Module A. Building a Foundation for Population Health
In this module, we will discuss the philosophy and values of public health, consider the field’s historical journey, and explore its relationship to global health. Public health adopts a population-level analysis and is both a multidisciplinary field of inquiry and a space for professional practice. We will explore global changes that present both risks and opportunities to health—the impact of globalization on health, shifting population dynamics, and changing epidemiological patterns. You will become familiar with a conceptual framework that is constructed around “the health challenges in the population” and “the organized societal responses to those challenges.” Within the context of that framework, we will explore the interrelationships between health conditions and the social, political, economic, and environmental determinants of health.
Defining Health and Public Health
In this lesson, we will consider different definitions of health and identify the advantages and disadvantages of each. We will discuss the principles, philosophy, and values of public health (e.g., social justice, human rights, community engagement, prevention, and health promotion) and the integrative nature of public health, bridging biology, population, society, and environment. We will introduce an informal conceptual framework constructed around two main questions: (1) How can we understand population health challenges by considering both health conditions and the “conditions for health"? and (2) How can we respond to these challenges, drawing on contributions from the health and non-health sectors? We will take a visual journey to appreciate how the field evolved and different periods and phases, and reflect on both successes and failures.
Learning Objectives
- Describe the strengths and limitations of the 1948 WHO holistic definition of “health.”
- Describe some of the basic core features, principles and values of public health.
- Describe a conceptual framework that is constructed around “the health challenges in the population” and “the organized societal responses to those challenges.”
- Recognize that understanding population health challenges requires knowledge on both “health conditions” (e.g., diseases, injuries, and risk factors) and “conditions for health” (e.g., social, political, economic, and environmental determinants of health).
- Recognize that responding to health challenges requires contributions from the health sector (e.g., health system) and non-health sector (e.g., public policy, law, and regulation).
- Appreciate the distinct periods or phases of the history of public health, and how these contributed to the fragmented and decentralized system we have now.
What do we mean by "Health"?
We discuss different definitions of health and identify the advantages and disadvantages of each. We acknowledge the spectrum of how “health” is conceptualized ranging from “absence of disease” to “complete social, physical, mental and spiritual well-being.”
What is Public Health?
We identify public health’s core feature–a population-level of analysis and discussed the principles, philosophy, and values of the field–including social justice, human rights, community engagement, protection, and health promotion. We acknowledged the interdisciplinary nature of public health– necessitating integration across academic domains, disciplines, and sectors, as well as the dimensions of biology, population, society, and environment.
A Conceptual Framework
In this lesson, we introduce an informal conceptual framework constructed to reflect two main questions for public health professionals: 1) How can we best define and understand the health challenges in a population by considering both health conditions and the “conditions for health”? 2) How can we best respond to those challenges, drawing on contributions from the health and non-health sector?
Perspectives on Public Health "Wins" in the U.S.
In this lesson, we ask students to scan an article on the Ten Great Public Health Achievements in the United States from 2001-2010, to gain an appreciation of public health successes and opportunities and consider them through a dual lens of public health challenges and failures.
History of Public Health: A Visual Journey
We consider the public health field’s historical journey and explore its relationship to the contemporary context.
Reference: Chapter 3: A History of the Public Health System. The Future of Public Health. The National Academies Press, 1988.
How Public Health Took Part in Its Own Downfall
We introduce the 2021 short essay, "How Public Health took Part in Its Own Downfall" by Ed Young, The Atlantic 2021
The Patchwork U.S. Public Health System
Editorial and Podcast reference: Wallace M, Sharfstein JM. The Patchwork U.S. Public Health System. New England Journal of Medicine 2022; 386: 1-4.
From Public Health to Global Health
In this lesson, we will become familiar with global changes of critical importance to the future of population health, such as: (1) the unprecedented pace of resources, people, products and ideas crossing borders and the impact of globalization on health; (2) shifting population dynamics (demographics) driven by changes in patterns of fertility, mortality and migration; (3) changing epidemiological patterns with a shift from infectious diseases, maternal and child mortality and undernutrition to non-communicable or chronic diseases; (4) the changing position of health on the global political agenda. We will discuss the attributes of global health that make it “global” and what features it shares with public health. This lesson will provide the broader context for why global transnational risks, such as emerging infectious diseases, pandemic risk, antibiotic resistance, climate change, geopolitical conflict, and displaced populations are so relevant to 21st-century challenges.
Learning Objectives
- Describe the major forces shaping contemporary ‘global health’, including: impact of globalization on health and emerging global systemic risks, shifting population dynamics (i.e., demographic transitions), changes in health patterns (i.e., epidemiological transition), and changing position of health on the global political agenda.
- Define global health and explain what we mean by the “transfer of global risks” that accompanies globalization, and the need for “global governance.”
- Define the Sustainable Development Goals (SDGs), be familiar with SDG3 (the health goal), and recognize the relevance of health to many of the other goals.
- Provide examples of three major global health challenges we are facing today.
- Describe the role the U.S. has played in global health and explain why rapid changes to reduce the nature, scope, and scale of that role through executive actions will have a profound impact.
Critical Global Changes
In this lesson, we familiarize students with global changes of critical importance to the future of population health—globalization, shifting population dynamics, changing epidemiological patterns, and the position of health on the global political agenda.
Professor Sue J. Goldie highlights the significant global changes that have occurred in recent years, including the devastating impact of the COVID-19 pandemic, conflicts in various regions, rising nationalism and geopolitical tensions, political polarization, and fiscal pressures. These changes have made it increasingly difficult to foster the international cooperation and collective action needed to address 21st-century global health challenges such as pandemics, antimicrobial resistance, and the health effects of climate change. The importance of considering these recent global developments when discussing the United States' relationship to global health is emphasized.
What is Global Health?
We discuss the attributes of global health that make it "global" and what features it shares with public health.
Global Health: Reflecting on a Decade
Professor Sue J. Goldie assigned students a reading from the report, Healthier, Fairer, Safer: The Global Health Journey 2007-2017 for Lesson 2: From Public Health to Global Health.
Report. Donaldson L, Rutter P. Healthier, Fairer, Safer: The Global Health Journey 2007-2017. World Health Organization 2017. Students were asked to read Chapter 2: Vital Signs (pages 4-8).
From the MDGs to the SDGs
We review the dimensions of Sustainable Development and provide a background for the eight Millennium Development Goals (MDGs) and the 17 Sustainable Development Goals (SDGs). Developed in 2015 by the United Nations General Assembly, the SDGs are intended to be achieved by 2030.
Portal. Sustainable Development Goals. United Nations 2025.
Understanding Basic Demographics
Given our central emphasis on a population-level of analysis, demographic literacy is critical for public health professionals – including an understanding of concepts, the ability to interpret data, and an appreciation of the analytic approaches to generate evidence that can contribute to policy. In this lesson we will describe the three core drivers of demographic change: fertility, mortality, and migration. We will use selected metrics (e.g., total fertility rate, infant mortality rate, percent urbanization) to describe general global trends and differences between countries. We will define and describe the demographic transition and explore how the relationship between changes in fertility and mortality predict population growth. Finally, we will discuss how demographic trends influence population age structure (e.g., proportion of youth under age 15 or aging populations over age 65), and what factors that need to be present for a country to experience a “demographic dividend.”
Learning Objectives
- Describe the three main drivers of population dynamics (demographic change) and explain the general global trends of each.
- Describe the demographic transition and explain how changes in fertility and mortality predict population growth.
- Explain how demographic trends influence population age structure (e.g., proportion of youth under age 15 or aging populations over age 65) and interpret a population pyramid.
- • Appreciate the multiple factors that need to be present for a country to experience a “demographic dividend”. Recognize that both quantitative and qualitative data will be needed to predict a country’s trajectory.
Population Dynamics I. Demographics 101
Demography is the study of human populations, including their composition, size, age distribution, density, and growth, as well as the factors that drive changes in each of those elements. We describe the three core drivers of demographic change: fertility, mortality, and migration, and use selected metrics (e.g., total fertility rate, infant mortality rate, percent urbanization) to describe global trends and explore differences between countries. We learn how changes in these drivers (mainly fertility and mortality) influence population growth and age structure, using Nigeria and Japan as two country examples.
Population Dynamics II. Demographic Transition
The demographic transition is the change in birth rates and death rates from historically high levels to low levels over time. In this video, we use a schematic to illustrate the way populations proceed through the demographic transition in a series of stages, and how the relationship between changes in fertility and mortality predicts population growth within each of the stages.
Population Dynamics III. Population Age Structure
In this video, we introduce a schematic called the population pyramid to illustrate the age structure of a population at a particular “point in time.” We discuss how a population’s age structure can influence the main policy challenges in the country, and identify factors that need to be present for a country to experience a “demographic dividend.” We use Nigeria and Japan as two country examples.
Population Dynamics IV. Migration
The three drivers of demographic change are fertility, mortality, and migration. In this animation, we focus on migration, using a simple visual schematic to describe how the movement of people can be within borders or across borders and can be voluntary or forced.