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INTRODUCTION TO PUBLIC HEALTH

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Title: INTRODUCTION TO PUBLIC HEALTH Author: wae revisions2013 Description: Adapted from R Freemn's ppt 2011 with revisions and hyperlinks Last modified by – PowerPoint PPT presentation

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Title: INTRODUCTION TO PUBLIC HEALTH


1
INTRODUCTION TO PUBLIC HEALTH
  • Walter Eisenhauer

2
DO YOU FEEL SAFE??
3
DO YOU FEEL SAFE?
  • JOPLIN, MISSOURI 2011
  • JAPAN, 2011

4
Oklahoma City 2013
5
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

6
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

7
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.

8
DETERMINANTS OF HEALTH
  • PHYSICAL ENVIRONMENT
  • SOCIAL ENVIRONMENT
  • GENETIC INHERITANCE
  • HEALTH BEHAVIOR
  • HEATH CARE

9
Public Health-Youve 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

10
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

11
PUBLIC HEALTH-DEFINED
  • INSTITUTE OF MEDICINE (IOM) 1988
  • Public healths mission is the fulfilling of
    societys interest in assuring conditions in
    which people can be healthy.

12
PUBLIC HEALTH-DEFINED
  • VICKERS 1958
  • Public health is the successive re-definings
    of the unacceptable.

13
PUBLIC HEALTH-DEFINED
  • 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.

14
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 healt
h 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.
15
PUBLIC HEALTH A WEIRD BUNCH
  • ABSTRACT CONCEPT
  • NOT WELL UNDERSTOOD
  • THUS OFTEN NEGLECTED

16
PUBLIC HEALTH- UNIQUE 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!!!

17
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

18
PUBLIC HEALTH- THE 3 CORE FEATURES
  • ASSESSMENT
  • POLICY DEVELOPMENT
  • ASSURANCE

19
ESSENTIAL PUBLIC HEALTH SERVICES
  • ASSESSMENT
  • MONITOR HEALTH STATUS TO IDENTIFY COMMUNITY
    HEALTH PROBLEMS
  • DIAGNOSE AND INVESTIGATE HEALTH PROBLEMS AND
    HAZARDS IN THE COMMUNITY

20
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.

21
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

22
ESSENTIAL PUBLIC HEALTH SERVICES
  • SERVING ALL FUNCTIONS
  • RESEARCH FOR NEW INSIGHTS AND INNOVATIVE
    SOLUTIONS TO HEALTH PROBLEMS

23
PUBLIC HEALTH MAJOR DOMAINS
  • ANALYTICAL
  • BIOMEDICAL
  • INFECTIOUS DISEASES
  • CHRONIC DISEASES
  • GENETIC DISEASES
  • EPIDEMIOLOGY
  • STUDIES
  • DATA COLLECTION
  • ASSOCIATION/
  • CAUSATION
  • BIOSTATISTICS

24
PUBLIC HEALTH-MAJOR DOMAINS
  • SOCIAL/
  • BEHAVIORAL
  • ENVIRONMENTAL
  • CLEAN, CLEAN,CLEAN
  • CLEAN AIR
  • CLEAN WATER
  • CLEAN SOIL
  • SOLID AND HAZARDOUS WASTE
  • SAFE FOOD/DRUGS
  • POPULATION
  • BEHAVIORAL HEALTH
  • SMOKING, DRUGS, ALCOHOL
  • NUTRITION
  • HEALTH EDUCATION
  • INJURY PREVENTION
  • WORK PLACE SAFETY
  • MATERNAL/CHILD HEALTH (Pre-Conceptual Care)

25
PUBLIC HEALTH-MAJOR DOMAINS
  • MEDICAL CARE
  • A BRAVE NEW WORLD!
  • BIOTERROISM
  • NATURAL DISASTERS
  • PANDEMICS
  • BIOTECHNOLOGY
  • GENOMICS/GM
  • The Unknown!!!!!!
  • ACCESS/EQUITY
  • COST
  • QUALITY
  • ETHICS
  • REGULATION

26
PREVENTION
  • CORNERSTONE OF PUBLIC HEALTH
  • PRIMARY
  • SECONDARY
  • TERTIARY

27
HEALTHY PEOPLE 2020
  • Vision
  • A society in which all people live long, healthy
    lives
  • http//www.healthypeople.gov/2020/about/default.as
    px

28
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29
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

30
HEALTHY PEOPLE 2020
  • Healthy People provides science-based, 10-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/DefaultPre
    ssRelease.pdf

31
SOCIAL JUSTICE
  • FOUNDATION OF PUBLIC HEALTH

32
HEALTH IMPACT PYRAMID
33
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?

34
  • POTPOURRI OF PUBLIC HEALTH STUFF

35
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

36
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37
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38
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.

39
The GuidelinesTHE QUESTION IS IS THERE ------
  • STRENGTH OF ASSOCIATION
  • Relative Risk (Bias- may be a problem)
  • CONSISTANCY
  • Repetition seen in different environments
  • SPECIFICITY
  • Single exposure?single disease
  • Weakest- Provides evidence but does not preclude
    causation
  • TEMPORALITY
  • Strongest- Cause precedes disease
  • A BIOLOGICAL GRADIENT
  • Dose response
  • PLAUSIBILITY
  • Does it make logical sense based on current
    knowledge
  • COHERENCE
  • Does it all fit together
  • MODIFIBILITY BY EXPERIMENTMENTATION
  • Does modifying (elimination or reducing) cause ?
    prevention, reduction or change in disease
  • AN ANALOGY
  • Is there a similar model that has already shown
    causation

40
SCREENING-THE 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 (COSTBENEFIT)
  • SAFE
  • SOCIALLY ACCEPTABLE
  • ACCESSIBLE TO ALL NEEDING SCREENED

41
THE BROAD STREET WELL
42
  • 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.
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