Public Health An Introduction. Public Health in the U.S. This introduction provides a broad overview of public health – what it is, its origins and evolution.

Public Health

An Introduction

Public Health in the U.S.

• This introduction provides a broad overview of public health – what it is, its origins and evolution and how it is structured and administered at the federal, state and local levels in the United States.

What Is Public Health?

• It is often easier to talk about examples of public health initiatives, such as vaccination programs and milk pasteurization, than to describe exactly what public health is.

• http://www.youtube.com/watch?v=R1aloiSY3dI

What Are You Studying?

• Suppose your Uncle Joe stops you and asks you what is Public Health?

• What would you tell him?

Uncle Joe

Public Health Accomplishments: A Field That Makes A Difference

• Technology, science, the arts: Lots of disciplines improve and enrich our lives.

• But none can match public health in extending the length – and improving the quality – of life in the United States over the past century.

Increased Years of Life

40

45

50

55

60

65

70

75

80

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000

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How did we add 30 years in one century?

• Mostly through the accomplishments of public health.

• Five of the 30 years can be attributed to improvements in medicine and drugs.

• The other years are due to various public health initiatives.

Contributions to Increase Life Expectancy

Public Health Accomplishments

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

The Evolving Need for Public Health 1700s-1800s

• The Age of Industrialization• People moved from the farms to the cities• Small pox inoculations - Lady Mary Wortley Montagu• Development of the smallpox vaccine - Edward Jenner• Introduction of epidemiology – John Snow• The Germ Theory of Disease - Louis Pasteur • The four postulates of infectious disease – Robert Koch• The unhealthy conditions of New York City tenements – Lillian Wald

Lady Mary Wortley Montagu Lillian Wald

Snow: The Initial Investigations

• Snow on Cholera http://www.ph.ucla.edu/epi/snow/Snowpart1_files/frame.htm

• The Initial Investigations http://breeze.unc.edu/p60491740/

• Next Steps http://breeze.unc.edu/p15812471/• Snow Takes Action http://breeze.unc.edu/p24403330/• Further Investigation http://breeze.unc.edu/p17552645/• The Case of the Hampstead Widow

http://breeze.unc.edu/p35464436/

The Evolving Need for Public Health 1900s to the Present

• 1918 Influenza Pandemic• In 1964, the U.S. Surgeon General report

on cigarette smoking and its connection with cancer

• In 1981, the HIV-AIDS virus was first recognized

• In 1990, as awareness of the relationship between diet and disease increased

• In 2001, the threat of bioterrorism

Development of the U.S. Public Health Infrastructure

1798. The U.S. Public Health Service

The first marine hospital owned by the Federal Government was purchased from the State of Virginia in 1801 and was located at Washington Point in Norfolk County.

Other Public Health Infrastructure Developments

• 1798: First local public health board

• 1870s: State boards of health created

• Late-1800s: Shift to social reform as strategy for public health

• 1970s – 1990s: Public health’s responsibilities broaden to include chronic diseases

Lemuel Shattuck New York, New York. Bread line beside

the Brooklyn Bridge approach, 1930s.

Public Health Today

• “Old” infectious diseases, such as tuberculosis, rear their ugly heads with new, more virulent strains,

• “Newer” diseases, such as West Nile virus and Severe Acute Respiratory Syndrome (SARS), have emerged.

• Infectious agents can travel faster – and farther – than ever before

• “Chronic” conditions, such as diabetes, heart disease, cancer and obesity, have become the leading causes of death and disability.

Public Health Today (Continued)

• The anthrax crisis of 2001

• Sudden Acute Respiratory Syndrome (SARS)

• Monkey virus

Public Health in the Future

• Public health issues are difficult to predict and are episodic (such as the spread of a new infectious disease).

• Other challenges are very predictable such as the impact of smoking and chronic diseases

• To be prepared the U.S. government has established national health objectives called “Healthy People 2010”

Goals of Healthy People 2010

• Goal 1: Increase quality and years of healthy lifeHelp individuals of all ages to increase life expectancy and improve their quality of life.

• Goal 2: Eliminate health disparitiesHelp our nation eliminate health disparities among different segments of our population.

What Are the Leading Health Indicators?

• Will be used to measure the health of the Nation over the next 10 years.

• Each of the 10 Leading Health Indicators has one or more objectives from Healthy People 2010 associated with it.

• Each were selected on the basis of their ability to motivate action, the availability of data to measure progress, and their importance as public health issues.

What Are the Leading Health Indicators? (continued)

• Physical Activity  • Overweight and Obesity  • Tobacco Use  • Substance Abuse  • Responsible Sexual Behavior  • Mental Health  • Injury and Violence  • Environmental Quality  • Immunization  • Access to Health Care 

Who is Responsible for the Public’s Health?

• Government agencies– federal, – state and – local

• Non-governmental agencies, such as non-profit organizations.

Federal Authority and Responsibility

• The colonies’ Suspicion of a strong central government has led to dominance of the states and local governments

• Health as a federal responsibility is not specifically mentioned in the Constitution.

Interpretation of the Constitution

• The Preamble to the Constitution

• Section 8 of Article I

Overview of Health and Human Services

• Responsible for protecting the health of Americans and providing essential human services, especially for citizens least able to help themselves

• it is charged with most (but not all) public health activities.

• The Secretary of Health and Human Services serves as a member of the President's Cabinet. is appointed by the President and must be approved by the U.S. Senate.

National Organizations For Public Health Professionals

• American Public Health Association

• Association of State and Territorial Health Officials

• National Association of City and County Health Officers

• HRSA Public Health Training Centers Network

State Authority and Responsibilities

• The more complete and coordinated structure for public health activities is at the state and local levels.

• Various states have taken different approaches to organizing and administering public health.

• Centralized vs. decentralized

Local Health Departments and Boards of Health

• Each community has its own unique local public health system

• Generally, public health decisions at the local level are made by professionals at regional or county health departments and by their boards of health.

• Public health practitioners at these departments are responsible for ensuring that all members of the community are served. Generally, a local board of health has primary responsibility and legal authority for public health decisions.

Role of Non-Governmental Entities

• Organizations that are not part of the government also play a vital role in the U.S. public health infrastructure.

• These organizations include hospitals, health care providers in private practice, and health plans.

• Private, non-profit organizations, too, contribute to public health’s mission. Among them are the United Way, American Red Cross and American Cancer Association.

Summary of Public Health Organizational Structure

• Primary responsibility and authority for public health in the U.S. is assigned to federal, state and local public health agencies

• Federal agencies set policy and standards and provide guidance and funding;

• State agencies define policies and establish and help fund local or regional public health initiatives; and

• Local/regional health departments implement public health programs.