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Medi ci ne

BERNAL • CRAYFORD
LEWIS • SHERINGHAM
Mastering Public Health SECOND EDITION
A Postgraduate Guide to Examinations and Revalidation

Mastering
“I am confident that this will rapidly become required reading for all those taking
the Faculty's exams, as well as for those undertaking training in public health in
many other countries.”
—Professor Martin McKee, CBE

Public

Mastering Public Health

Mastering Public Health: A Postgraduate Guide to Examinations and
Revalidation, Second Edition is an essential study aid for all those preparing
for postgraduate, master’s, and higher examinations in public health, and a
definitive guide for the MFPH Part A examination.
Features:

Health
• Comprehensive—Covers the five key areas of public health knowledge
• Structured—Closely follows the entire MFPH Part A examination syllabus
• Designed for success—Provides guidance on revision strategies, exam
techniques, and essay frameworks
• Concise—Delivers the key information you need at a glance with coloured
boxes, tables, diagrams, and succinct text

Now updated and revised for the second edition, Mastering Public Health
continues to provide all postgraduate students taking higher public health
examinations with a proven, successful core revision text.
A Postgraduate
Geraint Lewis FRCP FFPH, Chief Data Officer, NHS England Guide to Examinations
Jessica Sheringham PhD FFPH, Senior Research Associate,
University College London and Revalidation
Jamie Lopez Bernal MB BS MSc MFPH, Academic Clinical Fellow,
London School of Hygiene and Tropical Medicine

Tim Crayford MB BS MSc FFPH, Chief Medical Advisor, Just Retirement Ltd.
GERAINT LEWIS • JESSICA SHERINGHAM
JAMIE LOPEZ BERNAL • TIM CRAYFORD
K18777
SECOND EDITION

Mastering
Public
Health
K18777_Book.indb 2 9/22/2014 8:44:45 PM
SECOND EDITION

Mastering
Public
Health
A Postgraduate
Guide to Examinations
and Revalidation

GERAINT LEWIS • JESSICA SHERINGHAM

JAMIE LOPEZ BERNAL • TIM CRAYFORD

Boca Raton London New York

CRC Press is an imprint of the

Taylor & Francis Group, an informa business
CRC Press
Taylor & Francis Group
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Boca Raton, FL 33487-2742

© 2015 by Taylor & Francis Group, LLC

CRC Press is an imprint of Taylor & Francis Group, an Informa business

No claim to original U.S. Government works

Version Date: 20140422

International Standard Book Number-13: 978-1-4441-5270-8 (eBook - PDF)

This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to
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 Contents
Foreword xv
Preface xvii
Acknowledgements xix
List of Abbreviations xxi

Section 1 Research Methods 1

1A Epidemiology 3
1A.1 Health statistics 4
1A.2 Numerators, denominators, and populations at risk 8
1A.3 Time at risk 9
1A.4 Methods for summarising data 10
1A.5 Incidence, prevalence, and standardisation 12
1A.6 Years of life lost 16
1A.7 Measures of disease burden 16
1A.8 Variation 17
1A.9 Errors in epidemiological measurement 18
1A.10 Concepts and measures of risk 20
1A.11 Effect measures 21
1A.12 Association and causation 23
1A.13 Biases and confounding 24
1A.14 Effect modification 28
1A.15 Control of confounding 29
1A.16 Descriptive and ecological studies 31
1A.17 Analytical and intervention studies 32
1A.18 Small-area analysis 39
1A.19 Validity, reliability, and generalisability 40
1A.20 Intention-to-treat analysis 42
1A.21 Clustered data 43
1A.22 Numbers needed to treat 44
1A.23 Time trend analysis, time-series designs 45
1A.24 Methods of sampling from a population 48
1A.25 Methods of allocation in intervention studies 51
1A.26 Surveys 53

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 vi Contents

1A.27 Studies of disease prognosis 55

1A.28 Epidemiological research ethics 55
1A.29 Life-table analysis 58
1A.30 Epidemic theory and analysis of infectious disease data 60
1A.31 Combining studies 64
1A.32 Electronic bibliographical databases 67
1A.33 Grey literature 68
1A.34 Publication bias 69
1A.35 Evidence-based medicine and policy 69
1A.36 Hierarchy of research evidence 70
1A.37 Cochrane collaboration 73
1A.38 Genetic epidemiology 73
1B Statistics 77
1B.1 Elementary probability theory 79
1B.2 Methods for the quantification of uncertainty 81
1B.3 Estimation of confidence intervals 82
1B.4 Independence of events 84
1B.5 Conditional probability 85
1B.6 Standard statistical distributions 87
1B.7 Sampling distributions 89
1B.8 Principles of making inferences from a sample to a population 90
1B.9 Measures of location and dispersion and their appropriate uses 90
1B.10 Graphical methods in statistics 93
1B.11 Hypothesis testing 97
1B.12 Type 1 and Type 2 errors 98
1B.13 Problems of multiple comparisons 99
1B.14 Tests for comparing two or more groups 100
1B.15 Sample size and statistical power 107
1B.16 Regression and correlation 108
1B.17 Regression techniques 109
1B.18 Comparison of survival rates 110
1B.19 Heterogeneity 113
1B.20 Funnel plots 114
1B.21 Role of Bayes’ theorem 116
1C Assessment and Evaluation 119
1C.1 Need for health services 120
1C.2 Participatory needs assessment 122
1C.3 Service utilisation and performance 123

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 Contents vii

1C.4 Measures of supply and demand 125

1C.5 Study design to assess health services 125
1C.6 Structure, process, and outcomes 127
1C.7 Measuring health 129
1C.8 Population health outcome indicators 134
1C.9 Deprivation measures 135
1C.10 Evaluation 138
1C.11 Equity in healthcare 140
1C.12 Clinical audit 142
1C.13 Confidential inquiry processes 144
1C.14 Delphi methods 145
1C.15 Economic evaluation 146
1C.16 Epidemiological basis for preventive strategies 146
1C.17 Health and environmental impact assessments 149
1D Principles of Qualitative Methods 151
1D.1 Overview of methods of data collection 151
1D.2 Contribution of qualitative methods to public health research and
policy 153
1D.3 Appropriate use, analysis, and presentation of qualitative data 154
1D.4 Ethical issues 156
1D.5 Common errors and their avoidance 158
1D.6 Strengths and weaknesses of qualitative research 160
References 161

Section 2 Disease Causation and the Diagnostic Process

in Relation to Public Health 165
2A Epidemiological Paradigms 167
2A.1 Programming, life-course, and adult risk factor approaches 167
2B Epidemiology of Specific Diseases 169
2B.1 ‘Important’ diseases 169
2C Diagnosis and Screening 185
2C.1 Screening for diseases 185
2C.2 Statistical aspects of screening 189
2C.3 Differences between screening and diagnostic tests and case finding 192
2C.4 Likelihood ratios 195
2C.5 Pre- and post-test probability 196
2C.6 Ethical, economic, legal, and social aspects of screening 198

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 viii Contents

2C.7 Informed choice 200

2C.8 Planning, operation, and evaluation of screening programmes 201
2C.9 Developing screening policies 204
2C.10 Ethical, social, and legal implications of genetic screening tests 206
2D Genetics 207
2D.1 Elementary human genetics 207
2D.2 Inherited diseases 210
2D.3 Basic genomic concepts 211
2D.4 Disease in relatives 216
2D.5 Molecular biology 217
2E Health and Social Behaviour 221
2E.1 Nutrition 221
2E.2 Malnutrition 224
2E.3 Nutritional status 225
2E.4 Choice of diet 227
2E.5 Dietary recommendations 229
2E.6 Lifestyle 233
2E.7 Complex interventions 236
2F Environment 239
2F.1 Environmental determinants of disease 239
2F.2 Risk and hazard 240
2F.3 Climate change 243
2F.4 Principles of sustainability 246
2F.5 Housing and water 247
2F.6 Monitoring and control of environmental hazards 252
2F.7 Use of legislation in environmental control 256
2F.8 Health and safety at work 258
2F.9 Occupation and health 260
2F.10 Health impact assessment for environmental pollution 261
2F.11 Transport policies 261
2G Communicable Diseases 265
2G.1 States in the development of infectious diseases 265
2G.2 Surveillance 268
2G.3 Methods of control 271
2G.4 Design, evaluation, and management of immunisation programmes 272
2G.5 Choices in developing an immunisation strategy 275

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 Contents ix

2G.6 Outbreak investigations 276

2G.7 Emergency preparedness and response to natural and man-made
disasters 278
2G.8 Important infectious diseases 280
2G.9 Organisation of infection control 314
2G.10 Microbiological techniques 316
2G.11 International aspects of communicable disease control 318
2H Principles and Practice of Health Promotion 321
2H.1 Responsibility for health 321
2H.2 Determinants of health 323
2H.3 Policy dilemmas 328
2H.4 Prevention paradox 331
2H.5 Health education 332
2H.6 Settings for health promotion 333
2H.7 Models of health promotion 336
2H.8 Risk behaviour 341
2H.9 Communication in health education 342
2H.10 Legislation and health promotion 344
2H.11 Programmes of health promotion 347
2H.12 Community development methods 349
2H.13 Partnerships 351
2H.14 Evaluation 354
2H.15 International initiatives 354
2H.16 International health promotion initiatives 356
2I Disease Prevention and Models of Behaviour Change 359
2I.1 Prevention in the early years 359
2I.2 Pre-determinants of health 364
2I.3 Individual behaviour change 366
2I.4 Role of social marketing 366
2I.5 Involving the public 368
2I.6 Deprivation and its effect on health 370
2I.7 Community development 371
2I.8 Health impact assessment 371
2I.9 Strategic partnerships 372
2I.10 Setting targets 373
References 374

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 x Contents

Section 3 Health Information 381

3A Populations 383
3A.1 Conduct of censuses 383
3A.2 Collection of routine and ad hoc data 386
3A.3 Demography 387
3A.4 Major demographic differences 388
3A.5 Methods of population estimation and projection 392
3A.6 Life tables 393
3A.7 Population projections 394
3A.8 Effects on population structure of fertility, mortality, and migration 395
3A.9 Historical changes in population size and structure and factors
underlying them 397
3A.10 Effects of demographic change on healthcare 398
3A.11 Policies to address population growth nationally and internationally 399
3B Sickness and Health 401
3B.1 Routine mortality and morbidity data 401
3B.2 Biases and artefacts in population data 407
3B.3 International classification of diseases 408
3B.4 Measurements of health status 410
3B.5 Routine notification and registration systems 411
3B.6 Prescribing data and pharmacovigilance 412
3B.7 Data linkage 416
3C Applications of Health Services Information 419
3C.1 Use of information for health service planning and evaluation 419
3C.2 Specification and uses of information systems 422
3C.3 Common measures of health service provision and usage 423
3C.4 Mathematical modelling in health service planning 424
3C.5 Indices of needs for and outcome of services 426
3C.6 Issues with routine health information 428
3C.7 Information technology and healthcare provision 430
3C.8 Principles of information governance 431
References 433

Section 4 Medical Sociology, Social Policy, and Health Economics 435

4A Health and Illness 437
4A.1 Human behaviour 437
4A.2 Illness as a social role 440
4A.3 Concepts of health and well-being 442

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 Contents xi

4A.4 Concepts of primary and secondary deviance 443

4A.5 Stigma and how to tackle it 444
4A.6 Impairment, disability, and handicap 447
4A.7 Social and structural iatrogenesis 448
4A.8 Role of medicine in society 449
4A.9 Social patterns of illness 450
4A.10 Social factors in the aetiology of disease 452
4A.11 Social capital and social epidemiology 453
4B Healthcare 455
4B.1 Different approaches to healthcare 455
4B.2 Hospitals as social institutions 459
4B.3 Professions 460
4B.4 Clinical autonomy 461
4B.5 Illness behaviour 462
4B.6 Psychology of decision-making in health behaviour 463
4C Equality, Equity, and Policy 465
4C.1 Need and social justice 465
4C.2 Priorities and rationing 469
4C.3 Balancing equity and efficiency 471
4C.4 Consumerism and community participation 472
4C.5 Prioritisation frameworks and equity of service provision 474
4C.6 Public access to information 476
4C.7 User and carer involvement 477
4C.8 Power, interests, and ideology 478
4C.9 Inequalities in health and access to healthcare 479
4C.10 Health and social effects of migration 482
4C.11 Health effects of international trade 485
4C.12 Global influences on health and social policy 486
4C.13 Critical analysis of investment in health programmes in general and
in global initiatives 487
4D Health Economics 489
4D.1 Health economics 489
4D.2 Assessing performance 501
4D.3 Financial resource allocation 502
4D.4 Healthcare systems and incentives 505
4D.5 Economic appraisal 508
4D.6 Marginal analysis 520
4D.7 Decision analysis 520
4D.8 Economic evaluation and priority setting 522
References 523

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 xii Contents

Section 5 Organisation and Management of Healthcare

and Healthcare Programmes 527
5A Understanding Individuals, Teams/Groups, and Their Development 529
5A.1 Individuals, groups, and team dynamics 529
5A.2 Creativity and innovation 532
5A.3 Inter-professional learning 533
5A.4 Personal management skills 535
5A.5 Effective manager 537
5A.6 Principles of leadership and delegation 538
5A.7 Effective communication 539
5A.8 Principles of negotiation and influencing 540
5A.9 Power and authority 542
5A.10 Changing behaviour 543
Further readings 545
5B Understanding Organisations, Their Function, and Structure 547
5B.1 Organisational environments 547
5B.2 Evaluating internal resources and organisational capabilities 548
5B.3 Stakeholder interests 550
5B.4 Inter-organisational relationships 551
5B.5 Social networks and communities of interest 552
5B.6 External influences on organisations 553
Further readings 554
5C Management and Change 555
5C.1 Management models and theories 555
5C.2 Frameworks and tools for managing change 559
5C.3 Performance management 562
Further reading 564
5D Policy and Strategy Development and Implementation 565
5D.1 Differences between policy and strategy and the impact of policies
on health 565
5D.2 Principles underpinning the development of policy options and the
strategy for their delivery 566
5D.3 Stakeholder engagement in policy development including its
facilitation and consideration of possible obstacles 568
5D.4 Implementation and evaluation of policies including the relevant
concepts of power, interests, and ideology 569
5D.5 Problems of policy implementation 570
5D.6 Developing healthcare strategy 571

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 Contents xiii

5D.7 Theories of strategic planning 572

5D.8 Analysis, in a theoretical context, of the effects of policies on health 573
5D.9 Major national and global policies relevant to public health 575
5D.10 Health service development and planning 576
5D.11 Health service funding 577
5E Health and Social Service Quality 585
5E.1 Principles underlying the development of clinical guidelines, clinical
effectiveness and quality standards, and their application in health
and social care 586
5E.2 Public and patient involvement in health service planning 588
5E.3 Professional accountability, clinical governance, performance, and
appraisal 588
5E.4 Risk management and patient safety 591
5F Finance, Management Accounting, and Relevant Theoretical Approaches 593
5F.1 Cost of health services 593
5F.2 Paying for services 596
5F.3 Methods for audit of healthcare spending 601
References 601

Section 6 Skills Tested in the Part A MFPH Examination 605

6A Research Design and Critical Appraisal 607

6A.1 Skills in the design of research studies 607
6A.2 Critical appraisal 608
6A.3 Drawing conclusions from research 616
6B Drawing Conclusions from Data 617
6B.1 Drawing conclusions from data 617
6C Written Presentation Skills 627
6C.1 Written presentation skills 627
6C.2 Preparation of papers for publication 629
6C.3 Presenting to different audiences 631
References 639

Appendix A: Revision Tips 641

Appendix B: Core Statistical Techniques 649
Appendix C: Answer Frameworks 655
Appendix D: Last-Minute Revision 671
Index 683

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K18777_Book.indb 14 9/22/2014 8:44:46 PM
 Foreword
The work of public health professionals in the but also economics, sociology, demography, clin-
United Kingdom has changed enormously since ical sciences, and political science, among others.
the first edition of this book was published. The four They must also have a wide array of personal and
nations have increasingly gone their separate ways. organisational skills needed to turn their ideas
In England, where the magnitude of change has into reality. They will find all this and more in
been greatest, the public health function has been this book.
fragmented, with the creation of a new executive The primary purpose of this book is to prepare
agency and the transfer of some functions to local candidates for the examinations of the UK Faculty
government, but there is a considerable uncertainty of Public Health, something it does admirably,
about the role of those who have previously applied with the new edition incorporating advances in
their public health expertise to the delivery of effec- knowledge as well as changes to the faculty’s
tive and equitable healthcare. The remaining three curriculum. There are, of course, many books
nations have opted for more integrated models but, that cover different parts of the curriculum, but
in every part of the United Kingdom, neither those this has the great advantage of bringing it all
working in public health nor the populations they together in a single volume in which the candi-
serve are spared the effects of the government’s date can find the key elements of knowledge that
continuing failure to restore economic growth and he or she will need to pass the exams. But it is
its choice of austerity as a response to the 2008 much more than this and, in a rapidly changing
economic crisis. Although these are difficult times world demanding life-long learning, many expe-
for public health, the need for a well-functioning rienced practitioners will also find much that is
public health system has rarely been greater. of value here.
The second edition of this book, updated con- The authors of this book are to be congratulated
siderably, once again reminds us of the broad once again for the way in which they have met the
scope of public health. The determinants of need of the next generation of public health profes-
health stretch from the molecular to the societal. sionals (and their trainers), assembling an excel-
Similarly, the modern public health professional lent overview of the essential knowledge required
must be able to stretch from new insights into by public health practitioners in a clear and highly
genetics to the health effects of macroeconomic readable manner. Although designed primarily for
policy. It is not that they should be experts in all the exams of the UK Faculty, I am confident that it
of these areas; no one could hope to be. Rather, will also be of value to those in training in many
they will be aware of the scale of the canvas on other countries.
which they are working, know where to get the
information they need, and above all, have the Professor Martin McKee CBE MD DSc MSc
skills to appraise it critically, asking not only FRCP FFPH FMedSci
whether something will work but whether it will Professor of European Public Health
work in the particular circumstances that they
face. To do so, they must draw on a wide range London School of Hygiene and Tropical
of disciplines, including epidemiology, of course, Medicine

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K18777_Book.indb 16 9/22/2014 8:44:46 PM
 Preface
Six years have passed since we published the have introduced signposts in this second edition
first edition of Mastering Public Health, so it was that are designed to cross-refer the reader to other
high time that we refreshed and updated the text. relevant material within the book and to navigate
We were given added impetus to produce a sec- a more logical route through certain topics, such as
ond edition by the whole-scale reorganisation in health economics and statistics.
England of public health and the National Health As in the first edition, we are incredibly grateful
Service, by the changes that have occurred to the to our panel of expert contributors, to our interna-
syllabus of the Part A examination for Membership tional editors, and to our publishers. We would also
of the Faculty of Public Health (MFPH), but most like to thank our former co-author, Kanwal Kalim,
importantly, by the feedback we received from for her contributions to the first edition. We were
readers suggesting how we might improve the sad that due to work and family commitments, she
book. In this second edition, we have therefore was unable to work with us on this second edition.
attempted to build on what we are told are its key In her place, however, we welcome Jamie Lopez
strengths while attempting to address the short- Bernal as a new co-author and thank him for his
comings of the first edition and bringing it fully industry, his bright ideas, and his enthusiasm for
up to date. As a consequence, some sections of the the book and what it is trying to achieve. Finally,
book have changed relatively little compared to the we would like to thank you, our readers, for the
first edition, such as those on statistics and epide- invaluable feedback you have provided. Please
miology. Others, such as those about the organisa- keep it coming.
tion of healthcare, have undergone a more radical
Geraint Lewis FRCP FFPH
overhaul.
Chief Data Officer, NHS England
We believe that Mastering Public Health will be
useful to anyone studying public health at a Jessica Sheringham PhD FFPH
postgraduate level. However, we learnt from the Senior Research Associate, University College
feedback on the first edition that many readers London
appreciated how we organised the book strictly
according to the structure of the Part A MFPH syl- Jamie Lopez Bernal MB BS MSc MFPH
labus. Although it aids with revision, this dogged Academic Clinical Fellow, London School of Hygiene
approach has certain disadvantages in that it led to and Tropical Medicine
duplication in places, and elsewhere material was
presented in a less coherent order than we would Tim Crayford MB BS MSc FFPH
ideally have chosen. To address these problems, we Chief Medical Advisor, Just Retirement Ltd.

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K18777_Book.indb 18 9/22/2014 8:44:46 PM
 Acknowledgements
We would like to thank the following expert We would also like to thank the following interna-
reviewers for their help: tional contributors:
●● Dr Araceli Busby, locum consultant in pub- ●● Australia: Dr Wendy Scheil, public health phy-
lic health at Surrey, Sussex, and Kent, Public sician, SA Health
Health England ●● Hong Kong: Professor Sian M Griffiths, direc-
●● Helen Crabbe, environmental public health tor of the Centre for Global Health, Chinese
scientist, Centre for Radiation, Chemicals University of Hong Kong
and Environmental Hazards, Public Health ●● Ireland: Dr Emer Shelley, consultant in public
England health medicine, health service executive and
●● Sheila Holmes, radiological assessments senior lecturer in epidemiology, Royal College
scientist, Centre for Radiation, Chemicals of Surgeons in Ireland, Dublin
and Environmental Hazards, Public Health ●● Northern Ireland: Dr Dermot O’Reilly, senior
England clinical lecturer, Queen’s University Belfast
●● Alison Iliff, public health specialist, Rotherham ●● Scotland:
Local Authority
●● Dr Aileen Holliday, health effectiveness
●● Dr Nora Pashayan, senior clinical lecturer coordinator, NHS Forth Valley
in applied health research, Cancer Research
●● Dr Sue Payne, public health consultant,
UK Clinician Scientist Fellow, Department of
NHS Lothian
Applied Health Research, University College
London ●● Dr Anne Maree Wallace, director of public
health, NHS Forth Valley
●● Dr Simon Turner, senior research ­associate,
●● South Africa: Dr Stephen Knight, pub-
Department of Applied Health Research,
lic health medicine physician, University of
University College London
KwaZulu-Natal
●● Aris Tyrothoulakis, General manager,
Diagnostic Service, NHS Lothian ●● Wales: Dr Nigel Monaghan, consultant in pub-
lic health/dental public health, Public Health
●● Dr Laura Vallejo-Torres, principal research
Wales, and visiting professor in public health,
associate in health economics, Clinical Trials
University of Glamorgan
Unit, University College London
●● Isla Wallace, research associate, Department of
Applied Health Research, University College
London

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K18777_Book.indb 20 9/22/2014 8:44:46 PM
 List of Abbreviations
ADA Adenosine deaminase
ADL Activities of daily living
ADR Adverse drug reaction
ANOVA Analysis of variance
APHO Association of Public Health Observatories
AR Attributable risk
ARIA Accessibility/remoteness index of Australia
ARIMA Autoregressive integrated moving average
BAT Best available techniques
BBV Blood-borne virus
BMI Body mass index
BNF British National Formulary
BSE Bovine spongiform encephalopathy
CBA Cost–benefit analysis
CBT Cognitive behavioural therapy
CCA Cost–consequence analysis
CCDC Consultant in communicable disease control
CCG Clinical commissioning group
CEA Cost-effectiveness analysis
CFTR Cystic fibrosis transmembrane conductance regulator
CHD Coronary heart disease
CHP Consultant in health protection
CI Confidence interval
CIDR Computerised infectious disease reporting
CJD Creutzfeldt–Jakob disease
CMA Cost-minimisation analysis
CMV Cytomegalovirus
CO Carbon monoxide
COPD Chronic obstructive pulmonary disease
COSHH Control of substances hazardous to health
COVER Cover of vaccination evaluated rapidly
CPRD Clinical practice research database
CQC Care Quality Commission
CQRS Calculating Quality Reporting Services
CRHD Chronic rheumatic heart disease
CUA Cost–utility analysis
CVS Chorionic villous sampling
DAFNE Dose adjustment for normal eating
DALY Disability-adjusted life years
DCSF Department for Children, Schools and Families
DDD Defined daily doses
DEFRA Department for Environment, Food and Rural Affairs
DfID Department for International Development
DFPH Diplomate membership of the Faculty of Public Health
DHS Demographic and Health Surveys
DIPC Director of Infection Prevention and Control

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 xxii List of Abbreviations

DNA Deoxyribonucleic acid

DOT Directly observed treatment
DRG Diagnosis-related group
DRR Drug rehabilitation requirements
DRV Dietary reference value
DTP Diphtheria, tetanus, pertussis
DVLA Driver and Vehicle Licensing Authority
DWI Drinking Water Inspectorate
EA Environment agency
EAR Estimated average requirement
EARSNet European Antimicrobial Resistance Surveillance Network
EBM Evidence-based medicine
ECDC European Centre of Disease Control
EIA Environmental impact assessment
ELF Extremely low-frequency
EMF Electromagnetic field
EPPE Effective Provision of Pre-School Education
ERSPC European Randomized Study of Screening for Prostate Cancer
EU European Union
FAO Food and Agriculture Organization
FAP Familial adenomatous polyposis
FAQs Frequently asked questions
FRR Familial relative risk
FSA Food Standards Agency
FSAI Food Safety Authority of Ireland
FT Foundation Trust
GIS Geographic information system
GISRS Global Influenza Surveillance and Response System
GMS General Medical Services
GOARN Global Outbreak Alert and Response Network
GP General practitioner
GPES General Practitioner Extraction Service
GPHIN Global Public Health Intelligence Network
GRADE Grades of recommendation, assessment, development, and evaluation
GRE Glycopeptide-resistant enterococci
GSL General sales list
GUM Genitourinary medicine
GUMCAD Genitourinary medicine clinic activity database
HALE Health-adjusted life expectancy
HARS HIV/AIDS reporting system
HAV Hepatitis A virus
HBM Health belief model
HBV Hepatitis B virus
HCAI Healthcare-associated infection
HCV Hepatitis C virus
HDEC Health and Disability Ethics Committee
HDV Hepatitis D virus
HES Hospital episode statistics
HEV Hepatitis E virus
HIA Health impact assessment

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 List of Abbreviations xxiii

HNA Health needs assessment

HNIG Human normal immunoglobulin
HNPCC Hereditary non-polyposis colorectal cancer
HPA Health Protection Agency
HPCSA Health Professionals Council of South Africa
HPI Health poverty index
HPS Health Protection Scotland
HPSC Health Protection Surveillance Centre
HPV Human papillomavirus
HQIP Healthcare quality improvement partnership
HREC Human Research Ethics Committee
HRG Healthcare resource group
HRQoL Health-related quality of life
HSE Health service executive
HTML Hypertext markup language
HUS Haemolytic–uraemic syndrome
ICD International Classification of Diseases
ICER Incremental cost effectiveness ratio
ICHI International Classification of Health Interventions
ICIDH International Classification of Impairment, Disabilities, and Handicap
ICM Infection control manager
ICN Infection control nurse
ICSEA Community socio-educational advantage
ICT Infection control team
ICT Information and communications technology
IEC Institutional ethics committee
IHS Integrated Household Survey
IMC Integrated marketing communication
IMD Indices of multiple deprivation
INDEPTH International Network for the Demographic Evaluation of Populations and Their Health
IPA Interpretative phenomenological analysis
IQR Interquartile range
ISD Information services data
IUGR Intrauterine growth restriction
IVF In vitro fertilisation
JCVI Joint Committee on Vaccination and Immunisation
JSNA Joint strategic needs assessment
LBW Low birthweight
LRNI Lower reference nutrient intake
LSOA Lower-layer super output areas
MANOVA Multivariate analysis of variance
MBO Management by objectives
MBWA Management by wandering around
MCDA Multi-criteria decision analysis
MDR-TB Multidrug resistant tuberculosis
MeSH Medical Subject Headings
MFPH Membership of the Faculty of Public Health
MHRA Medicines and Healthcare Products Regulatory Authority
MINI Mental illness needs index
MPR Medication possession ratio

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 xxiv List of Abbreviations

MRSA Methicillin-resistant Staphylococcus aureus

MTB Mycobacterium tuberculosis
MUST Malnutrition universal screening tool
NATSAL National survey of sexual attitudes and lifestyles
NCEPOD National confidential enquiry into patient outcome and death
NG Nasogastric
NGO Non-governmental organisation
NHP Nottingham health profile
NHS National Health Service
NNT Numbers needed to treat
NPP Negative predictive power
NPV Negative predictive value
NRAC National Resource Allocation Committee
NRES National Research Ethics Service
NRI Nutritional risk index
NSC National Screening Committee
NSSEC National statistics socio-economic classification
OA Output area
OR Odds ratio
ORLS Oxford Record Linkage Study
PACS Picture and Archiving Communications Systems
PACT Prescribing analysis and cost
PAF Population attributable fraction
PAR Population attributable risk
PARR Patients at risk of re-hospitalisation
PBMA Programme budgeting and marginal analysis
PCR Polymerase chain reaction
PDC Proportion of days covered
PDP Personal development plan
PEM Protein–energy malnutrition
PH Public health
PID Pelvic inflammatory disease
PIL Patient information leaflet
PKU Phenylketonuria
PLCO Prostate, lung, colorectal, and ovarian cancer screening trial
PMD Prescribing Monitoring Documents
PPE Personal protective equipment
PPP Positive predictive power
PPV Positive predictive value
PRI Population reference intake
PROM Patient-reported outcome measure
PSA Public Service Agreement
PSU Prescribing Support Unit
PU Prescribing unit
PWS Private drinking water supplies
QALY Quality-adjusted life year
QMAS Quality management and analysis system

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 List of Abbreviations xxv

QOF Quality and outcomes framework

QoL Quality of life
RCT Randomised controlled trial
RDA Recommended dietary allowance
REC Research ethics committee
RIBA Recombinant immunoblot assay
RIDDOR Reporting of Injuries, Diseases and Dangerous Occurrences Regulations
RNA Ribonucleic acid
RNI Reference nutrient intake
ROC Receiver operating characteristic
ROP Retinopathy of prematurity
RRR Relative recurrence risk
SAQs Short answer questions
SARS Severe acute respiratory syndrome
SCID Severe combined immunodeficiency
SE Standard error
SEIFA Socio-economic indexes for areas
SEPA Scottish Environment Protection Agency
SIDS Sudden infant death syndrome
SIMD Scottish index of multiple deprivation
SMR Standardised mortality ratio
SOA Super output area
SOPHID Survey of Prevalent HIV Infections Diagnosed
SPC Summaries of product characteristics
STI Sexually transmitted infection
SUS Secondary Uses Service
TB Tuberculosis
THS Thematic household survey
TIA Transient ischaemic attack
TPFR Total period fertility rate
TRIPS Trade Related Aspects of Intellectual Property Rights
UN FCC United Nations Framework Convention on Climate Change
UNECE UN Economic Commission for Europe
USAID US Agency for International Development
UV Ultraviolet
VDU Visual display unit
VHF Viral haemorrhagic fever
VRE Vancomycin-resistant enterococci
WHO World Health Organization
WHS Welsh Health Survey
WNHSS Welsh Network of Healthy School Schemes
WTP Willingness-to-pay
XDR-TB Extreme drug-resistant tuberculosis
YLD Years lost due to disability
YLL Years of life lost

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K18777_Book.indb 26 9/22/2014 8:44:46 PM
 Section 1

Research Methods

Public health specialists need to understand how health knowledge is generated, not only so they can
select and use appropriate research methods for their own work, but also so that they can appraise the
quality of published research in order to provide credible professional advice.
Section 1 describes the epidemiological research methods that underpin public health. Epidemiology is
key to public health practice because it involves scrutinising data to generate inferences that can be used
as the basis of health policy. The validity of public health research therefore relies on the appropriate
use of statistics, from the design and collection of data through to the analysis and interpretation stages.
This section also covers qualitative research methods, which are essential for understanding why things
happen in the ways that they do. Section 1 ends with a description of healthcare assessment, which
draws on a range of research methods in order to evaluate the structure, function, and performance of
health systems and services.

K18777_Book.indb 1 9/22/2014 8:44:46 PM

K18777_Book.indb 2 9/22/2014 8:44:46 PM
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