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Essential Public Health

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  • 42 b/w illus. 27 tables
  • Page extent: 350 pages
  • Size: 246 x 189 mm
  • Weight: 0.77 kg

Paperback

 (ISBN-13: 9780521689830)




Index




abdominal aortic aneurysm, potential screening of older men 101

absolute poverty 191–2

accountability 147–8

‘active ageing’ policy 231,234,236–7

adult health determinants 208–9

   individual lifestyle factors 208

   interactions between factors 209

   living and working conditions 208

   social and community networks 208

   socio-economic, cultural and environmental conditions 208–9

adult health promotion 199,220–3

   determinants of health approach 222

   health of homeless people 222

   healthy workplaces 221–2

   improving housing 222

   prevention of mental illness 222–3

   public health problem approach 222–3

   settings approach 221–2

adult mortality and morbidity causes 209–20

   cancer 210–12

   cardiovascular diseases 212–14

   diabetes mellitus 214–16

   mental health disorders 219–20

   metabolic syndrome 217–18

   obesity 216–18

   premature death 15

adult population statistics 207

adverse events 146–7

aetiology of disease 56

age as an epidemiological variable 28

ageing

   and disability 228–9,230

   and health 228–31

   health conditions affecting the elderly 231

   health effects of neighbourhood deprivation 231

   healthy life expectancy 228–9,230

   influenza vaccination 232

   link to ill health 228–9,230

   potential screening programmes for older people 101

   prevention of chronic disease 234

   promotion of ‘active ageing’ 231,234,236–7

   strategies for healthy ageing 231

ageing population

   ‘active ageing’ policy 231,234,236–7

   admission to a care home 235

   ‘baby boom’ generation 227

   carers 235

   challenges identified by WHO 236–7

   changes in life expectancy 225,226,230

   contributory factors 226–7,230

   definitions of old age 226

   demography of old age 226–8

   economic cost of support 235

   end of life care 236

   health and social care services 234–5

   hospice care provision 236

   old-age categories 226

   old-age dependency ratio 227–8

   palliative care 236

   policy responses 236–7

   population pyramids 226,227

   support for economically inactive adults 227–8

   UK standards for health and social care 237

AIDS see HIV and AIDS

Alzheimer’s disease, potential screening of older people 101

American Board of Medical Specialties 279

analytical studies 45–50

attributable mortality rate 128

attributable risk (AR) 40–1

avian influenza 166

‘baby boom’ generation 227

behaviour and lifestyle choices, and child health 193–4

behaviour change

   among health-care professionals 69–71

   pre-conditions 83–4

behaviour change stages 84–5

   action 85

   contemplation 84

   maintenance 85

   pre-contemplation 84,85

   relapse 85

below replacement fertility 14

bias in screening programmes 107–9

Black Death 173

blood pressure distribution in two populations 29–30

breast-cancer screening programme (UK) 96–9,100

   predictive values 106

   sensitivity and specificity 104

Bristol Royal Infirmary, children’s heart surgery deaths 264–5

British Doctors’ Study of smoking and mortality 40–1

bronchitis 2–3

bullying and child health 191

cancer 210–12

   burden of disease 210,211

   health policy implications 212

   incidence 96–8

   mortality rates 210,211

   prevention 211–12

   risk factors 211

Cancer Registries 133

cardiovascular diseases 212–14

   burden of disease 212–13

   health policy implications 214

   prevention 213–14

   risk factors 213

case control studies 45–6

case fatality and survival rates 35

case reports 44

case series 44

causality 56

cervical-cancer screening programme (UK) 96–8,100–1

   predictive values 106

   sensitivity and specificity 104

Chagas disease 291

chance 50–1

child health determinants 189–94

   behaviour and lifestyle choices 193–4

   bullying 191

   community networks and social capital 193

   ethnic background 190

   family situation 190–1

   genetic factors 189–90

   individual and congenital factors 189–90

   media and the commercial world 194

   parenting 190–1

   physical environment 193

   poverty 191–3

   prenatal factors 190

   public services 194

   quality of daycare 191

   relationships 190–1

   school experiences 191

   social class 192–3

   social deprivation 192–3

   stigma and social exclusion 193

child health promotion 196–204

   childhood obesity 200–1,202,203

   developing personal knowledge and skills 198

   different levels of operation 198,201

   health policy for children 202–4

   healthy public policy 197

   healthy schools 198–200

   improving parenting 200,201

   Ottawa Charter (1986) 196–8

   re-orienting health services 197–8

   strengthening communities 197

   supportive environments 197

   toolkit for the generalist practitioner 204

child mortality and morbidity

   and social class 192

   main causes among older children 195,197

   main causes among under fives 195,196

   main concerns 194–5

   mortality rates 14–15

child population statistics (UK and global) 187–8

child public health

   components and scope 186–7

   definition 186

   importance of 185–6

   multidisciplinary cooperation 187

   range of organisations and departments involved 187

   twenty-first century goals 186

   UK policy 186

   vulnerable children 188–9

childhood mental health problems, and social class 192

childhood obesity

   public health measures 202,203

   rates and consequences 200–1

chlamydia 166

chronic disease prevention 234

   conditions affecting the elderly 231

   dementia (example) 234

   falls (example) 233

   primary prevention 232

   secondary prevention 232

   tertiary prevention 232–3

clinical audit cycle 144,145

clinical effectiveness 63

clinical governance 264–5

   adverse events 146–7

   blueprint for quality improvement 142,143

   clinical audit cycle 144, 145

   criticisms of 142

   definition and components 143

   health equity audit cycle 144–6

   Healthcare Commission 143

   National Institute for Health and Clinical Excellence (NICE) 143

   national standards and monitoring 143

   risk management 146–7

clinical trials 48–50

   origin 25,26

Clostridium difficile 166

Cochrane Database 64

cohort studies 46–7

commercial world, influences on child health 194

communicable disease control 166–73

   avian influenza 166

   challenges of infectious agents 167

   changing behaviours 169

   chlamydia 166

   Clostridium difficile 166

   containment of disease 170

   Creutzfeldt-Jacob disease 166

   drug-resistant infections 166,169

   elimination of infection 169–70

   eradication of the disease 169

   Escherichia coli 169–70

   flu infection (influenza virus) 169,171

   flu pandemics 171

   gonorrhoea 166

   herd immunity 171

   HIV/AIDS 166

   hospital-acquired infections 169

   immunisation programmes 170–1,173

   in individuals 167–8,169

   in populations 169–71,173

   incidence of infectious diseases 166

   leishmaniasis 166

   malaria 166

   measles, mumps and rubella (MMR) vaccination 170

   modes of transmission 167,168, 169

   monitoring 173,174

   MRSA (methicillin resistant Staphylococcus aureus) 166,169

   outbreak investigation 174–7

   poverty effects 291–2,293

   range of infection-causing agents (pathogens) 167

   reservoirs of infection 167–9

   salmonella 166,169–70

   SARS (severe acute respiratory syndrome) 166

   sexually transmitted infections 166,169

   smallpox 166,167–9,170

   surveillance 173,174

   syphilis 166

   tuberculosis (TB) 166,169–70

   types of control 169–70

   vaccination programmes 170–1,173

   WHO Global Burden of Disease project 166

   see also infectious diseases

community health promotion 86,87

community networks and social capital 193

community trials 50

confidence interval (CI) 50–1

confounding factors 44,53–5

Congo, total fertility rate 13–14

contagion theory of disease 25

correlation studies 44

cost benefit analysis 155,156

cost-effectiveness 63,154,155,156

cost minimisation 155

Creutzfeldt-Jacob disease 166

cross sectional surveys 44

crude birth rate 13

crude death rate 125–7

cultural conditions and adult health 208–9

cumulative incidence 31

DALYs (disability-adjusted life years) 20–1

databases, specialist 64

daycare quality and child health 191

death rates see mortality

demand for health care

   factors affecting 111

   relation to need and supply 113–15

dementia 234

demography

   causes of health inequalities 20–1

   collection of demographic data 21–2

   definition 11

   disability-adjusted life years (DALYs) 20–1

demography (cont.)

   disease and disability 20–1

   fertility 13–14

   fertility measurement 22

   global population trends 13

   health transitions 18–20

   implications for public health 11

   life expectancy 16–18

   life tables 16,22

   methodological issues 21–2

   migration effects 15–16

   migration measurement 22

   mortality 14–15

   mortality measurement 22

   of old age 226–8

   population pyramids 12–13

   population structure 12–13

   population surveys 22

   population trends in various countries 13

   processes which influence populations 11

   projected global population growth 13

   reasons for population trends 13–16

   standardised mortality ratio (SMR) 22

descriptive studies 44

Diabetes Control and Complications Trial (DCCT) 49–50

diabetes mellitus 214–16

   burden of disease 214–15

   health policy implications 216

   prevention 215–16

   risk factors 215

direct costs 154

directly standardised death rate (DSR) 127

disability adjusted life years (DALYs) 20–1

disability and disease, in demographic study 20–1

disaster planning 179–82

disease and disability, in demographic study 20–1

disease frequency measures (rates) 30–5

disease patterns and service planning 27–8

disease prevention 76–85

   and cure 76–7

   behaviour change pre-conditions 83–4

   behaviour change stages 84–5

   cost of preventive medicine 77

   evidence of preventable diseases 76

   high-risk individual strategy 79–80

   implications of risk-factor thresholds 81–2,83

   in clinical practice 81–2,83

   levels of 78–9

   population-based strategy 79–80

   prevention paradox 80

   primary prevention 78–9

   public health screening 80–1

   secondary prevention 78–9

   spectrum of disease 81–2,83

   strategies 79–81

   tertiary prevention 78–9

   treatment of risk factors 81–2,83

   types of preventive measure 80

   see also health promotion

disease progression in the community 77–8

   disease manifestation 77

   exposure to risk factors 77

   factors affecting access to health care 77

   factors affecting outcome 77–8

   possible outcomes 77–8

disease registers 133

disease risk markers 28–30

disease variation by time, place and person 26–42,43

Donabedian framework for quality measurement 273–4

Down’s syndrome screening during pregnancy 99

dracunculiasis 291

drug-resistant infections 166,169

Duncan, William 1–2

duration of disease 33–4,35

‘ecological fallacy’ 44

ecological studies 44

economic evaluation 154

   cost-benefit analysis 155,156

   cost-effectiveness analysis 155,156

   cost minimisation 155

   cost-utility analysis 155,156,157

   definition

   direct costs 154

   incremental costs 155

   indirect costs 154

   marginal costs 155

   opportunity costs 155

   quality adjusted life years (QALYs) 155,156,157,158

education and audit, role in quality improvement 279–80

emergency planning 179–82

environmental conditions and adult health 208–9

environmental hazard control

   occupational hazards 179

   source-pathway receptor model 177–8

   types of hazard 178–9

epidemiological study design

   analytical studies 45–50

   case-control studies 45–6

   case reports 44

   case series 44

   classification of design strategies 42

   clinical trials 48–50

   cohort studies 46–7

   community trials 50

   confounding factors 44

   cross-sectional surveys 44

   descriptive studies 44

   Diabetes Control and Complications Trial (DCCT) 49–50

   ‘ecological fallacy’ 44

   equipoise 48

   individual studies 44

   intervention (experimental) studies 47–50

   observational studies 45–7

   population (correlation or ecological) studies 44

   questions to be answered 42

   randomised controlled trials (RCT) 47–50

   summary of study designs 50–1

   types of epidemiological study 42–51

   Whitehall Studies of civil servants (cohort study) 46–7

epidemiological study results

   aetiology of disease 56

   causality 56

   chance 50–1

   confidence interval (CI) 50–1

   confounding 53–5

   error 52–5

   generalisability of a study 55–6

   information bias 53

   interpretation 50–7

   probability (P value) 50–1

   random error 52

   selection bias 52–3

   systematic error 52–5

   validity (external and internal) 55–6

epidemiological transitions 18–19

epidemiology

   absolute risk reduction (ARR) 38

   age as an epidemiological variable 28

   attributable risk (AR) 40–1

   blood pressure distribution in two populations 29–30

   British Doctors’ Study of smoking and mortality 40–1

   case fatality and survival rates 35

   contagion theory of disease 25

   cumulative incidence 31

   definition 24

   development of health statistics 25–6

   disease frequency measures (rates) 30–5

   disease ‘iceberg’ in a population 27–8

   disease variation by time, place and person 26–42,43

   duration of disease 33–4,35

   epidemiological variables 28–30

   history of 25–6

   importance in public health 24–5

   incidence of disease (definition) 31

   incidence rate 32–4,35

   markers for disease risk 28–30

   measures of disease frequency (rates) 30–5

   measures of population impact 40–1

   miasma theory of disease 25

   number needed to treat (NNT) 38–9

   Odds Ratio 35–7

   origin of the clinical trial 25,26

   population attributable risk 40–1

   population concept 27–8

   prevalence of disease 31,33–4,35

   quantifying differences in risk 35–41

   Relative Risk 35–8

   risk of disease (definition) 31

   stable and dynamic populations 28

   summary of concepts 42,43

   time, place and person descriptions of disease 26–42,43

   uses 24

equipoise 48

error 52–5

Escherichia coli 169–70

ethical frameworks for decision making 159,160

ethnic background and child health 190

evaluation see quality of health-care evaluation; screening programme evaluation

evidence, use in public health 309–10

evidence-based health care (EBHC)

   appropriate types of study 63–4

   behaviour change among health-care professionals 69–71

   clinical effectiveness 63

   Cochrane Database 64

   cost-effectiveness 63

   criticisms of 73

   definition and scope 59–60

   incentives to change 73

   limitations 73–4

   Medline Database 64

   meta-analysis of studies 66,69

   PICO approach to framing a question 60–1

evidence-based health care (EBHC) (cont.)

   PubMed Database 64

   sources of evidence 64

   specialist databases 64

   systematic reviews of literature 66,69

   uptake of innovation 69–71

evidence-based health care implementation 60–8,69,74

   ask a focussed question 60–1

   change practice in light of evidence 69–71

   critical appraisal of evidence 65–6,67–8,69

   evaluate performance 72–3

   track down best evidence 61–5

evidence-based medicine (EBM), definition and scope 59–60

evidence-based medicine (EBM) movement 25,26

experimental (intervention) studies 47–50

falls prevention (example) 233

family situation and child health 190–1

Farr, William 25–6

fertility 13–14

   below replacement fertility 14

   crude birth rate 13

   general fertility ratio 13

   influences on 14

   measurement 22

   total fertility rate 13–14

Finagle’s law 125

flu (influenza) 2–3,169,171

   vaccination for older people 232

flu pandemics 171

   disaster planning 181

funding decision-making

   and resource limitations 149

   levels of decision-making 149

   priority setting framework 150,151

future issues

   changes to causes of health and illness 307

   professional development and competencies 310–11

   social justice and public health 308

   use of information, evidence and knowledge 309–10

general fertility ratio 13

General Medical Council (GMC) 147–8,279

general practitioner records 132

generalisability of a study 55–6

genetic factors in child health 189–90

germ theory of disease 2,25

global annual death rates 14

global burden of disease 286,287–8

global life expectancy at birth 16–17

global population trends 13

global poverty and health issues

   access to medicines 292–4

   barriers to health services 298

   communicable diseases 291–2,293

   cost barrier to health services 298

   delivery of improvements in health 294–5

   effects of weak or corrupt governments 294–5

   gender inequalities 298

   health research needed 301

   HIV and AIDS 291–2,293

   making international aid more effective 301

   maternal health 290

   millennium development goals 299–300,301

   need for good quality monitoring data 299–301

   organising and financing health systems 295–7

   preventable illness and deaths among children 288–9

   relevance to UK policy 301–2

   reproductive health 290–1

   research on diseases of the poor 293–4

   role of good governance 294–5

   sector-wide approaches (SWAps) 301

   social exclusion 298

   staffing of health services 298–9

   vaccines for diseases of the poor 293–4

   vertical and horizontal approaches 297–8

gonorrhoea 166

government, conflicts with the medical profession 260

Graunt, John 25

guinea worm 287

health

   definition 85–6

   WHO definitions 85–6

health and social-care quality 5

health care

   contribution to increased life expectancy 271–2

   contribution to public health 271–2

   harm resulting from misuse 277

   overuse 276–7

   patient safety problem 277

   problems with 275–8

   under use 276

health care inequalities, and health-care quality measurement 276

health care interventions, effectiveness 89,90–2

health care professionals, opportunities to promote health 5–7

health education 86,87

health equity audit cycle 294.6, 667.2 see also health inequalities

health improvement 5

health inequalities

   causes 20–1

   contributory diseases 243,244

   differences in access to treatment 246

   distribution of health determinants 243,244

   impact of psycho-social stressors 245–6

   important health determinants and interactions 243–6

   influence at every stage of life 247

   life-course effects of health determinants 247,248

   probabilistic cascade of health effects 247,248

   public health policy 265,266

   social gradients in disease incidence 243,244–5

   socio-economic factors 240–1,242

   trends 241–3,248

   Whitehall Studies 245

health inequalities interventions 242, 247–54

   access to essential facilities and services 248,250–3

   inverse care law 251

   macro-economic and cultural change 248,253–4

   possible policy frameworks 242,248

   social capital 250,251

   strengthening communities 248,250, 251

   strengthening individuals 248,249

health inequity see health inequalities

health needs assessment (HNA) 115–18

   agreeing local priorities 117–18

   characteristics 115

   comparative needs assessment 116–17

   corporate needs assessment 117–18

   epidemiological needs assessment 118

   identification of priorities 116–18

   inverse care law 116

   objectives 115–16

   policy, planning and strategy development 118–20,121

health needs theory 111–15

   ability to benefit 112

   classification of needs 111–12

   cost-effectiveness of treatments 112

   factors affecting demand 111

   health needs definition 112

   individual or population needs 112

   need for health care 112

   need, supply and demand 113–15

health policy (England) 261–2

   and global poverty and health issues 301–2

   clinical governance introduction 264–5

   drive for efficiency and cost containment 262–3

   drive to improve quality 264–5

   for children 202–4

   health service reform 261–3,264–5,267

   implications of cancer rates 212

   implications of cardiovascular disease levels 214

   implications of diabetes mellitus levels 216

   implications of mental illness levels 220

   implications of obesity levels 218

   Labour government’s reform agenda 261–2

   market-based system 262–3

   models of provider motivation 267

   potential problem of ‘defensive medicine’ 265

   professional power issue 264–5

   public accountability 264–5,267

   public health agenda 265,266

   public sector service redefinition 267

   response to rate of ‘adverse incidents’ 264–5

   role of NICE 264–5

   role of the Healthcare Commission 265

health policy process

   conflicts between government and medical profession 260

   context for policy making 259–60

   definition of ‘policy’ 258

   factors which impact on health policy 259–60

   implementation as part of the policy process 260–1

   ‘incremental’ models 258–9

   influence of implementers 260–1

   models of 258–9

   nature of 257–8

   power of the medical profession 259–60

   ‘rational’ models 258

   strategies of health-care institutions 260–1

health promotion

   community development 86,87

   definition and scope 86

   definition of health 85–6

health promotion (cont.)

   effective interventions 89,90–2

   health education 86,87

   healthy public policy 86,87

   HIV case study 90–2

   legislative action 87

   local level organisations 88–9

   main routes for 86–7

   national level organisations 88

   Ottawa Charter (1986) 87

   responsible agencies and organisations 88–9

   tobacco control 86,88

   voluntary, non-governmental organisations 89

   WHO Bangkok Charter (2005) 88

health protection 5

   UK definition and scope 165–6

   US definition and scope 165–6

health-service reform 261–3,264–5,267

   re-orienting to promote child health 197–8

health statistics, development of 25–6

health transitions

   and changing health needs 18–20

   demographic transitions 18–20

   epidemiological transitions 18–19

   influential factors 19

   population ageing 19

Healthcare Commission 143,265,279

healthy life expectancy 228–9,230

healthy public policy 86,87

   and child health 197

helminth infections 291

herd immunity 171

historical background of public health

   bronchitis 2–3

   community and school nursing services 2

   criticism of modern medicine 2–3

   educational approaches to health promotion 3

   establishment of the NHS 1

   germ theory of disease 2

   health-promoting public policies 3

   hospital and clinic services 2

   immunisation and vaccination 2–3

   industrial revolution 1–2

   influenza 2–3

   insulin therapy 2

   introduction of school meals 2

   medical care contribution to life expectancy 3–4

   medical officers of health 1–2

   pneumonia 2–3

   preventive services for the individual 2

   public health contribution to life expectancy 3–4

   public health movement (1970s onward) 3

   public health movement origins 1–2

   raising nutritional standards 2–3

   reasons for health improvements 3

   reasons for reduction in death rates 2–3

   reduction in infectious disease mortality 2–3

   smallpox vaccination 3

   sulphonamide drugs 2

   therapeutic era 2

   tuberculosis 2–3

   water- and food-borne diseases 1–3

   whooping cough 2–3

HIV (human immunodeficiency virus) and AIDS 166

   global burden of disease 287,291

   history of appearance and spread 291–2,293

   strain on health services 298–9

   surveillance of HIV 173

HIV case study (effective health care interventions) 90–2

hospital-acquired infections 169

hospital-episode statistics (HES) 132

housing, improving health of homeless people 222

HPV (human papilloma virus) 97–8

ICD (International Classification of Diseases and Related Health Problems), origins 25–6

ICD-10

   linkage of HES data 132

   standardisation 128

ill health, links with poverty 286,287–8

Illich, Ivan 2

immigration screening (UK) 101–2

immunisation programmes 170–1,173

incidence of disease (definition) 31

incidence rate 32–3,34

   relationship to prevalence 33–4,35

income, relationship to life expectancy 17–18

income-related health inequalities 20–1

incremental costs 155

‘incremental’ health policy models 258–9

India, population pyramid 12–13

indirect costs 154

individual approach, comparison with population approach 6,7

individual studies 44

infant mortality rate 128–30

   and social class 192

infectious diseases 131–2

   reduction in mortality 2–3

   see also communicable disease control

influenza see flu

information, use in public health 309–10

information bias 53

innovation

   early adopters 70

   factors affecting uptake 70

   late adopters 70

   process of uptake 69–71

   tipping point 70

Institute for Healthcare Improvement 280

Institute of Medicine, framework for quality measurement 273–74

International Classification of Diseases and Related Health Problems see ICD

international development see global poverty and health issues

intervention (experimental) studies 47–50

intra-uterine life factors, and child health 190

inverse care law 116,251,276,308

knowledge

   as a cause of health 308–9

   use in public health 309–10

lead time bias 108,109

‘lean’ technique (Toyota) 281

legislative action to promote health 87

leishmaniasis 166,291

length time bias 108–9

leprosy 287,291

life-course effects of health determinants 247,248

life expectancy 16–18,130–1

   changes in 225,226,230

   contribution of health care 271–2

   definition 16

   demographic life tables 16,22

   factors affecting 16–18

   global life expectancy at birth 16–17

   healthy life expectancy 228–9,230

   medical care contribution 3–4

   population ageing 17

   public health contribution 3–4

   reasons for increase 3–4

   relationship to income 17–18

   variations between countries 16–17

life tables 16,22

lifestyle factors and adult health 208

likelihood ratios 106–7

Lind, James 25,26

living conditions and adult health 208

local health-care organisations 88–9

local health surveys 134

low birth weight, and social class 192

lymphatic filariasis 287,291

malaria 166

   global burden of disease 287,291,293

   vaccine for children 293–4

marginal costs 155

market and financial approach to quality improvement 275,280–1

mass screening 94–5

maternal health, poverty effects 290

maternal mortality rates 15,128–30

Maxwell framework for quality measurement 273–4

McKeown, Thomas 2–3,19

measles, mumps and rubella (MMR) vaccination 170

media, influences on child health 194

medical care

   contribution to life expectancy 3–4

   criticisms of modern medicine 2–3

medical profession

   conflicts with government 260

   power of 259–60,264–5

Medline Database 64

mental health disorders 219–20

   burden of disease 219

   health policy implications 220

   prevention 222–3

   risk factors 219–20

meta-analysis of studies 66,69

metabolic syndrome, and obesity 217–8

miasma theory of disease 25

migration

   effects on populations 15–16

   implications for public health care 15–16

   measurement 22

millennium development goals 299–300,301

morbidity measurement 131–33

   definition of morbidity 131

   disease registers 133

   general practitioner records 132

   hospital data 132

   infectious diseases 131–2

   primary care data 132

mortality measurement 22,125–30

   annual global death rates 14

   attributable mortality rate 128

   causes of adult premature death 15

   child mortality rates 14–15

mortality measurement (cont.)

   childbirth and infancy 128–30

   crude death rate 125–7

   directly standardised death rate (DSR) 127

   ICD-10 standardisation 128

   infant mortality rate 128–30

   maternal mortality 15,128–30

   neonatal mortality 128–30

   perinatal mortality 128–30

   post-neonatal mortality 128–30

   proportional mortality 128

   reasons for decline in death rates 14

   standardised death rates 127–8

   standardised mortality ratio (SMR) 22,127–8

   stillbirth rate 128–30

   under five mortality rate 130

   years of life lost (YLL) 15

MRSA (methicillin resistant Staphylococcus aureus) 166,169

National Clinical Assessment Service (NCAS) 147

national health-care organisations 88

National Health Service (NHS), establishment 1 see also health policy; health service reform 1

National Institute for Health and Clinical Excellence (NICE) 88,143,264–5

National Patient Safety Agency (NPSA) 147,277

National Screening Committee (UK) 101

National Service Framework (NSF) for children, young people and maternity services 202–4

National Specialist Commissioning Advisory Group 149

neonatal mortality 128–30

NHS, establishment 1

   see also health policy; health service reform

NICE see National Institute for Health and Clinical Excellence

notifiable diseases 131–32,173

number needed to treat (NNT) 38–39

Nursing and Midwifery Council 147

nutritional standards, raising (historical) 2–3

obesity 216–8

   and metabolic syndrome 217–8

   burden of disease 216–7

   health policy implications 218

   high-risk approach to prevention 218

   measures of 216

   population approach to prevention 218

   prevention 218

   risk factor for health problems 216–7

   risk factors for 217–8

   weight management 218

observational studies 45–7

Odds Ratio 35–7

older people see ageing

onchocerciasis (river blindness) 287,291

opportunistic screening 94–5

opportunity costs 155

osteoporosis, potential screening of older people 101

Ottawa Charter (1986) 87

   child health promotion 196–8

parenting

   and child health 190–1

   improving 200,201

patient administration systems (PAS) 132

patients

   important health-care issues 139,272–3

   safety problem 147,277

payment for performance 275,280–1

performance data, publication of 275,280–1

perinatal mortality 128–30

period prevalence of disease 31

physical environment and child health 193

PICO approach to framing a question 60–1

planning cycle, and health needs assessment 118–20,121

pneumococcus, vaccine development 293–4

pneumonia 2–3

point prevalence of disease 31

policy-making cycle, and health needs assessment 118–20,121

population ageing 17

   health transitions 19

population approach, comparison with individual approach 6,7

population attributable risk 40–1

population concept 27–8

population health improvement, three main approaches 4

population health status

   collecting health-status information 135

   data which are fit for purpose 125,126

   life expectancy 130–1

   local health surveys 134

   morbidity measurement 131–3

   mortality measurement 125–30

   population surveys 133

   public health observatories 135

   self-reported health status 133–4

   sources of additional data 134–5

   types of data required 124–5

   years of life lost (YLL) 130–1

population impact, measures of 40–1

population pyramids 12–13,226,227

population studies 44

population surveys 22,133

post-neonatal mortality 128–30

poverty

   absolute 191–2

   and child health 191–3

   and social deprivation 192–3

   links with ill health 286,287–8

   relative 191–2

   reproductive health effects 290–1

   see also global poverty and health issues

prenatal factors and child health 190

prevalence of disease 31

   relationship to incidence 33–4,35

preventive medicine

   cost of 77

   NHS cervical screening programme 77

primary care data 132

priority-setting framework 150,151

   assessing need 150–2

   cost-effectiveness 154

   economic evaluation 154

   ethical frameworks for decision making 159,160

   evidence of effectiveness 152

   intervention acceptability and appropriateness 153

   smoking cessation service example 150,151

probabilistic cascade of health effects 247,248

probability (P value) 50–1

professional development and competencies 310–11

proportional mortality 128

prostate cancer, reasons for not screening 101

PubMed Database 64

public health

   contribution of health care 271–2

   contribution to life expectancy 3–4

   definition 1

   three domains 5

   underpinning disciplines 5

public health challenges, life course model 7,8

public health measures, childhood obesity 202,203

public health movement 1–2

public health observatories 135

public health policy agenda

   government targets 265,266

   health inequalities issue 265,266

   supporting healthy choices 265,266

   see also health policy

public health toolkit 6,8

public services access, and children’s health 194

quality-adjusted life years (QALYs) 155,156,157,158

quality improvement in health care

   approaches 275,279,282

   education and audit 279–80

   Institute for Healthcare Improvement 280

   market and financial approach 275,280–81

   payment for performance 275,280–81

   publication of performance data 275, 280–81

   regulation and standards 279

quality measurement in health care

   approaches to quality measurement 274–5

   definition 272

   desired health outcomes 272–3

   Donabedian framework 273–4

   health-care aspirations of patients 272–3

   health-care inequalities 276

   Institute of Medicine framework 273–4

   ‘lean’ technique (Toyota) 281

   Maxwell framework 273–4

   multidimensional nature 273–4

   multilevel approaches to change 281

   patient safety problem 277

   performance against quality indicators 274–5

   problems with health-care quality 275–8

   risks and opportunity costs 282

   six sigma technique (Motorola) 281–2

quality of health care

   definition and scope 138–9

   issues of importance to patients 139

quality of health-care evaluation 139–42

   confounding effects of different factors 140–42

random error 52

randomised controlled trials (RCT) 47–50

‘rational’ health policy models 258

regulation and standards, role in quality improvement 279

regulatory bodies

   UK 279

   USA 279

relationships and child health 190–1

relative poverty 191–2

Relative Risk 35–8

research on diseases of the poor 293–4

resource limitations see funding decision-making

risk

   absolute risk reduction (ARR) 38

   Odds Ratio 35–7

   quantifying differences in 35–41

   Relative Risk 35–8

risk-factors, implications of treatment thresholds 81–2,83

risk management 146–7

risk of disease (definition) 31

Rogers, Everett 69–71

Rose, Geoffrey 79–80

salmonella 166,169–70

SARS (severe acute respiratory syndrome) 166

schistosomiasis 291

school, Healthy Schools 198–200

school experiences and child health 191

screening

   definition 94–5

   distinction from diagnosis 94–5

   mass screening 94–5

   opportunistic screening 94–5

screening programme evaluation 102–9

   monitoring effectiveness 107,108

   screening test performance 102–7

   sources of bias in screening 107–9

screening programmes

   acceptability of the programme 100

   acceptability of the test or examination 98,99

   breast cancer (UK) 96–9,100,104,106

   cervical cancer (UK) 96–8,100–1,104,106

   cost-effectiveness 100

   criteria for the condition to be screened 96–8

   criteria for the test or examination 98–9

   criteria for treatment options 99

   criteria to assess potential programmes 96–101

   Down’s syndrome (during pregnancy) 99

   establishment of a programme 99–101

   evidence of effectiveness of potential programmes 99

   examples of effective programmes 101,102

   immigration screening (UK) 101–2

   lead time bias 108,109

   length time bias 108–9

   National Screening Committee (UK) 101

   potential harms 95–6

   potential programmes for older people 101

   programmes which have not been introduced 101

   reasons for non-attendance 98,99

   resource implications 100

   selection bias 107–8

   sources of bias 107–9

   treatment policies 99

screening test performance

   likelihood ratios 106–7

   predictive values 105–6

   sensitivity and specificity 102–4

scurvy, early clinical trial 25,26

selection bias 52–3,107–8

sensitivity of a test 102–3

   calculation 103–4

sexually transmitted infections 166,169

Shipman case 147–8,264–5

six sigma technique (Motorola) 281–2

smallpox 3,166,167–9,170

Smith, Adam 251

smoking cessation service, priority setting example 150,151

social and community networks and adult health 208

social capital 250,251

social class

   and child health 192–3

   and child mortality (1–15 years) 192

   and childhood mental health problems 192

   and infant mortality (first year of life) 192

   and low birth weight 192

   and sudden infant death syndrome (SIDS) 192

social deprivation and child health 192–3

social justice and public health, future issues 308

socioeconomic status and adult health 208–9

specificity of a test 102–3

   calculation 103–4

standardised death rates 127–8

standardised mortality ratio (SMR) 22, 127–8

stigma and social exclusion 193

stillbirth rate 128–30

strategy development and health needs assessment 118–20,121

study design see epidemiological study design

sudden infant death syndrome (SIDS) and social class 192

syphilis 166

systematic error 52–5

systematic reviews of literature 66,69

TB (tuberculosis) 2–3,166,169–70

   global burden of disease 287,291,293

time, place and person descriptions of disease 26–42,43

tobacco control 86,88

total fertility rate 13–14

trachoma 287,291

tropical diseases 287,291

trypanosomiasis 291

tuberculosis see TB (tuberculosis)

UK

   population pyramid 12–13

   total fertility rate 13–14

under-five mortality rate 130

United Nations Convention on the Rights of the Child 185–6

utility analysis 155,156,157

vaccination

   administration methods 170

   and immunisation 170

   development of programmes 171–3

   flu virus vaccines 171

   herd immunity 171

   mass vaccination 170

   ring vaccination 170

   targeted vaccination 170

   types of vaccine 170

vaccination programmes 170–1,173

validity (external and internal) 55–6

voluntary, non-governmental organisations 89

water- and food-borne diseases 1–3

Whitehall Studies of civil servants (cohort study) 46–7,245

whooping cough 2–3

working conditions and adult health 208

workplace, health promotion 221–2

World Health Organization (WHO)

   ‘active ageing’ strategy 231

   Bangkok Charter (2005) 88

   Framework Convention for Tobacco Control 88

   Global Burden of Disease Project 166

   International Classification of Impairments, Disabilities and Handicaps 229

years of life lost (YLL) 15,130–3

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