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FRAN
BAUM
THE NEW
PUBLIC
HEALTH
FOURTH EDITION
THE NEW
PUBLIC
HEALTH
 DEDICATION
To Paul—I’m so lucky to love you—you make
my world a very much better place
FRAN
BAUM
THE NEW
PUBLIC
HEALTH
FOURTH EDITION
1
Oxford University Press is a department of the University of Oxford.
It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide. Oxford is a registered trademark
of Oxford University Press in the UK and in certain other countries.
Published in Australia by
Oxford University Press
253 Normanby Road, South Melbourne, Victoria 3205, Australia
© Fran Baum 2015
The moral rights of the author have been asserted.
First edition published 1998
Second edition published 2002
Third edition published 2008
Fourth edition published 2016
All rights reserved. No part of this publication may be reproduced, stored in a retrieval
system, or transmitted, in any form or by any means, without the prior permission in
writing of Oxford University Press, or as expressly permitted by law, by licence, or under
terms agreed with the appropriate reprographics rights organisation. Enquiries concerning
reproduction outside the scope of the above should be sent to the Rights Department,
Oxford University Press, at the address above.
You must not circulate this work in any other form and you must impose this same
condition on any acquirer.
National Library of Australia Cataloguing-in-Publication data
Creator: Baum, Frances, author.
Title: The new public health / Fran Baum.
Edition: 4th edition.
ISBN: 9780195588088 (paperback)
Notes: Includes bibliographical references and index.
Subjects: Public health—Australia.
Health promotion—Australia.
Dewey Number: 362.10994
Reproduction and communication for educational purposes
The Australian Copyright Act 1968 (the Act) allows a maximum of one chapter
or 10% of the pages of this work, whichever is the greater, to be reproduced
and/or communicated by any educational institution for its educational purposes
provided that the educational institution (or the body that administers it) has
given a remuneration notice to Copyright Agency Limited (CAL) under the Act.
For details of the CAL licence for educational institutions contact:
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Telephone: (02) 9394 7600
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Email: [email protected]
Edited by Julie Irish, Biotext
Cover image by Stocksy/Tom Tomczyk; Shutterstock/Pedo Pinto (walking man)
Text design by Denise Lane
Typeset by diacriTech, Chennai, India
Proofread by Vanessa Lanaway
Indexed by Bruce Gillespie

Links to third party websites are provided by Oxford in good faith and for information only. Oxford
disclaims any responsibility for the materials contained in any third party website referenced in this work.
 v

BRIEF CONTENTS

List of Boxes, Figures and Tables xvii

Acknowledgments xxv
About the Author xxvi
Thanks and Appreciation xxvii
Introduction xxix

PART 1 APPROACHES TO PUBLIC HEALTH 1

1 Understanding Health: Definitions and Perspectives 2
2 A History of Public Health 18
3 The New Public Health Evolves 33

PART 2 POLITICAL ECONOMY OF PUBLIC HEALTH 77

4 Ethics, Politics and Ideologies: The Invisible Hands of Public Health 79
5 Neo-liberalism, Globalisation and Health 102

PART 3 RESEARCHING PUBLIC HEALTH 149

6 Research for a New Public Health 150
7 Epidemiology and Public Health 171
8 Survey Research Methods in Public Health 186
9 Qualitative Research Methods 201
10 Planning and Evaluation of Community-based Health Promotion 228

PART 4 HEALTH INEQUITIES: PROFILES, PATTERNS

AND EXPLANATIONS 253
11 Changing Health and Illness Profiles in the Twenty-first Century:
Global and Australian Perspectives 254
12 Patterns of Health Inequities in Australia 276
13 The Social Determinants of Health Inequity 307

PART 5 UNHEALTHY ENVIRONMENTS: GLOBAL AND

AUSTRALIAN PERSPECTIVES 349
14 Global Physical Threats to the Environment and Public Health 352
15 Urbanisation, Population, Communities and Environments:
Global Trends 385
vi BRIEF CONTENTS

PART 6 CREATING HEALTHY AND EQUITABLE SOCIETIES

AND ENVIRONMENTS 417
16 Healthy Economic Policies 419
17 Sustainable Infrastructures for Health, Well-being and Equity 447

PART 7 HEALTH PROMOTION STRATEGIES FOR ACHIEVING HEALTHY

AND EQUITABLE SOCIETIES 479
18 Medical and Health Service Interventions 482
19 Changing Behaviour: The Limits of Behaviourism and
Some Alternatives 500
20 Participation and Health Promotion 524
21 Community Development in Health 547
22 Public Health Advocacy and Activism 565
23 Healthy Settings, Cities, Communities and Organisations:
Strategies for the Twenty-first Century 584
24 Healthy Public Policy 617

PART 8 PUBLIC HEALTH IN THE TWENTY-FIRST CENTURY 653

25 Linking Local, National and Global Public Health 655

Appendix: Public Health Keywords 665

References 670
Index 738
 vii

EXTENDED CONTENTS

List of Boxes, Figures and Tables xvii

Acknowledgments xxv
About the Author xxvi
Thanks and Appreciation xxvii
Introduction xxix

PART 1 APPROACHES TO PUBLIC HEALTH 1

1 Understanding Health: Definitions and Perspectives 2
Introduction 2
Health: the clockwork model of medicine 3
Health as the absence of illness 4
Measuring health 6
Health: ordinary people’s perspectives 6
Public and private lay accounts 8
Health in cultural and economic contexts 9
Spiritual aspects 10
Health: critical perspective 10
Health as ‘outcomes’ 12
Health and place: defining collective health 13
Population versus individual health: the heart of public health 14
Conclusion 16

2 A History of Public Health 18

Introduction 18
Era of Indigenous control 20
Colonial legacy 21
Theories of disease causation 21
Public health legislation and sanitary reforms 21
Australian responses 23
Status quo or radical change? 24
Relearning the nineteenth-century lessons: McKeown and Szreter 26
Nation-building era 27
Affluence, medicine, social infrastructure 30
Conclusion 32

3 The New Public Health Evolves 33

Introduction 34
International developments in the new public health 35
The 1980s: developing a new public health 38
The 1990s: implementing the Ottawa Charter strategies 40
viii EXTENDED CONTENTS

The 1990s to the twenty-first century: international developments in

the new public health 41
New century: Commission on Social Determinants of Health—strong
reinforcement for the new public health 44
Global health systems to promote the new public health 47
Does spending more on care determine health outcomes? 48
Comprehensive primary health care as the basis of health systems 53
Resisting growing medicalisation 55
Health sector stewardship function 56
Australia and the new public health: 1970s to the present 57
State variation in community health and health promotion in the 1980s 60
1990s: neo-liberalism takes hold in Australia 61
Howard’s Australia and the impact on the new public health 61
National, state and local public health responsibilities 62
Research for the new public health 64
Preference for selective primary health care and lifestyle health promotion 65
Specific policy areas in the past 25 years and their fit with the
new public health 69
How much does Australia spend on public health? 72
Conclusion 75

PART 2 POLITICAL ECONOMY OF PUBLIC HEALTH 77

4 Ethics, Politics and Ideologies: The Invisible Hands of Public Health 79
Introduction 79
Political systems and ideologies 80
Types of political systems 80
Growth of welfare states 81
Egalitarianism, socialism and capitalism 84
Ethical issues in public health 85
Roots of individualism 86
The dialectic between individualism and collectivism 87
Consequentialist and non-consequentialist ethics 88
Rights arguments 89
Victim blaming 90
Public health policies and individualism 92
Social-structural and communitarian perspectives 96
Individualism and the welfare state 97
Conclusion 100

5 Neo-liberalism, Globalisation and Health 102

Introduction 102
What is globalisation? 103
What is neo-liberalism? 105
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 EXTENDED CONTENTS ix

Key institutions 108

World trade system and health 113
International agreements that threaten global health 113
TRIPS and TRIPS-Plus 115
Trade in Services Agreement (TISA) 120
The impact of transnational corporations 120
The impact of neo-liberalism on health 124
Consumerism 137
The voices of dissent: civil society movements 140
Bringing the voice of ordinary people from the grassroots 141
Protest, advocacy and lobbying against international financial and
trade institutions 143
‘Watching’ the global institutions 145
Conclusion 145

PART 3 RESEARCHING PUBLIC HEALTH 149

6 Research for a New Public Health 150
Introduction 150
Limits to epidemiology 151
Other forms of knowledge generation 153
Need to change focus of health research 158
Reflective research practice 160
Using previous research findings: systematic reviews 162
Ethical issues in research 163
Do no harm 163
Methodological soundness 164
Informed consent 164
Privacy, confidentiality and anonymity 166
Being an ethical researcher 167
Research with Indigenous Australians 168
Conclusion 169

7 Epidemiology and Public Health 171

Introduction 171
What is epidemiology? 171
Population epidemiology 172
Clinical epidemiology 173
Social and eco-social epidemiology 173
Popular epidemiology 174
Key concepts and methods in epidemiology 174
Descriptive studies 176
Analytical studies 177
x EXTENDED CONTENTS

Experimental designs 179

Quality and error in epidemiological studies 183
Conclusion 183

8 Survey Research Methods in Public Health 186

Introduction 186
Strengths of surveys 187
Weaknesses of surveys 188
Planning and conducting surveys 189
Is the research question amenable to questionnaire or interview survey? 190
What type of survey to use? 190
Selecting respondents 191
How many people should be included in a survey? 191
Designing a survey instrument 192
Survey fieldwork 196
Self-completion questionnaires 196
Telephone surveys 196
Face-to-face surveys 197
Response rates to surveys 197
Analysis of survey results 198
Conclusion 199

9 Qualitative Research Methods 201

Introduction 201
What is qualitative research? 202
Application to public health 202
Qualitative research methods 203
Case studies 203
Participant observation 206
In-depth interviewing 210
Focus groups 212
Document analysis 216
Common issues of concern 216
Analysing qualitative data 219
Conclusion 226

10 Planning and Evaluation of Community-based Health Promotion 228

Introduction 228
Planning for community-based public health projects 229
Tools for needs assessment 232
Setting priorities and ongoing planning 240
Evaluation of complex public health initiatives 243
Objectives and outcomes 243
Ensuring a reflective approach 249
 EXTENDED CONTENTS xi

Methods for community-based evaluation 249

Validity of evaluation 250
Conclusion 250

PART 4 HEALTH INEQUITIES: PROFILES, PATTERNS

AND EXPLANATIONS 253
11 Changing Health and Illness Profiles in the Twenty-first Century:
Global and Australian Perspectives 254
Introduction 254
Data sources 255
Life expectancy 255
Social determinants of health 261
Cause of death 262
Deaths from violence and injury 264
Resurgence of infectious diseases 267
Chronic disease 272
Disability 273
Conclusion 274

12 Patterns of Health Inequities in Australia 276

Introduction 276
Key factors in health inequalities in Australia 277
Effects of socioeconomic status 277
Poverty, socioeconomic status and health 279
Socioeconomic status 280
Increasing inequities 282
Unemployment and health 284
Occupational illness and injury 284
Indigenous peoples 286
Refugees, migrants and health 292
Gender and health 295
Suicide 300
Gender and morbidity 302
Location and health 303
Rural and remote Australia 303
Conclusion 306

13 The Social Determinants of Health Inequity 307

Introduction 307
Explaining socioeconomic status inequities in health status 308
Artefact explanations 309
Theories of natural or social selection 310
Cultural/behavioural versus materialist or structuralist explanations 311
xii EXTENDED CONTENTS

Social capital, support and cohesion and health inequities 325

Gender and health 331
Inequities: the case of Aboriginal health 335
Conclusion 347

PART 5 UNHEALTHY ENVIRONMENTS: GLOBAL AND

AUSTRALIAN PERSPECTIVES 349
14 Global Physical Threats to the Environment and Public Health 352
Introduction 353
Climate and atmospheric change 353
Effects of climate change on human health 356
Direct effects of climate change on human health 358
Indirect effects of climate change on human health 360
Summary: climate change and human health 363
Declining air and water quality 363
Water supply 369
Nuclear power 370
Loss of biodiversity 372
Consumerism, neo-liberal globalisation and the environment 374
Global efforts to address climate change 376
Why don’t we take action? 377
Environmental justice 381
Feminism and environmental justice 382
The precautionary principle 383
Conclusion 383

15 Urbanisation, Population, Communities and Environments:

Global Trends 385
Introduction 385
Urbanisation 386
Violence and crime 389
Living conditions 391
Crowding and health 393
High density: a health hazard? 394
High density and social disorder 396
High density and environmental sustainability 396
Slums 397
Affluent suburbia: dream or nightmare? 397
Social impact of urban life: from community to anomie? 400
Social capital declining? 401
Transport in urban areas 403
Population, consumption and equity 411
Conclusion 415
 EXTENDED CONTENTS xiii

PART 6 CREATING HEALTHY AND EQUITABLE SOCIETIES

AND ENVIRONMENTS 417
16 Healthy Economic Policies 419
Introduction 419
Challenging economic growth 420
Beyond GDP AND GNP: indicators of well-being 422
Polluter-pays principle 425
Retreat from consumerism 426
Healthier economic options: Keynes, post-carbon and low growth 430
Controlling the transnational corporations 432
From global to local 435
Local action to resist globalisation 437
Fair taxation, income and wealth distribution 438
Trade justice 442
An economy that encourages healthy work 444
Conclusion 445

17 Sustainable Infrastructures for Health, Well-being and Equity 447

Introduction 447
The global framework 448
Sustainable development: oxymoron or salvation? 453
Creating ecologically sustainable and healthy communities 454
Characteristics of healthy and sustainable cities and communities 455
Tensions in creating healthy cities and communities 456
Energy use 464
Reducing fossil fuel use 467
Taming the car 467
Equitable provision of healthy infrastructure 471
Housing 473
Preserving agricultural land and natural spaces 474
The sustainability of rural areas 476
Conclusion 478

PART 7 HEALTH PROMOTION STRATEGIES FOR ACHIEVING HEALTHY

AND EQUITABLE SOCIETIES 479
18 Medical and Health Service Interventions 482
Introduction 482
General practitioners 483
Screening 485
Specific screening tests and their effects 486
xiv EXTENDED CONTENTS

Effectiveness of screening for behavioural risk factors and

follow-up on population health 488
Immunisation 490
Smallpox 491
Polio 491
Immunisation in Australia 492
Individual risks and social benefits of immunisation 493
The contribution of the health sector to promoting population
health and reducing inequity 493
Comprehensive primary health care 496
Conclusion 498

19 Changing Behaviour: The Limits of Behaviourism

and Some Alternatives 500
Introduction 500
Social learning theory 501
Health belief model 502
Theory of reasoned action 503
Stages of change model 503
Health action model 502
Application of behavioural theories 505
Second generation of heart health campaigns 510
Social marketing 511
Mass media campaigns 512
Health education through entertainment 514
Using social media 515
Criticisms of social marketing 517
Relational, mindful and positive: other approaches to health
promotion for individuals 520
Conclusion 522

20 Participation and Health Promotion 524

Introduction 524
Participation in practice 525
Values and principles for participation 525
Participation in health 526
Social media and participation 528
Lessons from participation in health 529
Pseudo or real participation? 529
Types of participation 530
Participation and power 532
Who participates? Issues of representation 538
Citizens or consumers? 539
The role of professionals in participation 540
 EXTENDED CONTENTS xv

Effective bureaucratic consultations 544

Conclusion 545

21 Community Development in Health 547

Introduction 547
What is ‘community’? 548
Community development and social capital 549
Community development and health services 555
Community development: ways of working 559
Dilemmas of community development 560
Conclusion 564

22 Public Health Advocacy and Activism 565

Introduction 565
What is public health advocacy and activism? 566
Who are public health advocates and activists? 567
What are key advocacy and activism strategies? 569
Advocacy and activism dilemmas 579
Conclusion 582

23 Healthy Settings, Cities, Communities and Organisations:

Strategies for the Twenty-first Century 584
Introduction 584
‘Settings’ approaches to health promotion 585
Bringing about change in healthy settings initiatives 588
Political and policy leadership and commitment is essential 592
Encouraging action across sectors 593
Types of partnerships 595
Detailed examples of healthy settings initiatives 597
Legislative frameworks that support healthy settings in the workplace 598
Healthy settings projects in the workplace 600
Healthy cities and communities 601
WHO’s Healthy Cities program 602
Healthy Cities in Australia 608
Healthy Cities: actions for health 609
Settings with a specific focus: obesity prevention in cities and
communities 610
Sustainability of healthy settings 611
Critical perspectives on healthy settings approaches 613
Conclusion 615

24 Healthy Public Policy 617

Introduction 617
What is policy? 618
xvi EXTENDED CONTENTS

What is healthy public policy? 618

Policy formulation 620
Phases in policy making 621
Approaches to policy formulation 622
Policies and power 625
Healthy public policy in a globalised world 627
Examples of healthy public policy 628
What makes for healthy public policy? 649
Conclusion 650

PART 8 PUBLIC HEALTH IN THE TWENTY-FIRST CENTURY 653

25 Linking Local, National and Global Public Health 655
Introduction 655
Global issues of ecology 658
A just world? 659
Leadership for a healthy future 660
Public health for the brave-hearted 661
Reflective, flexible and eclectic 662
A vision for 2050 662
Conclusion 664

Appendix: Public Health Keywords 665

References 670
Index 738
 xvii

LIST OF BOXES, FIGURES AND TABLES

BOXES
Box 1.1 Definitions of health (Blaxter’s survey of British sample) 7
Box 1.2 Qualities of a healthy city 13
Box 1.3 How does a population health perspective differ from an
individual or clinical one? 15
Box 2.1 E.P. Dark: new public health commentator in the 1930s and 1940s 29
Box 3.1 Five strategies of the Ottawa Charter for Health Promotion, 1986 38
Box 3.2 Recommendations of the Commission on Social Determinants
of Health 45
Box 3.3 Extracts from the Rio Declaration on Social Determinants
of Health 46
Box 3.4 Dying of AIDS and Ebola in Africa 52
Box 3.5 Primary Health Care: Now More Than Ever 54
Box 3.6 Key players in Australian public health and summary of
main roles 62
Box 3.7 VicHealth: health promotion that takes note of social
determinants 67
Box 4.1 Moral giants on the ethics of welfare and equity 83
Box 4.2 Individualism versus collectivism: comparing different politicians 92
Box 4.3 What is communitarianism? 96
Box 5.1 Three stages of neo-liberalism 105
Box 5.2 Insight into market triumphalism 107
Box 5.3 The Global Financial Crisis: bail-out for the banks, austerity
for most 110
Box 5.4 Unequal world 113
Box 5.5 How international trade and investment treaties threaten health 114
Box 5.6 TRIPS: a new form of colonialism 115
Box 5.7 How trade agreements may prevent governments passing
public health legislation 118
Box 5.8 Neo-liberalism and transnational corporations 122
Box 5.9 Consumerism: a threat to health and well-being? 138
Box 5.10 Dysfunctions of the global governance according to a Lancet
Commission 139
Box 5.11 The People’s Health Movement’s opposition to economic
globalisation 141
xviii LIST OF BOXES, FIGURES AND TABLES

Box 5.12 Examples of grassroots action against neo-liberal globalisation 144

Box 6.1 Value of using qualitative and quantitative methods in public
health 156
Box 6.2 Steps in conducting a systematic review 162
Box 7.1 Types of health data 174
Box 7.2 How to judge the quality of health data 175
Box 7.3 Conditions that have to be met in a community trial 182
Box 8.1 Examples of closed-ended questions 194
Box 9.1 Checklist for rating a case study proposal 205
Box 9.2 Using computer packages to analyse qualitative data 221
Box 9.3 What is participatory action research? 223
Box 10.1 Towards a comprehensive national health equity surveillance
framework 234
Box 10.2 Kiama Council Health Plan 2011–17 242
Box 11.1 Social and economic impact of HIV in sub-Saharan Africa 271
Box 12.1 Key health inequalities, Australia, 2009–11 277
Box 12.2 Leading causes of death and socioeconomic disadvantage
in Australia, 2009–11 281
Box 12.3 Factors contributing to poorer health in rural areas 305
Box 13.1 The difference between equality and equity 308
Box 13.2 Achieving health without wealth 315
Box 13.3 Some health consequences for the Stolen Generations 340
Box 13.4 The Northern Territory Emergency Response 342
Box 13.5 Racism and mental health in Adelaide: Aboriginal perspectives 345
Box 13.6 Extracts from Kevin Rudd’s speech, February 2008 346
Box 14.1 Evidence in support of global warming 354
Box 14.2 Water wars: the approaching risks 368
Box 14.3 Global biodiversity continues to decline 372
Box 14.4 Indigenous protection of the environment 379
Box 15.1 Problems associated with rapid urbanisation 388
Box 15.2 Different aspects of poverty 392
Box 15.3 Pedestrian road rage 407
Box 15.4 Local government subsidising private cars 409
Box 15.5 World Summit priorities on population and gender equity 413
Box 15.6 Is population growth or overconsumption the larger problem? 414
Box 16.1 Critique of gross national product and gross domestic product 422
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 LIST OF BOXES, FIGURES AND TABLES xix

Box 16.2 Happy Planet Index 424

Box 16.3 Economic development: the path to happiness? 428
Box 16.4 Principles for ecological economics 431
Box 16.5 Taming the corporations 434
Box 16.6 Mondragon Cooperative: an example of industrial democracy 436
Box 16.7 Options to increase government revenue exist even in the
poorest countries 440
Box 16.8 South Australian Council of Social Service 2014 state election
campaign: ‘Without taxes, vital services disappear’ 441
Box 16.9 Fair trade or trade justice? 443
Box 17.1 The United Nations draft Sustainable Development Goals 452
Box 17.2 A vision for resilient cities 455
Box 17.3 New York City Active Design Guidelines 457
Box 17.4 Christie Walk: a model for ecological and social sustainability 459
Box 17.5 Third places: community sites for health promotion 462
Box 17.6 Renewable energy: signs of progress 465
Box 17.7 Innovation in public transport systems 470
Box 17.8 LandCare: participation for sustainability 475
Box 17.9 Port Augusta: a solar future 477
Box 18.1 Evidence on effectiveness of screening and education about
cardiovascular disease risk factors 488
Box 18.2 Characteristics of a health equity–oriented health care sector 495
Box 18.3 Aboriginal community controlled health services: an
empowering model 496
Box 19.1 Typical composition of community heart health programs 505
Box 19.2 Examples of Aboriginal social marketing campaigns 516
Box 19.3 The Haven, Gabriola Island, British Columbia, Canada 521
Box 20.1 The boards of management of community and women’s
health centres in Victoria and South Australia 527
Box 20.2 New forms of participatory mechanism in South Australia 528
Box 20.3 The National HIV/AIDS Strategy 1989–95: participation in action 543
Box 20.4 Features of a bureaucracy that provide conditions conducive
to consultation 544
Box 21.1 KidsFirst: Canadian early childhood intervention using
community development and social capital 552
Box 21.2 Community empowerment: individual and collective action 554
Box 21.3 Main features of community-based health promotion 555
xx LIST OF BOXES, FIGURES AND TABLES

Box 21.4 Community development in Aboriginal health services 556

Box 21.5 Health agency policies supportive of community development 558
Box 22.1 Examples of public health advocacy and activism 567
Box 22.2 Close the Gap campaign 569
Box 22.3 Advocacy for universal health care 573
Box 22.4 Media bites 577
Box 22.5 Progressive health blogs 577
Box 22.6 Examples of activist research 578
Box 23.1 Hallmarks of a settings approach to creating health 585
Box 23.2 Healthy settings: approaches and examples 586
Box 23.3 Checklist for partnership in health promotion 595
Box 23.4 Your Rights at Work: ACTU campaign 599
Box 23.5 WHO’s Twenty Steps for Developing a Healthy Cities Project 604
Box 23.6 Strategic goals of the WHO European Healthy Cities
Network Phase VI, 2014–18 605
Box 23.7 Vision of the Alliance for Healthy Cities 608
Box 23.8 Healthy Together Victoria 611
Box 23.9 Sustainability of Healthy Cities: example of Noarlunga,
South Australia 612
Box 24.1 Definition of Health in All Policies 619
Box 24.2 The role of policy entrepreneurs in the adoption of Health
in All Policies in South Australia 624
Box 24.3 Demand and supply reduction methods in WHO’s Framework
Convention on Tobacco Control 631
Box 24.4 Achievements in Australian tobacco control 633
Box 24.5 National Drug Strategy 2010–2015 635
Box 24.6 The National Binge Drinking Strategy 635
Box 24.7 Guiding principles for nutrition-sensitive agriculture policy 640
Box 24.8 Global picture of overweight and obesity 641
Box 24.9 Examples of strategies that tackle structural impediments
to healthy weight 642
Box 24.10 Food labelling in Australia 644
Box 24.11 San Francisco’s Healthy Meals Incentive Ordinance 645
Box 25.1 Public Health Dreaming: 2050 663
 LIST OF BOXES, FIGURES AND TABLES xxi

FIGURES
Figure 2.1 Respiratory tuberculosis: mean annual death rates
(standardised to 1901 population, England and Wales) 26
Figure 3.1 International milestones in the development of the new
public health 34
Figure 3.2 Comparative life expectancy and health expenditure 51
Figure 3.3 Recurrent health expenditure, by area of expenditure and
source of funds, current prices, 2012–13 73
Figure 4.1 Political and economic spectrum 81
Figure 4.2 Alternative perspectives for assigning causality in public health 95
Figure 4.3 The characteristics of welfare regimes in industrialised societies 98
Figure 5.1 The Corporate Consumption Complex 121
Figure 5.2 The world’s largest corporations’ revenue compared with
selected countries 122
Figure 5.3 Conceptual framework linking globalisation to health outcomes 126
Figure 7.1 Design of a cohort study 178
Figure 7.2 Design of a case–control study 179
Figure 7.3 Design of a randomised controlled trial 180
Figure 7.4 Multiple baseline design 182
Figure 9.1 Participatory action research cycle 224
Figure 10.1 Towards healthy and sustainable living 229
Figure 10.2 Measuring participation 246
Figure 10.3 Community-based health promotion evaluation: outcomes
and attribution 247
Figure 10.4 Program logic for the evaluation of the South Australian Health
in All Policies initiative 248
Figure 11.1 Infant mortality rates in Australia per 1000 live births, 1901–2010 260
Figure 11.2 Projected deaths by major cause and World Bank income
group, all ages, 2030 263
Figure 11.3 Homicide and suicide rates by WHO region, 2012 266
Figure 12.1 Percentage of selected groups below the poverty line
(earning less than 50 per cent of the median income) 280
Figure 12.2 Comparison of age-standardised mortality rates across
socioeconomic groups, by age group, 2009–11 281
Figure 12.3 Income inequality in Anglo-Saxon countries, 1910–2010 283
xxii LIST OF BOXES, FIGURES AND TABLES

Figure 12.4 Australian Work Health and Safety Strategy 2012–2022 285
Figure 12.5 Peak Australian organisations express concern and urge
action on Aboriginal health status 291
Figure 12.6 Deaths by suicide in Australia: males, females and total, all ages,
1921–2010 (rates per 100 000) 301
Figure 12.7 Male deaths by suicide in Australia, 1921–25 to 2006–10,
selected age groups (deaths per 100 000) 302
Figure 13.1 Key determinants of health and health inequities 309
Figure 13.2 Health and social problems are worse in more
unequal countries 314
Figure 13.3 Increasing wealth inequality 318
Figure 13.4 Stress and health inequity: biological responses 329
Figure 13.5 How social determinants interact to affect mental health 331
Figure 15.1 Global urbanisation and level of development 386
Figure 15.2 Urban densities, 1990 404
Figure 15.3 Length of road per person, 1990 404
Figure 15.4 World population trends, 1950–2030 411
Figure 18.1 The 5 As for behavioural risk factors in Australian
general practice 484
Figure 18.2 Relative risk of death from coronary heart disease according to
employment grade and proportion of differences that can be
explained statistically by various factors 490
Figure 20.1 Health promotion winners’ and losers’ triangles 542
Figure 21.1 Community organisation and community-building typology 550
Figure 21.2 Big hART: Performance Arts for Social Change set in its
complex socio-political context 562
Figure 22.1 The landscape of public health advocacy and activism 566
Figure 23.1 Phases of organisational change 589
Figure 23.2 Healthy settings: shift in organisational form 593
Figure 23.3 Cardiff Healthy City Model 606
Figure 24.1 Kingdon’s three stream model of agenda setting 622
Figure 24.2 Health equity nutcracker 626
Figure 24.3 Drug policy dilemmas 637
Figure 24.4 Conceptual framework of drivers and determinants
of undernutrition 640
Figure 24.5 The impact of road safety measures on fatality rates 647
Figure 25.1 The new public health sustainable health equity stack 657
 LIST OF BOXES, FIGURES AND TABLES xxiii

TABLES
Table 1.1 Individual and population health perspectives: the differences
explained 15
Table 2.1 History and development of public health in Australia 19
Table 3.1 Contrasts and similarities between the ‘old’ and ‘new’
public health 39
Table 3.2 Meetings and documents key to the new public health,
1970s–2013 41
Table 3.3 Health expenditure and mortality outcomes, USA and
OECD countries 49
Table 3.4 Health outcomes and expenditure, USA, Costa Rica
and Australia 50
Table 3.5 Key Australian Government health policies, 1989–2014,
and their fit with the new public health 69
Table 5.1 Neo-liberal globalisation, health and equity: the arguments
summarised 127
Table 6.1 The ‘two communities’ model of researchers and policy makers 160
Table 6.2 Ethical questions for public health researchers 167
Table 7.1 Deaths from cholera in districts of London supplied by two
water companies, 8 July to 26 August 1854 172
Table 7.2 Types of epidemiological studies 176
Table 10.1 Differences between ‘sensory data’ and ‘standards’
approaches: air pollution 233
Table 10.2 Broad indicators for Healthy Cities, Local Agenda 21 or similar
initiatives 236
Table 11.1 International comparison of health indicators, selected
countries, 2012 and 2013 256
Table 11.2 Complete expectation of life in years, Australia,
1881–91 to 2010–12 257
Table 11.3 Life expectancy (LE) and under-five mortality rate (U-5 MR),
selected African countries, 1993, 1999, 2004, 2012 258
Table 11.4 Selected social determinants of health, comparison by
development level of countries 261
Table 11.5 Ten leading causes of death by countries according to
broad income group, 2012 (deaths per 100,000 population) 262
Table 11.6 Estimated global violence-related deaths, 2012 265
Table 11.7 Global regions HIV and AIDS statistics, 2012 270
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 Dia. IX.

DIA. X.
Dia. X is a five-seamer overcoat for the normal, but leaning toward
the erect form. The armhole is cut full forward to 45 deg., and the
sleeve base moved forward two seams, or ⅜ inches. The sleeve part
of this diagram makes a close sleeve head, and a lap at 60 deg. may
be made ¼ to ½ more, and at 45 deg. it may be made ¼ more or
any amount required to make a nice curve. The bottom of the
armhole is plenty low, and the gusset on the top of the under sleeve
fits it. The width of the shoulders may be made 9 at 60 deg. A half-
inch lap between the armhole and sleeve at the back sleeve center,
or at line 8, will make the whole sleeve extra easy, though the back
sleeve may hang a trifle loose when the arm hangs down, but this ½
inch extra length must not be accounted for in the sleeve-length.
The square of the coat is 18¾ only, which is ½ less than the
regular calculation would bring it. An overcoat must be close-fitting,
at and around the arm, though the armhole must be plenty large.
Dia. X was made over a 39 pattern and if that same draft is
measured and laid out with a scale of 38, the square will be 19¼,
which 19¼ numbers correspond to the square of 18 on a three-
seamer, taking in consideration the gore and the seams under the
arm on a five-seamer. To cut over Dia. X the measure must be taken
close over the undercoat, and the measure over the vest will make
the fit not too close.
 Dia. X.

DIA. Xa.
Is a three-seamed overcoat, and must be reproduced and made
as fine work requires it, and the person who wears it must be well
built, and with a rather small waist and seat. All clothing worn under
the overcoat should be neat and well fitting. Erect persons should
have the height of back at 13. The sleeve shown in Dia. X
corresponds to Dia. Xa. The collar must be sewed on easy, on and
along the sides. The whole front edge may be made ½ inch smaller
than Dia. X.
 Dia. Xa.

DIA. XI.
Dia. XI represents the garment in a three-fourths circle and on a
square of 20. The circle itself would make the vest too short, but it
represents the correct run of the bottom.
 Dia. 11.

DIA. XII.
Dia. XII represents the same as the foregoing in a three-fourths
circle, but on a square of 17½, also the equilateral triangle of 35
numbers. Each of the Dia. XI and XII are one square cut from the
center of a circle, and in order to make it as simple as possible the
vest is again used. The bottom of the forepart is on the circle, but
that would make a short vest, and for this reason the back shows 1½
longer.
 Dia. 12.

DIA. XIIa.
Dia. XIIa is made to illustrate all points obtained from the center of
a circle, or from a point of the angle of 135 deg. All it requires is to
lengthen the lines, so that they are long enough for the full scale.
Any other point in any other garment may be found in the same way.
Dia. XIIa.
 DIA. XIII.
This diagram I consider very valuable for illustration, because it
represents an entire garment from neck to ankle in one continuous
form, and on slopes in perfect harmony with the slopes of the body,
running to a point at each end, each point at an angle of 15 deg.,
and both joined at the widest part, representing the largest part of
the body, but cut off at the neck and at the feet. The upper part again
represents the vest, as the simplest garment worn by man. The
starting point for the garment is at a point where the angle of 15 deg.
has a width of 17½ numbers. The connecting points of the two
angles of 15 deg. are at the front of the waist, or at the pit of the
stomach, where the body turns backward, upward and downward,
and at the largest part of the seat. The lower point of the angle of 15
deg. is a center for the pants, from which center all connection for
the seams may be swept with certainty. And, although this point is
not convenient to sweep from for every pants we cut, a cutter must
know from what point he can obtain his balance without going to the
point—all of which is fully described in the article on “Pants.”
 Dia. 13.

DIA. XIV.
This is simply the lower part of Dia. XIII, but the sides are closely
connected on the angle of 15 deg., showing the pants in one solid
sheet, which will fit the form of the bare body from waist to ankle.
This diagram is in such a position that a new beginner may learn
how to produce a nice slope for the side seam. But it is intended to
serve for other and more important illustrations. It is to illustrate more
fully the so-called back slope.
The upper part, or the waist, is in a perfect square from the front
base. If the front and the back bases are laid on top of each other, all
the sweeps from point 80 will fit together and the whole front and
back will lay in position as most all pants are cut. From the position
of this diagram, there is no side, nor back slope; it is simply a square
block, consequently, the so-called back slope is only an imagination.
But the most important point to illustrate is the following:
Considering the ankles 1¼ inches apart, will give to each side ⅝,
and the front base line would run down parallel with the center of the
front, though slanting backward, and parallel with the front of the leg.
Now, it is true, the lower part of Dia. XIV is on an angle of 15 deg.,
but the upper part is also on a square, and we will now consider the
back square line finished clear down to the bottom of a pants, and
cut out a square sheet of stiff paper, as long as a pants may be and
as wide as the seat requires to go around it, say 40 inches both
ways, and place it on and around the body of a person whose front
of abdomen does not reach outside of a straight line, running parallel
with the front slope of the legs, and in this position the sheet will fit to
the body all along down in front, as well as the back of the waist from
the seat upward. The center of the front and the center of the back
run parallel up and forward and the square sheet will fit it, but at the
top of the side, and at the bottom of the side and at the bottom of the
back the square sheet, wound around the body will be too large, and
must be reduced as follows: On top of side of waist one or two gores
are cut to represent the difference between the seat hip and waist
measure. The bottom at the side and at the back is reduced from a
square to a slope of 15 deg., all of which is taken off from behind. It
should be observed on Dia. XIV that the center of the front and the
center of the back seams run parallel upward and forward above the
seat lines, and from the seat lines downward, both the front and back
forks start outward of the square, all of which is to be turned inward
to pass forward and backward between the legs.
The square sheet must be considered for the outside cover, as
though the legs were grown together. Again, a square sheet must be
considered so adjusted to the upper body that the square sheet
closes in all around the front from top to bottom, and from the seat to
the waist in the back, but stands off at the bottom behind where the
square is to be reduced to an angle of 15 deg. from seat to bottom.
Whatever such a square, wound around the upper body is too large
at the waist, must be reduced by one large or by two small gores at
the top of side, and it will be found that the reduction of the angle of
7½ deg. is always the difference between the seat and waist
measure, and if the waist is as large as the seat, no reduction is
required, and if the waist is larger than the seat, allowance must be
made at the side and in front. If that division is not properly made the
crotch will show the fault, because the sides will take up their share,
whether they have too much or too little cloth.
 Dia. XIV.

DIA. XV.
The figure on this diagram is poorly drawn, but it serves to
illustrate. It gives the side view of the crotch, and illustrates why a
larger waist must receive more cloth in front than a normal waist. Fig.
I shows the pants from the front or back view, but this gives the side
view, the back running backward and the front forward and away
from the body. In this position the pants must be considered as in
opposite position to Dia. XIV, and connected on the crotch seams.
Dia. XV is intended to illustrate the bases for the small waist as well
as for the large waist. On the small waist the body of the waist is
even with the front pants base, but when the waist becomes larger
the base will have to be considered as located inside of the front of
the abdomen, as shown on the figure. When the base strikes the
front of the body, as on a small waist, the front can be swung
sidewise and backward on a straight line, and the back can be
swung forward and sidewise, but in order to conform to the seat the
back must form the sack for the seat first.
When both the front and the back is settled to the shape of the
body, the center of each runs up and down and parallel above the
seat line. The larger waist extends outside of the base and after the
front is swung sidewise, to the side of the back, the front of the pants
must be considered to be brought forward to the front of the body,
the hinge being at the side, and when the front of the pants is swung
forward with the hinge or swing fastened to the side, the centre of
front is too small and must be supplied with extra width. Pants, as
well as coats, are fitted from the side forward to the front and from
the side backward to the back, and if the diameter of the center of
the body from back to front is larger than on the normal form, the
ends of the front will not reach the centre of the body in front and
more waist proportion must be allowed there. The back must be
considered stationary and requires no allowance behind, but may
require allowance at the side if the waist is well filled up there. (See
Dia. XX.)
In case of a back or forward leaning waist, Dia. XV will show that
the crotch must be considered stationary, and the crotch must also
be considered as a hinge on which the upper body swings back and
forward, and that if the backward leaning waist requires ½ inch less
cloth on top of front, the top of back must receive that ½ inch again,
or else the so-called back slope will become too large.
 Dia. XV.

The descriptions of Dias. XIII, XIV and XV should be well

considered by every cutter. I have figured on them for over twelve
years and the result is here given. Others might have done it in less
time, but so far as I know, nobody has done it yet.

DIA. XVI.
Dia. XVI shows the front and back of equal width except the tops
of each.

DIA. XVII.
This presents the small front and wide back.

DIA. XVIII.
Dia. XVIII illustrates the principle of the fold in the seat, and the
back and dress front nearly alike.
Dia. 16. Dia. 17. Dia. 18.
 DIA. XIX.
Represents pants of the present style and fashion. The waist is as
short as it ought to be for fine pants. Contrast the length of the waist
with Dia, XXI. Dia. XIX is calculated for a size 38 seat with a knee 19
inches wide. If this is laid out with a 35 scale, the knee will become
17½ inches wide, which is a good width for a close fitting pants,
which will soon come in style again. When small pants legs come in
style again, the crotch of such pants will have to be reduced about
one seam, and at the bottom the centre will be the same centre,
while at the knee the centre of the angle of 10 deg. is also a guide,
but there the outside requires about ½ less than the inside, because
the inside of the leg is straight, while the outside is hollow.
 DIA. XIX.

DIA. XX.
This diagram was made over a pants pattern of the following
proportion: Seat, 46 in.; Hip, 47; actual waist measure, 46; waist as
made up, 49 in.; knee, 22½; and bottom, 20½ in.
 Dia. XX.

DIA. XXI.
This diagram was made for the purpose of illustrating a pants with
a high waist, and how it is to be cut on top in order to have such a
pants feel good around the short ribs, and still fitting at the hollow of
the waist. The more spring such a pants has near the short ribs, the
better it will be. But the buckle straps must be set low, or at the
hollow of the waist, so they do not draw that width backward. For the
sake of making a change, I have thrown the top of front of the dress
side out ¾ and the undress side is to be ⅜.
DIA. XXI.