INTRODUCTION TO PUBLIC

HEALTH
 Purpose
These slides were developed for medical students and faculty.
They provide an overview of the relationship between
medicine and public health, and review why public health is
relevant to medical education and careers

From:
AAMCs cooperative agreement with CDC,
a partnership to Strengthen Collaboration
Between the Disciplines of Public Health
Did You Choose Medicine Because You
Wanted To
Make a difference?
Address societys health needs?
Help improve quality of life?
Apply science to challenging problems?
Pursue opportunities for leadership?
What is public health? What is
the relationship between
medicine and public health?
 Public Health
What Comes to Mind?
Conventional ideas
Services for the Poor
Sanitation and Clean Water
Restaurant Inspections
STIs and TB Clinics
Contemporary application
Handgun Control
Responding to Antimicrobial Resistance (MRSA)
West Nile Virus
Pandemic/Avian Flu
Childhood Obesity
Public Health Preparedness/Disasters
Terrorism
Addressing Disparities in Health Care/Health and Human Rights
Public health: AccomplishmentsU.S.
1900-1999 (From CDC data)
1. Vaccination
2. Motor-vehicle safety
3. Safer workplaces
4. Control of infectious diseases
5. Decline in deaths from coronary heart disease
and stroke
6. Safer and healthier foods
7. Healthier mothers and babies
8. Family planning
9. Fluoridation of water
10. Recognition of Tobacco use as a health hazard
 Public health: Impact
Five of the 30 years can be attributed to
improvements in medicine and drugs.
The other years are due to various public
health initiatives
80

75

70

65

60

55

50

45

40

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000
Public health: AccomplishmentsU.S.
2000-2010 (From CDC data)
1. Vaccine-Preventable Diseases
2. Prevention and Control of Infectious Diseases
3. Tobacco Control
4. Maternal and Infant Health
5. Motor Vehicle Safety
6. Cardiovascular Disease Prevention
7. Occupational Safety
8. Cancer Prevention
9. Childhood Lead Poisoning Prevention
10. Public Health Preparedness and Response
 The Disciplines of Public Health*
Environmental Health
Air quality; food protection; radiation protection; solid waste management; hazardous waste management; water quality; noise control;
environmental control of recreational areas, housing quality, vector control
Epidemiology
The study of the occurrence and distribution of health-related states or events in specified populations, including the study of the determinants
influencing such states, and the application of this knowledge to control the health problems.
Health Services Administration/Management
Managing the database at a school clinic; developing budgets for a health department; creating policies for health insurance companies; directing
hospital services
International/Global Health
Addressing health concerns from a global perspective, among different cultures in countries worldwide

Maternal Child Health

Providing information and access to birth control; promoting the health of a pregnant woman and an unborn child; dispensing vaccinations to
children
Nutrition
Promoting healthy eating and exercise; researching the effect of diet on the elderly; teaching the dangers of overeating and over dieting

Public Health Laboratory Practice

Diagnosing, preventing, treating, and controlling infectious and chronic diseases in communities, as well as environmental health and newborn
screening.
Public Health Policy
Analyzing the impact of seat belt laws on traffic deaths; monitoring legislative activity on a bill that limits malpractice settlements; advocating for
funding for a teen anti-smoking campaign
Public Health Practice
An interdisciplinary field that requires nurses, physicians, veterinarians, dentists and pharmacists; a degree in public health practice enables
clinicians to apply public health principles to improve their practice

*Adapted from: http://www.whatispublichealth.org/what/index.html#Practice

Porta M, ed. A Dictionary of Epidemiology. 5th ed. New York, NY: Oxford University Press; 2008.
 Public health: Definition
What we do collectively as a society to assure the
conditions in which people can stay healthy.
Institute of Medicine 1988

The science and art of preventing disease,

prolonging life and promoting health through the
organized efforts and informed choices of society,
organizations, public and private, communities
and individuals.
C. E. A. Winslow, 1920
Public health is thus a social institution, a
discipline, and a practice.
 What is Public Health?

Public health
professionals try
to prevent
problems from
The science of Public health
happening or re-
protecting and professionals A field that is
occurring through
improving the analyze the effect Concerned with concerned with
implementing
health of on health of protecting the limiting health
educational
communities genetics, personal health of entire disparities and a
programs,
through choice and the populations, as large part of
developing
education, environment in small as a local public health is
policies,
promotion of order to develop neighborhood, or the fight for
administering
healthy lifestyles, programs that as big as an entire health care equity,
services,
and research for protect the health country. quality, and
regulating health
disease and injury of your family and accessibility.
systems and some
prevention. community.
health
professions, and
conducting
research.

Adapted from: www.whatispublichealth.org: http://www.whatispublichealth.org/what/index.html

 10 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.
 10 Essential Public Health Services
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.

Research for new insights and innovative solutions to health problems.

 Public health approach
Implementation:
How do you
do it?
Intervention
Evaluation:
What
works?
Risk Factor
Identification:
What is the
cause?
Surveillance:
What
is the
problem?
Problem Response
Perspectives of Public Health and Medicine
Public Health Medicine
Primary focus on population Primary focus on individual

Public service ethic, tempered by concerns Personal service ethic, conditioned by

for the individual awareness of social responsibilities

Emphasis on prevention, health promotion Emphasis on diagnosis and treatment, care

for the whole community for the whole patient

Public health paradigm employs a spectrum Medical paradigm places predominant

of interventions aimed at the environment, emphasis on medical care
human behavior and lifestyle, and medical
care

Multiple professional identities with diffuse Well-established profession with sharp public
public image image

Table 1. Perspectives of medicine and public health from: Fineberg HV. Public health and medicine: where the twain shall meet. Am J of Prev
Med. 2011;41(4S3):S141-S143.

Harvey Fineberg, M.D., Ph.D. 1990

Perspectives of Public Health and Medicine
Public Health Medicine
Variable certification of specialists beyond Uniform system for certifying specialists
professional public health degree beyond professional medical degree

Lines of specialization organized, for Lines of specialization organized, for

example, by: example, by:
Analytic method (epidemiology, Organ system (cardiology,
toxicology) neurology)
Setting and population Patient group (obstetrics, pediatrics)
(occupational health, international
health) Etiology and pathophysiology
(oncology, infectious diseases)
Substantive health problem
(environmental health, nutrition) Technical skill (radiology, surgery)
Skills in assessment, policy
development, and assurance
Table 1. Perspectives of medicine and public health from: Fineberg HV. Public health and medicine: where the twain shall meet. Am J of Prev
Med. 2011;41(4S3):S141-S143.
Harvey Fineberg, M.D., Ph.D. 1990
Perspectives of Public Health and Medicine
Public Health Medicine
Biologic sciences central, stimulated by major Biologic sciences central, stimulated by needs
threats to health of populations; move between of patient; move between laboratory and
laboratory and field bedside

Numeric sciences an essential feature of Numeric sciences increasing in prominence,

analysis and training though still a relatively minor part of training

Social sciences an integral part of public health
education
Engineering relevant, especially systems
analysis, operations management, sanitary
engineering, and information technology
Clinical sciences peripheral to professional
training rooted mainly in the public sector
Social sciences tend to be an elective part of
medical education
Engineering and physical sciences relevant,
especially materials science, electronics,
imaging, and information technology
Clinical sciences an essential part of
professional training rooted mainly in the
private sector

Table 1. Perspectives of medicine and public health from: Fineberg HV. Public health and medicine: where the twain shall meet. Am J of Prev
Med. 2011;41(4S3):S141-S143.
Harvey Fineberg, M.D., Ph.D. 1990
What determines health?
Healthy People 2020: Goals
Attain high-quality, longer lives free of preventable
1 disease, disability, injury, and premature death

Achieve health equity, eliminate disparities and

2 improve health for all groups

Create social and physical environments that

3 promote good for all

Promote quality of life, healthy development, and

4 healthy behaviors across life stages
www.healthypeople.gov
 What are Determinants of Health?

Policymaking
Social factors
Social Determinants
Physical Determinants
Health services
Individual behavior
Biology and genetics
 Factors That Affect Health
Examples
Smallest
Impact Condoms, eat healthy,
Counseling be physically active
& Education

Rx for high blood

Clinical pressure, high
Interventions cholesterol

Immunizations, brief
intervention, cessation
Long-lasting treatment, colonoscopy
Protective Interventions

Fluoridation, 0g trans
Changing the Context fat, iodization, smoke-
to Make Individuals Default free laws, tobacco tax
Decisions Healthy
Largest
Impact Poverty, education,
housing, inequality
Socioeconomic Factors

Frieden TR. A framework for public health action. Am J Public Health. 2010;100(4):590595.
Clinical Prevention and Public Health: Actual Causes of
Death
How is public health important to
your training and careers?
 Physician Involvement
in Public Health
Public health Public health
physicians in physicians in
governmental other public
agencies health settings

Physicians in practices or specialties

with public health needs

All physicians

Figure 2.1 Physician involvement in public health. Training Physicians for Public Health Careers. Institute of Medicine (2007).

"All physicians are a part of the public health system"

 Public Health Matters to Medical Care and to
Medical Education
Epidemiology, the core
discipline of public health, is
essential to understanding the
cause and distribution of
disease
Public health teaches the
influence of environmental,
nutritional, social, and
behavioral factors on health,
illness, recovery, and wellness
Understanding the role and
potential for public health
interventions better positions
physicians to improve patient
health and foster
interdisciplinary collaboration
Fineberg HV. Public health and medicine: where the twain shall meet. Am J Prev Med. 2011; 41(4 S3): S141-S143.
Independently interpret the medical literature
Apply findings to individual patients
Central to sound medical care, health policy and public health practices
Understand the etiology and optimal management of disease
Appreciate multiple origins of illness
Have an integrative explanation of illness that embraces genetic,
molecular, biochemical, and physiological factors with behavioral,
social, nutritional and environmental factors
Interventions include: public health education, social campaigns,
ordinances and laws, standards and regulations, surveillance and
preparedness
Gain a deeper understanding of the conditions that preserve health, of
the primacy of disease prevention, and of the interfaces between
personal medical care and community health protection
 Public Health Matters to Medical Care and to
Medical Education
Public health emphasizes
cultural sensitivity (similarities
and differences in values, Supports the ability of patients to participate in their own health care and to
mores, and practices), protect their familys health
community engagement, and
health literacy

Public health stresses systems

thinking, an engineering
concept that explains observed Directly supports patient safety and the quality of medical care
performance in terms of Provides a way of describing and understanding the performance of everything
connected parts that interact in from an individual medical encounter to the health system as a whole
a variety of interdependent
ways

Public health exposes physicians
to exciting and fulfilling career
opportunities in such diverse
areas as global health, disaster
response, health policy, and
environmental health
Apart from those who will choose to concentrate in a public health field, many
practitioners in such fields as general and specialty medicine, emergency
medicine, pediatrics, family medicine, obstetrics and gynecology,
ophthalmology, and general surgery will find rewarding opportunities for part-
time engagement in one or another aspect of population health.
Many physicians will find that public health is the continuation of medicine by
other means, potentially affecting millions of individuals at a time

Fineberg HV. Public health and medicine: where the twain shall meet. Am J Prev Med. 2011; 41(4 S3): S141-S143.
What Will Medical Practice Look Like
In The Future?

Physician shortage to Shortage of public health

quadruple within decade trained professionals in the
(Association of American Medical field (Center for Studying Health System
Colleges) Change)

The number of physicians

practicing in
governmental public
health should be doubled
(Institute of Medicine)
 Future Physicians:
What Skills Will You Need?

Health Care
Reform

Increasing
Aging
Population
Population
Diversity
What do we know about student
perspectives on public health in
medical education?
 Canadian Medical Students Perceptions of Public
Health Education in the Undergraduate Medical
Curriculum
Major Themes:
Poor educational experiences in public health courses
Lack of positive role models, especially exposure to community
medicine specialists
Emphasis on statistics and epidemiology
Negative attitudes toward public health topics
Conclusions:
Students disillusioned, disengaged, and disappointed with the
public health curriculum currently provided.
Many students prefer a curriculum that is more challenging, has
more applied field experience and exposure to public health
physician role models

Tyler IV, Hau M, Buxton JA, Elliott LF, Harvey BJ, Hockin JC, et al. Canadian medical students perceptions of public health education in the
undergraduate medical curriculum. Acad Med. 2009; 84(9): 1307-1312.
Informal Needs Assessment (2008)
Ineffective public health learning experiences
included:
A focus on epidemiology and statistics
Didactic lectures and PowerPoint presentations in
general
Health policy content (considered boring, or
irrelevant)
Information presented with no context, too much
theory.
 Informal Needs Assessment
Public health learning experiences that students
found most effective involved
Experiential learning opportunities
developing community interventions
lobbying
field trips
study abroad
research projects
volunteer and community service work
Internships
shadowing doctors
Lectures given by individuals recognized as
knowledgeable/influential/expert in the areas of
preventive medicine and public health
 Preventive medicine: Basic concepts
Preventive medicine Public health attempts
enhances the lives of to promote health in
individuals by helping populations through the
them improve their application of organized
own health community efforts

Preventive medicine and public heath are not separate

but have a seamless continuum between them
 Preventive medicine: Basic concepts
Health: WHO defines health as a state of
complete physical, mental, and social well-
being and not merely the absence of disease
or infirmity
Successful adaptation: Different stressors can
induce helpful (eustress) and harmful forms of
stress (dystress). Good health requires more
of eustress with little dystress to adapt. The
ongoing level of demand for adaptation in an
individual is called the allostatic load on that
person that may be an important contributor
to many chronic diseases
 Preventive medicine: Basic concepts
Satisfactory functioning: Irrespective of any
anatomical/physiological/mental discomfort ,a
person seeks medical care only when there is
an inability to function properly.

Therefore appropriate nutrition, adequate shelter, a

non-threatening environment and a prudent life-style
contribute far more to the health and well-being than
does the medical care system.
 Topics of discussion in Epidemiology

Basic concepts and principles

Epidemiologic data sources and measurements
Epidemiologic surveillance and outbreak
investigation
Study of causation in epidemiologic investigation
and research
Common research designs in epidemiology
Assessment of risk and benefit
Understanding errors in clinical medicine
Topics of discussion in Biostatistics
Describing variation in data
Statistical inference and hypothesis testing
Bivariate analysis
Sample size, randomization and probability
theory
 Topics of discussion in Preventive
medicine
Introduction to preventive medicine
Methods of primary prevention
Methods of secondary prevention
Methods of tertiary prevention
The public health system: Structure and
function
THANK YOU FOR YOUR
ATTENTION