1. BCottrell, APHA 2004

2. You may end up somewhere else! If you don’t know where you are going... BCottrell, APHA 2004

3. complete the sentence: “Health is......” In small groups BCottrell, APHA 2004

4. Health is NOT primarily medical

5. Health is a dynamic state of complete physical, mental, spiritual, and social well being and not merely the absence of disease or infirmity. World Health Organization, 1998 BCottrell, APHA 2004

7. QUESTIONS  Describe what you see  What is the problem?  Where/How does this happen in real life?  Why?  What can be done?  Who will do it?

8. T. McKeown, The Modern Rise of Population (New York Acedemic Press, 1976} p. 93 Standard Of Living Immunization Generally Available

9. Reclaiming Our History: Equity and Public Health PUBLIC HEALTH as a modern institution arose as a response to industrialization. Historic advances in health status resulted from its actions… Abolition of child labor Shortening the work day Reductions in scale of poverty Minimum wage Improved sanitation Food safety Adequate housing Did more to reduce death and disease than medicine or immunizations Did more to reduce death and disease than medicine or immunizations (Adapted from Doak Bloss, Ingham Country Health Department, 2005)

10. Reclaiming Our History: Equity and Public Health Today, PUBLIC HEALTH has moved toward a more managerial and technical role Categorical, funded programs Regulatory compliance functions Solving discrete health problems At the same time, widening and persistent inequities have emerged, affecting all of society. At the same time, widening and persistent inequities have emerged, affecting all of society. A biomedical (disease-based) paradigm Public Health is a social enterprise, multidisciplinary by nature. It should naturally embrace a commitment to eliminating health inequities as a goal. Examples of “Trigger Information” (Adapted from Doak Bloss, Ingham Country Health Department, 2005)

11. Ten leading medical causes of death, USA (2001) Heart disease700,142 Cancer553,768 Stroke163,538 Chronic lung disease 123,013 Accidents101,537 Diabetes71,372 Pneumonia and influenza62,034 Alzheimer’s disease53,852 Kidney disease39,480 Blood infections25,192 National Center for Health Statistics, 2004

12. …and Lifestyle Factors Leading to Half of Them Tobacco400,000 Diet, Sedentary lifestyle300,000 Alcohol100,000 Infections90,000 Toxic agents60,000 Firearms35,000 Sexual behavior30,000 Motor vehicles25,000 Illicit drug use20,000 McGinnis. JM; Foege, WH; JAMA 270:18, Nov 1993

13. 10million 7million 3million WHO: Tobacco is the worst human disaster of the 20th century. Annual Deaths Globally 1970 1999 2010

15. Genetics 20% Medical 10% Lifestyle 50% Environment 20% COMMUNITY Natural Environment Social Environment Built Environment Government/ politics Housing Transportation/ mobility Access to Health Care Economy/ Employment Arts/ Culture Community Safety Individual and community Factors that Influence Health

16. Health is a dynamic state of complete physical, mental, spiritual, and social well being and not merely the absence of disease or infirmity. World Health Organization, 1998 BCottrell, APHA 2004

20. Social Structure Class (SES) Culture Gender Discrim. & Expl. Power and Wealth Imbalance Globalization Deregulation of Fin. Markets Labor Market Inequities Lack of Access to Productive Resources & Social Goods Lack of Access to Quality Education Social Exclusion Limited Social Welfare State Social Determinants of Health Lack of Affordable Housing Lack of Access to Transport- ation Poverty and Low Wages Community Social Decay Exposure to Hazards Job Insecurity Psychosocial Stress / Unhealthy Behaviors Inequity in the Distribution of Disease, Illness, and Wellbeing HISTORICALLEGACYHISTORICALLEGACY EXPOSUREPATHWAYEXPOSUREPATHWAY ” ) ( Adapted from Doak Bloss, Ingham Country Health Department, 2005)