Transcript PowerPoint 簡報

Perspectives and Challenges of
Public Health in the United States
Dr. Ted Chen, Ph.D., M.P.H., M.A.
Director: Asia-Pacific Health Promotion & Development
Professor/Head: Health Education/Communication Program
Tulane School of Public Health & Tropical Medicine
Tulane University Medical Center
Mortality & Longevity per 100,000 Population
• 1900
• 1980
–
–
–
–
–
TB
185
Pneumonia/infu
184
Heart dis
153
Enteritis
115
CVA
106
– Nephro diseases
84
– Accidents
79
– Cancers
68
– Diphtheria
33
– Typhoid fever
27
– All causes
1622
• Infant mortality: 77
• Life expectancy at birth
• male: 46
• female: 48
• total: 47
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–
–
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Heart dis
343
Cancer
168
CVA
77
Accidents
48
Pneumonia
23
– Diabetes
15
– Cirrhosis
14
– Arteriosclerosis
13
– Suicide
13
– Homicide
11
– All causes
893
Infant mortality: 13
Life expectancy at birth
• male: 70
• female: 78
• total: 74
Health Status Change
1900 - 1980 in U.S.
• The changes: leading causes, infant mortality, life
expectancy, life style
• The causes: vaccination, sanitation, medical technology,
drug & nutrition
• The challenge: rising health care expenditure &
prevention/promotion needs
1990 National Health Objectives:
Second Revolution of Public Health
• Preventive Health Measures
• Health Protection
• Health Promotion
1990 National Health Objectives
• Preventive Health Measures
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– High blood pressure control
– Family planning
– Pregnancy and infant health
– Immunization
– Sexuality transmitted disease
Health Protection
– Toxic agent control
– Occupational safety and health
– Accident prevention and injury control
– Fluoridation and dental health
– Surveillance and control of infectious diseases
Health Promotion
– Smoking and health
– Misuse of alcohol and drugs
– Nutrition
– Physical fitness and exercise
– Control of stress and violent behavior
The decade achievement
• Over-achieved 1/3 of the objectives
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– under-achieved 1/3 of the objectives
– 1/3 of the objectives unmeasurable
American fashion jogging, aerobics and
exercise
Eat less meat and more health foods
Smoking rate is dropping
Increase in high blood pressure detection and
control
40% drop in heart disease mortality rate
Leading Causes of Death 1997
Relationship Between Household Income and Fair or
Poor Health Status
Source: U.S. Department of Commerce, Bureau of the Census. Current Population Survey. March 1997.
Life Expectancy by Country
Female
Male
Country
Country
Years of Life
of Life
Expectancy
Expectancy
Years
Japan
82.9
Japan
76.4
France
82.6
Sweden
76.2
Switzerland
81.9
Israel
75.3
Sweden
81.6
Canada
75.2
Spain
81.5
Switzerland
75.1
Canada
81.2
Greece
75.1
Australia
80.9
Australia
75.0
Italy
80.8
Norway
74.9
Norway
80.7
Netherlands
74.6
Italy
74.4
Netherlands
80.4
England and Wales
74.3
Greece
80.3
France
74.2
Finland
80.3
Spain
74.2
Austria
80.1
Germany
79.8
Austria
73.5
Belgium
79.8
Singapore
73.4
England and Wales
79.6
Germany
73.3
Israel
79.3
New Zealand
73.3
The economics of
health care costs
• The cost of medical services was 12%
GNP in 1990 as compared to about 5% in
1960.
• Injury alone costs the nation over $100
billion annually, cancers over $70 billion,
and cardiovascular diseases $135 billion.
Year 2000 National Health Objectives
Health Promotion
•Preventive Services
–Physical activity and fitness
–Maternal and infant health
–Nutrition
–Heart disease and stroke
–Tobacco
–Cancer
–Alcohol and other drugs
–Diabetes/Chronic disabling conditions
–family planning
–Immunization and infectious diseases
–Mental health and mental disorders
–Chronic preventive services
–Violent and abusive behaviors
–Educational and community-based programs
Health Protection
–Unintentional injuries
–Occupational safety and health
–Environmental health
–Food and drug safety
–Oral health
•Surveillance and Data Systems
•Age-Related Objectives
–Children
–Adolescents and Young Adults
–Adults
–Older Adults
A Comparison of The Year 1990 and The Year 2000 National Health Objectives
1990 Objectives
Preventive Health Measures
–High blood pressure control
–Family planning
–Pregnancy and infant health
–Immunization
–Sexuality transmitted disease
Health Protection
–Toxic agent control
–Occupational safety and health
–Accident prevention and injury control
–Fluoridation and dental health
–Surveillance and control of infectious diseases
Health Promotion
–Smoking and health
–Misuse of alcohol and drugs
–Nutrition
–Physical fitness and exercise
–Control of stress and violent behavior
2000 Objectives
Health Promotion
–Physical activity and fitness
–Nutrition
–Tobacco
–Alcohol and other drugs
–family planning
–Mental health and mental disorders
–Violent and abusive behaviors
–Educational and community-based programs
Health Protection
–Unintentional injuries
–Occupational safety and health
–Environmental health
–Food and drug safety
–Oral health
Preventive Services
–Maternal and infant health
–Heart disease and stroke
–Cancer
–Diabetes/Chronic disabling conditions
–Immunization and infectious diseases
–Chronic preventive services
Surveillance and Data Systems
Age-Related Objectives
–Children
–Adolescents and Young Adults
–Adults
–Older Adults
Year 2000 National Health
Objectives
• Health Promotion: A Top
Priority
• Surveillance and Data Systems
• Age-Related Objectives
• Number of Objectives
Increased
The Year 2000 profile of the American people
grew about 7% to nearly 250 million
grew older with a mean age of >36 yrs as compared
to 29 yrs in 1975
Whites shrank from 76 to 72% with Hispanics rose
from 8 to 11.3%, Blacks increased from 12.4 to 13.1%
18 million new jobs were created. Women presented
47% of total work force
American population increased by up to 6 million
through immigration
Healthy People 2000
The Challenge
Increase the span of healthy life
Reduce health disparities
Achieve access to preventive services
Healthy People 2010 is grounded in science, built through
public consensus, and designed to measure progress.
National health objectives 2010
Healthy People 2010 contains 467 objectives to improve health,
organized into 28 focus areas.
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Arthritis, Osteoporosis, and Chronic
Back Conditions
Access to Quality Health Services
Cancer
Chronic Kidney Disease
Diabetes
Disability and Secondary Conditions
Educational and Community Based
Programs
Environmental Health
Family Planning
Food Safety
Health Communication
Heart Disease and Stroke
HIV
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Immunization and Infectious
Diseases
Injury and Violence Prevention
Maternal, Infant, and Child Health
Medical Product Safety
Mental Health and Mental Disorders
Nutrition and Overweight
Occupational Safety and Health
Oral Health
Physical Activity and Fitness
Public Health Infrastructure
Respiratory Diseases
Sexually Transmitted Diseases
Substance Abuse
Tobacco Use
Vision and Hearing
The Goals of Healthy People
Increase quality and years of healthy life.
Life Expectancy, Quality of Life
Achieving a Longer and Healthier Life—the Healthy People
Perspective
Eliminate health disparities.
Gender, Race and Ethnicity, Income and Education, Disability,
Geographic Location, Sexual Orientation
Achieving Equity—The Healthy People Perspective
Healthy People in Healthy Communities
A Systematic Approach to Health Improvement
2002 Institute of Medicine Report
• The Future of the Public's Health in
the 21st Century
• Educating Public Health Professionals
for the 21st Century
Major Findings of the IOM Study
• Public Health law outdated
• Public health workers lack training
• Communities passive service recipients
• Health care fragmented and inefficient
• Health communication underutilized
• Worksite health needs strengthening
• Community based research overlooked
The Future of the Public's Health in
the 21st Century: Action Steps
1.
Adopting a population health approach that considers the multiple
determinants of health;
2.
Strengthening the governmental public health infrastructure, which forms
the backbone of the public health system;
3.
Building a new generation of intersectoral partnerships that also draw on
the perspectives and resources of diverse communities and actively engage
them in health action;
4.
Developing systems of accountability to assure the quality and availability
of public health services;
5.
Making evidence the foundation of decision making and the measure of
success; and
6.
Enhancing and facilitating communication within the public health system
(e.g., among all levels of the governmental public health infrastructure and
between public health professionals and community members).
21st Century Public Health
Challenges:
• Globalization
• Scientific and medical Advances
• Demographic transformations
Education in Schools of Public Health:
Eight New Content Areas
– Informatics
– Genomics
– Communication
– Cultural competency
– Community-based participatory research (CBPR)
– Global health
– Policy and law
– Ethics
Social Ecology Model
• A Planning/analytical model
• Build a big-picture vision
• Account for multi-layer interaction of
public health practices:
intra-personal – inter-personal –
organizational - community - societal
influences
An Ecological Model Based SARS Prevention and Control Program Analysis
Government is facing
SARS crisis
Policy Level
Community Level
Hospital Level
Suspected
Community SARS
Contamination
Suspected
Hospital SARS
Contamination
Family Level
Suspected SARS
Family
•National SARS control strategy & policy
•International collaboration & support
•National SARS control center
•SARS policy implementation & law enforcement
•Community quarantine strategy
•Source detection and isolation
•Health and welfare support
•Lay-Health Advisors training & organization
•Health communication & education
•Environmental control & clean up
•Hospital quarantine strategy
•Source Detection and isolation
•Patient treatment & education
•Health worker protection & support
•Health communication & education
• Hospital environmental clean up
•Home quarantine & surveillance
•Home health & welfare management
•Electronic & non-electronic educational support
•Diagnosis and treatment
Individual Level
Suspected
SARS
Patient
INITIAL CONDITION
•Quarantine
•Patient counseling
•Patient education
PROGRAM INTERVENTION
Government
prevent & control
SARS epidemic
effectively
Community cleared of
SARS
Hospital cleared
of SARS & open
for full
operation
•Support prevention policy
•Free of family infection
•Recover from infection
•Recover from bereavement
•No infection
•Not to infect others
•Cured without implication
•Cured with mild implication
•Avoid death
DESIRE OUTCOME
125 Years of APHA
• Represent 50,000 members from over 50 occupations of
public health
• Executive Office, Executive Board, Governing Council,
American Journal of Public Health, Nation’s Health,
<www. apha. org>
• Concerned with federal and state health funding,
pollution control, chronic and infectious diseases, smokefree society, and professional education in public health.
Major Sections in APHA
• Public Health Education and Health
•
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Promotion
Health Administration
Medical Care
Public Health Nursing
Epidemiology
Maternal and Child Health
International Health
APHA Sections & Special Interest Groups Sections (1/3)
Alcohol, Tobacco, and Other Drugs- Promotes public health policy approaches to prevention and treatment of
alcohol, tobacco and other drug problems at all levels.
Chiropractic Health Care- Serves as a vehicle for chiropractic participation in mainstream public health
activities and works to enhance chiropractic communications, education and credibility on public health matters.
Community Health Planning and Policy Development- Influences the design of health systems and
policies that are responsive to a changing society, by bringing together technical information and the expertise of
communities, health professionals, business, and government.
Environment- Works to focus attention on human health effects of environmental factors; helps to shape national
environmental health and protection policies.
Epidemiology- Promotes epidemiological activities; determines optimal immunization policies; analyzes utility of
various approaches to disease prevention.
Food and Nutrition- Contributes to long range planning in food, nutrition and health policy which affects the
nutritional well-being of the public.
Gerontological Health- Works to focus the health system on the need for long-term care, hospices, and treatment
for the elderly; educates public health professionals about gerontological issues.
Health Administration- Concentrates on improvement of health service administration, including cost-benefit
and operations research, program activities, finances,standards, and monitoring the organization of health services.
APHA Sections & Special Interest Groups Sections (2/3)
HIV/AIDS- Provides a professional base for members of diverse disciplines to combine talents and interests to
help in the struggle with the HIV-AIDS pandemic; provides leadership to members on HIV-AIDS issues and needs.
Injury Control and Emergency Health Services- Serves as a forum for professionals committed to the
control of injuries and the delivery of emergency health care; addresses both intentional and unintentional injuries
for all age groups and encompasses research, education, training, and practice.
International Health- Acts as a focal point for APHA international health activities; encourages consideration
of international issues in APHA activities.
Maternal and Child Health- Contributes to policy development in adolescent health, child advocacy, injury
prevention, family violence, and perinatal care; keeps members current on related issues.
Medical Care- Encourages research, analysis, and policy development on organization, financing, and delivery
of medical care; strives for an affordable, accessible system of high quality.
Mental Health- Promotes public health policy and educational programs dedicated to enhancing the mental
health of all persons and to improving the quality of health care for the mentally ill.
Occupational Health and Safety- Strives to promote a healthy and safe working environment by organizing
around current issues; contributes to policy development regarding occupational health and safety.
Oral Health- Promotes the importance of oral health and increasing the public's access to oral health preventive
and treatment services; monitors and communicates the oral health needs of the public.
Podiatric Health-Advocates a national, preventive foot health strategy; ensures consideration of podiatric
concerns in the formation of public health policy.
APHA Sections & Special Interest Groups Sections (3/3)
Population, Family Planning & Reproductive Health- Addresses issues involving population, family
planning, and reproductive health; seeks to ensure that these issues and services remain major domestic and
international priorities.
Public Health Education and Health Promotion- Promotes the advancement of the health promotion and
education profession and provides a forum for public health educators and those involved in health promotion
activities to discuss ideas, research, and training; promotes activities related to training public health professionals.
Public Health Nursing- Advances this specialty through leadership in the development of public health
nursing practice and research; assures consideration of nursing concerns by providing mechanisms for
interdisciplinary nursing collaboration in public health policy and program endeavors.
School Health Education and Services- Focuses on development and improvement of health services,
health education programs, and environmental conditions in schools, colleges, and early childhood care settings;
advances public health in all school settings.
Social Work- Establishes standards for social work in health care settings; contributes to the development of
public health social work practice and research; promotes social work programs in the public health field.
Statistics-Develops and designs effective, uniform statistical programs and studies for recognition, analysis, and
solution of emerging health problems and needs.
Vision Care- Promotes recognition of the need for an effective, equitable, and affordable vision care system for
the public; advises on organization, delivery, and financing of vision care services.
APHA Caucuses
•Academic Public Health Caucus
•Peace Caucus
•American Indian, Alaska Native & Native
Hawaiian Caucus
•Caucus on Public Health and the Faith
Community
•Asian Pacific Islander Caucus
•Public Health Student Caucus
•Black Caucus of Health Workers
•Caucus on Refugee and Immigrant Health
•Community-Based Public Health Caucus
•Socialist Caucus
•Health Equity and Public Hospital Caucus
•Spirit of 1848 Caucus
•Caucus on Homelessness
•Vietnam Caucus
•Labor Caucus
•Women's Caucus
•Latino Caucus
•Staff Liaison
•Lesbian, Gay, Bisexual & Transgender Caucus
of Public Health Workers
Caucus of Asian American Health
Workers (Asian American Caucus)
• Founded 1976 in New Orleans APAH
Annual Meeting
• President, Executive Committee
• APHA Scientific Sessions
• Call for abstracts
• Speak for the cause of Asian American
health needs
A Review of the Needs
• System approach to health improvement
• Capacity/infrastructure building
• A social-ecological planning/evaluation strategy
• Meet the challenge of 21st century
Healthy People in Healthy Communities
A Systematic Approach to Health Improvement
Successful
community
partnerships
use a
systematic
approach to
health
improvement.
An Ecological Model Based SARS Prevention and Control Program Analysis
Government is facing
SARS crisis
Policy Level
Community Level
Hospital Level
Suspected
Community SARS
Contamination
Suspected
Hospital SARS
Contamination
Family Level
Suspected SARS
Family
•National SARS control strategy & policy
•International collaboration & support
•National SARS control center
•SARS policy implementation & law enforcement
•Community quarantine strategy
•Source detection and isolation
•Health and welfare support
•Lay-Health Advisors training & organization
•Health communication & education
•Environmental control & clean up
•Hospital quarantine strategy
•Source Detection and isolation
•Patient treatment & education
•Health worker protection & support
•Health communication & education
• Hospital environmental clean up
•Home quarantine & surveillance
•Home health & welfare management
•Electronic & non-electronic educational support
•Diagnosis and treatment
Individual Level
Suspected
SARS
Patient
INITIAL CONDITION
•Quarantine
•Patient counseling
•Patient education
PROGRAM INTERVENTION
Government
prevent & control
SARS epidemic
effectively
Community cleared of
SARS
Hospital cleared
of SARS & open
for full
operation
•Support prevention policy
•Free of family infection
•Recover from infection
•Recover from bereavement
•No infection
•Not to infect others
•Cured without implication
•Cured with mild implication
•Avoid death
DESIRE OUTCOME
21st Century Chinese Public Health
Challenges:
• Regionalization & Globalization
• Scientific and medical Advances
• Demographic transformations
• Cultural & ethical Adaptation
Meet the Emerging Chinese
Public Health Challenges
• Increase the quality & span of healthy life
• Reduce population health disparities
• Achieve access to preventive services
• Plan/evaluate with a social-ecological vision
• Build a new global Chinese health professional
partnership