Oxford handbook of public health practice

656 Pages·2013·3.178 MB·English

by  Charles Guest, et al

OXFORD MEDICAL PUBLICATIONS
Oxford Handbook of
Public Health
Practice
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Oxford Handbook of
Public Health
Practice
Third edition
Edited by
Charles Guest
Senior Specialist, Australian Capital Territory Government
Health Directorate & Australian National University,
Canberra, Australia
Walter Ricciardi
Professor of Hygiene and Preventive Medicine & Director
of the Department of Public Health, Università Cattolica
del Sacro Cuore, Rome, Italy; President of the European
Public Health Association (EUPHA)
Ichiro Kawachi
Professor of Social Epidemiology & Chairman of the
Department of Society, Human Development and Health,
Harvard School of Public Health, Boston, USA
Iain Lang
Consultant in Public Health, NHS Devon & Senior Clinical
Lecturer in Public Health, National Institute for Health
Research Collaboration for Applied Health Research
and Care for the South West Peninsula (PenCLAHRC),
University of Exeter Medical School, Exeter, UK
1
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1
Great Clarendon Street, Oxford, OX2 6DP,
United Kingdom
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It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide. Oxford is a registered trade mark of
Oxford University Press in the UK and in certain other countries
© Oxford University Press, 2013
The moral rights of the authors have been asserted
First edition published 2001
Second edition published 2006
Third edition published 2013
Impression: 1
All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted, in any form or by any means,
without the prior permission in writing of Oxford University Press,
or as expressly permitted by law, or under terms agreed with the appropriate
reprographics rights organization. Enquiries concerning reproduction
outside the scope of the above should be sent to the Rights Department,
Oxford University Press, at the address above
You must not circulate this book in any other binding or cover and you must
impose the same condition on any acquirer
British Library Cataloguing in Publication Data
Data available
Library of Congress Control Number: 2012946418
ISBN 978–0–19–958630–1
Printed in China by
C&C Offset Printing Co. Ltd.
Oxford University Press makes no representation, express or implied, that the drug
dosages in this book are correct. Readers must therefore always check the product
information and clinical procedures with the most up-to-date published product
information and data sheets provided by the manufacturers and the most recent
codes of conduct and safety regulations. The authors and the publishers do not
accept responsibility or legal liability for any errors in the text or for the misuse or
misapplication of material in this work. Except where otherwise stated, drug dosages
and recommendations are for the non-pregnant adult who is not breastfeeding.
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v
Dedication
Proceeds from the sale of this book will be donated to public health
projects undertaken by Oxfam.
The editors hope that this small text will help any reader to leave the
health of the public in a better state than you found it.
From CSG, to the memory of my brother James, who needed b etter
health care:
They also serve, who only stand and wait.1
From IAL, to GHCL and IJUL, both of whose gestations overlapped with
that of this book.
Reference
1 Milton, J. (1999). When I consider how my light is spent. In: Ricks, C, ed., Oxford Book of English
Verse, p. 168. Oxford University Press, Oxford.
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vi
Foreword to the
third edition
When tackling day-to-day problems in public health it is easy to forget its
spectacular successes. It is also easy to forget that many of the important
advances we now take for granted were not immediately accepted or put
into practice, even if the preventive strategy was surprisingly simple and
highly effective.
A well-known example is Semmelweiss’ demonstration that hand-wash-
ing with chlorinated lime solution prevented ‘childbed fever’. He instigated
the practice in an obstetric clinic in Vienna in May 1847 and showed that
the monthly maternal mortality rate in the clinic fell from 10–20% in the
preceding year to 1–2% in the following year. His fi ndings were dismissed
by the medical establishment, a major reason being that there was no
known mechanism to explain his fi ndings. Increasingly disheartened by his
failure to change practice, Semmelweiss was admitted to an asylum with
severe depression in 1861 and died there in 1865. Only years after his
death was the importance of hand-washing to prevent the transmission of
infections within hospitals widely accepted.
The resurgence of severe hospital-transmitted infections in the last few
decades was in part due to a failure to adhere to what Semmelweiss had
demonstrated so convincingly more than a century before. However,
modern surveillence systems soon identifi ed the emerging epidemic and
re-emphasis on hand-washing with anti-bacterial agents in hospitals has
much reduced the problem.
Nowadays we take the harmful effects of smoking for granted and anti-
smoking campaigns are a core public heath activity. Strong evidence linking
smoking to lung cancer and then to vascular and respiratory diseases was
fi rst published in the early 1950s. But these fi ndings were also dismissed
by the medical establishment, most of whom smoked. It took until about
1970 for there to be widespread acceptance that smoking was a major
cause of ill-heath, and only then did concerted actions start in earnest
against the use, sale, and advertising of tobacco.
In the 21st century smoking is still a major cause of premature death.
In most high-income countries the prevalence of smoking is declining, and
smoking-related mortality has also begun to decline. However, in the more
populous low-income and middle-income countries smoking rates are ris-
ing, and smoking-related mortality is becoming increasingly common.
Despite all that has been achieved there is still a need to convince the
medical profession and the general public of the effectiveness of popula-
tion-based approaches to disease prevention. In Semmelweiss’ time dis-
ease causation was often believed to be the result of imbalances in the
‘four humors’ within the body. Medical texts at the time emphasized that
each case of disease was unique, the result of a personal imbalance, and
that the main role of the medical profession was to establish precisely
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FOREWORD TO THE THIRD EDITION vii
each patient’s unique situation, case by case. Curiously, the current fash-
ion for ‘personalized medicine’ has elements of this type of philosophy.
Public health practitioners thus need to remind the public of how much
better their day-to-day lives are as a result of population-based preventive
measures, and that much can still be achieved from such interventions.
This handbook will stimulate beginners and experts in public health to
improve their practice.
Valerie Beral, DBE, AC, FRS
Professor of Epidemiology
University of Oxford, UK
2012
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viii
Foreword to the
second edition
At some point in their lives, readers of this handbook have no doubt
confronted the same dilemmas that I faced when I chose to retire from
clinical practice to embark on a career in public health. At the time I made
my choice, my senior colleagues alerted me to the strict hierarchy that
exists across the diverse branches of the health sciences. They cautioned
that the prestige of any given specialty within the house of medicine is
inversely proportional to the size of the object it addresses. Hence, if
your chosen fi eld of specialty happens to deal with microscopic objects
like chromosomes and genes, you can be assured of high prestige, as well
as unlimited access to funding. If, on the other hand, your chosen fi eld
happens to deal with the opposite end of the spectrum from genes—that
is, the health of entire populations—then you had better resign yourself
to a life of chronic under-funding, low prestige, and being ignored by the
rest of the world. Treating individual patients (as in clinical practice) lies
somewhere between these two extremes. Clinical practice may not be as
‘sexy’ as genetics, but at least you can be assured of a steady income, as
well as the satisfaction of seeing the fruits of your labour on a daily basis.
By contrast, the translation of public health knowledge into practice often
seems excruciatingly slow, and the results of our interventions are seldom
directly observable at the individual level.
As this handbook illustrates, the public health approach has at its disposal
a powerful set of practices that can transform the health of populations.
Indeed, public health can lay claim to a number of signifi cant victories that
have improved the lives of millions. Thomas McKeown considered that
the major improvements in mortality from infectious diseases during the
last century occurred not through medical advances, but through public
health measures, specifi cally improvements in sanitation and nutrition. The
earliest convincing evidence of cigarette smoking as a cause of cancer was
published by Ernest Wynder in 1953—the same year as the discovery
of the genetic code. Armed with this knowledge (as well as subsequent
epidemiological evidence), public health practitioners have helped millions
of smokers to quit their habit, as well as prevented millions more from
initiating, with the result that countless lives have been saved. It represents
a victory on a scale that few in the molecular fi eld could lay claim to—at
least so far …
There are dozens of textbooks dealing with advanced epidemiological
methods but precious few that focus on the skills needed to practice the
art of public health. This handbook provides a valuable antidote to that
imbalance.
Ichiro Kawachi
2006
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ix
Foreword to the
fi rst edition
Originality, practical focus and comprehensive coverage are not qualities
normally found together in textbooks in the fi eld of medicine and health
care. In public health, the fi eld, at least in Britain, is even thinner.
The editors have pulled off a remarkable feat—meeting these challenges
and drawing together a team of diverse talents to do the thinking and writ-
ing. From values to decision-making, from organizations to people, from
strategy to team-working, the whole of public health practice is conceptu-
alized in a fresh imaginative way.
Readers will see, described in this book, the skills they use day-to-day,
but will seldom recognize themselves, they will identify needs and knowl-
edge gaps that they had not previously acknowledged, and they will fi nd
inspiration in the examples of good practice …
In the Oxford Handbook of Public Health Practice …, you will have found
a true soul mate.
Liam Donaldson
Chief Medical Offi cer
Department of Health
2001
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