Public Health Principles and Practices: A Platform for College Health

1. Public Health Principles and Practices: A Platform for College Health Edward P. Ehlinger, MD, MSPH Director and Chief Health Officer Boynton Health Service University of Minnesota June 4, 2010 eehlinger@bhs.umn.edu

2. Ruth Westheimer born Karola Ruth Siegel on June 4, 1928 • "Talking from morning to night about sex has helped my skiing, because I talk about movement, about looking good, about taking risks."

3. Rosalind Russell born on June 4, 1911 • “Flops are a part of life's menu and I've never been a girl to miss out on any of the courses.”

4. Ruth Westheimer born Karola Ruth Siegel on June 4, 1928 • “Don't stint on foreplay -- or afterplay. Be inventive!”

5. Dik Browne American cartoonist died on June 4, 1989He wrote and illustrated Hagar the Horrible and illustrated Hi and Lois Examples of strips of his published on June 4th

6. Dik Browne American cartoonist died on June 4, 1989 Financial pressures Healthcare reform

7. The future of College Health is uncertain • Healthcare reform will raise questions that will threaten the existence of college health • “Everyone will have insurance so why have a health service?” • “Everyone will have insurance so what is the need for a health service fee?” • Some entrepreneurs may see healthcare reform as an opportunity to gain some college health business. • Some in college health may see healthcare reform as an opportunity to change the model of college health.

8. Rosalind Russell born on June 4, 1911 • "When something happens to you, you either let it defeat you, or you defeat it.“

9. How will you respond to those questions and challenges? How will you convince your college/university that what you provide is unique and best meets the needs of students (and others) on your campus and the needs of your institution?

10. Health is essential to the mission of Post-Secondary Education • “When health is absent, wisdom cannot reveal itself, art cannot become manifest, strength cannot fight, wealth becomes useless, and intelligence cannot be applied.” • Herophilus of Chalcedon, 335-280 BCE • Physician to Alexander the Great

14. No one provides the constellation of services offered by college health • On-campus location • Interest in serving a unique population with unique needs • Expertise in serving college students • Provides a constellation of services not provided by any other provider • Services that meet the needs of students and the campus • Services that help meet the needs of the broader community

15. College Health ServicesService – Teaching - Research • Medical Care/Primary Care (broadly defined) • Dental Care • Occupational Health • Health Promotion/Wellness • Health Education • Student Development • Environmental Health and Safety • Public Health

16. Today is a BIG day in Public Health June 4, 1912 June 4, 1919

17. June 4, 1912 Massachusetts became the first state in the US to set a minimum wage.

18. June 4, 1919

20. Thursday, June 5, 1919 Suffrage Wins in Senate; Now Goes to States Constitutional Amendment Is Passed, 56 to 25, or Two More Than Two-thirds Women May Vote In 1920 Leaders Start Fight to Get Ratification by Three-fourths of States in Time Debate Precedes Vote Wadsworth Explains His Attitude In Opposition - Resolution Signed with Ceremony

21. 19th Amendment The right of citizens of the United States to vote shall not be denied or abridged by the United States or by any State on account of sex. Congress shall have power to enforce this article by appropriate legislation.

22. 19th amendment to the U. S. Constitution Dates of Ratification by States Illinois, June 10, 1919 Michigan, June 10, 1919 Wisconsin, June 10, 1919 Kansas, June 16, 1919; New York, June 16, 1919 Ohio, June 16, 1919 Pennsylvania, June 24 Massachusetts, June 25 Texas, June 28, 1919 Iowa, July 2, 1919; Missouri, July 3, 1919 Arkansas, July 28, 1919 Montana, August 2, 1919 Nebraska, August 2, 1919 Minnesota, September 8, 1919 New Hampshire, September 10 Utah, October 2, 1919 California, November 1, 1919 Maine, November 5, 1919 North Dakota, December 1, 1919 South Dakota, December 4, 1919 Colorado, December 15, 1919

23. 19th amendment to the U. S. Constitution Dates of Ratification by States Kentucky, January 6, 1920 Rhode Island, January 6 Oregon, January 13, 1920 Indiana, January 16, 1920 Wyoming, January 27, 1920 Nevada, February 7, 1920 New Jersey, February 9, 1920 Idaho, February 11, 1920 Arizona, February 12, 1920 New Mexico, February 21 Oklahoma, February 28 West Virginia, March 10 Washington, March 22, 1920 Tennessee, August 18, 1920. Became National Law August 26, 1920 November 2, 1920 – Presidential election Warren Harding and Calvin Coolidge elected

24. 1921- The Shepherd-Towner Maternity and Infant Protection Act Authorized grants for state programs of maternal and children's services

25. Sheppard Towner Act (Maternity and Infancy Care Act) 1921-1929 First public grants-in-aid program in U.S. Developed MCH units in state Health Depts Birth registration (30 - 46 states) Increased Public Health Nursing Partnership of federal and state government Not continued because of fear of socialism Basis for Title V of Social Security Act

27. Core Functions of Public Health • Assessment • Policy Development • Assurance • Institute of Medicine, Future of Public Health

28. John Sundwall, MD, Ph.D. Director of University of Minnesota Health Service 1918-1921 University of Michigan Division of Hygiene and Public Health 1921-1941 “Unfortunately, parents, students, and faculty regard a health service as little more than a clinic or hospital concerned only with illness and injuries, their diagnosis and treatment; and regard the health fee paid directly or indirectly by students as sickness insurance.”

29. John Sundwall, MD, Ph.D. “Obviously, the best scientific treatment and care of illness and injuries must be one of the major concerns of the Health Service, but, in addition, a health service must be, as the term signifies, a health service. It bears something of the same relation to the university community that a public health department bears to a municipality or county, however in a more progressive and advanced state, in the vanguard of the public health movement.”

30. C. E. A. WinslowDean, YaleSchool of Pubic Health “a university health service can realize its possibilities of leadership only if it visualizes public health in the broadest terms.” 1929

31. Medical Care System Prevailing View of U. S. Health Care System Health Care System Public Health System Health Care System = Public Health Subsystem + Medical Care Subsystem

32. College Health/Public Health View of Health System

33. Factors Influencing Health Status

34. Scope of Public Health Society's Health Response Healthy Public Policy & Public Work Medical and Public Health Policy General Targeted Primary Secondary Tertiary protection protection prevention prevention prevention Becoming no longer vulnerable Afflicted Afflicted with Safer, Vulnerable without Complications Healthier Population Developing Complications Becoming Becoming Population Complications Vulnerable Afflicted Dying from Complications Adverse Living Conditions DEMOCRATIC SELF-GOVERNANCE DISEASE AND RISK MANAGEMENT • World of Transforming… • Deprivation • Dependency • Violence • Disconnection • Environmental decay • Stress • Insecurity • Etc… • By Strengthening… • Leaders and institutions • Foresight and precaution • The meaning of work • Mutual accountability • Plurality • Democracy • Freedom • Etc… • World of Providing… • Education • Screening • Disease management • Pharmaceuticals • Clinical services • Physical and financial access • Etc… Centers for Disease Control and Prevention Bobby Milstein

35. Guiding principles: Prevailing View/College Health View Public Health/College Health • Science-based Data are important! Basic and clinical research are important in medical care. Surveillance, monitoring, and epidemiology are important in college health/public health. Medical Care Science-based

36. Guiding Principles Public Health/College Health • Science-based • Population-based Medical Care • Science-based • Focus on individual

37. NIAAA - College Drinking Prevention 4 Tiers of Effectiveness • Tier 1: Evidence of Effectiveness Among College Students • Tier 2: Evidence of Success With General Populations That Could Be Applied to College Environments • Tier 3: Evidence of Logical and Theoretical Promise, But Require More Comprehensive Evaluation • Tier 4: Evidence of Ineffectiveness

38. College Drinking PreventionNIAAA 4 Tiers of Effectiveness • Tier 1: Evidence of Effectiveness Among College Students • Strategy: Combining cognitive-behavioral skills with norms clarification and motivational enhancement interventions. • Strategy: Offering brief motivational enhancement interventions. • Strategy: Challenging alcohol expectancies. • We should implement these strategies as part of our clinical role.

39. College Drinking PreventionNIAAA 4 Tiers of Effectiveness • Tier 2: Evidence of Success With General Populations That Could Be Applied to College Environments • Strategy: Implementation, increased publicity, and enforcement of laws to reduce alcohol-impaired driving. • Strategy: Restrictions on alcohol retail outlet density • Strategy: Increased prices and excise taxes on alcoholic beverages. • Strategy: The formation of a campus and community coalition involving all major stakeholders may be critical to implement these strategies effectively.

40. College Drinking PreventionNIAAA 4 Tiers of Effectiveness • Tier 3: Evidence of Logical and Theoretical Promise, But Require More Comprehensive Evaluation • Strategy: Increasing publicity about and enforcement of underage drinking laws on campus and eliminating "mixed messages." • Strategy: Conducting marketing campaigns to correct student misperceptions about alcohol use. • Strategy: Regulation of happy hours and sales. • We should implement Tier 2 and Tier 3 strategies as part of our public health role.

41. Guiding Principles Public Health/College Health • Science-based • Population-based • Health an individual and societal responsibility Medical Care • Science-based • Focus on individual • Health an individual responsibility

42. Norms Culture health care providers friends grandparents child care parents work relatives Laws ...isms sibs peers FAMILY police schools movies COMMUNITY Attitudes Values The Ecosystem of an Individual multinational corporations government violence crime Individual courts T.V. immigrants SOCIETY

44. Health PromotionHealthy People 2000 • Personal choices have powerful influence over one’s health. While health behaviors are personal, choices are made in a broader social context that is difficult to separate from the psychology of the individual. So while the choice may be individual, the locus of intervention needs to be wide enough to incorporate the environment that will either support or undermine personal choice.

45. Guiding Principles Public Health/College Health • Science-based • Population-based • Health an individual and societal responsibility • Broad definition of health Medical Care • Science-based • Focus on individual • Health an individual responsibility • Focus on specific illnesses or diseases

46. College Health View of Health System

47. Did women’s suffrage affect health?

48. U of MN Student Health Advisory Committee Smoke-free campus Bicycle trails Farmers Market Menu labeling Year-round fees Extended hours of operation Insurance RFP Late night transportation FDA blood donation policy

49. Guiding Principles Public Health/College Health • Science-based • Population-based • Health an individual and societal responsibility • Broad definition of health • Interdisciplinary/multidisciplinary Medical Care • Science-based • Focus on individual • Health an individual responsibility • Focus on specific illnesses or diseases • Specialization

50. Scope of Clinical Specialists, Clinical Generalists, and Public Health Centers for Disease Control and Prevention, Bobby Milstein