Download comp1_unit1b_audio_transcript

Introduction to Healthcare and Public Health in the US: Introduction and
History of Modern Healthcare in the US
Audio Transcript
Slide 1
Welcome to Introduction to Healthcare and Public Health in the US: Introduction and
History of Modern Healthcare in the US. This is Lecture b.
The component, Introduction to Healthcare in the US, is a survey of how healthcare
and public health are organized and services are delivered in the US.
Slide 2
The Objectives for Introduction and History of Modern Healthcare in the US, are to:
•
•
•
•
Delineate key definitions in the healthcare domain
Explore components of healthcare delivery and healthcare systems
Define public health and review examples of improvements in public health
Discuss core values and paradigm shifts in US healthcare
Describe in overview terms, the technology used in the delivery and
administration of healthcare
Slide 3
This lecture will provide a definition of public health and detail how public health has
improved healthcare.
According to Charles Edward Winslow, a famous American bacteriologist and public
health expert in the first half of the 20th century, public health is the science and art of
preventing disease, prolonging life, and promoting health through the organized efforts
and informed choices of society, organizations both public and private, communities,
and individuals.
Slide 4
So what are the ten great public health achievements in the United States this century?
The Centers for Disease Control and Prevention lists them as: vaccination, motor
vehicle safety, safe work places, control of infectious diseases, a decline in death from
coronary heart disease and stroke, safer and healthier food, healthier mothers and
babies, family planning, the fluoridation of drinking water, and the recognition of tobacco
use as a health hazard.
It’s interesting that each of these achievements requires large populations to actively
shift the way they think about illnesses and act in a large-scale fashion to make
changes in behavior in order to successfully implement public health improvement. It’s
also interesting that though scientific advancements have spearheaded many of these
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture b
This material, (Comp1_Unit1b) was developed by Oregon Health and Science University funded by the Department of Health and
Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.
1
achievements, public education remains a primary motivator of public health
achievements.
Slide 5
Let’s focus our attention on the control of infectious diseases. A classic example of
public health success in this arena is the successful control of typhoid.
Typhoid is caused by bacteria and is spread by ingesting contaminated food or water.
The organism spreads via the bloodstream and causes a fever and a systemic,
sometimes potentially fatal illness. In 1891 the typhoid death rate in Chicago alone was
174 per 100,000 people. Now, thanks to public health measures such as sanitation, the
improvement of hygiene, combined with the development of a vaccine, only about 400
cases are seen in the United States each year and most of these cases originate when
patients travel in developing countries.
Slide 6
Another example of the role of public health in the successful control of infectious
disease is the example of small pox. Small pox is a devastating disease. It’s an
epidemic viral illness and was responsible for hundreds of millions of deaths in the 20th
century alone. No effective treatment was ever developed for the disease and it killed
about thirty percent of patients who were infected. Between sixty-five and eighty
percent of those who survived the disease were marked with deep scars, most
prominently on the face. As late as the 18th century, small pox was responsible for the
death of every tenth child born in France. In the early 1950s, there were about fifty
million cases of small pox each year worldwide. By 1967, this figure fell to ten-to-fifteen
million because of mass vaccination drives. By 1977, small pox was eradicated. This
was predominantly due to an aggressive public health program and the use of an
effective vaccine.
Slide 7
Interventions dictated by public health have been responsible for the successful control
of many nutritional deficiencies. An example is that of goiter. A goiter [GOY-der] is an
enlargement of the thyroid gland in the neck due to impaired thyroid hormone synthesis
due to the lack of iodine in diet. The solution to the problem of nutritional goiter in the
United States was to fortify salt with iodine which virtually eradicated the problem.
Slide 8
Another example is the reduction of tooth decay in the population. Frederic McKay in
1891 first described the association between a reduction in the incidence of dental
caries [CARE-reez], or tooth decay, in populations and the addition of fluoride to
drinking water. In 1945, Dr. H. Trendley Dean and associates at the National Institute of
Health, added fluoride to the water in Grand Rapids, Michigan, and showed a
subsequent reduction in caries. Now, more than 10,000 US communities fluoridate their
water.
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture b
This material, (Comp1_Unit1b) was developed by Oregon Health and Science University funded by the Department of Health and
Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.
2
Slide 9
So how has public health improved healthcare? Public health is directly responsible for
improvement in understanding disease. Epidemiology [ep-ih-dee-mee-ALL-uh-jee] is
the basic science of public health. It is a quantitative basic science built on a working
knowledge of probability, statistics, and sound research methods. It is a method of
causal reasoning based on developing and testing hypotheses pertaining to currents
and prevention of morbidity and mortality. Epidemiology is also a tool for public health
action to promote and protect the public’s health based on science, causal reasoning,
and a dose of practical common sense.
Slide 10
Here is an example of epidemiology at work: In 1854, an epidemic of cholera ravaged
London, England. Cholera is a bacterial disease spread by contamination of food or
water. Lack of sanitation and overcrowding were important factors that led to the
spread of disease. Dr. John Snow, a physician, linked the spread of disease to a
contaminated public water pump on Broad Street. Snow hypothesized that the disease
was spread by contaminated water, and he used statistics to connect the quality of
water to the number of cases of cholera.
Slide 11
Public health successes have been assisted by improvements in the science and
processes associated with data collection. Original methods of data collection were
somewhat crude. An example of this would be field surveys. Progressive
improvements in methodology have lead to the use of sophisticated scientific methods
to collect data. One example is cohort studies. This is a form of a longitudinal study
that follows two sets of patients. One set has the factor that is being considered, the
other does not have the characteristic. Another use of sophisticated scientific
methodology is to conduct public health trials as randomized controlled trials.
Randomized controlled trials reduce the element of bias in a scientific study. Patients
are assigned to one of two pools. One pool receives an intervention and the other does
not. This reduces the influence of confounding variables in data analysis.
Slide 12
An example of improvements in data collection leading to better public health is the
Framingham heart study. In 1948, the National Heart Institute, which is now the
National Heart Lung and Blood Institute of the National Institutes of Health, and Boston
University began the Framingham Heart Study. The study recruited men and women
from the town of Framingham, Massachusetts, and followed them for a substantial
number of years to attempt to identify factors that contribute to the development of
cardiovascular disease. Over the years, three generations of participants have helped
to identify major cardiovascular disease risk factors. With the assistance of these
patients, researchers have also attempted to understand the effects of cardiovascular
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture b
This material, (Comp1_Unit1b) was developed by Oregon Health and Science University funded by the Department of Health and
Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.
3
disease risk factors on other diseases such as hypertension or high blood pressure and
dementia.
Slide 13
In addition to improvements in data collection, public health has also benefitted from
improvements in data analysis. For example, use of tools such as multi-variate and
meta-analysis offer specialized options to analyze collective data. There has also been
an improvement in disease surveillance. One example is the Real time Outbreak and
Disease Surveillance, or RODS [roads] Laboratory, which is a bio-surveillance research
laboratory at the University of Pittsburgh in Pennsylvania. This laboratory uses software
and algorithms to monitor emergency rooms and retail stores to detect and assess
disease outbreaks. As you can imagine, this is of immense use in the public health
arena.
Slide 14
Public health has also benefitted from improvement in training. In the early twentieth
century, in part due to the Welch-Rose report of 1915, and also partially because of the
support of the Rockefeller Foundation, many schools of public health were established
and awarded professional degrees such as the Master of public health. And finally,
public health has also benefitted from improvement in infrastructure at the federal, state,
and local health department levels.
Slide 15
This concludes Lecture (b), of Introduction and History of Modern Healthcare in the
US.
In summary, Public Health is the science and art of preventing disease, prolonging life,
and promoting health and involves various organizations within society. Public
education remains a primary motivator of public health achievements.
Public Health has significantly impacted the control of infectious diseases, such as
typhoid, small pox and goiter, and helped identify nutritional deficiencies and contributed
to a greater understanding of diseases. It has also supported improvements in data
collection, training and infrastructure.
Slide 16
(Reference slide)
No audio
end
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture b
This material, (Comp1_Unit1b) was developed by Oregon Health and Science University funded by the Department of Health and
Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.
4