Unit 1 Lesson 1 PDF

Lesson Tasks ​ Read through the “Getting Started” information provided on the MyLS page for this course. This will familiarize you with the structure of the course, outline how it will proceed from week-to-week, and provide information about...

Lesson Tasks ​ Read through the “Getting Started” information provided on the MyLS page for this course. This will familiarize you with the structure of the course, outline how it will proceed from week-to-week, and provide information about the assignments that you will need to complete. ​ Read this short article: “What is Public Health” (APHA) ​ Watch this short video: “What is Public Health” (5:33) ​ Review the online lesson notes and complete non-graded learning activities designed to prepare you to successfully complete graded assessments ​ Complete the discussion post if you choose. Remember you must complete three discussion posts of your choice this term. Lesson Outcomes After completing this lesson, you should be able to: ​ Describe the term ‘health’ and explain why the idea of health might be more complex than we presume ​ Define the term “biomedical” and explain how it relates to health ​ Define the term “public health” rofessor Kate Rossiter (the developer of this course) offers this message as an introduction. Hello students of HS102! I am writing this to you from home office, where, over the past three years, I have learned to exist in mid-pandemic and post-pandemic world. Meetings that were once in person are still in zoom. My garbage is still filled with masks and other COVID-related detritus. Like all of you, I am sick to death of COVID-related anything, and yet still reeling from the after effects of pandemic life. Over the past 36 months I’ve raced to the grocery store in a panic to stock up on toilet paper and medication, had online gatherings with friends who live a block away, masked, washed, distanced, coped. I’ve struggled with fear and boredom, laughed at absurdity, and raged at incompetence. This, of course, is not how I imagined my life would look. And, of course, you are all in the same boat. We all inhabited that weird reality together, even though it often felt like we were on our own desolate islands. Some of you may even have stories of much more intense hardship: stories of cut hours and lost jobs, of isolation and depression, of illness and loss. So we collectively know what a global public health feels like, but do we really know what public health is, or how it operates? Over the past three years you might have wondered things like: What makes a health issue a public health issue? What is a pandemic, anyway? What gives Doug Ford (or anyone, really) the right to tell us to mask or to stay home? What’s an epidemiologist and where do they get their numbers? What’s the WHO? Why is it so hard to get people to comply with public health orders? How does the vaccine work? What are the limits to how and when we should be forced to get a vaccine or participate in any public health measure? That is what this course sets out to do. It’s the course you wish you’d taken pre-COVID so that you could have sounded like a smarty-pants at your family’s weekly Zoom brunch or win a twitter fight with a complete stranger. We’re going to tackle these questions and more, giving you a broad overview of the field of public health. To do so we’ll address a different facet of public health every week, including public health history, ethics, practice, basic methodology, and application to particular areas like mental health and infectious disease. Most weeks I will illustrate the topic at hand with a particularly juicy public health issue or story. I’ll come back to why in a moment, but before we go further let’s pause so we can all get on the same page about what we mean when we say “public health.” Lesson 1  What is Public Health, and Why Public Health Stories? Okay. So let’s start with the basics. What IS public health, anyway? Authors Bartfay and Bartfay (who wrote the incredibly large tome listed in your syllabus as an optional resource for those of you who find you are just wild about public health) define public health as: …a holistic and evidence-informed discipline that seeks to promote, maintain and/or restore the health and quality of life of individuals, families, communities and/or entire populations over the lifespan through health promotion and prevention and various primary health care initiatives, activities, policies and or legislations. Similarly, the World Health Organization (or, as we will refer to it hereafter, the WHO) more succinctly defines it as “the art and science of preventing disease, prolonging life and promoting health through the organized efforts of society.” These definitions are fine, but a little dry for my taste. There are actually much more exciting ways to think about public health, but in order to do so we need to understand that public health is more complicated than the above definitions suggest. Here are some of the factors to consider… Lesson 1 Public Health is an Orientation to Health and Wellness Public health is a way of conceptualizing health issues that focusses on groups of people, or populations. In other words, public health is interested in “seeing” health issues not at the level of the individual, but at the level of the community or population. Further, public health seeks to remedy health issues at the community or population level through large-scale measures that seek to prevent disease and promote health. Lesson 1 Public Health is an Interdisciplinary Field of Study As you are learning, public health is a field of study that incorporates a number of disciplines, including biology and medicine, sociology, statistics, geography, political science, history, law and ethics. Because public health is interested in the health of populations, rather than individuals, it necessarily has to consider both biological mechanisms of disease AND social dynamics and human behaviour. In some ways, this is the public health story: how does the mix of disease factors and human factors play out across large groups of people? Because of this, each of these disciplinary strands provides important intel on how these dynamics might play out. Lesson 1 Public Health is a Type of Professional Practice We often talk about “public health” as if it were a monolith or some kind of shadowy secret society pulling the strings of government action (y’know, like “ugh - public health says we can’t leave our houses for the next month”). In reality, “public health” as an occupational category is made up of many different kinds of professionals who form a loosely-connected occupational network that does the work of public health in a particular region. Some, like health promoters and epidemiologists, are people specifically trained in public health who do the work of designing and measuring public health interventions for a particular community or group. Others, like doctors, nurse practitioners or midwives, are clinical practitioners who apply a public health lens to their work – for example, by practicing preventative, holistic forms of care with individual patients. Finally, some are policy makers and administrators who, like clinicians, may use a public health orientation in their work to design policy measures that promote and support the health of a population. To sum up: public health is a way of thinking about wellbeing that considers dynamics of illness, wellness and disease at the population level. Here we need to pause to explain the idea of population. A population, in this instance, means an aggregated group of people. To understand the health of a population, we have to measure and report everyone’s health status collectively, which means that individual experiences of health or illness are folded into an analysis that considers the overall health of the group. This is key to a public health perspective. So, for example, we might look at mortality rates for women and men. Women in Canada live, on average, for about 82 years. Men about 77. Now, this of course doesn’t mean that every woman in Canada will live until she is 82 then drop dead. Some will live much longer lives, some much shorter. However, we frequently use the idea of life expectancy – a metric that reflects a theoretical average age of death in a given population based on population-level characteristics – to describe the average age of death across the population. While life expectancy doesn’t reflect individual age of death, and nor does it predict when death will occur for an individual, it provides a useful population level metric regarding overall wellbeing. In order to understand health at a community or population level, public health draws on multiple fields of study to create a complex picture of how disease might unfold in particular groups or communities, and works to intervene at the community level to prevent or mitigate health issues before they arise. Still not hooked? Ok – consider this story: In 2017, a little boy from a nomadic group of people in Russia’s far north died of mysterious causes. Following this, 71 members of his community also became ill. Why? Because scores of dead human and reindeer carcasses, lodged in permafrost for decades, suddenly began to thaw (insert horrified climate change emojis here), bringing to life long-frozen microbes including anthrax, which found its way into local drinking water, thus poisoning the members of this group. (Read full story here.) Come ON. That’s a good story. It’s got mystery! It’s got pathos! It’s got weird microbes coming back to life! It’s also got some science (climate change) some medicine (diagnosis and treatment of anthrax), some geography (far northern climate, warming permafrost), some sociology (social dynamics of this particular group), some politics (how to manage the threat to this land and its people) and so forth. It’s a public health story. That’s why we will use stories like this to help us unpack what we are learning this semester: because at heart, the thing that is most compelling about public health are the fascinating, complicated, weird and yes, often gross, stories that emerge when we look at the world with a public health lens. Before we dive in, though, let’s unpack a few more important terms.  Lesson 1 What is Health? I’ve been throwing this term around a lot over the past few pages, so it might seem strange to circle back to define it. Because we all know what health is! It’s a no brainer! Right?? At least, it SEEMS like a no brainer…. So, uh, what IS health, anyway….? …take your time…I’ll wait right here… Ok, so it turns out that “health” as a concept is a little trickier to define than we might think on first glance. The WHO defines health as “a state of complete physical, mental and social wellbeing.” That’s fine, but wow is it broad! Within this definition, can any one of us truly claim to be healthy? We tend to start with the idea that health is an absence of illness: so health = not being sick. But when we start to think about it a little harder, there are some problems with this definition. Consider the following complexities: What about someone who is not actively ill but who lives in unhealthy circumstances – a slum, for example, or a war-torn country – can this person truly count as “healthy?” What about someone who is not actively ill but who harbours some trait that might make them ill – a genetic predisposition to disease (e.g., breast cancer), or a latent version of the disease (e.g., tuberculosis)? What about someone who is not physically ill but who suffers from mental illness – which can’t be diagnosed in terms of finding a germ or a virus, but rather is based solely on (very real) symptoms? On the flip side, what about someone who suffers from a chronic illness or a disability but who lives a happy, productive life? Who are we to define this as ‘unhealthy’? How do we understand the difference between pain and illness? And what if someone is technically ill but not in pain – are they healthy in some respects? Annoyingly complicated! So before narrowing ourselves down to a single pithy definition, let’s give the idea some contours to help us think in a more nuanced way about the subject. These include the following:  ​ Health, at minimum, has to do with how well we feel and how capable we are of managing our daily lives ​ Health has to do with wellbeing: one’s perception of whether one is healthy or not. ​ Health is not just individual, but is linked deeply to our social lives and our communities. ​ Health has to do with our bodies and our physical health, but also our minds and our mental health. ​ Health is a resource, rather than a state. In fact, the Public Health Agency of Canada (PHAC from here on out) provides a nice, if not pithy, summation of this approach to understanding health: The population health approach recognizes that health is a capacity or resource rather than a state, a definition which corresponds more to the notion of being able to pursue one's goals, to acquire skills and education, and to grow. This broader notion of health recognizes the range of social, economic and physical environmental factors that contribute to health. The best articulation of this concept of health is "the capacity of people to adapt to, respond to, or control life's challenges and changes" (Frankish et al., 1996). You’ll notice that these definitions do not include anything about illness or disease (i.e., physiological breakdown or malfunction) in this list. This is purposeful. In keeping with a public health orientation, I want our definition of health to be broad and inclusive. However, in order to understand the connection between health and illness, it’s important for us to unpack one last term: biomedicine. Figure 1.1. When you do a google image search of “healthy person” it comes up with some variation of this: a serene white lady out in nature in a vaguely yogic pose (trust me – I’ve done this a number of times). Why?? What does this lady have to do with health, or perhaps more importantly, what does this lady have to do with our perception of what health is? What does this image say, and what does it obscure, or leave out? Image by Emma Peneder, retrieved from Unsplash, Unsplash License. Lesson 1 What is Biomedicine? As I’ve noted, our idea of health is, at present, strongly linked to the idea of biomedicine. Next lesson we will talk about how ideas of health and illness have shifted over time, and will talk about the birth of the biomedical paradigm, but for now let’s just focus on biomedicine itself. Biomedicine is the predominant modern, western conceptualization of the body and bodily functions and systems. Biomedicine is rooted in modern scientific practice and method (i.e., experimentation and careful observation). A biomedical approach takes the body, and its responses to stressors and stimuli, as a predominantly mechanistic and biological entity. Biomedicine is rooted in the idea of the body as a machine whose systems and responses are regular and predictable. In this sense, biomedicine conceptualizes illness as a disruption of bodily systems, and health is conceptualized as a return to a state of bodily order. While biomedicine and public health are not entirely disconnected – for example, public health relies on biomedical diagnostic approaches and criteria in order to make sense of particular health issues – there are a few important facets of a strictly biomedical approach that are different from a public health approach. These include the following: ​ Biomedicine often approaches health from an individual perspective. This is to say that biomedicine thinks about health as an individual, rather than collective, issue. ​ A biomedical approach often focuses on cures and treatments after illness has occurred. ​ Biomedical approaches tend to be interested in the biology of illness, rather than the social roots of illness. ​ Biomedical approaches are often increasingly technological. ​ Biomedicine is often interventionist, meaning it inserts itself at the level of the individual in order to treat or cure. A helpful analogy here might be that of a car and a mechanic. A biomedical approach thinks about the body the way one might think about a car – a complex machine that needs particular kinds of care in order to run optimally. In particular, cars need good fuel, frequent tune-ups and oil changes, and a decent mechanic to give it its longest possible life. Similarly, a biomedical approach to health and longevity might argue that bodies need good food, exercise, regular visits to the doctor and a good health care system in order to achieve a long, healthy life. While this is, of course, a highly reductionist analogy, I use it to point out the differences between a strictly biomedical approach to health, and a public health approach. While public health certainly relies on biomedicine for some things, a public health approach is also deeply rooted in understanding health from a social perspective. Thus, public health approaches intrinsically link health to the social world, and, as such, thinks about interventions at the level of the community, rather than simply at the level of the individual. Finally, public health approaches are often not technological, but rather have to do with widespread social and political change through mechanisms like policy and health promotion. Stay tuned for more on both of these! Lesson 1 Learning Activity: Public Health Objects In 2016 Johns Hopkins University (JHU) compiled a list of 100 objects that have shaped public health. In this exercise, I would like you to look through these objects and choose four that are of interest to you. Using the knowledge that you have gained in this class about public health, please consider each of these images and make some notes about how you think these objects may have shaped public health over the last century. When you have finished making your notes, please click to reveal the explanation provided by JHU. What did you get right? What in the JHU explanation surprised you? What did you guess that JHU missed? Here are some thoughts on a few items that I found particularly interesting: 1.​ Birth certificate​ ​ Explanation:​ JHU writes:​ “This piece of paper does more than help you get a driver’s license or passport; it is a window into the health of a population. While only in wide use in the United States for a relatively brief period of history, birth certificates — and other vital records documenting life events such as marriage, divorce and death — shed light on a range of health concerns. For example, U.S. birth records have shown a dramatic decrease in births to teen moms over the past 25 years and documented profound racial and ethnic disparities in birth weight and prematurity. Not all countries keep birth records, a data gap that public health researchers would like to see filled.”​ It is astonishing to me that this kind of record keeping, which is absolutely invaluable for monitoring the health of a population is such a new invention. These kinds of records have only been kept over the last few centuries, but are deeply important to understanding ourselves as a population. 2.​ American Cheese​ ​ Explanation:​ Like many public health interventions, the road to hell is paved with good, if highly processed, intentions. While processed cheese has fallen out of favour in terms of public health, the original intention behind processing food was to make food both available for mass consumption and to make it safer from pathogens found in dairy products and foods like meat and fruit. Prior to food processing humans were at the mercy of invasive organisms  like salmonella, bovine tuberculosis, and a variety of parasites. However, we now know that the processing itself (which involves adding fats, sugars, salt and other substances) robs food of its original nutritional value, even as it prolongs shelf life and makes food much cheaper. Further, processed foods are heavily packaged and contribute to the accumulation of plastics globally.​ Can you think of other public health inventions or interventions that have, in the end, caused unexpected population level health issues? I think about the enormous amount of medical waste (including disposable masks) created by the pandemic response...I wonder what impact this will have. 3.​ Glow in the Dark Watches​ ​ Explanation:​ JHU writes: ​ “The 1898 discovery of radium by Marie Curie and her husband was an exciting breakthrough; the element’s glow-in-the-dark quality captured the public imagination. A decade and a half later, Sabin Arnold von Sochocky pioneered radium-laced paint, which was used on soldiers’ watches and aircraft instruments. In applying the paint, female factory workers hired by U.S. Radium Corporation began licking their brushes to aid with painting the fine details of the dials.​ By the 1920s, several “Radium Girls” died of radium poisoning and the darker side of the element became clear. (Von Sochocky would be killed by radium, as well). Survivors filed lawsuits against U.S. Radium Corporation, which eventually led to new worker safety laws that sought to hold companies accountable for worker health and wellbeing. Today’s glow-in-the-dark watches use safe phosphorescent materials and are not a public health threat.”​ Once again, file under “wish we’d known sooner….” However, this case also illuminates (see what I did there?) some other important public health issues. This case was essential for occupational health laws in the United States and beyond. Too often people who are considered disposable or expendable (in this case working class women) are subject to working conditions that are profoundly harmful to their health. One of the ways we can manage occupational public health threats is through laws and regulations that place limitations on workplaces and regulate working conditions. Stay tuned – Lesson 8 takes a deep dive into this area! 4.​ Automobiles​ ​  Explanation:​ What would we do without cars?! ​ Quite a bit, actually.​ Automotive transportation is ubiquitous and, arguably, has dramatically changed the face of public health. This includes facilitating much more sedentary lifestyles, contributing to climate change through fossil fuel consumption, and, of course, to car accidents. While we have normalized the impact of automotive-related injuries and fatalities, they comprise a rolling public health disaster, claiming thousands and thousands of lives per year. This threat has, of course, been mitigated by regulations such as speed limits, traffic regulations, seatbelt requirements, and increased car safety, however, automobile travel remains inherently risky and has real repercussions for population health and safety. Lesson 1 Conclusion In this introductory lesson my goal was to introduce you to a few key building block terms, specifically “health,” “public health” and “biomedicine.” In particular, I want you to pay attention to how these concepts overlap and how they differ. For the purposes of this class we will be focussing largely on public health, and expanding our understanding of this field. Of critical importance are the following distinctions: public health takes community or population-level perspective in terms of health and wellbeing; as such, the primary goals of public health are to protect and promote health and preventing disease. And if this sounds dry, I promise you that it is not. Stay tuned for next week’s lesson which features festering dung hills the size of houses and the slightly accidental discovery that rotting corpses and birthing mothers are not (gasp) a healthy mix….