Public Health and Society

187 Pages·2003·0.986 MB·English

by  John Costello, Monica Haggart (auth.)

Public Health
and Society
John Costello
Monica Haggart
Public Health and Society
Public Health and
Society
John Costello and Monica Haggart
Selection,editorial matter,preface © John Costello and Monica Haggart
Foreword © Dr Stephen Watkins
Individual chapters in order © Joel Richman;Ron Iphofen;Ross Brocklehurst
and John Costello;John Costello,Joel Richman and Louise Wong;
Maryam Spanswick;Martin King;Maria Horne;John Costello;and
Monica Haggart 2003
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Contents
List of Figures and Tables ix
Foreword x
Preface xii
Acknowledgements xv
Notes on the Contributors xvi
Part I Public Health and Nursing:
Origins and Development 1
1 Holding Public Health Up for Inspection 3
Joel Richman
Introduction 3
Differing Perspectives on Public Health 4
What is Public Health? 5
The Meaning of Public Health 6
Perceptions of Public Health 7
The Origins of Public Health: Historical Perspectives 8
What Is New About the Public Health Movement? 16
Lay Beliefs and Public Health 17
The Future for Public Health 19
Conclusion 20
2 Social and Individual Factors Influencing Public Health 23
Ron Iphofen
Introduction 23
The Influence of Social Structure 24
Methodological Problems 25
Power and Political Resources 26
The Influence of Culture 27
Mediating Factors 29
Individual Action 29
Costs and Benefits to Individuals and to Groups 31
Public Health Policy 34
v
vi Contents
The Mediating Role of the Health Professional 36
Conclusion 38
3 Health Inequalities: the Black Report and Beyond 42
Ross Brocklehurst and John Costello
Introduction 42
Public Health and Social Change 43
The Need for a Welfare State 44
Health, Social Inequalities and Entitlement 44
The NHS and Health Inequalities 46
Why Health Inequalities Persist 46
The Influence of Social Class and Employment on Health 47
The Black Report 48
Explanations for Health Inequalities 50
Beyond the Black Report 53
Health Divide Revisited 55
Why Do Inequalities in Health Persist? 57
Conclusion 58
Part II Public Health and Control: Social Responsibility
for the Promotion of Health 61
4 Public Health Issues in Diverse Ethnic Groups 63
John Costello, Joel Richman and Louise Wong
Introduction 63
Ethnic Minorities 64
Culture and Health 65
Closed and Open Networks 67
The Ethnic Minority Experience of Living in Britain 68
Ethnicity and Race 70
The Problem of Multiculturalism in Britain 70
Globalisation 71
Global Public Health 72
Conclusion 81
5 Access to Health Care: Vulnerable Groups in Society 83
Maryam Spanswick
Introduction 83
Vulnerability – its Definition and Characteristics 84
Poverty and Economic Inequality 88
Control 91
Social Support 92
Contents vii
The Public Health Dimension 94
Conclusion 96
Further Reading 98
6 Promoting Public Health: Media Constructions and Social
Images of Health in a Post-modern Society 100
Martin King
Introduction 100
Mass Media and Health 101
Mass Media and Public Health 102
Case Studies 105
Conclusion 112
Part III The Professionalisation of Public Health:
Current and Future Perspectives 117
7 Identifying the Health Needs of Communities and
Populations 119
Maria Horne
Introduction 119
Conceptual Dilemmas 121
Participatory Approaches to Health Needs Assessment 125
Collaboration 129
Conclusion 130
8 Social Exclusion and Public Health 133
John Costello
Introduction 133
Social Exclusion and Public Health 135
Understanding Patterns of Social Exclusion:
a Case Study Approach 140
Characteristics of Social Exclusion 142
Social Exclusion and Mental Health 144
People with Learning Disabilities 146
Why Are People Socially Excluded? 147
Contemporary Changes 147
Conclusion 148
9 Public Health: the Professional Response 151
Monica Haggart
Introduction 151
Overview 151
Public Health Nursing 157
viii Contents
Opposing Paradigms 162
The Case for Public Health Nursing 166
Conclusion 168
Index 172
List of Figures and Tables
Figure
7.1 Rapid participatory assessment pyramid
(Murray et al., 1994) 127
Tables
1.1 Selected communicable diseases posing a global
health and environmental risk 15
3.1 Abrief summary of the key conclusions of
the Black Report’s working party 49
3.2 Specific health and welfare measures for mothers
and pre-school children 54
3.3 Key areas of the Acheson Report relating to
health education 54
4.1 Common causes of psychological stress for
African students studying in Britain 67
4.2 Principles and practical approaches to
TB control 73
4.3 Reasons for the projected increase in
TB in London 74
4.4 Chinese population in Britain 75
4.5 Internalised and externalised health beliefs 80
5.1 Minority groups widely devalued in
Western societies 87
8.1 Individuals/social groups who experience
social exclusion 138
8.2 Characteristics of social exclusion 143
8.3 The origins of social exclusion 145
9.1 Criteria for evaluation 165
ix
Foreword
In Chapter 1 of this book the age-old question of the definition of public
health is quite properly comprehensively reviewed. I have always liked
the definition favoured by Alwyn Smith – that epidemiology is the study
of the health of human communities and public health is the practice
of improving the health of human communities. This begs of course the
definition of ‘health’ and ‘community’.
There is another debate that flows from this definition – is epidemiology
a biological science or a social science, and is public health a branch of the
health professions or a branch of social administration? This is a debate
which will run endlessly because important issues of status, identity and
territory rest on it. And yet it is a nonsense for the only possible answer to
each question is ‘Both’.
A public health professional must understand the hard statistical and
biological evidence of what it is that disturbs health and that causes death,
disability, illness and distress in human beings. How else can they set their
agenda? But unless that is linked to an understanding of the behaviours,
cultures, norms, economics and politics that shape the social and physical
environment in which the determinants of health are rooted, epidemiol-
ogy will, as Alwyn Smith has commented, forever remain a mass of
surgically clean data untouched by human thought, and public health
practice will be a process of analysis not change. Neither Disraeli nor Marx
are fashionable these days but Marx’s comments that the aim is ‘to change
society not to understand it’, and that ‘human beings are the masters of
their own destiny but not in the circumstances of their own choosing’ are
eminently valid in public health practice, as is Disraeli’s rallying cry that
‘the health of the people is the first concern of Government’. Indeed if we
counterpose Disraeli’s statement with Lenin’s comment that ‘the health of
the people is the concern of the people themselves’ we can recognise a key
tension in public health practice, with the strange paradox that the words
of Lenin would fit best in the mouths of Conservative Governments
whereas it seems to be Labour Governments that have heard the voice of
Disraeli.
It is timely therefore for John Costello and Monica Haggart to attempt
a review of the relations of public health and society. It is an ambitious
task and one in which no contribution can be definitive. But I believe that
they have produced a significant contribution to the evolution of ideas.
x