1. Ozren Polašek

2. Interventions in social medicine  Biologic – vaccines  Behavioral – individual, community  Political – lobbying and advocating  Structural – laws and regulations, norms

3. Biological strategies  Immunizations  Prophylaxis  Improved nutrition  Mother and child health programs  Microbicides  Improved sanitation  Improved water quality

4. Behavioural strategies  Promote lifestyle change  Focus people where they are available – schools and workplaces  Promote immunization programs and other interventions  TV, radio and media public health messages  Promote safe sexual behavior

5. Political strategies  Promote healthy, safe communities  Promote and enforce appropriate health laws and regulations  Promote universal access to health care, especially preventive care  Improve standard of living (e.g., housing) and reduce poverty

6. Basic intervention tools - Glossary  Needs assessment  Prevention  Harm reduction  Immunization and vaccination  Social anxiety

7. Needs assessment  Where we are and where do we want to be

8. Prevention

9. What if you hated the rain?

13. Needle exchange

14. Immunization. Vaccination  Immunization – a process of improving an individual’s immune system  Can be passive or active (vaccination)  Passive immunization – introduction of ready antibodies  Vaccination - admistration of antigenic material to stimulate an individual's immune system to develop adaptive immunity to a pathogen

15. Vaccination  Prevent infection (HPV)  Prevent disease (Influenza)  Prevent transmission and protect community

16. Technical requirements  Must be safe*  Should be easy to administer (e.g., nasal spray, oral)  Must elicit a protective immune response  Must stimulate both humoral and cellular immunity  Must protect against all variants of the agent  Must provide long-lasting immunity  Must be practical to produce, transport and administer

17. Social anxiety as a tool  Useful, but… Too little  No action Just as much  Action Too many  Panic and no action

18. Community intervention  Getting the community to recognize the problem  Getting the community to accept responsibility and implement change  Changing community norms (e.g., smoking, condoms)

30. 10,001 Dalmatians  The Croatian Biobank  Research resource, but also a health intervention  People are invited and are free to accept the invite or reject it  Those who approach the site are offered a number of examinations (blood, urine, ECG, DEXA, spirometry, …)

34. Increasing participation  Postal invites  Radio appearance  Phone calls  Local newspapers  Direct contact - it’s free, oh great :-/  Offered additional specialist exams (surgeon, ophtalmologist)

35. First fiasco  Sending out the laboratory results

36. … more ideas …  Retired people home  Invited NGOs  Approached informal groups  Leaflets, flyers  Asked friends and relatives for support

37. Response

38. Go out there and intervene…