Public Health 1

Monitor

Accurate, periodic assessment of the community's health status Utilization of methods and technology (e.g., GIS) to interpret and communicate data Population health registries Activities may include: Determining and monitoring water quality Mosquito surveillance Examining immunization rates STD/HIV testing Health screenings Child lead-poisoning surveillance

Develop Policies and Plans

Policy development to protect health and guide public health practice Community and state planning Alignment of resources to assure successful planning Activities may include: -State/local boards of health oversight, administration, and regulatory functions -Public hearings -Community health planning Updating of health and nuisance ordinances -Adopting rules for water management in well communities -Establishment of Procedures for water well permits Civil citation authority Procedures to deal with contaminated/high risk sites

Public Health vs. Medicine

Public Health and Medicine both seek to improve health, but the way they improve health is the difference PUBLIC HEALTH Looks at preventing disease and illness in populations MEDICINE Looks at treating disease and illness in individuals

Functions of Public Health

Public health has 3 main functions that it performs as given in the 1988 Institute of Medicine Report -Assessment Process of regularly collecting, assembling, analyzing information on the health of a community and making the information available -Policy development Serving the public interest through the development of public health policies -Assurance Ensuring that needed services are provided The Functions describe what public health does NOT what public health is

Public Health and Emergency Preparedness and Response

Public health's role in emergency preparedness and response involves the following areas: -Surveillance -Epidemiologic investigation and analysis -Laboratory Investigation and Analysis -Intervention -Risk Communication -Preparedness Planning -Community-Wide Response -Unique Aspects of Bioterrorism Emergencies -Workforce Preparedness

Enforce

Review, evaluation, and revision of legal authority, laws, and regulations Education about laws and regulations Advocating of regulations needed to protect and promote health Support of compliance efforts and enforcement as needed Activities may include: -Hazardous materials and sites inspections and certifications -Milk inspections -Professional licensure and regulation -Food inspections -Tanning and tattoo inspections -Enforcement of state/county/local health-related rules and ordinances

Definitions of Public Health

Science and art of preventing disease, prolonging life and promoting health and efficiency through organized community effort (Winslow, 1920) Successive re-definings of the unacceptable (Vickers, 1958) Fulfilling society's interest in assuring conditions in which people can be healthy (Institute of Medicine, 1988)

Assure

Assessment of the public health and personal health workforce Maintaining public health workforce standards Quality improvement and life-long learning Activities may include: -Food-service worker Safety Certification Course -Public health certification -Learning management system -Regional bio-emergency meetings -Public health practitioner performance evaluations -Sanitarian, water-contractor training -Certification of environmental health professionals

The Health System in the US

Economics -The US spends the most on healthcare than any other industrialized nation -Despite spending this much money, the US population is not healthier than other nations Demographic and Utilization Trends -The population is aging. More services needed for this segment of the population -Diverse population increasing. This increases the need for health professionals with cultural competence (sensitivity to different culture and ethnicities) -US leads industrialized nations in the number of people who lack health insurance

What influences health?

Elements that influence our health are: -RISK FACTORS-things that increase your risk of developing a health condition Examples: genetics, environmental factors, diet, stress, access to health services SOCIAL AND CULTURE INFLUENCES-things in society or one's culture that influence health -Examples: income, social class, GLOBAL HEALTH INFLUENCES -Examples: population size, pollution, poverty

Evaluate

Evaluation answers -Are we doing things right? Evaluation must be ongoing Evaluation should drive resource allocation and program improvement Activities may include: -Data management -Performance-plan monitoring -Public health contract requirements -Health needs assessments -Tracking responses to complaints

Unique features

Grounded in science -All of the main areas of public health are science based and help us understand the many levels of health and what influences health Focused on prevention -Overall, public health's goal is prevention. Prevention of death, disease, and all elements that can impact one's health Uncommon culture -Public health includes people from all different backgrounds who have a common goal. These groups work together to achieve this goal.

Measuring Health

Since there are so many elements that impact one's health, how can we measure health? Health is measured two ways: -Numbers that show the number of deaths known as mortality -Numbers that show sickness, disability, and quality of life Traditional mortality measures are: -Mortality-number of deaths -Life expectancy-how long someone is expected to live -Years of potential life lost (YPLL)-number of years someone's life is cut short from a certain death event. Other measures -Morbidity-number of people sick -Quality of life measures: Years of healthy life or Disability adjusted life years (DALY)-how many years does someone report good health free of disability or other issues

Health Services

Some of the strategies used to improve health are: -Health promotion-programs that attempt to modify behavior -Specific protection-activities that provide resistance or reduce harmful interactions to improve health -Early case finding-detecting a health issue early so that it can be treated -Disability limitation-limiting the effects of a disease or disability -Rehabilitation-returning a person with a health condition to a maximum level of function

Purpose of Public Health

The purposes of public health as outlined in the Public Health in America statement are: Prevent epidemics and the spread of disease Protect against environmental hazards Prevent injuries Promote and encourage healthy behaviors Respond to disasters and assist communities in recovery Ensure the quality and accessibility of health services

Role of the Federal Government

The world HEALTH does not appear in the Constitution Two areas interpreted as a way to allow the federal government involved in health -provide for the "general welfare" -power to regulate commerce, both international and interstate

Determinants of health

This figure shows the different elements that influence health and how they interact together

Diagnose and Investigate

Timely identification and investigation of health threats Availability of diagnostic services, including laboratory capacity Response plans to address major health threats Activities may include: Medical examiners Epidemiologists TB investigation HIV/AIDS investigations Investigation and evaluation of nuisance complaints assessments and site evaluations

Ten Great Public Health

Vaccinations Motor-vehicle safety Safer workplaces Control of infectious disease Decline in deaths from heart disease and strokeSafer and healthier food Healthier mothers and babies Family planning Fluoridation of drinking water Recognition of tobacco use as a health hazard

Defining Health

What do you think about when someone mentions the word health? -Do you think about what your physical health is? -Do you think about if you don't have any diseases or major health concerns? -Do you think about if you are stressed or not or other elements that may impact you mentally? The World Health Organization (WHO) defines health as the following: -"State of complete physical, mental and social well-being, and not merely the absence of disease or infirmity" (WHO, 1985)

Levels of Prevention

When addressing a health issue, there are three different levels where interventions can occur PRIMARY PREVENTION-preventing the disease or injury from occurring SECONDARY PREVENTION-identifying a disease early and preventing it from progressing TERTIARY PREVENTION-helping prevent the disability associated with a disease. Helping people deal with their disease so they can function at a maximum level.

1850-1949

1854, John Snow traced a cholera outbreak to a water pump at Broad Street and prevented the disease from spreading 1850, Lemuel Shattuck's report of the sanitary commission massachusetts outlined public health needs for the state and was America's blueprint for developing public health system 1870, states began to develop their own boards of health 1902, US Public Health Service founded 1913, first school of public health established-Harvard University

Health in the United States

Over the years our health has started improving: Increase in years people are living Better birth outcomes Disease changing from infectious to chronic Racial and ethnic disparities are increasing

Practice

PUBLIC HEALTH PRACTICE -Public health practice activities occur in public health agencies at the federal, state, and local level -Activities also occur in schools, social service agencies, industries, non profit health agencies, and in some medical settings MEDICINE -Medical practice involves traditional medical services given by a physical or other medical professional -Involves 3 levels: Primary-clinical preventive services, first contact services Secondary-specialized attention and management of medical conditions Tertiary-specialty referral care

Economic Dimension of Health

Many times to determine the economic impact of a health issue on a person or the population certain analysis are performed. COST-BENEFIT ANALYSIS Looks at the costs of a program compared to the benefits COST-EFFECTIVENESS ANALYSIS Looks at the cost of a specific outcome compared to other options to address an issue COST-UTILITY ANALYSIS Looks at the cost of a specific outcome as it relates to quality of life

What does this mean?

-MONITOR Understand health issues at the state and community levels What's going on in our state/community? Do we know how healthy we are? -Diagnose and investigate Identify and respond to health problems or threats Are we ready to respond? How quickly do we find out about problems? How effective is our response? -Inform, educate Keep people informed about health issues and concerns How well do we keep all people and segments informed about health issues? How accessible is this information? =Mobilize Engage people and organizations in health issues How well do we really get people and organizations engaged in health issues? =Develop policies and plans Plan and implement sound health policies What policies promote health? How effective are we in planning and in setting health policies? =Enforce Enforce public health laws and regulations When we enforce health regulations are we up-to-date, technically competent, fair and effective? -Link Make sure people receive the medical care they need. -Assure Maintain a competent public health and medical workforce. -Evaluate Evaluate and improve programs -Research Support innovation and identify and use best practices

10 Essential Services

-Monitor health status to identify and solve community health problems (Assessment) -Diagnose and investigate health problems and health hazards in the community (Assessment) -Inform, educate and empower people about health issues (Policy Development) -Mobilize community partnerships and action to identify and solve health problems (Policy Development) -Develop policies and plans that support individual and community health efforts (Policy Development) -Enforce laws and regulations that protect health and ensure safety (Policy Development) -Link people to needed personal health services and assure the provision of health care when otherwise unavailable (Assurance) -Assure competent public and personal health care workforce (Assurance) -Evaluate effectiveness, accessibility, and quality of personal and population-based health services (Assurance and Assessment) -Research for new insights and innovative solutions to health problems (All 3 functions)

Mobilize

Constituency development and identification of system partners and stakeholders Coalition development Formal and informal partnerships to promote health improvement Activities may include: -Tobacco-free coalitions -Bio-emergency regional collaboration -Collaborative efforts with private industry to combat domestic violence -Community partnerships with law enforcement, county attorneys, community betterment groups, and housing authorities -Referrals and collaboration with health-care providers -Collaboration with WIC, public health nursing, and special population advocates to meet the needs of special populations

Public Health Code of Ethics

Humans have a right to the resources necessary for health. Humans are inherently social and interdependent. The effectiveness of institutions depends heavily on the public's trust. Collaboration is a key element to public health. People and their physical environment are interdependent. Each person in a community should have an opportunity to contribute to public discourse. Identifying and promoting the fundamental requirements for health in a community are of primary concern to public health. Knowledge is important and powerful. Science is the basis for much of our public health knowledge. People are responsible to act on the basis of what they know. Action is not based on information alone.

Socioecological Model

INDIVIDUAL -Things that a persons does individual that contributes to their health INTERPERSONAL -The influence others have on an individuals health (family, friends, coworkers) ORGANIZATIONAL -The structure of where you work, play and how they impact your health COMMUNITY -The environment you live in and how it impacts your health SOCIETY -Policies and laws that impact your health

Research

Identification and monitoring of innovative solutions and cutting-edge research to advance public health Linkages between public health practice and academic / research settings Epidemiological studies, health policy analyses and health systems research. Activities may include: -Health needs assessments -Bio-emergency survey participation -Customer service evaluations -Study of successful public health programs in other jurisdictions -Research on water-treatment methods

Link

Identifying populations with barriers to care Ongoing care management Culturally appropriate and targeted health information for at risk population groups Activities may include: TB program -Public health nursing services -Breast and cervical cancer early detection program -WIC/Maternal and child health -Critical access hospitals -Linkages to regional landfills for disposal options -Informing the public on useful nuisance-abatement websites

Infectious diseases to chronic

Improvements in sanitation, housing, and other factors have eliminated exposure to and spread of infectious disease Because people are not exposed to infectious disease, they started living longer With a longer life, people become more susceptible to chronic diseases such as heart disease, diabetes, etc. If someone is more susceptible to chronic disease as they age, they are more likely to die from a chronic disease

Essential Public Health Services

In addition to the 3 function of public health, there are 10 essential services of public health. These services describe what public health activities should take place in all communities. These services also provide a working definition of public health and a guiding framework for the responsibilities of local public health systems.

Public Health Perspective

In public health, health is viewed as a combination of different factors interacting together to produce a certain outcome. This view is called the socioecological perspective or model This is also known as the "big picture" meaning you look at all dimensions of someone's life to see what impacts their health

Inform, Educate

Initiatives using health education and communication sciences Health education and health promotion partnerships within the community to support healthy living Media advocacy and social marketing Activities may include: -Community health education and health promotion -Public health education through the media, presentations, the internet, displays, etc. -HIV/AIDS risk reduction curricula -Child-abuse education -Domestic violence education -WIC educational programs -Informing and educating parties involved in nuisance investigations -Public education about well construction

21st Century Public Health Practice

The community is where pubic health meets different health threats and addresses different health concerns Community simply means a group of people with something in common. A community could be your neighborhood, place of work, where you go to school, the dorm you live in, your family, etc