Public Health: What It Is and How It Works, Fourth Edition

1. Public Health:What It Is and How It Works, Fourth Edition Chapter-by-Chapter Power Point Slides Links to Internet-based resources

2. Chapter 9Future Challenges forPublic Health in America

3. Chapter 9 Will Help You To: • describe lessons learned from the threats and challenges faced by public health in the 21st century • characterize the limitations and challenges facing public health in the new century • determine how these limitations and challenges can be overcome

4. Lessons from a Century of Progress in Public Health • Remarkable achievements • Unfinished agenda • Science and social values • Public health system: a work in progress

5. Emerging Infectious Diseases

7. Origin of EmergingInfectious Diseases • Changes in environment (technology and industry) • Economic development • Population growth or migration • Human behavior • International travel and commerce • Microbial adaptation • Breakdown in public health measures

8. SARS: Global Outbreak…Local ImpactLocal Outbreak…Global Impact…

9. SARS Transmission in SingaporeFebruary 25 – April 30, 2003 Bogatti SP. Reprinted in MMWR 5-9-03

10. SARS Transmission Spring 2003 2 family members 2 close contacts Guangdong Province, China 4 family members 10 HCWs 4 HCWs* Hospital 2Hong Kong Canada F A A F G † G † 3 HCWs K † K † Ireland 156 close contacts of HCWs and patients A Hospital 3 Hong Kong H H I Hotel MHong Kong L§ J I United States E 99 HCWs (includes 17 medical students) J D B M§ Hospital 1 HK C C D E B Germany 0 HCWs Singapore HCW HCW B Vietnam Hospital 4 Hong Kong 34 HCWs 28 HCWs 2 family members 37 HCWs HCW 37 close contacts 4 other Hong Kong Hospitals Unknown numberclose contacts HCW Bangkok

11. TX-2GR NJRS, BPTS, SM TX-3RS, SMDM TX-6TS, SMDM WI Human cases:17 confirmed22 probable/suspect IL‡ Human cases:8 confirmed4 probable/suspect 42 PDs traced 14 PDs traced IN Human cases:7 confirmed9 probable/suspect IL-1§GR, DM IA†GR, DM 24 PDs traced IL-2DM TX-10DM TX-4DM TX-5DM TX-8DM TX-7DM TX-9DM JapanDM MNDM WIDM 200 prairie dogs (PDs) at facility 1 PD traced MO Human cases:2 confirmed 1 PD traced SCNo human cases 11 PDs traced KS Human cases:1 confirmed MINo human cases Rodent Shipment Ghana Monkeypox Outbreak 2003 TEXAS 50 Gambian giant rats (GR)53 rope squirrels (RS) 2 brushtail porcupines (BP) 47 tree squirrels (TS)100 striped mice (SM)~510 dormice (DM)

13. Obesity as anEmerging Public Health Issue

14. Heart Disease Cancer Stroke Chronic lower respiratory disease Unintentional injuries Diabetes Pneumonia/influenza Alzheimer’s disease Kidney disease 0 5 10 15 20 25 30 35 Percentage (of all deaths) Health Problems: Two Different Views Leading Causes of Death* United States, 2000 Actual Causes of Death† United States, 2000 Tobacco Poor diet/physical inactivity Alcohol consumption Microbial agents (e.g., influenza, pneumonia) Toxic agents (e.g., pollutants, asbestos) Motor vehicles Firearms Sexual behavior Illicit drug use 0 5 10 15 20 Percentage (of all deaths) *Minino AM, Arias E, Kochanek KD, Murphy SL, Smith BL. Deaths: final data for 2000. National Vital Statistics Reports 2002; 50(15):1-20. †Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291 (10): 1238-1246.

15. 1991 Obesity Trends* Among U.S. AdultsBRFSS,1991, 1996, 2003 (*BMI 30, or about 30 lbs overweight for 5’4” person) 1996 2003 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

16. No Data <10% 10%–14% Obesity Trends* Among U.S. AdultsBRFSS, 1988 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

17. No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. AdultsBRFSS, 1993 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

18. No Data <10% 10%–14% 15%–19% ≥20 Obesity Trends* Among U.S. AdultsBRFSS, 1998 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

19. Obesity Trends* Among U.S. AdultsBRFSS, 2003 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

22. Factors Contributing to Obesity • Biological • Genetic • Metabolism • Medications • Behavioral • Diet • Physical Activity • Environmental • Culture • Socioeconomic Status • Home • Schools • Work

23. Discussion • What was the most important achievement of public health in the twentieth century? Why?

24. Discussion • What will be the most important achievement of public health in the twenty-first century? Why?

25. Discussion • Using a scale from 1 to 10, how effective is the public health system in the United States? How did you arrive at this rating?

26. Discussion • Do you agree with the IOM assertion that public health is in disarray or with the counter-assertion that it is government, not public health, that is in disarray?

27. Discussion • What impact did The Future of Public Health have on the public health community during the 1990s? • What impact has The Future of the Public’s Health in the 21st Century had on the public health community since 2003?

28. Discussion • What do you think are the most important new or expanded roles for public health in the twenty-first century?

29. Discussion • Your state has $100 million from tobacco settlement funds. What strategies and programs should receive funding? Why?

30. Discussion • How has your understanding of what public health is and how it works changed after examining the topics in this book?

31. Additional Resources • Public Health: Costs of Complacency. Government Performance Project Governing Feb 2004. • The Personal Predicament of Public Health. Smith JS. Chronicle of Higher Education; June 27, 2003. • The Pitfalls of Bioterrorism Preparedness: The Anthrax and Smallpox Experiences. Cohen HW, Gould RM, and Sidel VW. AJPH 2004;94(10):1667-1671 • The Unfulfilled Promise of Public Health: Deja Vu All Over Again. Fee E and Brown T. Health Affairs 2002;21(6):31-43