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The New Public Health


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Table of Contents

Introduction PART 1: APPROACHES TO PUBLIC HEALTH 1. Understanding Health: Definitions and Perspectives IntroductionHealth: the clockwork model of medicineHealth as the absence of illnessMeasuring healthHealth: ordinary people's perspectivesPublic and private lay accountsHealth in cultural and economic contextsSpiritual aspectsHealth: critical perspectiveHealth as 'outcomes'Health and place: defining collective healthPopulation versus individual health: the heart of public healthConclusion 2. A History of Public Health IntroductionEra of Indigenous controlColonial legacyTheories of disease causationPublic health legislation and sanitary reformsAustralian responsesStatus quo or radical change?Relearning the nineteenth-century lessons: McKeown and SzreterNation-building eraAffluence, medicine, social infrastructureConclusion 3. The New Public Health Evolves IntroductionInternational developments in the new public healthThe 1980s: developing a new public healthThe 1990s: implementing the Ottawa Charter strategiesThe 1990s to twenty-first century: international developments in the new public healthNew century: Commission on Social Determinants of Health-strongreinforcement for the new public healthGlobal health systems to promote the new public healthDoes spending more on care determine health outcomes?Comprehensive primary health care as the basis of health systemsResisting growing medicalisationHealth sector stewardship functionAustralia and the new public health: 1970s to the presentState variation in community health and health promotion in the 1980s1990s: neo-liberalism takes hold in AustraliaHoward's Australia and the impact on the new public healthNational, state and local public health responsibilitiesResearch for the new public healthPreference for selective primary health care and lifestyle health promotionSpecific policy areas in the past 25 years and their fit with the new public healthHow much does Australia spend on public health?Conclusion PART 2: POLITICAL ECONOMY OF PUBLIC HEALTH 4. Ethics, Politics and Ideologies: The Invisible Hands of Public Health IntroductionPolitical systems and ideologiesTypes of political systemsGrowth of welfare statesEgalitarianism, socialism and capitalismEthical issues in public healthRoots of individualismThe dialectic between individualism and collectivismConsequentialist and non-consequentialist ethicsRights argumentsVictim blamingPublic health policies and individualismSocial-structural and communitarian perspectivesIndividualism and the welfare stateConclusion 5. Neo-liberalism, globalisation and health IntroductionWhat is globalisation?What is neo-liberalism?Key institutionsWorld trade system and healthInternational agreements that threaten global healthTRIPS and TRIPS-PlusTrade in Services Agreement (TISA)The impact of transnational corporationsThe impact of neo-liberalism on healthConsumerismThe voices of dissent: civil society movementsBringing the voice of ordinary people from the grassrootsProtest, advocacy and lobbying against international financial and trade institutions'Watching' the global institutionsConclusion PART 3: RESEARCHING PUBLIC HEALTH 6. Research for a New Public Health IntroductionLimits to epidemiologyOther forms of knowledge generationNeed to change focus of health researchReflective research practiceUsing previous research findings: systematic reviewsEthical issues in researchDo no harmMethodological soundnessInformed consentPrivacy, confidentiality and anonymityBeing an ethical researcherResearch with Indigenous AustraliansConclusion 7. Epidemiology and Public Health IntroductionWhat is epidemiology?Population epidemiologyClinical epidemiologySocial and eco-social epidemiologyPopular epidemiologyKey concepts and methods in epidemiologyDescriptive studiesAnalytical studiesExperimental designsQuality and error in epidemiological studiesConclusion 8. Survey Research Methods in Public Health IntroductionStrengths of surveysWeaknesses of surveysPlanning and conducting surveysIs the research question amenable to questionnaire or interview survey?What type of survey to use?Selecting respondentsHow many people should be included in a survey?Designing a survey instrumentSurvey fieldworkSelf-completion questionnairesTelephone surveysFace-to-face surveysResponse rates to surveysAnalysis of survey resultsConclusion 9. Qualitative Research Methods IntroductionWhat is qualitative research?Application to public healthQualitative research methodsCase studiesParticipant observationIn-depth interviewingFocus groupsDocument analysisCommon issues of concernAnalysing qualitative dataConclusion 10. Planning and Evaluation of Community-based Health Promotion IntroductionPlanning for community-based public health projectsTools for needs assessmentSetting priorities and ongoing planningEvaluation of complex public health initiativesObjectives and outcomesEnsuring a reflective approachMethods for community-based evaluationValidity of evaluationConclusion PART 4: HEALTH INEQUALITIES: PROFILES, PATTERNS AND EXPLANATIONS 11. Changing Health and Illness Profiles in the Twenty-first Century: Global and Australian Perspectives IntroductionData sourcesLife expectancySocial determinants of healthCause of deathDeaths from violence and injuryResurgence of infectious diseasesChronic diseaseDisabilityConclusion 12. Patterns of Health inequalities in Australia IntroductionKey factors in health inequalities in AustraliaEffects of socioeconomic statusPoverty, socioeconomic status and healthSocioeconomic statusIncreasing inequitiesUnemployment and healthOccupational illness and injuryIndigenous peoplesRefugees, migrants and healthGender and healthSuicideGender and morbidityLocation and healthRural and remote AustraliaConclusion13. The Social Determinants of Health InequityIntroductionExplaining socioeconomic status inequities in health statusArefact explanationsTheories of natural or social selectionCultural/behavioural versus materialist or structural explanationsSocial capital, support and cohesion and health inequitiesGender and healthInequities: the case of Aboriginal healthConclusion PART 5: UNHEALTHY ENVIRONMENTS: GLOBAL AND AUSTRALIAN PERSPECTIVES 14. Global Physical Threats to the Environment and Public Health IntroductionClimate and atmospheric changeEffects of climate change on human healthDirect effects of climate change on human healthIndirect effects of climate change on human healthSummary: climate change and human healthDeclining air and water qualityWater supplyNuclear powerLoss of biodiversityConsumerism, neo-liberal globalisation and the environmentGlobal efforts to address climate changeWhy don't we take action?Environmental justiceFeminism and environmental justiceThe precautionary principleConclusion 15. Urbanisation, Population, Communities and Environments: Global Trends IntroductionUrbanisationViolence and crimeLiving conditionsCrowding and healthHigh density: a health hazard?High density and social disorderHigh density and environmental sustainabilitySlumsAffluent suburbia: dream or nightmare?Social impact of urban life: from community to anomie?Social capital declining?Transport in urban areasPopulation, consumption and equityConclusion PART 6: CREATING HEALTHY AND EQUITABLE SOCIETIES AND ENVIRONMENTS 16. Healthy Economic Policies IntroductionChallenging economic growthBeyond GDP: indicators of well-beingPolluter pays principleRetreat from consumerismHealthier economic options: Keynes, post-carbon and low growthControlling the transnational corporationsFrom global to localLocal action to resist globalisationFair taxation, income and wealth distributionTrade justiceAn economy that encourages healthy workConclusion 17. Sustainable Infrastructures for Health, Well-being and Equity IntroductionThe global frameworkSustainable development: oxymoron or salvation?Creating ecologically sustainable and healthy communitiesCharacteristics of healthy and sustainable cities and communitiesTensions in creating healthy cities and communitiesEnergy useReducing fossil fuels useTaming the carEquitable provision of healthy infrastructureHousingPreserving agricultural land and natural spacesThe sustainability of rural areasConclusion PART 7: HEALTH PROMOTION STRATEGIES FOR ACHIEVING HEALTHY AND EQUITABLE SOCIETIES 18. Medical and Health Care Service Interventions IntroductionGeneral practitionersScreeningSpecific screening tests and their effectsEffectiveness of screening for behavioural risk factors and follow-up on population healthImmunisationSmallpoxPolioImmunisation in AustraliaIndividual risks and social benefits of immunisationThe contribution of the health sector to promoting population health and reducing inequityComprehensive primary health careConclusion 19. Changing Behaviour: the limits of behaviourism and some alternatives IntroductionSocial learning theoryHealth belief modelTheory of reasoned actionStages of change modelHealth action modelApplication of behavioural theoriesSecond generation of heart health campaignsSocial marketingMass media campaignsHealth education through entertainmentUsing social mediaCriticisms of social marketingRelational, mindful and positive: other approaches to health promotion for individualsConclusion 20. Participation and Health Promotion IntroductionParticipation in practiceValues and principles for participationParticipation in healthSocial media and participationLessons from participation in healthPseudo or real participation?Types of participationParticipation and powerWho participates? Issues of representationCitizens or consumers?The role of professionals in participationEffective bureaucratic consultationsConclusion 21. Community Development in Health IntroductionWhat is 'community'?Community development and social capitalCommunity development and health servicesCommunity development: ways of workingDilemmas of community developmentConclusion 22. Public health Advocacy and Activism IntroductionWhat is public health advocacy and activism?Who are public health advocates and activists?What are key advocacy and activism strategies?Advocacy and activism dilemmasConclusion 23. Healthy Settings, Cities, Communities and Organisations: Strategies for the Twenty-first century Introduction'Settings' approaches to health promotionBringing about change in healthy settings-based initiativesPolitical and policy leadership and commitment is essentialEncouraging action across sectorsTypes of partnershipsDetailed examples of healthy settings initiativesLegislative frameworks that support workplace healthy settingsHealthy settings projects in the workplaceHealthy cities and communitiesWHO's Healthy Cities programHealthy Cities in AustraliaHealthy Cities: actions for healthSettings with a specific focus: obesity prevention in cities and communitiesSustainability of healthy settingsCritical perspectives on healthy settings approachesConclusion 24. Healthy Public Policy IntroductionWhat is policy?What is healthy public policy?Policy formulationPhases in policy makingApproaches to policy formulationPolicies and powerHealthy public policy in a globalised worldExamples of healthy public policyWhat makes for healthy public policy?Conclusion PART 8: PUBLIC HEALTH IN THE TWENTY-FIRST CENTURY 25. Linking the Local, National and GlobalIntroductionGlobal issues of ecologyA just world?Leadership for a healthy futurePublic health for the brave-heartedReflective, flexible and eclecticA vision for 2050ConclusionAppendix: Public Health Keywords Acknowledgements ReferencesIndex

About the Author

Fran Baum is a public health researcher, teacher and advocate. She is the Matthew Flinders Distinguished Professor of Public Health and Director of the Southgate Institute of Health, Society and Equity at Flinders University.

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