Looking at the other side: Families, public health and anti-vaccination

The choice to vaccinate or not to vaccinate a child is usually an ‘informed decision’, however, it is how this decision is informed which is of most importance. More frequently, families are turning to the Internet, in particular social media, as a data source to support their decisions. However, much of the online information may be unscientific or biased. While issues such as vaccination will always see dissenting voices, engaging with that ‘other side’ is difficult in the public policy debate which is informed by evidence based science. This chapter investigates the other side in light of the growing adoption and reliance on social media as a source of anti-vaccine information. The study adopts a qualitative approach to data collection and is based on a critical discourse analysis of online social media discourse. The findings demonstrate the valuable contribution this approach can make to public policy work in vaccination.

Defining health and public health

What is health? How is it defined and described? What do you mean when you describe yourself as ‘healthy’? How is ‘public health’ defined? What are the fundamental principles of public health? How does public health interact with other disciplines? And how do we describe what public health workers do? These are many of the questions that will be considered in this chapter and other chapters, which are designed to help you become familiar with the principles and practices of public health. This book is about introductory principles and concepts of public health for students. It is also relevant for health workers from a range of disciplines whose focus ranges from clinical to population health, and who want to understand and incorporate public health principles into their work. We begin our journey by considering a fundamental issue that underpins the notion of public health—that is, the definition of ‘health’, and we consider the range and variety of definitions, including the general public and professional.

History and development of public health

This chapter and the others that follow have the study of population health as their focus, as opposed to a focus on individual care and treatment. Clearly, however, we are concerned with the way in which population health is influenced by biomedical theories and practices, and the way population health is funded, and is influenced by the importance placed on therapeutic medicine. The discussions that follow include a brief overview of the ancient history of public health, and the modern history of Western public health dating from 1850. This date signifies the beginnings of a more organised, collective effort to protect the public’s health. These discussions will help you further expand your definition of public health. You will have an entertaining journey through public health achievements, and less successful outcomes, by examining the historical developments that have led us to a modern understanding of public health. The ancient Greeks and Romans, for example, had public health measures to ensure the safety and health of their populations, for a range of social and economic reasons. Convicts arrived in Australia with many health problems, and were put to work to satisfy the needs of a fledgling colony. It is important to understand the historical journey of public health and the way it is critically analysed, as it provides a looking-glass onto the present and the future.

Grand challenges for public health

What is the future for public health in the twenty-first century? Can we glean an idea about the future of public health from its past? As Winston Churchill once said: ‘[T]he further backward you look, the further forward you can see.’ What can we see in the history of public health that gives us an idea of where public health might be headed in the future? (Gruszin et al. 2012). In the twentieth century there was substantial progress in public health in Australia. These improvements were brought about through a number of factors. In part, improvements were due to increasing knowledge about the natural history of disease and its treatment. Added to this knowledge was a shifting focus from legislative measures to protect health, to the emergence of improved promotion and prevention strategies, and a general improvement in social and economic conditions for people living in countries such as Australia. Gruszin et al. (2012) consider the range of social and economic reforms of the twentieth century as the most important determinants of the public’s health at the start of the twenty-first century (Gruszin et al. 2012 p 201). The same could not, however, be said for second or third world countries, many of whom have the most fundamental of sanitary and health protection issues still to deal with. For example, in sub-Saharan Africa and in Russia the decline in life expectancy can be said to be related to a range of interconnected factors. In Russia, issues such as alcoholism, violence, suicide, accidents and cardiovascular disease could be contributing to the falling life expectancy (McMichael & Butler 2007). In sub-Saharan Africa, a range of factors, such as HIV/AIDS, poverty, malaria, tuberculosis, undernutrition, totally inadequate infrastructure, gender inequality, conflict and violence, political taboos and a complete lack of political will, have all contributed to a dramatic drop in life expectancy (McMichael & Butler 2007).

Introduction to Public Health [3rd Ed.]

Why is public health important? An Introduction to Public Health is about the discipline of public health, the nature and scope of public health activity, and the challenges that face public health in the twenty-first century. The book is designed as an introductory text to the principles and practice of public health. This is a complex and multifaceted area. What we have tried to do in this book is make public health easy to understand without making it simplistic. As many authors have stated, public health is essentially about the organised efforts of society to promote, protect and restore the public’s health (Brownson 2011, Last 2001, Schneider 2011, Turnock 2012, Winslow 1920). It is multidisciplinary in nature, and it is influenced by genetic, physical, social, cultural, economic and political determinants of health. How do we define public health, and what are the disciplines that contribute to public health? How has the area changed over time? Are there health issues in the twenty-first century that change the focus and activity of public health? Yes, there are! There are many challenges facing public health now and in the future, just as there have been over the course of the history of organised public health efforts, dating from around 1850 in the Western world. Of what relevance is public health to the many health disciplines that contribute to it? How might an understanding of public health contribute to a range of health professionals who use the principles and practices of public health in their professional activities? These are the questions that this book addresses. Introduction to Public Health leads the reader on a journey of discovery that concludes with an understanding of the nature and scope of public health and the challenges facing the field into the future. In this edition we have included one new chapter, ‘Public health and social policy’, in order to broaden our understanding of the policy influences on public health. The book is designed for a range of students undertaking health courses where there is a focus on advancing the health of the population. While it is imperative that people wanting to be public health professionals understand the theory and practice of public health, many other health workers contribute to effective public health practice. The book would also be relevant to a range of undergraduate students who want an introductory understanding of public health and its practice.

Child sexual abuse: Raising awareness and empathy is essential to promote new public health responses

Child sexual abuse is a major global public health concern, affecting one in eight children and causing massive costs including depression, unwanted pregnancy and HIV. The gravity of this global issue is reflected by the United Nations’ new effort to respond to sexual abuse in the 2015 Sustainable Development Goals. The fundamental policy aims are to improve prevention, identification and optimal responses to sexual abuse. However, as shown in our literature review, policymakers face difficult challenges because child sexual abuse is hidden, psychologically complex, and socially sensitive. This article contributes significant new ideas for international progress. Insights about required strategies are informed by an innovative multidisciplinary analysis of research from public health, medicine, social science, psychology, and neurology. Using an ecological model comprising individual, institutional and societal dimensions, we propose that two preconditions for progress are the enhancement of awareness of child sexual abuse, and of empathic responses towards its victims.

Analysis and evaluation of public health policy in Cuba : progress on millennium development goals

[EN] The main objective of this project is to analyze Cuban public health policy and the Millennium Development Goals, especially those linked to the issue of health, presenting their potential and strengths with a well-defined time horizon (2000-2015). The Millennium Development Goals are the international consensus on development and was signed as an international minimum agreement, with which began the century. The MDGs promote various goals and targets, with the corresponding monitoring indicators, which should be achieved by all countries for the present year. Health is an area that is at the center of the Millennium Development Goals, which reinforce each other to get a true human development itself. The research was done through theoretical frameworks of social production of health and disease, social justice and the power structure. A retrospective analysis of Cuban economic and social context is performed in order to study whether health-related MDGs are likely to be completed by the deadline on the island and likewise, the main parameters related to health compared with those of the neighboring countries in the Americas.

Recommendations on the effects of aquaculture on public health

The paper presents some recommendations on the effects of aquaculture on all persons affected by and involved in aquaculture, and to other users of waters in [which] aquatic organisms are farmed or which are affected by aquaculture: the farm workers, handlers and processors, sellers and consumers of aquaculture products.

Air quality and public health impacts of UK airports. Part I: Emissions

The potential adverse human health and climate impacts of emissions from UK airports have become a significant political issue, yet the emissions, air quality impacts and health impacts attributable to UK airports remain largely unstudied. We produce an inventory of UK airport emissions - including aircraft landing and takeoff (LTO) operations and airside support equipment - with uncertainties quantified. The airports studied account for more than 95% of UK air passengers in 2005. We estimate that in 2005, UK airports emitted 10.2 Gg [-23 to +29%] of NOx, 0.73 Gg [-29 to +32%] of SO2, 11.7 Gg [-42 to +77%] of CO, 1.8 Gg [-59 to +155%] of HC, 2.4 Tg [-13 to +12%] of CO2, and 0.31 Gg [-36 to +45%] of PM2.5. This translates to 2.5 Tg [-12 to +12%] CO2-eq using Global Warming Potentials for a 100-year time horizon. Uncertainty estimates were based on analysis of data from aircraft emissions measurement campaigns and analyses of aircraft operations.The First-Order Approximation (FOA3) - currently the standard approach used to estimate particulate matter emissions from aircraft - is compared to measurements and it is shown that there are discrepancies greater than an order of magnitude for 40% of cases for both organic carbon and black carbon emissions indices. Modified methods to approximate organic carbon emissions, arising from incomplete combustion and lubrication oil, and black carbon are proposed. These alterations lead to factor 8 and a 44% increase in the annual emissions estimates of black and organic carbon particulate matter, respectively, leading to a factor 3.4 increase in total PM2.5 emissions compared to the current FOA3 methodology. Our estimates of emissions are used in Part II to quantify the air quality and health impacts of UK airports, to assess mitigation options, and to estimate the impacts of a potential London airport expansion. © 2011 Elsevier Ltd.

Diphtheria, the public health response and the origins of the childhood immunisation programme in Ireland

In common with most countries, the childhood immunisation programme in Ireland was founded on a successful public health response to diphtheria. The success of the antidiphtheria public health intervention in Ireland has meant that no case of the disease has been recorded in the state for almost fifty years. This is a significant achievement considering that diphtheria continues to appear annually in many European states, albeit in much reduced numbers on former years. For parents and children of nineteenth, and early twentieth-century Ireland, diphtheria represented the ‘most dreaded disease of childhood’, however, for their modern day counterparts diphtheria is no more than an obscure disease mentioned in leaflets promoting the benefits of childhood immunisation. In Ireland, diphtheria has been consigned to history, and so too have the horrors and mass fatalities once associated with it. But how was this achieved? Was active immunisation received with open arms by public health authorities, the wider medical community, and the general public? This study tackles these questions by undertaking the first historical examination of the issues which underpin the origins of active immunisation in Ireland. It explores the driving forces that shaped the national childhood immunisation programme, and those that opposed them. In addition, it examines the complex social implications attendant on the introduction of this mass public health intervention in an Irish context.

Spatial distribution of bednet coverage under routine distribution through the public health sector in a rural district in Kenya.

Insecticide-treated nets (ITNs) are one of the most important and cost-effective tools for malaria control. Maximizing individual and community benefit from ITNs requires high population-based coverage. Several mechanisms are used to distribute ITNs, including health facility-based targeted distribution to high-risk groups; community-based mass distribution; social marketing with or without private sector subsidies; and integrating ITN delivery with other public health interventions. The objective of this analysis is to describe bednet coverage in a district in western Kenya where the primary mechanism for distribution is to pregnant women and infants who attend antenatal and immunization clinics. We use data from a population-based census to examine the extent of, and factors correlated with, ownership of bednets. We use both multivariable logistic regression and spatial techniques to explore the relationship between household bednet ownership and sociodemographic and geographic variables. We show that only 21% of households own any bednets, far lower than the national average, and that ownership is not significantly higher amongst pregnant women attending antenatal clinic. We also show that coverage is spatially heterogeneous with less than 2% of the population residing in zones with adequate coverage to experience indirect effects of ITN protection.

Fluoridation for dental public health

This article reviews the means by which fluoride is supplied to populations. Many public health authorities provide fluoridated drinking water, with typical concentrations of fluoride of between 0.5 and 1.0 ppm. This has been found to be safe and effective, though differences in caries incidence between fluoridated and non-fluoridated regions are less than they were 50 years ago, because of the wider availability of fluoridated products to the whole population. Concerns about the effect of fluoride on bone density and associated conditions are reviewed and the general conclusion from considering the literature on fluoride is that there is almost no cause for concern. Alternatives to water as a means of delivering fluoride to the general public that are being used in a number of countries are salt and milk. These alternatives are also reviewed and have been shown to give satisfactory levels of protection against caries, though milk is shown to be less satisfactory than water as a vehicle for fluoride delivery. Milk is also less effective in providing fluoride to individuals in the population, and is less likely to be consumed by people in lower socio-economic groups, precisely those who suffer most from dental caries. This study concludes that mass water fluoridation remains an important contribution to good oral health throughout the community.