Public Health What it is and Why you should care. Virginia M. Dato

Public Health What it is and Why you should care. Virginia M. Dato MD MPH FACPM FAAP President American Association of Public Health Physicians [email protected]

Clinical Medicine Diagnosing symptoms Enhancing the Capacity to Function Treating and preventing diseases Relieving Pain medicine & public health the power of collaboration Providing Comfort

The Public Health Perspective Implementing and evaluating population based strategies to promote health and prevent disease Developing and Enforcing Public Health Laws Assessing and monitoring health problems Assuring the provision of essential health services medicine & public health the power of collaboration

Public Health is the science and art of (1) preventing disease, (2) prolonging life, and (3) promoting health and efficiency through organized community efforts for the sanitation of the environment, the control of community infections, the education of the individual, the organization of medical and nursing service for the early diagnosis and preventive treatment of disease, and the development of the social machinery which will ensure to everyone a standard of living adequate for the maintenance of health. So organizing these benefits as to enable every citizen to realize his birthright of health and longevity. C.E.A. Winslow, 1920

Public Health Organized community efforts aimed at the prevention of disease and promotion of health. It links many disciplines and rests upon the scientific core of Epidemiology (The Future of Public Health)

The Organizational Framework of Public Health Encompasses both activities undertaken within the formal structure of government and the associated efforts of private and voluntary organizations and individuals” “ (The Future of Public Health)

Mission of Public Health The fulfillment of society’s interest in assuring the conditions in which people can be healthy - (The Future of Public Health)

The fundamental obligation of agencies responsible for population-based health is to: Prevent epidemics and the spread of disease Protect against environmental hazards Prevent injuries

Promote and encourage healthy behaviors and mental health Respond to disasters and assist communities in recovery Assure the quality and accessibility of health services

Vision Healthy People in Healthy Communities

Mission Promote physical and mental health and prevent disease, injury, and disability.

Old Wine In New Bottles F. Douglas Scutchfield Panacea and Hygeia - the Greek Gods of Healing and Health Hippocrates “urged physicians to pay attention to the environment, social, and behavioral context in which illness occurs” – medicine & public health

“When a committee of the Massachusetts legislature confidently asserted, on May 22, 1869 that all governments since the time of Moses had made provision to protect the life and health of their people, the legislators affirmed a tradition of corporate responsibility for the welfare of their people.” From Public Health and the State - Changing Views in Massachusetts, 1842-1936 - Barbara Gutman Rosenkrantz Harvard University Press - 1972

Historical Relationship an early supportive relationship prior to the early 20th century a period of professionalization and practice transformation spurred by the emergence of bacteriology an acceleration of functional separation in the postWorld War II era the brave new world of managed care and cost emphasis New understanding of public health in the post 9/11/01 world

Why should you care about Public Health? Duty and obligation (codified in law) to report certain conditions and cooperate with authorities. Help get individual patients services they need Help improve the legal, financial and social environment that you work in.

Medicine and Public Health Synergies - Models of Collaboration Medicine & Public Health, The Power of Collaboration I. Improving health care by coordinating services for individuals II. Improving access to care by establishing frameworks to provide care for the uninsured III. Improving the quality and costeffectiveness of care by applying a population perspective

IV Using clinical practice to identify and address community health problems V Strengthening health promotion and health protection by mobilizing community campaigns VI Shaping the future direction of the health system by collaborating around policy, training and research.

Amendment 10 The powers not delgated to the United States by the Consitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.

The “police power” Sovereign power of states To provide for health, safety, & welfare Delegated to local governments Delegated to the federal government

Formal Structure of Government in the US Federal Government – commerce – funding – national security State Government – primary responsibility Local Government – as delegated by the state

Pennsylvania "communicable disease declared reportable by regulation" or " any unusual or group expression of illness which in the opinion of the Secretary, may be a public health emergency" is covered under Chapter 3 of the Consolidated Statues Prevention of Spread of Diseases Communicable Diseases. Reports are covered under 521.4 of the Diseases Prevention and Control Law of 1955.

How Does Public Health Work?

Core Functions Assessment Policy Development Assurance

The Ten Essential Services of Public Health

Assessment The assessment function is the collection, assemble, analysis and distribution of information on the community's health

The Ten Essential Services - Assessment Monitor health status to identify community health problems Diagnose and investigate health problems and health hazards in the community Evaluate effectiveness, accessibility, and quality of personal and population-based health services

Policy Development This core function involves the development of comprehensive policies based upon scientific knowledge and decision making.

The Ten Essential Services - Policy 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

Assurance The committee recommended that a set of personal and community-wide services be determined by involving key policy makers and the general public. Once identified, the committee recommended that these services be provided to all members of the community either though encouraging actions by others, by requiring action by others or by direct provision.

The Ten Essential Services - Assurance Assure a competent public health and personal health care workforce 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

The Tenth Essential Service Impacts Assessment, Policy and Assurance Research for new insights and innovative solutions to health problems

Examples of the 10 Essential Services in Action

Monitor health status to identify community health problems Examples: Death Certificates, Birth Certificates, Immunizations Registries, Surveillance

Diagnose and investigate health problems and health hazards in the community Examples: Outbreak Investigations, Child Death Review Boards

Inform, educate, and empower people about health issues Example:Lead Paint displays in hardware stores, New Releases on Rabies and West Nile Virus

Mobilize community partnerships to identify and solve health problems Example: ACHD Tobacco Stakeholders Group, Advisory Boards, Collaborative Activities

Develop policies and plans that support individual and community health efforts Example: Smoking Bans, Helmet Laws, Restaurant Inspection Laws

Enforce laws and regulations that protect health and ensure safety Example: Food Inspection Certificates, Enforcement of Smoking Regulations

Link people to needed personal health services and assure the provision of health care when otherwise unavailable Example: Children’s Health Insurance Programs, Federally Qualified Centers.

Assure a competent public health and personal health care workforce. Example:Conferences, Training programs, journals, School of Public Health, Satellite Programs, Certifications

Evaluate effectiveness, accessibility, and quality of personal and population-based health services Example: Outcome evaluation and Economic Analyses

Research for new insights and innovative solutions to health problems Example: Programs Needle Exchange

Example: Heart Disease 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 Assure a competent public health and personal health care workforce

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

Evaluate effectiveness, accessibility, and quality of personal and population-based health services Research for new insights and innovative solutions to health problems

Exercise: Think about a current public health problem faced by you or your institution. Take that public health problem or issue and think about how the 10 essential services of public health can solve that problem.

“Never doubt that a small group of throughtful, committed citizens can change the world; indeed, it is the only think that ever has” Margaret Mead