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Public Health Text Book

1. Research methods appropriate to public health practice, including epidemiology, statistical methods and other methods of enquiry including qualitative research methods.

• 1a Epidemiology
  • Use of routine vital and health statistics to describe the distribution of disease in time and place and by person
  • Numerators, denominators and populations at risk
  • Time at risk
  • Methods for Summarising Data
  • Incidence and prevalence including direct and indirect standardisation
  • Years of Life Lost
  • Measures of disease burden (event-based and time-based) and population attributable risks including identification of comparison groups appropriate to Public Health
  • Sources of variation, its measurement and control
  • Common errors in epidemiological measurements, their effects on numerator and denominator data and their avoidance
  • Concepts and measures of risk
  • Effect measures including odds ratios, rate ratios and risk ratios (relative risk)
  • Association and Causation
  • Biases and Confounding
  • Interactions, methods for assessment of effect modification
  • Strategies to allow/adjust for confounding in design and analysis
  • The design, applications, strengths and weaknesses of descriptive studies and ecological studies
  • Design, applications, strengths and weaknesses of cross-sectional, analytical studies (including cohort, case-control and nested case-control studies), and intervention studies (including randomised controlled trials) 
  • Analysis of health and disease in small areas
  • Validity, reliability and generalisability
  • Intention to treat analysis
  • Clustered data - effects on sample size and approaches to analysis
  • Numbers needed to treat (NNTs) - calculation, interpretation, advantages and disadvantages
  • Glossary
  • Time-trend analysis, time series designs
  • Nested case-control studies
  • Methods of sampling from a population
  • Methods of allocation in intervention studies
  • The design of documentation for recording survey data, construction of valid questionnaires and methods for validating observational techniques
  • Construction of valid questionnaires
  • Methods for validating observational techniques
  • Studies of disease prognosis
  • The ethics and etiquette of epidemiological research
  • Appropriate use of statistical methods in the analysis and interpretation of epidemiological studies, including life-table analysis
  • Epidemic theory (effective & basic reproduction numbers, epidemic thresholds) & techniques for analysis of infectious disease data (construction & use of epidemic curves, generation numbers, exceptional reporting & identification of significant clusters)
  • Systematic reviews, methods for combining data from several studies, and meta-analysis
  • Electronic bibliographical databases and their limitations
  • Grey literature
  • Publication bias
  • Evidence based medicine and policy
  • The hierarchy of research evidence - from well conducted meta-analysis down to small case series
  • The Cochrane collaboration
  • Understanding of basic issues and terminology in the design, conduct, analysis and interpretation of population-based genetic association studies, including twin studies, linkage and association studies
  • Appendix
• 1b Statistical Methods
  • Elementary Probability Theory
  • Methods for the Quantification of Uncertainty
  • Estimation of Confidence Intervals
  • Independence of Events
  • Conditional Probability
  • Standard Statistical Distributions (e.g. Normal, Poisson, Binomial) and their uses
  • Sampling Distributions
  • Principles of Making Inferences from a Sample to a Population
  • Measures of Location and Dispersion and their appropriate uses
  • Graphical methods in Statistics
  • Hypothesis Testing
  • Type I and Type II errors
  • Problems of Multiple Comparisons
  • Parametric and Non-parametric tests for comparing two or more groups
  • Sample size and statistical power
  • Regression and correlation
  • Multiple linear regression
  • The appropriate use, objectives and value of multiple linear regression, multiple logistic regression, principles of life-tables, and Cox regression
  • Principles of life-tables and Cox regression
  • Comparisons of survival rates; heterogeneity; funnel plots; the role of Bayes' theorem
  • Heterogeneity: funnel plots
  • The role of Bayes' theorem 
  • Rates definitions
  • Glossary
• 1c Health Care Evaluation and Health Needs Assessment
  • The uses of epidemiology and other methods in defining health service needs and in policy development
  • Participatory needs assessment
  • Formulation and interpretation of measures of utilisation and performance
  • Measures of supply and demand
  • Study design for assessing effectiveness, efficiency and acceptability of services including measures of structure, process, service quality, and outcome of health care
  • Measures of health status, quality of life and health care
  • Population health outcome indicators
  • Deprivation measures
  • Principles of evaluation, including quality assessment and quality assurance
  • Equity in health care
  • Clinical audit
  • Confidential enquiry processes
  • The use of Delphi methods
  • Economic evaluation 
  • Appropriateness and adequacy of services and their acceptability to consumers and providers
  • Epidemiological basis for preventive strategies
  • Health and environmental impact assessment
  • Health Care Evaluation Frameworks
• ​1d Principles of Qualitative Methods
  • Introduction to qualitative research
  • Semi-structured, narrative, and in-depth interviewing, focus groups, action research, participant observation
  • The contribution of qualitative methods to public health research and policy
  • Use, analysis and presentation of qualitative data
  • The etthical issues which may arise
  • Common errors and their avoidance
  • Strengths and weaknesses
  • References

2. Disease causation and the diagnostic process in relation to public health; prevention and health promotion.

• 2a Epidemiological Paradigms
  • Programming, life-course, and adult risk factor approaches
  • Adult Risk Factor Approaches
  • Life-Course (KUH)
• 2b Epidemiology of Diseases of Public Health Significance
  • Infectious diseases
  • Cancers of public health significance
  • Specific Chronic Diseases 
  • Epidemiology of Diseases Frameworks
• 2c Diagnosis and Screening
  • Principles, methods, applications and organisation of screening for early detection, prevention, treatment and control of disease 
  • Differences between screening and diagnostic tests and case finding 
  • Statistical aspects of screening tests, including knowledge of and ability to calculate, sensitivity, specificity, positive and negative predictive values, and the use of ROC curves 
  • Likelihood ratios
  • Pre- and post-test probability
  • Ethical economic, legal and social aspects of screening 
  • The principles of informed choice 
  • Planning, operation and evaluation of screening programmes 
  • The evidence basis needed for developing screening policies and implementing screening programmes, including established programmes such as breast and cervix and those currently in development, being piloted or subject to major research activity 
  • Ethical, social and legal implications of a genetic screening test
• 2d Genetics
  • Introduction
  • Elementary human genetics
  • Inherited causes of disease in populations 
  • Basic genomic concepts including patterns of inheritance, penetrance, genotype/phenotype differences, polygenetic disorders, gene-environment interactions and the role of genes in health and disease
  • Ætiology, distribution and control of disease in relatives 
  • Elementary molecular biology as related to genetic epidemiology and microbiology
  • References
  • Glossary
• 2e Health and Social Behaviour
  • Principles of nutrition, nutritional surveillance and assessment in specific populations including its short and long term effects
  • The influence of malnutrition in disease aetiology, pregnancy, and in growth and development 
  • Markers of nutritional status, nutrition and food 
  • The basis for nutritional interventions and assessment of their impact 
  • Social, behavioural and other determinants of the choice of diet 
  • Dietary Reference Values (DRVs), current dietary goals, recommendations, guidelines and the evidence for them 
  • The effects on health of different diets (e.g. 'Western' diet) 
  • Physical activity 
  • Alcohol 
  • Drugs 
  • Smoking
  • Sexual behaviour 
  • Sun exposure 
  • Combating complex problems using a wide range of approaches, including health service interventions and broader cultural interventions
• 2f Environment
  • Environmental determinants of disease
  • Risk and hazard 
  • The effects of global warming and climate change 
  • Principles of sustainability 
  • The health problems associated with poor housing and home conditions, inadequate water supplies, flooding, poor sanitation and water pollution
  • Methods for monitoring and control of environmental hazards (including food and water safety, atmospheric pollution and other toxic hazards, noise, and ionising and electromagnetic radiation) and cluster investigations
  • The use of legislation in environmental control 
  • Appreciation of factors affecting health and safety at work (including the control of substances hazardous to health) 
  • Occupation and health 
  • Transport policies and health impact assessment for environmental pollution ; air pollution
  • Chemical incident management
• 2g Communicable Disease
  • Definitions including: incubation, communicability and latent period; susceptibility, immunity, and herd immunity
  • Use and evaluation of national and international surveillance
  • Methods of control 
  • The design, evaluation, and management of immunisation programmes 
  • Choices in developing an immunisation strategy 
  • The steps in outbreak investigation including the use of relevant epidemiological methods 
  • Knowledge of natural history, clinical presentation, methods of diagnosis and control of infections of local and international public health importance (including emerging diseases and those with consequences for effective control) 
  • Organisation of infection control
  • A basic understanding of the biological basis, strengths and weaknesses of routine and reference microbiological techniques
  • International aspects of communicable disease control including port health
  • Communicable Disease Control Frameworks
• 2h Principles and Practice of Health Promotion
  • Collective and individual responsibilities for health, both physical and mental
  • Interaction between, genetics and the environment (including social, political, economic, physical and personal factors) as determinants of health, including mental health 
  • Ideological dilemmas and policy assumptions underlying different approaches to health promotion 
  • The prevention paradox 
  • Health education and other methods of influencing personal life-styles which affect health
  • Appropriate settings for health promotion (e.g. Schools, the workplace) 
  • The value of models in explaining and predicting health-related behaviour 
  • Risk behaviour in health and the effect of interventions in influencing health related behaviour in professionals, patients and the public 
  • Theory and practice of communication with regard to heath education 
  • The role of legislative, fiscal and other social policy measures in the promotion of health 
  • Methods of development and implementation of health promotion programmes 
  • Community development methods 
  • Partnerships 
  • Evaluation of health promotion, public health or public policy interventions 
  • International initiatives in health promotion 
  • Opportunities for learning from international experience
  • Health Promotion Frameworks
• 2i Disease Prevention, Models of Behaviour Change
  • Evaluation of preventative actions
  • Including the evidence base for early interventions on children and families, support for social and emotional development
  • Understanding of pre-determinants of health including the effect of social cohesion on health outcomes
  • An understanding of social marketing
  • Involvement of the general public in health programs and their effects on health care
  • Concepts of deprivation and its effect on health of children and adults
  • The benefits and means of community development, including the roles and cultures of partner organisations such as local authorities
  • Health impact assessment of social and other policies
  • The role of strategic partnerships and the added value of organisations working together
  • The role of target setting, e.g. Public Service Agreements, local authority agreements

3. Health Information

• 3a Populations
  • Conduct of censuses
  • Collection of routine and ad hoc data
  • Demography
  • Important regional and international differences in populations, in respect of age, sex, occupation, socio-economic position, ethnicity and other characteristics
  • Use of area-based socio-demographic measures in the interpretation of health statistics
  • Methods of population estimation and projection
  • Life-tables and their demographic applications
  • Population projections
  • The effect on population structure of fertility, mortality and migration
  • Historical changes in population size and structure and factors underlying them
  • The significance of demographic changes for the health of the population and on the need for health and related services
  • Policies to Address Population Growth Nationally and Globally
  • Health Information Frameworks
• 3b Sickness and Health
  • Sources of routine mortality and morbidity data, including primary care data, and how they are collected and published at international, national, regional and local levels
  • Biases and Artifacts in Population Data
  • The International Classification of Diseases and other methods of classification of disease and medical care
  • Rates and ratios used to measure health status including geographical, occupational, socio-economic position and other socio-demographic variations
  • Routine notification and registration systems for births, deaths and specific diseases, including cancer and other morbidity registers
  • Pharmacoepidemiology, including use of prescribing and pharmacy sales data; pharmacovigilance
  • Data linkage within and across datasets
• 3c Applications
  • Use of information for health service planning and evaluation
  • Specification and Uses of Information Systems
  • Common measures of health service provision and usage
  • The Uses of Mathematical Modelling Techniques in Health Service Planning
  • Indices of Need for and Outcome of Services
  • The strengths, uses, interpretation and limitations of routine health information
  • Use of information technology in the processing and analysis of health services information and in support of the provision of health care
  • Principles of Information Governance

4. Medical Sociology, Social Policy, and Health Economics

• 4a Concepts of Health, Wellbeing and Illness and the Aetiology of Illness
  • Activities - Instructions
  • Section 1: The theoretical perspectives and methods of enquiry of the sciences concerned with human behaviour
  • Section 2: Illness as a social role
  • Section 3: Concepts of health and wellbeing
  • Section 4: Concepts of primary and secondary deviance
  • Section 5. Stigma and how to tackle it
  • Section 6: Impairment, disability and handicap
  • Section 7: Social and structural iatrogenisis
  • Section 8: The role of medicine in society
  • Section 9: Explanations for various social patterns and experiences of illness including: differences of gender, ethnicity, employment status, age and social stratification
  • Section 10: The role of social, cultural, psychological and family relationship factors in the aetiology of disease and illness
  • Section 11: Social capital and social epidemiology
  • References
• 4b Health Care
  • Introduction
  • Section 1. Different approaches to health care: including self-care, family care, community care; self-help groups
  • Section 2. Hospitals as social institutions
  • Section 3. Professions, professionalisation and professional conflicts
  • Section 4. The role of clinical autonomy in the provision of health care
  • Section 5. Behaviour in response to illness and treatments
  • Section 6. Psychology of decision-making in health behaviour
  • References
• 4c Equality, Equity and Policy
  • Concepts of Need and Social Justice
  • Priorities and Rationing
  • Balancing Equity and Efficiency
  • Consumerism and Community Participation
  • Prioritisation frameworks and equity of service provision
  • Public Access to Information
  • User and Carer Involvement in Service Planning
  • Principal Approaches to Policy Formation
  • Problems of Policy Implementation
  • Appreciation of Concepts of Power, Interests and Ideology
  • Inequalities in health (e.g. by region, ethnicity, soci-economic position or gender) and in access to health care, including their causes
  • Health and Social Effects of Migration
  • Health Effects of International Trade
  • Global influences on health and social policy
  • Critical Analysis Of Investment In Health Improvement and the Part Played By Economic Development And Global Organisations
• 4d Health Economics
  • Principles of health economics including: the notions of scarcity, supply and demand, distinctions between need and demand, opportunity cost, discounting, time horizons, margins, efficiency and equity
  • Assessing Performance
  • Financial Resource Allocation
  • Systems of Health and Social Care and the Role of Incentives to Achieve Desired End-points
  • Techniques of economic appraisal (including cost-effectiveness analysis and modelling, cost-utility analysis, option appraisal and cost-benefit analysis, the measurement of health benefits in terms of QALYs and related measures e.g. DALYs)
  • Marginal Analysis
  • Decision Analysis
  • The role of economic evaluation and priority setting in health care decision making including the cost effectiveness of public health, and public health interventions and involvement
  • References

5. Organisation and Management of Health Care and Health Care Programmes from a Public Health Perspective

• 5a Understanding Individuals,Teams and their Development
  • Motivation, creativity and innovation in individuals, and their relationship to group and team dynamics
  • Barriers to, and stimulation of, creativity and innovation (e.g. by brainstorming)
  • Learning with individuals from differing professional backgrounds
  • Personal management skills (e.g. Managing: time, stress, difficult people, meetings)
  • Principles of effective management
  • Principles of leadership and delegation
  • Principles of negotiation and influencing
  • Principles, theories and methods of effective communication (written and oral) in general, and in a management context
  • Interactions between managers, doctors and others
  • The theoretical and practical aspects of power and authority, role and conflict
  • Professional accountability - clinical governance, performance and appraisal
  • Behaviour change in individuals and organisations
• 5b Understanding Organisations, their Functions and Structure 
  • Internal and external organisational environments - evaluating internal resources and organisational capabilities
  • Identifying and managing internal and external stakeholder interests
  • Structure and management of inter-organisational (network) relationships, including intersectoral work, collaborative working practices and partnerships
  • Social networks and communities of interest
  • The impact of political, economic, socio-cultural, environmental and other external influences
• 5c Management and Change
  • Management models and theories associated with motivation, leadership and change management, and their application to practical situations and problems
  • Critical evaluation of a range of principles and frameworks for managing change
  • The design and implementation of performance management against goals and objectives
• 5d Understanding the Theory and Process of Strategy Development
  • Differences between policy and strategy, and the impact of policies on health
  • Principles underpinning the development of policy options and the strategy for their delivery
  • Stakeholder engagement in policy development, including its facilitation and consideration of obstacles
  • Implementation and evaluation of policies including the relevant concepts of power, interests and ideology
  • Problems of policy implementation
  • Strategy communication and implementation in relation to health care
  • Theories of strategic planning
  • Analysis, in a theoretical context, of the effects of policies on health
  • Major national and global policies relevant to public health
  • Health service development and planning
  • Methods of organising and funding health services and their relative merits, focusing particularly on international comparisons and their history
  • Risk management
• 5e Health and Social Service Quality
  • Principles underlying the development of clinical guidelines, clinical effectiveness and quality standards, and their application in health and social care
  • Public and patient involvement in health service planning
  • Professional accountability, clinical governance, performance and appraisal
  • Risk management and patient safety
• 5f Finance, Management Accounting and Relevant Theoretical Approaches - Mike Deacon, Martin Hensher
  • Linkages between demographic information and health service information - its public health interpretation and relationship to financial costs

Further Resources

• Hints and Tips for Taking the Part A Exam
• Past Papers (available on the FPH website)

Text Courses

1. Epidemiology

• Epidemiology for practitioners

• Measures of disease frequency and disease burden
• Measuring health and disease
• Errors in epidemiological measurements
• Introduction to study designs - geographical studies
• Introduction to study designs - cross-sectional studies
• Introduction to study designs - case-control studies
• Introduction to study designs - cohort studies
• Introduction to study designs - intervention studies and randomised controlled trials
• Introduction to study designs - developing a questionnaire
• Causation in epidemiology: association and causation
• Role of chance, bias and confounding in epidemiological studies

• Epidemiology for specialists

• Measures of the effect of an exposure
• Standardisation
• Confounding in epidemiological studies
• Measures of the burden of morbidity and mortality on the population
• Alternative study designs in epidemiology
• Evidence based medicine and healthcare
• Epidemic theory

2. Health Information

• Applications of Health Information for practitioners
• Applications of Health Information for specialists
• Population Health Information for practitioners
• Population Health Information for specialists
• Sickness and Health Information for practitioners
• Sickness and Health Information for specialists

3. Statistical Methods

• Statistical methods for practitioners

• Summarising binary data
• Summarising quantitative data
• Standard error and confidence intervals 
• Significance testing and type I and II errors
• Displaying data

• Statistical methods for specialists

• Diagnostic tests
• Linear regression and correlation
• Logistic regression
• Survival analysis

Video Courses

Finding and Appraising the Evidence

• Overall introduction to critical appraisal
• Finding the evidence
• Randomised controlled trials
• Systematic reviews
• Economic evaluations
• Making sense of results
•  

Learning from Stakeholders

• Introduction
• Chapter 1 - Stakeholder engagement
• Chapter 2 - Reasons for engaging stakeholders
• Chapter 3 - Identifying appropriate stakeholders
• Chapter 4 - Understanding engagement methods
• Chapter 5 - Using engagement methods
  • Part 1: Focus Groups
  • Part 2: Interviews
• Chapter 6 - Analysing the data
• Chapter 7 - Monitoring engagement
• Chapter 8 - Evaluating engagement
• Chapter 9 - Understanding the lessons learned

Obesity Care Pathway Support Package

• Introduction
• Initiation
• Stakeholder Engagement
• Development
• Implementation
• Evaluation

Programme Budgeting & Marginal Analysis

• Introduction
• Chapter 1 - Introduction to PBMA
• Chapter 2 - Endorsements & Evidence
• Chapter 3 - World Class Commissioning
• Chapter 4 - Marginal Analysis in Action
• Chapter 5 - Mental Health Example
• Chapter 6 - Diabetes Test Example
• Chapter 7 - The Challenge
• Chapter 8 - Programme Budgeting Spreadsheet
• Chapter 9 - Programme Budgeting Atlas
• Chapter 10 - NHS Comparators Website
• Chapter 11 - The Challenge

Screening

• Introduction
• Chapter 1 - What screening is and is not
• Chapter 2 - What screening does
• Chapter 3 - The screening programme
• Chapter 4 - Measuring what screening does
• Chapter 5 - Measures of test performance
• Chapter 6 - Handling media interviews
• Chapter 7 - Commissioning quality screening
• Chapter 8 - Screening prior to evidence
• Chapter 9 - Interview with Sir Muir Gray
•  

Sustainable Healthcare

• Introduction
• Chapter 1 - What is Climate Change?
• Chapter 2 - Greening the Health Service
• Chapter 3 - Changing the Energy of the NHS
• Chapter 4 - Distributed Health and Service and How to Reduce Travel
• Chapter 5 - The End of Waste
• Chapter 6 - Sustainable Clinical Practice
• Chapter 7 - Public Health Advocacy
• Chapter 8 - Turning Theory into Action
• Chapter 9 - Theory into Action

Training

Change Management

Collaborative Working for Health

Getting the Message Across

Health Everyone’s Business

Health Service Planning

Knowledge Management

Leadership and Management

Policy and Strategy Development

Prioritisation and Performance Management

Programme and Project Management

Supporting the Analyst

Teaching Public Health for Action