Donaldsons’ Essential Public Health

375 Pages·2017·67.39 MB·English

by  Liam J. Donaldson

DONALDSONS’ ESSENTIAL
PUBLIC HEALTH
FOURTH EDITION

DONALDSONS’ ESSENTIAL
PUBLIC HEALTH
FOURTH EDITION
Liam J. Donaldson
Paul D. Rutter
CRC Press
Taylor & Francis Group
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© 2018 by Liam J. Donaldson
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Library of Congress Cataloging‑in‑Publication Data
Names: Donaldson, Liam J., author. | Rutter, Paul D., author.
Title: Donaldsons’ essential public health / Liam J. Donaldson and Paul D. Rutter.
Other titles: Essential public health
Description: Fourth edition. | Boca Raton : CRC Press, [2017] | Includes
bibliographical references and index.
Identifiers: LCCN 2016050366| ISBN 9781909368958 (pbk. : alk. paper) | ISBN 9781138722019 (hardback : alk. paper)
Subjects: | MESH: Public Health Practice | Preventive Health Services | Great Britain
Classification: LCC RA485 | NLM WA 100 | DDC 362.10941--dc23
LC record available at https://lccn.loc.gov/2016050366
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Contents
Preface xiii
Authors xvii
1 Health in a changing world 1
Introduction 1
What is health? 1
Public health 3
Public communication 5
Global health 6
Populations in flux 7
Poverty 8
Development 8
Global health architecture 10
Regulatory mechanisms 11
Changing patterns of disease 12
New goals for the world 15
Conclusions 17
2 Epidemiology and its uses 19
Introduction 19
Routinely available data sources 19
Census data 20
Civil registration and vital statistics 21
Data on occurrence of disease and disability 21
Data on health-related behaviour and risk factors 24
Data on social and economic determinants of health 24
Data to evaluate the performance of health services 24
Disease nomenclatures and classifications 25
Surveillance data 26
Indicators 26
Access and transparency 26
Distribution of disease in populations 27
Counting events in populations 27
Measures of morbidity 28
Incidence 28
Prevalence 29
Measures of mortality 29
Specific mortality rates 29
Standardized mortality rates 30
Case fatality and survival 30
Measures of healthy and unhealthy ageing 31
Healthy life expectancy and disability-free life expectancy 32
Years lived with disability 32
Disability-adjusted life years 34
v
vi Contents
Making comparisons: Describing population patterns of health and disease 34
Pitfalls in interpreting health and disease patterns 38
What are the criteria for defining the disease? 38
Have all cases of the disease been identified? 39
Is the population at risk accurately defined? 40
Making comparisons between groups through planned studies 40
Example: Epidemiological study leading to successful prevention 41
Cross-sectional studies 42
Outline of methodology 42
Choosing a study population 43
Sampling 43
Data specification 44
Data collection 44
Example of a cross-sectional study: Health survey for England 45
Cohort studies 46
Outline of methodology 46
Choice of study population 46
Characterizing the cohort 46
Follow-up phase 47
Example of a cohort study: The nurses’ health study 47
Case–control studies 48
Outline of methodology 48
Choice of a study population 48
Matching cases and controls 49
Assembling data on the exposure 50
Example of a case–control study: The interstroke project 50
Example of a nested case–control study: Risks of oral contraceptives 51
Measures of association 52
Measures of population disease impact 52
Analysis of data from cohort and case–control studies 53
Making causal inferences 54
Chance 54
Bias 54
Confounding 55
Intervention studies (including randomized controlled trials) 55
Outline of methodology 55
Selection and definition of the intervention, control and study outcomes 56
Selection of the study population 56
Randomization 56
Follow-up and analysis 56
Example of a randomized controlled trial in public health: Abdominal aortic aneurysm screening 57
Qualitative research and mixed methods 57
Systematic review and meta-analysis 58
Genetic epidemiology 59
Application of epidemiology 59
Conclusions 60
3 Communicable diseases 61
Introduction 61
Essentials of communicable disease 62
Infectious agents 64
Classifications 64
Reservoirs 66
Routes of entry into and exit from the body 66
Modes of transmission 67
Susceptible recipient 67
Investigation 67
Contents vii
Prevention and control 71
Protecting the susceptible host: Vaccination and other measures 71
Interrupting transmission 75
Targeting reservoirs of infection 75
Surveillance 75
Infectious diseases causing a major burden of mortality: The big killers 78
HIV and AIDS 78
Tuberculosis 81
Malaria 82
Diarrhoeal disease 83
Pneumonia 85
Infectious diseases causing a major burden of morbidity and disability 85
Neglected tropical diseases 86
Blood-borne hepatitis viruses 88
Dengue fever 90
Measles 91
Meningitis 92
Healthcare-associated infection 93
Methicillin-resistant staphylococcus aureus 95
Clostridium difficile 95
Food-borne infection 97
Sexually transmitted infections 100
Emerging and re-emerging diseases 102
Ebola fever and the Viral Haemorrhagic Fevers 104
Severe Acute Respiratory Syndrome 106
Influenza 107
Key distinction: Seasonal, avian, animal and pandemic influenza 107
Pandemic influenza: Past and future 108
The 2009 pandemic 109
Pandemic preparedness 110
Antimicrobial resistance 110
Causes of antimicrobial resistance 110
The burden of harm 111
Strategies to combat resistance 112
Organizations and regulations 113
Public Health England 113
Local government 114
World Health Organization and Interntional Health Regulations 115
Conclusions 115
4 Non-communicable diseases 117
Introduction 117
Trends in the United Kingdom 117
Risk factors 120
Food 122
Macronutrients 122
Micronutrients 123
Other key dietary components 123
Action to improve diet 123
Smoking and tobacco control 126
Physical inactivity 129
Alcohol use 131
Education and information 132
Pricing 133
Regulation of sales and access 133
Marketing 134
viii Contents
Blood alcohol limits for drivers 134
Individual treatment services 134
Obesity and overweight 134
High blood pressure 138
Unintentional injury 139
Prevention, detection and slowing disease progression 142
High-risk and population approaches to primary prevention 143
Screening: Detecting disease in its presymptomatic phase 145
Running a screening programme 146
Screening programmes in the NHS 149
NHS health checks 151
Conclusions 151
5 Social determinants of health 153
Introduction 153
Social position and deprivation 153
Major health determinants 158
Income 158
Education 159
Occupation 160
Ethnicity 161
Neighbourhood 162
Social capital and social support 163
Social mobility 164
Biological pathways 165
Policy and action 166
Conclusions 167
6 Health systems 169
Introduction 169
Ideal of universal health coverage 169
Health system aims 171
Health 171
Quality and safety 171
People-centred care 172
Entitlements and protection 172
Resilience 174
Sustainability 175
Health system models 176
Tax-funded 176
Social and other insurance 177
Direct payment 177
Health system financing 177
Raising revenue 177
Fund pooling 179
Distributing funds and reimbursing service providers 179
Structure and functioning of the National Health Service 180
Founding principles 180
Early developments 181
The first reorganization: 1974 182
Introduction of general management: Griffiths 182
Creation of an internal market: The Thatcher reforms 183
New Labour’s modernization programme 184
Coalition government and the Lansley reforms 185
NHS management 186
National roles and accountabilities 186
Commissioning 187
Standard setting: National institute for Health and Care Excellence 189
Regulation 190
Contents ix
Other national-level specialist functions 191
Public health england and local public health services 192
Provision of primary care 193
Secondary and tertiary care 194
Emergency care 194
Independent and private hospitals 195
Integrated care 195
Health workforce 195
Social care 196
UK devolved administrations 197
Measuring health system performance 197
Conclusions 198
7 Quality and safety of healthcare 201
Introduction 201
Quality concepts and philosophies 202
Donabedian triad 202
Deming and the 14 principles: Total quality management 203
RAND’s leadership on quality: The concept of appropriateness 204
Clinical governance: The call for clinical leadership and accountability 205
McMaster and the evidence-based medicine movement 206
The Toyota Tradition: Stop the line and lean thinking 208
Six Sigma: The Motorola and General Electric way 209
Clinical standards and audit 209
Institute for Healthcare Improvement: Collaboratives and the improvement model 209
Standardization: The world of checklists and standard operating procedures 211
Patient safety 211
Burden of harm 212
Importance of systems thinking 212
Learning from other high-risk industries 215
Reporting, investigating and learning 217
Patient safety cultures 219
Towards high-reliability organizations 220
Assuring the quality of individual practice 220
Patient and family involvement 221
Building quality and safety into healthcare 223
System level 223
Within healthcare organizations 225
On the front line 225
Data and information 227
Inspection and regulation 228
Conclusions 228
8 Maternal and child health 229
Introduction 229
Maternal mortality 229
Child mortality 230
Fertility and family planning 234
Infertility 235
Contraceptive methods 236
Abortion 236
Teenage pregnancy 237
Antenatal Care 238
Healthcare after birth in the United Kingdom 239
Breastfeeding 240
Maternal mental health 240
Children’s services in the United Kingdom 241
Healthy and unhealthy behaviour 241
Adolescents and young people 242