INTRODUCTION TO PUBLIC HEALTH
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Transcript INTRODUCTION TO PUBLIC HEALTH
Walter Eisenhauer
DO YOU FEEL SAFE??
DO YOU FEEL SAFE?
JOPLIN, MISSOURI 2011
JAPAN, 2011
Oklahoma City 2013
INTRODUCTION TO
PUBLIC HEALTH
OBJECTIVES
DEFINE HEALTH
IDENTIFY AT LEAST FIVE DETERMINANTS OF
HEALTH
ARTICULATE DIFFERENT DEFINITIONS OF
PUBLIC HEALTH
DESCRIBE PUBLIC HEALTH AS A SYSTEM WITH
IMPUTS, PROCESSES, OUTPUTS AND RESULTS
IDENTIFY THE CORE FUNCTIONS AND
ESSENTIAL PUBLIC HEALTH SERVICES
HEALTH - DEFINED
World Health Organization 1946
“Health is a state of complete physical, mental and
social well being and not merely, the absence of
disease or infirmity.”
Honored in repetition, rarely in application
HEALTH-DEFINED
INTERNATIONAL EPIDEMIOLOGICAL ASSOC.
“Health is a state characterized by:
anatomic, physiologic and psychological integrity,
ability to perform personally valued family, work and
community roles,
ability to deal with physical, biological, psychological and
social stressors,
a feeling of well-being,
freedom from the risk of disease and untimely death.
DETERMINANTS OF
HEALTH
PHYSICAL ENVIRONMENT
SOCIAL ENVIRONMENT
GENETIC INHERITANCE
HEALTH BEHAVIOR
HEATH CARE
Public HealthYou’ve come a long way baby
TOP 10 HITS OF THE LAST CENTURY
VACCINE PREVENTABLE DISEASES
PREVENTION AND CONTROL OF INFECTIOUS DISEASES
TOBACCO CONTROL
MATERNAL & INFANT HEALTH
MOTOR VEHICLE SAFETY
CARDIOVASCULAR DISEASE PREVENTION
OCCUPATIONAL SAFETY
CANCER PREVENTION
Water Fluoridation
IMPROVED PUBLIC HEALTH/EMERGENCY
PREPAREDNESS
PUBLIC HEALTH
UNSUNG HEROES
Does more for the good of the population than
“medicine” could ever dream of doing!!!!!
BIGGEST BANG FOR THE BUCK!!!
Food for thought:
Life expectancy 1900 ~ 45 yrs -2000 ~75 yrs
Only 5 years of these 30 yrs are due to improved medical
care!!
Better nutrition, housing, sanitation, occupational safety
PUBLIC HEALTHDEFINED
INSTITUTE OF MEDICINE (IOM) 1988
“ Public health’s mission is the fulfilling of society’s
interest in assuring conditions in which people
can be healthy.”
PUBLIC HEALTHDEFINED
VICKERS 1958
“ Public health is the successive re-definings
of the
unacceptable.”
PUBLIC HEALTHDEFINED
WINSLOW 1920
“ Public Health is the science and art of preventing disease,
prolonging life, and promoting health and efficiency through
organized community effort for the sanitation of the
environment, the control of communicable infections, the
education of the individual in personal hygiene, the
organization of medical and nursing services for the early
diagnosis and preventive treatment of disease, and for the
development of the social machinery to insure everyone a
standard of living adequate for the maintenance of health, so
organizing these benefits as to enable every citizen to realize his
birthright to health and longevity.”
Public Health
• Prevents epidemics and the spread of disease
• Protects against environmental hazards
• Prevents injuries
• Promotes and encourages healthy behaviors
• Responds to disasters and assists communities in recovery
• Assures the quality and accessibility of health services
Essential Public Health Services
• Monitor health status to identify community health problems
• Diagnose and investigate health problems and health hazards in the community
• Inform, educate, and empower people about health issues
• Mobilize community partnerships to identify and solve health problems
• Develop policies and plans that support individual and community health efforts
• Enforce laws and regulations that protect health and ensure safety
• Link people with needed personal health services and assure the provision of health
care when otherwise unavailable
• Assure a competent public health and personal health care work force
• Evaluate effectiveness, accessibility, and quality of personal and population-based
health services
• Research for new insights and innovative solutions to health problems
Source: Reprinted from Essential Public Health Services Working Group of the Core Public Health
Functions Steering Committee, 1994, U.S. Public Health Service.
PUBLIC HEALTH –
A WEIRD BUNCH
ABSTRACT CONCEPT
NOT WELL UNDERSTOOD
THUS OFTEN NEGLECTED
PUBLIC HEALTHUNIQUE FEATURES
BASED ON THE SOCIAL JUSTICE PHILOSPHY
INHERENTLY POLITICAL IN NATURE
DYNAMIC, EVER-CHANGING AGENDA
CLOSELY LINKED WITH GOVERNMENT
GROUNDED IN THE SCIENCES
PREVENTION IS THE PRIMARY STRATEGY
UNCOMMON CULTURE AND BOND
COMPARE TO MEDICAL CARE!!!
DIMENSIONS OF PH
INPUTS: CAPACITY
Resources and relationships necessary to carry out the core junctions and
essential services of public health
Human resources, IT, information/data, fiscal/physical resources
OUTPUTS/PRACTICES: PROCESS
Collective practices or processes necessary and sufficient for those core
functions to be carried out efficiently
Including key processes that
identify and address health problems/causative agents
Interventions intended to prevent death, disease, and disability and promote
quality of life.
RESULTS: OUTCOMES
Indicators of health status, risk reduction and quality-of-life enhancement
outcomes are the long-term objectives that define optimal, measurable future
level of health status:
Maximize acceptable levels of disease, injury or dysfunction;
Prevalence of risk factors
PUBLIC HEALTHTHE 3 CORE FEATURES
ASSESSMENT
POLICY DEVELOPMENT
ASSURANCE
ESSENTIAL PUBLIC HEALTH
SERVICES
ASSESSMENT
MONITOR HEALTH STATUS TO IDENTIFY
COMMUNITY HEALTH PROBLEMS
DIAGNOSE AND INVESTIGATE HEALTH
PROBLEMS AND HAZARDS IN THE COMMUNITY
ESSENTIAL PUBLIC HEALTH
SERVICES
POLICY DEVELOPMENT
INFORM, EDUCATE AND EMPOWER PEOPLE ABOUT
HEALTH ISSUES.
MOBLIZE COMMUNITY PARTNERSHIPS TO IDENTIFY
AND SOLVE HEALTH PROBLEMS.
DEVELOP POLICIES AND PLANS THAT SUPPORT
INDIVIDUAL AND COMMUNITY HEALTH EFFORTS.
ESSENTIAL PUBLIC HEATH
SERVICES
ASSURANCE
ENFORCE LAWS AND REGULATIONS THAT PROTECT HEALTH
AND ENSURE SAFETY
LINK PEOPLE TO NEEDED PERSONAL HEALTH SERVICES AND
ASSURE THE PROVISION OF HEALTH CARE WHEN OTHERWISE
UNAVAILABLE
ASSURE A COMPETENT PUBLIC HEALTH AND PERSONAL
HEALTHCARE WORKFORCE.
EVALUATE EFFECTIVENESS, ACCESSIBILITY, AND QUALITY OF
PERSONAL AND POPULATION-BASED HEALTH SERVICES
ESSENTIAL PUBLIC HEALTH
SERVICES
SERVING ALL FUNCTIONS
RESEARCH FOR NEW INSIGHTS AND
INNOVATIVE SOLUTIONS TO HEALTH
PROBLEMS
PUBLIC HEALTH –
MAJOR DOMAINS
ANALYTICAL
EPIDEMIOLOGY
STUDIES
DATA COLLECTION
ASSOCIATION/
CAUSATION
BIOSTATISTICS
BIOMEDICAL
INFECTIOUS
DISEASES
CHRONIC DISEASES
GENETIC DISEASES
PUBLIC HEALTHMAJOR DOMAINS
SOCIAL/
BEHAVIORAL
BEHAVIORAL HEALTH
SMOKING, DRUGS,
ALCOHOL
NUTRITION
HEALTH EDUCATION
INJURY PREVENTION
WORK PLACE SAFETY
MATERNAL/CHILD
HEALTH (PreConceptual Care)
ENVIRONMENTAL
CLEAN, CLEAN,CLEAN
CLEAN AIR
CLEAN WATER
CLEAN SOIL
SOLID AND
HAZARDOUS WASTE
SAFE FOOD/DRUGS
POPULATION
PUBLIC HEALTHMAJOR DOMAINS
MEDICAL CARE
ACCESS/EQUITY
COST
QUALITY
ETHICS
REGULATION
A BRAVE NEW
WORLD!
BIOTERROISM
NATURAL DISASTERS
PANDEMICS
BIOTECHNOLOGY
GENOMICS/GM
The Unknown!!!!!!
PREVENTION
CORNERSTONE OF
PUBLIC HEALTH
PRIMARY
SECONDARY
TERTIARY
HEALTHY PEOPLE
2020
Vision
A society in which all people live
long, healthy lives
http://www.healthypeople.gov/2020/about/defaul
t.aspx
HEALTHY PEOPLE
2020 MISSION
Healthy People 2020 strives to:
Identify nationwide health improvement priorities.
Increase public awareness and understanding of the
determinants of health, disease, and disability and
the opportunities for progress.
Provide measurable objectives and goals that are
applicable at the national, State, and local levels.
Engage multiple sectors to take actions to strengthen
policies and improve practices that are driven by the
best available evidence and knowledge.
Identify critical research, evaluation, and data
collection needs
HEALTHY PEOPLE
2020
science-based, 10Healthy People provides
year national objectives for improving the
health of all Americans. For 3 decades, Healthy
People has established benchmarks and
monitored progress over time in order to:
Encourage collaborations across communities
and sectors.
Empower individuals toward making
informed health decisions.
Measure the impact of prevention activities
http://www.healthypeople.gov/2020/about/
DefaultPressRelease.pdf
SOCIAL JUSTICE
FOUNDATION OF
PUBLIC HEALTH
HEALTH IMPACT PYRAMID
SOCIAL JUSTICE
FOOD FOR THOUGHT
IS HEALTH A RIGHT?
IS SOCIAL JUSTICE POSSIBLE IN A
DEMOCRACY?
INDIVIDUAL LIBERTIES vs. SOCIAL GOOD
WHO IS RESPONSIBLE FOR SOCIAL
JUSTICE?
IS THE JUDAO-CHRISTIAN MODEL
COMPATABLE WITH SOCIAL JUSTICE?
POTPOURRI OF
PUBLIC HEALTH
STUFF
5-STEP APPROACH TO PUBLIC HEALTH
PROBLEM SOLVING
1. DEFINE THE HEALTH PROBLEM
2. IDENTIFY RISK FACTORS ASSOCIATED WITH
THE PROBLEM
3. DEVELOP AND TEST COMMUNITY – LEVEL
INTERVENTIONS TO CONTROL OR PREVENT
THE CAUSE OF THE PROBLEM
4. IMPLEMENT INTERVENTIONS TO IMPROVE
THE HEALTH OF THE POPULATION
5. MONITOR THOSE INTERVENTIONS TO
ASSESS THEIR EFFECTIVENESS
ASSOCIATION vs
CAUSATION
GUIDELINES OF SIR A. BRADFORD HILL
1965
THE “ WEB OF CAUSATION” IS MORE LIKE A
BLACK WIDOW SPIDER NEST!!!!. (Freeman)
CONTROVERSIAL!!!- BUT THAT IS WHAT PUBLIC
HEALTH IS ALL ABOUT.
The “Guidelines”:
THE QUESTION IS: IS THERE ----
STRENGTH OF ASSOCIATION
CONSISTANCY
Does it all fit together
MODIFIBILITY BY EXPERIMENTMENTATION
Does it make logical sense based on current knowledge
COHERENCE
Dose response
PLAUSIBILITY
Strongest- Cause precedes disease
A BIOLOGICAL GRADIENT
Single exposuresingle disease
Weakest- Provides evidence but does not preclude causation
TEMPORALITY
Repetition seen in different environments
SPECIFICITY
Relative Risk (Bias- may be a problem)
Does modifying (elimination or reducing) cause prevention, reduction or change in disease
AN ANALOGY
Is there a similar model that has already shown “causation”
SCREENINGTHE HANDMAIDEN OF PUBLIC HEALTH
IS THE DISEASE:
PREVALENT
MODIFIBLE/TREATABLE/PREVENTABLE
A SIGNIFICANT PUBLIC HEALTH PROBLEM
HAVE A SIGNIFICANT LEAD TIME
IS THE TEST:
RELIABLE
VALID
SENSITIVE
SPECIFIC
COST EFFECTIVE (COST:BENEFIT)
SAFE
SOCIALLY ACCEPTABLE
ACCESSIBLE TO ALL NEEDING SCREENED
THE BROAD STREET WELL
John Snow
Physician
John Snow was an English physician and a leader in
the adoption of anaesthesia and medical hygiene. He
is considered to be one of the fathers of
epidemiology, because of his work in tracing the
source of a cholera outbreak in Soho, England, in
1854.