Public Health Concepts Research Articles

Multilevel analysis of the role of women\u2019s empowerment on use of contraceptive methods among married Cambodian women: evidence from demographic health surveys between 2005 and 2014

BackgroundThe use of contraceptives is an essential public health concept that improves overall safe motherhood and infant health. Women empowerment has been reported to influence health behaviors in women. With recent efforts to increase access to contraceptive methods, uptake of the same remains a challenge in Cambodia. There are limited studies that have examined the role of women’s empowerment at both individual- and community- level on contraceptive use in Cambodia. This study examined the individual- and community-level factors associated with contraceptive use among Cambodian married women between 2005 and 2014.MethodsData from 2005, 2010, and 2014 Cambodia Demographic and Health Surveys were used to analyze 2211; 10,505; and 10,849 women, respectively. Multilevel binary and multinomial logistic regression models were applied to assess the association between individual- and community- level factors, and the use of contraceptive methods.ResultsThe prevalence of using modern contraceptive methods increased over time (i.e., 29.0, 38.1, and 42.3% in 2005, 2010, and 2014, respectively). At the individual level, women who attained secondary and higher education were more likely to use any contraceptives [adjusted odds ratio (aOR) = 1.43, 95% confidence interval (CI) = 1.22–1.68, and aOR = 1.23, 95% CI = 1.05–1.44 in 2010 and 2014, respectively] compared with those with no formal education. Similarly, having a high workforce participation level was significantly associated with increased likelihood of using any contraceptive methods [aOR = 1.12, 95% CI = 1.00–1.26, aOR = 1.44, 95% CI = 1.29–1.60 and in 2010 and 2014, respectively]. Other factors such as age at first marriage, residence, and having a health insurance were associated with contraceptive use. The proportional change in variance showed that about 14.3% of total variations in the odds of contraceptive use across the communities were explained by both individual- and community-level factors. Moreover, the intraclass correlation showed that about 5.2% of the total variation remained unexplained even after adjustments.ConclusionBoth individual- and community- level factors influenced contraceptive use in Cambodia. When designing programs to improve contraceptive use, contextual influences should be taken into account for the effectiveness of the programs.

Effectiveness of Health Guidance Simulation in Community Settings for Public Health Nursing Students: A Preliminary Study.

IntroductionSimulation-based learning is a relatively new concept in public health nursing education, and little is known about the efficacy of this approach for teaching of health guidance. Objective: The aim of this study was to evaluate the effectiveness of health guidance simulation in community settings for public health nursing students.MethodsUsing a pre/post-test design, 29 public health nursing students in their third year participated in a high-fidelity simulation program with standardized patients. We developed six scenarios on health guidance for three themes (mother and child, tuberculosis, and adult occupational health) and practice guidelines for the standardized patients to act and assist in understanding of the purpose of the course. Data were collected at baseline and after the simulation sessions through evaluation sheets that the students placed in a designated box on campus. Changes in the level of self-confidence of the students were evaluated based on the “practical skills required for public health nurses and achievement level at graduation” of the Ministry of Health, Labor and Welfare, and the skills in the minimum requirements for public health nurse education defined by the Japan Association of Public Health Nurse Educational Institutions.ResultsThe total score for self-confidence and the mean self-confidence scores for health guidance skills for mother and child, tuberculosis, and adult occupational health nursing were significantly higher post-test compared to pre-test (p < 0.001).ConclusionThese results indicate that high-fidelity simulation focused on health guidance in community settings can bridge the gap between theoretical knowledge and practice of students.

“Co-Benefits” as a Lens Through Which COVID-19 Building Upgrades Can Advance Environmental Sustainability, Climate Mitigation and Adaptation, and Social Equity

Buildings play a critical role in disaster preparedness and response. They can protect occupants from exposure to an environmental hazard like a hurricane, a flood, or an extreme heat event. On the other hand, if systems break down or structures collapse, they also contribute to the injury and death toll. Buildings have played a similarly contradictory role during the COVID pandemic. On the one hand, they have provided safety and shelter at a time when it is safer to stay physically distant from individuals outside of one’s family unit. At the same time, mechanical ventilation systems have contributed to the spread of SARS-CoV-2, the virus that causes COVID-19. This commentary proposes deploying the public health concept of “co-benefits” as a lens through which COVID upgrades to existing buildings and design considerations for new buildings could be leveraged to advance environmental sustainability, climate mitigation and adaptation, and social equity.

Evaluating a service-learning assignment in a doctor of chiropractic program public health course.

Despite the use of service learning in other health care education programs, little is published about its use in doctor of chiropractic programs. Since 2017, the public health course at our institution has included a service-learning assignment in which students volunteer for nonprofit organizations and write an essay about their experience. The objective of this study was to assess the effects of the assignment on students' self-reported public health knowledge and attitudes. Between April 2017 and June 2018, 56 essays were collected from students who volunteered at a nonprofit organization focused on 3 categories: youth, the environment, or poverty. Each essay was deidentified and assigned random 4-digit-number file names. Ten files were randomly selected from each of the 3 categories for qualitative thematic analysis using deductive and inductive coding. Student essays demonstrated competency in public health concepts, including organizational systems, levels of prevention, and the social ecological model. In addition, a majority of the students went beyond discussing knowledge gained from this assignment and described the impact of their experience on their personal growth. This study demonstrates that students respond favorably to a service-learning assignment that addresses public health competencies and may foster personal and professional development.

СУЧАСНІ ТА МАЙБУТНІ ВИКЛИКИ ДЛЯ ПУБЛІЧНОГО УПРАВЛІННЯ У СФЕРІ ОХОРОНИ ЗДОРОВ’Я

The general articulation of the issue and its connection with the important research and practice tasks. Demographic processes and epidemiological characteristics, social norms changes and standards of development of public expectations, evolution of organizational and legal bases of the health care system, improvement of medical technologies will have a significant impact on characteristic of public health administration in the future.The analysis of the recent publications regarding the issues this article deals with; identification of parts of the general problem that have not been previously addressed. Publications of Ukrainian and foreign scientists, analytical and statistical data of the World Health Organization, the World Bank, the Ministry of Health of Ukraine were researched. There is a need to substantiate competencies of public health administration taking into account the characteristics of social development and public expectations.The purpose (the objective) of this article is to substantiate of the main directions of improvement of public health administration, organization and financing of health care system in Ukraine according to the development of social norms, standards and public expectations.The key results and the background. In the future, the health care needs of the population in Ukraine will be primarily affected by the characteristics of demographic and epidemiological processes. They are population aging, lifestyle, individual risk factors, socially communicable diseases, in particular COVID-19.It will be important not only the result of health care institutions, but also the process (the concept of evidencebased public health, comprehensive quality management, horizontal integration of health care institutions and social assistance, assessment of impacts on public health, etc.).Conclusions and the prospects of the further research. Significant civilizational changes in the development of society, related to science, technology and management, will increase changes in the field of health care. Public administration and training programs for health care managers need to be improved in line with updated social expectations.

Integrating clinical and public health knowledge in support of joint medical practice

BackgroundStrong relations between medicine and public health have long been advocated. Today, professional medical practice assumes joint clinical/public health objectives:GPs are expected to practice community medicine;Hospital specialists can be involved in disease control and health service organisation;Doctors can teach, coach, evaluate, and coordinate care;Clinicians should interpret protocols with reference to clinical epidemiology.Public health physicians should tailor preventive medicine to individual health risks.This paper is targeted at those practitioners and academics responsible for their teams’ professionalism and the accessibility of care, where the authors argue in favour of the epistemological integration of clinical medicine and public health.Main textBased on empirical evidence the authors revisit the epistemological border of clinical and public health knowledge to support joint practice. From action-research and cognitive psychology, we derive clinical/public health knowledge categories that require different transmission and discovery techniques.The knowledge needed to support the universal human right to access professional care bridges both clinical and public health concepts, and summons professional ethics to validate medical decisions. To provide a rational framework for teaching and research, we propose the following categories:‘Know-how/practice techniques’, corresponding a.o. to behavioural, communication, and manual skills;‘Procedural knowledge’ to choose and apply procedures that meet explicit quality criteria;‘Practical knowledge’ to design new procedures and inform the design of established procedures in new contexts; andTheoretical knowledge teaches the reasoning and theory of knowledge and the laws of existence and functioning of reality to validate clinical and public health procedures.Even though medical interventions benefit from science, they are, in essence, professional: science cannot standardise eco-biopsychosocial decisions; doctor-patient negotiations; emotional intelligence; manual and behavioural skills; and resolution of ethical conflicts.ConclusionBecause the quality of care utilises the professionals’ skill-base but is also affected by their intangible motivations, health systems should individually tailor continuing medical education and treat collective knowledge management as a priority. Teamwork and coaching by those with more experience provide such opportunities. In the future, physicians and health professionals could jointly develop clinical/public health integrated knowledge. To this end, governments should make provision to finance non-clinical activities.

A plea to merge clinical and public health practices: reasons and consequences

BackgroundRevisiting professionalism, both as a medical ideal and educational topic, this paper asks whether, in the rise of artificial intelligence, healthcare commoditisation and environmental challenges, a rationale exists for merging clinical and public health practices. To optimize doctors’ impact on community health, clinicians should introduce public health thinking and action into clinical practice, above and beyond controlling nosocomial infections and iatrogenesis. However, in the interest of effectiveness they should do everything possible to personalise care delivery. To solve this paradox, we explore why it is necessary for the boundaries between medicine and public health to be blurred.Main bodyProceeding sequentially, we derive standards for medical professionalism from care quality criteria, neo-Hippocratic ethics, public health concepts, and policy outcomes. Thereby, we formulate benchmarks for health care management and apply them to policy evaluation. During this process we justify the social, professional - and by implication, non-commercial, non-industrial - mission of healthcare financing and policies.The complexity of ethical, person-centred, biopsychosocial practice requires a human interface between suffering, health risks and their therapeutic solution – and thus legitimises the medical profession’s existence. Consequently, the universal human right to healthcare is a right to access professionally delivered care. Its enforcement requires significant updating of the existing medical culture, and not just in respect of the man/machine interface. This will allow physicians to focus on what artificial intelligence cannot do, or not do well. These duties should become the touchstone of their practice, knowledge and ethics. Artificial intelligence must support medical professionalism, not determine it. Because physicians need sufficient autonomy to exercise professional judgement, medical ethics will conflict with attempts to introduce clinical standardisation as a managerial paradigm, which is what happens when industrial-style management is applied to healthcare.ConclusionPublic healthcare financing and policy ought to support medical professionalism, alongside integrated clinical and public health practice, and its management. Publicly-financed health management should actively promote ethics in publicly- oriented services. Commercialised healthcare is antithetical to ethical medical, and to clinical / public health practice integration. To lobby governments effectively, physicians need to appreciate the political economy of care.

Improving Collaboration Between Public Health and Medicine: A Timely Survey of Clinician Public Health Knowledge, Training, and Engagement

ObjectiveTo assess the core knowledge of health indicators, federal health programs, and public health functions in practicing clinicians along with perceptions of their education and engagement with public health. Patients and MethodsA paper survey in booklet form was administered to attendees at 2 general medical conferences in May 2019. The survey was divided into 5 sections: knowledge of health systems and policy, knowledge of public health concepts and function, public health engagement, public health education, and demographics. ResultsOne hundred two surveys were received from 402 attendees (response rate, 24.3%). Most were male (56%), older than 50 years (51%), and physicians (86%). Respondents had a fairly good knowledge of federal health programs (77%) and public health functions (84%), but less than half had a personal interaction with public health in the past 2 years (45%) or were aware of how to work with public health organizations in their community (46%). Only a few respondents rated their public health training as good or excellent during their primary degree (7%) or graduate medical education (15%), and most (75%) were interested in learning more about public health and health policy. ConclusionRespondents had generally good foundational knowledge of federal health programs and public health functions, although some gaps were identified. Inclusion of health policy and public health topics in continuing medical education would be well received by clinicians. To improve collaboration between public health and medicine, public health should personally engage clinicians more and explain how they can work together to improve population health.

Systems leadership in practice: thematic insights from three public health case studies

Background‘Systems leadership’ has emerged as a key concept in global public health alongside such related concepts as ‘systems thinking’ and ‘whole systems approaches.’ It is an approach that is well suited to issues that require collective action, where no single organisation can control the outcomes. While there is a growing literature on the theory of systems leadership in a number of fields, there remains a lack of published empirical studies of public health systems leadership for professionals to learn from. The aim of the current project was to conduct cases studies in UK public health to provide empirical evidence on the nature of effective systems leadership practice.MethodsThree system leadership case studies were identified in the key domains of public health: health protection, healthcare public health and health improvement. A total of 27 semi-structured interviews were conducted. Data were thematically analysed to identify the components of effective systems leadership in each case and its impact.ResultsThe thematic analysis identified themes around ‘getting started,’ ‘maintaining momentum’ and ‘indicators of success’ in systems leadership. In terms of getting started, the analysis showed that both a compelling ‘call to action’ and assembling an effective ‘coalition of the willing’ are important. To maintain momentum, the analysis identified themes relating to system structure, culture and the people involved. Regarding culture, the main themes that emerged were the importance of nurturing strong relationships, curiosity and a desire to understand the system, and promoting resilience. The analysis identified three components that could be used as indicators of success; these were a sense of enjoyment from the work, resource gains to the system and shifts in data indicators at the population level.ConclusionsThis study has provided insight into the nature of systems leadership in public health settings in the UK. It has identified factors that contribute to effective public health systems leadership and offers a thematic model in terms of establishing a systems leadership approach, maintaining momentum and identifying key success indicators.

A semi-automated approach to data harmonization across environmental health studies

The NIEHS-supported Human Health and Exposure Analysis Resource (HHEAR) Data Center maintains a public-use data repository to promote reuse of environmental health data generated by the HHEAR program. The creation and maintenance of this repository requires the integration of information from a wide variety of epidemiologic studies. We have developed the Human Aware Data Acquisition Framework to enable this complex integration, supporting harmonization across multiple studies, and enabling meaningful search and access of the data deposited in the HHEAR Data Repository. To integrate data from a new study, investigators engage in an initial, time-consuming effort to link study data to the HHEAR ontology, a controlled vocabulary of environmental and public health terms. This is accomplished by generating a semantic data dictionary (SDD) from the data dictionaries and codebooks provided by HHEAR study investigators. Originally, this had been done manually by an expert in both epidemiological terminology and ontological modeling. To increase the accessibility of these tools for environmental health scientists who lack formal ontologic training, we have developed an SDD-Editor that simplifies the ontology modeling process. The SDD-Editor reuses elements common to epidemiologic data dictionaries and spreadsheet software, while integrating features needed to form semantic links between public health concepts and existing ontologies. The SDD-Editor suggests potential concept matches for study variables within the SDD using natural language processing to capture the semantic similarity between data dictionary and ontology class descriptions. If no suitable suggestion exists, investigators can search for ontology terms using a search engine powered by Bioportal. Once finished, a validator is run to check that the SDD has the correct format and all classes are valid. By automating parts of the ontology modeling process, the SDD-Editor greatly facilitates the dynamic integration of HHEAR environmental health studies into a single repository, benefiting the scientific community.

Development of Conceptual Animation Video Library to Explain Health Behavior Theory Applications from the Peer-reviewed Public Health Literature

ABSTRACT Background While most undergraduate students in public health are aware of health behavior theories and models, they lack sufficient knowledge about how to apply and test them in Health Education/promotion research. Purpose: Evaluate eight new conceptual animation (CA) videos that explained theory and model testing in eight research articles from the public health literature. Methods: A convenience sample of public health faculty and undergraduate students pretested the CA video series during Summer 2019. Following pretesting, a convenience sample of 24 undergraduate public health majors completed an online evaluation survey about the CA video series to assess learning outcomes, quality, and student engagement. Results: Every CA video in the series received usability scores (>80.3) consistent with an “A” usability grade. Academic year and student usability ratings were significantly associated with perceived quality of the learning experience, R2 =.18, R2 adj =.14, F 9,229 = 5.28, P <.001. Discussion: The new CA video series improved the quality of students’ learning experience about select public health theories and models, especially among underclassmen. Translation to Health Education Practice: These promising findings warrant further investigation into how conceptual animation can be used as a pedagogical tool to improve student understanding of complex public health concepts.

Model &lt;i&gt;homo sustinens&lt;/i&gt; oraz &lt;i&gt;homo ecologicus&lt;/i&gt; we współczesnej koncepcji zdrowia publicznego

Model &lt;i&gt;homo sustinens&lt;/i&gt; oraz &lt;i&gt;homo ecologicus&lt;/i&gt; we współczesnej koncepcji zdrowia publicznego

Systematic analysis of the scientific literature on population surveillance

IntroductionPopulation surveillance provides data on the health status of the population through continuous scrutiny of different indicators. Identifying risk factors is essential for the quickly detecting and controlling of epidemic outbreaks and reducing the incidence of cross-infections and non-communicable diseases. The objective of the present study is to analyze research on population surveillance, identifying the main topics of interest for investigators in the area. MethodologyWe included documents indexed in the Web of Science Core Collection in the period from 2000 to 2019 and assigned with the generic Medical Subject Heading (MeSH) “population surveillance” or its related terms (“public health surveillance,” “sentinel surveillance” or “biosurveillance”). A co-occurrence analysis was undertaken to identify the document clusters comprising the main research topics. Scientific production, collaboration, and citation patterns in each of the clusters were characterized bibliometrically. We also analyzed research on coronaviruses, relating the results obtained to the management of the COVID-19 pandemic. ResultsWe included 39,184 documents, which reflected a steady growth in scientific output driven by papers on “Public, Environmental & Occupational Health” (21.62% of the documents) and “Infectious Diseases” (10.49%). Research activity was concentrated in North America (36.41%) and Europe (32.09%). The USA led research in the area (40.14% of documents). Ten topic clusters were identified, including “Disease Outbreaks,” which is closely related to two other clusters (“Genetics” and “Influenza”). Other clusters of note were “Cross Infections” as well as one that brought together general public health concepts and topics related to non-communicable diseases (cardiovascular and coronary diseases, mental diseases, diabetes, wound and injuries, stroke, and asthma). The rest of the clusters addressed “Neoplasms,” “HIV,” “Pregnancy,” “Substance Abuse/Obesity,” and “Tuberculosis.” Although research on coronavirus has focused on population surveillance only occasionally, some papers have analyzed and collated guidelines whose relevance to the dissemination and management of the COVID-19 pandemic has become obvious. Topics include tracing the spread of the virus, limiting mass gatherings that would facilitate its propagation, and the imposition of quarantines. There were important differences in the scientific production and citation of different clusters: the documents on mental illnesses, stroke, substance abuse/obesity, and cross-infections had much higher citations than the clusters on disease outbreaks, tuberculosis, and especially coronavirus, where these values are substantially lower. ConclusionsThe role of population surveillance should be strengthened, promoting research and the development of public health surveillance systems in countries whose contribution to the area is limited.

IMPORTANCE OF SOCIAL FACTORS IN HEALTH: CAUSES OF THE CAUSES

The industrial revolution in 1830 led to the urbanization resulting in creation of urban slums. More complex health problems ultimately steered the concept of public health. The social revolution during the Second World War emphasized that health could only be achieved through socioeconomic improvement. Progress in the field of social sciences rediscovered that man is a social being, not only a biological animal. Social services for the improvement of life conditions have been the major factors in reducing mortality, morbidity and improving the standard of life of an individual, family and society.

The origination and development of the public health concept as an investee: Theoretical forerunners

Subject. We determine the substance of public health as a target of management in terms of investment. Objectives. We analyze theoretical forerunners of the origination and the development of the public health concept in terms of its economic substance as a resource and investee. Methods. We sort out literary data and carry out the logic, focused and content analysis of the text. Results. The article analyzed approaches to understanding the substance and evolution of health and public health as concepts. We believe that it is necessary to specify the definition of public health in terms of its economic substance as a resource. We correspondingly analyzed the related concept, such as health capital, human capital. We suggest interpreting the public health as a medical, social and economic resource, whose quality and value are gauged with a set of demographic, medical and statistical metrics. Their level depends on the living conditions of people who are virtually investees. Conclusions and Relevance. The theoretical study and suggested definition contribute to the development of the public health theory in terms of its economic substance and dependence on the socio-economic situation in the country or the region, and the volume and method of investing in the living conditions of people. The findings can be used for further research into the nexus of the mix and volume of investment in public health and its level in the region.

25.K. Workshop: Unleashing the power of large routinely collected data for the benefit of public health

Abstract As for many other scientific domains, public health is nowadays contemplating the opportunities of using but also the challenges of mastering large routinely collected data ('big data') in order to generate knowledge, and to inform and evaluate decisions and policies. In a wide perspective, “public health relevant big data” extends from the “omics” to social network postings. In this workshop we will concentrate on electronic health records and medical claims data (hereafter referred to as eHRs) which are increasingly being used in public health research and practice. Depending of the national and historical contexts, eHRs encompass details pertaining not only to hospital admissions but also to deaths and infectious diseases registrations, prescriptions and contacts with health services. As a result, eHRs datasets are both long (ie, vast number of records) and wide (i.e., vast amount of information per record). Although the usual public health and epidemiological concepts of inference and causation are still relevant for the analysis of big health data and interpretation of their results, a new set of methodological approaches is also necessary to tackle them. These include for instance quasi-experimental/natural experimental analysis, data mining and machine learning. Recent reviews have demonstrated that these data science terms have corresponding concepts in public health research. This workshop will discuss the use of large routinely collected data in public health with a specific focus on eHRs. The objectives are: to understand the specificity of eHRs in the wider domain of big data; to discuss the challenges imposed when using such data (e.g., data heterogeneity, fragmentation, handling, access, privacy), to discuss how the analysis of big data can assist public health researchers, evaluators and policy-makers; to discuss their advantages and limitations; to outline the methodological, legal and ethical challenges that this entails. Following a brief introduction, the workshop will continue with 5 presentations drawing from a variety of national contexts. The spectrum will spread from countries where eHRs and data linkage have been applied for some years (e.g., Finland, Singapore), to others where development are more recent (France) or even being initiated (Brazil). Together, the presentations will address issues related to the development of big data set, access and training of users and implementation in public health research and practice. The remaining time will be dedicated to interaction with the audience and conclusion. Key messages Access and use of big data in the context of public health practice and research is spreading fast. The challenges ahead consist of maintaining and securing vast amount of heterogeneous health and related data, and in building the capacity to analyse them using old and new analytical approaches.

How to foster cities resilient to the COVID-19 pandemic through Urban Health strategies

BackgroundThe ongoing pandemic of COVID-19, which nowadays has exceeded 2.5 million notified infections in the world and about 200,000 deaths, is a strong reminder that urbanization has changed the way that people and communities live, work, and interact, and it's necessary to make the systems and local capacities resilient to prevent the spread of infectious diseases. How we can re-design the concept of Public Health in relation to the built environment and the contemporary cities?MethodsAccording to the previous statements and scenario, aim of this paper is to integrate the Urban Health strategic objectives, focusing the possible responses, both immediate and medium-long term, to the current environmental, social, and economic aspects of the “period” of physical distancing.ResultsImmediate Actions are 01. program the flexibility of city schedules; 02. plan a smart and sustainable mobility network; 03. define a neighborhood services' plan; 04. develop a digitization of the urban context, promoting the smart communities; 05. re-think the accessibility to the places of culture and tourism. Medium-long term Actions are 06. design the indoor flexibility of domestic living spaces; 07. re-think building typologies, fostering the presence of semi-private or collective spaces; 08. renovate the basic care services' network; 09. integrate the existing environmental emergency plans, with those related to the health emergencies; 10. improve stakeholders' awareness of the factors affecting Public Health in the cities.ConclusionsThe Decalogue of Public Health opportunities may provide a useful basis for Designers (Architects and Urban Planners), Policy Makers, Public Health experts and Local Health Agencies, in promoting actions and policies aimed to transform our cities in healthier and Salutogenic living environments.Key messages The strategies described in this paper are at the basis of a social and infrastructural rethinking of the city, careful to the Welfare and Public Health needs.The physical distancing imposed, may have amplified population's social and health inequalities.

Epidemiology and health consequences of early marriage: focus on Delta State Nigeria

Early marriage occurs for several reasons including gender inequality, poverty, insecurity and tradition. Marrying at such a young age means that these young girls are forced into sexual relations and often get pregnant when they are not ready, causing health challenges and adding to the health burden in developing countries. This paper reviews the epidemiology of early marriage with particular regards to the public health concepts and negative consequences of early marriage. This was a narrative review of previous works on early marriage. Evaluations included the statistics of the negative consequences on women and how best the practices have been ameliorated to its barest minimum. No data available on the previous works dearth of contextualized epidemiological information about Delta State Nigeria. However, available data shows as high as 88% prevalence rate of child marriage in Nigeria, with unexpected pregnancy at 23% being the major cause, maternal mortality at 90%, VVF over 500,000–1,000,000 reported annually in developing countries as the major health consequences. The causes, consequences and prevalence of early marriage constitute reasons for public health concerns to stem the tide. Willful and urgent attention is needed to prevent the pitiable situation of the victims, especially girls. Health literacy is a primary healthcare concept of community educational outreach to adopt.

Against the Public Goods Conception of Public Health

AbstractPublic health ethicists face two difficult questions. First, what makes something a matter of public health? While protecting citizens from outbreaks of communicable diseases is clearly a matter of public health, is the same true of policies that aim to reduce obesity, gun violence or political corruption? Second, what should the scope of the government’s authority be in promoting public health? May government enact public health policies some citizens reasonably object to or policies that are paternalistic? Recently, some theorists have attempted to address these questions by arguing that something is a matter of public health if and only if it involves a health-related public good, such as clean water or herd immunity. Relatedly, they have argued that appeals to the promotion of public health should only be used to justify the provision of health-related public goods. This public goods conception of public health (PGC) is meant to enjoy advantages over its rivals in three respects: it provides a better definition of public health than rival views, it respects moral disagreement, and it avoids licensing objectionably paternalistic public health policies. We argue, however, that the PGC does just as poorly, or worse, than its rivals in all three respects.

Громадське здоров’я: дискусійні питання, шляхи їх практичного вирішення

Ціль. Охарактеризувати поняття «громадське здоров’я», фактори, що його визначають, для формування стратегії і тактики розвитку охорони здоров’я. Методи. Аналіз наукової, науково-методичної літератури. Результати. В історичному аспекті представлено поняття «здоров’я», дискусійні подання цього стану. Відповідно до думки проф. М. П. Захарченка [9], «…здоров’я людини … завжди залежало, залежить і буде залежати від середовища її перебування, тобто від факторів навколишнього середовища, і порушувати питання про здоров’я як про автономне явище – це утопія» [9]. Представлено характеристику здорового організму, здорового способу життя, в якому поєднуються гармонійно фізичне, психічне й соціальне здоров’я. Наведено фізіологічні механізми позитивних ефектів рухової активності для людини. Розглянуто поняття «громадське здоров’я», його багатофакторність. Встановлено, що в Україні з 2011 р. у вищих медичних навчальних закладах IV рівня акредитації назву навчальної дисципліни «соціальна медицина й організація охорони здоров’я» було змінено на «громадське здоров’я» відповідно до її змісту в більшості країн світу. Висновок. У 2018 р. спеціальність Громадське здоров’я було ліцензовано в Україні, що спричинило необхідність проведення медичної реформи і підготовки нових кадрів за європейськими стандартами. Підготовка фахівців у цьому напрямі проводиться за фахом 229 Громадське здоров’я (галузь знань – 22 Охорона здоров’я) на трьох рівнях освіти: бакалавр, магістр і доктор філософії [5]. На базі НУФВСУ на підставі ліцензії з підготовки фахівців вищої освіти на першому (бакалаврському) рівні вищої освіти (наказ МОН України від 12.12.19 № 1010п) проводиться підготовка до навчання за ліцензованою спеціальністю 229 Громадське здоров’я.