public health 101

8/13/2019 Public Health 101

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What Is Public Health? 1 YORK DISTRICT PUBLIC HEALTH COUNCILQUARTERLY MEETING

January 21, 2009

Marc D. Hiller, DrPHCollege of Health and Human Services, University of New Hampshire

1 Sources: Bernard J. Turnock. 2009. Public Health What It Is and How It Works, FourthEdition. (chapter 1, pp. 1- 28, What is Public Health?) and Institute of Medicine, National

Academy of Sciences. 1988. The Future of Public Health . (Summary andRecommendations).


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Public Perceptions of Public Health (or, What the Person in the Street Thinks Public Health Is?)

General ignorance (no clue); I dont know, I never thought about it. Abstract; hard to pin down or define Surrounded by uncertainty and confusion (well.ummmm, Im notsure)

Vague/obtuse understanding (oh, well, its the health of the public) Considered simply another branch of medicine


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When Does Public Health Come to the Forefront?

Seldom, when it is working or doing what is supposed to; typically, itis simply assumed; going unnoticed or appearing to be invisiblemost of the time... EXCEPTWhen its absence is recognized when there is a problem

When a crisis is at handWhen the system seems to fail


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Health Care (Medicine) and Public Health

Health care is vital to all of us some of the time, but public health is vital to all of us all of the time.

Source: Former U.S. Surgeon General C. E VERETT K OOP , MD


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Public Health vs. Medicine

Public HealthPopulationDisease PreventionHealth PromotionInterventions

EnvironmentHuman behavior

Government (Some private)

MedicineIndividualDiagnosisTreatmentIntervention

Medical carePrivate (Some public)

Source: Brandt, AM and Gardner, M. 2000. American Journal Public Health. 90:707-715 .
http://images.google.com/imgres?imgurl=http://www.ci.berkeley.ca.us/publichealth/images/apha-logo-sm.gif&imgrefurl=http://www.ci.berkeley.ca.us/publichealth/overview/overview.html&h=148&w=150&sz=5&hl=en&start=4&tbnid=-qzCXxEvewlR1M:&tbnh=95&tbnw=96&prev=/images%3Fq%3DAPHA%2Blogo%26svnum%3D10%26hl%3Denhttp://images.google.com/imgres?imgurl=http://www.medgadget.com/archives/img/AMA-logo-old.bmp&imgrefurl=http://www.medgadget.com/archives/2005/06/the_staff_of_as.html&h=150&w=150&sz=67&hl=en&start=10&tbnid=w-UeT-Tt9svMjM:&tbnh=96&tbnw=96&prev=/images%3Fq%3DAMA%2Blogo%26svnum%3D10%26hl%3Den


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A Dictionarys Definition of Public Health

the science and practice of protecting and improving the health ofthe community , as by preventive medicine, health education, controlof communicable diseases, application of sanitary measures, andmonitoring of environmental hazards .

Source: The American Heritage Dictionary, Public Health Institute. P UBLIC H EALTH 101.


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CEA Winslows Definition of Public Health, 1920(short version)

the science and art of preventing disease, prolonging life and promoting health and efficiency through organized communityeffort.

Source: CEA Winslow, 1920.


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CEA Winslows Classic Definition of Public Health, 1920( expanded version)

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 diagnosisand preventive treatment of disease, and forthe development of the social machinery to ensure everyone a standardof living adequate for the maintenance of health,

so organizing these benefits as to enable every citizen to realize hisbirthright of health and longevity.


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John Lasts Definition of Public Health, 1980

efforts organized by society to protect, promote, and restore the peoples health combination of sciences, skills, and beliefs directed to maintenance and improvement of health of all peoplethrough collective or social actions emphasis on prevention ofdisease activities change with changing technology & socialvalues, but goals remain the same .

Source: John Last, 1980


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Public health is what we, as a society, do collectively toassure the conditions in which people can be healthy.

Source: Institute of Medicine Report (IOM).T HE F UTURE OF P UBLIC H EALTH . Washington DC:National Academy Press. 1988.

Public Health Defined, 1988


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Characteristics of Public Health

A broad social enterprise or system. A body of knowledge and techniques that can be applied to health -related problems . Public health is literally the health of the public as measured interms of health and illness .

Social justice is said to be the cornerstone of public health .

Source: Turnock B. P UBLIC H EALTH W HAT I T I S AND H OW I T W ORKS , F OURTH E DITION . 2009.Sudbury MA: Jones and Bartlett Publishers.


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Images of Public Health

The System and Social Enterprise (Including the Nations Public

Health Infrastructure)The Profession (Professionals and the Workforce)The Methods (Knowledge and Techniques Applied to Health-relatedProblems)Governmental Services (Especially Medical Care for the Poor)The Health of the Public (the Intended Results of Public HealthEndeavors, as Measured by the Levels of Health and Illness in thePopulation)

Source: Turnock B. P UBLIC H EALTH W HAT I T I S AND H OW I T W ORKS , F OURTH E DITION . 2009.

Sudbury MA: Jones and Bartlett Publishers.


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Selected Unique Features of Public Health

Basis in social justice philosophyInherently political natureDynamic, ever-expanding agendaLink with governmentGrounding in the sciences

Use of prevention as a prime strategyUncommon culture and bond

Source: Turnock B. P UBLIC H EALTH W HAT I T I S AND H OW I T W ORKS , F OURTH E DITION . 2009.

Sudbury MA: Jones and Bartlett Publishers.


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20th Centurys Top Ten Achievementsin Public Health

1. Fluoridation of drinking water2. Control of infectious diseases3. Motor vehicle safety4. Safer workplaces5. Safer and healthier foods6. Healthier mothers and babies7. Recognition of tobacco use as a health hazard8. Family planning9. Decline in deaths from coronary heart disease and stroke10. Immunizations
http://www.askcnet.org/CDC_edits/..%5Cicons%5Ccdc_logo.jpg


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Identified Themes Associated with Public Health Issues Uneasy tension between science and politics, and practice?What should the role of government be in public health?Newly emerging concern: preparednessThe role (and use) of incentives in public healthIntegral connection between environmental issues and public healthPublic health is global in nature (e.g., communicable diseasetransmission/travel; global warming), and broad in scope

Ethical issues arise in conducting public health research do the subjects of research also reap the benefits/rewards;should U.S. standards (protections) apply universally in other (developing)nations

Risks?

Risks associated with pandemic flu; avian fluRisks associated with HIV/AIDSVaccinations/immunizations

The Tragedy of the Commons


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Public Health Fundamentals

5 Ps of Public Health (expansion from the 3 Ps)Prevention (individual and community-focused)Promotion (voluntary, education, advocacy)Protection (policies/regulations; enforcement)Population-based (communities, groups)New 5 th P: Preparedness (e.g., bioterrorism, natural disasters,pandemics)

Closely linked to Environmental Health


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Major Eras in U.S. Public Health History

Prior to 1850 Influence of superstition, religion, miasmatheory; battling epidemics/pandemics:avoidance and acceptance;advent of bacteriological era

1850-1949 Sanitary reform through state and localinfrastructure (state and local healthdepartments); development of public healthinfrastructure

1950-1999 Filling gaps in medical care and expanding thehealth agenda; Major advances in medicine;

AIDS; control of infectious disease, growth ofchronic disease (largely behaviorally-related)

2000- Community public health practice; evolvingpublic health infrastructure development;preparing for and responding to communityhealth threats


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The Future of Public Health IOM Selected Findings The current state of our abilities for effective public health

action is cause for national concern and for the developmentof a plan of action for needed improvement we haveslackened our public health vigilance nationally, and the healthof the public is unnecessarily threatened as a result.

Clearly defined public health is basic terms

Stated that neither the general public or policymakers understoodpublic health or its importance

Urged those working in public health to reach out to educate thepublic about what public health is

_______________Source: Institute of Medicine (IOM), National Academy of Sciences. 1988.


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IOM Selected Findings - 2

Throughout the history of public health, two major factors have

determined how problems were solved:1. The level of scientific and technical knowledge2. The content of public values and popular opinions (and ultimately

political will)

Overtime, public health measures have changed with importantadvances in understanding the causes and control of disease (i.e.,epidemiology)

Public health practices have been affected by:1. popular beliefs about illness and2. by public views of appropriate governmental action


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IOM Selected Findings - 3

As poverty and disease came to be seen as both a societal as well

as a personal problem, and as governmental involvement in societalconcerns increased, collective action against disease becamegradually accepted Health became a social as well as anindividual responsibility .


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Selected Findings - 4Knowledge and values today remain decisive elements in theshaping of public health practice but they blend less harmoniouslythan they once did. On the surface, there appears to bewidespread agreement on the overall mission of public health ,as reflected in comments heard by the Committee

Public health does things that benefit everybodyPublic health prevents illness and educates the population


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Selected Findings - 5

But, when it comes to translating broad statements into effectiveaction, little consensus can be found

There is little agreement as to what services should be provided orto what intensity they should be provided (in some states the state healthdepartment was a major provider of prenatal care for poor women; inanother, women who could not pay got no care).Some state health departments are active and well equipped and

funded; others perform minimal functions and have little supportIn some states, there are large and sophisticated local healthdepartments; in many localities, there is no health department


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IOMs Three Basic Recommendations

The mission of public healthThe government role in fulfilling the missionThe responsibilities unique to each level of government

Other recommendations made by the committee were instrumental

in implementing the basic recommendations for the future of publichealth, e.g., statutory frameworks, structural and organization steps,strategies to build the fundamental capacities of public healthagencies technical, political, managerial, programmatic, fiscal,educational


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1. The Mission of Public Health

Fulfilling societys interest in assuring conditions in whichpeople can be healthy .

Generate organized community effort to address the public interest inhealth by applying scientific and technical knowledge to prevent diseaseand promote healthThe mission is addressed by both private organizations and individualsas well as by public agencies

Unique function of the governmental public health agency: to see thatvital elements are in place and that the mission is adequately addressed


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2. The Governmental Role in Public Health

The core functions of governmental agencies at ALL levels of

government are (a) assessment, (b) policy development, and(c) assurance.

a. What is Assessment?Every public health agency regularly and systematically collect,assemble, analyze, and make sensible information on the healthof the community, including statistics on health status, communityhealth needs, and epidemiologic and other studies of healthproblems


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2. The Governmental Role in Public Health (continued)b. What is Policy Development?

Every public health agency has the responsibility t oserve thepublic interest in the development of comprehensive public healthpolicies (a) by promoting use of its scientific knowledge base indecision making about public health and (b) by leading in thedevelopment of public health policy. Agencies must take a

strategic approach, developed on the basis of a positiveappreciation for the democratic political process.c. What is Assurance?Public health agencies must assure their constituents thatservices necessary to achieve agreed upon goals are provided,

either by encouraging actions by other entities (private or public),by requiring such action through regulation, or by providingservices directly.


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3. Levels of Responsibility

Each level of government bears its unique set of responsibilities.

a. StatesMust be the central force in public health, playing the primarypublic sector responsibility for health.State duties should include:

Assessing state health needs; statewide data collection Assuring an adequate state statutory base for health activitiesEstablishing statewide health objectives, delegating power tolocalities as appropriate and hold them accountable

Assuring an organized statewide effort to develop and maintainessential personnel, educational, and environmental health services,provision of access to necessary services, and solving health-relatedproblemsGuaranteeing a minimum set of essential health servicesSupporting local service capacity, particularly when disparities exist


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3. Levels of Responsibility (continued)

b. FederalThe following were viewed as federal public health obligations.

Support of knowledge development and dissemination through datagathering, research, and information exchangeEstablishing nationwide health objectives and priorities, andstimulating debate on interstate and national public health issuesProviding technical assistance to help states and localities determinetheir own objectives and to carry out action on national and regionalobjectivesProviding funds to states to strengthen state capacity for service,especially to achieve an adequate minimum capacity, and to achievenational objectives

Assurance of actions and services that are in the public interest ofthe entire nation such as control of AIDS and similar communicablediseases, interstate environmental actions, and food and druginspection


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3. Levels of Responsibility (continued)

c. LocalitiesBecause of the great diversity in size, powers, and capacities of localgovernments, generalizations must be made with caution. Nevertheless,no citizen from any community, no matter how small or remote, shouldbe without identifiable and realistic access to the benefits of public healthprotection, which is possible only through a local component of thepublic health delivery system

Assessment, monitoring, and surveillance of local health problems and needsand of resources for dealing with themPolicy development and leadership that foster local involvement and a senseof ownership, that emphasize local needs, and that advocate equitabledistribution of public resources and complementary private activities

Assurance that high quality services, including personal health services,needed for the protection of public health in the community are available ansaccessible to all persons; that the community receives proper consideration inthe allocation of federal and state public health funds, and that the communityis informed about how to obtain public health services or to comply with publicheath requirements


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What (Who) Comprise Public Health?

Broad and interdisciplinary in natureEpidemiologists and biostatisticiansBiomedical scientists (e.g., biologists, microbiologists, bacteriologists,virologists, chemists, physicians)Environmental health specialists (including environmental health specialists,toxicologists, sanitarians)Social and behavioral scientists (e.g., health educators, psychologists, socialworkers)Health policy makers and administrators (e.g., administrators, elected officials,program managers) Non -public health professionals who are involved in public health activitiesand programs (e.g., engineers, lawyers, nutritionists, teachers)Other workers and occupations whose work constitutes activities that protectand promote the public health, but who never think of themselves as playing arole in public health (e.g., plumbers, rubbish collectors, contractors)

In sum, people practicing skills aimed at protecting and promotingthe health of the public


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The Public Health System

MCOs

Home Health

Parks

EconomicDevelopment

Mass Transit

Employers

NursingHomes

MentalHealth

DrugTreatment

Civic GroupsCHCs

LaboratoryFacilities

Hospitals

EMS Community Centers

Doctors

HealthDepartment

Ch urches

Philanthropist

ElectedOfficials

Tribal Health

Schools

Police

Fire

Corrections

EnvironmentalHealth

Source: Centers for Disease Control and Prevention


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Dimensions of the Public Health System

Capacity (Inputs): the resources and relationships necessary tocarry out the core functions and essential services of public health

(e.g., human resources, information resources, fiscal and physicalresources, and appropriate relationships among systemcomponents).Processes (Practices and Outputs): those collective practices orprocesses that are necessary and sufficient to assure that the corefunctions and essential services of public health are being carried

out effectively (including the key processes that identify and addresshealth problems and their causative factors and the interventionsintended to prevent death, disease, disability, and to promote qualityof life).Outcomes (Results): indicators of health status, risk reduction, andquality of life enhancement outcomes are long-term objectives thatdefine optimal, measurable future levels of health status; maximumacceptable levels of disease, injury, or dysfunction; or prevalence ofrisk factors.

Source: Adapted from Public Health Practice Program Office. 1990.the Centers for Disease Control and Prevention.


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Public Health Prevents epidemics and the spread of disease

Protects against environmental hazardsPrevents injuriesPromotes and encourages healthy behaviorsResponds to disasters and assists communities in recoveries

Assures the quality and accessibility of health services


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The 10 Essential (Public Health) Services 1

1. Monitor health status to identify community health problems2. Diagnose and investigate health problems and health hazards in

the community3. Inform, educate, and empower people about health issues4. Mobilize community partnerships to identify and solve health

problems5. Develop policies and plans that support individual and community

health efforts6. Enforce laws and regulations that protect health and ensure safety7. Link people with needed personal health services and assure the

provision of health care when otherwise unavailable8. Assure a competent public health and personal health care work

force9. Evaluate effectiveness, accessibility, and quality of personal and

population-based health services10. Research for new insights and innovative solutions to healthproblems

________1 Source: U.S. Public Health Service, 1994.


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Ten Essential Services of Public Health

Source: Centers for Disease Control and Prevention


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Levels of Disease Prevention

Primary Prevent ion : activities intended to prevent future onset of

disease, e.g., immunizations, seatbelt use, avoidance of tobacco,reduced alcohol consumption, safe sex, exercise, air pollutioncontrol, restaurant inspections, health education programs

Secon dary Prevent ion : early detection of healthproblems/disease, to promote further recommended testing and theearly intervention of treatment or the risk that communicablediseases transmission to others, e.g., hypertension screening,cholesterol screening, HIV/STD testing, mammograms, pap smears,colonoscopies.

Tertiary Preventio n : rehabilitation activities designed to preventsubsequent worsening or reoccurrence of disease, disability, orinjury, e.g., cardiac rehab, adhering to strict dietary restrictions, re-learning to walk after an orthopedic injury or stroke.


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Health Promotion and Disease PreventionEncompasses a Broad Array of Functions and Expertise

Assess and monitor the health of communities and populationsat risk to identify health problems and priorities

In collaboration with community and government leaders,formulate public policies to solve identified local, state, andnational problems and priorities

Assure that all populations have access to appropriate,effective, and cost-effective health promotion and diseaseprevention services


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A Day in Your Life with Public Health An Exercise

In thinking about your activities that typically occur on a daily basis,lets try to make a list of how public health touches or impacts you(i.e., the ways in which you interface with public health)...Lets add to the list events or activities that you periodicallyencounter but not necessarily on a daily, or even weekly, basis Think practically and creatively

From the moment you arise in the morning, e.g., 6:30amGoing to work or to school, e.g., 8:00amMid-day, e.g., noonEnd of the work day or school day, e.g., 4:30pmEvening, e.g., 6:00pmRetiring for the night, 11:00pm


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A Day in Your Life with Public Health

In reviewing the above list(s), what do you realize?What does this illustrate to you?


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Public Health At Work in Maine
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