Question 3 requires explanation based on 

1) Artefact explanation

2) Biologic and genetic explanation

3) social and economic inequality

Question 1

a) What is Public Health? Discuss the tree core functions of public health

b) Distinguish between Public Health and Medical models of professional training (40 marks)

Question 2

Women get sicker, but men die quicker” sums up the morbidity and mortality patterns of men and women globally. How can this paradox be explained? (30 marks)

Clues (Should be based on the following)

-Artefact explanation

-Biologic and genetic explanation

-Social and economic inequality

Question 3

Two theoretical perspectives are advanced to explain gender differences in psychological health, discuss these theoretical perspectives. (30 marks)

Gender and Public health

Dr Stephen T. Odonkor


Key Concepts (1)

The biological differences between women and men, boys and girls, are limited to the differences in their sexual and reproductive organs and functions.

Sex is unchanging and universal. Gender is contextual and variable.

Key Concepts (2)

GENDER has been defined and constructed in different cultures and at different periods of history.

Social norms and expectations of what women and men should be and should do, and about their roles and rights change according to generation, culture and even family

Key Concepts (3)


Socially defined roles

Change over time

Influenced by education, income level, religion…

Are different among women and men


Biological characteristics with which women and men are born

Do not vary

Are not influenced by economic or social factors

Are the same for men and women

Key Concepts (4)

Gender refers to the socially defined roles and responsibilities of men, women and boys and girls. Male and female gender roles are learned from families and communities and vary by culture and generation

Gender equality means the absence of discrimination, on the basis of a person’s sex, in opportunities, in the allocation of resources or benefits or in access to services

Gender equity means fairness and justice in the distribution of benefits and responsibilities between women and men and often requires women-specific projects and programmes to end existing inequities


Global Magnitude

70% of the world’s 7.7 billion people living in poverty are women

Women represent two thirds of the world’s non-literate people

In most developing countries, boys enrolment in school exceeds that of girls

Approximately two thirds of the children of school age who do not or can not go to school are girls

Globally, violence against women causes more deaths and disability among women aged 15 to 44 than do cancer, malaria, traffic accidents or war

Over 4 million girls are at risk each year of female genital mutilation


Women and girls are disproportionately vulnerable to HIV/AIDS, with inequality between men and women fuelling its spread

Many countries continue to discriminate against women in law. Worldwide, women hold only 12% of parliamentary seats

Gender in the context of health

Gender Inequality in relation to health

Lower status/social value in the household

Cultural factors such as lack of female health provider

Being excluded from decisi

Introduction to Public Health

Stephen T. Odonkor



This lecture provides a fundamental understanding of public health by reviewing the mission of public health, core functions of public health and ten essential services of public health.


The 10 Essential Services of Public Health:

The Future of Public Health

What is Public Health ?

Definition (1)

  • Public Health is the science and art of (1) preventing disease, (2) prolonging life, and (3) promoting health and efficiency through organized community efforts for

the sanitation of the environment,

the control of community infections,

the education of the individual,


Definition (2)

the organization of medical and nursing service for the early diagnosis and preventive treatment of disease, and

the development of the social machinery which will ensure to everyone a standard of living adequate for the maintenance of health.

  • Thus, organizing these benefits as to enable every citizen to realize his birthright of health and longevity.
  • C.E.A. Winslow, 1920 (Classic Definition)


The Substance of Public Health

  • Organized community efforts aimed at the prevention of disease and promotion of health. It links many disciplines and rests upon the scientific core of Epidemiology
  • Epidemiology is “the study of the distribution and determinants of diseases and injuries in human populations. (Mausner and Kramer 1985).

The vision of Public Health included defining the Substance of Public Health as organized community efforts aimed at the prevention of disease and promotion of health. It links many disciplines and rests upon the scientific core of Epidemiology. Epidemiology is “the study of the distribution and determinants of diseases and injuries in human populations. (Mausner and Kramer – Epidemiology and Introductory Text, W.B. Saunders Company, 2nd Edition 1985).


The Organizational Framework of Public Health

  • Encompasses both activities undertaken within the

formal structure of government and

the associated efforts of private & voluntary organizations and individuals

The vision of public health included defining the organizational framework of public health. That framework encompasses both activities undertaken within th


16 ! Public Health Reports / 2011 Supplement 3 / Volume 126

Including Gender in Public Health Research

Susan P. Phillips, MD, MSc,

aQueen’s University, Department of Family Medicine and Department of Community Health and Epidemiology, Kingston, Ontario, Canada

Address correspondence to: Susan P. Phillips, MD, MSc, CCFP, Queen’s University, Department of Family Medicine, 220 Bagot St.,
Kingston, ON K7L 5E9, Canada; tel. 613-533-9303; fax 613-549-5403; e-mail <[email protected]>.

©2011 Association of Schools of Public Health

Diversity in both biological attributes and the external, lived environment gives
rise to different susceptibilities, exposures, health outcomes, and longevity.
Public policy can modify the effects of external differences, if groups at great-
est risk are identified and pathways to excess vulnerability are understood, by
rebalancing and redistributing the inputs or social determinants that work
their way under the skin to ultimately cause biological disadvantage. In the
past three decades, a large volume of research has identified the nature of
these social determinants of health—including income, socioeconomic status
(SES), income inequality, social connectedness, and social capital—and the
pathways by which they undermine or reinforce innate health. Often listed
among these, but rarely studied, is gender. Medical research may identify sex
differences when they exist; however, the varied social roles, expectations, and
constraints experienced by men and women in a given society go well beyond
the individual and sex differences and are rarely examined as inputs responsible
for variation in health outcomes. As a result, health-affirming policies tend to
homogenize groups (e.g., assuming that all women are the same) or target
individual behaviors, and do so in a gender-blind fashion rather than address-
ing structural biases and inequities that undermine those behaviors. This article
explores the nature of gender as a determinant of health and describes how
the effects of gender inequities can be included in health outcomes research
that can then shape health planning and policy.


In 2008, the World Health Organization’s Commission on Social Determinants
of Health reported, “It is not an unfortunate cluster of random events nor
differences in individual behaviors that consistently keep the health of some
countries and population groups below others. Where systematic differences
in health are judged to be avoidable by reasonable action globally and within
society, they are, quite simply, unjust. It is this that we label health inequity.”1

Universal among such inequities is the gend
Health Education & Behavior
The online version of this article can be found at:

DOI: 10.1177/1090198111428646

2011 38: 551Health Educ Behav
Howard K. Koh, Julie J. Piotrowski, Shiriki Kumanyika and Jonathan E. Fielding

: A 2020 Vision for the Social Determinants ApproachHealthy People

Published by:

On behalf of:

Society for Public Health Education

can be found at:Health Education & BehaviorAdditional services and information for Alerts:

at DREXEL UNIV LIBRARIES on January 20, 2012heb.sagepub.comDownloaded from

Health Education & Behavior
38(6) 551 –557
© 2011 by SOPHE
Reprints and permission:
DOI: 10.1177/1090198111428646

1U.S. Department of Health and Human Services, Washington, DC, USA
2University of Pennsylvania, Philadelphia, PA, USA
3Los Angeles County Department of Public Health, Los Angeles, CA, USA

Corresponding Author:
Dr. Howard Koh, Assistant Secretary for Health, U.S. Department of
Health and Human Services, 200 Independence Avenue SW, Washington,
DC 20201, USA
Email: [email protected]

Healthy People: A 2020 Vision for
the Social Determinants Approach

Howard K. Koh, MD, MPH1, Julie J. Piotrowski, MPH1,
Shiriki Kumanyika, PhD, MPH2, and
Jonathan E. Fielding, MD, MPH, MA, MBA3

For the past three decades, the Healthy People initiative has represented an ambitious yet achievable health promotion
and disease prevention agenda for the nation. The recently released fourth version—Healthy People 2020—builds on the
foundations of prior iterations while newly embracing and elevating a comprehensive “social determinants” perspective. By
clearly articulating a new overarching goal to “create social and physical environments that promote good health for all” and
a new topic area dedicated to defining the social determinants of health approach, it breaks new ground. Specifically, the 2020
plan emphasizes the need to consider factors such as poverty, education, and numerous aspects of the social structure that
not only influence the health of populations but also limit the ability of many to achieve health equity. Improving health is too
multifaceted to be left to those working in the h


The Population Health Approach in

Historical Perspective

I Siman Szreter, PhD

The origin of the population THERE IS NO DEFINITIVE

health approach is an historic de- history ofthe population health

bate over the relationship betwee[ approach. m living memor;y, the

economic growth and human health, imp~rmnt epi~emiological research
1 B.t . dF th 1 d published dunng World War 11 by
n ri aln an rance, e n us- …

” I R I . d. d I .Jerry Moms and Richard Tltmuss
tna evo utlon Isrupte popu atlon ..

k d minal od I fISffiVO e as a se m e a
health and stimulated pioneering ul ti. h alth al .1-5

Mpop a on e an YS1S. or-
epidemiological studies, informing ris andTitmuss carefully demon-

the early preventive public health strated that the incidence of such

movement.A century-long process of “individual” aftlictiOllS as juvenile

political adjustment between the rheumatism, rheumatic heart dis-

forces of liberal d~ocracy and prop- ease, and peptic ulcer alI varied

ertied interests ensued. according to changing social condi-

The 20th-century welfarestates tiallS, such as the rate afunem-

resulted as complex political mecha- playment Along with others, they

nisms for converting economic growth sought to widen the scope of tradi-

into enhanced population health. tional beyond.dis- Cartoon from lhe September 1919 issue of lhe journal Amer;can C;ty depicting

H th . f ” I’ b I” ease prevention toward SOCIal lhe defeat of typhoid fever by lhe large-scale municipal measures of water fil-
owever, e rlse o a neo I era di t t. d hl . t. IA . C.ty 191921 247 )me cme, antiClpating to some ex- ra lon an c onDa IODo mencan ,. ;: .

agenda, demgratlng the role of gov- .~
t th hil h fth Lal du;;n ep osop ya e an e

emment, has once again brought to Report and the World Health Or- factors such as smoking and hyper- The modem arigins of this de-

the fore the importance of prevention ganization’s concept of positive tension but that, it is argued, has bate lie in the late 18th century,

and a population health approach to health.6,7 However, social medicine become too rigid and alI-pervasive, when the fOCllS of discussion was

map and publicize the health impacts never successfully institutianalized partly because af its convenience over the significance of the so-

of this new phase of “global” eco- itself and instead an academic and for the administrative and account- called “diseases of civilization,”

nomic growth. clínical epidemiolagy tended, if ing approach afilie managerial such as gout, respiratory diseases

anything, to diverge from practical regime politically imposed on the and tuberculosis, “hysteria,” and

public health work during the health service sector du


Sexual and Gender Minority Health: What We
Know and What Needs to Be Done
I Kenneth H. Mayer, MD, Judith B. Bradford, PhD, Harvey J, Makadon, MD, Ron Stall, PhD, MPH, Hilary Goldhammer, MS,

and Stewart Landers. JD. MCP

We describe the emergence of lesbian, gay, bisexual, and transgender (LGBT)
health as a key area of study and practice for clinicians and public health pro-
fessionals. We discuss the specific needs of LGBT populations on the basis of
the most recent epidemiológica! and clinical investigations, methods for defin-
ing and measuring LGBT populations, and the barriers they face in obtaining ap-
propriate care and services. We then discuss how clinicians and public health
professionals can improve research methods, clinical outcomes, and service de-
livery for lesbian, gay, bisexual, and transgender people, {Am J Public Health.

Over the pasl few decades, clinicians, public
health researchers, and officials have become
increasingly aware ttiat lesbian, gay, bisexual,
and transgender (LGBT) persons constitute
sexual and gender minorities who have
tinique health care needs.'” This recognition
was enonnously heightened by the emer-
gence of the AIDS epidemic, which demon-
strated that sexual behavior could have major
public health consequences. But the realiza-
tion that sexual minorities have specific
health care needs could arguably have begun
witli Alfred Kinsey. whose work illuminated
the important roles that sexual expression
plays in people’s lives.*”•* Certainly, by the
early 1970s, debates in the American Psychi-
atric Association about whether homosexual
behavior was pathological suggested that cli-
nicians were aware that their gay and lesbian
patients had specific needs that could best be
addressed by knowledgeable practitioners.
The American Psychiatric Association ulti-
mately recognized that homosexuality was
not a psychiatric illness^ but that societal and
internalized homophobia may affect access
|{) appn)i)riate care and cause mental distress,
which in tum might compromise optimal
mental health.

Changing social nonns, led by the women’s
liberation movement, challenged societal as-
sumptions on gender roles and identities and
helped to empower the gay liberation move-
ment to demand dvil liberties for sexual mi-
norities. As part of the ethos of community-

based activism, sexual minorities developed
autonomous health facilities designed to pro-
vide culturally sensitive care.

By 1980, there were dozens of loosely net-
worked clinics, mental health pmgrams, and
provider groups that focused on sexual mi-
nority health. These institutions were among
the first to recognize an increase in sexually
transmitted infections among men who have
sex with men and to identily the need for
safer-sex interventions. Because of their
emerging expertise, public health officials