MEDF1021 Public Health and Healthcare Ethics (CUHK) 2024 Fall Lecture Notes PDF

MEDF1021 Public Health and Healthcare Ethics An Introduction to Public Health Prof. Roger Chung Associate Professor, JC School of Public Health & Primary Care...

MEDF1021 Public Health and Healthcare Ethics An Introduction to Public Health Prof. Roger Chung Associate Professor, JC School of Public Health & Primary Care Co-Director, Centre for Bioethics Associate Director, Institute of Health Equity The Chinese University of Hong Kong Sept 4, 2024 2024 Roger Y. Chung, CUHK  Lecture Outline What is health? What is public health? Development of public health  Why are you here? 1. [Pure intellectual curiosity] Wondering what public health is… 2. [Interests] Interested in public health-related topics… e.g. COVID-19, SARS, avian flu, disease prevention, health promotion/protection, environment, health policy, etc. 3. [Career plan] Looking for a career in public health 4. [Dream] You want to “be the one to make a difference!” (SPHPC motto) 5. [Forced to] Here for the credits! 2024 Roger Y. Chung, CUHK  Public Health Careers Medically related: – Public Health Doctor Policy and practicum related: – Legislative policy advisor – Tropical Disease Expert – Environmental health emergency – HIV Specialist response expert – Medical Doctor – Health communications specialist – Management Policy Advisor – Public Health Information Officer – Family Health Doctors – Public Health Consultant – Reproductive Health Specialist – Emergency Preparedness Coordinator Science/research: – Emergency Preparedness Specialist Other health-related – Professor – Consumer Safety Officer careers: – Behavioral Scientist – Behavioral Health Program ‒NGO Coordinator ‒Health Promotions Program – Mental health researcher – Health and Wellness Managers Coordinator – Program outcomes researcher – Public Health Planner ‒Nutritionist – Vaccine researcher – Community Health Worker – Bioterrorism researcher ‒Public Health Veterinarian – Pharmacoepidemiologist ‒Public Health Lawyer – Epidemiologist ‒Public Health Dentist – Infection preventionist Education: ‒Public Health Engineer – Biostatistician ‒Health Center Administrator ‒ Nurse educator – Disease Ecologist ‒Industrial Hygienist ‒ Academic policy advisor ‒Environmentalist – Medical Writer ‒ Health Teacher ‒Medical Investigator – Environmental Health Technician ‒Public Health Journalist – Disaster Preparedness Researcher 2024 Roger Y. Chung, CUHK  Public Health 2024 Roger Y. Chung, CUHK  What is Health? 2024 Roger Y. Chung, CUHK  What is Health? How would you define “being healthy”? Distributive? 2024 Roger Y. Chung, CUHK  What is Health? Social value? – E.g. Drapetomania 2024 Roger Y. Chung, CUHK  What is Health? Adaptive? – E.g. Oscar Pistorius 2024 Roger Y. Chung, CUHK  What is Health? Health – “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” (World Health Organization, 1946) 2024 Roger Y. Chung, CUHK  What is Health? In 1986, the WHO further clarified health as… “A resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities.” 2024 Roger Y. Chung, CUHK  What is Public Health? “What we as a society do collectively to assure the conditions in which people can be healthy” Institute of Medicine (IOM) 2024 Roger Y. Chung, CUHK  What is Health? Public – Latin “populus” or “poplicus” : “the people” Health – “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” (World Health Organization, 1946) 2024 Roger Y. Chung, CUHK  What is Public Health? The definition of public health is contested and without a single agreed definition across sectors Differs according to different fields (e.g. government officials, different fields of the government sectors, research and university academics, general population), and is shaped by the interplay with government and wider forces in society Changes by time 2024 Roger Y. Chung, CUHK  What is Public Health? A classic definition: “Public health is the science and art of preventing disease, prolonging life and promoting physical health and efficiency through organized community efforts for the sanitation of the environment, the control of community infections, the education of the individual in principles of personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and the development of social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health.” - Charles Edward Amory Winslow, US public health expert, 1920 2024 Roger Y. Chung, CUHK  What is Public Health? Definition of public health changes over time (reflecting the politics of the time): “The science and art of preventing disease, prolonging life, and promoting health through the organized efforts of society.” – Sir Donald Acheson, British Chief Medical Officer, 1988 “The science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals.” – Derek Wanless, commissioned by the UK Treasury, 2004 2024 Roger Y. Chung, CUHK  What is Public Health? A landmark definition by Institute of Medicine (IOM) (now National Academy of Medicine, USA) “What we as a society do collectively to assure the conditions in which people can be healthy” (IOM, 1988:1). “Although government bears special legal responsibility, this and similar definitions extend to more than just the activities of government, broadly referring to the efforts, science, art, and approaches used by all sectors of society (public, private, and civil society) to assure, maintain, protect, promote, and improve the health of the people.” (IOM, 1988; Last, 1995; Petersen and Lupton, 1996; Acheson, 1998; ASPH, 1999; Kass, 2001; Turnock, 2001). Reference: IOM. 1998. The Future of Public Health. Washington, DC: National Academy Press.; Last J. 1995. Dictionary of Epidemiology, 3rd ed. New York: Oxford University Press; Petersen A, Lupton D. 1996. The New Public Health: Health and Self in the Age of Risk. London: Sage.; Acheson D. 1998. Independent Inquiry into Inequalities in Health. London: The Stationery Office.; ASPH (Association of Schools of Public Health). 1999. Demonstrating excellence in academic public health practice. Washington, DC: ASPH Council of Public Health Practice Coordinators. Available online at www.asph.org/uploads/demon.pdf. Accessed November 3, 2002.; Kass NE. 2001. An ethics framework for public health. American Journal of Public Health 91(11):1776– 1782.; Turnock BJ. 2001. Public Health: What It Is and How It Works. Gaithersburg, MD: Aspen Publishers. 2024 Roger Y. Chung, CUHK 2024 Roger Y. Chung, CUHK 2024 Roger Y. Chung, CUHK  Public Health over Time Starting from Earliest history of public health: In India, Greece, Rome, China… 2,000 BC The start of modern history of public health: government to deal 18th century – 19th with environmental problems associated with rapid economic century growth and urbanization Germ Theory (Louis Pasteur): bacteriology → vaccines and Mid 19th century therapies for specific diseases, safe food and water, infant feeding practices for individuals Reorientation of Public Health to focus on lifestyle: decline of Mid 20th century traditional infectious diseases, more widespread access to health services and public housing (welfare states) The recent changes: 1980s HIV/AIDS: risk of emerging infectious diseases Climate change: environmental risk back on agenda New technology: Genetics and ethics 2024 Roger Y. Chung, CUHK  What is Public Health? “Whereas in medicine, the patient is an individual person, in public health, the ‘patient’ is the whole community or population. The goal of public health is to reduce disease and early death in populations.” - Dan Beauchamp and Bonnie Steinbock Ref: DE Beauchamp and B Steinbock. “Population perspective,” in DE Beauchamp and B Steinbock, eds. New Ethics for the Public’s Health (New York: Oxford University Press, 1999), at 25. 2024 Roger Y. Chung, CUHK  What is Public Health? The 3 functions of public health (The UK Faculty of Public Health, the national professional body): 1. Health improvement: promoting healthy lifestyles and healthy environments and encompassing issues of inequality and the wider social determinants of health 2. Health protection: protecting people from specific threats to their health, including such activities as immunization and vaccination, screening, injury prevention, control of infectious diseases, and emergency planning 3. Health service improvement: bringing an evidence-based population perspective to planning, commissioning, and evaluating services and interventions to ensure they are effective, high quality, safe, and supporting clinical guidance. 2024 Roger Y. Chung, CUHK  Three Domains 三大領域 2024 Roger Y. Chung, CUHK  What is Public Health? The three functions of public health (generally understood): 1. Disease prevention and health promotion 2. Risk/harm reduction 3. Early intervention/treatment 2024 Roger Y. Chung, CUHK  Public Health vs. Medical Care Public Health Medical Care Patient Community Individuals Core functions Disease prevention and Treating ill patients health promotion Contribution to the US Life expectancy increase US Life expectancy increase in population health in 20th century = 25/30 20th century = 5/30 years improvement years (Bunker et al. 1994) (Bunker et al. 1994) Recognition of More abstract More obvious achievements Road to treatment A lot more complicated: Up to patients to accept the political decision comes into doctor’s treatment or not play 2024 Roger Y. Chung, CUHK  Disciplines of Public Health 2024 Roger Y. Chung, CUHK  Health administration, Epidemiology Biostatistics policy and management ◆ Science of Public Health ◆ Study of the ◆ The field combines occurrence and politics, business and distribution of health- science in managing related states or ◆ Application of the human and fiscal events in specified statistics to health- resources needed to populations related problems deliver effective public ◆ Including the study ◆ Used in tandem health services of the determinants with epidemiology ◆ To improve influencing such states, public’s health through and the application of legislative action this knowledge to control the health problems 2024 Roger Y. Chung, CUHK  Health administration, Epidemiology Biostatistics policy and management Public Health Social & Behavioral Environmental Health Nutrition Sciences International / Global Biochemistry & Molecular Health economics Health Biology 2024 Roger Y. Chung, CUHK  Control of Infectious Diseases 傳染病控制 COVID-19 SARS Avian Flu (H5N1) HIV/AIDS Swine Flu (H1N1) Common cold and flu 2024 Roger Y. Chung, CUHK 2024 Roger Y. Chung, CUHK  Control of Chronic Diseases 慢性病控制 CVD 心血管疾病 Diabetes 糖尿病 Cancers 癌症 2024 Roger Y. Chung, CUHK  Environmental Health 環境健康 2024 Roger Y. Chung, CUHK  Food Safety 食物安全 2024 Roger Y. Chung, CUHK  Occupational Health 職業安全 2024 Roger Y. Chung, CUHK  Health Improvement 健康促進 Adolescent and school health 青少年健康及學校衞生 Nutrition and health 營養與健康 Cancer screening 癌症篩查 2024 Roger Y. Chung, CUHK  Global Health Challenges 環球健康的挑戰 Natural disasters 自然災害 Climate change 氣候變化 Migration 人口遷移 2024 Roger Y. Chung, CUHK  Health Services 健康及醫療服務 Health care financing 2024 Roger Y. Chung, CUHK  Infectious How the body How to be healthier? disease (SARS, works (Smoking, eating, flu, etc.) (Biological drinking, exercise) basis of health) What’s going on in health in the world How to do (global health) research (epidemiology/ biostatistic, etc.) Improving our health care service / system About future Work and career environment 2024 Roger Y. Chung, CUHK  A philosophical question: Why do you care about public health? Shouldn’t individuals alone be held responsible for his/her own health? Why is it the right thing to do to care about public health? 2024 Roger Y. Chung, CUHK  Why do you care about public health? To maximize health in society Moral duty Be a good person Collective responsibility: health of the population is beyond one individual’s own responsibility for his/her own health To protect individual’s freedom to enjoy life 2024 Roger Y. Chung, CUHK  THE ORIGIN OF PUBLIC HEALTH (UP TO THE 1700S) 2024 Roger Y. Chung, CUHK  Public Health over Time Starting from Earliest history of public health: In India, Greece, Rome, China… 2,000 BC The start of modern history of public health: government to deal 18th century – 19th with environmental problems associated with rapid economic century growth and urbanization Germ Theory (Louis Pasteur): bacteriology → vaccines and Mid 19th century therapies for specific diseases, safe food and water, infant feeding practices for individuals Reorientation of Public Health to focus on lifestyle: decline of Mid 20th century traditional infectious diseases, more widespread access to health services and public housing (welfare states) The recent changes: 1980s HIV/AIDS: risk of emerging infectious diseases Climate change: environmental risk back on agenda New technology: Genetics and ethics 2024 Roger Y. Chung, CUHK  Early History of Public Health Circa 1000 BC: Practice of inoculation was already developed in India Circa 400-260BC: Yellow Emperor’s Inner Classic – The most ancient Chinese medical text – Fundamental doctrine source for Chinese medicine until today – “The sage does not cure the sick but prevents illness from arising” (預防勝於治療) Circa 27BC – 476AD: Romans understood the necessity to divert human waste as a health and hygienic measure 2024 Roger Y. Chung, CUHK  Mohenjo Daro, Indus Valley (~2,000 BC) Bathrooms and drains were common Streets were broad, paved and drained by covered sewers City planning in rectangular blocks 2024 Roger Y. Chung, CUHK  The Hippocratic Oath 2024 Roger Y. Chung, CUHK  Hippocrates, Greek Physician (460 – 370 BC) Origin of theories about the health of the public 60 ‘Hippocratic’ writings, covering from diagnostics to disease prevention → basis and foundation to modern medicine and modern primary care The “whole patient” approach 2024 Roger Y. Chung, CUHK  The Health = sound balance of the 4 humors – 4 humors that constitute health and disease: blood, yellow bile, black bile and phlegm (publicized by Galen around 2nd Hippocratic century AD and was the conventional medical thinking until 18th century) – Humoral therapy: mixed with diet, exercise, massage and Public other interventions for individual patients (similar to health living and lifestyle in modern day public health) Health Prevalence of disease – With two books Epidemics and Airs, Waters and Places – Linked environmental factors (including social and economic circumstances) to disease and health – Endemic vs Epidemic Endemic: diseases always present in a population (associated with climate, soil, water, mode of life and nutrition) Epidemic: diseases that sometimes became excessive – Strategies to select healthiest sites for colonization 2024 Roger Y. Chung, CUHK 2024 Roger Y. Chung, CUHK  Romans’ Public Health Based their knowledge on Greek Successful as engineers and administrators Roman public baths, public hospitals, employment of city physicians, aqueducts, sewage system → public and personal hygiene Greek and Roman learning of health were translated into Arabic, Syriac, Hebrew 2024 Roger Y. Chung, CUHK  JC School of Public Health and Primary Care The Chinese University of Hong Kong 香港中文大學賽馬會公共衞生及基層醫療學院 2024 Roger Y. Chung, CUHK  Prof Roger Chung, PhD, MHS Email: [email protected] Associate Professor, JC School of Public Health and Primary Care: https://www.sphpc.cuhk.edu.hk/rogerchung Co-Director, CUHK Centre for Bioethics: http://bioethics.med.cuhk.edu.hk/ Associate Director, CUHK Institute of Health Equity Official Website: http://www.ihe.cuhk.edu.hk/ 2024 Roger Y. Chung, CUHK