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Transcript
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, 10Healthy 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 exposuresingle 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.