Unit 11: Changing Perspectives in Public Health

Introduction

The development of the concept of public health has its roots in the Victorian times. However, even prior to this era other measures were developed in keeping communities healthy including the development of sewage systems in Roman times and in early Egyptian medical practice up to 5000 years ago. Public health has evolved with time with an emphasis on the leading health issues of any community at any given time. Significant epidemiological factors have influenced the practice of public health.

Public health focuses on promoting improvements in attitudes to health and lifestyle based upon individual responsibility. There has been a shift in the perspectives of public health linked changing understanding and beliefs of what health means. Health improvement measures are often guided by societal attitudes and changes to health are influenced by government policies that legislate for measures aimed at limiting risk behaviours such as the banning of smoking in public places and increased tax revenues on alcohol.

In this unit, students will consider the evolution of public health over time with particular focus on public health research and development in policies and strategic planning. Students will review the impact of recent public health measures and how changed understanding of health has influenced responses to those measures. It is important that healthcare support staff have a sound understanding of the significance of the role of public health regulatory bodies and skills and knowledge frameworks in promoting health improvements across communities.

Completion of this unit will support progression to more senior roles in public health and to continuing higher education study in subjects related to health research and improvement.

Learning Outcomes - Unit 11: Changing Perspectives in Public Health

By the end of this unit students will be able to:

1 Review the timeline of the development of public health from historical antecedents through to contemporary practice

2 Examine the influence of public health research and policy on current practice in public health

3 Contribute to the implementation of an aspect of current public health strategy within own local community.

4 Explore the roles of public health regulatory bodies in promoting practice and strategies aimed at health improvement.

Essential content

LO1 Review the timeline of the development of public health from historical antecedents through to contemporary practice

Pre-1800s

Early Egyptians – earliest written evidence of medical practice

Early Greeks – causes of disease, Hellenistic approaches to health, Hippocrates –focus on patient rather than disease

Romans – sanitation

Plagues of the Middle Ages – development of reporting of victims with disease and quarantine measures

Urbanisation and industrialisation of the 1800s

Sanitary reform as basis for public health activities aimed at populations Development of legislation to address public health matters Recognition of poverty as significant determinant in health status

Early 1900s

Development in study of microbiology and recognition of bacteria Understanding of impact of environment on community health Understanding of relationship between bacteria and infectious disease Emergence of “new public health”

Stronger focus on social model of health Improvements in public health through reforms Health seen as a person’s individual responsibility

Introduction of welfare systems e.g. in the UK, National Insurance, state pensions, statutory welfare support

 Unit 11: Changing Perspectives in Public Health

Mid-late 20th century

Increased government involvement after second world war Establishment of the World Health Organisation (WHO)Growth in global approaches to tacking public health, International Aid agencies e.g. United Nations World Food Programme, ActionAid, Doctors without Borders Other developments applicable to home nation e.g. establishment of national emergency health services

21st century

Major health advances and health reforms

Impact of political, ideological and demographic changes on national systems of health and welfare support

Focus on major public health challenges, such as smoking, obesity, alcohol –through redefined national and international public health services

Focus on health promotion and health improvement

Other developments as applicable to home nation e.g. in the UK, the establishment of Regional Public Health Departments responsible for the public health agenda and strategy

Definitions of health and wellbeing

World Health Organisation (WHO) definition Other models e.g. social, medical

Influences on public health development

Environmental changes

Growth in knowledge and understanding of the causes of disease

Social changes, the enlightenment: linking disease transmission and protection, the Sanitarians: sanitary reform developments

Political influences from mid-20th century onward, e.g. changes in approach to public service provision Unit 11: Changing Perspectives in Public Health

Global health – migration

Contemporary practice

The reorganisation of public health

Focus on protecting the general health of the public Change and modernisation

Popularisation of non-medically qualified public health specialists Globalisation

Neighbourhood renewal Sustainability

LO2 Examine the influence of public health research and policy on current practice in public health

Influential public health research and strategy

Social Insurance and Allied Services Report (Beveridge, 1942) The Declaration of Alma-Ata (WHO, 1978)

Report of the Working Group on Inequalities In Health: The Black Report (1980) The Ottawa Charter for Health Promotion (WHO, 1986)

Independent Inquiry into Inequalities in Health Report (Acheson, 1998) Other public health research and strategy are relevant in own home nation

Policy development

Health for All (HFA) by the Year 2000 (WHO, 1981) Promoting Better Health (Department of Health, DH, 1987) Other policy developments as relevant to own home nation

Current practice

Guidance documents for best practice, e.g.: Review the timeline of the development of public health from historical antecedents through to contemporary practice

Good Public Health Practice Framework (Faculty of Public Health, 2016)

Current priorities

Reducing preventable deaths and the burden of ill-health associated with smoking, high blood pressure, obesity, poor diet, poor mental health, insufficient exercise, and alcohol

Preventing and recovering from the conditions with the greatest impact, e.g. dementia, anxiety, depression and drug dependency

Protecting the country from infectious diseases and environmental hazards, e.g. the growing problem of infections that resist treatment with antibiotics

Supporting families to give children and young people the best start in life Improving health in the workplace

Tutors should deliver with reference to priorities currently applicable in own home nation or internationally

LO3 Contribute to the implementation of an aspect of current public health strategy within the local community

Public health strategy/local initiatives

Improved health status Reduction in infectious illness Healthy eating

Active living

Promoting improved mental health Screening programmes Immunisation programmes

Tutors should provide examples as currently applicable in own home nation or locality

Strategic planning

Social research

Application of evidence into practice Public health policy

Place-based approach that engages local communities Addressing the wider determinants of health

A life course approach to public health

Promoting a holistic view, total health and wellbeing needs Community profiling

Strategic approaches to partnership working to improve public health Integrated approaches and multidisciplinary approaches Community involvement, e.g. support groups

Developing and maintaining partnerships with the individual, families, communities, the general public and across services

Own role in supporting local strategy

Measures of health improvement Health outcomes improving Reduced health gap

Reduction in morbidity and mortality rates

LO4 Explore the roles of public health regulatory bodies in promoting practice and strategies aimed at health improvement 

Regulatory bodies

e.g. in the UK, Public Health England, Wales, HSC Public Health Agency (Northern Ireland), Faculty of Public Health, Care Quality Commission (CQC) The Institute of Public Health in Ireland (IPH)

Health-related Professional Bodies and Councils

Roles of national agencies

Governmental agency responsible for public health strategy and policy, police, probation services, prison services, fire services, ambulance services Unit 11: Changing Perspectives in Public Health

Roles of regional/local agencies

e.g. Local Authority Care Commissioning Groups ,Social Service Authorities Local Health and Wellbeing Boards, local Health Trusts, local Housing services Review the timeline of the development of public health from historical antecedents through to contemporary practice

Roles of community-based services

Primary and community care services, e.g. GPs, health visiting services, dentists, community health teams, occupational health, community pharmacies, local education providers

Role of the independent and voluntary sectors

Current priorities in improving and regulating public health services

Focus on co-ordinated approaches to education, promotion, protection and improvement

Expansion of health services, e.g. remit Improved public health intelligence Academic public health

Workforce development

Regulatory standards and frameworks

Learning Outcomes and Assessment Criteria

Recommended resources For Unit 11: Changing Perspectives in Public Health

Textbooks

BENNETT, P., CALMAN, K., CURTIS, S. and FISCHBACHER-SMITH, D. (2010) Risk

Communication and Public Health. Second Edition. Oxford University Press.

BUSE, K., MAYS, N. and WALT, G. (2012) Making Health Policy (2nd Ed.) Berkshire: Open University Press.

CONNER, M.and NORMAN, P. (2005) Predicting Health Behaviour (2nd Ed.) Maidenhead: Open University Press.

CORCORAN, N. (2011) Working on Health Communication. Los Angeles: Sage.

COSTELLO, J. and HAGGART, M. (eds.) (2003) Public Health and Society. Basingstoke: Palgrave Macmillan.

NAIDOO, J. (2005) Public Health and Health Promotion: Developing practice (2nd Ed.)

New York: Bailliere Tindall. Review the timeline of the development of public health from historical antecedents through to contemporary practice

ORME, J. (2007) Public Health for the 21st Century: New Perspectives on Policy, Participation and Practice. Open University Press.

Websites

www.fph.org.uk                                 Faculty for Public Health

1. Good Public Health, Practice framework 2016

(Report)

1. Public Health Today (Online journal)

www.gov.uk Public Health England Strategic Plan 2016-20 (Report)

www.globalhealth.thelancet.com    The Lancet

Changing the perspective: from disease control to healthy people

(News article)

nice.org.uk Public Health Guidance (Guidance)

Pearson BTEC Levels 4 and 5 Higher Nationals in Healthcare Practice –

Links

This unit links to the following related units:

Unit 1: Law, Policy and Ethical Practice in Health and Social Care

Unit 5: Health Education in Action

Unit 8: Addressing Health Inequalities

Unit 14: Sociological and Psychological Perspectives on Health

Unit 24: Health Psychology

Unit 27: Social Policy in Public Health

Unit 28: Holistic Approaches to Health Promotion Unit 34: Global Health and Wellbeing

This unit maps to the qualification Practice Themes as below:

Essential requirements

Case study material is essential and can be provided by the tutor or based on students’ work situations.

Delivery

Tutors must be appropriately qualified and experienced in the health and social care sector to cover the principles and skills development aspects of this unit.

Assessment

Students must be given time to develop their workplace experience, knowledge and understanding before assessment of this unit. They will be expected to present evidence based substantially on their work in health, care and/or support services. Evidence against practice-based criteria can be collated in the Practical Learning and Development Portfolio (PLAD).

Employer engagement and vocational contexts

A letter to employers that briefly outlines the Learning Outcomes of this unit may be helpful to support students’ workplace learning needs. An exemplar letter is given in the PLAD that accompanies this specification.