THE NEW PUBLIC HEALTH

A WHO meeting in November 1995 on “new challenges for health” reported that the New Public Health was an extension, rather than a substitution, of the traditional pub-lic health. It described organized efforts of society to develop healthy public policies: to promote health, to pre-vent disease, and to foster social equity within a frame-work of sustainable development (Table 2.6). A new,

revitalized public health must continue to fulfill the tradi-tional functions of sanitation, protection, and related regu-latory activities, but in addition to its expanded functions:

The New Public Health is not so much a concept as it is a philos-ophy which endeavors to broaden the older understanding of public health so that, for example, it includes the health of the individual in addition to the health of populations, and seeks to address such contemporary health issues as are concerned with equitable access to health services, the environment, political governance and social and economic development. It seeks to put health in the development framework to ensure that health is protected in public policy. Above all, the New Public Health is concerned with action. It is concerned with finding a blueprint to address many of the burning issues of our time, but also with identifying implementable strategies in the endeavor to solve these problems. [Source: Ncayiyona, et al., 1995.]

The New Public Health is therefore still evolving as a concept or approach drawing on many ideas and experi-ences in public health throughout the world. It is influ-enced by a growing recognition of social inequality in health, even in developed countries with universal health programs, and an acknowledgment of the failure of state-operated health services to cope with dramatic changes in disease patterns affecting their populations. The World Bank evaluation of cost-effective public health and medical interventions to reduce the burden of dis-ease also contributed to the need to seek and apply new approaches to health. The New Public Health synthesizes traditional public health with management of personal services and community action for a holistic approach.

SUMMARY

The object of public health, like that of clinical medicine, is better health for the individual and for society. Public health works to achieve this through indirect methods, such as by improving the environment, or through direct means such as preventive care for mothers and infants or other at-risk groups. Clinical care focuses directly on the individual patient, mostly at the time of illness. But the health of the individual depends on the health promo-tion and social programs of the society, just as the well-being of a society depends on the health of its citizens.

The New Public Health consists of a wide range of pro-grams and activities that link individual and societal health.

The “old” public health was concerned largely with the consequences of unhealthy settlements and with safety of food, air, and water. It also targeted the infectious, toxic, and traumatic causes of death, which predominated among young people and were associated with poverty.

A summary of the great achievements of public health in the twentieth century in the industrialized world is Box 2.15 Millennium Development Goals by 2015

1. Cut poverty by half ($1/day) 2. Universal primary education 3. Gender equality in education

4. Cut child mortality rate and<5 mortality rate by two-thirds 5. Reduce maternal MR 75 percent

6. Reduce HIV/AIDS and malaria 7. Sustainable environment

8. Implement fully sustainable development strategies

TABLE 2.6 Origins and Synthesis of the New Public Health

Classical public health Social ecology Biomedical care Organization and financing To End of Nineteenth Century

Food and personal hygiene Settlement health Quarantine Nutrition/fitness Vital statistics Epidemiology

Sanitation, miasma theory Municipal organization Bacteriology, germ theory Vaccines, immunology Control of infectious diseases Maternal and child health Health education

Church and serfdom Renaissance Agricultural

revolution Improved

nutrition Rise of cities Rights of man Industrial

revolution Labor laws Universal

education Social reform Political

revolution Information

revolution

Basic sciences Clinical sciences Medical education

Hospitals: church, municipal, voluntary, university Specialization Therapeutics Antisepsis Vaccines

Private payment for the rich Municipal doctors for poor Charity, church, voluntary hospital

care

Guilds, mutual benefit, friendly societies for medical, pensions, burial benefits

National health insurance for workers and families

Sick funds and voluntary health insurance

To the 1980s Epidemiologic transition

Declining mortality and birth rates, aging of population Demographic transition Decreasing infectious disease Increase in noninfectious disease International health

Eradication of smallpox

Aging of population Rising

expectations Lifestyle and risk

factors Social inequities Social security The welfare state Governmental

responsibility for health Advocacy Health promotion

Advancing medical sciences Clinical specialization

Diagnostics, imaging, laboratory technology

Therapeutics, antibiotics, antihypertensives, cardiac, psychotropic drugs Preventive medicine Home care Long-term care

Hospital versus community care Ambulatory surgery

Collective bargaining health benefits

Government responsibility

National health insurance or national health service

Rising costs of health care Imbalance of hospital and primary

care

Health maintenance organizations Cost-benefit evaluation

Rationalization Reforms

2000 and Beyond — The New Public Health Policy coordination

Evaluation of health status Health promotion

Regulation of food, drugs, water, worksite, toxic agents, trauma, environmental risk factors Communicable disease control Control chronic disease Reduce risk factors Special needs groups Mental health Dental health

Health information systems Epidemiologic systems Planning and management

National health policy Resource

allocation Economic

development Social context Social security Ecology and

environment Nutrition and

food policy Healthy public

policy Healthy

communities Intersectoral

cooperation Advocacy Voluntarism Community

participation

University medical schools Postgraduate education Health management training Peer review systems Accreditation Quality of care (TQM) Targeted research

Balance hospital/community care, long-term care, home care, elderly housing, community services Integrated health systems Managed care systems Ethical issues

National health targets Decentralization/diffusion of

implementation District health systems Managed care systems (HMOs) Modified market mechanisms,

regulation of supply, incentives, fee control, competition, managed care Management accountability

Economic assessment Integrated health systems

included in Chapter 1 and throughout this text. These achievements are reflective of public health gains through-out the industrialized world and are beginning to affect policies in countries in transition from the socialist period.

Countries emerging from developing status are also facing the dual burden of infectious and maternal/child health issues along with growing exposure to the chronic diseases of developed nations such as cardiovascular diseases, obe-sity, and diabetes.

The continuing dilemma of health in the impoverished population of the world is addressed in the Millennium Development Goals. Jeffrey Sachs, Director of the Earth Institute at Columbia University and of the UN Millennium Project, states,

“Sixty years ago, at the launch of the World Health Organiza-tion, the world’s governments declared health to be a fundamen-tal human right without distinction of race, religion, political belief, economic or social condition. Thirty years ago, in Alma-Ata, the world’s governments called for health for all by the year 2000, mainly through the expansion of access to primary health facilities and services. While the world missed that target by a long shot, we can still achieve it, at remarkably low cost. Ten key steps can bring us to health for all in the next few years”

(Scientific American, Dec. 2007). Sachs goes on to outline a pro-gram of international aid to help the developing countries of sub-Saharan Africa to reinforce some of the gains and experience of recent years (Box 2.16).

The New Public Health has emerged as a concept to meet a whole new set of conditions — those associated with increasing longevity and aging of the population, with the growing importance of chronic diseases, with inequalities in health in and between affluent and developing societies,

with local and global environmental and ecological damage. Many of the underlying factors are believed to be amenable to prevention through social, environmental, or behavioral change and effective use of medical care.

The New Public Health idea evolved since Alma-Ata, which articulated the concept of Health for All, followed by a trend in the late 1970s to establish health targets as a basis for health planning. During the late 1980s and early 1990s, the debate on the future of public health in the Americas intensified as health professionals looked for new models and approaches to public health research, training, and practice. This helped redefine traditional approaches of social, community, and preventive medi-cine. The search for the “new” in public health continued with a return to the Health for All concept and a growing realization that health of the individual and of the society involves the management of personal care services and community prevention.

The challenges are many, and affect all countries with differing balances, but there is a common need to seek bet-ter survival and health for their citizens.

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Box 2.16 Application of the New Public Health

The New Public Health (NPH) is a comprehensive approach to protecting and promoting the health status of the individual and the society, based on a balance of sanitary, environmental, health promotion, personal, and community-oriented preven-tive services, coordinated with a wide range of curapreven-tive, rehabil-itative, and long-term care services.

The NPH requires an organized context of national, regional, and local governmental and nongovernmental pro-grams with the object of creating healthful social, nutritional, and physical environmental conditions. The content, quality, organization, and management of component services and pro-grams are all vital to its successful implementation.

Whether managed in a diffused or centralized structure, the NPH requires a systems approach acting toward achievement of defined objectives and specified targets. The NPH works through many channels to promote better health. This includes all levels of government and parallel ministries; groups pro-moting advocacy, academic, professional, and consumer

interests; private and public enterprises; insurance, pharma-ceutical, and medical products industries; the farming and food industries; media, entertainment, and sports industries; legis-lative and law enforcement agencies; and others.

The NPH is based on responsibility and accountability for defined populations in which financial systems promote achievement of these targets through effective and efficient management, and cost-effective use of financial, human, and other resources. It requires continuous monitoring of epidemi-ologic, economic, and social aspects of health status as an integral part of the process of management, evaluation, and planning for improved health.

The NPH provides a framework for industrialized and devel-oping countries, as well as countries in political–economic transition such as those of the former Soviet system. They are at different stages of economic, epidemiologic, and sociopolit-ical development, each attempting to assure adequate health for its population with limited resources.

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Measuring and Evaluating the Health of a Population

Introduction Demography

Fertility

Population Pyramid Life Expectancy Epidemiology Social Epidemiology

Epidemiology in Building Health Policy Definitions and Methods of Epidemiology

Rates and Ratios Measures of Morbidity Prevalence Rates Measures of Mortality Social Classification Sentinel Events The Burden of Disease Years of Potential Life Lost

Qualitative Measures of Morbidity and Mortality Measurement

Research and Survey Methods Variables

The Null Hypothesis Confounders Sampling Randomization Normal Distribution Standardization of Rates

Direct Method of Standardization Indirect Method of Standardization Potential Errors in Measurement

Reliability Validity

Screening for Disease Epidemiologic Studies

Observational Studies Experimental Epidemiology Establishing Causal Relationships Notification of Diseases

Special Registries and Reporting Systems Disease Classification

Hospital Discharge Information

Health Information Systems (Informatics) WHO European Region Health for All Database Surveillance, Reporting, and Publication Assessing the Health of the Individual Assessment of Population Health

Defining the Population Socioeconomic Status Nutrition

Environment and Occupation

Health Care Financing and Organization Health Care Resources

Utilization of Services Health Care Outcomes Quality of Care

Self-Assessment of Health Costs and Benefits Effects of Intervention Qualitative Methods

Summary — From Information to Knowledge to Policy Electronic Resources

INTRODUCTION

The history of health, its concepts, and scientific develop-ment have been discussed in previous chapters. Measuring the health of populations is fundamental to improving their health status. Traditionally public health deals with the health of populations, while the New Public Health deals with the health of both individuals and population groups.

This chapter discusses how measurements are used to describe, analyze, prescribe, and justify interventions to protect and improve the health of populations and of indi-viduals and monitor the outcomes of interventions.

The public health professional working with individual and community health needs to acquire the knowledge and skills necessary to measure and interpret the factors that relate to disease and health, both in the individual and in

Dalam dokumen The New Public Health (Halaman 93-99)

SUMMARY

ELECTRONIC RESOURCES

RECOMMENDED READINGS

BIBLIOGRAPHY

Measuring and Evaluating the Health of a Population

INTRODUCTION