Public Health and Epidemiology

Family based studies, including intergenerational, sibling and twin studies, are increasingly used to explore life course epidemiology. However, understanding the underlying assumptions of these studies and hence the inferences that can be drawn from them is complex. Further, there are issues relating to study design and the statistical analysis of family-based studies that are not well understood. This book provides in one volume the knowledge and skills required to design, analyse, and correctly interpret family based studies. The book is divided into four sections that cover the theoretical underpinning of using family based studies in life course epidemiology; practical issues of data collection, storage, and collaborative use (including a chapters on conducting such studies in low and middle income countries and the use of information provided by other family members); statistical analysis and correct interpretation of results from family based studies and a section that illustrates the use of these studies in life course epidemiology, with examples from three areas — cardiovascular disease, mental health and wellbeing, and reproductive health.

This book has a mission of describing the application of basic epidemiologic principles in real time, place, and person to solve problems of an urgent or emergency nature. Based on decades of experience in both infectious and non-infectious diseases at the Centers for Disease Control and Prevention, this book describes the distinct approach, tasks, and actions needed for successful field investigations. Guidance is given on such issues as how to perform surveillance, manage, and execute field investigations, collect and analyze data, perform surveys, adapt a personal computer for field use, and communicate the findings. Specific advice is also given on such subjects as dealing with the media; investigations in health care, day care, and international settings; and the legal aspects of field studies. An entire chapter covers the proper collection, handling, and testing of infectious and non-infectious agents in the field. This text is a new edition of the book and the book contains new chapters on environmental investigations and immunization practices for the field epidemiologist. The book is based both on science and experience. It deals with real problems, real places, and real people: nature's experiment rather than carefully designed studies in a laboratory or clinical setting.

This research book presents a critical analysis of mandatory food fortification as a technology for protecting and promoting public health. Increasing numbers of foods fortified with novel amounts and combinations of nutrients are being introduced into the food supplies of countries around the world to raise populations’ nutrient intakes. Three topical food fortification case studies representing the different public health rationales for adding nutrients to food were assessed for their public health benefits, risks and ethical considerations: Universal salt iodisation (USI) to help prevent iodine deficiency disorders; mandatory flour fortification with folic acid (MFFFA) to help prevent neural tube defects; and mandatory milk fortification with vitamin D (MMFVD) to help prevent vitamin D deficiency. These assessments found that whereas USI performs strongly as a public health intervention, MFFFA and MMFVD are associated with more risks and less ethical justification than an alternative policy option. Food fortification can be a blunt policy response to complex policy problems. The findings highlight that the primary predictor of a mandatory food fortification policy’s benefits, risks and ethics is its ability to address the underlying cause of the policy problem. The analysis of the policy-making processes for each case study found that certain powerful actors use their influence to determine what counts as evidence in policy processes to privilege food fortification activities over alternative policy options. Policy-making frequently was notable for the low prominence it afforded ethical considerations and its lack of public engagement. Priority activities to help strengthen policy processes and outcomes are suggested.

For over half a century, food policy has mapped a path for progress based upon a belief that the right mix of investment, scientific input, and human skills could unleash a surge in productive capacity which would resolve humanity's food-related health and welfare problems. It assumed that more food would yield greater health and happiness by driving down prices, increasing availability, and feeding more mouths. In the 21st century, this policy mix is quietly becoming unstuck. In a world marred by obesity alongside malnutrition, climate change alongside fuel and energy crises, water stress alongside more mouths to feed, and social inequalities alongside unprecedented accumulation of wealth, the old rubric of food policy needs re-evaluation. This book explores the enormity of what the new policy mix must address, taking the approach that food policy must be inextricably linked with public health, environmental damage, and social inequalities to be effective. This book reflects the myriad of perspectives essential to a comprehensive view of modern food policy. It attempts to make sense of what is meant by food policy; explores whether the term has any currency in current policy discourse; assesses whether current policies help or hinder what happens; judges whether consensus can triumph in the face of competing bids for understanding; looks at all levels of governance, across the range of actors in the food system, from companies and the state to civil society and science; considers what direction food policies are taking, not just in the UK but internationally; assesses who (and what) gains or loses in the making of these food policies; and identifies a modern framework for judging how good or limited processes of policy-making are.

This book provides a framework for developing and analyzing health sector reforms, based on international experience. It offers practical guidance and stresses the need to take account of each country's economic, administrative, and political circumstances. The book explains how to design effective government interventions in five areas—financing, payment, organization, regulation, and behavior—to improve the performance and equity of health systems around the world. There are a number of critical features in the book's approach to health-sector reform. The first is to see the health sector as a means to an end. Reformers should judge their systems by the consequences, to define problems in terms of performance deficiencies, and to assess proposed solutions by whether they promise to remedy those deficiencies. This approach leads to an analytically rigorous method for problem definition, causal diagnosis, and policy development. This kind of method has often been lacking in health reforms efforts, and its lack is partially responsible for the disappointing results. A second major feature of the book's approach is a commitment to combining international experience with deep sensitivity to local circumstances. A third feature of this study is that the book puts forward a multidisciplinary approach to the problems of health-sector reform. Finally, the book argues that health-sector policy inevitably involves ethical choices.

This book is the first to fill in the gaps in the map of occupational health by creating a picture that is truly global, both geographically and in its coverage of the impact of work on the health of individuals, families, and societies. Leaders from universities, international organizations, and nongovernmental organizations bring expertise from six continents to this book. Drawing from studies done around the world, this book critically examines the manifold ways in which work is affecting health. The first part covers the wide range of risks—physical, chemical, biological, and social—to the health of individual employees in agricultural, industrial, and post-industrial workplaces. Part II provides a detailed analysis of how working conditions can dramatically influence the health and welfare of workers' family members including children, elderly parents, and the disabled in both the developing and industrial world. Part III examines the relationships between work and health at the societal level by focusing on two examples: the ways in which working conditions affect income inequalities and health, and the ways in which they influence gender inequalities and health. Part IV investigates the new challenges to and opportunities for improving the relationships between work and health that are presented by a rapidly globalizing economy.

This book provides an introduction to a vital—but often neglected—area in the field of health sciences. Work-related illnesses and injuries are critical concerns for every country and at every stage of economic development and an important determinant of health and financial security for working adults and their families. This book addresses worker protection and the management of occupational health from rich industrialized countries to developing societies. The first section of the book concentrates on broad approaches and frameworks for the investigation and management of health in the workplace. The second section addresses important hazards. The third section addresses specific industry sectors, management challenges, and policies at the global level. Each chapter links occupational health to economic development concepts and future trends.

This book provides an account of the international state of public health, including an agenda for improving the practice of the discipline across the world. It addresses three major issues, presented in distinct sections: the changing global context for public health; the state of public health theory and practice in both developed and developing countries; and strategies for strengthening the practice of public health in the 21st century. Part one surveys the complex old and new challenges facing public health practitioners, and then summarizes the state of health globally using new data based on measures of the Global Burden of Disease developed by the Word Health Organization, and other groups, to better describe population health states and trends. Part two presents the first detailed review of the global state of public health. It analyses the public health situation in all regions of the world. Six chapters cover Europe, North and Latin America, and Australia and New Zealand, including a new chapter focusing on the UK. Three chapters cover China, India, and Sub-Saharan Africa. The lessons from these chapters are surprisingly similar: the challenges are great; the public health workforce and infrastructure have long been neglected; and much needs to be done to reinvigorate the practice of public health. The third section covers several cross cutting themes, including the developing field of international public health ethics and the central and neglected role of the public in strengthening the practice of public health. The final chapter summarizes the major themes of the book and explores the opportunities for building the capacity of the public health workforce to respond to the major global health needs. Despite the enormity of the challenges facing public health practitioners, especially in low and middle income countries, the tone adopted in the final section of this book is relatively optimistic.