Impact of EU Accession on Public Health in Croatia

1. Impact of EU Accession on Public Health in Croatia Development of a European Concept of Public Health AndrijaStampar School of Public Health 17th January 2011 Christopher Birt

2. Origins Goes back to the ancient civilisations of Rome, Greece, and many others (e.g. Albumasar in Baghdad)

3. Since 1800… Dr William Henry Duncan (1805 – 1863) • born in Liverpool • qualified in medicine in Edinburgh in 1829 • appointed MOH in Liverpool in 1847 • saw link between housing and cholera, smallpox, typhus, etc. • worked to tackle poor housing and sanitary provision

5. Sir Edwin Chadwick

6. Sir Edwin Chadwick, 1800 - 1890 • born and educated in Manchester • friend of Jeremy Bentham and John Stuart Mill • 1833 Royal Commission on condition of factory children • 1839 first Sanitary Commission appointed • 1847 Commission on the health of London

7. IgnacSemmelweis • born 1818, died 1865, in Budapest, • noticed mothers delivered by doctors died, while those delivered by nurses survived, • observed that doctors did not wash hands properly, • discovered puerperal fever and its prevention

9. Was this a golden age for PH in Europe? Medical Officers of Health (or equivalent title) usually a part of central or local government significant influence on housing and education prevention / control of environmental hazards communicable disease control and immunisation maternal and child health

10. End of the First Golden Age? By 1960 – 1990: • communicable disease and environmental health no longer the leading threats to health, • chronic diseases now heading mortality / morbidity threats, • understanding of wider determinants of health, • health promotion “invented”, • Ottawa Charter / Alma Ata Conference, • New Public Health / rebirth of primary health care

11. Health Promotion Defined as including health education, disease prevention, and health protection (Tannahill et al, OUP, 1990) • Health education increases awareness and influences favourably attitudes and knowledge relating to the improvement of health on both a personal and on a community basis. • Health protectionseeks, through legislative or other means, to promote healthier environments, within which healthy choices are easier to make. • Disease prevention refers to measures taken to prevent diseases or injuries rather than curing them or treating their symptoms, within the scope of public health methods, working at population level.

12. From 1975: a new Golden Age? 4 strands of public health activity emerge: • health promotion, • communicable disease and environmental health surveillance and control • planning and evaluation of health services: concepts of population need • great expansion of academic public health, both teaching and research

13. New Public Health • addressed the wider determinants of health, • embraced new approaches to health promotion, • brought PH perspective into primary care, • introduced epidemiology to health care planning, • maintained communicable disease and environmental health surveillance / control, • put good science at the heart of practice, • espoused evaluation of both PH practice and PH projects

14. Determinants of health • peace and absence of war, • wealth / poverty / distribution of resources, • agriculture / diet / nutrition, • employment, locus of control, • housing (heating, cooking, plumbing, etc.), • tobacco, alcohol, other drugs, • physical environment / open spaces, • transport: injuries, pollution, psychological effects, etc., • exercise and recreation: sport and culture, etc., • education, • health services, • etc.

16. “Healthy Plan-it” in Croatia Young-early drinking

17. Consequences of addressing health determinants • public health no longer limited to professional (medical) control; it belongs to everyone; • public health no longer limited to local government, etc., needs to influence decisions at all levels – global to local

18. In 1997 it was calculated that: of all decisions affecting the health of European citizens, around 50% are taken at EU level (diet & nutrition, environmental policy, employment law, transport strategy, etc.) – so PH is very important at EU level. BUT: • national and local government levels also important, • also NGOs, community groups, etc., • community development approaches to health promotion: outcomes may include (for example) community transport, fruit and vegetable deliveries, etc.

19. So Public Health activity may include: • multi-disciplinary trained public professionals who will have a wide variety of backgrounds, • other professionals, not self-identifying with public health, e.g. teachers, dental nurses, police, social workers….. • parents, members of community groups, those working with NGOs of various types….

20. A bit later I shall considerhow we might systematise all this public health work Now is time for questions and discussion – thank you for listening!