Population ageing is a result of increased life expectancy (lower mortality) and decreased fertility rates (UN, 2019). For the first time in history, in 2018, people aged 65 years or over outnumbered children under five years of age (UN, 2019). The world’s population is ageing. The United Nations (UN) (2019) estimates that, globally, the number of people aged 65 years and over will increase from 693 million in 2019 to 1.6 billion in 2050 and 2.5billion in 2100. Australia’s population is also ageing. In 2018, about 3.9 million Australians were aged 65 years and over, representing 16% of the total estimated population (Australian Institute of Health and Welfare (AIHW) 2020a). Healthy ageing is gaining momentum as an important goal for societies experiencing population ageing. This chapter presents the public health issues relevant to the wellbeing of older people, now and in the future.

The principles of public health promotion have been outlined in previous chapters within this textbook. Planning, implementation and evaluation should be viewed as three equally necessary and complementary components of any public health program. This chapter provides an introduction to planning and evaluation with respect to public health promotions and interventions. This chapter focuses primarily on overarching concepts. It identifies a simple, six-stage public health planning model that assists project teams to move from the initial identification of a need through implementation to assessment of the outcomes, with the evaluation also identifying any needs that remain partially or completely unmet. The concepts of planning and evaluation should be viewed as part of an ongoing process; the planning of public health interventions should be informed through reviewing outcomes of relevant previous projects while the evaluation phase should then provide observations and recommendations for future programs.

Many factors influence the health status of individuals or communities and create health inequalities. They are known as ‘determinants of health’. These determinants can affect health status positively or negatively, and include biological (for example, age), behavioural (for example, alcohol consumption), environmental (air quality) and social (employment status) factors. Not all of these determinants have an equal effect on health outcomes. Some may be affected by personal choices, while others require policy or structural interventions. Identifying the factors that influence health is important in preventing disease and promoting health. It is also necessary to differentiate the factors about which little can be done (for example, age and genetic inheritance) from those that may be modified (for example, built environments, social norms and individual behaviours). This chapter explores behavioural, nutritional and environmental determinants and describes the different levels of influence these have on health outcomes to illustrate key considerations when developing effective public health responses.

The health needs and experiences of rural residents are diverse. While common themes, such as limitation of access to health services are easily identified, also relevant is the diversity related to the geographic, social, economic and environmental factors that mould the character of a community. Rural people have poorer health outcomes, poorer health behaviours, and are more likely to experience the social determinants of health, particularly lower incomes, level of education and a higher proportion of First Nations’ populations (AIHW, 2019; Wakerman et al., 2017). This chapter employs a conceptual framework to assist in describing the complexity of rural health outcomes. The framework proposes that the interrelationships of six concepts can be used to interpret issues and scenarios in rural and remote health. These concepts are: geographical isolation, the rural locale and the social interactions of people in the local area, local health responses, broader health systems, broader social systems, and power relations. This chapter explores each of the six concepts in the framework to understand how public health measures at all levels can contribute to rural health outcomes.

This chapter introduces readers to primary health care (PHC) and community health in Australia. PHC is an integral part of health care provision and the first point of contact with the country’s health system. In this chapter, definitions of PHC and its rationale are described. Then an overview of current PHC in both Australian and global healthcare systems is provided including discussion of health reforms that have shaped PHC development and funding models. Finally, effective models of care within PHC and community health are examined using a range of examples in Australia and elsewhere. The final section of the chapter provides insights into some of the current challenges and future directions in PHC to respond to rising health care expenditure resulting from increasing costs of investigations, medications and health services and an epidemic of chronic diseases in a rapidly ageing population.

The COVID-19 pandemic has highlighted the importance of epidemiology and public health. In addition to the intensified health challenges of the pandemic, the constantly changing environment, global warming, increased international travel, globalisation, and social, economic and political changes all contribute to the fluctuating nature and patterns of disease and health issues. To better address the complex interrelationships of various determinants and health/illness outcomes, multidisciplinary efforts, including epidemiology, are required to protect and promote the population’s health. Epidemiology uses quantitative methods to collect and analyse data to investigate disease occurrence and possible causes of disease in order to find solutions to health problems in different populations. This chapter introduces the basic concepts in and use of epidemiology, the common epidemiological study designs and the quantitative measures used to describe the health status of populations and identify potential determinants of ill health. It also draws on examples of international and Australian research and health data to strengthen the theoretical concepts and principles introduced.

In this chapter, we discuss drug use in Australia. We take a public health approach to the problems created by the use of drugs. Public health approaches to substance use focus on reducing harmful consequences of substance use, irrespective of the type of substance being used (Csete et al., 2016). Reducing population-level harms related to substance use can be achieved by reducing the numbers of people who use drugs, but also by reducing harmful patterns of use among those who choose to use. These two goals can be compatible. Public health responses to drug use acknowledge that some people will continue to use drugs regardless of legal or social sanctions. Consequently, policies aimed at reducing drug-related harm are central to a public health framework. Some public health policies (for example, appropriate taxation) work by reducing both the numbers of users and the harmful patterns of use (Anderson, Chisholm & Fuhr, 2009).

Politics and health are inextricably linked through the government’s responsibility to provide health care funded by taxation. The political determinants of health underpin, directly and indirectly, all other determinants of health. Therefore, public health is innately political by the very virtue of its existence and its vulnerability to political cycles, political agendas, political will and promises of change. This chapter introduces the fundamental concepts associated with political determinants of public health. To begin with, the chapter discusses government responsibility for providing health services and people’s right to access health care. Australia’s healthcare system is distinctive, and this is explored in the next section of the chapter. Next, the chapter considers healthcare costs in the political context. The next section covers ideas about evidence-based policy and what counts as ‘evidence’. The last section covers advocacy and ethics, in particular the role of advocacy for better health outcomes (especially for at-risk groups), ethics as underpinning advocacy and coercive policies, people’s rights and population outcomes.

Public health practice involves protecting the public from ill-health and promoting conditions that help people to live healthy lives. Public health agencies, usually government-led, set and implement wide-ranging policies in populations or communities, with a view to reducing disease or mental or physical ill-health. The scope of public health work is vast but it generally involves making decisions about what matters, including about the goals of the public health enterprise and the outcomes to be sought. For that reason, along with being a ‘science and art’, public health is also a political and social exercise. It is largely those political and social aspects of public health that are the focus of this chapter. That is because we introduce ways of thinking about and justifying public health practice that all, at their core, hinge on the value judgements people make about what is important. We describe what public health ethics is, introduce three of the most widely used approaches in framing public health problems and solutions, and present some ethics frameworks that may be helpful to practitioners of public health.

Today, the concept that health is influenced by social determinants is widely accepted. There is more and more evidence pointing to the importance of the social determinants of health. Societies that support the most disadvantaged and are respectful of their Indigenous people have better health outcomes. Improving the social context means that contemporary public health has to be cross-disciplinary, encompassing not only medicine, but also sociology, psychology, anthropology, ecology, urban planning, architecture, engineering, social work, political science and economics. This chapter introduces the social determinants of public health. It discusses the relative contribution to health of individual behaviours, the factors external to individuals such as the healthcare sector and structural racism. Then it introduces the concepts of social justice and health equity which underpin healthy societies. Finally, it introduces a social determinant of health that has been identified by key workers in the field as having a profound influence on health namely unemployment. Spotlight case studies are provided throughout to give a practical understanding of the social determinants of health.

Adolescent health, development and behaviour lay a foundation for future population health (Patton, et al., 2018; Sawyer, et al., 2012). Adolescence now occupies a greater portion of the life-course. It is commonly framed as the period from 10-24 years of age, moving beyond earlier definitions of 10-19 years (Sawyer, Azzopardi, Wickremarathne, & Patton, 2018). Disadvantage, social inequality and a range of harmful health and social problems often become prominent during adolescence. This chapter explores some of the common health and social problems experienced by adolescents, including internalising and externalising problems, homelessness, substance use, and traditional and cyberbullying perpetration and victimisation. We also discuss some of the contextual factors (herein referred to as risk and protective factors) that may increase or decrease the likelihood of these health and social problems (Hawkins & Weis, 2017). We conclude by discussing some of the public health approaches used by practitioners and researchers to target these health and social problems.

Social justice is so central to the new public health model that it has been described as the field’s core value or principle. The sections that follow in this chapter introduce human rights and the various global, regional and national systems that exist to support their achievement, discussing the different ways in which human rights are important in public health. Human rights-based approaches are of great importance in providing grounding for public health policy and practice that seeks social justice in the health arena. Global, regional and national systems for human rights monitoring and accountability are introduced, and the chapter explores how progress towards meeting obligations to respect, protect and fulfil rights relates to progress towards achieving the social determinants of health and progress towards health equity. There are different routes by which governments can be held accountable for their achievements or lack of them, and action to address social injustice and health inequities supported. The final section in the chapter explores the links between human rights and empowerment.

People with intellectual and developmental disabilities (IDD) vary in terms of the nature and severity of their disabilities, but for all, their disability is lifelong. They experience of health inequities in the form of higher rates of poor health when compared with the general population. Together with biological factors relating to impairment or genetic factors, adverse social determinants of health contribute to their high rates of comorbid and secondary conditions that account for their poor health. There is a human rights imperative to address their health inequities through broader social change to reduce their socio-economic disadvantages, and systemic changes to healthcare systems to ensure they are afforded the same access to quality care as others in the community. This chapter explores the nature of the health inequities of people with IDD and identifies factors contributing to their poor health. The chapter ends with a review of strategies that show promise in addressing existing health problems, preventing the onset of poor health and improving healthcare systems.

Due to the shift to the social model of health care, public health researchers and practitioners are increasingly interested in the insider perspectives and experiences of key players in health, including health consumers and healthcare providers (Olson, Young & Schultz, 2016). Thus, qualitative research has been adopted in public health in many ways and in numerous fields of health research. The main focus of this chapter is on qualitative research. You will learn about the nature of qualitative inquiry and the need for qualitative research in public health. You will also gain a basic understanding of some philosophical assumptions of qualitative research that lead to different understandings about public health in different groups of people. Attempts have been made in the past few decades to provide evidence-based public health care to individuals and communities. Thus, we have witnessed a large number of research projects carried out in the public health arena. Evidence-based practice in public health and the need for qualitative inquiry are also discussed in this chapter.

Children and young people have the right to be healthy and to maximise their opportunities for a fulfilling life. This is enshrined in the 1989 United Nations (UN) Convention on the Rights of the Child, which articulates children’s rights to health, safety, wellbeing and citizenship (UN, 1989). A socio-ecological framework is useful in recognising the multi-level influences on health and wellbeing including family and sociocultural contexts; school and community settings; and the macrophysical, political and economic environments that alter living conditions and opportunities for health-promoting behaviours. Children’s direct interaction with these different levels of influence increases progressively over time as they mature, but is mediated throughout by adult guardians. This chapter explores socio-ecological influences on child health and wellbeing by examining overweight/obesity prevention, oral health, the experiences of children in same-sex parent families and mental health. In doing so, opportunities to reduce child health inequalities and to increase resilience and quality of life are discussed.

The health of the public is determined by a spectrum of complex individual, social, cultural, economic and environmental factors. This has been attributed to determinants of health.Based on the concept of a new public health, it is argued that public health practice is situated within the context of broader social issues concerning the underlying social, economic, cultural, environmental and political determinants of health and disease. Thus, this book has its emphasis on the sociocultural environment rather than on the biological and genetic factors associated with health. This chapter introduces public health and the salient issues relevant to it from local and global perspectives. The definition of public health, its values and major public health organisations are included. The chapter also discusses major public health challenges in Australia and from a global context. The social model of health, health inequalities and social justice are also discussed.

To tackle public health complexity, a capable workforce of sufficient scope and size is required. The public health workforce is multi-disciplinary and applies public health principles and methods across a range of areas including program management, policy development, research, and surveillance (Dhavan & Srinath Reddy, 2017). Public health practitioners may work in the public or private sector; within government, non-profit organisations or international agencies. Working in public health requires multisectoral collaboration, a willingness to tackle challenging issues, and a desire to improve the health of populations (Dhavan & Srinath Reddy, 2017). Consequently, public health practitioners must cultivate their knowledge and competencies in politics and advocacy (Kreuter, 2005; Moore et al. 2013). Collective effort is needed to call governments and institutions to act with urgency and prioritise public health action to address growing social and health disparities.

Public health aims to limit avoidable disease, injury, disability, and death in populations through preventative strategies (PHAA, 2018). But the development of strategies cannot occur until the nature and extent of any issue is first identified and analysed, and research is carried out to identify causes. If a public health framework is used, this involves trying to assess the roles that a range of non-health factors, labelled social determinants may be playing. In this chapter the preventable and very similar health issues faced by indigenous people throughout the world, will therefore be identified before some of the underlying determinants that make the causes of these issues extremely complex are described and discussed. While this may seem to be a ‘deficit approach’, an approach frequently criticised by indigenous people, these initial steps are necessary because they will provide a basis for a better understanding of what needs to be addressed, and what strategies work and why, providing context for those successful programs identified in the final section. As we progress through the chapter it should be apparent that indigenous people are best placed to find solutions and are gradually

We live in a world in which we are faced with a myriad of health issues. Addressing our most pressing concerns is a complex task that requires action on several levels, from global to local and from prevention through to treatment. At a global level, the World Health Organization (WHO) is a United Nation’s (UN) agency whose primary role is to lead and coordinate global health efforts. This chapter introduces readers to the discipline of health promotion, a core function of the WHO. The Ottawa Charter for Health Promotion (‘Ottawa Charter’) will be used to frame the chapter's discussion. The Ottawa Charter is the guiding framework that health promotion practitioners use to address the multiple determinants of health through multi-sectoral and multi-level approaches. The Ottawa Charter is guided by three main principles: advocate, enable, and mediate. The three guiding principles facilitate implementation of the Ottawa Charter’s five action areas: building healthy public policy, creating supportive environments, strengthening community action, developing individual skills and re-orienting health services. Each of the action areas is explored in the rest of the chapter.

Migration is a defining issue of our times (Orcutt et al, 2020). An estimated 281 million migrants (3.6% of the world’s population) live outside their countries of origin (IOM, 2020). In 2020, more than 55 million people were internally displaced within their countries of origin due to conflict and violence (48 million) or disaster (7 million) (Internal Displacement Monitoring Centre (IDMC), 2021). Human migration has consequences for health. Migration is not intrinsically unhealthy; migrants can experience health benefits through increased economic and educational opportunities and better access to health services in destination sites. Yet some migrants - such as those migrating between low-income countries, those displaced by conflict of natural disaster and irregular migrants - experience heightened threats to health. This chapter discusses the links between migration and social determinants of healthand encourages students to understand various health issues that may arise across various stages of migration processes. Students are also introduced to policy and practice in migrant health.