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The science and art of promoting health: public health and the role of culture

The science and art of promoting health: public health and the role of culture. Colin Cox Public Health Consultant Public Health Manchester. Defining Health. “Health is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity”

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The science and art of promoting health: public health and the role of culture

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  1. The science and art of promoting health: public health and the role of culture Colin Cox Public Health Consultant Public Health Manchester

  2. Defining Health “Health is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity” World Health Organization

  3. Defining public health “The science and art of promoting and protecting health and well-being, preventing ill-health and prolonging life through the organised efforts of society” Faculty of Public Health

  4. It all starts with the Greeks… Whoever wishes to investigate medicine properly, should proceed thus: in the first place to consider the seasons of the year, and what effects each of them produces. We must also consider the qualities of the waters and the mode in which the inhabitants live, and what are their pursuits, whether they are fond of drinking and eating to excess, and given to indolence, or are fond of exercise and labour, and not given to excess in eating and drinking. Hippocrates, 400 BC

  5. Four waves of public health Third wave Welfare state; institutional reform; NHS established; social housing; focus on living conditions. Politicians key players. First wave Sanitary reform; great public works; growth of municipal power; concern for civil order. Social reformers key players. Fourth wave Focus on risk factors, especially lifestyles and behaviours; emerging concerns about inequalities. Second wave Rise of scientific medicine; hospitals, health services etc; rationalist/reductionist approach dominates. 1830 1900 1950 1980 2000

  6. Characteristics of public health • Population focus rather than services to individuals • Upstream action: emphasising prevention and the determinants of health and wellbeing • Focus on social justice: the role of the state and the need to tackle inequalities in health outcome and access to health improving resources • Partnerships with all those who impact on the health and wellbeing of the population.

  7. Determinants of health Barton & Grant (2006): A health map for the local human habitat. Journal of the Royal Society for the Promotion of Health 156: 252-3 (after Dahlgren & Whitehead, 1991)

  8. Tackling health inequalities Life expectancy at birth by social class, England and Wales, 2002-05

  9. “On the state of public health” Cancer Circulatory disease

  10. However…

  11. Phil Hanlon “What happens After Now?”

  12. The challenge for future PH • Changing ourselves, our mindsets and our culture; • Re-integrating dimensions of life that have been separated in recent times: • the interior and the exterior; • the objective and the subjective; • the individual and the collective; • the true, the good and the beautiful (science, ethics and aesthetics) • Greater future focus

  13. Wilber’s integral model

  14. Public Health response - wellbeing

  15. Implications? New economic models Contraction and convergence More holistic focus on individuals including greater psychological/cognitive input “Mobilising inner resources for self healing”

  16. Stress and grade of employment: men Time of Day Steptoe et al. 2003, Psychosomatic Medicine, 65, 461-470

  17. Environmental determinants of inflammatory status

  18. hs-CRP and risk of future MI in apparently healthy men 3 2 1 0 <0.055 0.056–0.114 0.115–0.210 >0.211 P Trend <0.001 P<0.001 P<0.001 P=0.03 Relative Risk of MI 1 2 3 4 Quartile of hs-CRP (Range, mg/dL) Ridker. N Engl J Med. 1997;336:973–979.

  19. CRP and cumulative risk of type 2 diabetes Q5: > 4.18 mg/l 5 4 % diabetic 3 2 1 Q1 : <0.66 mg/l 0 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 Years in study Freeman et al. Diabetes 2002,51;1596

  20. Aaron Antonovsky 1923-1994

  21. Sense of coherence.... “.....expresses the extent to which one has a feeling of confidence that the stimuli deriving from one's internal and external environments in the course of living are structured, predictable and explicable, that one has the internal resources to meet the demands posed by these stimuli and, finally, that these demands are seen as challenges, worthy of investment and engagement."

  22. Action vs Pride

  23. The true, the good and the beautiful Creativity as part of wider wellbeing Inspiring new solutions Creating new symbols and narratives to facilitate culture change Art and creativity as therapy Connections to regeneration

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