somewhat subjective. Many
people determine their own health status based on how
they define their lives and what things are important to
Class Work 1

1.2 Factors affecting health

1.2 Factors affecting and maintaining

1. Physical environment
2. Social and economic conditions
3. Personal factors

by World Health Organization

1.21 Physical environment

Hygienic conditions e.g. clean water and air
Healthy and safe workplaces and homes
Well-planned communities and infrastructures
More health problems in developing regions

1.22 Social and Economic factors

Income and socio economic status
higher income and social status better health.
The greater the gap between the richest and poorest people (c.f.
gini coefficient, the greater the differences in health)
low education level more stress and lower self-confidence
poor health

Employment and working conditions

people in employment are healthier
miners and construction workers often have lung problems
Social support networks

greater support from families, friends and communities better health.

1.23 Personal factors

Personal lifestyle
Diet? Fast food culture meat > vegetable
Regular rest and exercise ?
Smoking ? Drinking ?
Personal character
Personal experiences
How we deal with stresses and challenges
Optimistic or pessimistic ?

Age infants and the old have weaker immune system
Hereditary diseases (e.g. Thalassemia )
Race e.g. White people are more likely to have skin cancer

1.24 Remark
The context of peoples lives determine

their health, and so blaming individuals

for having poor health or crediting them
for good health is inappropriate.
Therefore, maintaining health is not just a
personal matter.

What is public health?

Public health involves topics related to the health of

individual, community, and world health

Using social resources to make sure people stay healthy
Focus on prevention of diseases
Include social measures and scientific knowledge

Public health involves topics related to health of individual,

community, and world health. It aims to facilitate the

organized efforts of different sectors to create a hygiene
environment through the allocation of social resources
Using social resources to make sure people can stay
healthy through adopting a healthy lifestyle.
Focus on the prevention of diseases and formulation of
relevant measures.
Concern about the health of community, country, and
world population
Include social measures and scientific knowledge, which
is interdisciplinary.

Public Health


Promote health


Prevention of

Food nutrition

Improve living

Access to
health care



1.31 Definition of Public Health

Refers to the collective effort of the society and the use

of public resources to promote and maintain public

It is the concern of the whole community
It requires coordination of different sectors of the community
It focuses on preventing and controlling diseases

Issues concerning public health can generally be divided

into 3 domains:
Health protection
Health improvement
Health services

The 3 domains of public health

Public Health

Health Protection
- Control of
infectious diseases
- Food safety
- Environmental

- Vaccination
- Health education
- Organ donation

Health Services
- Public medical
- Reform of the
medical system

** Two types of disease: infectious and non-infectious disease

1.32 Current public health challenges

to HK
Challenges to health protection
Avian flu (H5N1)
Swine flu (H1N1)
Air Pollution
Food safety
Challenges to health improvement
Obesity, smoking, drug abuse and stress-related problems
Ageing population

Challenges to health services

Primary care over-burden of public medical services
Health care reform absence of medical insurance scheme
Managing chronic diseases due to ageing population

1.33 Evaluation of public health

Indicators used in HK to evaluate public health
Statistics on infectious diseases
Cases of infectious diseases and food poison etc.
Statistics on behavioural risks factors
Data regarding weight control, eating habits, physical activities etc.
Vital statistics
Death rate, average life expectancy etc.

Characteristics of public health

A focus on the whole community
An emphasis on prevention
An emphasis on collective responsibility for health (i.e.

every member of the society including individuals, public

and private organisations, government, etc)
A concern for the socio economic factors of health and
A close partnership between health care providers, the
government and the population served

Responsibilities of different stakeholders in

maintaining public health
It is responsible for coordinating issues related to global public
health. E.g. strengthening health and nutrition surveillance systems
to enable monitoring of any changes, early warning of
deterioration, and immediate life saving action through outbreak
response and technically sound nutrition interventions
Government (local level)
The Department of Health in HK executes the governments
healthcare policies. It protects peoples health through promoting
health, preventing diseases, providing medical care and
rehabilitation services, etc
Food and Health Bureau, Food and Environmental Hygiene
Department, Centre for Health Protection and Hospital Authority

NGOs (local/global level)

Promote healthy lifestyle, monitor the government and pressurize
the government for improving public health conditions, cooperate
with the government to maintain public health

Population structure of HK
Class work 2

1.34 Case Study: poverty and public


Class work 3
In sub-Saharan Africa, 71.8% of urban residents live in slums,
where sanitation, clean drinking water and electricity are lacking.
Pathogens that cause infectious diseases, such as cholera,
dengue fever, and yellow fever, breed in ditches and dirty water.
The crowded environment also enables the spread of pertussis
( ) and influenza. However, vaccination is not common.
In Niger, immunization coverage in slums is only 35%.

Climate change is expected to bring more frequent and

longer droughts to Africa. Droughts result in water scarcity, poor
agricultural productivity and food shortage. Malnutrition in slums
will get worse. Also, urban pollution leads to 49,000 premature
deaths a year in Africa. Slums are often located near factories
and roads. Many people living there have respiratory diseases.

Factors affecting the public understanding
about public health

2.1. Factors affecting peoples understanding and

decisions on health and public health issues


and culture


about Public

Mass Media




Factors affecting peoples understanding and

decisions on health and public health issues
Personal factors
Cultural and religious beliefs
e.g. some radical Judaists are against blood transfusion)
more access/awareness to health information)
economic situation
more income afford the cost of better medicine, e.g. targeted

medicine @$15000)
gender and age
female is more likely to look for treatment when compared with male


Determine a
opinion on

The media
Delivery of health and public health information
Monitor of health and public health issues (e.g. )
- Arouse decision makers awareness of the incident
- NGOs may pay attention to those loopholes upon reading the
relevant news reports.

Scientific evidence
Clinical research and statistical surveys
e.g. hazard of smoking
Government - medical system and policy
Quality of medical services
Health policies
Health education can raise publics awareness of precaution (e.g.
cervical cancer screening)

2.2. Stakeholders responsible for

maintaining public health
Global level - World Health Organization (WHO)
WHO is responsible for coordinating issues related to

global public health, e.g. ensuring international

cooperation and notification system when health crises
Strengthening health and nutrition surveillance systems
to enable monitoring of any changes
early warning of deterioration, and immediate life-saving
action through outbreak response and technically sound
nutrition interventions.

2.2. Stakeholders responsible for

maintaining public health
Local level government
The Department of Health in Hong Kong executes the
governments healthcare policies. It protects peoples health
through promoting health, preventing diseases, providing medical
care and rehabilitation services, etc.
Non-governmental organization (NGOs)
Promote healthy lifestyle, monitor the government and pressurize
the government for improving public health conditions, cooperate
with the government to maintain public health etc.

Development of Scientific theories and
Public Health:
Understanding of Infectious Diseases

2.1 The Development of Scientific Theory and

peoples Understanding of Infectious Disease

Development of science and Explanation of


Prehistoric times

Supernatural forces/ religious explanation

Fifteenth century

Theory of contagion ( )

Late eighteenth

Quarantine ( ) and isolation

Vaccination e.g. smallpox

Late nineteenth

Germ theory


Epidemiologic Triangle ( )

Plagues in Roman Empire

Evolution of scientific knowledge in the age of the Renaissance

Late 18th CenturyQuarantine and isolation

Quarantine (in Italian means forty days) is used to

separate and restrict the movement of well persons who

may have been exposed to a communicable disease to
see if they become ill.
Isolation is used to separate ill persons who have a

communicable disease from those who are healthy.

Late 18th CenturyVaccination

Vaccines are made from the same germs that cause

disease. But the germs in vaccines are either killed or

weakened so they wont make you sick.
The immune system reacts to the vaccine by making

The antibodies destroy the vaccine germs just as they

would the disease germs. Then they stay in your body,

giving you immunity.

Modern: Epidemiology
A theory proposes that microorganisms are the cause of

many diseases
E.g. Cholera ( )

Modern: Epidemiology
A specialized field of medical study that studies disease
To examine the features of diseases through the
analysis of disease distribution, trends and the

2.2. Impact of modern scientific development on

public hygiene

(a) Inventions of instruments for diagnosis and treatment

()Instruments for diagnosis: X-rays and CAT scanner
()Medicines/technology for treatment: antibiotics and organ

transplant surgery shortened the time for the course of

treatment and patients recovery

b) Negative impacts of science and technology

Invention and adoption of advanced technology would

have negative impact on health

E.g. walk less because people use automobile
Although science and technology can help people

understand better about health, this does not necessary

mean that the people would change their behaviour (e.g.

c) Questions and crisis accompanying modern

scientific development
Population explosion in developing countries
Medical technology improve diagnosis and effectiveness of
treatment longer human life expectancy, the lower natural death
Low mortality rate
Population explosion exerts burden on the economy, environment,
and resources of developing countries
E.g. World population hit 7 billion

d) What is the relationship between population

explosion and public health
Problem of unclean drinking water and shortage of

o 20th century water consumption of developed and developing

countries has increased by 18% and 50% respectively

Aggravation of inequality
Advanced technology is costly
The rich are more advantageous following the emergence of new
Widening wealth gap aggravates the problem of inequality (e.g.
Mental illness public hospital $0.5/pill Vs. private doctor $50/pill)

Moral issues
Illegal smuggling of organs
Development of embryonic stem cells
Tailor made babies?

2.2 Epidemiologic Triangle ( )

Something that can cause disease


Host is where the agent lives

Mode of transmission

2.2 Epidemiologic Triangle ( )



micro-organisms that cause disease

Micro-organisms: bacteria or virus

Non micro- organisms: poisons or stress

stands for organism (humans or animals)
that carries the disease

The same micro-organism can have different

effects on different hosts. It all depends on a wide
range of factors such as:
age, sex, ethnicity, immunity and human
behaviors, personal lifestyle
Physical environment such as climate, water and
Biological environment such as population density,
health care system, etc.
Socio-economic environment such as wealth,
religion and culture

stands for external factors that affect the
rate and mode of disease transmission

Vector of disease
stands for the transmitter of disease.

Biological: Mosquitoes which spread malaria; dogs

spreading rabies
Non-biological: contaminated needles transmit

Prevention of infectious disease

Factors to consider in prevention of infectious


Overall description of the epidemiologic triangle:

A disease exists when a vector connects all three components
If any of one of the connection between the environment, the host

and the agent is disrupted, the disease will stop existing.

Therefore, the epidemiologic triangle is important to the prevention

and control of infectious diseases.

Example: Malaria

Example 2: Ebola

Can you draw a epidemiologic triangle for Ebloa?

Bats family
Wild animals
eaten by
people; close

Ebola virus

Hot and wet

2.3 Differences between epidemics and


Epidemics ( )

Pandemics ( )

An epidemic is specific
to one city, region or

A pandemic goes much further than

national borders, covers a much wider
geographical area, often worldwide.

It occurs when the

number of people who
become infected rises
well beyond what is
expected within a
country or part of a

When an infection takes place in

several countries at the same time it
then starts turning into a pandemic.
It infects many more people than an


Epidemics like
influenza are generally
caused by subtypes of
a virus that is already
circulating among

A pandemic is usually
caused by a new virus
strain or subtype - a
virus human either
have no immunity
against, or very little
immunity so the virus
is much more likely to
spread around the
world if it becomes
easily human


Localized and cause

fewer deaths.

Globalized and caused

more deaths and greater
socio-economic loss.


SARS as a public health risk (infectious

3.1. Definition of infectious disease

An infectious disease can be spread between human and

human, animal and animal, human and animal

Influenza covers the three transimission routes mentioned,
including human flue transmitted among humans, swine flu
transmitted among pigs and human swine influenza
transmitted between human and pig.
Infectious diseases can be transmitted through the
following routes:
Droplet transmission (e.g. influenza)
Over-the-air transmission (e.g. tuberculosis)
Blood (e.g. AIDS)
Fascal-oral transmission (e.g. cholera)
Vector borne transmission (e.g. Dengue fever)

3.2. Outbreak of epidemic diseases

(a) Black Death of C14th
Most serious causing 75 million deaths worldwide
Unclear of the cause, people could neither take appropriate
control measures nor understand the importance of hygiene.
Black Death in HK (the plague) 1894
Lessons learnt regarding public health
Cleared the infected area (Tai Ping Shan area)
Improved drainage
Killed mice
Enacted public health and housing ordinances
Set up public bath houses
Set up the HK Pathological Institute
Aroused greatly peoples awareness of hygiene

(b) AIDS as a public health risk

The outbreak
First reported case in the US in 1981
34 millions infected and 1.7 millions died
Most new cases (2010) were
reported in developing since
people and even the
governments misunderstand
AIDS so they fail to prevent
or control the spread of it.

Lessons learnt regarding public health
Focus on Prevention, Education and Acceptance
Governments and NGOs active propaganda
Safety sex - use of condoms
Drug addicts dont share syringes
Proper support and guidance to HIV carriers

(c) Avian Flu (H5N1) as a public health risk

The outbreak 0 -154
Cases recorded in HK in 1997, 2003 and 2010 and spread
worldwide since 2003
Lesson learnt preventive and monitoring measures
Killed all chickens (vector of disease)
Regulating the sale of live poultry
Conducting regular cleaning of wet markets
Suggesting central slaughtering but was opposed by the industry

Avian Flu (H5N1) as a public health risk

Whats your view? Should chickens be blamed?

(d) Swine Flu (H1N1) as a public health risk

The outbreak 2009

Swine Flu (H1N1) as a public health risk

lesson learnt
Quarantine the infected or suspected

Conclusion: The influences of outbreaks of epidemic

diseases on the understanding of public health

Outbreaks of epidemic diseases raised peoples alertness about hygiene.

In ancient times: People did not know about epidemic diseases, so it was

difficult for them to prevent diseases from spreading, which usually

resulted in a large number of deaths.

Present: Both the government and the public are aware that preventive

measures are effective in controlling and preventing infectious diseases.

These measures include isolation, entry and exit control, tracking of the
sources of diseases, disinfection and cleaning, as well as raising
awareness of environmental hygiene.
Information is more developed than in the ancient times, and through

medias reports, together with the governments measures and appeals,

the general public can grasp the latest health information in a short time,
so they will be alert and take preventive measures. The deaths caused by
diseases are also reduced.

International collaboration in preventing infectious diseases

As different countries and regions are becoming more and more

closely connected outbreaks of epidemic diseases are more difficult to

control. Therefore, the development of international collaboration in
public health has become an inevitable trend.

Motivated by WHO, governments and non-governmental

organisations in the world have endeavoured to build a global public

health system for the prevention and control of outbreaks of epidemic

Worldwide preventive measures against infectious diseases will

undoubtedly arouse the awareness of the public. However, whether

the various measures will be fully executed depends on the
governments responses and transparency, as well as the
effectiveness of the allocation of resources.

Role of local government and public in preventing epidemic disease

Outbreaks of epidemic diseases often pose great

challenges governments and their abilities to respond.

Of course, a government is responsible for protecting

public health. However, only with the participation of the

public and with everyone taking all health and preventive
measures can the governments measures become

3.4. SARS 2003

In 2003, Hong Kong was attacked by an emerging infectious
disease named Severe Acute Respiratory Syndrome (SARS).
The SARS epidemic which lasted from March to June 2003 was
unprecedented in the modern history of Hong Kong in terms of its
severity and magnitude.
During the epidemic, 1,755 HK people were infected and 299 of
them died.
More than one-fifth of those infected were healthcare workers
(HCWs) and eight succumbed to the disease.
It spread to 27 countries. 8096 infected and 774 died.

Problems of the government in handling SARS

- (SARS)
| 2003 : 0 210

SARS Report (watch video)

Problems of the government in handling

Problem 1
Lack of collaboration between the HKSAR government and the mainland authority
e.g. The government was passive in acquiring information about the disease info
from the mainland authority

Problem 2
Lack of a sense of awareness/ prevention
e.g. health workers were unaware of the highly contagious nature of the disease
and therefore got infected collectively

Problem 3
Confused message delivered to the public
e.g. the government officials postponed the announcement of the outbreak of
SARS and failed to raise the alertness among the public

Problem 4
Lack of understanding about the diseases
e.g. SARS was a new disease and little information was available. Investigation
and invention of medicines were therefore slow.

Impacts of SARS on public health in Hong

Watch the video < >

Class work 4

What have Hong Kong citizens learnt from SARS?

(1) Rising awareness of personal hygiene
People start to understand that personal hygiene is crucial in the

prevention of infectious diseases.

(2) Transparency is of crucial importance
Governments worldwide understand that those cases identified must not
be concealed from the public. If not, the consequence will be
Delay in the dissemination of information on the epidemic may result
Hong Kongs and other cities not being able to combat the spread of the
Having learnt from SARS, governments worldwide are more transparent
and honest when disseminating information on the epidemic, such as
reporting to the WHO more quickly.

(3) Inadequate measures and knowledge

In January 2003, experts from Guangdong published a
report on SARS, claiming that the disease was highly
infectious in hospitals. Therefore, infection control in
hospitals is of immense importance.
When collective infection was found in Prince of Wales
Hospital in Sha Tin in March 2003:
The infection control was inadequate to prevent the spread of

SARS within the hospital, and the disease cannot be stopped from
spreading into the community.

Medical staffs knowledge in infection control and the supply of

protective gear were found to be inadequate. Medical staff laced

basic training in dealing with the mass outbreak of infectious
diseases. It was not until the outbreak of SARS that the problem
After SARS, Hong Kong received extra resources on the

prevention and control of infectious diseases, such as the

establishment of the Centre of infectious diseases in Princess
Margaret Hospital.
Hong Kong has been in the forefront in terms of preventing and

controlling infectious diseases. It has received extra resources.

Steps in the management of an

infectious disease outbreak





1. Preparation
Surveillance system: regular reports
Outbreak response plan for each disease:

resources, skills and activities

Stockpiles: sampling kits, appropriate
antimicrobial, intravenous fluids, vaccines
Contingency plans for isolation wards in
hospitals e.g. St Margarets Hospital
Laboratory support
Setting up of Centre for Health Protection

2. Detection

2. Detection
To ensure rapid detection of an outbreak in an

emergency situation, it will be necessary:

to set up an early warning system within the
surveillance system, with immediate reporting of
diseases with epidemic potential;
to train clinical workers to recognize priority
diseases/syndromes and report cases of priority

3. Response

4. evaluation

How does the outbreak of SARS

reflect the role of globalization?
Can be discussed in the following aspects
Spread of the disease
Information flow
Control of the disease

Globalization and Spread of the disease

ORIGIN OF SARS: Guangdong province
Spread to Hong Kong by a Chinese visitor
Further spread to the rest of the world as visitors got

infected in a hotel in Hong Kong

Countries around the world are closely connected and
interact with each other in the way that a local event may
affect other places, or even the whole world within a
short period of time.

2. Information flow
Hong Kong

Different countries

reported the infected case

to Hong Kong and alert
the government to handle
the crisis.

At first, China concealed the


news of SARS outbreak.

However, the information
about SARS outbreak in
Beijing on the internet was
soon widely spread .
The WHO gave pressure to
the Chinese government to
make daily reports of the
SARS cases

Globalization and Information flow

Under a globalization background, with the ever-

upgrading communication and information technology,

people will be able to find ways to break up the blockage
set up by any administrations or authorities.
The whole world is watching!!

3. Control of disease
Scientists in Hong Kong remotely connected 80 clinicians

from 13 countries to develop a uniform treatment plan and

a new serum test for control of SARS.
Global cooperation or global governance

between countries and authorities is inevitable

when facing a global common crisis.

Development of Scientific theories and Public
Understanding of Non-infectious Diseases (1)

Mental Disorder

3.2 Understanding of Mental Disorder

A test




Understanding mental disorder

Mental disorder refers to disorders in the functions of the

brain or nervous system, which lead to abnormalities in

ones perception, cognition, emotions and behavior.
Mental disorder can be further divided into neurosis and


Mental imbalance
which causes distress

anxiety, depression

Mental state that
impairs thoughts,
perception and

3.21 Causes of mental disorder



Physiological factor

Brain problems

Psychological factor

Personal character and emotion

Environmental factor

Pressure, great changes, traumatic experience

and drug effects

Hereditary factor

Schizophrenia and manic depressive


3.22 Situation in HK
The number of mental patients has been rising

mental patients in

Supply of professional medical services cannot meet the demand

Families of the patients live under great pressure
Ex-mental patients have great difficulties to adapt to society e.g.

social discrimination

Class work 6


Problems faced by mentally ill patients

Discrimination/ Social pressure

e.g. Hard to get jobs after recovery (Source C)

Discrimination in community

Lack of resources

e.g. Long waiting time for mental diagnosis (Source C)

e.g. Low doctor-patient ratio (Source B)
e.g. Lack of rehabilitation facilities in urban communities
(Source B & D)

Reasons behind the problem

1. Personal level
Lack of awareness and understanding (Source A)
e.g. Ah Ching felt reluctant to disclose her problems to
people around as she did not realize it would turn into
depression later. She delayed a year to seek medical

2. Socio-cultural level
Chinese traditional thinking regards mental disorder as a
moral problem (Source D)
This prevents people from seeking medical help as they
often feel shameful
Chinese tend to seek help from family and friends

This postpone the proper treatment of many mental


Media exaggeration

Media often selectively report extreme cases of mental

illness by exaggerating titles and pictures
This creates a labeling effects on mental patients

3. Political level
Lack of long-term policy (Source D)
- Treatment of mental illness is often conducted separately
from the mainstream community. Rehabilitation facilities
are inadequate in urban areas.
- Education concerning mental illness is fragmented and

Development of Scientific theories and Public
Understanding of Non-infectious Diseases (2)

Chronic disease

Understanding of Chronic diseases

5.1. Understanding of Chronic diseases

Some facts about chronic diseases
Chronic diseases are diseases of long duration and generally slow
progression. They are also known as life-style diseases or
diseases or civilization;
Examples: heart diseases, stroke, cancer, chronic respiratory

diseases and diabetes.

Chronic diseases by far the leading cause of mortality in the world,

representing 63% of all deaths. Out of the 36 million people who

died from chronic disease in 2008, nine million were under 60 and
90% of these premature deaths occurred in low- and middle-come

5.2. Causes of Chronic diseases

risk factors
risk factors
Cultural and
risk factors

Lack of exercises
High-calorie diet
Smoking and alcohol abuses

Cultural and religious malpractices

5.3. Chronic diseases as a potential

threat to public health of HK

Increasing cases
Ageing population
diseases a
threat Absence of
Imbalance of
mandatory medical
healthcare services insurance scheme

5.4. Case study :Obesity

Obesity and overweight
Overweight and obesity are defined as abnormal or excessive fat
accumulation that may impair health.
Body mass index (BMI) is a simple index of weight-for-height that is

commonly used to classify overweight and obesity in adults. It is

defined as a person's weight in kilograms divided by the square of
his height in meters (kg/m2).

The WHO definition is:

a BMI greater than or equal to 25 is overweight
a BMI greater than or equal to 30 is obesity.

What is Globesity?
What is the public health problem reflected?

Wealth and Obesity

Wealth and Obesity

Class work 5b

Is legislation feasible in controlling Obesity?

Class work 5c
(Michael Bloomberg)


(New York City's Board of Health)2012 9

16 (470 )


Obesity problem among Hong Kong students

Fat tax in Denmark
A fat tax was introduced in October 2011, in an attempt

to limit the population's intake of fatty foods.

Foods containing more than 2.3% saturated fat - including

dairy produce, meat and processed foods - were subject

to the surcharge.

Should HK government implement the fat tax similar

to that adopted in Denmark ?