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GEN-101: Public Health Pete Walton, M.D. Associate Dean for Academic Affairs School of Public Health and Information Sciences What is Public Health? “Public health is the science and art of promoting health health, preventing disease disease, and prolonging life in the population through the organized efforts of society society.” -- World Health Organization (WHO) Functions of Public Health Population Health Population Health Health Care Hospitals Clinics Providers Insurers Researchers Etc. Traditional Public Health Social Policy ACA Medicaid Taxation Smoking Guns Etc. Career Areas • • • • • • • • Medicine Dentistry Health management Epidemiology Environmental health Health information Wellness Health policy • • • • • • • • Health inspection Social policy Research Health instruction Program planning Program evaluation Health assessment Community health Public Health Competencies Discipline-Specific Cross-Cutting biostatistics communications and informatics environmental health sciences diversity and culture epidemiology leadership health policy and management public health biology social and behavioral sciences professionalism program planning systems thinking (critical thinking) How Do We “Measure” Disease • Morbidity – being sick – Prevalence – proportion of people who are sick at a given point in time – Incidence – proportion of people who get sick during a given period of time • Mortality – deceased – Mortality rate – proportion of people who die during a given period of time How Do People Get Infections? • Agents – – – – – – Bacteria Viruses Protozoa (one-celled animals) Fungi (plant-like) Helminths (worm-like parasites) Infectious proteins (e.g., mad-cow disease) • Routes – – – – Inhaled – droplets, cysts & spores Contact – direct, indirect Ingested – food, water & other liquids & solids Through skin – bites, needles, wounds & cuts Key Assumption of Evidence-Based Population Health “The underlying theory of population health is that the distribution of health and disease in the population is not random and that we can identify the reasons for the nonrandomness.” The Origin of Evidenced-based Public Health: Cholera in 19th-Century London 1831-1832: first modern outbreak in Britain 23,000 deaths helped to launch the sanitary reform movement, which was based on miasma theory of disease (“bad smells”) 1848-1849: 250,000 cases and 53,000 deaths prompted Snow (and others) to investigate causes based on contagion theory of disease (“person-to-person spread”) Snow’s “Ghost Map” Black squares are cholera deaths The green circles are public water pumps. What’s your interpretation of the evidence on this map? Snow’s “Ghost Map” Broad Street Pump (Southwark & Vauxahall) Other Pumps (Lambeth and others) John Snow’s Numerical Analysis Water Supplier # of Houses # of Deaths Deaths/10,000 Houses Southwark & Vauxhall 40,046 1,263 315 315 Lambeth 26,107 98 38 256,423 1,422 56 Other What Really Happened • Removal of the Broad Street pump handle by Snow, thereby stopping the epidemic, is legend and NOT based on historical evidence. – He persuaded the public authorities to remove it (grudgingly), and it was removed after the epidemic had already peaked. • It took Snow years to convince the authorities that water was the problem, not smelly air, and to force the water company to change where it drew water from the Thames, – Which was right downstream from the outlet from one of the sewers built to eliminate miasma! • Snow died in 1858; the cholera bacterium was not discovered until 1884 and proven by Koch to cause cholera. Questions