DPaC Lecture: Human Behaviour and Community Health

1. DPaC Lecture: Human Behaviour and Community Health Dr Julian Davis

2. Machu Pichu www.wiconi.com Musée du Louvre Codex Hammurabi History • Egyptians and Incas understood importance of urban planning and sanitation • Egyptians promoted good diet and hygiene • Babylonians drew up strict public health regulations governing personal behavior

3. Moderation in drink 1500 BC

4. www.bl.uk Middle Ages • Decline in Public Health measures • Governments did not recognize their responsibility to provide public facilities • Towns governed by wealthy elite • Difficult to enforce laws against the dumping of rubbish and sewage

5. www.chethams.org.uk 18th Century London Gin Lane William Hogarth

6. Gin Act • Gin consumption was thought to be responsible for a rising death rate • 1751 Gin Act imposed a high tax on the product and restricted availability • Lessons for today?

7. Definition of Public Health The art and science of preventing disease, promoting health , and prolonging life through organised efforts of society. Acheson Report, 1987

8. What is Public Health? • Interventions aimed at protecting and promoting the health of a population • Organized community efforts aimed at the prevention of disease and promotion of health • Links many disciplines

9. I keep six honest serving-men They taught me all I know Their names are What and Where and When And How and Why and Who Rudyard Kipling

10. What is Epidemiology ? determinants Who gets what, and where, and when distribution and why, and how

11. Why should I be Interested? • You need to understand the context of your patients • They exist as part of a community • Epidemiology is a tool which allows you to understand how things affect communities • It also has given us many major advances in medicine by watching groups of people

12. www.crystalinks.com Vibrio cholerae Cholera

13. Cholera • Epidemiology was exemplified by the work of John Snow (anaesthetist and epidemiologist) on cholera John Snow (1813-1858)

14. Dot map 1854

15. www.epi.msu.edu Source of the outbreak • Cluster ended in the identification of the Broad Street Pump as the source of the outbreak • Causes of ill health could be identified and measured

16. 1,300,000 580,000 1,000,000 900,000 480,000 450,000 6,500,000 27,900,000 1,600,000 32,000 Black figures, 2000; Red figures, 2003 Source: UNAIDS

17. www.truehealth.org Public Health Issues: An example

18. impleader.com Obesity • Major public health problem • Results from particular behaviour • Lifestyle issues

19. Why is it a problem? • Increased risk of: • Heart disease • Stroke • Diabetes • Death • Economic impact • Social impact

20. No Data <10% 10%–14% Obesity Trends Among U.S. Adults1985

21. No Data <10% 10%–14% 1986

22. No Data <10% 10%–14% 1987

23. No Data <10% 10%–14% 1988

24. No Data <10% 10%–14% 1989

25. No Data <10% 10%–14% 1990

26. No Data <10% 10%–14% 15%–19% 1991

27. No Data <10% 10%–14% 15%–19% 1992

28. No Data <10% 10%–14% 15%–19% 1993

29. No Data <10% 10%–14% 15%–19% 1994

30. No Data <10% 10%–14% 15%–19% 1995

31. No Data <10% 10%–14% 15%–19% 1996

32. No Data <10% 10%–14% 15%–19% ≥20 1997

33. No Data <10% 10%–14% 15%–19% ≥20 1998

34. No Data <10% 10%–14% 15%–19% ≥20 1999

35. No Data <10% 10%–14% 15%–19% ≥20 2000

36. 2001 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

37. 2002 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

38. 2003 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

39. 2004 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

40. How do we stop it?

41. Health Education Disease Prevention Health Protection Health Promotion

42. Health Education • Programmes in schools • TV & press advertising, for example…. • Health Education Board for Scotland (HEBS)

43. www.theage.com.au Health Protection • Reduction of fat in food • Healthy options at school meals • No tax on healthy food such as fruit & veg

44. Disease prevention • Prescribing statins to help lower cholesterol • Exercise and diet plans in primary care www.dreadmill.net/

45. Perceived susceptibility Perceived severity Demographic variables Perceived benefits Behaviour Perceived barriers Cues to action Why do people do it? • Models of health behaviour help us to understand • For example…. Health Belief Model

46. Health Belief Model Perceived susceptibility Perceived severity Demographic variables Perceived benefits Behaviour Perceived barriers Cues to action

47. Health Belief Model Perceived susceptibility Perceived severity Demographic variables Perceived benefits Behaviour Perceived barriers Cues to action

48. Health Belief Model Perceived susceptibility Perceived severity Demographic variables Perceived benefits Behaviour Perceived barriers Cues to action

49. Health Belief Model Perceived susceptibility Perceived severity Demographic variables Perceived benefits Behaviour Perceived barriers Cues to action

50. Health Belief Model Perceived susceptibility Perceived severity Demographic variables Perceived benefits Behaviour Perceived barriers Cues to action