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The New Public Health


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Table of Contents

Introduction Part 1: Approaches to Public Health 1. Understanding Health: Definitions and PerspectivesIntroductionHealth: the clockwork model of medicineHealth as the absence of illnessMeasuring healthHealth: ordinary people's perspectivesPublic and private lay accountsHealth in cultural and economic contextsSpiritual aspectsHealth: critical perspectiveHealth as `outcomes'Health and place: defining collective healthPopulation versus individual health: the heart of public healthConclusion2. A History of Public HealthIntroductionEra of Indigenous controlColonial legacyTheories of disease causationPublic health legislation and sanitary reformsAustralian responsesStatus quo or radical change?Relearning the nineteenth-century lessons: McKeown and SzreterNation-building eraAffluence, medicine, social infrastructureConclusion3. The New Public Health Evolves IntroductionInternational developments in the new public healthThe 1980s: developing a new public healthThe 1990s: implementing the Ottawa Charter strategiesThe 1990s to twenty-first century: international developments in the new public healthNew century: Commission on Social Determinants of Health-strongreinforcement for the new public healthGlobal health systems to promote the new public healthDoes spending more on care determine health outcomes?Comprehensive primary health care as the basis of health systemsResisting growing medicalisationHealth sector stewardship functionAustralia and the new public health: 1970s to the presentState variation in community health and health promotion in the 1980s1990s: neo-liberalism takes hold in AustraliaHoward's Australia and the impact on the new public healthNational, state and local public health responsibilitiesResearch for the new public healthPreference for selective primary health care and lifestyle health promotionSpecific policy areas in the past 25 years and their fit with the new public healthHow much does Australia spend on public health?ConclusionPart 2: Political Economy of Public Health 4. Ethics, Politics and Ideologies: The Invisible Hands of Public HealthIntroductionPolitical systems and ideologiesTypes of political systemsGrowth of welfare statesEgalitarianism, socialism and capitalismEthical issues in public healthRoots of individualismThe dialectic between individualism and collectivismConsequentialist and non-consequentialist ethicsRights argumentsVictim blamingPublic health policies and individualismSocial-structural and communitarian perspectivesIndividualism and the welfare stateConclusion5. Neo-liberalism, Globalisation and HealthIntroductionWhat is globalisation?What is neo-liberalism?Key institutionsWorld trade system and healthInternational agreements that threaten global healthTRIPS and TRIPS-PlusTrade in Services Agreement (TISA)The impact of transnational corporationsThe impact of neo-liberalism on healthConsumerismThe voices of dissent: civil society movementsBringing the voice of ordinary people from the grassrootsProtest, advocacy and lobbying against international financial and trade institutions`Watching' the global institutionsConclusionPart 3: Researching Public Health 6. Research for a New Public HealthIntroductionLimits to epidemiologyOther forms of knowledge generationNeed to change focus of health researchReflective research practiceUsing previous research findings: systematic reviewsEthical issues in researchDo no harmMethodological soundnessInformed consentPrivacy, confidentiality and anonymityBeing an ethical researcherResearch with Indigenous AustraliansConclusion7. Epidemiology and Public HealthIntroductionWhat is epidemiology?Population epidemiologyClinical epidemiologySocial and eco-social epidemiologyPopular epidemiologyKey concepts and methods in epidemiologyDescriptive studiesAnalytical studiesExperimental designsQuality and error in epidemiological studiesConclusion8. Survey Research Methods in Public HealthIntroductionStrengths of surveysWeaknesses of surveysPlanning and conducting surveysIs the research question amenable to questionnaire or interview survey?What type of survey to use?Selecting respondentsHow many people should be included in a survey?Designing a survey instrumentSurvey fieldworkSelf-completion questionnairesTelephone surveysFace-to-face surveysResponse rates to surveysAnalysis of survey resultsConclusion9. Qualitative Research MethodsIntroductionWhat is qualitative research?Application to public healthQualitative research methodsCase studiesParticipant observationIn-depth interviewingFocus groupsDocument analysisCommon issues of concernAnalysing qualitative dataConclusion10. Planning and Evaluation of Community-based Health Promotion IntroductionPlanning for community-based public health projectsTools for needs assessmentSetting priorities and ongoing planningEvaluation of complex public health initiativesObjectives and outcomesEnsuring a reflective approachMethods for community-based evaluationValidity of evaluationConclusionPart 4: Health Inequalities: Profiles, Patterns and Explanations 11. Changing Health and Illness Profiles in the Twenty-first Century: Global and Australian Perspectives IntroductionData sourcesLife expectancySocial determinants of healthCause of deathDeaths from violence and injuryResurgence of infectious diseasesChronic diseaseDisabilityConclusion12. Patterns of Health Inequalities in AustraliaIntroductionKey factors in health inequalities in AustraliaEffects of socioeconomic statusPoverty, socioeconomic status and healthSocioeconomic statusIncreasing inequitiesUnemployment and healthOccupational illness and injuryIndigenous peoplesRefugees, migrants and healthGender and healthSuicideGender and morbidityLocation and healthRural and remote AustraliaConclusion13. The Social Determinants of Health Inequity IntroductionExplaining socioeconomic status inequities in health statusArefact explanationsTheories of natural or social selectionCultural/behavioural versus materialist or structural explanationsSocial capital, support and cohesion and health inequitiesGender and healthInequities: the case of Aboriginal healthConclusionPart 5: Unhealthy Environments: Global and Australian Perspectives 14. Global Physical Threats to the Environment and Public HealthIntroductionClimate and atmospheric changeEffects of climate change on human healthDirect effects of climate change on human health Indirect effects of climate change on human health Summary: climate change and human health Declining air and water quality Water supply Nuclear power Loss of biodiversity Consumerism, neo-liberal globalisation and the environment Global efforts to address climate change Why don't we take action? Environmental justice Feminism and environmental justice The precautionary principle Conclusion15. Urbanisation, Population, Communities and Environments: Global Trends Introduction Urbanisation Violence and crime Living conditions Crowding and health High density: a health hazard? High density and social disorder High density and environmental sustainability Slums Affluent suburbia: dream or nightmare? Social impact of urban life: from community to anomie? Social capital declining? Transport in urban areas Population, consumption and equity ConclusionPart 6: Creating Healthy & Equitable Societies and Environments 16. Healthy Economic Policies Introduction Challenging economic growth Beyond GDP: indicators of well-being Polluter pays principle Retreat from consumerism Healthier economic options: Keynes, post-carbon and low growth Controlling the transnational corporations From global to local Local action to resist globalisation Fair taxation, income and wealth distribution Trade justice An economy that encourages healthy work Conclusion17. Sustainable Infrastructures for Health, Well-being and Equity Introduction The global framework Sustainable development: oxymoron or salvation? Creating ecologically sustainable and healthy communities Characteristics of healthy and sustainable cities and communities Tensions in creating healthy cities and communities Energy use Reducing fossil fuels use Taming the car Equitable provision of healthy infrastructure Housing Preserving agricultural land and natural spaces The sustainability of rural areas ConclusionPart 7: Health Promotion Strategies for Achieving Healthy and Equitable Societies 18. Medical and Health Care Service InterventionsIntroductionGeneral practitioners Screening Specific screening tests and their effects Effectiveness of screening for behavioural risk factors and follow-up on population healthImmunisation Smallpox Polio Immunisation in Australia Individual risks and social benefits of immunisation The contribution of the health sector to promoting population health and reducing inequity Comprehensive primary health careConclusion19. Changing Behaviour: the limits of behaviourism and some alternativesIntroduction Social learning theory Health belief model Theory of reasoned action Stages of change model Health action model Application of behavioural theories Second generation of heart health campaigns Social marketing Mass media campaigns Health education through entertainment Using social media Criticisms of social marketing Relational, mindful and positive: other approaches to health promotion for individuals Conclusion20. Participation and Health Promotion Introduction Participation in practice Values and principles for participation Participation in health Social media and participation Lessons from participation in health Pseudo or real participation? Types of participation Participation and power Who participates? Issues of representation Citizens or consumers? The role of professionals in participation Effective bureaucratic consultationsConclusion21. Community Development in Health Introduction What is `community'? Community development and social capital Community development and health services Community development: ways of working Dilemmas of community development Conclusion22. Public health Advocacy and Activism Introduction What is public health advocacy and activism? Who are public health advocates and activists? What are key advocacy and activism strategies? Advocacy and activism dilemmas Conclusion23. Healthy Settings, Cities, Communities and Organisations: Strategies for the Twenty-first centuryIntroduction`Settings' approaches to health promotion Bringing about change in healthy settings-based initiatives Political and policy leadership and commitment is essential Encouraging action across sectors Types of partnerships Detailed examples of healthy settings initiatives Legislative frameworks that support workplace healthy settings Healthy settings projects in the workplace Healthy cities and communities WHO's Healthy Cities program Healthy Cities in Australia Healthy Cities: actions for health Settings with a specific focus: obesity prevention in cities and communities Sustainability of healthy settings Critical perspectives on healthy settings approaches Conclusion24. Healthy Public Policy IntroductionWhat is policy?What is healthy public policy? Policy formulation Phases in policy making Approaches to policy formulation Policies and power Healthy public policy in a globalised world Examples of healthy public policy What makes for healthy public policy? ConclusionPart 8: Public Health in the Twenty-first Century 25. Linking the Local, National and GlobalIntroduction Global issues of ecology A just world? Leadership for a healthy future Public health for the brave-hearted Reflective, flexible and eclectic A vision for 2050 ConclusionAppendix: Public Health Keywords Acknowledgements ReferencesIndex

About the Author

Fran Baum is a public health researcher, teacher and advocate. She is the Matthew Flinders Distinguished Professor of Public Health and Director of the Southgate Institute of Health, Society and Equity at Flinders University.

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