Public Health

and Healthcare Ethics

MEDF 1021

Course Coordinator:
Professor Samuel Wong
School of Public Health & Primary Care
The Chinese University of Hong Kong
1
 Learning Outcomes
At the end of this course, students should
be able to:
• Define public health
• Describe and analyze 4 major global public health
issues and their determinants
• Describe the complexities of issues encountered
in healthcare settings and the importance of
professionalism
• Apply bioethical principles and theories in
analyzing contemporary public health problems
• Demonstrate ethical argumentation in a logical
and coherent manner

2
 Learning Outcomes
By the end of lecture, you should be able to
• define public health
• describe at least two examples of public health
achievements in the 20th century
• describe the health status of the Hong Kong
population using health indicators
• describe the assessment method for the course
• recognize the moral obligations and professional
accountability in the context of healthcare practice

3
 Date WK Topic & objectives Teaching format Venue Time References Learning Outcomes Lecturers
/tutors

4/9/13 1 -Course Introduction LT Guest lecture 1 Students will be able to: Samuel YS
-What are required for a health care starts at --understand professionalism WONG
professional in the 21st century? 4 pm --describe various professional issues facing healthcare providers Prof
-Reflection from healthcare professional: in the 21st centuries Sydney Chung
Guest lecturer Prof Sydney Chung

11/9/13 2 -History of modern medicine LT Tutorial x 12 Guest lecture 2 Students will be able to: Samuel YS
Guest speaker: Dr. Stephen Foo Tutorial groups x for the last 1.5 starts at -describe significant events in the history of medicine and public Wong
-Tutorial 1: Introduction to patients and 12 hour 2:30-4:00 pm health and their impacts on modern medicine and public health Dr. Stephen
professional attachments in groups with Foo
tutors

18/9/13 3 Global (Public) Health Problem I: Global LT 1 Guest lecture Students will be able to: Emily Chan
climate Change & Health starts at -describe the health impact of global climate change in various
4 pm parts of the world

25/9/13 4 Global (Public) Health Problem II: Pollution LT LTx1 2 -Students will be able to: Wong TW
Case study in environmental problems: the -recognize the complexity of policy development in dealing with air
case of air pollution in Hong Kong pollution in HK
-understand the politics of public health issues, the roles of
stakeholders, and the laws and social values

2/10/13 5 -Ethics & Professionalism 1: LT 1 Guest lecture 1 Students will be able to: Jennifer Yu
-Introduction to ethical approaches and starts at -understand the basic bio-ethical approaches, including theories Prof Tony Mok
decision making framework 4 pm and principles
Guest lecturer: Prof Tony Mok -appreciate the uniqueness of different ethical viewpoints

9/10/13 6 -Tutorial 2: Information and work on digital 12x Tutorial X12 3,4 Students will be able to: TAs
storytelling groups -describe and analyze the determinants of a global public health
problem

16/10/13 7 --Ethics and Professionalism 2: LT 1 1 Students will be able to: Helen Chan
Guest Speaker: Prof TF Fok: memorable - develop a heightened awareness and sensitivity to the ethical Prof TF Fok
cases in HK concerns in healthcare setting

4
23/10/13 8 -Ethics and Professionalism 3: LT 1 Patient 1 Students will be able to: SF Lui
First do no harm: Quality of sharing at 4 - Understand the important of “Patient
Care & Patient Safety by pm safety first”
Professor Lui Siu Fai - Why error occur and how to prevent
Patient sharing at 4 pm. - How to improve quality of care.

30/10/13 9 -Global (Public) Health Problem LT 1 Guest 2 Students will be able to: J Harwell
II: Emerging Infectious Disease lecture starts -learn differences between infectious and non- Prof David
Guest Lecturer: Prof David Hui: at infectious disease epidemiology Hui
reflection on the SARs 4 pm -learn basic terminology related to infectious
epidemic in HK diseases epidemiology

6/11/13 10 Tutorial 3: Making/Q & As of Tutorial groups X 12 3,4 -appreciate and reflect on students’ Tutors
Reflective Media Clips x 12 experiences with patients and health
professionals and the learning lessons

13/11/13 11 -Global (Public) Health Problem LT 1 Guest 2 Students will be able to: Martin CS
IV: Lifestyles and Non- lecture -acknowledge obesity as a public health Wong
communicable diseases starts at problem and various determinants of it
4 pm -describe communication strategies
commonly used in disease prevention and
health promotion
- understand the role of health advocacy as
a component of public health

20/11/13 12 Media reflective work Student LTx4 -sharing and reflection on group work and 4 teachers
Presentations Presentations their experiences on reflective work
(best video/media
presentations)

27/11/13 13 Media reflective work Student LT X 1 for -sharing and reflection on group work and 4 teachers
Presentations Presentations competition of their experiences on reflective work
(best video/media best clip
presentations)
Review

5
Guest Speaker Series
 Assessment Methods
• Media Reflective Work (group): 30%
– Best Prize for best 4 videos!
• Reflective Essay (1500 words): 30%
– Dean’s Best Essayists: A plaque and a cash prize
of HK$5000 each will be given to the top 5
students. Their essays will be published in the
faculty‘s Yearbook. Their names will be engrafted
on the plaques as Dean’s Best Essayists.
• Final Exam: 40%
 Experiential learning:
reflective digital storytelling
Purpose: This work aims to promote students’ moral sensitivity towards the impacts of clinicians on patients. It
encourages student reflection upon the professional behaviours of clinicians and identifies the good and bad
practices in clinician-patient interactions from different examples.

Description: Students from the same discipline would be divided into groups of 6-7 with a total of 520 students into
87 groups. Each group will invite health care service user, including individual(s) with chronic health problem or
family carers, to share their experiences related to interactions with clinicians in various situations. Patients will
also be available to them with the help of the Alliance for Patients’ Mutual Help Organizations. The group will
then have to capture either their positive or negative experience, and present it through the means of digital
storytelling (a short video clip that combines multimedia, including images, sound, text or video). The focus of the
digital storytelling will be to make explicit the meaning of different actions or attitudes of health professionals (can
be in general sense or a specific profession) from the patient’s/carer’s perspective. Lastly, the group can add their
reflections pertaining to their feelings and comments about the patient’s story, or how the story has changed their
perception or ways of knowing.
In addition to the patient attachments, they will also be required to attach to a health professional in their
respective professional field (e.g. medical students to be attached to a doctor in the community and to invite these
doctors to share their experiences with being a doctor in the community) in a group of 3. They can also use these
experiences as digital storytelling presentations.

The video clip should be submitted by 13 November 2013. The digital storytelling video clip should be about 10
minutes in duration (maximum length) and should include information/experiences and reflection related to both
your health professional and patient interviews. This should be a group project.
The guideline of what is required will be given in the first tutorial session.

8
 Samples of Videos
• http://www.patientvoices.org.uk/flv/0461pv3
84.htm

9
 Essay
The long essay is expected to be submitted
by November 20, 2013 and should be an
individual work. The essay should be type-
written and should contain no less than 1500
words in English. The report should be
submitted to the TAs of their assigned
groups. The guideline of the essay will be
given on Blackboard and also be given
during the first tutorial.

10
Defining Public Health…

11
 What is Public Health?
• Public
– Latin “populus” or “poplicus” : “the people”
• Health
– “Health is a state of complete physical, mental and social
well-being and not merely the absence of disease or
infirmity.” (World Health Organization, 1946)

12
 What is Public Health?
•“[Public health is…] The science and art of
preventing disease, prolonging life and
promoting health through the organized
efforts of society, organizations, public and
private, communities and individuals. ”
(Charles-Edward Amory Winslow, 1920)

Charles-Edward Amory Winslow (1877-1957)

•According to the UK’s Faculty of Public Health:

-Public health treats the population as its patient and is population-based
-Emphasizes collective responsibility for health, its protection and disease prevention
-Recognizes the key role of the state, linked to a concern for the underlying socio-
economic and wider determinants of health, as well as disease
-Emphasizes partnerships with all those who contribute to the health of the
population.

13
 What is Public Health?
•The Future of Public Health (U.S. Institute of
Medicine, 1988):
-Mission of public health:“What we as a
society do collectively to assure the
conditions in which people can be healthy.”
-Substance of public health: “Organized
community efforts aimed at the prevention
of disease and the promotion of health”
-Organizational framework of public health:
“Encompasses both activities undertaken
within the formal structure of government
and the associated efforts of private and
voluntary organizations and individuals.”
-Core functions of public health:
1. Assessment
2. Policy development
3. Assurance

14
 What is Public Health?
• Public Health vs. Medical Care
Public Health Medical Care
Patient Community Individuals
Core functions Disease prevention and Treating ill patients
health promotion

Contribution to the US Life expectancy increase US Life expectancy increase in

population health in 20th century = 25/30 20th century = 5/30 years
improvement years (Bunker et al. 1994) (Bunker et al. 1994)

Recognition of More abstract More obvious

achievements
Road to treatment A lot more complicated: Up to patients to accept the
political decision comes into doctor’s treatment or not
play

15
What do you think has contributed
to the increase in life expectancy in
the 20th century?

16
 What is Public Health?
• Based on scientific principles
• Uses a range of inter-disciplinary approaches in its
analysis of public health problems, including:

– Epidemiology & Biostatistics

– Health administration, policy and management
– Environmental health
– Public Health Biology: Biochemistry and Molecular Biology
& Nutrition
– Social and behavioral sciences

17
• It relies heavily on environmental sciences
and social and behavioral sciences
• It is also an art in that it involves applying
scientific knowledge to a range of practical
settings that require attention to issues a such
as needs of the community, selecting
intervention strategies and approaches that
the communities need.

18
Disciplines of
Public Health

19
 Disciplines of Public Health
• Epidemiology:
– The study of the occurrence and distribution of health-
related states or events in specified populations, including
the study of the determinants influencing such states, and
the application of this knowledge to control the health
problems
– The science of public health
– Studies include surveillance, observation, hypothesis
testing, analytic research, and experiments
– E.g. 1964 Surgeon General’ s Report on the harmful effects
of tobacco smoking

20
 Disciplines of Public Health
• Biostatistics
– Application of statistics to biological problems
– Encompasses various fields including medicine, agriculture, forestry and
ecology
– Are often used in tandem with epidemiology
– E.g. estimating the number of deaths from gun violence or looking at the
trends in drunk driving injuries by using math and science
• Health administration, policy and management
– The field combines politics, business and science in managing the human and
fiscal resources needed to deliver effective public health services
– To improve public’s health through legislative action
– E.g. managing the database at a school clinic; developing budgets for a health
department; creating policies for health insurance companies; directing
hospital services; analyzing the impact of seat beat belt laws on traffic deaths;
monitoring legislative activity on a bill that limits malpractice settlements

21
The SARS story……

22
Epidemiology & Biostatistics

23
24
 Disciplines of Public Health

• Public Health Biology

– Study of the molecular and genetic bases of cellular processes
– E.g. Application of these research knowledge to relevant public health
problems, including cancer, aging, neurological diseases,
fertility/infertility, and environmentally based diseases
– Nutrition: to examine how food and nutrients affect the wellness and
lifestyle of population

• Social and behavioral sciences

– The application of the disciplines that explore the activities of and
interactions among organisms and how human interacts with the
society to public health issues
– E.g. Helping youth recognize the dangers of binge drinking; Studying
the impact of poverty on health

25
Public Health Biology

26
 Disciplines of Public Health
• Environmental health
– Study of the health effects on populations of exposure to physical, chemical,
and biological agents external to the human body and of immediate and
remote social, economic and cultural factors (e.g. urbanization, agricultural
development, energy production/combustion) related to these physical,
chemical and biological agents.
– E.g. the air we breathe; the water we drink; the complex interactions between
human genetics and the surroundings
• International/Global health
– To address all different health concerns among different cultures in countries
worldwide from a global perspective
– Often emphasizes the on the underserved populations in the world
– E.g. addressing health concerns from a global perspective and encompassing
all areas of public health (biostatistics, epidemiology, nutrition, maternal and
child health, etc.)

27
Environmental Science

28
Policy and Health Service Management and
Administration

29
Social and Behavioral Science

30
A Brief History of Public Health

31
John Snow’s Map

32
Video 1

33
 Stopping the Epidemic

34
http://www.uic.edu/sph/prepare/courses/chsc400/mods/images/pumphandle.jpg
Broad Street Pump
John Snow (1813-1858):
•Contributed to the formation of
“germ” theory
•He knew nothing about Vibrio
cholerae
•His conclusion was only based on
observational data  “The Father of
Epidemiology”

35
John Snow Pub

36
What are the greatest public health
achievements in the 20th century?

37
 Greatest Public Health Achievements of the
20th Century

1. Vaccination 6. Safer, Healthier Food

2. Motor vehicle safety 7. Healthier Mothers and
3. Safer Workplace Babies
4. Control of Infectious 8. Family Planning
Disease 9. Fluoridation of
5. Decline in Deaths from Drinking Water
Coronary Heart 10. Recognition of Tobacco
Disease and Stroke as a hazard

Source: http://www.whatispublichealth.org

38
US CDC

39
Public Health in Hong Kong

How does this affect you?

40
 How much do you know?

What is the leading cause of death in H.K.?

1.Heart disease
2.AIDS
3.Cancer
4.Stroke
5.Suicide

41
 Leading Cause of Death in HK, 2011
Cause of death Mortality Rate (per 100,000)
1. Malignant neoplasms 185.4
2. Diseases of heart 89.3
3. Pneumonia 86.7
4. Cerebrovascular diseases 47.0
5. Chronic lower respiratory diseases 27.8
6. External causes 21.8
7. Nephritis, nephrotic syndrome and 21.0
nephrosis
8. Septicemia 10.8
9. Dementia 10.6
10. Diabetes mellitus 6.5
All other causes 89.8
All causes 596.6

42
CHP, Hong Kong 2011
Qing dynasty

Hong Kong

Colonialization of Hong Kong

Treaty of Nanking, 1842
Convention of Peking, 1860
Second convention of Peking, 1898
43
1865
1950s

2000s

44
Understanding Our Population

45
What are the measures we use to tell us
about a country’s health status?

Health indicators

46
 Mortality Rate
• Mortality rate
– Also called death rate or crude death rate
– An estimate of the portion of a population that
dies during a specified period
– The numerator is the number of persons dying
during the period
– The denominator is the number in the population
at risk of dying during that period (person-years)
– Mortality rate = Number of deaths during a
specified period / Number of persons at risk of
dying during the period X 10n

47
 Infant Mortality and Maternal Mortality Ratio,
1982-2009

48
Source: Centre for Health Protection, Hong Kong
 Infant Mortality Rate Comparison, 2010

Rank Country Deaths

Per 1,000 Live Births
224 (Lowest) Monaco 1.78
223 Singapore 2.32
222 Bermuda 2.46
219 Hong Kong 2.91
192 UK 4.78
180 USA 6.14
115 China 16.51
46 Cambodia 53.04
1 Angola 178.13

49
Source: CIA World Factbook
 Life Expectancy

• Life expectancy
– The average number of years an individual of a given age is
expected to live if current mortality rates continue to apply
– A statistical abstraction based on current age-specific
mortality rates
– A hypothetical measure and indicator of current health
– NOT a rate!
• Life expectancy at birth
– Average number of years a newborn baby is expected to
live if current mortality trends continue
– Mortality in the first years of life (i.e., infant mortality) can
affect the life expectancy at birth significantly

50
 Life expectancy at birth (1971-2009)

Female

Male

51
Source: Centre for Health Protection, Hong Kong
 Life Expectancy Comparison (2013)

52
Source: CIA World Factbook
 The Preston Curve
Relations between life expectancy at birth and national income per head in
the 1900s, 1930s, and 1960s

53
Source: Preston (1975)
Population Pyramid, 2010 & 2031

54
What health behavior indicators
we can use?

55
How Healthy is your Lifestyle?

Quiz…
 Quiz: Do you smoke?

1. Female - Never smoked

2. Female - Ex-smoker

3. Female - Currently smoke

4. Male - Never smoked

5. Male - Ex-smoker

6. Male - Currently smoke

 Smoking Pattern in HK (I)
6.3
5.8 13.6
22.1
10.1
15.1
Smoker
Ex-smoker
87.2 Never smoked
75.8
62.3

Female Male All

 Proportion of males and female smokers aged 15 or above

 Department of Health, Apr 2009

 Smoking Pattern in HK (III)
• Daily smoking prevalence has dropped to
11.1% in 2010, which is the lowest rate in
the past 30 years

• A drop of more than half from the high point

of 23.3% back in 1982

• A result of a collaborative force between the

Government and the community

• DH integrated smoking cessation hotline

• Had received 14,787 calls this year,
exceeding the number of calls received
in all of 2010 (13,880)

• Newly launched free smart phone

application for smoking cessation in August
2011
Source: Press Release August 24, 2011. Tobacco Control Office,
news.gov.hk
 Quiz: Exercise
During the past 30 days, how often did you exercise in
your leisure time, which at least makes you breathe
somewhat harder than normal and sweat?

1. Once or more a day

2. 4-6 times per week
3. 2-3 times per week
4. Once a week
5. Less than once a week
 Physical Activity in HK

<1 time/week
44.2 49.4
53.8 1 time/week

2-3
16.7 times/week
14.6
12.8 4-6
16.2 22.3 19.0 times/week
7+
7.9 8.8 8.3 times/week
8.6 7.3 8

Female Male All

 Number of times engaged in an adequate amounts of physical activity per week during lesire
time (Leisure-time exercise)
 Department of Health, Apr 2009
 Main concepts
• Can you define public health?
• What are the characteristics of public
health?
• What are some examples of public
health issues in Hong Kong?

62
 4 Global PH Problems
1. Climate Change & Health
2. Pollution and Health
3. Emerging Infectious Diseases
4. Non-communicable Diseases

63
 Learning Outcomes
By the end of lecture, you should be able to
• define public health
• describe at least two examples of public health
achievements in the 20th century
• describe the health status of the Hong Kong
population using health indicators
• describe the assessment method for the course
• recognize the moral obligations and professional
accountability in the context of healthcare practice

64
 CONTACT

• Prof. Samuel Wong (Course Coordinator):

[email protected]
• Ms Bonnie Fok (Undergraduate Programme):
[email protected]
• Mr Aaroy Chan (Teaching Assistant):
[email protected]
 Thank you!

http://www.sphpc.cuhk.edu.hk
Homepage of the School of Public Health
and Primary Care, CUHK
Email: [email protected]

66