public health in america: a state/local perspective georges c. benjamin, m.d., facp executive...
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Public Health In America:Public Health In America:A State/Local Perspective A State/Local Perspective
Georges C. Benjamin, M.D., FACPGeorges C. Benjamin, M.D., FACPExecutive DirectorExecutive DirectorAmerican Public Health AssociationAmerican Public Health Association
“Public Health: Prevent, Promote, Protect”
“Working for a Healthier World”
1854 Cholera Epidemic1854 Cholera EpidemicLondon, EnglandLondon, England
Severe and widespread cholera in LondonSevere and widespread cholera in London Dr. John Snow’s hypothesis: People were Dr. John Snow’s hypothesis: People were
getting cholera through contaminated getting cholera through contaminated drinking water; an infectious agentdrinking water; an infectious agent
Common view was it was from miasma or Common view was it was from miasma or bad airbad air
London obstetrician-mid-1800sLondon obstetrician-mid-1800s
1854 London Cholera Epidemic1854 London Cholera Epidemic
Documented cholera cases Documented cholera cases throughout the city throughout the city according to their according to their proximity to two different proximity to two different water companieswater companies
Demonstrated that cholera Demonstrated that cholera was occurring more often was occurring more often in people consuming in people consuming water from the Southwark water from the Southwark and Vauxhill company’s and Vauxhill company’s pumppump
Removed the Broad St. Removed the Broad St. water pump handlewater pump handle
Stopped the epidemicStopped the epidemic
Institute of MedicineInstitute of Medicine
“…“…[A] public health professional is [A] public health professional is a person educated in public health a person educated in public health or a related discipline who is or a related discipline who is employed to improve health employed to improve health through a population focus.”through a population focus.”
IOM 2002
The Public Health SystemThe Public Health System
CommunityCommunityHealth CareHealth Care
Delivery SystemDelivery System
Employers & Employers & BusinessBusiness
Governmental Public Governmental Public Health InfrastructureHealth Infrastructure
AcademicsAcademics The MediaThe Media
Assuring Conditions Assuring Conditions for Population Healthfor Population Health
IOM 2002IOM 2002
LegislatorsLegislators “Working for a Healthier World”
*Unpublished Survey Hill & Knowlton 2000
Public Health’s Contribution Public Health’s Contribution To HealthTo Health
Public health is responsible for Public health is responsible for the greatest increases in human the greatest increases in human life spanlife span
Yet it has been “invisible” to Yet it has been “invisible” to the publicthe public
Tragically in CY 2000, 78% of Tragically in CY 2000, 78% of Americans believe they had not Americans believe they had not ever used a public health ever used a public health service*service*
Its best work is done when Its best work is done when nothing happensnothing happens
Basic Framework For Public HealthBasic Framework For Public Health10 Essential Services10 Essential Services
A Day in the Life of a A Day in the Life of a Public Health OfficerPublic Health Officer
Your Community USA Your Community USA
Today Today
SymptomsSymptoms
FeverFeverMuscle achesMuscle achesAbdominal painAbdominal painDiarrheaDiarrhea
8:30 A.M.8:30 A.M.
““Hello. This is Dr. Phillips from Metro Hospital. I Hello. This is Dr. Phillips from Metro Hospital. I think you better sit down. Last night we admitted think you better sit down. Last night we admitted three unrelated patients ages 23, 44, and 79 from three unrelated patients ages 23, 44, and 79 from the emergency room with fever, muscle aches, the emergency room with fever, muscle aches, and diarrhea. Preliminary lab tests show an and diarrhea. Preliminary lab tests show an infectious diarrhea. What’s most interesting is infectious diarrhea. What’s most interesting is that all three patients attended the same that all three patients attended the same conference over the weekend with 300 other conference over the weekend with 300 other people. Not sure what’s going on. but I knew you people. Not sure what’s going on. but I knew you needed to know!”needed to know!”
8:45 A.M.8:45 A.M.
Local health officerLocal health officerchecks healthchecks healthdepartment’s onlinedepartment’s onlinedisease surveillance systemdisease surveillance systemfor latest information for latest information
8:50 A.M.8:50 A.M.
0
500
1000
1500
2000
Monday Wednesday Friday Sunday
High number of reported High number of reported ambulance runs noted ambulance runs noted over last 24 hours over last 24 hours
Larger statewide outbreak Larger statewide outbreak suspectedsuspected
State-integrated electronic State-integrated electronic surveillance system details surveillance system details mapping of cases by mapping of cases by county and zip codecounty and zip code
No. Cases Reported
Physician Report
Database GEPI 96
GIS SoftwareHealth
Department
9:00 A.M.9:00 A.M.
Local health officer alerts Local health officer alerts state health officials of a state health officials of a possible statewide possible statewide outbreak by e-mailoutbreak by e-mail
State health officer alerts State health officer alerts heads of medical, heads of medical, education, epidemiology, education, epidemiology, and public relations teams and public relations teams and schedules a 9:45 and schedules a 9:45 meeting using PDAsmeeting using PDAs
9:10 A.M.9:10 A.M.
Public relations & Public relations & education staff are in the education staff are in the building building
Epidemiologist and Epidemiologist and medical chief are at medical chief are at satellite office 60 miles satellite office 60 miles awayaway
They message back they They message back they can meet via the state’s can meet via the state’s interactive video systeminteractive video system
9:20 A.M.9:20 A.M.
State health official State health official views health views health department Web site department Web site
Reviews information Reviews information on infectious agentson infectious agents
Suspects food-borne Suspects food-borne cause!cause!
9:45 A.M.9:45 A.M.
Health official meets with Health official meets with staff to review new data: staff to review new data: notices outbreak crosses notices outbreak crosses State linesState lines
Case finding and disease Case finding and disease surveillance identifying surveillance identifying new casesnew cases
GIS mapping indicates GIS mapping indicates new cases in three States new cases in three States
Reports through wireless Reports through wireless communication systemcommunication system
10:30 A.M.10:30 A.M.
State health official State health official continues to watch data on continues to watch data on wireless computerwireless computer
Neighboring health Neighboring health agencies contacted in agencies contacted in three Statesthree States
Health agencies agree on Health agencies agree on regional strategy using regional strategy using interactive video interactive video conferencingconferencing
12:05 P.M.12:05 P.M.
Epidemiologist has audio Epidemiologist has audio conference with their conference with their counterparts in three counterparts in three jurisdictions jurisdictions
12:30 P.M.12:30 P.M.
Three State health Three State health officials have conference officials have conference callcall
Lab Results: Stool Positive for Lab Results: Stool Positive for Pathogenic E.ColiPathogenic E.Coli
Paper reportsPaper reports Some can view actual results Some can view actual results
through telemedicine linkage through telemedicine linkage with medical center or with medical center or public health lab public health lab
Suspect it’s the beef that was Suspect it’s the beef that was served through several served through several distributorsdistributors
1:10 P.M.1:10 P.M.
Health official alerts CDC, Health official alerts CDC, medical community, and medical community, and law enforcement through law enforcement through health alert networkhealth alert network
Regional screening and Regional screening and treatment protocols sent treatment protocols sent outout
Updates the 1-800 Updates the 1-800 “hotline” that informs “hotline” that informs community about public community about public health emergencieshealth emergencies
1:25 P.M.1:25 P.M.
Public Information staff Public Information staff issue press release to issue press release to alert media and educate alert media and educate publicpublic
Blast faxBlast fax E - mail E - mail
2:20 P.M.2:20 P.M.
Health educator Health educator teleconferences with teleconferences with community physicians via community physicians via interactive high speed interactive high speed fiber optic video networkfiber optic video network
Gives new information on Gives new information on diagnosis and therapydiagnosis and therapy
Start antibiotic treatment Start antibiotic treatment
Public Health Professionals Use Secure Public Health Professionals Use Secure Video Conferencing System to Coordinate Video Conferencing System to Coordinate
Regional Outbreak Response Regional Outbreak Response
4:00 P.M.4:00 P.M.
Regional response Regional response coordinatedcoordinated
Outbreak identified Outbreak identified Treatment givenTreatment given Disease containment Disease containment
begunbegun Lives saved! Lives saved!
Public Health Has A Broad MissionPublic Health Has A Broad Mission
Chronic Diseases
Bioterrorism
Safe Water
Safe Food
Clean Environment
Operating Environment Has Operating Environment Has Changed Changed
Invisible Invisible Visible Visible 9-5 Mon - Fri 9-5 Mon - Fri 24/7 24/7 Results tomorrow Results tomorrow Results now! Results now! Science & politics Science & politics Science and politics Science and politics Evolving science Evolving science Fast science Fast science Controlled communication Controlled communication Information Information
overloadoverload National scope National scope Global involvement Global involvement
Change Driven by Change Driven by Highly Visible Public Health EventsHighly Visible Public Health Events
Security dominates Security dominates national agendanational agenda
Public health part of Public health part of national security agendanational security agenda
Growing public interest in Growing public interest in healthhealth
Protection & preventionProtection & prevention Building infrastructure Building infrastructure
now a prioritynow a priority
Reducing Disease Burden:Reducing Disease Burden:Addressing Root Causes Addressing Root Causes
1.1. Heart diseaseHeart disease
2.2. CancerCancer
3.3. StrokeStroke
4.4. Unintentional InjuryUnintentional Injury
5.5. COPDCOPD
6.6. DiabetesDiabetes
7.7. Influenza & pneumoniaInfluenza & pneumonia
8.8. Alzheimer diseaseAlzheimer disease
9.9. Renal diseaseRenal disease
10.10. SepsisSepsis
National vital statistics reports, 2002
TobaccoTobacco Diet/activity patterns Diet/activity patterns AlcoholAlcohol Microbial agentsMicrobial agents Toxic agentsToxic agents FirearmsFirearms Sexual behaviorSexual behavior Motor vehiclesMotor vehicles Illicit use of drugsIllicit use of drugs
Ensuring A 21Ensuring A 21stst-Century -Century Public Health SystemPublic Health System
Building infrastructureBuilding infrastructure PeoplePeople TrainingTraining ToolsTools Resources (money, linkages, facilities)Resources (money, linkages, facilities)
Structural reform at local levelStructural reform at local level Insufficient investment in public health research Insufficient investment in public health research Strengthening nongovernmental public healthStrengthening nongovernmental public health Sustaining & reforming resource investmentsSustaining & reforming resource investments
Georges C. Benjamin, MD, FACPGeorges C. Benjamin, MD, FACP
Executive DirectorExecutive Director
American Public Health AssociationAmerican Public Health Association
www.apha.orgwww.apha.org
“ Public Health: Prevent, Promote, Protect”