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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, 10Healthy 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 exposuresingle 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.
