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What Exactly is Public Health? Some Multiple Perspectives

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What Exactly is Public Health? Some Multiple Perspectives Gary D. Gilmore, MPH, Ph.D., CHES Ayaz M. Samadani, MD, DCH, DTM&H Julie Willems Van Dijk, RN, MSN, Ph.D. – PowerPoint PPT presentation

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Title: What Exactly is Public Health? Some Multiple Perspectives


1
What Exactly is Public Health? Some Multiple
Perspectives
Gary D. Gilmore, MPH, Ph.D., CHES Ayaz M.
Samadani, MD, DCH, DTMH Julie Willems Van Dijk,
RN, MSN, Ph.D. Bevan K. Baker, FACHE Thomas L.
Sieger August 8, 2008 Wisconsin Public Health
Council Wisconsin Medical Society Madison, WI
2
Multiple Perspectives about Public Health
Challenges, Opportunities, Success Stories
  • Overview Gary D. Gilmore, MPH, Ph.D., CHES
  • Professor and Director, Graduate Community
    Health Programs
  • University of Wisconsin at La Crosse
  • Vice Chair, Wisconsin Public Health Council
  • Physicians Perspective Ayaz Samadani, MD, DCH,
    DTMH
  • Family Practice Physician
  • Chair, Wisconsin Public Health Council
  • Rural/Smaller Municipality Perspective Julie
    Willems Van Dijk, RN, MSN, Ph.D.
  • Health Officer Marathon County
    Health Department
  • Chair, Ad Hoc Finance Committee
  • Urban Perspective Bevan Baker, FACHE
  • Commissioner of Health, City of Milwaukee
  • Chair, Emergency Preparedness Committee
  • Statewide Perspective Thomas L. Sieger
  • Deputy Administrator
  • Wisconsin Division of Public Health

3
Overview
Public Health
  • A shared responsibility for community
    well-being through ongoing assessment,
  • advocacy, and assurance.
  • The combination of science, practical
  • skills, and values (or beliefs) directed at
  • the maintenance and improvement of the
  • health of all people.
  • Sources J. Last. Public Health and Human
    Ecology. 1998.
  • C.G. Sheps. Higher
    Education for Public Health. 1976.

4
Determinants of Population Health
SOURCE The Future of the Publics Health (IOM
2003).
5
Vision Healthy People in Healthy
CommunitiesMission Promote Physical and Mental
Health Prevent Disease, Injury,
Disability
  • 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

6
  • 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 to needed personal health services
    and assure the provision of health care when
    otherwise unavailable
  • Assure a competent public health and personal
    health care workforce
  • Evaluate effectiveness, accessibility, and
    quality of personal and population-

Source Public Health Functions Steering
Committee. July, 1995.
7
Source Public Health Functions Steering
Committee. July, 1995.
8
Ten Core Practices of Public Health
Assessment
1. Assess the health needs of the community
2. Investigate the occurrence of health effects
health hazards of the community 3. Analyze
the determinants of identified health needs
Policy Development
4. Advocate for public health, build
constituencies identify resources in the
community 5. Set priorities among health
needs 6. Develop plans policies to address
priority health needs
Assurance
7. Manage resources develop organizational
structure 8. Implement programs 9. Evaluate
programs provide quality assurance 10. Inform
educate the public
Source Dyal, WW. American Journal of
Preventive Medicine. 199511 (6 suppl)6-8.
9
Public Healthin relation toHealth Services
  • A Critical Balance
  • What Exactly is Public Health?
  • Physicians Perspective

Ayaz M.Samadani M.D., DCH., DTMH Family Practice
Physician Chair, Wisconsin Public Health Council
10
Public Health Components
  • Epidemiology
  • Biostatistics
  • Health Services
  • Environmental
  • Social
  • Behavioral
  • Occupational Health

11
Relationship
  • Inter-related
  • Dependent on each other
  • Medical Services
  • Education
  • Research

12
Opportunities withinClinical Encounters
  • Symptoms
  • Examination
  • Diagnosis
  • Treatment
  • Outcomes End Results
  • Credible Information
  • Data Management
  • Stock for Policy Development
  • Communication

13
Opportunities
  • Policy Development
  • Protecting Health Safety of population
  • Training of Providers
  • Developing Network of partnerships
  • Outcomes
  • Maternal Care
  • Successes
  • Tobacco
  • Immunization

Policy
Development Improved Care
Well trained work force
Improved Education Satisfied Population
14
Partnership Collaboration
  • Providers
  • Doctors
  • RNS
  • NP
  • PA
  • MA
  • Chiropractors
  • Podiatrist
  • Nutritionist
  • Physiotherapist
  • Work Force Issue
  • Infectious Diseases
  • Preventive Care
  • Chronic Disease Management
  • Patient Education
  • Web services
  • Volunteer Groups
  • Obesity Pandemic

15
Challenges
  • Communication
  • Funding
  • Implementation
  • Education of Partners
  • Education of Providers
  • HMO/PPO
  • Education of Consumers
  • Private pay/uninsured
  • Society/Community responsibilities
  • Governmental bodies
  • Legislature
  • Philanthropists

16
Challenges
  • Disasters
  • Natural
  • Man-made
  • Outbreaks
  • War
  • Apathy
  • Increased demands/Limited Resources
  • Matching Funds for Federal Emergency Funding
  • Special Population Preparedness
  • Access to Mental Health

17
Success Story
  • Tobacco Control
  • Vaccination of Target Population
  • Voluntary National Accreditation Program
  • Decreased demands
  • Increased Cessation
  • Decrease in Second Hand Smoke Exposure
  • Advance Wisconsin as a Smoke Free State

18
Rural/Smaller Municipality Perspective
Julie Willems Van Dijk, RN, MSN, Ph.D. Health
Officer, Marathon County Health Department Chair,
Ad Hoc Finance Committee
19
Opportunity!!
To improve the health of Wisconsins people
20
The Three Ps
  • Prevention
  • Population
  • Partners

21
Social Ecological Model
  • Individual
  • Family/
  • Interpersonal
  • Institutional
  • Community
  • Policy

22
Challenges to Rural/Small City Public Health
  • Root Causes (Its bigger than behavior.)
  • Data (Small populations, Fewer Resources, Delayed
    Timing)
  • Workforce (Fewer People, Smaller Pool of
    Professional Preparation, Wage Scales not
    Competitive)
  • Financing (See Our Report 2 Tax Levy Caps
    Current Economy)

23
Successes
  • Community Health Improvement Processes (CHIP)
  • Public Health Preparedness
  • Immunization Rates (Marathon Co 63 to 90 in
    six years 1995-2001. Maintained at 90 for ten
    years)
  • Adult Smoking Rates (Marathon Co 35 in early
    1990s 15 in 2006)

24
Urban Public Health Perspective
  • Bevan K. Baker, FACHE
  • Commissioner of Health, City of Milwaukee
  • Chair, Emergency Preparedness Committee

25
Challenges
Budget -Decreasing tax levy -Increasing reliance
in categorical grants that dont support core
services
City of Milwaukee Health Department,2008 source
of revenue
Workforce -Need competencies that support
population health focus at the same time there is
an increasing need for more direct
service -Accreditation
26
ChallengeMaking the Upstream Shift to Address
Disparities
  • Income Social Status
  • Social Support Networks
  • Education and Literacy
  • Employment and Working Conditions
  • Physical Environments Social Environments
  • Personal Health Practices and Coping Skills
  • Health Child Development
  • Biology and Genetics
  • Health Services
  • Gender
  • Culture

Source Social Determinants of Health - Public
Health Agency of Canada http//www.phac-aspc.gc.c
a/ph-sp/determinants/index.htmldeterminants
27
Opportunities
  • Teen pregnancy epidemic hurts Milwaukee
    businesses
  • The Business Journal of Milwaukee - A single
    teen pregnancy costs the Milwaukee community
    nearly 80,000 a year, and those mothers and
    their children are less likely to finish school,
    depleting the city's potential work force,
    according to a study released Thursday.

28
SuccessMPS Immunization Rates
29
Key Strategies
  • Data reconciliation between WIR and MPS data
    system including working toward electronic data
    exchange
  • Increasing parental awareness of immunization
    requirements and the immunization status of their
    children
  • Increasing access to immunizations through school
    based immunization clinics
  • Develop coordinated media and social marketing
    campaign to improve immunization rates
  • Assuring compliance with state immunization
    statute

30
Back to School Marketing
  • Posters on new requirements
  • Auto-dialer messaging to parents
  • Back pack messaging to parents
  • Distribution of educational materials at health
    fairs
  • Radio commercials
  • Bus tails
  • MPS Open enrollment clinics
  • McDonald tray liners

31
Statewide Perspective
Thomas L. Sieger Deputy Administrator Wisconsin
Division of Public Health
32
What is Public Health?
  • A social enterprise that is focused on the
    population as a whole
  • Organized efforts of society to protect, promote,
    and restore people's health, to reduce the amount
    of disease, premature death, and disease-produced
    discomfort and disability in the population.

33
Public Health Successes
  • Planning
  • - HW 2010 (2020?)
  • Disease Surveillance
  • - WIR, WEDSS and PHIN
  • Disease Prevention and Health Promotion
  • - Tobacco use, Pb poisoning, Immunization
  • Preparedness
  • - Flooding, measles and E. coli in spinach
  • Public Health Regulation
  • - HFS 196, 172 and others

34
Major Public Health Challenges
  • Public Health Infrastructure
  • Public Health Financing
  • Workforce
  • Health of the Population
  • Burden of Chronic Disease
  • Health Disparities
  • Social and Economic Determinants of Health

35
Crisis Danger/Opportunity
Source "Burdened by healthcare costs. US
Businesses seek a shift." The Christian Science
Monitor. February 13, 2007
36
Opportunity Prevention
  • An investment of 10/person/year in evidence
    based prevention programs could yield an ROI of
    6.15/1 over a 5 year period in healthcare
    savings,
  • or in Wisconsin
  • Total annual investment 54,990,000
  • 5 Year Net Savings 337,900,000
  • Source Trust for Americas health. 2008.
    Prevention for a Healthier America.

37
We Can Do Better Improving the Health of the
American People
  • The united states spends more on health care than
    any other nation in the world, yet it ranks
    poorly on nearly every measure of health status.
  • How can this be? What explains this apparent
    paradox? The two-part answer is deceptively
    simple
  • first, the pathways to better health do not
    generally depend on better health care, and
  • second, even in those instances in which health
    care is important, too many Americans do not
    receive it, receive it too late, or receive
    poor-quality care.

Steven A. Schroeder, M.D. N Engl J Med
20073571221-8.
38
Having a System that Lowers Costs by Helping
People be Healthy
Public Health
  • PRICELESS

39
Advocacy Organizations
Business Labor
Media
Community-Based Health Organizations
Faith Community
Health Care Providers
Civic Organizations
Community Health Centers
Educators
Healthcare Consumers
State and Local Public Health Departments
Foundations
Professional Organizations
Managed Care
Hospitals Clinics
Healthcare Purchasers
Community Residents
Colleges, Universities Technical Schools
Law Enforcement
DATCP, DNR, DPI and other governmental agencies
State Local Elected Officials
40
  • Summary
  • Next Steps
  • Questions
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