Overview of Public Health

1. Overview of Public Health Lisa Macon Harrison and Debi Nelson Welcome to the Overview of Public Health Training, sponsored by the North Carolina Center for Public Health Preparedness. This training is designed to provide an awareness level of knowledge on the key concepts of public health.Welcome to the Overview of Public Health Training, sponsored by the North Carolina Center for Public Health Preparedness. This training is designed to provide an awareness level of knowledge on the key concepts of public health.

2. Learning Objectives Define public health Examine the history of public health Identify the three core functions and 10 essential services of public health Understand public health competencies Explore the role of cultural competency in public health Understand public health advocacy and policy making Relationship of state and local public health In this training, we will begin by defining public health and providing a brief history of public health in the US. We will then discuss the 10 essential services of public health and how they guided the creation of public health competencies. Understanding the goals and mission of public health, it is important to ensure that these services reach all those within a population, and this is achieved through cultural competency. We will conclude with a look at the administrative aspects of public health in advocacy and policy making. In this training, we will begin by defining public health and providing a brief history of public health in the US. We will then discuss the 10 essential services of public health and how they guided the creation of public health competencies. Understanding the goals and mission of public health, it is important to ensure that these services reach all those within a population, and this is achieved through cultural competency. We will conclude with a look at the administrative aspects of public health in advocacy and policy making.

3. Health - A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Public health - The science and art of preventing disease, prolonging life, and promoting health through organized efforts of society. Public Health - Definition In 1946, two years before the formation of The World Health Organization, the International Health Conference defined health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. This definition, which has not been changed since its inception, shows the multi-faceted nature of health. Being healthy does not simply mean being disease free. With this in mind, public health can be defined as the science and art of preventing disease, prolonging life, and promoting health through organized efforts of society. Science and art refer to the broad applications in the public health realm. There are the hard sciences � microbiology, statistics, biology, etc.; but there are also facets that are more artistic or socially oriented. For example policy, behavioral, educational or programmatic aspects of public health. Another important part of the definition is the �organized efforts of society�. Public health is a population approach to health, not an individual approach. The ultimate goal of public health is to improve the health of the community. This does not necessarily mean that every individual in that community will be healthy (although that is certainly desired), but rather, when all the individuals are considered collectively, there is an improvement in health. Public health is dynamic, and responds to the needs of the society as they change over time. In 1946, two years before the formation of The World Health Organization, the International Health Conference defined health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. This definition, which has not been changed since its inception, shows the multi-faceted nature of health. Being healthy does not simply mean being disease free. With this in mind, public health can be defined as the science and art of preventing disease, prolonging life, and promoting health through organized efforts of society. Science and art refer to the broad applications in the public health realm. There are the hard sciences � microbiology, statistics, biology, etc.; but there are also facets that are more artistic or socially oriented. For example policy, behavioral, educational or programmatic aspects of public health. Another important part of the definition is the �organized efforts of society�. Public health is a population approach to health, not an individual approach. The ultimate goal of public health is to improve the health of the community. This does not necessarily mean that every individual in that community will be healthy (although that is certainly desired), but rather, when all the individuals are considered collectively, there is an improvement in health. Public health is dynamic, and responds to the needs of the society as they change over time.

4. Public Health Mission: �To promote physical and mental health, and prevent disease, injury, and disability� The mission of public health is �To promote physical and mental health, and prevent disease, injury, and disability.� This The mission of public health is �To promote physical and mental health, and prevent disease, injury, and disability.� This

5. Public Health Functions Prevents epidemics and the spread of disease Protects against environmental hazards Prevents injuries Promotes and encourages healthy behaviors Responds to disasters and assists communities in recovery Assures the quality and accessibility of health services There are many ways in which public health promotes physical and mental health and prevents disease, injury, and disability. Some of the basic public health functions are: Prevents epidemics and the spread of disease Protects against environmental hazards Prevents injuries Promotes and encourages healthy behaviors Responds to disasters and assists communities in recovery Assures the quality and accessibility of health services There are many ways in which public health promotes physical and mental health and prevents disease, injury, and disability. Some of the basic public health functions are: Prevents epidemics and the spread of disease Protects against environmental hazards Prevents injuries Promotes and encourages healthy behaviors Responds to disasters and assists communities in recovery Assures the quality and accessibility of health services

6. History of Public Health in the US Lets begin with a discussion of the history of public health in the US. While the need for an organized public health infrastructure was not limited to the US, it is easiest to narrow this discussion to the scope of public health in the United States. Most countries develop public health infrastructure reactively, in response to adverse events in the health of a given population.Lets begin with a discussion of the history of public health in the US. While the need for an organized public health infrastructure was not limited to the US, it is easiest to narrow this discussion to the scope of public health in the United States. Most countries develop public health infrastructure reactively, in response to adverse events in the health of a given population.

7. Need for Public Health Agencies Epidemics of acute infections Cholera epidemics in 1832, 1849, 1866 and 1873 Smallpox epidemics in Native Americans Yellow Fever epidemics in 1793, 1878-1879 No antibiotics, no knowledge of treatment No organized health system to care for ill Quarantine and isolation only method of protecting health of the public In the US, there was a dire need for public health infrastructure in response to numerous epidemics. Many people died of epidemics of infectious diseases, including cholera, smallpox, and yellow fever. Each of these diseases have caused large outbreaks throughout the history of early America. One smallpox epidemic in 1617 resulted in the death of almost 90% of the Massachusetts Bay Indians. These diseases spread throughout communities due to poor sanitation and the close proximity in which most people lived. In a more general look at the state of healthcare in the US, there was very little known about how diseases spread, and even less known about effective treatment of such diseases. Antibiotics and other treatment methods that have greatly decreased the spread of disease were not discovered until the 20th century. Additionally, there were few, if any, hospitals, and the lack of medical knowledge meant there were no skilled physicians to prevent the spread of disease. The only way to deal with disease epidemics was to quarantine and isolate infected persons in pest houses or almshouses where they were kept away from those who were not infected. In the US, there was a dire need for public health infrastructure in response to numerous epidemics. Many people died of epidemics of infectious diseases, including cholera, smallpox, and yellow fever. Each of these diseases have caused large outbreaks throughout the history of early America. One smallpox epidemic in 1617 resulted in the death of almost 90% of the Massachusetts Bay Indians. These diseases spread throughout communities due to poor sanitation and the close proximity in which most people lived. In a more general look at the state of healthcare in the US, there was very little known about how diseases spread, and even less known about effective treatment of such diseases. Antibiotics and other treatment methods that have greatly decreased the spread of disease were not discovered until the 20th century. Additionally, there were few, if any, hospitals, and the lack of medical knowledge meant there were no skilled physicians to prevent the spread of disease. The only way to deal with disease epidemics was to quarantine and isolate infected persons in pest houses or almshouses where they were kept away from those who were not infected.

8. Advances in Study of Infectious Disease John Snow, Cholera outbreak, 1854 Conducted epidemiologic investigation to find source of outbreak Had pump handle removed, ended the outbreak Germ theory The theory that microorganisms may be the cause of some or all disease Based on scientific evidence In the 1800s, great advances were made in understanding the cause and prevention of disease. These advances were not necessarily made in the United States, but the sharing of knowledge throughout the scientific community had benefits abroad. One of the most well-known figures in studying the cause of disease was a doctor named John Snow who lived from 1813 through 1858 in Great Britain. Snow is most famous for his study of cholera outbreaks and produced a work entitled �On the Mode of Communication of Cholera� which he published in 1849 and revised in 1855. During a cholera epidemic in 1854, he conducted an epidemiologic investigation and observed that most cases centered around a particular water pump in a section of London. He recommended to city officials that the pump be removed, and the outbreak in that section of London ended. Snow�s work supported the concept of the Germ theory, which was developed through a series of experiments and observations by numerous scientists throughout the mid 1800s. The germ theory was a scientific explanation of what caused disease, whereas before this theory, many believed disease was caused by bad air, sinful behavior, and other unsupported theories.In the 1800s, great advances were made in understanding the cause and prevention of disease. These advances were not necessarily made in the United States, but the sharing of knowledge throughout the scientific community had benefits abroad. One of the most well-known figures in studying the cause of disease was a doctor named John Snow who lived from 1813 through 1858 in Great Britain. Snow is most famous for his study of cholera outbreaks and produced a work entitled �On the Mode of Communication of Cholera� which he published in 1849 and revised in 1855. During a cholera epidemic in 1854, he conducted an epidemiologic investigation and observed that most cases centered around a particular water pump in a section of London. He recommended to city officials that the pump be removed, and the outbreak in that section of London ended. Snow�s work supported the concept of the Germ theory, which was developed through a series of experiments and observations by numerous scientists throughout the mid 1800s. The germ theory was a scientific explanation of what caused disease, whereas before this theory, many believed disease was caused by bad air, sinful behavior, and other unsupported theories.

9. Development of Public Health Programs Marine Hospital Service (1798 - 1902) Public Health and Marine Hospital Service (1902 - 1912) Public Health Service (1912 - present) These scientific breakthroughs led to a more practical approach to preventing infectious disease epidemics, and more focus was given to preventing the spread of infectious diseases. The extensive impact of infectious diseases during the 300 years of settlement in America necessitated some sort of public health response. This need grew as urban centers developed and grew. The largest urban centers developed in sea ports, and the combination of overcrowding, unsanitary conditions and the continual importation of disease from ships meant these areas were continually ravaged by infectious diseases. As the problems grew and people began to recognize the role of sanitation in the control of infectious diseases, local boards of health, county health departments and state health departments, as well as a national public health agency developed. In 1798 a collection of hospitals in port cities constituted the Marine Hospital Service that served sick sailors. It�s duties gradually broadened through it�s existence into the 1900s. In 1870, it became a more organized and official federal agency and soon after took responsibility for the new port quarantine law enacted in 1878. At that time, quarantine was used as the most effective prevention of infectious disease. In 1889, a Commissioned Corps was developed who became the men of the Public Health Service. They assisted the Marine Hospital Service in performing quarantine and other disease control related tasks and investigations. Here we see a picture of the Public Health Service officers in 1905 in New Orleans. In 1912 the Public Health and Marine Hospital Service was shortened to simply the Public Health Service. And to this day the Public Health Service exists and serves both domestically and internationally.These scientific breakthroughs led to a more practical approach to preventing infectious disease epidemics, and more focus was given to preventing the spread of infectious diseases. The extensive impact of infectious diseases during the 300 years of settlement in America necessitated some sort of public health response. This need grew as urban centers developed and grew. The largest urban centers developed in sea ports, and the combination of overcrowding, unsanitary conditions and the continual importation of disease from ships meant these areas were continually ravaged by infectious diseases. As the problems grew and people began to recognize the role of sanitation in the control of infectious diseases, local boards of health, county health departments and state health departments, as well as a national public health agency developed. In 1798 a collection of hospitals in port cities constituted the Marine Hospital Service that served sick sailors. It�s duties gradually broadened through it�s existence into the 1900s. In 1870, it became a more organized and official federal agency and soon after took responsibility for the new port quarantine law enacted in 1878. At that time, quarantine was used as the most effective prevention of infectious disease. In 1889, a Commissioned Corps was developed who became the men of the Public Health Service. They assisted the Marine Hospital Service in performing quarantine and other disease control related tasks and investigations. Here we see a picture of the Public Health Service officers in 1905 in New Orleans. In 1912 the Public Health and Marine Hospital Service was shortened to simply the Public Health Service. And to this day the Public Health Service exists and serves both domestically and internationally.

10. Development of the Public Health Infrastructure 1855 - First state health department, Louisiana 1911 - First NC county health department, Guilford County 1918 � First oral public health program in U.S. 1942 � 1945 - Malaria Control in War Areas 1946 � Communicable Disease Center formed During this time, the first state health department developed in Louisiana in 1855. In 1911, Guilford county, North Carolina became the site of the first county health department in North Carolina and only the second county health department in the nation. In 1942, under the direction of the Public Health Service, the Office of Malaria Control in War Areas was developed to control the occurrence of malaria in the southeast where many of the country�s military bases were located during World War two. In 1946, the name was changed to the Communicable Disease Center (CDC) and began actively taking on the task of malaria control and elimination in the United States. During this time, the first state health department developed in Louisiana in 1855. In 1911, Guilford county, North Carolina became the site of the first county health department in North Carolina and only the second county health department in the nation. In 1942, under the direction of the Public Health Service, the Office of Malaria Control in War Areas was developed to control the occurrence of malaria in the southeast where many of the country�s military bases were located during World War two. In 1946, the name was changed to the Communicable Disease Center (CDC) and began actively taking on the task of malaria control and elimination in the United States.

11. CDC�s Mission To promote health and quality of life by preventing and controlling disease, injury, and disability. From those beginnings the CDC, now the Centers for Disease Control and Prevention, has grown into an internationally recognized collection of centers committed to promoting health and quality of life by preventing and controlling disease, injury, and disability. From those beginnings the CDC, now the Centers for Disease Control and Prevention, has grown into an internationally recognized collection of centers committed to promoting health and quality of life by preventing and controlling disease, injury, and disability.

12. World Health Organization Formed April 7, 1948 Objective - The attainment by all peoples of the highest possible level of health Smallpox eradication Initiated in 1967 Last naturally occurring case in 1977 Certified eradicated in 1980 Polio eradication Initiated in 1988 Endemic in 6 counties with less than 800 cases occurring in 2003 It is also worth mentioning the global public health organization that was developing around this same time. As the CDC was forming and beginning it�s work on eliminating malaria from North America, the World Health Organization was formed on April 7, 1948 as the United Nation�s agency for health. It�s objective was and continues to be the attainment by all peoples of the highest possible level of health. I�ll remind you that, as was stated at the beginning of this lecture, health is defined as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The World Health Organization directed the most impressive public health accomplishment in history � the eradication of smallpox. The eradication campaign was initiated in 1967 and ten years later, in 1977, the last naturally-acquired case occurred in Somalia. In 1980, the World Health Organization officially declared the world free of smallpox. Not too long after this accomplishment, the World Health Organization initiated the polio eradication campaign in 1988. The goal was to rid the world of polio by 2000 through the use of cheap and effective oral vaccination. This project is still ongoing and currently polio is endemic in only 6 countries � Afghanistan, Egypt, India, Niger, Nigeria and Pakistan, causing fewer than 800 cases in 2003. This in and of itself is a huge accomplishment � the prevention of countless cases of childhood paralysis, and many are hopeful that in the coming years, we will witness the eradication of the second disease in history. It is also worth mentioning the global public health organization that was developing around this same time. As the CDC was forming and beginning it�s work on eliminating malaria from North America, the World Health Organization was formed on April 7, 1948 as the United Nation�s agency for health. It�s objective was and continues to be the attainment by all peoples of the highest possible level of health. I�ll remind you that, as was stated at the beginning of this lecture, health is defined as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The World Health Organization directed the most impressive public health accomplishment in history � the eradication of smallpox. The eradication campaign was initiated in 1967 and ten years later, in 1977, the last naturally-acquired case occurred in Somalia. In 1980, the World Health Organization officially declared the world free of smallpox. Not too long after this accomplishment, the World Health Organization initiated the polio eradication campaign in 1988. The goal was to rid the world of polio by 2000 through the use of cheap and effective oral vaccination. This project is still ongoing and currently polio is endemic in only 6 countries � Afghanistan, Egypt, India, Niger, Nigeria and Pakistan, causing fewer than 800 cases in 2003. This in and of itself is a huge accomplishment � the prevention of countless cases of childhood paralysis, and many are hopeful that in the coming years, we will witness the eradication of the second disease in history.

13. World Health Organization Priorities for 2004 � 2005 Malaria TB HIV/AIDS Cancer, cardiovascular disease and diabetes Tobacco Maternal health Health and environment Food safety Mental health Safe blood Health systems The World Health Organization does much more than promoting health by preventing infectious disease. Currently, the World Health Organization has six regional offices around the world along with numerous other collaborating centers. Together, they have identified the top priorities for 2004 and 2005. These include addressing issues related to Malaria, Tuberculosis, HIV/AIDS, Cancer, cardiovascular disease and diabetes, Tobacco, Maternal health, Health and environment, Food safety, Mental health, Safe blood, and Health systems. Although these priorities are established and overseen by the World Health Organization, it is the day to day work and persistence of local health departments, doth domestically and internationally, that will allow us to address these important issues.The World Health Organization does much more than promoting health by preventing infectious disease. Currently, the World Health Organization has six regional offices around the world along with numerous other collaborating centers. Together, they have identified the top priorities for 2004 and 2005. These include addressing issues related to Malaria, Tuberculosis, HIV/AIDS, Cancer, cardiovascular disease and diabetes, Tobacco, Maternal health, Health and environment, Food safety, Mental health, Safe blood, and Health systems. Although these priorities are established and overseen by the World Health Organization, it is the day to day work and persistence of local health departments, doth domestically and internationally, that will allow us to address these important issues.

14. Milestones in Public Health Over the Last 100 Years Vaccines and the eradication of smallpox Automotive safety Environmental health Infectious disease control Cancer screening Cardiovascular disease risk assessment Safer and healthier foods Advances in maternal and child health Oral health Addiction and substance abuse (tobacco) US Public health infrastructure For more information: request a free book from Pfizer www.pfizerpublichealth.com See the introduction and beginning pages of the book, Milestones in Public Health by Pfizer More information: www.pfizerpublichealth.comSee the introduction and beginning pages of the book, Milestones in Public Health by Pfizer More information: www.pfizerpublichealth.com

15. Health Influences This public health infrastructure that has developed over the past 2 centuries originated from the need to protect the health of populations. The provision of public health services requires a comprehensive knowledge of factors that influence the health of communities. This public health infrastructure that has developed over the past 2 centuries originated from the need to protect the health of populations. The provision of public health services requires a comprehensive knowledge of factors that influence the health of communities.

16. What Influences Health? Determinant : �any factor, that brings about [causes] change in a health condition or other defined characteristic�1 The level of the determinant influences the level of the health problem Risk: the likelihood or probability that an event will occur Risk factor: any factor that is associated with a change in the risk that a health condition will occur, but is not proven to cause that change Influence: a term that we will use to encompasses both determinants and risk factors