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“Public Health 101” Nancy Alfred Persily, MPH Assistant Provost, University at Albany Associate Dean, School of Public Health *Special thanks to Lia Snyder, MPH student Mission of Public Health “the fulfillment of society’s interest in assuring the conditions in which people can be healthy”1 Achieved through the application of health promotion and disease prevention technologies and interventions designed to improve and enhance quality of life2 1Institute of Medicine, The Future of Public Health, p.40 2Association of Schools of Public Health Substance of Public Health Organized community efforts aimed at the Prevention of Disease and the Promotion of Health…and encompasses both activities Undertaken through government and associated efforts of private and voluntary organizations and individuals Institute of Medicine, The Future of Public Health, p.40 Public Health vs. Medical Care Medicine is concerned with individual patients where as Public Health regards the “community” as its patient “Public health has many disciplines (medicine, dentistry, nursing, optometry, nutrition, social work, environmental sciences, health education, health services administration, behavioral sciences), its activities focus on entire populations rather than on individual patients” Association of Schools of Public Health 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 community recovery Assures the quality and accessibility of health services http://www.health.gov/phfunctions/public.htm Public Health During the 20th century, the average lifespan of individuals lengthened by 30 years, 25 years of this gain is attributable to advances in public health CDC, Morbidity and Mortality Weekly Report Ten Great Public Health Achievements Vaccination Motor Vehicle Safety Safer Workplaces Control of Infectious Diseases Decline in Deaths from Coronary Heart Disease and Stroke Safer and Healthier Foods Healthier Mothers and Babies Family Planning Fluoridation of Drinking Water CDC, Morbidity and Mortality Weekly Report Ten 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 to needed personal health services and assure the provision of health care when otherwise unavailable Assure a competent public health and personal health care workforce Evaluate effectiveness, accessibility, and quality of personal and population-based health services Research for new insights and innovative solutions to health problems http://www.health.gov/phfunctions/public.htm Public Health Functions Adopted: Fall 1994, Source: Public Health Functions Steering Committee, Members (July 1995): American Public Health Association·Association of Schools of Public Health·Association of State and Territorial Health Officials·Environmental Council of the States·National Association of County and City Health Officials·National Association of State Alcohol and Drug Abuse Directors·National Association of State Mental Health Program Directors·Public Health Foundation·U.S. Public Health Service --Agency for Health Care Policy and Research·Centers for Disease Control and Prevention·Food and Drug Administration·Health Resources and Services Administration·Indian Health Service·National Institutes of Health·Office of the Assistant Secretary for Health·Substance Abuse and Mental Health Services Administration Current Issues in Public Health Bioterrorism Smallpox Emerging Infectious Diseases West Nile Virus Violence Prevention Firearms Health Disparities Uninsured Obesity World Wide HIV/AIDS Bioterrorism – Smallpox Model History of Smallpox An acute contagious disease caused by variola virus Originated over 3,000 years ago For centuries, repeated epidemics swept across continents, decimating populations and changing course of history In some ancient cultures, smallpox was such a major killer of infants that custom forbade the naming of a newborn until the infant had caught the disease and proved it would survive Smallpox killed Queen Mary II of England, Emperor Joseph I of Austria, King Luis I of Spain, Tsar Peter II of Russia, Queen Ulrika Elenora of Sweden, and King Louis XV of France Killed as many as 30% of those infected; between 65-80% of survivors were marked with deep pitted scars, most prominent on the face No effective treatment ever developed Edward Jenner’s demonstration, in 1798, that inoculation with cowpox to protect against smallpox brought the first hope that the disease could be controlled In the early 1950’s – 150 years after the introduction of the vaccination – an estimated 50 million cases of smallpox occurred in the world each year, a figure which fell to around 10-15 million by 1967 because of vaccination In 1967, when WHO launched an intensified plan to eradicate smallpox, the “ancient scourge” threatened 60% of the world’s population, killed every fourth victim, scarred or blinded most survivors, and eluded any form of treatment WHO Fact Sheet on Smallpox, October 2001 Eradication of Smallpox Declared globally eradicated in 1980; however, there are concerns that smallpox virus could be used for bioterrorism Bioterrorism Preparations In May, 2002, a joint working group consisting of members of the Advisory Committee on Immunization Practice (ACIP) and the National Vaccine Advisory Committee (NVAC) met Draft Supplemental Recommendations of the ACIP on the USE of Smallpox (Vaccinia) Vaccine were approved and now under consideration by CDC and DHHS Now conflict on whether to give vaccine on voluntary basis or inoculate everyone CDC’s Smallpox Preparation and Response Activities Emerging Infectious Diseases – West Nile Virus Model Introduction The spread of the West Nile virus in the United States is a major health concern; since the first reported case in New York in 1999, the mosquito-borne disease has spread across the country History Encephalitis is an inflammation of the brain and can be caused by viruses and bacteria, including viruses transmitted by mosquito bites West Nile encephalitis is caused by the West Nile virus, a flavivirus commonly found in Africa, West Asia, and the Middle East; it is closely related to the St. Louis encephalitis virus found in the United States Discovered in Uganda in 1937; in 1999, it appeared in NYC and caused largest outbreak in US history - 62 cases, seven deaths Animals can also be infected - birds get it the most, but horses, cats, bats, chipmunks, skunks, squirrels, and domestic rabbits Symptoms Symptoms vary depending on the severity of the infection Mild infections Flu-like symptoms, fever, headaches and body aches, skin rash, swollen lymph glands Severe infections Higher fever, neck stiffness, disorientation, coma, paralysis, convulsions and muscle weakness, death Reducing Risks Stay indoors at dawn, dusk, and in the early evening Wear long-sleeved shirts and long pants when outdoors Spray clothing with repellents containing permethrin or DEET Apply insect repellent sparingly to exposed skin. Install or repair window and door screens so that mosquitoes cannot get indoors Centers for Disease Control and Prevention Violence Prevention – Firearms Model Over 200 million guns are in civilian hands; 25 percent of households have handguns In 1998, firearm-related injuries the second leading cause of injury death in US (31,000 deaths) 15,000 unintentional gunshot wounds are treated in US hospital EDs each year In 1994, treatment of gunshot injuries in US estimated at $2.3 billion in lifetime medical costs, of which $1.1 billion was paid by federal government CDC, Morbidity and Mortality Weekly Guns in Schools Over 3,500 students expelled in 1998-99 for bringing guns to school; 43% were in elementary or junior high (US Department of Education) 4.9% of high school students reported having carried a gun at least once in last 30 days (CDC, 1999) Public Health Approach 1. 2. 3. 4. Collection and analysis of data that describes scope and patterns of injury Identification of risk factors and causes Interventions are proposed, tested, and evaluated Based on evaluations, successful interventions are disseminated and monitored for ongoing effectiveness Handgun Epidemic Lowering Plan (HELP) Network Role of Public Health Professionals Education Teach parents/guardians about risk associated with keeping a gun in the home Educate children regarding guns Research Case find through Emergency rooms Study populations at risk (eg. suicide, socioeconomic) Determine risk factors (eg. guns in home, gangs, abuse) Role of Public Health Professionals Policy Safe storage requirements Close loopholes in secondary markets so that acquiring a gun requires same scrutiny no matter where purchased Computerized data on serious mental health problems so that background checks can be done quickly, thoroughly Harvard Public Health Review, Summer 2002 CDC Program - Prevent Firearm-Related Injuries Nationwide system to track firearm-related injuries (National Electronic Injury Surveillance System [NEISS]) Development of surveillance system Assess magnitude of firearm injury problem, evaluate programs and policies designed to prevent injuries Surveillance summary on firearm injury and mortality Risk and protective factor research on firearm violence Risk factors for gun use and injuries among young males living in inner cities CDC, National Center for Injury Prevention and Control Ongoing Interventions Rise High Projects – Chicago, Il Gun Safety Program – Baltimore, MD Public awareness campaign that uses billboards, posters and bus signs to “deglamorize” handguns and gun violence Baltimore Co Police Dept uses detectives to teach students in third, seventh and ninth grades about basic gun safety; included in course is info from Center to Prevent Handgun Violence’s Straight Talk About Risks curriculum People Opening the World’s Eye to Reality (POWER) – New York, NY Patients aged 21-53 paralyzed as result of gun violence or drug abuse speak to youth about unforeseen consequences of violence and gunplay Lack of Integration (local, state, government) Economic Impact Financing Ethics Confidentiality Lack of Educated Workforce Barriers to Implementation of a Public Health Initiative Education of Population Lobbying Groups (eg. NRA; military) “Our lives begin to end the day we become silent about the things that matter” Martin Luther King, Jr. What Can You Do? • • • Museum and Science Centers professionals are skilled communicators and presenters People are thirsty for reliable, trustworthy, and unbiased sources of information regarding Public Health issues You can give the public the information they want and need