INTRODUCTION TO

GLOBAL PUBLIC
HEALTH
Assignment Guidance
Dr Erdem Dikici
2023-2024
The details…
WHAT? A 3000 word essay

WHEN? By 2pm on the 20th December 2023

HOW? Submit electronically, via Blackboard submission system

Your knowledge and understanding of the key theories, concepts and issue
explored during the module

WHY? So that we can assess: Your critical skills in making sense of a public health issue
Your ability to summarise and synthesise large amounts of reading material
Your formal essay writing skills, style and argumentation
The Assignment outline
Students are required to research a global public health issue and develop a critical
analysis of the published evidence underpinning the issue, exploring the themes
of health inequality and social determinants.

2) Think about how to

2) Provide some evidence to 3) Consider key global and
1) Choose a Global Public identify the inequality in
show that there are national drivers, and role of
Health issue in a country of you’re your chosen country:
inequalities surrounding wider social determinants of
your choosing local, regional, national,
that public health issue health on the issue
global evidence

4) Select: 5) Describe how to

implement changes to
a) One of the health
reduce a; or address one of
inequalities, or
the wider determinants (b)
b) One of the wider social so that it was no longer a
determinants driver of health inequalities
 Structure of your essay
Part 1 (1000 words): Identify and describe a key global public health issue in a
country of your choosing. Critically highlight how the public health issue is
associated with health inequalities. How would you go about identifying those
health inequalities in your chosen country?

Part 2 (1000 words): What are the key global and national drivers and social
determinants of those health inequalities?

Part 3 (1000 words): Select either one of the (i) health inequalities or (ii) one
of the determinants. Describe how you would go about making necessary
changes to reduce the (i) health inequality or (ii) address one of the wider
determinants so that it no longer was a driver of health inequalities.
 1. Choose a Global Public Health issue
in a country of your choosing
What public health issue are you interested in, and which country are you looking to focus on?
 1. Choose a Global Public Health issue
in a country of your choosing
◦ If considering focusing on the UK it may help to refer to the following
list: https://www.gov.uk/government/collections/health-matters-public-health-issues
◦ And yet, most of these are global public health issues and will play a significant role across
the globe, due to:
◦ Gains in life expectancy and declining fertility rates
◦ Transformation of major causes of disease and mortality – increased in NCDs.
◦ Prevalence of obesity and declining physical activity
◦ Pattern of infectious disease shifting – emergent communicable disease (e.g. Covid-19)
and increase in antimicrobial resistance
◦ Globalisation – the processes of economic (trade), political (alliances/int.orgs),
electronic (www/social media), and environmental (climate change) connectedness

◦ There are topical discussions of global public health issues: e.g.

https://www.who.int/news-room/spotlight/10-global-health-issues-to-track-in-2021
◦ You can also have a look at this link:
11 global health issues to watch in 2023, according to IHME experts | The Institute for Healt
h Metrics and Evaluation (healthdata.org)
 2. Provide some evidence to show that there are
inequalities surrounding that public health issue
Provide some evidence to show that the global public health issue is a health inequality.

Return to the issue, what is a health inequality??

Health inequalities are ultimately about differences in the status of people’s health. But the term is also commonly
used to refer to differences in the care that people receive and the opportunities that they have to lead healthy
lives, both of which can contribute to their health status. Health inequalities can therefore involve differences in:
• health outcomes
• access to care, for example, availability of treatments
• quality and experience of care, for example, levels of patient satisfaction
• behavioural risks to health, for example, smoking rates

https://www.kingsfund.org.uk/publications/what-are-health-inequalities
 2. Provide some evidence to show that there are
inequalities surrounding that public health issue
This may be in the form of data at a global, international, national, regional and/or local level. Such data is available
from a variety of sources:

 At a local level… local policy/project

 Regionally (see the PHE public health profiles data: https://fingertips.phe.org.uk/)

 Nationally (see the Department for Health and other sites):

https://www.gov.uk/government/organisations/office-for-health-improvement-and-disparities; also:
https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare

 Globally/internationally (various websites, including the WHO and GBD data): https://vizhub.healthdata.org/gbd-compare/

 You can also refer to any key texts using the reading list and/or library searches
2. Provide some evidence to show that there are
inequalities surrounding that public health issue
Inequalities between who??

 socio-economic status (social class) and deprivation: e.g. unemployed,

low income, people living in deprived areas,

 protected characteristics: e.g. age, sex, race, sexual orientation, disability

 Vulnerable and socially excluded groups of society, or ‘inclusion health’

groups: e.g., migrants; asylum seekers/refugees, Gypsy, Roma and
Traveller communities; rough sleepers and homeless people; and sex
workers

 geography: e.g. urban, rural populations.

3. Consider key global and national drivers, and role
of wider social determinants of health on the issue
By global and national drivers, we mean:
◦ what are the key reports, wider policy goals etc that are important to your
topic area (e.g. SDGs; addressing health disparities)?

A key task is to identify the underlying social, economic, political and/or

behavioural determinants of these inequalities. These can be:
◦ Defined as the macro social, economic and environmental factors that impact on
people’s health
◦ Education – link to behaviour/social capital
◦ Work and work conditions – link to income/risk factors
◦ Living conditions – link to lifestyle and risk factors
◦ Local infrastructure such as water/sanitation – link to risk factors
◦ Housing – link to security and risk factors
https://fingertips.phe.org.uk/profile/wider-determinants
 4. Select: a) One of the health inequalities, or b) One
of the wider social determinants
In this part of the essay, you can choose to go more in depth on a specific issue, for example, you could
decide to look at:

• A specific health inequality connected to your public health issue, e.g. that a particular social group are more
disadvantaged in terms of health outcomes, access to care, quality and experience of care, and behavioural risks to
health

OR…

◦ One of the wider social determinants, such as:

◦ Education, housing, work environment, income, lifestyle and living conditions, etc…
 5) Describe how to implement changes to reduce a (the health
inequality); or address one of the wider determinants (b) so that it
was no longer a driver of health inequalities

Are we clear on what this means??

Put simply:

If you have decided to focus on the health inequality in the previous section, you think about what
changes you would like to bring about (e.g. policy, interventions, societal changes) to reduce the
inequality…

If you have decided to explore one of the wider determinants, you think about how you would address
(i.e. change) this determinant until it was longer driving the inequality
LET US CONSIDER AN
EXAMPLE…
1. THE GLOBAL PUBLIC HEALTH
ISSUE
The health outcomes of pre-school children of migrant parents living in the UK
2. The inequalities…
There are inequalities surrounding this specific public health issue, so we know that:

a) lifestyle changes among migrant groups once settled include higher levels of smoking and eating diets high in fat and
lower levels of breastfeeding and physical activity, all of which impact upon the health of children (behavioural risks)

b) For every 5 years spent in the UK a migrant mother is 5% less likely to breast feed to four months (behavioural risks)

c) Higher rates of obesity, dental caries and some infectious diseases (health outcomes and behavioural risks)

d) Migrant children (0–18 years) use most types of healthcare services less than local children, with only emergency and
hospital services used more (access to and experience of care)

*Migrants are defined as people who are born abroad and intend to stay in the country of settlement for at least one year
2. The inequalities…
What are the sources of evidence?

There is a lack of objective data from UK data sources, as the UK, like many EU countries does not
collect routine registry or survey data on migrants.

So, we have chosen to explore other evidence in research:

Condon, L. and McClean, S. (2020) “Differences between the earth and the sky”: migrant parents’ views and experiences of health
services for pre-school children in the UK. Primary Healthcare Research and Development, vol. 21.
Jayaweera H, Quigley M. (2010) Health status, health behaviour and health-care use among migrants in the UK: evidence from
mothers in the Millennium Cohort Study. Social Science and Medicine; 71:1002–10.
Hawkins S, Lamb K, Cole T. et al. (2008) Influence of moving to the UK on maternal health behaviours: prospective cohort study.
British Medical Journal, 336(7652):1052.
3. Global and national drivers
Global context:
 Migration of people between countries has been growing exponentially since the late 20th century (International Organisation for
Migration, 2013)
 WHO: Policy in the European Region
 The Strategy and Action Plan for Refugee and Migrant Health in the WHO European Region was unanimously endorsed by the WHO
Regional Committee for Europe in September 2016.

UK National context:
UK Policy: supported by Healthy Child Programme and public health nursing/health visiting – immunisation and developmental review
The NHS provides a range of guidance about the health needs of migrant patients for healthcare practitioners given the lengthy history of
migration to the UK. For children this is focused on:
• child health and development
• communicable disease
• language and culture
3. Wider social determinants
Some key issues here, such as:
Provide some examples if possible
 Migrants are likely to be negatively affected by social inequities within from the reading/literature
host societies, disadvantaged in terms of employment and housing and
with lower levels of health and wellbeing than the host population

 Many experience high social deprivation and poverty, lower quality

and insecure housing, and poorer working conditions

 Barriers to healthcare use among European migrants comprise

language barriers, fear of stigma and lack of trust, financial difficulties
and problems in navigating a new system
4. Let us select a – the
specific inequality
The inequality we want to address is:

Migrant children (0–18 years) use most types

of healthcare services less than local children,
with only emergency and hospital services
used more
5. How to implement change to reduce this
inequality…
We could discuss lots of issues here, but what we are going to suggest is that we could introduce an
intervention/policy to increase use of primary care services (GP) and other school-based or public health services,
and decrease ED (emergency) and hospital care.

What would you suggest?

Think about: a) what to offer for the families and the children, b) what to offer the health professionals, and c)
what to offer communities
 ANY
QUESTIONS?