Introduction to the US Health

HSA 6114

Introduction to Public Health

August 31, 2009
 What is Public Health?

Public health is what we, as a society, do

collectively to assure the conditions in
which people can be healthy.

The mission of public health is to "fulfill

society's interest in assuring conditions in
which people can be healthy."
Source: Institute of Medicine, Committee for the Study of the Future of Public Health, Division of Health Care Services. 1988. The Future of Public Health.
National Academy Press, Washington, DC
 Early Influences on Public Health

• Industrialism – population shifts to urban

centers

• Local boards of health

• Public health pioneers

• Edward Jenner “father of vaccination”
• John Snow “father of epidemiology”
• Edwin Chadwick “father of the sanitary movement’
• Lemuel Shattuck
• Louis Pasteur and Robert Koch “germ theory of disease”
 http://www.geocities.com/jenks436/parishpump.jpg
http://uhavax.hartford.edu/bugl/histepi.htm

In 1854, John Snow established the connection between cholera and

contaminated water supplies. Using statistical analysis, he identified
the pump as the source of the outbreak and removed the pump handle.

Source: National Library of Medicine. Images from the History of the Public Health Service. Available on the internet. Last viewed 3-3-05 http://www.nlm.nih.gov/exhibition/phs_history/intro.html
 Death Rate for All Causes: New York and
Brooklyn

1824 31 per 1,000

1851 41 per 1,000
1875 29 per 1,000
1925 12 per 1,000

Source: Novick page 13

 Core Public Health Functions

• Defines the problem (the who)

• Identifies risk factors for the disease (the
why)
• Develops and implements interventions
• Measures effectiveness

Assessment Policy Development Assurance

Public Health Core Functions
(defined by IOM, 1988)
• Assessment
– identifying health problems and causative
factors
• Policy Development
– developing strategies to address problems
• Assurance
– making sure that strategies are
implemented and goals are achieved
 Assessment

• Regularly and systematically collect, assemble,

analyze, and disseminate information on the
health of the community
• Monitoring health status to identify community
problems
• Diagnosing and investigating health problems
 Policy Development
Develop public health policy that uses
scientific knowledge in decision-making
– Informing, education, empowering individuals
about health issues
– Mobilizing community partnerships
– Developing policies and plans
 Assurance
Services that are necessary to achieve public health
goals are provided
– enforcing laws and regulations
– linking people to personal health care services
– assuring a competent workforce – public health and
personal care
– evaluating effectiveness, accessibility, quality of programs
provided
– Researching new insights and programs
 Essential Health Services
• Developed in 1994

• Issued by The US Public Health Service (Public

Health Functions Steering Committee)

• These services represented a further

development of the previously established
public health core functions

Source: J.A. Harrell, E.L. Baker and the Essential Services Work Groups. The Essential Services of Public Health.
American Public Health Association.
Available at /http://www.apha.org/ppp/science/10ES.htm. Accessed 1/13/06.
 Assessment Processes
(essential public health services)

1. Monitor health status to identify

community health problems

2. Diagnose & investigate health problems

and health hazards in the community
 Policy Development Processes
(essential public health services)
3. Inform, educate, and empower people
about health issues
4. Mobilize community partnerships to
identify and solve health problems
5. Develop policies and plans that support
individual and community health efforts
Assurance Processes (essential
public health services)
6. Enforce laws to protect health & safety
7. Link people with personal health services & provide
services when needed
8. Ensure a competent public health and personal health care
workforce
9. Evaluate effectiveness, accessibility, and quality of health
services
10. Support research on innovative solutions to health
problems
 A major question for public health…

Should a health department provide assurance of care

OR actually engage in the delivery of medical care?
• The 1988 report by the IOM strongly recommended the
assurance role rather than actual delivery

• Health Security Act (1993): Confirmed the role of public health

to provide population- based prevention, not direct provision
of medical services
 Public Health and the Delivery of Health
Care
• Federal programs of the 1960s (Medicare, Medicaid, etc.)
spurred growth of health services in local health departments

• Local health departments sponsored:

– 13 % of the neighborhood health centers
– 30 % of the child and youth projects
– 76 % of the maternal and infant care projects

• Involvement of local health departments in providing medical

care continued to increase over the following decades

Source: A. Miller and M.K. Moos, Local Health Departments: Fifteen Case Studies (Washington, DC: American Public Health Association, 1981)
 Core Functions and Essential Health
Services: Implementation
• Surveys of state public health agencies in 1989
revealed that they performed:
– Assessment (80%)
– Policy development (49%)
– Assurance (42%)

• Increase in delivery of personal services from 58% in

1989 to 83% in 1996
 National Objectives: Healthy People 2010
Objectives
• Released by the Department of Health and Human Resources
in 2000

• The framework was developed by leading federal agencies

who solicited the expertise of:
– More than 350 national membership organizations
– 250 state health, mental health, substance abuse, and environmental
agencies

• Two overarching goals:

– Increase quality and years of life
– Eliminate health disparities

Source: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, Healthy People 2010, About Healthy People.
Available at http://www.healthypeople.gov/. Accessed 1/13/06.
 Eliminate Health Disparities
• Reducing disparities (HP 2000) versus
eliminating health disparities (HP 2010)
• President Clinton (1998)
– Infant mortality
– Cancer
– Cardiovascular disease
– Diabetes
– HIV/AIDS
– Immunizations
 Healthy People 2010 Objectives (Cont’d)
• To meet these goals, 467 objectives are organized by
28 focus areas

• Ten leading indicators are specified to measure

progress in the nation’s health (Exhibit 2-6, p.57)

• Healthy People 2010 has 2 broad types of objectives

– Measurable objectives
– Developmental objectives
 Unique Features of Public Health
• Interdisciplinary Teams
• Social Justice Philosophy
• Link with Government
• Inherently Political Nature
• Expanding Agenda
• Grounding in Science
• Focus on Prevention
• Population Approach to Health
Source: A opted from Public Health: What It Is and How It Works, Bernard Turnock Aspen Publication 1997
 Governmental and Nongovernmental
Aspects of Public Health
• Contemporary relationships that support core public
health functions can be described
– (1) between different health agencies at various levels of
government
– (2) between health agencies and other public agencies
– (3) between health agencies and the private sector
– (4) between private and voluntary organizations

Source: Institute of Medicine, The Future of Public Health (Washington, DC: National Academy Press, 1988)
 The Public Health System
Police
Home Health
EMS Community Churches Corrections
Centers MCOs
Health
Department
Parks
Schools
Elected
Doctors Hospitals Officials Nursing Mass Transit
Philanthropist Homes
Environmental
Civic Groups Health
CHCs Fire
Tribal Health
Economic
Laboratory Drug Mental Employers
Development
Facilities Treatment Health
 How is Public Health Different from
Medicine?
• Medicine:
Public Health:
Primary
Primary
focusfocus
on individual
on population

Public Health Client: Community Medicine Client: Individual

Source: http://sphcm.washington.edu/about/whatis.asp
 10 most important achievements in public
health (1900-1999)
1. Vaccinations
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 drinking water
10. Recognition of tobacco use as a health hazard
Source: MMWR 48(12)241-243

Source: CDC. 10 Great Public Health Achievements-US-1900-1999. MMWR April 2, 1999/48(12); 241-43. Available on the internet: http://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm