Week 1 What is Public Health PDF

GEH1049/GEC1015 Public Health in Action CHIA Kee Seng Professor, Saw Swee Hock School of Public Health Turning Discovery into Healthier Communities 1 Turning Discovery into Healthier Communities 2  COVID19 was not just a pandemic event. We are in a PANDEMIC ERA! Turning Disc...

GEH1049/GEC1015 Public Health in Action CHIA Kee Seng Professor, Saw Swee Hock School of Public Health Turning Discovery into Healthier Communities 1 Turning Discovery into Healthier Communities 2  COVID19 was not just a pandemic event. We are in a PANDEMIC ERA! Turning Discovery into Healthier Communities 3 Influenza-like Pandemics: 1900s to Present Spanish Flu (1918-20) Asian Flu (1957-9) HK Flu (1968-70) SARS (2002-3) H1N1 (2009-10) MERS (2015-) COVID19 (2019-2023 ) 1900 1950 2000 Turning Discovery into Healthier Communities 4  NCDs are slow burns… …but they are BIG FIRES! Turning Discovery into Healthier Communities 5  Public Health Issues One Health Health Promotion Refugees Health Healthcare Financing Universal Health Coverage Health Systems Reform Climate Change and Health Healthcare Management Social Determinants of Health Primary Healthcare International Health Regulations COVID19 Healthcare Manpower … … u e Diabetes Influen ng De za Stroke Hypertension hikungunya Zika C Tuberculosis hyperLipidemia Renal failure Ca nce Heart attacks r Turning Discovery into Healthier Communities 6 Objectives of “Public Health in Action” ✓ Identify the roles of public health in your own lives. What is Public Health? ✓ Define the epidemiological, biological and socioeconomic features What are the biological and non-biological of a disease that provide opportunities for successful interventions factors that or present barriers to success. influence health? How does non-medical disciplines contribute ✓ Describe the interdisciplinary character to Public Health?of public health and the contributions of their own discipline to improving health. Turning Discovery into Healthier Communities 7 GEH1049/GEC1015 What is Public Health? ✓ PH focuses on the population and prevention rather than on patients and treatment. ✓ Public Health deals with the prevention and management of epidemics (IDs and NCDs). ✓ Public Health takes a multi-sectoral and multidisciplinary approach. CHIA Kee Seng Professor, Saw Swee Hock School of Public Health Turning Discovery into Healthier Communities 8 Health - Disease Continuum When is a person sick? Can the patient feel it? Symptoms and Signs + Can the doctor measure it? Signs -; Tests + BIRTH DEATH Pre-Clinical Disease Clinical Disease Complications Symptoms - - - Symptoms + + + Symptoms + + + Signs - Signs + + + Signs + + + Screening Tests + + Clinical Tests + + + Clinical Tests + + + Turning Discovery into Healthier Communities 9 How good is a screening test? DISEASE Predictive Yes No Value (PV) PPV Yes a b SCREENING a/(a+b) TEST NPV No c d d/(c+d) Sensitivity Specificity a/(a+c) d/(b+d) Turning Discovery into Healthier Communities 10 Who should be screened? Should screening start at 30 or 50? Higher PPV Turning Discovery into Healthier Communities 11 Does screening make a difference? Screening shortens lifespan Screening makes no difference Screening extends lifespan Pre-Clinical Disease Clinical Disease Complications Turning Discovery into Healthier Communities 12 Turning Discovery into Healthier Communities 13  Primary Secondary Tertiary Prevention Prevention Prevention Effective treatment to Prevent onset of disease, Screening: early diagnosis delay the onset of keeping the population and effective interventions complications and death. healthy. Health Protection to delay the onset of Rehabilitation to improve and Health Promotion clinical disease. the quality of life. BIRTH DEATH Pre-Clinical Disease Clinical Disease Complications PUBLIC HEALTH MEDICINE Population Patient National Perspective Institutional Perspective Health Protection and Promotion Treatment and Rehabilitation Turning Discovery into Healthier Communities 14 BMI and Body Fat 31 40/Male 30 29 28 27 26 25 % Body Fat BMI White BMI Chinese BMI Malay BMI Indian Adapted from: Asians are different from Caucasians and from each other in their BMI/body fat percent relationship. Obes Rev 2002;3(3):141-146 Turning Discovery into Healthier Communities 15  Obesity Prevalence, 1992-2010, Singapore 30 BMI>=30kg/m2 BMI>=27.5kg/m2 Age-standardized Prevalence (%) 22.5 15 Singaporeans 7.5 are obese! Females Total We just hide it Males well! 0 1992 1998 2004 2010 1992 1998 2004 2010 Turning Discovery into Healthier Communities 16  Obesity and overweight trend by age groups 4 20-29 30-39 40-49 50-59 60-69 All Prevalence Ratio 3 15.7% 22.9% 2 24.7% 27.2% 19.9% 1 5.8% 10.1% 15.0% 15.8% 20.1% 0 4 20.4% Males Prevalence Ratio 3 29.2% 2 26.4% 24.3% 16.9% 1 5.6% 10.3% 13.8% 15.2% 14.4% 0 4 Females Prevalence Ratio 3 2 11.1% 17.1% 30.2% 23.1% 1 22.9% 6.0% 9.8% 16.3% 16.4% 25.6% 0 '92 '98 '04 '10 '92 '98 '04 '10 '92 '98 '04 '10 '92 '98 '04 '10 '92 '98 '04 '10 Turning Discovery into Healthier Communities 17 Projected Number of Diabetics in 2050 Prevalence of Diabetes (Total Population) 25 1,000,000 diabetics 20 Aging and 15 Obesity 460,000 diabetics 10 Aging only 350,000 5 diabetics 1990 2000 2010 2020 2030 2040 2050 * Projections by School of Public Health @ NUS; First Singapore International Public Health Conference, 1 Oct 2012 Turning Discovery into Healthier Communities 18 Complications of diabetes Damage to small vessels Damage to large vessels Turning Discovery into Healthier Communities 19 Biomedical view of the causes of obesity MICROBIOME Humans Have Ten Times More Bacteria Than Human Cells: How Do Microbial Communities Affect Human Health? Epigenetics Energy OBESITY Intake >>> Output Metabolism HPA Appetite GENES Turning Discovery into Healthier Communities 20  Tackling Obesities: Future Choices – Project Report. UK Government Office for Science, 2007 Turning Discovery into Healthier Communities 21  If the 2013-2017 Prevalence of Obesity, Singapore plateau is 15 sustained, there will only be 600,000 diabetics in 2050. COVID-19 10 showed that the measures thus Prevalence (%) far have not resulted in a deep-seated internal 5 conviction about healthy living. Need for new strategies to achieve deep 0 changes. 2000 2010 2020 2030 Turning Discovery into Healthier Communities 22 Paradigm Shift: Deep Change Traditional KNOWLEDGE Digital Behaviour ATTITUDE Value Knowledge Nudges Attitude BEHAVIOUR Incentives Turning Discovery into Healthier Communities 23 We live like we value wealth more than health... Schooling Building habits and skills to create wealth. Working Pursuit of wealth, often at the expense of health. Retirement Ill-health and frailty in spite of wealth. Turning Discovery into Healthier Communities 24 The next generation need to value health as much as wealth 0 30 60 90 Building Creating Enjoying Developing habits Creating wealth and Resilience in wealth and skills to create health together and health wealth and health. Turning Discovery into Healthier Communities 25 Paradigm Shift: Deep Change Traditional KNOWLEDGE Digital Behaviour ATTITUDE EMOTIONS Value Knowledge Nudges Attitude BEHAVIOUR Incentives Turning Discovery into Healthier Communities 26 Summary ✓ Public Health focuses on the population and prevention rather than on patients and treatment. ✓ Public Health deals with the prevention and management of epidemics (infectious diseases and non-communicable diseases). ✓ Public Health takes a multi-sectoral and multidisciplinary approach to address a health problem. Turning Discovery into Healthier Communities 27