Public Health and Epidemiology at a Glance

Public Health and Epidemiology at a GlanceMargaret SomervilleMD, MRCP, FFPH Director of Public Health and Health PolicyNHS HighlandInverness, UK

K. KumaranDM, FFPHConsultant in Public Health MedicineNHS SomersetSomerset, UK

Rob AndersonPhD, MSc, MA(Econ.)Peninsula Technology Assessment Group (PenTAG)Institute of Health Service ResearchPeninsula Medical SchoolExeter, UK

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Library of Congress Cataloging-in-Publication Data

Somerville, Margaret, Dr. Public health and epidemiology at a glance / Margaret Somerville, Kalyanaraman Kumaran, Robert Anderson. p. ; cm. – (At a glance) Includes bibliographical references and index. ISBN-13: 978-0-470-65445-3 (pbk. : alk. paper) ISBN-10: 0-470-65445-7 (pbk. : alk. paper) I. Kumaran, Kalyanaraman. II. Anderson, Robert, 1967- III. Title. IV. Series: At a glance series (Oxford, England). [DNLM: 1. Epidemiologic Methods. 2. Public Health. 3. Needs Assessment. WA 105] LC classification not assigned 614.4–dc23 2011028910

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Set in 9 on 11.5 pt Times by Toppan Best-set Premedia Limited

1 2012

Contents  5

Preface  6Acknowledgements  7About the authors  7

  1  Introduction to public health  8

Epidemiology and Evidence-Based Practice  2  Incidence and prevalence  10  3  Risks and odds  12  4  Hierarchy of evidence and investigating causation  14  5  Bias, confounding and chance in epidemiological studies  16  6  Standardisation  18  7  Ecological and cross-sectional studies  20  8  Case-control and cohort studies  22  9  Trials (experimental studies)  2410  Systematic reviews and meta-analysis  2611  Diagnostic tests  28

Assessing Population Health12  Health and illness  3013  Demography  3214  Epidemiological transition  3415  Health information  3616  Measuring population health status  3817  Lifestyle determinants of health  4018  Environmental determinants of health  4219  Inequalities in health  4420  Socio-economic inequalities in health  4621  Health needs assessment  48

Improving and Protecting Health22  Disease prevention  50

Contents

23  Principles of disease transmission  5224  Communicable disease control  5425  Surveillance  5626  Immunisation  5827  Screening principles  6028  Screening programmes  6229  Health promotion  6430  Changing behaviour  66

Health Economics31  Economic perspectives on health  6832  Economic evaluation  7033  Economic perspectives on measuring health-related 

outcomes  7234  Economics of public health problems  74

Effective Health Care35  Health care systems  7636  Planning health services  7837  Health care evaluation  80

Self-Assessment    Self-assessment questions  82    Self-assessment answers  84

Appendix: Practical issues in conducting epidemiological studies  85

Further reading  87

Index  88

6  Preface

Preface

This book has arisen from our experience of developing a new undergraduate medical course for the Peninsula Medical School. In the early days, we were conscious of staying just one step ahead of the students in terms of planning the next stage of the curricu-lum. Now that the course is well-established, we are inevitably reflecting on where and how in the curriculum public health and epidemiology are best delivered. The GMC guidance in Tomorrow’s Doctors stresses the fundamental importance of public health as a core element of medical training; consequently our considered view is that learning about public health principles and practice should be fully integrated into all aspects of clinical learning.

Another important principle is that students should learn from people working in service public health, just as they learn from

active clinicians in other fields. We have tried to ensure that this book covers public health topics, and particularly epidemiology, in such a way that the practical applications of theory and princi-ples to public health service work can be seen. We would recom-mend that students whose interest is sparked by this book should actively seek out public health professionals (who can be found in many different places, not just the health service) to find out about their everyday work.

Margaret Somerville MD, MRCP, FFPHK. Kumaran DM, FFPH

Rob Anderson PhD, MSc, MA(Econ.)

About the authors 7

About the authors

Margaret Somerville

Margaret Somerville is Director of Public Health and Health Policy for NHS Highland, a post she took up in 2010. Previously, she was Director of Public Health Learning at the Peninsula Medical School, where she developed the public health aspects of the integrated undergraduate medical curriculum from the outset of the course in 2002.

K. Kumaran

Kumaran is a Consultant in Communicable Disease Control at the South West (South) Health Protection Unit and a Consultant in Public Health at NHS Somerset. He also holds an honorary academic post as Clinical Lecturer at the Peninsula Medical

School. Previously, in his substantive part-time role at the medical school, he was involved in the development and delivery of the undergraduate public health curriculum between 2004 and 2010 working with other colleagues.

Rob Anderson

Rob Anderson is Associate Professor of Health Economics and Evaluation within the Peninsula Medical School, at the University of Exeter. With others, he has developed and taught the health economics and related components of the undergraduate medical curriculum at the medical school since 2005. His research involves the evaluation and economic evaluation of health technologies and public health policies and programmes to inform national policy.

Acknowledgements

We had the support and guidance of many people in developing the Peninsula Medical School course and we have used much of the material as the basis for the chapters in this book, but we would particularly like to thank Stuart Paynter, Graham Taylor, Stuart Logan and Ken Stein for their help with parts of the cur-riculum relating to epidemiology, evidence-based practice and

statistics. Any misrepresentation of their original contributions to the teaching material is entirely our responsibility.

We are also very grateful for the help and guidance from Wiley-Blackwell, particularly Laura Murphy and Elizabeth Johnston, in getting this book from ideas to finished product.

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PublicHealthandEpidemiologyataGlance, First Edition. Margaret Somerville, K. Kumaran, Rob Anderson. 8 © 2012 John Wiley & Sons, Ltd. Published 2012 by John Wiley & Sons, Ltd.

1 Introduction to public health

InequalitiesEducationHousing

EmploymentFamily/community

LifestylesSurveillance and monitoringof specific diseases and risk

factors

Health improvement Improving services

Health protection

(a) An illustration of the ‘downstream’ approach of health care services in rescuing people who have fallen into the river, instead of moving ‘upstream’ to find out why people have fallen in

(b) The UK Faculty of Public Health’s domains of public health

Infectious diseasesChemicals and poisons

RadiationEmergency responseEnvironmental health

hazards

Clinical effectivenessEfficiency

Service planningAudit and evaluationClinical governance

Equity

Source: Faculty of Public Health, www.fph.org.uk. Accessed 25 March 2011